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Review of Andropause in Ayurveda, Rasayan, Vajikarana and Panchakarma

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 Research and Reviews: Journal of Ayurvedic Science, Yoga and Naturopathy

Volume 1, Issue 2
www.stmjournals.com

Review of Andropause in Ayurveda, Rasayan, Vajikarana

and Panchakarma Perspective
Sarvesh Kumar Singh1*, Kshipra Rajoria2
1
Department of Panchakarma, National Institute of Ayurveda, Jaipur, Rajasthan, India
2
Department of Panchakarma, M.J.F. Ayurvedic College and Hospital Jaipur, Rajasthan, India

Abstract
The term menopause is the used in the context of females who suffers from the hormonal
change. This is the end of the reproductive stage in the women, during this phase
menstruation and ovulation ceases. Similar hormonal changes occur in male too, that is
termed as Andropause. Here is an attempt made to understand this endocrine disorder
and find possible management through Ayurveda. At the same time scopes of Rasayan,
Vajikaran and Panchkarma in the treatment is also explored.

Keywords: Andropause, Ayurvedic management, Panchkarma, Rasayan, Vajikaran

*Author for Correspondence E-mail: sarveshksingh21@gmail.com

INTRODUCTION mood with concomitant decrease in

A progressive decrease in androgen production
is common in aging men. The physiological
causes for this phenomenon seem to be
multifactorial. The magnitude of the decline in
testosterone with age and the prevalence of
older men with low testosterone levels have
not been well established. Previously the
symptoms of Andropause were attributed to
symptoms raised due to old age or depression.
An interesting fact about it that in women
symptoms of menopause starts at the age 40–
55 years, whereas in male the symptoms are
expressed in the age 35–65 years. Andropause
or male menopause is a name that has been
given to a supposed menopause-like condition
in middle–aged men. This may relate to a
reduction of the production of the hormones
testosterone and dehydroepiandrosterone in
middle-aged men, and the consequences of
that reduction, which is associated with a
decrease in cells. Other terms used to describe
the condition are Viropause, midlife crisis,
male climacteric, low testosterone syndrome,
symptomatic late onset hypogonadism
("SLOH"), androgen deficiency of the aging
male ("ADAM") and partial androgen
deficiency in the aging male (PADAM).
Clinical Manifestations
Aging in men is generally accompanied by a
decrease in general wellbeing; changes in
intellectual activity; spatial orientation ability
fatigue; depression and Anger; decrease in
virility, sexual desire and erectile quality;
decrease in skin thickness; decrease in Energy;
decrease in muscular mass and in strength; an
increase in upper- and central-body fat;
decrease In bone mineral density resulting in
osteoporosis; and decrease in body hair.
Causes
Although all the causes of male menopause
have not been fully researched, the main
culprit behind the disorder is the declination of
testosterone which is attributed due to the fact
that physiologically testosterone levels
decreases by approximately 1% per year after
age 30 [1,2]. At the same time, another factors
in the body called Sex Binding Hormone
Globulin, or SHBG and circulating levels of
estrogen (which competes with testosterone
for cellular receptor sites) is increasing. This
increased level of SHBG traps much of the
testosterone that is still circulating and makes
it unavailable to exert its effects in the body's
tissues, whereas increased level of estrogen
can tilt the testosterone- estrogen balance
unfavorably and can reduce the availability of
testosterone to target cells. Andropause is
associated with low (bioavailable) testosterone
levels. Every man experiences a decline of
bioavailable testosterone but some men's

RRJoAsYN (2014) 19-26 © STM Journals 2014. All Rights Reserved Page 19
Review of Andropause in Ayurveda
levels dip lower than others. And when this
happens these men can experience andropausal
symptoms. Modifications of testosterone
levels are found in several diseases and
lifestyle disorders. Acute critical illness [3, 4]
or surgical injury [5] causes a profound
decrease of free testosterone (F)T levels. As
far as chronic diseases are concerned,
decreased testosterone and sex hormone-
binding globulin (SHBG) levels are observed
in elderly men with diabetes mellitus, with an
inverse correlation between testosterone and
plasma glucose [6]. Coronary atherosclerosis
has been reported to be associated with low
testosterone levels [7] Chronic renal failure
generally induces a hypogonadotropic
hypogonadism with impaired pulsatile release
of pituitary luteinizing hormone (LH) [8].
