Grumpy Old Men

Male Hormones at Midlife

(page 1 of 2)

Male menopause is the “buzz” word coined (no doubt, by a perimenopausal woman) to describe the issues men face at middle age.

Not the purchase of the red sports car, nor the weird flirtations with the babysitter in front of the kids; rather, the physiological issues. The lack of energy, the thinning hairline, the potbelly, the desire to spend kid-less Saturday morning hours actually sleeping in…

“Men experience what we call ‘andropause,’ a decline in testosterone over time,” states Anthony Retodo, internal physician and director of medical services at Kaiser Permanente in Folsom. Testosterone, made in the testes, is responsible for a host of healthy physiological functions. Testosterone receptors are located in the brain and heart; the right balance of this hormone regulates blood sugar, blood flow, and protein synthesis required for muscle and bone growth and maintenance. It’s required for healthy neurological function and is a natural antidepressant; and of course, testosterone is needed for satisfying sex. The symptom that usually gets men to the doc’s office? “Erectile dysfunction. That’s usually the reason men come in for treatment,” Retodo says.

The testes also produce trace amounts of estrogen. Problem is, inhibited testosterone, over time, can lead to increased estrogen production. In a way, what men have suspected and feared all their lives is true: Estrogen begins to “take over.” It multiplies in fat cells and is responsible not only for swollen and tender “man-boobs” or “moobs” but, in some cases, hot flashes. Hot flashes! Out-of-whack hormone levels put men at risk for serious health issues, including certain deadly cancers.

To determine hormone levels, blood is drawn over a period of time. If several tests yield abnormal levels, patients can be treated with synthetic hormones – injected or applied topically (patches or creams). “But doctors must be careful to rule out other medical issues, including coronary disease, depression, thyroid issues or diabetes,” Retodo warns. “Hormone therapy is controversial. Physicians must determine if the symptoms [of low testosterone] outweigh the risks of the therapy.”

While risky, hormone therapy also has benefits: It lowers cholesterol, improves memory and protects the heart from coronary disease. “Loss at mid-life is usually very gradual, but over time this loss can have serious consequences including diabetes, injuries related to bone loss, risk of prostate cancer and heart disease – serious conditions I would then treat with hormone therapy if low testosterone levels were the culprit,” explains Jaiwant Rangi, medical director of Capitol Endocrinology in El Dorado Hills.

Pamela Butts, a nurse practitioner with Sutter General in Folsom, thinks male patients are all too eager to embark on what they see as an “easy fix to aging issues.” She says, “I had a man come in the other day in his early thirties [requesting testosterone injections] and I said to myself, ‘what on earth is this about?’” Rangi agrees, saying, “I would advise men in middle age to develop healthy lifestyles. These will keep testosterone levels as optimal as they can be; behaviors that directly affect the rate at which testosterone is produced and how well it regulates function in the body.”

“Non-traditional medicines and alternatives are available, but also have not been studied well,” Retodo argues. The ‘growth hormone fad?’ “Many men who take growth hormones do claim to feel much better, but we don’t know what the long-term risks are,” warns Retodo, noting that men are eager to embrace any treatment for aging, but “growing old is a natural part of life. There is no ‘cure’ for it.”

Check back in August for ‘Female Hormones at Midlife.’


SYMPTOMS OF LOW TESTOSTERONE LEVELS:

  • Erectile dysfunction, reduced libido, fewer “spontaneous” erections
  • Infertility
  • Shrinking testicles
  • Insomnia or other sleep issues, such as sleep apnea
  • Increased body fat
  • Muscle loss (size and strength)
  • Decreased bone density (osteoporosis)
  • Hair loss and breast tenderness or growth (gynecomastia)
  • Possible hot flashes and fatigue
  • Depression, lack of motivation and self-confidence
  • Difficulty with memory and/or concentration
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