Transcription
Menopause symptoms. What kind of symptoms are there? Mind, body, and sex. Sex? Yes. Well, these are three problems. What kind of sex-related issues are there? The frequency of morning erections. Wow, you can tell from that? For younger people, some people start experiencing symptoms from around their 30s. We can't predict where symptoms will appear, nor can we predict who will experience them. No, that's incredibly scary. Uh, what in the body affects menopause? Well, in men, it's testosterone. It's produced more than 90% in the testes, and as you age, it decreases, which causes male menopause syndrome. Many people have the image that if your testosterone is high, you'll go bald. But actually, it's the complete opposite. The opposite? Yes. I want to prevent male menopause, and the key is strength training. Strength training? Yes. Hello. This is Nishikawa from Pivot. Today's theme is the truth about male menopause. Your mental and physical discomfort might be signs of menopause. I'd like to introduce our guest, Shinichi Hisao from the Urology Department. Thank you for coming. Thank you. I've heard that you've examined many men with male menopause in your specialized field. Yes. How many male menopause patients have you seen so far? I haven't counted precisely, but I think I've seen thousands. Yes. Uh, what are the symptoms of menopause? Roughly speaking, there are three pillars: mind, body, and sex. Sex? Yes. These are the three problems. What kind of sex-related issues are there? Sex-related issues refer to libido and sexual function. So, it's about erectile function and things like that. I see. When we talk about menopause, we first think of women, but men also experience it, right? Yes. The term "menopause" was originally coined by analogy to female menopause, leading to the term "male menopause." However, in reality, there are many differences compared to female menopause. Completely different? Basically, it's caused by a decrease in hormones, but women have a major event called "menopause" around the age of 50. Every woman experiences this. My wife is 50, and she's in the midst of menopause. Around that age, estrogen levels drop to almost zero, causing dramatic hormonal changes, and symptoms appear during that time. However, men do not have such an event called "menopause." Yes. So, some people start experiencing symptoms from around their 30s. Yes. I'm 35. So, there's a possibility, right? Yes. I'll be talking about various things, including preventive measures and how to avoid it. If you follow them, I think you'll be fine. I see. Uh, what in the body affects menopause? Actually, in men, it's testosterone. Yes. Testosterone is produced in the testes. More than 90% is produced in the testes, and a small amount is also produced in the adrenal glands, which are located above the kidneys. When this decreases with age, it leads to male menopause syndrome. Uh, I have the impression that testosterone is easily secreted through strength training. Is that correct? Actually, it's very important, and ultimately, I want to talk about preventive methods today. I want everyone to prevent male menopause, and the key is strength training. Strength training? I understand. However, I think many people are watching this thinking it doesn't concern them. Is there a simple finger test to check hormone levels? Yes. Male hormones work in various ways. Testosterone secretion begins even when you're in your mother's womb. When it's released in the womb, it changes the shape of the reproductive organs from female to male. And before you're born, a surge of it causes the brain to masculinize. Wow. Yes. So, whether someone is masculine or feminine is actually partly determined by testosterone. And one indicator of this is finger length. Finger length? You can tell from your fingers? Yes. It's often the right hand, but in men, the ring finger is longer than the index finger. Ah, Nishikawa-san, you're perfect. Long. Yes. This proves that you have benefited from testosterone since you were in your mother's womb. Wow. So, among men, are there some whose index finger is longer? It's not that the index finger is longer, but there are people whose index finger is about the same length. Wow. This indicates the amount of male hormone, testosterone, secreted, which varies from person to person, and the ability to produce it originally appears in these fingers. Uh, excuse me. How does having longer fingers affect menopause? Originally, those with higher levels tend to have a slower decline. While there isn't a dramatic change like in women with age, it decreases slowly. So, those who originally had higher levels may not reach