Men—Stay On Top of Your Health

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 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, 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 come like a "thief in the night," often bringing about abrupt changes in quality of life, the symptoms of andropause often go unnoticed, as they occur over the course of a decade.

So, while a woman's estrogen levels may fall precipitously, a man's testosterone levels may drop only 1 percent–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 excessive loss of testosterone. Unfortunately, these men get little relief from traditional medical approaches that typically fail to address the cause of the problem.

The first study on andropause was published in 1944 in the Journal of the American Medical Association. Researchers tried to determine whether falling testosterone levels could be causing similar symptoms among a group of men and affecting their quality of life. Of the 38 men they evaluated, 23 had a testosterone deficiency. Almost all of these men reported a change in mood, fatigue, hot flashes, sweating, and libido after testosterone injections. Potency returned to normal in 18 of those men.

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 plan to go with testosterone patches/injections.
• You also may want to test your growth hormone, as well as your estrone (a measure of estrogen), DHEA, PSA, and sex-hormone-binding globulin. This comprehensive profile can help pinpoint the cause of your problem and better tailor your therapy. For example, I give pregnenolone, a precursor to DHEA, to men with low DHEA levels and low testosterone. This combo is broken down into DHEA and progesterone. Progesterone inhibits the aromatase enzyme, which interferes with testosterone production
• 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) (ugly cholesterol fractions) checked. These risk factors for heart disease may be—and often are—elevated when testosterone is low.

Matching the Treatment to the Problem

Suppose you find out your testosterone is in the basement...then what?

Well, you have several options. Remember, though, this is not a one-size-fits-all approach. Every man is different.

My first 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 testosterone 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 of the skin. But 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 burn-like 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 they are 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 injections. They 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 (enlargement, cancerous changes).

For Those Who Want a More Natural Approach…

Chorionic Gonadotropic Stimulation, done through an injectable hormone, can jump-start the testes to increase testosterone production. It uses natural hormones to stimulate the Leydig cells in the testes that make testosterone. A lot of men do well with this. If you're getting sufficient testosterone production and feel good with this method, stick with it. It's best to build your own supply of natural testosterone when you can. If this method doesn't work for you, then consider one of the synthetic forms of testosterone that I've just discussed.

Another natural approach is soy (tofu and other soybean products), which can help suppress aromatase activity. Some people would say that real men don't eat tofu, but I would say that real men eat these foods! I always get a bowl of soybeans at my favorite Japanese restaurant when I go. Soy is good for any man approaching mid-life, regardless of which option he ultimately chooses. I recommend one serving of tofu or soybeans at least once a week.

Zinc (15–30 mg daily) and vitamin C (500 mg daily) also help boost testosterone production, and so does ginkgo biloba (120–240 mg daily). Many of my male patients have reported enhanced libido and erections and less depression when taking ginkgo. Researchers believe ginkgo may support the production of dopamine, one of the brain's "happy" hormones that can enhance sexual function.

Talk to your doctor about the options I've laid out here. If your health professional can't help you, ask him if he knows of an anti-aging specialist who can. The right professional may help you add years to your life and life to your years. There could be some light at the end of the tunnel for you!