Weblog
Tuesday, 25 November 2008
-
Dealing with Male Menopause
Dealing with Male MenopauseBy Christopher J. Gearon
Most people know that women experience menopause, but did you know that some men go through a kind of male menopause? For men who believe they are going through the proverbial midlife crisis, some doctors and researchers say you may actually be experiencing a form of male menopause called "andropause."
Shocking as it may be to some men, male menopause, or andropause, is becoming more widely recognized and accepted by physicians for the changes many middle-aged men experience — from energy loss to depression to loss of libido to sexual dysfunction. And some clinicians are recommending that certain men experiencing these symptoms, along with a host of others such as decreased bone density and weight gain, seek hormone replacement therapy and other treatments.
"It's like puberty in reverse," Jed Diamond, a California psychotherapist and author of "Male Menopause" and the forthcoming book, "Surviving Male Menopause", says of andropause. Like puberty, the changes that andropause wreaks in aging men, Diamond says, are "hormonal, psychological, interpersonal, social, sexual and spiritual."
Andropause is characterized by a loss of testosterone — the hormone that makes men men. Most men see testosterone levels drop as they age. However, some men are impacted more than others are. Diamond says that as many as 25 million American males between ages 40 and 55 are experiencing some degree of male menopause today.
"Male andropause can be very insidious," explains Dr. Stephen Sinatra, a Manchester, Conn., cardiologist board certified in anti-aging medicine. The loss of testosterone, which can happen to men as young as 35, is gradual, with testosterone levels dropping just 1 percent to 1.5 percent annually. Unlike the precipitous loss of estrogen that women hitting menopause face, the gradual loss of testosterone may take years to exact its mark on men with a host of symptoms not unlike changes menopausal women experience.
Irritability, fatigue, depression, reduced libido and erection problems are hallmark signs of andropause. "I felt like I didn't want to move," says Cecil Dorsey of Vernon, Conn. The 68-year-old retired truck driver, who discovered via a blood test nearly four years ago that his testosterone levels dropped, said, "I just didn't want to be bothered by anything."
A Fresh View on an Old Condition
Although the first study on male andropause was published in the "Journal of the American Medical Association" in the mid-1940s, it's only recently that the U.S. medical community has taken notice of this condition, says Dr. Adrian Dobs, an endocrinologist and associate professor of medicine at the Johns Hopkins School of Medicine.
Typically, men suffering from the symptoms of andropause are treated for a specific medical condition. And therein lies the problem, Diamond maintains. For example, an andropausal male may be diagnosed with depression and prescribed an antidepressant, and both doctor and patient think the man's problem has been addressed. However, if that man has other symptoms of male menopause such as loss of libido, the antidepressant will only exaggerate that problem.
"Conventional means [of treatment] don't look at it as a pattern," Diamond says, who believes a more holistic approach is needed to address all of the symptoms of andropause. This could include conventional therapies combined with testosterone replacement therapy, psychotherapy, herbs, and diet and exercise.
Pros and Cons of Testosterone Replacement
Testosterone replacement therapy is the primary means of treating men with declining levels of testosterone, and this is still a controversial area. "What are the problems faced and can they be treated with testosterone? That's where the question lies," Dr. Dobs says.
"All men should be brought up to a certain level of testosterone," advocates Dobs, who suggests that minimum levels should be 300 nanograms per deciliter of total testosterone. The mean level for a 40-year-old is 500 nanograms, she says.
Instances where testosterone replacement therapy is advised, Dobs says, include men with clear bone density loss, which can lead to osteoporosis and decreased height, and in treating sexual dysfunction in cases where Viagra or other often prescribed remedies don't work. Another area of possible benefits of testosterone therapy may be in cases to maintain body composition and muscle — for instance, in patients fighting cancer.
But testosterone replacement therapy is "not a benign treatment," warns Dr. Michael A. Werner, a White Plains, N.Y., urologist with specialized training in male reproductive medicine and surgery and male erectile dysfunction.
Specialists say that men considering testosterone replacement therapy—whether by injection, patches, cream, gel or oral form—should get their PSA levels checked as testosterone replacement therapy could increase the risk of prostate cancer. (A PSA blood test identifies a man's risk for prostate cancer.) Other risks associated with hormone supplementation, particularly with injections, include the risk of stroke, an increase in liver toxicity and breast development. Ironically, testosterone supplementation also shuts down the production of sperm, Werner says.
Retired trucker Dorsey used to get testosterone shots monthly, but in the last year his doctor has prescribed a pill form, after Dorsey complained that the injections would make him feel uneven—great at first but three weeks after the shot, "I'd feel like crap." Although some doctors warn against oral medication, Dorsey says the treatments increase his energy level, and he generally feels better. His hormone and PSA levels are checked monthly.