that point. However, those who originally had lower levels may reach that point more easily. Is that so? I see. I'd like to hear more about it. First, today's theme is divided into two parts. Part one: Symptoms and risks that might indicate you have male menopause. And part two: Male menopause countermeasures that you can still take. So, let's start with the first part, symptoms and risks that might indicate male menopause. Could you explain the difference between male and female hormones that we discussed earlier? Yes. Originally, both men and women reach their peak around the age of 20, during the period of secondary sexual development when physical changes become apparent. This peak is largely the same for both men and women. However, for women, after a slight decline with age, it drops sharply at 50 and becomes almost zero. By 60, it's close to zero. Yes. There's a period of a few years around this time, which is why it's called female menopause. However, men do not have such a period. Male hormones are produced from the testes and are very important for developing the male body. They affect the brain, influencing libido and aggression or assertiveness. They are also said to work on maintaining muscle strength. The significant difference in muscle strength between men and women is largely due to male hormones. They also work on the kidneys to produce erythropoietin, a hormone that increases red blood cells and helps prevent anemia. They also stimulate cells in the bone marrow, where blood is produced, to make it easier to create red blood cells. And what's most related is hair loss. In fact, testosterone is also involved in that. Oh, really? I thought hair loss was genetic, but is it not just that? Yes. That's right. Many people have the image that if your testosterone is high, you'll go bald. Yes. But actually, it's the complete opposite. The opposite? It's still just a hypothesis, but if people with high testosterone don't grow hair, and testosterone decreases with age, then hair will fall out, right? Yes. So, shouldn't hair become more abundant as testosterone decreases? If those with lower testosterone grow hair, that's not the case. Yes. And ultimately, testosterone changes into various forms. One is through an enzyme called aromatase, where it can actually be converted into estrogen, a female hormone. Male hormones turn into female hormones? Yes. And another is dihydrotestosterone, which is a very powerful form of testosterone. This happens through an enzyme called 5-alpha reductase. Dihydrotestosterone is, in simple terms, like a Super Saiyan. Wow. Like an awakening. There are three major organs in the male body that absolutely require testosterone. One is the hair follicles. Hair follicles require a lot of testosterone; they cannot survive without it. Is that so? Yes. And another is the prostate gland. The prostate also needs testosterone. And of course, the penis also needs testosterone. However, when testosterone decreases, the body tries to compensate. Yes. Yes. For example, if there were 1000 testosterone molecules and now there are 700, to compensate for the 300 missing, the body pulls them in and converts them into Super Saiyans. Yes. Yes. So, the power is equivalent to those 300, and it feels like it's been supplemented. However, this Super Saiyan also does bad things. Wow. In simple terms, it destroys the earth. Is it too strong and destroys the body? Yes. When that happens, as I mentioned earlier, the hair follicles are attacked and fall out. Also, the prostate gland is attacked, leading to benign prostatic hyperplasia, a condition that causes difficulty urinating after age 50. It's hypothesized that the conversion to these forms is triggered by the decrease. Yes. How do people fix that? Ultimately, if you can prevent testosterone from decreasing, Yes. Is that all there is to it? Yes. Yes. [Laughs] Testosterone. Yes. It's incredibly important. Yes. So, as I mentioned, it converts into estrogen. That actually protects the male body. Why? Because women have a very high incidence of osteoporosis. Yes. Why is that? It's because estrogen levels drop along with menopause. Ah, yes. Bones are actually very important for estrogen, and without it, bones become brittle. I see. In women, after menopause at age 50, estrogen becomes zero, and bones become increasingly brittle. Oh, really? However, in men, although it decreases slightly, testosterone remains in the body. This is converted by aromatase and maintained. So, for example, in their 60s, men actually have higher levels of estrogen than women. Higher? Yes. The levels reverse there. Is there any disadvantage to having more female hormones? I