Andropause Protocol 

Treating Androgen Deficiency in Men – Age Related and Premature Andropause by Joseph J. Collins, RN, ND
The physical symptoms associated with low testosterone levels and low testosterone function include; decline in sexual activity, poor or no erections, loss of muscle mass and strength, increased risk of cardiovascular disease, chest pain, insulin resistance (with increased risk of diabetes), loss of bone mass that can lead to osteoporosis, fatigue and loss of energy, reduction in body hair and skin thickness, development of hair in ears and nose, increase in upper and central body fat, increase in heart and artery disease, problems with circulation and sleep disturbances.

The mental and emotional symptoms associated with low testosterone levels and low testosterone function include decreased intellectual ability, trouble with memory, decreased interest in sex, difficulty focusing attention, depression, anxiety, agitation, irritability and a decreased sense of well-being.

Determination of andropause is made through analysis of symptoms and lab tests. For more information on andropause and premature andropause, see the article about Andropause.

Andropause Protocol
The growing interest in restoring testosterone function has resulted in many men going directly to Testosterone Replacement Therapy (TRT) before they even give the body a chance to restore its own natural production of testosterone. While TRT is an effective way to raise testosterone quickly, it does have its drawback and side effects. One major drawback is that going directly to TRT without working on foundational support of health may result in “feeling better” for a few months, but the benefits start to fade as time goes on.

Patients who go to TRT to quickly feel great for a few months – or longer – but the effect fades in time. Those men find themselves going from prescriber to prescriber – hoping that the next one that writes the TRT prescription will get “the right dosage”. Treating andropause requires more than a prescription for testosterone. The body has to be prepared to respond appropriately to the TRT.

One common side effect is that the testosterone given to men for TRT is converted to estrogens. When estrogen levels are elevated, men will not feel the benefits of TRT even if their testosterone levels are high. Noting that the aromatase enzyme converts testosterone and other androgens into estrogens we can use EstroQuench™ to naturally prevent testosterone from being converted to estrogens. Men who have excess body weight are more likely to convert testosterone and other androgens into estrogens. Even men with normal weight can create too much estrogen due to age, or genetics, stress, or medications. So, EstroQuench™ is a very important formulation for men on TRT.

Treating Andropause
The process of treating andropause begins with lifestyle and dietary choices that include good nutritional supplementation. Then, Hormone Specific™ Formulations can be used to improve the natural production function of testosterone. If other conditions need to be addressed, such as thyroid health and blood sugar health, then Hormone Specific™ Formulations for those conditions can be used as well. If needed basic hormone supplements such as DHEA and pregnenolone can be used. TRT is used as the las resort. If TRT is required, it will be more effective – and stay effective if the foundations for good hormone health have been established.

Foundations of Hormone Health
Foundations of Hormone Health include (1) lifestyle and dietary choices that support optimal hormone function, (2) Endocrine Complete™ (a high grade multiple-nutrient/herbal formulations), (3) essential fatty acids rich in docosahexaenoic acid and eicosapentaenoic acid, and (4) a high grade multiple species probiotic to support optimal health of digestive system and immune system. To more detail about the foundations of hormone health, please see the Hormone Health Guidelines series of articles.

Primary Hormone Health Formulations
The Hormone Specific Formulation most important for men experiencing Andropause is TestoGain. The specific herbs in TestoGain™ have been shown to increase testosterone production. Herbs in the formulation have documented anabolic properties, which help testosterone to maintain muscle mass and strength, and help maintain lower body fat percentage. Similarly, herbs in TestoGain™ have been shown to increase libido and sexual function. TestoGain™ also improves brain, mood and memory function due to its effect on testosterone production and function.

But if a man is also experiencing a significant amount of stress – or an inability to handle the routine demands of life – then the support of the adrenal glands is critical. TestoGain is primarily a testosterone supporting formulation that also provides some support of the adrenal glands. AdrenoMend may be considered as a secondary formulation for andropause if more adrenal support is needed, as discussed below.

TestoGain, which improves testosterone function in men, has a significant effect on libido, including desire, arousal, response, orgasm & satiety, including herbals which increase nitric oxide synthase, interact directly with androgen receptors, and enhance dopamine and GABA function – all important for optimal sexual function.

Significant clinical improvement should occur within the first two months of using formulations when foundational therapies are used concurrently. Please review Customized Dosing Guidelines for the protocols on increasing dosages, weaning, and determining maintenance dosage. The Primary Hormone Health Formulations should be taken at least three months after symptoms are under control before attempting to wean down to maintenance dosage.

Secondary Hormone Health Formulations
The secondary hormone imbalances commonly seen in andropause include excessive estrogens, adrenal fatigue, decreased thyroid function, and insulin resistance. While mild cases of each of these imbalanced may be improved by increasing the function of testosterone, additional support may be required in many cases. TestoGain is compatible with each of these formulations, and they can all be used together if need be. Please review  Customized Dosing Guidelines to learn the best way to wean off of secondary formulations once you make progress in these additional hormone imbalances.

Estrogen excess is more likely to be present in men as they age or if they have gained more than 20 pounds of excess body fat. Liver disease is also associated with increased estrogen production in men. Estrogen levels may also be increased due to the side effects of some prescription drugs, as well as some over-the-counter medication. One of the best ways to decrease the conversion of testosterone and other androgens into estrogens is to use EstroQuench™.

EstroQuench™ is a Hormone Specific™ Formulation that was created to decrease the activity of aromatase – the enzyme that converts testosterone and other androgens into estrogens. Taking EstroQuench™ will both preserve testosterone levels by decreasing its conversion to estrogens, and improve testosterone function by keeping estrogens low, so the estrogen does not interfere with testosterone function.

