This brings me to the issue at hand, HORMONES and hormone replacement therapy (HRT)! The topic has almost reached celebrity status with genuine confusion and concern regarding what is being talked about! I have been extremely perplexed at the whole notion of replacing hormones. I ask…where did they go? Which hole did they fall out of? Did a woman leave them at a party one night and wake up the asking “oh my..has anyone seen my hormones?” Our bodies have exactly what they need to make all the hormones we need at any particular stage in a women’s life. When there is trouble hormonally, it is more about RESTORING function rather than REPLACING it!

As my private naturopathic practice evolved, I was in awe at the number of women I experienced having trouble during normal hormonal transitions. I saw women having difficulty transitioning into menopause, a very natural, once celebrated once honored stage, and I also saw an extraordinary number of younger women experiencing weight gain, irritability, insomnia, decreased libido, and hot flashes. There were also women with sexual and reproductive problems—infertility, uterine fibroids, endometriosis, ovarian cysts, and severe premenstrual syndrome (PMS)—as well as breast and uterine cancer. Most of these women came in with a recommendation from their physician that they begin taking synthetic hormones. For women entering menopause it was HRT, and for the younger women it was the birth control pill. These artificial hormones suppress the body’s natural cycles; they do nothing to address why the symptoms are occurring.

A pattern was emerging among my patients, but it really hit home when my own 37-year-old body started to flare up. My periods became unbearable; I had cramping, clotting, and bloating. My PMS and irritability got so bad my family would mark the two weeks beforehand as the “red zone.” I wrestled with debilitating fatigue for the first time in my life, not to mention the unwelcome weight gain and changes in body temperature. I was frustrated because I couldn’t attribute these changes to anything different in my diet or lifestyle. I was desperate to figure out what was going on, and more importantly, what I could do about it. The stress of building my practice and business, having a family, being president of the California Association of Naturopathic Physicians, and having an overall unrelentingly stressful lifestyle was taking a toll. I had moved back to one of the most polluted—yet beautiful—areas in California. And my dietary choices tended to be less than ideal in times of stress when I needed quick energy. I was drinking coffee in the morning to get me going and looking forward to a glass or two of wine on the weekends so I could finally relax.

I was completely out of balance. My stress level was taxing my adrenal glands (the built in back up system for post menopausal hormone production). I developed digestive disturbances, which I knew were compromising my liver’s ability to do its many jobs, including processing and neutralizing hormones. The effects on my body were manifesting in the form of annoying and uncomfortable symptoms. I knew the last thing I needed was more estrogen from birth control pills. I needed to get my body back in balance. If I didn’t work to correct some things, I knew I was increasing my risk down the road for dangerous health conditions, such as cancer. Listening to the signals my body was sending, such as the difficult periods (which are not normal), then making some profound changes in my diet, lifestyle, and supplement regime got me back on track, in balance, and wiser than before. What I discovered in treating my patients and myself is that women are experiencing extreme difficulties during normal hormonal transitions due to being overall OUT OF BALANCE due to many underlying influences.

Most important, the treatment approach of just “replacing hormones” is not helping women live longer, healthier lives. More hormones are the last thing women need. In fact, this course of action could be harmful. Hormone imbalance can not only cause the symptoms mentioned above, but also can lead to cancer, heart disease, osteoporosis, and Alzheimer’s disease. Women’s hormone health did not become more problematic overnight. It has a lot to do with our modern environment and lifestyles. Pollution, stress, food quality, the way we nourish ourselves and prevailing medical practices take their toll on bodily systems. The good news is once we understand what creates imbalance; we can tap the many safe ways of restoring balance and eliminating uncomfortable, irritating symptoms while preventing disease and increasing overall quality of life and well-being.

When experiencing difficulties during hormonal transitions that are normal, natural and a birth right for all of us, before filling that prescription, take an internal inventory to see how well you are! Ask yourself these questions: What is my foundation like, are there any cracks? What is my exercise regime? Am I involved in re-creation activities? How am I moving through the stress in my life? Am I staying hydrated? Am I adequately rested with restorative sleep? How am I nourishing myself (what is my diet like)? Is it time for a 2-week cleanse? How is my digestion? Am I absorbing the nutrients I need and eliminating waste products regularly? Am I having fun? What is the quality of my relationships, with self, others and my higher source?

