Male andropause, male climacteric or viropause is a condition in which men suffer from complex symptomatology due to low androgen level with aging. After the age of 40 years testosterone level starts declining and andropause corresponds to the age at which a pathogenic threshold is reached.

Approximately 100 million men in India are above the age group of 40 and this figure is expected to double in the next decade. By 2010, India will have 49 million men above 65 years, accounting for 18% of world's elderly male. Aging related health problems have hence gained interest in the medical community. Healthy aging men undergo a variety of hormonal changes, including decreasing plasma androgen levels. Unlike menopause, the decrease in testicular function in men is gradual and many associated symptoms are vague and nonspecific. Unlike females, decrease in biologically active androgen levels in aging male is not profound and many elderly men have free androgen level in the low normal range. Terms such as “late onset hypogonadism” (LOH) , partial androgen decline in aging male (PADAM) , androgen decline in aging male (ADAM) ‘low testosterone syndrome' have gained some acceptance, but the term currently being used by the WHO and which also seems most appealing to aging men themselves is ‘andropause' or viropause'.

The etiology of testosterone decline with aging is multifactorial. Combined effects of decline and alteration in Leydig cells and age related changes in dynamics of hypothalamic – pituitary – gonadal (HPG) axis contribute to decreased testicular production with aging. Other factors also have an impact on serum testosterone levels, including hereditary factors, obesity, diet, stress, depression, chronic diseases such as diabetes mellitus, chronic liver disease, sleep apnea syndrome, rheumatoid arthritis and medications such as glucocorticoids, smoking and alcohol intake.

Consequences of decreased testosterone

Decreased libido, decreased performance

1. Decline in muscle mass and strength
2. Cognitive decline particularly visuospatial memory
3. Negative thinking
4. Mood changes – increased irritability / anger, depression
5. Decreased Bone Mineral Density resulting in osteopenia and osteoporosis
6. Increased visceral fat
7. Chronic fatigue and sleep disturbances

Screening and Diagnosis

Aging men often present with a variety of vague nonspecific symptoms that may be associated with testosterone deficiency. For symptom assessment a personal rating scale has been developed, the ‘Aging Males Symptoms' (AMS) questionnaire (Table 2) which any one can use by themselves to know the severity of the problem. Exact screening and diagnosis.