Andropause

Andropause is defined as the presence of signs and symptoms of low energy, low libido, erectile dysfunction, low metabolism, loss of muscle, increased fat, and depression (irritability) confirmed by laboratory values (levels and /or ratios) below optimum functional capacity.

Traditionally fertility in men persists until an advanced age.  In contrast, women undergo ovarian function failure and require multiple hormone replacements.  More careful evaluation in males shows progressive age-related changes including:

• Decreased muscle mass and strength
• Decreased vigor, low energy
• Decreased libido
• Insomnia
• Nervousness and depression
• Hair loss

These changes usually begin in the fourth and fifth decades and point towards hormone imbalances and deficiencies which may be considered the male equivalent of menopause, i.e. the Andropause.

A carefully taken history will identify problem areas. History includes an assessment of diet and nutrition, energy and fatigue, stress and anxiety levels and the use of exercise and relaxation techniques.  

What can you do about male hormone imbalance?

Optimal health is dependent on the balance of hormones, and not just a single hormone. 

This includes the thyroid hormone, cortisol, androgens, progesterone as well as estrogen. 

All of these hormones need to be in optimal levels to provide optimal function. Currently, men with low androgen hormones can benefit from hormone replacement therapy.  Also, men with imbalances in their androgen to estrogen and progesterone can also be hormone supplemented to achieve balance.

Supplemental hormones to be given by mouth, by injection, by skin patch or as a cream or by pellets.  Androgen supplementation, in states of deficit, improves fitness and produces a feeling of well-being, with a reduction in abdominal fat and enhanced lean body mass.

Testosterone production in males is mainly a testicular function.  Pituitary sex hormones (FSH & LH)  stimulate and regulate this function.  Specifically, LH ( luteinizing hormone) stimulates testosterone production in the testicles. This process is under negative feedback, meaning that the testosterone levels regulate LH secretion.  FSH ( follicle stimulating hormone) and testosterone stimulate sperm production.

Why measure male hormones?

Measurements of hormones can be used in two general ways.

• To estimate the body’s own production-baseline test
• To measure levels of hormones after supplementation-therapeutic monitoring

Baseline measurements will show normal and abnormal levels of several hormones.  If levels are too low, too high or hormone ratios are outside of expected limits, an objective treatment plan can be developed for the individual.  Symptoms are not a substitute for measuring hormone levels because many symptoms may involve non-hormonal factors.

Using appropriate test for monitoring hormone therapy is crucial in establishing the appropriate dosing regimen. This reduces the chance of undesirable side effects and maximizes beneficial effects.

The roles of the sex hormones we test are highlighted below:

DHEA-is the precursor for both male and female hormones. Also, it is an anti-stress hormone produced by the adrenal glands.

Androstenedione-is a weak male hormone (androgen) and a precursor of both male and female hormones.

Testosterone– is the main testicular androgen and his precursor to the highly potent dihydrotestosterone male hormone.

Dihydrotestosterone (DHT)- is made from testosterone in certain tissues.  The rate of its production is controlled by the level of free active progesterone.  Excess DHT causes prostate enlargement and the thinning of scalp hair.

Progesterone– this hormone is important in both sexes.  It is a natural calming Agent to our nervous system.  It also keeps in check excessive DHT production and counterbalances the effects of excessive estrone.

Estrone– is an estrogen that both sexes produce in the fat cells.  The more fat, the more estrone in which in turn itself promotes fat deposits.  It is produced from androstenedione and excess of estrone can cause breast enlargement and contributes to prostate enlargement.

Individualized Hormonal Replacement Therapy for Men

Arbitrarily given hormones may deal with the symptoms, but may pose other health risks

What we test and what it tells you

• The tests are based on your history and physical examination.
• A basic metabolic panel  including CBC, liver function, kidney function, cholesterol profile,thyroid function and PSA level are done by blood tests, if not already done by your primary care provider.
• Cortisol levels are checked in saliva tests; DHEA, Androstenedione, testosterone, dihydrotestosterone, estrone & progesterone levels are checked in 24 hour urine tests.
• The tests identify deficiencies, increased levels, as well as imbalances in the different hormones.

This test is for you if you are…

Middle-aged and having:

• Impaired libido
• Erectile dysfunction
• Baldness and/or extremity hair thinning
• Fat accumulation around the waist
• Urinary symptoms: pain and/or frequency; urgency; interrupted stream
• Change in sleeping habits
• Lack of enthusiasm for life
• Increase in bad cholesterol, decrease in good cholesterol
• Your doctor tells you that you have osteoporosis

Young and having:

• Impaired libido
• Erectile dysfunction
• Early baldness
• Inability to lose weight

Treatment is initiated based on your test results.