MEN’S HEALTH ALERT

"MALE MENOPAUSE" -VIROPAUSE, ANDROPAUSE, WHATEVERPAUSE: SOME FACTS

A few weeks back I turned 48. I'm not one for celebrating birthdays, concerned about adding a year to my age, or fretting about the fact I don't feel like I did when I was 28. However, during the past year I've had this persistent feeling that 'something isn't right-there's some medical thing going on". I've been feeling like I'm dragging--low energy, fatigue, foggy in the head, libido drop, and depressed. During a visit to my doctor last week, I told him something wasn't right and asked to get some blood work done. The only way to describe this sense to him was to mention it's similar to but not the same as before I was diagnosed with hypothyroidism about 15 years ago.

I mentioned to him that I've been reading up on testosterone levels and other endocrine system changes as men age. I ventured a guess that my testosterone level and possibly a thyroid value would be lower than than anything in the 'acceptable range (about a year ago, I raised the issue without having done all of my homework and he dismissed the testosterone idea-"look at you-you look like we should siphon some testosterone out of your system). Understandably, he was skeptical about the testosterone theory. However, he was happy to write for the blood work. I bet him an imaginary 10 thousand dollars the lab work would confirm my gut feeling.

The possibility that men might experience something akin to menopause has never been in vogue in mainstream medical circles. However, recent research has caught their attention as you will read below. Not only do male hormones like testosterone drop with time but over the last 20 years or so, it appears that there has been an environmentally induced unprecedented drop in testosterone levels in the general population as compared to any time in history.

Long story short, I just learned my testosterone level is off the chart low (like having a level like a 95 year old dead man) along with a low thyroid value. So, the game plan will include adjusting the synthroid I take for hypothyroidism and start treatment with 'Androgel' on some type of gel/cream that you just rub on your arm to bring the testosterone level into some acceptable range. I think I can use the 'Androgel' to give me a 'jump start'. I'll do all the things to naturally produce more testosterone and discontinue the Androgel down the road a bit--that's my plan anyway..

Most men I''ve talked to tell me they notice a major and pretty quick positive change. I should mention that Dr. Clint lit the fire under my behind to get the testosterone level checked wagering I wouldn't need the anti-depressant if I did as he said.

Typically, men who report symptoms consistent with low testosterone levels are diagnosed with depression if nothing abnormal comes back on a thyroid screen. It is rare that a physician will even think to include a testosterone level check on routine blood work.

I'm posting snippets from medical journals to give people a sense of how damn important it is for people to learn about more about this largely unrecognized medical problem. We've lots to learn about 'andropause'. As you read Dr. Bhasin's comments, keep in mind that it's EXTRAORDINARY for a physician to overstate things in a medical journal; these guys wait for research to prove that water is helpful to a dehydrated person rather than rely on common sense.

First, a bit about causes, symptoms, and treatment of low testosterone, followed by excerpts from reputable medical journals. Please pass this information around.

Testosterone is the building block for male characteristics , it is a male sex hormone and also is a anabolic steroid that plays an important role in male health. It manipulates a variety of characteristics including well being , sexual libido , immune system strength , assertiveness , and various vital functions that can contribute to your life everyday.

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CAUSES
Contributing factors to the development of androgen deficiency include:

* Medications, especially those used to treat depression or mental disorders
* Alcoholism
* Chemotherapy or radiation treatment for cancer that targets or harms the testicles
* Chronic illness
* Dysfunction of the pituitary gland (a gland in the brain that produces substances that regulate hormone production from the brain to the testis)
* Hemochromatosis (too much iron in the blood)
* Hypogonadism (when the testis is not able to produce high enough levels of testosterone, aka androgen deficiency, or sperm, aka spermatogenesis)
* Inflammatory diseases, such as sarcoidosis (a condition that causes injury to or infection of the testicles)
* Illnesses, such as AIDS, that compromise the immune system
* Excessive stress, which taxes the adrenal system.

symptoms
The diagnosis of testosterone deficiency can only be made through a full medical examination by a doctor. If you suspect you may be suffering from androgen deficiency, please contact your doctor; however, some of the symptoms are as follows:

