Hormone Balancing for Men (Andropause)
Conventional medicine has long recognized the effects of declining levels of estrogen and other hormones in menopausal women. But what about middle-aged men and their rapid hormone decline? Sadly, many doctors are unaware that testosterone deficiency is quite common in men. For example, in one study from the New England Research Institutes in Watertown, Massachusetts, researchers analyzed data from 1,500 men and discovered that 24% had low total testosterone! That translates to millions of men in America suffering needlessly from maladies as the result of this critical hormone being deficient.
The medical reality is that testosterone deficiency left untreated is a major risk to men’s health. The medical term for testosterone deficiency in men is hypogonadism. The decline of testosterone and other hormones in middle-aged men is known as andropause.
Research has shown that after age 40, serum testosterone levels decline between 0.4% and 2.6% per year. Interestingly, this decline parallels a decrease in bone density, muscle loss/strength, physical function/frailty, and sexual function.
Signs and symptoms of low testosterone3
- Incomplete or delayed sexual development
- Reduced sexual desire (libido) and activity
- Decreased spontaneous erections
- Breast discomfort, gynecomastia (enlarged breasts)
- Loss of body (axillary and pubic) hair, reduced shaving
- Very small (especially Inability to father children, low or zero sperm count
- Height loss, low trauma fracture, low bone mineral density
- Hot flushes, sweats
- Decreased energy, motivation, initiative, and self-confidence
- Feeling sad or blue, depressed mood
- Poor concentration and memory
- Sleep disturbance, increased sleepiness
- Mild anemia
- Reduced muscle bulk and strength
- Increased body fat and body mass index
- Diminished physical or work performance
For men receiving testosterone replacement therapy repeat testing is done after 4 to 6 weeks of initiating therapy. If values are normal then retesting is done a minimum of every 4 to 6 months thereafter. We also monitor red blood cell counts (which are rarely elevated in testosterone users), liver and kidney function, prostate, as well as estrogen because testosterone is converted into estrogen within the body. Men with low testosterone levels should also have a bone density test.
There are a variety of ways to administer testosterone. These include weekly or biweekly injections (100 mg weekly or 200 mg bi-weekly), daily application of topical creams/gels (50 to 100 mg each morning), patches (one to two 5-mg patches applied nightly), sublingual pellets (varies), lozenges (30 mg twice daily), and pellet implants (varies). We generally prefer the topical cream/gel form for ease of administration and ability to change the dose easily. Another good option is the injection form, preferably once weekly to maintain the most consistent levels.
1 A.B. ARAUJO, ET AL. “PREVALENCE OF SYMPTOMATIC ANDROGEN DEFICIENCY IN MEN.” J CLIN ENDROCRINOL METAB.2007;92:4241-4247.
2 G. CORONA, ET AL. “FOLLOWING THE COMMON ASSOCIATION BETWEEN TESTOSTERONE DEFICIENCY AND DIABETES MELLITUS, CAN TESTOSTERONE BE REGARDED AS A NEW THERAPY FOR DIABETES?” INT J ANDROL. 2009;32:431-441.
3 THIS TABLE ORIGINALLY APPEARED IN: S. BHASIN, ET AL. TESTOSTERONE THERAPY IN ADULT MEN WITH ANDROGEN DEFICIENCY SYNDROMES: AN ENDOCRINE SOCIETY CLINICAL PRACTICE GUIDELINE. CHEVY CHASE, MD: THE ENDOCRINE SOCIETY; 2010.