can't think of any offhand. So, Ah, so it's a good thing? Yes. Conversely, it protects your bones. Wow. That's why men have lower rates of osteoporosis. Uh-huh. Yes. So, it's very important, and maintaining male hormones means protecting men's health. I see. So, everyone needs to increase their testosterone levels, as it greatly affects human health. Yes. Ah, low male hormone levels are associated with higher mortality rates from all causes, heart disease, and cancer. Is this data related? Yes. I was surprised by this data. Regarding the heart, as I mentioned earlier, male hormones are said to have beneficial effects on blood vessels, so it's understandable that heart disease is less likely. But for some reason, cancer mortality rates are also higher in people with lower testosterone. Uh-huh. Uh-huh. So, it's also related to cancer. And in total, people with higher testosterone tend to live longer. Is that so? Even with cancer, which is often said to have unknown causes, based on past data, if you increase male hormones, the probability decreases. Yes. It might also help maintain your physical strength after developing cancer. Ah, I see. Yes. Therefore, maintaining testosterone levels is very important for men, especially in an era where people are expected to live to 100. And actually, among male hormones, there are active ones and those that are resting. The active ones are called biologically active T, and they are represented by the light blue line. It's understood that the active ones decrease significantly. And when this decreases, symptoms appear. And this varies greatly from person to person. As I mentioned earlier, there are people with naturally high or low baseline levels, so we can't predict where symptoms will appear or who will experience them. That's what makes male menopause syndrome difficult. No, that's incredibly scary. There's no major event. It's possible to develop it without realizing it. Exactly. And is it endless? That's a good point, as expected. Yes. So, there's really no specific period. So, it's endless. Patients often ask me how long they need to continue treatment. Ultimately, I think it depends on each person's lifestyle. Yes. Some people only want to be energetic during work and then relax afterward, so they don't mind the symptoms as much. Wow. The testosterone that is active in the body decreases at a very high speed. Is that biologically active T? Yes. Exactly. So, the point is how to slow down this decrease. Exactly. That's the point, and I want to teach you that today. Can't you stop it from decreasing? You can't stop it from decreasing itself, but you can try to slow down the rate of decrease as much as possible. Earlier, at the beginning, I mentioned that men with longer ring fingers have higher testosterone levels, supported by data. Could you explain that with data? Yes. The horizontal axis is 2D and 4D. What is this? 2D is the second digit, and 4D is the fourth digit, meaning the second and fourth fingers. The distribution is for the fourth finger, the ring finger. The numerator is the second finger, the index finger. So, the longer the ring finger, the larger the denominator, and the value becomes increasingly less than 1. When the ring finger is the same length as the index finger, it approaches 1. The vertical axis is testosterone. People with longer ring fingers and larger denominators tend to have higher testosterone levels on the left side. Wow. If the ring finger is shorter, the baseline testosterone level is lower. Yes. That's right. I see. This is also a checkpoint. Now, let's look at another point: awareness of male menopause. Yes. This is a survey by the Ministry of Health, Labour and Welfare, showing how well people know about menopause by age, or if they've heard of it but don't know the details, or if they answered "don't know." As age increases, more people have heard of it, but in their 20s and 30s, more than half answered "don't know." Yes. It seems that people who feel "I'm not feeling well lately, could it be aging?" are quite common. With the spread of the internet, opportunities to learn about male menopause are increasing. So, in younger years, people tend to feel it less or are not interested. I thought it was a distant issue. Yes. Yes. Nishikawa-san, you too, right? [Laughs] I thought so too, but are there patients in their 30s? Yes. There are. Yes. What brings them to the hospital? The most common reason for coming to the hospital is depression or thinking "Am I depressed?" and receiving treatment at a mental health clinic, but it's not getting better. Or, their wives notice that their husbands aren't feeling well and bring them in. This