Women would not be the only ones to experience a decrease in their hormonal activity with age. Even if the decrease in testosterone is not as abrupt in humans, it would not be without consequences. Should we use substitution treatment? Who to book it for? All these questions are at the heart of a lively debate.
Decreased libido, fatigue, increased cardiovascular risk, irritability, increased waist size … All of these common symptoms in older men could hide testosterone deficiency.
Andropause, an inappropriate term
Like women, would men see their hormones drop to their fifties? Much less brutal than the upheaval of menopause, the deficit in testosterone linked to age would translate a progressive reduction of this hormone. Not constituting a male fatality (unlike menopause which affects all women), this slow transition allows most men to maintain their reproductive function until an advanced age. This is why the term deficit in testosterone linked to age is preferred to that of andropause.
According to sexologist in Delhi, this decrease in testosterone begins at the age of 30 at a rate of 1 to 2% per year. But important personal factors come into play since some men will maintain high testosterone levels throughout their lives, while others will have very low testosterone levels. Apart from aging, other causes can lead to such a deficit: damage to the testicles (trauma, surgical removal, irradiation, chemotherapy, etc.), hormonal disorders (certain diseases of the pituitary gland), certain drugs and genetic abnormalities.
The number of men involved is the subject of controversial assumptions. According to the best sexologist in Delhi, “at least 20% of men over the age of 60 (…) and about 50% of those over the age of 80 have abnormally low testosterone”. Figures to be compared with the aging of the population.
Deficit in testosterone linked to age, your unforgiving world
Produced by Leydig cells in the testes, testosterone acts on many organs: muscles, vessels, liver, prostate, genitals, brain, bones, skin, hair, etc. Settling insidiously, the disorders are difficult to dissociate from the natural manifestations of aging.
Sexologist doctor in Delhi reminds that deficit in testosterone linked to age can manifest itself by symptoms of banal appearance after 50 years:
- Sexual disturbances with impaired libido, sexual activity, erectile function, pleasure and ejaculation deemed insufficient;
- Functional symptoms such as asthenia and increased fatigability, sleep disturbances but also sweating, hot flashes;
- Modification of the body diagram: decrease in muscle mass and strength, increase in visceral fat, pubic and axillary depilation, testicular hypotrophy;
- Character disorders: irritability or indifference, loss of self-esteem, lack of motivation and fighting spirit, disturbances in concentration, recent memory;
- The development of osteoporosis.
However, it is neither compulsory nor frequent that all of these events be simultaneously present. The assimilation of these symptoms frequently associated with physiological aging could lead to an underestimation of the problem or to a medicalization of a natural phenomenon.
A difficult diagnosis
“Faced with these uncharacteristic symptoms, it is the concordance of these signs that will cause the top sexologist in Delhi to think of a deficit in testosterone linked to age, whose sexual problems cover only about a third of the cases” declares sex specialist in Delhi. But in the end, only a hormonal assessment can confirm the diagnosis. The dosage should be done on an empty stomach in the morning between 7:00 a.m. and 10:00 a.m., the time of day when testosterone levels are highest. Normal values are usually between 3 and 10 ng / ml, but results may depend on the laboratory and the results of other dosages. In the event of an abnormally low result, the dosage should be repeated to confirm the permanence of the hormonal deficit. Additional dosages are sometimes necessary to verify the functioning of the pituitary gland, explains sex doctor in Delhi.
But here again, the rub, since it is not easy to determine the threshold value of testosterone below which it makes sense to treat. The value of testosterone sufficient to maintain libido or muscle tissue could vary from one man to another, says sexologist in South Delhi
As the list of harms attributed to low testosterone (an increase in cardiovascular disease, a decrease in bone density) grows , the rationale for hormone therapy remains the subject of debate, says sexologist in East Delhi.
When to treat?
Many products already offer different methods of administering testosterone (tablets, oily and intramuscular injections, patches, gel, etc.). Despite this amazing diversity, there are few scientific studies to confirm that these hormonal supplements can help older men. Most studies are only extrapolations from work carried out on young men suffering from an early testosterone deficiency (hypogonadism).
In addition to their small number, studies on deficit in testosterone linked to age argue in favor of such a treatment with a restoration of libido, sleep, spatial memory, an improvement in mood, a reduction in fat mass and an increase of muscle mass and strength… Knowing that this androgen deficiency is a usually permanent condition, the treatment would therefore be treatment for life. A period to be compared with the slight decline in these products which does not exceed 4 years, explains sexologist in Delhi.
A difficult assessment of the benefit-risk balance
Side effects include an increase in the number of red blood cells, worsening of sleep apnea, a moderate increase in prostate size, and a risk of advancing micro-cancer of the prostate.
Currently, the long-term effects of androgen replacement therapy remain unknown, particularly with regard to prostate and cardiovascular risk. Scalded by the dangers of HRT of menopause, some scientists fear that these treatments encourage the occurrence of hormone-dependent cancers (whose growth is promoted by hormones). In men, prostate cancer is androgen-dependent and high levels of testosterone could rapidly progress micro-cancers. Consequences which could be thwarted by more regular screening.
Such a prescription can therefore only be made after analysis of the benefits and risks specific to each patient who must be clearly informed, suggests sexologist in Delhi.
Men at particular risk of prostate cancer (men of color, men over 40 with relatives with prostate cancer and people in their fifties will need to undergo specific screening before treatment is started. -indicated for men who have had a history of prostate or breast cancer, this management requires strict monitoring, carried out in consultation with a blood test (PSA test), first at 3 months and then at a rate variable which will never be more than 12 months Finally, the treatment can be interrupted at any time without any particular risk, except the return to the initial situation, says sexologist in Delhi.