The male menopause, andropause - Just as real as the female version.

The Male Menopause, Andropause, Testosterone Deficiency or Hypogonadism as it is also known obviously has no medical connection with the female menopause. The only similarity is that it occurs at a similar point in the male lifespan.

Most women will scoff and say there is no such thing and, of course, medically, they are quite correct, but there is a set of circumstances in a man’s lifetime which when combined together are likely to cause a period of depression and reduction in physical abilities.

Testosterone, together with its metabolites, is collectively known as androgens. As a group of steroid hormones, they stimulate the development of masculine characteristics and are responsible for male puberty characterized by deepening voice, broadening shoulders, and facial hair growth. The hallmark of andropause is declining testosterone levels.

Symptoms - Sometime during a man's forties or fifties and even sometimes as early as his thirties, his body's production of testosterone may begin to slow. This gradual decline most often occurs between the ages of 50 and 55 and can manifest itself in a variety of changes and effects on the male body:

An example of these effects is as follows, but just because they are possible doesn’t mean that you will suffer all of them, indeed you may suffer none.

Mood disturbances, including depression, irritability and extreme fatigue

Loss of muscle size and strength combined with general weakness.

Osteoporosis (bone thinning)

Increased body fat

Hair loss

Anger and confusion.

Difficulty with concentration and memory loss

Sleep difficulties or general insomnia

Erectile dysfunction

Decreased libido (loss of interest in sex)

Sexual Functions. One of the greatest disappointments for men as they become older is that coital frequency declines rapidly with age from a mean maximal coital frequency of about 4 times per week at age 25, to once a week at age 50, 3 times a month at age 70, and 1.7 times a month between the ages of 75 and 79 years. Devastating impotence also increases dramatically with age. Ignoring illness it is rare before the age of 30. It is observed in 8 percent of people over 50 years, 20 percent of those over 65 years and close to 40 percent for those who are 70 years and more. Regrettably, from the male point of view, this loss of libido does not affect females as much who apart from some vaginal dryness have little physical symptoms that would prevent them from leading a healthy sexual life, far into old age.

Treatment - Treatment primarily involves hormone replacement therapy, which is the same system as used with women. It is aimed at maintaining masculinity, improving energy, strength, mood, feelings of well-being, and preventing bone degeneration. Testosterone can be introduced to the body by transdermal, mucoadhesive, and intramuscular injection. Mucoadhesive delivery allows testosterone to enter the bloodstream directly, bypassing the gastrointestinal tract and the liver. Transdermal delivery (i.e., through the skin) with a testosterone patch is becoming the favourite method of treatment for testosterone deficiency. Tests have proved that it establishes and maintains adequate serum levels in more than 90% of men treated, without any significant side effects. A patch is worn, either on the scrotum area or elsewhere on the body, and testosterone is released through the skin at controlled intervals. Patches are typically worn for 12 or 24 hours and can be worn during exercise, bathing, and strenuous activity. Two transdermal patches that are currently available are Androderm® (nonscrotal) and Testoderm® (scrotal). The Androderm patch is applied to the abdomen, lower back, thigh, or upper arm and should be applied at the same time every evening.

AndroGel® and Testim® are transdermal gels that are applied once daily to the clean dry skin of the upper arms or abdomen. If the instructions are followed, these gels deliver testosterone for about 24 hours. The gel must be allowed to dry on the skin before dressing or going to bed and must be applied at least 6 hours before showering or swimming.

Striant® (testosterone buccal system) mucoadhesive CIII is a hormone-replacement treatment that delivers testosterone twice daily through a tablet-like buccal system that adheres to the gum or cheek. It is placed in the mouth where the gum meets the upper lip and dissolves into a gel that remains in place for 12 hours. Utilising the moisture from the mouth, it gradually releases testosterone directly into the bloodstream, bypassing the gastrointestinal tract and the liver. In clinical trials, more than 85% of patients regained normal testosterone levels.

Side effects of treatment The most common side effects associated with transdermal patch therapy includes itching, discomfort, and irritation at the patch site. Some men may experience fluid retention, acne, and temporary abnormal breast development (gynecosmastia-).

AndroGel® is supplied in a metered-dose pump, which allows doctors to adjust the dosage of the medication according to body weight and size Side effects of transdermal gels include irritant reactions at the site of application, acne, headache, and hair loss (alopecia).

Side effects are usually mild and pass quickly, resolving themselves within 14 days. They can include gum or mouth irritation, pain, and swelling (edema); bitter taste, and headache. Abnormal breast development (gynecomastia) may also occur. Patients should report persistent gum abnormalities to their physician or dentist.

Striant® Is a drug with many contra indications and should not be used in men with prostate or breast cancer and should be used with caution in patients with chronic heart, kidney, liver, or lung disease. It may cause edema, congestive heart failure, and sleep apnoea, and may increase the risk for enlarged prostate and prostate cancer. Patients taking the medication must undergo regular digital rectal examinations (DRE) and prostate-specific antigen (PSA) tests to monitor for signs of the disease.

Intramuscular injection (IM) Tends to be used less frequently because it can cause erratic testosterone levels. The primary adverse effect caused by injected testosterone involves fluctuating mood, energy level, and libido caused by testosterone levels that rise rapidly upon injection and then fall too low before the next dose is due. There seems to be no slow release form available.

Kallmann's syndrome (delayed or absent puberty) may be treated with chorionic gonadotropin, which can correct undescended testicles (cryptorchidism) and infertility. Gonadotropin releasing hormone (GnRH) therapy can trigger secretion of testosterone and other sex steroids, improve sexual desire and may establish fertility where this is absent.

