Overcoming Andropause Part 1: Testosterone Therapy By J.W.

Simpkins Fit Men Over 40 I had just finished training a client, when Phil (not his real name), my five oclock first time appointment, came into the office and sat down in the chair opposite my desk. Actually, it was more slumping than sitting. He looked somewhat like a tired exlinebacker way past his prime, as opposed to a man on a mission to get fit. So, what brings you here today? I asked. I, uh my doctor told me I need to lose some weight, he sheepishly replied. Do you think you need to lose some weight? I asked. Yeah, I guess so. Things have kind of gotten out of hand the past few years. Did your doctor give a specific reason why you need to lose weight or is it just for general health? Well sort of. He said it might help with some of the other issues Ive been having, besides my weight. This piqued my curiosity. Tell me about these other issues, I said, leaning forward and making my best finger tent. Phil went on to rhyme off a laundry list of symptoms that included low energy, depressed moods, loss of strength, poor sleep, lack of mental focus, night sweats and irritability. Hows your libido? I asked. My what? he replied. Your sex drive. How is it? Oh yeah, I forgot about that. I dont have one. I nodded my head reassuringly and said, OK, no worries. Well come up with a plan to help get you back on track.

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Phils story is typical of many men who reach middle age and begin to feel the cumulative effects of a lifetime of less than optimal lifestyle choices. Any number of factors such as a bad diet, high stress, substance abuse or lack of exercise, combined with the natural aging process, can bring about a tipping point that results in the onset of a condition known as andropause. Andropause is the male equivalent of female menopause and is characterized by a decrease in the bodys production of the hormone testosterone, that can manifest itself in many of the vague but nevertheless distressing symptoms Phil was experiencing. The natural decline of testosterone in men is estimated to be at a rate of 1% per year after the age of thirty or 10% per decade, with a concomitant rise in total body estrogen levels and a protein called sex hormone binding globulin (SHBG) that binds free testosterone making it unavailable for use by the body. This can leave many once virile men looking and feeling like Richard Simmons on birth control pills by the time they reach their sixties. Not good for the manly mojo.

Unfortunately, because the hormonal decline seen in men suffering from andropause is less rapid and the symptoms not as pronounced as they are in menopausal women, there is still no general consensus in the medical community as to whether or not andropause is a valid condition that necessitates treatment. The unwillingness of some physicians to treat or even acknowledge the existence of andropause, leaves many middle-aged men confused, depressed and more prone to act out behavioral patterns associated with the stereotypical Copyright 2013 FitMenOver40.com 2

midlife crisis: Getting divorced, buying a convertible sports car, hanging out at singles bars, leaving their shirt open two buttons too low and having sex with women nearly half their age (although technically this could be considered as medicinal). But is it possible that the cringe worthy male midlife crisis might be prevented or at least partially averted by maintaining optimal testosterone levels? Benefits of Testosterone The Leydig cells in the testicles are responsible for producing approximately 95% of the testosterone in adult males, with the rest being produced by the adrenal glands. Most men are familiar with the role that testosterone plays in their body when it comes to sex drive, deepening of the voice, body hair growth and muscle building. But few are aware of just how vital maintaining optimal testosterone levels is to their overall health. There are receptors for testosterone located throughout your entire body and maintaining optimal testosterone levels well into adulthood has been shown to provide the following benefits: Higher bone density to prevent osteopenia and osteoporosis. Improved cardiovascular health to protect against heart disease and stroke. Enhanced sex drive and improvement of erectile dysfunction. Reduced body fat and increased muscle size and strength. Improved mood, self-confidence, motivation and drive. Better mental focus and concentration. Improved blood sugar regulation, which may help to prevent diabetes. Reduced risk of benign and/or cancerous prostate disease. Increased energy levels and less chance of falling asleep on the couch while watching Dancing With The Stars with your wife. With all of the seemingly miraculous benefits to be gained from maintaining optimal testosterone levels as you age, the question then becomes, Just how is the average middle-aged guy supposed to do that?

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The Good, the Bad and the Ugly If you pay any attention at all to the mainstream media, youve no doubt seen the reports on legions of male baby boomers rushing to their doctors office asking to be put on Testosterone Replacement Therapy (TRT). Many men have reported that TRT has significantly improved their quality of life, helping them to regain their edge in both the boardroom and the bedroom. However, if you are considering going on TRT, then its essential that you do your homework and find a physician skilled in treating andropause with the appropriate lab testing, interpretation of symptoms and correct prescribing of hormones. You should be aware that testosterone does not work alone in the body and must be balanced with other hormones such as DHEA, thyroid, insulin, cortisol, estrogen and others. Even though TRT can be a boon to men suffering with andropause, its not a panacea nor is it something to be taken lightly. Failure to properly measure, monitor and balance all of the hormones can lead to the following side effects: Erythrocytosis: Its a bit of a tongue twister, but its simply the technical term for increased red blood cell production. Why does this matter? Improper administration of TRT can cause your blood to become too viscous or thick, which increases your risk for a heart attack or a stroke. However, periodic monitoring of hematocrit and/or hemoglobin by your physician and then donating blood if an unhealthy elevation is detected, can help to effectively manage this situation. Testicular Atrophy: TRT can cause the hypothalamus in your brain to shut down production of gonadotropin releasing hormone (GnRH), which in turn stops the pituitary from releasing luteinizing hormone (LH). Without the production of LH, your testicles will cease output of what little testosterone they may have still been producing on their own. This results in a reduction of the size and firmness of the testicles in other words, your giblets can shrink. Some men dont mind this side effect, but those that do can speak to their physician about injections of human chorionic gonadotropin (hCG) hormone to help prevent and even reverse it.

