If all the hormones in the body work together like musical instruments in an orchestra, it means that male menopause is not only about low testosterone. The other players are also out of tune. If you’ve read about “male menopause”, you probably know about testosterone. In fact, in the first edition of Health Intelligence, a lot was explained about this hormone in the article “A moody man with no libido”. Dropping levels of testosterone cause many of the complaints of the typical grumpy man in the grips of a mid-life crisis. Indeed, if the hormones in the body work together like the instruments in an orchestra, testosterone is the strings, while estrogen is the brass section. If the testosterone level fades, estrogen begins to overpower and, before long, the whole orchestra plays out of tune.
So a better overall balance of hormones is required as a man grows older. The thing is, this involves not only testosterone and estrogen, but also all the other hormones. The challenge is noticing the discord when it starts, because the first few bad notes may be subtle and are often blamed on stress or simply getting older.
Men don’t usually come to the doctor’s once complaining about male menopause, also called andropause. The more common scenario is a fifty-something executive, slightly overweight, appearing exhausted and irritable, reluctantly showing up for a check-up. It was his wife, enquiring into her menopausal status the week before, who had mentioned to the doctor, “You know, I think my husband should come and see you. He hasn’t been himself lately. He’s grumpy. He lies down on the couch any chance he can get. He complains of vague aches and pains, and I can’t remember the last time we had sex!”
By asking a few probing questions, the doctor finds out that his symptoms were slower and more insidious in onset than his wife’s but, just as dramatic in their eventual outcome. Men traditionally tend to have a more stoic and fatalistic approach to encroaching signs and symptoms, but as an imbalance in hormone levels typically affects a man’s sexual performance first, this is often what propels him to seek medical attention.
The danger of ignoring all the other signs of declining hormone levels – those – offkey notes of the orchestra getting rusty – is that andropause is not necessarily a harmless, “natural” process. It often comes with major physical and mental changes that, over the long term, can have a dramatic effect on slowly developing diseases. But exactly what do these changes involve and when do they start?
Highs and Lows
Male menopause is a gradual shift in hormonal, physiological and chemical balances that occur in all men between the ages of 40 and 55, although it can occur as early as 35 and as late as 65 (1)
Incidentally, the term “hormone” is derived from the Greek word hormo, which means to set in motion. This is precisely what hormones do. Hormones are involved in almost every biological process, including sexual reproduction, growth, metabolism and your body’s immune response. It’s no wonder that the symptoms of andropause are so varied and widespread. Hormones stimulate, regulate and control the function of various tissues and organs and are manufactured by specialised groups of cells in your glands. These glands, which include the hypothalamus, pituitary, thyroid, adrenals, ovaries and testes, release the hormones into the body as and when they’re needed. But as men grow older, a slow change begins to set in.
The Slow fall
Hormone levels that decline as a man ages are:
- Growth hormone
- Dehydroepiandrosterone (DHEA)
The Gradual Rise
Hormone levels that go up with andropause are:
As mentioned before, testosterone is the strings in the ageing man’s orchestra of hormones – when it begins to fade, estrogen takes over. The detrimental effects of this drop in testosterone is summarised below.
Why Low Levels of Testosterone Are Dangerous
Studies have shown that too little testosterone in the ageing man’s blood is linked to:
- Heart disease (2)
- Declining memory (3)
- Anxiety (4)
- Depression (5)
- Alzheimer’s disease (6)
- Diabetes and metabolic syndrome (7)
- Loss of muscle mass and strength (8)
- Loss of bone thickness and strength (9)
- A greater chance of dying from any cause (10)
The fears around testosterone replacement therapy and whether it may cause prostate cancer have also been laid to rest by definitive studies. (11)(12) But what about the effects of all the other fading players in the hormone orchestra?
DHEA is a hormone made by the adrenal glands, gonads (testicles and ovaries), brain and skin in both men and women. It also declines with advancing age. By the time we are 70-80 years of age, peak levels of DHEA are only 10-20% of those in young adults (13)
As DHEA is the most important and abundant steroid hormone and the precursor of all other sex hormones, it serves extremely well to help restore many functions in the body. Low levels of DHEA are associated with ageing and most diseases of ageing.
