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"The Andropause Mystery"
by Robert Tan, MD
hosted by Joe Spataro
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The Andopause Mystery by Robert Tan, MD Interview: World Differences in Testosterone | Effects of andropause | Diagnosis of Andropause | Diet & Exercise | Supplemental Testosterone
Male Menopuse by Jed Diamond Interview: Introduction | What is Male Menopause | Common Signs & Symptoms | Erectile Dysfunction | Mid-Life Crisis | Book Excerpt: Male Menopause and Erectile DysfunctionQ&A with Jed Diamond | Natural Remedies
joe2.jpg (4335 bytes)mtalogo.gif (2318 bytes)Joe:
The Andropause is a syndrome in men usually above 50 years who may have low testosterone and decline in other hormones. The decline in hormones is not universal   and not all men undergo this process to the same extent. Studies have found that total and free testosterone begin to decline at about 50 years. The Andropause has been alternatively termed A.D.A.M. (Androgen Decline in Aging Males) because the decline is gradual unlike the sharp drop in estrogens at menopause in women.

tan.jpg (4604 bytes)Robert Tan, MD, visiting associate professor (geriatrics) is in the Department of Family Practice and Community Medicine at the University of Texas (Houston) He says that testosterone deficiency has its own symptoms. They can be bone loss (osteoporosis), impotence, weakness, memory loss, and depression all are symptoms of andropause that perhaps might be reversed with testosterone.

World Differences in Testosterone

joe2.jpg (4335 bytes)Joe:
I’d like to welcome Dr. Robert S. Tan, MD to our discussion on andropause. You call your book, "The Andropause Mystery." You say that it is an epidemic affecting 5 to 10 million men. With that many people affected, why is it so mysterious?

Dr. Tan:
tan.jpg (4604 bytes)The numbers of 5-10 million men in America is an estimation based on the prevalence of hypogonadism (low testosterone). Research shows that approximately one in three men to be hypogonadal above a certain age. We don’t go out and actually measure these 5-10 million men, but it is an extrapolation based on population studies. These population studies are samples of a group of men. What is interesting to me is that hypogonadism (which is in part the clinical basis of the andropause), is that it is seemingly a western world "disease".

There is some research showing declines in people from different parts of the world. Americans start off with the most amount of testosterone, but they loose it at the fastest rate with age. In contrast, men in Paraguay seem to start off with the least amounts of testosterone, and manage to ward off the decline with time. In a sense, the andropause is a "mystery". Why is it that we in the western world have this decline in testosterone? Testosterone is a hormone that is responsible for the "men" in us: builds muscle and libido etc. In my book, I tried to unravel this "mystery" by suggesting lifestyle modification process by recommending eating a balanced diet for male aging, exercise, weight management and smoking cessation etc. Hormonal replacement for men is available as a therapeutic strategy, but in my opinion is only one part towards managing the andropause.

The effects of andropause

Are there differences in the way that men experience andropause?

Dr. Tan:
tan.jpg (4604 bytes)Andropause has struggled to be recognized as an entity. It is a physiological entity and not a disease. It has been wrongly labeled "male menopause". Men do not have periods and the word menopause means "termination of the regular cycles that women have". We know for sure that hormones such as androgens (of which testosterone is the most potent) do decline with age in men.

  • This decline is much more gradual than in the menopause.
  • The gradual decline in testosterone often times allow men to adapt to the physiology better and perhaps that is why it is often missed.
  • A.D.A.M.
    Some have offered "androgen decline in aging males" as a clumsy alternative term for the andropause because of the gradual nature of decline in androgens in males.
  • Not unlike menopause, the initiation into andropause is associated with subtle changes in moods, energy, libido and memory. Occasionally, men can even have hot flashes in the andropause.
  • The long-term effects of andropause are similar to menopause: there may be loss of bone mass leading to osteoporosis, hair loss in genitalia areas and armpits and even dementia.

Diagnosis of Andropause

What is the best way for a man to decide if he has andropause?

Dr. Tan:
tan.jpg (4604 bytes)Interesting question. Spouses bring in many men to me because women first notice these changes. They are experienced in managing their own menopause and as such often notice symptoms first. To reiterate, the symptoms include lack of energy, loss of libido, memory loss and mood changes. Unfortunately, many illnesses including clinical depression, hypothyroidism, diabetes etc. overlap with the physiological phenomenon of andropause.

