MANAGING HORMONAL CHANGES IN MEN AND WOMEN WITH AGING

1. MANAGING HORMONAL CHANGES IN MEN AND WOMEN WITH AGING

2. DR MMA N. EWUZIE - WOKOCHA,mni CHIEF CONSULTANT OBSTETRICIAN/GYNECOLOGIST NATIONAL HOSPITAL ABUJA NATIONAL PRESIDENT MEDICAL WOMEN;S ASSOCIATION OF NIGERIA

3. introduction • A large and rapidly growing body of scientific evidence demonstrates that a number of hormones decline with aging, • These declines can result in many of the manifestations of aging.  • The first to be recognized, of course, is the precipitous decline in estrogen and progesterone production in women called 'menopause .' 

4. introduction • Hormonal decline may be the most important major contributor to aging. • For men - it is so gradual that men often reach their mid-forties or fifties without noticing the negative changes that have taken place in their body. • For women - hormonal changes can begin as early as the mid to late thirties.

5. introduction • This is most likely because of the signaling of ovarian failure by the absence of menstruation, infertility, and relatively acute symptoms such as hot flushes for the woman. • The other hormones that are well-documented to decline are testosterone in men (and, interestingly, women ), growth hormone ,  and the adrenal hormone  DHEA •   Decline in these hormones starts much earlier and is more gradual; • However, because of the analogy with menopause,  the terms andropause, somatopause, and adrenopause have been adopted. 

6. AGING CHANGES • The hypothalamus is located in the brain. • It produces hormones that control the other structures in the endocrine system. • The amount of these regulating hormones stays about the same, but the response by the endocrine organs can change as we age. • For example, a hormone called TRH makes the pituitary gland produce thyrotropin, or thyroid stimulating hormone (TSH). • In women, the amount of TSH produced does not decrease with time, but it does in men. • The pituitary gland is also located in the brain. This gland reaches its maximum size in middle age and then gradually becomes smaller.

7. AGING CHANGES • The pituitary gland has two parts: • The back (posterior) portion stores hormones produced in the hypothalamus. • The front (anterior) portion produces hormones that affect the thyroid gland (TSH), adrenal cortex, ovaries, testes, and breasts. • The thyroid gland is located in the neck and produces hormones that help control metabolism. • With aging, the thyroid often becomes lumpy (nodular). • Metabolism gradually declines, beginning around age 20. • Less thyroid hormone may be produced, but there is also less body mass (because of loss of muscle and bone tissue). • This means that thyroid function tests usually show results within the normal range.

8. AGING CHANGES • The parathyroids are four tiny glands located around the thyroid. • Parathyroid hormone affects calcium and phosphate levels. • This, in turn, affects the strength of the bones. Changes in the level of parathyroid hormones may contribute to osteoporosis. • Insulin is produced by the pancreas. A molecule of insulin fits into a place on the cell wall called an insulin receptor site. It acts like a lock and key to help sugar (glucose) go from the blood to the inside of cells, where it can be used for energy.

9. AGING CHANGES • The normal or average fasting glucose level rises 6 to 14 mg/dL (milligrams per deciliter) for each 10 years after age 50. This is because the cells become less sensitive to the effects of insulin, probably because of a loss in the number of insulin receptor sites in the cell wall. • Because of these changes, some doctors recommend that older people periodically have blood drawn to check glucose levels and make sure they aren't in the early stages of diabetes (high blood sugar).

10. EFFECT OF CHANGES Overall, some hormones are decreased, some unchanged, and some increased with age. Hormones that are usually decreased include: • Aldosterone • Calcitonin • Growth hormone • Renin • In women, estrogen and prolactin levels usually decrease.

11. EFFECT OF CHANGES • Hormones that remain unchanged or only slightly decreased include: • Cortisol • Epinephrine • Insulin • Parathyroid hormone • Thyroid hormones T3 and T4 • 25-hydroxyvitamin D • Testosterone levels usually decrease slightly as men age.

12. EFFECT OF CHANGES • Hormones that may increase include: • Follicle-stimulating hormone (FSH) • Luteinizing hormone (LH) • Norepinephrine

13. Female reproductive anatomy

14. Menopause

15. Menopause • Menopause is the transition in a woman's life when the ovaries stop releasing eggs, menstrual activity decreases and eventually ceases, and the body decreases the production of the female hormones estrogen and progesterone. • Women aren't the only ones who go through a hormonal shift as they age. • Very real and profound changes in the male body can result in symptoms such as depression, moodiness, apathy, hot flashes, metabolic syndrome, and erectile dysfunction. • Often ignored by conventional physicians, male hormone levels are easy to test and treat.