Listening to your body and answering these questions and increasing awareness in your life instead of increasing your hormones artificially might just be the key to overall hormonal health and well-being!

Can you tell me how you first came to yoga?

I discovered yoga while I was seeking relief from back pain…and I found that and much, much more! After two classes a week for a month, I knew that if I ever stopped doing yoga I’d be really sorry someday. I never expected to become a yoga teacher!

Would you define yourself as a pioneer in yoga in N. America? How so?

I think I’m a pioneer in wanting to bring the benefits of yoga to seniors. Most yoga in the early 90’s was geared to the hard-bodied athletic types. I knew that it was a powerful practice for everyone regardless of age or physical condition, and I started teaching to seniors. I wrote the first book that was in print at that time, Yoga for the Young at Heart, especially for senior yoga. Then I made the first Yoga for the Young at Heart video. That was the first video teaching senior yoga that I’m aware of. Recently, I launched my new website, http://www.YogaHeart.com. It’s been a great journey!

How did you arrive at the notion of accessible yoga as a driving force in your brand of yoga?

So much of the yoga we see presented is intimidating and demoralizing for people who are just beginning a yoga practice. I think that does a disservice to the gift of yoga, as well as to people who would benefit from it if they were comfortable beginning a practice. No one should be afraid to try yoga, so I wanted to make it available…and accessible to everyone. My style of teaching is not intimidating and will entice people to yoga who would otherwise be left out…even people in wheelchairs can stretch and breathe. I say, if you’re breathing, you can do yoga!

What are the defining characteristics of your approach to yoga?

On some level, yoga is accessible to every body; even only breathing is a form of yoga practice. My approach is based on the concept that the body should be gently treated and honored. Yoga is not competitive, and it shouldn’t hurt. We begin at the fitness level where we are and progress from there in a compassionate practice. We celebrate the wonder of our bodies, quiet our minds so we can hear our inner wisdom and gently become stronger, more flexible and more peaceful. Yoga works, all we need to do is do it.

Tell me more about your Basic Series for Boomers, the over 50 men and women in my age range.

Maturing Baby Boomers today are not passive about health. We’re proactive and creative. By making yoga part of our daily routines, we can develop and maintain the fitness and relaxed attitude that supports us in living life on our terms, then we can enjoy every minute to the fullest!
In my videos, the yoga student is actually joining my class and practicing along with a class of “real people”.

The Basic Series consists of three DVDs. Each program is progressively is bit more challenging than the previous one, giving the student the ability to progress in their practice, or mix the programs to fit their mood of the day. My programs bring the benefits of yoga to people who may not otherwise have a yoga practice. Or, it’s great for people returning to yoga and looking for a gentle and effective way to get back in shape.

If I’m over weight and out of shape, do you think I can do it?

My yoga programs can be adapted to any level of ability. One of the lessons of a yoga practice is self-acceptance. You can only begin where you are. Take it slowly and gently, honoring your limitations and lovingly doing what your body allows you to do. In time you’ll begin to see the positive effects of your practice and it won’t take as long as you think. Do what you can. Be patient. You have to start somewhere.

I’ve never exercised much. Why start yoga at my age?

Anyone can start yoga at any age. Baby Boomers want to stay strong, vital, healthy and youthful, and yoga has a 5000 year track record of success in doing just that. As we get older, we reach a point where we can’t get away with abusing or ignoring our bodies anymore. Either we’re doing something positive for ourselves, or we’re neglecting ourselves. We get to choose daily which way we’re going to go. To create and maintain the quality of life we desire, we need to take action! Why not start now? You won’t begin any younger!

Can yoga help prevent osteoporosis?

The Rhode Island Department of Health states, “Exercises that put demands on your bones are known as “weight-bearing” or “resistance” exercises. They help to strengthen bone. Exercise (in combination with a healthy diet and lifestyle) is important in the prevention of osteoporosis.” Yoga is a weight-bearing exercise. Our bones are not static; they are living tissue that renews itself throughout our lives. Poses that challenge our muscles put stress on our bones increase bone mass. If you do any type of weight-bearing exercise, you can begin to reverse osteoporosis regardless of age.

Other health benefits?

