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. 1997 Sep;73(863):553–556. doi: 10.1136/pgmj.73.863.553

The andropause: fact or fiction?

N Burns-Cox 1, C Gingell 1
PMCID: PMC2431423  PMID: 9373594

Abstract

The so-called andropause is an ill-defined collection of symptoms in a group of men who may have low but may also have normal androgen levels. Unlike the proven benefits of hormone replacement therapy in women, the effects of testosterone supplementation in men are equivocal. It may increase sexual interest, but rarely to a level thought adequate by the patient. It has no proven beneficial effect on erectile dysfunction and other possible beneficial effects on haemopoesis, bone metabolism, lipids and fibrinolysis have yet to be demonstrated. With the availability of the testosterone patch, sustained increases in the serum testosterone levels will be readily achieved and could theoretically significantly affect the behaviour of subclinical prostate cancer. At the present time, testosterone replacement therapy in hypogonadal men is of proven clinical benefit; this is not the case, however, for eugonadal men with symptoms attributed to the andropause. The symptoms of the andropause fatigue can readily be explained by stress and there is no scientifically valid, placebo-controlled study that shows any benefit for testosterone supplements in this not uncommon group of patients.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bancroft J., Tennent G., Loucas K., Cass J. The control of deviant sexual behaviour by drugs. I. Behavioural changes following oestrogens and anti-androgens. Br J Psychiatry. 1974 Sep;125(0):310–315. doi: 10.1192/bjp.125.3.310. [DOI] [PubMed] [Google Scholar]
  2. Bancroft J., Wu F. C. Changes in erectile responsiveness during androgen replacement therapy. Arch Sex Behav. 1983 Feb;12(1):59–66. doi: 10.1007/BF01542116. [DOI] [PubMed] [Google Scholar]
  3. Bardin C. W., Swerdloff R. S., Santen R. J. Androgens: risks and benefits. J Clin Endocrinol Metab. 1991 Jul;73(1):4–7. doi: 10.1210/jcem-73-1-4. [DOI] [PubMed] [Google Scholar]
  4. Benkert O., Witt W., Adam W., Leitz A. Effects of testosterone undecanoate on sexual potency and the hypothalamic-pituitary-gonadal axis of impotent males. Arch Sex Behav. 1979 Nov;8(6):471–479. doi: 10.1007/BF01541414. [DOI] [PubMed] [Google Scholar]
  5. Bonithon-Kopp C., Scarabin P. Y., Bara L., Castanier M., Jacqueson A., Roger M. Relationship between sex hormones and haemostatic factors in healthy middle-aged men. Atherosclerosis. 1988 May;71(1):71–76. doi: 10.1016/0021-9150(88)90303-6. [DOI] [PubMed] [Google Scholar]
  6. Bremner W. J., Vitiello M. V., Prinz P. N. Loss of circadian rhythmicity in blood testosterone levels with aging in normal men. J Clin Endocrinol Metab. 1983 Jun;56(6):1278–1281. doi: 10.1210/jcem-56-6-1278. [DOI] [PubMed] [Google Scholar]
  7. Cooper A. J. A clinical and endocrine study of mesterolone in secondary impotence. J Psychosom Res. 1980;24(5):275–279. doi: 10.1016/0022-3999(80)90017-3. [DOI] [PubMed] [Google Scholar]
  8. Davidson J. M., Camargo C. A., Smith E. R. Effects of androgen on sexual behavior in hypogonadal men. J Clin Endocrinol Metab. 1979 Jun;48(6):955–958. doi: 10.1210/jcem-48-6-955. [DOI] [PubMed] [Google Scholar]
  9. Ekins R. Measurement of free hormones in blood. Endocr Rev. 1990 Feb;11(1):5–46. doi: 10.1210/edrv-11-1-5. [DOI] [PubMed] [Google Scholar]
