ANDROPAUSE: WHAT TO DO ABOUT MALE MENOPAUSE

“A progressive decrease in androgen production is common in aging men. In men older than middle age, total testosterone levels may be misleading because of an increase in sex hormone-binding globulin levels (SHBG).  The most prominent endocrinological alterations with aging are related to the sex steroids, but others, such as growth hormone, melatonin cortisol, and thyroxine, are also affected.

The clinical picture of andropause syndrome is characterized by diminished sexual desire and erectile capacity, decrease in intellectual activity, fatigue, depression, decrease in lean body mass, skin alterations, decrease in body hair, decrease in bone mineral density that results in osteoporosis, and increase in visceral fat and obesity. Current medical treatments for androgen supplementation include oral tablets, intramuscular injections, and scrotal and nonscrotal patches.

Unfortunately, none of these preparations mimic the circadian rhythm…. Moreover, the androgen supplementation could have adverse effects on different organs, namely, the liver, lipid profile, cardiovascular disease, prostate, sleep disorders, and emotional behavior.” Taken from Male Andropause: Myth, Reality, and Treatment (International Journal of Impotence Research)

“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

Chronic conditions, including OBESITY, are not only exploding in our general population, they are growing even faster in the pediatric population (for instance, it’s no longer odd to see high school or even jr high school kids with Type II Diabetes).  But today, we are not going to talk about pediatrics, we are going to talk about the American, middle-aged male. 

It’s no secret that men have been getting heavier, weaker, sicker, more sedentary, and INCREASINGLY IMPOTENT, for decades.  And while everyone is at least somewhat familiar with the HORMONAL ISSUES THAT WOMEN FACE as they get older, few are aware that something similar, but usually far more subtle and less publicly discussed, is happening to aging men.

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: INFLAMMATION is a word that is constantly bantered around, but not well-understood by most of the general population.  It also happens to be the cause (or an EPIGENETIC-FACTOR) in almost every health problem you can name — and heavily drives blood sugar dysregulationANDROPAUSE & BLOOD SUGAR: For the most part, Americans tend to live the HIGH CARB LIFESTYLE.  The first big step in the process of blood sugar dysregulation is INSULIN RESISTANCE.  The problem is that IR is a heavy driver of inflammation, perpetuating a vicious cycle of endocrine dysregulation.  

There are so many wacky things that can cause Andropause-like symptoms, I barely know where to begin.  Back in 2005, the June issue of Molecular and Cellular Endocrinology (The Decline inTestosterone Biosynthesis During Male Aging:  A Consequence of Multiple Alterations) proved the first point above — that Andropause is highly related to inflammation.  “Recent studies have demonstrated an age-related increase in cyclooxygenase-2 (COX2) activity and its tonic inhibition of steroidogenic acute regulatory gene expression and steroidogenesis…. These findings indicate the presence of a novel mechanism in male aging involving COX2…” 

A few years later, Andrologia (C-Reactive Protein Levels and Ageing Male Symptoms in Hypogonadal Men Treated with Testosterone Supplementation) revealed that, “C-reactive protein (CRP), a marker of systemic low-grade inflammation, may be associated with symptoms of androgen deficiency.”  And as a great segue into Insulin Resistance, the May 2011 issue of The Urologic Clinics of North America (TestosteroneDeficiency and Risk Factors in the Metabolic Syndrome: Implications for Erectile Dysfunction) showed how it’s all really one big entity that essentially feeds itself.

“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 andropause-related 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 (all of which can be present without being in andropause).  Just be aware that there are a myriad of other characteristics of the Andropause, many of them easy to confuse with other problems.

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

andropause

“Millions of American men use a prescription testosterone gel or injection to restore normal levels of the manly hormone. The ongoing pharmaceutical marketing blitz promises that treating “low T” this way can make men feel more alert, energetic, mentally sharp, and sexually functional. However, legitimate safety concerns linger. For example, some older men on testosterone could face higher cardiac risks.

Because of the marketing, men have been flooded with information about the potential benefit of fixing low testosterone, but not with the potential costs. Men should be much more mindful of the possible long-term complications.” From a 2014 issue of Harvard Men’s Health Watch (Is Testosterone Therapy Safe? Take a Breath Before You Take the Plunge. Understand the Potential Risks and Consider Alternatives Before Boosting Your Hormones Indefinitely)

“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)

While it is certainly true that the medical community has and continues to capitalize on the many aspects of Andropause, as I have just shown you from the scientific literature, it is most definitely a real entity that cries out to be addressed.  So, what are you going to do about it?   While your doctor might give you DIABETES DRUGS (or HERE) for the diabetes, ANTIDEPRESSANTS for the depression, NSAIDS for the inflammation, OSTEOPOROSIS DRUGS for the osteoporosis, PPI’S for the digestive issues, AND ON, AND ON, AND ON; rest assured that if you are actually and “officially” diagnosed with Andropause, you are also going to be prescribed testosterone (HERE). 

The problem with this approach is that in similar fashion to the way a thermostat works, giving a man testosterone makes his body think it’s producing plenty of it’s own, shutting down endogenous production and further lowering his ability to make his own hormone (this is why guys on anabolic steroids might have massive muscles, but they often have shrunken or atrophied testicles).

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, which has the power to turn the crank on andropause.   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 (andropause included). 

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!

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