ANDROPAUSE

Andropause (Male menopause) is caused by a decline in the hormone testosterone resulting in symptoms such as:

  • Decreased energy and strength
  • Increased body fat
  • Osteoporosis
  • Depression
  • Decreased mental acuity
  • Inability to maintain muscle
  • Loss of eagerness and enthusiasm
  • Increased risk of cancer
  • Increased risk of heart disease
  • Increased risk of arteriosclerosis
  • Decrease libido
  • Decreased sensitivity to stimulation
  • Decreased strength of orgasm
  • Decreased erectile function

Men often rationalise the symptoms as due to aging, stress and the pressure in mid-life.

Testosterone deficiency is easily diagnosed through laboratory tests and resolved through natural hormone replacement of testosterone and DHEA. The tests cover total testosterone, free testosterone and DHEA-Sulfate. It is also good to have reference levels of PSA, Estradiol and cholesterol.

Diseases of the blood vessels are one of the main causes of premature death in Australia. Conventional medicine has not yet accepted that male menopause or more particularly decreased androgen levels increase the risk atherosclerosis. There is evidence dating back half a century that:

  • Testosterone is a primary factor in the health of the heart and blood vessels
  • Testosterone levels decline with age
  • Restoring testosterone (and DHEA) to youthful levels can yield significant health benefits, including protection against various manifestations of arterosclerotic disease

ATHEROSCLEROSIS – CAUSES AND SOME SOLUTIONS

Looking at the normal high fat diet eaten by most males one can see that this type of diet leads to the clogging of the arteries. If, and more likely when, these arteries go into spasm an occlusion follows and a stroke or heart attack follows. To remedy this situation one must look at dietary considerations and the taking of anti-oxidants as blood vessels with high levels of anti-oxidants have some protection.

Consider cholesterol – the LDL cholesterol protein carrier is more prone to oxidation. When this happens the body sees this as foreign and the immune system sends out macrophages that engulf the oxidised LDL in a foam cell that is then deposited on the arteries to form plaque that in turn clogs up the arteries.

Antioxidants reduce the likelihood of this chain reaction. Vitamin E is one of the best anti-oxidants for cardio-vascular tissue. There have been several studies that show that by taking vitamin E the risk of heart attack drops by 40%, and it will also help to remove plaque from artery walls.

MALE TESTOSTERONE – ITS AUTO-SHUTOFF MECHANISMS

Testosterone is produced in the testes and when too much testosterone is produced there is a feedback loop to the hypothalamus to make excess testosterone into estradiol. This estradiol then feeds back to the pituitary gland that then indirectly makes the hypothalamus shut down any more production of testosterone.

Other extraneous factors also influence the testosterone levels. If we eat too much meat that contains estrogens, the feedback is started and testosterone production is shut down – if we drink too much alcohol the loop is also activated, as alcohol is an estrogen producer. Fat cells also produce estrogens, so it can be seen that lots of us have too much estrogen and not enough testosterone.

There may be a biological point of no return when the normal balance of testosterone and estradiol starts tilting towards estradiol. When this happens the equilibrium between the two is put out of balance and estradiol seems to dominate. It is important that it is not the absolute value of each hormone but more likely the ratio between testosterone and estradiol. It has been found by various researchers that increased estradiol is directly linked with myocardial infarction – the opposite to women.

DHEA AND THE HEART

Although focusing primarily on testosterone, mention should be made of the beneficial effects of DHEA (dehydroepiandrosterone). Produced in the adrenal glands, DHEA lies at the heart of the steroid family tree. DHEA is descended from cholesterol by way of pregnenolone and is a direct precursor of androstenedione and androstenediol both of which are directly metabolised to testosterone.

DHEA normally reaches peak levels in the early twenties and then declines gradually so that by age eighty we have about 5% left. It has beneficial testosterone-like effects such as:

  • Feeling of energy and well being
  • Improved insulin sensitivity and glucose tolerance
  • Reduced death from coronary heart disease
  • Lower obesity and waist to hip ratio
  • Slowed progression of atherosclerosis
  • Enhanced libido and erectile ability
  • Reduced depression and enhanced cognition

Looking at the steroid family tree – we can see that cholesterol is at the top and it breaks down through various pathways to estradiol, testosterone and many other molecules. By simply adding a precursor we could assume that it slots itself in and things go on further down the pathway – for instance we take some DHEA and the testosterone level goes up accordingly. It’s not so simple, as sometimes this will work in some individuals and not in others. Hence constant monitoring of the situation must be performed to see if what we want to occur is actually occurring.

EFFECTS OF LOW TESTOSTERONE

Once the testosterone levels drop so does general well-being.

