Andropause (or symptomatic late-onset hypogonadism): facts, fiction and controversies

Abstract

The existence of the so-called 'andropause' is an irrefutable fact, although the terms 'SLOH' (symptomatic late-onset hypogonadism) or 'symptomatic ADAM' (androgen deficiency of the aging male) are more accurate. The term 'andropause' is, in most cases, inappropriate, except when the gonads cease functioning. Testosterone production decreases as a function of age, but this decrease is not universal. Several clinical manifestations are associated with hypogonadism, but these are not solely attributable to hypogonadism. Other hormones (i.e. dehydroepiandrosterone, growth hormone, thyroxine and melatonin) also decrease with age. Such multi-hormone alterations are closely inter-related and may influence 'andropause-related' symptoms. Many patients with SLOH, although by no means all, respond well to testosterone therapy. Although testosterone therapy can induce adverse effects, these can be largely minimized by proper monitoring by a knowledgeable clinician. Extrapolation of the effects of estrogens + progesterone in menopausal women to the use of testosterone in hypogonadal men is mythical, and more research on the effect of exogenous sex steroids in aging men and women is needed. However, to restrict the prescription of such hormones until all issues have been fully addressed is impossible. Indeed, the discourse on SLOH would benefit considerably from more science and less speculation.