Testosterone Deficiency In Old Age - Andropause

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Testosterone Deficiency In Old Age - Andropause
Testosterone Deficiency In Old Age - Andropause

Video: Testosterone Deficiency In Old Age - Andropause

Video: Testosterone Deficiency In Old Age - Andropause
Video: Andropause, Causes, Signs and Symptoms, Diagnosis and Treatment 2024, March
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Testosterone Deficiency in Old Age

Age hypogonadism (late-onset hypogonadism) is a syndrome characterized by a lack of testosterone and certain accompanying symptoms. Testosterone deficiency in old age is sometimes called andropause, although testosterone levels do not drop abruptly. A comparable hormonal change as in women during menopause does not take place in men.

The human hormone metabolism changes with age. Over time, the body loses the ability to properly regulate hormones and fewer hormones are excreted. This is part of the normal aging process and physical changes that come with age. In men, the level of total testosterone falls slowly from around the age of 40, by around 0.4 percent per year. However, testosterone production does not usually stop. For most men, testosterone levels stay in the normal range even with old age.

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In old age hypogonadism, the testosterone levels are below the normal values for healthy men. The testosterone deficiency can cause or worsen physical complaints and contribute to the development of diseases such as osteoporosis, metabolic syndrome.

In 50 to 59-year-old men, the frequency (incidence) of hypogonadism is 0.6 percent and in 60 to 79-year-old men 4.2 percent - around every 25th man in this age group.

How does testosterone deficiency arise in old age?

Two processes play an important role in the development of age hypogonadism:

  • The Leydig cells of the testes can produce less testosterone and
  • the hormonal control of testosterone production in the hypothalamus-pituitary system changes.

Age hypogonadism is a hybrid of primary and secondary hypogonadism. The symptoms can be influenced by various physical and psychological factors. Scientific research suggests that certain conditions are related to testosterone deficiency and that they may interact with one another. In the case of osteoporosis, metabolic syndrome or type 2 diabetes, the affected men often have low testosterone levels.

How can you prevent testosterone deficiency?

The development of a testosterone deficiency in old age can be favored by various lifestyle-related factors. These include, for example, obesity or high alcohol consumption. A healthy lifestyle - a balanced diet, regular exercise, no excessive alcohol consumption, no smoking - avoids additional negative influences on the production and effects of testosterone and helps to prevent a testosterone deficiency.

Risk factors for old age hypogonadism are obesity, chronic diseases and poor health in general.

What are the symptoms?

The syndrome of old age hypogonadism is usually characterized by the following symptoms:

  • Decrease in sexual desire (loss of libido),
  • Erectile dysfunction,
  • Mood swings, depressed moods and loss of drive,
  • cognitive disorders, especially a reduction in spatial perception,
  • Sleep disorders,
  • Decrease in body hair,
  • Gynecomastia,
  • Muscle decline (muscle volume, muscle strength),
  • Increase in belly fat,
  • Loss of bone density or signs of osteoporosis,
  • Signs of Metabolic Syndrome.

On their own, none of the symptoms are reliable indicators of hypogonadism. The signs of old age hypogonadism are usually less pronounced than hypogonadism occurring in younger years. The symptoms can also be triggered by other diseases, for example metabolic diseases such as diabetes, cardiovascular diseases. Sexual dysfunctions, e.g. loss of libido or erectile dysfunction, can also be caused by a variety of physical and psychological causes.

How is the diagnosis made?

In order to clarify the patient's complaints, the doctor first asks about the medical history and carries out a physical examination. If the patient has complaints or symptoms that indicate a testosterone deficiency, a precise diagnosis is necessary. This allows the doctor to narrow down possible causes.

Laboratory tests of the blood show the level of testosterone. The measurement must be made in the morning. The laboratory results and certain sexual symptoms (e.g. decreased sexual desire, weakened morning erection, erectile dysfunction) provide the doctor with evidence of whether there is a testosterone deficiency and whether a testosterone replacement is indicated.

The results of the first laboratory measurement must be confirmed by a second or third measurement. The doctor may prescribe further tests in order to narrow down possible causes. For more information, see: Testosterone Deficiency in Men.

How is geriatric hypogonadism treated?

Testosterone replacement is indicated if the patient's testosterone levels are too low and typical symptoms of old age hypogonadism are present. Before starting testosterone replacement therapy, the doctor clarifies whether there are any contraindications and prescribes the necessary examinations. The contraindications include prostate cancer, polycythemia, breast cancer in men, obstructive sleep apnea or severe heart failure.

For testosterone replacement therapy, preparations with natural testosterone are available in different dosage forms. The attending physician decides together with the patient which preparation is most suitable and informs the patient about possible risks and side effects.

Before starting therapy, the doctor checks the condition of the prostate and the risk of developing prostate cancer by means of a rectal finger and ultrasound examination or laboratory examination of the PSA. The incidence of prostate cancer increases after the age of 50. For this reason, shorter-acting preparations have the advantage over long-acting ones that testosterone replacement therapy can be interrupted immediately if a contraindication such as prostate cancer occurs.

For more information on therapy and side effects, see Testosterone Deficiency in Men.

Forecast and control

An improvement in the symptoms of geriatric hypogonadism usually occurs within three to six months of starting testosterone replacement therapy. The following positive effects have been observed in studies:

  • Increase in bone density,
  • Increase in lean body mass,
  • Increase in erythrocyte formation,
  • Metabolic parameters as well
  • erectile function.

Regular check-ups for testosterone replacement therapy include laboratory tests for total testosterone, PSA levels, blood counts (hematocrit), and ultrasound of the prostate. Further examinations can be ordered by the doctor to check the success of the treatment, e.g. measurement of the bone density.

Whom can I ask?

To clarify the suspicion that you are suffering from a testosterone deficiency, you can contact the following offices:

  • General Practitioner,
  • Specialist in urology,
  • Specialist in andrology or
  • Specialist in internal medicine (specializing in endocrinology).

How are the costs going to be covered?

The e-card is your personal key to the benefits of the statutory health insurance. All necessary and appropriate diagnostic and therapeutic measures are taken over by your responsible social insurance agency. A deductible or contribution to costs may apply for certain services. You can obtain detailed information from your social security agency. Further information can also be found at:

  • Right to treatment
  • Visit to the doctor: costs and deductibles
  • Prescription fee: This is how drug costs are covered
  • Health Professions AZ

and via the online guide to reimbursement of social insurance costs.

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