Man-Oh-Pause: When Things Are Not So Good Under The Hood

Blog #73     Andrew Siegel, M.D.


“T”  (an abbreviation for testosterone) has become a very commonly used and in vogue term. Many of my patients come into the office specifically asking for their T levels to be checked.  The pharmaceutical industry has been responsible for direct-to-consumer advertising of testosterone replacement products, a practice that has promoted this recent grass-roots awareness of testosterone issues, a subject that was previously the domain of urologists and endocrinologists.

T is that all-important male hormone that goes way beyond male sexuality.  Testosterone has moved to the endocrine vanguard and is now regarded as a key factor in men’s health. Current evidence suggests that a man’s testosterone level might serve a function as a good indicator/marker of general male health.

Aside for contributing to libido, masculinity and sexual function, T is responsible for the physical changes that commence at the time of puberty, including pubic, axillary and facial hair, deepening voice, prominent Adam’s apple and increased bone and muscle mass.  Additionally, T contributes to our mood, bone and muscle strength, red blood cell count, energy, and general mojo.  Most testosterone is manufactured in the testicles, although a small percentage is made by the adrenal glands.

There is a gradual decline in T that occurs with the aging process—approximately a 1% decline each year after age 30.  This will occur in most men, but will not always be symptomatic.  40% of American men aged 45 or older have low or low range T.  Low T is associated with metabolic syndrome and diabetes, bone mineral loss, and altered sexual function.  Specifically, symptoms of low T may include one or more of the following:  fatigue; irritability; depression; decreased libido; erectile dysfunction; impaired orgasmic function; decreased energy and sense of well-being; loss of muscle and bone mass; increased body fat; abnormal lipid profiles. Essentially, low T can accelerate the aging process.

Belly fat is literally the enemy of masculinity and a testosterone-choker that can push you in the direction of the female gender.  Perhaps when you are standing naked in the shower and you gaze down towards your feet, all you see is the protuberant roundness of your large midriff, obscuring the sight of your manhood.  Perhaps you’re wondering where your penis is hiding.  In most cases, the abundant pubic fat pad that occurs coincident with weight gain obscures the penis—the “turtle effect.”  If your belly blocks your view of your penis, your pubic fat pad makes your penis difficult to locate, your breasts have filled out, and your libido and erections are sub-par, it may just really be time to rethink your lifestyle habits!

Abdominal obesity—an accumulation of fat in our midsections—not only is unattractive from a cosmetic standpoint, but can have dire metabolic consequences that can affect the quality and quantity of our lives. Obesity has a pivotal role in the process leading to low T and waist circumference is a reasonable proxy for low T. Fat is not just fat—it is a metabolically active endocrine organ that does way more than just protrude from our abdomens.  Fat has an abundance of the hormone aromatase, which functions to convert T to the female sex hormone estrogen (E).  The consequence of too much conversion of T to E is the potential for gynecomastia, aka man boobs.  Too much E slows T production, and with less T, more abdominal obesity occurs and even more E is made, a vicious cycle (literally a vicious circus) of male castration and emasculation.

Obesity can steal away your masculinity, male athletic form and body composition, mojo, strength, and also one of your most precious resources—the ability to obtain and maintain a good quality erection.  Remember the days when you could achieve a majestic, heaven-pointing erection simply by seeing an attractive woman or thinking some vague sexual thought?  Chances were that you were young, physically active, and had a svelte build with a hard abdomen. If those days are mere memories, it is probable that you are now carrying extra pounds, have a soft and protuberant belly, and are not physically active.  When you’re soft in the middle, the consequence is that you will probably be soft down below. The good news is that by losing the abdominal fat, the unfortunate consequences of low T can often be reversed.

How To Turn On Your Testosterone Boosters: 

  • A healthy lifestyle, including good eating habits, maintaining a healthy weight, engaging in exercise, obtaining adequate sleep, moderation with respect to alcohol intake, avoiding tobacco, and stress reduction are the initial approaches to treating low T engendered by abdominal obesity.  Insufficient sleep can lower T.  Excessive alcohol increases the conversion of T to E.  Maintaining an active sex life can help maintain T.
  • It is of paramount importance to lose the abdominal fat, with the caveat that a sufficient caloric intake of quality food and nutrients is necessary to prevent the body going into “starvation mode,” which can substantially decrease T production.
  • In terms of exercise, a healthy balance of aerobic, resistance, and core training is best, but in particular, vigorous resistance exercise is crucial.  This will help the flabby abdomen disappear and build lean muscle mass, which in turn will increase metabolic rate.

If lifestyle modification fails to improve the symptoms of low T and T remains measurably low via a simple blood test, a trial of T replacement under the supervision of your doctor can provide a meaningful improvement of your quality of life.

Andrew Siegel, M.D.

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food

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