DIM Enhanced is another formulation that helps control excessive estrogen through a different mechanism. It promotes detoxification and removal of excessive estrogens, especially decreasing the most toxic estrogen metabolites. However, it is important to note that DIM does not ahve teh aromatase inhibiting properties of the herbs used in EstroQuench™.

Adrenal fatigue is a common occurrence in men as they age and go through andropause. This is most likely due to the fact that the adrenal glands are trying to help the body recover from stress caused by the drop of testosterone. On the other hand, if adrenal fatigue is caused by excessive stress, then andropause will happen sooner.

AdrenoMend is the only adaptogen formulation designed to restore normal adrenal function and support the normal function of multiple homeostasis regulatory systems that become imbalanced with adrenal fatigue. This formulation was designed to synergistically increase the specific actions of AdrenoMend™ adaptogens.

Thyroid hypofunction occurs in men, though to a lesser extent than in women. None-the-less, when it does occur is can dramatically interfere with normal function of the testes – and bring andropause on sooner. Hypofunction of the thyroid also is more likely to cause weight gain and  insulin resistance. Low thyroid function is also associated with increased production of toxic estrogen metabolites and less of the non-toxic estrogen metabolites.

ThyroMend is a synergistic combination of iodine containing seaweeds, and herbs which contain phytothyroidogenic, phyto-thyroid-receptor agonists, and other herbs designed to promote optimal function of thyroid hormones by maintaining the health of thyroid hormone producing tissues and by supporting the healthy function of tissues that respond to thyroid hormones. This formulation supports the function of the thyroid gland and the liver (which converts T4 to T3) and also supports the function and response of tissues that respond to thyroid hormones. It should be used use if there are persistence signs and symptoms of decreased thyroid function. 

Insulin resistance is more likely to occur in men as their testosterone levels drop, as their estrogens increase, as they age, and as they gain weight. If increasing testosterone function with TestoGain™, and lowering estrogen with DIM, and increasing thyroid function with ThyroMend™ are unsuccessful in restoring healthy blood sugar function, then GlucoQuench is appropriate.

 GlucoQuench is a Hormone Specific™ Formulation formulated by Dr Joseph Collins, RN,ND containing botanical ingredients, adaptogens, and phytotherapeutic extracts to help maintain the Glucose-Insulin-System (GIS), promote healthy glucose metabolism, and support insulin function, which are all effective in lowering excessive blood sugar. Excessive body weight also increases the risk for decreased blood glucose function. This formulation is also designed to help with weight loss.

Hormone Supplements & Bioidentical Hormone Replacement Therapy
As a rule, hormone supplements such pregnenolone, DHEA and 7-KETO are more effective in improving the quality of life if the foundations of good hormone health have been established and the Hormone Specific™ Formulations have already been started. In fact, pregnenolone and DHEA may actually help the body increase its production of other hormone if they are taken after a foundation of good hormone health has been established. Similarly, if testosterone replacement therapy is required, the TRT is more effective if the previous steps are taken to optimize hormone health as much as possible. 

Hormone supplements such as pregnenolone, DHEA and 7-KETO may be used to support hormone production pathways that create testosterone. DHEA dosages for men may start at 50 mg to 100 mg each AM. It is very important that estrogen and testosterone levels both be monitored before and after starting DHEA, to make sure the estrogens do not become elevated.

While DHEA may help increase testosterone, it may also increase estrogens - especially in men with excessive body weight or liver disease. So, it is really a good idea to be on EstroQuench™ before starting DHEA, if you do not want the DHEA to be turned into estrogens. DHEA and pregnenolone are best started only after a foundation of good hormone health has been established and the Hormone Specific™ Formulations have already been started.

7-Keto (3-acetyl-7-oxo-dehydroepiandrosterone) dosage of 100 mg is commonly used. Again, even though they are commonly referred to as “hormone precursors”, these supplements (1) may or may not be converted to more potent hormones such as testosterone or estradiol, and (2) even if they are not converted, they still have actions of their own. Sometimes these supplements are used with BHRT to get better results. If hormone precursors are going to be used, please see the guidelines for Proper Use of Hormone Precursors.

Testosterone Replacement Therapy (TRT), may be indicated based on lab tests. If they are used, hormone levels should be monitored. Hormone Health Formulations and Foundations of Health should still be used with testosterone replacement therapies (TRT) to improve the function of the testosterone and the response of tissues to the prescribed testosterone. By using the formulations with TRT healthcare professionals prescribing the testosterone notice that they are able to prescribe lower dosages of testosterone, and men are having a much better response to the testosterone prescriptions with lower side effects.

Keep in mind, that if the dosage of testosterone has to be increased because the previous dosage no longer works, then the problem is probably due to androgen receptor resistance and or increased levels of estrogens. So increasing testosterone dosage may not be the answer - especially if the testosterone is being converted to estrogens. If the testosterone is being converted to estrogens, then adding more testosterone is dangerous. Always keep bioidentical hormone replacement therapy safety in mind.

It may also be a good idea to stay on TestoGain while taking testosterone therapy to prevent the atrophy of testes because TestoGain™ has some gonadotrophic properties, which help maintain testes size in men. This is important because testosterone replacement therapy does not fully support the hormone production pathways, but instead provides “replacement”, which may further diminish endogenous hormone production, (the hormones made in your own body). Hormone Health Formulations also maintain proper tissue response to the BHRT and decrease the development of hormone resistance.