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Male Menopause


Menopause and aging is not just for women.  Men experience midlife changes as well.  This condition is caused by a shift in hormonal balance; however it involves different hormones than those in women.  Doctors label this condition “Male menopause,” also called “Andropause”.

Decreasing hormones is a natural part of aging and for some, may cause uncomfortable symptoms that affect quality of life .  These may include a gradual decline in sexual desire, impotence, moodiness, loss of motivation, competitive edge, and muscle mass.  Unlike women, men do not experience abrupt changes. Symptoms are more gradual and less severe, making it difficult to determine  what is happening within their bodies.

Symptoms of male menopause

  • Reduced libido
  • Difficulty with erections
  • Infertility
  • Disrupted sleep
  • Depression
  • Poor concentration
  • Heart disease
  • Osteoporosis
  • Prostate enlargement
  • Muscle weakness
  • Fatigue
  • Irritability

Studies indicate that 50 percent of men between 50-70 years of age, have testosterone levels that are on the lowest end for a healthy, normal 40 year old.  Testosterone levels fall by 1% a year.  Currently, 95% of men in America are not treated for hypogonadism.  What would happen if you could capture one-fourth of these patients and begin treating them?  You will become the expert for treating Andropause in your area and referrals will begin to role in.

Many men are reluctant to discuss these symptoms with their healthcare practitioners and are often sent by their wives.  It takes a keen ear and asking the right questions to obtain the pertinent information needed to safely and effectively treat your patients.

Andropause is diagnosed through laboratory findings and clinical evaluation.  Laboratory findings will be considered suboptimal and vary between labs.  I recommend looking for normal ranges in the upper one third of the normal range.   Physical changes should be present, as well as laboratory findings.  Physical signs that can be seen on exam are:  decreased muscle strength and size, increased abdominal fat, small wrinkles around the forehead, fatty breast tissue, smaller penis and testes, and lack of body odor.

Providing questionnaires in your office is a great way to bring up this subject with male patients.  I leave the questionnaire sitting on the counter in the exam room for men to complete in privacy;  they can hand it to me or ask questions about the subject when I enter the room.  I find this works very well.

There are a various reasons why testosterone levels fall.  If men are under chronic stress and  have high cortisol levels chronically, testosterone will be depleted.  Environmental exposure to xenoestrogens will deplete testosterone and can cause growth of breast tissue.  This can be seen daily when we see young boys with breast tissue.  My kids call this man boobs.   Studies show that when testosterone levels are normalized,  there is better control of blood glucose levels in diabetic men.

Various medications can reduce testosterone production or block testosterone from being utilized. The two highlighted medications are commonly used in the general population and are often not thought to reduce hormone production. I am concerned with lowering cholesterol levels, because all of the body’s hormones are produced from cholesterol.   The body produces 5-6mg of testosterone per day, but when cholesterol levels are lowered, the body is unable to make even this small amount of testosterone.

  • Spironolactone
  • Cimetidine
  • Ketoconazole
  • Long-acting Gonadotropin (lupron)
  • Chronic opiate use
  • Corticosteroids
  • Megace
  • Antihypertensive
  • SSRI’s

Testosterone is responsible for the development of genitals, puberty, bone growth, muscle mass, strength, and CNS effects.  Organ systems also directly affected by testosterone include the prostate, liver, kidneys, larynx, blood, immune system, and breast tissue.

Most of the circulating testosterone is bound to other substances, making it unavailable for use by the body.  Free testosterone consists of about 2-3% of total testosterone.  SHBG (sex hormone binding globulin) typically increases with age.  Estrogen is another hormone which increases the body’s production of SHBG.  High levels of estrogen can depress the production of SHBG.  When testosterone levels are low,  higher amounts of testosterone bind to SHBG.

Estrogen dominance occurs from environmental exposures as well as obesity.  Despite diet and exercise changes, midabdominal obesity ini particular contributes to estrogen dominance.   A lack of testosterone and a rise in SHBG cripples the effectiveness of the hormone, causing weight gain and increased estrogen.  Higher amounts of estrogen can have a neutering effect on men.

Estrogen dominance occurs for a variety of reasons:

  • Insulin resistance
  • Trans-fatty acid intake
  • Chronic stress
  • Sleep deprivation
  • Fluoridated water
  • Environmental Xenoestrogens
  • Cigarette smoking
  • Zinc deficiency
  • Progesterone deficiency
  • Sedentary life style
  • Cadmium toxicity
  • Lack of sulfur-containing amino acids
  • Lack of good exercise
  • Magnesium deficiency
  • Hypothyroidism
  • Testosterone deficiency

Many patients present to our office taking several prescribed medications, which can cause higher estrogen levels.  Commonly prescribed drugs such as: acetaminophen, NSAIDS, ASA, antibiotics, anti-fungal agents, antidepressants, and antacids also raise estrogen levels in men.

To reduce high estrogen levels, I use a product called Chezyn, which is essential for proper control of estrogen.  A study conducted by Metametrix looking at Cruciferous Complete and the benefits of metabolizing 2/16 hydrox ratio, proved to lower these estrogen metabolites.  Wheat germ oil is used for proper steroid production.  B6 niacinamide is used for proper zinc absorption.

Tribulus is a fantastic herb to support healthy DHEA & testosterone production.  The American diet must change, in order to balance testosterone levels.  Diets higher in sugar and fat reduce testosterone levels.  Encouraging patients to consume an organic diet high in fruits and vegetables, with lean protein, assists in balancing testosterone and estrogen levels.   Exercising the large muscles causes immediate and prolonged levels of testosterone; men should incorporate daily physical activity into their routine.  If the adrenal function is not addressed, any type of support for testosterone will be unsuccessful.  Relaxation should also be incorporated to the daily program.

If you are interested in helping the men in your practice feel better and regain their life, start by having them complete the Andropause questionnaire and talkto them about their hormone imbalance.  If you have patients you would like to get started with immediately and are unsure where to go, feel free to contact me for a consultation.

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