By Dr Gerard Lalande
Hormonal changes naturally occur as we age. At around the age of 50, women will inevitably experience menopause induced by an abrupt drop in the female oestrogens and progesterone hormones. Likewise, between 50 and 60 years of age, men will go through the so-called “male menopause” or andropause, as it is often referred to, due to a progressive decline in the male hormone testosterone.
A better understanding of the various symptoms linked to hormonal changes helps individuals better comprehend and accept their physical transformation and behaviour during these periods.
The testicles primarily produce testosterone. The hormone, which is measured in the blood, reaches its maximal levels during late adolescence and early adulthood. By the age of 30, testosterone gradually diminishes but the rate of decline differs markedly from one individual to another. Between 60 and 70, about half the peak blood level remains. In adulthood, testosterone has many physiological effects: it stimulates muscle mass, red blood cell synthesis and increases bone density. It is an essential contributor to sperm maturation and also increases libido.
Normal testosterone levels are between 2.7 to 17.3 ng/ml among 20 to 49-year-old adults and between 2.1 to 7.6 ng/ml after the age of 50. In general, values less than 2.0 or 2.5 ng/ml are considered low.
A relatively low testosterone level induces various symptoms that may also be related to the “normal” ageing process. Sleep disorders especially insomnia, modifications of the body appearance with higher fat deposits, lower muscle strength and the development of benign enlargement of the male breast (gynaecomastia) are commonly attributed to lower testosterone levels. The most typical symptoms are however related to impairment in sexual activity with difficulties in obtaining and/or maintaining erection (erectile dysfunction) and especially lower sex drive.
Due to massive advertising of the “wonderful effects” of testosterone preparations, some people may be tempted to use them when confronted with apparently low testosterone symptoms. Testosterone supplements should not be used prior to a thorough clinical evaluation to determine if the lower testosterone level is linked to the ageing process or induced by a pathology leading to excessively low testosterone (hypogonadism). Hypogonadism can be the result of a testicle abnormality (primary cause) or from a disorder at the level of pituitary gland (located in the brain) involved in the control of testosterone production by the testicles (secondary cause).
It is thus advisable to first seek a specialist’s opinion (usually an endocrinologist or an urologist), who will interpret the hormonal results in relation to the complaints and the medical background.
Low testosterone levels can also be induced by many conditions including diabetes, obesity, severe infections, other hormonal disorders and chronic liver or renal illnesses as well as a side effect of various medications.
When the condition has been evaluated, the specialist may propose a treatment that includes testosterone therapy. In such a case, the hormone supplementation generally improves the symptoms, in particular the sexual desire, but may also lead to unwanted side effects including breast enlargement, acne, sleep apnea, benign prostatic enlargement, reduction in testicle size and possibly the growth of an existing prostate cancer.
Therefore, in rather healthy older individuals with borderline low level of testosterone, the benefit/risk ratio of supplementation remains controversial and most specialists will not propose testosterone therapy.
Finally, as for all aspects of men’s health, adopting a healthy lifestyle with no tobacco, moderate alcohol consumption, a balanced diet, maintaining a healthy body weight and taking regular exercise is a must.
Dr Gerard Lalande is managing director of CEO-Health, which provides medical referrals for expatriates and customised executive medical check-ups in Thailand. He can be contacted at email@example.com.