Nov 18, 2015

Interviewer: Andropause is the male version of menopause. We'll find out more about that next on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: Dr. Jim Hotaling is a urologist and also a men's health expert here at University of Utah Health Care. Andropause, what is it?

Dr. Hotaling: There is a natural decline in testosterone in men after the age of about 30 or 35, testosterone goes down significantly. One of the things that's really tricky is we don't know what the normal testosterone is in a 20 year old, 30 year old, 40 year old, 50 year old. We know maybe in a 50 year old and above what an abnormal testosterone is, which is usually a total testosterone, depending on who you look at, below 350 or below 300.

But again this is a lab test that varies minute to minute and hour to hour and it has to be checked before about 10 in the morning to be accurate. So if a man goes to get their testosterone checked at 4 pm it's almost always going to be low. One thing that's difficult is the testosterone industry has had the most successful marketing campaign in the history of medicine.

So it literally took testosterone from in 2000 being about a $100 million a year industry, I think this year it will clear 2 or 3 billion. It's actually taught at Harvard Business School, the whole concept of low T as exactly how you should do marketing. And a lot of men come in because they're concerned with that. In summary andropause is real, but and this is the big but, you don't treat a number.

You really only treat patients if they have symptoms of low testosterone and have low testosterone. Ideally on one to two measurements in our opinion and everybody's bias, but urologist are great people to do that because they understand a lot of the issues that impact men's health.

Interviewer: So what exactly is it? Is it just a natural lowering of testosterone? Is that all andropause is?

Dr. Hotaling: Essentially, yes. The testosterone will decline in a man every year past the age of 30 or 35.

Interviewer: And is it the male version of menopause?

Dr. Hotaling: It is in the sense that it's a decrease in hormone levels and everything else. But for women it's a different issue because at some point they stop ovulating. Men really never stop producing sperm. There are people who've produced children in their 90s, which that's a topic for a different day, but men never stop producing sperm.

And it's not as severe as it is in woman. It's a very gradual decline and at some point, in some men, it declines to a point where it does cause symptoms and that is where I think there is some resemblance to menopause.

Interviewer: And that's where you as a urologist or a men's health expert would perhaps then consider doing some sort of therapy?

Dr. Hotaling: Yeah, that's correct and typically the therapy is testosterone replacement. There are other medications we can use. The downside to testosterone replacement is it will make men sterile, some men permanently. Most men not. But we can use other medications to actually boost testosterone and keep men's' fertility intact.

There are also some surgical procedures, one in particular we can do to actually help increase a man's testosterone.

Interviewer: So decreasing testosterone or going through andropause is just normal?

Dr. Hotaling: Yeah, it is normal and I think that's the key thing to understand. The testosterone companies would have you believe that you should treat a number. And what's tricky about testosterone is anyone, no matter what their testosterone starts at, will feel better when you put them on testosterone. That doesn't mean that everybody should be on testosterone and I think that's the real challenge.

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