Andropause (and other male hormone disturbances)

The male ‘mid-life’ or ‘change of life’ crisishas long been regarded an amusing anecdote; middle-aged men running off with the young secretary or the impulsive purchase of new red sports convertible!

The reality is men can and do experience life-altering changes due to decreasing hormone levels – and this can dramatically influence their quality of life.

The word hormone is derived from the Greek and means ‘to set in motion’. In males the ‘Testosterone (TT) Drive’ is the most potent force underlying stamina, mental energy, sexual virility & hand-eye coordination in sports. As this drive begins to decline – usually around the fourth decade of life – affected males will gradually experience the symptoms of Andropause – the so-called ‘male menopause’.

Andropause is about ageing and declining male hormone (termed androgens) is a natural consequence of this process. At his peak a male produces 95% of testosterone from the testes (testicles) in response to endocrine stimulation from the brain. By age 50, this signal to ‘make more testosterone’ has grown weaker, and the ageing testes are less likely – or able – to respond.

The initial symptom of andropause is often a subtle downward shift in strength & energy. The man may lose his enthusiasm for life’s challenges which he previously enjoyed – his work, competitive edge, or his physical capacity to compete at past sporting levels. Other common symptoms are disorders of mood – particularly anxiety, irritability or depression.

Sexual function & libido may well decline, but urinary disorders may intensify. He may prematurely age as his skin thins & sags, his eyelids droop, his body muscle mass decreases, and his breast tissue (pectorals) and girth often expand. By about age 55, males are at comparable risk of osteoporosis as menopausal women; 30% of recorded hip fractures occur in men.

The disturbance of other hormones is common in andropause and may complicate or accelerate the total decline.

Oestradiol (E2) – the most potent female oestrogen – is in a delicate ratio with testosterone. When testosterone levels decline oestradiol essentially remains constant, leading to a ratio shift in favor of the oestrogens.

This altered ratio shift is known to have adverse effects on the prostate gland. In a complex negative feedback mechanism elevated oestradiol decreases the production of testosterone, and what testosterone is produced is aromatised (converted) to oestradiol.

Reader please note disturbance of the sex hormones (TT, E1, E2 or DHEA-s) are not limited to older males but can occur in adult males of any age due to numerous intrinsic or extrinsic factors which should be thoroughly assessed.

In times of high stress Cortisol production from the adrenal glands is often elevated. Excess Cortisol disorders the brain’s hormonal signals to produce male hormone (Testosterone & DHEA) resulting in a further diminished production.

About Cortisol:

Cortisol (CC) is the major glucocorticoid produced in the adrenal cortex of the adrenal glands. Cortisol is a key stress response hormone – essential for carbohydrate, protein and fat metabolism; anti-inflammatory tasks, blood glucose regulation, and appropriate immune system function.

Cortisol is also essential for ‘active thyroid hormone’ Triiodothyronine (T3) expression because it up-regulates nuclear T3 receptors within the cells.

CC production varies throughout the day in a predictable rhythm; termed diurnal rhythm. Cortisol output is highest in the early morning; falling to its lowest concentration at night.

Persons suffering ‘Adrenal Fatigue’ exhibit a flattened – or even inverted – CC profile where the Cortisol morning surge is absent.

DHEA supplementation is usually unnecessary when Cortisol and thyroid hormone are at their respective desired ‘target’ levels (Van Zanden: 2008).

Minimising Andropausal Changes:

The treatment of andropause is crucial to maintaining a man’s quality of life & the old cliché of restoring and maintaining balance is again the answer:

• Plan a sound nutritional intake for each meal, minimizing caffeine, alcohol, & sugary foods – which have a lowering effect on testosterone.
• Consuming a light meal early in the evening & then fasting until breakfast will increase Growth Hormone (GH) production whilst sleeping. Growth hormone will have positive outcomes on hormone balance & metabolism.
• Regular moderate exercise – particularly weight-bearing work outs – helps control stress levels & can raise testosterone up to 20%.
• Maintain weight to healthy BMI as being overweight or obese exacerbates TT aromatisation and increased body fat cells (adipose tissue) which in turn increases excess Oestrogen output.
• Nicotine (cigarettes, cigars, pipes) can intensify andropausal symptoms and hormonal disturbance by overloading liver detoxification pathways*. Nicotine is a very potent (and well documented) toxin to the body.
• As much as possible maintain consistent and adequate sleeping hours; don’t deprive yourself of scheduled relaxation periods.
• Consult a qualified practitioner who can order & interpret hormone levels.

Steroid hormones such as testosterone and Cortisol are best measured by salivary testing, as saliva only reflects the free, active, ‘bio-available’ testosterone.

Where appropriate a testosterone cream– with added Chrysin -is the preferred restoration medium because it bypasses the initial liver metabolising pathways.

Chrysin is an Isoflavoid/Bioflavonoid that inhibits ‘aromatase enzyme’ and ‘xanthine oxidase’ i.e.:

1. ENHANCES the function of Androstenedione – a weaker androgen – because it inhibits the conversion of Androstenedione to Estrone (by inhibiting the aromatase enzyme that catalyses the conversion).
2. ENHANCES the function ofTestosterone because it inhibits the conversion of testosterone to oestradiol (again by inhibiting the aromatase enzyme that catalyses the conversion). Studies have suggested Chrysin could raise testosterone levels by 20 to 30%.

Note: it’s beyond the scope of this article to determine if a ‘Chrysin-elevated’ Testosterone levels will give rise to increased DHT conversion, resulting in accelerated to androgenic scalp hair thinning.

An earlier hypothesis suggested males could apply a low-dose bio-identical (‘natural’) Progesterone cream to their ‘beer belly’ to (in theory) decrease the aromatisation of testosterone to oestrogen and reduce girth size over time. It’s now been found that 1:10 people will convert progesterone to oestrogen – thus exacerbating their problem and risks to health.

Nutritional supplements that suppress aromatisation are zinc, flaxseed, Vitamin B6, selenium & boron. Progesterone & T3 thyroid hormone also have a suppressing effect.

There is also anecdotal evidence that the long-term use of medication for androgenic hair loss (Finesteride or Dutesteride) may have a Testosterone or general androgen-lowering effect on early middle-aged & older men (Van Zanden: 2017).

My professional opinion is men should not be taking these medications and supplementing with bio-identical (Testosterone) hormone replacement.

Males with elevated or fluctuating Prostate-Specific Antigen (PSA) levels, or any other concerns where a prostate disorder may be suspected, should NOT be prescribed any hormonal therapy unless authorised by their medical practitioner or Urology specialist (Van Zanden: 2017).

• Nicotine, Alcohol, Caffeine, Illicit drugs, Synthetic hormone therapies and many prescription medication (such as Spironolactone or Plaquinil) may overload the ‘bandwidth’ (detoxification capacity) of an already sluggish liver.

Copyright Anthony Pearce 2006 (Revised September 2019)