As a man ages and testosterone levels begin to decline, symptoms of dementia can become evident. Short term memory loss can be a forerunner for a myriad of other symptoms which culminate in dementia, both Alzheimer’s and non-Alzheimer’s. Men with dementia have a higher mortality rate than women and low bio-available testosterone has been shown to be a powerful predictor of memory loss in males.
Depression is also linked to a decrease in testosterone in males and testosterone replacement therapy has been shown to help. Depression in older males can cause weight loss, but more importantly it is a predictor of poor outcome after an acute myocardial infarction. Eve though depression is more common in women than in men, men have a higher risk of suicide.
Another silent problem in the aging male is hypertension, specifically systolic hypertension. Common cause of this can be sleep apnea. Hypertension increases nor-adrenalin and cortisol levels which in turn drive up blood pressure further.
BPH or benign enlargement of the prostate is a common problem with aging males which can lead to night time urination and sleep disturbances. Treating men with testosterone replacement helps to improve the symptoms of obstruction.
Let us address osteoporosis. Bone loss occurs in men just like in women but usually manifests itself ten years later. Males above the age of sixty should all be evaluated for osteoporosis with a DEXA scan as the disease is under diagnosed and under treated in males. Vitamin D levels also tend to be lower in older males compounding the problem. Hip fractures are associated with low testosterone levels and testosterone replacement will increase bone mineral density at the hip in older men. Testosterone replacement also increases muscle mass which helps to potentially decrease the risk of falling and possible fracture. As a matter of fact, studies do show that older men with low testosterone and low bone mineral density should be on testosterone replacement therapy.
Finally, Testosterone therapy has been shown to help with decreased libido. Erectile dysfunction is common in older males and the most common cause of this dysfunction is vascular disease. Therefore men who have impotence need to also be evaluated for atherosclerosis. Low testosterone levels have been shown to be associated with erectile dysfunction and decreased semen production. Testosterone is needed for the production of nitric oxide syntheses, which produces nitric oxide, a major vasodilator which helps with erections. Phosphodiesterase inhibitors such as Viagra and Cialis do not produce adequate erections when testosterone levels are low.
In summary, the issues faced by the aging male are mostly metabolic and for the most part preventable. Attention to exercise, nutrition and possible hormone replacement are the mainstays of therapy to promote male health and prevent illness. Please give yourself permission to be well and stay healthy. Prioritize the gift of health. It really will make you better with age- better to yourself, your partner, your children and your friends. Adhering to a few guidelines can bring you to the top of your game and keep you there!