Episode 61: Expat Health: The Overlooked Change: Male Hormones and Aging

Rachel: [00:00:00] Welcome back to Truly Expat Podcast. My name is Rachel and with me is Paula, where we dive into experiences, challenges, and well being of expats. Today we're diving into a topic that doesn't get talked about enough, men's hormones. From energy levels, mood swings, to sleep quality and overall health, hormones play a crucial role in Every stage of life.

Rachel: Returning with us is our favorite doctor, uh, Dr. Caroline Lowe, a family physician with special interest in hormone health and proactive aging for both men and women here in Singapore. Uh, to break down how hormonal changes affect men,, why testosterone levels fluctuate with age and what you can do to maintain the balance.

Rachel: So if you've ever wondered how stress, diet, or lifestyle choices impact your hormones and what it means for your well being, stay tuned. This conversation could be the key to feeling your best. Let's get started!

Caroline: [00:01:00] Today we are going to be talking about male menopause, andropause, late onset hypogonadism. Many words. Essentially, it just means that a man's hormones have started to drop. And the funny thing about endopause is, or male menopause, is that unlike a woman's menopause, where we know we are menopausal because everything happens in 12 to 18 months.

Caroline: And by the time we no longer menstruate after 365 days, on the 366th day, you are by definition menopause. A man, they don't menstruate, so they do not know when they are actually male menopausing. In fact, their hormones start to fall from the age of about 40 to 42. [00:02:00] And yeah, and it drops at 1 percent per year.

Caroline: Oh, wow. Yeah, so it's very insidious. It doesn't fall off the cliff. Unlike our hormones, it doesn't really fall off the cliff. It's so insidious that they don't realize, um, that it is definitely slowing down. Um, what do you call it? The, the, the gradient is very, very, very slow. And because of that, they don't understand what's actually happening to them.

Caroline: Unlike a woman. I mean, you think about it. From the first time you've had your period, you know everything about PMS. And before you know it, you see your mom undergoing menopause. You know everything about menopause. So when four women come together in our late 40s and early 50s, what do we talk about? We talk about hot flush.

Caroline: We talk about vaginitis. We talk about low sex libido. We know everything about there is to know about, um, menopause. For a [00:03:00] man, it's never discussed and there isn't an end point for them because they don't menstruate. So there isn't an end point. So, um, they will slowly but surely drop in their hormones and it may take up to 10 years before they realize what's happening.

Caroline: If you think about it, you get four guys coming together, I don't think they'd be complaining about hot flushing. And they do. They do. They do get hot flush because it has exactly the same reason why we get hot flush is to do with our luteinizing hormone that increases the vascularity and therefore increases the heat.

Caroline: We relieve the heat. So guys get hot flush too. Is that the only symptom that they get? It's not very common, but it does happen. Um, but the most common symptoms for them, and they may not realize it, is the motivation, the career drive, the weight gain and the inability to lose the fat, and mood swings. [00:04:00] Ah.

Caroline: Mood swings. You see, they understand when a woman undergoes mood swings because they've seen it. every cycle or somewhere. Um, but they don't understand it when they become, they get anxious, they get palpitation, they feel a sense of overwhelm and, uh, and poor sleep. They wake up in the middle of the night like us.

Caroline: Yeah, the symptoms are all the same and I think quite often for men we we put it down to oh They're just stressed at work. That's why they're waking up in the night or that's why they're mood swings or whatever, right? Correct, but it's very difficult for a man to tell his spouse or his partner that he is having mood swings and he's sensitive And, uh, and yes, it's very difficult for a man to do that when you, you get four guys coming together.

Caroline: What do they talk about? Talk about who's got bigger muscles. That's all they talk about, right? Talk about who's got a better sports car. Yeah. Yeah. And, and if all of this happened and if they don't understand [00:05:00] it's happening to them, they don't blame themselves. They blame everybody around them. Yeah. And it's not their fault.

Caroline: There's nothing. It's not their fault. It's all purely because. It's not known. 

Paula: There's 

Caroline: no education. They're not exposed to it. 

Rachel: And as you say, it's insidious and just creeps up on them. Yes. They just don't notice there's a difference in them. Suddenly it's like one day they're like, what? Yes. Correct. What is happening to me?

Rachel: Correct. 

