So far, the programmed hormonal descent around the age of 50 has been exclusively a woman's business, but the ravages of time are also gnawing on the body, psyche, and sexual experience of the masters of creation. PADAM is one of the buzzwords used to describe a symptom complex blamed for diminishing production of sex hormones.
Andropause, PADAM or climacteric virile?
There is disagreement about the right name:
- Feminists would like to describe the complaints of the older man as a climacteric virile.
- Linguists favor andropause to create a counterpart to menopause - even if it is a biological nonsense.
- And the term midlife crisis only considers psychosocial aspects.
- Endocrinologists, on the other hand, have found favor with PADAM, the partial androgenic deficit of the aging male, and thus describe the actual biological conditions.
In contrast to women, whose sex hormone levels fall relatively abruptly with the last menstrual period, testosterone production is slowly but steadily reduced in many men - but by no means all - between the ages of 40 and 70 years.
About every third man over the age of 55 has testosterone levels below 3.5 ng / ml of blood-low enough to speak of hypogonadism, a condition in which the sexual organs fail. The phenomenon of falling testosterone levels is basically observed in every man, but is based on different starting values. This explains the big differences in the occurrence of PADAM complaints.
PADAM: different symptoms
It is unclear whether the declining testosterone output is a completely normal aging process or whether the declining hormone levels and associated loss of function are the result of a pathological finding, for example atherosclerotic vascular changes. The fact is that patients with general conditions are more likely to experience lower testosterone levels than healthy older men. There is a suspicion that there is a connection between testosterone concentration and general health that goes beyond sexual performance.
Many little uncharacteristic Zipperlein spoil the elderly man's well-being:
- For some, the mood is in a constant low, the drive is missing, and performance and concentration leave something to be desired.
- Others struggle with insomnia, hot flashes, increased nighttime sweating or palpitations.
- Sexuality is diminished by libido, sexual activity, erection strength and duration.
- In addition, muscle strength is reduced and the risk of osteoporosis increases.
- The older man increases in fat mass, especially in the abdominal area. Whether this also goes hand in hand with changes in the metabolism such as diabetes is not yet certain.
- In the course of androgen deficiency, anemia can manifest, with all the possible consequences of a reduced number of oxygen carriers.
One thing is certain: testosterone deficiency is not due to a clear clinical sign. Presumably, PADAM is not only the result of a testosterone deficit, but more of a disturbed balance between various hormones such as testosterone, growth hormones, estrogens and DHEA (dehydroepiandrosterone).
Therapy with testosterone
Targeted hormone replacement should be envisaged if a man has a clear testosterone deficit below 3.5 ng / ml blood in addition to PADAM symptoms. The indication is therefore given when the symptoms combine with hypogonadism.
Newer research approaches continue. At the moment, the importance of testosterone therapy for age-related complaints, regardless of a significant androgen deficit, is being worked out. However, research on hormone replacement in men lags behind in women by about 20 to 30 years. The investigations available so far are only a few years old. First trends, however, show positive effects without significant side effects. The researchers warn, however: The substitution for the capping of PADAM complaints is currently still experimental.
Testosterone via syringes or patches
As for the treatment of their complaints, menopausal women have the better cards. The gynecologist can choose from more than fifty specimens plus different dosing grades in different forms of application - transdermal (via patches), perorally (through the mouth), vaginal, intramuscular.
In contrast, for men with a proven testosterone deficiency, pharmaceutical chemistry holds only one substance, testosterone, in only two useful forms, namely injections and patches. Whether syringes or patches are suitable, the doctor must decide.
Effects of a testosterone substitution
Around the age of sixteen, many men lose muscle mass and muscle strength. A 70-year-old carries around 12 kilograms less fat-free body mass, the most muscular in his body, than a 25-year-old. At the same time, the fatty tissue increases. A testosterone substitution can intervene here correctively.
Research shows that it can increase the proportion of lean body mass, regardless of whether it is healthy volunteers, bodybuilders, men with severe testosterone deficiency, or older men with a slight deficit. Muscle strength is similarly positive because the increase in lean body mass goes hand in hand with muscle buildup.
Osteoporosis due to testosterone deficiency
Especially in recent years, men are increasingly paying attention to osteoporosis. And indeed: About one-fifth of all femoral neck fractures affect the stronger sex. Not always the classic risk factors such as alcohol consumption, systemic diseases or immobilization are identified.
Possible explanation: By a testosterone deficiency in the age the bones are mineralized diminished. Two studies on male nursing home residents found that testosterone levels were lower in nearly 65 percent of femoral neck fracture patients, compared to 22 percent of non-fracture controls. These findings suggest a testosterone deficiency as a cause of osteoporosis, the final evidence for this is still pending.
Other effects of testosterone therapy
In contrast, it is certain that a testosterone substitution stimulates erythropoiesis, ie blood formation. Advocates of testosterone replacement rate the increased oxygen transport capacity as an improvement in overall physical performance. However, this is not proven.
It is also difficult to find out how a testosterone dose affects the mood and mental well-being. Well-founded data are rare and come only from small groups of patients. The results are satisfactory.
Libido loss and potency disorders
A not inconsiderable aspect of the quality of life are the sexual functions, which are getting increasingly older. It is estimated that about half of men over age 60 have potency disorders and about 15 percent are impotent. While the loss of libido is likely due to a testosterone deficit, the often-debited potency disorders almost always have multiple causes and are rarely remedied by testosterone replacement.
Therefore, potency disorders as an isolated symptom are no reason for a testosterone therapy. Experts wonder if the administration of testosterone could adversely affect the prostate. Both a benign prostate enlargement and a still dormant and therefore not yet recognizable prostate cancer could be activated by the hormone intake. Nothing has been proved so far, but the knowledge is rather sketchy.