Introduction

The word “Andropause” is derived from two Greek words- “Andras” meaning male and “Pause” meaning cessation. So, the term andropause is medically defined as a clinical and biochemical syndrome affecting multiple organ systems associated with advancing age and characterized by a deficiency in serum androgen levels with or without a decrease in genomic sensitivity to androgens.^[1] It is also known by the synonyms like Partial Androgen Deficiency in Ageing Men (PADAM), Male Menopause, Male climacteric etc. It may also be referred as Ageing male hypogonadism or late onset hypogonadism. According to UN estimates, India overtook China in having the largest population in the world with a population of 1,425,775,850 at the end of April 2023 and the report highlights that there are 14.9 crore persons aged 60 years as on July 2022^[2] and all these people are liable to suffer from different kinds of old age diseases. Thus, health of ageing population is a matter of concern. Andropause is a condition which is usually missed in a clinical scenario. It is a syndrome affecting the multiple organ systems in the body which hampers with the standard of living of an individual. This is a stage when one starts noticing the age-related changes in his body. Therefore, even though the patient is treated by different specialists, his actual problem is undiagnosed which can be rectified by checking the serum testosterone levels. Also, the different presentations of this syndrome make it difficult to create a clinical typeset of andropause. Ayurveda has already explained Rasayana and Vajeekarana Chikitsa in Samhithas which is meant for Swasthya Rakshanam. If both these treatment measures are adopted at the right time according to the condition of the patient then ageing can be dealt in a graceful manner.

Testosterone - Synthesis and Functional aspects

Testosterone is one among the important androgen in human body. It was first isolated from mice testicles by a Dutch scientist Ernst Laqueur in 1935 and later it was successfully synthesized by German biologist Adolf Butenandt.^[3] In humans this cholesterol derived hormone is produced in appropriate amount by Leydig cells of Testes and small amount by the adrenal glands.

It also affects many of the metabolic activities such as production of blood cells in the bone marrow, bone formation, lipid metabolism, carbohydrate metabolism, liver function and prostate gland growth.^[5] Functional aspects of testosterone in human body are still an incomplete area of research as the scientists are discovering the wider action of this wonderful hormone till date.

There is also a common misconception that testosterone is solely a male hormone. But this is not true. Testosterone is also produced in small quantities by the females. The only difference is that an average woman has 40 to 60 nanograms of testosterone in a deciliter of blood plasma whereas men has 300 to 1000 nanograms per deciliter.^[6] In females, it is the estrogen which is mainly concerned with the regulation of sexual functions. It is also proclaimed that at the time of conception even the embryo is female until and unless it is acted upon by testosterone.

The male menopause - Andropause

Andropause which is medically referred to as Androgen Deficiency in Ageing Male (ADAM) is a syndrome affecting the various organs of the body due to the decline in synthesis of the androgen- “Testosterone”. By the age of 30, levels of testosterone gradually begin to drop, which is supposed to be the beginning of andropause. Accordingly, it is estimated that by time a person reaches 80 years of age, his 90% of testosterone levels will be depleted. It is through this period of time natural process of ageing progress.

Figure 2

Some of the major signs and symptoms include:

Table 1

Diagnosis

There is a famous anonym which is as follows “Hormones do not decline as we age, we age because hormone decline”. Diagnosis is made by assessing the signs and symptoms of androgen deficiency and also by measuring the serum testosterone or its biologic active compound. Male total testosterone levels below 300 ng/dl from a morning serum sample (most accurate measurement) are generally considered low. To confirm the low levels of Testosterone, doctors recommend repeating the measurement of morning total testosterone. A total testosterone level <200ng/dl measured by reliable assay in association with symptoms is evidence of testosterone deficiency. An early morning sample shows testosterone levels between 200 and 350 ng/dl. For proper diagnosis and management, total testosterone level should be repeatedly monitored and a free testosterone level should be measured.

Management

In Allopathic system of medicine life style modifications, behavioural therapy and the Hormone replacement therapy are the major lines of treatment for managing the symptoms of Andropause.

Slow but assessable decline in function starts at about 30 years of age. Studies also supports fact that testosterone starts to decline from age of 30 which may be one among factor contributing to ageing.^[11] But usually, men do not feel any of symptoms until they reach an age of 60 years.

