Transcript MANAGING HORMONAL CHANGES IN MEN AND WOMEN …

MANAGING HORMONAL CHANGES IN
MEN AND WOMEN WITH AGING
DR MMA N. EWUZIE - WOKOCHA,mni
CHIEF CONSULTANT
OBSTETRICIAN/GYNECOLOGIST
NATIONAL HOSPITAL ABUJA
NATIONAL PRESIDENT
MEDICAL WOMEN;S ASSOCIATION
OF
NIGERIA
introduction
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A large and rapidly growing body of
scientific evidence demonstrates that
a number of hormones decline with
aging,
These declines can result in many of
the manifestations of aging.
The first to be recognized, of course,
is the precipitous decline in estrogen
and progesterone production in
women called 'menopause .'
introduction
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Hormonal decline may be the
most important major contributor
to aging.
For men - it is so gradual that men
often reach their mid-forties or fifties
without noticing the negative
changes that have taken place in
their body.
For women - hormonal changes can
begin as early as the mid to late
thirties.
introduction
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This is most likely because of the signaling of
ovarian failure by the absence of menstruation,
infertility, and relatively acute symptoms such as hot
flushes for the woman.
The other hormones that are well-documented to
decline are testosterone in men (and, interestingly,
women ), growth hormone , and the adrenal
hormone DHEA
Decline in these hormones starts much earlier and
is more gradual;
However, because of the analogy with
menopause, the terms andropause, somatopause,
and adrenopause have been adopted.
AGING CHANGES
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The hypothalamus is located in the brain.
It produces hormones that control the other structures in
the endocrine system.
The amount of these regulating hormones stays about
the same, but the response by the endocrine organs can
change as we age.
For example, a hormone called TRH makes the pituitary
gland produce thyrotropin, or thyroid stimulating
hormone (TSH).
In women, the amount of TSH produced does not
decrease with time, but it does in men.
The pituitary gland is also located in the brain. This gland
reaches its maximum size in middle age and then
gradually becomes smaller.
AGING CHANGES
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The pituitary gland has two parts:
The back (posterior) portion stores hormones produced in the
hypothalamus.
The front (anterior) portion produces hormones that affect the
thyroid gland (TSH), adrenal cortex, ovaries, testes, and breasts.
The thyroid gland is located in the neck and produces hormones
that help control metabolism.
With aging, the thyroid often becomes lumpy (nodular).
Metabolism gradually declines, beginning around age 20.
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Less thyroid hormone may be produced, but there is also less body
mass (because of loss of muscle and bone tissue).
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This means that thyroid function tests usually show results within the
normal range.
AGING CHANGES
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The parathyroids are four tiny glands
located around the thyroid.
Parathyroid hormone affects calcium and
phosphate levels.
This, in turn, affects the strength of the
bones. Changes in the level of parathyroid
hormones may contribute to osteoporosis.
Insulin is produced by the pancreas. A
molecule of insulin fits into a place on the
cell wall called an insulin receptor site. It
acts like a lock and key to help sugar
(glucose) go from the blood to the inside of
cells, where it can be used for energy.
AGING CHANGES
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The normal or average fasting glucose
level rises 6 to 14 mg/dL (milligrams per
deciliter) for each 10 years after age 50.
This is because the cells become less
sensitive to the effects of insulin, probably
because of a loss in the number of insulin
receptor sites in the cell wall.
Because of these changes, some doctors
recommend that older people periodically
have blood drawn to check glucose levels
and make sure they aren't in the early
stages of diabetes (high blood sugar).
EFFECT OF CHANGES
Overall, some hormones are
decreased, some unchanged, and
some increased with age.
Hormones that are usually decreased
include:
 Aldosterone
 Calcitonin
 Growth hormone
 Renin
 In women, estrogen and prolactin
levels usually decrease.
EFFECT OF CHANGES
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Hormones that remain unchanged or
only slightly decreased include:
Cortisol
Epinephrine
Insulin
Parathyroid hormone
Thyroid hormones T3 and T4
25-hydroxyvitamin D
Testosterone levels usually
decrease slightly as men age.
