Male
Menopause (Andropause)Introduction Male menopause
is a lot more subtle than menopause in women. Many men have male potency until
late in life. However, there are a significant number of men who get male impotence,
also termed "erectile dysfunction" (=ED). This problem usually occurs
in middle aged men. Diagnostic tests A significant
number of these men have low testosterone levels when they are tested as well
as increased levels of LH and FSH. It is generally accepted that the reason for
this is that the testicles no longer produce enough testosterone. However, there
might be a significant number of men who are producing less testosterone due to
inhibitory mechanisms of the gonadotropin hormone production at the level of the
pituitary gland. If the man is overweight and has a history of diabetes
or hypertension, there is a good chance that this man would suffer from the syndrome
of insulin resistance. In this case there is an inhibitory action on the pituitary
gland by interfering with cyclic
AMP production, which in turn leads to lower testosterone production.
As outlined under this link, this knowledge has some practical implications as
the low testosterone in this case is only a symptom, not the cause of the erectile
dysfunction. Another factor is that in an obese male estrogen hormones are produced
by the fatty tissue, which will weaken the effect of the residual testosterone
hormone. The testosterone/estrogen ratio when tested with saliva hormone tests
will be below the value of 20 (in younger males this ratio is found to be well
above 40). This has some therapeutic implications as we will see below. Symptoms
Men
with male menopause have often similar psychological symptoms that menopausal
women also have such as irritability, a lack of energy, mood changes and depression.
Most annoyingly though for them is that their sex life is suffering. There is
a diminished sex drive, sexual interests are also diminished, erection problems
are more common and erections do not last as long. Other health problems
such as cardiac problems, pulmonary problems like emphysema, hypertension and
diabetes have a lot to do with erectile dysfunction. However, all of these
medical ailments are usually treated with a variety of drugs that can cause impotence.
Such drugs as diuretics, many antidepressants, pain medications, anxiolytics and
cimetidine (an anti-acid medication) are all known to cause erectile dysfunction.
Recreational drugs such as alcohol and cocaine can cause erectile dysfunction.
Some hormonal problems such as hypo- and hyperthyroidism as well as Cushing's
syndrome are also known to cause erectile dysfunction. Diabetes and impotence
are also connected as with a diabetic neuropathy of the nerve pathways the connection
from the hippocampus of the brain to the genitals is interrupted. Impotence
Treatment It follows from what was said above that all the factors
that can be identified , which have a negative bearing on erectile dysfunction,
should be treated first. This includes a thorough history and physical examination
by your family physician, a review of drugs, alcohol consumption and medications.
Next there should be a life style change, which includes a zone diet program (Ref.1
and 12), a regular brisk walking program and relaxation exercises that could include
meditation and hypnosis. Often the change of all of these factors will have a
beneficial effect on the hormone balance to the point where within 3 to 4 weeks
a normal sexual function returns due to the returning of the normal gonadotropin
function (insulin resistance is disappearing).
In
recent years an attractive alternative to impotence pills like Viagra has come
into the forefront. Testosterone treatment with bioidentical hormone has been
found to be safe (Ref.16). However, this should not be looked at in isolation
as testosterone derives from progesterone and in Ref. 17 estrogen and progesterone
combination therapy is suggested rather than tesosterone treatment alone, in the
sense of an anti-aging approach. This has been reviewed by me in a separate chapter
("Antiaging for women and men").
If all of these measures do not help, an impotence pill such as sildenafil
(brandname: Viagra) and others of that type can be considered. However, there
are a significant number of side effects with this medication such as headaches
and clotting problems that limit the use for certain patients. As already stated
bioidentical testosterone replacement therapy, which can stimulate libido significantly
(Ref. 17), can be very useful. In the past, with the use of synthetic tesosterone,
hepatic toxicity and with longterm use the risk of liver cancer existed. Dr. Morgentaler
has shown that prostate cancer is not a risk with longterm use of bioidentical
testosterone (Ref.16). Also, with synthetic testosterone blood could get thickened
(secondary polycythemia), which could cause a stroke. Patients on synthetic testosterone
need to be monitored for these side effects accordingly, but not on bioidentical
testosterone. Viagra might be useful in some patients, if cardiovascular problems
allow this and erectile dysfunction is a prominent symptom. Ask your doctor about
this who can explain to you why a certain treatment program is required and what
the side-effects would be. Dr. Lee describes in Ref. 18 that testosterone
replacement alone is not sufficient for males with erectile dysfunction. Other
hormones that interact with testosterone also need to be taken into consideration
by doing a salivary hormone test of testosterone, estradiol and progesterone.
Similar to the testosterone/estrogen (T/E2) ratio having to be kept above 20 there
is a relationship of progesterone to estradiol (P/E2 ratio), which should be kept
above 200. Often in the aging male the progesterone production is low, which leads
to an unopposed estrogen presence (all measured by saliva hormone tests). Often
not only bioidentical testosterone has to be replaced by an appropriate cream
application, but also progesterone through a bioidentical progesterone cream.
Some males who are under a lot of stress may require higher progesterone doses
as progesterone competes with cortisol at the progesterone receptor level. By
balancing these hormones and paying attention to the ratios (T/E2 and P/E2) all
of the sex steroid hormones are balanced as they were when he was in his mid 30's.
Apart from bringing his sex life back to normal functioning this will also prevent
heart attacks, strokes, arthritis and many cancers.
|
|
