HORMONES -
ANDROPAUSE

• Male Hormone Profiles
• The Role Of Testosterone
• The PSA Factor

Male Menopause Exists!

Talk about old wives tales! The idea that menopause is an experience exclusive to women sounds more like an old husband’s tale! As they watch their wives (mothers, sisters) go through the hot flashes, night sweats and mood swings of menopause, men may heave a sigh of relief that they don’t have to go through it themselves. But in the face of physiology, we know that men are not, in fact, immune to the hormonal fluctuations of middle age. The effect may be more gradual, unlike the rollercoaster many menopausal women find themselves on, but male menopause is a very real phenomenon and it has a name: Andropause. That’s the textbook term for the midlife ‘pause’ or decline in male hormone production of the Androgens—specifically testosterone and DHEA—the major players in maintaining both physical and mental health in men. During the same timeframe, estrogen (particularly estradiol) levels in males tend to increase as androgen levels decline. The result is a negative ratio between the two; a hormonal imbalance that typifies the Andropause profile and signals an associated risk of prostate disease.

Functions of Male Hormones

The androgens increase energy and decrease fatigue; they help in maintaining erectile function and normal sex drive and in their anabolic (building) capacity are instrumental in increasing the strength of all structural tissues—the skin, bones, muscles and heart. Men make more testosterone than do women, accounting for their generally greater muscle and bone mass. A proper balance of the androgen hormones also helps to prevent depression and mental fatigue. These are the hormones that help provide the virility, stamina and drive we associate with the male of the species. To make a long story short, they put the M in ‘macho.’

Symptoms of Andropause

Needless to say, testosterone and DHEA levels in short supply are going to have a big impact on all those attributes both physical and mental that makes men, male. If at the same time, levels of the female hormone estrogen are too high as is not uncommon during this time, urinary and prostate problems may begin to enter the picture.

Usually, what the andropausal male first notices is a subtle loss of sexual desire, along with a downward shift in strength and energy. Bouts of depression and anxiety, the feeling of being ‘tired but wired’ and a persistent lack of stamina are also common symptoms as the androgens downsize with age. The mid-life male quite often finds himself short on enthusiasm for the things he used to enjoy; work is not quite as challenging and exercise is tougher. Fatigue sets in more quickly and the only bedroom activity he’s really up for is sleeping through the night; a feat too often sabotaged by frequent visits to the bathroom. Thinning hair, shrinking muscles, wrinkles and an emerging paunch seem to go with the territory. He may feel rundown, anxious, edgy and achy. If his stress quotient is too high the male baby boomer may describe himself as ‘burned out,’ an indication that is cortisol levels are elevated. Now he is aging rapidly. One thing’s for sure: he is not feeling like his old self.

Restoring Balance: Hormone Testing and Treatment

The first step towards restoring balance is to test hormone levels so as to identify specific deficiencies and excesses and to what extent they are out of range. This can be done through saliva or blood spot testing (Order a test HTML) in which optimal collection can take place in the privacy of one’s own home and sent by regular mail for processing in the laboratory. Test results include a complete evaluation of hormone lab levels correlated with symptoms and hormone usage. The report serves as a rationale for patient and provider to determine the most suitable treatment for restoration of hormone balance and relief of symptoms.

Stress management, exercise, proper nutrition, dietary supplements (particularly of adequate zinc and selenium) and androgen replacement with physician guidance have all been shown to raise androgen levels in men and help to counter andropause symptoms.

Case studies from our files provide a snapshot of andropause: a 77 year-old man complained of excessive fatigue, lack of stamina, loss of interest in sex, despite his recent marriage to an attractive younger woman, and general mental lethargy. His saliva testosterone level was found to be extremely low and his estradiol (estrogen) levels were high, a profile commonly seen in late andropause. This man’ s cortisol tested low throughout the day. After consultation with his health care provider, he began supplementation with a bioidentical precursor of testosterone (androstenedione) with added progesterone to balance his excess estradiol (estrogen) level. He rubbed a physiologic dose (tailored to his individual needs) of this natural hormone gel into his skin every morning and included in his regime adrenal supports such as optimal nutrition, vitamins, morning walks and an earlier bedtime. Followup testing showed balanced levels of estradiol, progesterone and testosterone along with great improvement in symptoms. According to this man, the testing and restoration of hormone balance gave him back his zest for life.

A 53 year-old workaholic complained of loss of concentration, poor recovery from workouts, loss of muscle tone and flagging energy. His capacity for exercise was much reduced and his quality of sleep suffered from recurring urinary urge throughout the night. This man tested his IGF-1 for growth hormone levels, Testosterone, SHBG  and PSA levels in dried blood spot . All levels were found to be out of range and out of balance in relation to each other. Stress management and supplementation with natural hormones was initiated. A topical gel to raise androgen levels, compounded with an aromatase inhibitor and progesterone to help lower estrogen levels resulted in a balanced ratio of testosterone to estrogen. Our workaholic lost weight, increased energy, improved muscle tone and reported an overall heightened sense of well being. His family and marital life thrived under the new regime.

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References:

• The Testosterone Revolution, Malcom Carruthers, M.D. (Thorsons)
• The Testosterone Syndrome, Eugene Shippen, M.D. (Evans & Co.
• A Woman’s Guide to Male Menopause, Marc R. Rose, M.D. (Keats)
• Male Menopause, John R. Lee, M.D.