Age-Related Low Testosterone Production

Age-related low testosterone production is likely to have existed since the creation of man! Following advancements in public health in the last century, life expectancy increased and men began to live into their 70’s and 80’s. Hence, more scientists began to probe the phenomenon of gradually decreasing testosterone production as the male body ages. The first such scientific studies were conducted in the 1940’s. Dr. R. J. Douglas was among the first to write about the diagnosis and treatment of age-related low testosterone production, publishing his article in the March 1941 issue of the journal Urology. This was followed by an editorial in the February 1942 issue of the Journal of the American Medical Association (JAMA).

A landmark study was performed by Dr.’s Heller and Gordon Myers at the Wayne University College of Medicine in Detroit which was published in the October 21, 1944 issue of JAMA in which the first scientific evidence that age-related low testosterone production is reality was presented.

There are indications that age-related low testosterone production has thus far been an under-diagnosed condition. There are several possible reasons as to why this condition remains widely under-diagnosed:

  • Patients reservations due to the sometimes sexual nature of symptoms.
  • Patients may present to their doctors with non-specific symptoms, such as tiredness, lack of motivation, anxiety, or depression which may in fact be rooted in marital issue which may in turn be the result of sexual problems.
  • Symptoms are non- specific and can frequently be seen as manifestations of other medical conditions.
  • Measurement of testosterone is not routinely performed.
  • The blood levels could be within the “normal” but not necessarily “optimal” range.
  • There is a general lack of clinical awareness of the condition.
  • Patients simply accept the condition as a consequence of getting older.

After Age 40, there is gradual decline of Testosterone levels by 1-2% per year. This is unlike the female experience of menopause in which the decline in estrogen levels is far more rapid. There is great variability with respect to the rate of testosterone level decline among individual men experiencing the aging process. Nevertheless, the proportion of men presenting with testosterone levels in the subnormal range increases significantly in general with advancing age. Longitudinal studies, such as those in populations of ageing men from Maryland and Massachusetts, demonstrate that clinically low testosterone levels can be found in less than 1% of men who are below the age of 40, but is present in more than 20% of men older than 60 years and greater than 40% in men above the age of 80. Hence, a subnormal testosterone level, while not necessarily a given, is a frequent feature of the ageing process among men.

When fitness is sustained, the decline is attenuated; among men who engage in regular physical exercise, 7% of those between 40 and 60, 21% between 60 and 80 and 35 % of the men over 80 year old have a total testosterone level below 330 ng/ml which is considered the threshold for boarder-line low.

As attention to the incidence of age-related low testosterone production have increased in recent years, a number of terms have emerged in the medical literature and the media in general, alluding to the female menopause and indicating that in men there could be an “end” to gonad testosterone production. However, as we will see, such conclusions appear to have been not well-founded as a drastic decrease in androgen production cannot be observed in healthy men; androgen depletion is a rather slow process and “Andropause” turns out to me a misnomer. Some of the terminology referring to hormonal changes in aging men:

  • Male Andropause
  • Viropause
  • Male climacteric
  • ADAM (Androgen Deficiency in Aging Men)

Note: for the sake of brevity and ease of communication, going forward I will use  either “age-related low testosterone production” or “ADAM” as the context suffices.

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