16. Symptoms of Menopause

17. Variables Affecting Female Sexual Function • Sexuality for women extends far beyond the release of neurotransmitters, the influence of sex hormones, and vasocongestion of the genitals. • A number of psychological and sociological variables may affect female sexual function, as may the aging process, menopause, the presence of diseases,

18. Psychological Factors Affecting Female Sexual Function • Relationship with sexual partner • Past negative sexual experiences or sexual abuse • Low sexual self-image • Poor body image • Lack of feeling of safety • Negative emotions associated with arousal • Stress • Fatigue • Depression or anxiety disorders and the use of certain medications

19. Effects of Aging on Female Sexual Response TABLE 3. Effects of Aging on Female Sexual Function3,12,13 • Decreased muscle tension • May increase time from arousal to orgasm, lessen intensity of orgasm, and lead to a more rapid resolution • Distention of the urinary meatus • Lack of breast-size increase with stimulation Clitoral shrinkage, decrease in perfusion, diminished engorgement, and delay in clitoral reaction time • Decreased vascularization and delayed or absent vaginal lubrication • Decreased vaginal elasticity • Decreased congestion in outer third of vagina • Fewer, occasionally painful, uterine contractions with orgasm • Genital atrophy Thinning of vaginal mucosa • Increase in vaginal pH • Decreased sex drive, erotic response, tactile sensation, capacity for orgasm

20. Effects of Aging on Female Sexual Response • A number of changes that occur with aging have effects on sexual response (see Table 3). • Despite these changes, most current studies do not show an appreciable rise in sexual problems as women age.1,2,5,11 • For instance, baseline data from the Study of Women’s Health Across the Nation (SWAN) suggest that sexual function and practices remain unchanged for premenopausal and perimenopausal women.

21. Effects of Aging on Female Sexual Response • Although early perimenopausal women reported more frequent dyspareunia than did premenopausal women, there were no differences between the two groups in regard to sexual desire, satisfaction, arousal, physical pleasure, or the importance of sex. • Seventy-seven percent of the women said that sex was moderately to extremely important to them, although 42 percent reported a desire for sex infrequently (0–2 times per month), prompting the authors to note that a “lack of frequent desire does not appear to preclude emotional satisfaction and physical pleasure with relationships.” • John Bancroft, lead author of the 1999–2000 national survey of 987 women that found emotional well-being and the quality of a relationship with a partner had more of an effect on sexuality than aging, suggests that aging affects genital response more in men than women, and sexual interest more in women than men.1

22. Effects of Peri/Menopause on Female Sexual Response • TABLE 4. Possible Changes in Sexual Function at Menopause • Decline in desire • Diminished sexual response • Vaginal dryness and dyspareunia • Decreased sexual activity • Dysfunctional male partner

23. Medical Conditions That Can Affect Female Sexuality TABLE 5. • Neurologic Disorders • Vascular Disorders, eg Hypertension • Endocrine Disorders, eg Diabetes • Debilitating Diseases, eg-Cancer etc • Voiding Disorders- stress incontinence

24. Medications that cause orgasmic disorders

25. As you age and your metabolism slows down, the amount of fat in your body slowly increases. • Women experience an even greater fat percentage increase than men do. • Then after menopause, your body fat distribution tends to shift — less in your arms, legs and hips, and more in your abdomen.

26. The midsection matters • Gaining weight in your abdomen does more harm than simply making your waistband too tight. • While putting on weight in general can have negative effects on your health, abdominal weight gain is particularly unhealthy. • Too much belly fat increases your risk of: • Heart disease • Breast cancer • Diabetes • Metabolic syndrome • Gallbladder problems • High blood pressure • Colorectal cancer

27. The midsection matters • Researchers also have found that abdominal fat cells aren't just dormant energy waiting to be burned up. • The cells are active, producing hormones and other substances that can affect your health. • For example, some fat-cell-produced hormones can promote insulin resistance, a precursor to type 2 diabetes; others can produce estrogen after menopause, which may increase your breast cancer risk. • Researchers are still sorting out how the excess hormones affect overall health, but they do know that too much visceral fat can disrupt the body's normal hormonal balance.

28. The midsection matters • Belly fat

29. Fight back the bulge • Belly fat exercises

30. Fight back the bulge • Since visceral fat is buried deep in your abdomen, it may seem like a difficult target for spot reduction. • As it turns out, visceral fat responds well to a regular exercise routine and a healthy diet. • Targeted tummy exercises can help to firm the abdominal muscles and flatten the belly. Exercise. • Daily, moderate-intensity exercise is the best way to lose belly fat — when you lose weight and tone your muscles, your belly fat begins shrinking, too. • In fact, you may notice that your tummy bulge is the first area to shrink when you start exercising. • The amount and type of exercise you should get varies depending on your current activity level and your health goals. • Talk to your doctor about the right exercise program to promote good health and specifically combat abdominal fat.

31. Fight back the bulge Strength training. • Some research has shown that exercising with weights is effective in trimming tummy fat. Talk to your doctor about how to incorporate strength training in your exercise routine. Healthy diet. • Changing unhealthy eating habits can help fight belly fat. Replace saturated fats with polyunsaturated fats. • Increase portions of complex carbohydrates such as fruits and vegetables, and reduce simple carbohydrates like white bread and refined pasta. • If you need to lose weight, reduce your portion sizes and daily calorie intake.

