Considering men’s health, when compared to women, men visit the doctor less frequently, have shorter visits, and only attend when their illness is in its later stages. When men are more likely to get sick from serious health problems, and see greater mortality rates than women from almost every non-sex-specific health problem1, it’s crucial that men have a health support system in place.
Testosterone
Testosterone is a key determinant of men’s health, being the main male sex hormone that is responsible for key male characteristics. Testosterone is present in women too, however in much lesser amounts. Unlike female hormones that ebb and flow every month, testosterone levels in men are fairly stable all their adult life. From about age 40, testosterone levels start to gradually decline by 1% each year2.
Testosterone helps men maintain muscle mass, promotes clear thinking, supports mood and motivation, and is also essential for fertility2.
Dihydrotestosterone, or DHT, is an offshoot of testosterone. About 10% of daily testosterone secretions are converted to DHT by an enzyme known as 5-alpha-reductase. DHT is a much stronger form of testosterone. In puberty, DHT is essential for the development of a deeper voice, muscle mass and bone mass, and body hair. Throughout adulthood, DHT is important for the maintenance of muscle and bone, male vigour and libido3.
However, DHT is also the culprit in many hormone related male health conditions. In adolescents and young adults, excess DHT conversion in the skin can cause acne. In older, susceptible men, DHT can promote hair loss and enlargement of the prostate gland4. Susceptibility to DHT can occur in two ways; susceptibility of excessive conversion of testosterone to DHT, or excessive sensitivity to DHT in tissues such as the skin or prostate gland4.
Men's health: Preventative healthcare during young adulthood
Men in their 20s and 30s are physically in their prime. This period is characterised by a drive for achievement, recognition and success.
Young men need to go out of their way to exercise and enrol in sports that used to be so accessible during education years. To maintain muscle and bone mass, prevent weight gain, and support healthy testosterone levels, men need to continue exercising for at least 30 minutes a day5.
Stress and mental health support
The 20s and 30s are often decades marked by major life changes. Finishing higher education degrees, entering the workforce and building careers, getting married and starting a family — all important life events to look forward to and enjoy, but also may be accompanied by periods of stress. 34% of men say they would be embarrassed or ashamed to take time off work for mental health conditions such as anxiety or depression6. Younger men need extra support given two thirds of deaths under 35 are male and the largest cause is suicide7. Given chronic stress is a leading factor in the onset of mental health conditions8, stress management techniques, lifestyle support and natural medicines such as adaptogenic herbs, are a large feature in naturopathic men’s health protocols.
Sleep
Sleep is important throughout the lifecycle but often neglected in younger men, and sleep loss in younger men has been found to dramatically decrease testosterone levels. Inadequate sleep is associated with a number of chronic illnesses including obesity, hypertension and type two diabetes9. Naturopathic sleep support includes identification and correction of problem sleep habits, respiratory assessment, stress support and nutritional and herbal medicines that aid relaxation and sleep onset.
Fertility
Sperm counts are declining at an alarming rate. Global figures suggest sperm concentrations have halved in the last 40 years, and the rate of decline is accelerating10. As a result, men, even in their 20s and 30s, can experience fertility issues. There are many factors that negatively influence fertility, including obesity, oxidative stress caused by a high sugar diet, zinc status, tobacco and drug use, excessive alcohol consumption, and exposure to environmental toxins and heavy metals10. Environmental toxicity can occur in certain occupations, those exposed to chemicals and fine particles, as in construction work and farming. Naturopathic support for men who are concerned about their fertility involves a nutritional, lifestyle, toxicity and hormonal assessment. Once the area(s) of issue is identified, a Naturopath can use nutritional, herbal and lifestyle medicine to improve sperm quality and boost fertility.
Men's Health: Optimisation during the middle years
Beginning in their early 40’s, men experience a decline in testosterone of 1 percent each year. These reductions coincide with increased incidence of depression and anxiety. While this decline in testosterone often goes unnoticed by some, 1 in 5 men experience symptoms like low energy, mood, and libido, poor concentration, weight gain and reduced muscle mass 2.
