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Male Menopause: Fact or Fiction
Jan 03, 2025
As a family physician and wellness advocate, I often encounter questions about whether “male menopause” is a real phenomenon. While aging related hormone changes in men are a reality, they differ significantly from the changes women experience during menopause. Let’s unpack the facts, debunk myths, and explore the signs, symptoms, and treatment options for age related hormonal changes in men.
Hormonal Changes: A Natural Part of Aging
Hormonal changes are inevitable as we age, but they manifest differently in men and women. Women experience a sharp decline in reproductive hormones over a short period, which results in drastic symptoms for many women. Men, on the other hand, experience a gradual decline in testosterone and other hormones over many years, even decades. This process is often referred to as late onset hypogonadism or age-related low testosterone, rather than "male menopause." Because testosterone is referred to as an androgen, another common term for the decrease in male reproductive hormones is “andropause.”
Understanding Low Testosterone Levels
On average, a man’s testosterone levels decrease by about 1% per year starting around age 40. Despite this decline, most older men maintain testosterone levels within the normal range, with only an estimated 10% to 25% experiencing levels that are considered low. Low testosterone often goes unnoticed because symptoms can be subtle or overlap with other symptoms that are considered normal signs of aging. A blood test is required to confirm low testosterone, but these tests aren’t routinely performed unless specific symptoms are present.
Some signs and symptoms that might indicate low testosterone include:
● Reduced sexual desire and activity
● Erectile dysfunction or decreased spontaneous erections
● Breast tenderness or swelling
● Infertility
● Loss of height, fractures, or low bone density
● Hot flashes or sweating episodes (yes men can experience hot flashes)
Other potential indicators include fatigue, low motivation, depression, poor concentration, increased sleepiness, disturbed sleep, mild anemia, reduced muscle mass and strength, and increased body fat.
Diagnosing Low Testosterone
Testing for low testosterone is recommended only for men displaying relevant signs or symptoms. However in my practice I follow testosterone levels, measuring every few years so that trends can be monitered. If a blood test indicates low levels, the test should be repeated to confirm the results. Additional evaluation of the pituitary gland is often necessary to identify underlying causes and rule out other hormone deficiencies, such as thyroid hormones.
Treatment Options for Low Testosterone
Recommendations for testosterone therapy vary among medical organizations:
● American College of Physicians (ACP): In 2020, the ACP suggested considering testosterone therapy for men with sexual dysfunction seeking improved sexual function, after discussing the risks and benefits.
● Endocrine Society: In 2018, it recommended testosterone therapy for men with confirmed low testosterone levels who also exhibit associated symptoms. Some experts advocate offering testosterone therapy even in the absence of symptoms, though this remains controversial.
Types of Testosterone Therapy:
Testosterone can be administered in several ways, including injections, patches, gels, or pellets implanted under the skin. Your physician will discuss the best method for you, set target hormone levels, and establish a follow-up plan.
Risks and Considerations
While testosterone therapy can alleviate symptoms for some men, it is not without risks. Potential complications include:
● Stimulation of abnormal prostate or breast cell growth
● Increased risk of exacerbation of cardiovascular disease, or blood clots
● Worsening of certain conditions such as obstructive sleep apnea or heart failure
Testosterone therapy is generally not recommended for men prioritizing fertility in the near future or those with a history of breast or prostate cancer, severe untreated sleep apnea, thrombophilia, or recent cardiovascular events.
Final Thoughts
If you suspect low testosterone, it’s important to consult your physician. Together, you can evaluate your symptoms, discuss testing, and discuss the benefits versus risk of treatment. Understanding age related hormonal changes in men can help you make informed decisions about your health and well-being.
References
1. American College of Physicians. (2020). Guidelines on testosterone therapy for age-related low testosterone. Annals of Internal Medicine.
2. Endocrine Society. (2018). Clinical Practice Guideline: Testosterone Therapy in Men with Hypogonadism. Journal of Clinical Endocrinology & Metabolism.
