Male health after andropause

Every week I am posting about  everything you need to know about hormones. This weeks topic is about male health after andropause

Did you know …

  • Andropause also called late-onset hypogonadism or age-related low Testosterone relates to the ‘natural’ decline in testosterone production
  • Andropause differs from menopause where the ovaries retire completely
  • And unlike the more dramatic hormone plunges that occurs in women during menopause, sex hormone changes in men occur more gradual, creeping up and men are often not aware of the changes.
  • Andropause is a decline in testicle testosterone not a complete stop
  • Total Testosterone (TT) decline is on average approx. 1.6% per year
  • Free and bioavailable Testosterone levels fall by 2%–3% per year
  • By approx. age 70 the decrease can be as much as 40 – 80%.
  • Sex Hormone Binding Globulin (SHBG) increases and binds more of the Free Testosterone circulating in the blood.
  • Many older men still have testosterone levels within the normal age related ranges, but this doesn’t mean it’s enough to prevent disease
  • 10% to 25% have levels considered to be lower than normal age related ranges
  • Welcome to the golden years
  • Life expectancy after 50 for men is approx. 30 years
  • The chances of developing certain diseases increase
  • Preventative measures should be taken to improve quality of life, enhance longevity, and lower the risks of age-related illnesses.
  • Andropause awareness is very important as many men over the age of 40 experience symptoms of low T, but are unaware that their symptoms are due to andropause and most importantly that there are solutions.
  • Young men under 30 will have T levels exceeding 1000 ng/dl
  • Average levels for men in their 70s and 80s is 200 ng/dl.
  • 30-40% of men in their 50s will experience symptoms of low T levels.
  • Remember this – just because you are within your ‘normal age range’ doesn’t mean you have enough T to function optimally as a man physically, mentally and or emotionally and or prevent disease
  • Levels vary during the day, with peak values in the early morning, which is why morning erections are a good sign of good T production
  • T production is increased during REM sleep, especially between 2 – 6am
  • Unfortunately the medical community is not united on the topic of male andropause and the need to replace T, which means many men don’t get the help they need and may suffer unnecessarily
  • Recent heart studies show that TT levels corresponding to the upper level of the age range for 50-59 year olds, ie 500-800 ng/dl to be beneficial – see the article studies and TRT in the blog.

Meet Sally and get to know all about male health after andropause


Disease states after andropause

Atherosclerosis 101

Low testosterone and prostate

Aging Male Health Risks

  • Obesity
  • Type 2 Diabetes
  • Metabolic Syndrome
  • Cardiovascular and Coronary Heart Disease
  • Abdominal Aortic Aneurysms – AAA
  • Osteoporosis and osteoarthritis
  • Sarcopenia
  • Cognitive decline and dementia
  • Depression
  • Prostate problems such as:

– Cancer

  • Erectile dysfunction
  • Cancer

NB! – While every man faces unique risks based on genetics and other factors, it’s a good idea to be mindful of how to protect yourself against these common health conditions that can increase in risk after the decline in testosterone.

Low Testosterone and Heart Disease

  • Low T levels in men may increase their risk of developing coronary artery disease (CAD), metabolic syndrome, and type 2 diabetes.
  • Reduced T levels in men with congestive heart failure (CHF) predicts a poor prognosis and is associated with increased mortality.
  • Studies in T-deficient men who underwent T replacement therapy versus untreated men have reported

– a reduced CV risk with higher endogenous T concentration

– improvement of known CV risk factors with T therapy

– reduced mortality

– In a 2014 study, researchers found that men who increased their levels of testosterone through TRT (testosterone replacement therapy) had a 55 % reduced risk of heart attack and stroke

  • Also in men with pre-existing heart disease
  • BUT – Higher-than-normal testosterone levels can increase the risk for heart attack and or stroke.
  • Men under 55, the risk of heart attack and stroke was reduced by 25%
  • Men over 60, the risk was reduced by 15%
  • Blood testing before and after TRT is imperative
  • TT (total testosterone) serum levels between 500-800ng/dl for optimal affect
  • Always check Estradiol levels
  • This review states – READ HERE:

– There is no credible evidence at this time that TRT increases cardiovascular risk, BUT there is substantial evidence that it does not.

