Andropause: Sometimes called "male menopause," it's the Male Hormone Crisis men don't talk about. Surprisingly, women often need it too. We'll talk about testosterone replacement ( TRT ) therapy here, discussing the topic that affects men and women - Published Monday through Friday, from the upcoming book by author Kenneth E. Lamb, "Andropause: A Man's Fate, A Woman's Fear." (C) 2013
Rejuve Health Clinics (RHC), Inc., (www.rejuvehealthclinics.com)
Orlando's Premier Testosterone Replacement Therapy Center is pleased to
announce the grand opening of its first location at 766 N. Sun Drive
Suite 1060 Lake Mary, FL 32746 (Fifth 3rd Bank Building).
"At Rejuve Health Clinic, we are focused on improving the quality of
men's lives," says Dr. Chester Miltenberger, Medical Director at Rejuve
Health Clinics, Inc., who is not only an advocate of testosterone
replacement therapy (TRT), but has experienced the benefits of this
technology for 10 years. "Many people associate low T with only sexual
dysfunction, when in fact, men suffering from low testosterone can
experience a number of physical and psychological symptoms." Dr.
Miltenberger is certified by the American Board of Internal Medicine and
has been practicing medicine for more than 25 years.
Adequate levels of testosterone help maintain adequate levels of
reproductive tissues, energy levels, fat distribution, muscle mass and
good bone health. When these levels fall below a certain level, men can
experience fatigue, irritability, decreased energy, loss of muscle mass,
weight gain, diminished sex drive, depression and sleep disorders.
Replacement of Testosterone may improve some or all of these symptoms.
Currently, 13 million men in the U.S. over the age of 40 have low
testosterone (low T) levels. Levels typically decline at age 40 at a 1-2
% annually with a marked decline after the age of 60.
"We are thrilled about the opening of our first Central Florida location
and are confident that men are going to benefit from our knowledge and
experience in the area of testosterone replacement therapy (TRT)," says
Rejuve Health Clinic's President and CEO, James Skalko. "Our clinic is
set up so men can walk in, take a simple blood test, and know the
following day whether or not they are a candidate for testosterone
replacement therapy (TRT). Men who qualify for TRT will be given their
first injection the same day and can expect to see results in as little
as two weeks."
Rejuve Health Clinics (RHC), Inc., Orlando's
Premier Testosterone Replacement Therapy Center, was established by
President and CEO James Skalko in June 2013. Brian P. Black is the
Executive Vice President and Dr. Chester Miltenberger is the lead doctor
and medical director of RHC. Rejuve Health Clinics, Inc. diagnoses and
treats male patients with symptoms of hypogonadism (low T). We are
dedicated to helping men with low testosterone regain their vitality and
achieve optimal health. Our doctors and experienced medical
professionals help address the many symptoms caused by this medical
condition including fatigue, decreased energy, low motivation, weight
gain and diminished sex drive. For more information, visit
http://www.rejuvehealthclinics.com or call (407) 331-LowT.
Is the male menopause myth or reality? When men reach their
late forties to early fifties, some may experience a reduction in libido
(sex drive), erectile dysfunction, weight gain, fatigue, depression,
and other emotional symptoms which bear some similarities to the female
menopause.
However, the female menopause
is completely different. In a woman the menopause marks the time when
her menstrual periods stop and she is no longer able to become pregnant.
Her levels of female hormones - estrogen and progesterone - decline
considerably.
Among males, the male menopause is much less abrupt. The signs and
symptoms emerge more gradually and subtly, and the decrease in male
hormone (testosterone) levels is nowhere near as steep as it is for
women.
Do doctors use the term "male menopause"? - No. A
health care professional may use the term andropause, testosterone
deficiency, or late-onset hypogonadism. Hypogonadism refers to a
deficiency in male hormones, where levels are too low even for an aging
man. The meaning of late-onset hypogonadism is more similar to what lay
people and the media refer to when discussing "male menopause".
Some lay people use the colloquial term "man-opause".
The World Health Organization does not recognize the term "andropause", but does recognize "menopause" (in women).
According to the Cleveland Clinic, health care professionals are currently debating whether males really do go through a well-defined menopause?
Researchers at Northwestern Memorial Hospital estimated that in the USA five million men are affected by male menopause.
What are the signs and symptoms of male menopause?
Research teams, experts and health authorities appear to have
different views when identifying the signs and symptoms of male
menopause.
According to the National Health Service, UK, the following are the most common signs and symptoms of male menopause:
A European study led by researchers at The University of Manchester, Imperial College London, and University College London identified the most common symptoms of male menopause, the study was published in NEJM (New England Journal of Medicine):
Decreased frequency of morning erection
Erectile dysfunction - impotence, problems in getting or maintaining an erection
Decreased sex drive
The same study also identified the following symptoms as (weakly) related to male menopause:
Inability to walk more than 1 kilometer (0.62 miles)
Inability to engage in vigorous activity, such as running or lifting heavy objects
The researchers also ruled out the following (not related to male menopause): problems getting up from a chair, anxiety, nervousness, poor concentration, feeling of worthlessness, and changes in sleeping patterns.
What are the causes of male menopause?
After the age of 30 years, a man's testosterone levels start to drop,
about 1% each year. Most men in their seventies have at least 40% less
testosterone in their system than they did when they were 30.
However, the normal decline of testosterone levels that comes with age is not believed to be the cause of male menopause. If it were, every man would experience it, and this is not the case.
According to the British Association of Urological Surgeon
(BAUS), who refer to the male menopause as Androgen Deficiency in the
Ageing Male (ADAM), "The overall picture associated with ADAM is,
therefore, very complex."
Although male menopause occurs in older men whose testosterone levels have declined, it tends to affect older males with heart disease, obesity, hypertension (high blood pressure) and/or type 2 diabetes.
In other words, unlike the female menopause, several factors together contribute to the development of male menopause.
Some underlying health problems, lack of exercise, smoking, alcohol consumption, stress, anxiety, and sleep deprivation could also be key factors.
Psychologists suggest the male "midlife crisis", when men are
supposed to wonder what they have accomplished so far professionally and
personally, can be a cause of depression and might possibly trigger a cascade of factors that lead to male menopause.
Could low estrogen be linked to male menopause?
Researchers at Massachusetts General Hospital wrote in NEJM that a proportion of testosterone in men is usually converted into estrogen by a type of enzyme (aromatase).
Men with higher testosterone levels therefore have more estrogen,
compared to men with low testosterone. Since those with low
testosterone also have low estrogen, it is unclear which hormones
support certain functions.
Professor Joel Finklestein and colleagues set out to determine
whether changes that occur in middle-aged and older men are due to low
testosterone, estrogen or both hormones.
They randomly selected 300 men into two groups of about 150. In one
group, men were given daily doses of testosterone gel at four levels of
dosage, or a placebo gel for 16 weeks. In the other group, the
participants were given testosterone gel plus an aromatase inhibitor,
which stops testosterone from being converted into estrogen.
They found that the participants on testosterone without the
aromatase inhibitor showed similar increases in body fat to what one
would expect in a male with mild testosterone deficiency.
What surprised the researchers, though, was that some of the symptoms
doctors usually attributed to testosterone deficiency were partly or
nearly exclusively caused by a drop in estrogen levels.
Diagnosing male menopause?
The doctor is not going to say "You are going through the male menopause and the treatments for this are...."
Male menopause is a term used by lay people, and
represents a set of symptoms (which experts seem unable to agree on)
which may be due to low testosterone (and consequently low estrogen),
some underlying diseases, mental issues, obesity, and several lifestyle
factors.
