Criteria:
(1) male >= 65 years of age (although one could argue that earlier detection might reduce development of adverse effects such as osteoporosis)
(2) depressed free testosterone levels (while total testosterone levels may not decline as a male ages, the binding proteins tend to increase with age, meaning that free testosterone levels tend to fall as a male ages)
(3) presence of symptoms
(4) reversal of symptoms with testosterone replacement
Symptoms and findings associated with andropause:
(1) depression, nervousness
(2) flushes (vasomotor disturbances) and sweats
(3) decreased libido
(4) erectile dysfunction
(5) easy fatigability
(6) poor concentration and memory
(7) osteoporosis
(8) decreased muscle mass
Critics claim that many of these findings can be ascribed to depression, concurrent medical conditions, reduced exercise, and drug effects rather than the decline in free testosterone levels.
Treatment:
(1) removal of precipitating conditions, if possible
(2) testosterone replacement (transdermal dihydrotestosterone, other)
Adverse effects of testosterone replacement:
(1) prostate: increased risk for or worsening of BPH and carcinoma
(2) cardiovascular risk from changes in blood lipids
(3) weight gain
(4) gynecomastia
(5) worsening of sleep apnea
(6) increased fibrinolysis
(7) increased erythropoiesis and red blood cell mass
