Andropause

What is the Andropause?

Andropause is a term coined in recent times to indicate the natural exhaustion of male reproductive capacities in old age. This neologism recalls female menopause in a rather evident way, even if the suffix "pause" is badly suited to the decline of man's procreative abilities. The typical hormonal profile of an individual in andropause is established in a way that is anything but drastic, obvious or sudden, while in women menopause is a well-defined process, an obligatory stage that begins with the disappearance of the menstrual cycle and is accompanied by a rapid decline in estrogen production.

For man, therefore, we cannot speak in all respects of a real "cessation" of reproductive abilities; rather, andropause should be described as a paraphysiological process (therefore in many respects normal), which manifests itself with extreme variability in the population. . The term, there is no doubt, renders the idea, but precisely by virtue of these considerations the very existence of the andropause has been questioned for a long time, and often still today.

The "true" andropause, understood as the complete loss of the procreative capacity, does not manifest itself in all men, but only in a limited number of individuals; it is in fact a subjective phenomenon, since numerous environmental factors (overweight, sedentary lifestyle, smoking and various types of excesses) can substantially affect male fertility. In the medical community, in reference to "andropause, we therefore prefer to speak of PADAM, an Anglo-Saxon acronym derived from"Partial Androgen Deficiency in Aging Male", that is" syndrome of partial deficiency of androgens in the third age. "Other authors, less permessive, eliminate the character of partiality and speak simply of ADAM (Androgen Deficiency in Aging Male or androgen insufficiency syndrome in old age).

THE ANDROPAUSE, even if understood in its broadest meaning, is NOT a disease, but a paraphysiological process that manifests itself with extreme variability.

Index Article

Causes of andropause

Drop in Testosterone

The inevitable phenomenon of aging is accompanied by a progressive decline in testosteronemia, that is, in serum testosterone levels. A decline, this, actually rather slow and progressive, which begins inexorably around 25/30 years of age and inversely correlates with the BMI. In other words, the more serious one's overweight condition is and the greater the probability that the andropause will knock on the door, even at a relatively early age. The risk, in particular, becomes substantial from the sixth decade of life onwards.

Examining the results of large population studies, starting from 25/30 years of age, the daily synthesis of testosterone decreases by "1-2% per year", so much so as to be almost halved around 70/80 years. In addition to those of testosterone, the levels of other androgens, such as dihydrotestosterone (DHT), DHEA and androstenedione, also significantly decrease in andropause.

In man, the synthesis of testosterone is entrusted to the testicular cells of Leydig, whose numerical reduction is typically related to the andropause; not surprisingly, the testicular volume of an elderly person is normally reduced compared to that of a young subject. The pituitary center that directs testosterone synthesis through the release of LH may also prove to be deficient. In particular, the decreased amplitude of the pulsatility of this hormone - in turn controlled by the hypothalamic GnRH (hormone for the release of gonadotropins) - is typical of senescence. Let us briefly recall that pulsatility is the phenomenon whereby a hormone is not secreted constantly over time, but in waves of variable intensity and amplitude, repeated at more or less regular intervals of time (in women, the pulsatility of GnRH is strongly correlated to various phases of the menstrual cycle, while in men it is relatively constant). Precisely because of this pulsatility, in the young the serum levels of testosterone show a classic circadian pattern (higher in the morning and lower in the evening), which tends to flatten and disappear in the elderly.

Andropause and Hypogonadism

The medical term used to describe the insufficient synthesis of testosterone by the testis is not "andropause", but "hypogonadism." at a young age. Therefore, instead of tracing any symptoms of andropause to the natural aging process and resigning oneself to it, it is better to bring them to the attention of an andrologist. The possible causes of hypogonadism are in fact numerous and even more are those responsible for its best known and feared manifestation: erectile dysfunction.

Total Testosterone and Free Testosterone

A final physiological note should be made on the difference between total testosterone and free testosterone. The latter is undoubtedly the most important diagnostic element, since it expresses the fraction of testosterone "released" from the transport proteins, and as such free to carry out its action (it is the active form of the hormone). Conversely, testosterone bound to transport proteins is in fact biologically inactive; for this reason, low levels of total testosteronemia are not necessarily an indication of hypogonadism or andropause, while the finding of a serious deficiency of free testosterone repeated over time is "pathognomic".

Cellular sensitivity to the action of androgens should also be evaluated, mainly influenced by the number of receptors in the nucleus and, to a lesser extent, in the plasmalemma.

In the next chapter we will analyze the causes of andropause and the symptoms associated with it.