What is Male menopause or Andropause?
Much like the menopause syndrome occurring among older women, a similar condition has been defined among men. Testosterone production increases rapidly at the onset of puberty, but dwindles quickly after age 50 to become 20 to 50% of the peak level by age 80. Many men older than age 50 have experienced frailty syndrome, which includes decrease of libido, easy fatigue, mood disturbance, forgetfulness, accelerated osteoporosis, and decreased muscle strength. Statistics show that 30% of men over 50 may have this condition which may manifest as decreased libido (91%), lack of energy (89%), erection problems (79%), falling asleep after dinner (77%), memory impairment (77%), loss of pubic hair (70%), sad or grumpy mood changes (68%), decrease in endurance (66%), loss of axillary hair (55%), and deterioration in work performance (51%). All this has been described as due to lower levels of testosterone in the blood. This is treatable condition once detected completely and these men after treatment can enjoy good quality of life.
Thus andropause is a condition where body’s “bioavailable” testosterone level is low. Starting at about age 30, testosterone levels drop by about 10 percent every decade. So every male experiences a decline of bioavailable testosterone but some men’s levels dip lower than others. And when this happens these men can experience Andropausal symptoms.
Is this a new phenomenon? What causes it?
In fact, Andropause was first described in medical literature in the 1940’s. So it’s not really new. But, our ability to diagnose it properly is new. Sensitive tests for bioavailable testosterone weren’t available until recently, so Andropause has gone through a long period where it was under-diagnosed and under-treated. Now that men are living longer, there is heightened interest in Andropause to improve the quality of life as we age. The concept of treatment involves proper identification and appropriate of treatment of men who are affected by this condition.
What are the symptoms of this in men? When there is less testosterone available, the testosterone actions on body organs decreases, which leads to:
- Memory loss
- Emotional, psychological and behavioral changes
- Low sex drive
- Decreased muscle mass
- Loss of muscle strength
- Increased upper and central body fat
Do all men really go through this, as similar to mid-life crisis in women -“menopause”?
There is great variability in testosterone levels among healthy men so not all will experience the same changes. It is estimated that 30% of men in their 50s will have testosterone levels low enough to be causing symptoms. These symptoms can impact their quality of life and may expose them to other, longer-term risks of low testosterone, like effect on bone, sexual drive and heart.
Are there any signs by which men can suspect that they have Andropause?
Andropause has been under-diagnosed over the years as the symptoms can be vague and can vary a lot among individuals. Man’s passage into middle and older age is a complicated phase. It may therefore be difficult to differentiate these changes from the symptoms of other conditions that elderly age is associated with like diabetes, BP etc:
To identify we now have rating scales:
- Do you have a decrease in your sex drive (libido)?
- Do you have a lack of energy?
- Do you have a decrease in strength and/or endurance?
- Have you lost height?
- Have you noticed a decreased “enjoyment in life”?
- Are you sad and/or grumpy?
- Are your erections less strong?
- Have you noticed a recent deterioration in your ability to play sports?
- Are you falling asleep after dinner?
- Has there been a recent deterioration in your work performance?
Is there a way you can diagnose andropause?
Apart from the rating scales, simple blood tests can confirm andropause.
If someone has a low testosterone level, how can they increase it?
Just as with estrogen replacement therapy in women with menopause, testosterone replacement in men with Andropause has been shown to be highly effective and very beneficial. The treatment is available as oral tablets, injections, skin patches and gels. Testosterone replacement therapy (TRT) is a good solution for many men who are experiencing symptoms that are having an affect on their enjoyment of life.
Are there any risks associated with the treatment?
Yes, in certain conditions where men have prostate or breast cancer or in certain blood disorders or heart conditions, which will be decided after evaluation.
Does age related erectile dysfunction also improve with treatment?
Yes, TRT definitely improves sexual performance, as well as mood, quality of sleep, mental and physical energy, reduces irritability, tiredness, helps bones and heart and reduces fat.
So in effect is testosterone an anti-aging medication?
Aging is a natural process, I don’t think we are in a position to reverse aging but we are aiming to improve the quality if life as we age, that is to make the person more mentally and physically fit – in effect helping him gain more energy levels.
Are there any “Tips to cope with these changes”?
Of course, any ongoing treatment to reduce the symptoms and risks of Andropause or aging should incorporate lifestyle approaches such as optimal diet, regular exercise, stress-management, and the reduction in tobacco and alcohol intake.
How does an erection occur?
