27 August 2009

Men and the mid-life slump

A mid-life crisis isn’t just a mental state - it turns out that many men experience a drop in testosterone levels as they get older.


There was a time when the term male menopause conjured up images of a 50 year old accountant suddenly leaving his job to cruise Route 66 on a Harley, or the conservative family dentist moving into a city love-nest with his young new assistant.

Male menopause is a misnomer, the correct term is andropause. And it isn’t just brought on by a man suddenly waking up one morning to find himself face to face with his own mortality. It turns out that many men experience a drop in their testosterone levels as they get older, and this can mean very real changes to their health and quality of life.

What does testosterone do?
In adult males, the presence of testosterone boosts strength and decreases the levels of body fat. Testosterone also affects:

  • Libido and penile erection frequency
  • Mental and physical energy
  • Maintenance of muscle trophism
  • The most recent and reliable studies have shown that testosterone does not cause prostate cancer, but that it can increase the rate of spread of any existing prostate cancer.
  • Recent studies have shown conflicting results concerning the importance of testosterone in maintaining cardiovascular health. Nevertheless maintaining normal testosterone levels in elderly men has been shown to improve many parameters which are thought to reduce cardiovascular disease risk, such as increasing lean body mass and decreasing visceral fat mass.
  • Under dominance challenge, testosterone may play a role in the regulation of the fight-or-flight response
  • Testosterone is necessary for normal sperm development

A drop in testosterone levels may, conversely, lead to a loss of libido, erectile dysfunction, loss of muscle tone and a build up of visceral belly fat, and even irritability and depression. Sounds unpleasant? Well, it can get worse.

ED often an early warning
According to Dr Pradaruth Ramlachan, Deputy President of the Southern African Sexual Health Association, erectile dysfunction (ED) is often a symptom of significant underlying conditions, such as abdominal obesity, diabetes, hypertension and high cholesterol in men over the age of 40. Ramlachan says that in an estimated 70% of diagnosed cases, ED has a physical cause. As many as 64% of men with ED report at least one or more of the following conditions: hypertension, chronic heart disease, high cholesterol, diabetes or depression.

The good news
For men who are battling with ED, a visit to the doctor is the answer. And while it may be tempting to ask for a few blue pills, it’s the proper time to request that your doctor give you a full check-up, concentrating on heart, cholesterol, blood pressure, and sugar levels. While checking testosterone levels is not yet a common test, you can discuss testing options with your doctor and treatment, as there are various supplements available.

Testosterone - other findings
Italian researchers showed in a study that injections of the male hormone testosterone increased blood-pumping ability and heart muscle strength in men with heart failure.

"From our study, it appears that testosterone supplementation is useful for both patients with low and normal testosterone levels, although the improvements are greater in those with low levels," said Dr Ferdinando Iellamo, an assistant professor of internal medicine at the University of Rome Tor Vergata, and lead author of a report in the Sept. 1 issue of the Journal of the American College of Cardiology.

"Historically, testosterone-replacement therapy has been contraindicated in men with chronic heart failure," Jones said. "This was due to the fluid retention observed with older forms of testosterone preparation. This study, along with our studies, show that testosterone is safe in these patients and has a benefit on the underlying condition."

Research is ongoing
But the case for testosterone therapy in heart failure is far from proven, he said. "Now, longer-term studies evaluating effects on survival, quality of life and longer-term safety need to be done to establish if this treatment should be used routinely in the treatment of heart failure in men," Jones said.

Sources: HealthDay News, Dr Pradaruth Ramlachan, Blackwell-Synergy
(Joanne Hart, Health24, August 2009)



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