MANopause

It?s no joke. Men go through the change of life, too. Although male menopause has been under the radar for years, the condition has gained credibility in recent years. What?s a guy to do?

So you feel hot under the collar these days, but seldom under the sheets. Your middle is getting softer by the day, and your mood swings and night sweats are enough to drive your partner to the couch.

I know what you?re thinking: It must be menopause.

But wait, you?re a guy. Could you too be in for a ?change of life??

?This is coming for the Baby Boomers, and we are going to see an explosion of interest in it,? says John Morley, MD, head of the geriatrics division at Saint Louis University Medical School, and a leading researcher on the subject of so-called ?male menopause.?

Scientists have long known that a man?s testosterone level begins a slow downhill slide as early as age 30, dropping 1 percent a year on average after the age of 50. Add that to the fact that other sex hormones and brain chemicals also begin to fluctuate, and middle-aged men can quite possibly look forward to an array of ?change of life? symptoms, including loss of muscle mass, fatigue, depression, erectile dysfunction, and even hot flashes. But because the condition is exceedingly hard to test for?and historically difficult to discuss?it has remained under the radar for doctors and patients alike, says licensed psychotherapist Jed Diamond, author of the sentinel book Male Menopause. ?If you go to your average doctor as a guy and say ?I think I?m going through male menopause,? most of them will still laugh at you,? says Diamond. ?Men tend to deny anything in themselves that is remotely feminine.?

As studies begin to link low testosterone with heart disease, cognitive decline, and bone loss, and aging Baby Boomers still insist on a thriving sex life well into their Golden years, organizations like the National Institutes of Health and the American Association of Clinical Endocrinologists have called for more research into the phenomenon of waning testosterone.

The burning questions: When and how should manopause be treated? And is treatment safe? Meanwhile, thousands are opting not to wait for the answer; instead they?re flocking to specialty clinics for everything from testosterone shots to acupuncture and herbal supplements.

?I hit a wall and traditional medicine just couldn?t help,? says 50-year-old California filmmaker John Upton, who declined recommendations of anti-depressants and instead turned to Diamond for help. ?I found myself, at 48, carrying around 70 pounds of body fat, not being able to get an erection, not feeling good, divorced twice and not in good shape at all. Jed said go to a doctor and get your hormones checked. I did, and they determined my testosterone was low.?

What?s in a Name?

Despite more than three-dozen clinical trials on the subject and scores more in the works, the notion of male menopause is far from universally accepted. A widely heralded report commissioned in 2004 by the US National Institute of Aging and the National Cancer Institute concludes, ?there is scant evidence that male menopause exists,? and points out that ?the likelihood a man will ever experience a major shut-down of hormone production similar to a woman?s menopause, is remote.? It also called for more research.

At the root of the controversy, says Morley, lies semantics: Because menopause, by definition, means the end of menses, calling the male experience by the same name often ruffles feathers. Some call it hypogonadism, which means low hormone production, but that can occur in men of all ages. Others call it andropause. Morley prefers Androgen Deficiency in the Aging Male (ADAM). ?It will never be fully recognized until people can find one title they can agree on,? he says.

Although menopause comes on fairly rapidly for all woman, halting production of progestin and estrogen and spelling the end of fertility, the male process comes on subtly and varies in severity, depending on the man?s lifestyle, experts say. ?It is a very slow, insidious, hard-to-figure-out process,? says Todd Dorfman, MD, a Boulder physician who specializes in treating male menopause. ?Men come in with one or two issues, (libido problems are typically Number One) and I have to drag the rest out of them.?

And while the female ?change of life? can lead to fairly specific health issues, such as rapid bone loss and hot flashes, linking testosterone-loss to conditions like weight gain, ED, and depression?all of which can have numerous other causes?can be tricky. Because men, even in their 30s and 40s, often turn to potentially-risky testosterone treatments to quell those changes, the subject remains controversial. ?A lot of patients come to me and they are already on testosterone and they have never even had their levels measured,? says Mark Carney, ND, LAc, of Denver, Colorado. ?In my opinion, that is very poor medicine.?

The Test

So just how can you know for sure if low testosterone is the problem? Another tricky question. Testosterone levels normally fluctuate throughout the day (higher in the morning), from season to season (highest in the fall; lowest in the spring), and can vary according to stress levels and diet. So you can have a hard time distinguishing whether testosterone levels have truly dipped, or if you took the test at an inopportune time.

Assuming that you truly have age-related testosterone loss, another question then arises: How low is too low? A ?normal? healthy adult male?s total testosterone concentrations can range anywhere from 300 ng/dL to 1,000 ng/dL. Those with levels of 200 ng/dL to 319 ng/dL are good candidates for therapy.

By those measures, one in 10 men between the ages of 40 and 60 has abnormally low testosterone levels, and after 75, the ratio rises to 3 in 10.

