Ageing male

Ageing MaleAgeing Male

Dr V.P. BansalDr V.P. Bansal

M.S.(Punjab) MCh Orth (Liverpool)M.S.(Punjab) MCh Orth (Liverpool)

Ageing…..Ageing…..

WHY DO WE AGE?WHY DO WE AGE?

“ “ Age is a question of mind over Age is a question of mind over matter. If you don’t mind, it matter. If you don’t mind, it doesn’t matter.”doesn’t matter.”

- Satchel Paige.- Satchel Paige.


Various concepts.Various concepts. Increased catabolic vs anabolic events.Increased catabolic vs anabolic events. Intracellular mineral and vitamin deficiencies of Intracellular mineral and vitamin deficiencies of

long standing even if there is a balanced diet.long standing even if there is a balanced diet. Hormonal imbalances.Hormonal imbalances. General public = Fate / Destiny.General public = Fate / Destiny.

Is it natural to age?Is it natural to age?


Human body is an integrated machinery.Human body is an integrated machinery.

Affection of one part may or may not be Affection of one part may or may not be linked to the other. On the other hand, several linked to the other. On the other hand, several parts may be affected simultaneously. parts may be affected simultaneously.

Severity of affection amongst organs may Severity of affection amongst organs may vary.vary.


Loosely misused terminology for explaining Loosely misused terminology for explaining the unexplainable.the unexplainable.

Andropause…..Andropause…..

Andropause is akin to Menopause in females.Andropause is akin to Menopause in females.

There are definitive changes with reduced There are definitive changes with reduced blood Testosterone levels which blood Testosterone levels which may or may may or may not be related to declining / ceased not be related to declining / ceased Testosterone productionTestosterone production..

Not all ageing cases are of Andropause but all Not all ageing cases are of Andropause but all Andropause cases are of ageing.Andropause cases are of ageing.

Andropause…..Andropause….. It is believed that the process leading to It is believed that the process leading to

Andropause starts anywhere between the ages of Andropause starts anywhere between the ages of 40 to 55 years40 to 55 years11 wherein the incidence is between 2 wherein the incidence is between 2 to 5 %. Beyond this age, incidence rises to to 5 %. Beyond this age, incidence rises to between 6 to 30 % (50-59 years), 20 to 45 % (60 between 6 to 30 % (50-59 years), 20 to 45 % (60 – 69 years) and 34 to 70 % (70-79 years). – 69 years) and 34 to 70 % (70-79 years).

The incidence in men who are over 80 is The incidence in men who are over 80 is estimated at 91%.estimated at 91%.22

Lam M., Symptoms of Andropause in Andropause. URL: Lam M., Symptoms of Andropause in Andropause. URL: http://www.LamMD.com/A3R_brief_in_doc_format/andropause2002.cfm. http://www.LamMD.com/A3R_brief_in_doc_format/andropause2002.cfm. 2 Werener MA., What is Androapuse in About Andropause URL: Werener MA., What is Androapuse in About Andropause URL: http://www.Andropausespecialist.com/aboutandrop.htmhttp://www.Andropausespecialist.com/aboutandrop.htm


Andropause is a “syndrome” affecting almost Andropause is a “syndrome” affecting almost all organs of the body, presenting in the form all organs of the body, presenting in the form as if simulating various diseases.as if simulating various diseases.

With ageing connective tissue loses its With ageing connective tissue loses its elasticity and its constitution is changed for elasticity and its constitution is changed for worse. worse.

MIDDLE AGE MAN BECOMES STIFFMIDDLE AGE MAN BECOMES STIFF


Andropause is often under-diagnosed:Andropause is often under-diagnosed:

- vague and variable symptoms.- vague and variable symptoms.

- reluctance to admit. - reluctance to admit.

- ignorance/ low weightage given to - ignorance/ low weightage given to possibility of low-testosterone as possibility of low-testosterone as cause.cause.

Almost all men are affected. The degree and Almost all men are affected. The degree and nature of affection varies.nature of affection varies.


““Andropause is the whole of physiopathological Andropause is the whole of physiopathological and psychopathological phenomena going and psychopathological phenomena going with the progressive natural cessation of the with the progressive natural cessation of the male activity as a consequence of the male activity as a consequence of the disordered state of the androgens’ production.”disordered state of the androgens’ production.”

- Georges Debled- Georges Debled


It is a disease since its cause is determined, its It is a disease since its cause is determined, its consequences well known and its treatment consequences well known and its treatment defined.defined.


With ageing ability to produce testosterone declines – With ageing ability to produce testosterone declines – decreased production of LH thereby reduced decreased production of LH thereby reduced Testosterone levels.Testosterone levels.

Increased levels of sex hormone binding globulin Increased levels of sex hormone binding globulin (SHBG) which reduces the amount of free (unbound) (SHBG) which reduces the amount of free (unbound) testosterone in the blood.testosterone in the blood.

Alteration in daily cycle of testosterone production. Alteration in daily cycle of testosterone production. For example, younger men show a peak of For example, younger men show a peak of testosterone in the morning, but this finding is testosterone in the morning, but this finding is blunted in older men.blunted in older men.


