1.What is male menopause syndrome?
It is generally believed that after men enter the age of 50, the gonadal structure and function will also undergo a process of evolution from bloom to decline, called male menopause. A series of symptoms will also appear during male menopause, such as prostate enlargement, weakened penile erection and reduced libido; breast enlargement; easy fatigue and decreased physical strength, called male menopause syndrome. It is characterized by typical clinical symptoms and low serum testosterone levels. It is also known as delayed hypogonadism (LOH) and partial androgen deficiency in middle-aged and older men (PADAM). This state will seriously affect the quality of life and bring adverse effects to the function of multiple organs and systems.
2.How to diagnose male menopause syndrome?
(1) Symptoms of testosterone deficiency + laboratory tests: symptoms of testosterone deficiency include decreased libido, decreased sexual activity, decreased hardness of penile erection, decreased number and quality of erections at night; depressive symptoms and easy irritability; easy fatigue and weakness; decreased intellectual and spatial skill activities; easy insomnia and sleep disorders; decreased lean body mass, decreased muscle strength and muscle mass, resulting in decreased ability to live autonomously; development of centripetal obesity and increased visceral fat; hair thinning and atrophic skin changes; decreased bone density and easy fracture; memory loss and poor concentration; hot flashes and easy han; some patients may develop breast development and anemia. Laboratory tests include total testosterone (TT, normal value 12-35 nmol/L), free testosterone (FT) and bioactive testosterone (Bio-T, normal value 3.5-4.2 nmol/L) and their related indicators, such as gonadotropin and sex hormone binding globulin (SHBG), of which Bio-T is the most critical. FT and Bio-T calculator: . http://www.issam.ch/freetesto.htm可在线计算.
(2) Experimental diagnosis of testosterone supplementation: Based on the presence of symptoms suggestive, combined with laboratory results of reduced serum testosterone levels TT≤11.5nmol/L,TSI≤2.8nmol/IU (TT/LH), cFT≤0.3nmol/L,FTI≤0.42nmol/nmol (TT/SHBG), after excluding the effects of other diseases or drugs and After the contraindication of use, it can be treated by experimental treatment for 3 months by oral administration of testosterone undecanoate for 3 months. If the symptoms improve significantly after the supplementation of exogenous testosterone, it suggests that the symptoms are related to the decrease of testosterone level and the diagnosis of male menopause syndrome is clear.
3.Which diseases should be distinguished from male menopause syndrome?
(1) Chronic diseases: such as liver and kidney function lesions, malignant tumors. Patients with previous primary disease presence, such as liver or kidney disease, can be clearly identified by laboratory and ancillary tests (e.g. imaging).
(2) Thyroid disease: can be identified by detailed questioning of symptoms, physical examination (goiter), and laboratory tests for thyroid hormones (TT-3, TT-4), free thyroid hormones (FT-3, FT-4) and thyroid stimulating hormone (TSH).
(3) Psychiatric diseases: such as senile dementia, schizophrenia, neurasthenia, depression, etc.
4.How to carry out testosterone supplementation therapy?
If serum FT, TT, Bio-T, TSI and/or FTI levels decrease (serum TT ≤ 8 nmol/L or 230ng/dl,) or serum FT ≤ 8.5pg/ml), testosterone supplementation therapy is recommended; if serum TT levels are between 8 and 12 nmol/L, repeat measurement of serum TT and SHBG levels and calculate FT levels, serum FT levels is between 8.5 and 11.8 pg/ml, testosterone supplementation can be performed if the symptoms of male menopause syndrome are obvious. However, the following conditions are not suitable for testosterone supplementation therapy.
①Patients with prostate cancer or breast cancer.
②Patients with erythrocytosis.
③Patients with severe sleep apnea syndrome.
④Patients with benign prostatic hyperplasia with severe lower urinary tract obstruction.
⑤ patients with severe cardiac or hepatic and renal failure.
⑥Patients with PSA>4ng/ml suspected of prostate cancer. Studies have proven that testosterone supplementation in men with menopausal syndrome does not increase the risk of coronary heart disease, nor does it promote the development of prostate enlargement and prostate cancer. Testosterone supplementation is available as oral, injectable, transdermal patches and gels.
(i) Patients with ED or hypoactive libido in combination with androgen deficiency should receive testosterone therapy.
(ii) Combined PDE5 inhibitor and testosterone therapy is recommended for ED patients with hypogonadism or borderline gonadal function.
(iii) Testosterone therapy improves the body composition (decreased fat weight, increased lean body mass) in hypogonadal male patients.
④ Sexual desire, sexual function, muscle function, and body fat should improve within 3-6 months, and bone density improvement may take longer. If there is no improvement, treatment should be stopped and further search for other causes of symptoms.
(v) Improvement in bone density after testosterone treatment in hypogonadal patients of all ages.
(vi) Testosterone measurement should be performed in all type II diabetic patients with symptoms of androgen deficiency.
(7) Patients with diabetes mellitus or metabolic syndrome combined with hypogonadism may have other unproven benefits from testosterone therapy.
5.How to maintain testicular “youth” and delay the onset of male menopausal syndrome?
From a physiological point of view, the aging of the testicles starts at the age of 30, so testicular “maintenance” should start from youth.
① Learn to adjust bad emotions and get rid of the pressure of work and life.
② Establish a harmonious relationship between husband and wife and maintain a moderate and regular sex life.
③ maintain a healthy lifestyle, such as maintaining adequate sleep and good eating habits, adhere to moderate physical exercise, avoid excessive obesity, quit drinking alcohol.
④Strengthen health care awareness and receive regular health checkups.