Category Archives: menopause-andropause

Benign Prostate Hyperplasia (BPH)

Getting old is not for sissies. No matter how good a life style we live now we still “Have to pay the piper” for the many past years we had a different life style. Hopefully we have evolved to a better, healthier life style but certain things still happen to us as it will to any older engine. For men, it is Benign Prostate Hyperplasia; an enlargement of the prostate.

Normally the prostate is the size of a walnut. But as men age the prostate enlarges and causes uncomfortable problems which is designated as BPH (Benign Prostate Hyperplasia): the urgency to “pee”, especially nocturia (the individual has to wake at night more then once to void (i.e. to urinate). This can leave him tired in the AM and maybe throughout the day especially since for some it is difficult to fall asleep immediately again. Besides the urgency to urinate there is the dribbling. This can be embarrassing if it is in the underwear or even coming through certain colored pants like khaki. It can limit the male to activities where he would be away from a bathroom. There is the slowing down of the stream so that he ends standing over a urinal for excessive time, often when there is a line behind him.

All the latter is because as the prostate increases in size it pinches the flow of urine from the bladder to the penis and not only causes the slow flow and dribbling but also stops the bladder from emptying on the first try. The latter can be just from the pinching or causing a backflow of some of the urine as if it was making a “U” turn. This leaves excess urine in the bladder which needs emptying sometimes soon after the first try or at least in the near future. This partially empty bladder leads to the uncomfortable feeling of urgency. This leads to the stress of feeling old, unmanly, loss of confidence for going to places where you have to sit for long periods of time like out to dinner or a movies. It can also increase the occurrence of urinary tract infections since the urine left in the bladder can be like stagnant swamp water to breed unwanted bacteria. This is specially true if the male does not want to frequently interrupt a meeting often to excuse himself to urinate.

In previous blogs and in my book I write a lot about the advantages of testosterone and enumerate the laboratory tests a male should undergo to check his testosterone levels and the hormones that are also necessary to check at the same time. Dihydrotestosterone (DHT) is a very strong testosterone – like hormone that derives from testosterone. This is especially true with very high levels of testosterone and/or with aging. In many cases I do not at first check the DHT unless I feel there are signs or symptoms that require the test. One of these is signs and symptoms of BPH. This is because DHT is believed to be a main causal factor for the enlargement of the prostate. Baldness is also attributed to DHT along with other evolutionary and DNA factors This does not mean that a man on testosterone needs to stop the advantages of it. There are many natural and pharmaceutical ways to interfere with this conversion of testosterone to block higher levels of DHT. Since we know the enzyme 5-alph reductase is what converts testosterone to DHT we can block this process either naturally or with pharmaceuticals.  I do not like to give medical treatments without seeing and examining a client but typically one can try combinations of saw palmetto, zinc with copper, pumpkin seed, beta sterols (which are plant steroids without the negative side effects),pygeum and a few other herbs. A good supplement for BPH will have most in one capsule. Remember each person is an individual so one does not always get the results wanted by following the instructions on the bottle. I usually recommend a loading dose higher then the bottle states. I may maintain this dose according to the results and then tweak them or let the client do so.

I also refer those reading this to my other blogs on prostate and also on testosterone and especially for easy clarification and greaat information to my book; Emotional Vampires and Your Hormones: an holistic physician’s view of how stress affects your well-being and what you can do about it.


andropause IILike any other hormone deficiency (thyroid, insulin, estrogen-progesterone) deficient testosterone in men will interfere with a healthy and vigorous life. Natural, bio-identical testosterone is available but is often avoided because of misunderstandings and myths about the role of this vital hormone. Please see my other blog: Testosterone and anti-aging.

A lot of men do not realize why they are experiencing certain symptoms and signs as they age; why they seem to have gained weight even though they exercise, or why their breast are larger and flaccid.  Other symptoms can be depression, irritability, mood swings, loss of morning erections. erectile dysfunction, poor focus and concentration. loss of incentive both for work and for things that thy once enjoyed, loss of muscle tone and yes, some even experience night sweats. (See my blog on comparing menopause to andropause or my book: Emotional Vampires and Your Hormones: an holistic physician’s view of how stress affects your well-being and what you can do about it.

As men grow older we produce less testosterone. This actually begins to happen at the age of about 30-35, but in men it is a slow, subtle, process until about 50-60 years of age (unlike women who go through a more rapid menopause in 1-8 years).

Many people think of testosterone as a man’s hormone created to annoy women, but much academic work shows  the remarkable physiological role testosterone plays in our lives in both males and females. Obviously men have  much more testosterone then females. Because it is the main muscle and bone builder it is why men do not get osteoporosis until  much later than women – but we do get it. Evidence shows that there exists 3-4  times more testosterone receptors in the heart cells than in the gonads, showing that nature intends for testosterone to give the heart protection. Testosterone also helps to produce more nitric oxide, which, like synthetic nitroglycerin helps to expand the vessels and give better circulation.

