The male menopause: Andropause

Many men tend to ignore or downplay health changes. This is especially true for the so-called male menopause, also known as andropause. Although some doctors, including some urologists, have not yet fully acknowledged the existence of andropause, there are clear signs of hormonal changes in middle-aged men.

The "Most Typical" Symptoms of Male Menopause

A man, like a woman, can show deficiencies in one or several hormones. This hormonal change manifests itself in the following changes:

1. Weight gain, especially in the abdominal area
2. Fatigue and declining interest in activities
3. Hot flashes
4. Difficulty concentrating
5. Mood swings or depression
6. Hair loss
7. Frequent nighttime urination
8. Snoring
9. Erectile problems
10. Heart problems

A detailed list of all symptoms can be found later in this guide.

These physical and psychological complaints are often related to a deficiency in certain hormones:

• Progesterone
• Estrogen
• Testosterone

Every man can be affected by a deficiency of a single hormone or a combination. According to Rimkus® research, chronic cardiovascular diseases such as high blood pressure, heart attack, and stroke can be caused by estradiol deficiency. Timely treatment with bioidentical hormones can help reduce these risks.

Note from Dr. Isabella Wilden: Cardiovascular diseases often have multifactorial causes, including lifestyle, nutrition, and genetic factors. Estradiol deficiency is not the sole cause of cardiovascular diseases.

Other symptoms such as high blood pressure, swollen feet, light sleep, joint pain, new allergies, hair loss, fungal infections, and prostate enlargement may indicate a pure progesterone deficiency.

From around age 50, many men show a deficiency in estradiol, progesterone, and often testosterone. An individually tailored hormone therapy can help here. It's important to understand that the effects of Rimkus therapy in men going through menopause often only become noticeable in the long term. Some men discontinue treatment prematurely, but those who persist often report significant improvements and are grateful for the therapy.

Hormones in the Male Body

Control Elements for Health and Well-being In our body, hormones play a central role in our health and well-being [3]. In men, steroid hormones are particularly important. Let's have a closer look at these important messenger substances.

1. Testosterone: The Versatile Male Hormone Testosterone is probably the best-known male hormone. It has various important tasks:

• It provides strength and energy
• It controls sexual functions
• It influences many other body functions

Our body produces testosterone from cholesterol. The pituitary gland (hypophysis) helps with this, directing hormone production like a conductor.

Testosterone affects many areas of our body:

• It shapes sexual differentiation during embryonic development (during embryogenesis through the Y chromosome)
• Together with estrogen, it strengthens our bones
• It builds and maintains muscles
• It promotes sexual desire and potency
• It stabilizes our psyche and strengthens self-confidence
• It stimulates the production of red blood cells (erythropoiesis)

DHT: Testosterone's More Powerful "Sibling"

DHT (Dihydrotestosterone) is a more active form of testosterone. It has some special tasks:

• It's important for the development of male sexual characteristics in the womb
• It can enlarge the prostate
• It influences hair growth
• It regulates sebum production in the skin

Estrogens: Not Just Important for Women

Surprisingly, estrogens also play an important role in men. Men produce about 10% of a woman's estrogen amount. Interestingly: When estrogen levels rise, testosterone levels fall. This happens through pituitary feedback. The same happens when insulin levels rise.

Estrogens have the following effects in men:

• They improve blood circulation throughout the body (cardiovascular system)
• They influence growth (epiphyseal plate closure)
• They strengthen the bones
• They have positive effects on the psyche and can (potentially) protect against dementia and depression

Signs of Andropause

When the Body Changes With increasing age, men can notice various changes in their body and psyche. These symptoms can indicate andropause, also known as male menopause. Here's an overview of the most common signs:

Mental Changes

• You feel tired or even exhausted more often
• Memory and concentration decline and you find it harder to concentrate
• Stress affects you more than before
• You feel depressed or anxious more often
• Little things upset you more quickly

Physical Changes

• Your interest in sex decreases
• You have difficulty getting or maintaining an erection
• Muscle atrophy
• Physical exertion becomes more difficult
• Your skin becomes drier
• You notice increased hair loss (on the head, under the arms, in the pubic area, or all over the body)
• Your muscles become weaker
• You notice a reduction in the size of penis and testicles
• You gain weight, especially around the abdomen (visceral fat / obesity)
• Hypermastia / gynecomastia (growth of breast fatty tissue in men)
• You experience joint and muscle pain more frequently
• You feel less energetic
• Urogenital problems: You have more frequent bladder or prostate problems
• Your blood pressure is elevated or you have heart problems caused by the androgen receptors of the heart muscle.

Emotional Changes

• You often feel overwhelmed
• Your mood fluctuates more than before
• You feel stressed more frequently
• Increased irritability

Note from Dr. Isabella Wilden: It's important to understand that not every man experiences all these symptoms, and they can occur with varying intensity. Some of these changes may also have other causes. If you notice several of these signs, it's advisable to discuss them with your doctor.