is also a very common pattern. Basically, when men experience menopause, they tend to withdraw from going out. Yes. That's one sign. Yes. So, they don't feel like going to the hospital. That's why wives often bring them in. Ah, I see. Partners, who observe them for a long time, might be more likely to notice. Yes. I see. But this feeling of "I don't want to go to work" or "I want to slack off" is something everyone has, right? Uh, it's scary that this might be a sign of menopause. Yes. There's a fear that no one notices this. Yes. Ah, I see. And as age increases, the number of people who know about it starts to increase slightly around their 50s. Yes. Yes. In those age groups, of course, it's most common. Are the symptoms similar? Yes. Male menopause symptoms are mind, body, and sex. Please. Yes. For the mind, for example, a lack of motivation, feeling anxious, or depressed. These are mental issues. For the body, it's fatigue, weakness in the legs and back, difficulty climbing stairs, shortness of breath, and other declines in muscle strength. These are also symptoms of male menopause. I see. Also, metabolic syndrome. I'm actually experiencing it myself. Earlier, you were concerned about your suit fitting. It's getting a bit tight, but your belly starts to protrude. This is visceral fat. In men, visceral fat tends to accumulate, leading to metabolic syndrome. This is also triggered by male menopause. Is it not just a problem of lack of exercise, but also a symptom of menopause? Yes. That's right. Yes. It's easy to understand that men who get married and have children experience a significant drop in testosterone. Why is that? This is actually common in male mammals that become fathers. It's convenient for the female. Yes. What happens is they don't want to go out, their libido decreases, so they don't feel like going to other females. So, they stay at home, meaning they take care of the children. Yes. Yes. And they also help with household chores. For wives, it's a dream come true. Yes. I see. Some couples might say their husbands don't help, but yes, what you're saying is [Laughs] Yes. However, for those who are working, it can be problematic if they can't go to work. So, many people come for that reason. That's why when I ask people in their 30s, I always ask when they got married and how old their children are. And if they have young children, I might say that could be the reason. Wow. Also, married men tend to gain weight, don't they? Yes. And people say, "You're living a happy life, being fed by your wife." Is that not "happy weight gain" but rather menopause leading to metabolic syndrome? [Laughs] Is that true? Yes. It's true. So, that's what happens, and that's why prevention is very important even after marriage. Wow. For that, as I'll explain, strength training and dietary adjustments are necessary. The last problem, after mind and body, is sex. The first thing you notice with male menopause or a decrease in testosterone is the frequency of morning erections. Wow, you can tell from that? Yes. Actually, morning erections are just something we notice in the morning, but men have several erections during the night while sleeping. Yes. This is called nocturnal penile tumescence, and it's a way to send fresh blood to the penis. Yes. Yes. This happens during REM sleep. REM sleep is a stage of light sleep where you dream. During this time, an erection mechanism occurs. The trigger for this is said to be the hormone LH, released from the hypothalamus in the brain, which stimulates testosterone secretion. When this is released, the penis responds and erects. Many people dream during full erections, right? I do too. This happens during REM sleep, and it's noticed as a morning erection. Yes. The frequency of these decreases significantly. So, as testosterone decreases, I hear people asking, "How many morning erections did you have this week?" Many men with severe male menopause say they haven't noticed any in the past month. Ah. That's also a sign. I don't know if it's the average or median, but how many morning erections should one have at a certain age to be considered normal? Generally, since it happens almost every day, and it's sleep-related, you might not notice it even if you wake up at night. So, if you've had it two or three times a week, it's generally considered normal. Yes. And for me, the difference between being on the borderline of male menopause and being normal is having it once a week. If you don't notice it even once a week, the possibility of male menopause is quite high. Another issue is libido. Yes. As testosterone decreases, libido also decreases. So, you might not feel like engaging