Menopause in women is a well-recognized public health issue. However, its male equivalent, andropause or age-related androgen deficiency (ARAD), remains largely unknown. Unlike the female transition, andropause does not mark a sudden end to fertility, but rather a gradual decline in testosterone levels, which can profoundly affect men’s vitality and metabolic health from their forties onwards.
1. What is andropause?
Andropause corresponds to the decrease in bioavailable testosterone levels associated with aging.
Hormonal decline: From the age of 40 onwards, total testosterone levels decline by an average of 1% per year, while free testosterone (the biologically active fraction) declines by 1.2% per year.
A biological reality: According to the European Male Aging Study (EMAS), approximately 2.1% of men aged 40 to 79 have symptomatic late-onset hypogonadism, but this rate increases significantly in men with comorbidities such as obesity or diabetes.
2. The “therapeutic gap”: telling figures
Beyond simple clinical observations, research shows a major discrepancy between the prevalence of androgen deficiency and its actual treatment. Andropause remains one of the neglected areas of preventive medicine for men.
The BACH (Boston Area Community Health Survey) study, published in the Journal of Clinical Endocrinology & Metabolism, found that while approximately 24% of men have testosterone deficiency (total or free), only 5% to 10% of those with clear clinical symptoms actually receive treatment.
This “treatment gap” can be explained by the insidious nature of the symptoms, which are often confused with stress or the simple effects of aging, but also by a persistent taboo that prevents men from talking to their doctors about it.
3. Symptoms: knowing how to identify them
Androgen deficiency manifests itself through a set of physical and psychological signs that develop slowly:
The sexual and intimate sphere
- Decreased libido (sexual desire)
Erectile dysfunction and reduced frequency of morning erections.
The physical and metabolic sphere
- Sarcopenia: Loss of muscle mass and decrease in physical strength
- Adiposity: Increase in fat mass, particularly in the abdominal area
- Fatigue: Persistent lack of energy and sleep disturbances
- Bone density: Increased risk of male osteoporosis
The psychological sphere
- Irritability, decreased motivation, and mood disorders: anxiety and depression.
- Difficulty concentrating and feeling of “brain fog.”
4. Long-term consequences and cardiovascular risks
Testosterone plays a major protective role in metabolism. A prolonged deficiency is not just a matter of comfort; it is a systemic health issue that promotes insulin resistance and alters the lipid profile, thereby increasing cardiovascular risk (atherosclerosis).
It is estimated that 20% to 30% of cases of male osteoporosis are directly attributable to androgen deficiency.
5. Substitution treatment (ST): a rigorous approach
This medical therapy requires a precise approach. It is intended for men whose deficiency has been confirmed by repeated blood tests and debilitating clinical symptoms.
The benefits of tailored care:
- Restoration of libido and sexual function
- Improved body composition (more muscle, less fat)
- Protection of bone capital
- Significant improvement in mood and cognitive abilities
Treatment (in the form of gels, injections, or patches) requires close medical monitoring, including PSA (prostate) and hematocrit monitoring, to ensure optimal safety.
