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PubMed1998

Age-associated testosterone decline in men: clinical issues for psychiatry.

OBJECTIVE: The author summarizes current knowledge about the diagnosis and treatment of testosterone decline in healthy aging men and the associated clinical issues for psychiatry. METHOD: A MEDLINE search was conducted in which the search terms "male climacteric," "male menopause," "andropause," "viropause," "low-testosterone syndrome," and "testosterone replacement therapy" were used. Literature published before 1966 was identified by reviewing the reference lists of later publications. RESULTS: Manifestations of testosterone deficiency have included depression, anxiety, irritability, insomnia, weakness, diminished libido, impotence, poor memory, reduced muscle and bone mass, and diminished sexual body hair. Although testosterone levels decline with age, there is great interindividual variability, and the connection between serum testosterone levels and clinical psychiatric signs and symptoms is not clear-cut, since other hormonal changes are implicated as well. Testosterone replacement therapy may offer hypogonadal men benefit, but long-term studies on its efficacy and safety are lacking. Comprehensive biopsychosocial assessment should be a routine part of the evaluation of complaints of low-testosterone syndrome in men. CONCLUSIONS: Testosterone decline/deficiency is not a state strictly analogous to female menopause and may exhibit considerable overlap with primary and other secondary psychiatric disorders.

Aged↗
PubMed2006

Does the Aging Males' Symptoms scale assess major depressive disorder?: A pilot study.

OBJECTIVES: The objectives of the study were to find the prevalence of major depressive disorder (MDD) in male climacteric outpatients in Japan, and to determine whether symptoms on the Aging Males' Symptoms (AMS) scale scores differed between patients with and without MDD, with the aim of increasing the specificity of future symptoms scales for partial androgen deficiency of the aging male (PADAM). METHODS: Eighty-three patients aged 40-70 who visited the male-climacteric services as outpatients were assessed using three items: a self-administered questionnaire corresponding to diagnosis for MDD, the Beck Depression Inventory, and the AMS scale. RESULTS: Almost half the patients had MDD. The total AMS score, the scores on the AMS psychological, somatic and sexual subscales, and the scores for all except three questionnaire symptoms were higher in patients with MDD. There were strong correlations between the AMS scale and the Beck Depression Inventory. CONCLUSIONS: There is a higher prevalence of MDD in male-climacteric outpatients and scores on most items of the AMS scale were higher for patients with MDD. We suggest that only those symptoms whose scores did not differ between patients with and without MDD are used to assess symptoms of PADAM in the presence of MDD, or that the current AMS is used only after diagnosis of MDD and elimination of these patients. Then the relevance of each item of the AMS to testosterone levels should be simultaneously examined in the future study, which will determine the items highly specific to PADAM symptoms.

Adult↗
PubMed2004

Perception of males' aging symptoms, health and well-being in elderly community-dwelling men is not related to circulating androgen levels.

Aging in men is associated with a progressive but variable decline in androgen production. In aging men there is also an increased occurrence of symptoms such as lack of concentration, nervousness, impaired memory, depressive mood, insomnia, lack of energy and general sense of well-being, decreased libido and erectile dysfunction, periodic sweating, bone and joint complaints, reduction of strength and increased adiposity. This ill-defined male climacterium syndrome is often referred to as "andropause", with the underlying implication that it is at least in part related to (relative) androgen deficiency. Recently an "aging males" symptoms' (AMS) rating scale was developed aimed at a more systematic description of severity of symptoms related to a clinically defined "male climacteric". We studied the relationship of male climacteric symptoms as assessed by the AMS with androgen levels and other questionnaires assessing the perception of health and well-being. Serum levels of sex steroids, sex hormone binding globulin and gonadotropins were measured in blood samples of 161 healthy, ambulatory, elderly men, aged 74-89 years who also completed the AMS scale. Mean value of total, free and bioavailable testosterone in this group was 401.6, 6.8 and 151.4 ng/dl, respectively, with 24.7, 32.4 and 52.2% of the values under the normal range for young men. The results of the AMS scores mostly suggested mild psychological and mild to moderate somatovegetative symptoms. However, clear sexual symptoms were reported in 88% of cases. None of the three AMS domain scale scores significantly correlated with testosterone, free testosterone or bioavailable testosterone. Significant correlations were observed between results for the AMS scores and those for other health questionnaires, but none of the subscores for the latter questionnaires correlated with androgen serum levels. In conclusion, the results of this study have shown that, as assessed by the AMS, healthy ambulatory elderly males over 70 had a high perception of sexual symptoms with mild psychological and mild to moderate somatovegetative symptoms. These data failed to support the view that in healthy elderly men, "climacteric symptoms" can predict androgen levels.

Aged↗
PubMed2003

[Men's health study: current status of erectile dysfunction of 6,112 ambulatory patients at general practitioners offices in Japan].

OBJECTIVES AND METHODS: The present study was performed to assess the current status of erectile dysfunction (ED) and so-called male climacteric disorders in male ambulatory patients through a self-administered questionnaire survey throughout Japan. The survey was especially focused on the relationship between ED, depression, and benign prostatic hyperplasia, the effect of ED on quality of life, and current status of ED treatment. RESULTS: The total number of completed questionnaire forms was 6,112 from 447 outpatient clinics. ED was strongly correlated with prostate disease, diabetes mellitus, and heart disease. Patients evaluated as ED by the shortened version of International Index of Erectile Function, IIEF-5, accounted for 81% of the evaluable replies. Thirty-two percent of these patients had either severe or moderate ED. Severity of ED was related to depression, dysuria, and perceived poor health condition. The proportion of ED patients who had received some ED treatments was 10%. Among ED patients, 22% of them were willing to receive pharmacotherapy for ED and the need was significantly high in patients with severer ED. CONCLUSIONS: ED is one of the symptoms frequently observed among male ambulatory patients. Physicians should be encouraged to ask their patients about their ED, in order to identify their unmet need for treatment.

