Document Type : Original Article


1 Resident of Pathology, Department of Pathology, Shariati Hospital of Tehran University of Medical Sciences (TUMS), Iran

2 Member of Department of Community Medicine, School of Medicine, Tehran University of Medical Sciences (TUMS), Iran

3 Pharmacy student, Tehran University of Medical Sciences (TUMS), Iran

4 Associate Professor of Social and Preventive Medicine, Department of Community Medicine, School of Medicine, Tehran University of Medical Sciences (TUMS), Iran


Introduction: Andropause is a common clinical entity of advanced age, with a decline in androgen levels in males. Many of the signs of male aging are results of this condition with significant decline in their quality of life and adverse effects on multiple organ systems function. Androgen Deficiency of the Aging Male (ADAM) questionnaire is one of the most applied screening tools for androgen deficiency. Few studies have examined the prevalence of this condition and reports on the relationship of potential risk factors especially at the population level are scarce. Material and Methods: We conducted an analytic cross-sectional study on a nationally representative sample of 906 Iranian male adults aged 40 to 88 years in a population based surveillance of prevalence and risk factors. A combined questionnaire comprising ADAM and Geriatric Depression Scale-15 (GDS-15) followed by questions regarding the risk factors was administered to each patient. Frequency of positive response to each question and the impact of risk factors on andropause were evaluated. Results: Out of the total population, 873 cases were included. Totally, 185(20.6%) of the subjects were diagnosed with andropause. The mean age of andropause was higher than non-andropause group, 70.20±9.42 and 65.61±11.64, respectively. The most frequent positively responded questions were number 1 and 7, respectively. Age, marital status, level of education and occupation, history of cigarette smoking, depression, hypertension, diabetes, hypothyroidism, glucocorticoid consumption, hepatic, renal and cardiac disease, independently had significant impact on andropause development our univariate analysis(P<0.05). Age, marital status, level of education, cigarette smoking and history of depression, hypertension, diabetes and cardiac disease were associated with a greater risk, in multivariate analysis(P<0.05). Conclusions: The high prevalence of andropause in our population points out the necessity to improve the social and medical health to prevent the condition that has serious consequences on patients’ quality of life.


