Q: I have recently heard about "andropause" and am wondering if I have it. What is andropause exactly?

A: Andropause is defined as "An age-related decline in serum testosterone levels in older men to below the normal range in young men that is associated with a clinical syndrome (i.e., symptoms and signs) consistent with androgen (testosterone) deficiency.

There are a couple of key points here. First, andropause has to do with an age-related decline in testosterone, which is the hormone that is responsible for much of "what makes men", as opposed to women or boys. Starting as young as 40, testosterone production starts to decrease, and the production of a substance known as Sex Hormone Binding Globulin (SHBG) starts to increase. SHBG effectively makes testosterone unavailable for the body to use, effectively lowering "useable" levels even further. The measure of "useable" testosterone is called bioavailable testosterone, and it's the measure now recommended to evaluate andropause. The second is that you need to have changes identified as signs (things you can measure) and symptoms (things you feel but can't measure) that relate to this drop in bioavailable testosterone.

Q: What are the typical signs and symptoms of andropause?

A: When we think about how increasing testosterone levels cause changes that turn "boys to men", it makes sense that the most common signs and symptoms of a decrease in testosterone would reflect a partial reversal of these changes. They can include:

• Testosterone and body composition: Decreased muscle mass, decreased bone density, increased body fat, especially abdominal/visceral fat



• Testosterone and sexual function: Erectile dysfunction and low sex drive



• Testosterone and depressed mood: poor sleep, low energy, mood swings, irritability, apathy, social isolation, anxiety



• Testosterone and red blood cells: Anemia



• Testosterone and cognitive function: Poor concentration, decreased short-term memory, poor decision making.

Q:Is there a way I can determine if I have andropause?

A: If you think you may have andropause, and want to know for yourself, you can complete the ADAM test, which is an excellent measure of whether or not you may have andropause. If it appears based on your answers that you may have andropause, it's important to take the test to your doctor, who will take a complete history and do an appropriate physical examination, including ordering blood tests. This will determine that you actually have andropause, and not any other condition that may produce similar signs and symptoms. The best test to determine low testosterone levels is the Bio-T Test,a test for bioavailable testosterone.

Q: What treatments are available for andropause?

A: The treatment for andropause is Testosterone Replacement Therapy (TRT). Historically this was primarily given by an injection every two weeks or so. In the last several years, newer products have been developed which act more like your body's own natural testosterone production, and are more convenient to use. They come in oral capsules, gels and skin patches and are all safe and effective. There are pros and cons to each and you should discuss these choices with your doctor. Don't forget that a healthy balanced lifestyle with adequate sleep, exercise and proper nutrition will also play a role in improving your situation.

Q: I've heard that andropause can be treated by taking testosterone. Are there any side effects to this medication?

A: If the dose is correct, you should not experience much in the way of side effects at all. Keeping careful track of how you're feeling will help you and your doctor determine whether you're on the right dose. Each product also may have some side effects that are common with its use. It's best to discuss these with your doctor.

Q: Are there any people who shouldn't take testosterone?

A: If you are found to have prostate or breast cancer, you must not take testosterone. Men with significantly enlarged prostates, or who have severe sleep apnea, very high hemoglobin or advanced congestive heart failure, are not good candidates for Testosterone Replacement Therapy (TRT) You should discuss this with your doctor. It's useful to note that there is no upper age limit in initiating TRT.

Q: How long does it usually take to experience improvement with testosterone treatment?

A: Once started, the medication should begin to reverse the signs and symptoms of andropause relatively quickly. There are however, a couple of things that you should know. Just as andropause tends to have a slow and subtle onset, to the point where you may not even notice it's happening until it's a full blown problem, the reversal of andropause with Testosterone Replacement Therapy will also be somewhat slow and subtle. There aren't likely to be any dramatic changes that happen overnight, so it's important to stick with it for at least 3 months, and keep good track of how you're feeling. There's also the possibility that your starting dose may need to be increased.

Some symptoms will tend to get better faster than others. You may, for example, start to notice improvement in your mood, thinking and concentration within a few short weeks. Other changes may take a little longer, and it can be different for each individual. It's important to be patient, to keep track of the changes you're experiencing, and to convey as much information as possible to your doctor so you can work together to find the right product at the right dose.

Q: Does needing to take testosterone make me any less of a man?

A: No, on the contrary, all men suffer a decrease in testosterone levels with age. Various factors, such as genetics and lifestyle, affect how quickly testosterone levels decrease, and thus different men may experience symptoms at different ages and to different degrees. Testosterone replacement just serves to increase testosterone levels back to a point where symptoms are no longer a problem.

Q: How long would I need to take testosterone for?

A: Because the process that causes andropause continues throughout your life, it make sense that it won't improve on it's own, and you'll likely need to stay on therapy for life.

Q: What type of follow-up do I need while taking testosterone?

A: You need regular follow-up with your doctor. In the first year, follow-up is recommended every 3 months and then yearly after that. At these visits, your doctor will assess your symptoms, perform a digital rectal exam (DRE), and measure your prostate specific antigen (PSA). Your hemoglobin, cholesterol and liver functions will also be monitored.

Q: What improvements can I expect while taking testosterone?

A: You should see improvements in all the things that caused you to think you had andropause in the first place, and some you may not have even known about. Your energy level, mood, including sex drive, concentration and thinking will likely be the first things to come back. Strength, decrease in body fat, and endurance may take a little longer. You'll likely also have improvements in bone density, red blood cell count, and potentially others that only testing through your doctor can determine.

Q: I take drugs for my erectile dysfunction (ED). Can I take testosterone as well?

A: Absolutely. In fact, some studies suggest that testosterone taken in combination with an ED medication may result in improvements in how your ED drug works. Please discuss this with your doctor.

Q: I'm 75. Am I too old to take testosterone if I have andropause?

A: No man is too old to receive Testosterone Replacement Therapy (TRT), as long as there are no other contraindications.

Q: I have been diagnosed with low bone density (osteoporosis). I've heard that testosterone can help. Is that true?

A: Testosterone has been shown to increase bone mineral density. Trials showing that this increase translates into a reduction in fracture rate are not completed yet. However, osteoporosis treatment guidelines for doctors state that men with osteoporosis should be tested and treated for andropause.

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