Aging is inevitable (We hope!), which is great because it means we get wiser, right? While our minds and souls are enriched by the collective wisdom of the preceding years, what about our bodies?
As both men and women transition into the later decades of life there is a relative decline in sex hormones. In women, the decline of estrogen may be marked by hot flashes, urinary symptoms, vaginal dryness and emotional lability-so called menopause. In men, there is not a defined stage whereby a decline in testosterone causes symptoms. However, there is certainly talk about “andropause,” male menopause, which may be associated with a decline in libido/sexual function, muscle mass, and an increase in abdominal obesity.
Logically, if these hormones decline with age and produce symptoms that negatively affect quality of life then why don’t we just replace them? Well, just like any area in medicine we must weigh the risks and benefits of the treatment prior to initiation.
Ladies first: Estrogen can be replaced as a pill, patch, topical lotion, or vaginal preparation. Hormone replacement therapy for menopause is the most effective treatment for the symptoms that many women experience during menopause. Large studies have evaluated the safety of replacing estrogen and the results demonstrate that long-term estrogen therapy (>10 years) may increase the risk for heart disease and strokes. Therefore, the guidelines recommend that estrogen therapy should be given short-term (2-3 years) with the goal of tapering off once the symptoms have improved.
For the men out there: It seems that the advertising for testosterone replacement has boomed in the last several years! The majority of us have seen the commercials for “Low T.” Your testosterone level can be checked via an early morning blood test. If the level is low, then referral to an Endocrine specialist should be considered for further evaluation. If deemed appropriate the testosterone level can be increased via a daily topical solution (preferred since it is more physiologic) or as an injection every 1-2 weeks. As stated with estrogen replacement in women, the risks and benefits of treatment should be discussed. Testosterone therapy may increase the risk for prostate enlargement, an elevation in red blood cell count, and worsening of sleep apnea. We do not recommend testosterone replacement in men with normal testosterone levels.
If any of these symptoms are impacting your quality of life please talk with your physician about possible therapies.
May all your golden years be GOLDEN!