Medicalization of Andropause

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Terminology

Medicalization

Medicalization is a social process through which a previously normal human condition (behavioral, physiological or emotional) becomes a medical problem in need of treatment under the jurisdiction of medical professionals. [1] Medicalization is dynamic and frequently changes and expands in new directions. [2] One visible area of expansion is how aging men’s lives and bodies are increasingly going under medical jurisdiction. The movement of aging from a natural life event to a medical problem in need of treatment is an example of medicalization and is mainly referred to as Andropause. [2]

Andropause

Andropause is not a clear-cut, easily identifiable, or definable condition. Broadly, andropause is defined as the age-related decline of testosterone in men that is accompanied by various symptoms, such as fatigue, lowered libido, and depression. [2] The confusion surrounding the condition is evident in the disputes over what to call it: andropause, veropause, male menopause, and the male climacteric. [2] This conceptual confusion has existed for some time, as physicians and scientists have debated the use of each of these terms.

Problems Associated with Current Terminology

Andropause and male menopause are physiologically incorrect terms because, unlike women, men do not universally experience a disruption of gonadal function and reproductive capability. [3] In fact, aging in healthy men is normally not accompanied by abrupt or drastic alterations of gonadal function, and hormone production as well as fertility can be largely preserved until very old age. [4] Some in the medical community have suggested that the more accurate term “partial androgen deficiency in aging males” (PADAM) be used. [2] This search for an accurate and scientific-sounding term indicates the process of medicalization, whereby a legitimate name for a condition promotes its diagnosis.

Diagnosis and Associated Problems

While scientists agree that some men may experience a decrease in testosterone with age, the measure and meaning of testosterone levels remain contentious issues. Measuring testosterone levels is not straightforward. Debates continue over whether the level of free, bound, or total testosterone is the most significant measure. [5] Concerns that testosterone levels can vary from hour to hour and that periodic declines can occur in some otherwise normal men fuel the debate as well. [2] Thus, there is currently no gold standard laboratory test to determine testosterone levels [6] and no agreement as to what measurement to use to arrive at a diagnosis of andropause. The American Association of Clinical Endocrinologists (AACE) suggests, that an important research goal is to establish a consistent method for determining free testosterone levels and to verify the results so that these levels can be more widely used and trusted. [7] Standardizing ways to measure testosterone levels and agreeing on what levels are considered abnormal will help with the diagnosis of andropause and contribute to increased rates of treatment - a crucial step in the medicalization of masculinity. [2]

Role of Testosterone

Testosterone is the most intriguing of the male hormones. Physiologically, it is claimed, testosterone increases sex drive, musculature, aggressive behavior, hair growth, and other traits traditionally considered masculine. [8] For the last century some physicians and other advocates have claimed that the age-related decline in testosterone levels requires testosterone supplementation and therapy. Although testosterone therapy for the treatment of andropause became less popular for most of the second half of the twentieth century, it never completely disappeared. [2] Indeed, while this constructed condition today is still somewhat ambiguous, the idea of a male menopause and the use of testosterone replacement therapy and supplementation are re-emerging by the distribution of drugs for an increasing range of male troubles. [2] These trends facilitate medicalization.

Treatment Modes and Associated Problems

The mode of delivery for testosterone has evolved over the past few decades as pharmaceutical companies continue to search for treatments that are more convenient and alluring. With the availability of a highly effective and convenient form of the drug more men are likely to participate in treatment. [2]

Oral preparations of testosterone, in the form of pills, are relatively easy to take. However, they are problematic because they do not maintain a constant level of the hormone in the body and may cause liver damage. [2]

Injections are uncomfortable for everyday use and result in a sharp spike of the hormone, and then a fall, and these fluctuations are often accompanied by swings in mood, libido, and energy. [2]

Patches, worn on the abdomen, back, thighs, or upper arm, maintain a steady level of the hormone but may be uncomfortable or fall off. [2]

