by Dr. Bill Rawls
With aging comes change — some of it welcome (kids and grandkids, greater wisdom and stability), some not so much (we all know what’s on this list). Certain factors can make getting older and the hormonal flux that comes with it more challenging, and unfortunately, chronic illness is one of them.
For example, if a chronic illness such as chronic Lyme disease, fibromyalgia, or chronic fatigue syndrome contributes to your sleep trouble and you’re a woman, you may find that when you enter perimenopause or menopause, the related night sweats and declining estrogen levels can amplify the difficulty you have falling or staying asleep at night. Similarly, in men, Nizagara research shows that declining levels of the hormone testosterone can lead to disrupted sleep, which may already be an issue for those with a chronic health condition.
Other symptoms that may worsen when chronic illness and aging-related hormone changes collide include weight fluctuations, lower energy levels, mood swings, loss of bone density, loss of libido, sexual dysfunction, and more.
Managing both chronic illness and the symptoms of shifting hormones at the same can feel like a double whammy, but in reassuring news, there are steps you can take to alleviate both. Keep reading to understand what happens hormonally as both women and men age, and gain advice for both minimizing the fallout and keeping chronic illness in check.
Menopause and Andropause, Defined
Hormonal changes tend to get more attention in women than in men, likely because the main end result — the loss of ability to bear children — is a significant life change. It’s also a gradual one, with production of estrogen and progesterone declining over several months to years.
When a woman hasn’t experienced a period or spotting for 12 consecutive months, she has reached menopause and is no longer able to get pregnant. In the United States, the average age of menopause for women is 52, according to the Office of Women’s Health of the U.S. Department of Health and Human Services.
But women aren’t alone in experiencing hormonal shifts with age. Some men enter a milder transitional period commonly referred to as andropause (also called late-onset hypogonadism, testosterone deficiency syndrome or TD, and low testosterone or low-T) around the age of 40, when testosterone levels begin to drop about 1% a year.
But unlike menopause — a natural process all women go through, regardless of health habits — andropause in men is not natural, and most men do not experience symptomatic hormone decline. But it is on the rise. A 2017 study, published in the journal Human Reproduction Update, documented a 50-60% decline in male sperm counts from 1973 to 2011, which suggests a dramatic decline in testosterone as well.
In addition, studies suggest a striking increase in the incidence of late-onset hypogonadism, defined as the reduction or absence of the production of sex hormones by the sex glands: Older studies from about 75 years ago put the incidence at 2%, while more recent ones are finding a rate of 20% in males over age 60, 30% in males over age 70, and an even greater one in elderly males.
That’s alarming. It suggests that something has changed in the world in recent years that’s affecting male reproduction. Top of the list of possible reasons for the decline include excessive carbohydrate consumption, high concentrations of xeno-estrogens in the environment (estrogen-like compounds that disrupt testosterone production), chronic stress, and sedentary lifestyle.
While these same factors do not influence the age of menopause onset in women, they do affect degree of symptoms. They’re also associated with increased risk of hormonally-related cancers, including breast cancer in women and prostate cancer in men.
Regardless of your gender, it’s important to be proactive about your health to enjoy healthy aging. To support your body and ease the symptoms of chronic illness and age-related hormonal changes, here are some natural approaches to help smooth out the transition so you can feel your best at any age.
Natural Help for Menopause
The hypothalamic-pituitary-adrenal (HPA) axis characterizes the relationship between the hypothalamus, pituitary gland, and adrenal glands. The primary job of the HPA axis is to facilitate the body’s stress response and secretion of hormones, like cortisol (a stress hormone), quickly and efficiently. The correlation between the HPA axis and menopause is complex but important, and further research is needed to understand additional aspects of how the two are interconnected, according to a study in the journal, Menopause.
Currently, we know that the hormonal fluctuations associated with menopause cause cortisol levels to wax and wane and disrupt the HPA axis and autonomic function. The result is classic symptoms such as body thermostat variation, hot flashes, sleep disturbances, changes in fat distribution, heart rate changes, and often fatigue. Perimenopause, the stage leading up to menopause, can include all the above symptoms, as well as irregular and sometimes heavy menstrual periods.
Because menopause that occurs on top of chronic illness can exacerbate an array of symptoms, it’s important to take a comprehensive approach to navigating both.
