Posts Tagged ‘andropause’

Testosterone Deficiency: Male Menopause Which Is HARDly The Pause That Refreshes!

November 21, 2015

Everyone has heard about menopause for women.  This is due to a decrease in estrogen production from the ovaries.  Men also have a fall in their testosterone, the male hormone produced in the testicles, also decreases a small amount after age 30 but becomes symptomatic around age 50.  The problem affects millions of American men who have decreased sex drive, lethargy, loss of muscle mass, decrease in bone density, and even irritability\depression.  This blog will discuss the problem of male menopause or andropause.

Men losing testosterone is a steady decline, like a leak in a swimming pool you never refill. Over time, you empty out all your stores, creating a constellation of problems.

The constellation of problems compound each other, too. The apathy comes in part from the decline in hormones, which results in loss of lean muscle mass, depression, and forgetfulness. But it becomes a downward cycle, as the less lean muscle mass a person has, the faster he or she gains weight, which leads to more depression.

The seriousness of the problem of male depression tied to aging cannot be denied, as middle-aged and older men account for more than 20 percent of suicides, as compared to about 5 percent for women. Older white males represent 70 percent of suicides.  Before starting anti-depressants, doctors caring for older men with symptoms of depression should get a serum testosterone level and replace the hormone with testosterone replacement therapy before initiating anti-depressants.

Most of my physician referrals come from psychiatrists and neurologists, as men are seeing them because of depression and memory issues. Psychiatrists and neurologists know what a reduction in testosterone does to emotional well-being and brain function. These specialists want their patients to be tested for low testosterone before trying anti-depressants or other prescription therapies.

The reason more general physicians don’t think of, or want, to go the hormone testing route? Testosterone therapy got a bad rap a few years ago when there was a lot of misinformation with regard to testosterone being dangerous and possibly being linked to an increase in prostate cancer and heart disease.

There have been poorly designed studies, just as there were poorly designed studies with women’s hormone studies, such as the Women’s Health Initiative, indicating that it might be dangerous for women to take hormone replacement therapy. The result is that these defective studies resulted in a lot of men are not doing testosterone optimization correctly. There is a big difference between what is considered a normal level of hormones, which in America, is often abused to build super-normal muscle mass, and those levels at which men literally come back to life again.

Ideally men need to have their testosterone levels drawn in the morning when the testosterone levels are the highest. If the man has the symptoms described above and has a low testosterone level, they are candidates for hormone replacement therapy using injections of testosterone, topical gels containing testosterone, or testosterone pellets that are inserted under the skin every 4-6 months.

Many of these men come in saying they feel like half a man; well they are, because they are trying to live on half the amount of testosterone they had when they were younger. When they feel better, they make changes such as losing weight, or changing careers, because with the low level of testosterone, they didn’t care enough to do it before.

Bottom Line: If you don’t feel the same way about yourself or your partner, and you are in your 40s, 50s, or 60s, it may well be that one or both of you have hormonal issues. It makes sense to try and fix that with a brief history, physical exam and a testosterone blood test.

Menopause or Andropause-Not the “Pause” That Refreshes Either Women or Men

July 19, 2015

Around age 50 women have a drop in their hormones and enter into menopause. At about the same age men start experiencing a decrease in testosterone occurs. This is the male hormone that is responsible for sex drive, muscle mass, bone strength, and even erections. This condition in men is referred to as andropause and it affects millions of American men.

The symptoms of andropause include hot flashes, fatigue, night sweats, mood swings; all the fun things that females going through menopause may endure. Men lose one percent testosterone for every year past 30 but usually don’t develop symptoms until age 50. As testosterone decreases, estrogen increases. Abdominal fat causes excess estrogen and low levels of testosterone may also lead to prostate problems. Ever wonder why suddenly you are gaining weight around the middle? It could be your hormone levels are unbalanced.

The diagnosis is easily made with a blood test to measure the testosterone level. Men more than 50 years of age should also have a digital rectal exam to check their prostate gland and a PSA test which is a screening test for prostate cancer. Treatment options include testosterone replacement therapy. This can be administered with self injections of testosterone, topical gels, or the insertion of testosterone pellets under the skin.

Bottom Line: Testosterone deficiency in middle age and older men affects millions of American men. The diagnosis is easily made and effective treatment is available. You don’t have to suffer this common condition. Help is available. See your doctor.