The method of delivery of testosterone is determined by age and duration of deficiency. Many of the drugs have a good history of tolerance but some can cause serious problems. For instance oral testosterone (methyl testosterone, Testred®) is associated with liver toxicity and liver tumours and so is prescribed sparingly.

Link between body fat and Andropause - Body Composition. The amount of lean muscled body mass in a sedentary person decreases by approximately 10 percent for every decade after the age of 30. You could have lost 30-40 percent of your lean body mass by age 60. Aging is accompanied by a decrease in lean body mass (LBM) and a subsequent significant increase in fat mass. Much of this can be avoided by using a structured exercise plan and significant decreases can be postponed until into the 60s and 70s. Although aging itself is an important determinant of body composition, plasma total testosterone levels are not correlated to fat mass, regardless of age. The decrease of muscle mass is highly correlated to free testosterone levels, which persists after correction for age. Testosterone supplementation increases muscle mass and therefore overall body weight. Aging males, like hypo gonadal men, accumulate visceral fat which can be a major cause of insulin resistance and the atherogenic lipid profile. It seems that obesity in elderly men is a more important health hazard than in young men. Contrary to popular belief, clinical trials have shown that a low androgen status increases the risk of coronary artery disease (CAD) or atherosclerosis. It was previously wrongly believed that testosterone and other androgens would have the opposite effect as men have higher rates, than women, of heart disease generally. However, research now shows that low androgen levels are associated with an increased incidence of CAD. While decreased free and total testosterone levels can lead to increased fat mass, it could also be suggested that the decrease in testosterone levels in the aging male is the consequence of an increase in fat mass.

Natural and Herbal remedies - The, so-called male menopause could be remedied by testosterone therapy alone but patients will suffer similar adverse side-effects as HRT in women. A high level of testosterone has been associated with prostate problems and an increased level of aggression.

Under the circumstances it seems to make more sense to look at more natural alternative remedies unless an urgent remedy is required.

Vitamins – there are special multivitamin supplements prepared for men over 50 which will contain all of the vitamins and minerals that you may be lacking.

Ginkgo Biloba - This works well in stimulating blood flow, which can bring help with sexual dysfunctions. The supplement will ensure that a good supply of blood flows to the genital region, in particular and this should bring about a great improvement.

Yohimbine - This is one of the recent supplements and is gaining much attention as researchers work to get the best from it in the treatment of male menopause sexual dysfunction, as well as other symptoms

Saw Palmetto – This will protect the prostate and balance the hormones as well as increasing any low testosterone levels and normalising high levels.

Damiana – Is a South American shrub known, in native medicine, for its aphrodisiac properties both in men and women. It will also help with impotence, sterility and anxiety.

Muira Puama -.In the mid 1990s a study of 262 men suffering from age-related sexual dysfunction showed that this herb improved the sexual desire and performance of about 60 percent.

Maca Root - Native to Peru, maca root is an ancient native remedy for numerous age and hormone-related health issues. Maca may help to strengthen and balance the endocrine system in both men and women and may help regulate hormones. It is also considered a sexual enhancer as a result of its ability to balance testosterone levels. In a trial of 56 men in which maca root and a placebo was carried out, sexual desire did increase, although there was no evidence of the herb's ability to significantly increase hormone serum levels.

Diet - You need to increase the amount of phytoestrogens in your diet to rebalance the hormone levels. The best way to do this is to add soya, chickpeas and lentils.

Tomatoes. - These common fruits are starting to be used widely as a preventative for prostate cancer, and can also work quite well as a home remedy for male menopause sexual dysfunction They can be eaten raw or cooked in various dishes.

Flaxseed - Which is also known as linseed, it is a plant with blue flowers that is commonly grown all over the world. . This plant is being cultivated for its oil rich seeds which contain high levels of omega-6 and omega-9 essential fatty acids, B vitamins, potassium, lecithin, magnesium, fibre, protein, and zinc and also provides approximately 50% more omega-3 oils than what you generally get from fish oils.

If you are suffering from a low testosterone level then there is a herb from eastern Europe called Tribulus terrestris which in clinical trials boosted testosterone levels by 40% in 5 days. Dosage level is 750mg per day. This can be taken at the same time as Siberian Ginseng which will boost the immune system and act as a general tonic. Care should be taken as ginseng can increase blood pressure. You could try a propriety preparation called “Manpower II” which is a blend of 500mg tribulus terrestris and a sex boosting herb Horny goatweed. You can order it from www.victoriahealth.com

Essential oils will help relieve stress in men also and I would suggest looking at my other hubs on stress reduction. Essential oils such as Clary Sage, Geranium, Petitgrain, Lavender, Bergamot, Atlas and Himalayan Cedarwood, Chamomile, Frankincense, Sandalwood and Vetiver have been found very effective used in aromatherapy diffusers and inhaled.

Relaxation using visualisation techniques or a course of Reiki treatment will help enormously in coping with stress and depression.

Our bodies and organs all age and wear naturally, but in most cases our mind remains sharp and we still want the things we did in our teens. However, allow for your physical age or infirmity but keep your outlook and attitude young and fresh. If you do this you will appear to those you love and those around you as someone who is still fun and they want to know, not some curmudgeonly ill-tempered old f**t.

There is nothing wrong with becoming eccentric as you age but do try to avoid become weird and unsettling. So buy your motorcycle and leathers or that totally impractical sports car, chances are you only get one go at life.