Consultant: Edward M. Lichten, M.D.
29355 Northwestern Hwy. Suite 120, Southfield, Michigan 48034
(248)358-3433
TESTOSTERONE: Necessary Muscle Building and
Maintaining Hormone
for MEN and WOMEN!
Is there a Male 'Menopause?'
The correct term is 'viropause;' and, YES, men do go through it. The symptoms are much more gradual than the female menopause, and only rarely do men get the 'hot flushes.' But they do find an increase in nightly and morning fatigue, decreased interest in sex and more irritability... just like their menopausal partners. Men, however, rely on denial. He rationalizes that the stress at work and the financial pressures at mid-life are the problem. But even with vacation and his attentive partner, his erections are less often, less firm, and ejaculation less often. But being a man, he will neither discuss this with his friends or go to a physician. "It must be normal... and ... there is nothing that can be done," are the keystone to his inactivity."Although women authors including Gail Sheehy and Susan Rako, M.D. have described this deficient testosterone state in men, almost no one talks about it and almost no one does anything about it," states Dr. Lichten. "When I experienced the 'hot flashes' at 48 years of age and would wake with my night shirt soaking wet, no one suggested to me to measure my hormones. They said male 'menopause' was an illusion!"
But I did measure my hormones and found testosterone levels to be below 350 ng/dl. With that information, testosterone replacement followed.
"And I found not only relief from night sweats,
but a better night's sleep and renewed sexual energy.""I do not think that I am the only 50 year old male
with a TESTOSTERONE 'hormonal' deficiency!"
Background Information:
Testosterone is recognized as the hormone of puberty: it makes muscles for boys and turns them into sexually functional men. But as men age, testosterone's effect regulates muscle development and skin turgor. The decreases in testosterone experienced with time can have profound effects on a man's health.The normal range of testosterone is reported as 350- 1200ng/ml. Studies in the 1940's showed the average testosterone level to be 300 ng/ml higher than for men today. Also, a drop in testosterone levels to 250 ng/ml was rarely reported before men were 80 years of age. Yet today, it is not an uncommon value for middle aged men!
Testosterone levels are highest in the early twenties. The decrease in serum levels is now occurring at an earlier age. Up to 20% of all men at 50 now have testosterone levels below the normal age. Recent studies imply that the pesticides and preservatives in foods act as "hormonal disruptors." Based on the low sperm counts and infertility I see in younger men and women, I fear this is true.
Physiology:
Testosterone is produced in the testes. These gonads are present within the scrotal sacs. Testosterone's effect start in utero; both genitalia and brain development are influenced by this hormone. With the surge at puberty, secondary sexual characteristics including facial hair, deepening voice, body shape, and increase size of sex organs are noted.Detecting Insufficient Testosterone Levels:
In young men, infections such as mumps or viral infections, removal of the testes due to cancer or trauma, and a genetic abnormality may cause Testosterone Insufficiency. However, for most, the development of testosterone insufficiency is directly related to aging.With 20 percent of the baby boomers showing decreased levels of testosterone by 50 years of age, testosterone deficiency is a major health problem.
Self-Test [Compliments of R. Klatz DO, Sexual Health, Vol1. No. 1, p38]
IT'S NOT ALWAYS EASY to recognize testosterone deficiency, because the physiological changes it produces tend to occur gradually. While anyone can experience some or all of the conditions cited here, symptoms that persist or are linked with decreased sexual function should be discussed with a medical professional. Testosterone levels can be checked with a simple blood test.
- Have you noticed any change in the size of your breasts? Do they appear to have become larger?
- Are you shaving less frequently than you used to?
- Do you have difficulty maintaining an erection or have your noticed any change in the firmness of your erection?
- If you and your partner are trying to conceive, have you had any fertility problems?
- Do you have sexual intercourse less frequenty than you used to?
- Are you less interested in having sex?
- Do you often feel extremely tired or sapped on energy at the end of the day?
- Has your muscle tone become less firm of has your physique changed to any significant degree?
- Do you tend to get irritable for no apparent reason?
- Have you lost interest in your work or other activities that you used to find enjoyable>
- Do you experience mood swings?
- Do you feel more stressed than usual?
- For older men, have your fractured any bones lately>
The Laboratory Test: Detecting the Problem
Testing is easily accomplished, once the decision is made. The blood test measures the serum levels of testosterone and the 'free' tesostosterone as well. Deficiency is denoted by a serum level below 350 ng/dl. The blood sample should be draw in the morning because there may be significant variation depending on stress at work, exercise, or other hormonal therapy (such as DHEA, thyroid, growth hormone].
