Many of life’s transitions are coupled with biochemical, emotional and spiritual changes. Examples include birth, puberty and the transition into parenthood. Just as women experience a stark midlife transition into menopause, conventional medicine is starting to characterize a similar transition – known as andropause – for men. The collection of symptoms include fatigue, reduced libido, lowered physical endurance, anxiety, reduced muscle mass, increased weight gain and fat deposition in the breasts – all of which cause many men to feel less virile. These changes can disrupt a man’s social life, his romantic relationships, impact his productivity at work, and can lead to anxiety and depression.

Under conventional medical treatment, hormone levels are tested in men for decreased testosterone numbers. If testosterone is found to be deficient, supplemental testosterone therapy will be prescribed. This parallels the conventional treatment approaches for menopausal women. Individuals who initiate hormone replacement therapy require re-testing of hormone levels to ensure that they are not overdosing on sex hormones. The body is incredibly sensitive to fluctuations in hormones; symptoms of testosterone overdose include agitation, aggressiveness, breast enlargement, and increased risk of stroke and other cardiovascular diseases.

Symptoms of andropause can improve after initiating hormone replacement therapy. However, the human body encompasses a large number of complex biochemical pathways that far exceed the simple algorithm of replenishing deficient testosterone levels. This transition into andropause provides individuals with the opportunity to better understand what their bodies need in order to improve the quality of their lives and experience healthy aging. Changes in some key lifestyle factors can improve health at midlife for men.

The Case of Too Much Estrogen

Estrogen, known as the “female” hormone, is necessary for men’s health as well. At normal levels, this hormone helps build bones, reduce cardiovascular risk, and increase feelings of sexual desire and connection. Estrogen levels naturally increase with age due, in part, to the increased activity of aromatase, an enzyme that converts testosterone to estrogen. It is when estrogen levels are too high that men start to experience symptoms related to andropause.

There are two major causes of estrogen overdose in men: exposure from the environment and obesity. Estrogen mimickers – such as the chlordane, DDT and dioxin pesticides and the benzo[a]pyrenes hydrocarbon – can cause symptoms of high estrogen in both men and women. Eating fresh organic fruits and vegetables and reducing use of plastics are ways to reduce exposure to environmental estrogens.

The fat cells that live in the belly of overweight men convert testosterone into estrogen via the same aromatase enzyme. For men, abdominal weight gain is an indicator that the levels of estrogen to testosterone may be out of balance. In these cases, treatment is focused on reducing estrogen levels rather than supplementing with testosterone. Finding effective and lasting weight loss strategies is important for hormone balance at midlife.

Too Little Sunshine

Vitamin D is critical for a healthy mood, healthy energy levels and erectile function. In some men, symptoms of andropause may be a sign of insufficient vitamin D levels. Correcting these levels may improve libido, stamina and energy levels throughout the year.

Not Enough Zzzz’s

Circadian rhythm dysfunction is a fancy way of saying that the quality of one’s sleep cycle is poor. As people age, they start to experience difficulty sleeping continuously throughout the night. Sleep is important for maintaining healthy levels of testosterone. It also accelerates metabolism; for some people, a lack of sleep can contribute to conditions such as diabetes and stubborn weight gain. Many overweight men suffer from sleep apnea, which is characterized by symptoms of snoring, nocturnal awakening and day-time sleepiness. Untreated sleep apnea can be life-threatening. Focusing on adequate sleep is a priority for men who want better midlife health.

Too Stressed

The adrenal glands are key players in producing sex hormones after the testes and ovaries decline in function. High levels of stress cause your adrenal glands to go into overdrive, adjusting to the unyielding levels of stress that you experience. When the adrenal glands must choose between producing the stress hormone cortisol and sex hormones, the body will choose cortisol. Establishing a healthy stress response by engaging in stress reduction habits at midlife is key to maintaining good health.

Highlighted above are a few of the key factors that contribute to andropause symptoms. While these recommendations sound simple enough, over time problems with any of these factors can disrupt physiological balance and lead to disease. The good news is that there is so much a man can do to improve his quality life at midlife without requiring supplemental testosterone therapy

Dr. Kulveen Virdee practices naturopathic medicine at Shalva Clinic in Westport. During her general medicine residency, she worked with experts in the field of men’s health, autism, gastroenterology and mood disorders. She can be reached at 203-916-4600 or ShalvaClinic.org. See ad on back cover.