[Hormonal changes affect the physical, mental and emotional health of both men and women.]

Q What is Andropause and how does it affect people?

A Andropause refers to the gradual, age-related decline in testosterone in men. Symptoms may include loss of libido, lack of energy and exercise tolerance, poor concentration and memory, depression or irritability, loss of lean muscle mass, among others. Some men have described it as, “My get-up-and-go got up and went.” Long-term consequences can include osteoporosis and increased risk for cardiovascular disease. Because the decline in testosterone occurs gradually over many years, symptoms are not as dramatic as those experienced by women in menopause.

It is estimated that around 5 million American men currently suffer from the effects of low testosterone. Declining testosterone levels can begin as early as age 30. By age 80, most men will have returned to pre-puberty levels of testosterone. Health problems may occur, however, when testosterone levels in the blood begin dropping too soon.

Excessive estrogen in the cells and tissues can be a problem for men as well as women. By age 54, the average man’s estrogen level is the same as that of the average 59-year-old woman. In men, excess estrogen often compounds the problems caused by decreasing levels of testosterone. Many factors may contribute to the cause of elevated estrogen in men. Fat tissue contains an enzyme called aromatase, which converts testosterone into other hormones, especially estrogen. Therefore, obesity often leads to elevated estrogen and decreased testosterone levels. Living in an environment polluted with estrogen-like compounds found in herbicides, pesticides and plastics can cause pituitary malfunction and the resultant sex hormone imbalance. The same problem can occur when hormones fed to livestock for weight gain end up in the human food chain. Overuse of alcohol and certain prescription medications can also cause hormonal imbalances.

Q Is this addressed by measuring testosterone levels and giving men testosterone?

A Much more is involved than simply checking the testosterone level. A good workup for andropause should include a comprehensive history and physical exam, including a digital rectal prostate exam. A screening tool such as the ADAM questionnaire is helpful for identifying the symptoms of andropause. Appropriate diagnostic testing, including estradiol level, PSA, sex hormone binding globulin, among other tests, must be done. As with women, the concern is not only the hormone level, but with the relative hormone balance.

Treatment is tailored to the individual and may include nutritional therapy and supplementation, lifestyle changes, exercise therapy and administration of “aromatase inhibitors” to decrease conversion of testosterone to estrogen, among other approaches. Therapy may or may not include administration of testosterone, as appropriate.

Q Why all the talk about menopause these days?

A Menopause is no longer the unspoken topic of previous generations. With the average American woman’s life span estimated to be over 80 years, she may expect to live more than a third of her life beyond childbearing age. Unless surgically induced, menopause refers to the time when menstruation has ceased for a full year. Hormonal changes begin years before this point and can dramatically affect a woman’s physical, emotional and mental health, as well as her prospects for good health later in life.

Q Does every woman suffer from the symptoms of menopause?

A Typical symptoms may include hot flashes, foggy thinking and memory lapses, sleep problems, emotional changes, vaginal dryness and urinary tract changes, among others. Most, but not all, women experience some of these symptoms to varying degrees. Because hormone levels fluctuate rapidly as women approach and enter menopause, symptoms may come and go. It is important to remember that our bodies operate as a whole; we have cell receptors for our “reproductive hormones” everywhere, and an imbalance can affect the adrenal glands, thyroid, neurochemistry, cardiovascular system and many other systems. We also need to consider the possible long-term consequences of post-menopause hormone levels such as osteoporosis and increased incidence of cardiovascular disease.

Q I’m 43 and my PMS has become more severe, affecting me now for two weeks, where it used to last a few days. Am I going through menopause?

A As we move from our reproductive years toward menopause, progesterone levels begin to drop, leaving estrogen the dominant hormone. Because of the estrogen-progesterone imbalance, symptoms typical of PMS may occur and become more severe years before menopause actually begins.

Q How can I relieve my symptoms and prevent future health problems?

A First, and always, good nutrition and regular moderate exercise are the foundation on which to build good health. A number of herbal remedies are available that may help manage symptoms. Bio-identical hormone replacement therapy prescribed in a controlled clinical setting, where therapeutic levels are closely monitored, and where dosing is adjusted accordingly, can significantly improve a woman’s quality of life. A program can be tailor-made for each woman, based on a thorough diagnostic analysis, including family and personal health history, lifestyle analysis, physical exam and blood and other diagnostic testing.

Hormonal health plays a significant role in our well-being, our quality of life and our future health. Andropause and menopause symptoms can be successfully addressed with a therapeutic approach tailored to the individual. The goal is not to treat normal aging as a disease, but to maximize the health potential of each individual as we move through life.

Dr. Gael Wheeler, D.O. and Dr. Douglas Nelson, D.O. are board certified osteopathic family practice physicians at Carrollwood Integrative Medicine in Tampa. Both have additional certification through the American Board of Holistic Medicine. 813-265-8885.