Men change gradually- its called 'Andropause'

Men’s Health NZ: Andropause

andropause – testosterone nz

Women are not the only ones who suffer from the effects of changing hormones and aging—men do, too. This decrease can even have people looking for testosterone boosters because they don’t feel like they used to. Because they do not go through a defined period referred to as menopause, doctors refer to this stage in men as andropause.

Men definitely are less health and prevention oriented than women, part cultural and part just being male. Bullet-proofing only lasts until the flak-jacket fails. Even then acceptance of medications and supplements is not high on priority stakes for most men. Fortunately for the cave-master, the cave-CEO is there to ensure compliance. Thank goodness for wives and partners!

Men are more than ever discovering that their potential mentally and physically is not ensured as of male right for ever and taking action can optimise, even enhance robust health. I see men’s lives completely change with attention to diet, weight loss and optimising their testosterone on treatment.


fatmensitAs men age, and there are great variations in the rate of physical and mental decline both from male to male and over different age ranges. We all have seen friends who seem younger than their age and the converse, looking aged far beyond their years. This     equally applies to females. The key to most of the issues of poor health, accelerated ageing etc is inflammation in affected parts of the body. It is this that must be reduced by a great diet, detoxification, hormone balancing and targeted supplements.

What influences male health decline

  • Genetic inheritance
  • Gene expression and polymorphisms (individual variations)
  • Gene telomere shortening speed
  • Ethnic bloodlines
  • Hormone production
  • Occupation
  • Diet
  • Toxin exposure
  • Stress and lifestyle, smoking, excess alcohol
  • Socio-economic factors
  • Micronutritional health – eg protection against cell damage

Typical symptoms would be:

  • Tiredness – physical and mental
  • Unhappiness even mild to severe demandepressedpresson
  • Decline in physical strength and muscle size
  • Change in body shape and tone
  • Less social
  • Irritable
  • Poor sleeping
  • Declining sexual function – less effective erections, less satisfying sex
  • Urinary changes – slow, less force, more night urination
  • Night sweats or changes in temperature control

Do the full Male Hormone quiz>

Review the Anti-ageing protocols (Page)

mantapegutDiet – one of the best diets is the Mediterranean, or more lately the ‘Palaeo’ Diet. Some go beyond the Mediterranean and with many great recipe books available, a mostly plant based diet, according to very credible research, is best if it suits you – for others an 80:20 (plant:animal protein) works well. Many chronic illnesses have been markedly improved even ‘cured’ on plant food. Books by Weston Price, Dr Esselstyn and his ‘Heart Disease Reversal’, Dr Perlmutter–explain why.

The key point is removal of the man killer, SUGAR and excess carbs, which turn into SUGAR. Dietary advice has been flawed for 30 years – with the fixation on FATS, which in now have been proven to  NOT cause high cholesterol nor increase heart risk. Dont go extreme and upsize on fat  – its all moderation. The fat guy above eats too much, exercises little, has bad genes, and consumes lots of alcohol which turns to SUGAR too.

manfatreclineExercise – Unquestionably important to maintain cardiovascular fitness. Preferably something you enjoy. No point signing up at the gym if you dont enjoy going. Maybe you prefer regular gardening, landscaping, cycling etc. Perhaps own a treadmill, rower or exercycle and listen to the iPod or watch TV to allay the boredom of it! You will get to enjoy exercise for feeling better, less tired and a sharper brain. Takes 6 weeks. Yep, he’s got the idea but just forgot the treadmill! 
PS. Ive noted at Anytime Fitness, when on the treadmill or cross-trainers, you can actually take real-time runs through various world parks, cities and trails – love it! Cant wait till it comes  in 3D headsets..

Weight training  – can restore muscles again to young  adult size as long as you have good nutrition and optimum hormone levels. This photo is a 60+ year old. Doesn’t take that long actually to look like that – you just do it! No its not me – good guess though!

fit older men

  • Cardiovascular fitness
  • Sport specific programs
  • Body For Life
  • Muscle development programs
  • Corporate Programs
  • Weight Loss

Workup

It is best to take a General Health Questionnaire, as well as full Hormonal Questionnaires – when you’re ready go to the Downloads Page when you have finished reading for a list of Health Checklists. Then an appointment at the Clinic.

