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Menopause and Andropause
By Jeffry S. Life, M.D., Ph. D.
Alan P. Mintz, M.D
“Making the Rest of Our life the Best of Our
life”
The average American
women’s life expectancy currently exceeds 81 years of age so most women
can expect to live more than one third of their lives well beyond their
childbearing years. Today menopause is no longer the hush-hush topic
of our grandmothers’ generation. Both the non-medical and medical
communities throughout our country now openly address the implications
of menopause. Billions of dollars are spent each year by advertising
targeted at the 44 million-plus baby boomer women that are near or in the
menopausal 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, like women, hormone imbalance is the root cause of the male menopause
– the Andropause.
While menopause
comes on rather abruptly, the symptoms of Andropause tend to come on slowly
and gradually, creeping up over a period of as long as 20 years.
Hardly noticeable at first, it eventually cuts to the very core of a man
when he realizes that he has lost much of his sexual function and finds
it harder and harder to keep himself mentally sharp and focused.
If left untreated, the Andropause can have as severe long-term consequences
as those of menopause.
Whether you are
a man or a woman in the –pre-, peri-, or post-menopausal or Andropause
stages of your life, the following information can help you determine what
steps you need to take for your own personal wellbeing.
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Andropause
Symptoms of Male Menopause
Physical Appearance
* Body fat gain, particularly
abdominal weight gain
* Loss of lean muscle
tissue
* Bone deterioration
* Loss of hair
* Wrinkling and drying of
the skin
Bodily Functions
* Fatigue
* Decreased libido
* Possible erectile
dysfunction (ED)
– reduced potency and/or penile size,
decreased ejaculatory force and volume
* Hot flashes, blushing and
sweating
*Aches and pains
Mental Functions
* Poor sleep quality
or insomnia
* Nervousness, anxiety
and irritability
* Memory lapses
* Depression
* Reduced motivation/apathy
Mental and emotional
changes resulting from the andropause can cause increased negativity, loss
of focus, loss of drive at play and work, and a questioning of one’s values,
accomplishments, goals and directions in life. Physical changes can
include loss of strength, muscle atrophy, loss of energy, and stiffness
and aching of muscles and joints.
While life’s stresses
can often exacerbate these physical and emotional changes, stress is no
longer universally accepted as the cause of the loss of male vitality and
virility. The signs and symptoms of the male menopause need not be
accepted as an inevitable consequence of the aging process. A large
body of data collected since the first study appeared in the Journal of
the American Medical Association (1944; d126 [8]:472-7) indicates a direct
connection between the variety of symptoms described and an imbalance of
hormones.
Too little? Too Much?
Simply stated,
the imbalance is one of too little 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 entire 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, regulates
proper cholesterol levels, and control blood pressure.
As men age, the
testosterone they produce diminishes and is increasingly converted to estrogen.
The most dangerous effect of too much estrogen and too little testosterone
is the increased risk of heart attack or stroke. Estrogen (estradiol)
is actually made from testosterone in the cells of every male’s body but
when there is too much, no matter what the level of testosterone, they
will suffer negative consequences. Furthermore, when a male is experiencing
high estradiol levels, he is also producing more sex hormone binding globulin
(SHBG), a protein that binds to testosterone and prevents it from doing
its work. Since typically about 98 percent of the testosterone in
the male’s bloodstream is bound to proteins, only approximately 1 to 2.7
percent is free and available for assimilation into the cells of the body.
As SHBG increases the amount of testosterone freely available to act on
cells diminishes.
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 (which increase aromatase enzyme),
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 that requires expert interpretation.
In addition to
declining levels of testosterone, growth hormone and DHEA levels
are also falling during andropause. As these levels decline, profound
changes begin to occur with growth and metabolism that affect men both
physically and mentally.
Available Help
The good news is that male hormone imbalance
is correctable.
Conclusion
Hormonal health plays a large part in determining
one’s overall well-being. Today both menopause and andropause, along
with the symptoms that accompany them, can be treated successfully.
Men and women and their loved ones need not suffer the consequences of
a mid-life crisis. There is definitely hope. It is within our
power to make the rest of our life the best of our life!
What is Menopause?
Menopause refers to that time in every woman’s
life when menstruation ceases completely. The ovaries’ decrease their output
of estrogen and progesterone and women begin experiencing the effects of
suboptimal levels of these hormones. In addition to signifying
the end of a woman’s ability to have children, declines in these female
hormones affect the entire endocrine system. This is a process that
takes approximately 3 to 5 years to complete. The early phase or
transitional phase is referred to as the climacteric, or peri-menopause.
Menopause is considered complete when a woman has had no period for a full
year. Although timing varies from woman to woman, menopause is generally
completed by the time they reach their early 50’s.
What to Expect at Menopause and Beyond
Every woman is
an individual, of course, but there are a number of side effects that can
generally be anticipated. Though some side effects may be considered
temporary nuisances to be “toughed out,” the reality is that the decline
of a woman’s hormonal levels results in changes that can seriously affect
her physical and mental health as well as her prospects for longevity.
Hot Flashes
The most common
side effect associated with menopause are hot flashes, a sudden sensation
of intense heat. Some women break out with red blotches on their
chest, back and/or arms, some sweat profusely, some also experience cold
and shivering until their bodies readjust. While many women never
experience hot flashes, others can 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 they can linger for years.
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 also change with the decrease of hormonal levels and
can cause incontinence and an increased susceptibility to urinary tract
infections.
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 pre-menopausal levels of testosterone can be
a contributing factor to a woman’s loss of desire for sexual intercourse.
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
just how much lifestyle, alteration of family roles, changing social networks,
and emptying of the nest contribute to the emotional changes of post-menopausal
women. It is clear, however, that hormonal decline is a major contributor
to this emotional instability.
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 seem 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 more 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.”
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 developing cardiovascular
disease (as well as other serious diseases), but when these are coupled
with low estrogen levels, the risk is much higher than either one alone.
As a direct result of estrogen deficiency, LDL cholesterol increases and
HDL decreases. As LDL levels rise, fat tends to accumulate on artery
walls eventually clogging them, and the falling levels of protective HDL
(high-density lipoproteins) make it impossible to remove these fat deposits.
Early recognition, lifestyle changes and hormone modulation have been show
to be very effective in reducing the incidence and severity of cardiovascular
disease in post-menopausal women.
In addition to
diminished levels of estrogen and progesterone, testosterone (also produced
in the ovaries) and growth hormone (produced in the brain) are also reduced
during menopause. As the levels of all of these key hormones diminish,
profound changes begin occurring with growth and metabolism that affect
the breasts, vagina, bones, blood vessels, gastrointestinal tract, urinary
tract, cardiovascular system, skin, brain, and energy levels.
Hormone therapy began in the 1940s and has
been refined considerably over the past 60 years Much of the medical field
agrees that hormone therapy:
* Reduces the risk of
osteoporosis
* Relieves hot flashes
* Reduces the risk of
cardiovascular disease
* Improves mood and
psychological well-being
* Results in a firmer
body and a more youthful appearance
* Improves mental alertness,
focus and concentration
* Increases energy and
vitality
* Improves desire for
sex
* Increases physical
stamina and muscle strength
* Reduces body fat |