But some men are waiting for more accurate treatment. Mendocino County, Calif., engraver and artist Michael Stewart says that the new and popular AndroGel, a clear and odorless topical testosterone gel by Unimed Pharmaceuticals, was too strong for him. While it gave him "a lot of good energy" sexually and otherwise, Stewart felt as though he was getting an unnatural amount of "testosterone juice." He is more cautious, he says. Meanwhile, Stewart is waiting for a product where the user can better regulate testosterone dosage, he says.
Reconsidering Grapefruit in the Male Diet
That grapefruit you've been eating to keep those pounds away may not be good for you after all if you're a man suffering declining testosterone levels. The body's aromatase enzyme turns testosterone into the female hormone estrogen when certain substances are ingested, says Dr. Stephen Sinatra, a cardiologist specializing in anti-aging medicine. Grapefruit is one of those catalysts.
Sinatra, author of "Heartbreak and Heart Disease", also advises his male clients suffering from the symptoms of andropause to cut out alcohol from their diet and increase exercise. The aromatase enzyme is also turned on by alcohol and fat, so men with declining levels of testosterone are particularly vulnerable.
To help increase testosterone production, Sinatra, who heads the New England Heart and Longevity Center in Manchester, Conn., suggests men take zinc and vitamins C and E. Sinatra also suggests herbs, such as muira puama, and L-arginine to increase a man's libido.
Sinatra does a blood screen for all his male patients older than age 50 to check their testosterone levels. While testosterone replacement therapy is the standard for treating men with declining levels of testosterone—which can set off symptoms ranging from depression and fatigue to sexual dysfunction—some experts advocate a more holistic approach to andropause, including diet and exercise.
Loss of libido, for example, can be treated with the vasodilator ginkgo biloba, suggests Jed Diamond, author of "Male Menopause." For men hitting midlife, Diamond recommends, eat soy products, lower fat foods, vegetables and tomato products, the last of which can reduce the risk of prostate cancer. Furthermore, drinking plenty of water is a key component for healthy living.
"Some of it's common sense," Diamond says. "Some of it is working to change patterns."
-
Andropause and men's health
Andropause and men's health
Wendy Rigby
KENS 5 Eyewitness News -You've heard of menopause, but how about it's male companion condition called andropause? More and more doctors are convinced hormonal changes in middle-aged men can be managed to help these patients feel better.
Andropause patient, Mike Anderson is a compounding pharmacist who makes many different custom medicines for patients, but only recently did he take advantage of some of the hormone replacement therapies he creates. In his mid-50s, Anderson began to feel tired all the time.
"Lethargic. Tired when I got up to go to work. Tired when I got home and I was basically ready to go to bed when I'd get home from work," he said. Anderson also noticed other symptoms like hurting knees and a slowing metabolism, signs that can be hallmarks of a hormone imbalance. "Some of the other physical signs and symptoms might be achy bones, achy joints.
They might notice that the waistline is getting bigger and it's becoming harder to lose weight," anti-aging specialist, Dr. Bernice Gonzalez said. Anderson turned to Dr. Gonzalez who determined through saliva and blood testing that he might benefit from a combination of creams and pills to even out his hormone levels.
Testosterone is important to maintaining muscle mass and fueling metabolism and it gives men the energy to maintain an active lifestyle. Anderson has noticed a difference. "I've been feeling really good. It probably took about three months to really begin to notice some significant changes," Anderson said.
At the Vital Life Wellness Center Dr. Gonzalez says she customizes her interventions for patients to help them keep the quality of life as they get older. "We're all going to age. But we can minimize the physical signs and the physical symptoms of aging if we simply get our hormones evaluated and keep those in balance for as long as we can," Dr. Gonzalez said. Dr. Gonzalez is conducting a public presentation on andropause tonight from 6 p.m. to 7 p.m. at the Metropolitan Methodist Plaza at 1200 Brooklyn — Admission is free.
Sunday, 16 November 2008
-
"Obesity" and "Clinical Obesity" Men's understandings of obesity and its relation to the risk of dia
Institute of Health and Society, University of Newcastle upon Tyne, Newcastle upon Tyne, UK. nicolaweaver@blueyonder.co.uk
BACKGROUND: The 2007 Wanless report highlights the ever increasing problem of obesity and the consequent health problems. Obesity is a significant cause of diabetes. An increasing evidence base suggests that in terms of reducing diabetes and CVD risk, it is better to be "fit and fat" than unfit and of normal weight. There has been very little previous research into the understandings that men in the general population hold about the issues of weight, exercise and health; we therefore undertook this study in order to inform the process of health promotion and diabetes prevention in this group.
