Andropause
Andropause, also known as male menopause or late-onset hypogonadism, refers to a set of age-related hormonal changes that occur in some men as they get older. It is characterized by a gradual decline in testosterone levels, which is the primary male sex hormone.
An estimated 10-25% of older men have testosterone levels below the normal range. According to global statistics, over 480,000 older men annually experience andropause, which gradually increases in severity and frequency with age.
While andropause is sometimes used interchangeably with male menopause, it is important to note that it is not an exact equivalent to menopause in women. Testosterone levels naturally decline in men as they age, typically starting around the age of 30. The decline is usually more gradual and less pronounced than the hormonal changes experienced by women during menopause. Unlike menopause, which involves a complete cessation of reproductive ability, men can still produce sperm and father children throughout their lives, even if their testosterone levels decrease.
Epidemiologic studies and meta-analyses have demonstrated higher all-cause mortality (35%) and cardiovascular mortality (25%) in men with low testosterone levels.
Symptoms
Symptoms associated with andropause can vary from person to person and may include:
Sexual changes: Reduced libido (sex drive), erectile dysfunction, and decreased sexual satisfaction.
Physical changes: Fatigue, decreased energy levels, loss of muscle mass, increased body fat, and decreased bone density.
Emotional changes: Mood swings, irritability, depression, and decreased motivation.
Sleep disturbances: Insomnia or changes in sleep patterns.
Cognitive changes: Difficulty concentrating, memory problems, and reduced cognitive function.
Other symptoms: Hot flashes, reduced body hair, and decreased testicle size.
Associated Health Concerns
While andropause is a natural process and typically not associated with severe medical problems, the hormonal changes that occur during andropause can contribute to various health concerns. Here are some potential medical problems that may arise or be exacerbated by andropause:
Sexual Dysfunction: Decreased testosterone levels can lead to sexual problems such as erectile dysfunction, reduced libido (sex drive), and decreased sexual satisfaction.
Osteoporosis: Testosterone plays a role in maintaining bone density. As testosterone levels decline, men may be at an increased risk of developing osteoporosis or experiencing bone loss, which can increase the likelihood of fractures.
Muscle Loss and Weakness: Testosterone is essential for maintaining muscle mass and strength. Reduced testosterone levels during andropause can contribute to muscle loss and weakness.
Increased Fatigue and Reduced Energy Levels: Lower testosterone levels may be associated with increased fatigue, decreased energy levels, and a general sense of low vitality.
Mood Disorders: Hormonal changes during andropause can contribute to mood swings, irritability, and an increased risk of developing depression or anxiety.
Cognitive Changes: Some studies suggest a potential link between low testosterone levels and cognitive decline, including memory problems, decreased cognitive function, and an increased risk of developing conditions like Alzheimer's disease.
Metabolic Changes: Low testosterone levels can impact metabolic function, leading to weight gain, increased body fat, insulin resistance, and an increased risk of developing metabolic syndrome and type 2 diabetes.
Cardiovascular Health: Testosterone plays a role in cardiovascular health, including maintaining healthy blood pressure, cholesterol levels, and blood vessel function. Low testosterone levels may contribute to an increased risk of cardiovascular disease.
Total Testosterone, Free testosterone, and SHBG
Total testosterone, free testosterone, and sex hormone-binding globulin (SHBG) all play distinct roles in regulating the levels and actions of testosterone in the body.
Total Testosterone:
Total testosterone represents the overall amount of testosterone in the bloodstream.
It includes both free testosterone and testosterone that is bound to proteins, primarily SHBG and albumin.
Total testosterone levels are measured in nanograms per deciliter (ng/dL) or picomoles per liter (pmol/L).
Total testosterone provides an overall picture of the body's testosterone production.
Free Testosterone:
Free testosterone refers to the portion of testosterone that is not bound to proteins and is therefore biologically active.
Only about 1-2% of the total testosterone in the body is free; the rest is bound to SHBG or albumin.
Free testosterone is the form of testosterone that can easily enter cells and exert its effects.
It is often considered the most biologically relevant form of testosterone because it's available for immediate use by the body's tissues and organs.
Levels of free testosterone are measured in either ng/dL or pmol/L.
Sex Hormone-Binding Globulin (SHBG):
SHBG is a protein produced by the liver and circulates in the bloodstream.