The Penis Has a Mind of Its Own-What Can You Expect From Your Best Friend Who Resides Between Your Legs as You Enter Middle Age

October 9, 2010

Let’s face it guys, as we get older our sexual prowess and our ability to engage in sexual intimacy decreases.  As we age our testosterone level falls and many men enter into a male menopause, often called andropause.  As a result it takes more stimulation to create an erection and it may take more time to achieve an orgasm and the time between an ejaculation\orgasm and the next erection increases.  If this isn’t enough, there is a decrease in semen volume and the power of the ejaculation also diminishes as we enter middle age and beyond.

Coupled with a decrease in sex drive and a decrease in the rigidity of the erections with age, there is a decrease in the length of the penis.  For some men the decrease in the length is more apparent than real.  That is, with increasing age there is a concommitent accumulation of fat in the lower abdomen which makes the penis appear shorter to the man when he looks down at Willy when he and Willy are in the shower!  So if you are looking for some motivation to lose weight and, as a result, increase the size of your penis by an inch or two, this just might be the stimulus you have been waiting for!

For some men the loss of length is more than just a figment of the imagination. As men age the natural depositon of cholesterol placques inside the blood vessels will restrict the blood supply to the penis and thus impair the deliver of oxygen and nutrients from the blood stream which are so necessary for maintaining the function and the length of the penis.  By the way, this same process of cholesterol deposits in the blood vessels to the penis are also occurring in the blood vessels of the heart and can contribute to heart disease and even a heart attack.

Another natural and normal consequence of aging is that the penis becomes less sensitive.  Thus the need for more genital stimulation in order to achieve and maintain an erection.  When a man is in his sexual prime, age 20-30, the mere touch of a feather can illicit an erection.  For a man in his 50s, it may take several minutes of genital stimulation in order to achieve an erection.

But there is some good news.  Although we have fewer erections, and need to work harder to achieve an erection, the sexual gratification remains intact.  Older men enjoy sexual intimacy just as much as their younger counterparts.

Bottom Line:  Don’t say good by to sex or put Willy to sleep just because you have reached middle age.  Sex is still good whatever your age.  It just takes a little more time, a positive attitude, and, oh yes, a partner!

Want To Lose Weight? Check Your Testosterone Level!

September 15, 2010

This blog was excerpted from an article by Dr. Julius Goepp in Life Extension, October 2010.

Low testosterone promotes abdominal obesity in aging men. As men age, many men become trapped in a vicious cycle that leads to life-threatening abdominal obesity. No matter how much men exercise or how little they eat, these men are unable to shed this excess weight that accumulates in their belly. It has been demonstrated that low testosterone and obesity reinforced each other, trapping men in a spiral of weight gain and hormonal imbalance. In spite of this widespread threat to men’s health, most physicians do not test for testosterone levels in their obese male patients. If they did, millions of men could be protective against the scourge of metabolic syndrome, type 2 diabetes, high blood pressure, atherosclerosis, erectile dysfunction and cancer. If you haven’t to be one of these plagued  men, please have your testosterone blood levels measure and share the results with your doctor. Experts now recommend testosterone testing for most men of middle-aged men and beyond.   There is compelling evidence for the role of testosterone therapy as a means of promoting weight loss.

A Little Dab Will Do Ya-Use of Testosterone Gel For Low Testosterone Levels

August 3, 2010

Most men who have symptoms of low testosterone levels such as decreased libido (sex drive), erectile dysfunction, lethargy, and loss of muscle mass who used testosterone gel every day had their testosterone levels restored to normal and experienced benefits over time. These benefits included:

  • Improvement in energy, sexual desire, sexual function, and mood within 1 month
  • More muscle mass and decreased body fat within 3 months
  • Increased bone strength within 6 months in patients receiving 10 grams of AndroGel daily

However, once you stop using testosterone gel, it is likely your testosterone  levels will fall below normal in just 5 days and your symptoms may come back.

Your Goal with Treatment

Low testosterone is a medical condition that likely won’t go away on its own. There is typically no cure for low testosterone levels. The goal of treating low testosterone is to raise your blood  level of testosterone and to keep the level in a normal range. Once your testosterone reaches a normal level and remains there, symptom relief may follow.

Bottom Line: Male hormone deficiency or low testosterone is a common condition affecting millions of American men.  Treatment with a topical testosterone gel is very effective

Pellets for Improving Your Libido or Sex Drive

April 27, 2010

Nearly 30 million men suffer from erectile dysfunction (ED) or impotence and nearly half that number have a decrease in their sex drive or libido.  However, many men believe that erectile dysfunction and diminished libido are the same thing.  It is important that men understand the difference between ED and libido.  ED is the inability to achieve and maintain an erection adequate for sexual intimacy with a partner.  Loss of libido is a decrease in the interest for sexual intimacy.  ED and loss of libido can be separate issues or can occur together as it is common for a man who suffers from ED for a prolonged period of time will also experience a decrease in libido.