The list is enormous! In addition to building strength, flexibility and stamina, Dr. Dean Ornish uses yoga in his heart disease treatment programs because it lowers blood pressure and initiates the “relaxation response” of the parasympathetic nervous system. Yoga helps to prevent osteoporosis, reduces stress and stress related maladies like headaches and high blood pressure, energizes and relaxes the nervous system, hydrates the joints and spine, stretches the hamstrings and can alleviate back pain. Yoga can increase and strengthen respiration, and help to cleanse the digestive system…the list goes on and on. In short, yoga can keep you healthier, stronger and more able to do the things you want to do with vitality and focus.

How can yoga help menopause?

My video, Embracing Menopause: A Path to Peace & Power gives Boomer women inspiration in addressing our opportunity to redefine ourselves through this important life transition. We don’t need to buy into the idea that we become useless or unattractive…to the contrary, menopause is our most powerful time of life. It’s an opportunity to live our wildest dreams and be our most attractive selves. Yoga brings us back to center, helping us to remember who we really are, feel our inner strength and reconnect with our inner wisdom.

Physically, mentally, emotionally, and spiritually, menopause is a rebalancing and redefining of ourselves on the deepest levels. Many of the symptoms of menopause can be aggravated by stress, and menopause can be a stressful time of life. Yoga relaxes us, brings us into balance and helps us to tune into our deepest self. Yoga helps to cool the body, relax the nervous system, oxygenate and detoxify our organs and muscles, and prevent osteoporosis. Yoga balances the endocrine system, which can help to stabilize hormone levels, and calm our emotions. As a total practice, yoga is a powerful support through the menopause process and Embracing Menopause: A Path to Peace & Power is an easy way to begin to reap those benefits.

How often do I need to do yoga for me to feel better?

Find your own rhythm. At least two times a week for an hour would be a minimum yoga practice. Make a commitment to yourself and stick with it for a month and see how it feels. Of course, the more yoga you do, the better you will feel and the benefits will be realized faster. Stay tuned in and encourage your body to keep going. Watch your process from both the inside and the outside. If you do yoga, it works. My website, www.YogaHeart.com, provides stories from many people who have enjoyed success with the programs.

How does your seated yoga program compare with a regular yoga class?

Although a consistent yoga program of standing, balancing, lying poses and inversions is a more complete practice; yoga need not be relegated to a full yoga class. Sitting Fit Anytime is a seated yoga program for those who sit too much…at work, at our computers, traveling, or any activity that makes us forget we have a body. Doing a seated pose or two hourly throughout the day can give you some of the benefits of a yoga practice and help relieve the inevitable stiffness that comes with sitting too long. Yoga poses adapted to small interludes may not have the same intensity as a full yoga class, but the benefits of yoga are readily available to those who nibble on yoga throughout the day.

Sitting Fit Anytime is available as a CD Rom & ScreenSaver for the computer bound, or as a DVD for people who are physically challenged. Seniors can benefit from Sitting Fit Anytime to assist in building the strength and flexibility that will enable them to do a standing yoga practice if they so desire.

Can people who are confined to a wheelchair do seated yoga?

People who are physically challenged due to age, illness, or who just can’t get down on the floor, don’t need to miss out on the many benefits of yoga. Those confined to wheelchairs or recovering from injury, with their physician’s approval, can benefit from their own adaptation of the breathing and gentle seated poses. Sitting Fit Anytime, seated yoga can build the strength and flexibility, needed to progress to more and more challenging poses. Breathing, stretching and strengthening can be introduced at a slow pace, gently bringing bodies to new levels of fitness, increasing circulation and bringing in healing energy and vitality.

If I feel agitated when I sit at my computer, what can I do about that?

Your body is asking you to move! Sitting needs to be balanced with moving, breathing and stretching, so try some simple yoga stretches: twists, arms overhead, forward bends and deep conscious breathing for a “mini yoga break.” With the Sitting Fit Anytime program, you’ll feel the difference and return your attention to your work refreshed, more relaxed and with a clearer mind.

Susan, thank you for sharing your insight and knowledge with us. We appreciate your depth of experience in this wonderful area of exercise we call yoga. In conclusion, what can you tell about the mental or spiritual aspects of yoga?

Yoga is widely recognized as a spiritual path as well as a physical fitness practice. In all of my programs, I incorporate the spiritual and physical. Through yoga we learn to focus, to bring ourselves to center and to calm our minds. By quieting the mind, we can hear more clearly our quiet inner voice. That voice is our highest wisdom that can guide us to our highest path in life. We become more centered, more insightful and more peaceful. Then we can take that inner strength and peace out into the chaos of the world and hold a calm, peaceful perspective. this is how world peace can be achieved…one heart at a time.