Reach for the Right Herbs
The benefit of certain herbal therapies is that they help balance the HPA axis, which can work to alleviate some of the overlapping symptoms of menopause and chronic illness, including difficulty sleeping, moods swings, fatigue, loss of libido, and brain fog. Some of the best herbs for this include:
- Ashwagandha: This herb is known to have multipurpose properties that affect different systems of the human body, such as the neurological system, the immune system, the energy-production system, the endocrine system, and the reproductive system, reports a study in the Indian Journal of Psychological Medicine. It found that ashwagandha improves a person’s response to stress, and the study participants self-reported improvements in anxiety, insomnia, and an enhanced sense of well-being.
- Chinese tree bark: This herb has a long history of use in Traditional Chinese Medicine (TCM). It’s used for its ability to nourish the liver and kidneys, increase strength in the muscle and bones, and more. It helps normalize adrenal function and balance the HPA axis.
- L-theanine: An amino acid found in green tea and certain mushrooms, l-theanine is a precursor to GABA, a calming neurotransmitter in the body. What makes l-theanine unique is that it crosses the blood-brain barrier, lessens anxiety, and brings about a state of calm and improved concentration. All this minus sedation or that hangover feeling that can come with some medications.
Stress Less, Sleep More
I know this is easy to say, hard to do — especially considering both chronic illness and hormonal flux have a tendency to add stress and steal sleep. But it’s important to keep trying to address both, because chronic stress and lack of sleep can do a number on the HPA axis and immune function.
Chronic stress signals to the body that it’s in a constant fight or flight mode, and the body responds with compromised immune function and increased inflammation — two things you definitely don’t want while trying to manage a chronic illness and menopause symptoms. Furthermore, lack of sleep can compound problems like brain fog, anxiety, depression, and muscle aches and pains.
Try your best to invite more calm and rest into your life so that your body has the time and energy it needs to restore and repair itself. You may find that activities like yoga, meditation, or spending time in nature calm you and reset an overtaxed nervous system.
Eat Real Food
By that I mean eat whole, unprocessed foods — the kind with labels that are short and understandable or totally absent (as with fresh fruit and vegetables). That’s in stark contrast to the modern Western diet, which is typically highly processed and full of refined carbohydrates, sugar, saturated fats, and all sorts of preservatives and chemicals, and tends to fall short on providing the body with the nutrients it needs to achieve optimal health. To nourish your body, head to the perimeters of the grocery store and stock up on fresh produce, lean protein, and healthy fats.
Reduce Your Toxin Exposure
Many of us may go about our daily lives and don’t give a second thought to the toxic substances that surround us. But our bodies are continually burdened by a wide spectrum of toxins, many of which are hormonally active.
Toxic exposure can lead to increased inflammation, further hormone disruption, and a sluggish immune system. While you can’t escape all toxins, be on the lookout for hidden sources, and support your body’s natural detoxification powers with herbal and natural supplements such as chlorella, andrographis, milk thistle, dandelion, resveratrol, and turmeric.
Consider Hormone Replacement
Since estrogen levels ebb and flow during the menopause transition, a woman may cycle through times of estrogen dominance due to reasons like excess body fat, chronic stress, and environmental factors. In this case, using a natural progesterone cream may warrant further consideration. It’s available over-the-counter, opposes estrogen dominance, and helps prevent heavy periods during perimenopause. Natural progesterone also reduces menopausal symptoms and slows bone loss. Typically, it’s applied to the skin daily.
Some women may need a little extra help beyond herbs and natural progesterone cream. If symptoms like hot flashes, vaginal dryness, mood changes, and painful intercourse persist after menopause, a combination of bioidentical estrogen replacement and progesterone may be helpful. This requires a prescription from a licensed healthcare provider.
Hormone replacement therapy (HRT) may be contraindicated in women with a history of heart disease, personal or familial breast cancer, elevated triglyceride levels, liver or gallbladder disease, or a history of strokes or blood clots. HRT should be used at the lowest dose that relieves symptoms for the shortest period of time. When properly administered, HRT can be life-altering.
Natural Help for Andropause
Generally, a healthy male will maintain robust testosterone levels until the end of his life — not being able to do so is a definite sign of poor health. Factors such as chronic illness, stress, and medications can impact testosterone levels. Some of the symptoms associated with low testosterone in men include erectile dysfunction, fatigue, irritability, and depression, as stated by the Urology Care Foundation.
As with menopause, implementing all of the same key health-conscious practices — managing stress, getting plenty of sleep, eating a clean whole-foods diet, and reducing toxin exposure — form the basis of managing symptoms of low testosterone as well as chronic illness. Add these habits to your daily routine as soon as possible, then considering the following herbs.
Take Energizing Adaptogens
Adaptogenic herbs can be highly effective for supporting hormonal health in men and relieving some of the symptoms that coincide with low-T and chronic illness. Traditionally, the four herbs below have been revered for their revitalizing and age-defying properties, and for their power to enhance sexual energy.