– Many studies have indicated that low serum T concentrations are associated with increased cardiovascular risk and mortality and that TRT may have clinically relevant cardiovascular benefits.

– Studies have reported

  1. reduced CV risk with higher endogenous testosterone concentration
  2. improvement of known CV risk factors with TRT
  3. reduced mortality in testosterone-deficient men who underwent TRT versus untreated men.

For more information see the article – Studies and TRT in this blog.

Factors that Drive Atherosclerosis – Hardening of the Arterial Wall

  • Glucose spikes
  • Insulin resistance
  • Inflammation
  • High blood pressure
  • Oxidative stress
  • Nutrient deficiencies
  • Iron overload
  • Heavy metals
  • Autoimmune issues
  • Infections
  • Smoking.

Heart Attack Predictor Tests

  • CAC – coronary artery calcium score is a powerful measure of cardiac disease risk.

CAC scores

– a very low risk of 1.4% of heart attack within the next 10 years

Between 1 and 100
– a 4.1% risk of heart attack within the next 10 years

Between 101 and 400
– raises risk to 15% of heart attack within the next 10 years

Between 400 and 1,000
-puts the risk at 26% of heart attack within the next 10 years

Above 1,000
– the risk of a heart attack within the next 10 years is 37%

  • While age is typically seen as the primary risk factor for CVD, the CAC score takes precedence when it comes to identifying the real risk


Other Predictors

  • High inflammation, such as CRP
  • High blood pressure
  • High blood sugar / Insulin
  • High iron, such as , s.Ferritin
  • High LDL particle count can be a significant risk factor for CVD, but other factors play a role in determining whether high LDL particle count is contributing to atherosclerosis. These include
  • oxidized LDL
  • endothelium damage
  • low HDL
  • high triglycerides
  • Low testosterone.

Low Testosterone and Abdominal Aortic Aneurysm – AAA

  • 4:1 male to female ratio
  • The reason for this gender disparity is unknown
  • Risk factors include:
  • Increasing age
  • Smoking
  • Hypertension
  • Two or more drinks per day
  • Recent epidemiologic studies have shown that men with AAA have lower serum testosterone compared to men without AAA, suggesting the preventive roles of testosterone in decreasing inflammation in blood vessel walls – READ STUDY 
  • Higher levels of Estradiol and Progesterone – READ STUDY 
  • Often asymptomatic and fatal
  • A ruptured aneurysm can cause massive internal bleeding, which is usually fatal.
  • Around 8 out of 10 people with a rupture either die before they reach hospital or don’t survive surgery.
  • Easily identified through an ultrasound screening
  • If the aneurysm is >5.5 cm, it can be surgically repaired to prevent a life-threatening rupture.
  • Current AAA screening recommendations focus on men between the ages of 65 and 75 years, who have ever smoked
  • Recent evidence suggest men of ages 50 to 80 years, regardless of smoking status, may also be at risk for and should be screened.

5 warning signs and symptoms

  • Chest tenderness or chest pain
  • Dizziness or light-headedness
  • Back pain
  • Coughing up blood
  • Loss of consciousness due to the rupture

NB! – Women with AAAs are older, have faster growing aneurysms, a 3–4 fold higher rupture risk, and rupture at smaller diameters than men.

The Aging Male and Cancer

  • 50% of all diagnosed cancers

– Prostate cancer – 451 per 100,000
– Lung cancer – 449 per 100,000
– Colon cancer – 176 per 100,000

  • Elderly men have an almost double cancer incidence rate compared with elderly women.