  10. FEARNLEY G. R., CHAKRABARTI R. Increase of blood fibrinolytic activity by testosterone. Lancet. 1962 Jul 21;2(7247):128–132. doi: 10.1016/s0140-6736(62)90009-0. [DOI] [PubMed] [Google Scholar]
  11. Forbes G. B., Porta C. R., Herr B. E., Griggs R. C. Sequence of changes in body composition induced by testosterone and reversal of changes after drug is stopped. JAMA. 1992 Jan 15;267(3):397–399. [PubMed] [Google Scholar]
  12. Gray A., Feldman H. A., McKinlay J. B., Longcope C. Age, disease, and changing sex hormone levels in middle-aged men: results of the Massachusetts Male Aging Study. J Clin Endocrinol Metab. 1991 Nov;73(5):1016–1025. doi: 10.1210/jcem-73-5-1016. [DOI] [PubMed] [Google Scholar]
  13. HOLLANDER N., HOLLANDER V. P. The microdetermination of testosterone in human spermatic vein blood. J Clin Endocrinol Metab. 1958 Sep;18(9):966–971. doi: 10.1210/jcem-18-9-966. [DOI] [PubMed] [Google Scholar]
  14. Ishak K. G., Zimmerman H. J. Hepatotoxic effects of the anabolic/androgenic steroids. Semin Liver Dis. 1987 Aug;7(3):230–236. doi: 10.1055/s-2008-1040579. [DOI] [PubMed] [Google Scholar]
  15. Jeffcoate S. L., Brooks R. V., Lim N. Y., London D. R., Prunty F. T., Spathis G. S. Androgen production in hypogonadal men. J Endocrinol. 1967 Apr;37(4):401–411. doi: 10.1677/joe.0.0370401. [DOI] [PubMed] [Google Scholar]
  16. Johnson L. Spermatogenesis and aging in the human. J Androl. 1986 Nov-Dec;7(6):331–354. doi: 10.1002/j.1939-4640.1986.tb00943.x. [DOI] [PubMed] [Google Scholar]
  17. Khaw K. T., Barrett-Connor E. Lower endogenous androgens predict central adiposity in men. Ann Epidemiol. 1992 Sep;2(5):675–682. doi: 10.1016/1047-2797(92)90012-f. [DOI] [PubMed] [Google Scholar]
  18. Korenman S. G., Morley J. E., Mooradian A. D., Davis S. S., Kaiser F. E., Silver A. J., Viosca S. P., Garza D. Secondary hypogonadism in older men: its relation to impotence. J Clin Endocrinol Metab. 1990 Oct;71(4):963–969. doi: 10.1210/jcem-71-4-963. [DOI] [PubMed] [Google Scholar]
  19. Kwan M., Greenleaf W. J., Mann J., Crapo L., Davidson J. M. The nature of androgen action on male sexuality: a combined laboratory-self-report study on hypogonadal men. J Clin Endocrinol Metab. 1983 Sep;57(3):557–562. doi: 10.1210/jcem-57-3-557. [DOI] [PubMed] [Google Scholar]
  20. Labrie F., Dupont A., Belanger A., Lacoursiere Y., Raynaud J. P., Husson J. M., Gareau J., Fazekas A. T., Sandow J., Monfette G. New approach in the treatment of prostate cancer: complete instead of partial withdrawal of androgens. Prostate. 1983;4(6):579–594. doi: 10.1002/pros.2990040605. [DOI] [PubMed] [Google Scholar]
  21. Luisi M., Franchi F. Double-blind group comparative study of testosterone undecanoate and mesterolone in hypogonadal male patients. J Endocrinol Invest. 1980 Jul-Sep;3(3):305–308. doi: 10.1007/BF03348281. [DOI] [PubMed] [Google Scholar]
  22. Matsumoto A. M. Effects of chronic testosterone administration in normal men: safety and efficacy of high dosage testosterone and parallel dose-dependent suppression of luteinizing hormone, follicle-stimulating hormone, and sperm production. J Clin Endocrinol Metab. 1990 Jan;70(1):282–287. doi: 10.1210/jcem-70-1-282. [DOI] [PubMed] [Google Scholar]
  23. Mineau G. P., Trussell J. A specification of marital fertility by parents' age, age at marriage and marital duration. Demography. 1982 Aug;19(3):335–350. [PubMed] [Google Scholar]
  24. Mårin P., Krotkiewski M., Björntorp P. Androgen treatment of middle-aged, obese men: effects on metabolism, muscle and adipose tissues. Eur J Med. 1992 Oct;1(6):329–336. [PubMed] [Google Scholar]
