MALE MENOPAUSE, MYTH OR MENACE

No discrete event marks a transition to male reproductive senescence; however, a number of investigations have suggested that male fertility and reproductive hormone secretion decrease with age, giving rise to the term male menopause. Nearly all studies of seminiferous tubular fu nction and morphology have found evidence of an age-related deteriorat ion including anatomical lesions, reduced semen quality, elevated seru m levels of inhibin, and diminished fertility. The question of altered androgen secretion remains controversial with evidence both for and a gainst age-related reductions in testosterone (T), free T, and/or DHT in multiple investigations. Much of this controversy probably stems fr om noncomparable populations, especially with regard to confounding va riables such as stress, illness, and medication use. Published finding s to date agree that in healthy aging men there is a small but signifi cant increase in basal levels of LH and a diminished T response to exo genous gonadotropin, suggesting an intrinsic loss of Leydig cell reser ve. Moreover, there is evidence of a gradual loss of function of the h ypothalamic/pituitary gonadotropic axis as well. Despite these changes , healthy aging men appear to maintain normal circulating total and fr ee T and DHT levels, despite modest increases in sex hormone binding g lobulin (SHBG) and an small downward trend in serum androgens. Whether there are metabolic consequences such as altered body composition, mu scle strength, and lipid profiles in the portion of the aging male pop ulation with larger androgen decrements requires further investigation .