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THE IMPORTANCE OF NATURAL HORMONE SUPPORT FOR MEN |
All of us have two lives: the life we learn with and the life we live with after.
GLENN CLOSE,
INÂ THE NATURAL
One of the more amusing stories about scientific research details the year-long, $100,000 program to determine why children fall off their tricycles. After several well-designed studies were completed and the highly degreed researchers had compiled and analyzed their data, they found that children fall off their tricycles because they lose their balance.
This story often comes back to me when I read various pronouncements from members of the medical profession, and never more often than when I read that there is no such thing as andropause (male menopause). Essentially, they say that because no study has found it, it does not exist. The comments of millions of men that they just donât feel like themselves and that something is wrong are passed off as psychologicalâour minds playing tricks on us. This same kind of denial has also occurred when discussing womenâs reproductive conditions, such as menstruation, pregnancy, and menopause. In response, women have pioneered research and exploration into the changes that occur for them during these times and none more so than those that occur during their passage into menopause. Men are long overdue for their own exploration into this territory because the changes that we experience are just as profound, just as life altering, and just as pervasive as those experienced by women. Although it is true that men, at advanced ages, can still participate in creating children and women cannot, there are significant alterations in menâs hormonal chemistries as they age, just as there are with women.
Sudden shifts in body chemistries occur for all of us during the major passages in human life: birth, adolescence, middle age, old age, and death. Most of us can remember our shift into adolescence. Our bodies were changing radically, preparing us for reproduction and independence. At the same time, just as significantly, our minds and spirits were shifting, preparing us for life as adults, for love and families of our own, for careers, and our individual and unique destinies.
These shifts had tremendous physical and emotional impacts as we moved into adolescence. Our bodies changed shape, our skin altered, we began growing hair in places it had not grown before, and our voices deepened. In short, our entire appearance changed. And, just as significant, how the world saw us changed. We had to get used to a new âimage,â a new âface.â The person we saw when we looked in mirrors, those at home and those in peopleâs eyes, had changed. The young boy we had been was gone, and a new someone had come to take his place. At the same time, a similar process was occurring in our minds and spirits. New options for life were opening up and the world of sex lay before us, with vast horizons of reproductive options and attractive bodies in endless variation. We were learning new interaction styles and figuring out where we wanted to go, what we wanted to do, and who we wanted to be as adults. A certain force of personality, an older self, had begun to take us over and come into being.
That new way of beingâthe physical, emotional, and spiritual processes of an adolescent and young adult that came into being as we moved out of childhoodâhad a certain life span, a certain arc, a period of growth, development, maturity, and then senescence or ending. A transition process, in many ways similar to adolescence, occurs again when we enter the middle of life. We look in the mirror and notice that someone new is taking the place of that young man we were. Then, one day, we mildly flirt with a young woman, much as we always have done since our movement into adolescence, and instead of the usual response, one we had become used to over long years of social interaction, the response we get is different. Her eyes respond with, âYouâre old enough to be my father.â In that moment, the changes that have begun catch up with us. We, whether we want to or not, have entered middle age.
Daily, this new truth is reflected back to us. We look in the eyes of attractive women, and the reflection we see is strange, distorted, and middle-aged. A certain shock runs through our system, and we begin to grapple with our own aging process and the end of an earlier, important period of male life. As with adolescence, there are emotional and spiritual components that are essential aspects to this change as well. We begin to examine our lives, to see what we have done and have not done, to sum up, and to take stock. Our function as a man begins to change. Now it is not so much concerned with the reproduction of children but with something else, something that our society is not so clear about, so it is harder to identify, harder to grasp. This cultural unclarity as so many of us find out, makes it harder to resolve this change, this shifting that occurs in midlife. At the same time, we notice our body is older. The impacts of twenty or thirty years of riotous, reproductive living, of raising children, learning our trades, surviving our mistakes have all taken their toll. Parts of our bodies are not working as well as they once did. As with adolescence, our bodies are ready for something else, some other function, a function that our society is not so clear about. And so we struggle with that during this midlife change.
The United States is a young country. In many ways our culture is still an adolescent and, as such, is concerned with adolescent things: sex and reproduction, protection of territory, making money, asserting independence, the freedom to do and say what we want, and being top dog. All these things are integral to the movement into adolescence and young adulthood. However, in middle age something else begins to happen. Because our culture is so unclear about what that is, each of us struggles perhaps more than we should with what we are becoming and the new tasks that lie before us. Many of us begin to realize that although it is true that if you are not top dog the view never changes, if you are top dog, the dogs behind you always see you as one thing. We begin to see that there is something other than the adolescent drives that we have known for so long.
