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Male MenopauseA 73-year-old man fell while on a walking tour in the Venezuelan Andes. He was going up a relatively steep, rocky incline when he lost his footing and fell forward. He did not fracture any bones, but, on returning to the U.S.A., decided to consult his physician concerning a general decrease in strength that had affected, among other things, his tennis game. The man, we'll call him Mr. B, also reported that he was often mildly fatigued, more grumpy than in the past, had diminished enthusiasm for sex and was less excited about planning future travel. Does this remind you of anyone you know?
In a younger person, below age 50, an emotional explanation, such as mild depression or family problems, would probably account for his complaints but, because he was well past 50 and had reported a decreased interest in sex, low testosterone syndrome was considered.
Here are Mr. B's answers to the St. Louis University Low Testosterone Syndrome Survey:
If a male over 50 answers yes to the first or seventh questions or yes on any three other questions, low testosterone syndrome should be suspected.
The Low Testosterone SyndromeAs is shown in Figure 1, nearly half of healthy males over 50 years of age have testosterone levels less than those seen in normal young males.(1)
Statistical studies have suggested the following effects may be associated with decline in testosterone:
TreatmentTestosterone replacement is the standard treatment. Studies have shown increased strength,(3)(4)(5) improved visual spatial thinking,(6) increased bone and lean body mass(7) and decreased levels of leptin (the fat hormone).(6)
The major side effect of testosterone therapy is an increase in the percentage of red blood cells (the hematocrit) in the blood. People with too thick blood run the risk of blood clots and other mechanical blockages, especially in the smaller arteries and veins. When the hematocrit is more than 55%, testosterone needs to be discontinued or the patient has to have a blood letting. Hematocrit should be followed every three months. Other side effects include:
However, evidence from available studies suggests that testosterone does not worsen benign prostatic enlargement in older men and has no effect, one way or the other, on blood cholesterol levels.
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