Adult↗
PubMedDate not supplied

Sex hormones and alcohol withdrawal: does a good supply of testosterone prevent serious symptoms during detoxification?

Owing to the clinical similarity between the male climacteric syndrome and the results of previous studies on the alcohol withdrawal syndrome in relation to sex hormones, we hypothesized that alcoholics with a poor supply of testosterone will develop more pronounced symptoms during alcohol withdrawal than alcoholics with high levels of testosterone. Fifty-two male alcoholics were studied. To test our hypothesis we entered the mean values of the hormones, the mean age, and the mean consumption of liquor (CL) the week before admittance as regressors in a multiple forward stepwise regression analysis with four subclass constructed from the CPRS as dependent variables. Our results indicate that patients with low levels of testosterone develop more neurotic-asthenic symptoms, such as indecision, worrying about trifles, fatigability, and lassitude during alcohol withdrawal. Further, high levels of SHBG were related to a history of seizures and younger alcoholics received higher ratings on the paranoid-aggressive subscale. It is concluded that there is a relation between levels of testosterone and symptoms during alcohol withdrawal. The question of a causal relationship remains to be answered, however. One way to illuminate this would be to add testosterone during detoxification, which may reduce the symptoms mentioned above analogous to the male climacteric syndrome, which could be prosperously treated by a supplement of testosterone. This treatment strategy would have obvious advantages compared to benzodiazepine detoxification as such drugs are potentially addictive.

Adult↗
PubMed1975

[Testicular histology in the aging man].

In aged men beyond 50 years--regardless of claims of impotence or infertility--testicular biopsies are discussed. Generally speaking all biopsies show more or less histological changes due to old age. Reduced spermatogenesis, fibrosis of tubule walls and retrogression of Leydig cells are mostly seen. The morphological changes in Leydig cells reflect the usual cell failure more convincably than the decrease in number. Selected microphotographs represent characteristic biopsies in old age. These findings confirm the previous results of other investigators. The various histological changes explain the different intensity and the variety of the claims in aged men as definite signs for male climacteric.

Age Factors↗
PubMed2003

Androgen replacement therapy in the hypogonadal ageing man.

In men, gonadal function is affected in a slow, progressive way as part of the normal ageing process. Recently, however, significant interest has developed on the importance of this condition, which is variously known as male climacteric, andropause or, more appropriately, androgen decline in the ageing male (ADAM). The term andropause is biologically wrong and clinically inappropriate but, it adequately conveys the concept of emotional and physical changes that, although related to ageing in general, are also associated with significant hormonal alterations. The inappropriateness of the term is based on the fact that in women, the reproductive cycle invariably ends with ovarian failure. In men, this process is not universal and when it occurs it is normally subtle in its clinical manifestations. This has led to a tendency to ignore the syndrome as an unavoidable and untreatable result of the ageing process. For the sake of simplicity and directness, this review will use the terms ADAM and andropause to denote the global hormonal alterations associated with ageing.

Aging↗
PubMed1979

Sexuality during the climacteric.

Menopause is a time of psychologic adjustment as well as of physical change. Its effects are closely related to sexuality, a neglected aspect. Sexual desire may increase, decrease, or remain the same, but the general pattern is one of declining sexual interest and activity with increasing age. The male climacteric is considered a time of decreasing sexual activity and capability, lowered self-esteem, and declining energy. Physical symptoms are milder than in women, and the process if more gradual. Health care professionals involved with menopausal patients should provide factual information and give supportive guidance which will permit women to continue to develop their full sexual potential.

Aged↗
PubMed1979

Update on the male and female climateric.

The gonadal steroids--estrogens and androgens--appear to have a mood-elevating, psychotonic effect. The improved sense of well-being and increased vigor probably is engendered by restoration of somatic efficiency and psychic equilibrium. 1. The male climacteric, as observed in a limited number of men, is associated with a low level of serum testosterone. The levels of follicle-stimulating hormone and luteinizing hormone are not elevated because estrogen concentration continues unaltered well into old age. Androgen replacement therapy often lessens fatigue, depression and headaches, and headaches, and improves libidinous drives. 2. In the aging female, many climatric symptoms other than those due to vasomotor instability were heretofore considered merely coincidental. Recent studies suggest that the metabolism of cerebral hormones is markedly influenced by endogenous and exogenous gonadal steroids. Thus, postmenopausal depression, headaches, and nervousness may be hormone-dependent symptoms. 3. The incidence of endometrial cancer is no greater and is probably less in estrogen-treated women than in women not treated with estrogen, if regular cyclic courses of an oral progestogen are added to the regimen.

Adult↗
PubMed1997

[Hormones and male sexuality].

In the review of the physiological, pathological and therapeutical aspects of the role of hormones in the erectile process four main topics are discussed: gonadotrop axis dysfunction, hyperprolactinemia, impotence and the potential climacteric male deficit. The conclusion for therapy is that only organic lowering of testosterone should be treated with a dosage adapted to the level of the decrease.

Androgens↗