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Make sure to always give positive reinforcement to your children. If they get good grades or score the winning point, take them...
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| -DrErika |
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 Detoxification
Detoxification is for everyone who wants to feel better, have more energy, enjoy better health and support their immune and hormone balance with pure, organic and natural protein supplementation. |
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| Mary Davenport |
| At the age of 29, my doctor put me on Premarin, subsequent to my total hysterectomy. For the following 20 years of my life, I felt rotten, had very little energy and a general overall loss of interest... |
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The role of male hormones is at the same time extremely important and baffling. We are bombarded by continuous reinforcement of how different men and women are. Not only do we think differently, many would have us functioning differently on a physiologic level as well. Yet we have the same internal organs and mechanisms to make our hearts beat, to breathe air in the lungs, to digest the food we eat, and to excrete the waste we create. Why would men and women be different when it comes to the hormone depletion we unequivocally have established is associated with aging?
When I became involved with the study of hormones, I never thought in terms of men. My involvement was mostly based on personal experience and need. I wanted a safe solution for my personal symptoms of hormone deficiency and by association found solutions for my female patients. I did not address men, but was an error of omission. No sooner did I focus my clinical practice on natural hormone supplementation for women, that the women started to discuss and include their men.
Without any doubts, testosterone was the hormone that differentiates men from women. It is made in the testicles and is responsible for the production and multiplication of healthy sperm. Secondary sexual characteristics occur as a direct result of testosterone flooding the boy's system in early puberty. Testosterone makes his voice change, it makes body and pubic hair grow, perspiration develop its typical pungent male odor, makes the penis and the testicles grow to adult size, makes men stronger than women, and enables them to develop beautifully sculptured bodies shortly after starting a regular work-out program. And yes, testosterone is probably responsible for the way men think and process problems. That is where my basic education on testosterone ended.
What followed in my medical school course about male endocrinology, was a series of syndromes and illnesses associated mostly with testosterone deficiency. Oddly enough, they all seem to occur in young men, unlike the later timing of the appearance of hormone problems in women.
Once you made it through puberty and adolescence, you brought down undescended testicles, treated the rare case of testicular cancer, an occasional inflammation or infection of the foreskin, or addressed poor sperm motility in infertile men, testosterone very much disappeared from the medical vocabulary. And even more oddly, it never returned.
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| Testosterone Today
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I rarely heard the terms male menopause or andropause until around five years ago. In my extensive research on hormones I never read an article decisively connecting male hormone deficiencies with symptoms of midlife. Looking back over the past 16 years I've spent in private practice I wonder why my profession overlooked the possible relation between men's midlife problems with hormone deficiency syndromes. We certainly are ready to admit that men do experience midlife problems, so why are we missing their connection to testosterone levels? What is midlife crisis really all about?
Male Menopause is technically known as Andropause, Hypogonadism, or Male Climacteric. The reason Andropause has never been in the public spotlight is because men who experience it have been reluctant and unwilling to acknowledge its existence.
Somehow the decrease in testosterone levels that naturally occurs in man during middle age, is a little known fact. I don't know why it should be so surprising to acknowledge that men are physiologically similar to women. Just like women, when men start aging, their hormones start to decline as well. Symptoms of hormone insufficiency in men present quite often, and closely resemble symptoms of hormone insufficiency in women. The middle age gut, the couch potato stance, the depression associated with men in their middle years, are clear and unequivocal symptoms of the decline in testosterone levels.
Look at the man in his fifties who is unsuccessfully trying to build muscle mass. Yes, he is aging, but it is his decreasing testosterone levels that make him ineffective when he tries to build muscle mass. It is not that he suddenly just stopped trying.
Unfortunately, the medical profession has not been keen on addressing this obvious similarity to female menopause. Most doctors are men and menopause does not have a pretty ring to it, it's about aging. And men are more afraid than women to address the inevitability of this process. Men pride themselves in the ability to father children into their eighties, so how could they be having the same problems as aging women? However, men who father children naturally in their eighties are as rare as women who do in their fifties.
