Terminology and Definitions

"Hypogonadism" refers to the consequences of diminished function of the gonads; occurs at any age and for a variety of reasons; and is classified into two forms on the basis of the source of the problem, that is, either of testicular origin, or as a result of disorder in the hypothalamic-pituitary axis (Fig. 4.3). Sex-related phenomena associated with hypogonadism are described in the "Hormones" section of this chapter.

The term "andropause" indicates a particular type of hypogonadism that is related to aging in men and is said to consist of the following: diminished sexual desire and erectile function, decrease in intellectual activity, fatigue, depression, decrease in lean body mass, skin alterations, decrease in body hair, decrease in bone mineral density resulting in osteoporosis, and increase in visceral fat and obesity (24). The word andropause is an attempt to draw a parallel in men to the experience of menopause in women. Whereas menopause occurs abruptly, andropause is said to occur quite slowly. As well, menopause is associated with the irreversible end of reproductive life, whereas in men spermatogenesis and fertility continue into old age. In the opinion of some observers, trying to equate the two is rather questionable (23).

The existence of andropause is a subject of controversy partly because of great difficulty distinguishing this syndrome from age-related confounding variables such as nonendocrine illnesses (both acute and chronic diseases), poor nutrition (inadequate or excessive food intake), smoking, alcohol use, and medications (24,48). Some observers have less doubt about the existence of a disorder but prefer to use a different name: ADAM (androgen decline in the aging male) (49), or PADAM (partial ADAM which refers to androgen decline that is still within the normal range).

To underline the fact that many hormones decline with age, the word "adre-nopause" has also been used to describe the diminution of the adrenal androgens DHEA and DHEAS (see section titled "hormones"), and "somatopause" to describe the same in the somatotrophic hormone, growth hormone (GH).

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