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Andropause

The term “Andropause” is to men what “Menopause” is to women. Andropause is a gradual but consistent decline in the sex hormones of middle-aged men. Andropause is a very real health phenomenon affecting millions of men in the world, but it is not officially recognized by the World Health Organization. The medical profession and the public’s awareness of andropause today are similar to their ignorance of menopause a few decades ago. As a result, men suffering from the effects of andropause are unable to find much-needed help and guidance (1).

Andropause plays out over a longer period of time than menopause. Hormonal shifts such as a decline in testosterone levels begin taking place starting in a man’s mid-30s, and continue until his 50s or later. These shifts, taking place over decades, mean that the day-to-day changes in men are subtle. By the time symptoms are evident—showing up as loss of muscle mass, decreased athletic performance, poor mental function, or diminished sex drive—a slow sapping of vitality and vigor have occurred, and the pathology is already in place.

man with glassesAndropause is best defined as a state in which males cease to be androgen, or male hormone, dominant. In other words, the male body and brain, which should operate predominantly on androgens, no longer do. Thus, they fall under the influence of the relatively dominant, increased estrogen levels.

Of the ten most common causes of death in males, five are directly related to this decline in androgen dominance. These five causes of death, heart disease, stroke, diabetes, suicide (depression) and Alzheimer’s disease are major players in health risks for men, and proper management of men’s health in their middle years can play a significant role in prevention and treatment of these disease patterns.

Benign prostatic hyperplasia (BPH) is a very common andropause disorder, and most men wrestle with this complaint at some point during their later lives. All men will have increased proliferation of their prostate tissues; nearly 60% of men between 40 and 59 have an enlarged prostate. So the question for men is not “How do I avoid prostate enlargement?” but “How do I keep an enlarged prostate from causing me problems?” The answer lies in good management of andropause.

The gradual presentation of andropause makes many men accept their symptoms as part of “normal aging,” which prevents them from seeking care for a decline that can respond well to intervention.

How does Western Medicine Treat Andropause?

Conventional medical treatment typically consists of medications to treat presenting symptoms such as high cholesterol, diabetes, depression, or erectile dysfunction. Fully 62% of the top 50 most prescribed drugs relate to the pathophysiology and metabolic effects of andropause.

For BPH, drug treatments, transurethral microwave radiation (heating the prostate to at least 111 degrees Fahrenheit), transurethral needle ablation, high intensity ultrasound and surgery are standard interventions.

How does OHS manage Andropause?

There are many contributing factors that increase risk for andropause symptoms.  Inflammation, insulin resistance or diabetes, low testosterone, obesity, declining mental function, and impaired circulation all work in an interrelated fashion to cause a shift from androgen dominance.

Supporting brain function, specifically acetylcholine activity, increasing blood flow to the brain and peripheral vascular system (erectile dysfunction is generally a vascular, neurologic or psychogenic issue, not an endocrine problem), regulating blood sugar metabolism, controlling inflammation, and enhancing digestion are among the goals of therapy at OHS. A thorough health history intake, physical examination according to Oriental Medicine principles, and possibly looking at laboratory blood tests will help to make clear the priorities for each man. Treatment is usually multi-faceted, involving:

Acupuncture to improve circulation and clarify an Oriental medical diagnosis, which will aid in refining an intervention for more rapid and patient-specific results;
Dietary counseling to improve blood sugar metabolism, help reduce inflammation, support energy production, and help achieve optimal weight maintenance;
Herbal and nutritional supplementation can target specific metabolic pathways and speed the process of balancing blood sugar metabolism, the endocrine system, brain function and digestion.

Historically, men tend to be poor at self-care, and are often reluctant to seek medical care whether it is from a conventional or a complementary provider. But more and more men are realizing the benefits of preventive care. As men live longer, they find it increasingly important to maintain optimal energy, acute mental function, balanced emotional states, and high physical strength and stamina. Tackling the health issues of andropause head-on, and addressing the multiple systems involved in the aging process, significantly reduces the risk of many age-related diseases while making a full and vital life, long into “old age”, a reality.

Selected studies of interest (some with select quotes from the studies):

1. Harrison J. Talking about my generation: a state of the art review of health information for men in the andropause. Health Info Libr J. 2011 Sep;28(3):161-70.

Wang X, Stocco DM. The decline in testosterone biosynthesis during male aging: a consequence of multiple alterations. Mol Cell Endocrinonol. 2005 Jun 30:238(1-2):1-7.
This study discusses, among other things, age related increases in COX 2 enzymes (inflammatory enzymes inhibited by NSAIDS) which may cause a reduction in testosterone concentrations. 

Zitzmann M. Testosterone deficiency, insulin resistance and the metabolic syndrome. Nat Rev Endocrinol. 2009 Dec;5(12):673-81. Epub 2009 Oct 27. “. . .  central obesity and insulin resistance are acknowledged as important causative factors (in metabolic syndrome). The amount of visceral adipose tissue is inversely associated with testosterone concentrations. Low testosterone levels are associated with insulin resistance and high testosterone concentrations are linked with insulin sensitivity.”

Carreau S, et al. The Promoter(s) of the aromatase gene in male testicular cells. Reprod Bil. 2004 Mar;4(1):23-34. “In human adipose tissue, the primary promoter of aromatase gene expression (is). . , driven by class I cytokines IL-6 and TNF alpha” (this means that testosterones will drop and estrogen levels will rise, a bad scenario for males).

Gouras GK, et al. Testosterone reduces neuronal secretion of Alzheimer’s B-amyloid peptides. PNAS. 2000;97(3):1202-1205.

Moffat SD. Effects of testosterone on cognitive brain aging in elderly men. Ann NY Acad Sci. 2005;1055:80-92. 

Giltav EJ, Haider A, Saad F, Gooren LJ. C-reactive protein levels and aging male symptoms in hypogonadal men treated with testosterone supplementation. Andrologia, 2008 Dec;40(6):398-400.