As women started to openly address their issues with hormone deficiencies in the 1990s, an interesting paradox occurred. Although not immediately acknowledged as a problem, the issue of the decline in sexual performance encountered by many middle-aged men moved to a more visible position as well. Maybe not as prominently displayed in the mass media, but nonetheless its presence started being felt in the medical community. Not that researchers haven't been studying male andropause for decades, along with the effects of reduced levels of testosterone in the aging process. However, it was the pharmaceutical companies who first saw an obvious opportunity for the population of aging men. Unfortunately, the direction the early solution took was synthetic and it addressed one isolated symptom and not the root cause of the male andropause problem. By approaching the problem from the angle of one symptom only, the larger issue of male menopause could be easily side-stepped and maintained its place in the closet of male problems.
Before the issue of male menopause would even be acknowledged, the treatment for impotence was flooding the market.
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| VIAGRA
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Viagra came onto the market like gangbusters. It carried a resounding message: "Our manhood is at risk, we have a problem with erections, and we are going to correct it quickly before anyone gets a chance to take a closer, more in-depth look at what is really going on with our men."
So Viagra moved into our consciousness. Practically every middle-aged patient in my practice called asking for prescriptions for Viagra. I learned about it form the media and my Pfizer pharmaceutical representative who came calling to my office with free samples of the new magical drug. It was odd, one day there was no conversation about impotence, the next, it was the hottest topic of conversation from Wall Street to the kids on Main Street.
Although I am very open-minded, I was hesitant to write the prescriptions. I had nothing against the quick fix Viagra promised men, but I was worried that the wrong man would take it and he would become mortally ill from it. My fear came from the understanding of how Viagra works. It increases the blood flow to the penis and the pelvic organs in general. It brings more blood to the penis and as a result, a harder erection. Great, exactly what we all want, but at what cost? If the man is older, has high blood pressure, or heart failure, Viagra, by diverting blood from the heart, lung and brain, will induce a rapid drop in blood pressure to the organs that need the blood flow the most. This increases the risk for potential strokes and heart attacks. I didn't want to scare anyone but I discouraged older men who had atherosclerotic disease, from using it. Unfortunately the very reason for their problems with erections was because they had plaques (atherosclerosis) in the blood vessels supplying the penis to begin with. They were the men on medications for high blood pressure and cholesterol. They were also suffering from impotence, the most disturbing side-effect of anti-hypertensive medication. A catch-22 situation: the men who need the medication the most are at highest risk of getting complications from it.
Despite the dilemma of its side-effects, Viagra had opened a new door. Its sheer existence acknowledges fairly prominently that men experience significant and disturbing problems as they age.
Men need help, too.
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| Male Hormones and Sex
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To feel sexual interest, you need hormones. When men pass from their mid-30s onto their mid-40s they undergo significant changes. Their hormone levels, starting with testosterone, start to dwindle. Since men never talk about hot flashes and night sweats, we never knew they experience them. But they do. Many women patients are starting to talk about their men's night sweats, their mood swings, their depression and their weight gain. And why not, just like in women, male hormones do drop with age. Testosterone made in the testicles and adrenal glands, starts waning with age and just like with women, as its quality and quantity declines, symptoms arise.
About two years ago, the medical literature, and in particular journals of urology started to publish articles connecting an improved sense of well-being in aging men, with testosterone supplementation. It was a major step forward for a profession where testosterone was used only to treat young males with diseases of hormone deficiency. It was a first step toward acknowledgment of the existence of male menopause. The connection between low testosterone levels and previously unaddressed and disconnected symptoms, was being made by both the lay public and conventional medicine.
Finally, in the past three years, testosterone supplementation has entered the conventional world of wellness and anti-aging. However, it has not yet moved into the mainstream of medicine or become a topic of dinner conversation in the way of menopause. Although, only recently men have started to admit to experiencing the same symptoms previously reserved to women, the door is only slightly ajar. In my practice, in response to the need, I developed The Hormone Solution program for men.
Every day one of my women patients brings up the topic of male menopause/ andropause. The question invariably is "How can I help my husband/lover?" The answer is clear and simple and backed by numerous medical publications: "supplement his testosterone". So, why aren't more doctors prescribing it? Do doctors still consider testosterone outside the area of conventional medicine? For our sake and our men's sake, I hope not. What used to be the domain of body builders and athletes, is now without a doubt a normal part of any man's world. To provide the proper solutions to the men, conventional medicine must follow.