  • Decreased libido and potency.
  • Early senility – as testosterone loss leads to brain cell memory failure.
  • Reduced mental agility.
  • Loss of ability to concentrate.
  • Moodiness and emotionality – grumpy old man syndrome caused by the imbalance in the testosterone/estradiol ratio.
  • Depression – this is a major problem for men who don’t talk about their problems.
  • Reduced activity in general – the couch potato syndrome. As the testosterone goes down you feel less energetic so you sit on the couch. This leads to putting on weight. Fat makes more estrogen. The estrogen tells the brain that you’ve got enough testosterone
    (remember the loop) leading to a downward spiral.
  • Less aggression, more passive – again think of the loop.
  • Nervousness, general tiredness, feeling weak, no oomph, anxiety etc.- these are all due to the estrogen/testosterone
    ratio being out of balance.

TESTOSTERONE AND HEART DISEASE

Vascular disease stroke or heart attack which is a major medical condition in Australian men and women. Testosterone addresses vascular disease in a number of ways.

Low testosterone affects us in the following ways:

  • Angina
  • Atherosclerosis
  • High blood cholesterol
  • High blood triglycerides
  • High blood pressure. High body mass index (obesity).

Testosterone has a major effect on changing the way your body processes insulin. High insulin levels lead to vascular disease, as it causes an increase in triglycerides, a decrease in HDL cholesterol that leads to clogging of arteries etc. Testosterone lowers LDL, raises UDL, reduces triglycerides (because of its effect on insulin)., reduces blood pressure, and changes the body mass index as it converts fat to muscle. It is worth noting that the two sexes tend to look alike as we get older and that’s because of the relative increase in estrogen.

It was, in fact found in a post-war study by Danish physician Jans Moller, that cholesterol levels dropped 83% in a study of 300 men. The average drop was 26%.

Dr. Moller was decades ahead of his time and tried to treat the cause of cardiovascular disease rather than its symptoms. Then, as now, the symptoms are, high cholesterol, hypertension, atherosclerosis, thrombosis, intermittent claudication, angina and other manifestations. The standard treatment has been to lower cholesterol, reduce blood pressure, and dilate coronary arteries (as well as replacing clogged arteries surgically as if they were clogged pipes). “This theory does not have anything to do with prevention and treatment of cardiovascular disease” wrote Moller.

Moller basically believed that the normal condition of living organism is a balance between anabolic (protein building) and catabolic (protein destroying) processes. The primary anabolic hormone is testosterone and the primary catabolic hormone is cortisol. Cardiovascular disease results when catabolic influences come to predominate, leading to an excess of cholesterol, impaired carbohydrate metabolism, decreased fibrinolysis and other symptoms.

Lowering cholesterol by reducing dietary intake and by use of drugs, can lead to impotence and impaired cardiac function. This is logical when one remembers that testosterone is made from cholesterol and testosterone improves libido and protects the heart.

TESTOSTERONE AND LIBIDO/POTENCY

There are two components to developing an erection. Firstly thoughts stimulate the production of testosterone, which in turn stimulates blood vessels in the penis to fill and thus form an erection. To maintain the erection the testosterone level goes down which stimulates the production of nitrous oxide which develops a couple of other products that dilate the vessels.

So to sustain an erection, simple testosterone supplementation will not work unless the blood vessels are free and clear to dilate effectively. This can be one of the first signs of coronary artery disease as this starts before the angina.

Thus as we get older, the gap between libido and potency gets wider.

TOTAL AND FREE TESTOSTERONE

Testosterone is found in the bloodstream in two forms, namely as free testosterone which is active, and the form bound to a steroid binding globulin, SHBG. As we get older the bound version rises but the free version falls. Blood results of total testosterone may show a small drop, when in fact from about 40 years of age free testosterone levels drop a lot, hence test both. Note that as the estrogen levels go up relatively so too does the SHBG, thus less free testosterone.

Testosterone supplementation increases the level of both total and free testosterone, and over a 12 month period the symptoms are reversed, the risk of coronary artery occlusion goes down, angina episodes go down, as do the other symptoms of testosterone deficiency.

Di-indolylmethane is an extract found in cruciferous vegetable s that has a number of actions:

  1. it increases the portion of testosterone that is free in serum (by altering the free: bound ratio)
  2. it alters the metabolism of estrogens in favour of the safer estrogens
  3. it increase the progesterone binding

DOSAGE OF TESTOSTERONE

On a daily basis men get a pulse of testosterone about midday, another about 3pm, and a big pulse between 3-8am. Thus the best way to mimic this is by using troches, taking them three times a day, or at least twice a day. Since the major secretion is in the morning and to improve compliance a single morning dose has proved to be adequate.

The actual dosage with troches varies, between 10-50mg twice daily, with age basically dictating the dose (i.e. the older the higher the dose). Sometimes doses as high as 200mg a day are necessary for such problems as vascular occlusion but this is rare. If there is an artery problem, often the last symptom to be corrected is erectile function, as that needs to be corrected before an erection can be maintained.