DOI: 10.1097/gme.0b013e31815708ee

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PMID: 17975518

Issn Print: 1072-3714

Publication Date: 2007/11/01


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Male menopause-time for a decent burial?

John B. McKinlay; Thomas G. Travison; Andre B. Araujo; Varant Kupelian

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Excerpt

After its emergence, examination, and subsequent dismissal from the epidemiologic scene in the early to middle 20th century, the notion of male menopause or male climacteric was resurrected in the early 1990s.1 Since that time, a supposed syndrome of male hormone decline associated with aging, variously named and renamed "male climacteric," "andropause," "viropause," and, most recently, "late onset hypogonadism" or "partial androgen deficiency in aging men" (PADAM), has been repeatedly examined2-8 and shows little evidence of life. It is now time for a decent burial.
The downstream clinical consequences of decreased androgens in men are now well understood. Low circulating testosterone (T) levels have been shown to contribute to abdominal obesity, diabetes and prediabetic states (insulin resistance, impaired glucose tolerance, and metabolic syndrome), dyslipidemia, impaired cognitive function, osteoporosis, low muscle mass, impaired sexual function, depressed mood, frailty, and decreased quality of life.9 Apparently these are not enough for androgen concentrations to be accepted as clinically relevant, as significant time and effort continue to be invested in describing the elusive "hormonal syndrome." Yet how many nails are required for the coffin to be considered closed?
In this issue of Menopause, Spetz and colleagues10 revisit the body and undertake yet another examination. Importantly, they describe the syndrome as a natural consequence of aging; a "clinically relevant hormonal deficit" appearing among "otherwise healthy men." Their results are at once surprising, unsurprising, and of some scientific concern. What is surprising is the need to revisit the body after so many death certificates have been issued. What is unsurprising is the discovery of little association between T and symptoms suggestive of PADAM. But what concerns us is the despondency produced by the results-"Unfortunately, and in line with others, we could not find any connection between those symptoms and circulating androgen levels." Despite finding no signs of life in PADAM, consistent with what others have also reported, Spetz et al proceed as if the syndrome is still alive, stating that "PADAM occurs over a number of years or decades" and further that "men with PADAM keep their reproductive ability despite lower androgens." This in the face all evidence to the contrary, including their own findings.

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