Question: I have heard that andropause is used to describe the male equivalent to menopause. Is there such a thing and, if so, how is it diagnosed?
Answer: Andropause is referred to as a complex of signs and symptoms related to a decline in androgen or testosterone production that typically occurs with age. While it is more typically associated with 50 years old and older, low testosterone levels are not limited to this older age and can occur in younger men impacting sexual performance and fertility.
Low energy, loss of muscle and bone mass, increase in body fat, hot flashes and irritability are all possible symptoms.
Statins taken for high cholesterol can lower testosterone if they lower LDL cholesterol too much, as LDL cholesterol is the raw material for all steroid hormones. If LDL is too low, the body increases its production to support hormone production. So perhaps instead of automatically increasing the statin it would be wise to rule out testosterone deficiency and consider treatment with testosterone available through a prescription from an MD from a compounding pharmacy. Then retest the blood after two months to see if testosterone levels are corrected.
Zinc is key for testosterone metabolism and for decreasing production of dihydrotestosterone (DHT), which overstimulates the prostate gland, a factor in both benign prostatic hypertrophy (BPH) and prostate cancer. DHT contributes to baldness and increased hair growth on the torso. For those men not on statins, first try zinc alone to raise testosterone in the form of zinc amino acid chelate or zinc carnosine, before jumping to testosterone treatments.
The herb maca also has been shown to increase testosterone levels. Testosterone deficient patients with stable chronic heart failure showed improvement in their functional capacity when given testosterone. So it seems that too little and too much testosterone are bad for the cardiovascular system, but that appropriate amounts can improve lipid profiles and cardiovascular function.
A blood test can tell you if your testosterone is too low. Total testosterone is a starting point, which includes both bound and free testosterone, and may be significantly deficient for a diagnosis. However, obesity, diabetes, high insulin and estradiol levels can increase binding of testosterone leaving not enough free testosterone to have an appropriate action in the body. So where total testosterone is normal, yet symptoms of deficiency with the above mentioned factors are present, then I would request a free testosterone test.
It is also important to screen for prostate health with a rectal exam and considering PSA levels where applicable before using testosterone since disease would be a contraindication to testosterone therapy.
Another very important note is that men who have abdominal obesity with male breasts should have their estradiol checked, and if it is elevated this suggests excess aromatase activity in the body, the enzyme that makes fat and converts testosterone to estradiol. So, testosterone would not be advised because it risks being converted to estradiol exacerbating the obesity/breast problem.
An ND could guide you through another approach to first lose weight and decrease estradiol.
It is a catch 22 because low testosterone does increase body fat, which makes estrogen, so it is about finding hormonal balance and breaking the cycle, which includes looking at other hormones such as progesterone, cortisol and thyroid hormone.
Kali Simmonds, ND, is a doctor of naturopathic medicine who practises in Charlottetown. The information provided is not intended to diagnose or substitute the advice of a health-care professional. Consult with a health-care provider before making any changes. She welcomes questions for this column, which is published every second Tuesday in The Guardian. She can be reached by mail at 34 Queen St., Charlottetown, C1A 4A3 or by email at firstname.lastname@example.org