Cosmetic in Japan 美容医学への扉-東京大学美容外科-アンチエイジング
Japanese page
Web Master -Kotaro Yoshimura, M.D.-

Andropause (Male Menopause) and its Treatment

Kotaro Yoshimura

In andropause, degradation of male hormones (androgen) in a man occurs with aging, and somatic alteration is seen accompanying it.While it is roughly equivalent to female menopause, in andropause we do not see the same sudden alterations, rather a gradual progress from the latter half of the 30s to the 50s. Compared with Westerners, Japanese generally tend to have lower androgen levels, and seem more easily influenced by aging or stress. Japanese also tend to be low among Asians, and the issue of a small number of children in Japan may be connected.
 The most serious thing in andropause is decrease of T (testosterone). Middle-aged men usually develop a belly and experience muscular decline due to decreased T. Because T represents anabolic steroids, muscular decline is seen, basal metabolism decreases, and an increase of adipose coefficient tends to occur. Of course there will be degradation of everyday vitality and sexual decline because T contributes significantly to male sexual function. Because T also contributes to aggressive feelings, feelings of rage or anger are less likely with age. In this male version of climacteric symptoms distress caused by degradation of sexual interest, achievement and maintenance of erections, feelings of sexual insufficiency, fatigue, depression, inflammation, pain, and stiffness can result. On the other hand, this seems to increase whether estrogenic blood concentration is the same or not. As a result, testosterone and estrogenic imbalance can adversely affect health with natural aging and be a direct cause of disorders.

One of the reasons for such a phenomenon is T aromatization with aging and conversion to estrogen. It can be said that excess estrogen and a lack of testosterone increases heart attack risk. Increased SHBG (sex hormone binding globulin) can be noted with decrease of androgen, too. SHBG restricts T (testosterone), and with aging, its quantity and effect. Decrease of T brings about an increase of blood cortisol, and there is mention of swelling in regressive change. Trials to improve such changes are ongoing..

There is an approach involving improving eating and living habits, but there is also one using drugs as follows:

@DHEA: It is an oral medicine, but it can be purchased as a supplement in the U.S.A. because is safe. It is a precursor sex hormone produced in adrenal glands. A lot of research and reports have been done about this.

AHCG: Has the same action as LH. In particular it is thought to be a safer method if T is administered by an age that testes still function enough in terms of testicular atrophy. It is usually used together with DHEA. Especially when T and LH are both low it seems we can expect results. As for side effects, oedema or gynaecomastia are possible.

BT: When testicular function is insufficient or we cannot fully expect reaction in stimulant hormones we need to directly administer T. This seems to lower SHBG and seems best if administered to those older than 60 years old. Can be used in combination with DHEA too.
Because haematocrit and estrogen elevation can occur, monitoring with PSA cannot be missed. If there is surplus estrogen we reduce dosage, and inhibitor anastrozole conversion enzyme is administered rather than T. It is necessary to watch for prostatic hypertrophy, tumors, and testicular atrophy due to continuous administration of T.

CGn-RH analog: When LH is low a little Gn-RH may be effective.
Hypophysis cerebri is stimulated, and secretion of LH is promoted.

DhMG: Has action of both LH and FSH. Can be an alternative when you want to stimulate the reproduction ability in men. Often combined with hCG.

EAntiestrogen: clomiphene citrate. It is antagonistic, and connects to sexual steroid receptors in hypothalamus and pituitary gland. Negative feedback by endogenic sex steroid hormone is inhibited, and secretion of GnRH and gonadotrophin is promoted.

FBromocriptine: Is used when blood PRL is high in ergot alkaloid.
A dopamine agonist, denohypophysis PRL production cells are controlled directly. High PRL seems to reduce secretion of GnRH, and T production.

G Pregnenolone: Can be used in a similar manner as DHEA.

There are many forms of administering T.

@Injection: Teststerone enanthate, testosterone cyprionate, testosterone propionate, and so on. Intramuscular injection of 125mg to around 250mg is done once in one or two weeks. Generally done in people who have esterification, and want longer lasting effects.

A Oral medicine: Methyltestosterone 25-50mg/day, liver function must be monitored. It is said that floxymesterone in high dosages of 2-10mg/day can prevent aromatization. Because there is no ethylestrenol aromatization, there does not seem to be any reason to worry about too much estrogen. Testosterone undeconate (Andriol(TM) causes little reduction in liver function. It is necessary to take 40mg capsules 4 times/day (effect is short) with milk and meals because is fat-soluble. Little aromatization. Proviron(TM)mesterone: 1-methyl DHT) is orally administered DHT, so the benefit is there is no aromatization.

B Patch: Androderm (TM) 5mg/day reaches maximum blood concentration in about 8 hours. Place one patch anywhere on body except scrotum every day. Testoderm TTS (TM): 5mg/day is another type of patch placed on scrotum.

CGel: Androgel (TM) 1% 5g gel/day

D Sublingual tablet: It is easy to use, but weak point is that half life is short. Methyltestosterone 5-10mg/day, testosterone propionate 5-20mg/day.

E Implant: It is buried in subcutis and replaced every 4-6 months.
[remarks] Anabolic (muscle augmentation) purpose: In the case of anabolic use strong (androgenic:anabolic=1:3+) products such as 19-nortestosterone, methandrosterone, oxymetholone, ethylesterenol) are used. In andropause those with strong androgenic action (androgenic:anabolic=1:1) are used. 19-nor-4-androstenedione is used for sports a lot, too.