3.17.2005

Menoporsche and Alzheimer's
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Mind and Body

Shari Rudasky, a journalist for the Indianapolis Star writes the following on 'male menopause' or 'menoporsche' a clever term which I had never heard but certainly applicable in California. It's a good piece. We don't all have to turn into Jose Canseco or McGwire, but clearly, there can be benefits to testosterone, not just for the body, but for the mind.

If we continue to exercise with a regimen that promotes muscular vigor our bodies continue to produce testosterone and the decline in natural levels may be slower. If you sit around in your 30's and 40's and then start a regimen, like the subject of this article did, you will have a problem. If you keep up with weights at even moderate levels, you will retain strength and some explosiveness. Another benefit, of course, is memory and thinking, and a reduced risk of memory loss. Think of all the fibrallations that become visible as tiny spots on the skin when you exercise heavily, especially playing soccer or an intense bout of circuit training with weights. Capillary action flushes away waste from your blood and promotes cellular development - the same thing happens in the brain due to the elevated blood flow.




The symptoms: Loss of energy, irritability, forgetfulness, decreased sex drive, weakness, fatigue, all stemming from hormone levels shifting as the person enters middle age. The treatment: Hormone therapy to restore the body to its previous vigor.

Sound like menopause, the experience women undergo as they enter the later years of their lives? It's the male version -- nicknamed "manopause," "andropause," or "viripause."

Change-of-life malaise is no longer a diagnosis limited to women. Doctors are now using testosterone to treat an increasing number of men whose hormone levels wane as they age.

Nine years ago, Scott Simmons, now 54, felt he had run out of steam. The Fort Wayne man sold his advertising business and decided to get back in shape. No matter how much time he spent at the gym, however, his body retained its less-than-taut middle-aged shape.

He read an article about testosterone and asked his internist to check his level of the hormone. Sure enough, he fell in the lower range.

After his doctor prescribed testosterone, his problems melted away.
Not only did his muscles pop out, his attitude did a 180.I felt so much better, I felt good," Simmons says. "All I remember was, suddenly now I wasn't tired as much. I just felt younger and more energetic again."

Male menopause is not as much a foregone conclusion as female menopause, which every woman who lives past a certain age will experience. While men lose about 1 percent of testosterone each year after age 30 or so, not every man will drop into the low range.

Nor will every man who hits that level necessarily experience symptoms. And not every man who experiences those symptoms will necessarily have reduced testosterone levels.

And not all those who have both decreased testosterone and symptoms will necessarily recognize that there's a physiological problem they can address.

"For men, the problem is, it's so subtle. One day you wake up and you're a grumpy male. And you think this must be normal," says Dr. Christopher Steidle, a urologist in private practice in Fort Wayne.

Some doctors believe that midlife crises often stem from men's waning testosterone levels. Dr. Harry Fisch, a New York physician and author of the "Male Biological Clock," drolly refers to the phenomenon as "menoporsche," noting that testosterone treatment may prove a better antidote for the condition than the purchase of a new sports car.

While testosterone therapy itself is nothing new, a patient's only option for many years was a shot in the buttocks or triceps every two weeks.

The shot doesn't provide a natural steady dose of testosterone, however; it peaks after three days, leaving the men with lower testosterone until it's time for the next shot.

Now, testosterone comes in a patch, as well as a gel which is applied daily to the shoulders, upper arms and/or abdomen.

Although shots are cheapest, running $14 to $20 a month, most patients prefer the skin-lotion-like gel, which costs about $190 a month, says Dr. John Mulcahy, a urologist at Indiana University School of Medicine. The patch falls in between, at about $120 a month. Some insurance plans cover the treatments.

Estimates vary as to how many men could benefit from testosterone replacement therapy.

Studies suggest that about 50 percent of all men have reduced levels of testosterone according to a test that measures "bioavailable testosterone," says Dr. Jerald Bain. He is president of the Canadian Society for the Study of the Aging Male, a group of professionals who study the topic of older men. As many as half of the men who have lowered testosterone levels could suffer symptoms, he says.

Replacing testosterone does more than alleviate the visible symptoms, advocates say. Men who have reduced testosterone levels are likelier to suffer osteoporosis, predisposing them to fractures, Mulcahy says.

Because testosterone stimulates red blood cell formation, it promotes bone development, notes Bain, professor emeritus in the Department of Medicine at the University of Toronto. The hormone also stimulates various centers in the brain, including regions responsible for mood, cognition and sexual arousal.

Still, the treatment has its limits, cautions Steidle, a clinical associate professor at Indiana University-Purdue University Fort Wayne.

"It will make you feel better, it will give you back things that you lost. It will help your memory and your mood, but it will not fix your 401. There's a myth out there that it can fix everything," Steidle says.

"Is it necessary to live? Of course not. I tell people it's a lifestyle choice."

Not everyone endorses the widespread use of testosterone therapy -- at least not at this point. A 2003 Institute of Medicine report on the treatment urged caution, noting that not enough was known about testosterone therapy to assure users that it's 100 percent safe.

"Though we don't see any tremendous red flags, I think one has to be cautious because we don't know," says Dr. Dan Blazer, a Duke University psychiatrist and co-author of the Institute of Medicine report.

"The real issue comes down to the fact that there just is a lack of evidence. We're not saying that the drug is not effective, we're saying we need to find out whether the drug is effective or not."

The lesson of female hormone replacement therapy is a critical one, Blazer adds. Once thought to stave off heart disease and other woes for women, HRT went under a microscope and actually turned out to have more risks than benefits.

Two and a half years ago, the Women's Health Initiative shocked women and doctors everywhere with the revelation that long-term HRT increased a woman's risk of heart attack and stroke.

No such correlation is known for testosterone therapy. In fact, about the only known reason to avoid it involves prostate cancer:

While there's no evidence to suggest that testosterone increases a man's chance of developing the cancer, it will stimulate an already-present cancer to grow.

And testosterone therapy may help address other problems. One 2004 study by University of Buffalo researchers showed that about a third of men who had Type 2 diabetes also had low testosterone levels.

Many of these men find that exercise will not improve their muscle mass, argues Fisch, a professor of clinical urology at Columbia University.

Treat them with testosterone, combined with exercise and diet, however, and they will see a marked improvement, he says.

"They say, 'I try to exercise but I can't,' because their tank is empty. If you don't have testosterone you can't exercise," Fisch says.

"I find that men have a real difficult time in losing weight if their testosterone is low. In my experience, it's impossible."

These men may find that they no longer need the testosterone after they shed the weight, Fisch says.

Most men, however, expect to stay on the drug for life. That's not a problem for Simmons, who a few years ago switched from the patch to the gel.

Re-energized, he has opened a string of oil change stores in the Fort Wayne area. He continues to head to the gym regularly, where he bests 22-year-olds in pull-up contests.

"I think I had a mini life crisis," he says, reflecting on his decision to try the therapy. "But instead of a crisis, I found a solution."



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