Chronic stress can exacerbate hormonal imbalances, as the body shifts its resources to synthesizing stress hormones at the expense of sex hormones such as Testosterone2. Again, we can see the importance of a toolkit of stress management techniques.
The risk of heart disease, hypertension and diabetes is exacerbated by obesity, and middle age is when men are likely to be overweight. Men lose 3 to 5 percent of their muscle mass for every decade after age 2511. Reduced muscle mass and physical activity, and declining testosterone levels, conspire to decrease men’s resting metabolic rate. Therefore, as men age, they burn less energy while resting and can gain weight even without changing their eating habits.
Cardiovascular health
All men in their 40s and 50s should have an annual heart health check-up. This involves checking blood pressure, glucose, cholesterol, and liver function. If any of these markers show up abnormal, diet and lifestyle changes should be implemented, and a follow up conducted in 3 months. From there, a bi-annual heart health check should be done until markers are consistently normal.
Digestive health and bowel cancer
Bowel cancer screening begins at age 50. However, increasing incidence of bowel cancer in younger years means GPs can request regular screenings for men of average risk from age 45. Being overweight or obese would categorise you as average risk. High risk involves a family history of bowel cancer, obesity, and an inflammatory bowel disease such as Crohn’s or Ulcerative Colitis. Although rates of bowel cancer are increasing, bowel cancer is one of the most treatable cancers, and research from 2021 indicates that up to 34% of bowel cancer cases may be prevented by a healthy lifestyle, increasing to 61% when combined with regular screening12.
Naturopathic care moderates the risk of bowel cancer by:
- – Supporting maintenance of, or achieving a healthy body weight
- – Lifestyle support to increase physical activity and moderate alcohol intake
- – Reducing the intake of red meat and strictly limiting processed meats
- – Support to quit smoking
- – Implementation of the naturopathic diet – plenty of fibre from fruits, vegetables, legumes, nuts, seeds and wholegrains
- – Assessment and support of a healthy gut microbiome
Key objectives of naturopathic healthcare to optimise men’s health in the middle years includes:
- – Achieve or maintain a healthy weight
- – Get seven to nine hours of sleep per night
- – Optimise diet by eating more vegetables, fruit, whole grains, and high-quality protein-dense foods; along with consuming less sugar and refined carbohydrates
- – Adequate intake of zinc-containing foods like lean meat, seafood, cashews and pumpkin seeds support healthy testosterone levels
- – Exercise regularly, and include strength training to support healthy testosterone levels, maintain lean muscle mass and bone mass
- – Implement daily stress management techniques, like deep breathing exercises, meditation, exercise and mindful movement like yoga or daily walking
Men’s Health: Looking ahead and preserving health and fitness for the golden years
While the health areas above are always relevant in men’s health, for men in their 60s and 70s, additional factors to consider are bone health, prostate health and bone hair loss. One thing that experts in all fields of health agree on is that it is never too late to positively affect one’s health.
Bone health
Continued production of testosterone and larger peak bone mass protects men from osteopenia and osteoporosis in the early older years. Men can stem bone loss in their 60s and 70s by undertaking weight-bearing and resistance exercises. Weight bearing exercises include walking, hiking, jogging, climbing stairs, yoga, playing tennis, and dancing. Resistance exercises – such as lifting weights – can also strengthen bones. Other exercises such as swimming and cycling can help build and maintain strong muscles, and have excellent cardiovascular benefits, but they are not the best way to strengthen your bones.
Prostate health
The continued production of testosterone, however, can also adversely affect men. Testosterone, or more rightly, DHT, causes hair loss and stimulates growth of the prostate gland in later years. Noncancerous enlargement of the prostate gland, or benign prostate hyperplasia (BPH), occurs in more than half of men in their 60’s and up to 90 percent of men in their 70’s and 80’s13. BPH can cause symptoms such as increased frequency of urination due to inability to fully void. This is usually all that the doctor would need to know to diagnose BPH. Naturopaths successfully use herbal medicines such as nettle root and saw palmetto, along with specific diet and lifestyle support, to manage symptoms and improve prognosis of BPH14.
