Andropause, or male menopause, is a result of an age related decrease in free testosterone and/or a increase of estrogens. A healthy young adult male produces on average about 7mg of testosterone every day. The pituitary gland produces a hormone called LH, in response to hypothalamus stimulation, which stimulates the testes to produce testosterone. Normal male aging is accompanied by a decline in testicular function resulting with a fall in testosterone production and thus a decline in free testosterone levels which may also be accompanied with a rise in estrogen levels also. Around the age of 40 the level of free testosterone begins to decline about 1% a year.
Symptoms of Low Testosterone or Andropause
Symptoms are: decreased libido, erectile dysfunction, ejaculatory problems, decreased energy and strength, increase in body fat, loss of muscle mass, prostate enlargement, osteoporosis, depression, inability to concentrate, reduced mental agility and loss of enthusiasm.
Men with low testosterone levels also tend to have these heart disease risk factors: angina, atherosclerosis, diabetes, high blood glucose, high cholesterol, high triglycerides, high blood pressure, high level of blood clotting factors, low blood clotting inhibitors and a high body mass index.
Causes of Low Testosterone
The reasons why free testosterone levels decline with age include:
- A protein called SHBG (Sex hormone binding globulin) rises as we age and more testosterone is bound up to it, reducing the amount of free and available testosterone.
- More testosterone may be converted into estrogens by an enzyme called aromatase. Increasing estrogen levels negatively feeds back onto the brain slowing down further testosterone production.
- More testosterone may be converted into dihydrotestosterone (DHT) by an enzyme called 5 alpha reductase.
- Decreased functioning by the aging testicles known as primary hypogonadism.
- Decreased pituitary output of LH hormone which ultimately causes a decrease in stimulation of the testicals to produce testosterone which is known as secondary hypogonadism. Decreased pituitary LH output may be due to decreased hypothalamus stimulation.
- Adrenal fatigue causes a decrease in DHEA production which in turn reduces testosterone production as testosterone is produced from DHEA in the body.
- Xenoestrogens – exposure to estrogen like pollutants in the environment such as certain pesticides (DDT, DDE), petrolum based chemicals (PCB’s, benzene), plastics (PVC), metals (cadmium, arsenic) and hormones from food sources may all cause a negative feedback in the brain which in turn reduces testosterone production in addition to blocking tstosterone receptors.
- Considering the whole being and not only the physical aspect, if a man gives up or withdraws from life due to a number of possible reasons such as he is not content, he may be overwhelmed with life, he lacks true love in his life, etc this withdrawal will then cause low life-force (low kidney energy causing adrenal fatigue) which then causes a vascular contraction. Both low life force and vascular contraction stagnate the testes causing a decrease in testosterone production. Low testosterone is therefore a marker that a man has been living in long term withdrawal or has given up on life. He needs to address his lack of commitment to life! Click here for more information on the emotional cause of hormone imbalances in men.
Diagnosis of Andropause – Low Testosterone
If you suspect you may have this condition then you should have at least your free testosterone, DHT, SHBG, Estradiol, DHEA and cortisol hormone levels measured. This test will determine if you are testosterone deficient, if a testosterone/estrogen imbalance is present, if estrogens are too high, if SHBG is too high, if DHT is too high and also help diagnose adrenal stress. Thyroid hormone testing is also essential.
Presently there is a real debate as to which method of testing is best. Refer to our article on blood, urine and/or saliva testing for details. Whichever method is used if total testosterone levels are found to be low (<13.9nmol/L) and/or you suffer from symptoms of low testosterone then you need to consider testosterone therapy.
When comparing your baseline test results we do not recommend you use the age adjusted reference ranges as an aging body still requires as much testosterone as a younger body of the same size and height. So called “normal” reference ranges are based on poor science, politics and economics rather than fact and science. “Normal” reference ranges are constantly being adjusted and reduced over time by the so called endocrine experts which is only reflecting the decrease in health and vitality of the average population. When diagnosing a testosterone deficiency your baseline levels should be compared to optimal levels and not “normal” reference range.
To further complicate diagnosis it has been noted by many physicians that men now days require higher levels of testosterone to achieve symptomatic relief due to increasing incidence of testosterone resistance which in part is due to the increased presence of environmental endocrine disruptors and not lower levels which is not being accepted by the medical establishment. A Testosterone Resistance paper published in 2008 concluded that “The many parallels and interactions between maturity onset diabetes and Testosterone deficiency Syndrome (TDS) suggest that a combination of lack of testosterone and its metabolites, combined with resistance to its action at multiple levels, underlies the pathology of androgen deficiency. Just as insulin resistance is thought to vary between tissues, so is androgen resistance, and therefore, different organs may respond functionally.” From their findings they further concluded that “This coincides with the emerging view that “An emphasis and reliance on serum T alone hinders the clinician’s ability to manage testosterone deficiency syndromes (TDS)”. Low total testosterone is just the tip of the iceberg of androgen deficiency.” Their final conclusions were “due to the complexity of factors involved in androgen resistance, and the invalidity of androgen assays, it seems logical to adopt the suggestion endorsed by Black et al., which where typical symptoms or conditions known to be related to androgen deficiency occur, that a 3-month therapeutic trial of testosterone treatment be given.”
In contrast to traditional synthetic hormones bioidentical hormones have a molecular structure which is an exact match of the hormones found in the human body, hence we call them bioidentical. Because bioidentical hormones are structurally identical to the hormones our bodies produce they are more consistent with our bodies biochemistry.
Bioidentical hormones are synthesized from a hormone precursor extracted from either soy beans or wild yam called diosgenin. Diosgenin has a molecular structure very similar to all these closely related hormones. Once the diosgenin has been extracted from the soy beans and purified its molecular structure is then modified in order to convert it into the appropriate hormone. Once the appropriate hormone has been made it is purified to a pharmaceutical grade purity and then micronized to maximise absorption. Although these hormones are synthesized it should not be mistaken that they are synthetic. Synthetic refers that the molecule does not exist naturally but has been designed and made by man to produce a totally new molecule that never existed before in nature.
When treating andropause by supplementing with bioidentical hormones the approach taken should be to use the minimum dose required to overcome symptoms. The use of hormone test to monitor therapy has become controversial as a result of many practitioners dosing patients based on lab test results ignoring the fact that symptoms still remain even though lab results indicate levels are “normal”. They are treating the lab results and not the patient. As mentioned above testosterone resistance and environment androgen blockers are the reason some men need higher levels so lab results cannot be relied upon. The minimum dose required to achieve complete elimination of symptoms should be the aim. Using test results should be a guide only.
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(1) Rhoden, E.L, Risks of Testosterone-Replacement Therapy and Recommendations for Monitoring Ernani Luis Rhoden, M.D., and Abraham Morgentaler, M.D. NEJM Volume 350:482-492 Jan 29, 2004.
(2) Perchersky AV et al. “Androgen administration in middle-aged and aging men: effects of oral testosterone undecanoate on di-hydrotestosterone, oestradiol, and prostate volume.” International J Androl 2002; 25(2): 119
(2A) Marks, Leonard S., Effect of Testosterone Replacement Therapy on Prostate Tissue in Men With Late-Onset Hypogonadism A Randomized Controlled Trial. , MD JAMA. 2006;296:2351-2361.
(2B) Press Release for JAMA , Leonard Marks MD article