The life expectancy of Indians has increased and the search for longevity and quality of life has triggered an increasing interest in identifying and treating hormonal deficiencies that affect men.
In men, the testicular function is progressively affected and the decline in testosterone production is slow and gradual after age 40. Thus, the clinical manifestations of adult male hypogonadism, which represents a drop in testosterone production, are more subtle, not being easily identified, however, they negatively impact the quality of life.
The term “andropause”, often used to define this clinical situation, is incorrect.
Hormonal alterations in elderly men are better defined as Androgenic Disorders of Male Aging – AAD, as the decrease in testosterone production is not an isolated phenomenon, with other important physiological alterations inherent to age occurring simultaneously.
The clinical manifestations that accompany the decrease in testosterone are: changes in the ability to have a rigid erection, lack of sexual interest, change in mood, less intellectual activity, difficulty concentrating, irritability, memory problems, and spatial disorientation.
Testosterone deficit can also cause constant depressive episodes. There is a progressive increase in abdominal fat (obesity) and a decrease in muscle mass, which is further aggravated by the lack of physical activity. A decrease in bone mineral density may occur resulting in osteoporosis.
Therefore, the diagnosis of decreased testosterone in men must be clinical and with a blood test for evaluation with total testosterone dosage. Men between the fourth and seventh decades of life tend to decrease total testosterone by 1.2% per year and this has a great impact on sexuality, affecting the couple’s relationship.
Treatment
Testosterone hormone replacement therapy is the most used form of treatment for men with male hormone deficit and aims to restore normal male hormone levels and decrease symptoms related to hypogonadism.
Testosterone replacement must follow certain precautions, in order to respect the biological needs of the patient and the maintenance of physiological concentrations of testosterone in the blood, this being evaluated in medical consultations with your urologist.
In our country, the most widely used forms are short-acting intramuscular injections of testosterone, which require applications every 15 days. They are effective and low-cost treatments, although multiple applications are required.
The long-acting testosterone undecylate injectable presentation is a formulation that provides stable and physiological therapeutic levels for a period of 12 weeks. It is a comfortable therapeutic option, but with a higher cost.
Recently, we had the launch in Brazil of topical testosterone, in the form of a gel, also with effective and safe results for male hormone replacement.
It is important to emphasize that testosterone replacement in elderly men is a lifelong commitment and, although it brings benefits, you should have a continuous follow-up with your top sexologist in Delhi.