Low Testosterone and Prostate Cancer

  • A paradox
  • For years clinicians have been concerned that providing testosterone replacement therapy (TRT) could cause and increase the risk of developing prostate cancer.
  • This idea was born from the current treatment of prostate cancer
  • Men with metastatic prostatic cancer are treated by medical castration – medication used to stop testosterone production by the testicles and or by blocking the androgen receptor.
  • (NB! – the effect of this treatment is time limited as the cancer cells become castrate resistant and grow without testosterone)
  • Leading to the conclusion – the treatment for prostate cancer is to lower testosterone levels.
  • And TRT would be counterproductive even dangerous
  • BUT is this true?
  • We know today, after years of research and clinical trials there is no evidence that links any increased risk of developing prostate cancer in men undergoing TRT.
  • There is no evidence that normal levels of testosterone have any relationship to prostate cancer.
  • In fact, we know today that men who have low testosterone actually have a higher risk of developing prostate cancer.
  • Having low testosterone level is a significant risk factor for developing prostate cancer.
  • In fact, under clinical investigation at John Hopkins Kimmel Cancer centre is the use of high dose testosterone therapy to treat metastatic prostate cancer.
  • There has also been a myriad of studies that have documented treating patients who have or had prostate cancer with TRT and there has not been any association or increased risk of prostate cancer development, prostate cancer spread or continued rise in prostate specific antigen (PSA)
  • We know today that frequency of prostate cancer development in men on TRT is the same as men not being treated with testosterone.
  • There has been no association between the level of testosterone, free testosterone or DHT levels and risk of developing prostate cancer.
  • Men with very low levels of testosterone who did get prostate cancer were more likely to develop an aggressive form of the disease
  • Low testosterone levels pre-treatment are related to a poor prognosis in prostate cancer
  • Prostate cancer is around 22 times more frequent among elderly men than among younger men (where testosterone is lower)


  • Estrogen levels must be checked as increased Estrogen / Estradiol does increase prostate cancer
  • Keeping Estradiol levels between 20-40 pmol/L is optimal
  • Prostate cells produce testosterone and estrogen
  • Important to check liver detoxification of Estrogens as the problem may be in the liver – READ MORE HERE

Update from Tony Collier with Stage 4 Metastatic Prostate Cancer who was on the Prostate show – READ MORE HERE 

  • He still has cancer cells trying to find a way of surviving and growing without testosterone
  • He also says the doctors never measure either Testosterone or Estrogen levels

Testing for Prostate Cancer

  • Common practice to screen with a digital rectal examination and PSA level
  • Should also include a serum testosterone levels – https://pubmed.ncbi.nlm.nih.gov/17005316/
  • There is a significant association between a low testosterone level and an increased detection of prostate cancer
  • Therefore when prescribing TRT for men above 40, a PSA level should be coordinated with the testosterone level to ascertain any increased risk of prostate cancer.
  • Low serum testosterone level was an independent risk factor for upgrading prostate cancer stage https://pubmed.ncbi.nlm.nih.gov/26439747/
  • Should also include Estradiol levels.

Test your self – Blood sugar, insulin and weight

Imbalances in the hormone Insulin are the main cause of many health problems and disease states. Insulin is responsible for reducing blood sugar/glucose, by ensuring its entry into cells where it is used to make energy/ATP or for storage. Glucose is often converted to fat making Insulin the body’s major fat storing hormone where persistent increased production of Insulin will increase the risk for obesity, type 2 diabetes, cardiovascular problems and much more.

The following tests can indicate if you have problems with blood glucose

Subsequently you can follow my guide to self-help, or book my personal assistance or talk with your doctor


  • Do you have high blood sugar and insulin resistance?
  • Do you have high blood sugar and low or no insulin?
  • Waist size test.

Common Complications of Long-term, Uncontrolled  High Blood Sugar

Heart disease

  • Coronary artery disease – CAD
  • Angina
  • Heart attack
  • Stroke
  • Narrowing of arteries aka atherosclerosis

Damage to and blocking of the tiny blood vessels aka atherosclerosis

  • Numbness, pain and dysfunction in extremities, such as feet  – leading to increased risk for poor healing and amputation
  • Nerve damage can also affect our ability to see, hear, feel and move.
  • Kidney dysfunction – leading to kidney failure
  • Eye dysfunction, such as retinopathy – leading to blindness
  • Clouding of the normally clear lens of your eye aka cataract
  • Possibly tinnitus and or hearing loss
  • Alzheimer’s – now known as type 3 diabetes
  • Depression

Gut dysfunction

  • Poor absorption of nutrients
  • Poor elimination of waste products
  • Obesity
  • Skin problems – aging skin, eczema, acne, etc,
  • Gum disease and other mouth problems


  • Increased risk of developing certain cancers.
  • Some cancer treatments can make it harder to control your blood sugar.

