The medical term for aging in men is andropause (which sounds similar to menopause in women). It is also known as male menopause or more recently the term ‘manopause’ has been coined. Whatever you call it, it describes the transition in life for men who experience physical and emotional changes associated with aging, such as fatigue, loss of endurance and strength, diminished sexual interest and performance, loss of muscle mass, moodiness and depression.
Written off as ‘this is what happens when you get older’ many men deprive themselves not only of a better quality of life but pass up the opportunity to significantly reduce their risks of heart attack, diabetes, and fractures through treatment.
Symptoms of Andropause
Every man is unique and may express various symptoms at different times in their life. Unlike menopause, characterized by the relatively rapid onset of flushes, night sweats, and sleep disturbance, changes in male symptoms are subtle and come about gradually, sometimes over the course of years.
Muscle mass decreases about 8% per decade, starting at 20 years of age. This is reflected by diminished endurance, loss of stamina, exercise fatigue and overall loss of strength.
There is often a loss of sexual interest and diminished libido, as well as various forms of erectile dysfunction. When a man takes certain medications for blood pressure control or uses an antidepressant, it can have a significant adverse impact on sexual function.
As one age, there is an increase in visceral fat in the abdomen which surrounds the intestine and other internal organs. Aside from additional weight gain, this fat is associated with the production of inflammatory proteins which contribute to the onset of diabetes, heart disease, and cancer.
Testosterone provides an important contribution to maintaining bone strength. With decreased production, there is an increased risk of osteoporosis and fracture. The effects can be devastating. Aside from the major impact on the quality of life, there is a significant mortality with hip fractures after the seventh decade.
Depression, fatigue, inability to focus, lack of concentration and memory loss become more and more prevalent with diminished hormone production through male menopause.
A thorough medical history and physical examination should precede the laboratory evaluation. Underlying medical disorders need to be diagnosed and treated, and a review of all medications needs to be studied for their impact on symptoms and the possible conflict with replacement hormone therapy.
Baseline laboratory testing is mandatory. Aside from general laboratory studies such as blood count, lipid profile, kidney and liver function, specialized testing for prostate health (PSA), diabetes and inflammation need to be determined. In addition, baseline hormone levels of free testosterone, DHEA sulfate, Vitamin D and thyroid hormone need to be determined.
In older men, testosterone decreases not only in amount but in the way it is produced. In younger men, peak hormone levels are usually seen in the morning, but as one age this variation changes and levels are fairly constant all day. It is important to measure the level of free hormone, not only the total amount in the blood. The free hormone is what the body sees and responds to on the cellular level; the total hormone measurement represents a combination of both free and bound circulating hormone. The bound hormone is not very biologically active and is not the best indicator of treatment. Second, laboratories provide a normal range of hormone for each age group, usually ranged by decades (e.g., 30-40 years, 40-50 years, etc.). Restoration of hormones to 20-30 year old male levels is called optimization. Unlike competitive sports abusers who take anabolic steroids at extremely high levels (and have to deal with complications inherent to excess treatment), we strive to maintain physiologic levels, well within the normal range for young men. There is an abundance of medical literature attesting to the safety and efficacy of this treatment plan.
What to Expect
Benefits are not apparent overnight. In fact, achieving noticeable physical changes may take months to become obvious. Reasonable expectations should be for a gradual reduction in fatigue, mood elevation, improved sexual function, greater muscle mass with a concurrent increase in endurance and strength. Behind the scenes, there will be the major cardiovascular benefits and protection against diabetes and fracture.
The rationale for hormone replacement therapy is for symptom relief and maintenance of a high quality of life for as long as possible, while simultaneously reducing the risks of cancer, cardiovascular and degenerative diseases. To accomplish these goals replacement therapy requires a commitment which may continue for decades. Once discontinued, many symptoms may return and the protective benefits are lost.
All replacement medications are initially introduced at low dosages since individual sensitivities vary and a response is difficult to predict. Modifications in dosage are adjusted monthly based on your personal response and laboratory measurements, with the goal to restore your hormone levels to men twenty to thirty years of age. This regimen continues monthly until you experience the benefits of treatment and your hormone levels are optimized. The monitoring interval can be gradually extended to every three to four months during your ongoing care. Periodic screening for an increased blood count, liver function, cholesterol, prostate health and evidence of cardiovascular protection should be coordinated with your general physician. Watching for evidence of depression, sleep disorder, fatigue and changes in mood is an ongoing part of your therapy.