What are the symptoms of andropause?

Symptoms of Andropause

Andropause is characterized by a constellation of physical, sexual, and psychological symptoms including decreased libido, erectile dysfunction, fatigue, mood disturbances, cognitive dysfunction, reduced muscle and bone mass, and physical changes such as gynecomastia and thinning of body hair. 1

Key Symptoms of Andropause

Physical Symptoms

• Fatigue and reduced energy levels 2
• Decreased muscle mass and increased body fat 1
• Reduced bone density (increasing osteoporosis risk) 1, 2
• Gynecomastia (breast enlargement) 1
• Decreased testicle size 1
• Thinning of body hair 1
• Hot flashes/night sweats (particularly in men on androgen deprivation therapy) 1
• Arthralgias and myalgias (joint and muscle pain) 1

Sexual Symptoms

• Diminished libido (reduced sex drive) 1, 2
• Erectile dysfunction 2, 3
• Sexual dysfunction 1, 3

Psychological and Cognitive Symptoms

• Depression 1, 2
• Anxiety 2
• Irritability 2
• Mood disturbances 1, 3
• Sleep disturbances/insomnia 1, 2
• Memory impairment 2
• Reduced cognitive function 2
• Decreased sense of vitality and well-being 1

Prevalence and Onset

Andropause symptoms typically begin to appear as testosterone levels decline, which happens at approximately 1% per year after age 40 2. It is estimated that about 20% of men aged 60-80 years have testosterone levels below the lower limit of normal 2.

Differentiating Features in Special Populations

Men receiving androgen deprivation therapy (ADT) for prostate cancer experience more pronounced andropause symptoms:

• 50-80% experience hot flashes that can persist after treatment 1
• Gynecomastia incidence can be as high as 80% in those on estrogen therapy 1
• More severe sexual dysfunction 3

Important Clinical Considerations

Relationship with Diabetes

Diabetic men may experience andropause symptoms earlier and more severely than non-diabetic men, with lower testosterone levels and more pronounced sexual dysfunction 4.

Diagnostic Challenges

Unlike menopause in women, andropause is a slow, progressive condition with varying symptoms and presentations, making diagnosis challenging 4. Many cases remain undiagnosed due to insufficient screening and awareness 4.

Potential Risks of Untreated Symptoms

• Decreased quality of life 1, 3
• Increased risk of osteoporosis and fractures 3
• Sarcopenia (muscle loss) 1, 3
• Cognitive decline 3
• Anemia 1, 3

Common Pitfalls in Recognizing Andropause

1. Attributing symptoms solely to normal aging rather than hormonal changes
2. Focusing only on sexual symptoms while overlooking other manifestations
3. Failing to distinguish between andropause and other conditions with similar symptoms (depression, thyroid disorders, diabetes)
4. Not recognizing the increased severity of symptoms in men with certain conditions (diabetes, those on ADT)
5. Overlooking the potential impact on quality of life and long-term health consequences

Understanding the full spectrum of andropause symptoms is essential for proper diagnosis and management, as these symptoms can significantly impact quality of life and may warrant appropriate intervention.