The doctor will ask the patient about symptoms, lifestyle and check his medical history.
If the doctor suspects there may be signs of depression or anxiety,
he or she may recommend that the patient sees a psychologist or
psychiatrist.
The patient may be advised to have a thorough check up that may
include blood tests and diagnostic tests to check for cardiovascular
disease.
What are the treatment options for male menopause?
Treatment for male menopause depends on what is causing it.
Depression or anxiety - the patient may benefit from behavioral therapy, antidepressant medications, or both.
Obesity - the patient will be advised to lose weight, become more physically active and eat a well balanced and healthy diet.
Heart and cardiovascular disease - the disease will have to be treated.
Diabetes type 2 - as with heart disease, it will
require proper treatment. Patients with good glucose control tend to
have fewer problems and complications.
Low testosterone - the doctor may recommend testosterone therapy. An article published in Drug Therapeutics Bulletin
questions whether testosterone therapy is effective in treating male
menopause. Testosterone therapy also raises the risk of blockage of the
urinary tract and prostate cancer. It may also aggravate ischemic heart disease, epilepsy, and sleep apnea.
Elizabeth Siegel Watkins, at the faculty of History and Social
Medicine, University of California, wrote an article published in the
journal Social History of Medicine titled "The Medicalization of Male Menopause in America.".
Watkins explained that male menopause was a much-discussed topic from
the late 1930s to mid-1950s. During the following four decades the
topic virtually disappeard.
In the late 1990s, popular American newspapers and magazines began discussing the subject more keenly.
Watkins' study described how the male menopause became medicalized.
It was not the result of scientific research or a push from eminent
clinicians, it was encouraged "instead by a model perpetuated by lay
people and medical popularisers."
In an Abstract in the same journal, Watkins concluded "This
framework, rather than persuasive evidence from the research laboratory
or clinic, helped to medicalise male menopause and provided the basis
for its eventual pharmaceuticalisation at the end of the twentieth
century."
Just a whiff of a woman close to ovulation is enough
to stimulate another woman's testosterone levels, along with her desire
to compete.
"It's well known that testosterone is linked to aggression and competitiveness," says lead author Jon Maner, a Florida State University
psychologist. "Based on our testosterone findings, one could speculate
that women exposed to the scent of ovulation might become more
antagonistic or competitive."
For the study, published in the latest issue of the journal Evolution and Human Behavior,
Maner and co-author James McNulty measured the testosterone levels of
women before and after they smelled t-shirts that were previously worn
by other women aged 18-21. The latter group wore the shirts when they
were at high fertility - days 13, 14 and 15 of the menstrual cycle - and
at low fertility- days 20, 21 and 22.
For the duration of the study, the t-shirt wearers refrained from
engaging in sexual activity. They also showered with unscented soap and
shampoo, did not use any perfumes or deodorants, didn't smoke, and
avoided eating odor-producing foods, such as garlic and asparagus.
The sniffers were told that the study concerned "how much we can tell
about another person without even meeting them," but had no idea about
how and when the t-shirts were collected.
Women exposed to the scent of high fertility females displayed
greater levels of testosterone. The smell of a low fertility woman
actually caused testosterone levels in the sniffers to significantly
drop.
We are not consciously noting the smells of other people all day
long, unless a particularly good or bad smell hits us, but odors are
working on us, even when we don't realize it.
"Humans are influenced much more strongly by ovulatory cues than we
tend to think," says Maner. "For the most part, people aren't likely to
be consciously aware of the effects ovulatory cues have over them."
"There is solid evidence that people find the scent of ovulation to
be pleasant and attractive (relative to the scent of a woman who is far
from ovulation), but beyond that, most of the behavioral and hormonal
effects are likely to occur below the conscious radar."
Under the radar
Prior
research found that men's testosterone levels are also sensitive to
female ovulation. For example, in one of Maner's earlier studies, men
who interacted with a female research assistant became more risk-taking
and flirtatious when the assistant was in the high fertility stage of
her menstrual cycle.
Such under-the-radar hormone dynamics might even influence what men and women wear.
Daniel Farrelly of the University of Sunderland and colleagues found
that men who chose to wear red when competing had higher levels of
testosterone than men who chose to wear blue.
"The research shows that there is something special about the colour
red in competition, and that it is associated with our underlying
biological systems," says Farrelly.
In all cases, it appears that today's human social interactions can be driven by how we've evolved as primates.
"Some people might like to believe that people aren't animals, or at
least that our behavior isn't beholden to the same biological processes
as other species," says Maner.
"But humans," he adds, "are very similar to other species in many
ways, and those similarities are no more apparent than when it comes to
sexuality."
For men with intermediate-risk prostate cancer, long-term hormone
therapy after radiation therapy provides no survival advantages compared
with short-term hormone therapy, according to a new study.
Hormone therapy is used to reduce the levels of male hormones
(androgens) such as testosterone, which can stimulate the growth of
prostate cancer cells.
Researchers examined data from 133 men with intermediate-risk
prostate cancer who underwent either long-term hormone therapy (59
patients) or short-term hormone therapy (74 patients) after receiving
external beam radiation therapy.
Ten-year overall survival was 61 percent in the short-term group and
65 percent in the long-term group, which is not a statistically
significant difference. Disease-specific survival was 96 percent in
both groups.
The study was scheduled for presentation Monday at the annual meeting
of the American Society for Radiation Oncology, in Atlanta.
"Most clinicians have felt that 'more was better' when it came to
blocking testosterone in prostate cancer patients, however, results for
the specific endpoints we focused on, OS [overall survival] and DSS
[disease-specific survival], indicate that this was clearly not the
case," study lead author Dr. Amin Mirhadi, a radiation oncologist at
Cedars-Sinai Medical Center in Los Angeles, said in a society news
release.
"This data supports administering less treatment, which will result
in fewer side effects and reduce patients' overall health care costs,"
Mirhadi added.
The data and conclusions of research presented at medical meetings
should be viewed as preliminary until published in a peer-reviewed
journal.
A study
released this month suggests men with small testicles are more likely
to take on a care-giving role when it comes to raising their kids.
Published in Proceedings of the National Academy of Sciences,
the report by US researchers out of Emory University in Atlanta,
Georgia, found a correlation between testis size and a father's
propensity towards instrumental care, such as changing nappies,
preparing meals, bathing and being present during doctor visits.
“Children with involved fathers have better developmental
outcomes; they do better socially, they do better psychologically, and
they do better educationally,” said study author James Rilling.
“We're interested in trying to identify variables that help
to predict how involved fathers are in raising their children. We're
certain that there must be many very important social influences —
things like was your own father around when you were a child, what are
the societal and cultural expectations, what are the demands of your job
and so forth — but in this study we wanted to look specifically at
biological variables that might explain some of the variation.”
Sampling 70 biological fathers living with children aged one
to two and the birth mother, researchers measured testicle size and
testosterone levels before conducting MRIs to monitor brain activity as
the men looked at photos of their own child and unfamiliar children.
They also asked the men's spouses to fill out questionnaires about their partner's parenting habits.
What they found is that fathers with smaller gonads showed
increased brain activity in the ventral tegmental area – a group of
neurons responsible for motivation and reward – when looking at pictures
of their own children.
“We know that when men become fathers, if they become
involved fathers, their testosterone decreases. That's pretty well
established,” said Rilling.
“But by looking at testis size we're getting at something
different, because most of the volume of testes is dedicated to sperm
production. The testes also produce testosterone, but the correlations
between testis volume and sperm production are higher than the
correlations between testis size and testosterone levels.
