andropause
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Etiology
Pathology
- decreased luteinizing hormone (LH)
- decreased testicular response to LH
- decreased testosterone secretion from Leydig cells of testes (bioavailable testosterone < 70 ng/dL)
- decreased adrenal secretion of DHEA & DHEA-sulfate
- hyporesponsiveness of hypothalamic-pituitary axis to decreased serum testosterone levels
Clinical manifestations
(also see hypogonadism)
- decreased libido
- erectile dysfunction
- sarcopenia
- decreased muscle strength
- decreased bone mineral density
- decreased sexual hair
- increased adipose tissue
- depression
- lack of motivation
Laboratory
- free testosterone < 5 ng/dL
- total testosterone in serum < 300 ng/dL
- diminished luteinizing hormone in serum
- complete blood count (CBC) may show anemia
- serum LH & serum FSH to distinguish primary from secondary androgen insufficiency
- serum prolactin to assess pituitary function
Management
- testosterone (also see testosterone replacement therapy)
- re-evaluate 3, 6 & 12 months after initiation of therapy, thereafter at least annually[2]
- monitor hematocrit, serum PSA
More general terms
Additional terms
- erectile dysfunction (ED)
- hypogonadism
- testosterone (Delatestryl Testopel, Striant, Intrinsa, Xyosted)
- testosterone replacement therapy; androgen therapy
References
- ↑ Solomon DH, in: UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
- ↑ 2.0 2.1 Kazi M et al, Considerations for the diagnosis and treatment of testosterone deficiency in elderly men. Am J Med 2007, 120:835 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17904450
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 15, American College of Physicians, Philadelphia 2009
- ↑ 4.0 4.1 Nguyen CP, Hirsch MS, Moeny D et al Perspective. Testosterone and "Age-Related Hypogonadism" - FDA Concerns. N Engl J Med 2015; 373:689-691. August 20, 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26287846 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMp1506632