Chronic liver disease is accompanied by
decreased (F)T levels and increased SHBG
[9]. Sleep apnea syndrome, with its hypoxia, is
accompanied by lowered testosterone levels,
secondary to a hypogonadotropism; these
patients are often obese, which may aggravate
the hypogonadism. Among drugs that may
adversely affect Leydig cell function in the
elderly, the frequently used glucocorticoids, as
long-term therapy, often induce a marked
suppression of (F)T levels as the result of both
testicular and central actions of the drug, as
well as a decrease of SHBG levels [10].
Smokers have higher testosterone levels than
nonsmokers [11]. Alcohol intake, even without
cirrhosis of the liver, may accentuate the age-
associated decline of testosterone levels [11].
The influence of diet can influence
testosterone levels. Fasting may affect
testosterone production through diminished
gonadotropic testicular control [11]. Androgen
changes with normal male aging the causes for
a decline in testosterone production with age
are multifactorial. The most important change
appears in the testes, where there is a decline
and an alteration of Leydig cell number [12].
Moreover, young adult men exhibit a circadian
rhythm in their serum levels of total
testosterone, with peak levels in the morning
and falling slowly by about 35% during the
day. This daily fluctuation in serum
testosterone is attenuated in older men [13,
14]. The ability of the testes to increase
testosterone secretion in response to increased
gonadotropin stimulation is also attenuated in
older men [15]. There is evidence that age-
RRJoAsYN (2014) 19-26 © STM Journals 2014. All Rights Reserved
Sarvesh Kumar Singh
related alterations in hypothalamopituitary
function also contribute to the decline in
testosterone production. Elderly men fail to
demonstrate an appropriate increase in LH
secretion in response to a hypoandrogenic
state. Most of older men with low testosterone
levels have gonadotropin levels (especially LH
levels) that are within the normal range for
young adult men, resulting in a relative
hypogonadotropic hypogonadism. It has been
also clearly demonstrated that the
hypothalamopituitary compartment of the
gonadal axis is more sensitive to the negative
feedback effects of sex hormones than is the
case in young adults [16]. A third aspect of the
physiopathological mechanisms responsible
for the age-related changes in circulating
testosterone levels, in addition to primary
testicular factors and deficient neuroendocrine
feedback regulation, consists of a progressive
increase of plasma SHBG binding
capacity[17]. The cause of this increase with
age remains unclear. A plausible hypothesis is
that the increase in SHBG levels is related to
the age-dependent decline in circulating
growth hormone or insulin-like growth factor
level [17].
Diagnosis
The most accepted parameter to establish the
presence of hypogonadism are the
measurement of total testosterone and free
testosterone calculated either from measured
total testosterone and SHBG or measured by a
reliable free testosterone analysis method.
Normal testosterone level are above 12 nmol/L
(346 ng/dl), or free testosterone levels above
250 pmol/L (72 pg/ml). The serum total
testosterone levels below 8 nmol/L (231 ng/dl)
or free testosterone below 180 pmol/L
(52 pg/ml) requires treatment. The other
parameter for diagnosis is a screening
questionnaire developed by St Louis
University and Aging Males Symptoms’
(AMS) questionnaire as a rating scale for
assessment of symptoms.
Treatment as per Modern Medicine
The sole treatment of the disorder is HRT
(Hormonal Replacement Therapy) or TRT
(Testosterone Replacement therapy) or
Selective Androgen Receptor Modulator
(SARMs), basically these are the terms used to
describe the supplementation of testosterone.
Page 20
Research and Reviews: Journal of Ayurvedic Science, Yoga and Naturopathy
Volume 1, Issue 2
Current medical treatments for androgen
supplementation include oral tablets,
intramuscular injections, and scrotal and
nonscrotal patches. Unfortunately, none of
these preparations mimic the circadian rhythm,
even if some of them may approximate the
circadian rhythm by dose adjustments.