Hair loss
DHT is the driver of both hair loss and prostate enlargement, so management goes back to that conversion of Testosterone to DHT by the enzyme 5-alpha-reductase. We want to normalise the conversion to DHT by reducing oxidative stress in the body, in large by following a wholefoods, high fibre, low sugar diet.
There are also specific foods, nutrients and herbs that down regulate 5-alpha-reductase, and protect sensitive tissues like the prostate and hair follicles from the effect of DHT:
- – Green tea
- – Spearmint
- – Quercetin
- – Turmeric
- – Pumpkin seeds and pumpkin seed oil
- – Soybean products, like soy milk, tofu and tempeh, edamame
Naturopathic care can support men in all stages of life, whether trying to optimise heath, prevent illness, or manage and improve a diagnosed condition.
When working in healthcare, the first people we want to help is often the people closest to us. Coming from a largely male family, men’s health has always been an area especially important to me. The present is always the right time to prioritise your health, work towards your goals and reach out for health support if you need it.
References
- 1. State Government of VIC. Men’s health. Better Health Channel. Published 2022. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/mens-health
- 2. Stanworth RD, Jones TH. Testosterone for the aging male; current evidence and recommended practice. Clin Interv Aging. 2008;3(1):25-44. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2544367/
- 3. Kinter KJ, Anekar AA. Biochemistry, Dihydrotestosterone. StatPearls Publishing; 2021. http://www.ncbi.nlm.nih.gov/pubmed/32491566
- 4. Swerdloff RS, Dudley RE, Page ST, Wang C, Salameh WA. Dihydrotestosterone: Biochemistry, physiology, and clinical implications of elevated blood levels. Endocr Rev. 2017;38(3):220-254. doi:10.1210/er.2016-1067
- 5. Riachy R, McKinney K, Tuvdendorj DR. Various Factors May Modulate the Effect of Exercise on Testosterone Levels in Men. J Funct Morphol Kinesiol. 2020;5(4). doi:10.3390/jfmk5040081
- 6. State Government of Victoria. Anxiety and depression in men. Better Health Channel. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/anxiety-and-depression-in-men
- 7. Australian Institute of Health and Welfare. Deaths in Australia. AIHW. Published 2022. https://www.aihw.gov.au/reports/life-expectancy-death/deaths-in-australia/contents/leading-causes-of-death
- 8. Davis MT, Holmes SE, Pietrzak RH, Esterlis I. Neurobiology of Chronic Stress-Related Psychiatric Disorders: Evidence from Molecular Imaging Studies. Chronic Stress. 2017;1. doi:10.1177/2470547017710916
- 9. Knutson KL, van Cauter E. Associations between sleep loss and increased risk of obesity and diabetes. Ann N Y Acad Sci. 2008;1129:287-304. doi:10.1196/annals.1417.033
- 10. Skakkebæk NE, Lindahl-Jacobsen R, Levine H, et al. Environmental factors in declining human fertility. Nat Rev Endocrinol. 2022;18(3):139-157. doi:10.1038/s41574-021-00598-8
- 11. Harvard Health. Preserve your muscle mass. Harvard Health Publishing. Published 2016. https://www.health.harvard.edu/staying-healthy/preserve-your-muscle-mass
- 12. Bowel Cancer Australia. Modifiable risk factors. Published 2022. https://www.bowelcanceraustralia.org/modifiable-risk-factors
- 13. Shergill IS, Dhanasekaran AK, Kalsi JS, McAllister WJ. Benign prostatic hyperplasia. In: Viva Practice for the FRCS (Urol) and Postgraduate Urology Examinations, Second Edition. CRC Press; 2018:279-296. doi:10.1201/9781351254540-19
- 14. Leisegang K, Jimenez M, Durairajanayagam D, et al. A systematic review of herbal medicine in the clinical treatment of benign prostatic hyperplasia. Phytomedicine Plus. 2022;2(1):100153. doi:10.1016/j.phyplu.2021.100153