Andropause: Introducing the Concept of ‘Relative Hypogonadism’ in Aging Males

Andropause affects many organ systems including the brain, heart, bones, muscle, adipose tissue, and blood vessels besides the sexual organs. The authors state that the prevalence of hypogonadism in aging males is not well established. There are many epidemiological studies that point towards a decline of testosterone with aging.

Andropause should be considered a physiological event that manifest with a low androgen state. It is a mistake to think that andropause should always be symptomatic, as menopause in itself is not always symptomatic. Some women make the transition into senior life without the hot flushes, palpitations and the mood changes. However, the long-term effects of low testosterone or estrogens on bone and muscle integrity are clear. The authors also fail to mention that there are many confounding issues in the consideration of the andropause syndrome. For example clinical depression, obesity, medications and psychological issues often overlap with the andropause syndrome. In clinical practice, it is important to differentiate these confounders before offering patients androgen supplementation. We have found that memory loss and cognitive problems; to be a dominant issue in patients undergoing andropause.

In our study, 36% of patients undergoing andropause reported memory loss.

Androgen supplementation has been shown to improve cognitive function in small trials. Finally, the authors mention that clinical response is a better guide to dose requirements rather than serum testosterone levels. We have found this to be true in our experience as well. As such, we like to hypothesize a concept of ‘relative hypogonadism’ in aging males. It seems that treatment should be based on symptoms, superimposed on relative age adjusted testosterone levels. Obviously, this hypothesis needs be tested in randomized controlled trials to be valid.

https://pubmed.ncbi.nlm.nih.gov/12152125/