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Gynecomastia: This is a condition that is jokingly referred to as bitch tits by Crazee Wear clad bodybuilders who use large doses of anabolic steroids. Although gynecomastia is rare in men given physiological doses of TRT, there are some individuals that have a propensity for converting testosterone into excess estrogen due to an enzyme called aromatase. This can cause a benign growth of glandular tissue in males, resulting in unsightly breast enlargement. If you fall into this category, then you can speak to your physician about taking an aromatase inhibiting medication to help minimize this occurrence. Interestingly enough, low testosterone levels can also cause gynecomastia. Infertility: Another unfortunate side effect of TRT (depending on your perspective) is that it could significantly reduce your sperm count often times to zero. If youre not planning on siring the next Brady Bunch, then this will be of little consequence to you. But if you choose to go on TRT and still want kids, then there is a way to have your birthday cake and eat it too. Talk to your doctor about injections of human chorionic gonadotropin (hCG) hormone to help keep your sperm swimming swiftly along. Prostate Cancer: For the past several decades, most medical students have been taught that giving TRT to older men increases their risk for prostate cancer. If prostate cancer was already present, then it was considered to be the equivalent of throwing gasoline on a fire. However, It turns out based upon the most current research conducted by Abraham Morgentaler M.D. and his colleagues at Harvard Medical School that high testosterone levels do not increase the risk of prostate cancer and in fact, low testosterone levels may actually increase the risk. In his book Testosterone for Life, Dr. Morgentaler states: The relationship of testosterone to prostate cancer has undergone a significant reevaluation, and all recent evidence has reinforced that T therapy is safe for the prostate. These new revelations may explain why young men with the highest testosterone levels have the lowest incidence of prostate cancer, compared to older men who have lower testosterone levels and higher prostate cancer rates.

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Of course, if youve recently been diagnosed with prostate cancer or you have been treated for it in the past, then it would be prudent to thoroughly discuss all of your options with your physician. Conclusion As you can see, overcoming andropause is not as simple as just getting weekly testosterone injections or rubbing a gel onto your skin. Without proper due diligence, your quest to go from a cubicle dwelling Clark Kent to a high flying Superman could end up leaving you permanently grounded. In Part 2 of this series I will be discussing the ideal carbohydrate food choices for managing andropause by balancing blood sugar and hormones, as well as maximizing energy production. References 1. Alvin M Matsumoto, MD. Fundamental Aspects of Hypogonadism in the Aging Male. Review in Urology 2003; v.5(Suppl 1). 2. Nazem Bassil, Saad Alkaade, John E Morley. The Benefits and Risks of Testosterone Replacement Therapy: A Review. Therapeutics in Clinical Risk Management 2009; v.5; PMC2701485. 3. Prasanth N. Surampudi, Christina Wang, Ronald Swerdloff. Hypogonadism in the Aging Male Diagnosis, Potential Benefits, and Risks of Testosterone Replacement Therapy. International Journal of Endocrinology; v.2012; PMC3312212. 4. Hsieh TC, Pastuszak AW, Hwang K, Lipshultz LI. Concomitant Intramuscular Human Chorionic Gonadotropin Preserves Spermatogenesis in Men Undergoing Testosterone Replacement Therapy. Journal of Urology 2012; pii: S00225347(12)04867-7. 5. Agarwal PK, Oefelein MG. Testosterone Replacement Therapy After Primary Treatment for Prostate Cancer. The Journal of Urology 2005; 173(2):533-6. 6. Hermann M. Behre, Sabine Kliesch, Eckhard Leifke,Thomas M. Link, Eberhard Nieschlag. Long-Term Effect of Testosterone Therapy on Bone Mineral Density in Hypogonadal Men. The Journal of Clinical Endocrinology & Metabolism 1997; Behre et al. 82 (8): 2386. 7. John P Mulhall, MD. Treatment of Erectile Dysfunction in a Hypogonadal Male. Reviews in Urology 2004; v.6(Suppl 6); PMC1472882.[/EXPAND]

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