What is Andropause?
The more commonly known process of menopause is a universal experience that almost all women will experience at some point in their lives. However, men also experience their own hormonal changes as they get older, a process called “Andropause”, although we may as well call it man-o-pause. The development of andropause is a multifactorial process however, the main feature is a significant decrease in testosterone levels in the aging male. This decrease in testosterone is related to abnormalities in the hypothalamic–pituitary–testicular axis, as well as a decrease in testicular cell mass and function. Lifestyle factors such as obesity, physical activity, alcohol, and recreational drug use can also contribute to the manifestation of andropause. (1)
How is Andropause Diagnosed?
Andropause is diagnosed in the presence of both low serum testosterone (<320 ng/dl) coupled with associated symptoms of low testosterone such as loss of muscle mass (sarcopenia), loss of bone mineral density (osteopenia / osteoporosis), loss of strength, fatigue, reduced libido and sexual function, various mood / cognitive disorders, and anemia. When both lab findings of low testosterone as well as clinic symptoms of low testosterone cooccur together, a diagnosis of andropause can be made. (2)
How is Andropause Treated?
The typical first line treatment for andropause is lifestyle modifications (e.g. alcohol / recreational drug cessation, improved diet, increased exercise, improved sleep hygiene, etc). (3,4,5,6,7) However, for those who do not respond to lifestyle changes alone or for whom lifestyle modifications are not feasible, hormone replacement therapy (HRT) is also a treatment option. HRT for testosterone can be administered through creams/gels, buccal tabs, injection, and subcutaneous pellets. Treatment route and dose is usually based on testosterone levels as well as severity of clinical symptoms. (8)
Pros and Cons of HRT for Andropause
Testosterone has a significant effect on the body which may be beneficial or detrimental depending on the patient. Pros of HRT with testosterone may include improved muscle tone / strength, improved bone mineral density, increased energy, fat loss, improved libido and sexual function, improved mood and cognition, and perhaps improved blood cell counts. However, the cons may include increased cardiovascular disease risk, worsening of sleep apnea, gynecomastia, polycythemia (overproduction of blood cells), increase in aggression, increased risk of benign or malignant prostate diseases, acne, skin aging, and hair loss. (8) It is also difficult to discontinue HRT once started as the body adapts to HRT by decreasing endogenous production of testosterone, making it harder to return to normal baseline levels once discontinuing the therapy. The choice to use HRT is one made collectively by both the patient and the physician, considering all the pros and cons in the context of the patient’s unique situation.
Alternatives to HRT for Andropause
When weighing the benefits and risks of treatment options for andropause, many people will decide that the benefit that HRT offers is not worth the risks. Luckily for those people, there is a plethora of alternative treatment options which have proven to improve testosterone production. As discussed earlier, lifestyle modifications can be a huge factor in improving testosterone levels in those suffering from andropause. Proper diet, exercise, sleep hygiene, and substance cessation / moderation can be monumental in both patients on HRT as well as those who are not. However, sometimes lifestyle modification may not be enough. When this is the case, there are several supplements and botanicals which may be utilized. Below is additional information on just a few of those options.
- Smilax: The herb Smilax (common known as greenbrier) is a powerful Male reproductive tonic which is used in 17 countries worldwide today and has been utilized by Chinese herbalists since 420-589 AD. (9) Recent animal studies suggest Smilax use may yield multiple benefits on male hormones. One active ingredient in Smilax is called Astilbin, which has been shown to reduce damage of microplastics in testes, increase antioxidants in testicular tissue, and increase testosterone production in testes exposed to microplastics. (10) Although more human trials are needed to fully understand Smilax’s effect on male hormones, recent human studies have demonstrated both its medicinal efficacy as well as its safety. (9)
- Trigonella foenum-graecum: The herb Trigonella foenum-graecum (commonly known as Fenugreek) is a staple in botanical medicine, touted for improving male hormones among other beneficial effects. Recent clinical trials have shown that Fenugreek can significantly increase free testosterone levels in resistance trained males when compared to resistance training alone, which we know has a powerful androgenic affect in and of itself. (11) Therefore, Fenugreek might be a good choice for someone who is already implementing exercise and is looking for a further improvement in their testosterone levels.
- Dehydroepiandrosterone (DHEA): DHEA is a hormone produced in the adrenal cortex of the kidneys, serving as a precursor for both testosterone and estrogen. (12) DHEA supplementation has been shown to attenuate reductions in testosterone after high intensity interval training in middle aged men. (13) A systemic review (one of the highest levels of evidence in medical research) have also shown that DHEA supplementation significantly increases testosterone production in both males and females. (14) Another systemic review has also shown that DHEA supplementation significantly improves body composition in elderly men, which was considered strictly dependent on the conversion of DHEA into testosterone and estrogen. (15) However if estrogen production is undesired, additional medications, supplements, or botanicals can be used to counteract this.
- Agaricus bisporus: The fungus Agaricus bisporus (commonly known as Champignon or White Button Mushroom) is that friendly and familiar white mushroom present in almost every grocery store produce aisle. Although Agaricus bisporus does not directly increase testosterone, research suggests that it inhibits the enzyme aromatase, which is responsible for converting testosterone into estrogen; working on the same pathway as the medication anastrozole which is commonly used for andropause as well as gender dysphoria. (16)
The Choice Is Yours
Andropause is a complex condition and its treatment even more so. With all the treatment options out there, it may be difficult to decide what to do. Luckily, physicians like myself are here to support. Whether patients decide to implement natural therapies, HRT, or a combination of both, I am committed to helping men feel good long into their golden years; defiantly pausing the clock in the face of andropause.
Let’s Persevere Together
If you’re ready to explore how naturopathic medicine can support your health through andropause, we’re here to assist you. Schedule a visit with a Heart Spring Health provider to take the first step.
To schedule an appointment, call 503-956-9396 or contact us now to schedule an appointment today.
