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  1. #1
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    Default Low Male Hormones: Hypogonadism in the Aging Adult Male

    Menopause has generated a large population of women who have excessive rates of bone fracture and CHD due to hypogonadism – low hormone levels. Andropause, which refers to sexual regression touches all men sooner or later over 40. The word appeared in the literature in 1952 and is defined at the ‘”‘natural cessation of the sexual function older men.'”‘ Low hormone levels have detrimental influences on mood and mental abilities with decline of memory as well as affecting sexual functioning. The sexual aging process causes organic impotence, ejaculatory and urination problems, decreased sexual motivation and deterioration of the general condition.
    Endocrinologically, the difference between the irreversibly hypogonadal man and the post-menopausal hypogonadal woman is not very great. (1) Neither has adequate levels of androgens or estrogens and they both can be expected to show similar tendencies; i.e. hypogonadal men also tend to have frequent MI’s and bone fractures. There is some evidence of a protective effect of testosterone against heart attacks and bone fracture.
    Testosterone is the hormone which regulates the structure of all body proteins and assures the development and integrity of the genitals in males. The testicles normally produce about 7-10mg of testosterone daily. A deficiency below this level causes only modest changes initially such as an increase in weight, progressive aging of the face, muscular weakening, weakening of bone tissue sometimes followed by rheumatism and arthritis of the vertebrae. Slow transformation of the body organs causes the failing of memory, irritability, general fatigue, the development of arteriosclerosis, varicose veins, hemorrhoids, atrophy of the skin, hypertension and increased cholesterol and body fat.
    Androgens and estrogens have similar metabolic effects in the liver where testosterone is enzymatically converted into estradiol. This hormone causes breast enlargement in men as well as all the female changes that occur in women. During menopause, women typically experience hot flashes, but no similar consistent signal seems to appear in aging men as they develop hypogonadism. However, most men do experience hot flashes when hypogonadism is abruptly induced by pharmacological agents that rapidly abolish lutenizing hormone (LH). The absence of obvious symptoms and the slow course and unpredictability of the development of hypogonadism contribute to its lack of recognition and attribution to “normal aging”. The loss of sexual drive and “the impotence experienced by hypogonadal men tends to be accompanied not by frustrated sexual urges or corresponding complaints of frustration but rather by passivity” according to Dr. Swartz in his article on Low Serum Testosterone. More than half of the healthy men over age 70 that he surveyed showed morning serum testosterone levels at or below 300ng/dl, the customary threshold of hypogonadism. One of the earliest signs of impending impotence is ejaculation without full erection. Men who notice that they masturbate and ejaculate without full erection should be seen by their physician.
    One of the major causes of impotence is heavy drinking which is common in 25% of American men at some time during their adulthood. The relationship between alcohol consumption and testosterone secretion has both reversible and irreversible components. Serum testosterone abruptly rises to normal levels when high alcohol intake is discontinued but moderate alcohol intake does not substantially affect its level in men less than 60 years of age. However, the very low serum testosterone level –under 300ng.–was found in 62% of long abstinent ex-alcoholic men over the age of 60 and in only 15% of nonalcoholic men of the same age, indicating that past heavy drinking is associated with a reduction of the current morning serum testosterone level by an average of 122ng/dl. Therefore, alcohol induced hypogonadism is common and may affect many men over the age of 60. A moderate amount of alcohol is the equivalent of 1-2 ounces per day or 2-4 beers or glasses of wine or 2 shots of hard liquor. Women are much more sensitive to alcohol’s effects and no more than three drinks a week are recommended to reduce breast cancer risk.
    The best-known consequences of hypogonadism in men are impotence and dwindling libido, but melancholia and psychiatric disturbances can also occur in association with testosterone deficiency. Perhaps the most dangerous consequence of hypogonadism in men is myocardial infarction (MI). Serum testosterone levels were about 90 ng/dl lower in patients who had suffered MI than in those who had not. Results also suggested that low testosterone levels predispose to MI and are lower in men with severe coronary artery atherosclerotic disease than in controls. Very high blood levels of testosterone might protect against atherosclerosis especially in men over age 60.
    Testosterone is not the only androgen that appears to protect again MI. Dehydroepiandrosterone (DHEA) is a precursor of testosterone which has digitalis like effects and strengthens the heart muscle. Both testosterone and DHEA prevent the death of CNS nerve cells and suggest that there are beneficial systemic effects in maintaining blood levels of androgens similarly to the benefits of maintaining normal thyroid hormone levels. Testosterone has been found to inhibit clot formation and hardening of the arteries by increasing HDL and decreasing serum triglycerides. It also strengthens muscles beyond normal limits and in cardiac tissue, testosterone is the androgen of greatest concentration. Testosterone can make heart muscle more resistant to death during ischemia through improved maintenance of cardiac output as well as generating feeling of well-being, greater strength and return of libido.
