Hope for Male “Menopause”

Men, if you’re experiencing fatigue, a loss of libido, weight gain and/or depression, please don’t chalk it up to the fact that you may just be “getting old.” Yes, you may be chronologically older, but age is not your enemy. You can grow older and have a perfectly good quality of life. You just need to know what you’re dealing with.

The truth is that you could be going through andropause, the male equivalent of menopause. This condition, while trickier to treat than menopause, is indeed treatable!

While menopause can often bring about abrupt and noticeable changes in a woman, the symptoms of andropause often go unnoticed since they occur over the course of a decade.

Thus, while a woman’s estrogen levels may fall precipitously, a man’s testosterone levels may only drop 1-1.5 percent a year. Over ten years, this dip can really take a toll on a man’s body.

Unfortunately, the andropausal male is often labeled with one or more diseases when, in fact, his problem is due to an accumulative loss of testosterone. Unfortunately, these men get little relief from traditional medical approaches that typically fail to address the cause of the problem!

I see the effect of low testosterone in my male patients all the time! In fact, while writing this article, a long-time patient called to tell me that he’s sure his low testosterone levels (confirmed by a blood test) are the cause of his excessive fatigue, loss of libido, and diminished erections. I told him to try a testosterone patch.

Yes, just as menopausal women have options, so do andropausal men. I’ll tell you more about treatment options in a moment. In the meantime, you may wonder…

…How to Find Out if Your Testosterone Is Low

The first order of business is to check your testosterone levels. Because mean testosterone levels fluctuate (they may be 700 ng/dL at 8 a.m., then drop to 425 ng/dL at 10 p.m.), have your blood drawn at least twice over a two-week period, at different times of day. The test provides a baseline, which is important if you go with a testosterone patch (or testosterone injections).

You also may want to test have the following tested as well:

• Growth hormone
• Estrone (a measure of estrogen)
• DHEA
• PSA
• Sex-hormone binding globulin.

This comprehensive profile can help pinpoint the cause of your problem and allow your doctor to better tailor your therapy.

If your tests reveal low testosterone levels, you should be screened for hemochromatosis (excessive iron) and have your insulin levels, blood sugar, fibrinogen, and Lp(a) checked. These cardiovascular risk factors may be elevated when testosterone is low.

Matching the Treatment to the Problem

If you find out your testosterone level is low, my first treatment choice is a transdermal testosterone patch (oral testosterone is not effective and may be dangerous to the liver).

The patch delivers testosterone at a controlled rate and avoids the peak-and-valley effect of injections. The best place to put the patch is on the scrotum since scrotal skin is at least five times more permeable than any other area. However, I must warn you that skin irritation can be a problem for many men, and scrotal hair must be shaved to secure contact with the skin. It’s for this reason that pharmaceutical companies have developed 5-mg patches to be applied nightly and rotated on the body: the back, abdomen, upper arms, and thighs.

The 5-mg patches are a suitable alternative to scrotal patches and can improve sexual function, energy and mood, but about 12 percent of men who use them still report blisters, which can occur after a single application.

If either type of patch irritates you, ask your doctor to write you a prescription for a testosterone cream or gel that can be applied to the backs of your knees after a morning shower.

Creams and gels are an effective remedy for treating low testosterone, and there’s very little irritation. The only problem is they can be messy and sticky and, if applied unevenly, you may not get what you need to boost your testosterone.

Another option is testosterone injections. Even though this is the least expensive and most common form of hormone-replacement therapy for men, I do not like this option because injections often result in wide swings in testosterone levels. Yes, testosterone increases, but it’s often followed by low or even subnormal levels.

These disturbing fluctuations can affect a man’s energy, mood, and sexual function. Some men have told me that they feel great for about a week after an injection, and then fatigue sets in and sexual desire/performance are lackluster.

Note: There are two things to consider before trying testosterone patches or injections. Overly high levels of testosterone may predispose you to acne and a blood disorder called polycythemia (excess red blood cell production).

Excessive testosterone also can lead to overly high libido, urinary obstruction, swelling of breast tissue, priaprism (excessive duration of an erection), and mood swings (especially for those receiving testosterone injections).

Also, before you begin hormone treatment, you should have a digital rectal examination and a PSA test. Once you receive testosterone, in any form, you must have periodic evaluations to make sure that no changes have occurred to your prostate gland.