In our Samhithas Jara is being classified into two

1. Kalaja^[12]
2. Akalaja^[13]

Time is always considered in relation to the standard human lifespan. When ageing occurs in accordance with this natural timeline, it is termed as Kalaja Jara. However, when biological ageing advances more rapidly than chronological ageing, it is referred to as Akalaja Jara. Features of Kalaja Jara has been explained by Acharya Susrutha as an inevitable phenomenon, where there is a progressive decline of biological factors like Dhathu, Indriya Bala, Veerya, Utsaha etc. Vardhakya is a Vata predominant stage associated with diminished metabolism. This stage associated with a Dhathu Kshaya Avastha contributes to Kharatwa and Rookshata of Srotas, thereby making the person prone to age related disorders. Considering the concept of andropause, Kshaya of Sukradhathu may be one among the factor accelerating the process of ageing. This Kshayavastha can be dealt with the appropriate use of Rasayana and Vajeekarana Chikitsa in which nourishment of the Dhatus can maintain the Bala of person.

But in the present scenario, where there is a drastic change in life style and environment, Akalaja Jara establishes soon. Acharya Charaka has explained it in the verse 3 of Chikitsasthana first chapter. The various Nidanas contributing to Akalaja Jara can be grouped under Aharaja Hetu, Viharaja Hetu and Manasika Hetu which can be related to improper meals at irregular timings, sedentary life style, stress etc. These factors result in the Lakshanas like looseness of muscles and joints, blood gets burnt, fat becomes abundant and liquefied, nonfunctioning of Sukra Dhathu and finally Ojas Deteriorates. As explained earlier these symptoms closely resemble those of andropause. Although it is a physiological process, the symptoms significantly impact the individual’s quality of life. They can also be described as signs typically seen in advanced age, now appearing at an earlier stage. Here comes the role of Ayurveda especially as a preventive tool.

A recent study with humans aged 45 to 60 years reported an increase in telomerase activity with no discernible change in telomere length in peripheral blood mononuclear cells following Amalaki Rasayana administration, suggesting that this can avoid the telomeres erosion, promoting healthy ageing. In aged human participants, Amalaki Rasayana intake maintained, or even enhanced, the DNA strand break repair, with no toxic effects. Amalaki extract also exhibited neuroprotective effects from H₂O₂-induced DNA damage and repair in neuroblastoma cells. These are the proven action of Rasayana in ageing. This can also be interpreted as the nourishment of Rasa Dhathu to Sukra Dhathu is happening in the process thereby delaying the stages of ageing. In addition, Medhya Rasayana has demonstrated significant efficacy in alleviating physiological stress, which is recognised as a contributing factor in the acceleration of ageing process.^[16] Samhithas has also mentioned about the use of Ghritha and Ksheera which acts as Rasayana by virtue of their Madhura Rasa, Guru Snigdha Guna and Sheeta Virya. Andropause is also accompanied by a set of psychological symptoms which strongly hampers with the quality of life. Therefore, Rasayana Dravyas provide an important support in managing the symptoms of andropause. Swasthya Rakshanam is not complete without mentioning Vajeekarana, which is the eighth branch of Ayurveda. Vajikarana is commonly meant for the management of Sukra Doshas. In andropause since the testosterone, which may be correlated with the Sukra Dhathu is affected, Vajeekarana will be good choice of medicine for managing the symptoms of andropause. In andropause key symptoms related to sexual functions includes loss of libido, sexual dysfunction and decreased sexual performance, primarily due to a decline in testosterone levels. Here comes utility of Vajeekarana. It is defined as:

वाजीकरणतन्त्रं नामाल्पदुष्टक्षीणविशुष्करेतसामाप्यायनप्रसादोपचयजनननिमित् तं प्रहर्षजननार्थं च ।^[17]

It can be utilized for improving the quality and quantity of Sukra Dhathu. This nourishment will in turn improve the quality of Ojas as it is considered as the essence of Sukra Dhathu, and thereby it helps in improving Vyadhikshamatwam. Even though Ayurveda has advocated Rasayana for nourishment of Dhathus and Vajeekarana for Prajanana Samartham, both are useful vice versa (Ubhayam Ubhayartha Krit).

Also identifying the already developed condition is a challenge in the present era due to the associated comorbidities. Quoting the words of Dr. V.P Bansal, “If in an old man, a physician is unable to diagnose a particular disease based on the history, clinical examination and laboratory investigations, where multiple systems are involved and physician himself is confused; then he should think of ANDROPAUSE.^[20] Ayurveda which strongly focusses on individual care has a lot to do in this clinical condition.

References