Signs of male menopause are subtle

Andropause is the male equivalent of menopause, and denotes the age-related decrease in male hormones, or androgens.

Andropause is a medical condition that is rapidly gaining recognition in the current press, although it was originally described more than 50 years ago.

Unlike menopause, the physical signs and symptoms associated with andropause are more subtle and progress slowly over a 10- to 20-year period, beginning at age 40. This is based on the initial decline of male hormones from age 30 and their accelerated decrease after age 50. By age 80, most men have only a small fraction (20 percent) of their peak physiological androgen levels.

While the strict definition of andropause varies, the common underlying disorder is the result of decreasing testosterone levels associated with symptoms of diminished libido and sense of vitality, erectile dysfunction, reduced muscle mass, reduced bone density and depression.

Doctors and researchers have contemplated the benefits of hormone restoration for men, a topic of dozens of welldesigned clinical studies over the past 30 years. The data from these studies reveals several striking benefits of male hormone restoration, along with some medical precautions that are critical to safe treatment.

We should make a clear distinction between restorative androgen therapy and the well-publicized cases of anabolic steroid abuse. Restorative androgen therapy is overseen by a medical doctor specifically trained in hormone management, who uses evidencebased guidelines for treatment.

These guidelines are designed to use only bioidentical hormones (hormone molecules that are identical to those circulating in the human body), dosed to fall within the physiologic range for younger adults. In addition, patients are monitored for appropriate bioactive hormone levels, with dosing and treatment plans individualized for each patient. The specific bioidentical hormones used include DHEA, testosterone and thyroid hormones.

In contrast, the use of anabolic steroids without the proper medical prescription is illegal. Further, most commonly abused steroids (stanazolol, winstrol or android) are not bioidentical and are routinely used in doses that result in supraphysiological hormone levels.

The health risks to synthetic steroid abuse are compounded by the lack of clinical studies on their use and the absence of physician involvement with their administration.

Restorative hormone therapy is a physician-directed treatment and monitoring program designed to restore naturally occurring hormones to their optimal physiological levels. The clinical rationale for doing this is well documented and is designed to increase wellness and overall health and functional status of the patient. The androgen doses used are small and are typically applied in synergistic combination with other natural hormones to restore health- not to create a super athlete or stimulate massive muscle growth.

Here are some clinical benefits that are seen with proper restorative treatment.

•Bone: increased bone mass, decreased osteoporosis, decreased arthritics

•Cardiovascular: increased HDL (good cholesterol), reduced LDL (bad cholesterol); reduced risk for heart attack and stroke; topical testosterone

•Lean body mass: increased muscle tone, strength and mass; decreased fat

•Skin: decreased thinning of skin, increased collagen production

•Sexual: increased libido, increased sexual performance

•Mental: improved sense of well being, increased energy level, improved memory and cognitive skills

While the above benefits are impressive, androgen restorative therapy is not without potential negative side effects and complications. One of the most discussed and often misrepresented health risks is the link between testosterone and prostate cancer.

A 2004 review article published in the New England Journal of Medicine stated that after 20 years of clinical research there is no concluding evidence that testosterone therapy causes prostate cancer. If a patient has active prostate cancer, testosterone or DHEA treatment should not be employed, as prostate cancer cells are specifically responsive to these hormones.

In addition, during the initial phase of treatment it is also important to monitor blood levels of free hormones to best ensure their proper bioactive levels, including estrogen levels in men. Very few men are aware that they actively convert testosterone into estrogen in the body and tissues, and that several physiological factors can negatively affect the ratio of testosterone to estrogen, causing side effects and health risks with restorative therapy.

The simple medical truth is that men can safely treat andropause under the proper medical guidance, and receive the benefits.

As the baby boomer generation ages, and the number of people over the age of 50 increases to it largest number in history, the demand for extended health and wellness will grow in tandem. Given the dynamic nature of the baby boomer generation, it is becoming clear that they favor a proactive approach to healthcare with an emphasis on extending the quality of life in parallel with the quantity of life.

Giannulli is a physician trained in internal medicine at the University of Texas at Houston, where he earned Alpha Omega Alpha honors. Giannulli's practice is based in Westlake Village at Restorative Medical Clinic, where he specializes in restorative hormone therapy for men and women.