What is the primary treatment for andropause (male menopause)?

Treatment for Andropause

Testosterone replacement therapy is the primary treatment for andropause in men with documented testosterone deficiency, specifically for those with symptoms of hypogonadism and total testosterone levels below 300 ng/dL. 1, 2

Diagnosis and Assessment

Before initiating treatment, proper diagnosis is essential:

• Confirm hypogonadism by measuring morning serum testosterone concentrations on at least two separate days, ensuring these levels are below the normal range 1
• Laboratory evaluation should include morning total testosterone and free testosterone levels 2
• Common symptoms warranting evaluation include:
  • Decreased libido and sense of vitality 2
  • Erectile dysfunction 2
  • Reduced muscle mass and bone density 2
  • Fatigue, lethargy, and loss of motivation 3
  • Mood disturbances and depression 2
  • Hot flashes (in 50-80% of men on androgen deprivation therapy) 2
  • Sleep disturbances 2
  • Cognitive dysfunction 2

Treatment Protocol

Testosterone Replacement Therapy (TRT)

• Starting dose: 40.5 mg of testosterone applied topically once daily in the morning to shoulders and upper arms 1
• Dose adjustment: Based on pre-dose morning serum testosterone concentration at approximately 14 and 28 days after starting treatment 1
• Target serum testosterone level: 350-750 ng/dL 1
• Dose titration:
  • If testosterone >750 ng/dL: Decrease daily dose by 20.25 mg
  • If testosterone 350-750 ng/dL: Continue current dose
  • If testosterone <350 ng/dL: Increase daily dose by 20.25 mg 1

Benefits of Testosterone Therapy

• Improvement in muscle strength and bone mineral density 4
• Positive effects on the hematopoietic system 4
• May increase sexual interest 5
• Potential improvement in quality of life 3

Non-hormonal Alternatives

For men with contraindications to testosterone therapy:

• Antidepressants, anticonvulsants, neuronal inhibitors, and certain antihypertensives may help manage symptoms like hot flashes 2

Monitoring and Follow-up

Regular monitoring is essential to prevent treatment-related complications:

• Serum testosterone levels should be assessed periodically after initial dose adjustment 1
• Monitor for potential adverse effects:
  • Polycythemia and sleep apnea (particularly concerning in men with compromised cardiac reserve) 4
  • Prostate-related issues 4
  • Cardiovascular effects 4

Contraindications and Precautions

• Absolute contraindication: Prostate cancer 4
• Other contraindications:
  • History of hormone-related cancers 2
  • Active liver disease 2
• Safety and efficacy of testosterone therapy in "age-related hypogonadism" (late-onset hypogonadism) have not been fully established 1
• Secondary exposure risk: Children should avoid contact with unwashed or unclothed application sites 1

Important Considerations

• The clinical diagnosis of andropause may be challenging as symptoms often progress slowly and can be subtle 6
• Not all men with symptoms attributed to andropause have low testosterone levels; some may have normal androgen levels 5
• Unlike hormone replacement therapy in women, the effects of testosterone supplementation in men with normal testosterone levels are equivocal 5
• Benefits of treatment are most clearly established for men with documented hypogonadism rather than those with vague symptoms and normal testosterone levels 5, 3