MANopause?We are all too familiar with the age around when women start to complain of hot flashes, night sweats, mood swings, loss of libido and all of the other symptoms that comes along with menopause. But many aren't aware that men can experience similar symptoms as well, but instead of menopause we call this andropause. The term andropause is becoming much more common amongst practitioners, but in many cases the mechanism is misdiagnosed and treatments only have a "honeymoon phase."
According to Wikipedia:
Andropause or male menopause, sometimes colloquially called "man-opause" is a name that has been given to a menopause-like condition in aging men. This relates to the slow but steady reduction of the production of the hormones testosterone and dehydroepiandrosterone in middle-aged men, and the consequences of that reduction, which is associated with a decrease in Leydig cells.
Unlike women, middle-aged men do not experience a complete and permanent physiological shutting down of the reproductive system as a normal event. A steady decline in testosterone levels with age (in both men and women) is well documented.
Unlike "menopause", the word "andropause" is not currently recognized by the World Health Organization and its ICD-10 medical classification. This is likely because "andropause" is a term of convenience describing the stage of life when symptoms of aging appear in men. While the words are sometimes used interchangeably, hypogonadism is a deficiency state in which the hormone testosterone goes below the normal range for even an aging male.
First of all it takes a certain type of male to actually admit to having andropause symptoms. Most likely in order for a man to see a doctor about his "hot flashes" he is being drug into the doctor's office against his will.
Common symptoms of Andropause:
- Low testosterone with high estrogens
- Fatigue
- Hot flashes or "sweating attacks"
- Irritability
- Emotional
- Weight gain, especially in midsection and breast area
- Low libido
- High cholesterol and/or triglycerides
- Sexual dysfunction
- Memory loss
- Can't build and maintain muscle as well as before
- Depressed
- Low passion/drive
What men will usually first notice is loss of stamina and initiative.
So what happens when a male seeks help for any of these symptoms?
In most cases when a male patient complains of any of the above symptoms doctors will test testosterone levels. What tests most often show is that testosterone is low, so the patient is immediately put on testosterone replacement, usually in the form of a cream.
Why does this not work?
First of all, yes the test is correct - testosterone is low, and patients may feel better at first on hormone replacements, but the effects are not lasting. What we need to look at is why? Instead of just giving the body the hormone that is depleted, why aren't we looking a bit further and determining why it is low in the first place. A simple step to answer this question is to run an estrogen panel along with testosterone. In most cases when testosterone is low, estrogens are high.
Why is it common to see estrogens high when testosterone is low?
During andropause men tend to convert testosterone into estrogen in a process called aromatization. Aromatase is an enzyme that is found in body fat. Giving someone a hormone cream will cause the hormones to build up in body fat, and along with other system imbalances can cause aromatization. Hence, the reason why giving a male a testosterone cream, and then testing his testosterone levels you will still see low testosterone! The more testosterone you give someone that is aromatizing the more estrogen levels you will see in the body. Testosterone is not the issue here, it is only a side effect.
So what causes aromatization in the body?
There are several reasons why aromatization can take place leading to andropausal symptoms. The most common reasons are due to blood sugar dysregulation and inflammation. It has been shown that insulin resistance and cytokine surges can up-regulate aromatase; converting testosterone to estrogens.
What if testosterone is normal, but a man still is experiencing andropausal symptoms?
In many cases testosterone may be normal, but the sex hormone-binding globulins in the body are high, thus causing free testosterone to be low. Free testosterone is what attaches to testosterone receptors in the body in order to achieve the desired affect. Ask your doctor to run a panel that includes not only testosterone but free testosterone as well to determine if this is an issue.
Other causes of andropause?
Oxidative stress can cause the leydig cells in the testes to reduce production of testosterone even when LH is elevated.
Andropause can also be due to something like chronic stress. Chronic stress can lead to adrenal hormone imbalances. The gonads are not the only place that testosterone is created; the adrenal hormone, DHEA is also converted into testosterone. As a man ages more and more of testosterone production is dependent upon healthy working adrenals. As long as they are working correctly there will be healthy testosterone production.
Liver detoxification can also be an issue that hormones are out of balance. Every hormone the body makes has to pass through the liver. The liver works to get the hormones to the correct cells and makes sure that any hormone in excess is excreted. If the liver is inhibited from doing it's job this could in turn cause hormone imbalances.
The best way to address andropause in men, is first of all to run a complete hormone panel; a simple testosterone panel is only part of the picture. The next part is diet and exercise of course! Stabilizing blood sugar is vital in rebalancing hormones. I recommend cutting out or reducing majority of carbohydrates from the diet. Focus on eating proteins, essential fatty acids and vegetables with each meal. Eliminate soy and minimize fruit consumption. Stimulators such as coffee and alcohol should be consumed sparing.
It is also important to reduce outside hormone exposure. Purchase antibiotic, hormone free meat; opt of organic grass-fed instead. Soy contains phytoestrogens, which is why I suggest avoiding unfermented soy sources.
Consume foods that support testosterone levels such as foods that contain zinc - oysters, nuts, pumpkin seed, etc. And foods that support prostate health like saw palmetto, stinging nettle, pygeum, etc.
Diets high in fiber are also suggested since the fiber can help bind to excess hormones such as estrogen, and remove it from the body.
Pura Vida!
Alica Ryan, NTP
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