EFFECT OF CHANGES
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Hormones that may increase
include:
Follicle-stimulating hormone
(FSH)
Luteinizing hormone (LH)
Norepinephrine
Female reproductive
anatomy
Menopause
Menopause
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Menopause is the transition in a woman's life when
the ovaries stop releasing eggs, menstrual activity
decreases and eventually ceases, and the body
decreases the production of the female hormones
estrogen and progesterone.
Women aren't the only ones who go through a
hormonal shift as they age.
Very real and profound changes in the male body
can result in symptoms such as depression,
moodiness, apathy, hot flashes, metabolic
syndrome, and erectile dysfunction.
Often ignored by conventional physicians, male
hormone levels are easy to test and treat.
Symptoms of Menopause
Variables Affecting Female
Sexual Function
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Sexuality for women extends far
beyond the release of
neurotransmitters, the influence of
sex hormones, and vasocongestion
of the genitals.
A number of psychological and
sociological variables may affect
female sexual function, as may the
aging process, menopause, the
presence of diseases,
Psychological Factors Affecting
Female Sexual Function
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Relationship with sexual partner
Past negative sexual experiences or sexual
abuse
Low sexual self-image
Poor body image
Lack of feeling of safety
Negative emotions associated with arousal
Stress
Fatigue
Depression or anxiety disorders and the use of
certain medications
Effects of Aging on Female
Sexual Response
TABLE 3. Effects of Aging on Female Sexual Function3,12,13
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Decreased muscle tension
May increase time from arousal to orgasm, lessen intensity of
orgasm, and lead to a more rapid resolution
Distention of the urinary meatus
Lack of breast-size increase with stimulation Clitoral shrinkage,
decrease in perfusion, diminished engorgement, and delay in clitoral
reaction time
Decreased vascularization and delayed or absent vaginal
lubrication
Decreased vaginal elasticity
Decreased congestion in outer third of vagina
Fewer, occasionally painful, uterine contractions with orgasm
Genital atrophy Thinning of vaginal mucosa
Increase in vaginal pH
Decreased sex drive, erotic response, tactile sensation, capacity for
orgasm
Effects of Aging on Female
Sexual Response
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A number of changes that occur with aging
have effects on sexual response (see
Table 3).
Despite these changes, most current
studies do not show an appreciable rise in
sexual problems as women age.1,2,5,11
For instance, baseline data from the Study
of Women’s Health Across the Nation
(SWAN) suggest that sexual function and
practices remain unchanged for
premenopausal and perimenopausal
women.
Effects of Aging on Female Sexual
Response
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Although early perimenopausal women reported more
frequent dyspareunia than did premenopausal women,
there were no differences between the two groups in
regard to sexual desire, satisfaction, arousal, physical
pleasure, or the importance of sex.
Seventy-seven percent of the women said that sex was
moderately to extremely important to them, although 42
percent reported a desire for sex infrequently (0–2 times
per month), prompting the authors to note that a “lack of
frequent desire does not appear to preclude emotional
satisfaction and physical pleasure with relationships.”
John Bancroft, lead author of the 1999–2000 national
survey of 987 women that found emotional well-being
and the quality of a relationship with a partner had more
of an effect on sexuality than aging, suggests that aging
affects genital response more in men than women, and
sexual interest more in women than men.1
Effects of Peri/Menopause on Female
Sexual Response
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TABLE 4. Possible Changes in
Sexual Function at Menopause
Decline in desire
Diminished sexual response
Vaginal dryness and dyspareunia
Decreased sexual activity
Dysfunctional male partner
Medical Conditions That
Can Affect Female Sexuality
TABLE 5.
 Neurologic Disorders
 Vascular Disorders, eg
Hypertension
 Endocrine Disorders, eg Diabetes
 Debilitating Diseases, eg-Cancer
etc
 Voiding Disorders- stress
incontinence
Medications that cause
orgasmic disorders
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As you age and your metabolism
slows down, the amount of fat in
your body slowly increases.
