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Introduction

Andropause, often termed male menopause, marks a significant phase in an aging man’s life, characterized by a gradual decline in testosterone levels. This phenomenon, akin to menopause in women, manifests through various physical and psychological symptoms, impacting overall health and quality of life. The article explores andropause’s multifaceted nature, examining its clinical presentation, diagnostic challenges, and treatment options. While commonly associated with decreased libido and energy levels, andropause also encompasses broader health issues like osteoporosis, muscle weakness, and mood fluctuations. The study’s objective is to provide a deeper understanding of andropause, moving beyond the traditional perception of aging, and emphasizing the need for effective diagnosis and personalized care. This article, based on an analysis of 50 cases, aims to shed light on this under-discussed aspect of men’s health, advocating for greater awareness and targeted healthcare strategies.

Materials and Method

This study was a five-year prospective screening at Cheikh Khalifa University Hospital, involving 50 men over 50 exhibiting andropause symptoms. Participants were chosen based on age and symptomatology, excluding those under 50 or with hypogonadism due to other causes. Data collection entailed compiling patient medical records. Methods included a detailed questionnaire (AMS scale; see Appendix), clinical exams, and hormonal assessments. Statistical analysis was conducted using SPSS software, and extensive literature research was done across multiple databases. Ethical considerations, such as patient confidentiality, were strictly adhered to.

Results

Epidemiology

The average age of patients was 68, ranging from 53 to 83 years. Most patients were of low socio-economic status. 40% had a history of smoking, 20% alcoholism, 30% diabetes, 4 cases of hypertension, and 1 case of stroke. 50% of the patients were diagnosed with andropause.

Clinical Findings

Symptomatology was evaluated using the AMS scale for somatic, psychological, and sexual components. 69% had severe sexual symptoms and 12% had moderate.

37% had moderate psychological symptoms and 28% had severe. 51% had moderate somatic symptoms and 39% had severe. Fig. 1. shows the distribution of sexual symptoms in the sample.

Fig. 1. Distribution of sexual symptoms.

Rectal examination was normal in 43 cases, with 5 cases showing prostatic hypertrophy.

Biological Findings

Hormonal deficit, beingdefined as total testosterone levels below 3 ng/mL, was found in 50% of patients. Elevated PSA levels were noted in 5 patients. Androgen-based treatments (Enanthate or Undecanoate of T) were started for those with andropause, along with specific treatment (sildenafil) for erectile dysfunction.

Progress

Clinical and biological surveillance included PSA and testosterone levels, and liver function tests. Improvement in the total symptom score was observed in 6 patients at 3 months, and in 16 patients at 6 months. The clinical improvement was mainly in sexual components. However, 5 patients did not follow their treatment

Discussion

Epidemiology and Symptomatology

Andropause commonly starts in men over the age of 35, with testosterone levels decreasing by about 10% every decade and 1% annually. Approximately 30% of men in their 50s experience andropause symptoms [1]. In our study, the average age of men experiencing andropause symptoms was around 68 years, with the most commonly reported symptoms being decreased libido, fatigue, and mood swings (Fig. 2). These symptoms significantly impact men’s health, including decreased sexual drive, weight gain, loss of energy, and decreased bone density. Erectile dysfunction is a notable symptom, influenced by low testosterone levels necessary for healthy erectile function [2].

Fig. 2. Evolution of total testosterone levels with age.

Diagnosis and Treatment Options

Diagnosis of andropause often begins with a medical history and physical examination, followed by blood tests to measure testosterone levels [3]. In our study, diagnosis was primarily based on clinical symptoms and confirmed by measuring serum testosterone levels. Treatment strategies include lifestyle modifications such as diet, physical activity, and stress management. Hormone Replacement Therapy (HRT) is a common treatment, aiming to replenish testosterone to alleviate symptoms and restore vitality. We found that patients on HRT showed significant improvement in symptoms like energy levels and sexual function. Other medications may include antidepressants for mood swings and PDE5 inhibitors for erectile dysfunction. The treatment choice should be based on a thorough assessment by a healthcare professional [4].

Psychological Impact and Body Composition Changes

Andropause is associated with mood and cognitive changes, making psychological evaluations crucial. Body composition changes, such as decreasing muscle mass and increasing body fat, are common. Our study noted significant correlations between testosterone levels and mood changes, including depression and irritability. Anthropometric measurements and tests like DEXA scans for bone density are helpful in tracking these changes [5].

Awareness and Knowledge

Despite the prevalence of andropause symptoms, awareness about the condition is relatively low. Our study revealed that while many men over 40 experienced andropause symptoms, there was a significant lack of awareness and understanding about the condition. Studies indicate that a significant percentage of men over the age of 40 have experienced symptoms of andropause, but their knowledge about the condition is limited [1]–[6].

