Male Menopause - Fact or Fiction?
by Mark Swircenski, PA-C

 

…hormone deficiency is the most underdiagnosed health problem in men over 40 years of age

Menopause for men? Yes indeed, though it is more aptly called andropause. Andropause like menopause involves a decline in hormones. This phenomenon in males is more gradual than the decrease in sex hormones experienced by women, but just as real. Andropause involves the progressive decline of free testosterone levels that occur with aging. This is coupled with an increase in the ratio of estrogen (feminizing hormone) to testosterone (masculizing hormone).

Symptoms of Andropause

Andropause often starts as early as age 35. Between the ages of 40 and 70, the average man loses nearly 60% of his testosterone. Because it is so gradual, men often accommodate to the loss of this important hormone. Symptoms of andropause may include: fatigue, irritability, reduced libido and potency, loss of drive and competitive edge, stiffness and pain in muscles/joints, falling levels of fitness, decreased effectiveness of workouts, increased aging of heart and circulation, and brain aging. The decreased bioavailability of testosterone to the tissues may be linked to type II diabetes, coronary artery disease, hypertension, osteoporosis, and arthritis.

In his book The Testosterone Syndrome, Dr. Eugene Shippen notes that hormone deficiency is the most underdiagnosed health problem in men over 40 years of age. He further states that the words "normal for age" should be removed from a doctor's vocabulary. Lab values based on "normals for age" are not optimal for age; instead, the doctor should say, "You are normal for an andropausal man and that is not healthy. We need to correct it."

What is Testosterone?

If someone told you that there was a magical substance that could increase your sex drive, strengthen your bone and muscle tissue, reduce your body's fat production, improve the tone and thickness of your skin, improve your thinking ability, boost your energy levels, and guard against the onset of depression and heart disease as you age - you might be skeptical. In reality, these are all clinical effects of a powerful anabolic hormone produced naturally in your body - the male sex hormone testosterone.

Testosterone has been given a bad rap in the past because body builders and athletes have abused it by putting large amounts of synthetic testosterone into their young bodies. Synthetic testosterone can cause harmful effects when abused in this manner. However, use of natural testosterone to replace normal physiological levels in the aging male has far greater benefits than risks.

Why Testosterone Levels Decline

Testosterone levels decline due to decreased production of testosterone by the testes, increased conversion of testosterone to estrogen, or increased production of SHBG. Testosterone production begins in the brain with release of a hormone called Gonadotrophin-releasing hormone. This hormone is released by the hypothalamus when a testosterone deficiency is detected. This in turn influences the pituitary gland to secrete luteinizing hormone (LH), which is released into the bloodstream and stimulates the Leydig cells of the testes to produce testosterone.

In some cases, the hypothalamus or pituitary gland fails to produce LH and a healthy pair of testes fail to produce testosterone. In other cases, the testes lose their functional ability to respond to LH no matter how much is produced. If testosterone levels are low, testing can determine the cause and appropriate therapies exist to safely restore testosterone to optimal levels.

Another problem facing aging men besides decreased production of testosterone is excessive conversion of testosterone to estrogen. Excess estrogen can also cause an increase in the production of SHBG. This is a protein that binds free testosterone and makes it ineffective. Either cause will decrease the testosterone/estrogen ratio and lead to andropause.

Excess estrogen can be caused by increased activity of the aromotase enzyme. This enzyme increases with age, body fat and lack of certain nutrients. The effects of aging, alcohol, certain drugs and medications can also compromise the liver's ability to eliminate excess estrogen and SHBG.

Clearly, just knowing your testosterone level is not enough. Information about "free" testosterone, estrogen levels and SHBG have to be factored into the equation as well.

Restoring Optimal Testosterone Levels

Older methods of replacement involved injections of synthetic testosterone that could cause unnatural highs and lows or synthetic oral testosterone that could be toxic to the liver at high doses. Now "bio-identical" testosterone can be prescribed that matches what your body produces exactly. Natural testosterone is available as the FDA approved Androderm Transdermal System (patch), Testoderm Transdermal System (patch) and the Androgel 1% cream. Also available are sublingual lozenges and pellets that can be inserted subcutaneously.

