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Integrative medicine and men's health beyond 40

Aging better than gracefully


Men over 40, this one is for you. 


All of us, myself included, want to not only age gracefully but vitally. As I frequently describe, there are foundational principles we all should follow regardless of age. That said as men age there are unique changes to our metabolism and physiology to which we need to attend. We also need to be cognizant of “what’s likely to kill you” and try to put off, as long as possible, the presentation of those conditions. 


Laying the Foundation: General Principles for Holistic Well-being

Let's first establish a solid foundation by focusing on three fundamental risks of health as we age: cardiovascular fortitude, cognitive resilience, and inflammation management. Then, we need to address a crucial aspect of men’s health: prostate health.


1. Cardiovascular Fortitude

Men over 40, listen closely. 


Prioritizing cardiovascular health is your key to a flourishing future. Engaging in regular aerobic exercises such as brisk walking, jogging, or cycling enhances heart function and promotes overall vitality. 


Resistance training, body weight exercises like squats, planks, push-ups, and others are critically important to maintain muscle mass as we age. Complement these exercises with a heart-healthy diet rich in omega-3 fatty acids and antioxidants, found in fatty fish, nuts, and vibrant berries.


2. Cognitive Resilience

Preserving cognitive function is paramount as we age. 


Men can actively contribute to this endeavor by engaging in mentally stimulating activities and continuous learning like learning a new language or how to play an instrument. Admit it: you always wanted to play the guitar. 


Just as important is maintaining and expanding those social connections with extended family and friends. Additionally, adopting an anti-inflammatory diet, abundant in fruits, vegetables, whole grains, and lean proteins, supports brain health, offering protection against cognitive decline.


3. Inflammation Management

Inflammation, often a silent contributor to age-related ailments, can be mitigated through conscious dietary choices. 


Embrace an anti-inflammatory lifestyle, focusing on foods that combat inflammation at the cellular level. Incorporate fruits, vegetables, whole grains, and healthy fats rich in omega-3 fatty acids into your daily meals to foster overall well-being. 


Stress reduction is key throughout our life and the balance we all need as we age includes regular mindfulness activities like meditation, yoga, breath work, or prayer to keep inflammation in check.


Prostate Health: Nurturing the Silent Guardian

Before we dive into erectile dysfunction, it's essential to shine a spotlight on prostate health, a vital but often overlooked aspect of men's well-being.


The prostate gland, a walnut-sized structure at the base of the bladder, plays a significant role in male reproductive function throughout life, but its function changes as men age. Here's a breakdown of the primary role of the prostate in different stages of a man's life:


Early adulthood (20s-30s):

  • Production of seminal fluid: The prostate contributes around 30% of the seminal fluid, a nutrient-rich fluid that nourishes and protects sperm. This fluid helps sperm survive their journey to the egg and aids in fertilization.

  • Muscle control for ejaculation: The prostate surrounds the urethra, the tube that carries urine and semen. During ejaculation, the prostate muscles contract to propel semen out of the penis.


Middle age (40s-50s):

  • Enlargement: Around this age, the prostate often begins to enlarge. This is a natural process called benign prostatic hyperplasia (BPH) and is not cancerous. 

  • Bladder obstruction: An enlarged prostate can press on the urethra, making it difficult to urinate fully or empty the bladder completely. This can lead to symptoms like frequent urination, weak urine flow, and straining to urinate.


Later age (60s and beyond):

  • Increased risk of prostate cancer: The risk of prostate cancer rises with age. While the prostate continues to be involved in urination and ejaculation, its primary function becomes a concern due to the potential for cancer development.


It's important to note that not all men experience prostate enlargement or cancer as they age. However, regular checkups with a doctor, including prostate exams and PSA tests, are crucial for early detection and management of any potential issues.


Incidence of Benign Prostatic Hyperplasia (BPH)

As men age, the prostate may undergo changes leading to a condition known as Benign Prostatic Hyperplasia (BPH). Symptoms include frequent episodes of getting out of bed to urinate at night, increasing sense of urgency to urinate, trouble starting to urinate, weak stream when urinating, or not being able to empty the bladder completely. 


Approximately 50% of men over 50 and 90% of men over 80 may experience symptoms related to BPH. Understanding these statistics emphasizes the need for proactive measures to support prostate health.


Link to Prostate Cancer

There's a crucial link between prostate health and the risk of prostate cancer. Prostate cancer is the most common cancer in males, underscoring the importance of early detection and holistic preventive strategies.


 The incidence of prostate cancer as men age:

  • 5.2% of men in their 60s

  • 9.1% of men in their 70s

  • 14.3% of men over 80


Dietary Considerations

An anti-inflammatory diet that supports cardiovascular health is also beneficial for the prostate. Incorporate lycopene-rich foods like tomatoes, watermelon, and pink grapefruit. Cruciferous vegetables such as broccoli and cauliflower, and green tea with its potent antioxidants, are valuable additions.


Regular Exercise

Engaging in regular physical activity, particularly aerobic exercises, not only contributes to cardiovascular health but also helps maintain a healthy weight, reducing the risk of prostate issues.


Supplements and Prostate Health 

Certain supplements, such as saw palmetto, beta-sitosterol, and selenium, have shown promise in supporting prostate health. It's essential to approach supplementation with caution if you are having symptoms of prostate enlargement and especially if you are having more serious symptoms like discomfort with urination or any blood in the urine. 


