How we help our male patients strive for successful aging during andropause.
Peter J. 52, my long time patient filled out his usual Patient’s Health Intake Form. He pressed the pencil against the paper and marked the line “Reason For Visit” as “not sure”. And he really said he was not sure. However, after a couple of words with my dear patient I noticed that he seemed to be quite concerned. Peter shared with me that even though he did not have any major complaints; his life quality has changed within the last couple of years. He said that after trying many different things on his own he decided to face his fears, so to say, and share them with me, his physician. He admitted that he did not feel like he used to before, just even two years ago and he did not recognize himself from the man he knew, at least not until lately.
Having a great sense of humor, he made a couple of jokes describing how he felt in a restaurant after just two drinks and an appetizer. He said that while everyone around him were just starting out, he, in most cases would be ready to call it a night, and just only think about a nap on the sofa. Then he humbly admitted that his mood changes quite often during the day “like he was a menopausal woman”, he said. Further, he complained of forgetting things, which never happened to him before. Lastly, he confessed that he did not have a sexual drive as he used to have just even a year ago.
Did Peter have obvious symptoms of andropause? Yes, and in fact after all the testing and close analysis- andrpoause, an aging process for men was confirmed.
Just admit it – not so many people speak about andropause for men as much as menopause for women. Maybe that is because men, generally speaking tend to be less articulate about their emotions, so their aging process was ignored by many physicians until just recently. It does not come as a surprise to me that the studies of andropause are approximately 20 years behind the hormone replacement therapy of women.
If women tend to be more open about their concerns and fears of aging does that mean that emotional and physical impact of andropause should be accepted or ignored?
The main question that remains is whether the symptoms can be postponed or the quality of life can be improved.
Luckily, we are now able to target the symptoms of andropause and look for the solutions.
How can we help?
We can start with a simple questionnaire describing the symptoms that involve the level of sexual desire and erectile quality, mood changes, decrease in intellectual activity, fatigue, depression, anger, and poor spatial orientation. Also, some of the symptoms can be reported as decrease in lean body mass, along with decreases in muscle mass and strength and decrease in body hair.
Of course, you do not have to have all of these symptoms to identify andropause. Also, remember that symptoms do not all appear to the same degree in all men. You may suffer from only one or two of these symptoms and at varying degrees. But if you have experienced at least several of the above conditions, we will start the diagnosis with a thorough testing.
Blood Test
Generally, only a blood test can definitively diagnose andropause.
And here is why: After the age of 50, the average testosterone level decreases at a rate of approximately 1% per year. A man may have large variations in his serum testosterone levels over time. Since you may have normal testosterone levels one day and have decreased testosterone levels the next, it is important to look at hormone levels over a period of time.
In older men, affected organs may respond differently to androgens. Not all men will need the same level of testosterone to maintain proper function of their brain, bone, prostate, or muscle cells. Therefore, it would be incorrect to say that there is one standard level of testosterone that should be achieved by every man.
We will work with you to find the level of testosterone that is most effective just for you.
Treatment
How does our testosterone replacement therapy work?
Our treatment plans are strictly individualized as we prefer transdermal (through the skin) patches and gels. This method has a number of advantages:
* It is easy to apply.
* It is relatively safe with low incidence of side effects.
* It more closely mimics the natural daily rhythm, with higher levels of testosterone delivered in the morning and decreasing levels delivered as the day progresses.
What are the results or benefits?
- Improved sexual function.
- Improved erectile function.
- Improved mood.
- Improved body composition and strength.
- Increased bone density.
- Improved cardiovascular system.
What are the negative effects?
Men with a history of prostate cancer or breast cancer are absolutely not candidates for testosterone therapy. The testosterone can make both of these hormonally sensitive cancers grow more rapidly.
Other negative effects may include: fluid retention, problems with fertility, sleep apnea: tender breasts or enlargement of breasts, increased red blood cell concentration, prostate growth.
Monitoring During Treatment is Mandatory To Avoid Negative Effects.
Monitoring is the key in hormone replacement therapy. Once started, it is usually maintained for life.
There is not yet a general consensus on how men with testosterone replacement should be monitored. It is clear that those patients who have begun testosterone replacement for a particular symptom should have that symptom carefully observed.
How does monitoring work?
In general, we begin with a low dosage. If your testing still does not show adequate blood hormone levels, the dosage should be increased. The goal is to get you in the mid-range of the testosterone values. Once this has occurred, you must then be monitored at regular intervals both in terms of symptoms and blood work.
We monitor blood fairly frequently. Once you have achieved the right dosage of hormone, we follow your progress and draw blood every 3 months for at least a year. The following year, we evaluate and draw blood every 4 months. Thereafter, appointments and blood work are required every 6 months.
During the initial follow-up appointments, we evaluate you psychologically and physically. Blood work includes hormone levels, a complete chemistry profile including chemistries, lipids (fat profiles), and liver function tests. We also perform a complete blood cell count to check the patient’s hematocrit (an increased hematocrit is a common side effect of testosterone replacement therapy). It is important that you receive serial prostate exams at all of these visits as well as a PSA test.
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