Age Management



What exactly is age management?

Age management medicine is preventive medicine focused on helping patients regain and maintain optimal health and vigor. It aims to prevent the changes seen with ageing that eventually leads to chronic diseases such as hypertension, heart disease, diabetes, strokes, cancer and osteoporosis.

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Is Age Management Medicine alternative medicine?

Age Management Medicine is not alternative medicine. Alternative medicine is to use methods of treatment that may not have been proven in a conventional medical setting. This does not mean that they do not work. Dietary change and exercise are medically proven ways of improving function, optimizing health and reducing disease risk. The hormonal benefits for optimizing function and reducing disease risk is also supported by medical research.

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How is Age Management Medicine different from Conventional Medicine?

Conventional medicine tends to target disease e.g. dealing with high blood pressure, high cholesterol or diabetes. Treatment is also often targeted towards managing the end points, meaning treating the blood pressure, controlling the sugar and lowering the cholesterol. However, many of these diseases are the end points of ageing and changes in the body that have accumulated due to the unhealthy diet that we take or the lack of physical exercises, changes in hormones as we age. Age management takes a more proactive, preventive approach to health. We are concerned with prevention of disease and also of optimizing a patient’s function. Disease management is often targeted at what caused the disease in the first place rather than treating the end point with drugs.

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Is Andropause a Natural State or a Disease?

Andropause is a term used to define the period in a man’s life where there are symptoms related to a decline in active testosterone. The symptoms that may be experienced include fatigue, increasing weight especially around the middle, mood swings and depression, decrease in exercise tolerance, decline in sexual interest and erectile problems.

The state of andropause is therefore considered a natural one that all men eventually come to, just like women come to the menopause. But this change is a more gradual in men than for women, and is more likely to be attributed to “aging” than a decline in hormone levels.

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When does Andropause occur?

The level of active testosterone and therefore symptoms seen in the andropause starts to occur as early as 40 years of age. The decline in testosterone levels may however, be accelerated by poor diet and lack of exercise, as well as a genetic predisposition. Twenty percent of men between the ages of 60 to 80 years of age have a lower than normal testosterone level.

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What are some changes seen in the Andropause?

  • Tiredness
  • Loss of sexual interest or erectile dysfunction
  • Increase weight around the waist
  • Poor concentration, memory loss and reduced work performance
  • Depression, anxiety and irritability

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Does Andropause affect my health negatively?

In addition to the symptoms mentioned above, andropause is also associated with an increase risk of chronic diseases. A man with a suboptimal but still normal testosterone level may already be at increased risk for coronary heart disease and diabetes, and this risk increases even further with an abnormally low testosterone level. Low testosterone levels also increases the risk of osteoporosis, a disease that is often considered a woman’s disease. A third of osteoporotic fractures actually occur in men.

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Can I have Andropause if my blood testosterone results are normal?

Symptoms are usually a more accurate assessment of testosterone insufficiency and they may occur even when testosterone levels fall within normal range

Measurement of active levels of testosterone in the blood is more important than measuring total testosterone levels.

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How is testosterone replaced?

In very mild cases of andropause, exercise and changing your diet along with supplements may help to increase testosterone levels.

In others, testosterone replacement may be considered.

Testosterone may be replaced via different methods including injections, creams, troches or suppositories.

Oral testosterone is not usually advised due to the frequency of ingestion required to achieve optimal levels.

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What are some of the Side Effects of Testosterone Replacement?

Testosterone replacement is safe if well monitored. However inappropriate replacement or monitoring may result in benign prostate enlargement giving rise to difficulty with urination, hair loss and increased red blood cells counts.

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Can Testosterone Replacement cause prostate cancer?

Testosterone replacement does not increase the risk of prostate cancer. It can however, sometimes make obvious early cases of prostate cancer. In fact, lower testosterone levels is associated with more aggressive forms of prostate cancer.

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What is Menopause?

Menopause occurs a year after a woman experiences her last menstrual period. Therefore it is only a term that is used in hindsight.

