The news about a rise in cases of young men with low testosterone has
become a source of worry to all, especially young women who are looking
forward to getting married and having children. Also, doctors have
discovered a worrisome increase in the female hormone, oestrogen, in
more men.
The findings have affected the psyche of many young ladies and
mothers who are now mulling the possibility of asking suitors to go for
testosterone (fertility) tests and getting clean bill of health before
accepting their marriage proposal.
This is to ensure that they are not getting married to ‘feminine’
men. Usually, in marriages where couples experience delay in conception,
accusing fingers are pointed at the woman.
In most cases, the woman runs from pillar to post, seeking medical
intervention for a health challenge that is not hers while the man is
adjudged fit. Testosterone is the defining hormone of a man, while
estrogen is the defining hormone of a woman, but estrogen is not
exclusive to women.
Some male, unfortunately, have more estrogen than necessary in the
system and this creates serious complications. Nowadays, the cases of
low testosterone in young men are common due to a number of internal and
external factors.
Researches have shown that high estrogen levels produced by the body
as a feedback to the hypothalamus or pituitary gland are bad for men.
This shuts down testosterone production which causes chronic
inflammation and several other reproductive diseases.
Dr. (Mrs.) Cynthia Obiora, a surgeon with Havana Hospitals, Lagos
Island, Lagos, said it’s true that low testosterone is rampant in men
over 50 years old. She added that it can affect men in their early 30s
and 40s, or even younger men. She noted that, as men grow in age, the
testosterone levels naturally declines. This is never a problem for men
just as in the case of women. But when it happens when a man is in his
prime, it becomes problematic.
“When the case is low testosterone in young men, it is defined as the
serum testosterone level. Low testosterone symptoms begin to appear to
be 300 nanograms per deciliter (9 ng/dl), or a free testosterone level
below 9 ng/dl.
This same level applies to older men,” she stated. The Consultant
Surgeon added that, while older men may find their testosterone levels
fall below threshold over time, largely due to different illnesses
including measles and staphylococcus, younger men in their 20s have
testosterone levels below 300 ng/dl. It was gathered that a 20 to 22
year-old male normally produces 5 to 10mg daily of testosterone.
It’s during this age range that men are at their physical peak of
testosterone production. But this production can be hampered by
illnesses.
Morning glory
It’s expected that a man has erection in the morning. Such erection
tells a lot about the sexual health of a male. Children should also
experience that too.
Absence of ‘morning glory’ for days needs to be investigated as it is
a sign of impending impotence. Dr. Perry Iloegbunam of Stem Cell
Transplant and Treatment, Enugu, said: “Weak wake erection is a sign of
impotence that requires immediate action if the organ has not been
affected.
Even with stress, when you wake up, your manhood should wake up with
you and you will need to work with it. This is the more reason people
engage in early morning sexual intercourse, than any other time of the
day. Between 4am and 6am, a sexually healthy man should have good
erection. Sex at this point is the sweetest.
Causes of low testosterone in men
A Lagos-based surgeon, Dr. (Mrs.) Obiora who insisted on a
comprehensive fertility test from her son-in-law before accepting
marriage proposal, observed that low testosterone in young men is caused
by illness or external factors that affect the testicles and pituitary
gland.
Two different types of low testosterone exist. The first type,
referred to as primary testicular failure, is caused by illness or
external factor, which affects testicles’ ability to produce
testosterone normally.
While the secondary hypogonadism encompasses a failure in the
communication loop between one’s hypothalamus for one reason or the
other.
She noted that a few possible causes of low testosterone in young men
include Sickle cell diseases, physical damages to the testicles,
obesity, pituitary disease, Down syndrome, Klinefelter syndrome,
alcoholism, damage to the testicles from illness or chemotherapy, opiate
pain medication use or abuse and hemochromatosis among others.
For more emphasis, she stressed that though one or more of these
factors don’t mean a male has low testosterone, but a combination of
these symptoms with a history of one or more of the illnesses mentioned
above, may indicate low testosterone.
Symptoms of low testosterone in young men
Dr. Perry Iloegunam corroborated Dr. Obiora’s claim when he said the symptoms vary from one patient to another.
