Between the
ages of 40 and 55, men can experience a phenomenon which is similar to
the female menopause that is referred to as male andropause.
When a woman
reaches her late forties or early fifties, she undergoes bodily changes
associated with reduction of female sex hormones and the ending of her
periods. These changes are often associated with symptoms such as hot flashes,
mood swings and/or depression, vaginal dryness, atrophic changes in the
vagina and skin, reduced sexual desire, and an accelerated bone loss leading
to osteoporosis.
These changes
in a woman are called the female menopause.
The symptoms
and signs associated with this condition can generally be corrected with
the judicious use of natural hormonal replacement therapy. Unfortunately,
most gynecologists today do not use natural female hormones for replacement,
but rather synthetic hormones or hormones that do not entirely match the
female hormones that are being replaced.
The concept
of a male andropause has been more controversial than that of the female
menopause, with many arguing that it doesn’t exist. Part of the reason
for the controversy is that, in contrast to women, men do not have a clear-cut
external signpost, namely the cessation of menstruation. Nevertheless,
even though women do have this clear-cut demarcation, the changes that
take place in their bodies associated with the stopping of menstruation,
occur gradually over months or even years. This period, during which a
woman may experience irregular menstrual periods, hot flashes, mood swings
and other bodily changes, is often called the peri-menopausal period.
A man often
begins to experience changes in his body somewhere between ages 40 and
55. These bodily changes may be accompanied by changes in attitudes and
moods.
During this
time a man frequently begins to question his values, accomplishments and
the direction of his life. The entire gestalt of these changes has led
to the notion of the mid-life crisis. In this series, I’ll not focus on
all aspects of these changes, but rather on the physical bodily changes
that has been termed the male menopause or andropause. We’ll look at what
occurs and what can be done to slow down these inevitable changes of aging.
The physical
changes that occur with andropause may be divided into: (1) urinary and
sexual changes and (2) more generalized changes. The urinary-sexual changes,
which may occur in any combination and in varying degrees, include: (1)
reduced sexual desire or libido, (2) reduced sexual potency or difficulty
developing or maintaining erections, (3) ejaculatory problems, (4) reduced
fertility, and (5) urinary problems, such as increased urinary frequency-especially
at night, a weak urinary stream, hesitancy during urination, difficulty
starting urination, and urinary incontinence. All of these changes, as
I shall show, may be due, at least in part, to a gradual failure of the
testes’ production of testosterone, the male sex hormone. This would be
analogous to the changes seen in a woman, who at the time of menopause,
has a reduction in the female sex hormones, estrogen and progesterone.
Metabolic
Effects of Testosterone
The importance of
testosterone to sexual and urinary functioning seems intuitively evident.
What is not so apparent is the role of testosterone in more generalized
functions.
Testosterone
is an anabolic hormone, which means it helps to build protein tissue, including
muscles, bones and connective tissue. This gives it a role in preventing
and treating osteoporosis in both men and women.
Testosterone
is helpful in building muscle mass, as every weight lifter knows. Unfortunately,
many weight lifters and athletes misuse the synthetic analogues of testosterone,
called anabolic steroids, by taking excessive doses, which can result in
serious adverse consequences. A deficiency of testosterone may bring about
a weakness in muscles and bones. This tissue deficiency of testosterone
is characteristic of the andropause.
Testosterone
has additional profound metabolic effects. It plays a role in preventing
and treating diabetes mellitus. This disease is characterized by high blood
sugar because the cells are not able to take in sugar and metabolize it
properly. Sugar enters the cells of the body as a result of the action
of insulin combining with insulin receptors on the cells. A problem with
these insulin receptors may result in a reduction of sugar entering the
cells and consequently an increase in blood sugar characteristic of diabetes.
Testosterone helps the insulin receptors to work more efficiently, thus
reducing the tendency toward diabetes, which increases with age.
