The menopause has long been understood by the medical community, characterised by a relatively sudden drop in oestrogen production leading to significant symptoms in many women. Although the onset is far less sudden, men can have a similar experience with a, generally more gradual, drop in testosterone, which is often called the andropause or late onset hypogonadism (LOH). This reduction in testosterone can have a significant effect on quality of life, wellbeing and health in general.
Testosterone levels in men tend to decrease by 1% per year after the age of 30. Therefore, by the age of 50 they have dropped by 20% which can initiate symptoms such as:
- low sex drive
- difficulties getting erections or erections that are not as strong as usual
- lack of energy
- irritability and mood swings
- loss of strength or muscle mass
- increased body fat
- hot flashes
There can be further complications associated with andropause including an increased risk of cardiovascular problems, diabetes and osteoporosis.
Decreased testosterone is generally attributed to the age-related reduction in the number of Leydig cells in the interstitium of the testes, which are the primary producers of testosterone. The consequent substantial loss in serum testosterone may result in the inactivation of spermatogenesis, loss of muscle strength, as well as declines in muscle performance and physical function, which can detract from quality of life.
A predominant proportion of ageing and older men have reduced levels of serum testosterone, which is a major reason for andropause symptoms1. Sex hormone binding globulin (SHBG) is a protein which binds to testosterone and transports it around the body. This is important as it will direct testosterone to appropriate sites of action. However, when SHBG levels are too high, free testosterone is reduced and symptoms of andropause can be exacerbated. Factors that increase SHBG include:
- Falling levels of testosterone, which stimulates increased production of SHBG by the liver
- Excess oestrogen due to environmental sources or increased endogenous production (e.g. obesity increases oestrogen production, see below)
Increased levels of SHBG-bound testosterone may still show normal serum ranges of total testosterone, despite a relative deficiency in bioavailable testosterone2.
Similar to the menopause, the andropause can have a greater or lesser effect on wellbeing depending on the individual. So what factors are involved in the severity of symptoms?
There is a significant correlation between a high BMI and andropause. Men with a BMI greater than 30 have on average 30% lower levels of testosterone compared to men with a healthy BMI. This is probably due to:
- Adipose (fat) tissue produces the enzyme aromatase which converts androgens such as testosterone into oestrogen thereby reducing testosterone levels and increasing oestrogen
- Obese patients have elevated levels of serum leptin which leads to the disruption of hypothalamus-pituitary-gonad (HPG) axis and decreased production of testosterone from Leydig cells3
- Adipose tissue secretes inflammatory cytokines and adipokines which have a negative influence on the function of the HPG axis with a subsequent effect on spermatogenesis4
Type 2 Diabetes/Insulin Dysregulation
There is also an association between type 2 diabetes and insulin resistance and andropause. This in part may be due to an increase in adipose tissue and therefore the above situation applies in those individuals. It has however also been shown that central and peripheral insulin resistance has a negative effect on the HPG axis and may disrupt testosterone regulation.
There is also an association of andropause with cardiovascular disease and chronic obstructive pulmonary disease, again likely due to a combination of the above physiology, increased adipose tissue, inflammation and insulin dysregulation all of which affect the HPG axis.
Oxidative stress can contribute to damage to Leydig cells, which produce testosterone, and therefore may contribute to low testosterone levels. This can be a vicious cycle as it is also suggested that reduced testosterone can induce oxidative stress and apoptosis (cell death). This apoptosis may contribute to the overall apoptosis of the prostate in andropause animal models5.
Complications of the andropause:
The general loss of wellbeing and vigour during the andropause can contribute to low mood and anxiety however there can also be physiological changes leading to depression. A study has shown that low testosterone in combination with obesity can contribute to neuroinflammation, which is consistent with low mood and depression as well as a risk factor for cognitive issues such as dementia and Alzheimer’s.
