Is andropause the same as 'male menopause,' and should men worry?

多亏了更年期，几乎每个人都知道年龄是如何影响女性荷尔蒙水平的.

虽然更年期引发了无数关于潮热的笑话，但男人有自己的版本. It's called andropause, and though it's less of a pop-culture presence, it's a medical reality that's subject to misconceptions, experts say.

Starting with equating it to menopause.

In women, menopause is when menstruation stops. The ovaries stop producing eggs, and the production of estrogen declines. It typically happens around the age of 50 but can begin earlier.

In men, andropause is a decline in testosterone levels that can begin in middle age, then it's "a gradual fall," said Dr. Robert H. Eckel, a professor of medicine emeritus in the Division of Endocrinology, 代谢和糖尿病和心脏病学在奥罗拉科罗拉多大学安舒茨医学院的分部. "It's nothing like menopause, which occurs over a finite period of time."

According to the American College of Physicians, 男性的睾丸激素水平在35岁左右开始下降，并以平均每小时1%的速度持续下降.6% a year. A study published in the journal Virulence in 2016 calculated that by age 75, a typical man will have lost about 30% of the testosterone he had at 25.

睾酮在性功能、骨骼健康、脂肪代谢、肌肉质量和力量方面发挥作用. Levels surge in adolescence with puberty. But advice varies on when low levels should be a cause for concern.

Low testosterone is sometimes referred to as hypogonadism, and andropause can also be referred to as age-related hypogonadism, among other names. 埃克尔说，没有症状的低睾酮本身并不值得担心. "Andropause is part of the aging process, but it isn't a disease on its own."

Dr. Nannan Thirumavalavan, 克利夫兰大学医院泌尿学研究所男性生殖和性健康主任, 他说，对于如何区分正常的年龄相关衰退和更严重的问题，没有“完美的答案”.

When testosterone levels fall, the most specific symptoms are a decreased sex drive or erectile dysfunction, said Thirumavalavan, 同时也是凯斯西储大学医学院泌尿学的助理教授. 其他症状包括难以集中注意力、精力下降甚至抑郁.

当然，“有很多很多因素都可能导致这些症状，”他说.

In younger men, 低睾丸激素可能表明脑下垂体或睾丸有问题, Thirumavalavan said. 但睾丸激素水平也会受到一些与心血管疾病有关的因素的影响, such as obesity, sleep quality and sleep apnea.

People with Type 2 diabetes, another cardiovascular risk factor, or kidney disease also tend to have lower testosterone levels, Eckel said, adding that "it needs to be made clear that, although related, the causation is not clear."

观察性研究表明，睾酮水平异常低的男性患心血管疾病的风险更高, but that's not the same as showing a cause and effect, Eckel said. “在这些环境中发生心血管疾病的风险完全是由于睾丸激素水平较低? Certainly not."

A declining testosterone level, Eckel said, 不一定是一个问题，除非它超出了性功能的适度下降. But if lower testosterone is accompanied by a loss of muscle, excess fatigue, anemia or profound sexual dysfunction, then the patient should be evaluated by an endocrinologist, he said.

"Male hypogonadism in the older man is a challenging diagnosis to make," Eckel said, 要求“生化测量、良好的病史和体格检查”."

The diagnosis requires multiple blood tests, Thirumavalavan said. 正常的睾酮水平因人而异，而且一天中的水平也会波动. "We never want to just treat a number," he said.

但是，近年来，治疗低睾酮(有时被称为“低睾酮”)的方法已经被大量推广, Eckel said guidelines from the Endocrine Society don't support routine testing of testosterone levels. Those guidelines say low testosterone readings alone, without symptoms, don't establish hypogonadism, 长期睾酮治疗对低睾酮浓度无症状男性患者重要预后的益处和不良后果尚不清楚."

For men older than 65, 该指南建议“在明确讨论潜在风险和益处后，在个体化的基础上提供治疗”."

Many men seek testosterone therapy because of libido issues. "There's no question that sexual function declines with age, and that's probably normal aging," Eckel said. 他说，睾酮疗法“对性功能有一定的改善”. 它不会把一个75岁的男人变成25岁，“但它会好一点。."

如果男性因睾酮水平低而寻求帮助，可以从他的初级保健医生开始, urologist or endocrinologist for a workup, Thirumavalavan said. But testosterone therapy is not a casual treatment, he said. It "basically will shut down your own testicles," he said, ceasing sperm production – a problem for someone hoping to father children. (Testosterone is being studied as a hormonal form of birth control for men.)

Thirumavalavan说，其他潜在的副作用包括痤疮和血压升高. Eckel said testosterone therapy also can lead to an enlarged prostate.

美国食品和药物管理局(Food and Drug Administration，简称fda)要求睾酮产品的制造商警告使用者可能会增加心脏病发作和中风的风险. Eckel noted, however, that a major study 去年发表在《线上娱乐电子游戏网站》上的一项研究表明，睾酮替代疗法不会增加中老年男性患主要心脏病的风险. 埃克尔说，这是证明睾酮替代可以安全进行的重要一步.

美国泌尿学协会的指导方针说，有心血管疾病的人不应该在三到六个月后开始睾酮治疗.

Over-the-counter supplements are not an alternative, Thirumavalavan said. Although the market is booming, there's no evidence that the most common ingredients in them work, according to a review he co-wrote that was published in 2019 in The Journal of Sexual Medicine.

Generally, he said, men can improve their testosterone levels by getting quality sleep, losing excess weight, eating a healthy diet and exercising.