What’s A Guy To Do?
Male Menopause
Traditionally, the term Menopause has been associated with women and their transition from the fertile, childbearing years to the post fertility years. This transition can be long and arduous. Well, men can experience a similar sympathetic transition as well. So why has there been so little talk about this male counterpart to Menopause?
Andropause or commonly calle “male Menopause” has significant health implications for men. We often experience many of the same symptoms as women, such as, cognitive and memory issues, decreased libido, sexual dysfunction (erectile an orgasm that dysfunction), sleep difficulty, anxiety and depression, anhedonia (loss of life’s enjoyments), fatigue, decreased exercise tolerance, decreased energy and weight gain, etc.
Typically, women are much more open about their feelings and freely discuss them with each other. Men are typically the opposite. You don’t often hear men talking in the locker room or at a restaurant about their sexual difficulties, loss of muscle and their once muscular bodies’ or their emotional difficulties, that is until recently. Men are now beginning to recognize that their feelings are not just something that they have too accept because it is the “manly” thing to do. men, today, want to live long, healthy and productive lives, so they are seeking out practitioners who are able to hep them safely maintain their best overall health. There has been more publicity about men’s issues, magazines that are devoted to male topics and books being written about topics from testosterone deficiency and prostate health to how to maintain our sexual function and how to cope with divorce. Since more women are seeking bio identical hormone balance and are feeling better, they are also encouraging their partners to seek similar hormone restoration.
There has been a fear of cancer from hormones and both men and women. For men, the case of prostate cancer has been associated as cause & affect with testosterone. However, there is an abundance of literature that not only supports the fact that testosterone does not cause Prostate Cancer but actually lessen the incidence. A Harvard-based Urologist, Dr. Abraham Morgentaler has written extensively on the subject and cites the evidence in the literature that supports the claim the testosterone does NOT cause prostate cancer.( Morgentaler A. Testosterone Replacement Therapy and Prostate Risks: Where’s the Beef? Can J Url. 2006. Feb;13. Suppler. 1:40-3).
In 2007, a study was published which reported that “all cases of mortality in men are associated with low testosterone” Khaw KT, Dowsett M, Folkerd E, et al. Endogenous testosterone and mortality causes, cardiovascular disease and cancer in men: European prospective investigations into cancer in Norfolk (EPIC-Norfolk) prospective Population Study. Circulation. 2007 Dec 4; 116923) : 2694-701. Testosterone has also been shown to improve insulin response and glycemic control and diabetic men. (Haffner S. SHBG, Hyperinsulinemia, Insulin Resistance and NIDDM. Hormonal Research. 1996; 45 (3-5) : 233-7.).
Testosterone can help to improve cholesterol levels by increasing reverse cholesterol transport which helps to clear cholesterol from the artery. Men with low testosterone are at increased risk for coronary artery disease. Malkin CJ, et al. Testosterone as a Protective Factor Against Artherosclerosis-immunomodulation and Influence Upon Placque Development and Stability. J. Endocrinology. 2003 Sept; 128 (3) : 373-80.
And proper testosterone restoration does note make men “angry”.
Many medications many lower a man’s circulating levels of testosterone. Statins to lower cholesterol, beta blockers to lower blood pressure and SSRI’s for depression are among the most commonly used medications that affect testosterone levels.
There are some important considerations when restoring testosterone to physiologic levels that must be considered. First, the expectation of men may be more than can be expected with proper restoration of hormone balance. That is, we will not return to the lean muscular body, exercise tolerance, and strength that we enjoyed in our late teens and 20s, when testosterone peaks and testosterone receptors and maximal. Rather, we can expect improvement in reduced body fat and improved lean muscle provided that we also address diet and exercise. Second, sexual function often improves, but there are many other factors to consider in male sexual performance, namely, vascular issues, stress, fatigue, etc. We have complicated hydraulics and there are many factors that must be working to achieve and maintain an erection. There are many psychological issues that must also be addressed. Thirdly, return of better function takes time. After all, it took many years are slow, almost imperceptible decline, to get to this point and it will take time to see a change and improvement. Lastly, and probably most importantly, the physician must take the time to discuss these issues and make sure that the patient has realistic expectations. It is simple not acceptable to just prescribe a topical testosterone gel or weekly injections and not consider these other factors.
There are many ways to restore testosterone baleen in men. These include topical gels, injectables, pellets places under the skin, Human Chorionic Gonadotropin (HCG) injections, patches, nasal sprays, and dissolvable lozenges place in the mouth. I most commonly use injectable subcutaneous testosterone or HCG and occasionally, topical testosterone. Proper testing can help to determine who is a candidate for testosterone restoration and what options are available to them.
A physical trained in hormone restoration will be able to help men achieve a better state of health & wellness. We can optimize our health, enjoy a more productive and rewarding life and do it safely.