Low Testosterone, Andropause, and Male Menopause
Phil’s chief complaint when he first came to my office was severe fatigue, describing his energy level as a 3 on a scale of 1-10. He had no other significant complaints. He had not responded to oral testosterone treatment previously. Subsequent laboratory testing revealed low adrenal function and low testosterone, for which he was prescribed testosterone replacement therapy and an adrenal support formula. When Phil returned 6 weeks later, he reported that his fatigue was resolved with an energy level of 8 out of 10.
Low testosterone, also called “low T,” “andropause,” or “male menopause,” is a common condition estimated to affect 5 million American men. While it is normal for testosterone levels to decrease with aging, some men experience greater declines than others. The most common symptoms of low testosterone are fatigue, depression, weight gain, erectile dysfunction, low libido, and loss of muscle mass.
Low testosterone is fairly easy to diagnose with a simple blood test. The best test measures free testosterone, which is the active portion of the testosterone supply in blood that is not bound to a blood protein known as sex hormone binding globulin. Capillary blood testing (done with a fingerstick), rather than serum testing (done with a regular blood draw), provides the best results in my experience.
Causes and Treatment
In addition to aging, low testosterone is caused in many men by excess abdominal fat. Abdominal fat converts testosterone into estrogen, hence causing low testosterone. Elevated estrogen can also compound the effects of low testosterone. Many men with excess abdominal fat also have insulin resistance or metabolic syndrome, a precursor to diabetes and a risk factor for heart attack and other diseases. The most effective way to treat this condition is through diet and physical activity, most especially by reducing the intake of high glycemic foods such as sugar and flour. Reducing the intake of high glycemic foods also promotes weight loss and the loss of abdominal fat and can be very effective for treating many of the symptoms of low testosterone, especially fatigue and depression.
Low testosterone is generally treated with testosterone replacement therapy. Men who start this therapy often notice a significant improvement in how they feel within 1-3 weeks. There are different forms and delivery methods of testosterone available, including oral, topical creams or gels, sublingual, and injections. I prefer a topical gel that uses bio-identical, rather than synthetic, testosterone. One of the advantages of topical gels is that they avoid the so-called “first pass effect” that occurs with oral testosterone. When oral testosterone is absorbed in the intestinal tract, it goes first to the liver before being distributed to the rest of the body. A portion of this testosterone is metabolized and excreted by the liver before ever having a chance to make it to the target tissues, decreasing the efficacy of the testosterone. This is avoided with topical testosterone, which is also more convenient than injections for most men. Androgel is a brand of topical, bio-identical, prescription testosterone.
Other treatment options for low testosterone include zinc and the herbal medicine Tribulus terrestris.
There are some risks to be aware of with testosterone therapy. The first is that men with prostate cancer should not use testosterone, because the growth of most prostate tumors is accelerated by testosterone. While there is no convincing evidence that testosterone causes prostate cancer, most men will have prostate cancer for years before it is detected. Those at high risk for prostate cancer should therefore exercise caution and weigh the pros and cons of treating low testosterone against the possible risks. Testosterone therapy can also aggravate Benign Prostatic Hypertrophy (BPH) in some men.
If you have fatigue, depression, weight gain, erectile dysfunction, and/or low libido, see a physician who specializes in bio-identical hormone therapy for testing and treatment. As with Phil, it could make a big and rapid difference in how you feel.
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