Another method of increasing testosterone is to take precursors to testosterone such as DHEA and androstenedione. Various herbal remedies are also available that will sometimes increase testosterone levels. A healthcare practitioner who is knowledgeable in this area should monitor either method.

Since the enzyme that causes conversion of testosterone to estrogen is found in fat cells, steps to reduce excess fat and thereby excess estrogen production is important. In addition, there are various minerals, nutrients and medications that can block the activity of this enzyme. A diet that lowers insulin production is important as well. Lifestyle changes such as diet, exercise, smoking cessation and reduced alcohol consumption is important to maximize testosterone production and should form the cornerstone of any testosterone enhancement program.

After extensive evaluation, my patients receive individualized treatment programs to optimize their hormone levels. These comprehensive programs include dietary and exercise recommendations, appropriate nutritional supplements, suggestions for stress reduction and balanced bio-identical hormone replacement therapy.

Diagnostic Questionnaire

The following questionnaire can be used to determine the potential needs of adult males.

Rate on Scale of 0 - 4

1. Fatigue, tiredness, or loss of energy
2. Depression, low or negative mood
3. Irritability, anger, or bad temper
4. Anxiety or nervousness
5. Loss of memory or concentration
6. Relationship problem with partner
7. Loss of sex drive or libido
8. Erection problems during sex
9. Loss of morning erections
10. Decreased intensity of orgasms
11. Backache, joint pains, or stiffness
12. Heavy drinking (past or present)
13. Loss of fitness
14. Feeling over-stressed

Add 4 points if you've had:

	Adult Mumps
	Testicular problems
	Prostate operation
	Vasectomy

To calculate points & score

0 - 9	Andropause is unlikely
10 - 19	Possible
20 - 29	Probable
30 - 39	Definite
40+	Advanced

If you feel you may benefit from treatment, make an appointment with a healthcare practitioner who is knowledgeable in this area for appropriate testing and evaluation.

Mark Swircenski, PA-C is a Physician Assistant practicing Medical Nutrition, Primary Care, and Anti-Aging Medicine at Alaska Family Wellness Center. To contact Mark, call 561-9444 or e-mail him at markswircenski@hotmail.com

Depression in Your Forties: Looking at Estrogen
by Bethany Buchanan

 

When life becomes more balanced and stress levels are lowered, hormones may naturally balance themselves.

 

The decline of two major hormones, estrogen and progesterone, are often responsible for the imbalance that begins the perils of PMS and peri-menopause. It is not unusual for women to have some premenstrual issues beginning in the mid to late-30’s, ultimately followed by a decline in estrogen in the 40’s, and leading up to the cessation of menses in the 50’s.

In their mid to late-30’s, women will often experience a decline of progesterone. Progesterone is responsible for maintaining the lining of the uterus should an egg implant. This decline happens for several reasons. Put simply, there is less motivation for the body to reproduce, so there is a decline in the production of progesterone. Without optimal levels of progesterone, estrogen levels dominate. Fluid retention, headaches, impatience, anger, irritability, bloating, and breast tenderness can denote estrogen dominance. Administering bio-identical progesterone during this time can be helpful.

Oftentimes, when the decline of progesterone is already present, women in their 40’s begin to experience the first slow decline of estrogen. This decline can lead to feeling warmer with mild hot flashes, night sweats, difficulty sleeping, cognitive challenges, and most commonly, an increase in teariness, depression, and feeling very sensitive with regard to feelings and self-esteem.

In my experience, there are two primary types of depression to differentiate from at mid-life. One is chemical depression, which is often hereditary and caused by imbalances of the neurotransmitters dopamine and serotonin. This type of depression is more likely to respond to prescription medications or amino acids. The other more common type of depression can be secondary to a decline of estrogen.