Historically, many cultures have understood this transition much better than we now do. Middle age was recognized for its importance, as were the tasks that lay before the newly awakening middle-aged man. The Jungian analyst James Hillman is one of the few writers struggling to understand the territory of middle and old age and its importance. In his book The Force of Character and the Lasting Life, he makes a deeply insightful point when he remarks:
The transition [to middle age] is first of all psychological, and to me it means this: It is not we who are leaving, but a set of attitudes and interpretations regarding the body and the mind that have outlasted their usefulnessâand their youthfulness. We are being forced to leave them behind. They can no longer sustain us, not because we are old, but because they are old.1
Middle age and old age are not simply the wearing out of the body but also the movement into new territories of self, into new tasks as human beings. As Hillman goes on to say, âAging is no accident. It is necessary to the human condition, intended by the soul.â Emotionally, we are, in fact, coming to terms with our youth, thinking it over. The dreams of who we would become, made during adolescence, are pulled out of the cupboard, dusted off, and examined. We compare them to what we have actually done. Then we look over who we are and what we want to do now. It is common to be less interested in the accumulation of power, reproduction, or making money and more interested in the respect of our peers, intimacy, and developing a new wealth of experience of the world. Often, men become more interested in learning, travel, and helping younger generations through their own struggles with young adulthood. We see our children into adulthood and our parents out. We look at who we are and discover important things that we must still accomplish, and often we leave one career and begin another, one more concerned, quite often, with deeper aesthetic values.
After this transition, men remain vital, strong, and possessed of new insights, tasks, skills, and strengths. Yet we are different. A new form of man has emerged. There is, in fact, a unique ego state that emerges, one as distinctive as that of the two-year-old, the four-year-old, or the adolescent. Like those other crucial developmental ego states, this one, too, is biologically encoded to emerge at a specific time, for a specific reason.
The lack of understanding in our culture of the importance of this new developmental stage of the self, of what it means, what it is for, and just how to move into it gracefully, makes the transition all the more difficult. We enter new territories of self that must be encountered, explored, and experimented with in order for them to be fully realized and for this new way of being to be integrated and whole. Of necessity, we must grieve the loss of that older self, the young man with whom we have lived so long. Eventually, if the territory is fully entered and fully encountered, its shape, its terrain, begins to make sense. We begin to find out who we are now and what we are meant to do. There is a celebration of sorts, and many of us come to know ourselves and our purposes here better than we ever have.
All of this takes work. It takes time, and if we are lucky, we can take that time away from work and family and the responsibilities that we have undertaken over the years of our lives. We can take the time to journey inside ourselves and to do this work in interior time.
This would be challenging enough were it the only thing to be dealt with, but there is another factor that makes it harder still, a factor that interferes with the successful transition into a healthy, vital middle age: the pervasiveness of chemicals throughout the ecosystem that mimic the actions of estrogens (female hormones). The powerful and historically unique presence of these chemistries in our ecosystem and on our bodies cannot be overstated. Their daily intake, through our food and water, alters the hormonal balance of our bodies and, during the shift into middle age, exacerbates the normal changes that our bodies are biologically intended to make. This results, quite often, not only in loss of energy and libido, but in a number of disease conditions that commonly plague men in later life: infertility, impotence, heart disease, and so on.
During our shift into middle age, our body chemistry begins to change. Testosterone and other androgen (male hormone) levels start to shift in important ways. Our bodies broaden out, our ears grow bigger and longer, hair, once again, begins to appear in unusual places (and disappear in others). These are normal changes. They and many others are elements of our shift into another kind of maleness. But something is interfering with this natural shift of our bodies. Researchers who study the endocrine system now realize that environmental estrogenic pollutants and substances are entering our bodies in tremendous quantities. When they do so, they shift the balance from testosterone (and other androgens) toward the estrogen side of the equation. Like women, we do have estrogens in our bodies (just as they have testosterone), we just donât have the same quantities, and we have a great deal more testosterone than they do. What is most important is the ratio of androgens to estrogens. Anything that upsets that balance changes who and what we become. We are not our chemistry, but we certainly are affected by our chemistry. The power of our androgenic chemistry to shape who we are begins while we are still in the womb.
| 2 | ANDROPAUSE |
| | Hormones and the Male Body |
Although men are accused of not knowing their own weaknesses, yet perhaps as few know their own strength. It is in men as in soils, where sometimes there is a vein of gold which the owner knows not of.
JONATHAN SWIFT
There are essentially four kinds of hormones in our bodies, and they are typed depending on what kind of molecule they are built from. Sexual hormones such as testosterone are built around a specific type of molecule, a sterol, from which the word steroid comes. You are familiar with the name of the particular sterol that is used for sexual hormonesâcholesterol. It is, in fact, cholesterol from which all steroid hormones are made.