Sexual Problems in Women

  • Decreased blood flow to the vagina and vulva decreasing sensation.
  • Increased risk for thrush or a urinary tract infection.

Sexual problems in men

  • Restricted blow flow to the penis
  • Erectile dysfunction such as no erection or weaker / shorter erection
  • Worst case scenario impotence



  • One of the ways glucose damages cells is by a process called glycation
  • Glucose is sticky and binds to anything and everything
  • Glucose sticks to fats and proteins in the blood stream creating Advanced Glycation End products aka AGE molecules
  • AGE molecules create inflammation and damage increasing the risk of diabetes, hypertension, vascular damage, dementia to name but a few
  • AGE molecules are big and don’t pass through the small blood vessel in extremities causing blockages and reduced blow flow, which may end in amputation of that extremity.

Tips to Control Blood Sugar

  • Keep blood glucose under 30-40g per meal
  • Doesn’t matter where the glucose comes from glucose is glucose
  • Keep your total fructose consumption under 30g per day – best source is whole fruits as they are also rich in other nutrients, antioxidants and fibre
  • Increase your consumption of short and medium chained fatty acids which are readily burned, not stored and not controlled by insulin, such as beef tallow / suet, butter coconut oils, MCT
  • When glucose intake is low fat intake in general can increase, minimum 30g per meal
  • Some of the best sources of fats in general include avocado, coconut oil, free-range eggs, organic butter and cheese, grass fed and finished beef, wild salmon
  • Intermittent Fasting aka Time Restricted Eating fancy words for Eating Windows. Cut back on your feeding window anywhere from 6 – 10 hours giving you 14 – 18 hours of fasting. Clinically proven again and again to have a positive effect on blood sugar and insulin sensitivity
  • Drink pure, clean water instead of sugary beverages like fruit juice and sodas
  • Add fermented foods to your meals as the beneficial bacteria will aid your digestion and provide detoxification support, even lessen the fructose burden on your liver, such as fermented vegetables, kefir made from grass fed milk, kimchi, natto and organic yogurt made from raw grass fed milk. NB! – those with SIBO may not tolerate fermented foods
  • Decrease the need for Cortisol – aka decrease stress and inflammation
  • Follow Cortisol natural rhythm

– 6am – 6pm – activity and food
– 6pm – 6am – rest/sleep and fasting

  • Sleep from 10pm as often as possible
  • Decrease inflammation with Omega 3 fatty acids.
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Supplements that May Control and or Lower Blood Sugar


  • may help lower blood sugar by making your cells more responsive to insulin.


  • up to 3 grams of ginseng daily may help lower fasting blood sugar and blood sugar after meals.
  • NB! – ginseng may interact with warfarin and other drugs

Probiotics supplements

  • especially those containing more than one species of beneficial bacteria
  • may help lower fasting blood sugar and A1C.

Aloe Vera

  • capsules or juice made from aloe leaves may help lower fasting blood sugar and A1C in people with prediabetes or type 2 diabetes.
  • NB! – Aloe may interact with several medications, most notably digoxin.


  • made from the roots and stems of certain plants
  • may help lower fasting blood sugar and A1C by improving gut health and decreasing the absorption of glucose

Vitamin D

  • deficiency is common in people with type 2 diabetes.
  • supplementing with vitamin D may improve overall blood sugar control, as reflected by A1C


  • deficiency is common in people with type 2 diabetes.
  • studies suggest that magnesium supplements may help reduce your fasting blood sugar

Alpha-Lipoic Acid

  • may gradually help decrease fasting blood sugar and A1C, with greatest effects at daily doses up to 1,200 mg.
  • it also exhibits antioxidant effects that may reduce damage from high blood sugar.
  • NB! – it may interfere with some Thyroid medication


  • may improve insulin action in your body and lower blood sugar in people with type 2 diabetes
  • possibly those with type 1
  • but it won’t cure the disease