But because some men naturally produce more testosterone in their youth, those benchmarks can be misleading, says Diamond. ?Let?s say you have a guy in his 20s who has a testosterone level of 1,000 and by the time he gets to be 50, [levels drop] down to 500. He has lost half of his testosterone and is likely to have symptoms. On the other hand, you might have a guy who is at 400 in his 20s and drops to 250 (considered abnormal). He may not have any symptoms.?

Dorfman says he runs an array of blood tests, asks patients to fill out a lengthy lifestyle questionnaire, and sits down for an in-depth interview with each one before making a diagnosis. If he can blame age-related hormone changes, he says he has good news: ?It can be forestalled, and it can be reversed.?

Natural Solutions

To start building hormone levels naturally, look to the following three options as a good, safe way to start:

Exercise.??There is a direct relationship between muscle mass and testosterone. One natural way a person can raise his testosterone levels is by getting into a weight-lifting program,? says Carney, a naturopath who specializes in men?s health. Studies have shown that as few as two sessions of strength training per week can increase muscle strength by more than 30 percent, while also boosting bone density (another victim of declining testosterone), speeding up metabolism, and pushing up production of testosterone and other sex hormones. Exercises that target several large muscle groups (like squats or bench presses) boost testosterone levels more than those that train isolated muscles (like curls).

Meanwhile, aerobic exercise boosts the production of feel-good neurotransmitters in the brain, which also have a tendency to get thrown out of balance as men age. So having a well-rounded exercise program helps.

Keeping weight in check also makes a difference, says Diamond. Because fat cells tend to convert circulating testosterone into estrogen, having too much fat around the middle can sabotage what little testosterone the body still produces. ?If you are overweight, you are really working against yourself.?

On the flip side, over-training and under-eating can also wreak havoc on testosterone production.

In one study, volunteer male soldiers undergoing an intense, eight-week training course also ate a restricted-calorie diet (about 1,200 calories less than what they needed). Their testosterone levels dipped to ?castrate levels,? far below normal, while their levels of sex hormone binding globulin (SHBG) which binds to testosterone and makes it less available to the body, went through the roof. Once they started getting enough calories again, their levels returned to normal.

Nutrition.?Men should also eat enough good carbohydrates, protein, and good fat, says Carney. Research shows that protein helps maintain lean muscle mass. Lack of carbohydrates can lead to decreased serotonin and, consequently, irritability. And it takes a certain amount of fat to keep testosterone production at healthy levels.

One recent study of 36 middle-aged, white, healthy men showed that switching to a strict, low-fat diet for eight weeks reduced circulating male hormone levels by 12 percent on average. Generally experts recommend that men get roughly 30 percent of their calories from fat (albeit good fat like that found in nuts, oily fish, and olive oil.) ?Cholesterol is a building block of many of the hormones and if you don?t have enough of it, you can?t build the house,? says Carney.

Another key piece of dietary advice: Cut back on the alcohol, which studies show also decreases testosterone levels. ?Contrary to what many men think?that a few drinks make them sexier?they are really taking away their testosterone,? says psychotherapist Diamond, who is also a Certified Addictions Counselor.

Herbs and Supplements.?Schuyler McHenry, ND, of Southwest College of Naturopathic Medicine, recommends B vitamins, which can help with stress and boost energy; C vitamins, which can stabilize production of stress hormones; and herbs such as ashwagandha and ginseng.

McHenry also recommends acupuncture, herbs and Chinese patent formulas aimed at strengthening the kidneys, which are considered the hearth of male sexual energy in Chinese Medicine. ?If there is anything that damages the kidneys, it can lead to weakness of the sexual organs,? McHenry says.

Perhaps the Number One over-the-counter dietary supplement for addressing male menopause is dehydroepiandrosterone (DHEA), a building block for sex hormones that the body has naturally, but that also tends to decline rapidly with age. Sales of DHEA supplements (often derived from yams) jumped from just $1 million in 1998 to $48 million in 2004, according to Nutrition Business Journal, as studies have suggested it can improve skin, sex drive, mood, and strength in aging men. However, practitioners warn that DHEA is a hormone, and overuse of hormones can result in serious side effects. So before adding DHEA to your daily supplement regimen, have your blood DHEA levels tested and then have them retested periodically once you start taking it.

Other popular supplements used for male menopausal symptoms include fish oil, or omega-3 supplements, which have been shown to improve cognitive function, boost energy, and prevent heart attacks, and L-arginine, an amino acid that helps dilate constricted blood vessels associated with erectile dysfunction.

Bringing it all Together

For John Upton, a combination of treatments has been the key to good health. He started with acupuncture, which he says lifted the ?fog? he?d been in for years. ?I remembered what it was like to be hopeful again.?

Today, he takes dozens of dietary supplements daily, spending between $300 and $500 per month, eats a high-protein, low-glycemic index diet, lifts weights regularly, sees a counselor, and injects prescription testosterone to keep his levels within normal range. ?The difference is stunning,? he says. ?I?d never want to go back.?