Moreover, the androgen supplementation
could have adverse effects on different organs,
namely, the liver, lipid profile, cardiovascular
disease, prostate, sleep disorders, and
emotional behavior. Therefore TRT is
unsuitable for patients with breast cancer (in
males), Prostate cancer, Prostate hypertrophy,
Renal disease, Liver disease, Cardiac or
Blood vessel disease, Diabetes mellitus,
Patient having allergic reaction to androgen or
anabolic steroid, Patient on anticoagulants.
Andropause as per Ayurvedic Context
In Ayurveda there is a concept of Jaraawastha
(ageing), the last phase of the life span is very
commonly known as Vardhakya. According to
Ayurveda, aging (Jara) is a natural
phenomenon like that of hunger, thirst, sleep
and death [18]. Sushruta has grouped them
under the heading of Swabhava pravritta
vyadhies. Acharya Dalhana has commented
over this concept that, this diseases occur due
to the power of nature while Acharya
Chakrapani has commented that nature of a
particular individual depends upon the
invisible factors hereditary carried out by that
particular race in which he or she is born [19].
It is classified as Kalaja Jara and Akalaja
Jara. The andropause could be rightly related
to the Akalaja Jara, in which the ageing
process starts before the natural time of onset
and the manifestation of the symptoms are
severe.
Nidan
Causative factors for Akalaja Jara causes the
Vatapradhna Tridosha Prakopa thus causing
Agnimandhya, Ama formation which leads to
Dhatu Kshaya. In the text nidanas are
described in Charaka chikitsa rasayana pada
which states that due to intake of Gramaya
aahara, i.e., Amala rasa, lavana rasa, katu
rasa, kshara, shuska shaka, shushka mamsa,
tila churana, tila kalka, pistaanna, virudha,
nava, shooka and shami dhanya, vriudha,
asatamya bhojana, ruksha anna, kshara
RRJoAsYN (2014) 19-26 © STM Journals 2014. All Rights Reserved
pradhana bhojana, abhishandhi bhojana,
paryushita bhojana, vishama Aasana, adhaya
Aasana, sleeping in day time, daily
indulgence in sexual activities and alcoholism.
Irregular exercises, over exercises,
disturbances in body, fear, anger, grief,
greediness, moha, and laziness lead to Vatadi
Prokopa [20]. These factors which contribute
to andropause are also discussed in modern
science such as excessive alcohol
consumption, obesity, smoking, hypertension,
poor diet, lack of exercise, poor circulation,
and psychological problems, notably mid-life
depression.
Doshik Classification of Symptoms of
Andropause
Depression, fatigue, poor concentration and
memory, decreased libido and erectile
dysfunction, decreased muscle mass, sleep
disturbances, osteoporosis, aches and pain and
loss of height due to degenerative changes in
vertebral column are Vata predominance
disorders. Excessive sweating and hot flushes
and sleep disturbances are Pitta predominance
disorders. Gaining in body fat, particularly
abdominal weight gain is Kaphaj
predominance disorders.
Samprapti
Role of Vata
Because of Nidana Sevana (biological
stimulations), vitiation of Vata Doshas take
place which results into diminished digestive
power and depletion of Kapha Doshas. This
diminished digestive power leads to deficiency
of nutrition in body. This nutritional
deficiency further increases Vata Dosha and
thus viscious circle. In this way the
progression of Jara (old ageing) increases.
Role of Pitta
The onset of disease is in middle age. During
this period there is a peak level of Pitta.
Further due to influence of coming Jarakala
and Nidana Sevana, Vata also remain in
aggravated condition. This vitiated Vata
expels out the Pitta from its original place
(Ashaya Apakarsh of Pitta by Vata). This
aggravated Vata along with vitiated Pitta
creates hot flushes, excessive sweating, sleep
disturbance, irritability, etc. which are similar
to Vataja-Pittaja symptoms.
Page 21
Review of Andropause in Ayurveda
Role of Kapha
Due to abnormal incensement in Vata Pitta
Doshas there is a condition of depletion of
Kapha Doshas.