The enzymes we need to break down and digest milk are renin and lactase. By the age of four, many of us lose the ability to digest lactose because we can no longer synthesize the digestive enzyme lactose. This lactose intolerance results in diarrhea, flatulence and stomach cramps. Some 90 per cent of adult Asian and black people, and 20 per cent of Caucasian children, are lactose intolerant.

The level of the protein casein in cows’ milk is 300 times higher than in human breast milk, which is predominantly made up of the protein lactalbumin, which is easily digestible by babies. Nature has designed the milk of each animal species specifically to meet the needs of its young. Casein is intended to be broken down by the four stomach digestive system of baby cows. In human stomachs, it coagulates and forms large, tough, dense, difficult to digest curds. When the protein of another animal is introduced into the body, it may cause an allergic reaction (Journal of Allergy, 41: 226, 1968), the most common symptoms of which are chronic runny nose, persistent sore throat, hoarseness, bronchitis and recurrent ear infections. The mucus membranes lining the joints and lungs can become swollen or inflamed, contributing to rheumatoid arthritis and asthma.

Some babies are so sensitive that they can react badly to the cows’ milk that their breast feeding mother ingests. In one study, breast fed babies were found to react to foods eaten by their mother, mainly cows’ milk and eggs, and once the mother stopped eating these, the baby’s symptoms cleared up (David Freed, ed, Health Hazards of Milk, Baslliere Tindall 1984). Cows’ milk can also clog the arteries of young children and babies. A pathologist in Derbyshire, England, noted that out of 16 cot deaths, the only baby with normal arteries was the one who was breast fed (reference, as above).

One of the most outspoken opponents of dairy products, US Dr William A Ellis says: “Over my 42 years of practice, I’ve performed more than 25,000 blood tests for my patients. These tests show conclusively, in my opinion, that adults who use milk products do not absorb nutrients as well as adults who don’t. Of course, poor absorption, in turn, means chronic fatigue” (Healthview Newsletter, Virginia, spring 1978).

Milk actively blocks absorption of iron from other sources. Breast fed babies have a much higher rate of iron absorption than those fed cows’ milk formulae, even if those formulae are fortified with iron (John Robbins, Diet for a New America, Stillpoint Publishing, New Hampshire, USA, 1987).

Milk is touted as a great natural source of calcium, and we are told to eat plenty of calcium to prevent osteoporosis, or thinning of the bones. In fact, eating dairy products can increase the rate at which calcium is lost from the body and so hasten osteoporosis. As well as being high in calcium, dairy products are also high protein foods. If we have too much protein in the diet from milk products or any other source, such as meat, fish or eggs, the body has to get rid of the excess. To do this, the kidneys must lose calcium as they cleanse the blood of excess waste, a process known as protein induced hypercalciuria (J Nutr, 1981; iii: 553; Trans NY Acad Sci, 1974; 36: 333; Am J Clin Nutr, 1974; 27: 916).

People in the United States and Scandinavian countries consume more dairy products than anywhere else in the world, yet they have the highest rates of osteoporosis (Clin Ortho Related Res, 1980; 152: 35). This fact emphasizes the threat of excessive protein in the diet and suggets that dairy products offer no protection against osteoporosis, probably due to the high protein content of milk (Am J Clin Nutr, 1985; 41: 254).

The body’s ability to absorb and utilize calcium depends on the amount of phosphorus in the diet (R Hur, Food Reform: Our Urgent Need, Heidelberg Press 1975). The higher the calcium/phosphorus ratio, the less bone loss takes place and the stronger the skeleton, provided the intake of protein is not excessive. The foods which contain higher calcium/phosphorus ratios are fruit and vegetables. Nor is low fat milk any better. It contains one per cent butter fat and a full complement of allergy inciting milk protein.

To the list of problems naturally inherent in human consumption of milk designed for baby cows, we can add a whole host of “unnatural” ones. Cows’ milk contains the accumulated pesticides that have been sprayed on the grain fed to cattle, and the female hormones given to cows to increase milk production and body fat. Some milk has also been shown to contain trace metals and radioactivity at levels higher than those permissible in drinking water (Health Hazards in Milk, reference as above). Some 20 per cent of milk producing cows in America are infected with leukemia viruses which, because milk is pooled when collected, infects the whole milk supply.

