WHAT TO DO ABOUT MALE MENOPAUSE
"The existence of the so-called 'andropause' is an irrefutable fact. Testosterone production decreases as a function of age, but this decrease is not universal. Several clinical manifestations are associated with hypogonadism, but these are not solely attributable to hypogonadism. Other hormones (i.e. dehydroepiandrosterone, growth hormone, thyroxine and melatonin) also decrease with age. Such multi-hormone alterations are closely inter-related and may influence 'andropause-related' symptoms." From the December, 2004 issue of Aging Male (Andropause or Symptomatic Late-Onset Hypogonadism: Facts, Fiction and Controversies)
"There are several problems facing aging men, especially sexual dysfunction, hypogonadism, and psychologic changes. Unlike the dramatic changes in the hormonal milieu occurring during menopause in women, the age-related changes in reproductive hormones of men are subtle and occur gradually throughout the years of mature life." From Management of the Cardinal Features of Andropause from a 2006 issue of the American Journal of Therapeutics
Let me first say that while it is usually at least a part of the picture, this is not simply an issue of "LOW T". What I am talking about here are the array of changes that occur to all of us men as the birthdays click by. Although to some degree, these changes are inevitable, there are any number of common-sense things you can do to hold on to your youthfulness longer and slow the aging process to a crawl. Today we'll take a look at what some of the experts in the scientific community have to say about the phenomenon of "Male Menopause" called Andropause, what it is, how to combat it, and possibly even reverse it.
Although Heller and Meyers wrote an article for the October 1944 issue of the Journal of the American Medical Association (Male Climacteric --- climacteric is the medical word for menopause), the topic largely languished until twenty years ago next month, when one of the many journals published under the umbrella of the British Medical Journal (the Postgraduate Medical Journal) released a study called The Andropause: Fact or Fiction? Before telling readers that Andropause was mostly the result of "fatigue" and "stress," the authors essentially pooh poohed the problem, saying "The so-called andropause is an ill-defined collection of symptoms in a group of men who may have low but may also have normal androgen levels." Fourteen years later, the journal Climacteric published a study called Male Menopause: Is it a Real Clinical Syndrome? in which they concluded that, "only a minor fraction (2%) of elderly men suffer from this clinical syndrome."
More recently, however, studies have shown that the male Andropause is indeed a real entity. And while Andropause has certainly become a marketable / profitable "disease," peer-review has clearly shown it to be linked to a variety of health problems. Just be aware that of all these problems, they can essentially be boiled down to two, inflammation and insulin resistance --- two problems that not only drive each other, but drive a myriad of other health issues as well.
ANDROPAUSE & INFLAMMATION
ANDROPAUSE & BLOOD SUGAR
"The most common cause of erectile dysfunction (ED) is penile vascular insufficiency. This is usually part of a generalized endothelial dysfunction and is related to several conditions, including type 2 diabetes mellitus, hypertension, hyperlipidemia, and obesity. These conditions underlie the pathophysiology of metabolic syndrome (MetS). Hypogonadism, or testosterone deficiency (TD), is an integral component of the pathology underlying endothelial dysfunction and MetS, with insulin resistance (IR) at its core."
Here is another problem for the aging male. Because most testosterone is bound to SHBG (Sex Hormone Binding Globulin), and because free or unbound hormone is the hormone that really matters no matter what hormone we are talking about, the fact that as males age, testosterone is much more likely to be bound to SHBG, creates a situation where we automatically have less "usable" T. And then there's the issue of aromitization.
Aromatase (aka estrogen synthase) is the enzyme that catalyzes androgens into estrogens. While a certain amount of this is good, normal, and necessary, just remember that either of the two factors above (inflammation or insulin resistance, not to mention obesity) automatically upregulates aromatase activity, causing increased levels of estrogen in males, which actually restarts the cycle since abnormal ratios of sex hormones are themselves inflammatory.
It's a big part of why I recently wrote the crazy-interesting article about SUGAR'S ABILITY TO TURN MEN INTO WOMEN AND WOMEN INTO MEN. Men who are over-aromatizing are going to have characteristics typically thought of as female --- excess fat on hips / butt, over-emotional, hot flashes or sweating for no good reason, moobs (man boobs), etc. Just be aware that there are a myriad of other characteristics of the Andropause, many of them easy to confuse with other problems.
