Andropause is a natural and entirely normal part of healthy ageing; however it presents certain important problems and challenges to the male patient, including loss of muscle mass, loss of libido and erectile dysfunction.
Frequently Asked Questions
- 1What is Andropause?
- 2What are the symptoms?
- 3What are the benefits of Optimizing Testosterone Levels in Aging Men?
- 4How is it managed at Health Renewal?
- 5Why we (at Health Renewal) do not accept mainstream medicine reference range for "Normal" levels of testosterone?
- 6What in office treatments can be done at Health Renewal?
- 7What is Carboxytherapy for male sexual rejuvenation?
- 8What integrative supplements are recommended?
- 9What are the risks and complications of this condition and its management?
- 10Does Testosterone replacement cause Prostate Cancer: a Myth?
- 11What combination of factors result in the age-related reduction in testosterone levels?
- 12Why is Estrogen Balance Critical to Aging Men?
- 13How do I get started?
- 14How often should I see the integrative Doctor?
- 15Health Renewal tip: How does one prevent unhealthy Testosterone Levels
Andropause is also known as male hormone balancing/restoration. Once men reach the age of around 30 years, their male hormone, testosterone, begins to gradually decline. As men age, a number of changes occur that reduce the testosterone level available to the body and this alters the ratio between testosterone and another hormone, Estrogen. This condition is now referred to as partial androgen deficiency of ageing men. This is a natural and entirely normal part of healthy ageing; however it presents certain important problems and challenges to the male patient, including loss of muscle mass, loss of libido and erectile dysfunction.
Men entering their forties will often notice subtle symptoms of fatigue, irritability, depression, insomnia and reduced muscle power and stamina. Lack of energy and weight gain are also common. There is a clear relationship between low levels of testosterone and increased incidence of cardiovascular disease, particularly as testosterone level relates to metabolic syndrome and insulin resistance.
- Testosterone, being the chief male hormone, is vital for libido and comprehensive erectile function. It also plays a central role in mood stability, maintaining energy levels, bone health, and body composition to name a few.
- Testosterone levels decline as a man ages, and signs become more visible after a male reaches his mid-30's declining testosterone levels have been linked with various health disorders such as the onset of depression and cognitive decline, as well as obesity and signs of fatigue setting in.
- If a man has low testosterone levels it can be strongly related to metabolic syndrome, which in turn can be a risk factor to get type 2 diabetes, or cardiovascular disease. By restoring youthful levels of testosterone in men it can result in a vast array of health benefits: such as heart health, improved body composition, mood, and memory.
- In contrast to popular believe it has been found that Bio-identical testosterone does not have any negative effect on a healthy prostate gland—in fact, it has the benefit of potentially improving prostate symptoms in men with low to normal testosterone levels.
- Regular blood testing is essential to help both patient and physician decide if testosterone therapy is the right treatment path to take.
- Testosterone therapy is listed as a contraindication in men with prostate cancer present.
Your Doctor at Health Renewal will ask you to complete a short questionnaire, perform a physical examination and request a hormone blood analysis at your local pathology laboratory. These results will be analyzed by your Doctor who will determine whether a definite deficiency exists and advise you on your treatment options. These options range from injections and applying creams to having bio-identical implants/pellets inserted.
Optimizing testosterone levels requires a multi-pronged approach that includes optimal diet, proper nutrition, nutritional supplements, exercise, and bio-identical testosterone.
The so-called "normal" levels of testosterone in older men reflect population averages. At Health Renewal we believe that most aging men would prefer not to accept the loss of youthful vigour as normal. Instead, we suggest that a more valid optimal level for all men would be in the UPPER one-third of the reference range used for men aged 21 to 49 years, and that any supplementation should aim to restore hormone levels to that range. the current Health Renewal optimal range level of TOTAL testosterone is 20-25nmol/mL.. When measuring testosterone levels, it is critical to determine the levels of both FREE and TOTAL testosterone to understand the cause of any observed symptoms of deficiency.
Erectile and libido disorders will be addressed through prescription medication and Carboxytherapy sexual rejuvenation treatments. Your Doctor will also exclude other medical causes for your symptoms, such as atherosclerosis, chronic anxiety disorder and chronic fatigue syndrome.
A new treatment offered by Body Renewal uses Carboxytherapy for penile rejuvenation/Sexual Rejuvenation. See Erectile Dysfunction. Carboxytherapy uses 5 to 6 virtually painless micro injections of carbon dioxide in the area to stimulate the tissues to grow new capillaries. This replenishes the blood supply, improves circulation to the area and thereby restores the function of the tissues and increases the amount of tissue in the treatment area. The effects of each treatment are accumulative; hence a treatment course will be prescribed for each patient.
The following conditions may be improved with Carboxy treatments: Erectile dysfunction, penile sensation and improved functionality, as well as improved cosmetic appearance as tissue regains plumpness i.e. tissue turgor, improved strength and improved size.