Attributable causesAttributable causes:: Testes based condition.Testes based condition. Pituitary/Hypothalamus-Based Conditions Pituitary/Hypothalamus-Based Conditions Genetically-Based ConditionsGenetically-Based Conditions Miscellaneous causesMiscellaneous causes

Andropause Effects…..Andropause Effects…..

Bones and Muscles:Bones and Muscles:1.1. Muscle WeaknessMuscle Weakness

2.2. Muscle Soreness and StiffnessMuscle Soreness and Stiffness

3.3. Osteoporosis / Bone Mass DecreaseOsteoporosis / Bone Mass Decrease

4.4. Fatigue (Less Endurance for Physical Activity)Fatigue (Less Endurance for Physical Activity)


Brain and Psychology:Brain and Psychology:1.1. Anxiety and Fear - About Losing Sexual PotencyAnxiety and Fear - About Losing Sexual Potency2.2. DepressionDepression3.3. Forgetfulness and Difficult ConcentrationForgetfulness and Difficult Concentration4.4. IndecisivenessIndecisiveness5.5. IrritabilityIrritability6.6. Loss of Purpose and Direction in LifeLoss of Purpose and Direction in Life7.7. Loss of Self-ConfidenceLoss of Self-Confidence8.8. Poor Concentration / Memory LapsesPoor Concentration / Memory Lapses9.9. Short Term Memory LossShort Term Memory Loss10.10. Stroke/ParalysisStroke/Paralysis


Heart and Blood VesselsHeart and Blood Vessels::1.1. High Blood Pressure.High Blood Pressure.

2.2. Atherosclerosis.Atherosclerosis.

3.3. Coronary Artery DiseaseCoronary Artery Disease..


General:General:1. Skin Thinning1. Skin Thinning2. Sleep Disturbances2. Sleep Disturbances3. Slower Injury and Illness3. Slower Injury and Illness4. Recovery4. Recovery5. Reading Difficulty (small print)5. Reading Difficulty (small print)6. Reduce Interest in Sex6. Reduce Interest in Sex7. Thinning or Loss of Hair7. Thinning or Loss of Hair8. Weight Gain8. Weight Gain9. Prostate Enlargement / Cancer9. Prostate Enlargement / Cancer


When and Why to SuspectWhen and Why to Suspect:: Male patients above 45 years.Male patients above 45 years. Mixed clinical picture not matching a particular Mixed clinical picture not matching a particular

diagnosis/ disease.diagnosis/ disease. Treatment of ‘routine’ complaints is not producing Treatment of ‘routine’ complaints is not producing

the desired results – delayed / ineffective response.the desired results – delayed / ineffective response.

Diagnosing Andropause…..Diagnosing Andropause….. Hormone assay (Serum Testosterone Levels).Hormone assay (Serum Testosterone Levels). Total testosterone levels:Total testosterone levels:

Normal values:Normal values:20-49 yrs20-49 yrs : 270- 1734 ngm/dl.: 270- 1734 ngm/dl.> 50 yrs> 50 yrs : 212- 755 ngm/dl.: 212- 755 ngm/dl.Subject valuesSubject values : : 215 ngm/dl215 ngm/dlDiagnostic criteria for andropauseDiagnostic criteria for andropause

More than 350 ngm/dl. : Rules outMore than 350 ngm/dl. : Rules out349-200 ngm/dl. : Borderline349-200 ngm/dl. : Borderline**

Less than 200 ngm/dl. : likelyLess than 200 ngm/dl. : likely* * Requires further evaluation- bio available testosteroneRequires further evaluation- bio available testosterone

Diagnosing Andropause…..Diagnosing Andropause…..

Bio-available (free) testosterone Bio-available (free) testosterone levels:levels:

Normal levels: 13-40 Pg/mlNormal levels: 13-40 Pg/ml

Subject levels: Subject levels: 1.2 Pg/ml.1.2 Pg/ml.

Scope of Physiotherapy…..Scope of Physiotherapy…..

Exercises enhance Exercises enhance Testosterone Testosterone production.production.

Exercise improve lipid, Exercise improve lipid, carbohydrate and carbohydrate and protein metabolism.protein metabolism.

Exercises elevate mood Exercises elevate mood and behaviour.and behaviour.

Role of Physiotherapists…..Role of Physiotherapists….. Musculoskeletal:Musculoskeletal:

Improve muscle strength.Improve muscle strength. Enhance muscle mass.Enhance muscle mass. Improve muscle power.Improve muscle power. Increase muscle endurance.Increase muscle endurance. Improve flexibility.Improve flexibility.

Cardiorespiratory:Cardiorespiratory: Safety from arteriosclerosis / atherosclerosis.Safety from arteriosclerosis / atherosclerosis. Improve cardio-respiratory performance functions.Improve cardio-respiratory performance functions. Enhance Cardio-respiratory endurance.Enhance Cardio-respiratory endurance.

General:General: Local / general relaxation.Local / general relaxation. Mood elevation.Mood elevation.

Ethical Considerations…..Ethical Considerations…..

If Andropause is confirmed:If Andropause is confirmed: Inform the patient.Inform the patient. Refer to the Physician with expertise in Age Refer to the Physician with expertise in Age

Management medicineManagement medicine

For further informationFor further information

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Ageing male