Applied Health Journal Topics of Health and Natural Healing

Issue 46 ISSN: 1525-6359

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Fatigue and losing sense of well-being - 82%
Joint aches and stiffness - 60%
Hot flashes, sleep disturbances - 50%
Depression - 70%
Irritability and anger - 60%
Reduced libido - 80%
Reduced potency - 80%
Premature aging, changes in hair growth, and skin quality - 60%

Sounds familiar, doesn't it? Right now, you are probably thinking we goofed up and you are again reading last month's article on female menopause. Guess again. . . this is a list of symptoms that men report having as they approach middle age, and begin experiencing hormonal changes.

Amazing but true, the same relationship that exists between the brain, the pituitary, the ovaries, and estrogen levels in a woman, exists between the brain, pituitary, the testis, and testosterone levels in a man.

Did you know that men and women produce the same types of hormones, only in different amounts? As an example, in normal hormone levels women produce high quantities of estrogen, but their bodies also contain a small amount of testosterone. Men make more of the androgens, such as testosterone, though they have a small percentage of estrogen, too.

How many of you (women included) have ever heard about, or thought about, male menopause. . .also known as andropause or viropause?

Ever notice how so much is said about female menopause, and so little is said about male menopause? For years, there has been controversy as to whether or not men actually go through male menopause. Studies have found that few men have any concept or understanding of the hormonal changes that they experience as they mature.

Because of this controversy, andropause has been poorly defined as a collection of various symptoms in which men typically have declining, but may also have normal, androgen levels. (Yes, that sounds 'poorly defined' to me, too.)

No wonder men do not recognize that they may be having symptoms. Andropause involves the hormonal, psychological, and physiological changes that occur in men, beginning typically between the ages of 40 and 55,though these changes can occur somewhat earlier, or in later years. These changes effect every aspect of a man's life - interpersonal, social, psychological, physical, and spiritual.

Though acute menopause symptoms in women are common, men rarely have acute indications of andropause. Evidence of andropause tends to be more subtle, because a man's hormone levels usually decline more gradually than that of a woman's.

Although, men's symptoms may be less overwhelming than what women experience, many men experience physical and psychological changes while neither recognizing symptoms, nor knowing what causes them.

Maybe one of the main reasons so little is known about andropause is that most men who begin to experience a decline in their virility, during their middle years, are unwilling to talk about it. The man may be asking himself, "what's wrong with me", but he can rarely bring himself to ask someone else that most intimate question.

The majority of men are not comfortable admitting that they are noticing changes in their bodies. Unless a man is aware that these changes are normal and to be expected, he can unwittingly be controlled by hormonal emotions and changes in physiology.

Usually, men will not speak to their doctors about their symptoms, unless a spouse or companion brings it to the doctor's attention. Since men are often unaware of what these changes mean, it helps to have an understanding partner to help alleviate the powerful anxieties and doubts, which may occur and possibly lead to total impotence and sexual frustrations.

Recently, doctors have become more willing to diagnose "male menopause". The Institute of Endocrinology and Reproductive Medicine has developed a comprehensive program for the treatment of male menopause.

In the past, this condition had received very little attention from the medical community. However, in the Spring of 1998, one of the main symptoms of andropause - a loss of male virility - became the "hot media topic" when Viagra was released.

Most endocrinologists and scientists believe that male menopause correlates with the decline, or imbalance, of male hormone levels (most predominately: testosterone). Testosterone is the hormone that is responsible for a man's sexual development when he is a child, along with the development of bones, muscles, and sex drive as he becomes a man.

In 1977, Dr. Karpas first published research results about the effects of aging on men's hormone levels. He found that even healthy men, by 55, had a significantly lower testosterone level than ten years earlier.

As the testosterone levels decrease, this alters the balance of the other hormones, and estrogen levels begin to increase. Some scientists believe that too much estrogen, which causes breast cancer, may also be a contributing factor in prostate cancer.

As men in their 50's and 60's have decreasing levels of testosterone, and accelerating levels of estrogen, they may want to consult an alternative health care professional about increasing the amount of natural progesterone in their body to discourage the excessive build up of estrogen, possibly avoiding the risk of prostate cancer.

Julian Whitaker, M.D., a nationally recognized alternative medicine educator and editor of the newsletter Health and Healing, believes most men are unaware that they experience a predictable decline in hormone production at mid-life.

Even though, after the age of 30 the hormone levels in men begin to slowly decline, most men do not notice a significant difference until they are in their forties or fifties.