An erection is an involuntary reaction in response to sexual stimulation excitement. A man cannot get an erection simply because he wants one. The sexual stimulation and excitement cause the brain, nerves, heart, blood vessels and hormones to work together and produce a rapid increase in the amount of blood flowing into the penis. The blood becomes trapped and held in the two spongy chambers in the shaft of the penis. As the chambers rapidly fill with blood, they expand, and the penis becomes firm and elongated. The result is an erection.
When and how does erectile dysfunction occur?
Erectile dysfunction can occur at any age. According to studies by the National Institutes of Health, 5% of men have some degree of erectile dysfunction at the age of 40, and approximately 15%-25% at age 65 or older. Erectile dysfunction affects all races, and crosses all ethnic and economic boundaries.
Is it all in the mind?
Many men mistakenly believe that ED is caused by psychological problems – a belief that may keep them from seeking medical treatment.
While psychological factors do play a role for some men, most cases of ED are associated with physical conditions, including:
Medical conditions that affect the blood vessels and restrict blood flow to the penis for example, diabetes, heart disease, high blood pressure, or high blood cholesterol levels Conditions that interrupt the connection between the central nervous system and the penis, such as injury resulted from trauma or prostate surgery.
Medications, such as some of the agents used to treat high blood pressure and depression, which can cause erectile dysfunction as an unwanted side effect. Depression.
The following lifestyle factors can also play a role in ED: Smoking Alcohol or other drug abuse Stress
Is it just part of getting older?
Some men mistakenly assume that erection problems are a natural consequence of aging.
As men grow older, they can expect some changes in their sex life. It may take a little longer to achieve an erection, for example, or they may require more direct physical stimulation. These are considered normal adjustments, but ED is not the inevitable result of aging and sexuality does not totally decrease.
Is there’s nothing anyone can do to help?
In fact, ED is a treatable condition. Only your doctor can make this decision. Treatment options may include
- Oral medications
- Vacuum devices
- Self-injections of drugs into the penis
- Medicines inserted into urethra
- Surgical implants
- Traditional medicines and herbal remedies
What to do if I have a problem?
If you know or suspect that you have impotence, remember: You’re not alone. Fifty-two percent of men aged 40 to 70 years have some degree of erectile dysfunction Most cases of impotency are caused by treatable medical conditions. Convenient medications are available that can restore a man’s natural sexual response to his partner. There’s no reason for a couple to give up a satisfying sex life when there are simple solutions to impotency. Discuss the problem with your doctor.
What is the role of a basic semen analysis in infertility investigation?
15% of couples have difficulty conceiving, and in 50-70% of these there is either a primary male factor or an impaired semen quality sufficient to reduce the probability of pregnancy in the subfertile female. Accordingly, the first and the easiest test in the evaluation of the subfertile couple should be the semen analysis.
It is always the male who needs to be evaluated FIRST, as the basic test is very simple and easy in the male. Although the semen analysis is not an absolute proof of fertility, yet it is the most important single indicator of the functional status in the male reproductive tract.
What are the most common signs and symptoms of problems with semen?
Yellow or greenish semen
Red or brown tinted semen (may indicate blood in the ejaculate)
Ejaculate with an especially strong, foul odor
Abnormally thick ejaculate
Low volume of semen
What is low sperm count (oligospermia)?
Low Sperm Count
Low sperm count also known as oligospermia is a common cause of male factor infertility. Twenty million or more sperm per millilitere of semen is considered as normal sperm count, with at least 15% of those sperm having normal shape and 50 % having good motility. In fact, many men with sperm counts lower than 20 million have fathered children, and some men with relatively high sperm counts have not, these cases are considered exceptions to the rule. A simple male fertility test can determine sperm count and also check for abnormalities with their movement and shape. Oligospermia can be caused by innumerable, and sometimes unexplainable, factors; there are generally no predictable signs of low sperm count other than infertility.
What is low sperm motility?
Low sperm motility is a condition in which the sperm’s capacity for swimming forward and penetrating the egg is diminished. The sperms have difficulty invading the cervical mucus Iif their movement is slow and, not in a straight line, or, leading to male infertility.
Normal sperm motility exists when approximately two- thirds of the sperm in the semen can move forward through the cervical mucus and pierce the ovum. If a male fertility test shows that fewer than 8 million sperm per millilitre of semen show normal forward movement, then low sperm motility may be causing male factor infertility.
What is abnormal sperm shape?
