Dr. Amy’s Wellness Tip for September 2016
Contributed by Dr. Amy Whittington, Trilogy’s Naturopathic Physician
Menopause is a household word. Everybody knows that as the years creep by, a woman’s body begins decreasing hormonal production. This process wreaks havoc for some women, causing sleep and mood disturbance, hot flashes, lowered energy, and lowered libido. What not everyone realizes is that hormones change for men as well, causing similar symptoms for some sufferers in a process called andropause.
The primary sex hormone for men is testosterone. For most, testosterone begins decreasing by age 30. If testosterone continues to deplete, as it does for many men, sufferers can begin to see symptoms of low mood (low motivation), easy weight gain, sleep disturbance, difficulty concentrating, low libido and function, and fatigue as early as their mid-forties. Although testosterone is the most prominent hormone, other alterations in hormones during these years can lead to similar symptoms. Estrogen, the prominent female hormone, is found in men as well and levels often increase as a man ages. An increase in estrogen causes a protein called Serum Hormone Binding Globulin (SHBG) to increase as well. SHBG can bind to testosterone, rendering it unusable (thus, higher estrogen levels equate to less useable testosterone). A depletion in the hormone precursor DHEA can cause similar symptoms of fatigue and weight gain. Furthermore, in a man’s fifties or sixties, he can also see a decrease in thyroid function, which can cause fatigue, weight gain, and a further decline in testosterone to boot.
If your head is not spinning from the possible hormone changes above, also keep in mind that levels of SHBG can be increased with blood sugar imbalance, liver dysfunction, and hypothyroidism. Weight gain can result in increased production of estrogen, and difficulty sleeping can result in diminished hormone production across the board. My point is not to drive those of you already suffering from andropause-induced depression further down by pointing out all of the possible disruptions, but to highlight that for most men, balancing your hormones requires a lifestyle, nutrition, and a hormone-balancing plan that goes well beyond merely addressing testosterone.
Weight loss and exercise are imperative to driving your natural production of testosterone and to decrease estrogen levels. Proper nutrition is beneficial to balancing blood sugar and increasing weight loss as well. If you aren’t sleeping well, it is important to figure out why, and perhaps even undergo a sleep study to rule out sleep apnea, Decreasing stress, which has been shown to alter testosterone production, may also be of benefit.
If an adjustment in lifestyle doesn’t decrease symptoms, it is a strong possibility that hormone levels are not ideal. A physician can guide you through hormone balancing, which will inevitably begin with hormone testing.
Lab testing can vary slightly based on a practitioner’s preference, but in general the following will be included: Free and total testosterone, serum estradiol, SHBG, and DHEA. To check for proper blood sugar and thyroid function, a complete metabolic panel (CMP), and thyroid panel (TSH, Free T4, and Free T3) should be performed. Vitamin D is a hormone which, when balanced, can aid in balancing other hormones. Additionally, a baseline PSA and CBC should be ordered so that they can be monitored, should you decide to proceed with testosterone therapy. Many alternative practitioners will also order a salivary test to measure cortisol levels, especially if fatigue and altered sleep are symptoms.
Once labs are complete, many men will find they can benefit from supportive therapies in addition to improvements in lifestyle. Quite often, labs will reveal low to normal levels of free (useable) testosterone, and higher than normal estrogen levels. Nutrients or prescriptions can be used to decrease elevated estrogen levels and increase useable testosterone, including an extract from cruciferous vegetables called diindolymethane (DIM), or its precursor, Indole-3-carbinol (I3C). A prescription called anastrazole is often used, especially alongside testosterone, if labs show low testosterone and high estrogen. Some men can simply replace DHEA to decrease symptoms, or may need blood sugar or thyroid support to decrease symptoms. Balancing other hormones will often lead to an increase in testosterone as well.
Others, however, will find that indeed, their total and free testosterone levels are low. This group often benefits from testosterone therapy via cream, gel, lozenge, or injection. A handful of herbs can be found over-the-counter that claim to support healthy testosterone levels, with most containing various adrenal boosters, or herbs thought to have testosterone-like effects, such as Maca, and/or Tribulus. Although some men using these herbs report improvement in symptoms, measurable changes are typically not seen on labs. For this reason, if low testosterone levels are problematic and symptoms are occurring, testosterone is usually the treatment of choice. Research into testosterone treatment reveals both positive and negative results. Whether testosterone might increase cardiovascular risk has been controversial, although many positive studies exist. Initial concerns about testosterone and prostate risk have diminished over the years for men without a history of prostate cancer. It has been shown that low testosterone in men is strongly associated with metabolic syndrome, type 2 diabetes, and cardiovascular disease, and a 2010 study showed an almost 50% increase in mortality rates over a seven-year period for men with low testosterone. Because studies and risk factors vary, it is important for the decision to use testosterone to be individualized by the patient and treating physician.
Every man over forty (and arguably over 30) should initiate lifestyle modifications that result in better health and improved testosterone levels: control weight, practice good nutrition, exercise, sleep, and decrease stress. If symptoms persist, investigation should begin to see if supportive therapies can help increase useable testosterone in your system. If testosterone levels are found to be low, it’s my opinion, as well as that of many others, that the benefits of properly restoring testosterone outweigh the risks for many, as long as proper monitoring takes place both prior to treatment and at regular intervals throughout treatment.
Stay healthy and be well!
Dr. Amy Whittington