Hormone Treatment

If the criteria are met – men can proceed with TESTOSTERONE treatment.

Male hormones are termed ‘androgens’ as they confer male or androgenic features. The common ones are testosterone (T), dihydro-testosterone (DHT), androstendione (A’dione), dehydroepiandrosterone (DHEA) – but dont forget we do have a little oestrogen too – helps understand the female psyche!

Mostly produced by the testes, but also by adrenals and fatty tissue, these hormones gradually decline as the testicle Leydig cells fail. There are 700 million of these at 18 and only a third left by 70. It is not just the amount of hormone we have but also how efficiently the homone can access cell receptor sites and the actuall health of the cell to respond!

Steroid Hormone chart thumbClick the Hormone Chart for the biochemistry details of ‘what goes where.’ 

So what happens to men when they lose their hormone levels?

Its termed the ‘Andropause’ or ‘male menopause’. Unlike the typical     female menopause men usually dont have a relatively sudden onset of symptoms. Rather, men develop gradual changes which usually     are either not noticed as such or put down to ‘getting older’ – or other more derogatory names!.

Treatment Strategies

Treatment

Men need a full medical history taken (see in Downloads) and general medical examination including prostate examination if it hasnt been  done recently.

Then general  blood work with attention to hormones. Other medical examinations may be required depending on  history:

  • Health Questionnaire
  • Physical examination including DRE (digital rectal examination – yes everything is going digital these days)
  • ECG, Treadmill heart test, Calcium Scan heart test or CT Angiogram, Chest X-ray, if indicated
  • Blood tests full range including hormones Testosterone, DHEA, Estradiol (an important oestrogen that men need too)
  • Further 24 hr urine tests or Dried Urine Test for Comprehensive Hormones (DUTCH test – see website) can be done as an option for an in depth look at the total androgen hormone system
  • Prostate screening – PSA, DRE, Ultrasound and Flow tests if indicated

What is it and how is it made

Testosterone, the predominant male hormone, can convert into DHT (dihydrotestosterone) by the enzyme 5-alpha-reductase. DHT is the most potent male hormone, producing male characteristics of virile body, beard growth, voice, male hair pattern, penis and erections and so on.

Testosterone can also convert, by the enzyme aromatase, into estradiol, the female hormone which feminises; enlarging breasts, increasing female body fat pattern, reducing hair, voice, increases libido etc.

Neither DHT or Estradiol can be converted back once changed.

Men produce about 30mg a day, 20-30 times more than women. Levels are higher in the morning hence the morning erections men have. The majority of T is produced in the testes under control of pituitary LH hormone. Small amounts can be made from the adrenal gland and fat tissues from DHEA and other androgens.

Testosterone metabolites (breakdown products) mainly are:

  • Androstenediol (blood tested)
  • Androsterone (urine tested)
  • Etiocholanolone (urine tested)

What does T do

  1. It is an androgen (male) group hormone, producing all the virilising characteristics of maleness and reproductivity
  2. T protects against heart disease and the vascular system. It is anti-atheroma, protecting blood vessels. Men with higher levels of T have less heart disease.
  3. It protects against developing diabetes and obesity by reducing fat mass and increasing muscle mass. It assists the transfer of glucose into muscles, brain and other tissues.
  4. T is good for the brain, increasing blood supply. It improves memory and cognitive brain function (better processor RAM !)
  5. It may protect against prostate cancer – still debated.

What affects T production and levels

  • Intense and prolonged physical activity, very frequent sex, can ‘burn’ more T and possibly deplete for a while.
  • Intense emotional stress can reduce T by blocking LH release hormone, happiness can increase it.
  • High sweet sugar diet and very high fibre diet can reduce T whereas high protein and good fats increase it.
  • Ageing reduces T gradually as testicle cells die off, and the symptoms of deficiency develop.
  • Studies show that men with higher levels of T have less prostate cancer. Testosterone DOES NOT cause prostate cancer – cancer cells may need T to grow but that’s quite a different story. Refer to the cancer page.
  • Being fat, especially the gut,  also increases production of oestrogens, too much, so the feminising effects – man-boobs, failed erections, reduction in penis size, less beard growth and perhaps some of the mood changes already mentioned.

Common symptoms of deficiency in men

For a full list refer to the Hormone Questionnaire.

