Aging in Humans and Nutrition
Note: In this article, the acronym AMAB will be used to designate individuals Assigned Male At Birth. The processes described affect AMABs, individuals who have testes and who experience testosterone production, as it is a process that occurs naturally with age in those with male sex organs. We acknowledge that, while not necessarily going through andropause, some individuals who identify as men may experience symptoms related to changes in hormones and may also benefit from the interventions named in this article.
Testosterone and Ageing
The primary sex hormone in Assigned Males at Birth (AMAB) is testosterone. During childhood and adolescence, this hormone is essential for the development of facial and body hair, muscle strength, and change in voice, also known as the male characteristics of puberty. It also plays a role in the production of red blood cells and sperm. Testosterone has protective functions in the maintenance of heart health, bone density, and muscle mass. It also has beneficial effects on mood and helps to regulate sexual function.
The mechanism and effects in Assigned Females at birth (AFAB) have long been documented and studied, and many people may conclude that the impact of hormonal changes AMABs and AFABs are the same. However, while there are some similarities in the changes in organ function and tissue distribution, ageing-related changes in hormones in AMAB and AFAB people are effectively different. Andropause is not simply a “male menopause”, although it is also a natural part of ageing, like menopause.
In people who experience menopause, there are well-documented symptoms that accompany a plummet in the hormones estrogen and progesterone at the start of menopause. These symptoms persist until the end of menopause, marked by the last ovulation cycle and thus the last menstrual period. In contrast, there is a much slower decline in testosterone in people who experience andropause which occurs progressively throughout the years rather than a sudden drop at a certain point. Starting at around 40 years of age, most AMABs begin to experience a gradual decrease in testosterone levels of about 1-2% of total testosterone per year.
Symptoms of this gradual decrease in testosterone include decreased energy levels, changes in memory and concentration, hot flashes, decreased libido and erectile dysfunction. The protective effects of testosterone for heart health, bone density and muscle mass also slowly decline, which can lead to an increased risk for certain health conditions such as cardiovascular disease and osteoporosis, amongst others. Some lifestyle factors can help in the maintenance of testosterone levels:
Adequate level of physical activity: aerobic training causes an increase in heart rate, which can help to boost the production of testosterone. Resistance training also has positive effects on testosterone levels. Health Canada recommends at least 150 minutes of moderate aerobic activity per week.
A balanced varied diet, as discussed in the “Nutrition and Andropause” section
Moderation of alcohol and drug use
Nutrition and Andropause
In general, a balanced diet with a variety of foods from all food groups is recommended to help with our growth and development and for the maintenance of our body’s functions. One way to follow this recommendation is to use Canada’s Healthy Plate as a reference: ½ of the plate is filled with vegetables and fruit, ¼ of the plate with a source of protein, and ¼ with grain products. Eating a variety of foods will allow us to meet our nutrient needs, and provide us the energy to continue doing the things we enjoy. Having an adequate protein intake especially helps to maintain our muscle mass. While progressive muscle loss occurs naturally as we age, the slow decline in testosterone in people who experience andropause contributes to this muscle loss more than hormonal changes do in people who experience menopause. Therefore, meeting the recommended amount of daily protein intake is beneficial in preserving and keeping our body strong.
A decrease in testosterone levels, similar to the decrease in estrogen in people who experience menopause, can lead to lower bone density and thus increased fragility. Osteopenia and osteoporosis are well-known to be at high risk for people going through menopause, with about 50% of individuals experiencing osteopenia and 30% developing osteoporosis. However, it is important to note that about 20% of people who experience andropause also suffer from osteoporosis. Osteoporosis causes an increased risk of falls and fractures, with even small injuries leading to broken bones. Recovery from these injuries can be difficult, especially with a decrease in bone density, which can significantly affect quality of life and mortality. Along with first-line medication treatment, proper nutrition can help maintain bone density and prevent further deterioration. Two nutrients in particular are important for bone density.
Calcium and Vitamin D: Calcium is an essential mineral in building and preserving bone density, as it combines with other minerals to form the crystalline bone structure. In fact, 99% of our body’s calcium is stored in the bones because of this vital role. Vitamin D helps absorb calcium from foods into the blood and therefore plays an important role in the maintenance of bone density.
Health Canada recommends a daily intake of 1000 mg/day of calcium, or 1200 mg/day of calcium for those aged 70 years and up for AMABs. Some good sources of calcium are dairy products, calcium-fortified foods and beverages, canned fish with bones included, leafy green vegetables, and nuts and seeds. Vitamin D intake is recommended at 600 IU/day, or 800 IU starting at 70 years. Of note, during the summer months, vitamin D can also be obtained at adequate levels by exposure to the sun via UV rays, which allow our body to transform certain compounds into an active form of vitamin D. Due to the nature of the cold and dark winter months here in Canada– when there is less sun exposure– a daily vitamin D supplement of at least 400 IU is recommended for all individuals to help meet their needs. Some good sources of vitamin D are oily fish (salmon, mackerel, sardines, herring), egg yolks, and some red meats.
Having an adequate oral intake of calcium combined with good vitamin D intake allows us to keep the stores necessary to keep our bones strong and healthy, which can help prevent fractures due to falls and injuries.
Consulting with a Registered Dietitian can help you choose the best plan of action for keeping a balanced diet while meeting your needs for these various nutrients and maintaining a good relationship with food. In some cases, supplements can be recommended if dietary intake of certain nutrients does not meet your needs. Your dietitian can also help you navigate through your dietary and health objectives, go over appropriate educational tools and give you the proper resources and support to eat the foods you want without the accompanying sense of guilt or restriction that may come with traditional forms of dieting. Frequent health check-ups are also essential to check for any signs of developing osteopenia, osteoporosis, and other health conditions that may arise with age and the subsequent decrease in testosterone levels.
Mélissa Mcallister, Nutritionniste, Dt.P.