The initial decline in estrogen is slight enough that there is no change in monthly bleeding. However, women can feel changes happening. The most common first sign of less estrogen being present is teariness and depression. Women may suddenly find themselves with a lowered self-esteem, feeling overly sensitive to remarks by others, or becoming teary or crying for no apparent reason. This depression prompts visits to health care providers, who in turn often write a prescription for an anti-depressant. These prescription medicines may be helpful, but they are not addressing the root cause of the depression. The cause for many women’s new onset of depression in the 40’s can often be alleviated with a very low level of bio-identical estrogen.

Bio-identical hormones refer to the chemical structure of the hormone molecule. They contain the exact molecular structure as hormones made in the body. The source of the hormones is often yam or soy, which is converted by chemists into bio-identical hormones. These hormones are found to be indistinguishable from those produced by the human body and exert the same physiological response.

Estrogen is not a single hormone; rather, it is a group of different hormones that perform functions normally attributed to estrogen. The three estrogens that predominate in an adult woman are Estrone, which constitutes 10-20% of circulation estrogen; Estradiol, also at 10-20% of circulating estrogen; and Estriol, which is about 60-80%. Estrone is a weak estrogen produced by the oxidation of Estradiol and is the primary estrogen present after menopause. Estradiol is the most potent estrogen secreted by the ovaries and has the strongest estrogenic effects throughout the reproductive years. Estriol is a weak estrogen that has anti-estrogenic properties.

Any combination of bio-identical estrogens can be compounded for women to support them through hormone imbalances. Common combinations include Triest (80% Estriol, 10% Estrone, 10% Estradiol) and Biest (80% Estriol and 20% Estradiol). Estriol can be administered as simply Estriol. This has been used in Europe as an estrogen replacement for over 20 years. These compounded estrogens are safe, tolerated extremely well, and easy to regulate.

Estriol is the weakest estrogen and can be replaced at very low doses. It is so low, in fact, that it won’t affect the menstrual period or estrogen dominance issues. Progesterone may or may not need to be replaced on the latter half of the cycle, as long as monthly bleeding continues. Some women find that Estriol replacement beautifully lifts them out of a depression that seemed unexplained.

It would be remiss not to mention testosterone. Testosterone levels also decline as women age. About 30% to 40% of women seem to be affected by this decline. Feelings of fatigue, lowered libido, difficulty concentration and depression can often be due to a decline of testosterone and bio-identical replacement can be helpful. Many women describe an overall feeling of contentment with testosterone replacement, making it helpful for mid life depression. This is especially true for women who have had a hysterectomy as their levels are lower than women who have not. Testosterone converts into estrogen, and it is easy to get too much of this hormone, so replacement needs to be monitored carefully.

Many things can contribute to depression at mid-life: high stress levels, lack of exercise, poor diet choices, or unhappiness at home or work. The initial decline of hormones is exacerbated when women are out of balance. Before considering replacement with bio-identical hormones, try these simple steps:

	Consume whole foods
	Cut sugar from your diet
	Decrease caffeine and alcohol consumption (which will help with weight gain as well).
	Make exercise a priority instead of putting it on the back burner

When life becomes more balanced and stress levels are lowered, hormones may naturally balance themselves. For many women, replacement of Estriol leads to a greater balance at mid-life and a stronger sense of well-being.

Bethany Buchanan is a certified Family Nurse Practitioner. She is co-owner of Avante Medical Center, where she specializes in women’s health and chronic illness. She has an extensive medical background in conventional and alternative medicine.

More on Menopause
by Bethany Buchanon

 

All women are concerned about the use of hormones, especially in light of women’s health studies, and I don’t blame them.

Several issues ago (May/June 2003), I wrote about how the beginning of peri menopause can cause depression in women. While the cause is often hormonal, it is frequently diagnosed by the medical profession as chemical depression, for which anti-depressants are prescribed. If the onset of depression is in the forties, menstruating women may relate their depression to the decline of estrogen. This depression is often described as a loss of self-esteem, feeling overly sensitive to comments directed at them, tearing easily, or crying for seemingly no reason. Estriol is a very weak bio-identical hormone that doesn’t seem to affect monthly bleeding (periods stay the same), and can be safely taken to ease this type of depression.

