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