Hello, and welcome to the Rev Up Health Podcast. Today we're going to be talking about hormones in midlife. Right now, menopause is getting lots of attention, and we love that — it's so important. Women's health has been grossly neglected. Very much so. But I do think that andropause, the male equivalent to menopause, has a lot of parts that have also been neglected. So today we're going to talk about hormones in general and how they change in midlife.
They're essentially the same. Yes, they happen in the different sexes, of course, but their symptoms are similar in some respects, and primarily their long-term symptoms can be similar — and that's a very important thing, as we'll talk about today.
A Slow Decline for Men
One key difference to note — and the reason menopause is getting so much attention right now — is that this change happens so rapidly and erratically for women, whereas with men it's pretty much a slow, steady decline. So it's one of those things where you don't realize you're not feeling the same, because it's happening at such a slow rate. And with andropause, men are kind of complacent about our health, so we need a little encouragement to understand why we feel like we do. It's also one of those things — "Is it just part of aging? Okay, it's just part of getting older." That's not an excuse. There's a reason for it, and there are root causes, and understanding why these things occur.
Beyond Hot Flashes and Low Libido
The other thing we want to focus on is that this isn't just about hot flashes and low libido — what you typically think of as menopause-type symptoms. It goes so much deeper. I like to separate these into short-term and long-term symptoms. I hope this podcast can be more of a no-frills, straightforward dialogue that people can resonate with, so they can understand, "Yeah, maybe I do have those symptoms, and maybe I do need to check into this."
The short-term symptoms are things like hot flashes, mood changes, vaginal dryness, low libido, and erectile dysfunction. The long-term symptoms are things down the line — stuff that takes years and decades to occur — and these are really important for everybody to have on their radar. They're also things people are quite scared of, but they don't really know why or how to avoid them. I'm talking about things like sarcopenia — loss of muscle mass — which starts at the age of 30. It's incredible; some studies say it even starts sooner. And bone health, and cognition — being able to have your wits about you, come up with ideas, be creative, and be functional. Those long-term effects, even heart disease, are avoidable.
We're going to keep it simple. Essentially, we're looking at estrogen, testosterone, progesterone, and also thyroid and vitamin D. Commonly we think estrogen and testosterone when we think about andropause and menopause, but it's really the decline of all of these hormones and how they collectively affect us. Men and women — we all have estrogen and testosterone, just in different, various forms. These declines happen slowly and steadily and very subtly, and that's where it takes years and decades for them to take effect on our body systems.
In our younger, reproductive years, that's where we start seeing these declines in our sex hormone levels and general hormone levels. As they persist into our older adult years, that's when we start seeing problems with an increased risk of dementia, mood changes, heart disease, and low libido, and then osteoporosis and sarcopenia — the muscle wasting. Osteoporosis is very important, and should be a little scary for people; it occurs a lot more for women than men, but it does occur for both sexes.
Hormones and Mental Health
Some of the less common symptoms linked to hormone changes involve mental health. We're not just talking about depression and anxiety — we're talking about cognition, the ability to remember, short-term and long-term memory. But it is really important to talk about depression and anxiety, because that's something that's not very well linked to changes in hormone health — and not just our sex hormones. Thyroid — there have been a lot of studies to show that resistant depression or chronic depression not helped by antidepressants could be related to your thyroid levels. You may bring this up to your healthcare provider, and they may say, "Okay, is there an SSRI, an antidepressant, an anxiolytic medication?" Yes — but there are alternatives, things a person can do or take that can help offset it, improve it, or reverse it. This typical decline in cognitive abilities can very well be linked to menopause and andropause, to an extent, with the hormonal slow declines we see.
Hormones and Your Lipid Panel
Your lipid panel is another thing very closely related to the change in these hormones for men and women. These hormonal deficiencies can lead to problems with insulin resistance, which can increase our visceral fat and subcutaneous fat, and then we start having issues with lipid profiles, and downstream effects like hypertension or atherosclerotic disease. There's a lot linked indirectly that we just don't realize — and truthfully, from a medical perspective as a physician, we weren't taught this stuff in medical school, and really not in residency. This is something you learn in a post-graduate, out-in-practice setting — something you have to have an interest in and understand. "Here's your high blood pressure medicine — why is this?" As a patient and a physician, the question is: why is this occurring, and what can we do to fix it? Even a decrease in thyroid function can affect our lipids. It's not just hypothyroidism; it's a lower-functioning, lower level of thyroid function that can cause these things to occur.