So, what happens in the next phase of menstrual cycle changes? First, periods may begin to change. Menstruation cycles may become heavier and closer together, or they may become lighter and further apart. Either way, unpredictable periods are a common hallmark of peri-menopause. Usually, with depression comes irritability. The decline in estrogen signals the pituitary to begin to stimulate the ovaries to produce more estrogen. This results in a surge of estrogen through the system, which can make women feel cranky and irritable (read: angry and bitchy). When the estrogen drops again, it brings on feelings of sadness and depression. These ups and downs become more pronounced. Hot flashes and their evening accompaniment, night sweats, begin to appear.

Vasomotor changes and emotional issues are often the first common signs of imminent menopause. Other common symptoms may be difficulty with memory, poor sleep, fatigue, dry skin, dry hair, increasing wrinkles, and vaginal dryness. Sometimes this happens while women are still menstruating monthly, but usually it happens around the time when cycles are no longer reliable in timing.

All women are concerned about the use of hormones, especially in light of women’s health studies, and I don’t blame them. Many women are choosing to be hormone free during this time in their life. I find that healthy women who eat well, exercise, and are height-weight proportionate often sail through menopause with little difficulty. Women who have always struggled with their health or hormones (PMS, fibroids, and painful periods, etc.), however, often have a more difficult time with menopause.

For women who need something to ease their symptoms, bio-identical hormones offer an option worth considering. They have been studied, but not to the extent of Premarin. This is because no patent can be obtained; hence, there is a lack of money spent on studies as there is no profit to be made. These bio-identical hormones thus remain an “alternative” hormone replacement as opposed to becoming mainstream.

The body makes three types of estrogen; estradiol, estrone and estriol. They are found in the following percentages: estradiol, ten percent; estrone, ten percent; and estriol eighty percent. Local pharmacies compound (make what we tell them to make) these estrogens into a variety of strengths. Triest (triple estrogen) is the name of the bio-identical hormone that is frequently given to women with acute menopausal symptoms. The beauty (and art) of this type of replacement is that it can be completely individualized. Compounding pharmacies will make creams, pills, troches, suppositories or gels in any combination you can imagine. They can also combine two or more hormones in the same cream or pill

Taking Triest for menopausal symptoms is easy: if you have symptoms of estrogen deficiency, then take more Triest until the symptoms have eased. If you get too much Triest, then you will begin to have symptoms of excess, and less medicine is taken. Common symptoms of too much estrogen include breast tenderness, fluid retention, cranky and impatient feelings, irritability, and headaches. Common symptoms of not enough estrogen include hot flashes/night sweats, depression and poor sleep.

Biest is another common combination using estradiol and estriol. I often recommend this for women who have higher estrogen needs, such as those who have had a hysterectomy or when transitioning women off Premarin or other stronger synthetic estrogens.

Along with estrogen, I also use bio-identical progesterone. This can be used therapeutically for PMS, to control bleeding, to regulate the period, and help with symptom management with menopausal symptoms. Bio-identical oral progesterone is the only form of progesterone that has been studied in clinical trials to test the effects on increasing the HDL (or good cholesterol) and protecting the uterus from estrogen. Some small studies have shown that progesterone increases bone density as well (unlike estrogen, which prevents further bone loss). Because progesterone has beneficial effects on the cholesterol and the bones, some women opt to simply take progesterone for relief of the menopausal symptoms. For more mild menopausal symptoms, progesterone can be safely taken alone and it often significantly helps hot flashes and especially sleep. This is a great option, especially if women are uncomfortable taking any type of estrogen.

Bio-identical hormones remain a healthy option for women struggling with symptoms of peri menopause and menopause. They can be safely taken for a short period of time to relieve symptoms and provide some therapeutic benefit as well. Geneva Woods has regular ongoing classes to learn more about this option. The classes are $25; if interested call 297-1111 in Anchorage or 376-8200 in Wasilla for a schedule.

Bethany Buchanan is a family nurse practitioner and co-owner of Avante Medical Center, where she practices. Contact her at 770-6700 or by email at bethanyanp@yahoo.com.