Diabetes Facts and Statistics

  • Also called Diabetes Mellitus a chronic medical condition in which glucose levels build up in the bloodstream.
  • So Diabetes is a blood glucose disease
  • Glucose is vital to your health it is used to make energy in every cell
  • The brain and red blood cells need glucose as they can’t burn fat to make energy
  • The type of Diabetes varies – see the article Types of Diabetes in the is blog, but the underlying cause is excess blood glucose – the question is why?
  • Muscle and fat cells need the hormone Insulin to get the glucose in and is used to produce energy ATP and or stored

Statistics from Diabetes.co.uk

– Since 1996, the number of people diagnosed with Diabetes in the UK has risen from 1.4 million to 3.5 million

– People likely to be living with undiagnosed diabetes in the UK is over 4 million

– Number estimated to rise to 5 million by 2025.

– Type 2 diabetes is now one of the world’s most common long term health conditions.

– It is estimated that worldwide 415 million people have diabetes ie.1 in 11 of adults.

– This figure is expected to rise to 642 million by 2040.

Type 2 Diabetes accounts for about 90% of all Diabetes cases

– Diabetes is currently the 5th most common cause of death in the world.

– Life expectancy for people with Type 1 Diabetes is more than 20 years

– Life expectancy for people with Type 2 it is up to 10 years

– 10% of the NHS yearly budget is contributed to the treatment of diabetes – 9 billion a year or £173 million a week. OMG

  • Having any form for diabetes will increase your risk and the outcome for COVID
  • Anyone at any age can develop Diabetes.

Types of Diabetes

Type 1 Diabetes

  • The Pancreas is unable to produce Insulin
  • So glucose remains in the blood

Type 2 Diabetes

  • Previously called Age Onset Diabetes as it was only seen in adults 50+
  • Cells are resistant to Insulin
  • So glucose remains in the blood

Type 3 Diabetes

  • Alzheimer’s and other types of Dementia are today considered as a blood sugar problem
  • Problems getting blood sugar into brains cells as we age
  • GLUT1 receptor may misfunction
  • So glucose remains in the blood

Gestational Diabetes

  • Occurs during pregnancy
  • Cells become more resistant to Insulin due to the increased production pregnancy hormones
  • So glucose remains in the blood
  • Will increase the risk of developing type 2 Diabetes later in life


  • Also called Insulin resistance is the precursor of type 2 diabetes.
  • Glucose is beginning to remain in the blood
  • Can be completely resolved if appropriate measures are taken to prevent progression.

Is it time to re-examine the current type 1 or type 2 diabetes diagnoses.

A large ground-breaking study finds there are actually five subgroups of Diabetes


Group 1: Severe Autoimmune Diabetes (SAID)

  • This type is what is currently classified as type 1 diabetes.
  • In people with this type of diabetes, the immune system produces antibodies that destroy beta cells (the cells that produce insulin).
  • This production is known as an autoimmune response.
  • The diabetes management plan for people with type 1 diabetes includes close monitoring of blood glucose levels and insulin replacement with daily injections or use of an insulin pump.

Group 2: Severe Insulin-Deficient Diabetes (SIDD)

  • People with this type of diabetes looked very similar to those with type 1
  • They were younger, not overweight and their bodies didn’t produce adequate insulin.
  • The difference was there weren’t antibodies present, which means their immune system wasn’t the underlying cause of their condition.
  • In people with SIDD, damage to insulin-producing cells caused their bodies to produce too little insulin.
  • This group had the highest risk of vision loss.
  • The diabetes management plan for people with this type of diabetes is similar to those with type 1, but they may also take oral medications.

Group 3: Severe Insulin-Resistant Diabetes (SIRD)

  • This type of diabetes was characterized by insulin resistance, which means their body doesn’t respond to its own insulin properly.
  • People with SIRD are generally overweight, which further contributes to insulin resistance.
  • The study found those with type 3 diabetes had a higher risk of kidney disease.
  • Researchers also found that of the five subgroups, the diabetes management plans for people with SIRD were the least effective.
  • That means these people stand to benefit the most from new diagnostics and more intensive treatment that may come from this research.