Adrenaline is another kind of hormone that serves as a source of energy during the flight-or-fight response. It is built around an amino acid called tyrosine (as is the thyroid hormone thyroxine) in the adrenal gland. Another type of hormone, insulin, which is highly important in the bodyâs ability to utilize glucose (a kind of sugar) effectively, is built in the pancreas using complex proteins. Others are built around short-chain amino acids called peptides.
Hormones regulate much of the functioning of our bodies. Through complex biofeedback loops, our bodies determine exactly what their needs are at any one moment in time and either make or release hormones to shift their functioning in the direction it needs to go. As an example of this kind of generalized biofeedback, there is no central thermostat in our bodies that keeps them at a certain temperature. Despite the famous 98.6° redlined on so many thermometers, the temperature of the body shifts constantly; it is always in flux. The various systems of the body compare notes as it were and together, in some manner not understood by scientists, come to a conclusion about how temperature needs to shift and then shift it. We are more a collection of cooperating parts, each with its own innate intelligence, than a mechanical system with the brain acting as intelligent overseer. Our hormone levels are, as well, constantly in flux. Our bodies make and release hormones as we need them to remain vital and healthy. Part of this process includes the making and releasing of sexual hormones. In middle age, the amount of testosterone in male bodies naturally shifts, as does the balance between androgens and estrogens. It is the movement toward excess levels of estrogen and the overreduction of testosterone that produces a great many of the problems that men face as they age.
THE SEXUAL HORMONES
Womenâs sexual hormones are collectively known as estrogens, the main ones being estradiol, estrone, estriol, and 16a-hydroxyestrone. Estradiol is the most pervasive and the strongest in its effects, much like testosterone in males. Progesterone, not usually considered an estrogen, is another female steroid hormone that most people have heard of.
Menâs sexual hormones are collectively known as androgens, the primary ones being testosterone, androstenedione (andro), androstenediol, dihydrotestosterone (DHT), dehydroepiandrosterone (DHEA), and dehydroepiandrosterone sulfate (DHEAS), a slightly more complex form of DHEA.
The precursor to all these hormones is cholesterol, which is converted, in sequence, into the steroid hormones pregnenolone and 17a-hydroxypregnenolone. Essentially, pregnenolone is the primary steroid hormone that is converted, or metabolized, into all the other steroid hormones in both women and men; for this reason, it is sometimes referred to as a prohormone. Other people sometimes refer to it as the âmotherâ steroid, which I guess would make cholesterol the âgrandmother.â All women have some androgens, all men have some estrogens. Each is important in the healthy functioning of our bodies.
In women, estrogens are made in the ovaries, adrenal glands (which sit on top of the kidneys), and brain. Increasingly, research is revealing that both androgens and estrogens also act as potent neurohormones that strongly affect central nervous system activity, which is why both estrogens and androgens are produced in the brain and central nervous system.
Androgens are made in menâs testicles, adrenal glands, brain, and peripheral tissues and cellsâthat is, any muscle tissue or any other cell or organ in the body that needs androgens for a particular function at a specific time. About 95 percent of testosterone is made in a manâs testes, most of the rest is made in the adrenal glands, and a small amount is made in peripheral tissues and cells. Other androgens (such as DHEA and DHEAS) are made in the brain from precursors or prohormones like pregnenolone. The two sexual hormones that seem to be the most important, at least on the surface, are estradiol in women and testosterone in men.
Everyone knows that testosterone makes a man a man. Its presence in our bodies literally does make us men. Testosterone peaks three times in our lives. During the second trimester of fetal development, blood levels of testosterone increase from nearly zero to about 4.0 nanograms per milliliter (ng/mL). (A nanogram is a billionth of a gram, and a milliliter is 0.034 of an ounce.) This is a tremendously tiny amount, yet it causes the fetus to develop as male. Then after birth, testosterone begins to rise again, peaks around six months of age at about 2.5 ng/mL, and drops slowly back to near zero by age one. Part of the purpose of this surge in testosterone after birth is to initiate the formation of the prostate gland. Still, the gland remains tiny, weighing only 1 to 2 grams. The final rise in testosterone begins between ages ten and eleven and rises slowly to a peak of about 5.0 ng/mL around the age of eighteen. Then it holds relatively steady until sometime around the age of forty-five, when it very slowly declines throughout the rest of life. During this last rise of testosterone in adolescence, the penis, scrotum, and prostate gland all enlarge, the voice deepens, facial and body hair begins to grow, sperm production begins, the bones lengthen and grow more massive, and the body expands rapidly to a much larger size.
Because the overall testosterone levels in the body that physicians usually test for (as opposed to free testosterone, which is ...