Male menopause is a complex of age–related changes in a man’s body caused by involution and hypofunction of the genital glands. Male menopause is accompanied by a decrease in sexual function (extinction of sexual desire and potency, accelerated ejaculation, shortening of sexual intercourse), vasomotor disorders (blood pressure lability, palpitations, heart pain), vegetative reactions (dizziness, sweating, hot flashes), metabolic disorders (decreased muscle mass, skin atrophy, osteoporosis), emotional experiences. The main diagnostic criterion of male menopause is a laboratory-confirmed decrease in testosterone levels in the body, correlated with age. Correction of pathological manifestations of male menopause is carried out with the help of androgen replacement therapy and non-drug methods (homeopathy, psychotherapy, IRT, etc.).
General information
Male menopause is a period of physiological aging of the body associated with a decrease in testosterone production and accompanied by certain changes in the genitourinary, nervous, cardiovascular and other systems. Everyone knows about the existence of a female menopause, characterized by the cessation of menstrual function and the loss of a woman’s ability to procreate. The presence of male menopause has long been the subject of scientific discussions in the framework of andrology, urology and endocrinology. Many authors consider the term “male menopause” to be incorrect, since men do not have such a sharp drop in hormone levels, and reproductive ability often persists into old age. Nevertheless, there is no doubt that a decrease in the age-related production of androgens entails a cascade of pathological reactions from various body systems. The concept of “male menopause” in the special medical literature also corresponds to the terms “andropause”, “age-related androgen deficiency”, “age-related hypogonadism”, “testosterone deficiency syndrome”, etc.
Causes
Male aging and male menopause are a hormone-dependent process associated with a decrease in the level of secretion of the male sex hormone – testosterone. The main part of the hormone (90-95%) is secreted by Leydig cells in the testicles and a small fraction (5%) by the adrenal cortex. Testosterone synthesis begins in the embryonic period and reaches its maximum by the age of 30; then, starting from 30-35 years, testosterone production decreases by 1-3% annually. The consequence of age-related hypoproduction of testosterone is a change in the activity of the entire “hypothalamus – testicles – target organs” system.
In addition to a direct decrease in testosterone synthesis, the concentration of sex hormone binding globulin (SHBG) increases with age. This leads to an increase in the proportion of testosterone bound to it and not entering the tissues, as well as a change in the testosterone/estradiol ratio and an increase in the effect of estrogens. However, despite the fact that by the age of 80, the level of total testosterone in men decreases to 60%, and free testosterone to 20% of the average figures at a young age, in most cases these values do not fall to the indicators of true hypogonadism. Hormonal changes during menopause are also accompanied by an increase in the level of follicle-stimulating hormone, a decrease in STH, melatonin, somatomedin C, estradiol.
Among the reasons for the age-related decrease in testosterone production are a decrease in the number of Leydig cells in the testicles, a decrease in the sensitivity of receptors to LH, disorders of the regulation of the hypotolamo-pituitary system, genetic predisposition, etc. Infectious and inflammatory diseases of the genitourinary system (orchitis, epididymitis), mumps, testicular tumors and injuries, orchiectomy, radioactive or chemical effects on the body, intoxication (including smoking and alcohol dependence) can contribute to an earlier onset of male menopause.
Male menopause symptoms
Clinical manifestations of male menopause are diverse, since androgen deficiency affects the course of many physiological functions and metabolic processes in the body. The most significant changes characterizing male menopause develop in the sexual, cardiovascular, musculoskeletal and central nervous systems. With the development of symptoms of andropause before the age of 45, they talk about early male menopause; after 60 years, about late male menopause. According to statistics, by the age of 40-50, about 8%, and by the age of 60, more than 20% of men experience pathological symptoms of age-related androgen deficiency.
First of all, men notice changes on the part of the reproductive system, characterized by a decrease in libido, a decrease in the frequency of sexual acts, a deterioration in erection, the disappearance of spontaneous morning erections, sexual dissatisfaction, etc. During sexual intercourse, there is a decrease in the sensitivity of the penis, difficulties arise in achieving orgasm and a decrease in the intensity of orgasmic sensations, premature ejaculation is observed, a decrease in the volume of ejaculate. It is possible to develop urination disorders unrelated to prostate adenoma: increased urge, nocturia, weakening of the urine stream, urinary incontinence, etc.
The extinction of sexual function in men is accompanied by strong emotional experiences: a decrease in mood, increased irritability, sleep disorders, depression. During men’s menopause, there is a decrease in physical strength and performance; an increase in fatigue and weakness, deterioration of memory, ability to perceive and analyze information. Characteristic vegetative-visceral manifestations of male menopause are excessive sweating, hot flashes, facial hyperemia, constipation.