What are the symptoms of decrease in libido and what are the causes of this condition?   A decrease in libido is usually a result of a decrease in the level of testosterone which is a hormone produced in a man’s testicles.  A decrease in libido is the most common symptom of testosterone deficiency.  Men with a decrease in testosterone also experience a lack of energy and often complain of lethargy.  Men with decrease in testosterone also experience a decrease in strength or endurance, lose height, fall asleep after dinner, and may even experience depression or a decreased enjoyment in life.

Now there are treatment options for low testosterone which include the insertion of testosterone pellets, Testopel, underneath the skin.  The pellets will boost the testosterone level for 4-6 months.

How is Testopel administered?

Other than the initial stick of a needle used to numb the insertion area, Testopel insertion is pain-free.

The insertion area is 3-4 inches below your beltline–approximately at the top of your rear hip pocket.

  • Each Testopel pellet is very small – about the size of a grain of rice
  • Testopel is placed just below the skin into your fat layer. Once implanted, most men have no awareness that the pellets are there.
  • The right number of pellets is based on the serum testosterone level
  • After Testopel is inserted, your doctor will close the implant site using Steri­Strips. Stitches are not needed. The area will then be bandaged and a cold compress applied.
  • Patients can return to work the same day that the pellets are inserted

The Testopel results in improvement in:

• Improved mood

• Increased sexual interest

• Restoration of erectile function

• Increased muscle mass

• Increased strength of bones

Bottom Line:  Testosterone deficiency is a very common disorder.  The diagnosis is made by a blood test that detects a low level of testosterone.  Treatment with Testopel is a very effective treatment option.

Testosterone Replacement Therapy-A little Dab Will Do Ya

April 25, 2010

A man’s sex drive or libido is thought to be connected to the level of testosterone, the hormone produced in the testicles which circulates in his bloodstream. Low testosterone, also known as hypogonadism, affects approximately four to five million American men. The condition is also linked with diminished interest in sex, impotence, reduced muscle mass, decreased bone density and lowered mood and energy levels.

Who needs testosterone?

Though the body’s own production of this hormone trails off gradually in men after the age of 30 or so, not many men seek testosterone-replacement therapy or even get their testosterone levels tested.   If a man is experiencing a decrease in his libido or sex drive, complains of lethargy or tiredness, he should see his doctor and obtain a simple blood test to determine if he is deficient in this important hormone.

In the past the only treatment to replace the testosterone was injections of the hormone every two weeks or applying testosterone patches to the scrotum or other areas of the body.  The injections were occasionally painful and the patches often caused skin irritation.

Now testosterone is available as a gel or paste (AndroGel, Teststim) applied to the skin of the shoulders, upper arms or abdomen once a day.  The gel is clear, colorless topical gel that men apply once daily to the shoulders, upper arms and/or abdomen. The gel dries within a few minutes, during which time the skin absorbs the testosterone. The skin serves as a reservoir for the hormone, which slowly enters the bloodstream. Normal testosterone levels are restored soon after application.  The testosterone gel will be available with a prescription in pharmacies throughout the United States by the end of the summer.

In studies conducted on hundreds of men who are testosterone deficient, the gel quickly raised circulating testosterone to desirable levels, and maintained it within normal range. The gel also increased sex drive, bone mineral density, and lean body mass and improved mood and energy levels.

At the present time the gel is not indicated for use in women and has not been evaluated in women. Pregnant women should avoid skin contact with the area on men where the gel has been applied as the testosterone in a pregnant woman can cause harm to the fetus.  The testosterone gel is not recommended in young men to improve athletic performance.   Testosterone is contraindicated for men who have prostate cancer that is spread beyond the prostate gland.  For some men with localized prostate cancer who have symptoms of low testosterone, a low serum testosterone level, and a PSA that is at very low levels, they may receive testosterone if they are monitored closely with PSA testing.  (See my blog “Testosterone Treatment in Men With Prostate Cancer-The Controversy”)

The next step.  If you are experiencing a decrease in your sex drive, feel lethargic, or have less energy, you may have a decrease in your testosterone level.  Contact your physician and request a testosterone blood level.  If it is decreased, the solution is just a dab of gel away.

