As men age, hormones get out of balance just like in women. Testosterone levels (and growth hormone) tend to decline while hormones such as estrogen and DHT tend to increase. When testosterone declines, signs and symptoms such as the following could occur namely; loss of muscle mass, wrinkling of the skin, osteoporosis, mood changes (depression), hair loss, increase in body fat and cardiovascular disease, among others. With an increase in estrogen (due to increased body fat in some men as well as exposure to xenoestrogens in general), men could experience gynecomastia, emotional lability (mood swings) and prostate issues. With an increase in DHT, hair loss, acne and prostate problems could occur.
We normally see this decline in men in their 50’s or older but we’re seeing this decline earlier in life now. Possible reasons for this include nutritional deficiencies, pharmaceuticals such as statins (which lower cholesterol, a precursor to testosterone), and environmental toxicity (organophosphates used in the agricultural industry for instance, mimic estrogen in our bodies). Among the people you know, how many of them actually manifest signs and symptoms of andropause? Unfortunately, most men who fall within the “normal” range may not be treated even if they’re symptomatic. The range of “normal” is so wide that those who are in the low normal range (and symptomatic as well) are not being treated properly. Fortunately, a doctor from Harvard named Abraham Morgentaler wrote a book called “Testosterone For Life” which seeks to educate more people about this issue. Anyway, the recommended treatment for low testosterone is testosterone itself.
It comes in different forms such as sublingual tablets, transdermals gels or creams, injectables and pellets. Since everybody is different, the dose and route of administration is individualized to each person. It’s always good to do a baseline PSA (prostate specific antigen) and DRE (digital rectal exam) before starting anyone on testosterone. Since testosterone could metabolize into estrogen (esp. in men with excess body fat) or DHT, it’ll be wise to block those pathways with aromatase inhibitors and 5-alpha reductase (or DHT blockers) inhibitors, respectively. This could be done through natural supplements or prescription medications. Frequent testing is key to make sure people don’t get side-effects whatsoever. For men who are hesitant on using any type of hormone for improving their testosterone levels, options could include the use of amino acids (such as L-carnitine, which increases cell receptor sensitivity to endogenous tesotosterone) or herbal supplements (such as tribulus). While on a hormone replacement program, it’s important to include dietary and lifestyle changes as well to get optimal results. I highly recommend the Paleolithic diet and the PACE program by Dr. Al Sears for my clients.