- Epimedium grandiflorum: This plant, which is native to China, Japan, and Korea, is used in Traditional Chinese Medicine (TCM). In addition to being considered an adaptogenic herb, meaning it helps to balance the HPA axis, epimedium may support sexual health, increase energy, bolster the immune system, and support cardiovascular health.
- Tongkat ali: This adaptogenic herb is native to Southeast Asia, and it’s long been used to promote sexual health and vitality. Tongkat ali works to balance the HPA axis, and it may increase sex drive, enhance sexual performance, boost energy levels, elevate mood, and more.
- Eleuthero: Eleuthero has a long-standing history as an adaptogenic herb that has a positive impact on a person’s tolerance to stress, and it fosters an overall sense of well-being. Additionally, it may have a positive influence on gut health, increase stamina, and support liver health.
- Rhodiola: Like the other adaptogens, rhodiola assists in balancing the HPA axis. Also, it may enhance cognition, increase alertness and focus, support healthy stress response, and improve libido.
Be Wary of Hormone Replacement
It’s important to recognize that low testosterone is a symptom of poor health, not a natural process. Taking testosterone is treating the symptom, not the cause, which is always fraught with peril. Not surprisingly, there are significant risks associated with hormone replacement therapy in men. Treating low testosterone production related to poor health with testosterone — a driving anabolic steroid that pushes the body even harder — can be downright dangerous.
Testosterone replacement therapy has been linked with increased risk of stroke and heart attack, accelerating non-cancerous prostate growths, encouraging the growth of existing prostate cancer, and increased blood clots in the veins. Furthermore, testosterone suppresses the body’s natural testosterone secretion, and it may alter sperm production.
Ultimately, the decision to pursue testosterone replacement should be weighed very carefully. Try herbal therapy and improved health habits first — most men find that route to be quite satisfactory. If you do make the decision to do testosterone, start with the lowest dose possible to achieve benefit. To make sure levels remain in a healthy range, patients should have their testosterone levels measured and adjusted as needed every six to 12 months. Know that once you take the first dose of testosterone, there is no turning back — you will have to take it the rest of your life at progressively increasing doses to feel normal.
Aging may be inevitable, but it doesn’t have to be synonymous with miserable symptoms — even if you also suffer from a chronic illness. On the contrary, getting older can be a wonderfully positive and health-filled experience if you’re proactive about making the smart choices outlined above. And by the way, it’s never too early get started! The sooner you do, the more manageable your experience with menopause or androgen is likely to be.
1. Chandrasekhar K, Kapoor J, Anishetty S. A Prospective, Randomized Double-Blind, Placebo-Controlled Study of Safety and Efficacy of a High-Concentration Full-Spectrum Extract of Ashwagandha Root in Reducing Stress and Anxiety in Adults. Indian Journal of Psychological Medicine. 2012 Jul-Sep; 34(3): 255–262. doi: 10.4103/0253-7176.106022
2. Eucommia Bark (Du Zhong). Chinese Healing Herbs website. http://www.chineseherbshealing.com/eucommia-bark/
3. Fugate Woods N, Sullivan Mitchell E, Smith-DiJulio K. Cortisol Levels during the Menopausal Transition and Early Postmenopause: Observations from the Seattle Midlife Women’s Health Study. Menopause. 2009 Jul–Aug; 16(4): 708–718. doi: 10.1097/gme.0b013e318198d6b2
4. Menopause Basics. Office of Women’s Health website. https://www.womenshealth.gov/menopause/menopause-basics
5. Salleh MR. Life Event, Stress and Illness. The Malaysian Journal of Medical Sciences. 2008 Oct; 15(4): 9–18.
6. Singh P. Andropause: Current concepts. Indian Journal of Endocrinology and Metabolism. 2013 Dec; 17(Suppl 3): S621–S629. doi: 10.4103/2230-8210.123552
7. What is Low Testosterone? Urology Care Foundation website. http://www.urologyhealth.org/urologic-conditions/low-testosterone
8. Levine H et al.Temporal trends in sperm count: a systematic review and meta-regression analysis. Hum Reprod Update. 2017 Nov 1;23(6):646-659.
9. Huhtaniemi I. Late-onset hypogonadism: current concepts and controversies of pathogenesis, diagnosis and treatment. Asian J Androl. 2014 Mar-Apr;16(2):192-202.
10. Huhtaniemi I, Forti G. Male late-onset hypogonadism: pathogenesis, diagnosis and treatment. Nat Rev Urol. 2011 Apr 19;8(6):335-44.