The possible symptoms of low testosterone in young men include loss
of endurance, sexual dysfunction, weight problems, fatigue, trouble
concentrating, loss of weight, loss of libido, depressed mood, muscle
weakness and loss among others. He advised young men, who experience
such symptoms, especially when they have had untreated STDs, to seek
advice from medical experts.
Defining estrogen as a female hormone that belongs to a set of
molecules known as steroid hormones, Dr. Perry said estrogen is produced
in women’s ovaries and little amounts are made in men’s testes, adrenal
and pituitary glands of males.
Men usually have low levels of estrogen and a number of undesirable symptoms can result when levels of estrogen are too high.
“In the case of hormonal imbalance, we evaluate hormones, test the
saliva and not just the blood. Saliva has been shown to reveal the
active hormone inside the cell at the site of an action. After initial
testing and a therapy programme, hormone levels are re-evaluated to
ensure the progression of treatment and necessary changes,” he said.
Fertility centres worried about quality of sperm
In blood banks, one can get low and high quality blood samples, the
same is applicable to sperm bank. “The quality of sperm we get
determines what to do with it. Some are so bad and cannot be used, while
others can be managed and boosted.
The quality of spermatozoa has a lot to do with age and feeding
pattern. If we have good sperm, it would be good enough to form zygotes
with ova,” said a lab scientist, Theresa Ashakegbe. Managing Director,
Nordica Fertility Centre, Dr. Abayomi Ajayi, added: “We are worried
about the quality of sperm we get.
Some people will come with donors but
when we check it out, it does not give us what we want. I wish I know
the causes of impotence. It’s happening all over the world. It’s not
just a Nigerian problem.
Many people are debating whether the causes of infertility come with
human beings right from childbirth or while in the womb or possibly
inherited and from external forces.” He noted that when a man inherited
infertility, it becomes problematic to cure, adding that anything that
is inherited cannot be cured but could be treated.
“IVF technology makes us to bypass the problem, that’s not solving
the problem. We have seen there are many factors responsible for it
including environment, lifestyle but there is no singular factor one can
say causes infertility.
If there is, it would have been easy to prevent it.
“It’s multi-factorial. But one thing is certain, the more one lives a
healthy life, the better you take away many vices – alcohol, tobacco,
and drugs, better for us. Also, the nature of job a man does can
contribute to male infertility.
“The quality of sperm we get is really dropping drastically on a
regular basis. We don’t just use people’s sperm anyhow. We have a
technology that helps us screen the sperm to find out whether there is
any congenital disease or deformity in it before giving it out.
This helps greatly in preventing the birth of children with Down
syndrome or albinism into the world. “Also, the quality of sperm we get
is affected by age and diet. Aged people are more likely to give you
sperm that is infertile and cannot make a baby. In most cases, the sperm
will not be good enough to sustain a pregnancy and that is why few
weeks after pregnancy, it is lost.”
Causes of high estrogen level in men
A Consultant Gynecologist with the Federal Medical Centre (FMC),
Lagos and the Managing Director, 3D Ultrasound Clinic, Dr. Greg Alabi,
said the causes of high estrogen level in men are from high aromatase
activity.
According to him, aromatase is the enzyme that converts
androstenedione and testosterone into estrone and estradiol
respectively.
Aromatase is present in many different tissues, but in men, it’s
highly concentrated in that mid-life bulge. He said: “Aromatase activity
in men accounts for 80 per cent of estrogen production. Over-dosage of
testosterone leads to high estrogen and this causes the Testosterone
levels in men to be very low.
The solution for this problem as experimented by most physicians is
to increase the testosterone without evaluating the underlying causes
for low testosterone. Over-dosage of testosterone increases estrogen
production.
“Most of the patients I have seen who are being treated with
testosterone have been, in fact, overdosed. The starting dosage for one
of the most highly-prescribed androgen gels is 1 gram daily. Men don’t
need 1 gram of testosterone in their early 20’s, and we don’t need it in
our 30’s and beyond. At least, 80% of male Estrogen production occurs
from Aromatase activity, and Aromatase activity increases as we age.”
Speaking on the problems of high estrogen levels in men, he said,
“One of the primary causes of low testosterone is a high estrogen level.
Not only do high estrogen levels decrease testosterone in men, they
also increase inflammation, which in most cases is substantial. When the
immune system becomes imbalanced, it causes damage through
inflammation.”