These cancer inducing viruses are resistant to being killed by pasteurization and have been recovered from supermarket supplies (Medical World News, 16 May 1969). Can it be a coincidence that the highest rates or leukemia are found in children aged three to 13 who consume the most milk products, and dairy farmers who, as a profession, have the highest rate of leukemia of any occupational group?

In our cover story this month, we’ve discovered that macular degeneration tends to be present in people with heart problems, such as high cholesterol, hypertension and atherosclerosis. It also develops in many patients with diabetes. I then came across an article on osteoporosis. A group of researchers at Tufts University, Harvard and Boston University had enlisted 2000 men and women, aged between 59-91, from the Framingham Study, the well-known study which has mapped the degenerative diseases of some 5000 residents in the small town of Framingham, Massachusetts, over 50 years.

The researchers had taken blood samples from these people during 1979-1982 and measured total homocysteine levels. These participants were then followed from that time until June 1998, and the incidence of hip fracture recorded. Those initial homocysteine levels were then compared with the hip-fracture rates.

What the researchers discovered was that those with the highest levels of homocysteine in the blood had four times the risk of hip fracture (if men) and twice the risk (if women) compared with those with the lowest levels of homocysteine. Interestingly, being male was more a risk factor than being female. Similar results were found in a Dutch study (N Engl J Med, 2004; 350: 2033-41, 2042-9).

Homocysteine is an amino acid resulting from the normal breakdown of proteins in the body. It is converted into another amino acid called methionine. Excess levels of homocysteine in the blood are an indication that this complicated process isn’t going as well as it should. It means quite simply that the body is drowning in protein.

Although the New England Journal of Medicine speculated that raised homocysteine levels could well just be an ‘innocent bystander’ to the development of osteoporosis, my own view is that this is the most crucial connection yet.

In the past, the Framingham study has determined a firm relationship between high levels of homocysteine and atherosclerosis and also stroke – the higher the level of homocysteine, the more narrowed the arteries (N Engl J Med, 1996; 332: 286-91).

It’s now been well established that raised homocysteine levels result from deficiencies of the B vitamins – specifically, B6, B12 and folic acid. Heart-disease patients with high homocysteine levels improve dramatically with simple supplements of these vitamins; in one study, for instance, the risk of vascular disease was reduced by about two-thirds (Irish J Med Science, 1995; 164 [Suppl 15]: 51A).

Low levels of folic acid and B12 have been linked to bone mineral density (Bone, 2003; 33: 956-9). It is also well known that high levels of protein in the diet predispose to osteoporosis.

However, B vitamins aren’t the entire story.

Other evidence shows that heart patients are also deficient in certain minerals, such as chromium and magnesium. All these nutrients – the B vitamins, chromium, magnesium – have one thing in common. They are all largely refined out of manufactured, high-sugar foods. Virtually any process that interferes with the natural state of a foodstuff – milling or canning grains, meats, fish and vegetables – will refine out up to three-quarters of B vitamins.

It may well be that osteoporosis, AMD and virtually all the major degenerative diseases of the West have only a single cause at their core. Everything leads back to processing and sugar. As E.M. Forster famously put it: ‘Only connect’.

Lynne McTaggart

Dual-energy X-ray absorptiometry (DEXA) uses two X-ray beams to test for levels of fat, lean tissue and bone mineral in the body.

But when doctors from St George’s Medical School in London and Dunn Clinical Nutrition Centre in Cambridge carried out scans on the same six patients at different locations, the findings on fat and lean tissue mass were wildly different.

The manufacturers could find nothing wrong with the two machines, a conclusion backed up by the fact that the bone mineral measurement was almost the same each time.

One patient was given three other scans to try and discover the discrepancy, and the readings were again very different each time (The Lancet, September 30, 1995).

After having been used for decades for birth control around the world, the black-box warning for Depo-Provera states that prolonged use of the drug may result in a significant loss of bone density, and that the loss is greater the longer the drug is taken. Also, this bone-density loss may not be completely reversible after stopping the drug. The warning also says that a woman should use Depo-Provera for birth control for no longer than two years, and only if other birth control methods have proved inadequate.

