While the idea of “man-o-pause” may seem like the punch line of a joke, late-onset hypogonadism, or andropause at it is commonly called, is a concept gaining much attention in the medical field today. Andropause refers to the decline in testosterone that occurs as men age. This decline has been linked with many health problems such as fatigue, depression, memory issues, and sexual dysfunction. There is much debate whether this is a natural process that should be accepted as one ages or a medical diagnosis worthy of treatment. Here is what you should know about the truths and myths behind andropause.
Male menopause? Really?
Don’t let the similar names fool you. While both menopause and andropause are associated with a decline in sex hormones, they are two very different entities. Many women experience abrupt onset of severe menopause symptoms in their mid 40s to 50s, however, andropause tends to be a more gradual process of hormonal decline starting around age 40. Men may experience a slow onset of symptoms such as fatigue, concentration problems, and decreased libido. These symptoms may be so vague and gradual that the man might not even notice them at first. While menopause signals the end of a woman’s ability to bear children, men can still reproduce as their testosterone declines, as evidenced by men like Hugh Hefner and Larry King fathering children well into their 60s.
What is testosterone anyway?
Testosterone is the principal male sex hormone which is primarily made in the testicles. Women have some natural levels of testosterone as well, though in much smaller amounts than men. In men, testosterone is responsible for the development of the male reproductive organs as well as the lowered voice, increased body hair and muscle mass associated with puberty. In adulthood, testosterone is necessary for bone health, muscle health, cardiovascular health, sexual function, mood and energy level. Testosterone is an anabolic steroid, so in very high levels we see changes commonly associated with athletic steroid use: aggression, muscle bulk, acne, and increased sex drive. Testosterone also increases the number of red blood cells in the blood, which brings more oxygen to the body for use during exercise, which is why athletes are at an unfair advantage when they dope up with high levels of steroids before an event.
What are signs of low testosterone?
Signs of low testosterone in the fourth and fifth decades of a man’s life are depression and mental fatigue, lowered sex drive, decreased muscle strength (including the heart) and decreased bone density. These changes happen gradually as one ages and testosterone naturally declines. Elderly men tend to have less muscle mass and bone density, and less strength, stamina, and libido than they did in their younger years. Where do we draw the line between natural aging and a problem that needs to be treated? Unfortunately there is not one clear answer to this question, and this topic needs to be discussed between a man and his doctor. If you think testosterone replacement would benefit you or a loved one, consider finding a qualified provider.
Who is at risk for low testosterone?
While all men experience a gradual decrease in testosterone with age, men with certain health conditions including diabetes and obesity seem to be more likely to have below-average levels of testosterone. It is unclear whether these conditions actually cause low testosterone, or if having low testosterone puts you at risk for developing these conditions. Other medical conditions that put men at risk for low testosterone include injury to the testicles, testicular cancer, and certain infections.
Should you believe the hype about testosterone replacement?
If you watch Dr. Oz or have been paying attention to internet pop-up ads lately, you may be aware that testosterone replacement is a hot topic right now. Many men credit testosterone with giving them their quality of life back, and some doctors tout its use in preventing age-related bone and memory loss, among other benefits. Other medical professionals consider testosterone replacement a trendy yet dangerous therapy without much research behind it. Whichever camp your doctor subscribes to, it should be known that testosterone replacement is not without risk. It is very important to use doses similar to what the body produces. Many providers will use products with doses as high as 50-150 mg which is ten times what a young man’s testes produce daily (5-10 mg). Side effects of high dose testosterone include acne, breast enlargement, aggression, hemochromatosis and mood swings. If a man and his doctor decide that testosterone replacement is right for him, he will need to be monitored closely with routine tests to make sure his hormone levels stay in range and he tolerates the treatment well.
If you are looking for a doctor who specializes in safe, low dose bio identical hormone replacement therapy, check out the WIBI provider locator tool.
Are there natural alternatives to balance male hormones?
Some of the best tools we have to combat the effects of andropause are good old-fashioned diet and exercise. As previously mentioned, there is a well-established link between low testosterone and lifestyle-related diseases such as diabetes and obesity. Fat cells actually convert testosterone into estrogen, thus decreasing testosterone levels in the body. Many men can turn around their andropause-related symptoms by incorporating regular moderate exercise and a whole foods diet into their daily lifestyle. It should be noted that men will get more of a testosterone building benefit from muscle building exercises like weight lifting rather than aerobic exercises like running. Alcohol, especially hops-containing beers, also have an estrogenic (and thus testosterone-lowering) effect in the body, so cutting back on alcohol consumption may be an important step in maintaining healthy testosterone levels in some men.
Specific herbs and supplements can also help balance hormones and decrease andropause symptoms. Herbs such as tribulus, epimedium (aptly named “horny goat weed”), and ginseng may all have beneficial effects in men with low testosterone. Supplements such as zinc and vitamin D are also being used to combat the effects of andropause. Keep in mind that each patient is an individual, and a doctor should always be consulted when determining whether or not to treat andropause symptoms, and before incorporating any herbs, supplements, or hormones into a daily routine.
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- Nicolai P. Emerging Trends in Men’s Health. Class Lecture. Grand Rounds. National College of Natural Medicine, Portland, OR. 10 June, 2013.
- Snyder PJ. Overview of testosterone deficiency in elderly men. In: UpToDate. Martin KA, ed. UpToDate; 2013. Available at: http://www.uptodate.com. Accessed July 6, 2013.
- Yarnell E. Naturopathic Urology and Men’s Health. Wenatchee, Wa: Healing Mountain Publishing; 2001.
By Niki Rarig, NCNM Naturopathic Medicine Program edited by Dr Elise Schroeder