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October 2003

Male Menopause
Avoiding andropause with testosterone treatment
By Edward D. Rosick

Testosterone strengthens muscles and bones
One of the most destructive effects of aging is the loss of muscle and bone mass. While the loss of bone mass, or osteoporosis, is now widely recognized as a significant factor in robbing elderly women of their ability to walk, osteoporosis is also a significant health concern for older men. In addition, the loss of muscle tissue, or sarcopenia, is now finally being recognized as a major debilitator of both men and women. In men, both sarcopenia and osteoporosis can be linked to the decline in testosterone and other steroid hormones.

A study of 403 healthy men aged 73-to-94 years, in the Journal of Endocrinology and Metabolism examined the hypothesis that the decreases in muscle strength, bone mass and body composition seen in aging males are related to falling testosterone levels.[5] The researchers measured the men’s hormonal levels and ran multiple tests to gauge their body composition, muscle strength and bone mass.

Their findings were that muscle strength and bone mass were at optimal levels in men with the highest levels of free testosterone, leading the authors to state that “a number of clinical problems present in older men may be related to androgen [testosterone] deficiency, including reduced muscle mass, changes in body composition, and loss of BMD [bone mass density].”

Testosterone–good for your heart and mind
Studies have shown that adequate levels of testosterone are important for maintaining cardiac health and preventing age-related senility. Reports from the oft-cited Rotterdam Study, where researchers examined the association between testosterone levels and cardiac health in 504 men aged 67-to-75, showed that men with higher levels of testosterone had lower levels of coronary artery disease.[6] As the authors of the study stated, “we found an independent, inverse association between levels of endogenous testosterone and severe aortic atherosclerosis and progression of aortic atherosclerosis in men.”

Adequate levels of testosterone are also needed for optimal brain functioning. Multiple studies have confirmed that men who maintain optimal testosterone levels as they age have significantly fewer symptoms of senility compared to men with low levels of testosterone. In a hallmark study published in 2002, 407 men aged 50-to-91 were followed for 10 years and were given multiple tests to determine their testosterone levels and cognitive functioning.[7] To quote the authors, “Higher FTI [free testosterone levels] was associated with better scores on visual and verbal memory, visuospatial functioning and visuomotor scanning and a reduced rate of longitudinal decline in visual memory.” Furthermore, those randomized, placebo-controlled studies showed that testosterone supplementation improved verbal memory, working memory and visuospatial performance in elderly men.[8-11]

Does testosterone cause prostate cancer?
Ask almost any mainstream physician what causes prostate cancer, the second leading cause of cancer in men, and chances are the answer will be excess testosterone. This is based on research that shows that the removal of a man’s testicles (his source of testosterone), either physically or through chemical means, slows (but does not cure) prostate cancer. However, there are a growing number of anti-aging researchers who believe that estrogen and its metabolites, such as 16-alpha-hydroxyesterone, may be more significant in the development of prostate cancer than testosterone. In fact, a recent report made the following statement, which just 10 years ago would have been considering heresy by mainstream medicine: “There is no evidence that exogenous testosterone stimulates the development of severe symptomatic prostate hyperplasia, nor does exogenous testosterone seem to increase the risk of clinically significant prostate cancer.”[1]

The concept that estrogen, rather than testosterone, is one of the prime hormonal initiators of prostate cancer is based on the fact that, while testosterone levels are highest in young men, prostate cancer is essentially never seen in this population. It’s only in older men, who have lower levels of testosterone but higher levels of estrogen and its breakdown products, that prostate cancer is a significant health threat. Animal studies have shown that male rats treated with testosterone alone showed significantly less prostate growth when compared to animals treated with both testosterone and estrogen.[12] A study published in 1993 showed that men treated with DHT (which cannot convert to estrogen) actually showed a reduction in the size of their prostate with no sign of prostate cancer.[13] A more recent article in the World Journal of Urology sums up the estrogen/ prostate cancer link quite succinctly: “Estrogenic stimulation through estrogen receptor alpha in a milieu of decreasing androgens [testosterone] contributes significantly to the genesis of benign prostatic hyperplasia, prostate dysplasia, and prostate cancer.”[14]

Environmental toxins may affect testosterone
There’s evidence that chemicals in the environment known as endocrine disrupters may be causing a decrease in testosterone. Endocrine disrupters interfere with the normal functioning of the endocrine system. Scientists in Britain have done research in rats on the estrogen-mimicking chemical HPTE, which is a metabolite of the commonly used pesticide methoxychlor. These scientists have shown that HPTE causes a decrease in, testosterone production from Leydig cells.[15] Other compounds, such as those found in plastic bottles that hold everything from bottled water to laundry detergent, are man-made mimics of estrogen.[16]

Maintaining optimal health and sexuality
There are multiple ways in which men can combat many of the deleterious effects of aging including andropause. It’s vitally important to eat a well-balanced diet full of fresh, organically grown fruits and vegetables to help avoid endocrine-disrupting chemicals. Second, a multivitamin that contains a full range of antioxidants and other essential nutrients should be part of every man’s diet, whether he is 20 or 90 years old. Third, engaging in a daily exercise regime and keeping your weight at a lean level is important in aging with vim and vigor intact.

Physical exercise increases testosterone
Regular high-intensity exercise has been shown in multiple studies to contribute to keeping a man’s testosterone at optimal levels. A study published in 1999 examined how heavy resistance training in both young (23-to-35 year old) and older (58-to-65 year old) men affected their testosterone levels.[17] In both the younger and older groups, there was a statistically significant increase in testosterone levels after exercise. A more recent study, again showed that strength training in middle-aged men (44-to-48) caused an increase in their levels of free testosterone.[18]

High-protein diets
It’s well known to weightlifters that a diet high in protein is key to adding muscle mass. Unfortunately, many middle-aged and elderly men (and women) probably aren’t getting enough protein in their diet to maintain muscle mass and stave off sarcopenia. In fact, a study that looked at the dietary habits of aging Americans came to the conclusion that “…the RDA [recommended daily allowance] for protein may not be adequate to completely meet the metabolic and physiological needs of virtually all older people.”[19] Unfortunately for aging men, not getting enough protein may also mean a hit to their testosterone levels. A study found that “…diets low in protein in elderly men [40-to-70 years old] may lead to elevated SHBG levels and decreased testosterone availability. The decrease in bioavailable testosterone can then result in declines in sexual function and muscle and red cell mass, and contribute to the loss of bone density.”[20]

Soy and fish oil keep estrogen and SHBG in check
As stated earlier, elderly men often have an increase in unhealthy levels of SHBG and estrogen via activity of the aromatase enzyme, both of which can lead to a decrease in testosterone levels. Two recent studies have shown some natural ways in which men can help tilt the ratio back in favor of testosterone. In one study of 97 men, 49-to-72 years of age, the researchers showed that men who had high levels of soy intake had lower levels of estradiol (a form of estrogen) when compared to men with lower levels of soy intake.[21] They postulated that this beneficial inverse relationship could be due to inhibition of the aromatase enzyme by soy and soy-based food products. Another study examined the effects of the essential fatty acids EPA and DHA (which are found in high concentrations in fish) on SHBG levels in men 43-to-88 years of age.[22] After controlling for other variables, the researchers came to the conclusion that both EPA and DHA decreased levels of SHBG in middle-aged and elderly men.