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Thursday, February 1, 2007

Andropause: Menopause For Men

Are women the only ones who go through hormonal changes as they age, or do men experience menopause too? The concept of a male climacteric was once highly controversial, but medical researchers are showing more interest in aging and the effects of declining hormone levels in men, and more doctors are diagnosing this common condition.
   
Basic Biology

Andropause refers to decreased levels of male sex hormones, or androgens. It is a normal process for aging men caused by complex physiologic and biochemical changes in the metabolism of testosterone, estrogen and sex hormone-binding globulin (SHBG). 75 year old men make approximately 65 percent of the testosterone found in younger men. Most of this hormone is inactive and bound to SHBG, a protein that shuttles it around the body. As production of SHBG increases naturally with age, a greater percentage of remaining testosterone is inactive. Furthermore, adipose tissue converts sex hormones into estrogen. Men who accumulate body fat as they age make more estrogen, compounding existing hormone imbalances.

Signs and Symptoms

Andropause is commonly referred to as male menopause, but some experts prefer the term “progressive androgen decline in the aging male” (PADAM). PADAM is a syndrome characterized by unpredictable onset, variable manifestations and several possible symptoms. These include decreases in sex drive, erectile function, cognitive abilities, body hair, bone density, muscle mass and strength. Symptoms also include changes in body fat distribution, fatigue, insomnia, depression, anger and other mood changes.

In some ways, PADAM is similar to peri-menopause. In both cases, symptoms usually start between the ages of 40 and 55, and different individuals experience different symptoms. Some men barely notice the transition, while severe symptoms cause others to seek treatment. However, unlike women, men usually do not experience abrupt changes in fertility and hormone levels. Andropause is a gradual and subtle process, which can make diagnosis difficult. 

Risk Factors

Because hormone function declines with age, men above the age of 50 are most likely to experience symptoms of andropause. Stress, cigarette smoking, certain medications, and diets high in processed foods and low in nutrients can contribute to its onset. Obese men have a higher risk for more severe manifestations.

Once men have been diagnosed with androgen deficiency, they are at risk for complications such as osteoporosis, cardiovascular disease and diabetes mellitus. Testosterone plays an important role in building bones, and declining levels can lead to decreased bone mineral density and osteoporotic fractures. Researchers have found that low levels of testosterone are associated with increased levels of triglycerides in the blood and increased blood pressure, raising the risk for heart attack and atherosclerosis. Studies have also shown that deficient testosterone levels can be associated with excess glucose in the blood and increased body mass index (a measure of body fat based on height and weight). These symptoms set the stage for diabetes mellitus and other chronic diseases. 

Hormone Replacement Therapy

Researchers have noted significant improvement in both symptoms and hormone levels when deficient men were supplemented with testosterone and/or its precursor dehydroepiandrosterone (DHEA). However, there have been no long-term studies supporting their safety. Just as synthetic hormone replacement therapy in women poses an increased risk for breast cancer, synthetic testosterone replacement therapy in men may cause increased risk for prostate cancer. Bioidentical testosterone is always a better choice than synthetic versions because it exactly matches the hormone produced by the body, making it easily recognized and safely eliminated.

Natural Intervention

Organic foods reduce exposure to xenoestrogens in pesticide residue that may promote androgen imbalance. A nutritious diet rich in fruits, vegetables and whole grains provide vitamins, minerals, nutrients and fiber that support strong bones and a healthy heart. Soy and flaxseeds contain phytoestrogens, which are compounds that can have anti-estrogenic effects in the body. Botanical and homeopathic medicines can offer acute symptom relief as well as constitutional balance.

An active lifestyle supports optimal physiological function as the body ages. Exercise not only promotes hormone balance, strong bones and cardiovascular health, but it also improves mood, reduces diabetes risk and helps correct other symptoms common in aging adults. People who exercise regularly benefit from improved sleep, stronger immunity, healthier joints, better balance and coordination. A combination of aerobic, strengthening and stretching exercises is the best prescription.

The Bottom Line

Symptoms of andropause are common and often overlooked as normal signs of aging, but they may be cause for concern and intervention. Everyone, especially aging men, should address any health problems with their doctor, and get permission before starting a new exercise program or taking new medicines, whether natural or pharmaceutical.

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