Men's midlife challenge
Andropause, sometimes called male menopause, refers to a collection of symptomrs that appear in certain men between the ages of 40 and 65.
Andropause, sometimes called male menopause, refers to a collection of symptoms that appear in certain men between the ages of 40 and 65. As a condition of male midlife, andropause has been the subject of much debate.
Andropause has been linked to a reduction of free testosterone blood levels (about 10 percent per decade after age 40) somewhat akin to the estrogen drop in women. But while all women experience the cessation of menstruation and loss of fertility, male fertility does not stop during andropause, and only some men experience its symptoms. Since andropause does not affect all men, what are some of its potential causes?
The Hormone Approach
Most studies into andropause focus on testosterone depletion as a cause. While most investigators agree on the short-term safety of testosterone replacement, long-term safety is yet unknown.
In biological models, testosterone therapy in aging males improves body composition and certain brain functions and may also decrease cardiovascular risk. Other measurable clinical effects are less apparent such as weight gain, depression, bone mass loss, etc.
Potential risks include erythrocytosis (an excess of red blood cells), edema (swelling caused by excess fluid in body tissues), gynecomastia (development of abnormally large breasts), and prostate stimulation. Studies have also investigated the possibility of increased risk of prostate cancer and cardiovascular disease.
Some of the symptoms of andropause are consistent with a reduction of free testosterone, but other factors come into play. For instance, increases of estradiol (an estrogen normally present in both men and women) and of sex hormone binding globulin (SHBG, a testosterone transporter) also occur. Any increase in SHBG is automatically linked with a reduction of the available testosterone.
SHBG is a protein that carries a certain percentage of the hormone around the body. The remaining testosterone floats free in the bloodstream, available to link with cellular receptors. If levels of SHBG increase, the amount of free testosterone drops.
This reduction of free testosterone forms the basis of the pharmaceutical approach to resolving symptoms associated with andropause. Some clinical studies show that oral or topical testosterone supplementation relieves some symptoms and brings positive benefits in body composition.
Studies have also been done to test the effect of DHT, DHEA, and growth hormone on symptoms that are related to testosterone depletion. Controversy remains as to the real impact of these therapies as well as the long-term safety of hormone replacement in older individuals.
Why do only some men suffer from the symptoms associated with andropause? This basic question has yet to be addressed in clinical studies. However, there are clues that point to some potential causes.
It is important to remember that the symptoms associated with andropause (see sidebar) are also associated with many other illnesses including anemia, thyroid gland dysfunction, or depression, so a thorough medical check-up should eliminate possible underlying causes.
Since andropause was virtually unknown before the 1950s, we need to look at what is new in our environment. One such example may be hormonal disruptors, compounds that have the capacity to alter our hormonal ratios and cause an increase in the secretion of SHBG, reducing available testosterone.
Though a definite link between andropause and hormonal disruptors is not well documented, these substances do have a major impact on the hormonal makeup.
Plasticizers such as phthalates or bisphenol A (BPA) are known to have potent estrogenic effects and can be linked to reduced fertility and increased hormonal-dependent cancers.
Organochlorides, such as DDT or the residual molecules left from chlorination of tap water, are known to accumulate in the fatty tissues (including testes, adrenals, and brain). These substances are potent estrogens that may cause hormonal imbalances. Pesticides derived from pyrethrines are sold as safer alternatives but have an anti-androgen effect (blocking androgen’s receptors).
Is the danger real enough or is it only one more hypothesis? No one yet knows for sure, but in the environment, minute concentrations of a mix of potential culprits including plasticizers, organochlorides, bromated fire retardants (applied to prevent electronics, clothes, and furniture from igniting), sunscreens, and other hormonal disruptors appear to be synergistic.
Any strategy that helps us eliminate these compounds, such as eating organic foods and wearing organic clothing, avoiding plastic products such as water bottles, and generally following a natural lifestyle will provide the best road toward midlife health and happiness.