"So we think we're getting at something different and the
reason that we're looking at testis size is we're testing a hypothesis
that comes out of a branch of evolutionary theory known as life history
theory.
"The prediction is that organisms face a trade-off between
energy that they invest in mating versus energy that they invest in
parenting, and that if you invest more in one of those categories you
have less available for the other and vice versa.”
Drawing on further evidence from closely related primates
such as chimpanzees and baboons, Rilling and fellow researchers Jennifer
Mascaro and Patrick Hackett used testis size as an indirect measure of
mating effort — because testes produce sperm, men with larger testicles
invest more in mating effort in a physiological sense because they're
producing more sex cells.
Data from these other species show a direct correlation
between this and parental bonds; namely that primates like chimpanzees,
who live in promiscuous societies and have large testes for their body
size, are less likely to be concerned with childrearing.
Whereas species whose fathers are more involved live in
monogamous, two-parent social settings and have a lower testicle-to-body
ratio.
Speaking of earlier studies related to testosterone
production, Rilling offers up a potential explanation for the decreased
levels seen in fathers.
“There is some evidence that testosterone can interfere with
empathy and so you can imagine when you have a helpless infant that
demands a lot of care it would be important to maintain an empathic
stance towards the infant,” he said.
“The other thing is the inconsolable crying on the part of
the infant can often be a really frustrating stimulus for parents and
it's also thought that testosterone impairs frustration tolerance and
impulse control.
"So it may be that when testosterone levels decrease it makes
men a little more tolerant of some of the frustrations that go along
with parenthood.
"The third prediction would be that it lowers libido and
makes men less interested in mating, so that they're more focused on the
parenting aspect and not distracted by sexual stimuli, either within or
outside the confines of marriage.”
Rilling, however, is at pains to express that these new
findings shouldn't be misconstrued to suggest all men with small
testicles make great fathers and their big-balled brethren are
automatically lousy parents.
Acknowledging that there are variations left unaccounted for
in the study — such as personal morals and how committed one is to
parenting — he also notes that some of those in the data set with large
testes were demonstrably involved with their offspring; though they were
in the minority.
He is also uncertain about the direction of causality. Like
the decrease seen in testosterone production after the birth of a child,
researchers don't yet know whether men with small testicles are natural
caregivers or if their testes shrink as a result of their increased
parental involvement.
“There are a lot of different ways to be a good father. Not
only through this instrumental care-giving but by providing for your
family economically, by being a playmate, by coaching and mentoring your
kids, helping with homework, all those sorts of things.
"I don't think it's fair to say that men with large testes
are bad fathers,” he said, adding he also didn't want men with big
testicles to have a convenient get-out-of-jail-free card.
“It's important to recognise that not all men are built the
same and it may actually be more challenging for some men to get
involved. But we certainly don't want to suggest that men should use
having large testes as an excuse for not being involved … all men are
capable of being involved fathers.”
After
adjustment for potential confounders, higher total testosterone levels
were associated with a 25% reduced risk of acute MI in that group (HR
0.75, P=0.006), according to Bledar Daka, MD, of the University of Gothenburg in Sweden.
"In
the future, we probably could use serum testosterone for the assessment
of cardiovascular risk in men with type 2 diabetes," he said, noting
that the findings should be validated in other studies before drawing a
definitive conclusion.
Previous studies have revealed a
relationship between low testosterone and the development of type 2
diabetes in men, as well as with a greater risk of cardiovascular mortality in otherwise healthy men.
The
current analysis used data from 538 men and 571 women 40 and older
(mean age 62) who were living in Skara in southwest Sweden and responded
to a survey conducted in 1993 to 1994. All had total testosterone and
sex hormone-binding globulin (SHBG) measured with radioimmunoassays;
free testosterone was calculated using the Vermeulen method.
At
baseline, the level of total testosterone was 13.5 mmol/L in men and
1.00 mmol/L in women.
Corresponding levels of free testosterone were
0.26 and 0.014 ng/mL.
The rate of type 2 diabetes was 9.8% in men and 7.3% in women.
Through
an average follow-up of 14.1 years, there was a significantly higher
rate of acute MI in men versus women among the non-diabetic individuals
(14.2% versus 9.7%, P=0.02), but not among those with type 2 diabetes (20.8% versus 24.3%, P=0.45).
Having
a serum total testosterone level in the highest quartile was associated
a lower rate of acute MI, but only among men with type 2 diabetes (P=0.02).
The difference remained significant after adjustment for age,
waist-to-hip ratio, smoking, physical activity, LDL cholesterol, and
systolic blood pressure. The finding was similar when free testosterone
was used.
The test for an interaction between diabetes status and
the relationship between testosterone and acute MI achieved only
borderline statistical significance, however (P=0.051).
In comments following Daka's presentation, one of the co-chairs of the session, Naveed Sattar, MD, PhD,
of the University of Glasgow in Scotland, called the study
hypothesis-generating and said that it remains unclear whether
testosterone has a direct effect on the risk of acute MI or is simply a
marker of risk, even though there are some plausible direct links. Those
include testosterone's effects on blood flow and vascular function.
"We're
a long way from proving that it's causal," he said in an interview,
adding that larger and more comprehensive studies that incorporate
genetic information are needed.
"Because if the genes are related,
that would suggest it's causal," Sattar said. "And only then should we
do some intervention studies, but do them very very carefully."
He
noted that a case-control study in the U.K. that includes 10,000
patients with MI and is measuring levels of testosterone and SHBG should
be able to provide a definitive answer.
"I think we're kind of
early on in the game of testosterone and cardiovascular events in men,"
Sattar said, "and my gut feeling is it probably won't be the answer."
The study was supported by grants from the Swedish Institute and the FoU VGR. Daka did not make any additional disclosures.
Just
as the symptoms of menopause in women are attributed to a sharp drop in
estrogen production, symptoms often seen in middle-aged men – changes in
body composition, energy, strength and sexual function – are usually
attributed to the less drastic decrease in testosterone production that
typically occurs in the middle years. However, a study by Massachusetts
General Hospital (MGH) researchers finds that insufficient estrogen
could be at least partially responsible for some of these symptoms.
"This
study establishes testosterone levels at which various physiological
functions start to become impaired, which may help provide a rationale
for determining which men should be treated with testosterone
supplements," says Joel Finkelstein, MD, of the MGH Endocrine Unit, corresponding author of the study in the Sept. 12 New England Journal of Medicine.
"But the biggest surprise was that some of the symptoms routinely
attributed to testosterone deficiency are actually partially or almost
exclusively caused by the decline in estrogens that is an inseparable
result of lower testosterone levels."
Traditionally a diagnosis
of male hypogonadism – a drop in reproductive hormone levels great
enough to cause physical symptoms – has been based on a measure of blood
testosterone levels alone. Although such diagnoses have increased
dramatically – leading to a 500 percent increase in U.S. testosterone
prescriptions between 1993 and 2000, the authors note – there has been
little understanding of the levels of testosterone needed to support
particular functions.
In addition to its direct action on some
physical functions, a small portion of the testosterone that men make is
normally converted into estrogen by an enzyme called aromatase. The
higher the testosterone level in a normal man, the more is converted
into estrogen. Since any drop in testosterone means that there is less
to be converted into estrogen, men with low testosterone also have low
estrogen levels, making it unclear which hormones support which
functions. The MGH team set out to determine the levels of hormone
deficiency at which symptoms begin to occur in men and whether those
changes are attributable to decreased levels of testosterone, estrogens
or both.