Studies have shown that the dramatic age-related drop in DHEA levels is accompanied by an equally dramatic rise in heart disease.(14) It seems DHEA is incorporated into both HDL “good” cholesterol and LDL “bad” cholesterol and helps to protect both from becoming oxidised – a process that spells trouble for the heart and arteries. As our DHEA levels drop with age, less of this hormone is available to protect our cholesterol and the more at risk we are of developing heart problems.
It’s well known that cortisol, the stress hormone, harms the brain. But DHEA, due to its action in keeping cortisol in check, appears to protect the brain from these damaging effects (15)
Many of the diseases of ageing, such as heart disease, Alzheimer’s, certain cancers, diabetes and osteoporosis, are all linked in one way or another to inflammation. Studies have shown that DHEA is an effective anti-inflammatory and maintaining youthful levels of this hormone as we age may play a key role in protecting us from these in inflammatory diseases (16)
DHEA is also a mood modulator (17) One study showed that supplementing with 50mg of DHEA every night for six months in both men and women, aged 40-70, improved energy levels, quality of sleep, mood and the ability to handle stress (18)
How to Boost your DHEA Levels Naturally:
- Eat a low-calorie diet containing less than 40g of carbohydrates per day
- Exercise and meditate
- Take part in creative, physical activities that reduce stress.
A drop in growth hormone (GH) as you grow older can also have a dramatic effect on your sense of well-being. GH has multiple protective roles and is responsible for our major growth spurt during puberty.(19) In adulthood, GH maintains skin, muscle and bone health. With a deficiency of this hormone, signs of ageing are quickly accelerated. Skin wrinkles and sags; fat soon replaces muscle. GH also helps maintain and repair the health of various organs, including the heart, lungs, liver kidneys joints, nerves as well as the brain. As growth hormone activates the calming, regenerative parasympathetic nervous system, a deficiency may result in increased tension, anxiety, depression and a decreasing ability to cope with stress.
From the age of 30 onwards, GH levels decline fairly rapidly, about 1-3% per year. This loss is quickly accelerated if you’re obese. The most efficient way to replace GH is through daily injection, similar to a diabetic insulin injection. Most anti-aging doctors will not treat GH in the first year of restoring optimal hormone levels, as a protein rich diet, adequate sleep and exercise programme, and the replacement of testosterone, progesterone, melatonin and thyroid levels, may increase GH levels by as much as 20-30%. Treatment with GH begins only when all the other hormone levels in the body have been brought back to normal.
How to Boost your GH Levels Naturally:
- Supplement your diet with amino acids
- Exercise daily
- Make sure all the other hormones are at youthful levels
- Eat a diet rich in proteins
- Avoid alcohol, sugar, sweets, breads and pasta
- Lose weight
- Avoid milk products
- Avoid sleep deprivation
- Avoid prolonged stress.
In the third edition of Health Intelligence, we wrote in depth about progesterone replacement therapy for men, who typically produce between 1,5-3mg of this hormone per day. But as men age, progesterone levels fall exponentially. Progesterone is used in the production of cortisol, the stress hormone. So, if a man leads a particularly stressful life, it’s very likely he will have low levels of progesterone. This hormone is vital in keeping the higher levels of estrogen in aging men in check and thus minimising the risk of heart attacks, prostate enlargement and prostate cancer. If a typical dose of progesterone may lower estradiol levels – a cancer-causing form of estrogen – by up to 30%.(20) Progesterone also lowers the hormone responsible for causing hair loss and baldness in men, called dihydrotestosterone (DHT), while reducing water retention and possibly high blood pressure. (21)
How to Boost your Progesterone Levels naturally
- Eat a diet rich in protein
- Manage stress daily with stress reduction techniques
- Supplement with herbs and nutraceuticals, such as Rhodiola rosea, siberian ginseng, liquorice root extract, ashwagandha and vitamins B5 and C.