    There are health problems in aging men associated with testosterone administration. Enlargement of the prostate, accelerated progression of undiagnosed prostate cancer, increased hematocrit and a variety of liver lesions can occur. Administering testosterone by intramuscular injection tends to avoid the liver toxicity seen with oral preparations. Administration of testosterone cypionate reduced HDL and synthetic androgen also increase total serum cholesterol. Synthetic androgens are not preferable to preparations of testosterone itself.
    Natural testosterone has been available for over 60 years. Most of the anabolic (tissue building) steroids are synthetic analogs of natural Testosterone, the male hormone. Usually they are taken orally in large quantities which are dangerous and can cause serious liver diseases as well as organ failure; examples such as stanozolol or Winstrol and Android or methyltestosterone, are used by bodybuilders. Injections of nandrolone deconate, or Durabolin, have been available for over ten years. It is a synthetic hormone which transforms to produce both testosterone and excess estradiol which can cause gynecomastia (breast enlargement) in men. Testosterone’s action on the muscles has been observed by young male athletes who try to bulk up and recover faster.
    These hormones cause increased incorporation of new amino acids which increase protein synthesis and result in growth or hypertrophy of the muscle. They are used to treat breast cancer, anemia, hypogonadism and replacement therapy in deficient males.
    Natural Testosterone can be used safely in large doses by men who are deficient . Physiologic doses present no apparent health risks. A novel method of administration through a skin delivery system is now available pharmaceutically. (2) Testoderm(c) is a patch delivery system of natural testosterone. It delivers 4-6mg of testosterone daily and is applied to the shaved scrotum. Since the normal pattern is to have higher levels in the morning, the patch is applied each morning and results in a surge of hormone within a few hours of application. Self-administration by this technique is safe but awkward. A Dihydroxytestosterone gel and a natural testosterone cream, in various doses up to 100mg., are also available for hormone replacement in men. These are prescription items and need to be applied twice daily due to their short duration of action. The hormone testosterone is naturally derived and is identical to that secreted by the testicles. Testosterone pellets , containing 25mg., can be inserted beneath the skin to deliver testosterone over 4-months.
    It does not take much hormone to exceed the recommended physiologic dosage. Monitoring by a physician and regular blood tests are important. A study is now underway in this office using the testosterone cream. Depot or longer lasting injectable preparations are synthetic steroid supplements and should only be give intramuscularly by injection under physician supervision. These synthetic products do have various potentially dangerous side effects. It is also extremely dangerous for women to take steroids since they can become masculinized and grow facial hair among other problems they may develop. However testosterone does convert to progesterone in the female and it has been used successfully as an implant in a low dose, for women with decreased sex drive due to menopause.
    The testosterone cream is a prescription item and requires an early morning blood test to check the serum level before starting on the hormone therapy. It is also recommended that the PSA (prostate surface antigen) and a DRE ( digital rectal exam) be done prior to hormone treatments.
    Testosterone cream costs about $20.00 per month depending on the dose used and is applied directly to the scrotum or penis twice a day. Monthly testing must be performed initially to check your hormone response levels and should be covered by your insurance. Please keep your appointments and report your results to the doctor.
    Get It Done!

  2. #2
    BigZ MC Site Admin Board Certified MD

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    My question to all of this is this: Is this a "new normal?" It seems we hear much more of this happening these days than we did in the past. Is this only because we know more and have it checked out and we didn't really report low testosterone back in the 70s? We hear a lot about how the environment today is feminizing males. Is this part of it? I really wish the steroid laws would be repealed so real studies can be done.

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    Preach it brother.
    Get It Done!

  4. #4
    BigZ MC Site Admin Board Certified MD

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    Oh don't get me started! We're legalizing cannabis/marijuana all over the place, and we can't legalize a hormone that naturally occurs in the body? Somethings really wrong with that. We were all fine and dandy before Biden came along and whined because he thought he was slighted by a better athlete in college who "had to be using steroids" just because he beat him. And then Congress and the Senate did what they always do and completely IGNORE all the real experts in the medical field and the FDA and slapped steroids into the schedule III list. I don't want to get too far off the topic of this thread, but it seems to me that re-legalizing would help men as they age and experience lower hormone levels. Need more study in this area.

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