Caroline: Correct. And, and when there is no education and when you have all the symptoms, they have nowhere to turn. Um, they panic. That's the way a man will behave. Um, they panic. And, uh, unfortunately, this is a time when it gets very, a man and a woman, when one is menopausing, one is andropausing, and if they don't come together and understand it's the hormones that's causing all these funny symptoms, it, it, it can cause domestic issues.[00:06:00]

Caroline: I've seen a lot. I've seen a lot. Um, a guy thinks that, oh, you know, perhaps it's The model of my spouse, which I need to upgrade and it is a reality in life. So it is important that a man needs to understand that all that he's undergoing, there's nothing wrong with that. It is very real. It is, it is a reality and there is no shame.

Caroline: And it is what it is. It's all to do with the hormones. So I guess when they say midlife crisis in men, that's what they're talking about. Exactly. Exactly. Exactly. Exactly, so you know what happens when they suffer a midlife crisis. We suffer menopausal, they suffer midlife crisis. Yeah, yeah, they go buy themselves a Lamborghini.

Caroline: No, they buy a new sports car, they buy, they go and join a Harley Davidson club and they, they, they change the model of their spouse. Yeah. And they go and they [00:07:00] exercise more. Yeah. Um, there's all those things. And is there anything else, like, are there any other symptoms that, that men No, the thing, the thing about andropause that every man needs to understand is not only the testosterone is falling, the estrogen is climbing.

Caroline: Ah, okay. That makes sense. So what they're suffering can be double whammy. Yeah. Yeah. Double whammy. So, uh, a 36 year old couple and a 56 year old couple, okay, I'm going to tell a little story. You see a couple in the shopping center, they're both 36 years old, you see a man, he's very likely half a, half a step in front of the lady, she's hanging on to him for dear life, and, and, and, you know, he, he's the man of man, and the woman is the woman of woman, and that's what we see.

Caroline: Yeah. And, um, what he wants to do is he wants to go and [00:08:00] hang out with these guys. And what the woman wants to do is, you know, very womanly and want to hang out and hanging on to, to, to the man's arm. You fast forward that 20 years down the line, and they're now both 56. The woman is now half a foot in front of the man.

Caroline: And it's a man hanging on to the woman. And this is a time when a woman goes, she's menopause. She's all done. And she goes, all I want to do is go traveling my girlfriends. Yeah. Or he's asking at this age, he's kept asking, what time are you coming home? And if you're half an hour late, he starts. Texting you, calling you.

Caroline: Why aren't you home yet? I don't want you home. That's so true. It is so true. 

Rachel: Uh, yeah. Women seem to be a lot more independent at this age and yeah, want to break free. I always thought it was because, um, you know perhaps they had, you know, [00:09:00] children and the children have left the madness so they're just like, oh now I can be myself but it's actually those hormone changes.

Rachel: Yes. It's the hormones, 

Caroline: the hormones. Um. Doing hormonal work is like doing detective work. I love my job. It really tells you how people are going to behave based on what the results show. And there's nothing wrong with that. Nothing wrong. The main thing for a patient to understand is once the results are out, they know that they are deficient in certain things or they've got excess in certain things.

Caroline: And that's why they're behaving the way they're behaving. So we just now take steps. To correct it. Yeah. That's all. And can men as well? Like, I know we have hormone replacement. Yeah. HRT. Yeah. So HRT just means hormonal replacement therapy. If you have got a hypothyroid, it's also hormonal replacement therapy.

Caroline: So hormonal replacement therapy can be any hormone, it's just replacing the hormones. Okay. So women, we [00:10:00] do female hormonal replacement therapy, a man is called testosterone replacement therapy. Okay. therapy, TRT. Ah, okay. But it's not so much just replacing the testosterone. Remember, the two things that's happening, the testosterone starts to fall 1 percent per year, and then obviously going the opposite is the estrogen starts to climb 1 percent a year.

Caroline: And as you get older, your testosterone falls, then the ability for you to get rid of the fat. reduce. So you get, you get fatter, faster. And in the presence of adipose tissue, the testosterone gets converted to estrogen at a faster rate. So that makes worse. So it's a vicious cycle. Yeah. Oh, wow. Yep. And then more estrogen you have, then you become, um, you know, emotional mood swings, sensitive.