The study enrolled two groups of men with normal
reproductive function, ages 20 to 50, and all participants were first
treated with a drug that suppresses normal production of all
reproductive hormones. Men in the first group were randomly assigned to
receive daily doses of testosterone gel at one of four dosage levels or
a placebo gel for 16 weeks. Men in the second group received the same
testosterone doses along with an aromatase inhibitor which markedly
suppressed conversion of testosterone into estrogen. More than 150 men
in each group completed the study, including monthly visits for blood
tests and questionnaires about their overall health and sexual function.
Body composition and leg strength were assessed at the beginning and
end of the study period.
Among participants in whom estrogen
production was not blocked, increases in body fat were seen at what
would be considered a mild level of testosterone deficiency. Decreases
in lean body mass, the size of the thigh muscle and leg strength did not
develop until testosterone levels became quite low. In terms of sexual
function, sexual desire was reported to decrease progressively with
each drop in testosterone levels, whereas erectile function was
preserved until testosterone levels were extremely low.
In
participants also receiving the aromatase inhibitor, increases in body
fat were seen at all testosterone dose levels, but suppressing estrogen
production had no effect on lean mass, muscle size or leg strength.
Adverse effects on sexual function were much more obvious when estrogen
synthesis was suppressed regardless of participants' testosterone
levels. Overall the results imply that testosterone levels regulate
lean body mass, muscle size and strength, while estrogen levels regulate
fat accumulation. Sexual function – both desire and erectile function
– is regulated by both hormones.
Finkelstein notes that this
study artificially induced the kind of hormone deficiency usually seen
in aging men to provide a controlled model. He and his colleagues hope
to do follow-up studies in older men to confirm the accuracy of the
model. Right now, decisions about whether an individual is a candidate
for testosterone replacement should be made based on his symptoms and
not just his testosterone level. The findings regarding estrogen's
effects suggest that the forms of testosterone used for therapy should
be capable of being aromatized into estrogen, he adds.
"We also
need to look into how testosterone replacement therapy would effect
prostate health – both prostate cancer and the prostate enlargement that
causes unpleasant symptoms in many older men – and heart disease," says
Finkelstein, who is an associate professor of Medicine at Harvard
Medical School. "In light of what the Women's Health Initiative
discovered about the unexpected effects of estrogen replacement therapy
in women, we need a Men's Health Initiative to investigate those
questions before large-scale testosterone replacement can be
recommended."
Additional co-authors of the NEJM paper
are Sherri-Ann Burnett-Bowie, MD, MPH, Carl Pallais, MD, MPH, Elaine Yu,
MD, Lawrence Borges, MD, Brent Jones, MD, Christopher Barry, MPH,
Kendra Wulczyn, Benjamin Leder, MD, MGH Endocrinology; Hang Lee, PhD,
MGH Biostatistics Center, and Bijoy Thomas, MD, MGH Radiology. The
study was supported by National Institutes of Health grants R01
AG030545, K24 DK02759 and RR-1066 and a grant from Abbott Laboratories.
Massachusetts
General Hospital, founded in 1811, is the original and largest teaching
hospital of Harvard Medical School. The MGH conducts the largest
hospital-based research program in the United States, with an annual
research budget of more than $775 million and major research centers in
AIDS, cardiovascular research, cancer, computational and integrative
biology, cutaneous biology, human genetics, medical imaging,
neurodegenerative disorders, regenerative medicine, reproductive
biology, systems biology, transplantation biology and photomedicine.
Media Contacts: Mike Morrison, (617) 724-6425, mdmorrison@partners.org
Men who have low testosterone levels may have a slightly elevated
risk of developing or dying from heart disease, according to a recent
study accepted for publication in The Endocrine Society’s Journal of Clinical Endocrinology & Metabolism (JCEM).
Testosterone is a key male sex hormone that helps maintain sex drive,
sperm production and bone health. Over time, low testosterone may
contribute to an increase in body fat, loss of body hair and muscle
bulk.
“When we reviewed the existing research into testosterone and
cardiovascular disease, a growing body of evidence suggested a modest
connection between the two. A specific pathogenesis did not come
forward, but perhaps less frequently investigated events may play a
role, such as thrombosis where a blood clot develops in the circulatory
system or arrhythmia, where there is a problem with the heart beat or
rate,” said the study’s lead author, Johannes Ruige, MD, PhD, of Ghent
University Hospital in Belgium. “Based on current findings, though, we
cannot rule out that low testosterone and heart disease both result from
poor overall health.”
Treating low testosterone with replacement therapy did not have any
beneficial effect on cardiovascular health, Ruige said. Although the
number of older and middle-aged men who are being prescribed
testosterone replacement therapy is rising rapidly, there is debate
about whether the practice is too widespread. In its testosterone therapy clinical practice guidelines, The Endocrine Society recommends treating only men who have unequivocally low testosterone levels and consistent symptoms.
The clinical review examined findings from studies on cardiovascular
disease and testosterone published between 1970 and 2013. Although the
studies suggested some sort of relationship, existing research found
little evidence of a connection between low testosterone and arteriosclerosis, the hardening and narrowing of arteries that can cause
heart attacks and strokes. The reviewed studies also found no
relationship between testosterone levels and heart attacks.
Many of the studies had cross-sectional designs that do not provide
information about causality, but the review also looked at 19
prospective observational studies that can provide additional
information about whether one condition causes another. Because these
studies did not completely rule out some potential preceding causes of
both low testosterone and cardiovascular disease, additional research is
needed to confirm the relationship between the two conditions, Ruige
said.
“Gaps still remain in our understanding of low testosterone and
cardiovascular disease,” he said. “Ultimately, the goal is to more
accurately assess the impact testosterone substitution therapy may have
on the heart health of men who qualify for the treatment.”
Other researchers working on the study include D.M. Ouwens and J.-M. Kaufman of Ghent University Hospital.
The article, “Beneficial and Adverse Effects of Testosterone on the Cardiovascular System in Men,” was published online, ahead of print.
# # #
Founded in 1916, The Endocrine Society is the world’s oldest, largest
and most active organization devoted to research on hormones and the
clinical practice of endocrinology. Today, The Endocrine Society’s
membership consists of over 16,000 scientists, physicians, educators,
nurses and students in more than 100 countries. Society members
represent all basic, applied and clinical interests in endocrinology.
The Endocrine Society is based in Chevy Chase, Maryland. To learn more
about the Society and the field of endocrinology, visit our site at www.endocrine.org. Follow us on Twitter at https://twitter.com/#!/EndoMedia.
The study, by Jong Wook Kim, MD, PhD, of the Korea University Guro
Hospital, Seoul, South Korea, and colleagues, analyzed the parameters of
men treated with demopressin in an open-label trial that ran from April
2011 to November 2012. The men were older than 40 years, had at least
two nocturia episodes per night, and serum total testosterone levels
below 3.5 ng/mL or a positive score on the Androgen Deficiency in Aging
Men scale. The investigators excluded individuals with cardiovascular
disease, hyponatremia, primary hypogonadism, hypogoandotropic
hypogonadism, or who were using hypnotics or desmopressin for treatment
of other diseases such as diabetes. The subjects received desmopressin
0.1 mg once daily.
The study population had an average age of 68.4 years and average body mass index of 24 kg/m2.
Their mean total testosterone at baseline was 4.28 ng/mL, their mean
free testosterone was 5.47 pg/mL, and their mean PSA level was 1.4
ng/mL.
In addition, the patients' average scores on the overall
International Prostate Symptom Score (IPSS) scale dropped significantly,
as did their scores on question 7 of the IPSS (which probes nocturia),
the IPSS subscores of voiding and storage symptoms, and the IPSS quality
of life question. The patients' nocturnal urine volume levels also fell
significantly, as did their nocturnal polyuria index scores, their
actual number of nightly voids, the nocturia index scores and their
nocturnal bladder capacity index scores.