Black-box warnings are designed to highlight special problems, particularly those that are serious, and to give healthcare professionals a clear understanding of a potential medical complication associated with a drug.

The warning came about as a result of an analysis of data that finally established the drug’s long-term effects on bone density.

Pfizer, the drug’s manufacturer, is also issuing a letter to all healthcare practitioners in the US, warning them of the dangers of prolonged use of the drug.

There is a wealth of evidence to support the other measures you can take to protect yourself and your bones besides the use of a potentially cancer causing drug.Calcium and vitamin D supplements. Researchers in France (N Eng J Med, 4 December 1992) looked at more than 3000 healthy women with an average age of 84. Half were given 1-2g elemental calcium, plus 800 IU of vitamin D; the rest, a placebo. After 18 months, those taking the supplement had 43 per cent fewer hip fractures than the other group. The femoral (thigh) bone density of those in the treatment group rose by 2-6 per cent and fell by 4-7 per cent in the placebo group. An earlier study (BMJ, 7 November 1992), reported that women taking calcium alone reduced the risk of hip fracture by a quarter.

Regular, weight bearing exercise has consistently been shown to stave off bone loss. The BMJ (5 December 1992) estimates that regular exercise reduces the risk of hip fracture by 50 per cent.

Stopping smoking. Cigarette smoking accelerates the destruction of estrogen and so hastens the onset of both the menopause and osteoporosis. According to the BMJ (as above), stopping smoking reduces the risk of hip fracture by 25 per cent.

Cutting down on your intake of protein. Homeopath Miranda Castro says that, as calcium is needed to metabolize protein, a high protein diet means calcium is constantly leeched from the bones. “Osteoporosis is not known in Africa. It is much more common in the West, where protein intake is excessive,” she writes in Here’s Health magazine (March 1991).

Magnesium and zinc supplements. In her upcoming book Sexual Chemistry (Cedar Books) to be published in January 1994, Dr Ellen Grant cites a study of 19 women taking HRT and magnesium. After eight to nine months, the bone mineral density in the women taking the supplements had increased by 11 per cent. There was no increase in the women taking HRT alone. Bone minerals were still improving after two years of taking supplements. Dr Grant also claims that chronic deficiencies in zinc which is essential for normal bone formation and a co-factor for vitamin D is also a main cause of osteoporosis.

Researchers tested the rub on cream Progest on 20 postmenopausal women aged between 37 and 70. All the participants had had a hysterectomy at some stage.

The women applied one teaspoon of the cream morning and night, which is four times the manufacturer’s recommended dose. But on analysis, it was found that absorption of progesterone from Progest was far too low to offer protection or conserve bone.

The researchers, from the Menopause Clinic at King’s College Hospital in London, say Progest should not replace conventional HRT treatment (Lancet, 1998; 351: 1255-6).

Last year, however, then manufacturer Norwich Eaton were so enthusiastic that they ran a campaign which appeared to urge doctors to prescribe it for wrist and hip fractures and also as a preventive for osteoporosis in women after the menopause despite the fact that the drug was not licensed for such use. The Consumers’ Association responded angrily to such apparent poetic licence being taken, saying that the product was being “illegally promoted”. (EA of their own accord, they say, withdrew the promotion.)

When taken continuously, studies show that etidronate can cause osteomalacia an adult form of rickets caused by lack of vitamin D. In 1976, researchers found that etidronate at a dose of 20mg per kilogram of body weight per day for six to 12 months did, indeed, reduce thinning of the bones. But it also caused a reduction in bone mineralization (RP Heaney and PD Saville, Clin Pharmacol Ther, 20;593-604). Didronel PMO is designed to be taken intermittently in conjunction with calcium carbonate supposedly to prevent osteomalacia. However, at least one study suggests that taken in this way, etidronate fails to prevent the loss of vertebral bone (R Pacifici et al, Miner Electrolyte Metab, 1988; 66;747-53).

Even if the drug does work, you may just be substituting one bone problem for another. An editorial in The Lancet warns that the length of time the drug stays in the body “could theoretically lead to increased amounts of ‘old bone’ in the very long term because of reduced remodelling.” (5 May 1990) Etidronate’s established side effects include angiooedema (water retension around the heart), nausea, diarrhoea, abdominal pain, constipation and vomiting. There have also been reports of patients developing aberrations in their white blood cells.

