Andropause, also known as male climacteric or testosterone deficiency syndrome, is a term that refers to collection of signs and symptoms in men commonly associated with the aging process. Beginning mostly sometime during or after middle-age, these can include one or more of the following:

Sexual dysfunction
Lower lean muscle mass to fat ratio
Erectile dysfunction
Physical decline or frailty
Low libido 
Cognitive impairment
Loss of muscle mass and function
Loss of body hair
Decreased bone density

It should be quickly noted that my wife is certain that the last few of these are increasingly apparent in my case. It should also be noted that these signs and symptoms are speculated to be due to declining androgen levels associated with aging and that some medical authorities do not recognize andropause as a distinct clinical phenomenon separate from the normal aging process.

Nonetheless, men have certainly been made more aware of this condition in recent years, mostly due to the marketing of products claiming to restore our youthful vigor. As we shall see, the typical pattern of decline in male strength and prowess was documented by ancient Chinese medical scholar-practitioners at least as early as the 1st century C.E. Moreover, determining and slowing the causes of testosterone decline in men is as important from a Chinese Medicine perspective as restoring or adding to it.

What Is Testosterone and What Does It Do?

Testosterone is a steroid hormone produced by both males and females. In men testosterone is produced in the testes; in women it is generated in the ovaries, with lesser amounts generated from the adrenals. The functions of testosterone are mainly to facilitate muscle development and maintenance of bone (i.e. strength), libido, and fertility (i.e. sperm production). From a TCM perspective, then, testosterone is yang in nature.

What Are Symptoms of Low Testosterone?

In men, low testosterone (i.e., “low T”) may lead to decreased libido, erectile dysfunction, fertility issues, fatigue, hair loss, decreased muscle mass and/or bone density, anxiety, insomnia and other issues. Women with low T may lead to menopausal type symptoms such as hot flashes, insomnia, osteoporosis, decreased muscle strength, irritability, anxiety and low libido.

What Are the Western Biomedical Causes of Low Testosterone?

Causes of low T can vary widely which is why proper diagnosis and treatment are key, particularly if TCM is part of the treatment regimen. This is because low T exemplifies the need to look at each individual as a unique case with a variety of resultant treatment options. But anything that injures the testes or ovaries (e.g. trauma, cancer treatments (chemo, radiation), the mumps virus in men, genetic causes and/or removal of the ovaries in women - among other causes including cancers in certain areas of the brain, obesity, HIV/AIDS, the use of steroids, etc. Certain high blood pressure medications or SSRI medications for the treatment of depression/anxiety may depress testosterone levels.

What Are Contributing Lifestyle Factors From a Chinese Medicine Perspective?

To the list of biomedical causes for low T, traditional Chinese medicine (TCM) would add certain excesses such as physical or emotional work to exhaustion or excessive sexual activity (the latter particularly as one ages).
  • Stress.  Stress, particularly chronic, long-term stress, can impact testosterone levels. Stress can also be a byproduct of sexual issues, fertility problems, fatigue and psychological issues which may arise creating a cycle of contributing factors.

  • Sleep (or lack of).  Regular, deep sleep is important to testosterone levels. When this does not happen our bodies deplete their reserve of Kidney essence; they draw down their balance.

  • Alcohol consumption. While some is probably not detrimental a regular habit of consumption will decrease levels primarily by converting testosterone to estradiol.
  • Chemical exposure. Xenoestrogens are chemical endocrine disruptors associated with everyday exposure to industrial chemicals such as petrochemicals, pesticides, pharmaceuticals, dairy products, meats, canned foods (bisphenol-A / BPA that lines metal food cans), personal care products and plastics.

  • Age.  Not much to be done about this one, per se, but testosterone levels will generally decrease by 1 percent every year after age 45 or so.

  • Diabetes (perhaps caused by poor diet and lack of physical movement).

  • Degree of regular physical exercise. Too little (leading to the metabolic syndrome or diabetes mentioned above) may depress testosterone levels. Too much excessive physical activity may tax the body and deplete testosterone levels. Exercise helps to lower estrogen levels and enhance testosterone levels. Inactivity contributes to up to 5 percent loss of muscle mass per decade.

  • Sexual activity. Again, balance is the key here. The Huang Di Nei Jing (The Yellow Emperor’s Classic of Internal Medicine, the foundational classic text of TCM from the 1st century CE) detailed a precise schedule regarding seminal emission among men, with fewer longer periods between instances as one ages.

The TCM Pathomechanisms Involved in Low Testosterone

Chapter 1 of the Su Wen (Plain Questions), the first section of the Huang Di Nei Jing, clearly associates testosterone levels with the Kidney function in traditional Chinese medicine (here capitalized to distinguish the TCM function from the biomedical /anatomical organ). This section of the Nei Jing demonstates that the main issue in the aging of men is decline of Kidney essential qi, including Kidney yang, yin, and Kidney essence. However, since the TCM Kidney and Liver share the same source, there will also be Liver involvement. Here we can see the role of sleep in as much yang becomes yin at night (yang returns to the Liver as Liver blood to be replenished).

The Su Wen also notes that “[In] the fortieth year, yin qi is naturally [depleted] by half, [being] debilitated by living.” So testosterone declines simply as part of the normal aging process. And although there are various causes and pattern varieties of Kidney vacuity it is Kidney vacuity nonetheless.

TCM offers Safe and Effective Treatment Options for Low T

  TCM can be a useful part of an overall treatment plan for low T. There are three things to keep in mind:
  1. Treatment will likely include both acupuncture and Chinese herbal medicine. Chinese dietary therapy and/or movement prescriptions may be advised as well, depending on the individual case.

  2. The patient must commit to a prudent life-style. This is always sound advice, particularly as we age. It is particularly important in the treatment of low T.

  3. Treatment must be based on an accurate TCM pattern diagnosis. This is because signs and symptoms vary among patients and, in TCM, are specific to different patterns. Different acupuncture point combinations and Chinese herbal medicine formulas are pertinent to different patterns. These patterns generally include:

Kidney yin vacuity
Kidney essence decline and vacuity
Debility of Kidney yang
Heart - Spleen dual vacuity
Kidney yang and yin dual vacuity
Binding depression of Liver qi

Respect the Aging Process and the Delicate Balance of Kidney Qi

Today men are bombarded by advertisements to regain their lost youth. While it is tempting to attempt a return to our youthful vigor (yes, that’s right; you may no longer be a babe magnet), being too aggressive can have consequences. Among younger men, over consumption of Kidney yang supplementing medicinal can lead to anxiety, palpitations, acne, headache, constipation or other heat-type signs and symptoms. Among middle aged or older men, excessive consumption of yang supplementing medicinals may cause a brief period of well-being only to be followed by a “crash” as we push the aging body beyond its natural capacity and deplete it even further.

So follow the recommended self-care steps of regular moderately-vigorous exercise, stress management, prudent diet, and proper rest. Accept that your body has and continues to change constantly and that aging is simply a part of that ongoing process. Follow the recommended schedule of physical examination for a man of your age. If you suspect that you suffer from low testosterone check with your physician. A physician can order a blood test for total testosterone to show both bound and unbound forms. Older men can show a normal level of total testosterone but have a low level of free testosterone.

Remember that traditional Chinese medicine offers several safe and effective treatment options for low T.

Click here to read an article about yang supplements, one category of herbal medicinals used to treat low testosterone.

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