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    Testosterone Deficiency (Andropause): What You Need to Know

    Testosterone Deficiency (Andropause): What You Need to Know
    Everyone knows about menopause in women. It is an identifiable time in a woman’s life when her ovaries no longer produce estrogen, and certain physical and psychological symptoms are often seen as a result of this loss of hormone. For years, some researchers have indicated that men go through a time of hormonal changes in middle life, as well. They think that it is due to a decrease in the hormone testosterone, and they claim that it also has a group of identifiable symptoms.

    Unfortunately, not everyone agrees that male menopause, or andropause, is a true condition. Some doctors do not believe that the decrease in testosterone affects men, that not all men lose this hormone, and that it is not a group of identifiable symptoms. For this reason, the treatment behind andropause is seriously lacking, and many men turn to herbs and supplements to get their libido and energy back.

    Although medical boards do not officially recognize it, andropause is gaining more and more support in the medical community. Various treatment options have already been developed to assist with restoring testosterone in men who show signs of andropause. In addition to pharmaceutical solutions, a large range of herbal supplements has also been designed to help the body naturally increase the production of this vital male hormone.

    What is Testosterone, And What Is Its Role In The Male Body?

    Testosterone is a hormone that is produced in both male and female bodies. It is classified as a steroid hormone and plays a number of crucial roles in both genders. Even though the hormone is found in the bodies of men and women, it should be noted that there is a much larger concentration of the hormone present in the male body, than there is in the female body.

    In the male body, the tests are the main area where testosterone is produced. The adrenal cortex also produces some testosterone. In the female body, the hormone is produced by the ovaries, as well as the adrenal cortex.

    When a male teenager reaches the stage of puberty, testosterone starts to come into play. During this time, their body will start to produce more testosterone and this is when they go through a number of changes. [1] The boy goes through various physical maturation processes, and sexual maturation processes, as testosterone levels increase in their body. They start to grow pubic and body hair, they grow in weight and height, their voice becomes deeper than before, they start to grow a beard, and many other changes also occur.

    In adult men, testosterone continues to play an important role.

    A particularly important function of testosterone is its ability to regulate a man’s sex drive. [2] When testosterone levels decline and become low, then men often find that their libido becomes low as well. Even though testosterone does not have a direct impact on a man’s erectile function, the effects that the hormone has on libido may cause a man to experience implications with his ability to have a normal functioning erection and to participate in sex without any problems. Furthermore, it is often found that a lack of testosterone can lead to problems with a man’s stamina and cause him to feel weak and tired. This, in turn, can further implicate his abilities in the bedroom and even have an adverse impact on his erectile function.

    The growth of lean muscle tissue is also regulated by testosterone hormones. When testosterone levels are high, it is easier for a man to experience muscle growth when he participates in strength training workouts. On the other hand, if testosterone levels decline, so will lean muscle mass. Furthermore, muscle strength is also greatly influenced by the testosterone levels in the man’s body. Low testosterone leads to poor muscle strength, which means working out becomes harder as well.

    One review paper explains that the role of testosterone in the production and well-being of sperm among men is an underestimated and often overlooked topic. [3] The paper explains that at least 50% of cases where a couple is having difficulty becoming pregnant are because the man has problems with his sperm – this may include a low sperm count or poor sperm motility. They continue to explain that infertility is often seen among men with hypogonadism, where the testosterone levels in the man’s blood circulatory system become lower than what is considered normal or healthy.

    Apart from these particular effects and roles that testosterone has in the male body, it is important to understand that the hormone also affects the growth of bones, as well as bone strength. Men with low testosterone levels are known to be at a higher risk of developing problems with their bone health, which may later lead to the development of chronic bone-related diseases, such as osteoporosis.

    What is Andropause?

    Andropause is caused by a decrease in testosterone due to aging. While testosterone levels tend to increase during a man’s years as a teenager and young adult, the production of the hormone gradually starts to decline between the ages of 30 and 40. It is also known as late-onset hypogonadism and androgen decline in the aging male. [4] Symptoms associated with andropause can start to develop as early as 40, and 2 to 5 percent of men in this age group display symptoms. From 50 to 60 years of age, the numbers are more shocking. It is estimated that between 8 and 40 percent of men in this age group have andropause. For men in their 70s, 34 to 70 percent experience the decline, and if you are in your 80s, 91 percent of men have the condition. It was thought that this was a normal part of aging, but recent studies have determined that medications can support or reverse the signs of andropause.