- ANDROPAUSE IS LINKED TO OTHER "GERIATRIC" SYNDROMES: In the March 2013 issue of the journal Maturitas (A View of Geriatrics Through Hormones. What is the Relation Between Andropause and Well-known Geriatric Syndromes?), researchers linked Andropause to, "frequent geriatric syndromes such as falls, osteoporosis, cognitive and mood disorders, anemia and cardiovascular disease." Authors of the 2012 study in Minerva Medica (Andropause -- Androgen Deficiency of the Aging Male: Diagnosis and Management) let readers know that, "it is a pathological syndrome and should not be viewed simply as a stage in physiological aging." I would agree. While I undoubtedly see Andropause looked at by a segment of the medical community as a meal ticket (a billable ICD-10 CODE), these authors are right; it is pathological. Most people have gotten far too used to the idea that we men are supposed to fall apart and not be able to "get it up" after a certain age.
- ANDROPAUSE IS LINKED TO ANEMIA: We know that women get anemia due to the amount of monthly bleeding they do over their lifetimes, and that said anemia can be a deal-breaker as far as solving chronic health issues is concerned (HERE). What many don't realize is that hormonal issues (in this case Andropause) are sometimes associated with anemia in males as well. A Dutch journal that I will not even attempt to pronounce, let alone spell, published a study in 2012 called Unexplained Anemia in Men: Be Aware of Hypogonadism. The authors concluded that, "Testosterone exerts anabolic effects in multiple organ systems; in bone marrow it potentiates the stimulatory effect of erythropoietin on erythropoiesis. Primary hypogonadism frequently occurs in elderly patients, while secondary hypogonadism is frequently seen in middle-aged men with type 2 diabetes mellitus and obesity." In other words, as your male hormones slide south, it not only affects your sex life, it affects your organ systems as well.
- ANDROPAUSE LINKED TO AUTOIMMUNITY: Take a gander at this amazing study from the November 2013 issue of Clinical Immunology (Autoimmune Diseases and Reproductive Aging). "Testosterone’s impact on the immune system is, on aggregate, anti-inflammatory. Studies of autoimmune disease onset and course during reproductive transitions such as puberty and pregnancy have highlighted the modulatory role of gonadal hormones. In men, lupus, rheumatoid arthritis (RA), and multiple sclerosis (MS) are associated with lower androgen levels." The thing is, while RA, MS, and LUPUS are some of the bigger-name heavy-hitters in the AUTOIMMUNE FAMILY, there are about a jillion others (HERE) --- thousands of them unnamed simply because no one has figured out the auto-antigen or how to test for it yet. By the way, this study was mostly about women and the increase in autoimmunity seen after menopause (testosterone is diminished in aging women as well as aging men, and happens to also be the driving force in women's libido, unless there are pathological amounts present due to PCOS, which effectively squelches female sex drive).
- ANDROPAUSE LINKED TO TYPE II DIABETES: There is no possible way we could be surprised by this bullet. For instance, we already know that if 55% of the adult population of California has either diabetes or pre-diabetes, it's likely that most of the rest of the nation is even higher (HERE). A study from the British journal Diabetic Medicine (Andropausal Symptoms in Men with Type 2 Diabetes) reiterated this connection when it concluded five years ago this month that, "The Pittsburgh Sleep Quality Index was higher [worse] in patients with neuropathy than without. The Self-Rating Depression Scale was higher [worse] in patients with advanced retinopathy. The International Index of Erectile Function was lower [worse] in patients with advanced retinopathy and nephropathy. The International Index of Erectile Function was lower and the International Prostate Symptom Score was higher [both worse] in patients with cardiovascular disease than without. Our data demonstrated that men with Type 2 diabetes have higher prevalence of andropausal symptoms, especially those with diabetic complications." But you already knew most of this (HERE and HERE) since the majority of health issues --- particularly ENDOCRINE PROBLEMS --- get started thanks to our bodies not being able to keep up with the mass quantities of sugar and processed carbs we continue to foist on ourselves.