Caroline: Obesity. Have you seen male [00:11:00] boobies? I call them the male boobies. Gynecomastia. Boobs. Boobs. There is nothing wrong having estrogen. We all need estrogen. We all need testosterone. Just that the ratio is different. Yeah. A man will have a lot of testosterone, but you need a little bit of estrogen. Because what does estrogen do for you?

Caroline: Increases longevity, multitasking, protects the bones, memory recall, empathy. What happens as you get older when testosterone falls and estrogen goes up? Mm. Increase in weight, mood swing, emotional, but the worst thing is it changes the DNA of your prostate, prostatic cells. It does not increase the size, but it changes the DNA, which means increases the risk for malignancy.

Caroline: Ah, is that why at a certain age they have to start getting tested? Correct. Makes sense. Correct. But there is a third hormone that [00:12:00] comes into play. When a man Andropauses so you have to remember testosterone sits on top and testosterone will either end up being estrogen, which is a feminine side, or it will end up being, uh, dihydrotestosterone, which is the masculine side.

Caroline: So, but you need all three like a trinity. You need all three for it to work. Just as the ratio changes as you get older. Now. I call estrogen the feminine side, as we spoke about. Testosterone is actually unisex for a man. It protects your sugar, protects your insulin, controls your cholesterol, makes you happy.

Caroline: Without testosterone, you go into depression. Protects your muscle and a sense of well being. But the masculine side of a man comes from this hormone [00:13:00] called dihydrotestosterone. . If a testosterone likes to become dihydrate testosterone, then what you have is it's very good for you because the the male sexuality increases.

Caroline: Male sexual fantasy, male aggression for career is, it's the one where you go out, kill the mammals and drag it home for the wife to cook. I call it, I call the dihydrotestosterone, the testosterone of testosterone, I call it the Neanderthal hormone. It's the basic maleness in you, that's the one. But too much what happens, you know, God is fair, nothing is ever good all the way.

Caroline: Yeah. When you have too much of that, you start to lose hair. Oh. Yes. You start to lose hair and increase premature increase in the prostate size, giving you peepee problem. Oh, okay. So remember, one is prostate cancer, one is size increase, but you need all three to make a man a man. Uh, the [00:14:00] balance at all. Yeah.

Caroline: Is that why so many men lose their hair? So a lot of it depends on the testosterone's ability to either convert to estrogen or dihydrotestosterone. Yeah. Yeah. When we're talking about endoplasm, everything starts to fall and the ratio changes. So the, unfortunately, when the testosterone falls, it becomes, it doesn't just fall, fall.

Caroline: It goes and becomes something else. So most of it, it becomes estrogen. Okay. When a man is younger, most of it becomes dihydrotestosterone. Ah, okay. Okay. And that, and that's when the, the whole female, no, I won't say female, but you know, the more sensitive side and all that sort of stuff happens. Yes. Male boobies, obesity.

Caroline: Yeah, all that nagging. Yeah. Ah, okay. Yep. And so does that, is that something that can be controlled? Yes. Yeah. Okay. Yes, it can certainly be [00:15:00] controlled and it's quite easily controlled because we can manipulate the we can manipulate the the risk of Testosterone becoming estrogen. It's called aromatization.

Caroline: We can control aromatization Do you see, do you see many clients? Like, does it, do you, I mean, And it's all the same, all the same numbers. As the older you get, the higher the estrogen becomes. And if a man comes in, that is. You know, um, that is class one, class two obesity without even doing the blood test.

Caroline: I can tell you, his estrogen, his estrogen will be high. Wow. Yeah. And, and, um, but the only thing a man cares about when he's andropausing is obviously erection, right? Okay. Erectile dysfunction. Yeah. So when we talk about erectile dysfunction, um, it is the, there are a couple of reasons why the [00:16:00] erection becomes less.

Caroline: Um, qualitatively working is because number one, the overall hormones have fallen. Uh, that's one reason. The other reason is as you get older, the vascular supply to the penis drops. The penis has no muscle. It's actually two very large columns of blood that needs to be filled. So when the penis is flaccid, the columns of blood is flat.

Caroline: So obviously with foreplay, the blood gets drained down to the penis, and then it fills up like a balloon. You know, have you seen the balloon that's filled up with air, it just stands up like that. Yeah. Yeah. As you get older, uh, with a risk of diabetes, cholesterol, and all the other vascular issue, then the amount of blood that will go to the vascular supply, the two tubes, obviously it's not going to be a hundred percent.[00:17:00]

Caroline: And that also 

Rachel: Sorry, can that also be something to do with heart health? 

