Andropause

=Objectives= These objectives are entirely student generated.

What is Andropause?
It is the "late-onset hypogonadism (LOH, also referred to as age-associated testosterone deficiency syndrome, TDS) is a clinical and biochemical syndrome associated with advancing age and characterized by symptoms and deficiency in serum testosterone levels (below the young healthy adult male range). This condition may result in significant detriment in the quality of life and adversely affect the function of multiple organ systems." -- Henker 1977

Causes of Decline

 * Changes in hypothalamic/pituitary function
 * LHRH release/responsiveness
 * Pulse frequency/amplitude
 * Feedback sensitivity
 * Decline in Leydig cell function
 * Lower Leydig cell number
 * Reduced LH responsiveness
 * Increased protein binding (SHBG)
 * Concurrent systemic illness/conditions

Testosterone Therapy

 * While T levels decrease with age, it is not clear that supplementation makes a difference

Andropause Diagnosis
===Androgens and Sexuality
 * Low AM serum testosterone levels (<230 ng/ml) AND symptoms
 * Sexuality
 * Strength
 * Cognition
 * Bone Mass
 * We have fewer "sexual events" as we get older
 * And T levels drop as we age
 * But, it is not clear that the drop in T is directly related to the decrease in "sexual events"

Androgens and Muscle Strength

 * There was an increase shown in grip strength data and some exercises in low and borderline patients, but NO PERFORMANCE DATA
 * I don't really get this section though, I think the jist is that it isn't really shown in older patients to increase muscle strength definitively

Androgens and Cognition

 * Actors, football players, and neurosurgeons all tend to have high T levels
 * T therapy improves spatial cognition and working memory, as well as visual-spatial cognition
 * Verbal memory improves
 * But, in those in whom T therapy was tested with and without T
 * Visual-perceptual improved with T
 * Verbal fluency and memory improved without T
 * In patients with low serum T levels, T therapy was shown to improve positive mood parameters (energy, well/good feelings, friendliness) and decreased negative mood (anger, nervousness and irritability).
 * There is a suggestion that there is a threshold above which T therapy does not improve these parameters

Androgens and Skeletal Health

 * As men get older, they have more fractures, and they have lower T
 * Association, but not necessarily causation
 * However, castration shown to increase bone remodeling and reduce bone mass!
 * Several important causes of bone loss may be related to gonadal dysfunction (glucocorticoid, EtOH, etc)
 * T therapy shown to have positive effects on bone density in hypogonadal males!
 * However, is this do to excess T being converted to estrogen?
 * Males with loss of function of ER-a gene demonstrated severe osteoporosis
 * Males with aromatase deficiency can be successfully treated with estrogen, but not T
 * Important to note that all sex hormones decrease with age

Testosterone Therapy Risks

 * Prostate disease
 * Hypertrophy and neoplasia
 * Cardiovascular events
 * Associated with lower HDL levels
 * Effects from T are uncertain on cardiovascular health
 * Sleep disturbance
 * Possible association with sleep apnea
 * Erythrocytosis
 * Chance of increased Hct with IM therapy