Women experience an even greater
fat percentage increase than men
do.
Then after menopause, your body
fat distribution tends to shift — less
in your arms, legs and hips, and
more in your abdomen.
The midsection matters
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Gaining weight in your abdomen does more harm than
simply making your waistband too tight.
While putting on weight in general can have negative
effects on your health, abdominal weight gain is
particularly unhealthy.
Too much belly fat increases your risk of:
Heart disease
Breast cancer
Diabetes
Metabolic syndrome
Gallbladder problems
High blood pressure
Colorectal cancer
The midsection matters
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Researchers also have found that abdominal fat
cells aren't just dormant energy waiting to be
burned up.
The cells are active, producing hormones and
other substances that can affect your health.
For example, some fat-cell-produced hormones
can promote insulin resistance, a precursor to
type 2 diabetes; others can produce estrogen
after menopause, which may increase your
breast cancer risk.
Researchers are still sorting out how the excess
hormones affect overall health, but they do know
that too much visceral fat can disrupt the body's
normal hormonal balance.
The midsection matters
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Belly fat
Fight back the bulge
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Belly fat
exercises
Fight back the bulge
Since visceral fat is buried deep in your abdomen, it may seem like
a difficult target for spot reduction.
 As it turns out, visceral fat responds well to a regular exercise
routine and a healthy diet.
 Targeted tummy exercises can help to firm the abdominal muscles
and flatten the belly.
Exercise.
 Daily, moderate-intensity exercise is the best way to lose belly fat —
when you lose weight and tone your muscles, your belly fat begins
shrinking, too.
 In fact, you may notice that your tummy bulge is the first area to
shrink when you start exercising.
 The amount and type of exercise you should get varies depending
on your current activity level and your health goals.
 Talk to your doctor about the right exercise program to promote
good health and specifically combat abdominal fat.
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Fight back the bulge
Strength training.
 Some research has shown that exercising with
weights is effective in trimming tummy fat. Talk to
your doctor about how to incorporate strength
training in your exercise routine.
Healthy diet.
 Changing unhealthy eating habits can help fight
belly fat. Replace saturated fats with
polyunsaturated fats.
 Increase portions of complex carbohydrates such as
fruits and vegetables, and reduce simple
carbohydrates like white bread and refined pasta.
 If you need to lose weight, reduce your portion sizes
and daily calorie intake.
Fight back the bulge
Tone your tummy.
 While you can't "spot-burn" belly fat, you can firm up your abdominal
muscles and get a flatter belly.
 Traditional sit-ups aren't the most effective way to firm your tummy,
however.
 Instead, use these exercises to target both deeper and lower
abdominal muscles:
Deeper abdominal muscles.
 Target deeper abdominal muscles by doing "abdominal hollowing"
or "drawing in the bellybutton." First, get down on all fours. Let your
tummy hang down as you take a deep breath. Let your breath out,
and at the end of your exhalation, gently draw your bellybutton
inward and upward toward your spine. You should feel a slight
tightening around your waist — think of it as trying to squeeze
through a partially closed door. Hold for 10 seconds, then rest for 10
seconds. Work up to 10 repetitions.
 During each effort, your spine position shouldn't change and you
should breathe freely.
 Eventually, you'll be able to do this exercise standing up. It's so
subtle, no one should be able to tell you're doing it.
Fight back the bulge
Lower abdominal muscles.
 Tone your lower abdomen by doing pelvic tilts and pelvic
lifts.
 To do a pelvic tilt, lie on your back on the floor with your
knees bent.
 Flatten your back against the floor by tightening your
abdominal muscles and bending your pelvis up slightly.
Hold for five to 10 seconds.
 Repeat five times and work up to 10 to 20 repetitions.
 For pelvic lifts, lie on your back with your knees bent up
toward your chest and your arms relaxed by your sides.
 Tighten your lower abdomen and lift your buttocks up off
the floor, with your knees aimed toward the ceiling. Hold
for five to 10 seconds.