Group 4: Mild Obesity-Related Diabetes (MOD)

  • People with this milder form of diabetes are very overweight and have some insulin resistance.
  • Because the insulin resistance isn’t as severe as with SIRD, this milder form of diabetes is believed to be caused by obesity.

Group 5: Mild Age-Related Diabetes (MARD)

  • People with MARD were elderly and had a milder form of diabetes than those who developed it in middle age.
  • The study found this was the most common form of diabetes.

Diabetic Ketoacidosis / DKA

  • Ketones are energy molecules
  • In diabetics ketones develop when blood glucose levels are high
  • The opposite to the popular ketogenic diets where ketones develop when blood glucose is low
  • This is due to severe lack of insulin (Type 1) and or severe insulin resistance (Type 2)
  • This leads to low or no glucose getting into the cells to produce energy
  • So the body will use fat instead
  • As the brain can’t use fat it needs another fuel – ketones
  • The liver (and brain) converts fats to ketones
  • If left unchecked, ketones can build up and making your blood more acidic
  • DKA is a serious condition mostly affecting Type 1 Diabetics, occasionally Type 2.

Glucose and the Brain

  • The brain is dependent on glucose as its main fuel as it can’t burn fat
  • Plus it’s rich in nerve cells aka neurons makes it is the most energy-demanding organ, using 50% of all the sugar energy
  • Thinking, memory, and learning are closely linked to glucose levels and how efficiently the brain uses this fuel source.
  • Low glucose in the brain leads to low neurotransmitters, the brain’s chemical messengers leading to low communication between neurons and poor attention and cognitive function.
  • High glucose is increasingly being linked to brain-related health issues such as depression, learning disorders, memory problems and overeating
  • High blood glucose levels can affect:

– the brain’s functional connectivity, which links brain regions that share functional properties, and brain matter.

– can cause the brain to atrophy or shrink.

– can lead to small-vessel disease, which restricts blood flow in the brain, causing cognitive difficulties even the development of vascular dementia

– can affect self-control

– can affect mood, such as sadness and anxiety even depression

– can stimulate cravings for more

– glucose has drug-like effects in the reward centre of the brain and can produce addiction-like effects in the human brain, driving the loss of self-control, overeating, and subsequent weight gain.

– behavioural and neurobiochemical characteristics of substance abuse and overeating are quite similar

– The brain may recognizes sugar as a drug.

Getting Glucose into Brain Cells aka Neurons

  • The brain uses GLUT 1 transporters to get glucose in to the cells which aren’t Insulin dependent
  • Expression of GLUT1 in cell membranes are increased by reduced glucose levels and decreased by increased glucose levels.
  • Expression of GLUT1 is also affected by Estrogen (and Progesterone) which might explain the reduced ability for the brain to utilize glucose after menopause
  • While Insulin isn’t necessary for glucose uptake it has other roles in the brain:

– is thought to act a neuropeptide (brain hormone)

– plays key roles in neuroplasticity (networks), neuromodulation (alteration), and neurotrophism (growth)

– regulates feeding behaviour, such as inhibiting food intake and reducing body weight

– the deletion of insulin receptors from midbrain dopamine neurons increases appetite and body weight

– BUT – the removal of insulin receptors from adipose tissue produces the opposite effect – weight loss

– disrupted proper signalling of insulin in the brain induces many of the characteristic brain changes seen with Alzheimer’s disease, including confusion, disorientation and the inability to learn and remember

– overindulgence on sugar and grains overwhelms the brain due to consistent high levels of insulin

– eventually insulin, leptin and signalling become profoundly disrupted, leading to impairments in your memory and thinking abilities.

– the body’s response to the poor signalling is Type 2 Diabetes and obesity

– Type 2 diabetes is associated with a 60% increased risk of dementia in men and women

– even a mild elevation of blood sugar is also associated with an elevated risk for dementia

– ultimately anything that promotes insulin resistance will raise the risk of Alzheimer’s

  • Is there a difference between Glucose and Fructose?

– research suggest fructose increases the interest in food while glucose increases satiety

– BTW – fructose as HFCS in energy drinks, fruit juices, soda and sports drinks, as well as countless other sweetened beverages packs on abdominal fat faster than any other nutrient

– BTW – similar to alcohol.

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