Solutions to Age-Related Hormone Decline

With age comes wisdom…but unfortunately, a few things go too. Where there’s been great focus on how women can maintain vitality after the changes of menopause, less is said about how age-related hormone depletion impacts men. Do they, too, have symptoms and problems as a result?

In fact, they do—though not exactly in the same way. Christopher Saigal, MD, MPH, a board-certified urologist in practice in Santa Monica, and an associate professor of urology at David Geffen School of Medicine at the University of California Los Angeles, likes the term “ADAM” (Androgen Decline in the Aging Male) to describe what others refer to as the “male menopause” or “andropause.” In his view, it’s inaccurate to call what happens with men a male menopause. “With female menopause you have a sudden and dramatic drop in hormone levels that leads to distinct changes in body function, whereas men have a much more gradual decline,” says Dr. Saigal.

“Hormones for men start to decline around age 29,” I was told by David Leonardi, MD, medical director of the Leonardi Executive Health Institute in Greenwood Village, Colorado, where he specializes in what he calls “vitality and longevity medicine.” “Measurable circulating testosterone declines about 1% each year, Human Growth Hormone about 1.3% and DHEA about 2%,” he said, calling the long-term consequences “significant—most especially for testosterone.” As a result of this decline, men may experience decreased libido, lethargy, depression and anxiety. Though it’s hard to tease out whether these are just the result of lifestyle and life circumstances, in the view of both doctors there is often a hormone connection, too. Some physicians—especially those like Dr. Leonardi who are working in this new area of anti-aging medicine—believe that there are alternatives that can preserve men’s virility.

MALE HORMONE REPLACEMENT

It’s not as simple as merely taking supplements for the hormones that decline with age. As with female hormones, replacement therapy has risks and so is not to be undertaken lightly or on your own. It’s better to have a comprehensive hormonal assessment, using a 24-hour urine sample, managed by a physician experienced in this area. Assuming proper oversight, here are some of the deficiencies for which many doctors now consider hormone replacement a viable treatment…

  • Testosterone. Conventional medical wisdom only supports supplementing testosterone when serum measurement falls below the “normal range” of between 250 to 1,100, but Dr. Leonardi told me he thinks that’s “ludicrous.” He said patients report symptoms that can include fatigue, increased body fat, muscle loss and when testosterone levels fall below 500, some cognitive and memory issues and depression.
  • DHEA. “DHEA (dihydroepiandosterone) is very important in regulating mood,” Dr. Leonardi said, noting that numerous studies associate low levels of DHEA with depression. DHEA also serves to stimulate the immune system and improve bone density. Though DHEA supplements are available over the counter, it’s not safe to self-medicate with powerful hormones like this one.
  • Melatonin. Also available over the counter, melatonin is best known for its beneficial effect on sleep. According to Dr. Leonardi, melatonin levels drop by 80% between the ages of 13 and 35. This is a key reason why adults have more and more trouble sleeping as they get older. (Have you noticed this is not a problem for children?) While melatonin is most commonly promoted as a sleep aid—which it may be—some evidence suggests that it can also function as an immune system stimulator, an antioxidant and a tumor inhibitor. Interestingly, he said, “In one study, blind people have 31% fewer cancers, across all races and nationalities.” Dr. Leonardi believes this likely relates to melatonin, since blind people produce more of the hormone than those who can see. Melatonin is available over the counter, but many physicians voice concern about the long-term consequences of its regular use.
  • Human Growth Hormone (HGH). Even more controversial, human growth hormone has generated lots of back-and-forth in the medical and sports worlds, with anti-aging specialists vocal about its benefits and pretty much the rest of the medical world equally vociferous about the dangers. One study published in the New England Journal of Medicine indicated that replacing HGH in older men led to an increase in lean body weight (muscle) and a decrease in fat. This finding generated great interest in replacing human growth hormone, which became a prestigious and highly profitable component of anti-aging therapy. However, many doctors dispute its safety and benefits. While production of HGH does decrease with age, and many people are convinced enough of its rejuvenating effects to pay hundreds of dollars per month for the supplements, the downside is that HGH elevates another hormone in the body called IGF-1 (Insulin growth factor-1). Some studies have linked elevated IGF-1 with prostate cancer (while one from Kaiser found an inverse link between IGF-1 and prostate cancer), adding weight to the fears that artificially raising HGH is dangerous. The controversy continues.

WHAT TO DO?

Different physicians approach ADAM or male menopause differently. As a urologist, Dr. Saigal concentrates primarily on testosterone replacement because it is the least controversial and more medically accepted than other supplements, and he says he sees many for whom testosterone replacement therapy has made a world of difference. Dr. Leonardi says he prefers a broader approach since many hormones work in concert with each other. He therefore tests levels for all important hormones and balances them with careful replacement therapy. In his view, hormones are not unlike an orchestra: They need to be in balance and closely monitored over time to get the best results, he said.

Are there downsides to hormone replacement for men? “There are some unclear long-term risks,” Dr. Saigal cautioned, “such as some changes in cholesterol and spikes in red blood cells. Using the really high doses of testosterone, like what bodybuilders might take on their own, there are mood swings and other unpredictable emotional problems.”

Remember, the best medicine represents the melding of art and science, and complex interactions like those involving hormones are best addressed by supporting your body’s natural ability to change with dropping levels. A wise, experienced physician can help optimize your health at any age—especially if you are following a healthy lifestyle. You can—and should—expect to feel good, but you can’t expect miracles that turn back the clock.