Another role
of testosterone is to help regulate the immune system. Patients with autoimmune
disorders, such as rheumatoid arthritis, systemic lupus erythematosus and
multiple sclerosis appear to benefit from testosterone. It has been used
to improve appetite, increase weight in malnourished patients, improve
wound healing and increase resistance to infection. By building protein,
it builds body mass while at the same time reducing obesity. It also seems
to lower serum lipids, such as cholesterol and triglycerides and has been
used in Europe to treat patients with gangrene of the feet, coronary artery
heart disease, high blood pressure, and other cardiovascular diseases.
A man’s general motivation, aggression and drive also seem to be related
to tissue levels of testosterone.
So, the reduced
production of testosterone by the testes with aging may indeed contribute
to many of the physical, emotional and mental changes that are seen during
this andropausal period. The question then becomes whether or not men may
benefit by the administration of natural testosterone in physiologic doses
to replace deficient testosterone of andropause. This is directly analogous
to the use of natural female hormones, estrogen and progesterone during
menopause in women. Furthermore, just as younger women may benefit from
the administration of natural female sex hormones if they are deficient
for various reasons, so may younger men benefit from the administration
of natural testosterone if they are deficient.
What is testosterone
and how does it relate to other hormones? Testosterone, like all of the
other sex hormones, is chemically a steroid hormone. A steroid is an organic
(carbon containing) compound consisting of a four-ring structure. In addition
to the sex hormones, estrogen and progesterone, other steroid compounds
important to the body are vitamin D, cholesterol, and hormones from the
adrenal cortex, including cortisone, hydrocortisone, aldosterone, and DHEA.
Cholesterol, that most maligned compound, is the mother of all of these
compounds.
Testosterone
works directly on many tissues of the body.
But, dihydrotestosterone
or DHT, a hormone derived from testosterone, is much more potent than testosterone,
and acts on the prostate gland and other sexual organs. DHT is produced
within the prostate gland and some other organs from testosterone by the
enzyme 5-alpha reductase. Without DHT a male would not develop his external
sexual organs or his prostate. DHT is necessary for the normal growth and
development of the prostate. Its presence is also necessary for the pathologic
enlargement of the prostate, known as benign prostatic hyperplasia (or
BPH) in older men. Because the presence of DHT is necessary for the development
of BPH, a recent therapeutic approach to treating this condition is to
reduce the formation of DHT by blocking the enzyme 5-alpha reductase. This
can be done by the new, highly promoted drug finasteride (or Proscar),
which has been approved by the FDA for this purpose. The herb serenoa repens
(or saw palmetto) also has this effect, as one of its actions. What is
not discussed in the literature of these 5-alpha reductase inhibitors is
that testosterone may be converted to one of two compounds. The first is
DHT as we’ve been discussing. The second is estradiol, the female sex hormone.
So, a blockage of DHT formation, may lead to an increased level of estradiol
via the enzyme aromatase. Increased levels of estrogen may play a role
in the development both of prostate cancer and BPH.
The position of most urologists
has been to view the therapeutic use of testosterone, especially for men
with enlarged prostates, with great skepticism, since its presence is needed
for the development of a benign prostatic hyperplasia or BPH. Other reasons
for urologists reluctance to use testosterone include: (1) early testosterone
enthusiasts promoted the belief that testosterone held the key to the fountain
of youth, a view ridiculed by conventional medicine, (2) the fact that
since the 1940's, it has been known that the growth and spread of prostate
cancer was largely dependent upon the presence of testosterone, and (3)
the abuse of testosterone analogues or anabolic steroids by athletes, resulted
in the FDA classifying testosterone and derivatives as dangerous drugs.
Although the
predominant view about benign prostatic hyperplasia or BPH is that it is
due to a buildup of DHT, this hypothesis is far from proven. Two conditions
must be present for BPH to occur. They are: (1) a man must be at least
in his forties or fifties, as it never occurs in younger men, and (2) DHT
needs to be present for BPH to occur. But, as men grow older, their blood
levels of testosterone and DHT tend to decrease rather than increase. A
more characteristic finding in BPH is that estrogens and the estrogen to
testosterone ratio tends to increase with age in men. It is this increased
ratio of estrogen to testosterone that may be more responsible for the
development of BPH and prostate cancer than DHT and testosterone.
--
Information Provided By
Health WorldOnline
--
|
