Andropause

Testosterone plays an essential role in male health. A recent study which followed men over 18 years showed that the group of men with the lowest testosterone levels had a 33 percent greater risk of death than the men with the highest levels. A woman’s decline in hormones at menopause is well known and well described. Not as well known is that men also go through a similar hormonal decline in testosterone called andropause. The signs of andropause can include lower sex drive, erectile dysfunction, weight gain, depression, fatigue, irritability and memory loss. And, as noted above, this decline in testosterone can also have serious health consequences.

Unlike women the drop in testosterone may happen so slowly that it isn’t really noticed, but a recent study showed that by age 70 men have only 10 percent of the testosterone they did at age 25. In men a number of changes occur that reduce the testosterone level available to the body and alter the ratio between testosterone and the chief female hormone, estrogen. Starting at about age 30, testosterone levels drop by about 10 percent every decade. At the same time, another factor in the body called Sex Binding Hormone Globulin, or SHBG, is increasing. SHBG traps much of the testosterone that is still circulating and makes it unavailable to body’s tissues. Only free testosterone exerts the effects that are attributed to the hormone.

The ratio of testosterone to estrogen is also important. One factor that affects testosterone levels of aging men is an enzyme called aromatase, which is found in fat tissue. This enzyme is responsible for converting testosterone into estrogen, thus altering the ratio of estrogen to testosterone . Men who have excessive body fat, especially abdominal fat, are likely to have increased estrogen levels caused by aromatase activity and a dramatically increased estrogen level compared to testosterone. Low testosterone levels also lead to an increase in abdominal fat. This is a vicious cycle because the excess fat leads to increased aromatase activity, which leads to further conversion of testosterone to estradiol.

Sex Steroid Therapies

The benefits of replacement seem fairly obvious and are well advertised. Better sex. Increased vitality. More muscle. Improved health. Greater mental agility. Improved mood. Other benefits of testosterone can include lowering cholesterol and improved cardiovascular health and overall mortality. Some prominent urologists have even claimed that it leads to lowering the risk for prostate cancer, not increasing it as is commonly thought.

Bioidentical testosterone gels and creams marketed by the pharmaceutical companies are called Testostim, Androderm and Androgel. Bioidentical testosterone can also be obtained from a compounding pharmacy where the dose can be invidualized. A significant advantage of compounded testosterone is that it is usually half the cost of pharmaceutical products. If the gels or creams are not sufficient testosterone can also be injected intramuscularly. Synthetic testosterones are not identical to the testosterone the body produces. They undergo different paths for metabolism and do not have the same activity (they may be more potent for example), nor the same safety as the testosterone our body produces.

Side Effects

Although male hormone therapy is now mostly bio-identical, when it was first introduced in the 1940s, the synthetic methyltestosterone was almost universally prescribed. But when methyltestosterone was observed in the 1950s to cause liver cancers and cardiovascular disease, it was dropped.. Some health risks can be produced by long-term use or excessive doses of anabolic, or synthetic steroids. These effects include harmful changes in cholesterol levels, acne, high blood pressure, liver damage, and dangerous changes in the structure of the left ventricle of the heart. Androgenic anabolic steroid abuse can also result in multiple medical and psychiatric problems. For these reasons all anabolic steroids are tightly regulated by the government. Examples of synthetic testosterones include methyltestosterone, Anavar, Nandrolone, and other androgenic steroids.

Side effects of bioidentical testosterone replacement are erythrocytosis, or overproduction of red blood cells which can lead to “thick” blood. Although testosterone was once thought to be a cause of prostrate cancer that theory has been discredited. Nonetheless a yearly digital rectal exam and PSA level is recommended. Remember that most recent studies have shown that men with the highest testosterone levels have the lowest mortality rates.

Natural Therapies

There are other methods of increasing testosterone besides direct hormone replacement. For some, increasing testosterone by supplementing the body’s depreciated blood level with natural supplements is preferable to seeing a doctor and getting a prescription for bio identical testosterone. Exercise and diet play a big role, especially since increased fat stores increase male estrogen. A food to avoid for most men is soy, since soy increases estrogen. Foods such as meats and milk in which the animals have been exposed to hormones also contribute to increasing estrogen levels in males including breast development. Therefore dietary changes which include avoiding soy and using only meat and milk products marked hormone free can be helpful. Xeno estrogens are manmade compounds that increase estrogen. Some of the 100,000 registered chemicals for use in the world have hormonal effects in addition to toxic and carcinogenic effects. They are found in plastics such as bisphenol -A, pesticides and common chemical compounds used in the home. Avoiding these compounds is also advisable.

Nutrients supplements can also increase testosterone availability, often by affecting testosterone’s interaction with SHBG. A large proportion of the testosterone that circulates in your body is bound by a protein call SHBG (sex hormone binding globulin). Remember only testosterone that is free has an effect on the body. Tongkat Ali , dubbed the Asian Viagra, raises the body’s levels of free testosterone possibly by decreasing SHBG. Men may also want to try maca, which is a potato-like herb/fruit from Peru that has been known to naturally increase hormonal levels, particularly testosterone, in both men and women.

One reason testosterone production may decline is because of oxidative damage directed at the tissues that synthesize testosterone. A Chinese study examined the role of antioxidants in male hormone imbalance or partial androgen deficiency of aging men. The article’s authors note that antioxidants (including vitamin A, vitamin E, zinc, and selenium) all support testosterone production. Zinc is related to testosterone levels. In one animal study, rats subjected to an acute swimming test were either supplemented with zinc or placebo. The study showed that zinc supplementation led to significant increases in testosterone levels and athletic performance . Among humans, zinc supplementation in a group of male wrestlers prevented the depletion of testosterone after exertion . Additional studies have suggested that zinc is important to the synthesis of testosterone. Although chrysin is a known inhibitor of aromatase, in one study it did not result in the expected increase in testosterone levels (Gambelunghe C et al 2003).

For many the ability to live well and feel good is as important as how long they live. Many boomers have memories of their grandparents living out their last years in misery from depression, fatigue and pain. Upon learning that some of that misery may have simply have been due to declining hormone levels their natural reaction is NOT ME! I see patients every day who state when it’s my time to go fine, let me go. But until then I want to dance, I want to laugh, I want to enjoy my spouse and keep up with my grandchildren when they come to visit. And if that is not happening let’s fix it. And one of the simplest ways to fix it is to correct the hormone level. In the case of testosterone it appears after that after nearly sixty years of use that testosterone replacement is safe and effective, and that for many men may in fact may be the key for a long and beneficial life.

Mary Ackerley MD, MD(H), ABIHM is a board certified psychiatrist specializing in hormone replacement, depression, anxiety and natural weight loss.

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