andropause Archives

Apr

2023

What you Must Know about Male Hormones

By Ray Schilling | andropause, Anti-aging medicine, Cancer, Diabetes, hair loss, heart attack, Infertility, prostate cancer, prostate hypertrophy, Stroke, testosterone

Dr. Pamela Smith, an anti-aging physician gave a talk about what you must know about male hormones. She spoke on Saturday, Dec. 10, 2022 at the Sands Conference Center of the Palazzo Hotel in Las Vegas. The title was “What you must know about male hormones”. She presented 199 slides, so the following can only be a brief summary of what she said. She started by saying that the term “male menopause” goes back in time to 1944. Other terms are andropause and late onset hypogonadism.

Different testosterone levels at different ages

It is important to realize that at age 20 the blood testosterone level is around 900 ng/dL, but this declines after age 30. It is 550 ng/dL at the age of 40. At the age of 50 the testosterone level is 350 ng/dL. And at the age of 70 the testosterone level has shrunk to 200 ng/dL or less. With this in mind, there are also seasonal variations with higher levels of testosterone occurring in summer and early fall, and low levels happening in winter and early spring. A healthy male produces the following male hormones: Testosterone, 5-6 mgs/day; Androstenedione, 3 mgs/day; DHT, 0.300 mgs/day; DHEAS, 50 mgs/day; and DHEA, 15 mgs/day.

Functions of testosterone

In other words, testosterone is the male hormone responsible for the male body characteristics. Every male body cell has testosterone receptors on it. Truly, this way testosterone is involved in protein manufacture and muscle maintenance. In fact, bone formation depends on testosterone and oxygen uptake as well. It is also controlling blood sugar together with insulin. In addition, normal sperm production depends on testosterone. To clarify, testosterone also regulates cholesterol and the immune system. By all means, it also helps to improve mood, is important for mental concentration and helps protect against Alzheimer’s disease. Finally, there is stimulation of platelets and megakaryocytes by testosterone, which makes blood clotting easier.

Symptoms of andropause

It must be remembered, towards the end of their 60’s many men get symptoms of tiredness, loss of energy and depression. Specifically, they may get a bad temper, present with irritability, anxiety and nervousness. Specifically, they complain of a loss of memory, loss of sex drive and libido. Certainly, their erections are getting weak or they lose them altogether. There is a decreased intensity of orgasm and they are gaining weight. All this should prompt their physician to have a total testosterone blood test done. When the testosterone level is less than 500 ng/dL the person should see their physician for replacement testosterone therapy.

Other signs of testosterone deficiency

There are other signs and symptoms of testosterone deficiency: backaches and joint pains, loss of fitness, being overstressed. In addition, testosterone-deficient males experience a decrease in job performance and a decline in physical fitness. They have bone loss, elevation of their blood cholesterol and an increased risk of heart disease. They often also have increased insulin resistance, diabetes and metabolic syndrome. Mortality in men with low testosterone is much higher than in controls with normal testosterone. Several dozens of literature references were provided to support the above statements.

Testosterone replacement and hormone balance

When a patient is on testosterone replacement, a digital rectal exam should be performed to check for the size of the prostate gland. A PSA should be done every year (in former prostate cancer patients every 3 months). PSA should stay below 4.0 ng/mL. If the PSA rises by 1.5 ng/mL in one year or by 0.75 ng/mL in two consecutive years, a urologist should be consulted to rule out prostate cancer.

Men produce small amounts of estrogens, which are important for memory function of the brain and for strong bones. Androgens and testosterone aromatize into estrogen via the enzyme aromatase in fatty tissue. There are a few reasons why aromatase increases: obesity, excessive alcohol intake, chronic inflammation and high insulin levels.

The following medications lower estrogen levels: phenobarbital, carbamepazine, trazodone, chlordiazepoxide and sulcrafate.

Side effects from elevated estrogen levels

Increased estrogen levels in males cause gynecomastia (colloquially called “beer tits”), decreased sex drive, heart attacks, strokes and benign prostate hypertrophy. Elevated estrogen levels also cause insulin resistance, rheumatoid arthritis and prostate cancer. Dr. Smith referenced all of these statements again with many literature quotations.

Dihydrotestosterone (DHT)

This metabolite of testosterone is 3-times stronger than testosterone. It is formed from testosterone by the enzyme 5-alpha reductase. It is responsible for the male-specific characteristics, the male genitalia and the prostate gland. Low levels of DHT cause reduced sexual function, decreased libido and weakened muscle function. On the other hand, elevated DHT causes male pattern baldness, hirsutism and benign prostate hypertrophy (BPH). There are two 5-alpha reductase inhibitors, namely finasteride and dutasteride, that clinicians use to lower elevated DHT levels. This can reduce the risk of prostate cancer by about 50%. Dr. Smith provided many literature quotations to support these statements.