* Erectile dysfunction (the inability to get or maintain an erection)
* High cholesterol levels (having high cholesterol or high blood pressure causes hardening of the arteries, which can decrease blood flow to the testicles and cause enough damage to lower testosterone)
* Obesity, especially around the waist
* Depression
* Anxiety or mood swings
* Problems with concentration and memory or other cognitive and intellectual functions
* Low sex drive
* Decreased bone density, possibly leading to osteoporosis.

what is trt?
There are solutions if you discover that you are suffering from androgen deficiency. Testosterone Replacement Therapy (TRT) may be administered to men who are not producing high enough levels of testosterone. Such treatment is usually long-term and should only be started when androgen deficiency has been clinically proven, including testing hormone levels in the laboratory and ruling out other possible medical conditions.

Testosterone is available in pill form, patches, gels, creams, and intramuscular injections or it can be implanted under the skin. Absorbing testosterone through the skin via a patch or gel, or receiving an intramuscular injection (every two weeks), are the best methods of delivering TRT. Testosterone in an oral form is not absorbed very well by the body and may increase the risk of high cholesterol, as well as heart and liver problems.
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The lower a man's testosterone level, the higher his risk of death -- especially death from heart disease.

The finding comes from a study of British men aged 40 to 79 by University of Cambridge gerontologist Kay-Tee Khaw, MBBCh, and colleagues.

"The men with lower testosterone levels had an increased risk of dying from any cause, but most particularly of cardiovascular disease," Khaw tells WebMD. "We looked at cancer, too, and found no evidence of a link to cancer with higher testosterone levels."

Nearly 12,000 men enrolled in the long-term study from 1993 to 1997. More than 800 of the men died by 2003; Khaw compared these men's testosterone levels to those of some 1,500 living study participants.

After adjusting for factors that might affect risk of death -- including age, weight, smoking , alcohol use, high blood pressure, diabetes, physical activity, education, and social class -- the link between low testosterone and earlier death remained.

Compared to men with the lowest quartile (25%) of testosterone levels:

* Men in the second lowest quartile were 25% less likely to die.
* Men in the second highest quartile were 38% less likely to die.
* Men in the highest quartile were 41% less likely to die.

"We found that low testosterone predicts early mortality in men over the next 10 years or so," Khaw says. "But we think this finding needs to be replicated. We would like others to look at this in other populations of men and see if they get the same results."

The findings make sense to Robert Davis, MD, professor of urology at the University of Rochester, N.Y. Davis says low testosterone is common among men with metabolic syndrome -- a constellation of risk factors including abdominal fat, high blood sugar, high blood pressure, low HDL cholesterol, and high blood-fat levels.

"Certainly I'm not surprised at this finding. It's been shown that low testosterone correlates with metabolic syndrome, which is related to diseases like diabetes, heart disease, and vascular disease," Davis tells WebMD. "The need to check testosterone levels in people with metabolic syndrome is being recognized more and more among physicians."

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What does it mean?

Travison et al. find that testosterone levels declined in Massachusetts men by approximately 1.2% per year from the late 1980s through 2004, controlling for the age of the men and other possible confounding variables.

This study is important because of its large sample size and long duration. Few studies have looked directly at testosterone levels over time.

The results are surprisingly consistent with another set of long-term human epidemiology studies. Those studies also show a long-term decline in male reproductive functions, such as decreased sperm health and increased infertility, which are highly associated with or controlled by testosterone and other androgen hormones. The rate of decline reported in this study is roughly comparable to the rate of decline of sperm count reported first by Carlson et al. in 1992 and then reanalyzed by Swan et al.in 2000.

In commentary accompanying Travison et al.'s study in the Journal of Clinical Endocrinology and Metabolism , Dr. Shalender Bhasin (Boston Medical Center) writes: The data in this study are "important because they provide independent support for the concerns raised earlier about the reproductive health of men." ... "it would be unwise to dismiss these reports as mere statistical aberrations because of the potential threat these trends-- if confirmed-- pose to the survival of the human race and other living residents of our planet."

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