31 Jul
31Jul


Men don't really acknowledge this term, but it can parallel a woman's experiences, though usually to a lesser degree.  Statistically only 2.1 percent of men go through "male menopause", I beg to differ with the low number.

Men accuse us of being tricky and complain about our menopause symptoms and mood swings, but let's delve into theirs with empathy and a bit of humor.

As a Nurse Practitioner, I enjoyed taking care of male patients, many became friends.  When a man finds a medical person they can trust, their hearts open up.  They ask questions, they  share a great deal of their personal lives, and they want to understand their bodies.  It is truly an honor to work with men at this changing time in their lives. 

Let's embark on some facts.

We all understand the power of testosterone, right?  It known to be sexy, strong, scary, it can create wars, make great teachers, powerful, and most of all, it is the difference between a man and a woman.

The rise of testosterone begins at puberty, then it is a slow acceleration. The voice gets deeper, there is increased muscle mass, bone strength improves, acne, increased sex drive and mood fluctuations which we don't fully understand, etc. It peaks in the 20s. We witness some anger, hypersexuality, and a false sense of invincibility, ie risk taking. For some, the beginning of the peaking testosterone leaves a young man with mixed emotions.  As parents, we are sometimes alarmed at this "new person" in our home.

Testosterone is the most potent male hormone though it is not the only hormone.  The  LH, luteinizing hormones, and FSH, follicular stimulating hormones act with testosterone to stimulate sperm production. Also, 95% of testosterone is produced in the testes, due to LH.  

Throughout a man's life he is dealing with the fluctuating hormones, as are we.  But it is not talked about. There lies the problem.  Very rarely does a young man get educated by his father, school, etc.  It is a difficult discussion for some men, so their sons' are left without an education on the normal phenomenon of hormones.  It is complicated by a "secretiveness", even with their Health Care Provider.  I wish more HCPs would open the subject of hormones for boys/men at various stages in their lives.

I suppose that is because most fathers don't really understand it as well.  There were the proverbial sex education classes that adolescents giggled through, but I am pretty sure that nothing stuck.  Certainly it didn't go into the detail of aging hormones.  There are some magazines that promote male health, but they are filled with body builders and busty women which confuses a mans identity, "why don't I look like that".

But, back to hormones.

As he ages, there is a final complexity in the last stage. This hormone is converted to estradiol, estrogen, a major female hormone.  Much of the conversion occurs in fat cells, which increases the estrogen levels in men and women.  Have you noticed him softening a bit, more compassionate, patient, tearing up with sappy movies plus a thickening of the waist?

This is designed to be a mini course on male hormones, as it is important to understand the physiology. 

Some men actually have high testosterone their whole life, but normally around age 40-50 it begins to decline. 

The decline is approximately 1% per year. Men can have an almost normal range in 75% of older men, only some.  Thus older men fathering children in the 70s, ie Al Pacino.

Have you ever asked to have your testosterone checked?  Ask for it, bring up the subject.  Ask to add it to your yearly chem panel. Science tells us it is highest at 8 am, and lowest at 9 pm.  Obviously it is best to check in the morning for a true evaluation.

As he ages, there is a slow down in mental function, new learning is slower, short term memory typically weakens, long term seems preserved, difficulty with erections, a decreased sex drive, a thickening in the waist, mood changes, lowered self confidence, male breasts and increased body fat. 

 A 2004 from Baltimore Longitudinal Study of Aging, evaluated 574 men over a 19 year period.  The lower the testosterone, the more risk of developing Alzheimers. 

TESTOSTERONE AND MOOD

When testosterone levels are lower, there seems to be an increased risk of depression, but there is debate on this. I think we have all witnessed an older man sitting in a chair, retired, not wanting to exercise, maybe cranky, but appearing to have lost his luster for life and you. Muscle mass fades, decreased bone density and sex drive are just part of this decline.

I have worked with men who actually want to start testosterone supplements in their 50s, preservation I suppose. But little does he know that if he takes supplements his testes won't produce the same level of testosterone and they will actually shrink.  That bothers men.  Testing wise, under 200 is low.

TREATMENT

Frequently men turn to supplementing their testosterone and are seeking alternatives, but not without risk. They include  prostate enlargement, prostate cancer,  polycythemia, excess red blood cells , sleep apnea or even a risk of a stroke or heart attack. These risks are not inconsequential.  It is very important to only supplement with a Health Care Provider approved means.

The risk are real, so if considering replacement, it is important to have a risk assessment evaluation with your HCP, complete with lab tests, exam, etc.  It is not the time to "John Wayne" it through indiscriminate means.

 Other alternatives include a healthy diet, avoiding ultraprocessed foods, increase your protein, normalizing your weight, exercise/weight lifting, Calcium 1200 mgm per day, reading labels to understand what is in your food, 6-7 hours sleep, talk with your partner, and decrease your alcohol.  Alcohol directly affects the testosterone levels and is also known to increase male breast enlargement.

Another thing, think young!  I have many male friends and the men that exercise, socialize, live in loving relationships, continue sexual intimacy and challenge their minds daily are "holding up" the best.  But doesn't that parallel the things you did as a younger man?  It kept you young and spirited.  Just because you are older, don't retreat from life.  It won't be pretty.

Life  is still calling you!


Testosterone and Aging, Harvard Medical School, excerps



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