Andropause: Male Menopause The Facts Every Man and Woman Should Know
The bulk of my patient population are men. Young, old, and older. Men’s health is one of my areas of concentration. I very often treat men for subfertility and other sex-specific pathologies, but quite often, men are unaware that they are experiencing the symptoms of andropause and neither do their significant others. Part of my job is to educate my clientele about this stage of life and treat them for the symptoms so that they can have a full and fabulous life, instead of a ‘midlife crisis’ filled with low libido, depression, loss of muscle mass and loss of ‘self’. Male menopause, or andropause, is a word that if you ask 100 educated people what it means, most will tell you they just don’t know. So many men suffer silently from this imbalance. As a result, their lives become unnecessarily difficult, as well as the lives of their loved ones and co-workers who interact with them every day. This is a real shame.
What is Andropause?
Andropause is a phenomenon similar to the female menopause, and is prevalent in men between the ages of 40 and 55 (although there have been diagnosed cases of andropause as early as 35 years of age). Quite often, andropause goes undiagnosed because men do not have a cessation of menses or other signs and symptoms that women experience while going through menopause. When andropause occurs, there is a distinct decline in the levels of the male hormone, testosterone. Changes in the level of testosterone can manifest as disruptions in energy, attitudes and moods, libido, and physical agility.
The decreased levels of testosterone can also play a role in the increased risk of heart disease and bone density. At the same time, during the ages of 40 to 55, men usually question their own self worth and meaning of their lives; this can lead to a false state of depression that can be driven by imbalance of hormones. There are many cases where men are given anti depressant pharmaceutical drugs because they have been grossly misdiagnosed as purely psychologically depressed without having had a blood test taken to determine abnormal hormonal levels.
Andropause: It Doesn’t Happen Overnight Andropause can actually occur over a period of several decades. It can be slow and insidious. Just like women, lifestyle plays a great role in how a male will fare in the aging process. Obesity, stress, overuse of alcohol and prescription drugs, prior physical injuries and/or surgeries; these can all be contributing factors when it comes to the andropausal stage. Every man will experience andropause in a different manner than the fellow he sits next to.
Women Get All The Hype This is true. We’ve been hearing nothing but the word menopause for years. But….did you know that the word ‘andropause’ was written and discussed in medical books dating back to the 1940’s? Wow!!! I’ll bet your father never talked about it! The difference is this: men are now living longer and have more leisurely time. Men are paying more attention to their health and well being. Medical testing for hormonal imbalances haven’t really been spotlighted on men’s health until quite recently and the biotechnology just wasn’t sensitive enough to test and diagnose andropause until a very short time ago. Oh yes….we forgot one more thing here…..traditionally, men never discussed feelings and sensitive medical conditions with each other, and for the most part – they still don’t! Men suffer silently more so than women because unlike women, men have not been encouraged to prepare for andropause by making certain lifestyle changes. Women have been all over this one for years.
Here’s the Skinny on Andropause Testosterone levels drop approximately 10 percent every ten years beginning around the age of 30. Coincidentally, the level of Sex Binding Hormone Globulin, or SHBG increases. SHBG imprisons any available testosterone it can find and this prevents testosterone from going to various tissues of the body and doing its job. That leaves only a very small amount of testosterone (bio available) to try to a very big job. This is what causes the symptoms of andropause and the decreased levels of testosterone can put a man at a higher risk of health related conditions, because this hormone is vital to the health of a male.
So What Exactly Does Testosterone Do? Testosterone affects the male as a whole entity. Testosterone is produced in the testes and in the adrenal glands (the ‘caps’ over the kidneys). Testosterone is to males what estrogen is to females. Just as females require estrogen to be female (breast development, the menses, ovulation), men need testosterone to be a male (normal sexual behavior, body hair, erections). It is also quite necessary for the production of red blood cells in the bone marrow and bone health, the metabolism of lipids and carbohydrates, good prostate health and healthy liver function. Conversely, when the levels of testosterone drop, and the body’s health is left only to the bio available testosterone, the results can be any of the following:
- Low sex drive and fatigue
- Emotional and psychological changes, mood swings
- Loss of muscle strength and mass, back pain, and osteoporosis
- Increased upper and central body fat
- Cardiovascular risk
Andropause & Osteoporosis Now here’s some news! Between the ages of 40 and 70 years, just like women – male bone density can decline by as much as 15%. One in eight men over age 50 have osteoporosis. Incidence of hip fractures also increases at the same ratio as women. Before you run out for some added testosterone, better know before you go:
Hormone Replacement Therapy You are at a high risk and looking for trouble by taking HRT (hormone replacement therapy) if you have any of the following:
- Male breast cancer
- Prostate cancer
- Liver, heart or other blood vessel disease
- Enlarged prostate
- Kidney disease
- Diabetes mellitus
- Allergies to androgens or anabolic steroids
- Plan to have children (HRT could cause infertility)
- A prescription for anticoagulants (blood thinners).
