The first thing a man entering andropause generally notices is a subtle downward shift in strength and energy as hormone levels taper off. Muscle tone and stamina are the first to go and he starts to gain weight and that "spare tire." He may also develop a voracious appetite and food cravings he never had before. As symptoms kick in at mid-life, hormone testing can identify hidden imbalances that complicate symptoms of andropause and contribute to rapid aging.
The 2006 HIM Study found that nearly 40% of US males over 45 years old had low testosterone levels (an estimated 13 million US males), however the majority of men in the study did not recognize that the weight gain, sore muscles, lack of libido, insomnia, and burnout they were experiencing could have something to do with andropause and hormone imbalance – instead they put their symptoms down to "just getting old."
Getting old was the recurrent theme at a recent 50th birthday party I attended where non-stop over the hill jokes and "low-T" lamentations were heaped upon the birthday boy. All that talk of testosterone reminded me of an article in Atlantic magazine a few years ago that slammed the drug industry’s promotion of supplemental testosterone as "god's gift to men," and questioned whether every modern man really needs testosterone?
One way to begin to answer that question is to start with physiology and understand that the androgens (primarily testosterone and DHEA) in their natural state bestow the heavier bone and muscle mass, deeper voice, drive and virility we associate with the male of the species. And that when they start to decline around the age of 45, the average Joe will experience some of the following symptoms:
- Decreased strength/stamina/endurance
- Decreased muscle mass/sore muscles
- Weight gain in the hips, thighs, waist, and/or breasts
- Increased body fat
- Poor recovery from exercise
- Burnout and fatigue
- Lack of mental clarity
- Decreased sex drive and/or competitive drive
- Prostate problems
The natural decline of hormone levels in aging men also poses an increased cardiovascular risk which is where the controversy over replacement therapy comes in: whether it can hurt or help healthy men, and those who already have heart disease. It's an important question, particularly in light of the skyrocketing numbers of men using testosterone products to feel better and to increase muscle mass and energy. According to the FDA, the use of testosterone therapies increased from 1.3 million patients in 2009 to 2.3 million patients in 2013, a doubling of prescriptions in less than five years. In light of these numbers and that the risks vs. benefits of androgen supplementation in men have not been clearly identified, the Atlantic article raised some important questions, for which recent research has some good answers.
Replacement has its place
In a 2015 study of 1472 generally healthy men between the ages of 52 and 63 with no history of heart disease, researchers found that those who received testosterone supplementation to achieve normal levels did not increase their risk of heart attack stroke or death but actually showed a reduction of risk compared to patients not on testosterone therapy. Even more good news came in a follow-up study this year (2016) of 755 male patients between the ages of 58 and 78, all with severe coronary artery disease. Researchers found that the men who received testosterone therapy as part of their follow-up treatment fared much better than those who didn't. In fact, the non-testosterone therapy patients were 80 percent more likely to suffer an adverse event.
Its always about balance
Aging is inevitable and dropping hormone levels go with the territory, but what is not inevitable, is how rapid or steep the decline in hormones needs to be. Whether men age well, or rapidly, depends a great deal on their stress levels, diet, exercise, alcohol intake, weight gain etc. For example, the more overweight the man, the more estrogen he will churn out in his fat cells, creating a surplus in relation to waning testosterone, and a raft of estrogen related symptoms, like moodiness, depression, and female pattern of weight distribution in the hips, thighs, and breast tissue. (A fact that should not be lost on those concerned about prostate health is that estrogen is a growth hormone linked with the development of prostate cancer.)
Experts in the field of hormone testing and balance, like Dr. David Zava, owner of ZRT Laboratory will tell you that where the need is clearly established and monitored through testing, supplementing with testosterone can be beneficial, particularly, when used in tandem with a healthy lifestyle.
Men in balance do these things during andropause
- *Test their hormone levels to detect and correct imbalances linked to symptoms.
- Follow up with a natural hormone friendly physician
- Lose weight as needed. Fat cells contain aromatase, an enzyme that robs the male body of available testosterone by converting it into estrogen.
- Stick with a program! A low glycemic Mediterranean style diet that's high in protein and fiber and low in fat and carbs can help rebalance hormones and assist weight loss
- Throw out testosterone robbers like caffeine, alcohol, cigarettes, and unnecessary stressors like burning the candle at both ends day in and day out etc.
- Take up strength training or weight bearing exercise to boost testosterone and DHEA levels naturally by building up lean muscle mass
- Counteract stress (the higher the stress levels, the lower the testosterone) with regular exercise – 45 minutes is optimal but even 10 mins. 3x a day adds up to 30 minutes and that is GOOD
- St-r-e-t-c-h and breathe deep to release tension held in the muscles and lower stress hormones that deplete T levels
- Hit the sack earlier – less than 7 hours of sleep disrupts appetite hormones to increase cravings and feelings of hunger
- Take time to do the things you enjoy! Stress reduction is the key to normalizing cortisol and T levels
*Topical supplements rubbed into the skin (gels, creams) do not always show up in a serum test and can lead to possible OVER supplementation. This is why so many physicians test hormone levels in saliva or dried blood spot sampling to track and adjust dosage as needed.
The Good Andropause
I encourage you to read the Atlantic article with the awareness that hormone balance never boils down to just one hormone! Getting to the land of optimal health and aging is about getting ALL key players – estrogen, progesterone, testosterone, DHEA, cortisol, thyroid – working together in sync! Just like the symphony orchestra, if one instrument is out of tune, so goes the melody…hormones are your internal symphony. Replacement has its place as long as it is in tune with your body’s natural rhythms and need for proper care, feeding and rest during andropause!