“Male Menopause”…… Does It Exist?

RoseMarie Pierce, B.Sc. Pharm., “The Holistic Pharmacist”

Gynecologist Edward M. Lichten, M.D. confesses, “When I experienced the ‘hot flashes’ at 48 years of age and would wake with my night shirt soaking wet, no one suggested to me to measure my hormones. They said male ‘menopause’ was an illusion!” Men are in no way immune to menopause, more correctly know as andropause. Dr. Lichten found himself to be one of the 20 percent of baby boomers showing decreased levels of testosterone, below the normal range.

Andropause or “male menopause” is a phenomenon for which all men should take note. Sexual desire and sexual activity is a barometer of a man’s general health. Changes in sexual function can forecast heart disease, osteoporosis and diabetes, and can be a telling sign from the body.

What are the symptoms of “Male Menopause” or Andropause?

Although this phenomenon is controversial and often denied by the medical profession, men do experience a condition similar to female menopause between the ages of 40 and 55. Bodily changes accompanied by changes in attitudes and moods often occur at this time. The first, and possibly the most noticeable symptom of the male menopause, is fatigue. Typically, there are restless, interrupted sleep patterns at night with rare night sweats and a pronounced feeling of exhaustion upon rising in the morning. Andropausal men can also experience a decreased sexual drive, difficulty developing or maintaining erections, increased urinary frequency especially at night, impaired memory, a change in body shape (less muscle, more fat), and a decrease in strength or endurance. All this will probably be accompanied by a decreased ability to handle stress, mood swings, irritability, depression and a slump in a man’s overall sense of well being.

What role does testosterone play in “Male Menopause”?

“Male Menopause” is a medical condition that is considered a counterpart to menopause in women. A decline in the levels of sex hormones in both females and males occurs during this time although, in the male, there is also a more complicated pattern of physical changes. The main male sex hormones collectively are known as androgens, which mean ‘male producing’. Testosterone is the main androgen, 95% of which is produced by and secreted from the testicles. Testosterone is responsible for a man’s ability to perform sexually and for secondary sex characteristics such as: body hair, increased muscle bulk, body shape, and a deepening of the voice.

However, testosterone is much more than a sex hormone. There are testosterone receptor sites in cells throughout the body, most notably in the brain and heart. Testosterone has a role to play in nearly every aspect of a man’s physical function.

Total testosterone levels are highest in the early twenties and decline steadily from a man’s fortieth year on, at the rate of approximately 1 percent per year. This drop in total testosterone is so gradual that it may not explain all of the symptoms of andropause. What appears to be more relevant is the drop in free testosterone; this is the active form of testosterone that is not bound in the blood to the protein, sex hormone binding globulin (SHBG). This protein limits the amount of free (active) testosterone by hooking up to it, making it unavailable to tissue. As men get older, the mechanisms for freeing enough testosterone begin to shutdown, and one of the signs is an increased level of SHBG in the blood.

This increased binding of free testosterone helps to explain why most older men who are on testosterone-replacement therapy do not report long-term aphrodisiac effects. On the other hand, the herbs stinging nettle (urtica urens) and pygeum (prunus africana) are known to block the testosterone-binding effects of SHBG. Preparations made from the nettle root have a unique mechanism for increasing levels of free testosterone by displacing it from the SHBG binding site. Nettle root and pygeum extracts also benefit the prostate gland as a preventive treatment for benign prostatic hyperplasia (BPH).

What part does estrogen play in “Male Menopause”?

Estrogen also has a part to play in increasing a man’s blood level of SHBG.

A perfectly normal aspect of a man’s hormonal makeup is a small supply of estrogen. The same is true for a female to have a small supply of testosterone. In the bodies of both men and women, the balance of estrogen and testosterone is critical. The two hormones are chemically quite similar. The male body can convert a certain portion of testosterone into estrogen using an enzyme found in the adrenal glands and fat cells called aromatase. This conversion process is necessary for the healthy functioning of estrogen-sensitive tissues in a man’s body. Estrogen is extremely beneficial to the male brain. However, as a man grows older, he produces larger quantities of aromatase, which convert excessive amounts of testosterone to estrogen. If estrogen levels get out of hand, the estrogen to testosterone ratio shifts and estrogen will compete with the masculinizing effects of testosterone. Estrogen has a powerful opposing or reducing effect on testosterone, increasing the risk of heart attack or stroke, as well as a cell growth promoting effect on the prostate gland, increasing the occurrence of benign prostatic hyperplasia or BPH. Also, estrogen increases the body’s production of SHBG, which lowers the amount of the active free testosterone. Conversely, high levels of testosterone will depress production of SHBG.

