Menopausal men

First the confusion of terms: Andropause or ADAM (for Androgen Decline in the Aging Male = androgen decline in the aging man) or climacteric virile (virilis = male) or penopause?

Testosterone has made its way from the black market to the mass phenomenon. So far, athletes and bodybuilders have largely used the hormone illegally to get their bodies in shape. In addition, there were men with a rare underactive testicle. But more and more doctors want to tell us about a mysterious phenomenon that could eventually make every man a candidate for a testosterone cure: the “menopause of men”. 

But the scientists are extremely contentious. 

The new theory is modeled on the menopause of women. Then the ovaries stop producing estrogens. About one in three women feel the decrease in sex hormones as menopausal symptoms. However, we are already much further here than with men: as a hormone-dependent symptom, only the hot flushes (especially at night) are recognized as a disease, against which many women are prescribed the female sex hormone for relief. In addition, estrogens quickly gained a reputation as an elixir of eternal health: the hormones should also help against heart diseases, Alzheimer’s and so on (which is demonstrably not true – see! ).

Age problems should not be confused with hormone deficits!

A real testosterone deficiency in men over the age of 60 is less common than previously thought. Instead of 10 to 30 percent, as was assumed a few years ago, only about 3 to 5 percent of 60 to 79 year olds actually have a real testosterone deficiency, which explains the lack of libido and other symptoms. Men over 60 years of age sometimes no longer feel vital, muscle mass shrinks, fat tissue increases. If the libido then decreases, sometimes even hot flashes and depressive moods are added, media reports of the consequences of a testosterone deficiency in old age naturally fall on fertile ground.

In these reports, however, the relationships are greatly simplified. Age complaints are generally attributed to testosterone deficiency. But the complaints attributed to hormone deficiency are so numerous and unspecific that many other causes can be considered. In fact, even for older men with excess testosterone, there are enough reasons to get into a “mid-life crisis”. Strength and potency decrease with age; the role in the family changes; one realizes that one has not achieved one’s goals in life, the younger competitors threaten one another at work and, in addition, age-related illnesses are on the horizon – this can sometimes put pressure on the mood. There are few research groups that have systematically examined whether older men with lower hormone levels are really less fit. One is the group around the psychologists Annette Degenhardt and Andreas Thiele from the University of Frankfurt. In their study of 300 men between 35 and 65, the opposite of what testosterone believers assume today came out. The men who were not satisfied with themselves had significantly higher levels than those without complaints. Still, it’s not surprising that despite these gaps in knowledge, belief in the hormone is increasing. Testosterone suits the zeitgeist too perfectly. US studies show that male models have gained more and more muscle in recent years. Some commercials for aftershave are more of an advertisement for mass doping, because the model’s washboard belly, biceps and chest circumference can only be reached with the help of hormones.

Warning: FDA warning! 

The FDA is tightening its warning for all products that contain testosterone and warns of risks such as heart attack, stroke, infertility, depression, and aggressive behavior. Testosterone is often taken in combination with the anabolic steroid, which increases the risks. Withdrawal symptoms often include withdrawal symptoms such as tiredness, loss of appetite, insomnia, etc. Moreover, “normal” men do not benefit from the intake but have the same risks … ( FDA Safety Information and Adverse Event Reporting Program. Posted 10/25/2016. Http : //www.fda.gov/Drugs/DrugSafety/ucm526206.htm )

The big problem with younger men who take testosterone is that the natural testosterone often doesn’t get going properly after taking it! Testosterone can ruin you forever: Taking it as an anabolic substance carries the significant risk that the pituitary gland will fall asleep irreversibly and cause a so-called “hypogonadotropic hypogonadism” to develop!

Libido deficiency is the guiding principle of the testosterone deficiency!

I also recommend all men over 60 with reduced libido and erectile dysfunction to the laboratory test – as well as men with excess weight, increased blood pressure, increased blood lipids and increased blood sugar, who often experience erectile dysfunction. It has been proven that it only helps against osteoporosis in “hypogonadic” men, ie when there is a real lack of testosterone – see here ! 

Studies examining the effects of testosterone on some age-related complaints are too small and too short to be really meaningful or show an insignificant effect ( see here). In essence, they confirm the effects bodybuilders have on buying the hormone on the black market: testosterone is an anabolic steroid. Men over 65 also gain muscle under the effect. However, this is not necessarily of medical importance. In a study on 108 men, US researchers found that after three years of testosterone therapy, their muscle mass had increased, but not their strength.

What is too little testosterone?

The testosterone level of men drops by 1 to 2 percent each year in earlier years. This natural process usually has no noticeable effects. 