There are also testosterone receptors in the brain. Using functional MRI (fMRI which shows what part of the brain is being used for a specific function) it has been shown that men (and women) with low testosterone levels were more ” foggy brained.” In fact, when the levels were real low the ability to fantasize was lost.  Other studies have shown that lower testosterone levels are a factor to increase the  likelihood of developing Alzheimer’s disease. A study of men with Alzheimer’s demonstrated that taking testosterone dramatically  slowed the progression of Alzheimer’s although it did not cure it. All these studies demonstrate that there are receptors for testosterone in the brain. (All these facts are documented as evidence based medicine in my book’s biography).

Studies have indicated that as much as 65%-70% of depression in men over 50 could be due to low testosterone levels, so there is often no need for antidepressants  and their possible side effects. I believe it is necessary to always check testosterone levels when a man has consistent depression.

Testing for testosterone is a simple blood test, but it’s important to get the right tests and interpret them properly.  One not only wants to know the total testosterone but also the amount getting into the cells (free testosterone).  Obviously if a hormone is not getting into the cells it is like not being there. Also, testosterone can bind to a protein called Sex Hormone Binding Protein (SHBG) ; so this test should be done if the physician believes this is one of the problems. If the testosterone levels seem good but the SHBG is high the testosterone is not going to perform its job since it is being tied – up.  A man’s estrogen level must be examined since testosterone can convert to estrogen  (aromatization)  through an enzyme called aromatase.  This enzyme is found in adipose tissue and as men get older they gain more fat (often because of the lack of testosterone). Also, other tests may be appropriate, but certainly a PSA (prostate specific antigen) is necessary. (See my blog or book on prostate evaluation).

Testosterone levels in the “low Normal” range can be misleading (400ng-1000ng).  For a real low level the physician may say they are in the norm. They may be normal for an eighty year old, but the signs and  symptoms presented by an eighty year old are not particularly desirable.

The belief that testosterone causes cancer is a myth and of the old school.  If it were true then men at twenty when testosterone levels are the highest would be more prone to prostate cancer or have signs of future development of the cancer.  It is now known that it is estrogen that contributes to prostate cancer (the same hormone that contributes to breast and uterine cancer in women) along with life style. This is  because inside the prostate is a vestige of the uterus called a utricle  that has estrogen receptors. To simplify, all fetuses begin as female but may change to male due to genetics but this vestige gets locked inside the prostate. If the utricle is constantly hit by estrogen excess cancer may occur. Statistically overweight men have a higher rate of prostate cancer, probably aromatization contributes to this.

There are several ways to take testosterone, one should always and only use bio-identical hormones. These are made by a compounding pharmacist (not a big chain pharmacy) and are made specifically for the individual since each person is different then another. The two ways I prefer are creams that are absorbed through the skin, and tiny pellets that are inserted into the buttocks and  last for about  5-6 months. I do not use  oral testosterone since the levels fluctuate too much and they can be harmful to the liver as can injectable testosterones. I must repeat her that I only believe in bio-identical hormones since this is what nature has put into our bodies.

So one does have to get older but one does not have to age. It is not only longevity but also quality of life.

I have written out all tests for both males and females that are necessary for hormone testing in the appendices of my book along with many other helpful charts pertaining to hormones. The book and charts will help you have intelligent discussions with your physician. Also this subject is expanded in layman’s terms for a more didactic but easily understood education.

Alan J. Sault MD, ABHM-Diplomat

Author: Emotional Vampires and Your Hormones: an holistic physician’s view of  how stress affects your well – being and what  you can do about it.



menopause compared to andropause (mens’ menopause

Symptoms of menopause compared to andropause (mens’ menopause)

Women                                                                                      Men

Anxiety                                                                                     Anxiety

Irritability                                                                                Irritability

Fatigue                                                                                    Fatigue

Loss of energy                                                                       Loss of energy

Poor concentration                                                              Poor concentration

Depression                                                                            Depression

Loss of muscle tone                                                             Loss of muscle tone

Decreased exercise tolerance                                            Decrease exercise tolerance                                                                                 tolerance

Prolonged recovery from exercise                                   Prolonged recovery  from exercise                                                                         from exercise

Little or no improvement with exercise                         Little or no improvement

Weight gain in spite of exercise                                      Weight gain in spite                                                                                       of exercise

Loss of memory                                                                 Loss of memory

Osteoporosis                                                                     Osteoporosis

Decreased                                                                          Decreased sexual  desire

Cardiac disease                                                                 Cardiac disease

Higher bad cholesterol                                                    Higher bad cholesterol

Hot flashes                                                                         Hot                                                                                     Some men get this

Night seats Night sweats                                                Some men get this

Prostate enlargement                                                     women don’t get this