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What is Andropause?

Andropause, the male equivalent of menopause is real, although more subtle than menopause. Estrogen levels in women decline abruptly after menopause. With men, there is a gradual decline in androgens, the male sex hormones, usually starting in the 40's. Along with the decline in androgens is a rise in SHBG (sex hormone binding globulin), which are proteins that bind to testosterone that limit the amount and effectiveness of this hormone as men age. As with the age-related decline of human Growth Hormone (hGH), the loss of testosterone contributes to the familiar "pot belly" and declining muscle tone in middle-aged men. The symptoms of the male menopause include a waning interest in sex, difficulty in having and maintaining an erection, and decreased sexual satisfaction, as well as fatigue, depression, irritability, aches and pains, and stiffness.

The Andropause Evaluation

The Age Management M.D. Andropause Program begins, like all our programs, with an evaluation. This includes a blood draw to determine

• free testosterone
• total testosterone
• estradiol (estrogen)
• DHEA (dihydroepiandrosterone)
• DHT (dihydrotestosterone)
• PSA (Prostate Specific Antigen)
• IGF-1 (Insulin like Growth Factor ­ 1)
• LH (Luteinizing Hormone)
• free T3
• free T4
• TSH (Thyroid Stimulating Hormone)
• 25-OH Vitamin D3
• Vitamin B12
• HgbA1c
• hs C Reactive Protein
• Homocysteine
• Cholesterol Panel
  
  

As men age, hormonal changes occur that perceptibly alter physical, sexual and cognitive functions. The outward appearance of a middle-aged man shows increased abdominal fat and shrinkage of muscle mass, a hallmark effect of hormone imbalance. Decreased sense of well being, sometimes manifesting as depression, is a common psychological complication of hormone imbalance.

Until recently, these changes were just accepted as part of "growing old". Now we know that we grow old because our hormones decline.

A significant amount of data has been compiled indicating that many of the conditions that middle-aged men begin experiencing anywhere from their late 30¹s through their fifties and beyond-including depression, abdominal weight gain, and loss of sexual desire and the ability to perform. Prostate cancer and heart disease - are directly related to hormone imbalances that are now correctable with currently available drug and nutrient therapies. Even greater improvements can be made when these hormone and nutrient therapies are combined with lifestyle changes in diet and activity.

Why we measure testosterone and estrogen
The most significant hormone imbalance in aging men results from a decrease in free testosterone, while estrogen levels remain the same or increase. As men grow older they often suffer from the dual effects of having too little testosterone and too much estrogen. The result is a testosterone/estrogen imbalance that directly causes many of the debilitating health and performance problems associated with normal aging.

One of the reasons this happens is that as men age, testosterone is increasingly converted to estrogen. One report showed that estrogen levels of the average 54 year old man are higher than those of the average 59 year old woman. This is precisely why taking testosterone by itself, without monitoring the other hormones measured in the Andropause Program, is usually not a good idea. Testosterone may convert into even more estrogen (a process called aromatization) thus potentially making the hormone imbalance problem worse. Too much estrogen and not enough testosterone increases your risk for a heart attack or stroke. High levels of estrogen have also been implicated as a cause of benign prostate hyperplasia. Your Age Management Physician will explain to you the exact nature of any imbalance you may have in your testosterone/estrogen profile, and will show you how the Andropause Program will improve it.

Testosterone and Libido
Sexual stimulation and erection begin in the brain when neuronal testosterone-receptor sites are prompted to ignite a whole cascade of biochemical events that involve testosterone-receptor sites in the nerves, blood vessels and muscles. Free testosterone promotes sexual desire and facilitates both sensation and performance. Without adequate levels of free testosterone the quality of a man¹s sex life is unquestionably diminished.

Remember, however, it does not matter how much free testosterone is available if excess estrogen is competing for the same cellular receptor sites. And estrogen has a further impact on testosterone¹s effectiveness because it contributes to the age-related rise in sex hormone-binding globulin (SHBG). SHBG binds the active free testosterone into non-active bound testosterone, and this bound testosterone can¹t be picked up by testosterone receptors on cell membranes, so it is of no benefit to you. For testosterone to have the desired long-lasting libido enhancing effects it must be kept in the free form, and excess estrogen must be suppressed. Restoring youthful hormone balance can have a significant impact on male sexuality, and this is precisely the goal of the Age Management M.D. Andropause Program.

Testosterone and the Heart
An increasing number of studies have shown an association between high testosterone and low cardiovascular disease rates in men. Testosterone is a muscle building hormone, with many receptor sites in the heart. The weakening of the heart muscle as we age can sometimes be attributed to testosterone deficiency. Testosterone is not only responsible for maintaining heart muscle protein synthesis, but it promotes coronary artery dilation (good circulation) and helps maintain healthy cholesterol levels as well.

Testosterone and Depression
A consistent finding in the scientific literature is that testosterone supplementation therapy produces an increased feeling of well being. Newly published studies show that low testosterone correlates with symptoms of depression and other psychological disorders. A common side effect of prescription anti-depressant drugs - SSRI¹s like Prozac and Zoloft - is a reduction in libido. Many people suffering with depression either accept this drug-induced reduction in the quality of their lives or they discontinue the anti-depressant drugs so that they can at least have a somewhat normal sex life. Testosterone supplementation, the foundation of the Andropause program, often enhances libido, which is the opposite effect of most prescription anti-depressants. And at least one study showed that patients with major depression, given Testosterone, experienced improvement that was equal to that achieved with standard anti-depressant drugs.

Testosterone and Aging
A consistent pattern that deals with fundamental aging are that low testosterone causes excess production of a potentially dangerous stress hormone called cortisol. Excess cortisol can contribute to multiple degenerative effects such as immune dysfunction, brain cell injury and arterial wall damage. Excess cortisol tears down muscle, ligaments, and bone, and puts on fat! Excess cortisol can also suppress testosterone and growth hormone production; the administration of testosterone acts as a "shield" against the over-production of cortisol.

What about the other hormones in the Andropause evaluation?
DHEA (dihydroepiandrosterone) is a natural hormone that is produced in the brain, skin and adrenal glands. It is the most abundant steroid hormone in the body. As we age, our levels of DHEA drop, so that typically by the age of 45 we produce only half of the DHEA we produced at 20. Many scientists believe that the decline in DHEA (along with the decline in testosterone) has a role in much of the physical and mental decline we associate with "normal" aging.

Hundreds of studies have documented the vital role that DHEA plays in the body, but it appears to be especially important for normal immune function. It also appears to have a significant effect on our emotional well being, with one study reporting "a remarkable increase in perceived physical and psychological well-being for both men and women". The men and women not only felt better when they were taking DHEA but said they were better able to cope with stress.

Other studies have shown that low levels of DHEA increase the risk of heart disease in men. And interestingly, in one study of men over the age of 40, low levels of DHEA were strongly correlated with sexual dysfunction.

What effects can I expect to see from the Andropause Program?
Studies have shown that supplemental testosterone can result in lower levels of cholesterol, glucose, triglycerides, reductions in blood pressure and decreased abdominal fat mass. Most patients also experience:

• increased sense of well-being
• increased libido
• more energy
• better focus and concentration
• fat loss and muscle gain in response to workout program