In fact, the importance of hormones for the well-being of a man is still completely open. We don’t even know how much testosterone is normal for an older man. Out of embarrassment, you help yourself with the values ​​foofoung men. Due to a lack of studies and long-term experience, there are currently hardly any binding guidelines and recommendations as to the level at which a deficiency that requires treatment is present. 

The Institute of medicine in 2004, the United States decided that the effectiveness of treating older men with low-normal testosterone levels (300-400 ng/dl or 10-12 nmol / l) was not sufficiently established to be effective in long-term studies of testosterone administration. A large, well-controlled and best-conducted 6-month study shows no positive results in 2007 ( Emmelot-Vonk MH et al. Effect of testosterone supplementation… .JAMA 2008; 299: 39-52 )!

The reference range for free serum testosterone, calculated by harmonizing measurement data and uniformly calibrating the analysis technology for healthy, non-obese (BMI <30 kg / m2) men aged 19 to 39, is between 264 and 916 ng/dl.   (Travison TG et al .: Harmonized reference ranges for circulating testosterone levels in men of four cohort studies in the USA and Europe. J Clin Endocrinol Metab 2017; DOI: 10.1210 / jc.2016-2935) .

• Testosterone should only be considered if the total testosterone is clearly reduced in an older man over the age of 60:  total testosterone: measured twice between 6 a.m. and 9 a.m .: <9 nmol / l (depending on the study, however, only <7 nmol / l! ). If this is the case, the question arises whether there is a so-called primary hypogonadism (= LH high: genetic Klinefelter syndrome) or a secondary hypogonadism (LH low to normal: ie looking for other causes of this under function of the testicles, e.g. in the pituitary gland or medication side effects, e.g. pain medication abuse, chronic pain, obesity, stress, a lot of sport, …).
• Patients who are being treated with testosterone should be carefully monitored. For the time being, the aim of the therapy is values ​​of 300-450 ngnglresp. 10.4-15.6 nmol / l.
• Patients should be checked for the derailment of testosterone-dependent diseases (e.g. prostate cancer, cardiovascular, liver damage, etc.). ( Snyder PJ. Hypogonadism in elderly men – what to do, until evidence comes. N Engl J Med 2004; 363: 440-2 and 482-92 ). Always have laboratory controls of PSA and hematocrit while taking testosterone.
• Most likely, testosterone administration shortens life by increasing cardiovascular risks!
• Men with prostate cancer, increased red blood cells (hematocrit), untreated obstructive sleep apnea or untreated heart failure must not be treated with testosterone!
• DHEA (precursor of testosterone) has no anti-aging effect!

Testosterone is no longer fun, health, and youth!

The only detectable effects of studies with testosterone are undesirable side effects !!! >>> see here!

Role of the pharmaceutical industry

In addition, the pharmaceutical industry is cleverly picking up on this trend and has the idea of ​​male menopause marketed vigorously by advertising agencies. The success is evident in the USA: Testosterone preparations have been experiencing annual sales increases of 30 percent for several years. And for those for whom injections or plasters were previously too annoying, there is now a testosterone gel: If you have the impression that something is missing, you can rub yourself in with masculinity like with sunscreen. (Side effects of gel include involuntary smearing and “spreading” to loved ones, to women and children & it usually smells a bit …).

Against the background of such trends, the warnings of some experts about the risks of testosterone therapy sound more like a know-it-all. Some of them consider the sex hormone to be one of the reasons why strong sex dies of cardiovascular diseases a few years earlier than women.

Can Testosterone Shorten Life ?!

Men with testosterone supplementation may be at higher cardiovascular risk! This is suggested by an observational study from the USA, in which the data from around 9000 US veterans with testosterone values ​​below 300 ngngl10.4 nmol / l) were evaluated. 20% of men without testosterone therapy, but 26% with therapy, experienced either death, a heart attack or stroke within 28 months of observation, even though the men in the testosterone group were somewhat younger and healthier on average! 

(Vigen R et al. JAMA 2013; 310 (17): 1829-1836)

The TOM study ( Basaria S et al., N Engl J Med 2010; 363 (2): 109-122 )was therefore canceled prematurely! There the risk ratio was already 22% within half a year instead of 5%!

Heart attack under testosterone

Taking testosterone increases the risk of a myocardial infarction, at least in the first three months after taking it! The risk of a myocardial infarction under testosterone treatment increases with age. The risk of a myocardial infarction with testosterone intake increases significantly in under 65 year olds with existing coronary heart disease. The risk triples in the first three months of taking testosterone. (Among others, Finkel WD et al. Increased risk of non-fatal myocardial infarction following testosterone therapy prescription in men. Plus One 2014; 9, e85805.)

Prostate cancer

Added to this is prostate cancer, the most common cancer among older men. 

