Dec 27

Andropause is an onset of hormonal changes in men – mostly between the ages of 40 and 50 -, which is triggered by reduced testosterone levels.

Testosterone is the primary male sex hormone and is produced in the testes. It affects all body cells and is responsible not only for sexual development, but also for the specific skin, bone and muscle structure of men. It is equally important for the production of red blood cells, which supply the body with oxygen. And after all, testosterone also plays a significant role in providing sexual pleasure and emotional balance. At around one’s middle years, however, the production of this hormone gradually drops, and so do the testosterone levels in the blood. This reduction causes problems for many affected men: in German language, the saying “die Fitness ist kraftlos und die Lenden sind saftlos” (freely translated as ‘no gas in the muscles, no fluids in the loins”) expresses the feeling when the so-called andropause kicks in: depression, irritability, loss of concentration and vitality.

Possible symptoms of the andropause include:

  • Mood disorders such as anxiety, irritability, aggression
  • Tendency to depression
  • Increased weight and body fat, increasing abdominal girth
  • Increasingly poor short-term memory
  • Decreased concentration and attention span
  • Sleep problems and / or stronger daytime fatigue than before
  • Reduced desire for intimacy and lower sex drive..
  • ..or rational desire for sex, but still, sexual apathy
  • Erectile Dysfunction
  • Less frequent and intense ejaculation
  • Osteoporosis
  • low self-esteem
  • Hot flashes and night sweats

There are, however, considerable differences of opinion among experts as to which of these symptoms actually indicate a so-called ‘male menopause’ or andropause and were initially caused by testosterone deficiency, because for each of the symptoms in the list, there could be other root causes, even if a reduced testosterone level would actually be detected in a patient. Thus, in a way, the so-called ‘testosterone replacement therapy’ is often not much more than a ‘shot in the dark’.

Testosterone replacement therapy – yes or no?

Some doctors and hospitals today offer testosterone replacement therapy without much hesitation to men, often with the particular aim of helping them to regain their desire for a satisfying love life. Even with impending cardiovascular diseases, this hormone is sometimes used for prevention, because studies have shown that testosterone has a protective effect on arteries and veins, so there are good, potential reasons to say ‘yes’ to this kind of therapy (usually in the form of tablets, gels, patches or nose sprays). However, it is important to know that a hormone replacement therapy does not help at all if one simultaneously depletes his bodies’ health and resources. It is remarkable and perhaps not entirely coincidental that many men who are looking to start a hormone replacement therapy are also often frivolous users of  ‘fitness booster medication’ (self-medicated).

Ideally, taking on an artificial testosterone substitution should increase muscle mass, bone density, libido and performance. Under certain conditions, the ‘extra dose’ testosterone may also accelerate the development of an existing prostate cancer. A preventive control (PSA control) is therefore highly advisable.

But there are also proven health tips for men, which in contrast to the artificial feeding of testosterone reliably pose no health risks and are also very well suited to raise the testosterone levels:

  • Development of more self-discipline for a healthy lifestyle – something that many men never achieved in their lives
  • Balanced nutrition (vitamins: more fruit and vegetables; low-fat: greasy, oily foods and refined carbohydrates lead to weight gain, but: obesity appears to influence the production of testosterone!)
  • The waist circumference should be less than 100 cm (see BMI test on this website)
  • Enough sleep – at least 6-8 hours per day
  • Care for a balanced mental state – if something brings you out of your balance on a reglar basis, seek necessary support through psychotherapy or coaching: optimism and a balanced state of mind help to reduce stress. On the other hand, if men are overloaded (perhaps even chronic), endocrine glands will produce significantly less amounts male sex hormones.
  • Smoke and drink less
  • Natural resources: oats and ginseng have a testosterone-like effect, and an extra portion of zinc also helps the testosterone levels: lobsters, oysters and shrimp, soybeans, wheat bran and pumpkin seeds. Casanova was known to eat 40 oysters a day!
  • Exercising also stimulates the production of testosterone: best results are achieved with intense strength training with sets of 10-15 reps, peppered with breaks of 60-90 seconds (intervals of 15-30 sec will stimulate the production of growth hormone).
  • Good sex: sexual excitement and ‘games of desire’ help to raise our hormone levels over a period of up to two days and thus counteract the natural way of deficiency. Even erotic fantasies will stimulate testosterone production in the short term, falling in love raises our testosterone for up to many months.