“Although the mechanism of action is still unknown, we suggest that
desmopressin could correct disturbances of the circadian regulation of
testosterone secretion,” the authors concluded in their poster
presentation.
Parameters not changed by desmopressin treatment included blood urea
and nitrogen level, creatinine level, potassium and chloride levels,
overall International Index of Erectile Function score, and Aging Male
Symptom score.
This effect, researchers concluded, may be beneficial for cardio-metabolic and urological outcomes.
Abdulmaged Traish, MBA, PhD, professor of biochemistry and urology at
Boston University School of Medicine, led the prospective, Bayer-funded
registry study of 181 men who, at baseline, had a testosterone level
below 12.1 nmol/L and a body mass index (BMI) of at least 30 kg/m2.
Subjects' mean age was 59.1 years (range 33-69 years). Each received
one 1,000-mg testosterone undecanoate parenteral injection and, starting
six weeks later, received this same dose every 12 weeks for up to five
years.
All of the men had dyslipidemia, 97% had hypertension, 39% had
type 2 diabetes, 22% had coronary artery disease, and 19% had
experienced a previous myocardial infarction. One patient was diagnosed
with prostate cancer after 10 months of treatment.
The researchers tracked subjects' testosterone trough levels and
found that, starting at 12 months of treatment and going out to 60
months, the levels were significantly higher than baseline levels. At
the same time, subjects' body weights and waist circumferences fell
significantly. They lost an average of 18.83 kg from a baseline average
weight of 114 kg, and 9.87 cm from an average baseline waist
circumference of 111 cm. The men's mean BMI also declined significantly,
from 36.72 kg/m2 at baseline to 30.22 kg/m2 at the 60-month mark.
These changes took place gradually, with the men experiencing
significant year-to-year weight, waist circumference, and BMI losses
each year. Ninety-nine percent of the men lost at least 5 kg over the
five-year period, while 70% lost at least 15 kg and 40% lost at least 20
kg.
About 3%-5% of the men gained weight, averaging 1-2 kg. “Most of
these men have some inflammatory diseases, and the weight gain is
explained by the fact that their inflammation got better and they were
able to gain some weight,” Dr. Traish said.
Other changes the men experienced over the duration of the study included a:
· gradual and steady drop in average residual bladder volume, starting at 52 mL and falling to 20.5 mL by 57 months;
· gradual increase in average prostate volume, starting at 31
mL, rising to 34 mL at three years and falling again to 32 mL at 60
months;
· slight but statistically significant increase in average
PSA levels, starting at 1.8 ng/mL and rising to 1.95 ng/mL at the
five-year mark;
· steady drop in average International Prostate Symptom
Score, falling from 7.8 at baseline to 3.5 at three years and 2.9 at
five years;
· sharp fall in average C-reactive protein levels, from 4.0 mg/dL at baseline to 0.8 mg/dL at five years; and,
· gradual increase in average score on the International
Index of Erectile Function-Erectile Function subscale, starting at 21.1
at baseline and reaching 25.25 at the 60-month mark.
Long-term testosterone treatment also produced positive effects on
lipid profiles (reduction in total and LDL cholesterol, increased HDL
cholesterol, and reduction in triglycerides), and decreases in fasting
blood glucose, hemoglobin A1c, and inflammation. The study has been
accepted for publication in the International Journal of Clinical Practice.
Testosterone replacement therapy can improve a man’s sex life, or it
could lead to the loss of vision in one eye or even death because of
blood clots, warns a doctor at Jewish Hospital–Mercy Health.
All men should have a simple blood test to determine whether they are
at high risk for blood clots before starting testosterone replacement
therapy, according to Dr. Charles Glueck of the Jewish Hospital Cholesterol and Metabolism Center in Cincinnati.
Postmenopausal women also should be tested in advance before taking
testosterone to treat low libido, depression or fatigue. The U.S. Food and Drug Administration hasn’t approved such use out of concern about the hormone’s long-term adverse effects in women, according to Mercy Health.
Dangerous blood clots can develop as soon as one month after
testosterone replacement therapy begins, according to a study by Glueck
published Aug. 7 in the medical journal Clinical and Applied
Thrombosis/Hemostasis.
“Our research found that 1.2% of men who landed in the hospital with
dangerous and potentially lethal blood clots in the deep veins of the
legs or in the lungs developed these clots within three months of
starting testosterone therapy,” Glueck said. “Not one of these men knew
previously that they had an inherited clotting disorder that put them at
greater risk for developing clots, nor did their providers test them
before putting them on testosterone therapy.”
Testosterone levels decrease as men age, and more men are turning to
replacement therapy to try to regain their feelings of youthful
vitality, according to a Mercy Health spokeswoman. Naturally occurring
testosterone has a role in sex drive, and it helps men maintain muscle
mass, red blood cell production, fat distribution and bone density.
To try to determine how often external testosterone use led to blood
clots in deep veins or in the lungs or both, Glueck studied 596 men who
had been hospitalized in the last three years.
Glueck and his research colleagues, all medical residents at Jewish
Hospital, reported 18 cases in men and four in women of blood clots in
the lungs or blood clots in the bones after patients started
testosterone therapy. All of the men and women had a previously
undiagnosed inherited tendency for increased blood clots.
Other complications suffered by some of the patients studied included
loss of vision in one eye because of a temporary lack of blood flow to
the retina. Others suffered osteonecrosis of the hip, which can lead to
the destruction of the hip joint because of a disruption of the blood
supply to the bone.
“Before starting testosterone, men and women should get a blood test
for common inherited risk factors for clotting, including the Factor V
Leiden mutation, homocysteine and high Factors VIII and XI,” Glueck said
Giving women the male hormone testosterone could boost their memory and may even help ward off dementia.
New
research shows women who rubbed testosterone gel on their skin every
day for six months performed better in brain function tests than those
who were given a dummy gel.
Researchers tested the treatment on a group of 96 healthy post-menopausal women. The
hormone group performed significantly better at verbal learning, where
they listened to dozens of different words and had to recall as many as
they could.
They also scored higher in tests designed to assess the efficiency of their short-term memory.
Boosting
brain function is thought to be one of the most effective ways of
warding off dementia, as it helps strengthen connections between brain
cells.
Experts advise doing this through a healthy diet, regular exercise and 'brain training' routines such as crosswords and puzzles.
But
the latest research, carried out at Monash University in Australia,
suggests women may also benefit from a daily dose of testosterone gel.
Women are twice as likely as men to get Alzheimer's, although researchers are still unsure why.
However, falling testosterone levels are now being considered.
Although testosterone is
considered to be a male hormone, women produce small amounts in their
ovaries. When they reach the menopause, testosterone production
declines.
Some research
suggests this causes a reduced libido in many women and that their sex
drive may benefit from testosterone replacement therapy - such as gels
or skin patches.
But the hormone has also been linked to brain function
A 2010 study at St Louis University
in the U.S. found older men with depleted hormone levels were more
likely to develop the brain-wasting disease. The Australian team behind
the new research focused on whether women too might benefit.
Those
in the trial, with an average age of 61, rubbed either a hormone gel or
placebo gel on to the arms, shoulders or tummy every day for six
months.
The women had their
memory tested before and after the experiment, and the treatment group
showed a significant improvement while there was no change in the
placebo group. Blood tests also showed an increase in testosterone
levels in the treatment group.
The results were presented at a recent conference but have yet to be published in a peer-reviewed journal.