Advantages of HRT: It is possible in some cases that the following can occur over time while taking HRT:
- Fewer mood swings, increased sense of self
- Increase of energy and sex drive, decrease of insomnia
- Decrease in amassed fat and increase in lean muscle (exercise and diet helps here)
- The possible, but not proven decreased risk of coronary diseases.
Male Sexuality And Traditional Chinese Medical Tradition Male longevity has been a main concern for the Chinese for thousands of years. In ancient China, an old man would have a prepubescent boy or girl (they had to be virgins, of course!) lie on top of them and breathe into the old man’s nostrils. The rationale was that the breath of youth blown into a man would make him live longer and keep him young. The practice of holding back an ejaculation was quite a common practice in China. It was believed that the vital essence of the man (the semen) would be lost if ejaculated. Better to not ejaculate and ‘recycle’ the Essence or ‘Jing’ in the quest for immortality and eternal youth. The Chinese male practiced many rituals to maintain youth, beauty and longevity.
Prostate Health and the Kidneys The ancient Chinese Emperors viewed sexual dysfunction as a very important limb of health and longevity. Impotence (Yang Wei) means flaccidity in Chinese. Impotence is the inability to attain erection or the ability to attain only partial erection. There are many different causes – most common are overindulgence in sexual activity and emotional distress.
Urinary Dysfunction Men’s supply of Jing depletes as they grow older (just as the testosterone levels decrease over time). When a man typically arrives at the age of 40, the Kidney Qi begins to wax and wane with the Jing. It is this time of life when men experience their own kind of Men-opause. There is no single physiological change, but many imbalances can be experienced, because estrogen begins to be the dominant hormone in the body.
There are Three Treasures in Traditional Chinese Medicine: Jing (Essence), Qi (the ‘Life Force’), and Shen (the Spirit). The natural progression of living and aging manifest from the Jing concept. The Jing can be considered the ‘engine room’ of the body – the ‘nectar’ or ‘juice’ that contains all the necessary ingredients needed to create new life and maintain life. Jing is distinctly connected with sperm in men; hence its importance and the paramount role of the Kidneys in Men’s Health.
In Traditional Chinese Medicine, the Kidneys are the root of Pre-Heaven Qi. They are responsible for storing the Jing – hence, the Kidney is the organ that, energetically is looked at as the culprit for most sexually-related disorders and age-related disharmonies. The ancient Chinese did not identify with a prostate gland. BPH was thus put into various categories related to urination. The symptoms were treated as Kidney deficiencies quite successfully, and the same diagnostic and therapeutic procedures are used today in Traditional Chinese Medicine.
The Root of Pre-Heaven Qi: The Kidneys The Kidneys are the root of all the remaining organs of the body. Kidney Yang energy is the cornerstone for the Yang energy of the Lungs and the Spleen. Conversely, Kidney Yin is the cornerstone for the Yin energy of the Liver and Heart. The Kidney is closely connected with urinary function and dysfunction. Therefore, as a man ages, he may experience urinary incontinence as well as premature ejaculation. By strengthening the Kidneys’ function of controlling the opening and closing of these orifices through acupuncture and herbal formulas, frequent dribbling, urination or incontinence can be treated effectively.
Sexual Dysfunction As men age, their prostate gland sometimes enlarges. This is commonly known as benign prostatic hypertrophy (BPH). As the prostate enlarges, the layer of tissue surrounding it prevents it from expanding. This causes the gland to press against the urethra. Symptoms commonly seen with BPH are: hesitant and uninterrupted weak stream of urine, urgency or leaking or dribbling, frequent nocturnal urination. If left untreated, these conditions could lead to prostate cancer, urine retention, kidney or bladder damage, bladder stones and incontinence. Male Infertility can occur if the quality of the sperm is poor or there is a decreased quantity. Although sperm is ‘fresh brewed’ throughout the life of a man, the quality and quantity decrease over time. The ancient Chinese believed that the Kidneys played a very important role in the production and quality of semen – but not in all cases. Lifestyle plays a huge role on the Stage of Infertility. Overwork, excessive exercise, excessive sexual practices, stress, poor diet, excessive alcohol and drugs – these are many factors that contribute to the depletion of the Jing and the wearing down and creation of both Kidney Yin and Yang.