 Repeat five times and work up to 10 to 20 repetitions.
Male Menopause/Andropause
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Do aging males undergo a menopause like
women?
Yes, and not surprisingly men are not spared from a
“menopause”.
The andropause or the “male menopause” is the time
in a man’s life when the hormones naturally decline.
It is also a time where there is a change of life that
may be expressed in terms of a career change,
divorce, or reordering of life.
This event brings about psychological changes as well.
Like menopause, the andropause usually occurs from
fifty years onwards.
Some have questioned whether the male menopause
is more myth than reality.
Male
Menopause/Andropause
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there is an undeniable hormonal
decline as one age, and this in turn
accelerates the aging process.
The decline in hormones for men is
more gradual unlike in women’s
menopause, which is a more abrupt
event.
The andropause is sometimes
termed medically as the A.D.A.M.,
an acronym for Androgen Decline in
Aging Males
Male Menopause/Andropause
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Men can suffer from symptoms of the andropause,
and they may be similar to that of menopause.
Between the ages of 50 to 70, some men report
symptoms such as erectile dysfunction (failure to
achieve an erection), general tiredness, mood
changes, night sweats and sometimes palpitations.
My research reveals that most men attribute erectile
dysfunction to be the most significant event of the
andropause.
Apart from erectile dysfunction, mood changes can
take place too. Some have complained of
nervousness, irritability and even depression.
Male
Menopause/Andropause
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Some of the physical and
accompanying psychological
changes may be treated with
counseling as well as with
certain hormones.
Treatment for impotence or
erectile dysfunction and mood
changes is easily available
today
Symptoms of Andropause
Coping mechanism
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The andropause brings about physical and
psychological changes.
As the older male ages and undergoes the
andropause, he has to grapple with profound
changes and issues.
These changes bring about stress, and if stress
is not managed well, it can be very disabling
and even lead to depression:
Coping mechanism
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1. Learn to love and reward yourself
and others:
Much satisfaction can be obtained
from not only receiving but also
giving.
We cannot bring our earthly wealth
to the afterworld, and we should
learn to reward not only ourselves
but also those around us.
There comes a point in life where
leaving legacies behind become
important
Coping mechanism
2. Take control and organize yourself.
 Discipline is important even in the later part of life.
 In particular, learn not to abuse alcohol and quit
smoking.
 Time management is crucial as well. It is important for
instance, to prepare our wills, estate management and
advance directives and that is part of organizing
ourselves.
3. Exercise yourself.
 A combination of cardiovascular and muscle
conditioning will help delay aging processes.
Coping mechanism
4. Relax and Rest yourself.
 The body is changing with aging and there are
physiological changes occurring and that he and you
should be mindful of that.
5. Feed yourselves- not quantitatively but qualitatively! It is
important to eat the right kinds of food to adjust for
physiological aging changes.
6. Enjoy Aging and the Andropause.
 Some things are inevitable, no matter what we do!
 It is important to be satisfied.
 Most of us will have to pass through this journey so let
us make the best of it.
 May we make this journey of profound change one also
of positive evolvement, and a time of rich blessings for
ourselves as well as those around us, as we age
graciously through the andropause!
Conclusion
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Effectively supporting individuals who are undergoing
andropause or menopause requires sustaining healthy
hormone levels.
At the same time, men and women entering either of
these life phases should strive to prevent excess
detrimental metabolites—in particular estrogens in both
sexes and detrimental testosterone forms in men—in
order to achieve healthy aging and maximal quality of
life.
Gratitude is a way to remain positive, not dwelling on
the pains and loss of old age.
Gratitude means each day is a gift, life in its entirety is a
gift, and whatever comes our way we are given the
strength and grace to manage.
Conclusion
“If [you‟re] happy in what [you‟re]
doing it‟s easier to grow old
gracefully.
 Don‟t let life overtake you.
 It‟s in a sense planning for old age,
planning to live your life and to know
that it‟s going to work along this way.
You are going to get old.
No one is immortal.
 You can‟t begin this in your old age.”
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