Commenting
on the trial, Dr Simon Ridley, head of research at Alzheimer's Research
UK, welcomed the study but warned: 'We will need to wait for these
findings to be peer-reviewed and published before we can evaluate what
they could mean for people with dementia.'
Jess
Smith from the Alzheimer's Society stressed that it's not certain that
improved brain function scores actually translate into a reduced risk of
dementia. But she added: 'This small study indicates a possible future avenue for research into memory loss in women.'
TesoRx Pharma, LLC and CoreRx, Inc. today announced a manufacturing
joint venture to produce TSX-002, a first-in-class oral testosterone
drug targeting the $2.5Billion low testosterone market. TesoRx’s novel,
proprietary formulation orally delivers therapeutic levels of
unmodified testosterone in a safe and convenient manner. The company
will be commencing its final Phase 3 Clinical Study in Q1 of 2014.
“This joint venture solidifies our ability to manufacture TSX-002 to
the highest standards in an environment that can easily scale from our
current level through Phase 3 and, ultimately, commercial release,” said
Ramachandran “TR” Thirucote, Ph.D., CEO of TesoRx. “The CoreRx team has
set itself apart with its service commitment and innovation, making
them an obvious choice as TesoRx moves to the next phase of
development.”
“This project represents a significant expansion in both the size and
mission of CoreRx,” said Todd R. Daviau, President and CEO. “An oral
therapy is long overdue in the treatment of male hormone deficiency and
is the cornerstone of TesoRx’s current portfolio. We are happy to have
been chosen as TesoRx’s development partner and are looking forward to
this long-term manufacturing project with TesoRx.”
The acquisition of the Myerlake II site will add approximately 47,000
sq.ft. of additional manufacturing and office space. TesoRx plans to
begin construction in the buildings across from CoreRx’s current 35,000
sq.ft. facility in the ICOT Center campus. It will house several
additional suites dedicated to process development, clinical trial
manufacturing and commercial manufacturing of hormone products.
Work on the expansion has already begun and should be completed by the middle of Q2 2014.
About TesoRx, Inc.
TesoRx is a privately held pharmaceutical company focused on the
development of a first-in-class unmodified oral testosterone for
androgen deficiency. The company is advancing its proprietary
pro-liposomal formulation of testosterone (TSX-002), through Phase 2
clinical studies for low testosterone in adult males. TSX-002 has the
potential to be the first unmodified testosterone for oral delivery to
enter the international market. The US market for topical, transdermal
and injectable testosterone formulations alone is currently estimated at
US $2.5 Billion with prescriptions having grown 34% over the last 12
months.
About CoreRx, Inc.
CoreRx is a contract research organization providing customized
pre-formulation services, formulation development, manufacturing, and
analytical services to pharmaceutical, biotechnology, academic, and
veterinary clients. The company is renowned for reliably expediting
early development activities to speed potential drugs to clinical trials
while applying stage-specific scientific knowledge and experience.
CoreRx's unique corporate structure creates project teams that work
intensively with each client, bringing an extension of its own
organization into the CoreRx lab.
Testosterone plays an important role in keeping your mind sharp and
your body healthy—from the heart to muscles and bones to erectile
dysfunction (ED). If you’re middle-aged, your body’s testosterone levels
have already begun to decline.
Testosterone is a hormone that is produced primarily in the
testicles. It is essential in the development of masculine
characteristics, muscle strength, fat distribution and sex drive.
Testosterone peaks during adolescence and as you get older, your
testosterone level gradually declines — typically about 1 per cent a
year.
Researchers have found low testosterone contributes to weight gain
and obesity, elevated harmful blood fats, and insulin resistance – each
of which is a risk factor for the development heart disease, type 2
diabetes and ED.
Heart health concerns with testosterone include elevated cholesterol
and blood pressure, thus increasing the risk of heart attack and stroke.
According to a UK-based study, having high testosterone isn’t what
makes men susceptible to heart issues—it’s having too little.
Weight gain, diabetes and alcohol use can lead to fat forming around
the mid-section — this contributes to the production of the female
hormone oestrogen that counteracts the function of testosterone.
“Other men produce testosterone but may be resistant to it, just like
diabetics are resistant to insulin,” says Dr Malcolm Carruthers,
founder of The Centre for Men’s Health in London.
Low testosterone has also been linked to changes in sexual function.
This may include reduced sexual desire, fewer spontaneous erections, and
infertility. Many men blame their age or their relationship for
problems with their sex lives, but it could be due to a hormonal
imbalance.
Emotional changes have been linked to low testosterone as well. It
can contribute to a decrease in motivation and self-confidence while
increasing depression, trouble concentrating and forgetting things.
Low testosterone is partly due to the testicles not working properly,
but a lot is related to the testes’ communication to the brain. Various
underlying factors, including excessive levels of stress, medication
side effects, thyroid disorders and excessive alcohol use can negatively
affect the nervous system.
Raising your testosterone levels naturally
The most effective way to increase testosterone production is through
one’s lifestyle. Decrease alcohol and sugar consumption while
increasing vegetables, lean proteins, healthy fats and exercise.
Sex can
also raise your testosterone level.
The testes produce testosterone by converting cholesterol in to
testosterone. We get cholesterol from eggs, red meats, fish, avocados
and nuts. Natural sources of saturated, monounsaturated, and
polysaturated fats won’t make you fat and will help in the production of
testosterone.
Un-natural fats found in packaged and fried foods have the opposite
effect. Sugars, carbohydrates and man-made fats facilitate gaining
weight around the waistline and contribute to the development of heart
disease, diabetes and low testosterone levels.
A lack of sleep and excessive stress can lower testosterone levels
throughout life. Stress triggers a hormone called cortisol that opposes
testosterone. Cortisol also contributes to weight gain and the
development of type 2 diabetes.
Exercise is an effective way to manage stress, balance hormones,
increase muscle mass, and lower body fat levels. Lower body fat
correlates to higher testosterone levels and lower risk of
chronic-diseases.
By raising testosterone levels naturally, you’ll not only increase
your body’s ability to gain lean, athletic muscle, but also improve your
sex life. Testosterone is key to a healthier, more energetic life –
both physically and mentally.
Dr Cory Couillard is an international health columnist that works
in collaboration with the World Health Organization’s goals of disease
prevention and global health care education. Views do not necessarily
reflect endorsement.
Email: drcorycouillard@gmail.com
Facebook: Dr Cory Couillard
Twitter: DrCoryCouillard
My wife and I are in a sexual time-out. That is my polite way of
saying that right now I would rather do the dishes than make love to
her. This isn’t about my wife, as much as she sometimes wants to make it
about her so that she can fix it. The most beautiful woman in the world
could show up right now ready to fulfill my wildest sexual fantasy, and
I would say, “Eh, there is some leftover pasta in the fridge. I am
going to heat some up. Want some?”
Why am I telling you this? I believe that our ideas about marriage
are distorted by how little we hear about the true inner workings of
functioning marriages. Normally, you would only hear about something
like this after the marriage has imploded. It is my hope that by talking
about these things as what they are – a normal part of marriage – that
we will not panic or despair when we encounter them.
This isn’t the first time that we have gone through something like
this. However, it is the first time that we have been able to
communicate about it clearly. And it is the first time that a dry spell
has not left my wife feeling unattractive and deeply insecure.
♦◊♦
It started not long after we fell in love with each other. There was a
few heady weeks of pleasure, but quickly we sank into the routine that I
had with my ex-wife: I avoided and she got frustrated and confused. The
major difference between my current wife, Lynn, and my ex is that Lynn
does not abide avoidance. She insisted that we talk about the issue.