- ANDROPAUSE LINKED TO TYPE II DIABETES PART II: Want to see the whole thing working together to create a nightmare? A 2008 issue of The Aging Male (Hypogonadotrophic Hypogonadism in Type 2 Diabetes) put this whole scenario together when stating in the abstract (cherry-picked) that, "Recent work shows a high prevalence of low testosterone concentrations in type 2 diabetes. This is associated with obesity in patients with type 2 diabetes. C-reactive protein (CRP) concentrations have been shown to be elevated in [these] patients and are inversely related to plasma testosterone concentrations. This inverse relationship between plasma free testosterone and CRP concentrations in patients with type 2 diabetes suggests that inflammation may play an important role in the pathogenesis of this syndrome. This is of interest since inflammatory mechanisms may have a cardinal role in the pathogenesis of insulin resistance. Low testosterone concentrations are also related to an increase in total and regional adiposity." Once you see how adipose tissue (fat) acts as its own hormone-producing endocrine system (HERE), you start to see how freaky this whole thing becomes, rolling down the hill like a snowball gathering size and speed. By the way, in the decade since this study was published, there have been dozens of others, all coming to similar conclusions.
- ANDROPAUSE LINKED TO OSTEOPOROSIS: Although we don't typically associate problems like OSTEOPOROSIS with men, you need to remember that osteoporosis is not a female issue, but an "inflammatory" issue (HERE), that is greatly fed by sedentary lifestyles, obesity, and LIVING THE HIGH CARB LIFESTYLE. A year ago this month, the Journal of Postgraduate Medicine bore this out in a study called Severity and Pattern of Bone Mineral Loss in Endocrine Causes of Osteoporosis as Compared to Age-related Bone Mineral Loss. The authors concluded that, "A large number of endocrinopathies are known to be associated with impaired bone health." After listing some of these (THYROID ISSUES, both kinds of diabetes, problems associated with the HPA-AXIS, etc), the authors suggested Calcium with Vitamin D as a solution. Before following this advice, make sure to learn about the absolute very best calcium supplement available anywhere (HERE).
- ANDROPAUSE LINKED TO HEART / CARDIOVASCULAR PROBLEMS: If, as we saw earlier, it's true that lower levels of androgens lead to systemic degradation of all organs and organ systems, it would make sense that the heart and blood vascular systems would be included in this list. Not only did a study from a 2015 issue of Andrology reveal that we could actually use testosterone levels to "predict major adverse cardiovascular events during long-term follow-up," but a 2011 study published in the Journal of Geriatric Cardiology stated that, "increasing data has emerged that revealed the effects of low levels of androgens on cardiovascular disease progression. As an example, low levels of testosterone have been linked to a higher incidence of coronary artery disease". In an article titled The Male Andropause, Charles Evans (MD / Ph.D) put it this way. "It is now well accepted that women’s risk of atherosclerosis (hardening of the arteries) and cardiac events increases after menopause. New evidence suggests that a similar phenomenon occurs in men as their testosterone levels diminish with age. Research thus far point to a strong association between low-testosterone levels and an increase in cardiovascular risk in men." Be aware that there are lots of studies linking heart and cardiovascular issues to "Low T". Also be aware, however, that there are likewise lots of studies linking supplemental testosterone to cardiovascular problems as well.
- ANDROPAUSE LINKED TO NEUROLOGICAL AND NEURO-ENDOCRINE DEGENERATION: The long title of this study from the November 2015 issue of Hormones and Behaviour (The Endocrine Dyscrasia that Accompanies Menopause and Andropause Induces Aberrant Cell Cycle Signaling that Triggers Cell Cycle Reentry of Post-mitotic Neurons, Neurodysfunction, Neurodegeneration and Cognitive Disease). Endocrine dyscrasia is an age-related dysregulation of the hypothalamic-pituitary-gonadal (HPG) axis and is associated with abnormal neurological function as well as neurodegenerative changes in the brain. "Sex hormones are the physiological factors that regulate neurogenesis during embryogenesis and continuing through adulthood. These hormones support the formation of brain structures such as dendritic spines, axons and synapses required for the capture of information (memories)." Without getting into incredible detail, suffice it to say that inflammation commonly seen in Andropause leads to the changes that leads to cognitive dysfunction, an inability to concentrate, and even dementia. It's not a coincidence that Alzheimer's Disease is actually known in the medical research community as TYPE III DIABETES. Think I'm exaggerating the link between Alzheimer's and Andropause?