3. Snyder, P. J. (2020). Approach to older men with low testosterone. UpToDate.
4. Nieschlag, E., Behre, H. M. (2012). Testosterone therapy in the aging male. Best Practice ; Research Clinical Endocrinology; Metabolism.
5. Bhasin, S.,; Coviello, A. (2018). Testosterone in older men: To treat or not to treat? New England Journal of Medicine.
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Are Neurodevelopmental conditions actually on the rise?
Nov 29, 2024
In recent decades, there has been a striking increase in diagnoses of neurodevelopmental conditions like autism, attention deficit disorder (ADD), and attention deficit hyperactivity disorder (ADHD). We see more organizations to address these issues. We heard about it more in the news. People have theories about this being caused by the things we eat or, on the other side, that we are better at diagnosing diseases. This surge has sparked debates and curiosity: Are these conditions becoming more common, or is our understanding of the brain simply evolving? The answer, as it turns out, is a mix of both.
The Numbers at a Glance
- Autism diagnoses in the United States have increased from 1 in 150 children in 2000 to 1 in 36 in 2023, according to the CDC.
- ADHD diagnoses among children rose from 6.1% in 1997 to 10.2% in 2016, per the National Survey of Children's Health.
- Similar trends have been observed for other conditions like ADD, dyslexia, and even sensory processing disorders.
This rise may seem alarming, but it's essential to examine the factors driving these numbers.
Why the Rise?
1. Improved Awareness and Diagnostic Tools
One of the most significant reasons for the increase is better awareness and understanding of neurodivergence. Decades ago, many children with autism or ADHD were often misdiagnosed with unrelated conditions, labeled as "difficult," or overlooked entirely.
Today, improved diagnostic tools, broader diagnostic criteria (e.g., the DSM-5's reclassification of autism spectrum disorder), and more accessible mental health services have led to earlier and more accurate identification of neurodevelopmental conditions.
2. Shifting Stigmas
Cultural shifts have reduced the stigma around neurodivergence, encouraging families to seek evaluations and support for their children. This is especially true in schools, where accommodations and Individualized Education Plans (IEPs) have become more common.
3. Environmental Factors
Some researchers suggest that environmental influences may play a role. These include:
- Parental age: Studies have shown that older parental age at conception is associated with a higher likelihood of neurodevelopmental conditions in offspring.
- Prenatal and perinatal factors: Issues such as maternal stress, exposure to toxins, or preterm birth may influence brain development.
- Urbanization and lifestyle changes: Urban environments and modern stressors have been associated with higher rates of conditions like ADHD.
4. Genetic Research
The rise in neurodevelopmental conditions may also be tied to the expanding field of genetics. Many of these conditions have a heritable component, and advanced genetic testing can now identify predispositions that may have gone unnoticed in the past.
5. Broadening Definitions
The way we define neurodivergence has evolved significantly. For example:
- Autism is now recognized as a spectrum, encompassing a wide range of traits, from nonverbal individuals to highly verbal, highly functional adults.
- ADHD is understood to manifest differently across genders, with inattentive forms often missed in girls in earlier studies.
These broader definitions mean that more people meet the criteria for diagnosis than in the past.
Is It Truly an Increase?
Despite rising numbers, some experts argue that the actual prevalence of neurodevelopmental conditions may not have changed significantly. Instead, the "increase" reflects improvements in identification, shifting societal attitudes, and access to healthcare.
However, others contend that changes in environmental factors and modern lifestyles could be contributing to a genuine rise. For instance, the increased exposure to technology and decreased outdoor playtime have raised questions about their long-term impact on cognitive and social development.
Implications and Opportunities
The increase in neurodivergence diagnoses has both challenges and benefits:
- Education and Policy: Schools and workplaces are now more focused on inclusion, with accommodations like sensory-friendly environments and flexible workspaces.
- Research and Resources: The rise has spurred funding for research into the causes, treatment options, and support systems for neurodiverse individuals.
- Cultural Change: The shift toward acceptance and celebration of neurodiversity has given rise to movements like the Neurodiversity Paradigm, which emphasizes the strengths and unique perspectives of neurodiverse individuals.
