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The Menopause Misnomer: Male Hormonal Optimization

Florence Comite MD

Aug 12, 2021
Man staring at sky

Hormones are the messengers that orchestrate the various systems in our bodies. If our hormones are low, high, or fail to work in an optimal manner, that can and will significantly impact health. I believe that, for both sexes, the most vital biomarker that begins the aging process in our thirties is testosterone.

Most people know about the hormonal changes that occur for females during menopause. What is perhaps less known are the changes that occur in males. Often referred to as the ‘male menopause’, andropause – derived from the Greek andros (man) and pauses (cessation) – describes a diverse process of gradual hormonal decline that occurs throughout your system as you age through the decades.

What is Andropause?

Although commonly referred to as ‘the male menopause’, there are distinct differences. Unlike in women, andropause may emerge anytime from the late thirties to the eighties. As such, when men complain about their symptoms, they are often mis-diagnosed or told to “Get used to it, you’re aging.” Conservative medical practitioners raise questions about andropause itself and will challenge the diagnosis despite sarcopenia (loss of muscle), osteopenia/osteoporosis (loss of height), and other issues being evident. The term “hormonal replacement therapy” (HRT) is popular, though we prefer the term, ‘hormonal optimization’. We can’t do what Mother Nature does, so replacement is not possible, but optimization is.

The transition to andropause in men can be underway for decades—unlike women, where the average menopausal age is 51.8 years and the window of time when menopause occurs is narrower. By age 65, greater than 95 percent of men have experienced periandropause and/or andropause, the most significant measurable indicator being low testosterone, or ‘low T.’ The fall in testosterone is associated with it a multitude of risk factors, including diabetes, heart disease, osteoporosis, cancer, and depression. A study has even suggested that low testosterone levels in the blood are linked to a higher risk of requiring intensive care or dying from Covid-19.

Signs of Low Testosterone

Testosterone is known to be optimal, in general, between 25 to 30, after which it begins to decline – in your 30’s, for both sexes will fall by 1 to 3 percent. For adult males of this age, free testosterone should be greater than 180 pg/ml, however it is important to note that these are average figures; testosterone is highly individualized. For example, while some men might do just fine with a free T of 180 pg/mL, others may be symptomatic with the same free T.

As testosterone diminishes, you feel the reduction in lean muscle and it becomes harder to lose fat, especially around the middle. You will often put on weight faster, expect to buy larger belts. many middle-aged men report symptoms to their physician such as lack of energy, sleep disturbances, anxiety, fatigue, libido, and even ‘hot’ flushes – like those experienced in perimenopausal and menopausal women.

Treatment for Andropause

You may have undergone basic metabolic tests, including urinalysis, fasting glucose, lipid panel, complete blood count (CBC), and a kidney and liver profile to get to the bottom of these symptoms. The good news is that hormonal optimization can reduce risk factors and, in many cases, prevent the emergence of disorders of aging, and even reverse the progression of many of these conditions, including diabetes, heart disease, decreased mobility, and osteoporosis.

For men who have not yet gone through andropause, I prefer to use injectable human chorionic gonadotropin (hCG), which spurs the testes to produce its own testosterone, rather than “replace” it with an alternative testosterone. As men enter andropause, it is necessary to cycle hCG with testosterone.

Ultimately, testosterone can be used to optimize hormonal levels. Symptoms such as weight gain, muscle loss, fatigue, decreased energy, libido, and sexual dysfunction will resolve and reverse, and you begin to feel ‘like yourself’ again. This is a commonly heard from middle-aged men undergoing hormonal optimization. Our data is clear, the vast majority of men feel terrific, and their enjoyment of life returned. Aging does not have to be absolute!

Further Considerations

As well as testosterone, men are reliant on a balance of factors, including growth hormone, insulin growth factor, dehydroepiandrosterone (DHEA), dihydrotestosterone (DHT), thyroid-stimulating hormone (TSH), and thyroid hormones. It’s also critical to measure and balance other hormones, such as insulin and cortisol, along with other dynamics which affect male function, as well as considering your overall health and wellbeing.

These include prostate-specific antigen (PSA), a protein associated with testosterone and DHT, carbohydrate and lipid factors, such as glucose and cholesterol particles. These indices are vital, and all play a role in maintaining healthspan for life. Other biomarkers, such as complete blood count, hemoglobin and hematocrit and iron markers, should also be monitored and managed, as they too may react to optimizing testosterone.

The most important factor is the way your entire system, body, mind, and spirit, respond to any intervention, including hCG and testosterone. Your response to T is measured by biomarkers in serum lab tests, and by determining your own indicators, signs, and symptoms, and most relevant, how well you feel. It is also important to remember that the breakdown products of testosterone, such as estradiol, and DHT, need to be followed and may require adjustment with supplements or medication depending upon your response.

Florence Comite MD is the CEO & Founder, Comite Center and Groq Health, as well as the author of Keep It Up! which examines the myths and secrets behind optimal health and reversing aging in men.


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