Its primary function is to bind to sex hormones, including testosterone and estradiol (a form of estrogen).
When testosterone binds to SHBG, it becomes inactive and cannot easily enter cells to exert its effects.
SHBG helps regulate the levels of free testosterone in the body by binding to it.
Conditions that affect SHBG levels can influence the availability of free testosterone.
High levels of SHBG are associated with decreased bone mineral density and increased fracture risk in older men.
The balance between total testosterone, free testosterone, and SHBG is crucial for maintaining normal physiological functions, including libido, muscle mass, bone density, and overall well-being.
High levels of SHBG can lead to lower levels of free testosterone, which might result in symptoms of testosterone deficiency even if total testosterone levels are normal.
Low levels of SHBG can increase the availability of free testosterone, potentially causing symptoms of testosterone excess.
While several supplements are marketed to decrease SHBG (resulting in increased free testosterone), it is crucial to determine WHY SHBG is elevated and treat the underlying cause, rather than directly reducing SHBG. What raises SHBG:
Elevated estrogen
Altered thyroid function
Liver disease
Certain medications
Obesity
Insulin resistance
Anorexia
Smoking & excessive alcohol consumption
Supplements that may decrease SHBG include boron, fenugreek, and Stinging nettles.
Nutrition
Maintaining healthy testosterone levels is important for men's overall well-being. While nutrition alone may not significantly raise testosterone levels, it can support hormonal balance and optimize overall health. Here are some recommendations:
Balanced Diet: Maintain a healthy and balanced diet that includes a variety of nutrient-rich foods. Focus on consuming lean proteins, whole grains, fruits, vegetables, and healthy fats. Adequate protein intake is essential for muscle maintenance and hormone production.
Phytoestrogens and Antioxidants: Include foods rich in phytoestrogens, such as soy products, flaxseeds, and legumes. These plant compounds may help balance hormone levels. Additionally, antioxidants found in fruits and vegetables can help reduce oxidative stress and support overall health.
Consume Adequate Calories: Ensure you're consuming enough calories to support your energy needs. Severe caloric restriction or prolonged fasting can lower testosterone levels. However, excessive calorie intake leading to obesity can also negatively impact testosterone levels, so aim for a balanced calorie intake.
Essential Fatty Acids: Include sources of omega-3 fatty acids in your diet, such as fatty fish (salmon, sardines), walnuts, flaxseeds, and chia seeds. Omega-3 fatty acids have anti-inflammatory properties and may support hormonal balance.
Include Healthy Fats: Include sources of healthy fats in your diet, such as avocados, nuts, seeds, olive oil, and fatty fish. Testosterone is synthesized from cholesterol, and consuming sufficient healthy fats supports hormone production.
Consume Adequate Protein: Adequate protein intake is important for testosterone production. Include lean sources of protein in your diet, such as poultry, fish, eggs, dairy products, legumes, and plant-based protein sources like tofu and tempeh.
Limit Sugar and Processed Foods: High sugar intake and processed foods can contribute to weight gain and insulin resistance, which can negatively affect testosterone levels. Aim to minimize your intake of sugary foods, sodas, and processed snacks.
Lifestyle Changes
Lifestyle changes that may help alleviate symptoms and promote overall well-being include:
Limit Alcohol and Caffeine: Excessive alcohol consumption and caffeine intake may worsen symptoms associated with andropause, including mood swings and sleep disturbances. Limiting or moderating these substances can be beneficial.
Regular Exercise: Engage in regular physical activity, including both aerobic exercises (such as walking, jogging, or swimming) and strength training. Exercise can help improve energy levels, mood, muscle mass, and overall well-being.
Resistance Training: Engage in regular resistance training exercises, such as weightlifting or bodyweight exercises. Resistance training can help increase testosterone levels and support muscle growth.
Weight Management: Maintain a healthy weight. Excess body weight can contribute to hormonal imbalances and exacerbate symptoms. Excess body fat, particularly around the abdomen, can contribute to hormonal imbalances and lower testosterone levels.
Stress Management: Practice stress reduction techniques such as meditation, deep breathing exercises, yoga, or engaging in hobbies that help you relax. Chronic stress can impact hormone levels and overall health.