    In addition, andropause is more confusing because of its nature. It doesn’t always happen to men over the age of 40, and it can manifest in ways that are often too subtle to be detected. For instance, fatigue may be brushed off as a normal part of aging or stress in your lifestyle. The symptoms also have a tendency to begin slowly and eventually culminate in life-altering symptoms. For this reason, it is helpful to screen men at regular check-ups for their testosterone levels.

    Symptoms of Andropause

    Since testosterone is a hormone concerned mostly with sexual function, many of the symptoms of andropause are sex-related. First, you may experience a lack of interest in sex, and then you may notice that the quality of your erections is not as strong as before. The erectile dysfunction symptoms are often taken for blood flow problems or stress when in reality, testosterone might be behind these issues that the man is facing in the bedroom. This is because testosterone does not have any direct effect on erectile function, but it does affect a man’s ability to have an erection and to maintain that direction indirectly. These symptoms tend to happen over time, and it can be easy to overlook them. Mood changes are another hallmark symptom of andropause. You may experience confusion, brain fog, and difficulty concentrating. In addition, anger, depression, and fatigue are often quite common. [5]

    In one paper, scientists at the Zurich University Hospital of Psychiatry in Switzerland explains that a definite connection has been observed between low testosterone levels and the onset of depression symptoms. [6] They did multiple tests on a group of 64 male participants. Among these participants, there were 39 who experience symptoms that qualified them for subsets of depression. A total of 25 patients had scores that qualified them for a diagnosis with melancholic depression, while 14 participants had met the qualifying criteria for a diagnosis with atypical depression. Lower levels of testosterone were noted among those participants who were showcasing symptoms of these depression subsets, while healthy individuals without depression-associated symptoms did not experience such declines in their testosterone levels.

    Some other symptoms are also present with the loss of testosterone. You may notice a decrease in lean muscle mass and a loss of strength. Some men notice that they lose body hair or that it grows in sparser than before. Internally, you may lose some of your bone mass. The lack of testosterone can create brittle bones and lead to fast approaching osteoporosis.

    [7] In addition, fat begins to develop around the internal organs, and this can lead to problems with the liver, kidneys, and heart if left unchecked.

    Abdominal obesity might also start to develop in men when their testosterone levels decline. Testosterone has an influence in the distribution of fat throughout a man’s body. This is a particularly dangerous kind of obesity that causes a significant increase in the risk of developing numerous health issues.

    In a study by the University of Birmingham in the UK, scientists found that a strong relationship exists between abdominal obesity and the development of type 2 diabetes. [8] It was found that, among a large group of participants, type 2 diabetes was much more prevalent amongst those with excessive amounts of fat accumulated in the abdominal region of the body.

    Furthermore, a review paper that was prepared by scientists at the Airedale NHS Foundation Trust’s Research & Development Department explains that abdominal obesity is also considered a predominant risk that is associated with metabolic syndrome. [9] With this in mind, it means men who develop obesity that primarily affects their abdominal region are predisposed to the development of other factors that are associated with metabolic syndrome. These factors include an elevation in their serum triglyceride levels, a reduction in their high-density lipoprotein levels, which is also known as the “good” kind of cholesterol, and the possible development of insulin resistance. Hypertension, a medical term that describes high blood pressure, is also considered a risk factor that may develop.

    What Causes Andropause And A Decline In Testosterone?

    According to a scientific paper published in the Journal of Reviews in Urology, medical scientists have already established the fact that testosterone naturally starts to decline after a man turns 30. [10] They also explain that, after 30 years of age, the body will gradually produce less and less testosterone, with a natural decline of around 1% in testosterone produced on an annual basis.

    Even though there is a natural decline in testosterone production in the male body as they age, this decline should not necessarily lead to andropause or a deficiency of testosterone.

