Male Hormone Problems by Wendy Meyeroff, Ghostwriter Who Grabs Attention

Lifting the Veil on Male Hormone Problems

7/4/09 10:45 PM

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Lifting the Veil on Male Hormone Problems By Wendy J. Meyeroff THE ERICKSON TRIBUNE “Your golf score is getting worse. You don’t concentrate as well. You aren’t as strong and are losing height. You are grumpier. When symptoms like these appear in men, they are told (or believe) that such problems are just natural parts of aging. But these and other symptoms may actually be indications of low testosterone levels in men,” says John Morley, M.D. Morley, the director of the division of geriatric medicine at the University of Saint Louis in Missouri, is one of this country’s leading experts on testosterone deficiency in men. The Food and Drug Administration (FDA) estimates at least four million men suffer from low testosterone levels, but only about 5 percent are ever treated. “One recent study indicates 20 percent of men have low testosterone, and the number jumps to at least 50 percent in men age 80 and older. As a doctor in the Erickson HealthSM system, the largest geriatric health care group in the country, I would say lowered testosterone is definitely a public health issue, one that has been misdiagnosed or ignored for years,” says Dimitri Cefalu, M.D., medical director at Seabrook, a community in New Jersey built and managed by Erickson. The Male Version of Menopause “I believe all men after age 50 or 60 should have a total testosterone level taken,” says Wayne J. G. Hellstrom, M.D., professor of urology at Tulane University in Louisiana. One reason is because otherwise it is easy to dismiss the symptoms of testosterone decline. “For most men, testosterone decline is something that happens gradually, over decades, with mostly subtle symptoms,” says Morley. With this hormonal decrease, men experience andropause, a phenomenon similar to women’s menopause. Besides symptoms Morley has already mentioned, other indications of lowered testosterone range from the seemingly innocent (like not shaving regularly) to more serious signs, including fatigue and depression. The symptoms that usually alert men or their partners to a possible male hormonal problem are a diminished libido or erectile dysfunction. Even then, these problems are often dismissed as just something to be accepted with getting older. The Obstacles to Diagnosis

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There are several obstacles to men being properly diagnosed as having diminished testosterone levels. First, many of the symptoms mentioned can be indicative of numerous other problems.

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Second, there is still extensive disagreement on how to evaluate testosterone levels. Should the total level of testosterone in the man’s system be the standard, or only what is called “bioavailable” testosterone? Bioavailable is the fraction that enters the cells and is what the man is actually using. While some experts believe bioavailable levels are a more accurate reading, everyone agrees few labs are equipped to do it. The general consensus of the experts The Erickson Tribune interviewed is that a skilled, conscientious physician can make the right evaluations from a total testosterone level.

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What testosterone levels cause concern? “Between 2 and 4 nanograms per milliliter (ng/ml) is considered a possible deficiency and less than 2 ng/ml is deficient, using a total testosterone level,” says Shreyasee Amin, M.D., assistant. professor of medicine in rheumatology at the Mayo Clinic. Morley feels men themselves are a major obstacle. “Men find it hard to discuss. Many are too macho to admit there is a problem. Many of my patients come only because their wives bring them,” he says. The Estrogen/Testosterone Connection “One of our greatest difficulties is we’re still trying to determine what causes andropause. In a proposal for a new study, scientists indicate men’s estrogen levels stay the same (both men and women have each hormone in their systems), but their testosterone levels drop and that creates the hormonal imbalance,” says

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Lifting the Veil on Male Hormone Problems

7/4/09 10:45 PM

Cefalu. Other research indicates a man’s estrogen level may play a more prominent role in conditions associated with andropause. Take the increasing risk of a hip fracture as a man ages. “We found it is not so much low testosterone alone that indicated increased risk of hip fracture in men. We found it is lowered estrogen levels in men; it increased their risk three times. And men with both diminished estrogen and testosterone had a six-fold increase in risk,” says Amin. She admits science is still studying what would be a correct level of estrogen replacement in men. “It might be low-dose estrogen like we use in women, or we might use this research as a basis to find something that works in men like estrogen,” she says. One thing everyone agrees on is that fighting bone loss is a major argument for encouraging testosterone replacement or balance. “It keeps the bone structure strong, important in preventing the fractures that are more common in older women and men,” says Hellstrom. Getting Your Doctor’s Help Morley feels it takes a specialist, a urologist or an endocrinologist, to make a proper diagnosis. “I think it takes a caring physician, one the man sees yearly, to recognize the patient has a problem beyond the normal aging process,” says Hellstrom. The standard initial test that helps indicate if a man might be experiencing lowered testosterone is a simple questionnaire Morley developed. “It is the ADAM Questionnaire, which stands for Androgen Deficiency in Aging Men. It is ten simple ‘yes’ or ‘no’ questions. A yes to questions number one or seven, or to three of any of the others indicates you may have low testosterone,” says Morley. The ADAM Questionnaire can be found by clicking on the following link: http://www.picrx.com/adam.htm Treatment Decisions There is some debate over when testosterone replacement doesn’t pay. Both Cefalu and Morley agree that chronological age isn’t as much a factor as quality of life, pointing out it is unwise to decide that a man of 70 shouldn’t still be enjoying himself. Once diagnosed, there are several options for delivering increased testosterone. “There is a gel that comes in premeasured packets and is applied every day to your shoulder, or chest. Do NOT put it directly on the sex organs and keep it away from women and children,” says Cefalu. “Many men find the gel inconvenient because you have to wait to let it dry before dressing and you can’t bathe or swim for five hours after application,” says Cefalu. For others there is a testosterone patch, or injections which are given every two weeks. “At least a third of my patients take injections,” says Hellstrom. It is best for each man to discuss the pros and cons of each delivery methodwith his doctor. There are also questions as to when a man should start treatment and how long he should stay on treatment. Considering the dangers low testosterone levels pose to men’s overall health, experts are acknowledging it needs to be brought more into the open. “Doctors, even geriatricians, are just starting to become aware of the need for screening men for andropause. It has taken a back seat in men’s health to managing issues like diabetes and hypertension. But I really think testosterone screening should become part of a state-of-thearthealth care program for older men,” says Cefalu. Posted on Tuesday, August 01, 2006 Copyright Erickson Retirement Communities. All rights reserved. Read by more than 6 million people every month, The Erickson Tribune is a popular and trusted resource for individuals looking to live life to the fullest. For additional information on Erickson and our commitment to serving you, please visit www.erickson.com. The information contained in this article is not intended to provide advice on personal medical matters, nor is it intended to be a substitute for consultation with a medical professional.

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