Male factor infertility can also be caused by abnormalities in the shape and size of the sperm. As with low sperm count, at least two-thirds of the sperm in the ejaculate must be of an adequate shape and size in order to be considered normal. Male infertility can result when the sperm’s shape prevents it from having normal mobility or strength to penetrate the ovum. In fact, some specialists believe that abnormal sperm shape has an even greater effect on male fertility than low motility or oligospermia (low sperm count).
A male fertility test can reveal whether the sperms are of normal shape and size. Some of the common sperm abnormalities are:
- A very large round head
- An extremely small pinpoint head
- A tapered head
- A crooked head
- Two heads
- A tail with kinks and curls
If you are struggling with male infertility issues, it is important to be tested for abnormal sperm shape and begin seeking solutions quickly.
How is the semen sample collected?
The sample has to be collected after minimum of 48 – 72 hours abstinence, in a sterile container, either in the laboratory collection room or if brought from home, should be delivered to the lab within 30 minutes.
What are the normal values of various semen parameters?
5th ed of WHO reference values for semen analysis (Feb 2011):
Total ejaculate 40 mil/ml
Concentration 16 million per ml
Volume 1.6 ml – 6 ml
Progressive motility 32%
Non progressive + Progressive motility 42%
Normal forms 4% – Kruger criteria
All these are 5th percentile values which means values below this range has only a 5% chance of pregnancy – however values above the 5th percentile value is not a proof of fertility and may need values to be higher range for better chance of pregnancy or may need treatment depending on the duration of infertility.
What are the causes for poor sperm count?
Sample collection problems
- Inadequate period of abstinence
- Use of lubricants or soap during collection
- Hormonal problems
- Blood supply problems to the testis – varicocele
- Erection problems
- Ejaculation problems
- Childhood undescended testis
- Testicular trauma or a history of unilateral testicular torsion
- Delayed or incomplete puberty
- Bilateral mumps orchitis
- Diabetes mellitus or multiple sclerosis
- Treatment for cancer
- History of a herniorrhaphy
- Prior vasectomy
- Previous bladder, pelvic, or retroperitoneal surgery
- Exposure to certain medications or drugs
Contrary to popular belief, wearing tight pants or briefs is no longer considered a viable cause of oligospermia. However, it is still advisable to avoid restrictive, tight clothing if you and your partner are trying to conceive.
In many cases, low sperm count and subsequent male infertility is only temporary – solutions like losing weight, quitting smoking, or avoiding hot baths and saunas can often lead to improvements in sperm count.
If you want to learn more about the signs of infertility and low sperm count, or arrange for a male fertility test, it is always best to speak directly with a fertility specialist.
What is varicocele
Varicocele is a mass of enlarged veins that develops in the spermatic cord, which leads from the testicles (testes) up through a passageway in the lower abdominal wall to the circulatory system. The spermatic cord is made up of blood vessels, lymphatic vessels, nerves, and the duct that carries sperm from the body (vas deferens). If the valves that regulate blood flow from these veins become defective, blood does not circulate out of the testicles efficiently, which causes swelling in the veins above and behind the testicles. A varicocele can develop in one testicle or both, but in about 85% of cases it develops in the left testicle. A one-sided (unilateral) varicocele can affect either testicle.
What are the symptoms and signs?
The patient may be aware of a lump, especially when standing, but may notice that the swelling usually disappears when lying down, is soft to feel, like a bunch of grapes or a bag of worms. The degree of discomfort or pain varies considerably from one person to another. There may not be any discomfort; however, some men may experience an uncomfortable dragging pain, especially in hot weather or after exercise.
Who can get a varicocele?
A varicocele is generally first noticed in males between puberty and 35 years of age, especially near the end of adolescence. However, any male can be affected.
What is the cause?
The cause is a mechanical problem in the drainage of the testicular vein into the renal vein of the kidney. A faulty valve in the testicular vein leads to back pressure in the system and thus swollen varicose veins around the testicle. There is not a known reason why only certain men experience the condition; however, there is a tendency for varicoceles to run in families.
What is the risk?
A primary varicocele is a relatively minor condition without serious consequences. However, in some men the discomfort is such that surgical treatment is required while others can live with a very mild discomfort. Varicoceles are thought to be associated with decreased fertility, although this needs to be correlated with sperm count.
Is surgery needed?
Surgery may be recommended if the varicocele is causing significant discomfort, or associated with a reduced size of the left testicle or infertility. The operation is a straightforward but delicate procedure in which the vein draining the varicose veins is ligated, or tied off. This causes the veins to collapse without affecting the testicles function. Results from surgery are very good, with an 80% success rate and pregnancy rates of 45% – to 50 %.