Menopause Sanctuary
by Kim-Marie Walker

 

Women are not powerless during the years it may take to transition to menopause.

In a recent workshop, a perimenopausal woman experiencing extreme mood shifts said she had an overwhelming urge to be alone. Living in a cramped apartment with her husband and two children, she had little space to call her own. Time spent in the bathroom and in the car, driving to and from work, were her only “alone” periods of the day. Another woman, saddened by the end of her monthly menses, still grieved months into her menopause.

My own journey has taken about eleven years. In 1992, my left ovary and fallopian tube were removed, making me perimenopausal at the age of 36. Eight years later, my body manifested uterine fibroids and the requisite enlarged uterus. I knew something was up when I could no long suck-in my bulging stomach to fit into my favorite jeans. I soon abandoned the effort to fit into jeans and took to wearing blousy tops and loose-fitting pants or dresses.

Throughout my transition, I often battled for control of something that was simply a natural process. I’d sometimes forget or just plain ignore the fact that my body was perimenopausal. Reading books, changing my diet, trying yam cream, checking in with ob-gyns’ (both medical and naturopathic), and receiving therapeutic massage and energy work were wonderful sources of information and release, but I needed to do major inner work, something both emotionally and spiritually based. Striving for balance and a sustained awareness of my transition, I called upon eighteen years of Vipassana meditation, movement, and journal writing.

Working from my passion, I designed Menopause Sanctuary, a class where women explore movement, meditation, and journal writing on their journey through perimenopause and menopause. All three activities have wonderful qualities of play and exploration that are inspirational and transformative.

Remember when you used to skip, twirl, do somersaults or turn-up the volume on a favorite song and dance? When was the last time you moved your body to your own rhythm? Moving your body—when done with awareness—can put you back in touch with sensations and thoughts that increase your trust in the natural rhythm of perimenopause and menopause. Yoga, Tai Chi, and Continuum Movement are examples of how the mind-body connection supports well-being. Certain dance forms (such as belly dance, modern and African dance) can also support women as they seek positive self-imagery. In Menopause Sanctuary, women are encouraged to move to their “own beat” in addition to trying structured forms of movement from invited instructors.

Through meditation, we become clearer about our needs for balancing the body, mind, and spirit. Applying basic meditation techniques (paying attention to the inhale/exhale of breath and thoughts as they occur in the present movement) is a profound way of discovering how we resist change, especially those changes in our body!

In the workshop mentioned earlier, I asked the woman who had a strong desire to be alone to explore using visualization to create her own sanctuary, a place of comfort and beauty she could go to in her meditations before bedtime. With practice, she could retreat to her sanctuary whenever and wherever she felt the need.

Journal writing is another way to increase awareness. Through writing, you can journal your progression. My suggestion to the woman in menopause who grieved the loss of her period was to journal her thoughts and create some ritual ceremonies - one for the loss, one to welcome the transition.

Last year, during a day of unusually heavy bleeding, I wrote in my journal: “I’m 46 going on crazy. My body has deserted me just when I need it the most. What is up with this?” I then remembered a book I had that contained yoga exercises to reduce heavy flows. I found it, blew the dust off the cover and commenced the exercise. It worked!

Earlier this year, after doing a loving-kindness meditation that involved looking in the mirror, I wrote, “This is me, in all my glory. This is me, in all my perfection. Any imperfections I might have are only the world’s perfect illusions.”

Women are not powerless during the two to 13 years it may take to transition to menopause. Women who have artificial menopause from surgical removal or illness that disrupt the reproductive tract or related hormones are not powerless. From the day we are born, our bodies gift us with amazing bio-chemical and hormonal transformations. Perimenopause and menopause represent phenomenal life phases that are just as powerful as when we began our pubescent journey.

I find myself in a happy place, accepting this phase of being with a rich and sweet sense of joy. My intention is to share that joy with others.

Kim-Marie Walker, founder of onyx communications: seminars for well-being & building community. Menopause Sanctuary is a 6-week class meeting 90 minutes each week. Visit: www.onyxcommunications.com, E-mail: info@onyxcommunications.com or phone 907.376.1306.