Before we go on, let's pause and look at the most common symptoms associated with testosterone depletion in the average, healthy, 50 year old man:
- Inability to build muscle as easily as at age 20
- Problems losing weight as easily as at age 20
- Inability to ejaculate as often as at age 20
- Problems maintaining an erection as long as at age 20
- Diminished sex drive
- Depression and loss of excitement about life and career
- Insomnia and other sleep disorders
- Having to urinate at least once a night
- Lack of energy
Even if these symptoms do not appear to be exactly the same as those experienced by women as a result of hormone depletion, they are strongly similar. And beyond that point, women and men are not identical in the expression of these deficiencies.
Just like women, certain men suffer from symptoms, incapacitating to various degrees, while some sail through this period of their life with minimal problems and settle into the next stage without much trouble. Those who do have difficulties are easy to identify. Just like their female counterparts, these men's lives are turned upside down. Coping mechanisms fail and the aging process becomes unmanageable.
Allen came to see me in a state of quiet desperation. He was a successful 52 year old attorney. His life had been on an even keel. When he turned 50, things started to unravel. He stopped enjoying work, he had difficulties with family and friends, even stopped playing golf, his favorite hobby. His wife suggested he see a psychiatrist. The psychiatrist spent a long time talking to Allen finally deciding to start him on Prozac. Allen felt a little better. He seemed to regain some of his lost joie de vivre, he even returned to his Saturday morning golf game.
But something still wasn't right. The psychiatrist raised the dose of Prozac, and added another antidepressant for better balance (Wellbutrin). Allen became groggy and the little sex drive he had, was gone. His wife, also a patient of mine on the Hormone Solution Program was coping well and Allen's problems were a source of worry to her. One day, at work, Allen lost his temper and spun out of control. During an important meeting he started screaming and acting totally out of character. Embarrassed, he apologized to his boss and that same evening, asked his wife to get him help. She brought him to me. I tested Allen's PSA and testosterone levels. His testosterone level was very low. He was depressed and anxious at the same time. The psychotropic medications were clearly not helping him, they were only confusing an already difficult situation. After an extensive consultation I started Allen on the Hormone Solution Program including transdermal testosterone cream and we checked his blood hormone levels every six weeks. By the time his testosterone levels neared 600, Allen felt well enough to stop taking anti-depressant medications. It only took two months to get Allen back to the life he thought he'd lost.
Allen's story is the rule for men in the 40s and 50s who start taking testosterone supplementation. The unfortunate exceptions are the men who don't know about the miraculous recoveries achieved through testosterone supplementation. Because they don't know about the testosterone solution, they either ignore bothersome and destructive symptoms, or take antidepressant medications prescribed by physicians unfamiliar with the benefits and safety of the testosterone option.
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| Testosterone Testing
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When I started seeing men in need of testosterone supplementation, I could not find any clinical guidelines for dosing or systems of administration, in the medical literature. Interestingly, in the general field of wellness, testosterone was first recognized as the feel-good hormone women needed to maintain and improve their sex drive in their 40s and later years. Although testosterone is the male hormone, little is reported on its use in men for similar purposes, in either conventional or alternative medical literature. Rare articles in the scientific journals reflect a sense of surprise when men treated with their own hormone for impotence, depression and involutional melancholia react well to testosterone. In July 2000, Dr. Jay Adlersberg of WABC reported that more than 4 million men in the US suffer from low testosterone. He also added that low testosterone can cause " impotence, depression, and fatigue". His report concluded with patient testimonials praising the remarkable results of testosterone supplementation. After six months in the study, the participants reported increase in lean body mass, sex drive and energy levels.
Similar to the situation with women, the level of testosterone in men is not routinely measured when undergoing routine physical examinations. In those unusual cases where the levels are measured, the value considered normal is variable, the range of healthy quite broad, thus most levels are deemed within normal range.
This returns diagnosis of problems back to the area of clinical judgment of subjective symptoms.