Low testosterone is also associated with muscle loss known as sarcopenia. Muscle is considered by some to be the “Anti-Ageing God” because maintaining muscle mass as we age helps to prevent falls and therefore bone breakages, maintains activity and mobility and also helps to improve insulin sensitivity (therefore reducing risk of diabetes, cardiovascular disease, dementia and cancer). Therefore, sarcopenia can further exacerbate the risk factors affecting andropause symptoms.
Nutritional and Lifestyle Interventions:
The major effective intervention for andropause symptoms is weight reduction and blood sugar regulation in order to reduce insulin and improve insulin sensitivity. This can be done by:
- Consuming low glycaemic load carbohydrates (lots of vegetables and small portions of wholegrains) with protein and healthy fats to slow down blood sugar release.
- Intermittent fasting which reduces insulin levels. This can be achieved by ensuring caloric intake is below 500Kcal for 2 days out of 7, or ensuring food is only consumed in a maximum of a 12-hour window e.g. from 7am-7pm. Even more effective is an 8-hour window (e.g. 10am-6pm or 12 noon-8pm)
- Supplementing nutrients or herbs which aid glucose uptake and improve insulin sensitivity such as chromium, magnesium, zinc, alpha lipoic acid and cinnamon
- Performing 150 minutes of moderate to intense exercise per week. This increases muscle mass, reduces adipose tissue and increases insulin sensitivity. Include weight training exercise as well
It is also useful to protect Leydig cells from damage by reducing oxidative stress. Therefore, increasing the intake of antioxidants can be really useful.
- One study demonstrated that anthocyanin supplementation may contribute to preventing excessively rapid cell death by apoptosis in the prostate in an animal model of andropause
- Consume 6-8 portions of vegetables and 1-2 portions of fruit per day which are high in antioxidants and phytonutrients – choose a wide range of colours.
- Remove exposure to pro-oxidative toxins such as heavy metals, pesticides and persistent organic pollutants
- Increase antioxidants such as vitamin A, vitamin C, selenium, zinc, N-acetyl-cysteine, alpha-lipoic acid and polyphenols
Reducing inflammation is also important as there is an association between inflammation/inflammatory conditions and low testosterone. Ways to reduce inflammation include:
- Reduce foods high in omega-6 – e.g. farmed meats, dairy products and vegetable oils (such as sunflower and corn oils). These are high in the omega-6 fatty acid arachidonic acid or linoleic acid (precursor to arachidonic acid). Arachidonic acid can be converted to the pro-inflammatory prostaglandin PGE
- Increase sources of omega-3 from oily fish and flax, chia seeds and/or a supplement containing EPA. EPA is found in oily fish or can be supplemented. Alpha linolenic acid is found in flax, chia seeds and dark leafy green vegetables and can be converted to EPA by the body. EPA is converted into anti-inflammatory prostaglandins
- The ratio of omega-6 to 3 is very important. The majority of people are consuming too much omega-6 relative to omega-3 and therefore are often producing excess amounts of pro-inflammatory prostaglandins
- Curcumin – found in turmeric, has been shown to inhibit Cox-2 enzymes which produce inflammatory prostaglandins
A small percentage (roughly 5%) of testosterone is produced by the adrenals glands, these are generally responsible for our stress response. Therefore, supporting adrenal function and stress management can help to support testosterone levels. Useful ways to support adrenal function include:
- Nutrients such as vitamins B5, B6 and C, magnesium
- Adaptogenic herbs such as liquorice, ashwagandha and Siberian ginseng
- Relaxation techniques such as meditation, mindfulness, massage and yoga
Nutrients to support testosterone levels
Zinc – important for the maintenance and health of the testes as well as normal testosterone production. It also helps prevent testosterone from being converted into oestrogen. Suboptimal zinc status appears to have a negative influence on serum testosterone concentrations as well as on seminal volume8.
Vitamin B6 – necessary for testosterone production and is also supportive of adrenal function and neurotransmitter production.