32. Fight back the bulge Tone your tummy. • While you can't "spot-burn" belly fat, you can firm up your abdominal muscles and get a flatter belly. • Traditional sit-ups aren't the most effective way to firm your tummy, however. • Instead, use these exercises to target both deeper and lower abdominal muscles: Deeper abdominal muscles. • Target deeper abdominal muscles by doing "abdominal hollowing" or "drawing in the bellybutton." First, get down on all fours. Let your tummy hang down as you take a deep breath. Let your breath out, and at the end of your exhalation, gently draw your bellybutton inward and upward toward your spine. You should feel a slight tightening around your waist — think of it as trying to squeeze through a partially closed door. Hold for 10 seconds, then rest for 10 seconds. Work up to 10 repetitions. • During each effort, your spine position shouldn't change and you should breathe freely. • Eventually, you'll be able to do this exercise standing up. It's so subtle, no one should be able to tell you're doing it.

33. Fight back the bulge Lower abdominal muscles. • Tone your lower abdomen by doing pelvic tilts and pelvic lifts. • To do a pelvic tilt, lie on your back on the floor with your knees bent. • Flatten your back against the floor by tightening your abdominal muscles and bending your pelvis up slightly. Hold for five to 10 seconds. • Repeat five times and work up to 10 to 20 repetitions. • For pelvic lifts, lie on your back with your knees bent up toward your chest and your arms relaxed by your sides. • Tighten your lower abdomen and lift your buttocks up off the floor, with your knees aimed toward the ceiling. Hold for five to 10 seconds. • Repeat five times and work up to 10 to 20 repetitions.

34. Male Menopause/Andropause • Do aging males undergo a menopause like women? • Yes, and not surprisingly men are not spared from a “menopause”. • The andropause or the “male menopause” is the time in a man’s life when the hormones naturally decline. • It is also a time where there is a change of life that may be expressed in terms of a career change, divorce, or reordering of life. • This event brings about psychological changes as well. • Like menopause, the andropause usually occurs from fifty years onwards. • Some have questioned whether the male menopause is more myth than reality.

35. Male Menopause/Andropause • there is an undeniable hormonal decline as one age, and this in turn accelerates the aging process. • The decline in hormones for men is more gradual unlike in women’s menopause, which is a more abrupt event. • The andropause is sometimes termed medically as the A.D.A.M., an acronym for Androgen Decline in Aging Males

36. Male Menopause/Andropause • Men can suffer from symptoms of the andropause, and they may be similar to that of menopause. • Between the ages of 50 to 70, some men report symptoms such as erectile dysfunction (failure to achieve an erection), general tiredness, mood changes, night sweats and sometimes palpitations. • My research reveals that most men attribute erectile dysfunction to be the most significant event of the andropause. • Apart from erectile dysfunction, mood changes can take place too. Some have complained of nervousness, irritability and even depression.

37. Male Menopause/Andropause • Some of the physical and accompanying psychological changes may be treated with counseling as well as with certain hormones. • Treatment for impotence or erectile dysfunction and mood changes is easily available today

38. Symptoms of Andropause

39. Coping mechanism • The andropause brings about physical and psychological changes. • As the older male ages and undergoes the andropause, he has to grapple with profound changes and issues. • These changes bring about stress, and if stress is not managed well, it can be very disabling and even lead to depression:

40. Coping mechanism • 1. Learn to love and reward yourself and others: • Much satisfaction can be obtained from not only receiving but also giving. • We cannot bring our earthly wealth to the afterworld, and we should learn to reward not only ourselves but also those around us. • There comes a point in life where leaving legacies behind become important

41. Coping mechanism 2. Take control and organize yourself. • Discipline is important even in the later part of life. • In particular, learn not to abuse alcohol and quit smoking. • Time management is crucial as well. It is important for instance, to prepare our wills, estate management and advance directives and that is part of organizing ourselves. 3. Exercise yourself. • A combination of cardiovascular and muscle conditioning will help delay aging processes.

42. Coping mechanism 4. Relax and Rest yourself. • The body is changing with aging and there are physiological changes occurring and that he and you should be mindful of that. 5. Feed yourselves- not quantitatively but qualitatively! It is important to eat the right kinds of food to adjust for physiological aging changes. 6. Enjoy Aging and the Andropause. • Some things are inevitable, no matter what we do! • It is important to be satisfied. • Most of us will have to pass through this journey so let us make the best of it. • May we make this journey of profound change one also of positive evolvement, and a time of rich blessings for ourselves as well as those around us, as we age graciously through the andropause!

43. Conclusion • Effectively supporting individuals who are undergoing andropause or menopause requires sustaining healthy hormone levels. • At the same time, men and women entering either of these life phases should strive to prevent excess detrimental metabolites—in particular estrogens in both sexes and detrimental testosterone forms in men—in order to achieve healthy aging and maximal quality of life. • Gratitude is a way to remain positive, not dwelling on the pains and loss of old age. • Gratitude means each day is a gift, life in its entirety is a gift, and whatever comes our way we are given the • strength and grace to manage.

44. Conclusion • “If [you‟re] happy in what [you‟re] doing it‟s easier to grow old gracefully. • Don‟t let life overtake you. • It‟s in a sense planning for old age, planning to live your life and to know that it‟s going to work along this way. You are going to get old. No one is immortal. • You can‟t begin this in your old age.”