  • Measuring testosterone
    As such, when you turn to a medical doctor, he or she often ends up measuring your testosterone levels to decide if you are "in andropause". The problem is that there is some fluctuation of testosterone levels within different hours of the day and that not being in the normal range for testosterone can still be indicative of andropause. I believe that testosterone levels should be adjusted for age, and not many laboratories I know do that. They just give a range form 250-1000 ng/dl, but it covers a range for someone between 20- 80 years of age.
  • "relative hypogonadism"
    Also, there is what I call "relative hypogonadism" and that you could have the same level of testosterone as another person but still suffer these same effects. Replacement with testosterone and the reversal of symptoms is a guide for me to say that you have entered the andropause.

Diet & Exercise

What is the role of diet and exercise in andropause?

tan.jpg (4604 bytes)Dr. Tan:
You are what you eat. Definitely, eat moderate amounts of protein. Eat plenty of fresh fruit and vegetables. Eat minimal amounts of carbohydrate. This includes bread, cakes, donuts, rice, pasta etc. If you can, avoid them. Research has shown that foods high in protein and low in carbohydrate cause the greatest sustained levels in testosterone and growth hormone. In the andropause, there is muscle loss and substitution with fat. As such, protein replacement is important. Fresh fruit and vegetables can act as valuable antioxidants and have anti-aging properties. What about fat? You need some fat if you want to produce testosterone. Testosterone is synthesized from cholesterol. As such, not all cholesterol is bad. Zinc and chrysin supplements are being investigated as means to maintain testosterone.

menshealth.jpg (6021 bytes)fitandtrim.jpg (5087 bytes)Both lack of exercise and over activity can actually result in decreased levels of testosterone. Exercise stimulates the pituitary gland to produce regulatory gonadotrophins to stimulate the testes to produce testosterone Paradoxically, endurance training e.g. running for more than 60 minutes can lead to lowered testosterone. As such, moderate aerobic exercises combined with weight training for 20-30 minutes several times a week is more productive of testosterone. Research has shown that short bursts of intense exercise seem more effective than continuous lower intensity exercise. However, many men have concomitant heart problems when they enter andropause, and it is always advisable to consult a physician before embarking on an exercise regimen.

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Supplemental Testosterone:
Should Men Use It?

Should men be taking supplemental testosterone? Who should be taking it?

Dr. Tan:
I mentioned how you can improve testosterone by lifestyle modification processes including diet and exercise. Testosterone replacement is not an easy way out of exercise and diet. They can be supplemental, and additional in effect. Men who are symptomatic of the andropause and who have low testosterone levels (relative to their age) can benefit. A physician should closely supervise the treatment. Contraindications include coexistent prostate cancer, hyperlipidemia and sleep apnea. Side effects may include breast swelling, leg swelling and increase in blood count. PSA should be followed to monitor prostate safety.

Interested in this book?
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Get your copy today - click here

"Making Love the Way We Used to...Or Better"
interview with Laurie Ashner and Alan M. Altman MD
hosted by Sue Spataro, RN, BSN
gonext.gif (388 bytes)Interviews & FREE excerpt
altman.jpg (5845 bytes)ashner.jpg (5815 bytes)Within the last 15 years, intimate relations at midlife has made it to the talk show circuit. Laurie Ashner and Dr. Alan Altman have worked together to write the complete guide to regaining the intimacy, love, and yes, the fun that you shared before hitting 35. Laurie, as an established health author and Dr. Altman a prominent gynecologist and expert on midlife sexuality, have written an in depth, easy to read, and most importantly, easy to use handbook. Find out more about the science of intimacy and what you can do to improve your love life.

Meet the Author
Jed Diamond
author of: "Male Menopause"
hosted by Sue Spataro, RN, BSN
gonext.gif (388 bytes)Interview & FREE excerpt on Erectile Dysfunction
diamond.jpg (5741 bytes)The vast majority of men and women do not recognize the signs of male menopause.  The signs can be subtle and "sneak up" on a man.  They also can be attributed or blamed on something else, like stress, a move, the job etc. These warning signs of male menopause have their roots in real and measurable physical changes.  This is more than a "mid-life" crisis. This interview with Jed Diamond talks about: What is Male Menopause?; Common Signs & Symptoms; Erectile Dysfunction; Mid-Life Crisis; and a FREE Book Excerpt on Male Menopause and Erectile Dysfunction.

The Testosterone Syndrome
Maximizing Manhood
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by Jed Diamond Interview
redchk.gif (175 bytes)The Andropause Mystery
by Robert Tan, MD interview

Iron John: A Book About Men
by Robert Bly
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is a wonderful book that I've had for a few years in hardcover that I tend to reread every once in a while. It's a great "jump start" for the soul. It tells a story as abstracted from an ancient legend with practical applications for the men of today. Definitely worth buying for your personal library.

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