Grumpy, tired and tubby? Why your man might need HRT
IT’S not just women — men, too, can have a midlife hormone crisis, says DR ERIKA SCHWARTZ, and natural treatments could be the solution. In the final part of her series, she explains the options . . .
Whatever our age, we all have constant fluctuations in our hormones. When they are in balance, the results are amazing — our skin looks radiant and fresh, our minds work smoothly, we remember things, we focus well, our weight and moods are stable and our sex drive soars.
But when they are out of balance, problems can occur: we may have difficulty concentrating, we get tired and stay tired, we can’t catch up on sleep, we lose interest in sex, become bloated and gain weight.
We develop aches and pains in our joints, our skin becomes wrinkled and dry, we have digestion problems, arthritis, heart disease . . . put simply, we age.
Nor are men immune from the effects of hormonal imbalance.
When I began studying hormones, I never thought in terms of men.
I wanted a safe solution for my personal menopausal symptoms, and by association found solutions for my female patients.
But it wasn’t long before they started to discuss and include their husbands and partners, and for the past 15 years or so I have treated men, too.
the male menopause, technically called ‘andropause’, has never been in the spotlight because men who experience it have been reluctant to acknowledge its existence.
But, just like women, when men start ageing their hormone levels decline. the middle-age belly, the unwillingness to get up off the sofa and the grumpy moods associated with men in their middle years are clear symptoms of a natural drop in testosterone.
Unfortunately, the medical profession has not been keen to address this obvious similarity to female menopause.
Of course, researchers have been studying andropause for decades, but it was the pharmaceutical companies who first saw an opportunity in this group of ageing men — in the form of viagra.
The problem was that this addressed one isolated symptom: poor erections (viagra works by increasing blood flow to the penis). It does not resolve the root cause of the andropause — a drop in testosterone.
and there are risks with taking viagra if the man is older, has high blood pressure, or suffers from heart problems.
this is because viagra, by diverting blood from the heart, lungs and brain, can induce a rapid drop in blood pressure to the organs that need the blood flow the most — potentially increasing the risk of stroke and heart attack.
and in any case, to feel sexual interest, you need hormones — viagra does not help with this.
It’s not just sexual desire that flags — as their hormone levels start to dwindle, men might notice night sweats, mood swings, depression and weight gain.
Men need help with hormones just as much as women do.
every day, one of my female patients brings up the topic of male menopause. the question is invariably: ‘ how can I help my partner?’ the good news is that, for men using natural hormones, the payoff is just as high as it is for women.
But andropause is a dirty word in our society — few talk about it, which means the road to finding a hormonal solution is a lot steeper for men than it is for women.
SHOULD I BE TAKING TESTOSTERONE?
treating men who are going through andropause is much easier than treating women. It takes only one hormone — testosterone.
In the past 15 years or so, some doctors have started to prescribe the hormone to men. But mainstream medicine has resisted the idea.
as a result, testosterone levels are not routinely measured in general physical examinations.
even if they are, what is considered the ‘normal’ range is so wide that a mild deficiency is unlikely to be treated — even if that man is experiencing significant symptoms.
Men in the UK are very unlikely to be prescribed testosterone on the NhS unless they have a disorder such as hypogonadism (where the testicles don’t produce the hormone as a result of disease or damage).
Indeed, many doctors argue that male symptoms are actually a sign of unhealthy ageing rather than the andropause.
Certainly, there is much to be gained from adopting a healthy diet — including weight loss, which may trigger a rise in testosterone. Sleep is important, too, as sleep deprivation can cause testosterone levels to drop alarmingly. You should also try to reduce stress and exercise regularly. however, I firmly believe there is also a role for hormone treatment — specifically, with testosterone.
I prescribe my patients natural, or ‘bio-identical’, hormones that are derived from plants — the testosterone form comes from yams.
Bio-identical hormones have the same chemical structure as our own hormones and are gentler than conventional synthetic hormones. For while synthetic hormones are similar to the ones our bodies naturally make, they are not exactly the same.
the similarities mean these kinds of hormones are able to alleviate some symptoms by tricking your body into thinking it is getting the human hormone. But you could be worsening the situation by replacing your own good (albeit depleted) hormones with synthetic substitutes, and adding foreign substances to your already stressed system. there are two types of bio-identical products: those with a set (or ‘standardised’) dose made by the drug companies and which could be prescribed by an NhS doctor, and those made up to your specific requirements by so- called ‘compounding’ pharmacies.
these compounded forms are only available through a private doctor or clinic.
Standardised bio- identical testosterone comes in several forms: androgel (a gel that you rub on to your shoulders once or twice a day); a testosterone implant; or twice- weekly or monthly injections in the thigh or buttocks.
the injections contain bioidentical testosterone combined with a synthetic substance that helps the body absorb the hormone. there is also a bio- identical testosterone patch, androderm.
I tend to prescribe androgel or compounded creams — using compounded products isn’t necessary, but some men prefer these. I also prescribe the patch, or twice- weekly injections — which raise levels faster — if the man isn’t squeamish about giving himself a shot.
Some readers might wonder why I am happy to use these injections (which aren’t entirely bio-identical) on men, given that I am such a firm advocate of women using only bio-identical hormones. It’s because the chemical structure of the hormone is identical to human testosterone — unlike the synthetic forms of oestrogen and progesterone, which are similar to, but not the same as, human hormones.
Just to remind you, most of the oestrogen used in synthetic products is derived from pregnant mares’ urine, also known as conjugated equine oestrogen.
ARE THERE ANY SIDE-EFFECTS?
IF USed properly — which means under medical supervision — there should be no side-effects from supplementing your testosterone either with purely bio-identical products or the bioidentical/synthetic injections.
In the U.S., testosterone products — like all hormone items — carry a warning about the ‘possible increased risk of heart attacks and stroke’.
european guidelines say there is ‘no consistent evidence of an increased risk of heart problems with testosterone medication’.
Indeed, there is some evidence to suggest that men with low testosterone are at greater risk of heart disease.
It’s also been suggested that testosterone treatment can raise the risk of prostate cancer. But an authoritative review, published in 2007, of all the studies on the subject failed to find any link.
Furthermore, a recent study linked aggressive prostate cancer to low testosterone levels.
another concern is baldness: in the body, testosterone is metabolised into dihydrotestosterone (dht), and men with high levels of this have a higher risk of losing hair.
So when giving men testosterone treatment, I check their dht levels and prescribe medication to keep these down.
the fact is, I am happy for my own husband to be taking testosterone (although, of course, I don’t treat him myself) and I certainly would not allow anyone to do anything that would endanger his wellbeing.
But natural hormone treatments cannot work in a vacuum — testosterone treatment must be integrated with diet, stress management, sleep, lifestyle changes and exercise.
AdApted by Louise Atkinson from the Hormone Solution by dr erika Schwartz, published by Warner Books. For more information, visit drerika.com