Terminology and Definitions

"Hypogonadism" refers to the consequences of diminished function of the gonads; occurs at any age and for a variety of reasons; and is classified into two forms on the basis of the source of the problem, that is, either of testicular origin, or as a result of disorder in the hypothalamic-pituitary axis.

The term "andropause" indicates a particular type of hypogonadism that is related to aging in men and is said to consist of the following: diminished sexual desire and erectile function, decrease in intellectual activity, fatigue, depression, decrease in lean body mass, skin alterations, decrease in body hair, decrease in bone mineral density resulting in osteoporosis, and increase in visceral fat and obesity. The word andropause is an attempt to draw a parallel in men to Male Hypoactive Sexual Desire Disorder 97 the experience of menopause in women. Whereas menopause occurs abruptly, andropause is said to occur quite slowly. As well, menopause is associated with the irreversible end of reproductive life, whereas in men spermatogenesis and fertility continue into old age. In the opinion of some observers, trying to equate the two is rather questionable.

The existence of andropause is a subject of controversy partly because of great difficulty distinguishing this syndrome from age-related confounding variables such as nonendocrine illnesses (both acute and chronic diseases), poor nutrition (inadequate or excessive food intake), smoking, alcohol use, and medications. Some observers have less doubt about the existence of a disorder but prefer to use a different name: ADAM (androgen decline in the aging male), or PADAM (partial ADAM which refers to androgen decline that is still within the normal range).

To underline the fact that many hormones decline with age, the word "adrenopause" has also been used to describe the diminution of the adrenal androgens DHEA and DHEAS, and "somatopause" to describe the same in the somatotrophic hormone, growth hormone (GH).

Diagnosis

Low sexual desire is usually seen as a symptom of andropause/ADAM/ PADAM. To explain the desire change, a great deal of emphasis has been given to laboratory values, especially alterations in T. However, the typical history has received much less attention. Only one study of aging men seems to have examined various manifestations of sexual desire. Schiavi et al. reported on 77 volunteer couples who responded to an announcement concerning a examination of factors contributing to health, well-being, and marital satisfaction in older men. Three groups of men were compared: 45–54, 55–64, and 65–74. The following were conclusions related to the issue of sexual desire: (i) sexual interest, responsiveness, and activity was noted even among the oldest men; (ii) increasing age was associated with ED, but not with HSDD or PE (premature ejaculation); (iii) the following frequencies consistently decreased with age: desire for sex, sexual thoughts, maximum time uncomfortable without sex, coitus, and masturbation; and (iv) ". . . the degree of satisfaction with the men’s own sexual functioning or enjoyment of marital sexuality did not change with age".

As far as the laboratory is concerned, measuring BAT is the preferred parameter for determining hypogonadism, although it is not always available. Abnormality is judged by comparing the T level with young adult men. "If the testosterone level is below or at the lower limit, it is prudent to confirm the results with a second determination with assessment of LH and . . . FSH."

Etiology

In addition to hormones, many other changes take place in male physiology which contribute to the aging process. One nonsexual example that is cited for the purpose of providing perspective, is the multiple factors which are associated with diminished bone mass and which include: low estradiol, vitamin D deficiency, low GH, low T, poor nutrition, smoking, certain medications, excess alcohol, inactivity, lack of exercise, poor calcium intake, genetic predisposition, and certain illnesses.