Caroline: Yes, yes, everything. It's to do with vascular, vascular supply that goes everywhere. So heart is one of the organs, one of the end organs. Brain is another end organ. Kidneys, these are the three very important organs when we say vascular supply.

Caroline: But actually, you think about it, the penis is also another organ for vascular supply. And if it's not going to be 100 percent filled, then you're going to be not 100% Erected. Active. So that's, that's, that is what, you know, a man, when they come and see a doctor, that's the first thing they, they want. And all they ever ask for is, I want the blue pill.

Caroline: Yeah. Yeah. Is that, I mean, is that what people come? No, hold on. Let me rephrase. So is the reason that people come to you in the first place is because they have issues, not because they realize that there are a lot of patients that [00:18:00] come and see me because their wife sent them a lot of times in a very rarely, I get a man who knows exactly.

Caroline: What he wants that means he comes in he said I think I'm andropausing because my body fat has gone up my Determination has dropped a bit my stamina I can't play tennis as well as I could two years ago And I think I'm a little bit depressed very rarely a man comes in and tell me all of this So what we do is we have to drag it out of them and we have to tell them these are the symptoms That is indicating that your testosterone has fallen, but all they care about is the erection Yeah, right.

Caroline: So a man did the best way for me to ask a man whether you're andropausing is the first thing I ask is morning spontaneous morning erection If a man has forgotten when was his last spontaneous morning erection, then [00:19:00] we know the testosterone has fallen So let's use the last to go Okay, the last to go

Caroline: Taking a proper history is very important Yeah, and then doing the correct blood test at the correct time of the day is also very important. Ah, okay. Why, why is it a certain time of the day? Yeah, testosterone has seven peaks. Oh. The highest peak is first thing in the morning before nine o'clock. Ah, okay.

Caroline: So if you take your testosterone at four o'clock in the afternoon, it's going to look very low. It may not be that low. Yeah. 

Rachel: Okay. That's interesting. Yes. And so what, what kind of, with all these types of things, so if somebody's around 40 and they're starting to feel like this is happening, how can they support their hormone health?

Rachel: So 

Caroline: basically the first thing to do is [00:20:00] try to reduce testosterone becoming estrogen. That's culprit number one. Okay, so how do you reduce that? Some people genetically likes to convert testosterone to estrogen. That's called genetic aromatization. That one you may need help with some medication. But generally for most people is you have to trim your fat.

Caroline: So you have to be careful what you eat. You have to trim your fat and taking zinc, taking zinc can reduce aromatization. Oh, we can slow the aromatase down a little bit. Yeah. And that's why, you know, men with some kind of sexuality problem, um, his, his, uh, doctor may say, go and take zinc, but they don't really explain to you why you need to take zinc because it slows down the estrogen production and maintains the testosterone at a higher level.

Caroline: And therefore by default, we'll then swing to become dihydrotestone where the men's men. testosterone. Yes. [00:21:00]

Rachel: Okay. Yeah. 

Caroline: So that's the first thing. The second, the second thing to note is don't add more estrogen into your system more than necessary. And we're talking about tofu. Men who are vegetarian and they think tofu is the only protein they're going to get.

Caroline: Tofu is one of the nicest, highest phytoestrogen available. Great for women to have them, not good for men. I was gonna say that, so maybe I should be having more, um, tofu in my diet. So, but not great for men because it increases your total estrogen. Okay. And then of course, things like, uh, fatty food, uh, grain fat, beef, um, chicken that's injected with hormones because they tend to be the female hormones.

Caroline: So things like that, yep, plastic, plastic containers has a lot of what we call xenoestrogen. Xenoestrogen is [00:22:00] artificial estrogenic mimicking property. 

Rachel: Wow. Do you think that that could cause, because there is quite a high, in the world, there's quite a high, uh, amount of obesity. Do you think that comes from Oh yeah, contributory, plastic, 

Caroline: yes, contributory.

Caroline: You think about it, 1945, 1950, what do our parents eat? Everything organic. And they essentially eat one large meal a day. The rest of the time they eat half meals. And when you, when you bring, you know, when you bring food to your neighbor's house, you put them in glassware. Yeah. Now, and 70 years of plastic, plastic, everything.