Symptoms of high estrogen in men
The symptoms of high estrogen in men, he said, are presence of male
breast growth; low sex drive; heart attack, infertility; stroke risk;
prostate problems; and weight gain.
He said: “Men who have high levels of estrogen may have erectile
dysfunction, unable to maintain an erection. Such person with sexual
problems should talk to his doctor about a possible hormone imbalance. A
man’s fertility is determined by the number of sperm he produces, the
movement of the sperm and whether they can survive long enough to reach
and fertilise an egg in a woman’s ovary.
“Men who are exposed to high levels of estrogen have a higher rate of
infertility than men who are not. This is because estrogen lowers the
sperm’s mobility as excess estrogen may cause blood clots. This can lead
to a stroke. An imbalance like this is often overlooked as a possible
cause of cardio vascular disease.”
Treatment for high estrogen in men
There are a number of things that could be done to lower the effect of high estrogen in men’s body.
This include limiting alcohol intake, avoiding excessive soya,
maintaining a healthy weight, exercising the body and eating more of
nuts; taking zinc supplements and consider hormone replacement therapy.
While the kidneys remove excessive estrogen from the body, alcohol
interferes with that process and causes the body to make more estrogen.
Another way to lower estrogen levels is to eat nuts. The fat in nuts,
such as Brazilian nuts, almonds, cashews, walnuts, and sunflower seeds
help raise the level of testosterone in the body. Broccoli contains one
of the strongest anti-estrogen supplements, so eating broccoli more
often will help to lower the level of estrogen in the body.
“Hormone replacement therapy is also an option. This can come in a
variety of medications like gelatin capsule pills, topical creams and
gels, pellets and skin patches. The pellet type is inserted under the
skin by a doctor. To get the highest amount of hormone, choose the
pellet or capsule options.”
No fertility test, no marriage - Women
The thought that some virile young men are actually ‘feminine’ is
giving some young ladies sleepless night. While some are already toying
with the idea of getting their suitors to go for fertility test before
marriage, Joy Eurukere, a nursing student of Hill City University,
Cotonou, Benin Republic, has her mind made up already. She told news men: “Women are always at the receiving end in cases of
childlessness, while they are most of the time innocent.
There is no need going for fertility or potency test. I have to check
it physically. May be we will go for sperm count to be sure his semen
is good enough to give me a child because I don’t want any man that will
make me childless. Family members of such men will turn around later in
life to demand for the wife’s head, thinking the woman is the cause of
the family’s childlessness.”
She added: “I suggest that churches whose pastors preach that
‘marriage is honourable with bed undefiled,’ should incorporate
fertility test to their list of requirements before they give their
approval for any marriage.
We now know that women are not the sole cause
of most childlessness in the marriages. Today, we have more cases of
male infertility. As for me, I must taste before venturing into
marriage. Lilian Umo is worries “My aunt died a barren woman, yet she
was not the cause of the problem. It was discovered that her husband was
impotent and out of love, my aunt ended up not having any child in life
before she died. The couple adopted a son and trained him.
My aunt’s husband’s brother impregnated a girl and denied
responsibility as he was not ready to have a baby, but my aunt’s husband
decided to adopt the child.”
“I’ve seen some couples who grappled with challenges of conception
for years. I don’t think I want to go through that stress. My brother
got married five years ago and till date, his wife has not been able to
get pregnant. They have visited many doctors and there seems to be no
solution to their problem. Since it’s now established that a man can be
responsible for childlessness in a marriage, I’ll insist on my fiancé
goes for fertility test before I take him to my parents,” Lillian Umo
told the media. For Mrs. Omoh Ikeade, she won’t allow her
daughter to go through the stress of delayed conception, if she can help
it.
“If it is possible for doctors to know which man is man enough to
impregnate a woman, then, women should encourage their husbands to check
their fertility status before marriage. I must be sure my daughter’s
husband has good sperm before he can get married to my daughter,” she
said.
However, 32 year-old Clarence Omoniyi cannot imagine his girlfriend
or her parents asking him to go for fertility test. “How can my
potential in laws be giving me such condition? Is their daughter the
only woman in this world? I will never subject myself to such test. What
do they aim to achieve with that? There are many fishes in the ocean,”
he said.
