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The Journal of Urology Vol. 163, 705–712, March 2000


Alvaro Morales, Jeremy P. W. Heaton and Culley C. Carson, III
From the Department of Urology, Queen’s University, Kingston, Ontario, Canada,
and Department of Urology, University of North Carolina, Chapel Hill, North Carolina

Purpose: A progressive decrease in androgen production is common in males after middle age. The resulting clinical picture has been erroneously named male menopause or andropause. A more appropriate designation is androgen decline in the aging male (ADAM). The syndrome is characterized by alterations in the physical and intellectual domains that correlate with and can be corrected by manipulation of the androgen milieu. We review the epidemiological aspects of aging and endocrinological manifestations of ADAM, and provide recommendations for treat-ment and monitoring of these patients.
Materials and Methods: We performed MEDLINE, Pubmed, Current Contents and Pharma-ceutical Abstracts searches of relevant peer reviewed publications on andropause, male climac-teric, adult hypogonadism and aging. In addition, conference proceedings were researched to provide a more complete review of the literature. Information was scrutinized and collated, and contributory data were reviewed and summarized.
Results: ADAM is a clinical entity characterized biochemically by a decrease not only in serum androgen, but also in other hormones, such as growth hormone, melatonin and dehydroepiandro-sterone. Clinical manifestations include fatigue, depression, decreased libido, erectile dysfunc-tion, and alterations in mood and cognition.
Conclusions: The onset of ADAM is unpredictable and its manifestations are subtle and variable, which has led to a paucity of interest in its diagnosis and treatment. Urological practice commonly includes a large proportion of men older than 50 years. Therefore, it is important for urologists to recognize the manifestations of and be familiar with evaluations necessary to document ADAM as well as its treatment and monitoring.

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