Hormone Therapy

THE MALE HORMONE ISSUES

Traditionally, age-related male hormone changes were not considered problematic because fertility in men persists until an advanced age. More careful evaluation in males shows progressive age-related changes caused by declining hormone production.

These changes usually begin in the fourth and fifth decades and point towards hormone imbalances and deficiencies which may be considered the male equivalent of menopause, i.e. the Andropause.

SYMPTOMS OF ANDROPAUSE MAY INCLUDE:

  1. decreased muscle mass & strength
  2. decreased vigor, low energy
  3. decreased libido & decline in sexual function
  4. nervousness / irritability / depression
  5. hair loss
  6. “burned out” feeling
  7. loss of sense of well- being
  8. difficulty concentrating
  9. decreased stamina
  10. change in sleep pattern / insomnia
  11. decrease in bone mass (osteoporosis)
  12. reduction in masculinity
  13. decreased urine flow / prostate problems
  14. difficulties losing weight

WHAT IS ANDROPAUSE?
Testosterone, the important male hormone reaches its peak levels at puberty. Contrary to a popular belief testosterone level is progressively declining throughout life.

There is about 1-1.5 % annual drop in testosterone production starting after age 30. This decline has been labeled “Andropause”

The clinical manifestations of male hormone deficiency usually lag 10-20 years behind the onset of hormone decline. It’s manifested as a progressive decrease in energy, vitality, sexual performance and mental capacity.

Statistically, andropause affects at least 40% of men aged 55-65 and up to 80% of those aged 65 years or more.

WHAT YOU CAN DO ABOUT MALE HORMONE IMBALANCE?
Optimal health is dependent on the balance of hormones, and not just a single hormone. Currently, men with low androgens can benefit from hormone replacement therapy. Also, men with imbalances in their androgen to estrogen and progesterone ratios can also be hormone supplemented to achieve balance.

Supplemental hormones can be given by mouth, by injection, by skin patch, or by implant. Androgen supplementation, in states of deficit improves fitness and produces a feeling of well being with a reduction in abdominal fat and enhanced lean body mass.

Testosterone production in males is mainly a testicular function. Pituitary sex hormones (FSH & LH) stimulate and regulate this function. Specifically, LH (Luteinizing hormone) stimulates testosterone production in the testes. This process is under negative feedback, meaning that testosterone levels regulate LH secretion. FSH (Follicle Stimulating Hormone) and testosterone stimulate sperm production.

WHY MEASURE MALE HORMONES?
Measurements of hormones can be used in two general ways:

  1. To estimate the body’s own production (baseline test)
  2. To measure levels of hormones after supplementation (therapeutic monitoring)

Baseline measurements will show normal and abnormal levels of six distinct hormones. If levels are too low, too high or if hormone ratios are outside of expected limits, an objective treatment plan can be developed for the individual. Symptoms are not a substitute for measuring hormone levels because many symptoms may involve non­hormonal factors.

Using appropriate tests for monitoring hormone therapy is crucial in establishing the appropriate dosing regimen. This reduces the chance of undesirable side effects and maximizes beneficial effects.

For example, excessive use of androgens (testosterone, androstenedione, DHEA) can activate subclinical prostatic tumors which are androgen-dependent. Monitoring is especially important in older males. By the age of 70, at least 50% of men have subclinical prostate cancer. These are especially susceptible to growth stimulation by androgens.

WHICH MALE HORMONES DO WE MEASURE?
Testosterone – is the main testicular androgen and is a precursor to the highly potent dihydrotestosterone hormone. Excessive amounts of testosterone promote hardening of the blood vessels, aggression, prostate problems and increase in total cholesterol.

Dihydrotestosterone (DHT) – is made from testosterone in certain tissues. The rate of its production is controlled by the level of free active progesterone. Excess DHT causes prostate enlargement and thinning of scalp hair.

Androstenedione– is a weak male hormone (androgen) and a precursor of both male & female hormones. Unmonitored intake in men can cause excessive female hormone production with minimal male hormone production.

DHEA – is the precursor for both male and female hormones. Also, it is an antistress hormone produced by the adrenal glands. Unmonitored intake can easily alter the delicate balance between male to female hormones.

Progesterone – This hormone is important in both sexes. It is a natural calming agent to our nervous system. It also keeps in check excessive DHT production and counterbalances the effects of excessive estrone. Unmonitored intake can lead to breast enlargement, depression and weight gain.

Estrone – is an estrogen that both sexes produce in the fat cells. The more fat, the more estrone which in turn itself promotes fat deposits. It is produced from androstenedione and excess of estrone can cause breast enlargement and contributes to prostate enlargement. In males, a certain low level of estrone is mandatory to balance the androgens.

FSH – stimulates and regulates spermatogenesis

LH – stimulates and regulates testosterone production

 

MIDDLE AGED AND HAVING:

  1. impaired libido
  2. erectile dysfunction
  3. baldness and/or extremity hair thinning
  4. fat accumulation around the waist
  5. urinary symptoms: pain and/or frequency; urgency; interrupted stream
  6. change in sleeping habits
  7. lack of enthusiasm for life
  8. increase in bad cholesterol, decrease in good cholesterol
  9. your doctor tells you that you have osteoporosis

YOUNG AND HAVING:

  1. impaired libido
  2. erectile dysfunction
  3. early baldness
  4. inability to lose weight

Suggested reading:

 

Belly fat in Men: What you Need to know (by Michael Jensen, M.D.)

 

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