While the rise in neurodevelopmental diagnoses can be attributed to multiple factors, it ultimately reflects a growing understanding of the human brain's complexity. As science continues to unravel the mysteries of neurodivergence, society has an opportunity to embrace these differences—not as deficits, but as essential parts of human diversity.
Citations
- Centers for Disease Control and Prevention (CDC). (2023). "Data and Statistics on Autism Spectrum Disorder."
- Faraone, S. V., et al. (2021). "The Worldwide Prevalence of ADHD: A Systematic Review and Metaregression Analysis." Psychological Medicine.
- Sandin, S., et al. (2014). "The Familial Risk of Autism." JAMA.
- Volk, H. E., et al. (2013). "Environmental Factors in Autism Spectrum Disorders." Current Environmental Health Reports.
- American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).
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What is Movember?
Nov 17, 2024
Every November we hear about "Movember." So, what is it? Movember, a time dedicated to raising awareness about the unique health challenges men face. While men tend to be less likely to visit doctors regularly or discuss their health concerns openly, they are also more vulnerable to certain health conditions than women. This discrepancy in health outcomes is not just due to genetics; behavioral factors, societal norms, and access to healthcare play significant roles in why men are more likely to suffer from chronic illnesses and preventable diseases. Understanding these factors and making proactive changes can help improve men’s health outcomes.
Why Are Men More Likely to Get Sick?
- Higher Risk of Chronic Diseases Men are more likely to develop certain chronic conditions, such as heart disease, high blood pressure, type 2 diabetes, and cancer. In fact, heart disease is the leading cause of death for men in the U.S., responsible for nearly one in four deaths. Men are also at a higher risk for conditions like prostate cancer, lung cancer, and liver disease【1】.Several factors contribute to this increased risk, including biological differences in how men and women process fat, hormones, and stress. For instance, testosterone in men has been linked to higher cholesterol levels, which increase the risk of heart disease【2】.
- Poor Health Habits Men are more likely to engage in unhealthy behaviors such as smoking, excessive alcohol consumption, poor diet, and lack of physical activity. According to the Centers for Disease Control and Prevention (CDC), men are more likely to drink alcohol in excess and smoke cigarettes compared to women, both of which contribute to a higher risk of conditions like lung cancer, cardiovascular disease, and liver damage【3】.Additionally, men are less likely to engage in preventative care practices such as regular physical exams, screenings, and vaccinations. Studies show that men are significantly less likely to visit a healthcare provider for routine check-ups, which can result in delayed diagnosis and treatment of conditions like high blood pressure and diabetes【4】.
- Mental Health Stigma Mental health is another area where men are more likely to struggle in silence. Societal norms often discourage men from expressing vulnerability or seeking help for emotional distress. As a result, men are more likely to experience mental health issues like depression, anxiety, and substance abuse without seeking the necessary help. Suicide rates are higher in men, with men accounting for about 75% of all suicide deaths in the U.S【5】. The stigma surrounding mental health in men has contributed to these outcomes, preventing many from getting the support they need.
- Genetics and Biology Biological factors also contribute to differences in health outcomes between men and women. For instance, men are more prone to certain types of cancers, such as prostate cancer and testicular cancer. Genetics can also play a role in male-specific conditions like male pattern baldness and erectile dysfunction, which can affect overall well-being and quality of life【6】.
What Can Men Do to Improve Their Health?
Despite these challenges, men’s health can significantly improve with proactive care and lifestyle changes. Here are some ways men can take charge of their health:
- Regular Check-ups and Screenings Men should prioritize regular visits to their healthcare provider for annual physical exams, screenings for heart disease, diabetes, and cancer, and vaccinations. Early detection of conditions like prostate cancer, high blood pressure, and diabetes can save lives. For example, the American Cancer Society recommends that men aged 50 and older discuss the need for prostate cancer screening with their doctors【7】.
- Healthy Diet and Exercise Eating a balanced diet and staying physically active are key components of a healthy lifestyle. Regular exercise can reduce the risk of heart disease, type 2 diabetes, and obesity, while a diet rich in fruits, vegetables, and lean proteins supports overall health. The CDC recommends that men aim for at least 150 minutes of moderate-intensity exercise per week【8】.