Estrogenic chemicals, known as xenoestrogens, found in our commercial foods and our environment, also have a powerful estrogen-like effect on the human body. This also adds to the estrogen overload.

In contrast, organic, non-GMO soy protein foods and flaxseeds have a positive effect on the estrogen over-load. Both are high in isoflavones, a type of natural phytoestrogen that competes with estrogen for receptor sites and blocks its action. The herb saw palmetto also seems to have a similar phyoestrogenic blocking effect on estrogen receptor sites

What is the connection between obesity, estrogen and “Male Menopause”?

In many cases, obesity, especially in the abdominal area, is attributed to male hormonal imbalances. Fat cells contain large amounts of the aromatase enzyme, and estrogen is stored and manufactured in fat. Fat cells synthesize the aromatase enzyme, causing male hormones to be converted to estrogen. Therefore, an increase in fat will cause estrogen levels to go up. Eating high-fat foods may reduce the levels of free (active) testosterone. A fat-containing meal can reduce free testosterone levels for about 4 hours. Central obesity (potbelly) is recognized as a risk factor for cardiovascular disease and type II diabetes. Obese men suffer from testosterone deficiency caused by the production of excess aromatase enzyme in fat cells and also from the fat they consume in their diet.

Medical doctor, Eugene Shippen in his book, The Testosterone Syndrome” states that, alcohol, grapefruit and a number of drugs: NSAIDS, antibiotics, analgesics, antibiotics, antifungal agents, anti-lipid agents (statins), SSRI type anti-depressants, beta-blockers, calcium channel blockers and abusive substances such as marijuana, cocaine and amphetamines inhibit the liver’s primary processing enzyme system known as P450. This results in slower metabolism or breakdown of estrogen and therefore, increased estrogen levels in the body. Substances that increase the P450 enzyme system and decrease estrogen levels include: high-dose vitamin C (1-3 grams), niacin (all the B vitamins are valuable during andropause), soy protein, cruciferous vegetables (broccoli, cauliflower), oysters, and grape seed extract.

Alcohol also decreases zinc levels, and zinc is known to play a beneficial role in the male body as an inhibitor of excessively high levels of aromatase.

Many men can help restore a proper testosterone/estrogen balance through supplementation of zinc (citrate or chelate), at a suggested dose of 30 to 90 mg./day for a period of six months.

In men over forty, maintaining a youthful level of free testosterone has many health benefits and often requires dedicated effort. However, studies show that men are often reluctant to admit, even to themselves, when they need help dealing with sexual health problems. Hopefully, this article has provided some of the information needed to support those who recognize themselves or their loved ones experiencing the “male menopause” phase of life.

Male Menopause References:
1) Shippen, E. The Testosterone Syndrome, NY: Evans & Co., 1998.
2) Sheehy, G. Understanding Men’s Passage, NY: Random House, 1998.
3) Rose, M. A Woman’s Guide to Male Menopause, LA: Keats Publ. 2000.
4) Saul, D. Sex For Life, BC: Apple Publ. 1999.
5) Martin,P. Testosterone & regional fat distribution, Obes Res 1995 Nov;3
6) Gooren, L. Endocrine aspects of aging in the male, Mol Cell Endcr. 1998 Oct 25;145(1-2):153-9
7) Lichten, E., M.D. http://www.usdoctor.com/testost.htm

RoseMarie Pierce, B.Sc.Pharm, earned her degree in Pharmacy from Dalhousie University in 1972. After extensive studies in herbal and nutritional medicine, RoseMarie integrated these disciplinary practices with her pharmacy education to become Canada’s first Holistic Pharmacist.