Aches and pains. Tiredness and fatigue. Loss of enthusiasm. Loss of strength and muscle mass. Weight gain. Erectile dysfunction. These are all just natural effects of aging that a man should learn to adjust to, right?
While these are symptoms that a man is entering a phase of life known as Andropause, men don’t have to accept these changes as untreatable. There are many treatments—including, medical, supplemental, and lifestyle—that can reduce and even reverse these symptoms.
What Is Andropause?
Andropause is often thought of as the equivalent of menopause in women, but it more simply refers to a time in a man's life when his body is producing less testosterone than the man needs. All men produce less testosterone as they get older. By the time a man reaches his 70s and 80s, his testosterone level has decreased by at least 50 percent.
When women experience menopause, everyone knows it. That’s because her hormones drop off over a period of months. Andropause symptoms typically progress very slowly, over years, so men think they’re just getting older without realizing that it is due to lower testosterone levels.
While testosterone reduction can begin in a man's 30s, the impact of it usually doesn't start showing up until his 50s. However, men who are under a lot of stress may experience symptoms of low testosterone earlier or more dramatically.
As this happens, a man starts feeling less like his old self. He may no longer have the zest for life he once had. He can also experience a reduction in strength and endurance, and develop a spare tire around his waist. And, he can have erectile dysfunction (ED) that impacts his love life and self-esteem. If his ED doesn’t respond fully to Cialis, Levitra, or Viagra, that’s another sign suggestive of low testosterone. These drugs will not work without optimal levels of testosterone.
Low-grade depression, lack of mental clarity, and loss of drive and self-confidence are also common symptoms. Many men find that life gets overwhelming when their testosterone is low. They notice they are more indecisive, unable to embrace life’s challenges, and feel meek and powerless. Guys really do feel “over the hill.”
This is because testosterone has an energizing effect. It prompts desire, motivation, and a can-do attitude. Without it, people (both men and women) become meek, withdrawn, and uncertain of themselves. This often results in frustration, anxiety, irritability, and angry outbursts.
In addition, low testosterone can impact a man's risk for other diseases and overall health. There is an increased risk of cardiovascular disease, high blood pressure, high cholesterol, increased clotting, infertility, obesity, type 2 diabetes, Alzheimer’s disease, depression, and osteoporosis when testosterone levels drop.
Many men who experience the symptoms I've described go to the doctor to have their testosterone tested and are told their levels are normal. They then assume the real cause of their changing health is simply old age.
If this has happened to you, don't resign yourself to the idea that your body's changes can't be addressed. You should know that a "normal" reading on a standard testosterone blood test doesn't necessarily mean your testosterone level is where it should be.
For many men, testosterone levels technically fall in the normal range but are so close to the bottom of that range they might as well be abnormal. If your testosterone is within normal limits, but in the bottom 10 percent, that's like being one step above the basement.
Also, some men naturally need higher levels of testosterone. Tall men, for example, ideally should have levels in the upper range of normal or even 10 percent to 25 percent above “normal range.” Optimal range is much narrower and is influenced by age and height. Men who are tall (over 6 feet) had to have a high testosterone (and growth hormone) during puberty to reach that height. So even mid-range levels may be low for them.
Also, there are other tests that can give a doctor insight into a man's testosterone level. Doctors may recommend testing estradiol, prolactin, luteinizing hormone (LH), thyroid, sex hormone binding globulin (SHBG), prostate specific antigen (PSA) and zinc levels.
Any number of imbalances in the body can make testosterone levels functionally lower. That means that the levels are “normal” but the man is clearly deficient in available, functioning testosterone. For example, high levels of estradiol can interfere with testosterone. This happens when men drink too much alcohol or get fat. The body makes too much estrogen instead of testosterone.
High prolactin levels suggest a pituitary tumor, not a cancer, which compresses the remainder of the pituitary gland and testosterone production falls off. This will be accompanied by low LH; the messenger made by the pituitary gland that tells the testicles to produce more testosterone.
Elevated LH means your brain wants more testosterone than your testicles are making. So a low testosterone level with a high LH suggests the problem is low production of testosterone in the testicles. This may be due to trauma, damage from having the mumps as a child, varicocele and getting older.