- Mental Health Awareness Men need to prioritize their mental health by seeking support when needed. Breaking the stigma around mental health issues is crucial. Men should feel encouraged to reach out to therapists, counselors, or support groups when experiencing stress, depression, or anxiety. Understanding that emotional well-being is just as important as physical health is a key step in improving men’s overall health outcomes.
- Quit Smoking and Limit Alcohol Reducing smoking and limiting alcohol consumption can have a profound impact on men’s health. Quitting smoking is one of the most effective ways to reduce the risk of lung cancer and cardiovascular disease. Moderating alcohol intake can also help prevent liver disease and improve overall physical and mental health【9】.
- Sleep and Stress Management Sleep is often overlooked, but it plays a critical role in overall health. Men should aim for 7-9 hours of sleep per night to support immune function, cognitive health, and emotional well-being. Managing stress through relaxation techniques such as mindfulness, meditation, or deep breathing exercises can also be helpful.
A Call to Action for Men’s Health
Movember serves as a reminder that men face unique health challenges that require attention and action. By acknowledging the factors that contribute to men’s higher risk for illness, we can start a conversation about prevention and treatment. Regular health check-ups, lifestyle changes, and addressing mental health concerns are key steps toward improving men’s health outcomes.
References
- Centers for Disease Control and Prevention (CDC). (2022). Heart Disease in Men. Retrieved from cdc.gov.
- National Institutes of Health (NIH). (2020). Testosterone and Cardiovascular Health. Retrieved from nih.gov.
- CDC. (2021). Men's Health: Risk Factors and Prevention. Retrieved from cdc.gov.
- National Institutes of Health (NIH). (2021). Men's Health: Why They Don’t Seek Medical Care. Retrieved from nih.gov.
- American Foundation for Suicide Prevention. (2023). Suicide Statistics. Retrieved from afsp.org.
- Mayo Clinic. (2022). Men's Health: Common Conditions and Treatments. Retrieved from mayoclinic.org.
- American Cancer Society. (2023). Prostate Cancer Screening Recommendations. Retrieved from cancer.org.
- Centers for Disease Control and Prevention (CDC). (2021). Physical Activity for a Healthy Lifestyle. Retrieved from cdc.gov.
- National Institute on Alcohol Abuse and Alcoholism. (2020). Alcohol and Men's Health. Retrieved from niaaa.nih.gov.
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Advancements and Hope During National Alzheimer’s Awareness Month
Nov 17, 2024
German psychiatrist Dr. Alois Alzheimer discovered Alzheimer's disease in 1906. He had a patient named Auguste Deter who suffered from memory loss, paranoia, and other psychological changes. After Deter died, Alzheimer examined her brain and found abnormal deposits and shrinkage around nerve cells, which are now known as amyloid plaques and tau tangles. Every November, National Alzheimer’s Disease Awareness Month draws attention to a condition that affects millions of lives and families across the United States. Established in 1983 by President Ronald Reagan, this observance aims to increase awareness about Alzheimer’s disease, highlight advancements in research, and inspire hope for a future free from its devastating effects.
Understanding Alzheimer’s Disease
Alzheimer’s disease is the most common cause of dementia, accounting for 60-80% of cases worldwide. It is a progressive neurological disorder that impairs memory, thinking, and behavior, ultimately making it difficult for individuals to carry out daily activities. Today, over 6.7 million Americans aged 65 and older live with Alzheimer’s, a number projected to nearly double by 2050 without medical breakthroughs 【1】【2】.
The disease also places a significant burden on caregivers and the healthcare system, with Alzheimer’s care costs reaching an estimated $345 billion in 2023 in the U.S. alone 【1】.
