Embracing Transitions: Supporting the Aging MaleMay 27, 2021 12:19PM ● By Ashlyn Zikmund
Both men and women are equally susceptible to experiencing hormonal shifts at midlife; however, males, unlike females, often do not have a notable moment where this becomes evident. While a woman may notice changes surrounding her menstrual cycles and eventually a complete cessation of the cycle, males may notice more subtle changes in how they feel, but may not associate this with a hormonal shift as frequently as women do. This can result in men not seeking care and thus feeling better as quickly as they could if this association were more commonly identified.
Many people are familiar with the term menopause, which signifies a decrease in estrogen in women. Fewer people, however, are familiar with the term andropause, which signifies decreasing levels of testosterone in men. A decline in testosterone occurs naturally as men age, but can occur more drastically due to lifestyle factors such as chronic disease, obesity, excessive stress, lack of sleep, a poor diet and certain medications. It is estimated that by the time a man is in his mid-40s, he has already decreased his testosterone level by 40 percent.
Symptoms commonly associated with declining levels of testosterone include low libido, erectile dysfunction, sleep disturbances, depressed mood, fatigue, decreased stamina, decreased muscle mass and insulin resistance. Men also typically notice changes in body fat composition and may start to notice more abdominal fat deposition correlated to imbalances of estrogen and testosterone.
There is much evidence to support that low testosterone levels are associated with increased risk for cardiovascular events, inflammation, cancer and Type 2 diabetes. Testosterone replacement therapy has even been found to be protective against cardiovascular events in men at high risk for a heart attack. Further, testosterone replacement therapy has immune-modulating properties and may suppress the expression of inflammatory cytokines and lower total cholesterol.
Contrary to popular associations of estrogen as a female-only hormone, estrogen levels in men are highly indicative of health and well-being. Men that are more overweight will likely have higher levels of estrogen, creating a more drastic imbalance between the declining levels of testosterone. This occurs because an enzyme called aromatase is highly concentrated within fat cells and converts testosterone into estrogen. Thus men that are overweight may have more drastic declines in testosterone compared to men with less body fat.
Men in this scenario may experience more moodiness and fat distribution around the hips, thighs and breast tissue. Further, high estrogen levels signal the body to produce more sex-hormone binding globulin. This can help bind up some of the excessive estrogen; however, it binds with a higher affinity to testosterone and can make symptoms of low testosterone even more pronounced. On the contrary, low levels of estrogen, in addition to low testosterone, can result in poor mental clarity, more pronounced fatigue and decreased stamina and have more negative impacts on bone mineral density. Long-term estrogen deficiency is associated with more cardiovascular disease and sexual decline.
When assessing men's health, two additional factors that are important to focus on are cortisol levels and thyroid hormones. Diurnal cortisol rhythms and thyroid hormones are important contributors to overall mood and metabolism. While testosterone is a key hormone that drops in men at mid-life, hormone balance does not typically lead to the focus on one hormone alone. Achieving hormone balance in men is both about feeling good and about prevention of risk factors associated with declining hormones. Hormone-literate health care providers can assess men and set them up for long-term success.