Gary S. Ross, M.D., who practices in San Francisco, California, says that usually by the time a man has reached his fifties, evidence of the "andropause complex of symptoms" (another name for a condition of unbalanced hormones in men) may be noticeable.

The physical and psychological symptoms are indications that a man's hormonal levels are shifting into a different balance. Though many of the symptoms are vague and nonspecific, the beginning signs of andropause often result in changes in a man's sexuality.

Dr. Ross says, "hormone levels, especially testosterone, start off high in puberty and peak throughout the teenage years. A healthy average for a man about 35 to 40 years old is 600, so this is a desirable level to maintain if a man wants to stay strong.

By the time he reaches age 55, a man's testosterone levels will typically be averaging 500. Even so, this is below the optimal level needed to stay young."

Typically, when a man has reached his mid-seventies, his male hormone levels will have decreased below pre-puberty levels. These testosterone levels decline in both the central (pituitary) and peripheral (testes) areas. As the amount of testosterone and other male hormones decreases in the bloodstream, andropause symptoms increase.

Approximately 40% of men, when they have reached their 40's will begin to have some of these symptoms. These may include increased fatigue, and diminishing physical stamina, muscle strength/endurance, and sex drive.

Men may also notice longer time periods to recover from injury or illness; aches in joints and muscles; weight gain; increased nervousness and irritability; mood swings; depression; increased difficulty in attaining and sustaining erections, or complete loss of sexual enjoyment.

Other changes may include decreased short-term memory or concentration; increased anxiety/fear (panic attacks); irregular sleep habits or insomnia, indecisiveness; and loss of interest and/or self-confidence. All of these signs commonly are indicative of male hormone-production levels dropping.

Although studies have proven the correlation between decreasing hormone levels and decreasing virility, there are still many urologists who question the importance of hormones in the role of male sexuality. This is because there are other circumstances that also contribute to deficiency of testosterone levels and impotence.

Conditions such as obesity, hypertension, smoking, high cholesterol and heart disease can all result in poor vascular health, and contribute to impotence. Vascular disease will cause a loss of elasticity in the arteries, poor circulation and blood flow. This hampers proper circulation and blood flow, which in turn interferes with healthy erectile function.

In a study conducted at the Veterans Affairs Medical Center, men were interviewed and responded to questions about 22 different topics. These included information on patient demographics, their understanding of andropause, their understanding of possible hormonal therapy, and their medical history and social habits - such as smoking and drinking.

A total of 302 male patients were questioned, of which 71% were above the age of 60. Though most patients knew little about andropause, they were interested in obtaining more information.

The results of this study showed the 50 to 60 year old patients more frequently reported obvious symptoms of andropause. Their symptoms included impotence, muscle weakness and memory loss.

It was noted that some symptoms of andropause are similar to an under-active thyroid, such as a sluggish metabolism, sensitivity to cold, constipation or dry skin.

The second most common age to report symptoms was between 60 to 70 years old. Results disclosed an earlier onset of symptoms from smoking, high alcohol consumption, hypertension, various forms of vascular degeneration, and other debilitating health problems.

A study testing impotency in men diagnosed with cardiovascular disease showed that at least two-thirds of the 40 year old men exhibited some signs of at least moderate impotence.

Also, it was found that while a variety of drugs can cause a probability of impotence, a small amount of alcohol usually does not hinder most men's sexual performance, until they reach mid-life. This is because alcohol increases dilation of all the blood vessels, making it more difficult to have a concentrated blood supply in the penile tissues.

Long term effects of excessive alcohol can be even more dangerous, where ten or more years of heavy drinking and alcohol abuse can cause permanent damage to the penile nerves.

Smoking can also be a major cause for male sexual dysfunction, because of the damage smoking does to the blood vessels throughout the body, including the penis. Other health problems can cause various forms of impotency, such as diabetes, chemotherapy, etc.

Hypertension and its medications (beta-blockers) can also increase the chance for impotence, as do medications for antidepressants, diuretics, antihistamines, digestive medicines, and even cold and flu remedies.

Warning is given to men who, because of penile vascular disease, have been given medication, such as Viagra, to dilate blood vessels. Most likely they have similar vascular disease problems in the heart and other areas, and are at great risk of major complications such as heart attack or stroke, from drug use.

If a man is questioning whether male menopause may be the cause of symptoms he is experiencing, he may want to have either a blood test done by his doctor, or check with his alternative health practitioner.

The saliva test that Dr. Force recommends in his accompanying article in this month's newsletter can provide an accurate measurement of the balance (or imbalance) of key hormones.