METHODS: A qualitative study in North East England General Practice using a purposive sample of men aged 25 and 45 years (selection process designed to include 'normal', 'overweight' and 'obese' men). One to one audio-recorded semi structured interviews focused on: overweight and obesity, diet, physical activity and diabetes. Transcripts were initially analysed using framework analysis. Emerging themes interlinked.
RESULTS: The men in this study (n = 17) understand the word obesity differently from the clinical definition; "obesity" was used as a description of those with fat in a central distribution, and understandings of the term commonly take into account fitness as well as weight. Men in their late 30s and early 40s described becoming more aware of health issues. Knowledge of what constitutes a 'healthy lifestyle' was generally good, but men described difficulty acting upon this knowledge for various reasons e.g. increasing responsibilities at home and at work. Knowledge of diabetes and the link between obesity and diabetes was poor.
CONCLUSION: Men in this study had a complex understanding of the interlinked importance of weight and fitness in relation to health. Obesity is understood as a description of people with centrally distributed fat, in association with low fitness levels. There is a need to increase understanding of the causes and consequences of diabetes. Discussion of increased health awareness by men round the age of 40 may indicate a window of opportunity to intervene at this time.
The main findings of this study are as follows:
• The men in this study understood the word obesity differently from the clinical definition; the term "obesity" was used mainly as a description of those with centrally distributed fat, and understandings of the term commonly took into account fitness as well as weight.
• Men described becoming more aware of health issues in theirlate 30s and early 40s, suggesting there may be a window of opportunity to intervene at this time.
• Knowledge of healthy lifestyles was generally good, but men described difficulty acting upon this knowledge as they approach middle-age and have increasing responsibilities at home and at work.
• Knowledge of diabetes and the link between obesity and diabetes was poor.
This study set out to understand important health issues from the individual perspectives of men in the general population. As a qualitative study this research sets out to understand the range of views held by men but does not make claims about the distribution of those views, and is therefore not generalisable in the quantitative sense. We can however generalise theoretically in the sense that the understandings gained here enable us to better judge the issues of importance to men in this age and socio economic group and provide the parameters for quantitative studies of the distribution of these understandings. Validity in qualitative research is established through standard mechanisms to assess the plausibility and credibility of the claims made. Here this was achieved through saturation of themes, exposition of methods, attention to negative cases and reflexivity. While we interviewed men in the age group 25 to 45 years and achieved a good mix of weight and occupation, the group had higher levels of educational attainment than would be expected in the general population and this is a potential source of bias. Our conclusion that men in their late 30s and early 40s are open to change could result from having particularly attracted a group of participants who feel this way. Conversely however, the lack of understanding of diabetes in this relatively well educated group suggests that the problem may be much worse in a different sample which better represents the average educational achievement in the population at large.
For men in this study the word obesity implies elements relating to the central distribution of body fat, and to levels of physical fitness. The focus on 'round' body shape interestingly fits with scientific research which suggests that waist circumference is a better measure of cardiovascular risk that BMI. Many men actually prefer the way they look when their BMI is > 25 and do not see this higher level of weight as a problem in the context of a healthy lifestyle. These men aspire to be physically fit, and public health messages about healthy eating seem to have made an impact. They discuss the factors which limit opportunities for exercise and healthy diet. Patterns of employment are seen as very significant, as well as the related economic factors e.g. sedentary occupations, such as taxi driving, and easy access to cheap fast food. They notice an age related increase in their awareness of health issues.
The ideas we demonstrate about the scepticism held in relation to a target BMI of < 25 have been seen elsewhere. Monaghan interviewed 37 men, (mean age 43), exploring the way men felt about conforming to a 'healthy' BMI, and found "talk about the compatibility of heaviness, healthiness and physical fitness; looking and feeling ill at a putatively 'healthy' BMI; and the irrationality of standardisation".
Research showing that the association between overweight or obesity and mortality is markedly attenuated and in some instances eliminated when objectively measured cardio respiratory fitness is included in the statistical models fits with the perception of the men in this study, that any level of weight cannot be viewed in isolation from levels of physical fitness.
For the men in this study the word diabetes conjures up a number ofconcepts which link to it, but are not easy to understand as a whole. Facts relating to 'type one' and 'type two' diabetes are mixed together, and the side effects of insulin are mixed up with the signs and symptoms of diabetes. Diabetes is understood as an illness, rather than a risk factor, but people are confused about the lack of tangible symptoms relating to the 'illness' of diabetes itself. The understanding of diabetes is like self assembly furniture without the instructions-there are lots of pieces which clearly go together but it is not clear how.
