The Male Sex Hormone: Testosterone, Chapter Seven
The phenomenon termed andropause, (known in England as viropause) involves the progressive decline of free testosterone levels with age, coupled with an increase in production of a protein called sex hormone-binding globulin
Andropause: The Male Menopause
The phenomenon termed andropause, (known in England as viropause) involves the progressive decline of free testosterone levels with age, coupled with an increase in production of a protein called sex hormone-binding globulin. Testosterone links with the protein, reducing its availability to the tissues. As a result of these hormonal changes, men as early as age forty can develop impotency or libido problems.
A large-scale epidemiological study of male sexual behavior called The Massachusetts Male Aging Study of 1984-89 looked at a cross-sectional random sample of 1,709 men between ages forty and seventy. It was found that mean testosterone levels decline annually by about one percent. Also, 51 percent of normal, healthy males in this age group reported experiencing some degree of impotence. However, Dr. Irwin Goldstein, an organizer of the study, points out that organic factors contribute to impotence in up to 80 percent of men affected. Goldstein cites diabetes, hypertension (medications used), smoking, chronic alcohol use, and high cholesterol as major factors in loss of male potency.
Andropause is not universally understood, and study of the phenomenon is still relatively new. However, scientists do know that it is not analogous to menopause. As we learned in the last chapter, the profound reduction in ovarian function at the time of menopause for women has substantial physiologic consequences, including an accelerated loss of bone mass, sleep and behavioral changes, vaginal atrophy, and the loss of fertility. Andropause can also have profound effects on physical health and well-being in men, particularly on mood and libido, and some men even experience sweating and hot flashes at night. But the difference between the two conditions is that men experience a more gradual and incomplete loss of testicular function with increasing age (many men can sire children well into older age), resulting in reduced testosterone and sperm production.
How Testosterone Fights Aging
Men diagnosed with hypogonadism are good candidates for testosterone replacement therapy (TRT). However, only about 5 percent of the estimated 4 to 5 million American men with hypogonadism currently receive TRT.
Major studies of TRT in hypogonadal men ages fifty to sixty-five were conducted at the University of Utah, Johns Hopkins University, and Karolinska Hospital in Stockholm Sweden. Overall, treatment resulted in normalization of morning testosterone levels in 92 percent of the ninety-four patients who completed the trials.
Another eight-week study of twenty-nine patients produced notable improvements in erectile function, libido and mood, and decreases in complaints of fatigue.
Men undergoing andropause have also benefited from TRT. One study of men over age fifty who received the hormone found that it renewed strength, improved balance, increased red blood cell count, increased libido, and lowered LDL cholesterol. In a double-blind, placebo-controlled, crossover study, thirteen healthy elderly men with low testosterone levels were given 100 mg of the hormone a week for three months. Twelve of them experienced behavioral changes such as increased libido and feelings of well-being.
Another study of men ages fifty-seven to seventy-five found that testosterone supplementation likewise increased red blood cell count and lowered LDL cholesterol as well as overall cholesterol levels. Of the thirteen men in the study who were receiving testosterone (as compared with a control group that was receiving a placebo), twelve could predict that they were, in fact, getting the actual supplement, because they felt more aggressive and energetic at work. In addition, the men reported better sexual performance, more frequent initiation of sexual intercourse, and increased ability to maintain an erection.
Dr. Michael Perring, medical director of the Optimal Health Clinic in London, which specializes in hormone replacement therapies, has seen more than 800 patients with symptoms of andropause. Dr. Perring believes that the benefits of TRT in conjunction with other hormone precursors, such as DHEA, are beneficial to men who have demonstrably low testosterone levels for their age. However, he stresses the importance of a full-patient assessment, including a careful history, clinical examination, and endocrine, biochemical, and blood profiles before embarking on therapeutic interventions.
In addition, Dr. Perring points out that an individual's lifestyle, including physical, emotional, and sexual factors, can put strain on the prostate. "The lifestyles of men attending the clinic suggest a high prevalence of stress either in the workplace or at home, with poor communication within the primary relationship. There may be excessive alcohol intake, high cigarette consumption, and a sedentary job with inadequate or inappropriate exercise. The total cholesterol and HDL cholesterol levels may be elevated with a diet that is erratic, and unbalanced by too much saturated fat and insufficient fresh fruit, vegetables and fiber."
Numerous studies have found correlation between low testosterone levels and higher risks of cardiovascular disease. Men who have had heart attacks tend to have low testosterone levels, according to Dr. Gerald Phillips of Columbia University Medical School. Phillips studied fifty-five men undergoing X-ray exams of their arteries and found that those with low testosterone levels had higher degrees of heart disease. He also found that men with higher testosterone levels also had higher protective HDL cholesterol levels.
Another study demonstrating the positive effects of testosterone on heart disease was conducted by Dr. Maurice Lesser. He studied the effect of testosterone injections in 100 people with angina pectoris - caused by a spasm or blockage of arteries in the heart. Ninety-one of the 100 showed "moderate to marked" improvement in chest pain, with both the frequency and severity of heart attacks reduced. Only nine showed no improvement at all.
Advocates of HGH in elderly men are also focusing on TRT because of its comparative cheapness and bone-strengthening qualities. After age sixty, hip fracture rates in men increase dramatically. Short-term studies with testosterone on mildly deficient elderly males have reported beneficial effects on lean body mass and muscle. According to Dr. Fran Kaiser, associate director of geriatric medicine at St. Louis University School of Medicine, hypogonadal males are about six times more likely to break a hip during a fall than are those with normal testosterone levels.