in sexual activity at all, or lose interest in the opposite sex. This is a significant problem. Yes. How do you deal with that? It's about increasing testosterone. Is that also strength training? There are various methods. What I recommend is that as muscles increase, each muscle fiber has a receptor for male hormones. So, as muscle fibers increase, the number of male hormone receptors also increases. Then, the brain sends more signals to release male hormones, which stimulates testosterone secretion. Then, to satisfy the receptors in the muscles throughout the body, testosterone levels increase. That's the trigger. So, increasing muscle mass is good. My recommended strength training method is Yes. Squats. Yes. Thighs. Yes. Yes. The largest muscles in the human body are in the thighs. So, I think squats are good for increasing this area. However, it's difficult for office workers to find time in the busy mornings, and going to the gym is also difficult. So, I have a recommendation. Every morning, after brushing my teeth, while gargling, I do squats 10 times. You gargle quite a bit. But does it work? [Laughs] Yes, it does. And I'll never forget it because I won't skip brushing my teeth. Yes. I never skip brushing my teeth in the morning, so I've decided to do squats while gargling. I've been doing it every day for about five years without fail. Wow. For those who don't do it, even 30 times might be quite difficult at first. Ah. Also, I now commute by stairs. Yes. I always use the stairs and avoid escalators and elevators. Wow. Elevator cancellation. Elevator cancellation. Are you aiming for the "escalator and elevator cancellation" movement? [Laughs] Yes. I aim for that. I go up the stairs almost every day, up to the 7th floor. Up to the 7th floor? [Laughs] Ah. Yes, that's amazing. But people often say vague things like "let's walk for health." If you connect it to your own life's problems and think you can solve them, you might change. Of course. If you start this and your muscles become more defined, those who are just on the borderline of male menopause will definitely return to normal. Return. Wow. Yes. I count one squat for every two flights of stairs I climb. So, climbing to the 7th floor is about 60-something flights, and I consider that as doing 30 squats. Yes. Yes. You mentioned strength training as the most effective. Are there any other effective methods? Another thing I recommend is diet. Ah, diet. Yes. It's important, isn't it? Yes. Regarding diet, garlic, Yes. Yes. And leeks, Yes. Ah, they seem to give you energy. Right? And the source of that energy, or what we often call stamina. Have you ever thought about what stamina is? I haven't really thought about it. I have the image of physical strength. Yes. And I believe stamina is testosterone. Ah, wow. I see. Yes. Yes. And garlic, chives, and leeks, which seem to give you stamina, have something in common. They're pungent. Yes. They do have a smell. Yes. And this pungent smell is actually allicin. And this allicin increases testosterone. Wow. Is that so? Yes. However, allicin has a drawback: it's sensitive to heat. Yes. Uh, so it's bad to cook it? Yes. But garlic, chives, and leeks can be eaten raw, but it's a bit difficult, isn't it? So, there's a way to make it heat-resistant. Yes. Is there? When it's combined with vitamin B1, allicin turns into allithiamine, a heat-resistant substance. Wow. So, what is vitamin B1? The best recommendation is meat. Ah, so like garlic wrapped in meat? You can probably imagine various dishes. Gyoza, too. And grilled leek set meals. So, Should I just mix them? Yes. When you cook them, they turn into allithiamine. Yes. Yes. I believe this is the strongest. And the stamina-boosting dishes that men all over love and eat when they feel unwell or want to regain energy, like "Let's go for yakiniku and eat a lot of garlic," are fulfilling that desire. Yes. Uh-huh. I see. Garlic baked in foil, if overcooked, is it? Ah, it gets destroyed. Yes. That's right. So, it's important to cook it properly, and meat is its partner. Whether it's pork or beef, I think it's fine. These contain a lot of vitamin B1. Yes. Wow. I see. So, it's about diet. There's one more thing. Sleep? No? No. Before diet, can I say one more thing about diet? Another thing is zinc. Zinc. Yes. I see many patients for conditions other than male menopause, and zinc is also very important. Zinc increases appetite. Uh-huh. Yes. Because it has that effect, it's important for everyone, but it's also important for men with male menopause. In fact, testosterone is related to zinc, and if you're deficient in zinc, your testosterone levels will also decrease. Why is