Andropause- The Male Menopause

In our clinic, the pear tree we've dedicated June to Men's health awareness. Seeing as testosterone level is hormonally what separates the men from the boys, (and the girls, and the women), I thought I'd breech the topic of Andropause, a condition very specifically, male. Andropause is the much less discussed, male version of menopause. The andropause typically occurs during the late 40’s early 50’s, and like menopause can have subtle or overt symptoms throughout the body’s systems. The hormonal shift responsible for andropause is the increase in estrogen relative to testosterone in the body. In a young man there can be fifty times more testosterone than estrogen. As a man heads towards andropause this decreases closer to thirty times as much, while anything lower than twenty times can be problematic. In older men this ratio is often closer 7 (testosterone):1 (estrogen). To further compound this hormonal disequilibrium higher estrogen values will also inhibit the breakdown of dihydroxytestosterone (DHT) the converted form of testosterone known to contribute to prostate enlargement and hair follicle shrinkage.

While like menopause, some of this hormonal shift is purely associated with

aging, there are other factors that can influence men’s estrogen levels. The enzymatic conversion of testosterone to estrogen in the liver is known as aromatization. We ultimately want to avoid life style and nutritional habits that increase aromatase activity, to prolong or avoid the arrival of andropause.

    More testosterone gets converted to estrogen in the liver when certain enzyme systems (p450) get overworked. Heavy alcohol use, especially beer (wine is less problematic), not only overworks these enzymes but also decreases zinc in our systems. Zinc deficiency increases aromztase activity and stops brain (pituitary hormone) signals for testosterone production. Certain medications and herbal supplements can also overwork these liver enzyme systems, check with your health care provider to see if anything you are taking is known to stress the p450 system in the liver.  Fat cells increase aromatase activity, and therefore estrogen levels. Low vitamin C levels are also known to increase aromatase activity. It’s also important to point out that there are many environmental sources of estrogens. The highest estrogen sources in the diet are; beef, chicken, eggs, American dairy products many of these animals are given estrogen directly to “beef up” their yield. Livestock may also be given antibiotics that mimic estrogens actions in the body. Xenoestrogens are environmental estrogen mimickers in our environment, found mostly soft plastics.

      The Symptoms we see with andropause are numerous and might be hard to pick out, and associate with the reduction of testosterone relative to estrogen as they overlap with so many other conditions and concerns. Mentally we see fatigue, especially when men are consistently tired in afternoon or evening. We may also see a decrease in mental sharpness and creativity. Memory challenges can also associated with this shift. With sexual function we see decreased interest and activity, less fullness of erection, with lower volume of ejaculate. In the musculoskeletal systems we see gradual loss of mobility coinciding with increased stiffness (more prone to injury, longer time to heal). We see arthritis (both rheumatoid and osteoarthritis start to develop, and bone loss can also start. Metabolic changes include increased total cholesterol, triglycerides, and decreased HDL (produced by exercise), the onset of type II diabetes, and increased blood pressure.

      As with menopause this can be quite a daunting and depressing list of changes associated with a shift that comes partially with age. We cannot really  control aging, but we can influence many of the other variables. Hormone testing, liver enzyme testing. Zinc and vitamin C status checks are all parts of a naturopathic work up to evaluate andropause. Once the contributing factors are identified we can address them with lifestyle factors (aforementioned beer consumption, exercise, whole foods diets) as well as correction of nutrient deficiencies (the two big ones are Zinc and vitamin C), and support with nutritional supplements and herbal medicines. Naturopathic Acupuncture protocols are also very helpful with andropause cases as acupuncture is always a wonderful tool to help achieve hormone balance. If you, or someone you know seems to be shifting into low gear due to low relative testosterone, come in to see me or your regular ND for a re-charge.