Ageing related hormone changes affect men and women differently. However, the changes that occur in both sexes can have a similar impact on mood, sleep, energy levels and libido.
In women the sudden decline the female sex hormones (estrogen & progesterone) corresponds to the final ovulatory cycle the occurs for most between the ages of 45-55 years. There is often a time prior to this where ovulation can become irregular and hormone levels fluctuate, this is known as perimenopause.
In contrast to this, the decline in the male sex hormone (testosterone) in men is a much slower and more gradual process occurring over many years. As a result of this, the effects often go unnoticed until it is having a significant impact on that patient’s wellbeing. This often manifests as:
- Changes in sexual function (reduced sexual desire, erectile dysfunction and infertility)
- Changes in sleep (insomnia, poor sleep quality, daytime sleepiness)
- Physical changes (increased body fat, decreased muscles mass, decreased strength, gynaecomastia and loss of body hair)
- Emotional changes (decreased motivation, decreased energy, depressed mood)
In males, testosterone levels vary greatly with older males tending to have lower levels than younger males. Throughout adulthood these levels will decline on average about 1% per year from the age of 30.
In suitable patients, both men & women can have a noticeable improvement in these with hormone replacement therapy. It is important that this occurs under the supervision of an appropriately trained medical practitioner that has taken a thorough history, examination and relevant investigations. Dr. Allison is a Cosmetic Physician & Specialist General Practitioner with extensive experience in reproductive health and is able to safely monitor this treatment for appropriate patients.
It should be noted that the symptoms of menopause & androgen deficiency can also occur with other medical conditions, these must first be excluded before any medical treatment can occur. Certain hormonal conditions that result in sex hormone deficiencies will not be suitable to be managed here and will need to be referred to a specialist endocrinologist.
Testosterone is the major androgen (male sex hormone) in men and is required for normal reproductive and sexual function. It is integral to the changes that occur during male puberty, and for the features typical of adult men such as facial hair, body hair and a male physique. It also acts on the testes to make sperm. Testosterone is also important for men in overall health, whereby it helps the growth and maintenance of muscle & bone, affects mood, libido and sexual function.
Androgen deficiency occurs when the body is not able to make adequate amounts of testosterone for normal body function. Although this is rarely life threatening, it can have a significant detrimental effect on the quality of life for that patient.
Symptoms of androgen deficiency include decreased energy levels, low mood, irritability, difficulty concentrating, reduced muscle mass & strength, low sex drive (libido). Symptoms can be non-specific, so it is important to have a full medical assessment so that other underlying medical conditions can be excluded first.
Androgen deficiency occurs when there are problems with the testes or the hormonal axis from the brain to the testes resulting in an overall decrease the testosterone production. This can be due to genetic conditions, medical or surgical problems affecting the testes or pituitary disorders.
A diagnosis of androgen deficiency requires a thorough medical assessment and at least two blood tests (taken in the morning on different days) to measure hormone levels. These blood tests will help in determining whether this is due to a problem with the testes or the pituitary gland. A clinical diagnosis is only made when patients have low hormone levels combined with symptoms of androgen deficiency.
Androgen deficiency is treated with testosterone therapy. This means administering testosterone to bring the testosterone levels in the blood back to a normal range. This can be prescribed for men with androgen deficiency confirmed by blood tests. Once started, testosterone therapy is generally continued for life and monitored regularly by an appropriately trained medical practitioner. There are some medical conditions that can result in low testosterone (such as obstructive sleep apnoea) and these should be corrected before treatment is started.
Menopause is the final menstrual period which occurs for most women between the ages of 45-55 years. This corresponds to the final ovulatory cycle and causes a number of hormonal changes to occur. This can occur through natural physiological changes in women or can be due to surgical intervention (such as hysterectomy and removal of the ovaries for cancer). These sudden hormonal changes can result in symptoms of menopause.
The three main hormones that are affected in menopause are oestrogen, progesterone and testosterone. These hormones are important in physiological and sexual function throughout life. They play a role in growth, energy, repair of cells, reproductive function and digestion. When these hormones suddenly decline patients will often report menopausal symptoms. These include:
- Hot flushes
- Night sweats
- Muscle/joint pains
- Sleep disturbance
- Lessened concentration
- Vaginal Dryness
- Decreased libido
Menopause is often considered in stages. Women will often report menopausal symptoms in the perimenopausal time when ovulation becomes erratic and hormone levels fluctuate.
Treatment of menopause symptoms can be improved with hormone replacement therapy, however, requires a thorough medical assessment prior to commencement. This is usually achieved by supplementing estrogen +/- progesterone depending on the individual patient. It is important to identify any medical reasons that hormone replacement may not be suitable and ensuring that all preventative health activities (such as cervical & breast screening) is up to date.