Alternative Medicine
Magazine
June, 2007
MANopause
It’s
no joke. Men go through the change of life, too. Although male menopause has
been under the radar for years, the condition has gained credibility in recent
years. What’s a guy to do?
By Lisa Marshall
So you feel hot under the collar these days, but seldom under the sheets. Your
middle is getting softer by the day, and your mood swings and night sweats are
enough to drive your partner to the couch.
I know what you’re thinking: It must be menopause.
But wait, you’re a guy. Could you too be in for a “change of
life?”
“This is coming for the Baby Boomers, and we are going to see an
explosion of interest in it,” says John Morley, MD, head of the geriatrics
division at Saint Louis University Medical School, and a leading researcher on
the subject of so-called “male menopause.”
Scientists have long known that a man’s testosterone level begins a slow
downhill slide as early as age 30, dropping 1 percent a year on average after
the age of 50. Add that to the fact that other sex hormones and brain chemicals
also begin to fluctuate, and middle-aged men can quite possibly look forward to
an array of “change of life” symptoms, including loss of muscle mass, fatigue,
depression, erectile dysfunction, and even hot flashes. But because the
condition is exceedingly hard to test for—and historically difficult to
discuss—it has remained under the radar for doctors and patients alike, says
licensed psychotherapist Jed Diamond, author of the sentinel book Male Menopause (Sourcebooks,1997).
“If you go to your average doctor as a guy and say ‘I think I’m going through
male menopause,’ most of them will still laugh at you,” says Diamond. “Men tend
to deny anything in themselves that is remotely feminine.”
As studies begin to link low testosterone with heart disease, cognitive
decline, and bone loss, and aging Baby Boomers still insist on a thriving sex
life well into their Golden years, organizations like the National Institutes
of Health and the American Association of Clinical Endocrinologists have called
for more research into the phenomenon of waning testosterone.
The burning questions: When and how should manopause be treated? And is treatment safe? Meanwhile, thousands are
opting not to wait for the answer; instead they’re flocking to specialty
clinics for everything from testosterone shots to acupuncture and herbal
supplements.
“I hit a wall and traditional medicine just couldn’t help,” says 50-year-old
California filmmaker John Upton, who declined recommendations of anti-depressants
and instead turned to Diamond for help. “I found myself, at 48, carrying around
70 pounds of body fat, not being able to get an erection, not feeling good,
divorced twice and not in good shape at all. Jed said go to a doctor and get
your hormones checked. I did, and they determined my testosterone was low.”
What’s in a name?
Despite more than three-dozen clinical trials on the subject and scores more in
the works, the notion of male menopause is far from universally accepted. A
widely heralded report commissioned in 2004 by the US National Institute of
Aging and the National Cancer Institute concludes, “there is scant evidence
that male menopause exists,” and points out that “the likelihood a man will
ever experience a major shut-down of hormone production similar to a woman’s
menopause, is remote.” It also called for more research.
At the root of the controversy, says Morley, lies semantics: Because menopause,
by definition, means the end of menses, calling the male experience by the same
name often ruffles feathers. Some call it hypogonadism,
which means low hormone production, but that can occur in men of all ages.
Others call it andropause. Morley prefers Androgen
Deficiency in the Aging Male (ADAM). “It will never be fully recognized until people
can find one title they can agree on,” he says.
Although menopause comes on fairly rapidly for all woman,
halting production of progestin and estrogen and spelling the end of fertility,
the male process comes on subtly and varies in severity, depending on the man’s
lifestyle, experts say. “It is a very slow, insidious, hard-to-figure-out
process,” says Todd Dorfman, MD, a Boulder physician
who specializes in treating male menopause. “Men come in with one or two
issues, (libido problems are typically Number One) and I have to drag the rest
out of them.”
And while the female “change of life” can lead to fairly specific health
issues, such as rapid bone loss and hot flashes, linking testosterone-loss to
conditions like weight gain, ED, and depression—all of which can have numerous
other causes—can be tricky. Because men, even in their 30s and 40s, often turn
to potentially-risky testosterone treatments to quell those changes, the
subject remains controversial. “A lot of patients come to me and they are already
on testosterone and they have never even had their levels measured,” says Mark
Carney, ND, LAc, of Denver,
Colorado. “In my opinion, that is very poor medicine.”
The test
So just how can you know for sure if low testosterone
is the problem? Another tricky question. Testosterone
levels normally fluctuate throughout the day (higher in the morning), from
season to season (highest in the fall; lowest in the spring), and can vary
according to stress levels and diet. So you can have a hard time distinguishing
whether testosterone levels have truly dipped, or if you took the test at an
inopportune time.
Assuming that you truly have age-related testosterone loss, another question
then arises: How low is too low? A “normal” healthy adult male’s total testosterone
concentrations can range anywhere from 300 ng/dL to 1,000 ng/dL. Those with levels of 200 ng/dL to 319 ng/dL are good candidates for therapy.
By those measures, one in 10 men between the ages of 40 and 60 has abnormally
low testosterone levels, and after 75, the ratio rises to 3 in 10.