Table I. Symptomatology

Symptoms	Intensity of symptoms
	None	Mild	Moderate	Severe	Very severe
Decreased feeling of general well-being (health status, subjective perception of health)	1	2	3	4	5
Joint and muscle pain in the kidneys, limb, back	1	2	3	4	5
Excessive sweating (sudden and unexpected sweating, hot flashes not related to physical effort or stress)	1	2	3	4	5
Sleep problems (difficulty falling asleep, waking up during the night, waking up too early in the morning with a feeling of tiredness, poor quality sleep, insomnia)	1	2	3	4	5
Increased need for sleep, frequent feeling of tiredness	1	2	3	4	5
Irritability (aggressiveness, easily irritated, unstable mood)	1	2	3	4	5
Nervousness (tension, agitation, constant movements)	1	2	3	4	5
Anxiety (which can lead to panic)	1	2	3	4	5
Great fatigue/lack of vitality (general decline in performance, decreased activity, not wanting to do anything, feeling like doing less than before or having to force yourself to undertake something)	1	2	3	4	5
Decreased muscle strength (feeling of weakness)	1	2	3	4	5
Depressed mood (feeling depressed, sad, on the verge of tears, lack of enthusiasm, mood swings, feeling of uselessness of everything)	1	2	3	4	5
Feeling of no longer being at your best, that the best is behind you	1	2	3	4	5
Feeling of discouragement, of having reached the background	1	2	3	4	5
Slowed beard growth	1	2	3	4	5
Decreased sexual performance	1	2	3	4	5
Decreased number of morning erections	1	2	3	4	5
Decreased sexual desire, lack of pleasure during sexual intercourse	1	2	3	4	5

Holistic Wellness Strategies

A holistic approach to managing andropause is crucial. Our research supports the importance of a comprehensive approach, including lifestyle interventions and hormone therapy. This includes understanding individual health status through blood work and considering hormone therapy as part of a broader plan that incorporates lifestyle changes [7]. Environmental factors like exposure to toxins and chronic stress can disrupt hormone production and exacerbate symptoms [1].

Current Research and Controversies

Research on andropause has evolved over the years, from being considered a clinical syndrome diagnosed with disease-targeted questionnaires to a well-defined clinical and biochemical syndrome [8]. Our findings align with this perspective, highlighting the multifactorial nature of andropause. The pathophysiological causes have been described, but there’s still no consensus on the definition, incidence, treatment, and especially testosterone therapy. In our study, we noted some controversy surrounding the use of testosterone therapy, particularly concerning potential risks and benefits. Current literature reports on the risks and benefits of using testosterone therapy are still being debated [9].

Conclusion

This study deepens our understanding of andropause, affirming its impact on men’s health similar to menopause in women. Key findings include a range of symptoms linked to declining testosterone levels, particularly affecting sexual function, mood, and physical health. The research emphasizes the importance of holistic treatment strategies, combining lifestyle changes with medical interventions like Hormone Replacement Therapy (HRT). However, HRT should be used cautiously due to potential risks. A significant gap in awareness and knowledge about andropause among men was observed, highlighting the need for better education and advocacy. The study also underscores the evolving nature of andropause as a medical condition, with ongoing debates around its definition, incidence, and treatment. Ultimately, the research advocates for early diagnosis and personalized treatment approaches, aiming for improved health outcomes and quality of life for aging men. This study contributes to the growing body of evidence in understanding and managing andropause effectively.

Appendix

Operating Sheet: Andropause Screening

Surname Name: ___

Phone: ___

Age: ___

Occupation: ___

City: ___

History

     Personal

          Lithiase urinaire□

          Ulcere gastrique: Father □ Uncle □

          Tabacco

          Alcohol

          Obesity

          Other: ___

     Family

          Prostate cancer □: ___

Physical examination

     Height: ___

     Weight: ___

     Testicles: ___

       Volume: hypertrophy □ normal □

       Consistency: soft □ firm □

     TR: dysuriant prostatic adenoma □ prostatitis □

     Sleep apnea syndrome □

     Gynecomastia □

Biological assessment

     Bioavailable testosterone: ___ nmol/L

     Total testosterone: ___ nmol/L

     PSA: ___Ng/ml

Treatment

     Molecule: ___

     Dosage: ___

     Duration of treatment: ___

     Adverse effect: ___

Follow-up

     Improvement of score □

     Digital rectal examination: normal □ abnormalities□

     PSA: normal □ increased □

Table II. Scoring Sheet

Question no.	Score	Psychological subscale	Somatic subscale	Sexual subscale
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
Total of subscales		____	____	____
Total Sum of Subscales = Total Score = ____

Table III.

Total score	Symptom severity
17–26	None
27–36	Mild
37–49	Moderate
≥50	Severe

Table IV. Scores of Subscales

Psychological	Somatic	Sexual	Symptom severity
5	7–8	5	None
6–8	9–12	6–7	Mild
9–11	13–18	8–10	Moderate
12–25	19–35	11–25	Severe