1.    MK., Brawer, Testosterone replacement in men with andropause: an overview. Rev Urol. 2004;6 Suppl 6:S9-S15.
2.    Hochreiter WW, Ackermann DK, Brütsch HP., [Andropause]. Ther Umsch. 2005 Dec;62(12):821-6.
3.    Krysiak R, Okopień B, Gdula-Dymek A., [The testosterone therapy in patients with andropause]. Wiad Lek. 2007;60(7-8):356-64.
4.    Morales A, Lunenfeld B., Investigation, treatment and monitoring of late-onset hypogonadism in males. Official recommendations of ISSAM. International Society for the Study of the Aging Male. . Aging Male. 2002;5:74–86.
5.    Urban RJ, Bodenburg YH, Gilkison C, Foxworth J, Coggan AR, Wolfe RR, Ferrando A., Testosterone administration to elderly men increases skeletal muscle strength and protein synthesis. Am J Physiol. 1995 Nov;269(5 Pt 1):E820-6.
6.    Behre HM, Kliesch S, Leifke E, Link TM, Nieschlag E., Long-term effect of testosterone therapy on bone mineral density in hypogonadal men. J Clin Endocrinol Metab. 1997 Aug;82(8):2386-90.
7.    Morales A, Heaton JP, Carson CC. , Andropause: a misnomer for a true clinical entity. J Urol 2000; 163: 705–712.
8.    Ershler WB, Keller ET., Age-associated increased interleukin-6 gene expression, late-life diseases, and frailty. Annu Rev Med. 2000;51:245–270.
9.    AM., Matsumoto, Andropause: clinical implications of the decline in serum testosterone levels with aging in men. . J Gerontol A Biol Sci Med Sci. 2002;57:M76–M99.
10.  SS., Holcomb, Andropause in the aging male patient. Nurse Pract. 2007 Dec;32(12):5-7.
11.  LJ., Gooren, The age-related decline of androgen levels in men: clinically significant? Br J Urol. 1996 Nov;78(5):763-8.
12.  Vermeulen A, Kaufman JM, Giagulli VA., Influence of some biological indexes on sex hormone-binding globulin and androgen levels in aging or obese males. J Clin Endocrinol Metab. J Clin Endocrinol Metab. 1996;81(5):1821-6.   .
13.  Gray A, Feldman HA, McKinlay JB, Longcope C., Age, disease, and changing sex hormone levels in middle-aged men: results of the Massachusetts Male Aging Study. J Clin Endocrinol Metab. 1991 Nov;73(5):1016-25.
14.  Casulari LA, Motta LD., Diagnostic of andropause: a problem not yet solved. Arq Bras Endocrinol Metabol. 2008 Dec;52(9):1401-2.
15.  AC., Bonnacorsi, Andropausa: insuficiência androgênica parcial do homem idoso. Uma revisão. Arq Bras Endocrinol Metab. 2001;45(2):123-33.
16.  Hohl A, Marques MO, Coral MH, Walz R., Evaluation of late-onset hypogonadism (andropause) treatment using three different formulations of injectable testosterone. Arq Bras Endocrinol Metabol. 2009 Nov;53(8):989-95.
17.  Tan RS, Pu SJ., Is it andropause? Recognizing androgen deficiency in aging men. Postgrad Med. 2004 Jan;115(1):62-6.
18.  Watson LC, Pignone MP., Screening accuracy for late-life depression in primary care: a systematic review. J Fam Pract. 2003 Dec;52(12):956-64.
19.  American Psychiatric Association, Diagnostic and statistical manual of mental disorders, (4th ed) American Psychiatric Association APA Press, Washington, DC (1997).
20.  Luppa M, Sikorski C, Luck T, Ehreke L, Konnopka A, Wiese B, Weyerer S, König HH, Riedel-Heller SG., Age- and gender-specific prevalence of depression in latest-life - Systematic review and meta-analysis. J Affect Disord. 2010 Dec 29.
21.  Ebrahimi M, Mansournia MA, Haghdoost AA, Abazari A, Alaeddini F, Mirzazadeh A, Yunesian M., Social disparities in prevalence, treatment and control of hypertension in Iran: second National Surveillance of Risk Factors of Noncommunicable Diseases, 2006. J Hypertens. 2010 Aug;28(8):1620-9.
22.  Sarraf-Zadegan N, Boshtam M, Mostafavi S, Rafiei M., Prevalence of hypertension and associated risk factors in Isfahan, Islamic Republic of Iran. East Mediterr Health J. 1999 Sep;5(5):992-1001.
23.  Azizi F, Ghanbarian A, Madjid M, Rahmani M., Distribution of blood pressure and prevalence of hypertension in Tehran adult population: Tehran Lipid and Glucose Study (TLGS), 1999-2000. J Hum Hypertens. 2002 May;16(5):305-12.