Caroline: We are third generation plastic people. So does that mean I have to throw away all my tupperware? In theory, yes. Economically speaking, that's up to you, but in theory, in theory, yeah, yeah, [00:23:00] okay. I mean, I've heard about, um, plastic in terms of drinking water and stuff like that. Yes, yes. And that's why glass, you know, glassware is much better.

Paula: Thank you, buy your bottled water, buy them in glass, expensive. Yeah. That's also the other thing. That is what we like in a nice world and that's what we can afford in reality. Yeah, that's the problem. That's the problem. That's the problem.

Paula: Do you see, I mean, you see a lot of divorce rates skyrocket around the 50s, 60 year olds, you know, like, and you think, well, you've been married for that long.

Paula: Why would you divorce now? Is this some of the reason, do you think? 

Caroline: Yeah, it's definitely contributory. Definitely contributory. And you know, the world is going so fast. We don't have time to, to think about anything. In the seventies, when there was no such thing as a social [00:24:00] media or a mobile phone, when you leave work at five o'clock, you spend time with the family.

Caroline: Yeah. Yeah. And if you leave work on Friday, five o'clock, nothing gets done until Monday, eight o'clock in the morning. Yeah. Now, thank goodness, you know, a place like Australia said that after five o'clock, you're not allowed to actually. email your employees. 

Paula: Yeah, that's a new thing, right? They've just brought that in.

Caroline: Because even though you email and say, don't, don't need to reply. You think about it. It's already in the employee's brain. They can't get rid of it. And they thought, if I don't do it now, I'm going to do it tomorrow. I must do it now. That, I think that's a whole, that instant world, right? That's another hormone on its own.

Caroline: That's, that's adrenal fatigue. That's another, that's another chapter on its own. A lot of people are, are burnt out. They're burnt out. It's so true. It is so true because I was just listening to a podcast this morning And where they're talking about that our phone has taken over the world. Like yeah, you know, it's doesn't help a lot of [00:25:00] inflammation Yeah, well, there's enough going on in the world for us still So the the mood swings are they mainly just getting angry or they can be actually It takes in, it comes in different forms.

Caroline: Some people are actually actively depressed. Some people have anxiety, they can't sleep, they wake up with palpitation. Some people have a sense of overwhelm. And that's why, you know, they lose that, uh, that drive for the career drive. They get 25 emails, they sense of overwhelm, they start to panic. These are all very real.

Caroline: Not just happening to women, to men, except that women, we are a lot more vocal, we talk about it, we cry about it, we are allowed to because we're women in a way, which I think is not very fair because a man is kind of not allowed to, they have nowhere to go, they have [00:26:00] no outlet that they can actually discuss and that's why I always tell a woman and a man, I say you must understand both your hormones, a spouse's hormones, And therefore that way, if you both have the knowledge for it, you both can help each other.

Caroline: Yeah. I think because when I speak to people about it, they're like, no, men don't go through it. I'm like, I'm telling you. Men go through it. They go through it. And in a way, because it hits them like a ton of break because they don't realize it until it's there. They suffer worse than us. We're prepared from the first period.

Caroline: We're prepared about PMS, about perimenopause. You know, we're all prepared. Yeah, we've had to deal with it for a very long time. 

Rachel: And I think 

Rachel: that naturally, we talk about things that are sort of taboo subjects in the male zone. 

Caroline: That's why I said, you know, you 

Caroline: get four girls coming together, and what do you talk about?

Caroline: You talk about vaginitis, you talk about low sex drive, and you go, Oh God, you know, I hope he doesn't, I'm sleeping. [00:27:00] But you get four guys coming together, you think they're going to say, You know, I think my erection is not great. I don't even have, and the sexual libido drops. Yeah. They're never gonna, that's,

Paula: I mean, I think from a very early age, they're taught not to talk about things like that.

Paula: So, you know, and it must scare them. That's probably why they get depressed because they'll be feelings and things they've never had before. 

Rachel: Yeah. 

Hey, truly expat podcast listeners,

Rachel: this is the first half of getting to understand male andropause. I bet you learned something in this episode. Stay with us. Next week we have the second half and I hope to see you there because it's so good. Cheers. Have a good week. Bye. [00:28:00]