I have to say that I didn’t see that one coming. I thought that she
would be relieved that I was not going to impose on her by asking to
have sexual needs met. But I was wrong. My wife loves sex and withers
without it.
And so we talked about it for years. We tried marriage enrichment
workshops and the exercises found in sex advice manuals. When that
didn’t work, I talked with a therapist. Lynn’s pet theory was that some
of the sexually traumatic things that I had experienced when young had
led me to cut off my sexuality.
I would like to say that I was fully cooperative with all of this.
But in truth, I found it a bit annoying. I didn’t really see what all
the fuss was about. The idea of sex didn’t particularly fill me with joy
any more than exercise does. But like exercise, I was glad to have done
it when I was through.
In retrospect, I can see where my responses must have been very
painful to my wife. I didn’t just want to avoid sex; I also wanted to
avoid being asked for sex. So if I thought that she was even moving that
direction, I got anxious. And that anxiety came out as hostility or
even shaming.
♦◊♦
About six years into our marriage, my wife did something utterly
unexpected. She told me simply and clearly that barring a major change
in our relationship, she would never again initiate sex. It was too
painful, she said, to keep putting herself out there and being rejected.
It was breaking something deep inside of her to have something so core
to who she is, her sexuality, routinely rejected with seemed to her to
be a hint scorn. She had gained a lot of weight and felt worse than
merely unattractive. She felt like she must be grotesque.
She had not made the decision lightly. She had considered the fact
that in the three years since she had been keeping track, I had not once
initiated sex. Given that, she assumed that we would now be entering a
sexless marriage. After a few months of consideration, and a period of
mourning, she had decided that for now, she was willing to put aside her
sexuality and live as a married celibate.
I expected her pledge to last a few weeks, and then things would go
back to normal. But I had clearly underestimated just how hurt she was
and how determined she was not to make herself vulnerable to me again.
There was not the slightest hint of sexuality between us. She was my
friend and seemed happier and more relaxed than I had seen her in a long
time.
Lynn said something that really stuck with me: “The person with the
‘no’ has all the power in the relationship.” She had taken back her own
power by taking the question off the table. Her sexual needs were no
longer any of my concern.
That was a wake-up call for me. I was not okay with a sexless
marriage, not even in theory and not even when I didn’t particularly
want sex. It sounded like a recipe for eventual divorce. And I love this
woman more than life. There was no way I was going to let her go when I
could do something to win her back.
As I mulled it over, I came face-to-face with what I had been asking
of my wife. Without thinking about it, I had been asking her to stay in a
vow of fidelity that was truly a vow of celibacy. She was in her sexual
prime, and I was asking her to amputate a part of herself as casually
as I might ask her to do the dishes.
I was requiring of my wife what religious organizations were asking
gay people to do: Have all the feelings and desires of sexuality but
never act on them. It was not acceptable when they asked for it and it
was not acceptable for me to ask this from my wife.
I tried just being a good sport and going along with sex. It worked
about as well as you would imagine it. That is when I decided that I was
going to find an answer. I would either find a way of becoming a full
partner in our marriage, or I would release my wife from her duties of
fidelity.
♦◊♦
My first step proved to be the most important one. I went back to our
family doctor and demanded a testosterone blood test. On previous
visits, when I had asked for one, they had told me that I obviously had
plenty of testosterone. After all, I have enough hair on my body to pass
for a Sasquatch, and I had classic male pattern baldness. This time, I
insisted.
Later that week, we found out that my testosterone levels were those
of a pre-adolescent boy. No wonder I was uninterested in sex. My body
was still in grade school where girls are icky.
I won’t tell you that our life was all wine and roses after I started
taking testosterone supplements. Lynn still had a lot of years of hurt
to overcome. But it helped a lot that I suddenly turned into a horny
teenage boy. I discovered the wonders of the female body and what the
fuss about sex was really all about. As the months went by and our sex
life became something that bonded us, that was fun and that fostered
rather than destroyed intimacy, I watched my wife blossom. The weight
peeled off of her, and she practically radiated happiness.
So why are we back in sexual time-out? A few months ago, my insurance
company required that I switch to a generic form of testosterone. It
didn’t occur to me to be on the look-out for changes in my sexuality.
But as my levels slipped so did my interest in sex.
Last week, Lynn calmly told me that she was aware that I was no
longer interested in sex. And I was beginning to exhibit the same subtle
shaming behaviors that I had years before. She pointed them out to me,
and for the first time I realized just how far I slid into scorn of sex
when I had too little testosterone. I supported her decision not to
bring her sexual needs to me until something changed. I didn’t want to
hurt her anymore than she had already been.
I now have the correct dose of testosterone in a form that my body
can absorb. I expect to be chasing Lynn around the kitchen by the end of
next week. I look forward to watching her re-emerge from her shell and
blossom again.
Lynn says she is sort of glad that this happened. It proves to her
that my lack of desire had never been about her. She said, “I know now
that there was nothing that I could have done to save our marriage if
you hadn’t gotten testosterone treatment.”
I am somewhat grateful as well. It gives me mercy on people who are
overtly prudish, and it makes me less scornful of men I know who cheat. I
can see how someone in Lynn’s position, who knows that sex would
obviously be an imposition on her spouse, could try to save her marriage
by breaking her marital vows.
For the record, Lynn never cheated on me, although I would have
forgiven her if she did. And, I am not in any way condoning cheating. I
believe that spouses have the responsibility to do as my wife did for so
many years: Keep talking about it and insisting that you work on it
together as a couple.
♦◊♦
I think I should also be clear in stating that of course no spouse
has the right to demand sex from his or her partner. But marriage is a
contract that covers sex, among other things. And if you cannot meet
your obligations under the agreement, you need to at least be addressing
it as a problem. You don’t get to just say “no” for months on end. You
are obligated to at least say, “No, and I will do x to address this
problem.”
I love Lynn, and I am truly sad about all the years of great sex that
I missed out on. But I hope to make up for lost time now that the kids
have left home and I have a good testosterone supplement.
"One of the things I've learned is that most, or even all, guys don't know how to refuse sex," he said.
"When
I've asked specifically about refusing sex, the guys tell me that part
of why it's hard to say 'no' is that they're concerned about how she'll
respond, including concerns that she'll think he's either some type of
wimp or gay," he said.
"Those comments have always come from heterosexual men and almost always about a relationship in the early stages."
Dr Smiler, former president of the Society for the Psychological Study of Men and Masculinity, recently wrote A Guy's Guide on When to Refuse Sex for the Good Men Project about when men should refuse sex with a new partner.
"Our
cultural assumptions about male sexuality don't allow for the
possibility that a guy would ever choose to say 'no'," he wrote.
"In
fact, you may have a hard time imagining that a guy would ever turn
down sex unless he was in the middle of a massive heart attack.
"Let
me be clear about one thing. Guys are allowed to refuse sex by saying
'not now' or just 'no' and their partners need to respect that
decision."
Dr Smiler said his empirical work on sex has been entirely with young heterosexual males.
He said guys are often uninterested in sex if they're tired, sick or too drunk to perform sexually.
"For
older guys - typically aged 40 or over - other physical conditions
start to come in to play including obesity, heart conditions, pulmonary
issues, anything that impacts blood flow and a variety of other
disorders," he said.
A recent survey for online pharmacy
ukmedix.com found 62 per cent of men turn down sex more frequently than
their female partner, with a third admitting they had lost their sex
drive, reports the Daily Mail.
They
report that another poll reveals one in four men no longer has sexual
intercourse at all - and the figure rises to 42 per cent for men over 55
- while a quarter said they had been affected by erectile dysfunction
at some point in their lives.