Ultimately, the ideal program will depend on the results of various tests. Below are 3 examples of common scenarios and solutions to correct hormone imbalances:
1. Low Free Testosterone, High Estradiol, Mid Total Testosterone:
This scenario suggests excessive aromatase activity, which has the ability to convert free testosterone into estrogen. Inhibition of aromatase and reduction in fatty tissue is required in such an instance. When managing a decline in testosterone levels, supportive supplements may reduce the aromatase enzyme in your body (which means that you will reduce the amount of testosterone converted to estrogen). These may include some or all of the following suggestions:
- Quercetin and
- Follow a calorie restricted diet to lose weight, which will reduce aromatase activity in the body.
- Assist you liver to remove excess estrogen by reducing (or eliminating) the consumption of alcohol.
- Ensure the liver is fully functional by checking your current medication, as some medications might influence liver efficiency. Consult with your Doctor to check all possibilities.
- Common medications that may decrease liver functionality are:
- non-steroidal anti-inflammatory drugs (NSAIDs) (e.g. naproxen, ibuprofen, myprodol)
- paracetamol and aspirin
- the statin class of cholesterol-lowering drugs;
- some heart and blood pressure-lowering medications;
- and some antidepressants.
It is important to note some drugs being prescribed to treat the symptoms of testosterone deficiency (such as the statins and certain antidepressants) may actually worsen the testosterone deficit, which in essence can make the cholesterol problem or depression worse. However, before stopping with a prescribed medication, please consult your physician to decide on this together.
If none of the above improve the level of free testosterone and as a result lower excess estradiol, consider discussing the use of the aromatase inhibitor anastrozole (Arimidex) with your physician at the very low dose of 0.5 mg twice per week.
2. Low Free Testosterone, Low Estrogen, and High Total Testosterone:
This second scenario suggests excessive SHBG (Sex hormone-binding globulin) levels, making sufficient testosterone unavailable to target tissues. The elevation of SHBG explains why some older men do not have a long-term benefit of being on testosterone replacement therapy. Because the administered testosterone becomes bound by SHBG it is not bioavailable to cellular receptor sites, and as a result it can`t produce an effect as it normally would. Suggestions to improve this situation include:
Inhibit aromatase by following some of the recommendations in the previous section (Low Free Testosterone, High Estradiol, Mid Total Testosterone), since low testosterone and high estrogen are involved in excess SHBG activity. Take the following supplements (based on blood results):
- Nettle root extract
- Cruciferous vegetable extract (DIM)
- Omega 3 Fish oil and
3. Low Free Testosterone, Low Estrogen, and Low Testosterone:
This scenario suggests low production of testosterone in the male and results in a low conversion to estrogen. Suggestions to treat this condition include:
- Check Cortisol levels and address if necessary with DHEA (based on blood results). DHEA is a steroid hormone made by the adrenal glands, which are located above each kidney. The body converts DHEA into hormones, such as estrogen and testosterone. DHEA levels go down when stress goes up. The level of DHEA can be determined by measuring cortisol levels in the blood. The best way to raise DHEA is to learn to see life in a less stressful way.
- Use testosterone creams or pellets; be sure to not use testosterone injections or tablets.
- LH(Lutenizing Hormone). If tests reveal low levels of LH, ask your physician about the possibility of using human chorionic gonadotropin (HCG). HCG functions in a manner similar to that of LH, thus helping to stimulate the leydig cells of the testes to produce more testosterone
A recent study has suggested that a man with a sub-optimal level runs the risk of an increased mortality over 10 years, as compared to his counterpart with above-mean levels of testosterone.
Recent studies have demonstrated that low testosterone in men is strongly associated with metabolic syndrome, type 2 diabetes and cardiovascular disease Restoring testosterone to youthful ranges in middle-aged, obese men resulted in an increase in insulin sensitivity as well as a reduction in total cholesterol, fat mass, waist circumference and pro-inflammatory cytokines associated with atherosclerosis, diabetes, and the metabolic syndrome.
Testosterone therapy also significantly improved erectile function and improved functional capacity, or the ability to perform physical activity without severe duress, in men with heart failure–High blood pressure and high blood cholesterol risks will be improved by improving circulating free testosterone levels, however cases of uncontrolled high blood pressure must be controlled prior to supplementing testosterone.
For more than 60 years, medical professionals incorrectly speculated that testosterone replacement therapy for men would increase the risk of developing prostate cancer. This fear caused physicians to deprive hypogonadal male patients of testosterone replacement therapy that could otherwise assist in improving their bodies with cardiovascular, musculoskeletal, cognitive, metabolic and other health benefits.
Remarkably enough, it appears that, the contrary is true in most cases–lower levels of endogenous testosterone present a larger risk of prostate cancer than if a patient had higher levels.
The risk for prostate cancer is not increased by supplementing testosterone, however it may unmask a subclinical case and your Health Renewal Doctor will carefully monitor your PSA (prostate specific antigen) levels to avoid and detect these rare cases.
There are various factors that can result in the reduction of testosterone levels, some of these include: Increasing body fat (especially belly fat) Oxidative damage to tissues responsible for the production of testosterone; a reduction in testicular testosterone synthesis; declining levels of predecessor molecules, such as DHEA and the individual’s nutritional status and liver functionality.