Tick Tock or When Your Biologic Clock Slows Down

March 10, 2010

When the phrase “biologic clock” is mentioned, most think this is in reference to women who experience a loss of hormone production at the time of menopause.  But men also have a clock that starts to slow down around age 35.  It is at this time that men experience decreasing hormone production, decrease in fertility potential, as well as an increase risk of genetic problems in children born to men who are older.

The theory that men go through a change in life, similar to what women experience, could be taking hold. We know for certain that the cause of the slowing of the biologic clock in women is due to a decrease in the production of estrogen.  If less estrogen in women leads to the end of menstruation, moodiness, hot flashes, loss of sexual interest and osteoporosis, couldn’t male versions of these symptoms be caused by less testosterone?

How common is male hormone deficiency?  Currently in the U.S., at least 6 to 10 million men suffer from the effects of extremely low testosterone levels in their bloodstream.  Sadly, only 1 out of 6 of these men will ever receive treatment to resolve this problem.

Infertility and aging

It has been noted that more men, and women, are deferring parenting until they are older, finished their education, and are more financially stable.  As a result the number of children born to fathers older than 35 years has increased considerably in the past few decades.  This creates a problem as there is a decrease in fertility in men with increasing age.  Since it takes longer to achieve a pregnancy in older men, they should be counseled and may consider starting their family sooner before their clock completely winds down.

Since there is evidence of the existence of a male “biological clock,” the likelihood of taking more than a year to conceive doubles when the man is over 35. The implication is that a man’s age should be another factor that is taken into account when looking at the chances of conception in couples who are having difficulty conceiving.

In addition, as men age, the genetic quality of their sperm declines significantly. According to the Centers for Disease Control and Prevention, the number of babies born to parents older than age 35 more than doubled from 1970 to 1999, from 6 percent to 13 percent. This trend has led to the rise in the rates of infertility in the past decade, and to increased miscarriage rates and the possibility of a baby born with Down Syndrome (in addition to other genetic abnormalities).

When testosterone levels drop

In women, menopause generally marks the end of youth, hence the idea of a “mid-life crisis.” Some women get hot flashes, are moody, irritable and/or depressed. Male menopause, or andropause, is not as clearly defined for men as it is for women.  There probably is a syndrome of testosterone deficiency in aging men, and that testosterone deficiency is manifested by a diminished sexual drive, difficulty in getting or maintaining an erection, lack of energy, even irritability and grumpiness.  There are even changes in a man’s height, caused by bone loss and osteoporosis.

If a man is experiencing any of the symptoms of testosterone deficiency, they need to see their physician and undergo an evaluation which includes a blood test to measure the testosterone level.  Not all male mid-life crises are a result of testosterone deficiency.  First, the doctor must be sure that the symptoms are not due to depression.  Many of the issues in testosterone levels could be confused with the effects of depression. If you’ve got symptoms that may be suspicious, the first thing is to have a thorough physical and laboratory work and make sure you rule out other medical conditions such as diabetes, which also affect testosterone levels. Treat those conditions first, before you consider looking at testosterone.

There is also a useful questionnaire, ADAM-Androgen Deficiency in the Aging Male, that is helpful for men to identify testosterone deficiency.

The ADAM questionnaire asks you to check for the following symptoms:

  1. Decrease in sex drive
  1. Lack of energy
  1. Decrease in strength and/or endurance
  1. Lost height
  1. Decreased “enjoyment of life”
  1. Sad and/or grumpy feelings
  1. Erections less strong
  1. Deterioration in sports ability
  1. Falling asleep after dinner
  1. Decreased work performance

Men experiencing Loss of morning erections depression, tiredness, memory loss, decreased muscle mass and increased weight, more fragile bones, or a diminished sex drive might be candidates for testosterone replacement therapy.  Treatment of testosterone deficiency is easily accomplished with injections of testosterone, patches placed on the skin that transmit the medication from the skin to the blood stream, or topical gels applied to the upper arm or lower abdomen can quickly restore a man’s libido and sex drive.

So if you are over 35 and are feeling less than your best, you should talk with your doctor about your symptoms. A complete medical examination that includes laboratory tests can help show whether testosterone supplements might help you feel better. If treatment is suggested, then I encourage men to try it for a period of a few months while keeping track of the changes. If low testosterone is the cause of their symptoms, men will not have to wait long to see the effects of treatment.   Bottom line…men, you may not be able to turn back the clock of time but you certainly can reset your biologic clock with hormone replacement therapy.

Dr. Neil Baum is a urologist at Touro Infirmary.  For more information, contact Dr. Neil Baum at (504) 891-8454 or go to his Website,