It is commonplace in nature for most conditions to be of dual phenomenon. Thus where ever you have a positive charge, there usually is a corresponding negative charge to be able to achieve a balance and neutrality. So by implication every male phenomenon should have a female counterbalance. And it goes on and on to the atomic level. In our previous outing we had stated that menopause is the complete cessation of the ability to reproduce. This is as a result of total shut down of ovarian egg production and endocrine activity. In males it is not exactly so, because in reality males retain their reproductive ability even up to the age of 90.
To appreciate this situation, a listing of the hormones involved in feminist attributes and masculinity is important. In females, during active reproductive life the important hormones are OESTROGEN/OESTRADIOL, PROGESTERONE and TESTOSTERONE while in the males often described as Androgens, the most important ones are TESTOSTERONE and DEHYDROEPIANDROSTERONE. Can you pronounce that?!
Andropause is the result of the gradual drop in the level of testosterone with advancing age in males. This usually starts in most people from the age of 30 and may not show any symptoms for quite a while. It must be restated here that testosterone as an androgen helps the body in building up proteins and is necessary for normal sexual drive and stamina. It is also involved in other metabolic activities like bone formation a synthetic functions of the Liver. Just like oestrogen that is produced in the ovaries, testosterone is produced by the cells lying close to the SEMINEFEROUS tubules (tubes that convey semen) in the testicle. These cells are known as the interstitial cells of LEYDIG or LEYDIG cells for short.
The production of testosterone depends on the presence of LUTEINIZING hormone (LH) secreted by the PITUITARY gland in the brain. We can now appreciate the similarity in the production of oestrogen and progesterone in women by Follicle Stimulating hormone (FSH) and LH; collectively known as GONADOTROPIC hormones. There is an interesting twist in this hormonal interplay. The Hypothalamus is a higher centre in this axis. Its main function is the secretion of Gonadotropin RELEASING hormone which stimulates the Pituitary gland to produce gonadotropins. Not that complicated you’d say! In normal circumstances this HYPOTHALAMIC—PITUITARY—OVARIAN/TESTICULAR axis is modulated by a negative feedback mechanism. This simply means that when the level of oestrogen or testosterone rises, the hypothalamus-pituitary complex receives a signal instructing it to stop or reduce its activity and vice versa.
In Andropause despite decreasing level of testosterone there is NO response by the hypothalamic-pituitary complex; rather there is also low levels of gonadotropic releasing and luteinizing hormones. A condition most would refer to as HYPOGONADISM, where there is a holistic reduction on sex hormones production. The manifestations of this condition are wide and varied. The common features include swinging moods with anger and depression, loss of sexual drive and erectile dysfunction, back pains, headaches and hot flashes. Others would include increase in size of the male breast known as GYNAECOMASTIA. Irritability, sleep disorders, night sweats and weight gain are some of the features of andropause. The loss in bone density could lead to pains and deformity with fractures in incidents and accidents that in normal circumstances would not lead to breaking of bones. This condition is known as OSTEOPOROSIS
In terms of DIAGNOSIS, we must state here that andropause as a nomenclature has not been approved by the WHO. The decline in the level of testosterone has an estimated onset and progresses to the end of life. The manifestations of the conditions listed vary from one individual to another in terms of age of onset but averages 50. So there are no diagnostic criteria or markers. Some schools of thought regard andropause as a state of the aging process and cannot really be classified as a disease.
On the other hand, some insist that andropause is a distinct condition that is a biological change experienced by the male gender in mid-life that compares seriously with menopause in females and therefore deserves to be identified as such. The decline of testosterone with age is an undisputed fact and the connection with erectile dysfunction, loss of energy and concentration and in some people symptoms of IMPOTENCE are well documented. While menopause is of rapid onset, andropause could be insidious with testosterone declining at the rate of 10% every10years. The debate would eventually make room for a better acceptance of andropause as an entity and one of those that signals the commencement of the journey to our ultimate destination.
This argument is strongly supported by men who have received testosterone replacement therapy with attendant improvement in their libido and general well being. In our environment however, there is no serious and we would add bold engagement in this area of clinical practice. The clinician will quietly give occasional jabs of testosterone propionate to his patient and most of the time not even estimating the level of testosterone—both free and bound—in his blood. In our clime for the records, a level of testosterone of about 250 units per decilitre is significant. If it is lower than this with wide margin and symptoms the necessity for testosterone replacement therapy on short time basis may be indicated but not absolutely necessary. Honestly we hardly practice that in our environment.
It must be stated here that testosterone replacement therapy is froth with dangers. Topping the list are stroke and heart attack. Others include increase in the red cells count in the blood, sleep suffocation and rapid progression of cancer of the prostrate if present. As a rule exogenous testosterone administration causes suppression of sperm production in the body. Thus by trying to increase ones libido he ends up with low sperm count! Ironically in this environment this is the period you see men going for more wives and concubines. And they do get them; after all what the ladies want is their money to chop.
Andropause as must be understood is a natural process that may have its own frustrating drawbacks but it is not exactly the end of life itself. There is more to life than sex but one also acknowledges how frustrating it could be to the less economically endowed who have limited relaxation and recreational options. The reality is that it never zero’s off in males. All that it requires is understanding that one is aging and should not compound your health with sex enhancing substances that could lead to death. Libido does come back after periods of rest and that should be the trend as one progress in life .We will rest it here. See you next fortnight.