Melatonin, the sleep hormone, is another hormone on which to keep an eye with advancing age. Signs that you may be deficient include light, restless sleep with many anxious thoughts, easy waking during the night, difficulty falling asleep and falling back asleep once you’re awake, bad dreams or poor dream recall, anxiety at night, depression (especially the winter blues) excessive emotionality and irritability, and restless leg syndrome with increased muscle spasms. You may also have intestinal spasms or cramps. Melatonin has a positive effect on the part of our nervous system involved in rest and relaxation. In particular, melatonin plays a part in slowing the release of adrenalin, so, without enough of it, the body reacts with a fight-or-flight response.(22) Melatonin may also improve your sexual performance, particularly enhancing serenity and relaxation after sex.(23)
Studies have linked a melatonin deficiency to hypertension, artery disease, heartbeat irregularity, obesity, diabetes, osteoporosis, lowered immunity with recurrent infections, breast and prostate cancer, and brain diseases like Parkinson’s and Alzheimer’s disease. Melatonin supplements should be taken at bedtime, either under the tongue or in pill form. It works best when you combine it with vitamin B6 and tryptophan or 5-hydroxytryptophan, which convert to melatonin with the help of vitamin B6. Interestingly, some asthmatics may react negatively to melatonin, so use with care if you‘re an asthma sufferer.(24)
How to Boost your Melatonin Levels Naturally
- Increase your exposure to morning daylight (use a sunlamp)
- Make the room pitch black at night, use an eye mask
- Avoid alcohol and caffeinated drinks
- Avoid stressful activities
- Avoid electromagnetic exposures at night such as to cell phones or electrical clocks and radios
- Wear turquoise coloured glasses 30 minutes before bed.
Pregnenolone is made from cholesterol and is the mother of many hormones, including DHEA, testosterone, estradiol, progesterone, cortisol and aldosterone.(25) In addition to functioning as a hormone, it also serves as a brain chemical, or neurotransmitter, in specific areas of the brain responsible for memory. Pregnenolone regulates the flow of calcium through the cell membrane, and this process determines how memory is encoded by our nerve cells. In addition, pregnenolone increases the levels of the neurotransmitter acetylcholine, the brain chemical responsible for creating memories, as well as assisting the main part of the brain that stores memory. (26) The most common complaints of men with pregnenolone deficiency include memory loss and joint pain, as well as dry skin and fatigue. Replacement doses are typically 30mg twice a day for memory loss.
You may choose to use other brain boosting nutraceuticals such as:
- Acetyl-L -carnitine
- Phosphatidylserine, combined with omega-3 fatty acids
- Vitamin D
Oxytocin, a hormone known to improve social bonding, is made by the pituitary gland in the brain. It helps us fall in love, spurs parenting instincts and intensifies orgasms. Studies have found that similar to women, men report an improved sexual response in all respects when using an oxytocin nasal spray, including stronger feelings of tenderness and closeness with the sexual partner before, during and after sex.(27)
Armed with information about the importance of youthful hormone levels at hand, there is no reason why men of a certain age couldn’t stay completely tuned into the music of life, no matter what their age.
The following Aspects Boosts Oxytocin levels Naturally
- Romantic love
- Soft touching
- Partner support
- Physical exercise
- Warm climate
- Positive environment
- Positive social contacts
- Viewing pictures of loved ones
- Living with others (cohabitation).