Deficiencies of the Kidneys – The Yin and Yang of It All other organs in the body co-exist and depend on the balance of the Kidney Yin and Yang for total well-being and health. If there is a deficiency of Kidney Yin, the Yang fire will dominate and the communication between the Heart and Kidneys will be affected. The Heart is the Master of the Shen. When there is too much heat, the Heart will react – bad temperament, insomnia, palpitations – will all arise from this disharmony. This leads to irritability and fatigue from lack of sleep. Left untreated, there will manifest a depletion of Kidney Yang energy and conversely, erectile dysfunction. The Liver is responsible for the smooth flow of the Qi in the body. The Liver also rules the tendons and sinews. Hence, when there is a deficiency of Kidney Yin to nourish and moisten the Qi and Blood, the Liver will be deprived of the Kidney Essence needed to direct the flow of Qi. There will be stiffness of motion, and tightness of body. The Spleen rules the muscles. When there is a deficiency of the Kidneys, the Spleen is deprived of nourishment. This is why there occurs flaccidity of muscle tone. When a male patient presents with the signs and symptoms we have already described as possible andropause, the first question I ask is, ‘have you seen your primary healthcare provider?”, because I want to see results of a complete physical: testosterone levels, thyroid levels, serotonin, blood counts. Further investigation and questioning of the patient will reveal lifestyle and other physiological and psychological clues to what ails this individual. Typically, there arises a pattern or combination of patterns. For example, Spleen Qi Deficiency (which can be responsible for fatigue), combined with a Deficiency of Heart Qi can lead to depression-like symptoms. Kidney and Liver Yin Deficiency can manifest as insomnia, blurred vision, dry eyes, sudden outbursts of anger, and nocturnal emissions to name a few.
Kidney Energetics and The Body The Kidneys can be further broken down into the Kidney Yin and the Kidney Yang. Both exist energetically, in symmetry, in harmonious balance. When this balance of Yin (Earth, Rest)/Yang (Sun, Activity) energy is disrupted, there will occur discomfort and dis-ease. Therefore, the ancient Chinese expression Man is what is between Heaven and Earth. Yang is responsible for giving life and Yin is responsible for its growth. Fire of the Gate of Vitality (the Ming Men) is born of the Kidneys according to Chinese philosophy. Water, which cools down the Fire and moistens the body’s organs and tissues originates from the Kidneys as well….hence, Kidney Yang (Fire) and Kidney Yin (Water).
Diagnosis and Treatment of Andropause with Traditional Chinese Medicine:
The key to successful treatment with Traditional Chinese Medicine is to discover and treat the root cause of the dis-ease; not merely address the secondary pattern symptoms (known as the limbs). Once the root of the problem is treated, usually all other secondary complaints subside. The combination of Acupuncture and Chinese herbal formulas may successfully treat a large percentage of these types of cases.
Case Study: A 44 year old male presents with a chief complaint of fatigue, feeling of depression and no sex drive. There is no history of mental illnesses or mental trauma. The patient was prescribed Wellbutrin by his general medical practitioner having been given a diagnosis of depression. When I asked this patient for a copy of his lab results, the answer was ‘no tests were taken’. I strongly advised this patient to telephone his primary care physician and insist on blood work to rule out a chemical imbalance. The patient telephoned from my office and an appointment was set for blood work. The primary care physician then determined that the patient should not commence taking the Wellbutrin until test results could be evaluated. Further inquiry into the patient’s lifesty
le and past medical history revealed a daily cycle of long stressful hours of work, poor diet that consisted primarily of carbohydrates and dairy, little or no exercise, and a decline in the verbal and sexual communication with his wife. Further questioning revealed that this patient also experienced low back pain, nocturnal urination 2 or 3 times per evening, grey ‘fuzzy’ patches in front of his eyes, and low sex drive because he is ‘afraid he won’t be able to perform’. The patient prefers warm to cold and quite often, his legs and knees feel weak, so he’d rather lie down than go to the gym. Further questioning and palpation of the pulses and tongue diagnosis lead to a pattern of Kidney Yang Deficiency. The patient was given acupuncture and a Chinese herbal pill prescription to take three times per day, every day for a week. The patient is asked to check in after 3 or 4 days to report any changes. The patient telephoned after 4 days to report he was feeling much more energetic, his sleep was better (because he was only waking up once per night to urinate), and his back and knees were not bothering him as much. I prescribed a treatment plan of one visit per week for 4 weeks. During this time, the prescription was adjusted weekly. The patient began to modify his diet and hired a personal trainer. The diagnostic tests confirmed a lower than normal level of testosterone, but the patient decided to continue trying Traditional Chinese Medicine for a few months since he was feeling a bit better, rather than opt for HRT. After two months, the patient began jogging, swimming, and using a recumbent bicycle. His mood was positive and his sex drive began to ‘come back’. Four months into weekly treatments, this patient is now training for an Olympic distance triathlon, has hired an assistant to take some hours off his work week, and is taking a week’s holiday with his wife, who is now also my patient.
In Summary: If you or a loved one is experiencing any of the symptoms we’ve just covered, first have a complete physical and have hormone levels tested. Make an appointment to see me and bring those test results with you to your appointment. We will discuss a proper treatment protocol during your first treatment. Whether you select HRT or Traditional Chinese Medicine or a combination of both modalities for your treatment protocol, remember that together, we will work as a team so you reach your optimal health. Traditional Chinese Medicine is a safe, all-natural and effective method on your road to wellness!
If you have questions about andropause and how Traditional Chinese Medicine can help you or a loved one, please feel free to email me at firstname.lastname@example.org. I will be most happy to answer your questions and guide you to a path of action.