Diagnosis of Andropause

If you suspect signs of andropause, the first step is a thorough examination by a doctor. Alternatively, you can book an appointment with Dr. Wilden, who is an expert in hormone therapy. The diagnosis is based on two important pillars:

• Your symptoms and general health condition
• A comprehensive blood test

The blood test is particularly important as it provides an accurate insight into your hormone levels. Here are the most important values that are checked:

• Thyroid hormones (TSH, fT3, fT4): These control many bodily functions and can cause symptoms similar to andropause.
• Vitamin D: important for bones, muscles, and the immune system.
• Estrogens (E1, E2)
• Progesterone: Another "female" hormone that is also important in men.
• DHEA: A precursor to other hormones.
• Testosterone: The best-known male hormone.
• Pregnenolone: Also a precursor to other hormones.
• PSA Depending on your individual symptoms, additional values may be important.

Perfect Timeframe for Blood Collection

Tip from Dr. Isabella Wilden: The timing of blood collection plays a major role!

• Best in the morning, no later than 11 AM.
• If you are already taking hormones:
• For capsules: 3-5 hours after intake
• • For creams: 3-4 hours after application These rules help to obtain the most accurate results possible.

Treatment of Andropause: A Holistic Approach

The treatment of andropause is as individual as your personal medical history. There is no universal therapy, and treatment strongly depends on your blood test results. An overview of possible therapeutic approaches:

Lifestyle Changes

These measures can help support your hormones naturally:

More Exercise: Regular physical activity can positively influence your hormone levels.

Avoid hormonally active substances: Reduce contact with plastic, especially in cosmetics.

Reduce alcohol and nicotine: These substances can disturb your hormone balance.

Weight loss: If you are overweight, weight reduction can improve your hormone levels.

Review your medications: Some medications, such as blood pressure or cholesterol-lowering drugs, can affect testosterone levels. Discuss this with your doctor.

Medicinal Therapy

Depending on your individual needs, your doctor may consider various treatments:

Aromatase inhibitors: These can help increase testosterone levels. Chrysin is a natural aromatase inhibitor. In some cases, a prescription medication like letrozole may be used. Medical note from Dr. Wilden: Aromatase inhibitors can have significant side effects and should only be taken under medical supervision.

Bioidentical hormones: These are chemically identical to the hormones your body produces naturally. They can help balance hormone levels. Learn more.

Thyroid medications: If your thyroid isn't functioning optimally, special combination preparations can help.

Testosterone gel: According to Dr. Rimkus® method, testosterone can be administered through the skin. DHT levels are carefully monitored during this process.

Progesterone: This hormone can inhibit the conversion of testosterone to DHT, which can be helpful for certain symptoms.

DHEA: Various hormones that can be supplemented if deficient.

Important note from Dr. Wilden: Any hormone therapy should only be conducted under medical supervision. Regular monitoring is necessary to adjust dosage and detect possible side effects early.

Laboratory Values: Depending on Illness

In this article, we have tried our best to simplify the complex topic of andropause as much as possible for our readers. The following section is intended for interested readers or other experts and shows how laboratory values can be interpreted in "male menopause":

Andropause (male menopause)

Phase 1: Adrenal weakness

• Slightly decreased DHEA (blood)
• Normal/slightly elevated cortisol (saliva) Phase 2: Adrenal exhaustion
• Decreased DHEA (blood) and cortisol (saliva) Phase 3: Adrenal insufficiency
• Very low cortisol (saliva)

Gonadopause (Menopause or Andropause):

Laboratory diagnostics:

• Free testosterone
• Androstenedione (precursor to testosterone)
• LH/FSH
• E2

Differential diagnosis:

• LH > 10-11: Hypogonadism
• LH < 3.5: Chronic stress (LH is a stress marker in men)
• Metabolic disorder (Extra glandular): Causes: Alcohol consumption, lack of exercise, nicotine use, carbohydrate-rich diet. All these causes lead to suspected aromatase deficiency:

Laboratory diagnostics:

• DHT
• E1, E2
• SHBG

General information: Men have 2x more diabetes risk, 5x more heart attacks, 3x more suicides (between 45 and 60 years old) and die at least 5 years earlier than women The cause of hormone disorder can be found in the medical history.

Somatopause (decline in growth hormone, Growth-Hormone, and Insulin-like growth factor 1, IGF-1):

Pituitary disorder before Andro-Menopause

Laboratory diagnostics:

• IGF-1 (serves as a proxy when growth hormone cannot be measured)
• IGFB3
• hGH (human growth hormone)

Burn-out:

• Laboratory diagnostics:
• Cortisol (saliva)
• Adrenaline and noradrenaline
• GABA and glutamate
• Serotonin

During substitution, note that:

• Too much DHT and too much E1 and E2 indicate that the substitution therapy is not correct