November 30, 2008
Number Crunching In Andropause
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Andropause is a medical term for the male menopause that many people are not familiar with. Indeed, there are many facets of andropause that are being understood and disseminated at... |
Andropause is a medical term for the male menopause that many people are not familiar with. Indeed, there are many facets of andropause that are being understood and disseminated at this moment; such is the rate of study on this subject.
In an informative and benchmark study, Drs Daniel E Federman and Geoffrey A Walford lay out some of the newest thinking on the subject.
As the levels of testosterone in a man start to drop around the age of thirty, it does so in tiny increments that may measure 1% a year for the rest of his life. These falling numbers may not even be felt until a man reaches his fifties, seventies, or not at all. Some men with significantly low levels of testosterone in their bodies feel no symptoms, while others with similar levels feel it acutely. To add to the complexities of diagnosis, there are several diseases whose symptoms are similar to testosterone deficiency: alcohol abuse, disorders of hormones other than testosterone; liver, kidney and lung disease, heart failure, and certain other rare conditions that all need to be ruled out before diagnosis can be sure.
Understanding testosterone blood studies is another tricky matter. There is active testosterone at work in blood and there is inactive testosterone. It is the low levels of active testosterone that need to be taken into account, because that is the level that causes the symptoms of testosterone deficiency. Still, physicians often order a test for "total testosterone" that, by definition, will not give them the answers they are seeking.
Next, the matter of what is a "normal" testosterone level adds more confusion. Testosterone levels vary so widely among men of the same age, including the men without any symptoms of testosterone deficiency. To make it even trickier, testosterone levels fluctuate throughout the day. As you can see, quantifying "normal" is perplexing.
However, this is not to say that symptoms due to testosterone deficiency cannot be treated; they certainly can. If you are over fifty years old and have symptoms (loss of bone strength, muscle mass, weight gain, decreased energy, loss of interest in sex, erectile dysfunction, irritability, depression, or sleep disorder) see your physician. First your doctor should rule out other conditions causing your symptoms. When the doctor orders lab tests, he should order blood levels of total testosterone and that the blood be taken in the morning, when testosterone levels are at their highest. The tests should be repeated once more to ensure accuracy.
Levels of 400 nanograms per deciliter and greater are not testosterone deficient, so the likelihood is that your symptoms are coming from some other cause. Borderline levels, between 200ng/dl show you may be deficient: then it is time to test your active testosterone level. And remember, the morning is the optimum time for your blood draw.
Hormone replacement therapy can benefit those with extremely low levels of total or active testosterone levels; with borderline levels the evidence is less clear that any benefit will be achieved.
Hopefully, all the number crunching done today will lead to broader knowledge and safer and more useful treatment for all.