Are You an ADAM? Understanding Androgen Deficiency in Aging Men

ADAM is a short form of Androgen Deficiency in the Ageing Male. This is a medical condition result from declination of male hormone (testosterone) levels due to progression of age. It is physiological and it is the male counterpart of 'men-opause' or also known as andropause. In comparison to women, male andropause does not have a clear-cut transitional sign (such as cessation of menstrual cycle). It is important to understand about andropause as it is a journey that all men will go through and bring in its wake its own concerns and symptoms.

Understanding ADAM

ADAM is a journey that all men will inevitably go through. It occurs around the age 40-55 though it can occur as early as the age of 35 or as late as the age of 65. Testosterone does decline as men grow older. Symptoms of ADAM can vary between men. Sexual dysfunction symptoms tend to be one of the key prominent symptoms that is highlighted by most men undergoing ADAM.

What is the underlying reason for ADAM?

Testosterone hormone plays a vital role in male characteristics. This male hormone is mainly produced by the testicles and regulated/ controlled by the pituitary gland that is found in the brain. When there is a discrepancy or disruption of the pituitary-testicle-testicular axis, the end point male sexual hormone is affected and reduced.

We know that the sexual hormone tends to dwindle progressively with time. Other factors that may speed up and exacerbate the process includes poor lifestyle such as stress, smoking, heavy alcohol drinking or thyroid disorders.

What are the symptoms of ADAM?

ADAM can manifest itself in various facets of manhood. Here, we categorize the symptoms and effects on major health components of a man. It is known that ADAM increases men in metabolic disorders such as obesity, hypertension, type 2 diabetes mellitus, heart diseases and even osteoporosis. 

One of the common major concerns of men with ADAM

Following decline in testosterone levels in ageing men, one tends to find changes in sexual life in comparison to younger days. One may have the interest or desire in sexual life, yet having difficulty in producing or sustaining healthy erection. This is commonly one of the key reasons patients with ADAM seek medical assistance. 

What can I expect when I see my doctor for ADAM?

Your doctor will go through your concerning symptoms and assess you further in the form of history and physical examination. Aside from understanding on your symptoms, social and lifestyle history, concurrent medical histories will be evaluated. Your doctor will then proceed with a physical examination to evaluate for telltale signs of ADAM. 

Often, further workups are also offered. This includes

• General blood tests: This usually includes checking your cholesterol, blood glucose, liver function, thyroid function, kidney function and cell counts, anaemia and other nutritional workup
• Hormone blood tests: this is to measure the circulatory testosterone hormones (free testosterone), brain hormones (FSH, LH, Prolactin) and other sexual hormones (sexual hormone binding globulin)
• Specific prostate tests: prostate tumor marker blood tests, prostate ultrasound

Depending on individual needs and risk factors, your doctor may further work you up for tests such as ECG, Echocardiogram, Treadmill ECG, osteoporosis workup and etc. 

What are the treatment options for men with ADAM?

ADAM is a physiological journey that men go through with time. As one can experience a myriad of non-specific symptoms, management of ADAM should be customerised individually depending on the affecting symptoms and risk factors.

Multi-pronged management of ADAM condition includes

• Leading a healthy lifestyle, managing daily stress
• Consider weekly 150min of physical activities- including cardio workout and strength training exercises.
• Consider healthy moderate eating- low glycemic index carbohydrate, healthy protein diet
• Daily adequate and sleep
• Avoid smoking 
• Moderate alcohol intake (aim 14 units per week)
• Medical treatment with testosterone replacement therapy (TRT), Phosphodiesterase-5 inhibitors (PDE-5 inhibitors), Extracorporeal Shockwave Therapy (ESWT) may be offered to manage clinical symptoms

Testosterone Replacement Therapy in ADAM

The use of testosterone replacement therapy TRT is considered the backbone treatment for ADAM in better coping with associated physical symptoms. TRT comes in the form of gels, tablets, patches, injections depends on dose, patients tolerance and preference.

Benefits of TRT

The key improvement of ADAM's physical symptoms occurs following restoring dwindling testosterone levels with TRT. 

Hence, symptoms benefits following TRT include

• Better sexual health with better libido, sexual desire.
• Improvement in general energy level, daily performance
• Better muscle mass and body strength 
• Better brain function and thinking abilities 
• Better bone mineral density
• General improvement of mood and wellbeing

What are the drawbacks of TRT

When a person is on TRT, one should regularly monitor their testosterone levels, prostate health and general cardiovascular risk factors. 

Common side effects of TRT include

• Headache
• Weight gain
• Acne 
• Worsening hair loss- male pattern hair loss
• Gynaecomastia (benign male boobs)
• Worsening cholesterol (bad cholesterol-LDL)
• Increase red cells, resulting in high blood viscosity and vascular disease
• Liver tumors

TRT can be associated with causing enlargement of prostate gland, leading to prostatic abnormal symptoms. Although there is no sufficient evidence to suggest TRT can cause prostate cancer, prostate cancerous tissues are known to be sensitized towards androgen hormones such as testosterone. It should be avoided in those with active prostate cancers, and use selectively and cautiously in those who has had history of prostate cancer..

Who is contraindicated in taking TRT

Those who has 

• Breast cancer or prostate cancer
• High viscosity of blood (sticky blood_
• High red cell packed cell volume
• Sleep apnea
• Severe Heart failure

Synergy and Complementation from PDE-5 inhibitors and ESWT with TRT

While TRT can alleviate the sexual dysfunctional component of ADAM in male, PDE-5 inhibitors and ESWT options can further enhance and boost the outcome of TRT in one with ADAM. 

Both PDE-5 inhibitors and ESWT are non-invasive clinically proven medical treatment options in managing sexual dysfunction by improving blood circulation to the penis and promoting erection.

Speak to a Doctor About ADAM Symptoms

If you are experiencing ADAM symptoms, do not suffer alone. While it is a physiological ageing process, there are medical treatment options that may help alleviate symptoms and support quality of life as you age. At Dr Ben Medical, assessments may include medical history review, physical examination, and relevant investigations to better understand your hormonal health and overall well-being. Speak to our doctors for further medical advice.

References

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3. Morley JE. Andropause, testosterone therapy, and quality of life in aging men. Cleve Clin J Med. 2000 Dec;67(12):880-2.
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