Andropause: A turning point for men

“Suddenly, I’m not half the man I used to be...” If the words to that Beatles song make a lot more sense to you now than they did when you heard it as a teenager, there may be more to your newfound understanding than the wisdom of years.

As men get older, testosterone levels in the body gradually become lower than in the days of your youth, when you probably felt like you had the drive and energy to tackle just about anything that came your way.

Testosterone is the hormone responsible for such typically “male” characteristics as deep voices, muscle mass, and facial and body hair patterns, and a shortage can spell tiredness, low sex drive, and a slew of other effects that may make you feel old beyond your years.

Starting at the age of 30, men experience a drop in testosterone by about 10% every decade, while amounts of the hormone that are still being manufactured may not be as effective because of increased production of another hormone called SBHG.

Just because low testosterone has got you down, it doesn’t mean that the down-in-the-dumps feeling and all the physical symptoms that come with it are something you have to put up with.

Testosterone replacement therapy, which is available in a number of forms, has been shown to increase energy levels, muscle mass, bone density, and sex drive and to reduce other symptoms in men who suffer from low testosterone for a range of reasons.

Testosterone supplements come in a variety of forms, including capsules, gels, injections and patches.

* Capsules are usually taken once or twice daily. This form of testosterone replacement therapy must be taken with food and maybe a convenient option for men who follow a regular daily schedule. People taking testosterone in capsule form should have their liver function tested periodically, so it is important to make follow up appointments with the doctor.

* Injections are generally administered every three to four weeks, usually in the doctor’s office or clinic. Injections are likely to be a convenient option for men who require regular contact with their physician or have a very busy lifestyle. This form of testosterone may cause mood swings due to testosterone level “ups and downs”; levels peak just after the injection and drop just before the next injection.

* Gels may also be convenient to use, and are applied once daily. Men should wait several minutes to allow the gel to dry before dressing and allow five to six hours before bathing or showering.

The treated area should be covered with a shirt or other clothing to prevent accidental skin-to-skin transfer of the gel to women or children (which can cause them to develop male features such as lower voices or facial hair over time). If skin contact occurs, they should wash the affected area promptly with soap and water.

* Patches are a form of testosterone replacement that is also convenient for men to use, including those with active lifestyles. They should be applied once daily to the back, abdomen, upper arms, or thighs and can be worn during activities such as exercising, showering, or swimming.

The patch mimics the natural daily rhythm of testosterone production in healthy young men. Patches may cause skin irritation. Using a topical corticosteroid cream (which can be purchased at a pharmacy) before applying the patch can usually prevent this.

Side effects of testosterone replacement therapy can include acne, prostate growth, sleep problems, increased blood cell production, and other effects that are related to the specific dosage form. As well, men with prostrate cancer, breast cancer or allergies to testosterone or any ingredient in the dosage form should avoid testosterone replacement therapies.

There’s no doubt both sexes experience a “change of life” in some form sometime in their 40s or 50s. But that doesn’t mean that this change is the same for both sexes. Though andropause is often referred to as “male menopause,” there are actually a number of differences in the effects of aging on men’s and women’s hormones and on their bodies.

But before we focus on the divide between the sexes, let’s look at the similarities - or at the least the similarities that have to do with the effects of aging! Both men and women experience a drop-off in sex-related hormone levels as they age, which can cause a number of changes in the body.

In women, the decrease and eventual stop in production of the “female” hormones estrogen and progesterone causes menopause, which is marked by the end of menstrual periods. This results in some symptoms similar to those of andropause.

Like andropausal men, women going through menopause may experience hot flashes, low sex drive caused by both emotional changes and physical changes, weight gain, irritability, and depression. Like their male counterparts, women going through this “change of life” are also at an increased risk for osteoporosis and cardiovascular disease.

Looking at those symptoms, it may seem that men and women are actually pretty similar - at least in this case. But there are a number of key differences between andropause and menopause.

For starters, menopause literally means the end of menstruation, while there is no such specific signpost to characterize the condition for andropausal men.

Secondly, women experience a much faster drop-off in hormone levels than men do as they age - testosterone decreases gradually over decades, while the onset of menopause is relatively short.

As well, while some of the symptoms of menopause may vary from woman to woman, all females do stop getting their menstrual periods. In contrast, though all men will experience a decrease in testosterone production, not all men will have a big enough drop to cause any physical symptoms. For some men, this decrease in testosterone results in a condition called andropause, which has a range of symptoms, including:

* low sex drive
* difficulties getting erections or erections that are not as strong as usual
* lack of energy
* depression
* irritability and mood swings
* loss of strength or muscle mass
* increased body fat
* hot flashes

While many men think it’s inevitable, feeling “down in the dumps” is not a necessary part of getting older. While an estimated 4-5 million men in the U.S. and 400,000-500,000 in Canada suffer from symptoms related to testosterone deficiency, only about 5% are treated.

Aside from the fact that that leaves a lot of men who simply aren’t feeling as good as they should, it also puts a high number at risk for osteoporosis, or a weakening of the bones, and cardiovascular problems such as atherosclerosis, hardening of the arteries - both of which are conditions associated with low testosterone although further study is needed to determine the benefit of testosterone replacement therapy and cardiovascular health.

But there’s no reason for this condition to get so many men down! Doctors can easily diagnose low testosterone with a simple blood test. If levels come back low, further testing, including more blood tests, taking a sample of tissue from the testicles (called a biopsy), semen analysis, or brain imaging may be required. Once low testosterone is diagnosed, there are a number of different treatment options available.

Live young, feel younger?

