Andropause
WHAT IS IT?
Andropause is the male semi-equivalent to menopause. Although men do not usually have an abrupt and dramatic change in their sense of wellbeing parallel to the sudden (more or less) stop of menses in a woman, they also tend to have hormonal changes with aging that can make them feel less than optimal.
But this change can be more subtle causing a man to be unaware of the slow, insidious change.
Often his wife will notice changes. She’ll say that he is much more tired or lazy. That he never/rarely wants to have sex any more. He complains of things that never used to bother him. Or he’s just gotten irritable. Sometimes he just wakes up one day and it hits him, “I feel like (use a negative adjective to fill in the blank)!”
Whether he’s the one that first becomes aware or his wife, there’s the recognition that I could, I hope, be doing a whole lot better than this. The challenge for most is then - What do I do?
CAUSE
A drop in testosterone
A rise in estrogen. Yes! When young, women have significantly higher estrogen levels than a man. Somewhere around the 50s, the woman’s estrogen drops like the proverbial rock. And the man seems to balance things out by increasing his estrogen; ) By the 60s, the man usually has significantly more estrogen than his wife.
Too much estrogen bothers the prostate & makes a man feel weaker and moodier.
An often associated problem in andropause is the impact of years of higher than optimal blood sugar and insulin levels that are too high. These create inflammation and fatigue.
Another issue is that frequently prescribed medications can weaken a man in general by, for instance, slowing his mitochondrial function, and many meds will weaken his sex drive and erections. There are often other ways to help a man get healthier so that he no longer needs most or all of the meds he’s on.
The overall effect is not good for the aging man.
BUT, the good news is that this can all be turned around (mostly) if a man chooses to be healthy again.
TREATMENT
The usual thing that people think of, if they are aware of “andropause”, is low testosterone. And the implication is that if they just take enough testosterone they are going to feel great.
Typically, that is not true!
Testosterone is great and can be helpful, but just taking testosterone as the sole treatment is not a good nor effective one in many cases.
Why? There are many reasons. But let me give you just one. Testosterone is made from cholesterol through a somewhat complicated pathway. Testosterone is converted into estrogen directly by an enzyme called aromatase. There are many men who will start taking testosterone and they end up make more estrogen proportionally than the testosterone they get. Example: I had one patient who came from Seattle as he had started taking testosterone prescribed by another doctor. At first he felt better. But after a short time, he did not feel the benefit that he had previously even though he was still taking the testosterone. The ideal estrogen level for a man is probably less than 30. A menstruating woman may be 400, often less, at her peak estrogen during the cycle. This man who was no longer feeling good with his testosterone treatment had a continuous estrogen level of about 250. VERY high levels. No wonder he didn’t feel good.
When a man is on testosterone there are several parameters that should be monitored routinely - and that includes his estrogen level.
When the estrogen is high, there are both natural and pharmaceutical methods to lower the estrogen.
But to really be well, a man must also aggressively deal with his blood sugar levels, his insulin levels, inflammation, sleep, hydration, and exercise.
We can help you with this journey. And generally men do great on a comprehensive program.