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The Masters Men's Clinic Radio
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Andropause is associated with low ("bioavailable") testosterone levels. Every man experiences a decline of bioavailable testosterone but some men's levels dip lower than others. And when this happens these men can experience Andropausal symptoms.
These symptoms can impact their quality of life and may expose them to other, longer-term risks of low testosterone. It is estimated that 30% of men in their 50s will have testosterone levels low enough to be causing symptoms or putting them at risk. Why is testosterone so important?Testosterone is a hormone that has a unique effect on a man's total body. It is produced in the testes and in the adrenal glands. It is to males what estrogen is to females. Testosterone helps to build protein and is essential for normal sexual behavior and producing erections. It also affects many metabolic activities such as production of blood cells in the bone marrow, bone formation, lipid meta-bolism, carbohydrate metabolism, liver function and prostate gland growth.
Impact of low bioavailable testosteroneWhen there is less testosterone available to do its work, the testosterone target organ response decreases, bringing about many changes. There is great variability in testosterone levels among healthy men so not all will experience the same changes to the same extent. But typical responses to low bioavailable testosterone levels include:
Is Andropause a new phenomenon?
Diagnosing AndropauseAnother reason why Andropause has been under-diagnosed over the years is that symptoms can be vague and can vary a lot among individuals. Some men find it difficult to admit that there's even a problem. And often physicians didn't always think of low testosterone levels as a possible culprit. So these factors often lead doctors to conclude that symptoms were related to other medical conditions (i.e. depression) or were simply related to aging and often encouraged their patients to accept that "they were no longer spring chickens". But this situation is changing. New blood testing methods are available and there is a increased interest in men's' aging among medical researchers. In fact, so much attention is being focused on Andropause that major efforts are underway to quickly share emerging scientific information with Canadian physicians. Am I going through Andropause?Take this test and take the first step to feeling better. 1. Do you have a decrease in your sex drive (libido)? YES NO 2. Do you have a lack of energy? YES NO 3. Do you have a decrease in strength and/or endurance? YES NO 4. Have you lost height? YES NO 5. Have you noticed a decreased "enjoyment in life"? YES NO 6. Are you sad and/or grumpy? YES NO 7. Are your erections less strong? YES NO 8. Have you noticed a recent deterioration in your ability to play sports? YES NO 9. Are you falling asleep after dinner? YES NO 10. Has there been a recent deterioration in your work performance? YES NO Of course, every person is different. And not all men going through this stage of life will experience it exactly the same way. The passage into middle age is a complicated phase. It's full of changes at all levels - personal, social, economic, family, etc. It may therefore be difficult to differentiate these changes from the symptoms of other conditions that can create some of the same symptoms. Nevertheless, if you did answer "Yes" to 1 or 7 or to any three questions in all, it would be worthwhile discussing these symptoms with your physician. He/she may then have your bioavailable testosterone level checked. Why should Andropause be taken seriously?Apart from the impact that Andropause may have on your quality of life, there are other longer-term and silent effects of Andropause that are harder to track: increased cardiovascular risk and osteoporosis. Andropause & Osteoporosis
Unfortunately, with advancing age and declining testosterone levels, men seem to demonstrate a similar pattern of risk for osteoporosis as women. What's more, approximately one in eight men over age 50 actually has osteoporosis. The incidence of hip fractures rises exponentially in aging men, as it does in women, starting about 5 to 10 years later than in women. In Canada, 20-30% of osteoporotic fractures occur in men. The incidence in fractures has been increasing in men, whereas it seems to be stabilizing in women Ñ likely due to the lifestyle changes, calcium supplements and hormone replacement therapies that women are embracing. Why should I worry about osteoporosis?Low bone density puts one at risk of frequent fractures, associated pain, and in many cases, loss of independence. Wrists, hips, spine and ribs are most commonly affected. The consequences of osteoporosis are often seen as a slow but progressive rounding of the shoulders and loss of height. Particularly devastating seem to be hip fractures - up to one third of patients never seem to regain full mobility. Cardiovascular risks *It is now well accepted that women's risk of atherosclerosis (hardening of the arteries) increases after menopause. Estrogen replacement therapy seems to reverse this trend. New evidence suggests that a similar phenomenon occurs in men as their testosterone levels diminish with age. While research is not as complete as for women, the clinical findings point to an association between low testosterone levels and an increase in cardiovascular risk factors in men. * A cause and effect relationship has not yet been established in large clinical trials. The current clinical work does support further research into this important area of study. What can you do about Andropause?1. Understand your own risks for osteoporosis. It is impossible to predict who will get osteoporosis. However, there are several factors that can put certain men at increased risk. These include:
