Jerald Bain, BScPhm, MD, MSc, FRCPC, CertEndo, BA, Professor of Medicine and Obstetrics and Gynecology, University of Toronto; Staff Physician, Division of Endocrinology and Metabolism, Mount Sinai Hospital; President, Canadian Andropause Society, Toronto, ON.

The time has come to put to rest the barbs and criticisms of the naysayers who either question or outright deny that the andropause exists. It is also time to put to rest the hesitation and discomfort some may have with the terminology, andropause. Andropause exists and andropause is its name, and many of yesterday's naysayers are among today's converts.

The Four "Pauses"
Perhaps the easiest way to envisage andropause is to view it as one of the four major "--pauses" in the endocrinology of aging.¹ There are many theories as to why we age and many studies trying to understand the molecular basis of aging. Yet whatever the underlying mechanisms finally turn out to be, there are at least four significant alterations of endocrine function, each of which has been designated the suffix "pause". Whether or not this is an appropriate designation or the most descriptive of each of these endocrine changes is a moot point. The names transmit concepts that we can recognize and study, and that we can influence, if needed, with therapeutic strategies.

The most well known of the four "pauses" is menopause. Menopause is the culmination of a process that occurs over several years.

Jay Lee, MD, FRCS(C), Urologist, Division of Urology, Rockyview General Hospital, Calgary, AB.

"Andropause" is currently a controversial clinical diagnosis. However, more information is being garnered due to physician and patient interest. Declines in testosterone are known to have a multitude of systemic effects. Replacement in those who are truly androgen deplete has been demonstrated to be beneficial. This article reviews the diagnosis of andropause and its treatment and related side effects with testosterone replacement therapy.
Key words: androgen, andropause, hormone deficiency, testosterone replacement.

Roland R. Tremblay, DSc, MD, PhD, Professor Emeritus of Medicine, Laval University, Quebec City, QC.

Introduction
In both sexes, aging is associated with a progressive reduction in skeletal muscle mass and strength, although this may be masked by increases in subcutaneous fat or abdominal obesity that give the impression of stable body weight. Progressive frailty, however, occurs on a more global level with seniors "affected by multiple chronic diseases which cause physical and functional limitations."¹ These comorbid diseases may cause a systemic stress, which by itself (excess cortisol secretion), or by virtue of its suppressive action on the pituitary-gonadal axis, leads to a decline in androgen production. While the tendency to associate andropause and androgens has become increasingly common, the causal link between male hormone deficiency and the clinical disorder andropause still remains a weak one. A medical anthropologist is certainly likely to qualify the association as a reductionist vision of the frailty syndrome. In a sense, this vision serves the interests of both patients and physicians: it facilitates the diagnostic approach and the treatment strategies in an aged population, estimated at 20%, that seeks medical attention because of frailty, low mental and physical energy, depression-like symptoms and sexual hypofunction.

Aly S. Abdulla, BSC, MD, LMCC, CCFP, DipSportMed(CASM)
Faiza Abdulla, CDA
Contributing Authors,
Geriatrics & Aging.

Introduction
Unlike female menopause, which has been at the forefront of the medical community for over a decade, male menopause has been ignored and its very existence contested. This article will review this controversial topic in terms of its definition, mechanisms, evidence, symptoms, diagnosis, treatment options and follow-up.

Definition
Andropause is a clinical condition characterized by a partial deficiency of circulating androgens in blood and/or a decreased sensitivity to testosterone or its active metabolites in target tissues. This state of hypogonadism leads to a decline of energy, an altered sense of well-being, sexual dysfunction and various metabolic alterations. These issues may have effects on muscle mass, bone density, lipid profile and eventually cognitive function.^1,2 This syndrome tends to begin around age 50. Its insiduous onset can predate the finding or suspicion of symptoms by ten years.1 There is large overlap between andropause and other entities like neuro-vegetative dystonia, sleep disorders, mood disorders (anxiety and depression being the predominant two), hypothyroidism, drug abuse including alcoholism, medications, anemia, diabetes, obesity, hyperprolactinemia and erectile dysfunction due to non-hormonal factors (i.e. stress).