But because some men naturally produce more testosterone in their youth, those
benchmarks can be misleading, says Diamond. “Let’s say you have a guy in his
20s who has a testosterone level of 1,000 and by the time he gets to be 50,
[levels drop] down to 500. He has lost half of his testosterone and is likely
to have symptoms. On the other hand, you might have a guy who is at 400 in his
20s and drops to 250 (considered abnormal). He may not have any symptoms.”
Dorfman says he runs an array of blood tests, asks
patients to fill out a lengthy lifestyle questionnaire, and sits down for an
in-depth interview with each one before making a diagnosis. If he can blame
age-related hormone changes, he says he has good news: “It can be forestalled,
and it can be reversed.”
Natural solutions
To start building hormone levels naturally, look to
the following three options as a good, safe way to start.
• Exercise. “There is a direct relationship between muscle
mass and testosterone. One natural way a person can raise his testosterone
levels is by getting into a weight-lifting program,” says Carney, a naturopath
who specializes in men’s health. Studies have shown that as few as two sessions
of strength training per week can increase muscle strength by more than 30
percent, while also boosting bone density (another victim of declining
testosterone), speeding up metabolism, and pushing up production of
testosterone and other sex hormones. Exercises that target several large muscle
groups (like squats or bench presses) boost testosterone levels more than those
that train isolated muscles (like curls).
Meanwhile, aerobic exercise boosts the production of feel-good
neurotransmitters in the brain, which also have a tendency to get thrown out of
balance as men age. So having a well-rounded exercise program helps.
Keeping weight in check also makes a difference, says Diamond. Because fat
cells tend to convert circulating testosterone into estrogen, having too much
fat around the middle can sabotage what little testosterone the body still
produces. “If you are overweight, you are really working against yourself.”
On the flip side, over-training and under-eating can also wreak havoc on
testosterone production.
In one study, volunteer male soldiers undergoing an intense, eight-week
training course also ate a restricted-calorie diet (about 1,200 calories less
than what they needed). Their testosterone levels dipped to “castrate levels,”
far below normal, while their levels of sex hormone binding globulin (SHBG)
which binds to testosterone and makes it less available to the body, went
through the roof. Once they started getting enough calories again, their levels
returned to normal.
• Nutrition. Men should also eat enough good carbohydrates, protein, and good
fat, says Carney. Research shows that protein helps maintain lean muscle mass.
Lack of carbohydrates can lead to decreased serotonin and, consequently,
irritability. And it takes a certain amount of fat to keep testosterone
production at healthy levels.
One recent study of 36 middle-aged, white, healthy men showed that switching to
a strict, low-fat diet for eight weeks reduced circulating male hormone levels
by 12 percent on average. Generally experts recommend that men get roughly 30
percent of their calories from fat (albeit good fat like that found in nuts,
oily fish, and olive oil.) “Cholesterol is a building block of many of the
hormones and if you don’t have enough of it, you can’t build the house,” says
Carney.
Another key piece of dietary advice: Cut back on the alcohol, which studies
show also decreases testosterone levels. “Contrary to what many men think—that
a few drinks make them sexier—they are really taking away their testosterone,”
says psychotherapist Diamond, who is also a Certified Addictions Counselor.
• Herbs and Supplements. Schuyler McHenry, ND, of Southwest College of
Naturopathic Medicine, recommends B vitamins, which can help with stress and
boost energy; C vitamins, which can stabilize production of stress hormones; and
herbs such as ashwagandha and ginseng (see “10 Herbs
and Supplements to Quell Male Menopause Symptoms” on page TK).
McHenry also recommends acupuncture, herbs and Chinese patent formulas aimed at
strengthening the kidneys, which are considered the hearth of male sexual
energy in Chinese Medicine. “If there is anything that damages the kidneys, it
can lead to weakness of the sexual organs,” McHenry says.
Perhaps the Number One over-the-counter dietary supplement for addressing male
menopause is dehydroepiandrosterone (DHEA), a
building block for sex hormones that the body has naturally, but that also
tends to decline rapidly with age. Sales of DHEA supplements (often derived
from yams) jumped from just $1 million in 1998 to $48 million in 2004,
according to Nutrition Business Journal, as studies have suggested it can improve skin, sex drive, mood,
and strength in aging men. However, practitioners warn that DHEA is a hormone,
and overuse of hormones can result in serious side effects. So before adding
DHEA to your daily supplement regimen, have your blood DHEA levels tested and
then have them retested periodically once you start taking it.
Other popular supplements used for male menopausal symptoms include fish oil,
or omega-3 supplements, which have been shown to improve cognitive function,
boost energy, and prevent heart attacks, and L-arginine,
an amino acid that helps dilate constricted blood vessels associated with
erectile dysfunction.
Bringing it all together
For John Upton, a combination of treatments has been the key to good health. He
started with acupuncture, which he says lifted the “fog” he’d been in for
years. “I remembered what it was like to be hopeful again.”