Advancements in Alzheimer’s Research
Recent years have brought promising developments in Alzheimer’s research, offering hope to millions of patients and families:
- New Treatment Approvals
In 2021, the FDA approved Aducanumab (Aduhelm), the first drug targeting amyloid plaques—a hallmark of Alzheimer’s disease—in nearly two decades. This was followed by the approval of Lecanemab (Leqembi) in 2023, another amyloid-targeting therapy that has shown promise in slowing cognitive decline in early-stage Alzheimer’s patients 【3】【4】. - Breakthroughs in Biomarkers
Advances in diagnostic tools, such as amyloid PET scans and blood tests for beta-amyloid and tau proteins, allow for earlier and more accurate detection of Alzheimer’s. Early diagnosis is crucial for treatment effectiveness and planning 【5】. - Lifestyle and Risk Reduction Studies
Research suggests that lifestyle modifications, including regular physical activity, a heart-healthy diet, cognitive training, and social engagement, may reduce the risk of developing Alzheimer’s. Studies like the U.S. POINTER trial are currently investigating these interventions further 【6】. - The Role of Genetics
Progress in genetic research, particularly the identification of risk genes like APOE-e4, has deepened our understanding of Alzheimer’s mechanisms and paved the way for targeted therapies 【7】. - The Promise of Precision Medicine
Precision medicine approaches, which tailor treatments based on a person’s genetic makeup and disease stage, are emerging as a powerful tool in Alzheimer’s research. Personalized interventions could transform the way the disease is treated 【8】.
Hopes for the Future
As research continues to gain momentum, several developments inspire hope for an Alzheimer’s-free future:
- Disease-Modifying Treatments: Researchers aim to develop drugs that not only slow disease progression but also repair damage caused by Alzheimer’s.
- Preventative Strategies: With a deeper understanding of lifestyle and genetic risk factors, prevention strategies may soon become as common as treatments.
- Global Collaboration: International initiatives like the World Dementia Council and funding from organizations such as the Alzheimer’s Association have fostered collaboration and increased resources for research.
- Brain Health Equity: Efforts to address disparities in Alzheimer’s research and care, particularly in underserved communities, are gaining traction. Inclusive studies will ensure that advancements benefit all populations 【9】.
Raising Awareness and Supporting Families
National Alzheimer’s Disease Awareness Month also emphasizes the importance of supporting families and caregivers, who often bear the emotional and physical challenges of the disease. Resources like the Alzheimer’s Association’s 24/7 Helpline (800-272-3900) and local support groups offer vital assistance to those affected.
What Can You Do?
- Get Informed: Understanding the symptoms, risk factors, and resources for Alzheimer’s is a crucial first step.
- Advocate: Support policies and funding for Alzheimer’s research and caregiving services.
- Participate: Consider joining clinical trials or supporting research organizations to help advance scientific discoveries.
- Care for Caregivers: Recognize and support the caregivers in your life—they are the unsung heroes in the fight against Alzheimer’s.
Alzheimer's discovery was a major breakthrough in understanding neurodegenerative disorders. He set a new standard for relating symptoms to physical brain changes by establishing close relationships with his patients and using new scientific tools. While Alzheimer’s disease remains a formidable challenge, advancements in research and care provide renewed hope for patients and families. This November, let us not only raise awareness about the disease but also commit to supporting those affected and championing the quest for a cure.
Together, we can move closer to a world where Alzheimer’s is a memory of the past.
References
- Alzheimer’s Association. (2023). 2023 Alzheimer’s Disease Facts and Figures. Retrieved from alz.org.
- CDC. (2023). Healthy Aging: Alzheimer’s Disease. Retrieved from cdc.gov.
- FDA. (2021). FDA Approves Aducanumab for Alzheimer’s Disease. Retrieved from fda.gov.
- Alzheimer’s Association. (2023). Lecanemab Approval News. Retrieved from alz.org.
- NIH. Advancements in Alzheimer’s Biomarkers. Retrieved from nih.gov.
- U.S. POINTER. Study on Lifestyle Interventions. Retrieved from alzheimers.gov.
- Genetics Home Reference. APOE Gene and Alzheimer’s Disease. Retrieved from ghr.nlm.nih.gov.