Testosterone replacement therapy

Based on more than 3 dozen literature quotations Dr. Pamela Smith outlined the following:

Most men tolerated transdermal testosterone application very well.
Erectile dysfunction affects 1 in 5 older men.
Erectile dysfunction in association with low blood testosterone and low libido responds to transdermal application of testosterone very effectively.
It may take 14-25 weeks before transdermal testosterone treats erectile dysfunction successfully, more than 50% of men respond to this.
Testosterone replacement prevents beta amyloid precursor protein production, which increases memory and decreases the risk of Alzheimer’s development.
High stress produces high cortisol levels in the blood, which affect the hippocampus, where memory is located. Testosterone is neuroprotective, and it preserves memory.
Transdermal testosterone decreases coronary heart disease by relaxing coronary arteries. This prevents heart attacks and strokes.
Testosterone decreases inflammation and lowers LDL cholesterol.

More facts about testosterone replacement therapy

Testosterone lowers inflammatory cytokines and stimulates interleukin-10 production. This has anti-inflammatory and anti-atherogenic actions, which prevents heart attacks.
There was a reduction in mortality from heart attacks in the testosterone treated group of between 66% and 92%. In addition, 30 nonfatal strokes and 26 nonfatal myocardial infarctions occurred in the control group, but none in the testosterone group. Testosterone deficient heart failure patients responded very well to testosterone replacement therapy.
Prostate cancer or benign prostate hypertrophy do not increase with transdermal testosterone replacement therapy.

A Meta-analysis showed that older men with the highest risk for prostate cancer have the lowest testosterone blood levels.
Type 2 diabetics with a high insulin resistance respond well to testosterone replacement therapy. They increase insulin sensitivity and lower their blood sugars. This improvement peaks after 3 months and the effect stays for 12 months.

Further facts about testosterone replacement therapy

Testosterone replacement is safe. It provides significant benefits for erectile dysfunction, for muscle mass, prevention of Alzheimer’s disease, prevention of heart attacks and strokes. Testosterone treatment is for males above the age of 50, there is no cut-off for higher ages. There are many controlled clinical trials spanning over 70 years, which support all of what is presented here.
Testosterone can’t be taken orally, because it is rapidly metabolized in the liver. Instead, patients use transdermal testosterone gel or cream. Gels are commercially available and very expensive. Compounding pharmacies can provide testosterone creams for you, which are considerably cheaper and can be dosaged according to the patient’s needs. Testosterone esters in oil are available for subcutaneous or intramuscular injection twice per week. This ensured a steady testosterone level.

Improvements after testosterone replacement therapy

Timing of improvements: cholesterol reduction occurs by 12 months, for triglycerides it takes 22 months. Testosterone levels take 4 to 12 weeks to normalize. Fasting blood sugars and Hemoglobin A1C come own within 3 months with further improvements by 12 months. Sexual desire and energy are back to normal within 3 to 6 weeks.
It is important that you go for blood tests to measure testosterone levels every 3 months initially (blood level). If the levels are stable, the physician may decide to only order tests every 6 months.

What you Must Know about Male Hormones

Conclusion

The goal in the aging male is to maintain optimal male hormone levels. This achieves optimal health and prevents diseases of older age. First, it is important to preserve his erections, but at the same time testosterone replacement therapy prevents Alzheimer’s disease and memory loss. It also prevents heart attacks and strokes. Testosterone helps to preserve muscle mass. Hormone replacement therapy keeps lipids like cholesterol and triglycerides under control. Testosterone replacement reduces blood sugars and prevents type 2 diabetes mellitus. Replacement therapy also reduces elevated insulin levels. The end result is that testosterone replacement therapy maintains the health of the aging male.

Dec

2021

Green Light Laser Treatment for an Enlarged Prostate

By Ray Schilling | andropause, Men's Health, prostate hypertrophy

This article describes the use of green light laser treatment for an enlarged prostate. Physicians call an enlarged prostate “benign prostatic hyperplasia” or else “prostate hypertrophy”. When men turn older than 60, they often develop an enlarged prostate gland. This in turn can squeeze the urethra as it travels through the prostate resulting in problems passing urine.

A complication of an enlarged prostate gland can be frequent urinary tract infections

Men who have an enlarged prostate also often develop recurrent urinary tract infections. As a recent example that went through the news, former President Bill Clinton had to be hospitalized for such an infection. However, a simple surgical procedure like the green light laser treatment for an enlarged prostate allows for normal urination. This procedure opens up the previously narrowed urethra and reduces the prostate size to normal. As a result, the recurrent urinary tract infections stop. The green light laser treatment for an enlarged prostate is relatively new. It has much less blood loss than the conventional transurethral resection of the prostate (=TURP). The new laser procedure also goes under the name “green light laser TURP”.