As modern medicine has turned menopause into a disease, so it has now manufactured the male equivalent. Dr Malcolm Carruthers, a Harley Street psychiatrist and author of Maximising Manhood: Beating the Male Menopause, is one of those most responsible for coining the term “male menopause”. Although the condition was described in a medical article in 1944 (JAMA, 1944; 126: 472), it wasn’t accepted or dignified with the euphemism “andropause” until recently.

Carruthers became interested in the condition after studying 1000 men attending his London clinic complaining of numerous symptoms similar to those mentioned in the early study. These included fatigue (82 per cent), depression (70 per cent), irritability (61 per cent), reduced libido (79 per cent), awareness of premature ageing (43 per cent), aching and stiff joints in the hands and feet (63 per cent), increased sweating, especially at night (53 per cent) and even classic hot flushes (22 per cent). Some 80 per cent reported erectile dysfunction, or reduced early morning erections-an early warning sign.

Much as many like to think of this as equivalent to female menopause, there are a number of important differences between the male and female condition. The collection of symptoms reported in Carruthers’s men didn’t come on at a set threshold of life, as they do, in the main, with women. In Carruthers’s study, the men were aged anywhere from 31 to 80.

So-called andropause also doesn’t appear to be an inherent condition of being male, but one that is brought on by a variety of external factors. Ordinarily in healthy men, bioavailable levels of testosterone decline by about one per cent every year between ages 40 and 70. But this decline is more pronounced in men who aren’t healthy (Ann Med, 1993; 25: 235-41).

In Carruthers’s study, most patients had suffered some psychological or physical stress which triggered their symptoms. Nearly two-thirds reported suffering from psychosocial stress, a third had problems with alcohol consumption and a quarter with smoking. Nearly a third had suffered injuries or underwent an operation, particularly vasectomy, and almost a third were taking some form of medication. A fifth were too fat, a tenth had had some form of infection, such as the orchitis caused by mumps, glandular fever or prostatitis, and one in 20 had undescended testes.

In other words, not all men go through the menopause, as all women do. Rather than a natural diminishing of hormones, the male menopause is an unnatural insult to the male body.

There is no question, however, that this insult affects levels of testosterone, the most important male hormone. Although total testosterone levels, which is all that is usually measured in men complaining of these symptoms, were only low in 13 per cent of Carruthers’s cases, levels

of the carrier protein, Sex Hormone Binding Globulin (SHBG), were too high. These caused levels of the Free Active Testosterone (FAT), obtained by dividing total blood testosterone level by SHBG, to decrease in 74 per cent of his cases.

Carruthers argues that this biologically active testosterone in the blood and tissues decreases markedly with age. In Carruthers’s survey, andropause symptoms appear when the FAT levels fall to around 50 per cent, or if the total testosterone level is subnormal.

The problem, of course, is that the definition of andropause is so elastic that any man over 35 suffering from stress could fall into this category. Fatigue, loss of energy, depression, excessive sweating, irritability and anxiety could be symptoms of stress, undiagnosed allergies or even AIDS. Loss of memory could be due to drinking, ageing or mobile phones. A low sex drive could be caused by low levels of a variety of nutrients, or difficulties in a relationship. Most of these problems could have a source in nutritional deficiencies, which also occur more often with ageing if not addressed. In a landmark study, Dr Stephen Davies demonstrated that most adults have marked deficiencies of chromium as they age (J Nutri Environ Med, 1997; 46: 1-4).

As with women, medicine treats andropause with a magic bullet – in this instance, testosterone replacement therapy (TRT). In the US, synthetic testosterone is given by tablet or injection.

Methyl testosterone, the oral synthetic variety, has been removed from the market in Europe because of potential liver toxicity and even a possible cancer risk. Both countries offer natural testosterone implant pellets, which, when inserted under the skin, deliver testosterone over four months. America’s Food and Drug Administration recently approved a transdermal patch of natural testosterone, and pharmaceutical companies, who sniff the financial implications of discovering a new type of menopause, are at work on creams and gels.

Luckily, men are more reluctant than women to take hormone replacement and for good reason. TRT is often confused with its synthetic version, anabolic steroids, which are often abused by athletes. It’s also associated with hypersexual criminal behaviour.