A recent study published in the Journal of the American Medical Association (JAMA) measured blood estradiol in 501 men with chronic heart failure. The findings stated that men in the balanced quintile–and subsequently the fewest deaths–had serum estradiol levels between 21.80 and 30.11 pg/mL. This is the ultimate range that Health Renewal Doctors recommend male patients to strive for.
An epidemic problem in aging male members is insufficient free testosterone, i.e. less than 20-25 pg/mL of serum. When this status is accompanied by excess estradiol (over 30 pg/mL of serum), it can signal excess aromatase enzyme activity in the body. In addition, as a patients belly fat increases, there is an increase in activity of the enzyme "aromatase", which converts testosterone in the fat cells to estrogen. Having less testosterone and more estrogen can deposit fat in areas of the body similar to women (breasts, hips, thighs). It also increases your risk of enlargement of the prostate and even prostate cancer.
Make an appointment to consult with your Health Renewal Doctor and they will assist you in measuring your levels and advising you of further preventative and supplemented measures. Testosterone is best measured in the morning hours and you should have your sample drawn at a pathology laboratory before 9am.
Depending on which form of hormone supplementation you and your Health Renewal Doctor have decided on, one could expect to follow up with your physician from anything between every 2 weeks to once every 6 months. All men receiving testosterone therapy must be evaluated at least annually by an ECG and blood pressure test.
Maintain healthy body weight
This is probably the most important thing a man can do. As belly fat increases, there is an increase in activity of the enzyme "aromatase", which converts testosterone in the fat cells into estrogen. Having less testosterone and more estrogen can deposit fat in areas of the body similar to women (breasts,hips,thighs). It also increases your risk of enlargement of the prostate and even prostate cancer. With every one point drop in your body mass index (BMI), your testosterone level will increase by a point (roughly).
The Body Renewal Medical Weight loss program is offered at Body Renewal. If the program is strictly adhered to patients lose between 8 and 15 kilograms a six week cycle. Patients generally find it quite easy, and feel good with high energy levels. In fact, depressed patients have mood elevation as the Leptin levels "Kick in" 10 days into the program. Many of our patients have tried numerous other well-known diets but find this to be the magic one that actually works.
A combination of aerobic (increase in heart rate) and resistance (weightlifting) has been found to increase the production of testosterone. Regular aerobic exercise of at least 20 minutes, three times per week and weight training of at least 30 minutes, twice weekly will further improve free testosterone levels in the blood. This also helps prevent the most common diseases from which we can die (heart disease and cancer).
Get a good night's sleep
Most testosterone is made during deep REM (Rapid Eye Movement) sleep. A poor sleep cycle with less time spent in REM has been associated with low testosterone levels. See our hand-out "Improving and Maintaining a Healthy Sleep/Wake Cycle".
Avoid tobacco products
Tobacco reduces testosterone.
Alcohol (more than two units a day) causes more testosterone to be converted into estrogen.
Wear loose fitting underwear
Testicles hang away from the body to be cooler. Heat can reduce sperm count and testosterone production. Wear boxers, not briefs.
Xenobiotics are chemicals found in the environment that do not occur naturally in the body and can act like hormones. Research has shown that the average testosterone level in men has gradually dropped over the years. This may be due in part to all the potential toxins that have accumulated in our environment.
The main ones include:
Bisphenol A (BPA) found in plastics. Don't microwave food in plastic containers. Avoid plastic containers with the numbers 3,6 or 7 engraved in the triangle on the product. Some, but not all, #7 containers contain BPA. Those labeled PLA are OK to use as they are made from corn husks. Buy BPA-free water containers. Drinking water out of containers with the numbers 2, 4, 5 or 7-PLA is OK. Don't drink out of Styrofoam containers.
Phthalates. These chemicals are used in plastics, coatings, lubricants and binders. Many are found in hygiene products such as shampoos and colognes.
Organophosphates. These are mainly found in pesticides and herbicides. Eat organic products whenever possible.
Manage your stress.
When researchers study long term stress, they measure cortisol in the blood. This is a steroid hormone. When cortisol levels are high, they can increase fat deposits. This in turn results in more testosterone being converted into estrogen.
Poor nutrition is at the root of many diseases and it can also create an imbalance of male hormones.
Foods to avoid: Avoid red meat and animal fat, food dyes, and processed foods. Limit caffeine, dairy products, and sugar (by itself or in products). Foods to include: green tea; multi-colored fruits and vegetable, nuts (particularly Brazil nuts, which are rich in selenium - just two a day are plenty.); fiber (covered by eating fruits and vegetables); ground flax seed (1 tablespoon a day); soy products (e.g., drink soy milk instead of cow's milk).
Consider supplements / nutraceuticals
If you want to maintain healthy testosterone levels, the changes discussed above will trump any supplement. The nutrients mentioned above which inhibit aromatase. Taking them may add to the benefits you will get from lifestyle changes.