COULD IT BE LOW TESTOSTERONE?

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1 COULD IT BE LOW TESTOSTERONE? By Dr. Lauren M. Bramley For thousands of years women have been recognized for their sensitivity to hormones. PMS, post partum depression, menopause have long been plights of the female existence and are characterized by predictable symptoms based on sudden changes of hormone levels. So recognized are these features they have been well accepted by our society and were the basis for words such as hysterical (derived from the Latin word for uterus). But do such effects happen in the male? Is there a predictable collection of symptoms which plague men suffering a hormonal change? Picture the irritable, middle aged man with the expanding waist line who finds it more difficult to cope with everyday stressors, passes out on the couch after dinner and won t remember where he put his wallet the next day. This may not be just middle age, this may be a hormone problem. The symptoms have been coined Irritable Male Syndrome (IMS) which is a state of hypersensitivity, frustration and anger with loss of male identity which occurs in males. Men and women are both driven by the hormones estrogen and testosterone, it is just the ratio which differs between the sexes. Testosterone is the hormone that governs drive, assertiveness, lean body mass, sex drive in

2 both men and women. From about the age of 30-35, testosterone, the predominant hormone in men, may start to dwindle. With this new change in the ratio of testosterone to estrogen predictable symptoms can develop. These include fatigue, loss of strength and muscle mass in the arms and legs, collection of fat around the middle, markedly reduced or absent sex drive, headaches, poor quality sleep, cognitive dysfunction, memory loss, irritability and poor coping skills. The psychological impairment can be so marked that it may often be confused with depression. With low testosterone, a man may feel less optimistic and lose his spark or drive in life rather than the sadness that characterizes depression. He may also be less assertive and confident which can lead to frustration and irritability. The testosterone deficient male may often be prescribed sleeping tablets or SSRI medications (antidepressants) which may help relieve some of the symptoms but worsen others such as weight gain and lack of sex drive with prolonged use. A number of factors can exacerbate the normal decline in testosterone levels resulting in very low levels and severe symptoms. These include a number of medical conditions such as diabetes, liver impairment most commonly from alcohol abuse (testosterone levels are regulated by the liver), hypothyroidism and other hormonal imbalances such as hypopituitarism. More commonly, social factors such as lack of exercise, obesity, stress, abstinence,

3 excessive alcohol intake and medications can reduce testosterone levels. Addressing these lifestyle issues by increasing exercise, improving relationships, losing weight, improving nutrition, reducing alcohol intake, dealing with stress can naturally raise testosterone levels and markedly improve symptoms. In some cases the decline may be marked and not caused by any other factors. Following a full examination and work up, men may be prescribed testosterone supplementation in the form of gels, tablets or injections. Testosterone levels can be measured by a blood test and is best done in the morning, when levels are at their highest.. Following a full assessment of symptoms, measurements of blood PSA (prostate specific antigen, which when raised may signify prostate cancer), liver function tests, blood count, cholesterol tests and a prostate and cardiovascular examination a decision whether supplemental testosterone is warranted can be made. Prescription for testosterone supplements have doubled since the year This represents a push toward supplementation by many doctors, notably endocrinologists and anti-aging enthusiasts. The improvement on testosterone supplementation can be dramatic even as quickly as a few days to weeks. Many men call it a lifesaver. One patient who had endured a decade of sleeplessness, headaches and irritability inappropriately treated with antidepressants, had improved dramatically off of his antidepressant and onto testosterone

4 supplementation, said upon questioning that he had become a little more aggressive at work. When a decrease in dose was suggested, he laughed No, please don t, finally people are listening to me again. However, the use of testosterone remains controversial and warrants far more research into its side effects and potential for harm. Many doctors fear that testosterone supplementation could potentiate prostate cancer, liver damage and heart disease. Other doctors claim just the opposite, that testosterone supplementation staves off prostate cancer and significantly improves heart disease. Clearly more randomized trials are needed before testosterone can become more widely used in men. In the meantime, testosterone is never used in people with a history of prostate or breast cancer. It must be frequently monitored with examinations and blood tests by a doctor familiar with its use. Its use must be carefully considered from a risk to benefit perspective on an individual basis and should be discontinued if there has been no benefit after 3 months of use. Men should always be committed to improving lifestyle in an effort to naturally raise their testosterone levels. Regular exercise, moderation of alcohol and conquering stress are as important as supplementation.

5 With the aging population and a focus on health optimization in middle age and beyond, the role of testosterone in male well being is sure to be further studied. Resources The Irritable Male Syndrome. By Jed Diamond. Rodale Books USA September, ISBN RHODEN E. L., MORGENTALER A. MEDICAL PROGRESS: RISKS OF TESTOSTERONE- REPLACEMENT THERAPY AND RECOMMENDATIONS FOR MONITORING N ENGL J MED 2004; 350: , JAN 29, 2004 KUNELIUS P. ET AL. THE EFFECTS OF TRANSDERMAL DIHYDROTESTOSTERONE IN THE AGING MALE: A PROSPECTIVE, RANDOMIZED, DOUBLE BLIND STUDY. J CLIN ENDOCRINOL METAB 2002 APR;87(4): Dr Lauren Bramley is the co-author of The Baby s Table :Over 100 Easy, Healthy and Homemade Recipes for The Pickiest, Most Deserving Eaters on The Planet By Brenda Bradshaw and Lauren Bramley. Random House Canada ISBN and a Canadian and American trained Family Doctor who has practiced in Hong Kong since She practices at Dr Lauren Bramley and Partners in Central, Hong Kong. She can be reached at her clinic on (852)

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