Understanding Men’s Issues: Testosterone & Andropause (Part 2)

I know from experience (as both an aging adult and from research in the Anti-Aging arena) that hormone balance can play a key role in our physical as well as our psychological well being.

This article will be devoted to a better understanding about Testosterone’s role in both Men and Women.

We know that testosterone is a man’s primary sex steroid hormone, and that estrogen is a woman’s primary sex steroid hormone. A man needs just a little estrogen for proper hormone balance, while a woman needs just a little testosterone for her proper hormone balance. Some of the shared symptoms of low Testosterone (T) in both men and women are as follows:

• Low energy
• Low self esteem
• Depression
• Low libido (sexual desire)
• Impaired maintenance of muscle tissue (in the last article, we talked about how testosterone is a building hormone in both men and women). It helps to maintain muscle tissue and strength as well as reduce fat tissue.
• Poor bone density
• *Decreased activation of HDL (the good cholesterol)

It is thought by many researchers that if both (T) and thyroid hormone (look for more information in a future article) were adjusted and balanced, that most of the diagnosed depression in the world could be cured. One of the most significant symptoms of low testosterone in both men and women is one that we can’t see or feel. It is one of the most life-threatening of all symptoms of low (T). *REDUCED ACTIVATION OF HDL. A critically important role of testosterone is to activate or enable HDL (our good cholesterol) to remove excess cholesterol from the arterial wall and transport it to liver for removal or disposal. This effect of enhancing HDL is termed “reverse cholesterol transport”. This mechanism is vital to preventing arterial occlusion (blockages which can lead to strokes). This mechanism is activated only when sufficient levels of (T) are maintained.

When a woman enters menopause, her ability to produce testosterone decreases by 60-70%. When a man enters andropause, his levels of testosterone can be in the “normal range,” but not sufficient to activate the “reverse cholesterol transport” mechanism. Recent studies have now established a baseline for total testosterone to be 550 ng/dl in men to provide a 30% lower risk of cardiovascular events. Any level below this concentration can result in increased risk. The normal range for total testosterone in men is 300-1200 ng/dl. With this very broad normal range in (T) levels, it is easy to understand why many men are over looked for (T) replacement.

Studies have also shown that men with the highest level of (T) showed a decreased prevalence of diabetes, hypertension and body fat mass. Men with low (T) levels were twice as likely to have a history of cardiovascular disease. 550ng/dl seems to be a very consistent baseline for establishing effectiveness of (T) in men. Studies have shown that men who maintained a level of (T) above 550ng/dl had a 24% reduced risk of TIA’s (transient ischemic attack) or full-blown stroke.

I have not seen any information establishing a baseline for women and (T) levels to activate the HDL; but in my experience, it is rare to see a 55+ year old female with normal testosterone levels who is not supplementing with testosterone. Physical activity will increase (T) levels naturally in both men and women.

Women have a very narrow range of effectiveness with (T). Not enough (T) results in very little effect in relieving symptoms of low (T) and just a little too much results in dramatic effects such as aggressive behavior and anger. Women normally respond well to 1-2mg of testosterone topical supplementation daily, while men usually require 50-100mg of topical supplementation of (T) daily.   

Pre-menopausal women in general do not suffer from arthrosclerosis or plaque build-up in the arteries before menopause. But once menopause starts and hormone levels drop the atherosclerotic process is accelerated dramatically. Roughly 10 years after menopause, plaque build-up in the arteries will be approximately equal to their male counter parts of the same age.

Main stream medicine generally does not look at (T) levels in women as a routine lab, but understanding the importance of (T) in the activation of HDL, the fact that women loose 60-70% of their (T) levels at menopause, and the atherosclerotic process acceleration at menopause…it might be time to re-think this very important laboratory test.

Laboratory testing is vitally important when considering (T) supplementation; especially in the average aging man. As men age, total and free testosterone levels drop but sometimes more significant is the increase in estrogen levels. Free testosterone, the testosterone which is free to combine with a receptor to have a therapeutic response, can also convert to estrogen. This conversion is made possible by an enzyme called aromatase.

It is well established that as men age and fat levels increase, aromatase levels and activity also increase; thereby causing those very important levels of (T) to drop, resulting in the symptoms of andropause.  As estrogen levels go up, a binding globulin called SHBG (sex hormone binding globulin) also increases to help decrease estrogen levels and estrogen activity. However SHBG is not specific for estrogen. It also binds up testosterone resulting in a net loss of (T) activity. If that isn’t enough, free (T) can also be converted to DHT (dihydrotestosterone) which can affect the prostate in a negative way by causing BPH (benign prostatic hyperplasia) or enlarged prostate. It is ABSOLUTELY NECESSARY to establish base lines for: estrogen (estradiol), SHBG, DHT, and free & total testosterone when supplementing with (T) in men.

When testosterone levels are low and have been low for years (as seen with most aging men), one of the first things the body tries to do when (T) supplementation is introduced, is to convert or bind up the (T). (Remember, the body will always act in a defensive manner.) When testosterone levels have not been normal for years, and all of a sudden we raise levels (T) levels, the first thing the body will sometimes do is to try to lower (T) levels to what our body recognizes to be normal. When a man’s symptoms are not improved with (T) supplementation, the first thing I look for is the established baseline blood levels. Why is he not responding? Is the (T) not being absorbed? Is the (T) being converted or bound up?

These are some of the questions I will address in the next article.   …..Tom White