Quality Sleep: Aim for adequate and quality sleep each night. Establish a consistent sleep routine, create a sleep-friendly environment, and avoid electronic devices before bedtime. Sufficient sleep is crucial for hormone regulation and overall well-being.
Remember, it is important to consult with a healthcare professional for personalized advice tailored to your specific needs and circumstances.
Supplements
While a balanced diet should be the primary focus for obtaining necessary nutrients, some supplements may provide additional support for men experiencing andropause. Here are some supplements that are commonly suggested for andropause:
Vitamin D: Many individuals, especially older adults, may have insufficient levels of vitamin D. Adequate vitamin D levels are important for overall health and hormone regulation.
Omega-3 Fatty Acids: If you struggle to consume sufficient amounts of omega-3 fatty acids through diet alone, you may consider a fish oil or algae oil supplement. Omega-3 fatty acids have anti-inflammatory properties and can support overall health.
Zinc: Zinc is an essential mineral that plays a role in testosterone production. It's important for maintaining healthy hormone levels and supporting reproductive function.
Ashwagandha: Ashwagandha is an adaptogenic herb that has been traditionally used to support vitality and hormone balance. It may help reduce stress, improve mood, and support overall well-being.
DHEA: Dehydroepiandrosterone (DHEA) is a hormone produced by the adrenal glands, and its levels decline with age. Some studies suggest that DHEA supplementation may help improve symptoms associated with andropause.
Tribulus terrestris: This herb is commonly marketed as a testosterone-boosting supplement. However, evidence supporting its effectiveness in increasing testosterone is limited, and more research is needed. While it may not directly increase testosterone, there is evidence that it increases libido.
D-Aspartic Acid (D-AA): Some research suggests that D-AA supplementation may help increase testosterone levels, particularly in individuals with low testosterone levels or impaired fertility.
Fenugreek: Fenugreek is an herb that has been traditionally used to boost libido and testosterone levels. Some studies suggest that fenugreek supplementation may have a modest positive effect on testosterone levels and sexual function.
Tongkat Ali: Also known as Eurycoma longifolia, tongkat is an herbal supplement that is also promoted as a natural testosterone booster. It has a long history of traditional use in Southeast Asian medicine for various purposes, including enhancing male sexual health and vitality. Tongkat may function by increasing testosterone and inhibiting the aromatase enzyme which converts testosterone to estrogen. It might also provide osteoporosis protection and improve erectile dysfunction.
Fadogia: Fadogia has been shown to increase the release of luteinizing hormone (LH) from the pituitary gland resulting in an increase in testosterone. Some individuals, however, may note increased anxiety and restlessness. Long-term and excessive doses may be detrimental to hormone balance.
Lepimedium meyenni (Maca): Shown to help with libido and mild erectile dysfunction. While maca has been shown to be beneficial in increasing testosterone levels in women, it’s effect in men is modest.
If you suspect low testosterone levels or have been diagnosed with low testosterone by a healthcare professional, they may recommend testosterone replacement therapy (TRT) as the most effective treatment option. TRT involves prescribed medications, such as testosterone injections, gels, patches, or pellets, to raise testosterone levels to a healthy range.
It's important to note that self-prescribing or using testosterone-boosting supplements without medical supervision can be risky. Many over-the-counter testosterone-boosting supplements lack scientific evidence to support their effectiveness and safety. Moreover, they may contain ingredients that are not accurately labeled or potentially harmful.
Additionally, it's important to recognize that boosting testosterone levels alone may not necessarily lead to desired outcomes or address the underlying causes of symptoms related to andropause. It's crucial to approach hormonal health holistically, considering lifestyle factors, overall health, and personalized medical advice.
Thyroid Function and Testosterone
There is a connection between thyroid function and overall hormonal balance in the body, which includes sex hormones like testosterone. Thyroid hormones help regulate the metabolic processes that influence the production and utilization of various hormones, including sex hormones.
An imbalance in thyroid hormones, such as hypothyroidism (underactive thyroid) or hyperthyroidism (overactive thyroid), can lead to reduced testosterone levels in men. Treating the underlying thyroid condition may help improve hormone production.
