What is andropause?
Andropause, also called age-related androgen deficiency in men (DALA — Déficit Androgénique Lié à l’Âge), corresponds to the progressive decrease in testosterone production with age. Unlike female menopause, which corresponds to a sudden cessation of hormonal production, andropause is characterized by a progressive and gradual decline in testosterone, beginning around 40 years of age.
It is estimated that 20% of men over 60 years of age, and up to 50% of men over 80 years of age, present a clinically significant androgen deficiency.
Symptoms of andropause
The symptoms of andropause are varied and not specific, which can make the diagnosis difficult. They affect several spheres:
Sexual symptoms
- Decrease in libido (sexual desire).
- Erectile dysfunction.
- Decrease in the frequency of nocturnal and morning erections.
- Decrease in the volume of ejaculation.
General and physical symptoms
- Persistent fatigue, decrease in energy.
- Decrease in muscle mass and strength.
- Increase in fat mass, particularly abdominal.
- Decrease in bone density (risk of osteoporosis).
- Hot flushes, sweating.
Psychological and cognitive symptoms
- Depressed mood, irritability.
- Decrease in motivation and self-confidence.
- Sleep disorders.
- Decrease in concentration and memory.
Diagnosis of andropause
The diagnosis of andropause is based on the combination of compatible clinical symptoms and a confirmed biological androgen deficiency.
Clinical assessment
The clinician assesses the symptoms, through validated questionnaires (ADAM, AMS), and looks for risk factors (obesity, diabetes, chronic diseases, certain medications).
Biological assessment
A blood test is performed in the morning (testosterone production is higher in the morning) and measures:
- Total testosterone: a level lower than 2.3 ng/mL (or 8 nmol/L) suggests androgen deficiency.
- Free testosterone or bioavailable testosterone: more accurate, particularly in obese patients or in those with elevated SHBG.
- LH and FSH: distinguishing primary deficiency (testicular) from secondary deficiency (pituitary).
- Prolactin: looking for a pituitary cause.
- PSA: before any consideration of treatment.
A second test is necessary to confirm the deficiency.
Complementary tests
According to the clinical context:
- Bone mineral density (osteoporosis screening).
- Lipid and glucose assessment.
- Urological assessment (PSA, digital rectal examination).
Treatment of andropause
The treatment of andropause relies on testosterone supplementation, called androgen replacement therapy. It is indicated only in case of confirmed clinical and biological deficiency.
Available forms
- Transdermal gels: daily application on the skin, allowing stable testosterone levels.
- Intramuscular injections: short- or long-acting (every 3 months for testosterone undecanoate).
- Oral forms: less used because of variable absorption.
Hygiene and dietary measures
In addition to drug treatment, lifestyle adaptations are essential:
- Regular physical activity, particularly muscle strengthening, is particularly important.
- Balanced diet, weight loss in case of overweight.
- Treatment of associated comorbidities (diabetes, hypertension, sleep apnea syndrome).
- Stress management and improvement of sleep quality.
Contraindications and follow-up
Androgen replacement therapy has contraindications:
- Active prostate cancer.
- Active breast cancer.
- Severe untreated sleep apnea syndrome.
- Recent severe cardiovascular events.
- Untreated polycythemia.
A regular follow-up is necessary:
- Clinical evaluation at 3, 6 and 12 months, then annually.
- Biological monitoring: testosterone, PSA, blood count, lipid profile.
- Urological monitoring: digital rectal examination, PSA.
Management by Dr Vardi
Dr Adam Vardi, urologist and andrologist in Paris and Neuilly-sur-Seine, supports men in the diagnosis and treatment of andropause, with a comprehensive approach combining hormonal assessment, urological evaluation, and personalized therapeutic management.