Pronounced changes directly related to men’s menopause develop from the cardiovascular system. Many men begin to worry about fluctuations in blood pressure, palpitations, arrhythmias, cardialgia. Androgen deficiency is accompanied by an increase in the level of cholesterol and low-density lipoproteins in the blood, which contributes to the development of atherosclerosis of the coronary and cerebral arteries, worsens the course of coronary heart disease, increases the likelihood of myocardial infarction and ischemic stroke.
Due to hormonal changes accompanying male menopause, disorders of carbohydrate, lipid and mineral metabolism may occur. This is associated with a decrease in muscle mass and an increase in the amount of adipose tissue, the development of age-related gynecomastia and obesity, metabolic syndrome, type 2 diabetes mellitus. As a result of a decrease in bone mineral density, the risk increases significantly osteopenia, osteoporosis and bone fractures. During men’s menopause, the external signs of aging progress: flabbiness and dryness of the skin, the formation of wrinkles, a decrease in the degree of hair loss on the trunk, limbs, pubis, etc.
Diagnostics
Since the manifestations of age-related androgen deficiency are often disguised as concomitant somatic pathology, patients suffering from the pathological course of male menopause are usually treated by a cardiologist, neurologist, endocrinologist. At the same time, symptomatic therapy brings only temporary relief, but does not eliminate the true cause of the disorders that have arisen. Therefore, in parallel with narrow specialists, a man who has entered the time of male menopause should be examined by a urologist or andrologist.
In order to identify age-related androgen deficiency and determine indications for medical hormonal correction, a certain diagnostic algorithm has been adopted worldwide. First of all, the level of total and biologically active testosterone in the blood is determined during the periods of their peak content (from 7 to 11 am), as well as other hormones (globulin binding sex steroids, LH, FSH, prolactin). To assess the symptoms of male menopause, various questionnaires are used (a jackal for assessing age-related androgen deficiency, a scale for the severity of erectile function, a scale for assessing lower urinary tract obstruction, etc.).
It is extremely important to exclude organic pathology of the male genital organs: for this purpose, a finger rectal examination of the prostate, ultrasound of the scrotum, ultrasound of the prostate gland, ultrasound of the vessels of the penis, determination of the level of blood PSA, etc. is carried out. As part of the diagnosis of concomitant disorders accompanying the course of male menopause, it may be necessary to conduct an examination of the cardiovascular system (ECG, EchoCG, ultrasound of the vessels of the head and neck), the state of metabolic and metabolic processes (determination of blood glucose, cholesterol, lipoproteins, study of bone metabolism).
Differential diagnosis of age-related androgen deficiency and associated male menopause is carried out with secondary hypogonadism induced by infectious and inflammatory processes and tumors of the hypothalamic-pituitary region, traumatic brain injuries, endocrine diseases (hypothyroidism, thyrotoxicosis, hyperprolactinemia, Itsenko-Cushing syndrome).
Treatment
In order to reduce the pathological manifestations of male menopause, drug and non-drug therapy is used. Testosterone replacement therapy is used to reproduce and maintain the physiological level of testosterone production in men with age-related androgen deficiency. For this purpose, various dosage forms of testosterone are used: tableted, injectable, transdermal (gels and patches with testosterone). Substitution therapy is performed under the supervision of an andrologist or endocrinologist. Properly selected hormone replacement therapy allows you to increase physical activity, reduce depression, increase libido and quality of sexual life. In some cases, patients may be shown stimulating HCG therapy, which helps to enhance the synthesis of endogenous testosterone.
In addition to androgen replacement therapy, methods of homeopathy, phytotherapy, psychotherapy, acupuncture, osteopathy, hirudotherapy, physical therapy are widely used to relieve pathological symptoms of menopause. Positive general and symptomatic effects are given by balneotherapy (radon, carbon dioxide, sulfide therapeutic baths, circular shower, mud therapy), physiotherapy (electroson, transcranial electrical stimulation, laser therapy, galvanization, interference therapy), massage, ozone therapy, etc.
Forecast
Male menopause, as a natural age-related process, cannot be prevented. At the same time, the achievements of modern medical science allow using various ways to improve the quality of life of a man who is faced with the problem of male menopause. The key to male and age longevity is a preventive visit to a urologist-andrologist 1-2 times a year, physical and mental activity, weight control, abstinence from alcohol and smoking. The approach of male menopause allows you to postpone regular sexual activity. Prevention of early and pathological male menopause is closely related to the prevention of premature aging in general.
