|
by Alan P. Mintz, M.D.
Menopause and Andropause:
Making the Rest of Our Life the Best of Our Life
Both men and women go through a "change of life."
With the average American woman’s life expectancy currently exceeding 81 years of age, most women can expect to live more than one third of their lives well beyond their child-bearing years. No longer the hush-hush topic of our grandmothers’ generation, the implications of menopause are openly being addressed by the medical community and billions of dollars are being spent by advertisers aiming at the 44 million-plus baby boomer women in the menopause and beyond category.
Likewise, whether it is referred to as a condition or phenomenon, most men begin to experience changes in their bodies somewhere between the ages of 30 and 55. Formerly attributed to “growing old,” a great deal of data now indicates that, as it is for women, hormone imbalance is at the root of the male menopause—the andropause.
Unlike those of the female undergoing menopause, the symptoms of andropause tend to come on slowly and gradually, creeping up over a period as long as 20 years. Hardly noticeable at first, it eventually cuts to the very core of the male when he realizes that he has lost much of his sexual hunger (he’s lost his “edge”) and he finds it harder to keep sharp and focused. If left untreated, the andropause can have even more severe long-term consequences than those of the female change of life.
Whether you are a man or a woman, approaching or going through the andropause or in the pre-, peri-, or post-menopausal stage of your life, the following information can help you ascertain what steps you need to take for your own personal welfare.
What is Menopause?
Menopause refers to that time in every woman’s life when menstruation ceases completely, the ovaries’ output of estrogen and progesterone diminishes severely. In addition to signifying the end of a woman’s ability to have children, the changing hormone levels affect the entire endocrine system. This is actually a process taking three to five years. The transitional phase is referred to as the climacteric or peri-menopause. Menopause is considered complete when the woman has had no periods for a full year. Although timing varies from woman to woman, menopause is generally complete in her early 50s.
In addition to diminished levels of estrogen and progesterone, testosterone levels (also produced in the ovaries) are reduced during menopause. Changing hormone levels affect the entire endocrine system, the system that controls growth, metabolism and reproduction. The diminution of hormone levels at menopause affect the breasts, vagina, bones, blood vessels, gastrointestinal tract, urinary tract and skin.
What to Expect at Menopause and Beyond
Every woman is individual, of course, but there are a number of side effects that might be anticipated. Though some side effects may be considered temporary nuisances to be “toughed out,” the reality is that the reduction of a woman’s hormonal output results in changes that can seriously affect her physical and mental states of health as well as her prospects for longevity.
Hot Flashes
The most common side effect is hot flashes, a sudden sensation of intense heat. Some women break out with red blotches on the chest, back and/or arms, some sweat profusely, some also experience cold, shivering until their bodies readjust. While many women never experience hot flashes, others endure them for up to?30 minutes at a time. Hot flashes are generally considered to be a direct result of decreasing estrogen levels and can linger for years. Hormone modulation can prevent and relieve hot flashes.
Vaginal/Urinary Tract Changes
As hormone levels decrease, the walls of the vagina become thinner, dryer, less elastic and more susceptible to infection. This condition can also make intercourse uncomfortable. Tissues in the urinary tract can also change with the decrease of hormonal levels. Some women experience incontinence. Some become more susceptible to urinary tract infections. Restoring hormone levels to optimal levels can make the vaginal mucosa thicker, more moist, more elastic and healthier.
Loss of Libido
Rarely discussed, the loss of sex drive is another by-product of the menopausal experience. Women generally have 1/10th to 1/20th of the testosterone levels that men have. The waning of her pre-menopausal level of testosterone can be a contributing factor to a woman’s loss of desire for sexual intercourse. Hormone modulation, including testosterone, can increase a woman’s sexual desire and enjoyment and help maintain normal body composition and energy.
Emotional Changes
For some women, menopause heralds a period of enormous freedom. For others it is a roller coaster ride, with emotional peaks and valleys and for many depression becomes an all-too-frequent companion. There is no consensus as to how much the lifestyle, alteration of family roles, changing social networks, emptying the nest and loss of hormones contribute to the emotional changes of post-menopausal women.
Osteoporosis
Osteoporosis is definitely not just a woman’s disease. More men get it than prostate disease, according to Miriam Nelson, Ph.D., author of Strong Women, Strong Bones. However, it is more common in women and it is now estimated that one out of every two post-menopausal women will suffer some degree of osteoporosis. Those with a history of osteoporosis and those who are thin and?fair skinned seemed to be more at risk, but osteoporosis is a manifestation of estrogen insufficiency. It is a gradual, yet debilitating, condition in which bones become fragile, thin and prone to fracture. Building up bone density prior to menopause is the best strategy for osteoporosis prevention but once menopause has occurred, the most effective therapy is hormone modulation. The National Institute on Aging has said “Remarkably, estrogen saves more bone tissue than even very large daily doses of calcium.” Hormone modulation and optimizing nutrition with phytonutrients and supplementary calcium and vitamin D have been very promising therapies.
Cardiovascular Disease
Heart disease is the number one killer of American women. It is responsible for over half the deaths of women over age 50. After menopause the incidence of cardiovascular disease increases. Smoking and a family history of heart disease give women a higher chance of develop-ing cardiovascular disease (among other serious diseases), but coupled with low estrogen levels, the risk is much higher than either one alone. As a direct result of estrogen deficiency, LDL cholesterol appears to increase and HDL decreases. In other words, after menopause, fat tends to accumulate on artery walls, eventually clogging them, and the high density lipoproteins decrease, making it less possible to cleanse the bloodstream. Early recognition, lifestyle changes and hormone modulation have been shown to be very effective in reducing the incidence and severity of cardiovascular disease in post-menopausal women.
