Andropause (Male Menopause)
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Menopause for Men?

by Brock Smith, RPh, BS PharmD and Paul Hueseman, Doctor of Pharmacy
February 2003

brought to you by Bellevue Pharmacy, a ProjectAWARE sponsor

Most do not realize that men experience a change in their hormonal production and balance that in many ways is very similar to menopause. It is called andropause. In fact, andropause is often referred to as "male menopause".

   Some signs of andropause
  • inability to concentrate
  • mood swings
  • weakness
  • irritability
  • loss of memory
  • decreased energy
  • depression
  • loss of libido (sex drive)
  • decreased erectile function
  • decreased strength of orgasm
  • decreased muscle mass
  • increased fat

Andropause occurs when a man's production of hormones declines to below normal levels. These hormones include testosterone, thyroid, human growth hormone (HGH), and dihydroepiandosterone (DHEA). In addition, production of estrogen actually increases in men undergoing andropause.

A man's testosterone level typically begins to fall by the time he reaches his 50s, but for many men it may start to occur in his early 30s. The diagnosis of andropause should include complete blood count and chemistry profile, free and total testosterone, estradiol (estrogen), progesterone, DHEA, luteinizing hormone and homocysteine. When interpreting the results, the free testosterone in the serum or blood should be in the mid- to high-normal range (10.8 nmol/L to 24.6 nmol/L), and estradiol (estrogen) in the low-normal range (below 32 pg/ml). A saliva test can also be used to measure testosterone, DHEA, and estrogen levels, although the normal levels are different than normal levels from serum that are provided above. Saliva tests can be purchased from Bellevue Pharmacy Solutions with a prescription, and the results can be interpreted by your physician along with consultation by one of the hormone specialists on staff at Bellevue Pharmacy Solutions.

The balance between the testosterone and estrogen is very important. While some estrogen protects against osteoporosis by increasing bone density and may decrease the risk for prostate cancer, men’s testosterone level should be greater than their estrogen level. In many men over fifty, the estrogen level is greater than the testosterone level, which is unacceptable.

The choices for supplementation of testosterone in males are quite numerous at this time, but only a few are commercially available. Patients and their physician have options to choose from that best fit their needs which include: topical gels, creams, oral capsules, and injectable forms. The other choices that can be made by a compounding pharmacy may include a gel, cream, pellet, or sublingual tablet that is custom made to your physician's order. The sublingual tablets dissolve under the tongue and are absorbed by the blood vessels in the oral mucosa thereby bypassing the step many drugs go through in the liver—called "first pass metabolism"—to be broken down. Gels and creams are applied topically to the skin and absorbed through the skin into the bloodstream. A less popular but very effective way to administer testosterone is in a pellet form. The pellet is placed under the skin with a local anesthetic and a trochar device. The pellet dissolves in the subcutaneous layer of the skin, providing a steady release of testosterone over eight to twelve weeks. This procedure is generally done four to six times per year.

A breakdown product of testosterone is dihydrotestosterone (DHT). Increased levels of DHT may lead to hair loss. Bellevue Pharmacy can compound combination of anastrozole and finasteride with a prescription. This has been used in combination to lower the DHT and estrogen levels. Oftentimes, this combination is taken in addition to a testosterone supplement. Patients taking testosterone supplements should have their testosterone and estrogen levels measured after four to six weeks to determine if they are receiving the proper dose of medications.

In addition to testosterone products, other hormone supplements, such as DHEA and human growth hormone (HGH), are available from compounding pharmacies. In addition, a nutritional supplement, "Prostasixx", can help lower estrogen levels and at the same time increase testosterone levels.

The goal of therapy in treating andropause is hormone replacement to achieve younger, healthier levels in order to reverse the signs of andropause and the effects of aging. Treating andropause may also have positive effects on blood pressure, diabetes, heart disease and arthritis.


For questions and further information about andropause, treatments and Prostasixx, contact Bellevue Pharmacy.



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This content is not intended to substitute for professional medical advice. Always consult your physician or other qualified healthcare provider with your questions regarding a medical condition.

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