In Europe, a more sensitive test of Free Testosterone function is measured. It is called the F.A.I.; free androgen index. The value is determined by dividing the level of free testosterone by 100 times the sex hormone binding globulin. "This key factor should normally be in the range of 70- 100% and andropausal symptoms are almost always present when it falls below 50 per cent." Malcolm Carruthers, MD. p.132 Male Menopause: Restoring Vitality and Virility. HarperCollins Publishing. London, England. 1996
Lastly, measurements of FSH (follicle stimulating hormone) and LH (luteining hormone) are elevated in 70% of the men with complaints of "andropause." Normal values are less than 5; often much less.
The Prostate Examination:
Before starting on testosterone replacement, every male needs to have a prostate examination. This examination, often by a urologist, is to document the status of the prostate gland. Any irregularities, hypertrophy, or urinary complaints needs to be documented and treated, prior, to starting testosterone.Before starting testosterone replacement, the man needs to have a PSA (prostate specific antigen) blood test. Values that are raised are followed by a PSA II test that may identify prostatic hypertrophy. Testosterone replacement is absolutely contraindicated in men with prostate cancer.
Men should repeat this prostate and PSA testing every six months or as directed by their physician.
Treatment Alternatives:
Since in healthy young men, testosterone is secreted all day long with a peak in early morning, the ideal replacement would follow this pattern. There are two delivery mechanisms for testosterone: oral and parenteral. Parenteral refers to through the skin or injections.
While oral tablets may be easy to use, they are not natural, physiologic or healthy. Oral testosterone may dramatically raise the testosterone level, only to have it drop a few hours later. The major drawback to oral testosterone is the "first pass effect." This means that the oral testosterone is absorbed and sent directly to the liver. In the liver, the testosterone effects many enzyme systems and raise the potential for liver dysfunction and even tumors. Most of the oral testosterone is deactivated by liver cells. Oral testosterone raises 'bad' cholesterol and lowers 'good.'The newest delivery system for testosterone is the testosterone patch. One company, Alza Corporation, produced a scrotal patch called Testoderm(R). The individual applied the patch to a shaved scrotum and it delivered 2.5-4 mg of testosterone. It is somewhat awkward and uncomfortable.
Ciba-Geigy Corporation produced a larger testosterone patch worn on the back; Androderm(R). Although it contains 12.5 mg of testosterone, because of the thicker skin on the back it delivers 2.5 mg of testosterone. Both patches need to be changed daily. Most men need two Androderm(R) patches, and are not comfortable with either method.The parenteral delivery system used most often since the 1940's has been intramuscular injections of testosterone. There are five injectable testosterone approved in the United States:
Physicians will mix two or three of these to get a longer and mixed effect. With the short acting testosterones, some men will feel a rush due to the unnaturally high levels for a few days. Occasionally, they may become more aggressive and experience fluctuations in mood, energy and sexual function. But reduction of the dose and education are usually sufficient to modify his behavior.
- Aqueous Testosterone: very short acting (1-2 days)
- Testosterone Cyprionate: short acting (2-4 days)
- Testosterone Proprionate: short acting (2-4 days)
- Testosterone Enthanate: longer acting {7-10 days)
- Deca-Durabolin: longer acting, muscle pain relief (7-10 days)
Some compounding pharmacists will make testosterone gel in 3-5% solutions. This works similarly to the patch, but is applied twice daily. More rapid absorption occurs over thin skin (scrotum, face) while slower absorption occurs over the abdomen. This is aqueous testosterone-- do not use methyl -testosterone as it has liver toxicity effects.
However, the best delivery system for high daily levels of testosterone is the testosterone pellets. Studies in the United States, Europe and the Far East show that testosterone pellets can maintain a stable hormonal level for up to 120 days. Although there is individual variation from manufacturer and by patient, this delivery system has been the easiest for men to accept when long term replacement is indicated.
Additional Steps to Be Taken:
Men on testosterone replacement should take 160 mg of Saw Palmetto with Pygeum twice daily. This herb will block the conversion of testosterone to dihydrotestosterone (DHT) which affects prostate hypertrophy and possibly cancer development. There are no significiant side-effects to this herb. In higher dosages, it is registered as Proscar.(R)Risks of Low Testosterone:
Until recently, few men in the United States elected testosterone replacement because of the fear of prostate cancer. In Europe, testosterone replacement is much more common. Recent studies imply that U.S. men are misinformed. Rather, the medical literature documents that low levels of testosterone are directly correlated to:Conclusion:
- heart disease and myocardial infarction
- strokes and cardiovascular disease
- prostate cancer (yes, low levels are higher risk)
- senile dementia
- osteoporosis and hip fracture
A new philosophy directs the replacement of testosterone in men. Higher testosterone levels have systemic effects, not only improved sexual performance, but also, decreased stress, stronger muscles and possibly less heart, bone, and blood vessel disease.
references:
Malcolm Carruthers, MD. p.132 Male Menopause: Restoring Vitality and Virility. HarperCollins Publishing. London, England. 1996
Updated:July 19, 1997