Common side effects include acne, increased body hair growth, increased male pattern baldness, and increased muscle mass. Doctors are advised to monitor a patient’s liver function, and to stop their patients from taking the hormone if there is any change. Since exogenous testosterone suppresses the production of luteinizing hormone and follicle stimulating hormone, TRT lowers sperm count and general testicular volume. The longer lasting injectable preparations, which are synthetic steroids, have numerous potentially dangerous side effects, including liver toxicity from excessive doses.

The greatest issue about TRT concerns whether it causes benign enlargement of the prostate or prostate cancer, since high levels of testosterone are present in both conditions. Carruthers says that in his study, TRT did not adversely affect heart, liver or prostate gland over five years of continual monitoring.

Many enthusiasts like to tout TRT as helping to “prevent” prostate disease. Carruthers says that in his study, 12 cases of early non invasive prostate cancer were found prior to testosterone treatment in his first 1000 patients. During treatment, he says, only two developed it, and they were picked up by repeated screening at an early, treatable stage. “This would suggest that by providing the benefit of this careful repeated screening, testosterone treatment is overall more likely to save lives from prostate cancer than to cause it,” says Carruthers.

By test, presumably he means the prostate specific antigen (PSA) test, which has been wrong in detecting cancer 52 per cent of the time (JAMA, 1995; 273: 289-94). Even a recent ejaculation can send PSA levels soaring (Urology, 1996; 47: 511-16).

This echoes the logic used by many doctors in their claims that HRT, by requiring constant monitoring to detect whether it has caused breast cancer, actually helps “prevent” it.

In the medical literature, Carruthers argues that testosterone treatment has been used in a multitude of studies right round the world often in much higher doses than those used to treat the andropause without any convincing evidence of it causing either benign enlargement or cancer.

It’s true that little evidence exists on the effects of long term TRT. However, a few medical reports have established a relationship between TRT and prostate cancer or prostatic disease (Arch Intern Med, 1989;149: 2365-6).

Furthermore, animal studies have shown that synthetic testosterone supplementation is twice as potent in stimulating prostate growth as ordinary testosterone (J Clin Endocrinol Metab, 1998; 83: 4212-9). Other animal tests show that synthetic testosterone causes significant growth of cells in the prostate (Anat Rec, 1998; 252: 637-45). While these animals studies may be irrelevant to human experience, they do raise significant questions.

In one other human study, which followed 23 middle aged men given TRT for eight months, the average prostate volume increased by 12 per cent (Prostate, 1993; 23: 99-106). However, TRT may only have this effect on older men; a study of healthy young men with a normal prostate who were given testosterone injections didn’t show any increased prostate size or activity (Urol, 1998; 159: 441-3).

This means that TRT may have a negative effect only on the population most likely to use it. Indeed, one other study showed that prostate size increases with age in men with low levels of hormone treated with testosterone (Clin Endocrinol [Oxf]. 1994; 40: 341-9).

As with female HRT, TRT is being promoted as the equivalent of a male fountain of youth, which will help to stave off heart and bone problems. Testosterone is an anabolic hormone, which helps to build protein tissue, muscles, bones and connective tissue hence why synthetic versions help pump up athletes. Therefore, the argument goes, taking testosterone must serve a function in preventing osteoporosis. Although a few studies show that bone mineral density increases during TRT (Pol Arch Med Wewn, 1998; 100: 212-21), no solid evidence has demonstrated that testosterone will actually prevent bone loss, any more than there is good evidence that HRT prevents osteoporosis in women (see WDDTY Guide to the Menopause).

Palidronate, originally developed for bone problems in cancer patients and Paget’s disease of bone, is now being (wrongly) used to treat bog standard osteoporosis. One common side effect is low levels of blood calcium and magnesium, which would exacerbate osteoporosis.

Instead of relying on a magic bullet, any man suffering from what he considers the “andropause” might do better to work with a good nutritionist, who will suggest a nutrient dense diet with appropriate supplements and regular exercise. As with women, as WDDTY panel member Annemarie Colbin writes in her new book Food and Our Bones (New York: Dutton-Plume, 1998), bone loss is not inevitable with ageing or loss of sexual hormones, but has more to do with Western diet. See WDDTY vol 9, no 10 for a detailed dietary programme for minimising bone loss. Briefly, eat fresh, unrefined and organic foods, good quality plant or animal protein, soy products, high iodine sea vegetables, whole grains and lots of water.

Harald Gaier is on holiday. His Alternatives column will return next month.