Holistic Hormone Balance

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"Andropause", defined as the male equivalent of the menopause, which in women signals the end of reproductive life and a near total cessation of sex steroid production by the gonads, does not exist. Indeed, aging in healthy men is normally not accompanied by abrupt or drastic alterations of gonadal function, and androgen production as well as fertility can be largely preserved until very old age.

The limited data available suggests that aging has no major influence on sperm quality and fertilizing capacity (Nieschlag et al. 1982; Rolf et al. 1996), changes in semen parameters being essentially limited to a decrease of ejaculate volume and sperm motility (Rolf et al. 1996). Moreover, a decreased ejaculatory frequency, as observed in elderly men (Rolf etal. 1996), might account for at least part of these age-related changes, but may also mask more subtle changes in spermatogenetic activity (Cooper et al. 1993). Serum inhibin B, a marker of Sertoli cell function and spermatogenesis, was shown to be relatively well maintained in healthy elderly men, albeit at the cost of clearly increased FSH stimulation that compensates for an age-related regression of Sertoli cell mass and function (Mahmoud etal. 2000).

As to hormonal testicular function, it is now well established that mean serum testosterone levels decrease progressively in healthy elderly men, notwithstanding considerable inter-individual variability in the extent of the changes (Vermeulen 1991). Well over 20% of otherwise healthy men over 60 years of age present with subnormal testosterone levels compared to serum levels in young adults. Moreover, this age-dependent decline in androgen production can be accentuated by comorbidity with transient or more permanent adverse effects on Leydig cell function.

The extent to which a relative hypoandrogenism in the elderly contributes to clinical signs and symptoms of aging remains a largely underexplored issue that certainly deserves further attention as many clinical features of aging in men are reminiscent of those of hypogonadism in younger subjects and the indications for as well as the potential merits of androgen supplementation to aging men are a subject of debate.

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