One of the things we've learned is that you can have symptoms of thyroid deficiency without actually having a clinical diagnosis of hypothyroidism. You need optimal levels — there are cellular responses that need to respond to these levels of hormones. If there are problems within the cells themselves to even see the hormone levels, then you may have a normal level in your bloodstream, but your cells aren't responding to it. That's part of the "why" we get into for individuals.
Sarcopenia and Building Muscle
Then we get into sarcopenia, which is a huge topic right now — essentially muscle wasting. You're looking at about a 2 to 3% reduction in your muscle strength and muscle mass per year, and if we do nothing to improve it, it continues, leading to frailty — problems where we're just not able to hold ourselves up as we step off the curb, go down the stairs, or if we trip. Then we get to fractures becoming one of the leading causes of death in older adults, and it's really something that gets overlooked.
This is one thing I'd recommend young people pay attention to — do that strength training. As a young person, you have so much more capacity to build muscle, and then it's easier to maintain as you age. And it's never too late. Don't fall into the old adage that "I'm old, I can't do that." Yes you can. You've probably seen on Instagram or online older folks in their 70s and 80s who simply have trouble going up and down steps, and with time, perseverance, and the right nutrition and support, they can actually build that muscle. You can improve your muscle mass and your VO2 max — the cardiopulmonary aspects of life — even in older age. But it's nice to maintain what we have when we're younger.
Strong Muscles, Strong Bones
The connection between strong muscles and strong bones needs to be reiterated, because having strong muscles increases your bone strength too. It increases bone density — it puts stress on those bones, and that's how we remodel. There's a buildup and a breakdown process, and that's how we have healthy bones. By doing resistance training and plyometric-type activities, those are things that will help build that bone. And healthy levels of hormones also help that process — vitamin D, your proteins, the amino acids. You need to have that gram of protein per ideal body weight a day to maintain and hopefully improve muscle synthesis and production. Just being sedentary and complacent is not going to be helpful — we have to move. Bone health is so impacted by daily activities and hormone levels; the estradiol and testosterone levels, and thyroid optimization, are so important.
How This Is Treated — A Functional Approach
Then you get into the differences in how this is treated. "I've gone to my healthcare provider and just haven't gotten the answers — maybe they're just, 'Here's your medication.'" Some of the difference we see is that with traditional, conventional medicine, we're taught to identify a diagnosis for a patient and treat that disease, usually with pharmaceuticals or surgical interventions, which are indicated for some situations — there's no doubt about that. Pharmaceuticals have their place, absolutely. But oftentimes we've changed from a thought process of "I need this medication to get me through this season of disease" to "I have to be on this medication for the rest of my life." That's not always the case — sometimes it is, but not always. And you won't know unless you start digging to find the root cause.
There are a lot of ways to find those root causes, and that's where a functional, integrative medicine approach is different. It's looking a little further into understanding why it's gotten to this point, and what's really the base root cause. In our practice, we're focused on looking at those preventive or corrective things, whether it be through lifestyle changes, nutrition, or environmental changes, but specifically hormone optimization. You don't have to take hormones just to improve yourself — there are lifestyle and nutrition changes that can happen. But sometimes we all just need guidance. Some people just need somebody to help hold them accountable for what they need to do, and direction on the most effective, appropriate way to improve.
Along with this guidance is the idea of helping the individual get back in touch with their own intuition, so they can hear what their body is saying. Our body is always talking to us and letting us know what's going on and what it needs — we've just gotten disconnected from it. So another key part of the guidance we can offer is helping you get back in control of your own health. The body is pretty smart; it's going to know what it needs, and we just need to learn how to listen to it. A lot of us realize we need to do certain things, but sometimes we just need a little convincing. This is ongoing forever — it's the journey of life.
Wrapping Up
What we like to do at Revelation Health KC is take more of a holistic view, which can include a lot of different parts: looking at your muscle health, your bone health, improving cognition, and integrating wellness practices that can help improve the midlife declines that want to happen. A lot of people say, "I don't like this age thing, it's hard to cope with," but you don't have to age as fast as you might. So — not as fast as you don't like it, and don't age as fast as you want to.
Well, that wraps up our conversation today. Please let us know if you have any other questions — we'd love to answer them for you. Reach out, and we hope you have a healthy day.