- Mayo Clinic. Precision Medicine in Alzheimer’s Care. Retrieved from mayoclinic.org.
- World Dementia Council. Equity in Alzheimer’s Research. Retrieved from worlddementiacouncil.org.
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Why November is Crucial for Diabetes Awareness and Action
Nov 17, 2024
Diabetes awareness month falls at a very apropos time. We are getting into the holiday season when we eat candy, cookies, and tons of food. According to the CDC there are 38.4 million Americans with diabetes (that's 11% of the population). 23% of those people are undiagnosed. Even worse, the CDC has said that the rate of diagnosis has increased at an alarming rate in the United States. Every November, American Diabetes Month takes center stage as a nationwide effort to increase awareness about diabetes—a chronic disease impacting millions of Americans. Sponsored by organizations such as the American Diabetes Association (ADA) and supported by public health campaigns, this observance focuses on prevention, early detection, and supporting those living with diabetes.
The Two Different Diabetes Types
Diabetes is a group of diseases that affect how the body processes blood glucose (sugar), with two main types:
- Type 1 Diabetes is an autoimmune condition where the body attacks insulin-producing cells in the pancreas, usually developing in childhood or early adulthood.
- Type 2 Diabetes is a condition in which the body becomes resistant to insulin or does not produce enough, commonly linked to lifestyle factors.
【1】【2】.
Why Awareness Matters
American Diabetes Month plays a critical role in:
- Highlighting Prevention and Education:
Many Type 2 diabetes cases are preventable with lifestyle changes such as healthy eating, regular exercise, and weight management. Programs like the CDC’s National Diabetes Prevention Program have shown that lifestyle changes can reduce the risk of developing Type 2 diabetes by as much as 58% 【2】. - Reducing Health Disparities:
Diabetes disproportionately affects certain populations, including African Americans, Hispanics, Native Americans, and Pacific Islanders. These groups are more likely to develop diabetes and experience complications such as kidney disease, vision loss, and heart disease 【3】. Awareness campaigns during November aim to reduce these inequities by promoting accessible care and culturally tailored interventions. - Encouraging Early Detection:
Early diagnosis of diabetes and prediabetes can prevent or delay complications. Blood sugar screenings and increased public awareness of symptoms—such as frequent urination, extreme thirst, and fatigue—are key components of the campaign 【4】. - Showcasing Advances in Research and Technology:
The month also highlights ongoing advancements in diabetes treatment, such as continuous glucose monitoring systems and artificial pancreas devices. Research into potential cures continues to offer hope for millions 【1】【5】.
Each year, the ADA spearheads awareness efforts under a unifying theme. Recent campaigns like “This Is Diabetes” have featured personal stories to shed light on the real-life challenges and triumphs of managing diabetes. Social media hashtags, including #DiabetesAwarenessMonth, further amplify the message and engage a broader audience.
How can you help? Individuals, organizations, and communities can support American Diabetes Month in various ways:
- Schedule a Screening: Routine blood glucose tests can detect diabetes or prediabetes early.
- Educate Others: Share information about risk factors, such as obesity, family history, and age.
- Get Active: Physical activity is a cornerstone of diabetes prevention and management.
- Support Research and Advocacy: Donations to diabetes organizations help fund research and advocacy efforts aimed at improving care and affordability.
With diabetes on the rise globally, American Diabetes Month provides a crucial opportunity to confront the disease head-on. Through education, advocacy, and community engagement, we can reduce its prevalence, improve the quality of life for those affected, and support groundbreaking research.
To learn more, visit the American Diabetes Association (ADA) at diabetes.org or the CDC's diabetes resources at cdc.gov/diabetes.
References
- CDC. (2023). National Diabetes Statistics Report. Retrieved from cdc.gov.
- American Diabetes Association. (2023). Prevention. Retrieved from diabetes.org.
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Health Disparities and Diabetes. Retrieved from niddk.nih.gov.
- Mayo Clinic. Diabetes: Symptoms and Causes. Retrieved from mayoclinic.org.
- JDRF. Advances in Diabetes Research. Retrieved from jdrf.org.
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