The menopause marks the end of a woman’s reproductive lifespan. A woman is born with a fixed number of eggs in her two ovaries and with each menstrual cycle and over time, the number of eggs will decline and menopause occurs when there are no more useful eggs left in the ovaries. The ovaries release hormones namely estrogen, progesterone and testosterone, as a result of developing eggs in the ovaries, therefore when the eggs run out, a woman will experience symptoms due to a deficiency in these hormones. In fact even before a woman reaches the menopause, she is likely to experience symptoms as a result of changing hormone levels.

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What are some Common Symptoms seen in the Perimenopause and Menopause?

  • Changes in frequency of menstruation: some experience a delay in periods, whilst others may experience more frequent menstrual periods
  • Changes in period flow: some experience a lightening of the periods, whilst others experience very heavy bleeding that can result in anemia
  • Increase in premenstrual symptoms: there may be breast pain and swelling, bloating, water retention, headaches, mood swings, hot flushes and sleep difficulties before the periods
  • Sleep difficulties: either a difficulty falling asleep or difficulty with sleep maintenance
  • Tiredness
  • Poor concentration and memory loss
  • Weight changes and changes in weight distribution: more weight around the middle and the hips
  • Decline in sexual interest and vaginal dryness
  • Hot flushes, night sweats

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I have some of the above symptoms and have had my blood measured for hormones before and my doctor tells me that the hormones are normal. Can these symptoms still be because of my hormones or are they all in my head?

Common blood tests done include FSH (follicular stimulating hormone) and LH (luteinizing hormone) which are hormones from the pituitary gland, as well as estradiol and progesterone. These hormone levels vary with the menstrual cycle and must be interpreted in context of the menstrual cycle. Relative levels of estradiol and progesterone are more important than absolute levels. Symptoms are often a much more reliable indicator of hormone imbalance or insufficiency than blood results.

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If Menopause is a normal occurrence, when do I need to see a doctor?

To get more information about keeping healthy through the menopause and beyond

Unsure if symptoms are related to menopause

Symptoms are bothersome and affecting your sleep and performance

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If I see a doctor, does it mean I have to start on Hormone Replacement Therapy?

No, seeing a doctor is about understanding your condition and getting accurate information to cope and to ensure you keep healthy as the change in hormones may affect your risk of other diseases such as heart disease, diabetes mellitus and osteoporosis. Whilst some symptoms are best treated with hormone replacement therapy, there may be lifestyle modifications or natural alternatives that may help you to cope without hormone replacement therapy. There are also many options available for hormone replacement therapy. Ask your doctor about bioidentical hormone replacement therapy.

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When Should I Consider Hormone Replacement Therapy?

Premenstrual tension may be an indication of an imbalance between the hormones estrogen and progesterone.

Common symptoms seen in premenstrual tension include:

  • Migraines
  • Breast pain
  • Bloating and water retention
  • Mood swings and irritability

Often progesterone supplementation may bring great relief to these symptoms

The perimenopause is the period that leads up to the menopause and may start as early as the late thirties in some women. Common complaints in this time include:

  • Sleep disruptions
  • Poor concentration and memory lapses
  • Premenstrual tension
  • Hot flushes, night sweats
  • Loss of sexual drive
  • Vaginal dryess

Progesterone therapy may be considered with or without estrogen replacement and testosterone

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Why a Bioidentical Hormone?

A bioidentical hormone is a hormone that is identical in structure to the hormones found in the body. Many synthetic hormones are altered in structure and may give less imperfect relief to symptoms and may also be associated with increased side effects.

Bioidentical progesterone in particular is associated with less symptoms of water retention, acne and has improved effect on the cardiovascular and possibly less effect on breast cells than a progestin (altered progesterone).

Bioidentical hormones can have dosages adjusted to optimise symptom control for individual patients. Since side effects of hormone replacement are dose related, using the lowest possible dose for symptom control is associated with the lowest risk of side effects.

Bioidentical hormones are available in various forms such as a cream, gel, oral or vaginal pessaries.  Certain symptoms are better managed using a particular route of dosing. Some medical conditions may necessitate dosing hormones via a specific route.

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    Dr Julinda Lee is board certified by the American Academy of Anti-Aging Medicine and has served as a examiner for the American Academy of Anti-Aging Medicine Examinations.