Besides physical symptoms, even more difficult to recognize are the psychological symptoms. As humans, we all have a tendency to reflect our physical ill health in our emotional or mental state. Feeling poor physically is tightly woven into feeling poor mentally, even when we know the cause of our physical illness.

Often times, with the decline in testosterone levels, and other hormones, psychological symptoms are manifested. The most typical response toward the decline in hormones is depression. This may be due to outside psychological influences, but most likely is influenced by a reaction to the physical changes. Unbalanced hormones do have psychological repercussions.

An article in the Postgraduate Medical Journal (September 1997, 73 <863>: 553-6) says: "testosterone decline/deficiency . . .may exhibit considerable overlap with primary and other secondary psychiatric disorders."

Drs. Caroline and Andrew Dott, teachers and professional lecturers, often speak about the influence of hormones on psychological and biological behavior in men during andropause.

Depression and anxiety can produce symptoms of "psychogenic impotence". In reverse, it is true that biological impotence problems can aggravate depression and anxiety. Biological impotence can be effected by declining hormone levels, cardiovascular health, and/or general health condition.

External factors may contribute to psychological stress and depression experienced during andropause, leaving a man feeling vulnerable, inadequate, obsolete, or like a failure.

Some of these factors may include children leaving home; job opportunities diminishing or displacement by a younger male; an unhappy marriage, or going through a divorce (sometimes 2nd and 3rd time). Other occurrences may include, becoming a grandparent; friends and parents getting sick or dying; and having minor or acute virility problems - causing a major concern about sexual dysfunction.

Men often express depression far differently from women, so again, the symptoms may be more difficult to recognize and understand. Men typically deny the problem, because of their belief that they have to "be strong". A man's most major concern could be his sexuality, which would be the last symptom he would want to discuss. This alone could have an increased effect on depression.

Family members, physicians, or mental health professionals rarely recognize symptoms of depression, and this can lead to devastating consequences. Jed Diamond, in his book Male Menopause, reports that 80% of all suicides in the U.S. are men, with the rate during mid-life being three times higher; for men over age 65, it is seven times higher.

Of the 20 million Americans who will experience depression in their lifetime, 60-80% will never seek professional help. For those who do seek help, it will take an average of ten years, and three health professionals to properly diagnose the disorder. Shocking statistics!

(For a brief explanation describing differences between male and female depression, refer to the section following this article.)

Now for the women reading this, if the signs of male depression sound familiar, and you are concerned about a particular man in your life, is there anything you can do?

The most important first step is to recognize the problem, because most men will not see it within themselves. Remember that their most basic psychological defense is denial. Keep in mind, men will probably not seek help on their own unless pressured to do so, by people they care about.

Men need to be reminded that there are various approaches that will help them: exercise, healthy diet, individual or group therapy sessions, seeing an alternative health care practitioner who can help them balance male hormones through natural means, or seeing their regular physician.

It is also important to encourage men not to give up, if at first they do not receive the expected support from others. With determination, they will eventually find the individuals who can offer help and encouragement.

Men in depression also need to be encouraged to love and accept themselves, and to learn to focus on their positive qualities, not the negative.

Certainly, there are proactive steps a man can take to improve his overall health during andropause. He can improve his health with certain lifestyle changes, such as limiting alcohol intake, eliminating smoking (if applicable), choosing correct eating habits, and appropriate exercise (reports have shown that men who exercise regularly have a stronger sex drive than men who are inactive).

Fortunately, there are alternatives that can provide nutritional support for men during andropause, without the typical side effects that accompany most drugs. It is definitely worth researching or visiting with alternative health care practitioners to see what choices are available.

A variety of vitamins and herbs can be beneficial, such as St. John's Wort for depression, valerian root for insomnia, ginkgo biloba for improving memory. Studies done on Vitamin C, E, zinc, and HCL show their effectiveness in promoting prostate health and fighting prostate cancer.

The article "Herbal Medications For Common Ailments in the Elderly" by E. Ernst (The Department of Complementary Medicine, School of Postgraduate Medicine and Health Sciences, University of Exeter, England) states:

  "It has been well documented that Aesculus hippocastanum
   (horse chestnut) seed extracts . . . reduce the objective
   signs of chronic venous insufficiency.  Serenoa repens
   (saw palmetto) is effective in improving the symptoms
   of benign prostatic hyperplasia.  Finally, yohimbine
   has been shown to be effective for erectile dysfunction.
   It is concluded that several plant-based medicines can
   be useful additions to our therapeutic repertoire for
   treating common conditions. . ."

