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?
Wrong.
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meek, withdrawn, and uncertain of themselves.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.
Testing
Testosterone
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)
- Vasectomy
- 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.
Getting Results
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."
