MALE “MENOPAUSE” (ANDROPAUSE) –FACT OR FICTION?
It is not a hypothesis anymore- men do suffer from age-related hormonal decline. In fact, testosterone physiologically decreases at 1% per year from the age of 30, but in some men, the testosterone decline can be much greater thereby leading to premature andropause. A suitable example of this would be a man whose figure could be described as ‘apple-shaped.’ His prominent belly hugely affects his bioavailable testosterone level leading to premature menopause. Supplementary studies have shown that today’s men who are in their 30’s and 40’s have lower testosterone levels than they would have had 20 years ago. In addition, 40% of all men with a low testosterone level will experience symptoms of andropause as early as the ages of 40 -55. Understanding and acknowledging all of this data is important for men and women in a relationship with an andropaused man or a man with prematurely low testosterone
What is the function of testosterone in men?
Male hormones (Androgens) and testosterone are responsible for a man’s strength, the sexual function including performance and potency, mood stability and firm thinking, good memory, muscle mass and absence of “spare tire” appearance on his waist, uninterrupted sleep, bone structure, etc. Also, optimal testosterone levels are essential for cardiac health, prevention of visceral fat formation and accumulation of fat in the belly, and subsequent prevention of inflammation, cardiometabolic syndrome, and heart attack. Numerous studies are done in this field, and it is one of the reasons why Bio-identical testosterone replacement is necessary for aging men especially those with a
with a prominent belly. Prostate health is another current topic amongst aging men. Despite many contradictory studies, the conclusion is pointing out that males with normal testosterone levels as of men in their 20’s and 30’s do not have a prostate problem. Therefore, keeping optimal testosterone levels in aging men to a level of a 25-year-old is the solution excluding any prostate problem prior the treatment.
Causes of Testosterone decline and Androgen hormones imbalance?
1.Besides aging, testosterone decay can happen under very unhealthy life style circumstances and nutrient deficiencies.
High carbohydrate intake combined with high-fat diet is an inflammatory enhancing condition that leads to Insulin resistance, diabetes type 2, Cardio -metabolic syndrome, prostate cancer, etc. In very inflamed abdominal and visceral fat, Testosterone undergoes aromatization, and one portion transforms into estrogen. In addition to estrogen being dangerous for a male’s body, the lack of testosterone from this process further generates fat (contributes to insulin resistance). It is a vicious cycle that needs to be addressed from an integrative medicine point of view rather than just by replacing testosterone.
2.Endocrine disruptors related to everyday life toxic products like bisphenols in plastic bottles, pesticides, insecticides, phthalates, etc. can interrupt testosterone production via various mechanisms. I recently came across one study that shows how low testosterone was associated with a high level of PSBs, in even in younger men. One of the steps that I always take for treating low testosterone in my patients is to ensure that they have safe detoxification and opt only for organic food.
3.Many medical conditions, as mentioned previously, can alter testosterone levels: Diabetes type 2, cardio-metabolic syndrome, insulin resistance, stress related hypothalami –pituitary abnormalities, Immune and inflammatory conditions.
4.Men using corticosteroids, or other anabolic therapies can alter testosterone levels in a more permanent way.
5.Finally, genetic factors play a paramount role in orchestrating when and how testosterone will decline. I will never forget a 72-year-old man my patient, who exhibited physical and psychological traits with that of a 45-year-old man and later tests showed that his testosterone level was, in fact, equivalent to that of a 40-year-old man. Aromatase activity which contributes to higher estrogen production in men is also genetically determined.
Symptoms of low testosterone?
Symptoms of low testosterone differ from person to person do not usually appear as abruptly as women’s menopausal symptoms. They are often devious, not recognized and most importantly, ignored by men. They often lead to changes in men’s behavior rather than making men pro-active in seeking help.
Loss of libido and sexual functions
Inability to build muscle and loss of strength
Mood swings, irritability, depression.
Grumpiness, loss of confidence
Increased waist size and susceptibility to insulin resistance,
Cardiometabolic syndrome and predisposition to heart attack
Increase risk for osteoporosis
Men’s behavior under low testosterone
Being unable to recognize symptoms and not understanding the physiological changes of low testosterone makes men change their behavior. They often work too much, drink excessively and enjoy the thrills that arise from taking risks in business and private life. Their irritability, lack of confidence and loss of libido often works as a projection towards their partners –actually accusing external factors (partners) for their feelings and creating family disturbances.
What can be done for male andropause?
Men with symptoms of testosterone deficiency need an Integrative medical approach with topical bioidentical testosterone replacement therapy (which gives a more physiological outcome rather than non –bioidentical testosterone injections) and lifestyle interventions. Genetic tests for prostate cancer predisposition, exclusion of current prostate cancer and male breast cancer should be done before any therapy. Identifying aromatase activity and the underlying presence of visceral fat and insulin resistance are necessary for a successful outcome.