Testosterone and Growth Hormone
Growth hormone (GH) and testosterone are both essential hormones that play distinct roles in the body, although they can also interact and influence each other to some extent. Here are some key points about the relationship between growth hormone and testosterone:
Production and Regulation: Both growth hormone and testosterone are produced and regulated by the endocrine system. Growth hormone is primarily produced in the pituitary gland, while testosterone is mainly produced in the testes in males and in smaller amounts in the adrenal glands in both males and females.
Stimulation of Testosterone Production: Growth hormone can stimulate the production of testosterone indirectly. It acts on the testes to promote the synthesis of testosterone and enhances the sensitivity of Leydig cells (cells in the testes that produce testosterone) to luteinizing hormone (LH), a hormone that directly stimulates testosterone production.
Muscle Growth and Anabolic Effects: Both growth hormone and testosterone have anabolic effects, meaning they promote muscle growth, protein synthesis, and tissue repair. They work synergistically to support muscle development and maintenance, and deficiencies in either hormone can lead to muscle loss and reduced strength.
Impact on Body Composition: Both growth hormone and testosterone play a role in regulating body composition. Growth hormone helps to decrease body fat by promoting the breakdown of stored fats (lipolysis), while testosterone helps to increase lean muscle mass and reduce body fat.
Interaction and Synergy: Growth hormone and testosterone can have interactive effects on various physiological processes. For example, growth hormone can indirectly influence testosterone production, and testosterone can modulate the actions of growth hormone receptors in different tissues.
Aging and Hormonal Decline: Both growth hormone and testosterone levels naturally decline with age.
Fasting and Growth Hormone
Fasting has been shown to have an impact on growth hormone (GH) levels in the body. During fasting, the body undergoes various hormonal adaptations to conserve energy and maintain blood glucose levels, and one of these adaptations involves an increase in growth hormone secretion.
Research suggests that short-term fasting, such as intermittent fasting or time-restricted feeding, can lead to an increase in growth hormone levels. Studies have shown that fasting for 16-24 hours can result in a significant elevation of growth hormone levels.
The increase in growth hormone during fasting is believed to be part of the body's response to maintain energy balance and preserve lean body mass.
Fasting has also been shown to affect growth hormone receptors in the body. Growth hormone (GH) receptors are proteins located on the surface of cells that bind to growth hormone, initiating the cellular response to its presence. The regulation of growth hormone receptors can influence the sensitivity and effectiveness of growth hormone signaling.
Research suggests that fasting can increase the number and activity of growth hormone receptors in various tissues. Studies have demonstrated that short-term fasting, such as intermittent fasting or time-restricted feeding, can enhance the expression and function of growth hormone receptors.
However, evidence suggests that prolonged fasting or severe caloric restriction may potentially lead to a reduction in growth hormone receptor sensitivity. Prolonged fasting or very low-calorie diets can trigger adaptive responses in the body aimed at conserving energy and preserving vital functions. These adaptations may involve a decrease in growth hormone receptor sensitivity as a means of conserving energy and reducing metabolic demands.
Nutrition for Growth Hormone
Several foods and herbs have been suggested to potentially support the natural production or release of growth hormone (GH) in the body. While the effectiveness of these options may vary, incorporating them into a balanced and healthy diet may have some positive impact. Here are some examples:
Protein-rich foods: Consuming adequate amounts of high-quality protein sources, such as lean meats, poultry, fish, eggs, dairy products, and plant-based protein sources like legumes and tofu, is essential for supporting growth hormone production.
L-arginine & L-carnitine: L-arginine & L-carnitine are amino acids that can potentially promote growth hormone release. They can be found in foods like meat, poultry, fish, dairy products, nuts, and seeds. However, L-carnitine, whether from food or supplementation, is converted to TMAO (or trimethylamine N-oxide). Increased levels of TMAO have been associated with an increased risk of atherosclerotic cardiovascular disease. Allicin (from garlic) and berberine may help decrease conversion to TMAO.
L-ornithine: L-ornithine, another amino acid, may support growth hormone production. It is naturally found in meat, fish, eggs, dairy products, and legumes.
Melatonin-rich foods: Melatonin, a hormone involved in regulating sleep patterns, has been linked to increased growth hormone secretion during sleep. Foods naturally rich in melatonin include tart cherries, walnuts, almonds, and tomatoes.
Glycine: Glycine is an amino acid that may help stimulate growth hormone release. It can be obtained from protein-rich foods such as meat, fish, dairy products, legumes, and bone broth.
