Menopause not only happens to aging women, but also to men
This health column is jointly run by The Jakarta Post and Singapore-based Parkway Group Healthcare. Readers are encouraged to e-mail their questions to features@thejakartapost.com. The following article is an excerpt of Professor Peter H.C. Lim's paper to be delivered at a health seminar in Surabaya, East Java, on Sept. 30 and Oct. 1
SINGAPORE (JP): The state of menopause is not excluded to aging women, but also to middle-aged and elderly men.
Many of the symptoms accompanying the male menopause and the aging process in men are similar to those of hypogonadism. They include a decrease in such things as libido and sexual activity, less signs of virilism such as a thinning of male hair or beard growth, a decrease in muscle mass and strength, lack of energy, ostopenia (weakened or soft bones), a decrease in cognitive functions, irritability, excessive sweating with occasional hot flushes, and a lowering of the feeling of general well-being. We can attribute at least some of these symptoms to an age associated decrease in testosterone levels.
(a) Sexual functions. Coital frequency declines rapidly with age from a mean maximal coital frequency of about four times a week at age 25 years, to once a week at age 50, three times a month at age 70 and 1.7 times a month between the ages of 75 and 79 years.
Moreover impotence increases dramatically with age: rare before the age of 30 years, it is observed in 8 percent of subjects aged 50 years, 20 percent of those aged 65 years, 40 percent at age 70 years and 60 percent in men over 70 years old. This might however be related to the aging process itself, as the hormonal differences diminish with age.
(b) Body composition and other things. Aging is accompanied by a decrease of lean body mass (LBM) and an important increase in fat mass and, although aging itself is an important determinant of body composition, plasma testosterone levels are negatively correlated to fat mass, independently of age.
This data indicates that elderly men, like hypogonadal men, accumulate preferentially visceral fat and as the latter is the major cause of insulin resistance and the atherogenic lipid profile, this suggests that obesity in elderly men is a more important health hazard than in young men.
As obesity is a cause of decreased free and total testosterone levels, it could be hypothesized that the decrease in testosterone levels in aging males is the consequence of an increase in fat mass.
Age is also accompanied by an important decrease of muscle mass and there exists a highly significant correlation between muscle mass and FT levels, which persists after correction for age; moreover testosterone supplementation increases muscle mass.
Bone mass decreases with age in both males and females even if osteoporosis manifests itself at a later age in men than in women. There exists a negative correlation between bone mass and testosterone levels.
Aging is accompanied by a decrease in cognitive functions and androgen substitution improves spatial abilities and mathematical reasoning. As far as memory is concerned, the age associated impairment is evident, but the role, if any, of sex hormones in the loss of memory is questionable.
Androgen
Levels of total plasma testosterone are known to have a progressive age-related decrease after age 50. Most investigators agree that circulating biologically available testosterone decreases with age because of the increase in circulating SHBG. The circulating testosterone which is bound to SHBG is biologically unavailable.
Reproductive capacity
Semen analysis in elderly men reveals an alteration in sperm counts in varying degrees from normal to increased or a decreased sperm motility and increase in abnormal sperm forms. This finding in older men suggests some degree of primary testicular failure. Thus, two factors may contribute to hypogonadism in aging men. One is a slightly decreased production of testosterone and the other is an increase in the circulating fraction of testosterone bound to SHBG.
With regard to sexual function in elderly men, many studies have noted a progressive decline in male libido and sexual performance with age and a striking increase in the prevalence of impotence in men over 50.
However, after controlling for age, the correlation between serum testosterone levels and sexual activity was not significant, suggesting that 1) reduced testosterone levels are not likely to be responsible for sexual dysfunction and 2) hypogonadism per se is an uncommon cause of impotence in elderly men.
Based on these findings, the supplementation of testosterone in older men to improve erectile function may be of questionable benefit. Nevertheless, other studies have shown that aging men with high sexual activity levels have greater plasma testosterone concentrations than men with less sexual activity. Although decreases in serum testosterone may have a correlation with the diminished sexual activity in older men, this effect is probably minor compared with the contributions of psychological, social, and health factors.
Hormone deficiencies
Other hormones that become low from 35-40 years of age onwards are Human Growth Hormone, Melatonin, DHEA, Thyroid Hormone etc.
Deficiency of Human growth hormone causes the many changes of somatopause & many of these overlap those due to testosterone deficiency. Replacement of Testosterone without replacing growth hormone does not produce effective results as both hormones work in synergy with each other to produce the best results - in an anti-aging program this would be to produce a 10 year reduction in biological age in a man 10 years older.
Growth hormone thus has been touted as the elixir of growth but more studies need to be conducted before we can substantiate this. DHEA falls after 38 years of age and feelings of well-being amongst many others declines with falls of DHEA. Again no adequate randomized placebo-controlled studies to date have resolved this issue.
Certainly lowered thyroxine levels, of for example T3, contribute to the declining energy levels of the elderly and detecting this is important. Melatonin levels fall during the aging process and older people often find it difficult to sleep easily. Since growth hormone is released during deep sleep, it may be that melatonin is connected to the beneficial effects that follow with good levels of growth hormone.
Measures
Good dietary habits with adequate minerals, vitamins, essential fatty acids, essential amino-acids and a diminished intake of red animal meat with generous helpings of green vegetables and fruits make for longevity. Adequate exercise, sleep and freedom from stress - psychological and physical are important. Avoidance of oxidative stress pollutants that cause free radical scavengers to destroy and damage cells will prevent early senescence.
An adequate intake of anti-oxidants will help in this respect. Essential oils will contribute to generating enough good ecosanoids that protect against harmful ecosanoids which can cause degenerative diseases and hasten the process of aging.
Benefits vs risks
Taking androgens (testosterone) is not without risks. If there is a cancer of the prostate then the latter may be stimulated to grow. Thus the attending doctor must test the subject by excluding a cancer of the prostate before treatment. Also an enlarged non-cancerous prostate must be excluded before treatment as testosterone causes the prostate to grow. A man with sleep apnea likewise must be treated before taking testosterone.
Those with too much lipids in their blood, those with abnormal liver function or whose blood is thicker than normal must have close doctor surveillance. The use of growth hormone too requires no pre-existing diabetes or cancer. The dose must be kept to a minimum or joint pains, heart failure or carpal tunnel syndrome can occur. The benefit must exceed the risk to justify therapy!
The writer is medical director of Urology Center, Gleneagles Hospital, Singapore. Chief, Dept of Urology, Changi General Hospital and Adjunct Professor, Edith Cowen University, WA.