It is not entirely clear what role testosterone plays in the development of tumors in the prostate gland, but it clearly promotes the growth of existing tumors. Fortunately, these tumors tend to grow so slowly that most men die before they notice anything of their tumor. This could change testosterone therapy: Even advocates of testosterone therapy, therefore, advise you to monitor your prostate continuously.

Bone density

First, it turns out differently, and second, then you think! Osteoporosis is a concern not only for postmenopausal women. It also affects men over 50 in 13%. And 30% of all femoral neck fractures occur in aging men. Testosterone improves bone density (BMD) in young hypogonadal men. Shouldn’t older men also benefit from it? Not at all! In 448 men over the age of 70, (total) testosterone and estradiol, luteinizing hormone and bone density were followed for eight years. Surprise: In the elderly man, age-related hypogonadism is not associated, but reduced estradiol levels are associated with reduced BMD. It would be premature to draw therapeutic conclusions from these results. (Amis S. et al. Association of hypogonadism and estradiol levels with bone mineral density in elderly men from the Framingham study. Ann Intern Med 2000; 133: 951-63 (Editorial 1002-4))

Phthalates (BPA or Bisphenol A) = plasticizers from plastic in our environment and testosterone/sperm count

A good, but also terrifying review article here: https://www.piqd.de/gesundheit/das-sperma-problem-das-ende-der-menschheit-kann-schneller- coming- as- we think?

What else can you do

• Avoid nicotine, alcohol, and stress. This trio in particular drops testosterone’s hormone levels. Increasing it does exercise and slimming down.
• If you exercise regularly over a long period of time, you can keep your testosterone levels high. That means taking at least three times a week for half an hour of endurance training.
• Pay attention to your diet: It should contain enough zinc because this mineral is necessary for the build-up of testosterone. Zinc is mainly found in cheese, fish, seafood, poultry, meat, nuts and to a lesser extent in cereals, legumes, and vegetables.
• Those who are overweight should slim down. If the organism loses five kilograms of fat through regular sporting activities, for example, the testosterone release is automatically promoted (5 kilos less means around a third higher testosterone level).
• Regular sex has a positive effect on testosterone levels.
• Men who are exposed to bright light in the early morning are able to raise their testosterone levels. To do this, men need 1000 lux for one hour between 5 a.m. and 6 a.m. The luteinizing hormone (LH) responsible for testosterone formation climbed by almost 70%  (In-Young Yoon et al., Neuroscience Letters 2003; 341: 25- 28). Just like depression, the researchers conclude that loss of libido and subdued sex activity – which is known to often accompany depression – can be favorably influenced by bright light. The increase in testosterone may be just a consequence of the increased sex activity and not a direct result of the influence of light.
• Phytoandrogens also have an impact on testosterone levels. Phytoandrogens are herbal substances that have a similar effect to androgens. These include the isoflavones, which also have an estrogenic effect (contained in soy, for example), as well as ginseng, nettle root, and oats. There are ready-made products of these. The nettle root is also very suitable for tea.
• Milk helps muscles grow: If you want to gain muscle mass during strength training, you should drink milk. This is shown by a study in men who lifted weights for 12 weeks. They were divided into three groups: the first drank low-fat milk after training, the second a soy drink and the third carbohydrate drink. Milk drinkers lost most of their fat – and most of their muscles (Hartmann JW et al, Consumption of fat-free milk after resistance exercise, Am J Clin Nutr. 2007 Aug; 86 (2): 373-8) .
• Anti-aging: what you can do yourself!

Does Estrogen Deficiency Syndrome Exist in Men?

No! Not directly … It is always the result of a testosterone deficiency, which is the prohormone of estrogen in men, ie most of the estrogen in men is generated from his testosterone. If this is too deep, there is also a lack of estrogen. Therapy with estrogens is therefore senseless in men, even dangerous since breast growth and cardiovascular diseases can develop or worsen. You should only ever treat with testosterone!

Is there an androgen deficiency syndrome in women?

Just at a time when the benefits and safety of long-term estrogen administration after menopause are increasingly being questioned (read about it here!), women are increasingly talking about androgen deficiency syndrome. Not only the aging man, so the advocates of the new syndrome plead, but also women after menopause felt in certain cases thanks to the administration of male sex hormones more vital and had a greater sexual resilience. However, the existence of such a syndrome – at least in healthy, older women – is extremely controversial in specialist circles, because the role of androgens in the female organism has been little investigated, and any deficiency symptoms are unspecific and show wide individual fluctuations. Above all, it is extremely difficult to differentiate the symptoms from the expression of an unsatisfactory partnership situation, depression or other illnesses. There are also no large studies

There is an exception here: if you have severe hirsutism (male hair on a woman) and testosterone is over 5, testosterone therapy is the order of the day.