Change of life: for men?
Sometimes called “andropause”, the question of whether men have a change of life similar to menopause for women has long been debated. While women experience age-related physical changes at a rather specific time (when ovarian function declines leading up to around age 50), for men the shift occurs much more gradually. A reduction in testosterone production happens over many years as men age, and can result in diminished muscular strength, energy and libido, erectile dysfunction, depression, and even osteoporosis. The problem is that these symptoms are often not seen in men with low testosterone and may also be caused by other factors such as stress, illness, medications, obesity, psychiatric conditions, diabetes, high blood pressure or low thyroid levels.
When should you suspect low testosterone?
On average, men’s testosterone levels decline about 1% per year after the age of 40. While this can add up with time, despite what you might see on television only about 10% to 25% of older men have levels considered to be low. And even within this group, there are often no signs or symptoms.
Doctors typically recommend testosterone testing for older men only when they have symptoms such as:
Reduced sexual desire and activity
Decreased spontaneous erections or erectile dysfunction
Breast discomfort or swelling
Infertility
Height loss, bone fracture or low bone density
Hot flushes or sweats
Other symptoms might include decreased energy, motivation and confidence, depressed mood, poor concentration, increased sleepiness, sleep disturbances, mild unexplained anemia, reduced muscle bulk and strength, and increased body fat[i].
Depending on your health indicators, your doctor might recommend doing other tests instead of or in addition to testosterone.
Testosterone levels for healthy men fall roughly in the range of 300 nanograms per deciliter (ng/dL) to about 800ng/dL. If an initial blood test shows low testosterone, repeat tests are often done to confirm the result. If needed, follow-up tests might be recommended on the pituitary, an endocrine gland in the brain that produces and regulates hormones. This is to rule out other hormone deficiencies and further investigate the cause of your symptoms.
For many men, the aging process can be associated with other life changes: pressures from work or career, or changes in marital or partner relationships. It can be challenging to sort out which of your symptoms might be due to these newer stresses, and which might be due to low testosterone.
Then there are sexual performance pressures on men and/or the reality of getting older itself, which a changing body is a reminder of. Do you see aging as primarily a negative process in your life? Our society very strongly reinforces this view, and attitudes about getting older can affect the experience of even physical age-related symptoms. For more on this, check out physician Robert Tan’s The Andropause Mystery: Unraveling Truths about the Male Menopause.
Aging is an attribute of life cycle transition like others such as puberty. While some men experience symptoms to one degree or another, it can be important to discern whether any cross the line into pathology (or not).
Conventional medical treatment for low testosterone
Testosterone therapy is the main intervention for low testosterone, however, there are inconsistencies in the practice of who receives this. Some doctors recommend it for men of any age who might be experiencing sexual dysfunction. Others recommend it only for older men who have symptoms. Still others may also suggest it for older men without symptoms. Finally, special hormone treatment may be recommended for a younger man if low testosterone is a problem for a couple trying to get pregnant.
For any of these circumstances, doctors also advise of the risks of testosterone therapy. These include possible growth of metastatic prostate and breast cancer (if either of these is present), increased risk of heart attack, stroke, and the formation of blood clots in the veins.
Doctors typically recommend against testosterone therapy if you have prostate or breast cancer, or would like to have children in the near future.
Studies show that for older men with low testosterone levels who don’t have identifiable medical conditions, testosterone therapy might provide small improvements in sexual functioning and quality of life but few other benefits. Effectiveness and safety of continued use are not known[ii].
When prescribed, testosterone replacement can be given orally, by injection or through a skin patch. Men who receive testosterone therapy are typically monitored carefully by their doctor[iii].
As seen in frequent television ads, there is a huge market for the sale of male-enhancement supplements, 90% of these claim to boost “low T”. But only 24.8% are supported with data and more than 10% actually contain ingredients known to have a negative effect on testosterone levels[iv]. This sobering information strongly suggests a need for caution in responding to these ads!
An integrative approach
Because of the large range of symptoms that cause men to investigate or suspect low testosterone and the lack of strong research evidence supporting the use of testosterone therapy and its potential risks, a natural approach like homeopathic remedies, which are federally recognized in the US, can be very helpful.
We will first have a long conversation that includes a detailed analysis of all your symptoms (physical, cognitive, etc.; some may be common, others may not).
First are the things you can do on your own:
If you have a high-stress life, you may be able to consider including more stress-management techniques into your daily routine such as exercise, spending time in nature (always relaxing!), or deep breathing (there are apps for this like “Stop&Breathe”, or “Calm”). That may be a lot to add on, but including one of these at a time over the longer-term can be helpful.
Most of the long list of symptoms associated with possible andropause can be addressed using various homeopathic remedies, and we would probably start with the symptoms that are of greatest concern to you, working through them until you are once again feeling fully functional.
If you are considering homeopathic care for symptoms related to men’s health and aging, call me for a free 15-minute consultation or schedule one online.
[i] Huo, S, A Scialli S McGarvey E Hill B Tugertimur A Hogenmiller A Hirsch A Fugh-Berman (2016) “Treatment of Men for ‘Low Testosterone’: A Systematic Review” PLoS One 11:9 : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5031462/
[ii] Diem, S, N Greer R Macdonald L McKenzie P Dahm N Ercan-Fang A Estrada L Hemmy C Rosebush H Fink T Wilt (2020) “Efficacy and safety of testosterone treatment in men: an evidence report for a clinical practice guideline by the American College of Physicians” Annals of Internal Medicine 172(2):105-118 https://www.acpjournals.org/doi/full/10.7326/M19-0830?rfr_dat=cr_pub++0pubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org
[iii] Qaseem, A, C Horwitch S Vijan I Etxeandia-Ikobaltzeta D Kansagara (2020) “Testosterone Treatment in Adult Men With Age-Related Low Testosterone: A Clinical Guideline From the American College of Physicians” Annals of Internal Medicine: https://www.acpjournals.org/doi/10.7326/m19-0882
[iv] Clemesha, C, H Thaker M Samplaski (2019) “’Testosterone boosting supplements’ composition and claims are not supported by academic literature” World Journal of Men’s Health 38(1):115–122 https://pmc.ncbi.nlm.nih.gov/articles/PMC6920068/pdf/wjmh-38-115.pdf