Andropause--a multisystem disease

The syndrome of androgen deficiency with aging has important biochemical and clinical manifestations. Whether this is called the andropause or by another name the patients with this condition appear to be suffering an accelerated form of aging and some will have individual or clinical reasons to receive treatment. The changes usually attributed to androgen deficiency have been recognized more recently to be due to a broader problem with a number of interlinked hormonal systems (including growth hormone, IGF-I, melatonin, leptin). Several clinical domains can be identified comprising the andropause: Substance (lean body mass, visceral fat, bone mineral density and hematopoiesis); Surface (hair and skin alterations); Central Nervous System (intellectual capacity, mood and sleep patterns); Sex (desire and erection); Prostate. Investigation is directed at the presenting complaints and measuring the serum bioavailable testosterone. Treatment is currently by testosterone replacement using one of a number of routes (parenteral, oral, transdermal). The object of treatment is improvement in the index clinical domains and biochemical normalization. Contraindications include known or suspected prostate or breast cancer.