- ANDROPAUSE SPECIFICALLY LINKED TO ALZHEIMER'S DISEASE: This link is not new information. The February Y2K issue of PNAS showed via the study's title (Testosterone Reduces Neuronal Secretion of Alzheimer's β-amyloid Peptides) that male sex hormone is preventative against the brain plaques associated with Alzheimer's. And while there are literally scores of similar studies, a 2005 issue of the Annals of the New York Academy of Sciences (Effects of Testosterone on Cognitive and Brain Aging in Elderly Men) concluded that, "evidence suggests that testosterone loss may be a risk factor for cognitive decline and possibly for dementia. Conversely, the maintenance of higher testosterone levels either endogenously or through exogenous supplementation may prove beneficial for cognitive and brain function in elderly men." Because exogenous testosterone has proven dangerous and rife with SIDE EFFECTS, increasing your own "endogenous" testosterone is definitely the way to go. Here is another having to do with MICROGLIAL CELLS from the May 2009 issue of Neurologic Clinics (Age and Neuroinflammation: A Lifetime of Psychoneuroimmune Consequences). "The literature indicates that the innate immune cells [Glial Cells] of the brain become more reactive with age. Although it is unclear how glia reactivity increases, emerging evidence suggests these alterations allow exacerbated neuroinflammation and sickness behavior following peripheral immune activation. This amplified or prolonged exposure to inflammation in the brain may impair neuronal plasticity and underlie a heightened neuroinflammatory response in the aged that also may lead to other neurobehavioral impairments such as delirium, depression, and, potentially, the onset of neurologic disease." Neurologic disease? Can anyone say Alzheimer's? Unfortunately, it's only one of many.
- ANDROPAUSE IS LINKED TO POOR BLOOD FLOW TO THE BRAIN: One of the classic signs of Andropause is sexual dysfunction. For twenty years now, men (and probably in many cases, their wives) have been enamored with Viagra or similar type drugs --- drugs that increase blood flow, allowing impotent men to have sex while under its effects. Unfortunately, diminished blood flow is another fact of aging, but a fact that also happens to be heavily associated with inflammation-associated issues as well. The April 2009 issue of Brain Research (Resting Cerebral Blood Flow, Attention, and Aging) showed that, "Aging is accompanied by a decline of fluid cognitive functions, e.g., a slowing of information processing, working memory, and division of attention. This is at least partly due to structural and functional changes in the aging brain. Although a decrement of resting cerebral blood flow (CBF) has been positively associated with cognitive functions in patients with brain diseases" Several months later, the August issue of the International Journal of Geriatric Psychiatry (Longitudinal Study of Chronic Depressive Symptoms and Regional Cerebral Blood Flow in Older Men and Women) concluded that, "Late-life depression is associated with alterations in regional cerebral blood flow... Higher average depressive symptoms were associated with longitudinal CBF decreases..." This means that the next bullet should come as no surprise either.
- ANDROPAUSE IS LINKED TO DEPRESSION: A year and a half ago, the December issue of Aging, Clinical, and Experimental Research asked a question via the title of a study; Are Andropause Symptoms Related to Depression? Their conclusions? Not only was it related, but the authors said that, "Based on our results, there is a direct association between andropause symptoms and depression, where the increasing Aging Males Symptoms Scale score corresponds with the severity of depression." The point here is that you can never forget that Depression is yet another of the numerous diseases that fall under the umbrella of inflammation (HERE and HERE).
I could go on, but hopefully you are getting the point. Andropause is one of those physiological realities that we cannot completely get away from. However, we can certainly buffer it's effects. This raises the question of what it takes to turn this mess around (or better yet for you young bucks, prevent it before it starts)?
