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IF WOMEN HAVE MENOPAUSE, DO MEN HAVE MANOPAUSE?

The answer is yes, but it’s called Andropause. Androgens are the group of drugs that mimic testosterone. Androgens stimulate or controls the development and maintenance of male characteristics in vertebrates by binding to androgen receptors. This includes the activity of the accessory male sex organs and development of male secondary sex characteristics. Androgens were first discovered in 1936. Androgens are also the original anabolic steroids and the precursor of all estrogens, the female sex hormones. The primary and most well-known androgen is testosterone. Androgen ablation can be used as an effective therapy in prostate cancer. However, for our purposes, let’s discuss the condition known as andropause and what can be done to improve the condition.

THE CHEMISTRY

Did you know that the average 60 year old female has more testosterone than the average 60 year old male? Did you know that the average 60 year old male has more estrogen than the average 60 year female? As we age the body begins to metabolize our hormones differently because of age related liver enzyme changes. If you look at the steroid structure of testosterone

and estradiol you will have to look hard to see the difference between the two. Look in the lower left corner to see the =0 instead of =OH. That my friends is the difference between men and women. In the older liver of the man aromatization takes place. This means that the =O turns into =OH. In chemistry we call these =OH groups alcohols, which give off an aroma, hence the term aromatization. One way to keep your testosterone intact is to take an “aromatase inhibitor”.

THE PHYSIOLOGY

In general, androgens promote protein synthesis and growth of those tissues with androgen receptors. Testosterone effects can be classified as virilizing and anabolic, although the distinction is somewhat artificial, as many of the effects can be considered both. Testosterone is anabolic, meaning it builds up bone and muscle mass.

As men age the level of testosterone drops and the effects of lower testosterone gradually begin to occur. The best way to describe the symptoms are “ my get up and go is gone”. We have all heard of erectile dysfunction “ED” and can understand how upsetting that can be. In fact, unlike women, men usually don’t complain to anyone until the dreaded “ED” occurs. Then it becomes important. Amazingly enough, because the lack of testosterone also causes men to become more complacent, they may not even complain about ED. However, their wives do. I’m sure you know that we help lots of menopausal women with their hormones. Not surprising to know that when we have restored the libido of many of our female patients, they are “ready” to resume their normal sex life.  Many times they find that their husbands have become “couch potatoes” during the long drought, and he has lost his libido. This too is something that can be restored over time. After a saliva test and an examination by a qualified physician, a testosterone deficiency can be resolved.

One would think this is simple. Give testosterone! Not so fast there cowboy. The physician will need to verify that the patient has normal blood levels. He/she will need to do an DRE- “digital rectal exam” to insure that the prostate is not enlarged. A blood test called a PSA (Prostate Specific Androgen) is also imperative. After all these tests are confirmed and in the correct range, then the physician needs to determine the best method to treat each patient. If the patient in young (20-50 years old) the dose of testosterone will need to lower ( in some cases) to prevent the possibility of inhibiting the “endogenous” (the self production) or testosterone. If we give a large dose for a long period of time, the body will determine that it no longer needs to make testosterone and it will cease to produce it.  In these cases we normally see lower doses used to augment the endogenous testosterone production. Most of the time in older patients the dose is higher. I strongly suggest that the patient use an over- the-counter zinc supplement.  The purpose of the zinc is to inhibit a metabolism of testosterone (by 5-alpha reductase) to hydroxy-testosterone. Elevated levels of Hydroxy-testosterone is responsible for male pattern balding and prostate inflammation. Prostate inflammation is known at BPH-(benign prostate hypertrophy). We also suggest that a weak aromatase inhibitor be added to the formula to avoid the “aromatization” we spoke of early. Think of it this way: If you are taking two steps forward (increasing testosterone) while losing 3 steps backward (aromatization to estradiol), you net result is negative. Using the weak aromatase inhibitor “chrysin”, can prevent this estrogen conversion. Typically patients who use this medications see results in 2-3 months. Many will use it for several months in a row with excellent results. Many will discontinue using it after time and do well for many months, until levels drop to the levels where symptoms appear again. Of course, repeating the process nets the same results in time.

CANCER RISK

Given all the safeguards mentioned above that are employed during normal therapy, the risk of cancer while using testosterone is very low, and perhaps even lower since the patient is being followed so closely. Of course, cancer can occur in patients using no therapy. All men over the age of fifty should get a prostate exam and PSA yearly.

THE NEXT STEP

Men get off the couch. Go see your family doctor or your urologist to find out your testosterone levels. Women, you know they are not going to do that- so make the appointment for him. . If your own family doctor is willing to do this treatment and is qualified, by all means do that. If not, call me for more information. We will be happy to provide you with a list of knowledgeable - experienced physicians. In the meantime, you may also purchase a saliva test kit at the pharmacy to begin the process.

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