On Journeying Inward

Kim-Marie Walker

 

Your journey inward will be greatly enhanced if you allow intuition to guide you towards what is true for you.

This time of year is precious for gaining inner perspective.  When approached as an adventure, it’s an exploration sure to gain clarity or resolve issues. Essentially, a private journey, going inwards, getting quiet, has distinct advantages.

For starters, you get to choose what guiding materials (or tools) to take on your journey. As vehicles for self or re-discovery, perhaps you choose a particular self-help book, write a memoir, use a life-changing event, artwork, travel, or some other endeavor, such as volunteering locally or internationally for a cause greater than yourself. Maybe it’s a combination of meditation and journaling. Whatever you choose, your journey inward will be greatly enhanced if you allow intuition to guide you towards what is true for you.

Often, when sharing personal insights with others, we consciously tell ourselves we want to be understood though, really, we secretly wait for approval. We get disappointed or become doubtful when others don’t “get” us. We become suspicious of our intuitive process and lose trust in our ability to decipher and understand our truth. At that point it becomes tempting to accept another’s truth as our own. Well, self-discovery isn’t about getting approval from others. Self-discovery entails connecting clearly with intuition. Journeying inward, you can empower and test your intuition through a lens or filter of your own design.

There are many words describing intuition: perception, insight, sixth sense, instinct, hunch, feeling, or inkling. Ancient and contemporary folklore, as well as cultural traditions, abound in relation to intuition. Yet, there is another aspect to consider.

I’ve learned that specific hormonal changes, associated with menopausal transition, have an affect on our temporal lobe, the region of the brain associated with enhanced intuition. The literature of Dr. Christaine Northrup, Dr. Joan Borysenko, and other biochemical scientists reveals that a menopausal woman’s temporal lobe (located on the right side of the brain, forward and above the cerebellum) can become saturated with these ‘transitioned menopausal’ hormones. At no other time in a woman’s life do the temporal lobes contain these hormones.

How cool is that? Our reproductive hormones transitioning to provide a “last-minute, super-jazzed” brain cocktail to re-connect with our intuitive power! The pot-of-gold at the end of hot flashes, night sweats, and irregular menses is not all those expensive anti-wrinkle-creams; rather, it’s nature saying, “Woman, thou has done amazing things. Here’s a little something-something to explore. Heed those wise women tales.” 

I imagine nature offers a complementary cocktail for men going through male menopause. In many traditions around the world, maturing women and men are revered for their knowledge, wisdom and insight. By studying the ways in which our bodies change, science has given us another level of awareness about the interconnection of mind, body and spirit. How much more can you and I develop by exploring these connections?

Intuition has space, fluidity, and depth.  Approaching 50, I’ve used my premenopausal years as a vehicle for increasing inner awareness. I’ve empowered myself beyond my wildest imagination. Through meditation, creating affirmations, movement, music, and journaling, I have, with minimum effort and lots of intuition, let go of patterns, thoughts, and emotions that have not served my wellbeing for years. As a result, I’m clear about my life purpose.

Rumi, a 12^th century mystic said, “Let the beauty you love, be what you do. There are a hundred ways to kneel and kiss the earth.” Rumi provides clear instruction: Each of us has something that allows us to connect with one another. Expressing that something, clearly and truthfully, is our continual journey.

More than ever, as global humanity moves towards maturity, we need intuitive voices to dispel, forever, the illusions of separateness. Journeying inwards allows us to mingle our intuition with the wisdom of those who’ve come before us and with those whom we engage on our path. Every day we are bombarded with absurdities, inconsistencies, ironies, and contradictions. Every day we have the capacity to create love, consistency, and clarity. When nothing else seems to work, journeying inwards can help us deal with life’s profound paradoxes.  When we can deal with paradox, bypassing fear-based reactions, we can re-connect with insights that nurture and serve both individual and community wellbeing.

Kim-Marie Walker is the founder of onyx communications, creative works for well being and building community. Visit www.onyxcommunications.com or e-mail info@onyxcommunications.com about ongoing seminars, cds, and book releases.