CONVENTIONAL AND NON-CONVENTIONAL TREATMENT OF ANDROPAUSE
"The promise of testosterone therapy may seem enticing, but there are a lot of misconceptions about what the treatment can and can't do for you. As you get older, testosterone therapy may sound like the ultimate anti-aging formula. Yet the health benefits of testosterone therapy for age-related decline in testosterone aren't as clear as they may seem. Testosterone therapy has various risks. For example, testosterone therapy may contribute to sleep apnea — a potentially serious sleep disorder in which breathing repeatedly stops and starts, cause acne or other skin reactions, stimulate noncancerous growth of the prostate (benign prostatic hyperplasia) and growth of existing prostate cancer, enlarge breasts, limit sperm production or cause testicle shrinkage, and increase the risk of a blood clot forming in a deep vein (deep vein thrombosis), which could break loose, travel through your bloodstream and lodge in your lungs, blocking blood flow (pulmonary embolism)" From the Mayo Clinic (Testosterone Therapy: Potential Benefits and Risks as You Age)
"In the United States, approximately 43 percent of women and 31 percent of men experience sexual dysfunction. It is not surprising that testosterone, primarily used to treat sexual problems, is being prescribed more often than in the past; a 500 percent increase in sales has been documented from 1993 to 2001. However, testosterone therapy is controversial." From a position paper by the American Family Physician (Testosterone Treatments: Why, When, and How?)
"Record numbers of men are turning to testosterone replacement therapy to increase energy levels, muscle mass and sex drive. However, boosting levels of the manly hormone can cause serious health risks, including heart attack, stroke, prostate cancer and even death. Drug companies heavily market their products promising men increased vitality, strength, sex drive and an overall better quality of life. The reality, however, is that testosterone therapy can cause a number of health complications that, some doctors say, might not be worth the benefits. Studies and clinical trials have linked the drugs to heart attacks, blood clot injuries, stroke and an increased risk for prostate cancer, among other health reactions. Evidence from published studies and expert input from an advisory committee prompted the U.S. Food and Drug Administration (FDA) to require labeling changes to reflect some risks associated with use of testosterone products. Still, critics say even more warnings about side effects are needed." From Drugwatch dot com (Testosterone Therapy Side Effects)
This is particularly problematic once you realize that most of the bullet points mentioned earlier cause Low T as a secondary function --- as a side effect. Primary Hypogonadism (men whose testicles cannot make enough testosterone due to primary problems with the pituitary, hypothalamus, FSH, LH, or receptor site issues) is much more rare when compared to the scenario(s) we've been describing (Secondary Hypogonadism). This is almost exactly what I showed women concerning HORMONE REPLACEMENT THERAPY (HRT) just a few short weeks ago. Although there has been a huge and ongoing battle about whether or not testosterone prescriptions (pills, patches, injections, lotions, etc) cause major side-effects, there are a few studies that settle this issue for me.
By anyone's definition, supplemental testosterone use has exploded over the course of the past two decades. While there are certainly times that medical testosterone can be a godsend, as in the case of primary hypogonadism above, there are numerous warning signals that this therapy is not all it's been made out to be --- particularly for the general population of AGING MALES. This fact is verified by a 2013 issue of the journal Endocrinology and Metabolism Clinics of North America (Reproductive Aging in Men)
"Aging in men is associated with a decrease in serum testosterone levels. The practicing endocrinologist is frequently consulted for consideration of testosterone therapy in older men with late-onset hypogonadism (LOH) [secondary hypogonadism], a condition that many clinicians fail to distinguish from organic hypogonadism [primary hypogonadism]. Recent data using syndromic definition show that only 2% of 40-80-year-old men have LOH [primary hypogonadism]."
A study from a 2012 issue of Gender and the Genome (Testosterone Replacement Therapy in Reversing “Andropause”: What Is the Proof-of-Principle?) verifies what I've been telling you about simply prescribing men going through Andropause testosterone. "Testosterone replacement therapy is often equated with the macho male physique and virility and is viewed by some as an antiaging tonic. The growth in testosterone's reputation and its increased use by men of all ages has seemed to outpace the scientific evidences." There are so many factors to think about and deal with concerning Andropause, that simply supplementing with hormone is not going to address. While will undoubtedly see some benefits, this approach has a potential dark side to it --- especially once you consider that there are still no long-term safety studies out there.
