Dr.Swiner’s Medical Notes-Nov. 2013-Low T or “man-o-pause”

In my practice, I treat both men and women, but for a long time, I primarily saw female patients. I like Women’s Health and Gyn care, but now that I’ve been in practice for a while, my male patient population is increasing. As these men age into their 40s and 50s, I’ve noticed more complaints about low libido (sexual desire), low energy, mood changes, and decreased stamina. Often, these same men have a medical history positive for diabetes, hypertension and high cholesterol. Initially, I thought the complaints were due mostly to getting older, but later recognized that men go thru a hormonal process as they age much like women do. In the medical world, this is called Low T, hypogonadism, or simply low testosterone. The term I like the most is the clever “MAN-opause”.
 So, most of us are familiar with what women go thru in their 50s with menopausal symptoms, including decreased menstrual cycles or lack thereof, vaginal dryness and irritation, and hot flashes. This is due to a dwindling amount of estrogen. However, men have similar issues as I mentioned above, but due to a lack of testosterone. Gentlemen, just think back to when you were in your teens and 20s–you were virile, full of energy and life, had a head (and maybe chest) full of thick hair, and felt on top of the world. This largely had to do with a full and healthy amount of testosterone running through your veins. Testosterone, like estrogen, is controlled by the pituitary gland, which then communicates with men’s testes (ovaries for women) and adrenal glands and is released into the blood stream. With aging, there is less communication between these organs causing hypogonadism, or low production of these hormones.
“Manopause” comes on insidiously. Here you are, going through life, doing well and then all of a sudden, you wake up and feel less of yourself with less of a spark. As I’ve seen more men and they become more comfortable talking to a female about this, we discuss testing and treatment of low testosterone. Health-wise, low testosterone appears to be more prevalent in men who are obese and have low bone density or osteoporosis, erectile dysfunction, diabetes, and high blood pressure. The hope is that with treatment, some of these medical problems can improve or even be prevented. Never fear, recent research has found some options for this!
Replacement is available in pill form, injections, creams, and pellets. Cost can vary from a small amount to a lot depending on whether you choose the natural bioidentical route or prescription meds. Insurance companies haven’t truly jumped on board with the prescription meds and covering them well, but generally it’s most cost effective to try the injections that you can self administer or have administered at your doctor’s office. If they are not helpful, creams  (usually applied to the armpits) are the next most popular option.
Of course, these treatments aren’t without potential side effects. The most concerning to look out for include kidney problems and prostate issues. It is recommended that these not be used in men with known prostate problems or elevated PSA (prostate specific antigen) levels. All men should have a PSA, blood cell count, and creatinine, among other important labs, checked before starting these medicines and should have them monitored regularly while continuing therapy.
I hope this helps to enlighten some men to what is a natural and normal aging process and what can be helpful to increase the “zest” in life again. Feel comfortable talking to your doctor about it and asking more questions.
Be healthy and be blessed,
Dr. Swiner

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