Vitality for the Aging Man
Men, if you feel like you are losing your mojo then maybe it time to check your testosterone level. Aging men will have a predictable decline in the male sex hormone, testosterone, leading to decreased energy and fatigue, weight gain, loss of muscle mass, and loss of sex drive or erectile function. They will also have increasing risk for heart disease, diabetes, osteoporosis and dementia.
The decline in male hormones is called andropause, with a decline in hormones similar to menopause in women, but it occurs over 10-15 years instead of the few years it takes for menopause. And men can supplement their hormones, just like women.
With declining testosterone levels men tend to feel more and more apathetic, with decreasing motivation, security, and confidence. Feeling so blah causes many men to feel anxious or depressed. Insomnia is also common.
Testosterone Replacement Therapy (TRT) is a well-established science and there are hundreds of studies documenting the safety and effectiveness of TRT. Some of the largest studies, and some over 20 years long, show that men who are low in testosterone have about a 50% increased death rate over the subsequent decade when compared to men with normal testosterone levels.
Heart disease is the number one killer in men and testosterone helps prevent it by improving the cholesterol profile, discouraging blood clots, and by keeping blood vessels open and elastic. Testosterone can be given to men with advanced heart disease and is shown to improve their functional ability to stress the heart.
Sarcopenia is the age-related loss of muscle mass, strength and function. Muscle is replaced by fat and fibrous tissue. Hormone decline – particularly androgens like testosterone – is one of the biggest reasons for sarcopenia in men and women. Maintaining muscle mass means less frailty, more energy and more stamina.
Testosterone indirectly prevents diabetes by preventing sarcopenia. But, TRT also has a direct effect on helping insulin work well. Several studies show men who replace testosterone need about 50% as much insulin. Adding TRT to an exercise program results in much better blood sugar control than exercise alone. I consider TRT in all my patients with type-2 diabetes or metabolic syndrome X.
Osteoporosis or “brittle bones” is not as common in men as women, since men build stronger bones in the first place due to testosterone. However, the mortality and disability caused by osteoporosis in men in worse than in women. Again, TRT has a direct stimulating effect on bone – testosterone will build bone.
Dementia and depression are much higher in men with low testosterone levels. Testosterone has both protective and growth stimulating effects on nerve tissue in the brain, and is shown to have a regulating effect on the plaque that accumulates in the brain with Alzheimer’s dementia. TRT improves cognition and mood, especially abstract and spatial skills such as reading a map, coordination and balance, and motor control.
The myth of testosterone causing prostate cancer has been thoroughly debunked. In fact, at the time of diagnosis, men with prostate cancer tend to have a lower testosterone level than average. Men with low testosterone also tend to have more aggressive forms of prostate cancer. TRT does not increase the risk of cancer and studies show it is even safe to use TRT after treatment of prostate cancer.
Recently there have been several studies suggesting a link between TRT and increased risk of heart disease. Both of these studies have some serious flaws in their methodology and major review boards such as the Pharmacovigilance Risk Assessment Committee (PRAC) of the European Medicines Agency (EMA) have reported “there is no consistent evidence that the use of testosterone in men with hypogonadism increases the risk for cardiovascular problems”.
Starting TRT involves first checking blood levels of testosterone and if they are lower than optimal then you may start TRT. I recommend getting the “free” T level in addition to the “total” T, as the free portion is the active portion. With aging the free portion tends to get smaller and smaller in proportion to the total and more accurately determines if T levels are low.
One can raise T levels with a few natural supplements. Diindolylmethane, or DIM, is derived from cruciferous vegetables such as broccoli and can effectively raise free T levels by improving the metabolism of estrogens. Other natural supplements are known to raise T levels 10-30%, such as Tribulus terrestris, chrysin, nettle root or muira puama.
Prescription TRT options include under the tongue tablets, topical creams or patches, weekly injections, or implanted time-release pellets. Improved mood, energy, sleep, sex drive and general outlook will usually happen within a few weeks of starting TRT. It may take a few months to fully appreciate the improved stamina, muscle building, fat burning and erectile function effects of TRT.
There are a few caveats to testing and monitoring TRT. Once on TRT one should get a “free” testosterone blood level, and monitor the normal by-products, estradiol and DHT. We also watch for increases in red blood cells or the prostate specific antigen. I suggest only considering TRT with a physician who is familiar with the process.
Scott Rollins, MD, is Board Certified with the American Board of Family Practice and the American Board of Anti-Aging and Regenerative Medicine. He specializes in bioidentical hormone replacement for men and women, thyroid and adrenal disorders, fibromyalgia and other complex medical conditions. He is founder and medical director of the Integrative Medicine Center of Western Colorado (www.imcwc.com) and Bellezza Laser Aesthetics (www.bellezzalaser.com). Call (970) 245-6911 for an appointment or more information.