abstracted & translated by
Bob Flaws, L.A.c, FNAAOM (), FRCHM ()

Aging in males is accompanied by a series of signs and symptoms suggestive of androgen deficiency. These signs and symptoms include a decrease in muscle mass and strength, an increase in abdominal, mainly visceral, fat with insulin resistance and atherogenic lipid profile, a decrease in libido, erectile function, and sexual hair, osteopenia and osteoporosis, a decrease in cognitive performances and mental vigor, insomnia, excessive sweating, and a decrease in general well-being, and it is tempting to relate these symptoms to the age-associated decrease in androgen levels. Although there has been some controversy for a long time over whether testosterone (T) levels in men decline with age, at this point in time, several methodologically sound studies have shown that testosterone, particularly free, bio-active testosterone, does declines with age. According to this research, free T levels decrease continuously beginning at 30 years of age. By 70 years of age, the mean total T level is only two-thirds of the mean level at age 25. Nevertheless, this decrease in free T levels is only one of the factors responsible for the signs and symptoms of aging in males. Hence, the diagnosis of androgen deficiency in elderly men should be based on both the clinical symptomatology and the biochemistry, i.e., decreased free T levels, the latter being defined, more or less arbitrarily, as levels below the lowest 1% of levels in young healthy males. The pathophysiological mechanisms of this age-related decline of T production lies mainly at the level of the testes but also includes the hypothalamic-pituitary stimulation of testicular steroidogenesis which wanes with aging. Further, the most significant carrier protein of T, sex hormone-binding globulin (SHBG), increases with aging, thus resulting in lower free, bio-available T levels. (Sex hormone-binding globulin is a glycoprotein that binds to sex hormones, specifically testosterone and estradiol.) Within Western medicine, this age-related decrease in free T is referred to as partial androgen deficiency in the aging male (PADAM) and is treated with testosterone-supplementation therapy.

Chinese medicine & PADAM

On pages 43-44 of issue #6, 2008 of Xin Zhong Yi (New Chinese Medicine), Wang Xi-kun published an article titled “Clinical Comparative Research on the Treatment of Partial Androgen Deficiency in the Aging Male Syndrome with Liu Wei Di Huang Wan (Six Flavors Rehmannia Pill) with Additions & Subtractions.” A summary of this article is presented below.

Cohort descriptions:

One hundred thirty-eight males 45-70 years of age suffering from PADAM were randomly divided into two groups – a treatment group and a comparison group. All men in this study had serum T levels of less than 13.0 nmol/L. Exclusion criteria included serious heart, liver, kidney, and circulatory disease, prostate cancer, marked prostatic hypertrophy, or a prostatic serum antigen (PSA) level of 4 mg/mL or above, psychiatric disease, recent medical treatment for this condition, and inability to complete the treatment regimen. In the treatment group, there were 76 cases with a mean age of 57.45 ± 7.54 years. In the comparison group, there were 62 cases with a mean age of 56.80 ± 6.97 years. Therefore, these two groups were considered statistically comparable for the purposes of this study.

Treatment methods:

All members of the treatment group were orally administered the following Chinese medicinal formula:

Shu Di Huang (cooked Radix Rehmanniae), 24g

Shan Zhu Yu (Fructus Corni)

Shan Yao (Radix Dioscoreae), 12g each

Ze Xie (Rhizoma Alismatis)

Mu Dan Pi (Cortex Moutan)

Fu Ling (Poria), 10g each

If there were night sweats, uncooked Long Gu (Os Draconis) and Mu Li (Concha Ostreae) were added.

If sexual function was markedly decreased, Ba Ji Tian (Radix Morindae Officinalis) and Tu Si Zi (Semen Cuscutae) were added.

If there were heart palpitations, forgetfulness, and serious nvexatious heat in the five hearts or centers, Mu Li, Gui Ban (Plastrum Testudinis), Fu Shen (Sclerotium Pararadicis Poriae), and Yuan Zhi (Radix Polygalae) were added.

If there was marked premature ejaculation, Jin Ying Zi (Fructus Rosae Laevigatae) and Qian Shi (Semen Euralis) were added.

One packet of these medicinals was decocted in water and administered per day in two divided doses, with three months’ administration equaling one course of treatment.

All members of the comparison group were orally administered 80 milligrams of Shi Yi Suan Gao Tong Nong Bao (Undecylinic Adic Testosterone Gelatin Capsules) BID, with three months’ administration also equaling one course of treatment.

Study outcomes:

Marked effect meant that the total symptom score for PADAM had decreased by 80% or more. Some effect meant that this total score had decreased by 30-80%. No effect meant that the total scores decreased less than 30%. The following table shows these outcomes in the two groups.

The next table shows changes in mean serum T from before to after treatment.

The last table shows the total mean PADAM scores before and after treatment.

Therefore, based on all of these parameters, the Chinese medical protocol was more effective in the remedial treatment of PADAM than the Western medical protocol.  Further, in the comparison group treated with Western medicine, there were three cases of urinary retention and two cases cardio-cerebral vascular accidents which required stoppage of the medication. In comparison, there were no obvious adverse reactions in the treatment group.

Discussion:

According to Dr. Wang, PADAM is categorized as vacuity taxation, depression condition, visceral agitation, yang wilting, dizziness, and subcardiac glomus in Chinese medicine. This means that the clinical symptoms of PADAM may be reframed into the above Chinese medical disease categories. Dr. Wang believes that the root of this condition is either, kidney qi vacuity, or yin detriment reaching yang, yang detriment reaching yin resulting in kidney yin essence and yang qi both being insufficient. If kidney yin and yang lose their regulation, then the viscera and bowel function become disordered, and this is the basis for the occurrence of this disease at the male climacteric. Therefore, Dr. Wang believes that treatment should mainly secure and guard the kidney qi. Liu Wei Di Huang Wan has the effect of supplementing the kidneys and fostering essence. As the above research shows, when this formula is used with modifications based on the patient’s personally presenting patterns, it is quite effective for the treatment of PADAM. In fact, it is more effective for treating this disorder than simple testosterone supplementation therapy.

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