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May 30, 2004

Andropause and the Male Client

If your client is 40 or older, feels lethargic, grumpy, a general lack of interest in life, insomnia, anxiety, memory loss and depression, chances are he's going through andropause. Robert S. Tan, MD, a geriatrician and author of The Andropause Mystery, encourages advising your male clients on how they can deal with andropause--change of life.

What is andropause?
Andropause is male puberty in reverse. It was first described in scientific literature in the 1940s. Andropause is a biochemical, physiological state, where androgens, the male hormones, decrease. Eventually, all men will make the transformation of andropause, but not all will experience symptoms.

It's been called the male menopause, but that's not exactly correct, since men still retain their ability to father children throughout andropause, although the level of testosterone does decline. However, like menopause, andropause can lead to serious long-term effects, such as loss of bone and muscle, and other cumulative problems. Your clients may think that testosterone is linked to impotence; but this is not true. Testosterone does nothing to improve erectile function, but does change the libido. When your client's testosterone declines, so does his sex drive. Today, 25 million American males between 40-55 are experiencing some degree of male menopause. There are case reports of men as young as 35 beginning to show signs of andropause.

Symptoms
In men 55 and older, 20-50% have hypogonadism, which is lower testosterone, the pathological basis of andropause. Obese and diabetic men are more likely to feel symptoms because an enzyme in the fat tissue causes testosterone to turn into estradiol, a female hormone in every man's body. Diabetics often are insulin-resistant and this can depress testosterone production and increase leptin, a hormone for obesity. Premature aging, andchanges in hair growth and skin quality are immediate signs. Others include depression; memory loss; fatigue; tiredness; lack of sexual drive; bone loss; and loss of hair in the beard, groin and armpit area. Scalp hair loss has nothing to do with

Treatment
The challenge of diagnosing and treating andropause lies in the fact that not everyone has heard about it, making it more difficult for clients to find professionals who are educated in this area. The whole field of aging and andrology--the study of men--is rapidly growing and overlaps several disciplines, including endocrinology, psychiatry, urology and geriatrics. Tan finds that among his patients, men who experience andropausal symptoms are obese. He has found success for his patients with the following:
• Weight loss. This is very important. Your client should be at recommended body mass index for his height and age.
• Exercise. Exercise can increase testosterone. Men who pump iron have shown higher levels of testosterone in their blood. However, warn your client not to overdo it: marathon runners and Olympians develop hypogonadism, because any available hormones in the blood go to the muscle. Have your client work out three times a week with 20 minutes each of weight lifting and aerobics.
• Diet. Testosterone naturally comes from cholesterol, so be sure your client includes a little cholesterol in his diet. He'll need to consume protein too, in order to build up muscle and bone. Suggest he take protein supplements. The teeth decay with age, making it harder to chew meat. Recommend eating colorful fruits and vegetables such as tomatoes, broccoli and peppers, since their antioxidant properties will get rid of excess free radicals. One glass of wine a day will help the cardiovascular system. Your client also can ask his physician for other over-the-counter supplements.
• Medical treatment. Medical options for symptomatic patients include hormonal replacement therapy for testosterone, also called Testosterone Replacement Therapy (TRT).
Specialists say that men considering TRT--whether by injection, patches, cream, gel or oral form--should get their PSA levels checked as TRT could increase the risk of prostate cancer. A PSA blood test identifies a man's risk for prostate cancer.

Posted by at May 30, 2004 12:00 AM

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