Reversing the Potbelly of Male Menopause

This health tip begins with a mildly off-color story. If you’re offended by such things, please skip to paragraph three.

During the 1920s and 30s the epicenter of New York City’s intellect and wit was the café at the Algonquin Hotel, with the famed Algonquin Round Table hosting luminaries Dorothy Parker, Alexander Woollcott, and Robert Benchley, among others. A topic they often despaired over was getting old. One afternoon, Woollcott remarked that it really annoyed him that old age was accompanied by his genitals shrinking. “Ah, Alex,” quipped Parker, “I do wish that were my problem.”

Yes, as Bette Davis once remarked, “Old age is no place for sissies.”

Many of the changes that take place in your body with age occur because of a gradual but inexorable decline in sex hormones. I’ve written a lot about bioidentical hormone replacement for women, but today, because of some really good news for men, this one’s for the guys and their concerned partners. As in, “Uh, honey, I’ve been a little worried about you…”

Another word for the sex glands (testicles and ovaries) is gonads. When these glands are producing an inadequate amount of hormone (testosterone for men, estrogen + progesterone for women), the medical term is hypogonadism. So, for men, hypogonadism =low testosterone.

Low testosterone symptoms
No two men experience exactly the same symptoms of low testosterone. The age when symptoms are first noted varies widely, too, and they’re actually quite possible any time after 35. The most common complaints I hear are:

•Lack of sex drive
•Low energy
•Mental fogginess
•Weight gain (especially middle-age spread)
•Depression
•Decrease in muscle mass (often despite regular exercise)
•Woollcott’s complaint of smaller genitals

The popular press has dubbed all this “male menopause,” as good a term as any, it seems to me.

Testosterone replacement therapy: an amazing response

It’s well known that most women with low levels of estrogen and progesterone feel better on hormone replacement therapy, and researchers wanted to see what happened when the same principle was applied to men. (There was plenty of funding for this from Big Pharma—no fewer than six testosterone replacement products for the burgeoning Baby Boomer population have been released in the past few years.)

The results, reported at the annual meeting of the Endocrine Society in Houston, were actually better than expected. Physicians tracked five years of testosterone replacement in 255 men with known low testosterone. Virtually all reported improvements in vitality, virility, mood, and motivation.

But most interesting were changes in weight. Practically every participant started out significantly overweight, but by the end of the study a full 95% had lost an average of 36 pounds and 97% reduced their waist circumference, with nearly half losing 10 cm of waistline (nearly four inches). This was without a structured exercise or diet program, though as men started to feel better they were motivated to do more physical activity.

To quote one researcher, “This is an amazing response. I don’t know of many other therapies where you have more than 90% of treated patients respond in a positive way.” Other studies using testosterone replacement therapy have shown declines in metabolic syndrome (heart disease/diabetes risks), blood pressure, resting heart rate, fasting blood sugar, LDL (the bad) cholesterol, and triglycerides, all pretty much without side effects.

In the past, doctors were concerned about an increased prostate cancer risk with testosterone, but this fear has proven to be ungrounded. Two men of the 255 did develop prostate cancer, a figure considerably less than would have been expected in the average male population. One researcher commented that it really didn’t make sense to think that raising testosterone to normal levels (normal for younger men, anyway) using natural testosterone should trigger prostate cancer. “It would mean that nature had made a major mistake.”

First, check your testosterone levels

If you (or the man in your life) are wandering through the foothills of male menopause, the simplest first step is to get your testosterone levels checked. There are two ways to do this:

1. Health insurers generally cover a single blood level measurement of testosterone. If you’re a WholeHealth Chicago patient, call and schedule a “lab only.” However, since testosterone levels vary throughout the day, one sample might not reflect your actual testosterone status.
2. Alternatively, you can get a small kit from our office. With it, you’ll collect four samples of saliva throughout a single day and then mail the specimens directly to the lab. We’ll receive the results and forward them to you via email. The cost of the kit is $170.00. You can order one by calling our apothecary (773-296-6700, Ext. 2001) and we’ll send it to you. Or stop by to pick one up. It’s worth noting that most insurers (including Blue Cross) will not pay for salivary measurement of sex hormones.

If your results show low testosterone, you’ll need a short appointment with either me or Dr. Kelley so we can review the therapeutic options. We’ll also draw a baseline PSA (prostate specific antigen), a prostate cancer screening test of dubious general value, but necessary in this case because testosterone is contraindicated with a high PSA.

Once you’re all clear, the easiest testosterone replacement treatment is a prescription for one of the testosterone creams, applied each morning to the skin. Unfortunately, these creams can be quite expensive and insurance companies dislike paying for them so intensely that they occasionally want to know your testosterone level before approving coverage. We’re hearing “Sorry, not low enough” from them as a reason for denial.

Far more affordable is using a compounding pharmacy to prepare a cream and having it sent to your home. Average cost is $40 to $50 per month, about the same as your co-pay alone on a branded product. The quality of the testosterone from these compounders is excellent and you can anticipate exactly the same results. I provide the compounding pharmacy with a prescription, starting with a standard dose and re-checking your levels after 8 to 12 weeks, increasing the dose if needed to achieve and maintain normal testosterone levels.

No guarantees about reversing Woollcott’s problem, but think how happy you’d be minus that potbelly.

Be well,

David Edelberg, MD