Adaptogenic herbs: Certain herbs, such as ashwagandha and maca root, are considered adaptogens and may support overall hormonal balance, including growth hormone regulation. However, more research is needed to establish their direct impact on growth hormone levels.
The use of human growth hormone (HGH) is highly controversial and is not recommended by medical professionals. Using HGH without a legitimate medical need can have serious side effects and health risks including insulin resistance, Type 2 diabetes, gynecomastia, joint/muscle pain, carpal tunnel syndrome, and increased risk of certain cancers.
Growth hormone stimulating peptides act on the pituitary gland to stimulate GH release. Examples include Sermorelin, Ipamorelin, GHRP-6, and CJC-1295. While these peptides can stimulate GH production at a safer level than HGH, their safety and efficacy are still being studied. Individuals considering them for any purpose should consult with a healthcare provider to discuss potential benefits and risks based on their specific medical history and needs.
Estrogen and Testosterone
Estrogen is commonly associated with women's health, but it also plays important roles in men's bodies. While men typically have lower levels of estrogen compared to women, maintaining a proper balance of estrogen is crucial for men's overall health and well-being. Here are some key functions and importance of estrogen in men:
Sexual Health: Estrogen helps regulate sexual function in men. It plays a role in libido (sex drive), erectile function, and the maintenance of healthy sexual tissues. Imbalances in estrogen levels can contribute to sexual dysfunction.
Bone Health: Estrogen is important for bone health in both men and women. It helps to maintain bone density and strength, and low estrogen levels can increase the risk of osteoporosis or bone loss. Estrogen receptors are present in bone tissue, and the hormone supports bone mineralization and remodeling.
Cardiovascular Health: Estrogen can have beneficial effects on the cardiovascular system. It helps to maintain healthy blood vessel function, regulates cholesterol levels, and has antioxidant and anti-inflammatory properties. Imbalances in estrogen levels may contribute to an increased risk of cardiovascular disease in men.
Brain Function: Estrogen plays a role in cognitive function and brain health in men. It influences mood, memory, and cognition. Low estrogen levels in men have been associated with cognitive decline, mood disturbances, and an increased risk of neurodegenerative diseases such as Alzheimer's disease.
Metabolic Health: Estrogen contributes to metabolic regulation in men. It helps to maintain healthy body composition by influencing fat distribution, insulin sensitivity, and glucose metabolism. Imbalances in estrogen levels can contribute to weight gain, insulin resistance, and an increased risk of metabolic disorders such as type 2 diabetes.
Emotional Well-being: Estrogen is involved in mood regulation, and imbalances can impact emotional well-being in men. Low estrogen levels have been associated with symptoms such as depression, anxiety, and irritability.
It's important to note that estrogen levels in men should be balanced, and excessive levels of estrogen can have negative effects. Conditions such as estrogen dominance, where estrogen levels are relatively high compared to other hormones, can occur, and may lead to symptoms like gynecomastia (enlarged breasts), weight gain, and reduced libido.
Cortisol and Testosterone
Cortisol is often referred to as our "stress hormone" because its production increases in response to stress, whether it's physical stress (such as illness or injury) or psychological stress (such as anxiety or work-related stress). Cortisol is primarily produced by the adrenal glands, which are small organs located on top of each kidney.
One of cortisol's primary functions is to help the body respond to stress by increasing energy availability, suppressing inflammation, and regulating blood sugar levels.
Cortisol production is controlled by the hypothalamic-pituitary-adrenal (HPA) axis, which is a complex feedback system involving the hypothalamus and pituitary gland in the brain and the adrenal glands.
Elevated cortisol levels, especially chronically high levels due to chronic stress, can lead to the suppression of the hypothalamic-pituitary-gonadal (HPG) axis, which regulates the production of sex hormones, including testosterone. When cortisol levels are consistently elevated, it can disrupt the normal hormonal balance, potentially leading to decreased testosterone production.
The drop in testosterone levels with age is a unique experience for every man. Embrace self-care, prioritize your well-being, and be patient with yourself as you navigate through this transformative phase. If you suspect you are experiencing symptoms of andropause, consult a qualified healthcare provider who can provide personalized guidance based on your individual health and hormone levels.