    For this reason, additional factors need to be taken into account when a man suffers from a low level of testosterone. There are several categories of factors that may lead to a reduction in the production of testosterone among men, and each category should be carefully considered in order to pinpoint a specific cause – in such a case, treatment may be tailored toward the specific cause to provide a more successful outcome.

    Primary Hypogonadism

    Primary hypogonadism usually occurs when there is a problem with a man’s testes, which causes them to produce an insufficient amount of testosterone. This may be the case when a man has undescended testicles. Hemochromatosis, a condition where levels of iron in a man’s blood is excessively high, and an inherited condition known as Klinefelter’s syndrome, also causes primary hypogonadism.

    When a man suffers a physical injury to their testicles, then the injury can also cause him to develop hypogonadism and lead to a significant decline in testosterone production. Other possible causes of primary hypogonadism include mumps orchitis and as a result of damage dealt with the testicles through radiation and chemotherapy.

    Secondary Hypogonadism

    Secondary hypogonadism or andropause is much more common than primary hypogonadism, and there are also a relatively large number of possible causes behind this particular condition. Several diseases have been found to cause a decline in testosterone levels in a man’s body.

    These diseases include Kallman syndrome, as well as HIV. Tuberculosis, histiocytosis, sarcoidosis, and many other inflammatory diseases can also have an adverse impact on the hypothalamus, as well as the pituitary gland, both of which play an important part in the endocrine system. In turn, this may lead to a decline in testosterone production. When a man develops a pituitary disorder, then he may also start to experience a decline in testosterone levels throughout his body.

    Another important possible cause of secondary hypogonadism that also need to be considered is obesity. Even though low testosterone levels have been found to contribute to the accumulation of fat in the abdomen of a man, as well as eventually cause obesity, men who are obese may also be at a higher risk of developing a testosterone deficiency.

    A review paper published in the Asian Journal of Andrology provides a detailed explanation of this complex association between testosterone and weight – or, in particular, how low testosterone contributes to obesity, and how a vice-versa connection also exists. [11]

    They found that men who are moderately obese experience a decline in testosterone due to the development of insulin resistance. When a man develops insulin resistance, levels of sex hormone binding globulin in their blood starts to become lower. In turn, this means they will have lower levels of testosterone as well.

    Furthermore, when a man becomes more severely obese, a suppression of their hypothalamic-pituitary-testicular axis also develops. This, in turn, causes a further decrease in testosterone production and also leads to a lower concentration of free testosterone being available in their blood circulatory system.

    Treatment – How to increase testosterone?

    The standard treatment for andropause is hormone replacement therapy, although this presents a few roadblocks. [12] First, testosterone is best absorbed through the skin over an extended period of time, and this means that it must be administered in skin patch form. For some patients, this affects compliance. Second, if you had or are at risk for prostate cancer or male breast cancer, then this treatment is not for you. Taking more of the hormone may actually cause a recurrence of these types of cancer, and the danger of taking it may be serious. These two facts sometimes keep men from having their andropause treated.

    Different Types Of Pharmaceutical Options For Testosterone Replacement Therapy

    Since testosterone replacement therapy has been proven an effective option for men who has a deficiency of this crucial hormone, medical scientists have developed a variety of options that can be utilized to introduce synthetically products testosterone hormones into a male patient’s body.

    It should be noted that men will not usually be provided with testosterone replacement therapy options if their hormone levels are found to be low, but they do not experience any of the obvious symptoms that have been associated with a significant decline of testosterone hormones.

    There are four main types of pharmaceutical testosterone replacement options available for men, each with a set of benefits and possible drawbacks, which should be considered before the patient undergoes treatment.