24.  Shirani S, Kelishadi R, Sarrafzadegan N, Khosravi A, Sadri G, Amani A, Heidari S, Ramezani MA., Awareness, treatment and control of hypertension, dyslipidaemia and diabetes mellitus in an Iranian population: the IHHP study. East Mediterr Health J. 2009 Nov-Dec;15(6):1455-63.
25.  Haghdoost AA, Rezazadeh-Kermani M, Sadghirad B, Baradaran HR., Prevalence of type 2 diabetes in the Islamic Republic of Iran: systematic review and meta-analysis. East Mediterr Health J. 2009 May-Jun;15(3):591-9.
26.  Aminorroaya A, Janghorbani M, Amini M, Hovsepian S, Tabatabaei A, Fallah Z., The prevalence of thyroid dysfunction in an iodine-sufficient area in Iran. Arch Iran Med. 2009 May;12(3):262-70.
27.  Tuei J, Okoth F, Kasomo A, Ireri E, Kaptich D, Watahi A, Kamau G, Mathenge E, Tukei PM., Prevalence of hepatocellular carcinoma, liver cirhosis and HBV carriers in liver disease patients referred to Clinical Research Centre, Kemri. . Afr J Health Sci. 1994 Aug;1(3):126-128.
28.  Najafi I, Attari F, Islami F, Shakeri R, Malekzadeh F, Salahi R, Gharavi MY, Hosseini M, Broumand B, Haghighi AN, Larijani B, Malekzadeh R., Renal function and risk factors of moderate to severe chronic kidney disease in Golestan Province, northeast of Iran. PLoS One. 2010 Dec 3;5(12):e14216.
29.  Hadaegh F, Harati H, Ghanbarian A, Azizi F., Prevalence of coronary heart disease among Tehran adults: Tehran Lipid and Glucose Study. East Mediterr Health J. 2009 Jan-Feb;15(1):157-66.
30.  Morley JE, Charlton E, Patrick P, Kaiser FE, Cadeau P, McCready D, Perry HM 3rd., Validation of a screening questionnaire for androgen deficiency in aging males. Metabolism. 2000 Sep;49(9):1239-42.
31.  Goel A, Sinha RJ, Dalela D, Sankhwar S, Singh V., Andropause in Indian men: a preliminary cross-sectional study. Urol J. 2009 Winter;6(1):40-4; discussion 44-6.
32.  Clapauch R, Carmo AM, Marinheiro L, Buksman S, Pessoa I., Laboratory diagnosis of late-onset male hypogonadism andropause. Arq Bras Endocrinol Metabol. 2008 Dec;52(9):1430-8.
33.  Tancredi A, Reginster JY, Luyckx F, Legros JJ., No major month to month variation in free testosterone levels in aging males. Minor impact on the biological diagnosis of 'andropause'. Psychoneuroendocrinology. 2005 Aug;30(7):638-46.
34.  Fatusi AO, Ijadunola KT, Ojofeitimi EO, Adeyemi MO, Omideyi AK, Akinyemi A, Adewuyi AA., Assessment of andropause awareness and erectile dysfunction among married men in Ile-Ife, Nigeria. Aging Male. 2003 Jun;6(2):79-85.
35.  Cackett P, Yeo I, Cheung CM, Vithana EN, Wong D, Tay WT, Tai ES, Aung T, Wong TY., Relationship of Smoking and Cardiovascular Risk Factors with Polypoidal Choroidal Vasculopathy and Age-Related Macular Degeneration in Chinese Persons. Ophthalmology. 2010 Dec 9.
36.  Doherty S, Byrne M, Murphy AW, McGee HM., Cardiac rehabilitation staff views about discussing sexual issues with coronary heart disease patients: A national survey in Ireland. Eur J Cardiovasc Nurs. 2010 May 29. .
37.  Phan A, Ishak WW, Shen BJ, Fuess J, Philip K, Bresee C, Czer L, Schwarz ER., Persistent Sexual Dysfunction Impairs Quality of Life after Cardiac Transplantation. J Sex Med. 2010 May 19. .
38.  Jaarsma T, Steinke EE, Gianotten WL., Sexual problems in cardiac patients: how to assess, when to refer. J Cardiovasc Nurs. 2010 Mar-Apr;25(2):159-64.
39.  Mooradian AD, Korenman SG., Management of the cardinal features of andropause. Am J Ther. 2006 Mar-Apr;13(2):145-60.
40.  Bhasin S, Cunningham GR, Hayes FJ, Matsumoto AM, Snyder PJ, Swerdloff RS, Montori VM., Testosterone therapy in adult men with androgen deficiency syndromes: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2006 Jun;91(6):1995-2010. Epub 2006 May 23.
41.  Rosner W, Auchus RJ, Azziz R, Sluss PM, Raff H., Position statement: Utility, limitations, and pitfalls in measuring testosterone: an Endocrine Society position statement. J Clin Endocrinol Metab. 2007;92(2):405-13.