Christopher Saigal, MD, MPH
Christopher Saigal, MD, MPH, a board-certified urologist in practice in Santa Monica, and an assistant professor of urology at University of California, Los Angeles.
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.
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…
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.