  1. Ageing appearance of face and body, increasing abdominal obesity
  2. Loss of muscles and strength – more prone to injury
  3. Tiredness, fatigue worse with activity
  4. Loss of mental drive, cant be bothered any more, loss of assertiveness
  5. Memory worsening, can’t concentrate
  6. Poor erections or none at all, loss of sensations, reduced sex drive
  7. Even hot flushes and upper body sweats
  8. Moodiness, depression, anxiety, worrying more, even crying spells
  9. Can become socially more withdrawn

Most successful is the use of Testosterone transdermal creams and gels applied daily to the skin. Termed Bio-identical as they are exactly the same as human. Skin route is best as the T bypasses  the liver where it can be converted into other byproducts (metabolites) – refer to the DUTCH TEST. 

Injectable testosterone can be used for worse levels of deficiency and if higher levels are needed quickly. Also good if transdermal creams aren’t working.

For our patients on testosterone – We supply a Testosterone Protocol

Precautions

  • Don’t use if prostate cancer or possibly any other cancer – do regular checks
  • Caution with enlarged prostate causing obstruction to urination
  • Caution with prostate infection

Follow Up

Close supervision with regular blood work monitoring PSA, T and E levels for conversion.

Sometimes hormone lab results can be very misleading especially with Transdermals – routine blood testing is more useful for body’s own testosterone. Urine DUTCH test is best.

What about the PROSTATE !

Heart disease and cancer are the most likely catastrophes a man may encounter right when he least needs this – middle-age, kids grown up, planning more leisure time after all those years of long hours of work. Of the cancers, colon and prostate are highest. Prostate cancer Pca is generally very slow growing – on occasion it can be aggressive and fast.

Avoidance is a better proposition than later hospitals, doctors, IV drips, unpleasant physical intrusions, surely. Did you know that men with higher testosterone levels have less heart attacks and prostate cancer! We shall explore ways to help to avoid the prostate cancer trip.

Refer to the page on Prostate Cancer for more information.

There has always been reluctance from mainstream to prescribe testosterone for middle-aged or older men because of possible adverse effects. Chief suspect of course was prostate cancer. IN this case, indeed, most prostate cancer cases will be accelerated by the body’s own testosterone and presumably any extra taken. The operative word is accelerated NOT caused! So much so that treatment includes drugs to lower testosterone.

Another potential risk was accelerated heart disease. In some men, the blood haemoglobin can increase with T supplementation which may increase risk of arterial blood clotting.

Here is a reprint from a 2015 medical article:

Introduction

Low testosterone can negatively impact quality and quantity of life in men.[1–3] Treatment of hypogonadism with testosterone therapy (TT) has been shown to improve muscle mass and strength, sexual function and desire, mood, bone mineral density and mortality.[3–7] However, there remains concern about possible negative health effects of TT.

Int J Impot Res. 2015;27(2):46-48. 

The current report found no increased risk of death for men on Testosterone Therapy  (TT) for up to 15 years. Moreover, on subgroup analysis, there was no difference in risk based on the type of TT or baseline testosterone levels.

(TT) has been shown to benefit men in quality-of-life measures such as sexual function and desire and mood.[3,13,14] In addition, health benefits have also been demonstrated including increased muscle mass and strength, bone mineral density and even overall mortality.[4–6,10]
Despite benefits, there are concerns about the risk of TT for cardiovascular health.
Moreover, given that dyslipidemia and polycythemia can result from testosterone, biologic plausibility does exist for a higher incidence of cardiovascular disease.

The current report suggests that TT does not alter mortality risk in men. Indeed, all subanalyses that compared testosterone methods and baseline patient characteristics demonstrated no alteration in mortality risk. On subanalyses, cardiovascular mortality did not show any trends toward increased incidence with testosterone.

However – 

Another report from a major journal says:

(JAMA Intern Med. Published online May 11, 2015.)

Compared with men using testosterone gels, men receiving testosterone injections were more likely to have a cardiovascular event (myocardial infarction, stroke, or unstable angina), be hospitalized, or die within a year of starting treatment. Rates of venous thromboembolism did not differ between the formulations.

The increase was statistically small yet valid. Men should use gels and creams where possible. If on injections  – ensure you have regular checkups and blood tests especially in the first year.

And simply keep T levels in the normal ‘physiological’ range – which is the whole idea of replacement therapy. 


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