For Those Who Want a Natural Approach to Increased Libido

It is far better to improve your overall sexual health in a way that allows you and your partner to be spontaneous, carefree, and safe. Fortunately, such an approach is possible by taking certain nutritional supplements and by making some other lifestyle changes. You can find all of the following supplements in health food stores or order them through Internet retailers.

L-arginine

Over the years, my favorite natural alternative has been L-arginine, an amino acid supplement that steps up your body’s release of nitric oxide, which is naturally produced by sexual stimulation. Nitric oxide causes the smooth muscle tissue and arteries to relax. In the penis, this means an increase in the amount of blood flowing in, a decrease in amount of blood flowing out, and overall improved erection potential. It also keeps arteries dilated throughout the body.

Recommended dose: Take 2–8 g of L-arginine about an hour before bedtime, starting with the lower amount and increasing if needed. As a precaution, be sure you take an antioxidant supplement that includes a form of vitamin E called gamma tocopherols. These antioxidants will help mop up the possible surge in free radicals that can follow a big release of nitric oxide after taking L-arginine.

Two other caveats: Don’t take higher doses (more than 4 g) of L-arginine for at least six months after you’ve had a heart attack. At eight months out from a heart attack, you can take the higher doses provided that you are taking a good antioxidant supplement. Second, if you are taking lysine for a latent viral infection, you should avoid supplemental use of L-arginine since it may counteract any potential benefits of the lysine.

Acetyl-L-Carnitine

Another supplement I highly recommend is called acetyl-L-carnitine. Not only does it promote delivery of fatty acids for energy production, it also enhances memory and promotes libido. Recommended dose: Take 1–3 grams daily on an empty stomach.

Niacin

Niacin is another of my favorite supplements. It’s a water-soluble B vitamin that supports energy metabolism, cardiovascular health, and detoxification processes in the body. Like L-arginine, it’s a powerful vasodilator that promotes blood flow where you need it.

If you take niacin as a separate supplement, be aware that starting with too high a dose can cause an uncomfortable flushing of the skin (from the vasodilation).

Recommended dose: Take 10–20 mg daily. First, check your daily multivitamin to see how much you’re getting and whether you need to add more.

Ginseng

Ginseng is another helpful herbal remedy, but make sure you use an organic product. Ginseng works cumulatively, so you won’t see an effect right away. However, you’ll enjoy its great overall ”tonic“ and energizing effect more immediately.

Recommended dose: Follow specific product instructions and monitor your blood pressure. I’ve had some patients whose blood pressure was raised by ginseng.

Lifestyle Also Plays a Key Role

Targeted nutritional supplements can help promote sexual health, but you also need to keep your whole system in top condition. Good sex is a combination of many factors: good circulation for stimulation, stamina, a healthy heart, and a healthy outlook.

In short, your overall health is also important. In addition to taking the targeted supplements I’ve mentioned, there are lifestyle changes you can make to support and enhance your sex life—and your overall health.

Limit Alcohol

Although an occasional glass of red wine may be good for promoting heart health, “too much of a good time” can negatively affect sexual performance. What’s more, long-term alcohol use has been associated with myriad other health problems. So just remember, moderation is always the best course.

Don’t Smoke

Cigarettes can constrict blood vessels, which can limit or reduce blood flow to the sexual organs.

Exercise Regularly

Dancing is my favorite form of exercise, and it’s hard not to feel joy when you’re moving to the beat. The key is to exercise on a regular basis, so find an activity you like and stick with it. Exercise will also help you maintain a healthy weight, which can then help promote a satisfying sex life.

Unlock the Emotional Side of Sex

While the supplements and lifestyle changes I’ve mentioned can help spice up your love life, don’t neglect the emotional side of your relationship. Getting in touch with your deepest feelings can open the door to more fulfilling relationships. In many instances, couples can benefit from counseling to help them release buried emotions so they can express healthy sexuality.

I know many men feel uncomfortable about openly discussing their feelings. However, your physician may assume that “all is well” with your sex life unless you take the first step by speaking up.

Also remember that sexuality is not just intercourse. You and your partner must pay attention to one another. You must also listen to your own body. See if your heart flutters or pounds, or if your breathing speeds up when you touch or even just sit next to one another.

Choose a time and place for a sexual encounter that is relaxed and familiar to you. As your body comes alive, follow its natural ebb and flow. Refrain from intercourse if you are angry, upset, or fatigued. Above all, don’t rush. Be considerate of each other and have fun. Play music, light candles, and be content just to caress one another. Live in the moment, and enjoy your time together.

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