    • Transdermal Treatments – One of the most popular forms of testosterone replacement therapy is through the use of skin patches, which utilizes a transdermal delivery system to introduce synthetic testosterone to the male patient’s body through their skin. The patches are usually applied each day and are most common placed somewhere on the upper body.
    • Mouth Patches – Another option that men can opt for is mouth patches. These are usually in the form of a tablet gets stuck on the male patient’s upper gums. The treatment introduces testosterone into oral tissue throughout the day, which then carries the testosterone into the male patient’s blood system. In the majority of cases, these tablets need to be inserted into the mouth two times each day for maximum efficiency.
    • Testosterone Gels – Some men prefer to opt for gels that contain synthetically produced testosterone, along with ingredients that help the gel penetrate the skin and enter the bloodstream. There are different options available to patients. Some of these gels are applied to specific areas of the patient’s body, such as on the inside of their nose, while others have a more generalized approach to its application.
    • Injections – Testosterone injections are also available, where synthetic testosterone is injected into the patient. In most cases, the injection is made directly into a muscle. The testosterone will then be absorbed into the bloodstream, where it can bind to enzymes and other bodily tissues to provide a replacement for the natural testosterone that the patient’s body relies on.
    • Implants – While not the most popular option, implants are also sometimes used as a testosterone replacement option. In these cases, a pellet is implanted into the patient’s soft tissues, usually in the upper body. The pellet slowly releases testosterone into the patient’s bloodstream.

    Herbal Supplementation To Increase Testosterone Levels

    More and more men turn to herbal supplements to increase their testosterone levels, and one of the most popular is tongkat ali. [13] This supplement has shown very good results in increasing testosterone in lab rats and the positive clinical studies in human are also increasing. Talk to your doctor about your symptoms and only purchase quality tongkat ali from reputable sources to make this supplement work for you.

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    References   [ - ]


    Johns Hopkins Medicine Site. (n.d.). Puberty: Adolescent Male. Retrieved from,P01636


    Wein, H. (2013). Understanding How Testosterone Affects Men. Retrieved from the National Institute of Health Web Site:


    Kliesch, S. (2010). Testosterone and infertility. Der Urologe, Ausg. A, 49(1):32-6. doi: 10.1007/s00120-009-2195-x


    Huhtaniemi, I. T. (2014). Andropause–lessons from the European Male Ageing Study. Annales d’Endocrinologie, 75(2):128-31. doi: 10.1016/j.ando.2014.03.005


    Khosravi, S., Ardebili, H. E., Larijani, B., Nedjat, S., Nikbakht Nasrabadi, A., Ardebili, M. E., … Samizadeh, E. (2015). Are andropause symptoms related to depression? Aging Clinical and Experimental Research, 27(6):813-20. doi: 10.1007/s40520-015-0341-4


    Rodgers, S., Grosse Holtforth, M., Hengartner, M. P., Müller, M., Aleksandrowicz, A. A., Rössler, W., & Ajdacic-Gross, V. (2015). Serum testosterone levels and symptom-based depression subtypes in men. Frontiers in psychiatry, 6: 61. doi:10.3389/fpsyt.2015.00061/


    Tirabassi, G., Biagioli, A., & Balercia, G. (2014). Bone benefits of testosterone replacement therapy in male hypogonadism. Panminerva Medica, 56(2):151-63. Retrieved from


    Freemantle, N., Holmes, J., Hockey, A., & Kumar, S. (2008). How strong is the association between abdominal obesity and the incidence of type 2 diabetes?. 023International journal of clinical practice, 62(9), 1391-6. doi: 10.1111/j.1742-1241.2008.01805.x


    Paley, C. A., & Johnson, M. I. (2018). Abdominal obesity and metabolic syndrome: Exercise as medicine?. BMC sports science, medicine & rehabilitation, 10: 7. doi:10.1186/s13102-018-0097-1


    Brawer, M. K. (2004). Testosterone Replacement in Men with Andropause: An Overview. Reviews in urology, 6 Suppl 6(Suppl 6), S9-S15. Retrieved from


    Fui, M. N. T., Dupuis, P., & Grossmann, M. (2014). Lowered testosterone in male obesity: Mechanisms, morbidity and management. Asian Journal of Andrology, 16(2): 223–231. doi: 10.4103/1008-682X.122365


    Institute of Medicine (US) Committee (2004). Assessing the Need for Clinical Trials of Testosterone Replacement Therapy. National Academic Press (US). Retrieved from


    Tambi, M. I., Imran, M. K., & Henkel, R. R. (2012). Standardised water-soluble extract of Eurycoma longifolia, Tongkat ali, as testosterone booster for managing men with late-onset hypogonadism? Andrologia, 44 Suppl 1:226-30. doi: 10.1111/j.1439-0272.2011.01168.x