Andropause - Optimal Takeaways

Welcome to part 9 of the ODX Andropause & Low T Syndrome Series. In this final post in our series, we cover the Optimal Takeaways for the assessment and treatment of Andropause or Low T Syndrome

Andropause - Optimal Takeaways

Dicken Weatherby, N.D. and Beth Ellen DiLuglio, MS, RDN, LDN

The ODX Male Andropause Series

1. Andropause Part 1 – An Introduction
2. Andropause Part 2 – Biology & Physiology
3. Andropause Part 3 – How to identify it
4. Andropause Part 4 – Lab Assessment and Biomarker Guideposts
5. Andropause Part 5 – Clinical Determination
6. Andropause Part 6 – Lab Reference Ranges
7. Andropause Part 7 – How do we treat and counteract andropause?
8. Andropause Part 8 – Lifestyle approaches to addressing Andropause
9. Andropause Part 9 – Optimal Takeaways
10. Optimal The Podcast – Episode 9: Andropause

Assessment and treatment of late onset hypogonadism should be a priority for men’s health because of its close association with morbidity and mortality. It can interfere with function and quality of life and should be addressed as early as possible. LOH is most often associated with older age, obesity, co-morbidities, and general poor health.

Diagnosis depends on:

• Ruling out conditions with overlapping non-sexual symptoms
• Addressing acute and chronic conditions that can reduce testosterone levels
• Measurement of T in the fasting state between 7 and 11 am.
• Repeating measurements to confirm to LOH and association with symptoms
• At least 3 sexually-related symptoms
  • Erectile dysfunction, decreased morning erections, and decreased libido or sexual thoughts
• Reproducibly low serum levels:
  • Total T below 320 ng/dL (11 nmol/L)
  • Free T below 64 pg/mL (220 pmol/L)
• Free or bioavailable testosterone should be measured [i]
  • When TT is 250-350 ng/dL (8.7-12 nmol/L)
  • When SHBG is decreased,g., hypothyroidism, insulin resistance, diabetes, obesity, excess growth hormone, exogen androgens, liver disease, nephrotic syndrome
  • When SHBG is increased,g., aging, liver disease, hyperthyroidism, elevated estrogen, anti-seizure medication

Testosterone replacement therapy

• Decisions should be made jointly between patient and practitioner and contraindications must be considered.
• A trial of testosterone therapy is indicated if:[ii]
  • Total T is 230-345 ng/dL (8-12 nmol/L)
  • Free T is less than 65 pg/mL (225 pmol/L)
• The goal of testosterone therapy is to restore or improve anabolic, psychological, and sexual symptoms.[iii]
  • Testosterone therapy is likely indicated if
    • Total T is 231 ng/dL (8 nmol/L) or less
    • Free T is 52 pg/mL (180 pmol/L) or less

Lifestyle modification

• A healthy whole-foods Mediterranean-style diet.
• Micronutrient sufficiency, supplementation as needed.
• Consider plant-based compounds that support testosterone metabolism.
• Healthy weight loss of at least 10% if needed.
• Regular activity including 90-150 minutes of mild to moderate intensity exercise at least 3 days per week.
• Minimize exposure to environmental hazards such as pesticides, phthalates, and other xenobiotics.
• Minimize stress exposure and maximize stress management

NEXT UP: Optimal The Podcast - Episode 9: Andropause

Research

[i] Karakas, Sidika E, and Prasanth Surampudi. “New Biomarkers to Evaluate Hyperandrogenemic Women and Hypogonadal Men.” Advances in clinical chemistry vol. 86 (2018): 71-125. doi:10.1016/bs.acc.2018.06.001 [R]

[ii] Jakiel, Grzegorz et al. “Andropause - state of the art 2015 and review of selected aspects.” Przeglad menopauzalny = Menopause review vol. 14,1 (2015): 1-6. doi:10.5114/pm.2015.49998 [R]

[iii] Corenblum, Bernard. "Could this man have andropause?." Canadian Journal 107 (2004). Continuing Medical Education.[R]