"The Andropause Mystery"
by Robert Tan, MD
hosted by Joe Spataro
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Joe:

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

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:
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".

The effects of andropause

Dr. Tan:
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

Dr. Tan:
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

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.

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.

Supplemental Testosterone:
Should Men Use 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.

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