There is little published research into the general population's understanding of diabetes with which to compare these findings. Diabetes UK commissioned a MORI conducted survey of 2,135 adults in the UK in 2000 which found that public understanding of diabetes and its impact is poor. Four out of five people believed that some people get a milder form of diabetes than others; three quarters (76 per cent) of those in high risk groups were unaware of their risk of developing the condition; less than half (46 per cent) of the public know that death can result from diabetes; only one quarter of the population know that diabetes can lead to heart disease despite the fact that it significantly increases the risk. Our findings mirror these results.
A number of men described knee pain as having significantly interrupted their exercise regime. The perception seems to be that exercise is responsible for the problem, and that weight gain is a consequence. Some evidence suggests that participation in exercise does not cause knee osteoarthritis , but other more specific follow up studies of professional footballers do indicate long term problems, including osteoarthritis of the knee . Obesity however is clearly associated with knee pain and osteoarthritis in the knee . In obesity and diabetes prevention in men, education about good knee care, and the impact of weight on knee problems may be an important factor.
-
Alcoholic beverage intake and risk of lung cancer: the California Men's Health Study.
Alcoholic beverage intake and risk of lung cancer: the California Men's Health Study.
Cancer Epidemiol Biomarkers Prev. 2008 Oct
Chao C, Slezak JM, Caan BJ, Quinn VP.
Department of Research and Evaluation, Kaiser Permanente Southern California, 100 South Los Robles Avenue, Suite 201, Pasadena, CA 91101, USA. chun.r.chao@kp.org
We investigated the effect of alcoholic beverage consumption on the risk of lung cancer using the California Men's Health Study.
METHODS: The California Men's Health Study is a multiethnic cohort of 84,170 men ages 45 to 69 years who are members of the Kaiser Permanente California health plans. Demographics and detailed lifestyle characteristics were collected from surveys mailed between 2000 and 2003. Incident lung cancer cases were identified by health plan cancer registries through December 2006 (n=210). Multivariable Cox's regression was used to examine the effects of beer, red wine, white wine (including rosé), and liquor consumption on risk of lung cancer adjusting for age, race/ethnicity, education, income, body mass index, history of chronic obstructive pulmonary disease/emphysema, and smoking history.
RESULTS: There was a significant linear decrease in risk of lung cancer associated with consumption of red wine among ever-smokers: hazard ratio (HR), 0.98; 95% confidence interval (95% CI), 0.96-1.00 for increase of 1 drink per month. This relationship was slightly stronger among heavy smokers (>or=20 pack-years): HR, 0.96; 95% CI, 0.93-1.00. When alcoholic beverage consumption was examined by frequency of intake, consumption of >or=1 drink of red wine per day was associated with an approximately 60% reduced lung cancer risk in ever-smokers: HR, 0.39; 95% CI, 0.14-1.08. No clear associations with lung cancer were seen for intake of white wine, beer, or liquor.
CONCLUSION: Moderate red wine consumption was inversely associated with lung cancer risk after adjusting for confounders. Our results should not be extrapolated to heavy alcohol consumption.
-
Human Papillomavirus Vaccine Acceptability Among Young Adult Men.
Human Papillomavirus Vaccine Acceptability Among Young Adult Men.
Sex Transm Dis. 2008 Sep 30
Gerend MA, Barley J.From the Department of Medical Humanities and Social Sciences, Florida State University College of Medicine, Tallahassee, Florida.
BACKGROUND: For human papillomavirus (HPV) vaccination to have maximum benefit to public health, both men and women should be vaccinated. Although efficacy trials in men are still ongoing, the HPV vaccine will likely be licensed for men in the near future. Little is known about men's interest in HPV vaccination. This study assessed whether informing men about the benefits of male HPV vaccination for their female sexual partner(s) boosted interest in the HPV vaccine beyond informing them about the benefits to men alone. Predictors of HPV vaccine acceptability were also identified.
METHODS: Heterosexual male college students (n = 356) were randomly assigned to receive a self-protection versus a self-protection and partner protection message about HPV and the quadrivalent HPV vaccine. Participants provided demographic and sexual history information, HPV-related awareness and knowledge, health beliefs, and HPV vaccination intentions.
RESULTS: Men reported moderate interest in the HPV vaccine; vaccine acceptability did not differ by experimental condition. A multivariate regression model identified several independent predictors of HPV vaccine acceptability including sexual activity, perceived susceptibility to HPV, perceived benefits of the vaccine, perceived hassle and cost of vaccination, self-efficacy for vaccination, and perceived norms for vaccination.
CONCLUSION: Informing men about the benefits of male HPV vaccination for reducing cervical cancer risk in women did not increase men's interest in the vaccine. Correlates of vaccine acceptability among men were generally consistent with those identified for women. Findings have important implications for future HPV vaccination campaigns targeting young adult men.
Mens_Health
-
- Name: Pat
- Gender: Male
- Member Since: 10/27/2007