History of the green light laser treatment for an enlarged prostate

In 2003 the first series of 10 patients with an enlarged prostate received treatment with a green light laser. After one year their prostate glands showed an average of 27% volume loss. This was less than 40-50% prostate volume loss with the conventional TURP procedure. In 2004 and 2005 urologists started larger series with the green light laser treatment were, also with a more powerful laser application. The urologists used 80 W instead of 60 W laser applicators. They achieved a reduction in prostate volume ranging from 37% to 53%. This was comparable to what conventional TURP treatments achieved.

Statistics regarding enlarged prostate glands

Prostate enlargement in older men is very common. By the age of 60 about 50% of men have an enlarged prostate gland. Compare this to men at 85 years: 90% of them have prostate gland enlargement. There is a lack of leadership among physicians regarding prostate hypertrophy. Many physicians consider it a minor nuisance in aging men. However, urinary tract infections that are rare in younger men are found more commonly in men with enlarged prostate glands. Also, urination problems can occur that may lead to bladder wall thickening and hydronephrosis of the kidneys. If no surgery is done for the prostate enlargement, the patient has to do intermittent or permanent urinary catheterization.

Surgical options for an enlarged prostate gland

TURP (transurethral resection of the prostate gland)

When patients have difficulties urinating or get frequent urinary tract infections, the urologist often recommends a TURP, which stands for “transurethral resection of the prostate gland”. This is the oldest form of prostatic surgery. The urologist introduces a resectoscope into the urethra and the prostate and removes bits and pieces of prostatic tissue. Complications can be bleeding, leakage of urine and infections after the TURP.

GreenLight™ laser treatment (Photoselective vaporization of the prostate)

This is a more modern form of the TURP, but the knife is replaced with a GreenLight™ laser. This procedure takes about one hour for most cases of prostatic hypertrophy. The urologist does a cystoscopy. When he views the prostate portion of the urethra a green light laser removes tissue from the prostate gland. This allows for free flow of urine through the urethra after the procedure. The advantage of this procedure is that the laser stops any bleeding right away, so patients lose only very little blood. More than 1 million GreenLight™ laser procedures have been performed around the world and urologists have done it on a large scale for about 15 years.

Water vapor therapy (Rezum™)

With this office-based procedure water vapor is introduced into the prostate gland, which causes some prostate tissue to die off. Over a 3 months period pieces of the prostate gland are shed into the urine. The urethra opens up and the prostate gland decreases in size. Unfortunately, many patients have to wear a urinary catheter for several days and sometimes weeks. Surgeons started to use this procedure on a large scale approximately 5 years ago and the urologist can do it at the office.

As the link shows, there are other treatments that urologists can do to open up the passage for urine and decrease the size of the prostate.

Best approach is the green light laser treatment for an enlarged prostate

Currently the best approach is the green light laser treatment for an enlarged prostate. The original TURP is too aggressive with bleeding complications after the procedure. The Rezum method has a prolonged recovery time and does not always succeed restoring normal urine flow. The green light laser treatment is safe, has a minimal amount of bleeding due to the nature of the laser and allows for a faster recovery. The green laser immediately stops any bleeding from the prostate gland.

Green Light Laser Treatment for an Enlarged Prostate

Conclusion

Many older men beyond the age of 60 develop prostate gland enlargement. The prostate puts pressure on the portion of the urethra immediately underneath the bladder. This results in difficulties urinating and frequent urinations to empty the bladder. Often there are significant amounts of urine that stay in the bladder. This urinary retention predisposes the man to urinary tract infections. In the past urologists did transurethral resections of the prostate (TURPs). But they could be very bloody and in some cases caused leakage of urine or infections. 15 years ago surgeons started to use a new type of TURP, a green light laser treatment for an enlarged prostate. Green light laser stops any bleeding during the procedure right away. Post-surgical complications are minimal. Many urologists and patients prefer this method to treat prostate enlargements.

Dec

2020

Hormones Play an Important Role in Survival from Covid-19

By Ray Schilling | andropause, Hormones, immune system, Infectious Disease, Menopause

I am describing here that hormones play an important role in survival from Covid-19. There are two publications that illustrate that point.

Estrogens protect women against Covid-19

A study from Dec. 4, 2020 covering 17 countries and involving nearly 70,000 women discovered these principal findings.

Women aged 20 to 50 have moderately higher Covid-19 infection rates than men
In all of the age groups men have higher mortality rates than women
Beyond the age of 50 the fatality rate from Covid-19 is 50% higher in men than that of women
Postmenopausal women above the age of 50 and on estradiol supplementation had 50% less mortality from Covid-19 than women without estradiol supplementation

The researchers said about the study: “In a nutshell, it’s likely that the apparently protective effects of 17β-estradiol, a naturally occurring, abundant female hormone, relate to a key property of this molecule: it attenuates the so-called “cytokine storm” that’s thought to underlie much of the cellular-scale and organ/tissue-level damage wrought by a SARS-CoV-2 infection, via dysregulation of a patient’s immune response.”