While researchers have yet to find the elusive fountain of youth, there are some lifestyle changes you can make to help reduce the symptoms and risks of andropause and bring you back up to the way you used to feel 10 years ago.

* Exercise: Regular exercise can help you control your weight, improve your mood and energy levels, and increase muscle and bone mass - which is key to preventing osteoporosis. Whether you are just starting out or have been exercising for years, try to make fitness a regular part of your routine. Aim for 30 minutes of exercise at least 4 days a week with a combination of activities that will get your heart pumping and your muscles working. Check with your doctor before starting a new exercise program.

* Healthy diet: Eating well doesn’t have to be complicated, but getting the foods you need will help raise your energy levels, make it easier to maintain your weight, and help cut your risk of disease.

Follow Canada’s Food Guide to ensure you are getting the proper balance of energy, protein, carbohydrates, and fat, and make sure to eat a colourful variety of plant-based foods.

Because andropause can put men at risk for osteoporosis, make sure you get enough calcium and vitamin D in your diet. Men under the age of 50 should aim for 1000mg of calcium and 400IU of vitamin D daily, while men over 50 need 1500mg of calcium and 800IU of vitamin D a day.

* Quitting smoking: Though the reason is unclear, smoking has been shown to increase bone loss. It also puts you at an increased risk for heart disease. Talk to your doctor about a strategy for quitting.

* Counselling: If low testosterone has you feeling depressed, psychological counselling may help you manage your moods. Talk to your doctor about whether counselling, antidepressants, or a combination of both may help.

Canada.com

Gum disease may raise cancer risk, study finds

Gum disease may increase the risk of developing cancer, researchers said on Tuesday. Male health professionals with a history of gum disease in a long-running study had a 14 percent higher overall risk of developing cancer, they said.

“After controlling for smoking and other risk factors, periodontal disease was significantly associated with an increased risk of lung, kidney, pancreatic and hematological (blood) cancers,” Dr. Dominique Michaud of the Imperial College London and colleagues wrote in the journal Lancet Oncology.

This higher overall risk persisted even in people who had never smoked.

Gum or periodontal disease is an infection of the tissues surrounding and supporting the teeth. Prior studies have suggested people with periodontal disease are more likely to develop heart disease and diabetes.

People with gum disease have inflammation in their blood and inflammation also has been linked with cancer. But this could simply mean that whatever causes the inflammation may also cause gum disease and cancer. Michaud and colleagues wanted to see if gum disease increases the risk of cancer.

They used data from a large study of male doctors and other health professionals aged 40 to 75. The study was started in 1986 at Harvard University.

Nearly 50,000 men filled out health surveys and were followed for more than 17 years. The survey included information on gum disease and bone loss as well as number of teeth and tooth loss.

More than 5,700 of the men developed cancer, excluding cases of non-melanoma skin cancers and non-aggressive prostate cancer. The researchers found that men who had gum disease had 14 percent higher cancer risk compared to those who did not.

The risks were higher depending on the type of cancer.

Those with history of gum disease had a 36 percent higher risk of lung cancer, a 49 percent higher risk of kidney cancer, a 54 percent higher risk of pancreatic cancer and a 30 percent higher risk of having a blood cancer (such as non-Hodgkin lymphoma, leukemia or multiple myeloma) compared to men who did not have a history of gum disease.

In those who never smoked, gum disease was linked with a 21 percent increase in overall cancer risk and a 35 percent higher risk of blood cancers. They found no association for lung cancer in this group. Men who had fewer teeth (0 to 16) at the start of the study had a 70 percent higher risk of lung cancer compared with individuals with more teeth (25 to 32) at the start of the study but this may be linked with smoking.

Reuters

Premature babies ‘need cuddles’

Even very premature babies benefit from skin to skin contact with their parents, research suggests.

A Canadian study found that cuddling babies born as early as 28 weeks reduced the stress of painful medical procedures which many must undergo.

Writing in the journal BMC Pediatrics, the McGill University team said it might aid the recovery process.

UK neonatal units do not always encourage skin to skin contact, said a London-based expert studying the issue.

There is already some evidence that regular cuddling can help babies, even those dependent on incubators, not only by promoting their health, but by encouraging a parental bond which could be important to their progress in months to come.

This study is the first to look at extremely premature babies, born between 28 and 31 weeks. It was previously thought by some experts that such young babies were not developed enough to benefit from human touch.

A common test used in neonatal units is the “heel prick” blood test, which produces a sample which can be used to check blood sugar levels.

This is inevitably painful for the baby, and in some cases, it can take minutes for this distress to recede - which could be a problem for a baby whose health is in the balance.

The McGill researchers carried out the test on some babies who were being actively cuddled, skin to skin, measuring facial expressions, heart rate and blood oxygen levels to assess the amount of pain suffered.

Pain scores after 90 seconds for the cuddled babies were much lower than for those who were not cuddled.

Half the cuddled babies did not show any facial expression of pain when undergoing a heel prick test.

Lead researcher Celeste Johnston said that the shorter recovery time could help maintain the baby’s health.

“The pain response in very preterm neonates appears to be reduced by skin-to-skin maternal contact,” she said.

Parent pressure

Professor Linda Franck, from the Institute of Child Health in London, said that parents were often not encouraged to have skin to skin contact with their premature babies in UK neonatal units, despite growing evidence that it could help.

She said: “Neonatal units can be very intimidating places, and parents often do not know the best way to get involved. “Parents want to do the right thing, but the message is difficult to get out there. “This study suggests that, even for the very youngest premature babies, skin to skin contact can reduce the stress response.”

She is currently carrying out a pilot study in four London units which is using a variety of methods, including skin to skin contact, to encourage parents to become more involved with the care of their newborn children.

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