Vitamin D – a study confirmed previously observed positive associations between circulating vitamin D and total and free testosterone levels before and after administration of vitamin D supplementation. It demonstrated that vitamin D deficiency is associated with a significant reduction of testosterone6.
Omega-3 fatty acids – help to maintain and increase testosterone levels. They also play an essential role in reducing inflammation and promoting normal cognitive function.
- Andropause is characterised by a gradual drop in the production of testosterone, usually in males over the age of 50, leading to symptoms including reduced libido, increased muscle loss, fat gain, depression, low energy, irritability and mood swings.
- Obesity and insulin resistance is strongly associated with an increase in andropause symptoms. Therefore, weight loss and improvements to insulin sensitivity may be important.
- Oxidative stress and inflammation play a role in damage to Leydig cells which produce testosterone. Therefore, anti-inflammatory and antioxidant interventions are useful. Anthocyanin supplementation has shown promise as an effective therapy.
- Nutrients that support testosterone production include zinc, vitamin B6, vitamin D and omega-3 fatty acids.
- Supporting adrenal function and managing stress can also support normal testosterone production.
If you have any questions regarding the topics that have been raised, or any other health matters, please do contact me (Helen) by email at any time (email@example.com)
Helen Drake and the Cytoplan Editorial Team
Relevant Cytoplan Products
CoQ10 Multi – This is an adult only formula and the composition includes CoQ10, Beta 1-3, 1-6 Glucan and vitamins B12 and D3 meaning it is particularly suited to both men and women and those on Statin medication. It is also an excellent additional multi formula for those people taking our Red Rice Yeast Plus supplement (for cholesterol support).
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Adrenal Support – Adrenal Support comprises a blend of herbs – liquorice, ginseng and sum/pfaffia, alongside the mineral iodine and importantly, good levels of Food State™ pantothenic acid (vitamin B5).
Organic Ashwagandha – Used in traditional Ayurverdic medicine, Organic Ashwagandha comes at a potency of 500mg per capsule.
Vitamin B6 (P5P) – Pyridoxal 5 Phosphate is the metabolically active form of vitamin B6 – essential to physical activity due to its involvement in the energy cycle by activating the release of glycogen from the liver and muscle. Similarly Vitamin B6 plays an important role in the breakdown of carbohydrates, fats and proteins.
Liposomal Glutathione Complex – contains the antioxidant glutathione as well as N-Acetyl L Carnitine, Alpha Lipoic Acid, Gingko Biloba, Rosemary Leaf Extract and Resveratrol
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Phyte-Inflam – Containing curcumin (from turmeric) and gingerols (from ginger root) – two polyphenolic compounds (natural found in many fruits, vegetables, and other plants).
- Singh P. Andropause: Current concepts. Indian J Endocrinol Metab. 2013;17(Suppl 3):S621-9. doi:10.4103/2230-8210.123552
- Meletis CD, Barker JE. Holistic Approaches to Treating Andropause. http://online.liebertpub.com/doi/pdf/10.1089/act.2004.10.241. Accessed February 22, 2018.
- El Salam MAA. Obesity, An Enemy of Male Fertility: A Mini Review. Oman Med J. 2018;33(1):3-6. doi:10.5001/omj.2018.02
- Fuoco D, di Tomasso J, Boulos C, et al. Identifying nutritional, functional, and quality of life correlates with male hypogonadism in advanced cancer patients. Ecancermedicalscience. 2015;9:561. doi:10.3332/ecancer.2015.561
- Jang H, Bae WJ, Kim SJ, et al. The effect of anthocyanin on the prostate in an andropause animal model: rapid prostatic cell death by apoptosis is partially prevented by anthocyanin supplementation. World J Mens Health. 2013;31(3):239-246. doi:10.5534/wjmh.2013.31.3.239
- Nimptsch K, Platz EA, Willett WC, Giovannucci E. Association between plasma 25-OH vitamin D and testosterone levels in men. Clin Endocrinol (Oxf). 2012;77(1):106-112. doi:10.1111/j.1365-2265.2012.04332.x