This was reiterated yet again just months ago, with the publication of February's issue of Rejuvenation Research (Testosterone Replacement Therapy: The Emperor's New Clothes). I'm sure everyone remembers the children's story of the Emperor's New Clothes by Hans Christian Andersen. To make a long story short, a couple of clever swindlers took the emperor for a whole lot of cash by telling him they could make him beautiful new clothes that were, "invisible to anyone who was unfit for his office, or who was unusually stupid". Wanting to find out who these people were in his kingdom, the emperor took the bait. When on public parade in front of his people one day, with everyone oohhing and aahhing about the beauty of the his "clothes," an innocent little boy cried out the truth; "But he hasn't got anything on" with the rest of the population soon following suit. Just how "naked" is prescription testosterone given for Andropause?
"Testosterone levels decrease steadily and continuously during aging, ultimately resulting in late-onset hypogonadism. Treatment of this condition might mitigate most symptoms; however, testosterone replacement therapy should be prescribed only in selected patients and it should not be considered as an anti-aging treatment. In recent years, different authors have questioned health risks associated with testosterone treatment; while position statements from many scientific societies seem to be reassuring, the Food and Drug Administration has issued a warning in regard to the possible side effects of this therapy."
The final straw for me, however, was a study published in the May 2015 issue of the American Journal of Men's Health (High Estrogen in Men after Injectable Testosterone Therapy: The Low T Experience). "Testosterone replacement improves quality of life and is aromatized in men in adipose tissues to estrogen. Hyper-estrogenism is believed to be harmful to male sexuality." This, folks, is the a definition of an oxymoron if I've ever seen one. I've already shown you that the aromatase enzyme converts testosterone to estrogen. I've also shown you that obesity is not only inflammatory, it tends to increase with age because men automatically get more inflamed as they get older. Unfortunately, adipose tissue (fatty tissue --- which can act as its own endocrine organ -- HERE) also increases aromatase activity. So in essence, the testosterone in older and heavier men with THE INFLAMMATORY PROBLEMS ON THIS LIST, has a much higher probability of ending up being converted to estrogen. GULP! What might be a better option?
First off, realize that there is a possibility you have a problem with your PITUITARY or HYPOTHALAMUS. If this is the case, you might need to try a FUNCTIONAL NEUROLOGIST to see if it is possible to jump-start those systems. Secondly, there are a wide variety of supplements available, some of which have been shown to be effective via peer-review (emphasis on "some" as most "Testosterone Boosters" are high-priced crap. If you are really interested, talk to my friend Dr. Eric Serrano over at Mountain Dog Diet). Thirdly, there are some cool glandular products like STANDARD PROCESS'S Symplex M, that actually help rebuild the testes as opposed to simply "boosting" testosterone levels (or at least claiming to do so). And lastly, but most importantly, if you really want to get a handle on Andropause as it relates to all systems in your body, you'll have to change your wicked ways. Wicked ways?
You're going to have to kick your SUGAR / CARB ADDICTION. And many of you are going to have to stop lying to yourself --- telling yourself that it's OK to eat a ton of crap since you are young and thin (hey; I used to be young and thin -- HERE). You're going to have to change your approach to what what you eat. For those who say they can't do this, ask yourself a few tough questions. Is not giving up (insert your poison-of-choice here --- sodas, ice cream, beer, chips, Ding Dongs, TWINKIES, etc, etc) worth not having energy to do almost anything beyond coming home from work, plunking down in your easy chair, and crashing in front of the TV for the evening? Is it worth not being able to concentrate enough to carry on a conversation, do your office work, or solve a crossword puzzle? Is it worth being fat and out of shape? And maybe most importantly of all, is it worth not being able to have sex with your wife? If continuing in your current lifestyle is more important than grabbing life by the --- well; balls --- then by all means, continue on. If not.....
If you are looking for a change --- a real change (AN EXIT STRATEGY if you will), and not just another drug to mask another symptom, HERE is the protocol for you. Heck no, it's not a fool-proof or cure-all. I never said it was. However, this simple protocol addresses most aspects of male health and virility at their root level. If you are interested in getting your life, health, strength, stamina, cognitive function, and BEDROOM PROWESS back, at least take a few minutes to read the post. The cool thing is that I'm not even selling you anything. It's just information, and completely free information at that. But nonetheless, information that you could use to change your life!