Navigating Erectile Dysfunction

Now that we've laid the groundwork, let's delve into other men-specific health concerns, starting with the often-taboo topic of erectile dysfunction (ED). Recognizing that ED is not just a physical issue, but a complex interplay of physical and psychological factors is essential.


Understanding Erectile Dysfunction

ED becomes increasingly prevalent as men age, affecting a significant percentage. Studies indicate that approximately 40% of men in their 40s experience some degree of erectile dysfunction, with this percentage rising to 70% for men in their 70s. This highlights the importance of addressing ED as a common aspect of aging, necessitating a holistic and proactive approach to maintaining both physical and mental well-being.


ED can stem from various causes–hormonal imbalances, cardiovascular issues, psychological stress, or a combination of these factors. Just to emphasize the cardiovascular component, if you have an elevated LDL level in your cholesterol panel it could be contributing to your ED due to the effect on your microvascular blood vessels. Acknowledging the multifaceted nature of ED empowers men to seek comprehensive solutions that address the root causes rather than merely treating symptoms.


Holistic Approach to Erectile Health

A holistic approach encompasses both physical and psychological dimensions. Counseling and psychological support should be integrated into any strategy to address the emotional aspects contributing to ED. By fostering a supportive environment, we empower men to confront and overcome the psychological barriers that may exacerbate erectile challenges.


Testosterone Replacement Therapy (TRT)

Testosterone Replacement Therapy (TRT) has recently gained attention as an intervention for men experiencing ED. 


Testosterone, the cornerstone of male vitality, experiences a natural decline with age. For some men, this decline may lead to symptoms such as fatigue, reduced libido, and mood disturbances. Understanding the medical indications for TRT involves a comprehensive evaluation of a patient's health history, symptoms, and hormonal profile. 


Not surprisingly, before we jump to TRT we will want to address other causes of low testosterone and its associated symptoms as outlined in this article:


  • Are you getting enough sleep? Lack of sleep is known to lower testosterone levels by 15% as evidenced in one study.

  • Maintaining a healthy weight as obese individuals can have up to a 30% drop in testosterone.

  • A whole-food diet will help inflammation, which can contribute to lower testosterone levels

  • Being active with a focus on resistance training has been shown to increase testosterone acutely by 15-30%

  • High stress and cortisol levels have been known to decrease testosterone levels

  • Specific micronutrient deficiencies such as Vitamin D and hormones like DHEA have been shown to correlate with lower testosterone levels. 

  • Minimize alcohol and narcotic use due to its negative impact on testosterone


TRT, at its essence, is about restoring hormonal balance. The approach involves a nuanced combination of pharmaceutical and supplement-based interventions, each tailored to address the specific needs of the individual. Pharmaceutical options, such as testosterone injections or transdermal patches, may be employed under close medical supervision. Additionally, carefully selected supplements, including DHEA, zinc, and vitamin D, complement the therapeutic landscape.


The medical indications for TRT include:

  1. Hypogonadism: This is the most common reason for TRT. Hypogonadism refers to a condition in which the testes produce insufficient testosterone. It can be either primary (testicular failure) or secondary (resulting from dysfunction of the hypothalamus or pituitary gland). Measurement of a serum total testosterone below 300 ng/dl is a required part of the evaluation although there is variability from individual to individual. 

  2. Andropause or Age-Related Hypogonadism: As men age, testosterone levels tend to decline gradually. Some men may experience symptoms such as fatigue, reduced libido, and mood changes due to age-related testosterone decline. TRT may be considered in such cases, especially if symptoms are severe.

  3. Delayed Puberty: TRT may be prescribed for adolescents who experience delayed puberty due to insufficient testosterone production.

  4. Testicular Injury or Damage: Trauma or injury to the testicles can impair testosterone production, and TRT may be considered to supplement the natural production.

  5. Pituitary Disorders: Dysfunction of the pituitary gland can lead to insufficient stimulation of the testes, resulting in low testosterone levels. TRT may be used in such cases.


Here are the primary medical indications and symptoms indications for TRT:


Confirmed hypogonadism with symptoms:

  • Sexual dysfunction: This includes low libido, erectile dysfunction, and decreased spontaneous erections.

  • Physical symptoms: Decreased muscle mass and strength, increased body fat, decreased bone density, fatigue, and loss of energy.

  • Psychological symptoms: Poor mood, irritability, depression, and trouble concentrating.

  • Other signs: Decreased facial and body hair growth, gynecomastia (breast enlargement in men).


Other potential indications for TRT, which are still under research and have less clear evidence:

  • Testosterone deficiency linked to HIV/AIDS.

  • Osteoporosis in men.

  • Cognitive decline and memory problems.


It's important to note that TRT is not appropriate for everyone, and there are potential risks and side effects to consider. TRT requires ongoing monitoring of not only testosterone levels but also PSA as well as other markers. Therefore, it's crucial to consult with a healthcare professional to determine if TRT is right for you. They will assess your individual situation, including your symptoms, testosterone levels, health history, and potential risks and benefits.


Here are some additional resources you may find helpful:


Embracing a holistic approach becomes even more important for men's health as they move beyond 40 years old. Integrative medicine will help guide you towards enduring well-being, not just avoiding bad outcomes.


From fortifying cardiovascular health and preserving cognitive function to addressing men-specific issues like prostate health, erectile dysfunction, and navigating the nuanced realm of TRT, the goal is to maximize vitality and minimize progression of normal physiologic processes. Finally and most importantly, paying attention to the increasing risk of chronic disease as we age.

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