Men have the luxury of being able to affect their hormone levels through their lifestyle more than women, because their hormonal situation does not change so abruptly and radically with age.

In the “self test” on my website you will find a self-test for testosterone deficiency, which can allow an initial self-assessment. In case of doubt, a medical examination with blood test is recommended.

(Initially published in German language (‘Testosteron-Spiegel erhöhen’) in 10/2010. Image source: understandinglowt.com)

Jan 13

Have you been scared lately? If your fears come back again and restrict your daily life, this could be a phobia, a specific form of anxiety disorders. The main symptom of a phobia is an intense and persistent fear of certain situations, activities, objects, animals or people – but usually this fear is irrational, and often there was no specific previous experience that could have triggered the phobia. Phobics often try to the utmost to avoid the fear-prone situations – often to such an extent that their fear begins to interfere with daily life and increasingly dominates their thinking.

A former client would feel uncomfortable in normal social situations such as parties or business meetings and tried to avoid them if possible. Also, the eating and drinking in public was a problem for him and led to great internal stresses. This special form of phobia is called ‘social phobia’, as it relates to other people or social situations. Performance anxiety (the fear of giving speeches or performing on a stage), is something that affects many people and also a form of social phobia.

The difficulty to get rid of phobias is that rational explanations and efforts of relatives and friends almost never help, but sometimes even increase the internal pressure. Also, ‘exposure therapy’, which is a popular for TV shows on the topic -, showed only limited long term success for most people. Good success, however, can be achieved with modern psychotherapeutic approaches, like methods of hypnotherapy and solution-oriented counseling. In severe cases of phobia, medication can help get started in therapy and counseling. Thereafter, continuous work on the problem is crucial to avoid falling back into the old patterns of fear.

(This short article is part of a weekly series dealing with psychological expat problems and general mental health issues and was published in various newspapers and magazines in Thailand, 2011)

Nov 18

Bipolar Disorder: Caught between depression and excitement

John always felt that his wife was ‘changeful’ – but it took both of them years to find out that she was in fact suffering from so-called ‘bipolar disorder’. People with what was formerly called ‘manic depressive disorder’ cycle between unusually intense emotional states that occur in distinct periods: ‘manic episodes’ are defined by overly joyful or overexcited states, and ‘depressive episodes’ by extremely sad or hopeless feelings. However, sometimes symptoms of one state may also occur during the other, depending on the variation of the disorder which has been estimated to afflict about one of every 45 adults, independent of sex, culture or ethnic group.

One of the most common problems of persons dealing with this disorder is that they have serious difficulty set ting and achieving goals and maintaining stable relationships in their lives. During their manic episodes, they often experience an increase in energy, set themselves highly ambitious goals and might break up their relationships with people they consider as inferior or slowing them down. They tend to self-medicate, often through substance abuse (particularly stimulants or depressants, alcohol, cocaine or sleeping pills). Some of them tend to gambling, others might become aggressive or violent or experience a break with reality. As soon as the depressive episode kicks in, almost nothing of that remains: now, feelings of sadness, anxiety and guilt are dominating, and the person might feel isolated and hopeless. The formerly high sexual drive now almost disappears, fatigue, apathy or even suicidal thoughts may occur: The rate of bipolar patients committing suicide at certain points in their lives is very high.

Today, we still know little about the causes for bipolar disorders, but studies have indicated a substantial genetic contribution, as well as environmental influence (like an unstable or traumatic childhood). It is also likely that certain triggers are required to cause an outbreak of the disorder in some people, particularly relationship issues, cultural or job-related stress or physical illness. The basis of treatment usually consists of medication (which especially for this kind of disorder should really only be prescribed by a psychiatrist!) and complimentary psychotherapy to work on environmental triggers and efficiently learn to deal with the symptoms. The prognosis for most individuals with bipolar disorder is a good one – provided that they were diagnosed accurately and received the correct treatment.