Interpretation of Pathogenesis in Context of
Andropause
The conclusion drawn by Ayurvedic and
modern prelance, it could be considered that
due to present day lifestyle, i.e., the diet and
physical activity the biological activities of the
body gets disturbed, i.e., Tridosha Prakopa as
a result this the whole system of the body gets
shattered down. This result in excessive
production of free radicals and there is
reduction in rate of its clearance. This further
leads to disrupted homeostasis of the
hormones resulting in rapid depletion in
testosterone production.
At the same time increase in the production
Sex Binding Hormone Globulin, or SHBG
and estrogen, which results in further
depletion of the testosterone and this
expresses itself in the form of the symptoms
stated above.
Treatment
Since it is clear that there is physiologically
gradual decrease in the level of testosterone in
all males starting in age of 30, but the men do
not feels any changes until they are in their 60
ties. But if the symptoms are manifested early
and at a faster pace than the due management
is required.
In Ayurveda causes, symptoms, signs and
treatment of andropause are clearly mentioned
in Rasayan Adhyay Prankamiyama
Rasayanpadam. For treatment of andropause
Urjaskar drugs such as Rasayan and
Vajikaran should be administered. Purification
of body should be done to get maximum result
of Rasayan and Vajikaran in andropause.
Aachar Rasayan should also be followed in
andropause.
So regarding the Ayurvedic management part
the following lines of treatment should be
followed:-
1. Removable of causative factor
2. Purification of Body
3. Rasayana and Vajikaran Sevana
4. Shaman Chikitsa
RRJoAsYN (2014) 19-26 © STM Journals 2014. All Rights Reserved
Sarvesh Kumar Singh
Removal of Causative Factor
The basic causative of the disease is the
disturbed lifestyle as called Gramaya Aahara
and Vihara, therefore a healthy lifestyle
should be followed. Few guidelines are
suggested below:–
1. Rising early, if possible before sunrise
because it is very effective in correction of
biologic clock
2. Regularly intake of exercise – It will help
in making body capable of dealing with
physical stress, as well help in enhancing
the biological activities in positive mode
(Yogic Kriyas like Aasana and
Pranayamas are highly effective). The
suffers of Andropause should start from a
comparative milder form of exercise and
when get accustomed should be raised to
higher levels. It could be considered as
graded exercise therapy.
3. Following of definite healthy regime-
Dincharya- In Dincharaya the various
regimes should be followed regarding life
style. Like –
 Care of scalp and hair-regular use of oils
(Shiroabhayanga), using natural cleansing
products for hair wash (decotion of
Triphala Churana with Reeta fruits). It is
beneficial for the scalp skin and hairs
growth and coloration as well helpful in
increasing the blood circulation of the
head and neck region which might be
possible in correction of the disturbances
in the hypothalamic-pituitary-adrenal
function which is thought as one of the
probable cause.
 Care of eyes, nose, ears, oral cavity, teeth-
daily use of Anjanas, Pratimarsh Nasya
(Tila oil), Karna purana(tila taila),
Oushhadha Kaval (Jati Patra, Nimba
Patra), Sneha Gandush (Sarshapa Taila
mixed with Saindhava Lavana and
Haridra Churna), Dantadhavana
(Triphala, Trikatu Trisugandhi Churana
with honey) and Mukhaalape. The basic
idea behind the proper treatment of these
natural orifices is that to build up a strong
immunological barrier in these regions
since everything that enters the body is
bypassed though one of these route.
 Care of body– The whole body should be
massaged with Sarsapha oil 15–20 min
prior to bath special care should be taken
for the foot part. The proper foot massage
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Research and Reviews: Journal of Ayurvedic Science, Yoga and Naturopathy
Volume 1, Issue 2
is quite effective in correcting various
physical ailments but the exact mechanism
is still obscure. For bathing natural scrubs
like Triphala Churana could be used
instead of chemical based soaps. If
possible use of body temperature
equivalent water should be used.
4. Proper and timely intake of meals– the
food should be natural and in appropriate
quantity, much cooked food should be
avoided, eating of raw food like fruits and
vegetables (properly washed), milk
products, dry fruits should be encouraged
and avoidance of chemical based food
should be done (jams, jellies, sauces, soft
drinks, preservative based foods etc.). It is
necessary because the whole functioning
of the body is dependent on the food that
we eat, if the food is not appropriate the
chances of getting diseased is increased
thousand folds. Special precaution should
be taken regarding Viruddha Aahara,
Aahara Viddhi Vidhan [21].