Dr Malcolm Caruthers, founder of the Centre for Men's Health, told the Daily Mail that testosterone deficiency is becoming more common and happening younger.
"It
used to be mostly men in their 50s, but it's now men in their 40s, or
even 30s. Large studies done in America show that every decade there's a
decrease in testosterone levels by as much as 10 per cent. I believe
the same is happening in (the UK)."
Even rock star Robbie Williams has struggled to maintain a sizzling sex life.
The singer, who has been open about his low libido, said in a 2011 interview that he injects himself with testosterone twice a week to boost his sex drive.
The 39-year-old said a doctor told him that he had the "testosterone of a 100-year-old".
He's not alone. News.com.au spoke to a couple of ordinary blokes about their sex-lives.
One man said his sex drive was higher than his wife's.
"Although
this has changed over the years. Speaking to other blokes I know, I
think women's sex drive peaks in their early 30s then drops off in their
40s - partly for biological reasons I guess and partly because of
kids/exhaustion," he said.
"I think that because of television shows like Sex and the City and other cultural influences, women don't feel cool about admitting this."
The 43-year-old said he never refused his wife's advances.
"I used to, but again, like most men I think I now have a 'take it when it's available' kind of mentality.
"It's
definitely OK (to refuse). In a mature relationship, partners
understand that you may just not be in the mood or have stuff on your
mind or whatever. It can still feel like a rejection, but not
devastatingly, underminingly so."
The father-of-two said women need to know that their formula of "intimacy first, sex second" doesn't always work for men.
"Seems
you always want a perfect meal and a kind of perfect emotional state of
togetherness or something before you agree to hop in the sack with us,"
he said.
"For men it's often the other way around. We want the
physical closeness and release of sex, and then relish the emotional
closeness that follows.
"For men, sex brings us closer to you. We
wish women would recognise this and be prepared to treat sex not as the
ultimate expression of emotional closeness, but as a physical act which
is a great way of helping achieve that closeness."
Another man who chatted to news.com.au said his girlfriend had the higher sex drive, but that he never refused sex.
"Even
if you're not in the mood for sex to begin with, it isn't exactly
difficult to get in the mood. It's not as though sex is a chore," the
23-year-old said.
"I'd imagine it'd be OK to say no as long as I
explained myself properly. Refusing sex without offering an explanation
will only make your partner feel inadequate or insecure.
"Women
need to know that men aren't always horny. So if your partner isn't keen
to have sex at any given time, it doesn't necessarily mean he doesn't
find you attractive - it could just mean he's not in the mood."
According to Sydney Men's Health clinic testosterone is responsible for the peak in sexual interest in men around the age of 20 and women in their mid-thirties.
"The
ageing process in men and women reduces the available level of
testosterone resulting in a natural decline in libido in the older
years. However it has been found that an older man's libido may not
necessarily be related to his level of testosterone," their website
says.
"A common cause of low libido is not related to lack of
production of testosterone but rather due to relationship problems, such
as when a decision is required for a long-term commitment in a new
relationship. Any medical condition as well as excessive alcohol intake
may contribute to reduced libido."
Other reasons men aren't in the
mood (according to an office poll) include exhaustion, energy levels,
overtraining, sickness, stress, wanting a sleep-in and eating too much
chocolate mouse for dessert.
Serum levels of pituitary, adrenal, and gonadal hormones are the most
objective biomarkers of severe uncontrolled pain, said Forest Tennant,
MD, DrPH, of the Veract Intractable Pain Clinic, West Covina,
California, in a presentation that focused on pain and hormones.
Hormones critical for pain control are cortisol, pregnenolone,
dehydroepiandrosterone (DHEA), progesterone, testosterone, estrogen, and
thyroid. The blood panel recommended as a pro le for pain management
is adrenocorticotropin (ACTH), cortisol, pregnenolone, testosterone,
DHEA, and progesterone. Dr. Tennant emphasized it is important to
determine abnormal serum hormone levels for several reasons: to validate
the presence of severe pain and need for enhanced treatment, determine
if hormone replacement is needed, provide an objective measure of
treatment success, and identify the complication potential of hormones,
particularly cortisol and testosterone.
Patients who should be screened for hormone abnormalities are those who
require daily opioids, complain their current regimen is not effective,
or have central pain. Hormones suppressed by opioids include cortisol,
testosterone, pregnenolone, estrogen, progesterone, and oxytocin; in
addition, other hormones may also be affected. Long-acting opioids are
more suppressive than short-acting, he said, due to their longer
duration; some tolerance and homeostasis may develop over time.
Common manifestations of hypocortisolemia include low blood pressure,
weakness, poor analgesic response, weight loss, cold, muscle wasting,
brown pigmentation (in scars, under eyes, axillae, and creases), golden
hue to skin or vitiligo, slow mentation, sitting still and staring
straight ahead, and weak voice.Testosterone deficiency manifests with
symptoms of fatigue, decreased libido and performance, depression, slow
mentation, poor analgesic response, muscle weakness, and gynecomastia.
To spare or reduce opioids, serum hormone levels should first be
normalized. If a patient is already taking an opioid, hormone levels
should be determined prior to initiation of a long-acting opioid. In
addition, an opioid should not be determined to be ineffective or
causing hyperalgesia or allodynia until hormone serum levels are
determined and normalized. Replacement hormone is needed when pain
and/or opioids and other medications have reduced serum hormone levels.
In patients with pain, the pituitary, adrenal, and gonadal glands are
usually not irreparably damaged; therefore, sub-replacement is used in
pain management.
Dr. Tennant said bio-identical, and not potent synthetics, should be
used; for example, hydrocortisone in lieu of methylprednisolone,
dexamethasone, or prednisone. The most common hormone replacements and
their usual daily dosages are hydrocortisone (5 mg to 15 mg),
pregnenolone (100 to 300 mg), testosterone (male, 10 mg to 100 mg;
female, 2.5 mg to 25 mg), and DHEA (100 mg to 300 mg). Dosages should be
increased daily over 6 to 8 weeks, with serum levels repeated every 1
to 4 weeks until hormone is in normal range. The patient can attempt
tapering after pain is well-controlled.
With respect to hydrocortisone dosing, experts have various opinions,
he said, which basically comprise two methods: higher morning dosage or
split dosages throughout the day. For testosterone dosing, the
injectable form should be avoided due to high serum levels and pituitary
suppression. Topical compounds with concentrations ranging from 1% to
10% are popular; for example, 30 gm of 5% concentration provides 1 gm of
base cream and 50 mg of active drug/day. Testosterone alternatives and
enhancers include human chorionic gonadotropin (hCG), DHEA, and
medroxyprogesterone.
Noting a “new vocabulary” is needed for neuroregeneration therapy,
Dr. Tennant explained that neurosteroids, hormones that control
neurogenesis and neuroprotection, are produced in the CNS and have a
steroid ring structure not under control of the pituitaryadrenal-gonadal
axis. This controls neurogenesis and neuroprotection. The pain-related
functions of pregnenolone is neuroprotection; progesterone,
neurogenesis; and DHEA, receptor regulation and nerve conduction.
Neuroregenerative hormones include hCG, progestins, pregnenolone, and
oxytocin. The most promising research to date is with long-term use of
hCG, he said. An open-label study in 26 patients with centralized pain
who received hCG for 12 to 74 months resulted in pain free hours,
permanent pain reduction, or less severe flares. Two patients were able
to come off opioids. The hair loss and headaches reported by patients
were relieved when the dose was lowered.
