Male Hormone therapy
You may be surprised to hear that the menopause can affect men as well. Male menopause generally affects men over 50. The condition is also known as testosterone deficiency, androgen deficiency, or late-onset hypogonadism.
Causes of Male Menopause
As women go through the menopause, a series of clear changes occur as ovulation ends and periods stop. For men, it is a different process but as levels of testosterone decrease with age, they can also suffer a series of troublesome symptoms.
What are the Symptoms of the Male Menopause?
A decline in testosterone occurs as men age can cause a range of physical, emotional and mental issues such as:
· Erectile dysfunction
· Mood swings
· Problems sleeping
· Forgetfulness
· Fatigue
· A loss of muscle mass
Is it a ‘midlife crisis’?
At approximately 50, some men go through times of high stress and experience physiological problems. This can be caused by work, money worries, relationship issues or divorce. Heightened stress and anxiety is often referred to in conversation as a ‘midlife’ crisis. It is often made light of but can have a distressing affect on a man’s life and contribute to male menopause symptoms. Please contact us for diagnosis and treatment
The Gonadal Axis
What is it?
An interaction between the Hypothalamus, the anterior pituitary and the testes.
•The hypothalamus secretes GnRH.
•GnRH travels down to the anterior pituitary gland and binds to receptors on the gland.
•This promotes the release of LH (luteinizing hormone) and FSH (follicle-stimulating hormone).
•LH stimulates Leydig cells in the testicles to produce testosterone (testosterone is required for spermatogenesis and many other important biological processes).
•Increased levels of testosterone have a negative feedback effect on the pituitary and hypothalamus.
•This results in decreased production of LH and FSH.
•As a result, the production of testosterone is decreased.
Causes of low testosterone
Acquired circumstances that can lead to secondary hypogonadism include:
•Normal aging: Aging affects production and response to hormones.
•Obesity: High body fat can affect hormone production and response.
•Medications: Opioid pain meds and steroids can affect function of the pituitary gland and hypothalamus.
•Concurrent illness: Severe emotional stress or physical stress from an illness or surgery can cause the reproductive system to temporarily shut down.
•Smoked nicotine is bad for testosterone and estrogen; even chewed nicotine is a vasoconstrictor
Alcohol significantly increases aromatase (an enzyme that converts testosterone into estrogen) – avoid more than 3-4 standard drinks every two weeks
Natural ways to boost your free testosterone:
•Working out: strengthening exercises especially the larger muscle groups
•Eating testosterone boosting foods (Healthy fats, good quality protein, complex carbohydrates, ginger, zinc foods, magnesium foods).
•Good sleep quality and quantity
•Reducing stress levels
•Decrease alcohol intake
The three forms of testosterone:
Total Testosterone: all the bound (unavailable) and unbound (available) testosterone in your body. This includes Free testosterone, testosterone bound with Sex hormone binding globulin and testosterone bound with albumin.
Free testosterone: Responsible for the all good things we associate with Testosterone: Muscle building, Libido, general wellness. This makes up only about 1-2% of the total testosterone in your body. It’s so potent, that this is enough!
Bioavailable Testosterone: Testosterone bound with albumin a protein made by the liver. Testosterone bound to this is not as available as Free testosterone but still has some action on the tissues.
Sex Hormone Binding Globulin (SHBG). Testosterone bound to this is completely inactive. Therefore people with high levels of SHBG can exhibit symptoms of hypogonadism (low testosterone).
SEX HORMONE BINDING GLOB: 19 – 83 nmol/L
TESTOSTERONE: 7.6 - 31.4 nmol/L
Free Testosterone 5.0 - 21.0 pg/ml
Testosterone replacement therapy
Gels or Injections?
The first decision is topical testosterone (a cream or gel you apply to the skin), versus injectable testosterone. Many men have negative views about gels, but for many men they work well, have fewer side effects and mean they don’t have to deal with needles.
Testogel Topical Gel
Advantages
•Topical testosterone is easy to use.
•It doesn’t involve any injections or needles.
•Lower risk of side effects: hardly ever causes raised oestrogen, haematocrit or acne vs injectables
•We have really good long term data on the cardiovascular safety of topical testosterone (TRAVERSE study)
Disadvantages:
•Daily application
•Need to wait for it to dry for a few minutes
•Some men don’t absorb it so well
•Risk of transfer to another person
Injections:
Nebido (Testosterone undecanoate)
Advantages:
•Licensed in the UK
•Slow release testosterone. Only one injection needed every 3 months after first 3 months - therefore fewer injections
Disadvantages:
•Levels change over the course of the three months, which some find unsatisfactory
•Large volume of injection
•More difficult to adjust levels. Once the medication is in, it is there for three months
Sustanon
Sustanon is a mix of four different types of testosterone. Each has a different half life. This was designed to reduce the ups and downs of testosterone levels, which works for some men.
It’s licensed for injection every three weeks, but many men find that they feel pretty awful in the third week when their levels drop. Instead it can be microdosed, injecting a small amount once or twice a week.
Advantages:
•Can be used for microdosing
•Licensed in the UK & readily available
Disadvantages
•Some men don’t do well with the multiple esters, although this is rare
•It can’t be used subcutaneously
•Often not available outside Europe & the UK
Before:
Testosterone levels
Comprehensive blood test including Prostate Specific antigen and yearly thereafter
During:
Regular free testosterone testing