Article Tags: health education | integrative medicine | men's health | healthy aging
The 4-T Treatment for Aging Men with Fatigue, Low Libido and Depression
Have you heard of “Male Menopause” or “Mano-pause?” This really happens in many men as they age. Besides the common issues of high blood pressure, pre- or early-diabetes, high cholesterol and joint pain, men can suffer from mood and energy issues including fatigue and insomnia, low libido, anxiety and depression.
What I see in my male patients over 40-50 years old, is they may be experiencing low energy in various forms and they can be helped with the 4-Ts. That stands for Testosterone, Thyroid, Tryptophan and Tyrosine (amino acids).
Let’s break them down:
Testosterone
There’s a common tendency of lower testosterone production in men as they age. With blood testing, this level, as well as free testosterone, can be measured. The typical lab’s normal range is wide, like 250-900. Most doctors go by this and would not give supplemental hormone without it being lower than 200. An important Healthy-Aging, Integrative Medicine approach is to attain and maintain optimum levels of various hormone, such as testosterone. When men achieve a higher amount of this important male hormone, they begin to feel better in energy, mood, libido and more.
Testosterone needs to be prescribed by your physician, and can either be applied topically or by injection. Clearly, topical is easiest and can be adjusted easily, whereas the usually injection is 100-200mgs weekly and it’s a stronger and more dynamic effect usually. There are minimal side effects other than feeling a bit agitated or aggressive. Injections often has activity for 1-2 weeks.
Thyroid
This is also an important hormone for energy and libido, as well as overall metabolism and body temperature. The thyroid blood levels need to be checked thoroughly with tests that include TSH (Thyroid Stimulating Hormone), Free T3 (Liothyronine), and Free T4 (Levothyroxine) to look at both the pituitary’s measurement and interaction with thyroid as well as the thyroid gland’s production of its two primary hormones. Again, we consider optimum levels and not just fitting into the normal laboratory ranges. Adding some thyroid hormone when indicated can improve energy, endurance, metabolism and body temperature. When thyroid is low, there are a lot of symptoms, such as dry skin, constipation, coldness, and low endurance and libido. There are both natural and glandular thyroid medicines that contain both T3 and T4. Typical thyroid prescriptions are synthetically made T4 (levothyroxine or with brand names Synthroid or Levoxyl) and T3 (liothyronine or Cytomel). Dosages range from fairly low to higher amounts and would be prescribed by your practitioner.
Tryptophan
Amino acid therapy can be quite helpful in balancing mood, energy and sleep, and especially in reducing depression naturally. The two main ones are tryptophan (and 5-HTP, 5-hydroxy-tryptophan) and Tyrosine. Tryptophan and 5-HTP are precursors to serotonin and melatonin and help with sleep and low moods, or depression. Typical support amounts are 500-1,000 mgs of L-Tryptophan before bed or 100-200mgs 5-HTP. Good sleep helps with mood and depression and these serotonin supporters helps reduce a low mood too.
Tyrosine
L-Tyrosine is another important amino acid that has some anti-depressant effects, and more energizing than tryptophan, so I usually recommend it during the day, as with 500-1,000 mgs in morning and after lunch. Tyrosine amino acid also supports thyroid hormone production.
Ideally, treatments should be individualized based on the patient’s clinical state and lab testing. Thyroid and testosterone levels are easily done whereas amino acid levels are more specialized, and certain labs offer either urine or blood levels on most amino acids. I might order these tests and look at the overall balance, mostly on people with chronic problems and fatigue, or those that underweight when I believe they are deficient. Adequate protein diets often support good energy and amino acid balance. I use Genova Labs in North Carolina for amino acids, as well as other testing.
If you are a man who has some of the issues described here, I suggest you schedule a checkup, ideally with an integrative practitioner who understands hormone therapy. You might also be the partner or family member of someone with this condition and you could encourage the man in question to seek advice. Often the treatment with the 4 T’s is a trial to see how things can change for the better. As I tell any practitioners, anything we do in medical treatment is an experiment/experience, so we need to see and assess what happens.
Stay Healthy at every stage of life.
Elson Haas, MD