- Jed Diamond. Male Menopause Sourcebook INC. Naperville, IL 1998, 1v
- English K, et al. Men with coronary artery disease have lower levels of androgens than men with normal coronary angiograms. Eur Heart J. Jun 2000;21(11):890-4
- Moffat SD, et al. Longitudinal assessment of free testosterone concentration predicts memory performance and cognitive status in elderly men. J Clin Endocrinol Metab. Nov 2002;87(11):5001-7
- Cooper MA. Testosterone Replacement Therapy for Anxiety Am J Psychiatry. November 2000;157:1884
- Margolese HC, et al. The male menopause and mood: testosterone decline and depression in the aging male–is there a link? J Geriatr Psychiatry Neurol. Summer 2000;13(2):93-101
- Gouras GK et al. Testosterone reduces neuronal secretion of Alzheimer’s beta- amyloid peptides. Proc Natl Acad Sci USA. Feb 2000;97(3):1202-5
- Laaksonen DE, et al. Testosterone and sex hormone – binding globulin predict the metabolic syndrome and diabetes in middle-aged men. Diabetes Care. May 2004;27(5):1036-41
- Bhasin S. The dose-dependent effects of testosterone on sexual function and on muscle mass and function. Mayo Clin Proc. Jan 2000;75 Suppl: 70-5
- Van Den Beld AW, et al. Measures of bioavailable serum testosterone and estradiol and their relationships with muscle strength, bone density and body composition in elderly men. J Clin Endocrinol Metab. Sep 2000; 85(9):3276-82
- Gail A. Low serum testosterone and mortality in older men. J of Clin Endocrin and Metab. Jan 2008;93(1):68-75
- Morley JE. Testosterone replacement and the physiologic aspects of aging in men. Mayo Clin Proc. Jan 2000; 75 Suppl: S83-7
- Roddam Aw et al. Endogenous sex hormones and prostate cancer: a collaborative analysis of 18 prospective studies. J Natl Cancer Inst. Feb 2008;100(3):170-83
- Genazzani Ad, et al. Might DHEA be considered a benefcial replacement therapy in the elderly? Drugs Aging. 2007;24(3):173-85
- O’ Donnell AB, et al. The health of normally aging men: The Massachusetts Male Aging Study. Exp Gerontol. Jul 2004;39(7):975-84
- Canning MO, et al. Opposing effects of DHEA and dexamethasone on the generation of monocyte-derived dendritic cells. Eur J Endocrinol 2000;143:685-95
- Straub RH, et al. Serum Dehydroepiandrosterone (DHEA) and DHEA Sulfate Are Negatively Correlated with Serum Interleukin-6 (IL-6), and DHEA Inhibits IL-6 Secretion from Mononuclear Cells in Man in Vitro: Possible Link between Endocrinosenescence and Immunosenescence. The Journal of Clinical Endocrinology & Metabolism. 1998;83(6):2012-17
- Cameron Dr, Braunstein GD. The use of dehydroepiandrosterone therapy in clinical practice. Treat Endocrinol. 2005;4(2):95-114
- Morales AJ, et al. Effects of replacement doses of DHEA in men and women of advanced age. J Clin Endo Metab. Jan 1994;78(6):1360-67
- Hertoghe T. The Hormone Handbook. International Medical Publications, UK. p54
- See reference 13, p247
- See reference 13, p246
- See reference 13, p47
- Drago F, Busa L. Acute low doses of melatonin restore full sexual activity in impotent male rats. Brain Res. 2000;878 (1-2):98-104
- Sutherland E, et al Elevated serum melatonin is associated with the nocturnal worsening of asthma. Jour Allergy Clin Immunol. 2003;112:513-17
- See reference 13, p144
- Schumacher M. Neurosteroids in the Hippocampus: Neuronal Plasticity and memory. Stress. Oct 1997;2(1):65-78
- Burri A, et al. The acute effects of intranasal oxytocin administration on edocrine and sexual function in males. Psychoneuroendocrinology. Jun 2008;33(5):591-600
- Herthoge T. Passion, sex and Long Life: The Incredible Oxytocin Adventure. International Medical Books, Luxemburg. 2009:103
Dr. Bruce Hoffman, MSc, MBChB, FAARM, IFMCP is a Calgary-based Integrative and Functional medicine practitioner. He is the medical director at the Hoffman Centre for Integrative Medicine and The Brain Centre of Alberta specializing in complex medical conditions. He was born in South Africa and obtained his medical degree from the University of Cape Town. He is a certified Functional Medicine Practitioner (IFM), is board certified with a fellowship in anti-aging (hormones) and regenerative medicine (A4M), a certified Shoemaker Mold Treatment Protocol Practitioner (CIRS) and ILADS trained in the treatment of Lyme disease and co-infections. He is the co-author of a recent paper published by Dr. Afrin’s group: Diagnosis of mast cell activation syndrome: a global “consensus-2”. Read more about Dr. Bruce Hoffman.