If you have any of these risk factors you may want to find out more about osteoporosis prevention from your physician or from other providers of information on osteoporosis. 2. Talk to your physician about the role testosterone replacement therapy can play. Just as with estrogen replacement therapy in women with menopause, testosterone replacement in men with Andropause has been shown to be highly effective and very beneficial. Its not for every man, of course, even men who have the symptoms on the previous quiz may have other health problems at the root of it all. Testosterone replacement therapy is a good solution for many men who are experiencing symptoms that are having an affect on their enjoyment of life. Your doctor will check carefully to see if you are a suitable candidate, including performing blood tests and physical examinations. Importantly, if you have an established prostate tumor or have breast cancer you will not be a candidate for testosterone replacement therapy. If you are a candidate for testosterone replacement therapy the options include oral capsules, injections and skin patches. Expect your physician to monitor your progress and your overall health while on testosterone treatment. If you're like the majority of men, you will experience very few side effects, if any. 3. Maintain a healthy lifestyle. Of course, any ongoing strategy to reduce the symptoms and risks of Andropause should incorporate lifestyle approaches such as optimal diet, regular exercise, stress-management, and the reduction in tobacco and alcohol intake. What should I expect from testosterone replacement?Very good responses to testosterone have been reported for men with low testosterone in various clinical studies and they include:
With testosterone therapy, one's attitude improves, reinforcing self-esteem and self-confidence in success at work, and increased energy at home and in social activities. Most men will feel more vigorous, experience improvement in energy levels, mood, concentration, cognition, libido, sexual performance and overall sense of well-being. This effect is usually noted in 3 to 6 weeks. Other potential benefits include maintenance or improvement in bone density, improved body composition, muscle mass and muscle strength, as well as improvement in visual-spatial skills. Questions and Answers
A: It is testosterone that is the normal basis of sexual desire in both men and women. So if it is low, so is the desire for sex. Viagra is not a testosterone replacement therapy and it is prescribed to help maintain erections. It does not treat the whole man. Other symptoms such as reduced mental and physical energy, irritability and sweating may also impact your sex life. And these symptoms may also be caused by a decline in your testosterone level. So talk to your doctor about choosing the strategy that's right for you to improve your sexual well-being.
A: It took many years for women to accept hormone replacement therapy. Estrogens are known to offer postmenopausal women many physical benefits, improve their psychological well-being, and therefore their overall quality of life, going full charge to the end.
A: No patient is too old to start testosterone therapy if it is clearly indicated. As for any medication, testosterone should be taken under a physician's care, with regular appropriate follow-up evaluations.
A: Not at all. In fact, even the most "macho" men can develop this condition.
A: Because of reports of the abuse of anabolic steroids by athletes, testosterone has suffered a negative public image. The perception is that testosterone is responsible for undesirable male traits such as aggression and hyper-sexuality. And some people have developed a fear that it will "bring out the beast in men". These, of course, are myths. They stem from results of testosterone being used by men with normal testosterone levels who took testosterone at doses which were much higher than supplementation doses that are used in men going through Andropause.
A: No. In men who have an existing cancer of the prostate testosterone can promote its growth. This is why testosterone replacement is not recommended for men with prostate cancer.
A: The prostate slowly enlarges as men age. And in some men, testosterone can cause this process to speed up. However, in most studies, no growth was found - even after long-term testosterone replacement. Consequently, some men with enlarged prostates can qualify for testosterone therapy, but others do not. Only a physician can make the decision of whether you qualify. If you do take testosterone replacement your physician will monitor the health of your prostate with regular (PSA) blood tests and physical examinations.
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In a healthy
individual, bone tissue is constantly being broken down and rebuilt. In an
individual with osteoporosis, more bone tissue is lost than is regenerated.
We've all heard of women suffering from weaker bones, or osteoporosis, after
menopause. In men, testosterone is thought to play a role in helping to maintain
this balance. Between the ages of 40 and 70 years, male bone density falls by up
to 15 percent.