The newest form of testosterone, a clear, odorless transdermal gel, can be rubbed into the shoulders once a day without any major effects. However, the Food and Drug Administration (FDA) approved this mode of treatment (AndroGel) only for well-defined conditions associated with hypogonadism, such as Klinefelter syndrome. [2] Pharmaceutical companies often obtain FDA approval of a new product for a niche population with a relatively rare disease, hoping to expand later to a larger and more profitable market. [2]

Another current mode of treatment is testosterone replacement therapy, which is prescribed for a set of vague and general symptoms. [2] A recent report estimated, that more than 1.75 million prescriptions for testosterone therapy were written in 2002, up from 648,000 in 1999 [8]. Despite the widespread use of testosterone replacement therapy, there is an inadequacy of information and clinical studies about its risks and benefits. [2] Among many in the scientific community there is growing concern about an increase in the use of testosterone by middle-aged and older men who have borderline testosterone levels or even normal testosterone levels in the absence of adequate scientific information. [9]

Conclusion

While there is a basic understanding of testosterone decline and aging, scientists and clinicians know little about the mechanisms behind the decline and its connection to the physical symptoms of aging. It is clear that testosterone decreases with age, but whether this decline means that a man has an actual condition such as andropause is not known. [2] That professional societies are pushing for a resolution of diagnostic uncertainties, the acceptance of a standard laboratory analysis, and an accurate label to replace andropause is clear evidence that the medical and scientific communities are contributing to the medicalization of aging men’s bodies. [2] Despite all the known, adverse side effects of testosterone supplementation and therapy, as many as 1.5 million men are taking testosterone in one way or the other. [2] The availability of testosterone as a supplement in a convenient form will increase the chance that healthy men will use it to help them treat the symptoms of aging. [2]

References

  1. Medicalize. (n.d.). Retrieved November 16, 2016, from https://en.oxforddictionaries.com/definition/medicalize.
  2. 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 2.14 2.15 2.16 2.17 2.18 2.19 2.20 Conrad, P., & Ebrary Academic Complete (Canada) Subscription Collection. (2007). The medicalization of society: On the transformation of human conditions into treatable disorders. Baltimore: Johns Hopkins University Press
  3. Clarke, A. E., & e-Duke Books Scholarly Collection 2010. (2010;2009;). Biomedicalization: Technoscience, health, and illness in the U.S. Durham, NC: Duke University Press.
  4. Nieschlag, E., Behre, H. M., & Nieschlag, S. (2004). Testosterone: Action, deficiency, substitution (3rd;3; ed.). New York, NY, USA;Cambridge, U.K;: Cambridge University Press.
  5. Stas, S. N., Anastasiadis, A. G., Fisch, H., Benson, M. C., & Shabsigh, R. (2003). Urologic aspects of andropause. United States: Elsevier Inc. doi:10.1016/S0090-4295(02)02242-2.
  6. Tan, R. S., & Culberson, J. W. (2003). An integrative review on current evidence of testosterone replacement therapy for the andropause. Maturitas, 45(1), 15-27. doi:10.1016/S0378-5122(03)00083-5
  7. Petak, S. M., Nankin, H. R., Spark, R. F., Swerdloff, R. S., Rodriguez-Rigau, L. J., & American Association of Clinical Endocrinologists. (2002). American association of clinical endocrinologists medical guidelines for clinical practice for the evaluation and treatment of hypogonadism in adult male patients--2002 update. Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists, 8(6), 440.
  8. 8.0 8.1 Hoberman, J. M., & Ebrary Academic Complete (Canada) Subscription Collection. (2005). Testosterone dreams: Rejuvenation, aphrodisia, doping. Berkeley: University of California Press.
  9. Liverman, C. T., Blazer, D. G., National Academies Press Free eBooks, Ebrary Academic Complete (Canada) Subscription Collection, & National Research Council (U.S.), Committee on Assessing the Need for Clinical Trials of Testosterone Replacement Therapy Staff. (2004). Testosterone and aging: Clinical research directions. Washington: National Academies Press.