Low thyroid function can lower the body’s ability to utilize or respond to testosterone. And lots of things can make someone hypothyroid ... even low Vitamin D!
Lastly, high SHBG binds up testosterone, making it unavailable to your cells. Because of these possibilities, additional tests paint a more accurate picture of testosterone’s effectiveness and the type of treatment needed.
Other causes of low or poorly functioning testosterone that should be discussed during a medical exam include:
- Exposure to environmental estrogenic toxins like BPA, pesticides, and herbicides
- Loss of or damage to a testicle
- Varicocele (large varicose vein in the scrotum)
- Long-distance running, cycling and other strenuous activities
- A vegan diet
- A diet with too few Omega 3 fats or zinc
- A high-sugar diet
- A high-grain diet
- Too much body fat
- High alcohol consumption
- Some prescription and over-the-counter medications
- Intense emotional stress
- A history of head injury
A Treatment Plan
Considering low testosterone can have numerous causes, treatment of it should be customized to a man's unique health situation.
Testosterone Replacement Therapy: There are several versions of testosterone therapy. Initially, testosterone shots may be given in the doctor's office. They load the body and saturate testosterone receptors resulting in more rapid response.
This is usually followed by a prescription for topical testosterone therapy. This may be a brand name gel like Androgel, Axiron or Testim. Some physicians prescribe individually compounded testosterone creams or gels which are more concentrated than those made by pharmaceutical companies resulting in a smaller volume to spread over the body. Topical testosterone is best applied to the inner aspects of the arms, the forehead, or the top of the chest near the collarbones. For best results, a man should avoid putting testosterone on fatty or hairy areas of his body.
Men need to wash their hands after application to avoid contaminating their family members with the testosterone. Family members need to avoid touching those parts of the man’s body to which testosterone has been applied for a minimum of 2 hours and better yet 6 hours as the testosterone is gradually absorbed.
Some men fear testosterone therapy will cause them to develop prostate cancer. While testosterone doesn't cause prostate cancer it may feed a tiny prostate cancer that isn't detected using PSA tests or digital rectal exams. So, any man who is on testosterone replacement therapy should have his prostate monitored very closely for the first two years of treatment.
It's also important to remember that not all men with low testosterone will need testosterone therapy. In some men, supplements and lifestyle changes may be all that are required to normalize testosterone levels.
Other Prescription Medications: Aromatase is the enzyme that converts testosterone to estrogen. Alcohol, caffeinated drinks and obesity speed up aromatase. Studies have shown that the inhibition of aromatase can increase testosterone production in elderly men who have low or borderline-low testosterone levels. It can be blocked with anastrozole (brand name: Arimidex), a drug often used in the treatment of breast cancer in post-menopausal women.
Supplements: Chrysin, which can be taken orally or compounded into a cream, works like anastrozole to block conversion of testosterone into estrogen. Supplements like fish oil and di-indole methane (DIM) benefit the prostate and help a man maintain healthy sex steroid metabolism. Zinc along with saw palmetto inhibit 5 alpha reductase, the enzyme which converts testosterone into dihydro-testosterone (DHT). Benign prostatic hyperplasia (BPH) is partially caused by an increase in conversion of testosterone to DHT.
Lifestyle changes: Stress, poor diet, alcohol consumption, and lack of sleep are all lifestyle factors that can lower testosterone. To address these factors, learn to recognize when you are stressed out and do something about it. Being out in nature, taking a long hot shower, meditation, using Heart Math or any one of several computer-based relaxation programs may help. Achieve a healthy weight. Eat lean meats, healthy fats, and lots of above-the-ground vegetables; avoid sugar, grains, dairy, and alcohol as much as possible. Make a good night's sleep each night a priority. Also avoid tobacco and marijuana and the use of beta blockers.
Aging is a fact of life, but low testosterone doesn't have to be. If you work with your doctor to regain optimal levels, you'll find that you're more like your old self. You'll feel stronger, less anxious, and more robust than you have in years. You will also reduce your risk of many other illnesses associated with being “over the hill."