By Howard Liebowitz, M.D.
The aging process is inevitable, but there are many options available as to how we age. There is extensive research on the aging process and how to avoid illness associated with aging. Successful, healthy aging means being vital and functioning normally for our full lifespan. This should translate into a lifespan of 120 years. Yet when we hear of someone who is that old, it makes the news. It shouldn’t be a rare occurrence. One prominent area of study is the role of hormones in aging. Hormones are the chemical communicators in the body. They tell organ systems how to function. Hormones can decline and become unbalanced as we age, which results in multiple medical problems associated with aging. Evidence indicates that by replacing hormones to closely resemble normal levels and normal hormone fluctuations, the aging process may be altered and slowed.
The interaction of the various hormones in the body is quite complex. There are approximately ten different hormone-producing organs that interact with each other. It is impossible to alter just one system without affecting the balance of all the others. The human body is a dynamic continually adjusting organism. Every action, treatment, medication or injury sets off a cascade of reactions. The hormone system in the body is called the endocrine system. It is made up of hormone producing glands such as the thyroid, adrenals, testicles, ovaries, and pancreas, to mention a few. All of the glands in the endocrine system are controlled by feedback inhibition from a tiny gland in the brain called the pituitary gland. The pituitary in turn is controlled by the hypothalamus, also in the brain. This control center in the brain is known as the hypothalamic pituitary axis.
Our male sex hormones (testosterone and its derivatives) are primarily manufactured in the testes, but the adrenal glands produce testosterone as well. Men also produce the female sex hormones estrogen and progesterone, but at a much lower level than in women. As men age, one of the problems they encounter is that their testosterone declines, and estrogen rises. Testosterone is normally converted to estrogen in small amounts. As men age, this conversion process increases. A normal testosterone to estrogen ratio in men is about 50:1. Men in the throws of aging may have a ratio as low as 8:1. This abnormal ratio causes men to lose masculine features such as muscle bulk, narrow hips and waist, and start to develop feminine traits such as enlarged breast tissue and unwanted fat deposits around their middle. This is often considered a normal male aging pattern. I consider this to be an abnormal and undesirable way to age.
There are a multitude of reasons for the rise in estrogen conversion as men age. Some of these causes are stress, diet, lack of exercise, alcohol consumption, increased body fat, medications, and ingestion of estrogen enhancing substances in food (pesticides, for example). Identifying, understanding and correcting this enhanced testosterone to estrogen conversion is an important goal of our male hormonal balancing program.
This is why our Male Hormone Balancing Program includes an analysis of many hormonal systems, as well as diet, lifestyle, and exercise counseling.
The typical presentation of a man going through these hormonal aging changes (also known as Andropause) is a "middle-aged man" gradually losing his strength, energy, vitality, sex drive and enthusiasm for "life and love." He changes from "action man" to "inaction man." He expresses unexplained mental and physical fatigue. Once a positive, up, fun person to be around he has become a negative, depressed bear, who is difficult to work with. Other symptoms of andropause include mental fatigue and difficulty concentrating, depression, increase in fat around the mid-section, decreased intitiative, muscle soreness, decrease in physical stamina, decrease in libido or sex drive, and decrease in fullness of erections and ejaculations. Beyond these concerns, other serious health problems associated with andropause are increased cholesterol and trigycerides, decrease in HDL, elevation of fasting blood sugar and elevation of blood pressure. These aging related changes increase the risk of heart attacks and stroke. Other less serious changes are development of varicose veins, including hemorrhoids, and decrease in visual acuity.
Research has already shown that "there is no doubt that testosterone replacement in hypogonadal men [another term for andropause] is beneficial, resulting in improvement in libido, sexual function and sense of well-being. Additionally, increased muscle mass (and potentially increased muscle strength) and increased bone mass as well as decreased fat mass are frequently observed with testosterone therapy."1
The cardiac protective effects of testosterone supplementation in men include:
* Decreased Total Cholesterol
* Decreased LDL Cholesterol
* Increased HDL Cholesterol
* Decreased Angina
* Decreased Systolic Blood Pressure
* Increased Clot Dissolving Factors in the Blood
The goals of hormone replacement therapy (HRT) in men are to:
# Improve psychological well-being and mood
# Increase muscle mass, improve strength and stamina
# Preserve or improve bone mass
# Improve libido
# Decrease cardiovascular disease risk
# Decrease chronic aging associated with blood sugar elevations
# Promote successful aging
In our Male Hormonal Balancing Program, we offer replacement of declining hormones with the exact missing hormone. These exact hormones are called bioidentical hormones, and represent a technological advancement in the management of male aging problems. Even though we use bioidentical, natural hormone preparations, hormone supplementation can still sometimes produce unwanted side effects or reactions. Prostate cancer is the most feared complication of testosterone replacement therapy. However, there is general agreement that testosterone administration does not cause prostate cancer.
Furthermore, we now know that prostate cancer tends to develop in older men who have the lowest levels of testosterone2. It is felt that prostate cancer is perhaps related to high estrogen levels. Research studies point to elevated estrogen in aging men as the culprit in benign prostatic hypertrophy (BPH)3. Commonly seen in aging men, BPH is enlargement of the prostate gland, which may be a precursor to prostate cancer. However, if someone has a microscopic, sub-clinical prostate cancer, testosterone therapy might make it worse.
The most frequent side effect of testosterone therapy is an insignificant rise in the red blood cell count or hematocrit. For this reason anyone with a hematocrit of 52% or higher should not take testosterone therapy. There are also reports of testosterone therapy in younger men causing sleep apnea. Testosterone therapy can also suppress the hypothalamic-pituitary axis, which could theoretically result in a decreased sperm count. For men wishing to father a child, they might need to stop the testosterone temporarily if they experience this side effect.
We recommend that anyone over the age of 45 have ongoing interval screening of their prostate gland every 3 months for the first year of supplementation and then every 6-12 months after that, depending on one's prostate cancer risk. Screening should comprise of a digital rectal exam and PSA level. The PSA (Prostatic Specific Antigen) is a blood test that screens for disease in the prostate gland. Any abnormalities should be further evaluated by ultrasound and/or biopsy. We require that you either have this screening done by your regular Physician, or by us before we re-fill testosterone prescriptions.
It can be a difficult personal decision to embark on a program of healthy aging by balancing your hormones, yet one that has many successful outcomes. This decision relates to quality of life issues, as well as your own personal assessment of the risk versus benefit of this therapy. At your appointment I will be happy to discuss any of your concerns, so that you feel comfortable with your decisions and confident that you are making the best possible choices for your health.
References:
fn1. Andropause, M.L. Vance/Growth Hormone & IGF Research 13 (2003) S90-S92
fn2. An Integrative Review on Current Evidence of Testosterone Replacement therapy for Andropause, R.S. Tan, J.W. Culberson/ Maturitas 45 (2003) 15-27
fn3. Endocrine environment of benign prostatic hyperplasia: prostate size and volume are correlated with serum estrogen concentration, Scandinavian Journal of Urology and Nephrology, 1995:29:65-68
A prospective study of plasma hormone levels, non-hormonal factors, and the development of benign prostatic Hyperplasia; The Prostate, 1995; 26: 40-49
This information is for educational purposes only, and is not intended to treat or diagnose any health condition.