For the last several months my wife has been going through "the changes." I don't mean that she's turning into a werewolf (although that would be cool). I mean that she's entered that phase of her life known as menopause. Her body, molded by a million years of evolution has determined that she's too old to produce children and safely raise them to self-sufficiency. Over the next couple of years the monthly hormone cycle that has beat like clockwork for most of forty years will sputter and stop. She'll be relieved of the nuisance of periods, pre-menstrual headaches and concerns over possible pregnancy. But her body, deprived of the hormonal surges will suffer and deteriorate. He skin will slacken and her bones become brittle. I'll find her attractive until my eyeballs fall out but it's doubtful that she'll turn the heads of men much younger than myself. There's only so much we can do to defy our essential programming.
My wife laments the passing of her fecundity. She thinks it's unfair that my hormones will keep pumping while her tap dries up. And she's right. Nature is not fair, never has been. But she's wrong in thinking that my hormone levels will stay high indefinitely. In fact while my wife's hormones were still sloshing about her body, mine were already in decline. I can feel it too. My mood has been flatter, my pecs, never much to speak of in the first place are even smaller and I don't have the same spring in my step. I'm also not as pimply and I no longer need to whack-off every time I get a glimpse of cleavage. Middle-age is not completely without advantages.
It has been suggested that men undergo their own form of menopause. They've even given it a name - Andropause (although I prefer Manopause). But while men do experience a decline in testosterone production as they age, equating this decline with female menopause is akin to likening a roll down a gentle incline to falling off a cliff. It's nowhere close. That said, although the decline is shallow, it's very long. It starts in the mid to late thirties, picks up speed after age fifty and just keeps on going. By the time the average man hits eighty he's sporting less testosterone than a ten year old boy.
All of this comes at a cost. Testosterone may have its downsides in excess - adolescence springs to mind - but it's quite wonderful in the proper dosage. Among other things it helps build and maintain muscle as any athlete, injecting himself with it, can attest. It keeps the skin thick and supple, guards against bone lose and deterioration. It keeps our dicks full and at attention. It even keeps us sharp and on our toes. Testosterone in many ways is a veritable fountain of youth. Take away enough of it and we start to lose on all fronts. We age.
Why does this happen? Aging is obviously written into our genetic constitution and is evolutionarily necessary but that doesn't explain why testosterone production should decline. Keep a man's testosterone levels artificially high as he ages and he'll still up and die. In fact, he'll probably die earlier (a fact we'll explore later). A woman's hormonal drop off serves a function. Not so a man's.
Whatever the why of it, scientists have a good idea as to how it happens. To understand we'll need a very brief overview of the process of hormone production. Essentially, testosterone production is part of a feedback loop. A part of the brain called the hypothalamus controls hormone production in the pituitary gland by means of gonadotropin-releasing hormone (GnRH). The GnRH stimulates the pituitary gland to make follicle-stimulating hormone (FSH) and luteinizing hormone (LH), the same hormones that control the female menstrual cycle, if you didn't already know. LH circulates in the blood and signals the testes to produce testosterone.
As men age, this process becomes hindered on three fronts. The pituitary produces less LH so less testosterone production is stimulated. The testicles themselves become less able to produce testosterone in response to LH signals, compounding the problem. On top of all this, a protein that binds strongly to testosterone, called sex hormone binding globulin (SHBG) increases as men age. This reduces the amount of free testosterone in circulation. Free, unbound testosterone is the only form of the hormone that is able to bind to cells and produce its masculizing effects.
Given that all the things that accompany a low level of testosterone (a condition known as hypogonadism) are debilitating, shouldn't every guy over forty be slapping on a testosterone patch? Well, not necessarily, for a number of reasons.
Firstly, before you start pumping up your testosterone levels, you should be sure that they're actually low - and that's not easy. There is a wide range of serum testosterone that is considered normal - 300 to 1,200ng/dl (nanograms per deciliter) total testosterone. What is normal for one man, may be low for another. And even within each individual there are wide variations in the level of serum testosterone depending on one's emotional circumstances and even the time of day. By controlling your thoughts you can actually control your testosterone levels. Depression, especially clinical depression, can drive down the level of serum testosterone below that of a ninety year old man. Play an intensely competitive game of hockey and your levels will rise sharply. Your middle age depression may be caused by low testosterone, but it's also possible that your low levels of testosterone are caused by your depression over the fact that you're getting uglier, your career has peaked and your lovely, sweet children have turned into pimply ungrateful monsters.
Secondly, even if your doctor has determined that you are suffering from a testosterone deficiency, simply goosing the levels of serum testosterone may not work the way you hope. For one thing, your hormone cycle is an incredibly complex system and you mess with it at your peril. Among the reported side effects: Zits, tits, small balls, sleep apnea, high cholesterol and cancer.
Okay you expected zits, but tits? How does that figure? Well, estrogen grows tits and estrogen is actually derived from testosterone by the action of an enzyme called aromatase. Depending on your level of this enzyme, an increase in testosterone may result in an increase in estrogen – ergo tits. Small balls? As I elaborated in The Male Period, testosterone production is part of a feedback loop. Too much testosterone at the wrong time and the cycle shuts down, producing even less testosterone than it did before. Since most testosterone is produced by the testicles, if they stop producing they shrivel up.
How about cancer? It was once thought that too much testosterone caused cancer. Recent evidence has cast doubt on this assertion. But testosterone does seem to feed pre-existing cancers, especially those of the prostate. If you don't have a pre-existing cancer then you're probably alright but the problem with cancer is that it doesn't announce itself. Sometimes cancers grow so slowly they don't become manifest for years. It's been estimated that fifty percent of men over the age of eighty have some form of prostate cancer. Most of these men are unaware of it. Start pumping testosterone into these men and they'll soon find out.
Thirdly there's a growing sense in some quarters that growing old is a natural, necessary process and maybe we should just accept it with grace and good humor. I think there's something to this but I also think that the losses are real and if they can be forestalled then... why not? Perhaps a zit or two and the risk of throwing gasoline on a slowly smoldering cancer are worth the renewed vigor that can come with careful application of testosterone therapy. Your choice bub.
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