Mid life crisis

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Midlife Crisis diagnosis

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Differential Diagnosis of andropause and male mid-life crisis

Probably the best current definition of the term andropause is that proposed by Tremblay and Morales as ‘when men exhibit several of the symptoms and/or clinical features of reduced testosterone availability to various systems or organ functions’¹. This key article goes on to give a detailed list of symptoms, which are strikingly similar both in content and frequency to those originally listed by Werner², and several other authors over the past sixty years^3;3;4;4-6;6.

This characteristic "identikit" pattern of andropause symptoms is the same as that seen in androgen deficient adult males generally, whether caused by testicular damage, suppression of testosterone by a prolactinoma, anti-androgens, or increases in sex hormone binding globulin (SHBG) caused by thyrotoxicosis or anticonvulsant drugs⁷.

It is also important to distinguish the symptoms of the andropause from those of male mid-life crisis. While the former most commonly starts in the 45-55 age group, and is brought on by androgen deficiency, the latter typically occurs age 35-45, and is a psychological, existential crisis. Though they are often confused in both lay and professional minds, to the detriment of the diagnosis and treatment of both conditions, they have widely different clinical pictures, which can and should be distinguished³.

Equally importantly in relation to the differential diagnosis, the symptoms are reversed by giving adequate doses of testosterone, as reported consistently in the above studies and numerous others over the last 50 years. Too often this group of symptoms is written off as inevitable ageing, even if it is occurring in forty or fifty year-olds, without adequate clinical and laboratory investigation or a therapeutic trial. This is in stark contrast to women suffering similar symptoms who have far easier access to their form of HRT.

Reference List

1. Tremblay RR,.Morales AJ. Canadian practice recommendations for screening, monitoring and treating men affected by andropause or partial androgen deficiency. The Aging Male 1998; 1:213-8.

2. Werner AA. The male climacteric:Report of two hundred and seventy-three cases. J.Am.Med.Ass. 1946;132:188-94.

3. Carruthers M. Male menopause:Restoring vitality and virility. HarperCollins, London, 1996.

4. Reiter T. Testosterone implantation: A clinical study of 240 implantations in ageing males. Journal of the American Geriatrics Society 1963;11:540-50.

5. Heller CG,.Myers GB. The male climacteric: Its symptomatology, diagnosis and treatment. JAMA 1944;126:472.

6. Morley JE, Charlton E, Patrick P, Kaiser FE, Cadeau P, McCready D et al. Validation of a screening questionnaire for androgen deficiency in aging males. Metabolism 2000;49:1239-42.

7. Toone BK, Wheeler M, Nanjee N, Fenwick P, Grant R. Sex hormones, sexual activity and plasma anticonvulsant levels in male epileptics. Journal of Neurology, Neurosurgery and Psychiatry 1983;46:824-6.

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