  25. Nahoul K., Roger M. Age-related decline of plasma bioavailable testosterone in adult men. J Steroid Biochem. 1990 Feb;35(2):293–299. doi: 10.1016/0022-4731(90)90287-3. [DOI] [PubMed] [Google Scholar]
  26. Neaves W. B., Johnson L., Porter J. C., Parker C. R., Jr, Petty C. S. Leydig cell numbers, daily sperm production, and serum gonadotropin levels in aging men. J Clin Endocrinol Metab. 1984 Oct;59(4):756–763. doi: 10.1210/jcem-59-4-756. [DOI] [PubMed] [Google Scholar]
  27. Nieschlag E., Lammers U., Freischem C. W., Langer K., Wickings E. J. Reproductive functions in young fathers and grandfathers. J Clin Endocrinol Metab. 1982 Oct;55(4):676–681. doi: 10.1210/jcem-55-4-676. [DOI] [PubMed] [Google Scholar]
  28. O'Carroll R., Bancroft J. Testosterone therapy for low sexual interest and erectile dysfunction in men: a controlled study. Br J Psychiatry. 1984 Aug;145:146–151. doi: 10.1192/bjp.145.2.146. [DOI] [PubMed] [Google Scholar]
  29. Purifoy F. E., Koopmans L. H., Mayes D. M. Age differences in serum androgen levels in normal adult males. Hum Biol. 1981 Dec;53(4):499–511. [PubMed] [Google Scholar]
  30. Rubens R., Dhont M., Vermeulen A. Further studies on Leydig cell function in old age. J Clin Endocrinol Metab. 1974 Jul;39(1):40–45. doi: 10.1210/jcem-39-1-40. [DOI] [PubMed] [Google Scholar]
  31. SNIFFEN R. C. The testis. I. The normal testis. Arch Pathol (Chic) 1950 Sep;50(3):259–284. [PubMed] [Google Scholar]
  32. Schwartz D., Mayaux M. J., Spira A., Moscato M. L., Jouannet P., Czyglik F., David G. Semen characteristics as a function of age in 833 fertile men. Fertil Steril. 1983 Apr;39(4):530–535. doi: 10.1016/s0015-0282(16)46946-3. [DOI] [PubMed] [Google Scholar]
  33. Simon D., Preziosi P., Barrett-Connor E., Roger M., Saint-Paul M., Nahoul K., Papoz L. Interrelation between plasma testosterone and plasma insulin in healthy adult men: the Telecom Study. Diabetologia. 1992 Feb;35(2):173–177. doi: 10.1007/BF00402551. [DOI] [PubMed] [Google Scholar]
  34. Skakkebaek N. E., Bancroft J., Davidson D. W., Warner P. Androgen replacement with oral testosterone undecanoate in hypogonadal men: a double blind controlled study. Clin Endocrinol (Oxf) 1981 Jan;14(1):49–61. doi: 10.1111/j.1365-2265.1981.tb00364.x. [DOI] [PubMed] [Google Scholar]
  35. Tenover J. S. Effects of testosterone supplementation in the aging male. J Clin Endocrinol Metab. 1992 Oct;75(4):1092–1098. doi: 10.1210/jcem.75.4.1400877. [DOI] [PubMed] [Google Scholar]
  36. Vermeulen A. The male climacterium. Ann Med. 1993 Dec;25(6):531–534. [PubMed] [Google Scholar]
  37. Waxman J., Man A., Hendry W. F., Whitfield H. N., Besser G. M., Tiptaft R. C., Paris A. M., Oliver R. T. Importance of early tumour exacerbation in patients treated with long acting analogues of gonadotrophin releasing hormone for advanced prostatic cancer. Br Med J (Clin Res Ed) 1985 Nov 16;291(6506):1387–1388. doi: 10.1136/bmj.291.6506.1387. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Wheeler M. J. The determination of bio-available testosterone. Ann Clin Biochem. 1995 Jul;32(Pt 4):345–357. doi: 10.1177/000456329503200401. [DOI] [PubMed] [Google Scholar]
  39. Winters S. J., Sherins R. J., Troen P. The gonadotropin-suppressive activity of androgen is increased in elderly men. Metabolism. 1984 Nov;33(11):1052–1059. doi: 10.1016/0026-0495(84)90237-3. [DOI] [PubMed] [Google Scholar]

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