Hormone Modulation Can Help
Hormone therapy began in the 1940s and has been refined considerably over the past 60 years. While there are still contraindications for some women (e.g., those with history of breast disease and uterine cancer), many physicians feel that?the benefits far outweigh the risks. Much of the medical field agrees that hormone therapy:
• Reduces the risk of osteoporosis,
• Relieves hot flashes,
• Reduces the risk of cardiovascular disease, and
• May improve mood and psychological well-being.
Each woman, whether pre-, peri- or post-menopausal, can be prescribed a tailor-made program, based upon a thorough and comprehensive diagnostic analysis, including family history, personal medical history, lifestyle analysis, blood tests, physical examination and other diagnostic tests. With a synergistic combination of hormone modulation, optimal nutrition (including, where indicated, those nutrient supplements that are needed) and regular exercise. Women simply need not suffer the debilitating physical, emotional and mental effects of menopause any longer.
Combating Symptoms of Male Menopause
Signs and symptoms of andropause include:
• Fatigue
• Poor sleep quality or insomnia
• Body fat gain, particularly abdominal weight gain
• Lean muscle decline
• Decreased libido
• Possible erectile dysfunction (ED)—reduced potency and/or penile size, decreased ejaculatory force and volume
• Nervousness, anxiety and irritability
• Hot flashes, blushing and sweating
• Aches and pains
• Bone deterioration
• Loss of hair
• Wrinkling and drying of the skin
• Memory lapses
• Depression
• Reduced motivation/apathy
Mental and emotional changes can also include a loss of drive at play and at work, questioning one’s values, accomplishments, goals and directions in life, increased negativity and loss of “focus” and concentration.
Physical changes can also include loss of strength (if left untreated, this can lead to gradual muscle atrophy) loss of energy (getting tired early in the evening, falling asleep in front of the TV), stiffness and aching of muscles and joints.
While life’s stresses can often exacerbate these physical and emotional changes, they are no longer universally accepted as the cause of the loss of male vitality and virility. In other words, the signs and symptoms of the male menopause need not be accepted as inevitable parts of the aging process. A large body of data collected since the first study appeared in the Journal of the American Medical Association (1944; 126[8]:472–7), indicate a direct connection between the variety of symptoms described and male hormone imbalance.
Too little? Too much?
Simply stated, the imbalance is one of too little free testosterone and too much estrogen but this is far from a simple matter and it needs to be noted that testosterone is much more than a sex hormone. With receptor cites in the brain?and heart, and in fact throughout the body, testosterone is critical in maintaining healthy bone density, lean muscle, red blood cell production and safeguarding the immune system. It is also vital for proper cardiac output and neurological function. There is a body of literature that supports the thesis that testosterone helps control blood sugar and regulates proper cholesterol levels.
As men age, their testosterone is increasingly converted to estrogen. The most dangerously acute effect of too much estrogen and too little testosterone is the increased risk of heart attack or stroke. Why testosterone levels are low can be that the male simply has low testosterone production, resulting in switching off some the normal activity of the testes. Secondly, a more complicated issue can be seen in the male who is found to have physiologically normal testosterone levels but has excessively high estrogen (more accurately estradiol) levels. Estradiol is actually a vital component that is made from the testosterone in the cells of every male’s body but when there is too much estradiol, no matter what the level of testosterone, the man will suffer negative consequences. Furthermore, if the male is experiencing high estradiol levels, he is also producing more sex hormone binding globulin (SHBG), a protein that binds to the testosterone. Since typically about 98 percent of the testosterone in the male blood stream is bound to proteins, leaving only approximately 1 to 2.7 percent available for assimilation in the cells of the body, an increase in SHBG will reduce even further the amount of testosterone freely available to act on his cells.
There are a number of factors that can cause the testosterone-estrogen imbalance in men. These include excess “aromatase” enzyme (the enzyme that converts testosterone into estradiol), impaired liver function (often caused by?excessive alcohol or certain drug interactions), obesity (increasing aromatase enzymes), and zinc deficiency (zinc is a natural aromatase enzyme inhibitor). To complicate matters even more, there is a wide range of “normality” in the?testosterone/estradiol reference range, requiring expert interpretation.
Available Help
The good news is that male hormone imbalance is correctable and youthful hormone balance can be safely restored. I suggest an evaluation to determine free and total testosterone levels, estradiol (estrogen), DHEA, dihydrotestosterone (DHT). A PSA blood test should also be performed.
Then if therapies are indicated, a personalized Andropause Program can be developed.
Hormonal health plays a large part in determining one’s overall well-being. Andropause and the symptoms that accompany it can be treated successfully. Men and their loved ones need not suffer the consequences of their going through a mid-life crisis. There is hope.
Male or female, the more we know the better we can prepare for or treat andropause or menopause. It is within our power to make the rest of our life the best of our life.
Alan Mintz, M.D., diplomat of the American Board of Anti-Aging Medicine, is chief medical officer of Cenegenics Medical Institute. For further information on menopause and andropause therapies or to contact a physician certified in antiaging medicine, Dr. Mintz may be reached at 1-888-YOUNGER (968-6431) extension 230 or visit www.888younger.com
.
|