In conclusion, though doctors have a variety of different opinions about andropause, the majority agree that a general decline in a man's hormone levels and potency, at the approach of mid-life, are to be expected in most of the male population.

Even with the resulting symptoms, men can choose options that will help ease them through the psychological and physical changes of andropause. In addition, they can learn to reassess their lives, review their priorities, become better people by learning, and growing from their experiences (good and bad).

With the appropriate tools, men can go through this transition into what can be the "better" half of life - with confidence.

 

References:

"Age-Associated Testosterone Decline In Men"
 by Sternbach H.
 Department of Psychiatry, UCLA-Neuropsychiatric Institute,
 Los Angeles, CA.
 American Journal of  Psychiatry, Oct. 1998; 155(10):1310-8. 

"Environment, Human Reproduction, Menopause, and Andropause"
 by Vermeulen, A.
 Department of Endocrinology and Metabolism,
 State University of Ghent, Belgium
 Health Perspective, July 1993; 101 (2:91-100).

"Men's Health In Action", by Gary S. Ross, M.D.
 Creative Health Works, P.O. Box 2889,
 San Francisco, CA 94126 

(For more information about the following books, visit
 our website at www.appliedhealth.com, and click on
 "book search".)

"Male Menopause", by Jed Diamond, 1998.  

"Maximizing Manhood : Beating the Male Menopause"
 by Malcolm Carruthers. 

"The Testosterone Syndrome: The Critical Factor for
 Energy, Health, & Sexuality--Reversing the Male
 Menopause", by Eugene Shippen, William Fryer. 

"Dr. Whitaker's Guide to Natural Healing"
 by Julian M. Whitaker.

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Depression:

The following comparative list, from "Male Menopause" by Jed Diamond, describes the differences between male and female depression.

When Bill took one look at this list, he said: "hey, based on this criteria, I've been depressed since I was twelve!"

To which, I responded: "That could be true. Sometimes signs of depression can be confused with the typical signs of 'personality disorder'!"

(Even at our age, it's still fun to have some of that 'sibling combativeness' left.)

With all joking aside, it is important to note that similar symptoms can be observed in someone going through puberty, or just be someone's normal personality.

The most definitive sign would be in "change" - if someone you know does not typically have, yet is beginning to demonstrate, some of the following symptoms.

(Be aware that a person with manic-depressive disorder would not have a sudden onset of these symptoms. Manic-depressive or bi-polar personality disorders need extensive research, themselves, because these problems are even more complicated than clinical depression. Though it may take multiple visits to various qualified professionals, it is worth the search to find someone who can properly diagnose any mental illness.)

Most Common Symptoms of Clinical Depression - Women vs. Men:

1. Women are more likely to turn their feelings inward. 
   Men tend to "act out" their inner turmoil. 

2. Women blame themselves, while men blame others.

3. Women feel sad, apathetic, and worthless.
   Men feel angry, irritable, and ego inflated.

4. Women feel anxious and scared.  
   Men feel suspicious and guarded.

5. Women avoid conflict at all costs.  Men create conflicts.

6. Women always try to be nice.
   Men become overtly or covertly hostile.

7. Women withdraw when feeling hurt.  
   Men attack when feeling hurt.

8. Women have trouble with self-respect.  
   Men demand respect from others.

9. Women feel they were born to fail.  
   Men feel the world set them up to fail.

10. When depressed, women slow down and are nervous.  
    Men become restless and agitated.

11. Women become chronic procrastinators.  
    Men become compulsive timekeepers.

12. Women sleep too much.  Men sleep too little.

13. Women have trouble setting boundaries.  
    Men need control at all costs.

14. Women feel guilty for what they do. 
    Men feel ashamed for who they are.

15. Women become uncomfortable receiving praise.
    Men are frustrated for not receiving enough praise.

16. Women find it easy to talk about weaknesses and doubts.  
    Men are terrified to talk about weaknesses and doubts.

17. Women have a strong fear of success.
    Men have a strong fear of failure.

18. Women need to "blend in" to feel safe.  
    Men need to be "top dog" to feel safe.

19. Women use food, friends, and "love" to self-medicate.  
    Men use alcohol, TV, sports, and sex to self-medicate.

20. Women believe their problems could be solved only if they
    could be a better (spouse, co-worker, parent, friend).  
    Men believe their problems could be solved only if their 
    (spouse, co-worker, parent, friend) would treat them better.

21. Women constantly wonder, "Am I lovable enough?"  
    Men constantly wonder, "Am I being loved enough?"

For a complete list of past and current articles,
visit Applied Health Journal Archives.

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