Male Menopause: Dilemmas in assessment

and treatment

Probal Moulik

Why is it important?

• We are living longer

• Our expectations of ‘health’ are increasing

• Media/Internet provides more information and awareness

• Desire for ‘quick fix’ and lasting youth!

Terminology

• Male menopause

• Andropause

• Age related hypogonadism

• Late onset hypogonadism (LOH)

• Androgen deficiency in the ageing male (ADAM)

Associations of testosterone deficiency

• Obesity/metabolic syndrome/T2 DM

• CVS disease

• Depression/cognitive decline/alzheimers

• Osteoporosis

• Fatigue, reduced muscle mass, frailty

• Reduced libido, ED, orgasmic difficulty

T circadian rythms

Diabetes risk

Metabolic risk(TG, Waist)

Commonly prescribed replacement

• Nebido 1 gm deep IM 12 weekly (additional dose at 6 weeks at initiation)

• Tostran Gel 2% : 4 pumps daily

• Adjust dose based on blood levels

• Check FBC, PSA, Total Testosterone, LFT before, at 3months, 6 months, 12 months and yearly

Symptom assessments