Male menopause could still be a controversial concept, but UK doctors are suggesting screening. As many as one in five of the over-65s may be affected by the problem, it is felt.
The existence of a male equivalent to the menopause is still disputed, but most experts agree some men experience a crash in testosterone that can leave them tired, depressed and lacking in libido.
Unlike menopause, which generally occurs in women during their mid-forties to mid-fifties, men's "transition" may be much more gradual and expand over many decades. Attitude, psychological stress, alcohol, injuries or surgery, medications, obesity and infections can contribute to its onset.
Although with age, a decline in testosterone levels will occur in virtually all men, there is no way of predicting who will experience andropausal symptoms of sufficient severity to seek medical help. Neither is it predictable at what age symptoms will occur in a particular individual. Each man's symptoms may be also different.
Andropause was first described in medical literature in the 1940's. So it's not really new. But sensitive tests for bio-available testosterone weren't available until recently, so andropause has gone through a long period where it was underdiagnosed and undertreated. Now that men are living longer, there is heightened interest in andropause and this will help to advance our approach to this important life stage which was identified so long ago.
Another reason why andropause has been underdiagnosed over the years is that symptoms can be vague and can vary a lot among individuals. Some men find it difficult to admit that there's even a problem. And often physicians didn't always think of low-testosterone levels as a possible culprit. So these factors often led doctors to conclude that symptoms were related to other medical conditions (i.e. depression) or were simply related to ageing and often encouraged their patients to accept that "they were no longer spring chickens".
This situation is changing. New blood testing methods are available and there is an increased interest in mens' ageing among medical researchers. So much attention is being focused on andropause that major efforts are underway to quickly share emerging scientific information with the international medical community.
Medical associations, including the European Association of Urology, have issued guidelines recommending that men with type 2 diabetes and symptoms of testosterone deficiency be tested.
"It is going to pick up a lot of men with low testosterone who previously would have been sat at home without their doctor investigating it," said Hugh Jones, professor of andrology at Sheffield University.
Eberhard Nieschlag, who worked on the guidelines at the University of Münster in Germany, told the New Scientist magazine that testosterone injections could be used to kickstart weight loss or alleviate the symptoms of diabetes.
Doctors should be more aware of the effects low testosterone can have, he said.