5. Proper timing of sleep– like the food,
sleep is also an important and inevitable
part of the life cycle. A proper and timely
sleep could make a body resistant to most
of the psychosomatic disorders. So an
individual should try to in bed between
3–6 h after dawn. Because like the other
natural beings, human body is regulated
by the cycle of day and night and special
care should be taken to follow it strictly.
6. Following of seasonal regime– special
precaution should be taken to follow the
seasonal regime called Rita Chary. And
more than the Rita Charya, Ritusandhi
Charya should be followed because during
the course of change of season there is
tendency of human body that the
immunity gets lower down.
7. Encouraging patient to firmly believe in
existence of God– It is a sort of
psychological therapy in which the patient
’s moral is boosted up and he is assured to
be in a safer zone where his aliments will
be cured. This regime is quite effective in
patients with psychosomatic background.
These were the few guide lines which have
been found practical and quite easy to follow
and has been incorporated in many of patients
of endocrinal and autoimmune disorder. And
RRJoAsYN (2014) 19-26 © STM Journals 2014. All Rights Reserved
to summarize the above statements one should
follow Dincharaya, Ratricharaya, Ritucharya,
and Aaharavidhi Visheshaayatana.
Purification of the Body
In the management part, Shodhana is the
second most important point to be considered.
The patient should be undergone for
Panchakarma procedures like Vaman,
Virechana, Basti Karma and Nasya Karma for
speedy recovery. To insure prolonged results
the milder forms of purification like Kunjala,
mild purgation, Basti Yoga, Pratimarshya
Nasya etc should be used timely according to
patient’s requirements after complete
purification.
Rasayana Sevana
After the shodhana the next line of
management is the administration of Rasayana
drugs. This is the step were the excellence of
the physician is utilized because for each
patient different rasayaana is prescribed as per
his body need. Satavari, Shalaparni, Karjura,
Ghrita and milk should be used if the patient’s
requirement is at nutritious level. If the
patient’s requirement is at metabolic level
Bhallataka, Pippali, Haritaki, and Chitraka.
Swarna, Kasturi, Makaradhwaja, Kupilu
Satavari, Shalaparni, Karjura, Ghrita,
Dugdha Satavari, Shalaparni, Karjura,
Ghrita, Dugdha should be used.
If the patient’s requirement is at assimilation
level - Guggulu, Pippali, Rasona should be
used. At immunomodulation level - Pippali
Rasayanam should be used. For antioxidant
properties- Guduchi, Aswagandha and for
adaptogenic activity – Satavari, Haritaki,
Amalaki and Tulasi should be used. For tissue
protection and regeneration - Yastimadhu,
Amalaki, Lasuna, Gokshura, Aswagandha and
intellect promation and stress relieving –
Aswagandha, Brahmi, Sankapuspi, Jatamamsi,
Bala, Jyotismati and Guduchi and for cell
proliferation and regeneration - Aswagandha
is used.
In the case of andropause the Rasayana drugs
are beneficial which have Antioxidant,
adaptogenic, anti-anxiety, anti-depression
effects.
Page 23
Review of Andropause in Ayurveda
Apart for the oral administration of the
Rasayana drugs an important and indispensible
form of Rasayana that should be followed is
Aachara Rasayana. The various possible
mechanisms by which the Aachara Rasayana
can influence the total body functions and
maintain harmony between mind and body are
melatonin mechanism, psycho-immunological
axis, psyscho-endocrine axis, anti-oxidant
property and stress adaptation through –D H E
A.
The Rasayana is a specialized type of
treatment influencing the Dhatus, Agnis and
microchannels of the body leading to an
overall improvement in the formation and
maintenance of the living tissues and helps in
the prevention of ageing, improving of
resistance against diseases, bodily strength and
process of improving mental faculties.