Today, he takes dozens of dietary supplements daily, spending between $300 and
$500 per month, eats a high-protein, low-glycemic
index diet, lifts weights regularly, sees a counselor, and injects prescription
testosterone to keep his levels within normal range. “The difference is
stunning,” he says. “I’d never want to go back.”
Just how many American men are willing to go to such lengths, expense, and
potential risk to slow down the ticking clock? That remains to be seen. But
whether they should will likely remain a hot topic of conversation for some
time.
Lisa Ann Marshall is a contributing editor for Alternative Medicine.
10 Herbs and Supplements to Quell Male Menopause
Symptoms
DHEA (dehydroepiandrosterone). An over-the-counter supplement designed to mimic natural hormone
building blocks, which decline in the body with age. Improves
mood, exercise capacity, sex drive, and skin conditions such as lupus.
Maca (Lepidium
meyenii, L. Peruvianum). A root used for centuries in Peru for its
fertility and libido-enhancing properties.
Horny goat weed (Epimedium sagittatum, D. Grandiflorum). A Chinese herb, also called yin yang huo,used to increase libido and address erectile dysfunction and premature
ejaculation.
Yohimbe (Pausinystalia yohimba). Some studies show that yohimbe, which
comes from the bark of an African tree, can be effective in addressing erectile
dysfunction.
Ginseng: This age-old standby
promotes energy, stamina, and endurance, affects hormonal imbalance, and
nourishes the kidneys, considered vital organs for supporting sexual health.
Ashwagandha (Withania somnifera). A powdered root used in the East as an
aphrodisiac for 3,000 years.
Damiana (Turnera
diffusa; var. T. Aphrodisiaca).A mood-elevating aromatic herb that helps calm
anxiety.
Chaste tree (Vitex agnus-castus). Historically used to reduce male libido in
monks and others entering the priesthood, it has since been used to help
normalize hormonal changes associated with male menopause.
L-arginine. An amino acid that helps dilate constricted
blood vessels associated with ED. Should not be used in people who have had a
heart attack
Fish oil or omega-3 supplements. Either improves cognitive function, prevents
heart disease, and provides an energy source.
Sources: The Male Herbal (Sourcebooks, 1997), by herbalist James Green; Mark Carney, ND.
Hormone Replacement
Therapy for Men?
By far the most controversial treatment, prescription testosterone, comes in
the form of twice-monthly self-injections, prescription gels, or skin patches.
According to IMS Health, a pharmaceutical market research firm, sales of
prescription testosterone soared to $568 million in 2006, nearly double what
they were in 2002, and with a host of new easier-to-use products in the
pipeline those numbers will surely continue to rise.
Some studies have shown that supplemental testosterone can indeed restore
sexual function and muscle strength, improve memory, prevent bone loss, and
possibly protect against heart disease. But supplemental testosterone has
potential risks: Too much can trigger aggression and cause breast enlargement;
it also thickens blood, potentially increasing the risk of stroke; and it has
been shown to cause sleep apnea in some men.
Although research to date remains inconclusive, some also fear excess
testosterone may fuel the growth of prostate cancer. That concern has prompted
many researchers—fans and critics of testosterone replacement alike—to call for
more long-term health studies like the Women’s Health Initiative (which
ultimately exposed the risk of hormone replacement therapy in women). “We are
lacking the Women’s Health Initiative equivalent for men and we need that,”
says John Morley, MD, head of the geriatrics division at Saint Louis University
Medical School. “Everybody knows that until we do one large study that includes
side-effects, we won’t have a clue.”
Many experts say they prescribe testosterone in cases when needed, but only
after rigorous testing. Todd Dorfman, MD, a Boulder
physician who specializes in treating male menopause, says that in some cases
he can use other, more benign synthetic hormones, such as a self-injected
“luteinizing hormone” intended to amplify the signal from the pituitary to the
testes and jump-start the body into making its own testosterone. That way, he
says, “I’m using the patient’s own physiological mechanism to get him to
produce his own testosterone”
When he does put men on testosterone supplementation, he prescribes plant-based
bio-identical testosterone (which some believe is less disruptive to the
hormone system). He also checks their Prostate Specific Antigen (PSA) levels
every six months. “The bottom line is, there are no good quantifiable long-term
papers out there yet about its safety,” says Dorfman,
“I very specifically describe to my patients the fact that I do not know
long-term what the consequences will be.” And their typical answer? They are
willing to take the risk.
Are you Suffering from
Male Menopause (a.k.a. Androgen Deficiency in Aging Men)?
Answer the following questions to find out if you may be going through the
“change of life.” If you answer yes to question 1 or 7, or at least three of
the other questions, you may have low testosterone and may want to discuss the
results of this quiz with your health care provider.
1.
Do you have a decrease in libido (sex drive)?
2. Do you lack energy?
3. Do you have a decrease in strength and/or endurance?
4. Have you lost height?
5. Have you noticed a decreased enjoyment of life?
6. Are you sad or grumpy?
7. Are your erections less strong?
8. Have you noticed a deterioration in your athletic performance?
9. Are you falling asleep after dinner?
10. Is your work performance deteriorating?
Source:
John Morley, MD, Saint Louis University School of Medicine