However, the road to finding solutions is a lot steeper with regard to men. Andropause, or male menopause is still a dirty word in our society. Andropause has not emerged from the closet yet, although it certainly has reared its ugly head. Just like with women, men do not experience the same symptoms. They do not have incapacitating hot flashes and night sweats. They don't have periods, a situation that precludes the choice of an arbitrary point in time the change can be pinned on. Thus diagnosing hormone deficiencies in men, requires more detective work. And just think of how long it took women to start talking about menopause openly! No wonder men are so far behind in this area. However, there is no reason to give up or continue ignoring the existence of andropause. Men need help with hormones just as much as women do.
And the payoff is just as high.
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| Administration of Testosterone Supplementation
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One of significant drawbacks to testosterone supplementation has been its method of administration. Testosterone cannot be given by mouth because it does not get absorbed from the stomach. For years, the only method in use was by injection. Unreasonable, this is too invasive and painful. Most men would rather have symptoms of hormone depletion than take a shot every day or once a week. Most likely, this situation precluded testosterone supplementation from becoming popular with the public at large. For years, injectable supplementation it was reserved for the very young, sick with severe medical needs, not commonly used by men wanting to stay young and healthy.
Finally a patch named Androderm was developed. Initially it was used in men with testosterone deficiency diseases, AIDS related malnutrition. Body builders quickly followed and women too. Androderm did not make a big splash with middle-aged men. Medical drawbacks abounded: too many skin reactions, unpredictability of absorption, often times increase in aggressive behavior. The dosing is rigid, and absorption unpredictable because the patch stays on your skin for days. It holds a small reservoir of testosterone and the amount released is variable. Another problem with the use of Androderm by healthy people is its esthetics. Wearing a patch is unsightly and many men and women feel it detracts from feeling sexy and remove it during sex. This makes its reliability even poorer and its cost becomes prohibitive.
In 2000, Androgel 1% testosterone gel, came to the market. The FDA approved it for "treatment of low testosterone levels linked to decreased sex drive, impotence, reduced lean body mass, decreased bone density, and lowered mood and energy levels". The once-daily topical gel was not evaluated in women or men with prostate or breast cancer. Androgel is a synthetic form of testosterone (methyltestosterone) in gel form, with good absorption but rigid dosing. Androgel is superior to Androderm because its method of administration is more appealing, and the absorption improved.
Internal Medicine World Report, in an article published January 2001, reported on the successful use of testosterone in pellet form. This method involved insertion of testosterone under the skin, in three to six 200-mg pellets that provided adequate testosterone supplementation for 4 to 6 months. The study came from Australia and reflected the results of an exhaustive 19 year study involving men between the ages of 24 and 67. Beneficial results of testosterone involved more than its effects on enhanced sexuality and muscle mass. The possibility of positive cardiac effects on the men who participated was raised by the results of the study.
Another form of administration is micronized testosterone. Like natural estrogen and progesterone, this form of supplementation is sold directly to pharmacists in powder form and is mixed to the doctor's specifications. This method is superior to the pharmaceutical standard methods because the dosage can be individually altered by the physician. It is of great value to the patient because it addresses the individual's needs and not statistically determined dosages. Adroderm, Androgel and pellets are rigidly dosed and the doctor does not have much input as to the adjustment of each patient's dosage. They're also synthetic preparations of the hormone. Micronized testosterone is a natural base formulation and the patients followed in the Hormone Solution program, experience a rapid, gentle rise in their testosterone levels with remarkable effects and exquisite safety records. The method of application is gentle and comfortable. A specifically designed amount is rubbed into the area of the inner thigh or on the scrotum once or twice a day.
The dosage is easily adjusted using this method: it is determined by symptom relief in conjunction with close monitoring of testosterone blood levels.
Testosterone is available by prescription only. Some states further supervise its usage by classifying it as a controlled substance. That is because it has been recklessly used by body builders. Androgel and Androderm patches can be obtained at any regular pharmacy, or it can be individually compounded in the micronized form in specialized pharmacies.
The Hormone Solution program successfully integrates individualized dosing of micronized testosterone with diet, exercise and lifestyle in a comprehensive, medically supervised fashion treating the whole man's needs. I strongly advise you to talk to your doctor and together evaluate your particular situation. Once the diagnosis of testosterone deficiency is made, you owe it to yourself to get the best preparation for you. Work with your doctor and find the type of supplementation best suited for your symptoms and lifestyle.
Adapted from The Hormone Solution by Erika Schwartz, M.D. Buy the complete book for $13.99 including postage.
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