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