Just how many American men are willing to go to such lengths, expense, and potential risk to slow down the ticking clock? That remains to be seen. But whether they should will likely remain a hot topic of conversation for some time.

10 Herbs and Supplements to Quell Male Menopause Symptoms

  • DHEA (dehydroepiandrosterone). An over-the-counter supplement designed to mimic natural hormone building blocks, which decline in the body with age. Improves mood, exercise capacity, sex drive, and skin conditions such as lupus.
  • Maca (Lepidium meyenii, L. Peruvianum). A root used for centuries in Peru for its fertility and libido-enhancing properties.
  • Horny goat weed (Epimedium sagittatum, D. Grandiflorum). A Chinese herb, also called yin yang huo,used to increase libido and address erectile dysfunction and premature ejaculation.
  • Yohimbe (Pausinystalia yohimba). Some studies show that yohimbe, which comes from the bark of an African tree, can be effective in addressing erectile dysfunction.
  • Ginseng. This age-old standby promotes energy, stamina, and endurance, affects hormonal imbalance, and nourishes the kidneys, considered vital organs for supporting sexual health.
  • Ashwagandha (Withania somnifera). A powdered root used in the East as an aphrodisiac for 3,000 years.
  • Damiana (Turnera diffusa; var. T. Aphrodisiaca). A mood-elevating aromatic herb that helps calm anxiety.
  • Chaste tree (Vitex agnus-castus). Historically used to reduce male libido in monks and others entering the priesthood, it has since been used to help normalize hormonal changes associated with male menopause.
  • L-arginine. An amino acid that helps dilate constricted blood vessels associated with ED. Should not be used in people who have had a heart attack
  • Fish oil or omega-3 supplements. Either improves cognitive function, prevents heart disease, and provides an energy source.

Hormone Replacement Therapy for Men?

By far the most controversial treatment, prescription testosterone, comes in the form of twice-monthly self-injections, prescription gels, or skin patches. According to IMS Health, a pharmaceutical market research firm, sales of prescription testosterone soared to $568 million in 2006, nearly double what they were in 2002, and with a host of new easier-to-use products in the pipeline those numbers will surely continue to rise.

Some studies have shown that supplemental testosterone can indeed restore sexual function and muscle strength, improve memory, prevent bone loss, and possibly protect against heart disease. But supplemental testosterone has potential risks: Too much can trigger aggression and cause breast enlargement; it also thickens blood, potentially increasing the risk of stroke; and it has been shown to cause sleep apnea in some men.

Although research to date remains inconclusive, some also fear excess testosterone may fuel the growth of prostate cancer. That concern has prompted many researchers?fans and critics of testosterone replacement alike?to call for more long-term health studies like the Women?s Health Initiative (which ultimately exposed the risk of hormone replacement therapy in women). ?We are lacking the Women?s Health Initiative equivalent for men and we need that,? says John Morley, MD, head of the geriatrics division at Saint Louis University Medical School. ?Everybody knows that until we do one large study that includes side-effects, we won?t have a clue.?

Many experts say they prescribe testosterone in cases when needed, but only after rigorous testing. Todd Dorfman, MD, a Boulder physician who specializes in treating male menopause, says that in some cases he can use other, more benign synthetic hormones, such as a self-injected ?luteinizing hormone? intended to amplify the signal from the pituitary to the testes and jump-start the body into making its own testosterone. That way, he says, ?I?m using the patient?s own physiological mechanism to get him to produce his own testosterone?

When he does put men on testosterone supplementation, he prescribes plant-based bio-identical testosterone (which some believe is less disruptive to the hormone system). He also checks their Prostate Specific Antigen (PSA) levels every six months. ?The bottom line is, there are no good quantifiable long-term papers out there yet about its safety,? says Dorfman, ?I very specifically describe to my patients the fact that I do not know long-term what the consequences will be.? And their typical answer? They are willing to take the risk.

Are You Suffering from Male Menopause (a.k.a. Androgen Deficiency in Aging Men)?

Answer the following questions to find out if you may be going through the ?change of life.? If you answer yes to question 1 or 7, or at least three of the other questions, you may have low testosterone and may want to discuss the results of this quiz with your health care provider.

  1. Do you have a decrease in libido (sex drive)?
  2. Do you lack energy?
  3. Do you have a decrease in strength and/or endurance?
  4. Have you lost height?
  5. Have you noticed a decreased enjoyment of life?
  6. Are you sad or grumpy?
  7. Are your erections less strong?
  8. Have you noticed a deterioration in your athletic performance?
  9. Are you falling asleep after dinner?
  10. Is your work performance deteriorating?

 

By Lisa Marshall

Sources: The Male Herbal (Sourcebooks, 1997), by herbalist James Green; Mark Carney, ND.

Source: John Morley, MD, Saint Louis University School of Medicine

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