For and against: The male menopause---does it exist? For Against

Testosterone Replacement Therapy in Reversing “Andropause”: What Is the Proof-of-Principle?

“…57,58 This may suggest such changes in sexual behavior are androgen dependent, but this does not prove the cause. Although erectile dysfunction in older men is often of nonhormonal etiology, T deficiency accounts for 6%-45% of all cases.…”

“…In addition, male aging, by itself, is associated with an increase in central and upper body fat deposition. 57 This could be explained by the age-associated decline in growth hormone concentrations, which results in an increase in SHBG and therefore a reduction in FT concentration. 89 …”

“…90 Sex hormones are also important for the development and maintenance of acquired cognitive capacities, 90 and changes in androgen levels modulate, at least in part, the cognitive changes with advancing age. 57 In a longitudinal study (407 men, aged 50-91 years), the FT index (i.e., serum T/SHBG) was positively associated with scores on measures of verbal, visual memory, and visuospatial performances and inversely with rate of decline in visual memory. 93 Finally, clinical manifestations suspected to be caused by androgen deficiency are numerous; however, parallels between the clinical effects of aging and the age-related perturbations in TT, FT, and SHBG concentrations obscure its distinction from the normal aging process.…”

“…57,90,91 However, all of those symptoms overlap with signs and symptoms of major depression and age-associated cognitive impairments. 90 Recently, in the Longitudinal Aging Study Amsterdam, Joshi et al assessed yearly 608 men aged 65 years or older for the Center of Epidemiologic Studies-Depression (CES-D) scale.…”

“…Moreover, some of these signs and/or symptoms are a normal part of aging and others can be caused by various underlying factors, including medication side effects, thyroid problems, depression, and excessive alcohol use. 57 Finally, symptoms and low T do not often coincide, and there is a high background prevalence of symptoms in men with normal T levels. In addition, the clinical relevance of population-level associations between hormones and symptoms is still unclear given that the measurement of hormones in men is not a routine part of clinical practice in the absence of symptomatology.…”