that? It's said that zinc is involved in testosterone synthesis. And when it decreases, testosterone synthesis is reduced. I see. Zinc is important, but where do you get zinc? The best source is oysters. Yes. Oysters. Wow. Yes. They're delicious this season, but I've had food poisoning from raw oysters, so you can't eat that much raw. And even cooked, they're quite expensive, so you can't eat large quantities every day. So, besides oysters, zinc is found in small amounts here and there. So, it's good to eat those in combination. Vegetables, and among them, beans are high in zinc. Edamame? Yes. They are high in zinc. And among vegetables, cabbage, which you can eat in large quantities, Yes. Yes. You can get it by eating a lot of it, even if the amount is small. And at that time, it's good to use oyster sauce as a seasoning. Yes. It goes well with oysters, doesn't it? Yes. Oyster sauce is concentrated oysters. Yes. So, dishes made with oyster sauce, like Chinese stir-fries, are also very good. You can add cabbage, meat, and garlic. Yes. So, those are very good. And motsunabe (offal hot pot) is also great this season, isn't it? You add garlic, right? Yes. It also contains chives. And a lot of cabbage. And burdock root is also very rich in nutrients. Burdock root is often included, isn't it? Yes. And it contains vitamin B1, which converts allicin into allithiamine. So, I believe that hot pot is the strongest testosterone-boosting food. I see. You just talked about diet. Does sleep have any relation? Sleep. Of course. As I mentioned earlier, testosterone is actually produced at night. Yes. And testosterone has a diurnal variation. It's produced at night, and peaks in the morning. Wow. Then it gradually decreases, and by early afternoon, it's quite low. It's low by early afternoon? Yes. That's why, even though it's cold now, in the summer, you often see middle-aged office workers napping in their cars in the afternoon heat. That's because testosterone levels drop around that time. I see. So, they get sleepy. It's not laziness. Yes. It's because hormone levels drop. And by bedtime, it's at its lowest point, but then it gradually increases during sleep and peaks in the morning. So, sleep is very important. Yes. So, naps seem to be beneficial. In that case, Yes. However, if you nap too much, you might not be able to sleep at night. Uh-huh. So, light naps of 30 minutes or less are fine. Yes. Yes. Caffeine is also important. Also, try not to stay up all night. In fact, the male nurses I work with, who have to work night shifts, find it very difficult, much more so than women. Yes. If you repeat all-nighters or night shifts, your testosterone levels will gradually decrease. And then, if those male nurses get married, have children, and continue working, it's a double blow, and their testosterone levels drop further. That's why symptoms of male menopause can appear even in people in their 30s. I see. I'd like to summarize the sleep part. What is the golden time? The time you go to sleep. As I mentioned earlier, after early afternoon, it's at its lowest point, so you can raise it anytime. However, a daily rhythm is important, so it's best to go to bed at a set time for a set duration. How many hours is considered good? Generally, the longer you sleep, the more REM sleep you get, and the more signals are sent from the brain to release testosterone. So, the longer, the better. However, that might disrupt your daily rhythm. So, between 6 and 8 hours is generally considered good. I see. Understood. Checklist. 31 points. Wow, mild. Mild. The mental and physical problems are cleared, but the sexual problems are quite significant. I see. Does that mean nearly 30% are in their 20s and 30s? Yes. I think it varies from person to person, but with more children playing video games and less time spent playing outside, I think that might be related. Yes. And moderate alcohol consumption. There was an interesting experiment with mice where alcohol-loving mice had high testosterone levels. Yes. Is that so? Absolutely no all-nighters. [Laughs] This is a definite no. Yes. If you stay awake for two consecutive days, your testosterone levels will drop to almost zero. Even when I prepared a very soft bed and tried to get them to sleep, their testosterone levels did not recover. We call it the menopause spiral. It gradually decreases. Yes. And for some people, it becomes difficult to pull themselves out of it. Injections. Yes. Pivot is recruiting new members. We are actively hiring for sales and video production roles. For details on the recruitment, please see the URL in the description. Let's make Japan Pivot together. [Music] Wow. [Music]