Properties of Rasayana Drug are prevention of
senile degeneration, stimulation of
metabolism, promotion of body resistance and
immunity, improvent in memory and
intelligence and increasement in vitality. It
keeps body free from diseases and restores
health and increase long life
Shamana Treatment
It’s the last step in the management of the
disease and it is majorly based on the
symptomlogy of the individual patient. Like –
1. Fatigue, Joint aches, Muscle aches–
could be treated with Abhayanga and
Swedana using medicated oils and vapors
from medicated decoctions, or either use
of Patrapinda or Shalishatika for 21 days
or more according to patient’s
requirements. In oral medication Guggulu
and Mandura preparations should be used.
2. Psychiatric problems, Difficulty sleeping,
Difficulty concentrating– These aliments
can be dealt by use of Shirodhara using
medicated oils, decoctions, Takra Amalaki
etc. In oral medications use of Medhya
drugs like Sankapuspi, Joytishmati,
Brahmi, Vacha, and Aswagandha based
preparations should be used.
3. Decreased muscle mass– for this aliments,
Kshira Basti and Santarpana diet and
drugs (Atmagupta, Shatavari, Musali,
Aswagandha, Nagabala, Pippali, testis of
goat, Mandukaparni, milk, Kharjura,
Draksha, Kashmari, Satavari) Bhrimhana,
RRJoAsYN (2014) 19-26 © STM Journals 2014. All Rights Reserved
Sarvesh Kumar Singh
Balya, and Vayasthapana Mahakshaya is
used.
4. Weight gain– for these aliments Lekhana
Basti, oral administration of Medohara
Guggulu, Chausata Prahari Pippali, and
Purnavamandura in association of regular
physical exercise should be done.
5. Osteoporosis, loss of height– these
aliments can be treated with
administration of Ksheera Basti Siddha
with Tikta dravya like Panchtikta and
Sneha dravya. In oral administration the
calcium containing compounds like
Mukta, Mukta shukti, Pravala, Shankha,
Godanti, Laksha Guggulu etc. should be
used.
6. Sweating and hot flashes– In case of
sweating and hot flashes the Pitta
Shamaka treatment should be done like
application of Sheet pradeha of Amalki,
Ushira, Chandana, Avaghana with Kanji,
in oral administration the drugs used
should be Shootshekar Ras, Kamdhugdha
Ras, Avipattikar Choorna, Panchnimb
Choorna, Amalki Choorna etc.
7. Decreased libido and erectile
dysfunction– for this aliment the Vrishya
Basti Siddha with Ksheera, Ghrita,
Mansarasa, Madhur Dravya and orally
Vrishya drugs should be administered.
They are Ashwagandha, Shatavari,
Shalaparni, Kapikachu, Shukra Janana
Mahakshaya etc. should be administered.
Scopes of Panchkarma in the Management
Improvement in mood and sense of well-
being, decreased anger, irritability, sadness,
tiredness, nervousness and improvement in
quality of sleep may be through Abhayanga,
Shirodhara and Nasya. Increased mental and
physical energy (reduce fatigue) can get
through Abhayanga and Swedana. For
improved libido and sexual performance can
get through Abhayanga, Vrishya Basti and
Uttar Basti. For lean body mass, Abhayanga
and Brihmana Basti should be used. For
decline in fat mass Abhayanga and Brihaman
Basti should be used. An increase in muscle
strength (hand grip, upper and lower
extremities) can get through Patrapinda
Sweda, Pizzichil and Shastika Shali pinda
Sweda. For increasing bone density Tikta
Ksheera Basti should be used.
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Research and Reviews: Journal of Ayurvedic Science, Yoga and Naturopathy
Volume 1, Issue 2
CONCLUSION
Andropause is not the beginning of the end, as
most fear, but the end of the beginning," says
Jed Diamond, a psychotherapist and author of
Male Menopause (Sourcebooks, 1997) "It is
the passage to the most passionate, powerful,
productive, and purposeful time of a man's
life." and the few physical ailments could be
dealt easily and cured completely through
Ayurvedic principles. The major factor that lies
in the treatment part is the lifestyle
modification which causes the removal of the
root cause of the disease and the remaining
parts are dealt with oral medicine and
therapeutic procedure. They slow down the
process and help to stay active and maintain a
more youthful vigor.
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