(This short article is part of a weekly series dealing with psychological expat problems and general mental health issues and was published in various newspapers and magazines in Thailand, 2010)

Oct 28

Psychosomatic medicine is rooted in the idea of a mind-body connection, which recognizes that what a person experiences emotionally and mentally can affect his or her body. The medical community now fully recognizes the value of psychotherapy: today it is state of the art in Western clinics to offer patients complementary counseling or psychotherapy if they have to deal with severe diseases like cancer, genetic diseases, Parkinson’s disease, cardiovascular diseases and others, or if patients require surgery. Often, therapeutic counseling is also offered if someone has to deal with infertility, psychosomatic illness, allergies or other burdening physical problems where psychological factors might play a part.

psychotherapy has been shown to improve compliance and to reduce fears and phobias related to treatment procedures. It can further help reduce anxiety and depression, and to communicate better with the physicians. Observational studies evaluating the psychosocial status of patients with severe diseases like cancer even showed that patients with low levels of social and emotional support, or that suffered from chronic depression were more likely to die from cancer. Studies by S.Levy, for example, showed that breast cancer patients that had poor adjustment and lack of social support had a lower natural killer cell activity, and that natural killer cell activity predicted disease progression and disease recurrence.

However, even if some results of similar studies have shown insignificant results and though there has still lots of research to be done to find out about the correlation of well-being and physical recovery when having to face diseases, the fact that complementary counseling during treatment and recovery can strongly improve quality of living and contribute to a more balanced emotional state calls to consider counseling or psychotherapy as an important part in a holistic treatment approach. Way too often, patients recovering from surgeries or other effects of severe diseases develop depression or anxiety – and often enough it is on us – good friends or relatives – to help them regain their mental wellbeing and strength as well.

(This short article is part of a weekly series dealing with psychological expat problems and general mental health issues and was published in various newspapers and magazines in Thailand, 2010)

Sep 07

His heart starts to beat stronger with every minute, sweat starts to run down on his back and it becomes more and more difficult to get air, it is as if his lungs were blocked. Suddenly his heart begins to burn – is he finally having his first heart attack? He panics, he might die right here on the street if he doesn’t get immediate help – unbearable fear is climbing up his spine…

The effects of a panic attack vary – most sufferers feel intense fear they are having a heart attack, might ‘go crazy’ or have a nervous breakdown. Experiencing a panic attack can feel like one of the most intensely frightening, upsetting and uncomfortable experiences of a person’s life.
But unlike many might think, panic attacks are not necessarily related to high stress, but can even hit people with a very relaxed lifestyle. However, panic attacks are often indicators of anxiety disorders, depression or other psychological conditions that had been untreated (or treated improperly) for a long time. Other potential causes are side effects of medications, alcohol, medication or drug withdrawal or chronic illness.

If panic attacks are untreated, agoraphobia might develop, where a person develops a fear of having panic attacks in certain places. Concerned that they might feel trapped or run into a panic attack, they increasingly avoid any situation that might put them at risk, might avoid open spaces, to drive or even to leave their homes at all. It can also be related to social anxiety, where the fear revolves around social situations, interactions with others, or being evaluated or scrutinized by other people. This can result in one of the most harmful side-effects of panic disorder, as it can prevent sufferers from seeking treatment in the first place or to develop psychological dependence of drugs. However, treatment is possible and usually consists of regular psychotherapeutic sessions over an individually advised amount of time, sometimes combined with complimentary medication. That way, more than 90% of agoraphobics can achieve a full recovery.

(This short article is part of a weekly series dealing with psychological expat problems and general mental health issues and was published in various newspapers and magazines in Thailand, 2010)

Jun 04

If everything goes well for Paul, he enjoys his life. But then there are the times when anxiety robs his sleep and even during the day he suffers from the fear of being seriously ill. A headache could be an indication of a brain tumor; swollen lymph nodes, diarrhea, or a birthmark could be a reference to cancer; the memory of a particular sexual adventure raises fear of having been infected with HIV.

Paul spends lots of time every day examining his body for suspicious signs and to gather information about possible symptoms. The Internet turns out to be a diabolical companion: vast amounts of information are openly available, but sometimes their reliability is doubtful, or certain contradictions turn up. Doctor visits also provide only temporary relief: couldn’t the doctor have been wrong or missed something?

Often people burdened by fears like Paul’s are intelligent, physically fit and live a very healthy lives. Their fears severely constrict the extent to which they can enjoy their lives. Short spells of relief are inevitably followed by the next phase of panic-like feelings of worry.

When suffering from such fears there is no need to be ashamed. This form of anxiety has causes that are not the affected persons’ fault and can be treated with strategies applied during psychotherapy or hypnotherapy – provided that there is a readiness to attend regular counselling sessions for a certain period. During the treatment new ways of dealing with these chronic concerns will be developed, relieving the heart from the heavy cloak of fear.

(This short article is part of a weekly series dealing with psychological expat problems and general mental health issues and was published in various newspapers and magazines in Thailand, 2010)

06.01.16