Men need enough testosterone to fight Covid-19

Another study from September 17, 2020 pointed out that males have much worse outcomes with Covid-19 than females. Men are affected by Covid-19 twice as often as females and they experience a much more severe course with a higher mortality. The authors also point out that there is a direct correlation between lower serum testosterone levels in men and inflammation severity by cytokines and poor clinical outcomes. The decline in total and free testosterone in aging men leads to serious pulmonary complications and the need to treat the patient in the ICU. The Covid-19 coronavirus utilizes Angiotensin-Converting Enzyme II (ACE2) for entry into the host cell. A male requires testosterone for ACE2 expression. Lower testosterone causes higher mortality in men. In contrast, if testosterone in a male is too high, blood clots can form in the circulatory system, which often lead to complications and deaths in patients with Covid-19.

Vitamin D levels and course of Covid-19

There are three major effects that vitamin D has.

A strengthening of the epithelial barrier not allowing the coronavirus to penetrate into the lung tissue as easily.
Release of defensins and cathelicidin, two crucial antiviral polypeptides, that eradicate the SARS-CoV-2 virus in the system.
Interruption of the “cytokine storm”, an overwhelming inflammation which is responsible for viral pneumonia to develop. Without the cytokine storm there is no damage to the lungs, and people do not need treatment in the ICU. This is particularly important for people above the age of 60 and for people with pre-existing diseases.

Similarly, with the stabilizing effect of vitamin D regarding the immune function more severe forms of Covid-19 can turn into less severe forms with a better outcome.

Discussion

Research showed that in women estrogen has a modifying effect on the course of Covid-19. In males it is testosterone that leads to an improved course of Covid-19. Both sexes require adequate doses of vitamin D, which helps to strengthen the epithelial barrier. In addition, enough vitamin D releases defensins and cathelicidin, two crucial antiviral polypeptides that eradicate any virus in the system. Vitamin D also interrupts the “cytokine storm”, an overwhelming inflammation, which is responsible for viral pneumonia to develop. All of these factors together modify the course of Covid-19 and improve the probability of survival from this otherwise serious viral illness.

Hormones Play an Important Role in Survival from Covid-19

Conclusion

Two lines of research showed that both women and men do better with Covid-19 when their hormone levels are either adequate or are substituted to normal levels. Women in menopause taking estradiol for postmenopausal symptoms had 50% less mortality from Covid-19. Men who were testosterone deficient and were put on testosterone supplementation do better with respect to Covid-19. In aging men total and free testosterone decline and serious pulmonary complications occur with a need to treat the patient in the ICU. On top of hormones both men and women benefit from high doses of vitamin D, which strengthens the epithelial barrier. Vitamin D also releases defensins and cathelicidin, two crucial antiviral polypeptides that fights the SARS-CoV-2 virus directly. In addition, vitamin D interrupts the “cytokine storm”, an overwhelming inflammation which causes the viral pneumonia. Taken together the hormones and vitamin D can improve the outcome of Covid-19 significantly.

This text includes part of this blog.

Oct

2020

Medical Myths about Aging

By Ray Schilling | andropause, cholesterol, Circadian rhythm, Dementia, diet, exercise, fractures, heart attack, High Blood Pressure, Hormones, lung cancer, Menopause, Mortality, Obesity, Pain, Smoking, Stroke

Medical myths about aging are easy to debunk. Many people believe that it is inevitable that they become disabled as they age, their lives become unbearable, without passion, boring and full of pain. Some aspects of your health may decline with age, none of the myths discussed below is inevitably happening in everyone. Studies showed that a positive outlook on aging and life in general will help you to live longer and stay healthier. Here I discuss 7 common myths about aging.

Myth 1: Everyone will experience physical deterioration

It is common for people to experience reduced muscle strength, increased blood pressure, excessive fat accumulation and osteoporosis. A study with 148 older patients showed that an expectation of reduced fitness in older age actually resulted in less physical activity when older age arrived.

But you can maintain good cardiovascular function and good muscle strength with a regular exercise program. This study showed that men and women can reduce mortality by exercising regularly, even in older age.

Myth 2: Older adults cannot exercise

There are several reasons why older people stop exercising or are afraid to start exercising. People use the excuse of their arthritis getting worse from exercise. But studies showed the opposite: joint function improves and joint pains are getting better with exercise. Your muscles get stronger and you are less likely to fall. Your heart and lungs are improving their functions and your mentation improves. Exercise increases the HDL cholesterol, which reduces the risk for heart attacks and strokes.

Myth 3: As we age, we need less sleep

For many years there was the notion that older people need less sleep. What was not known then was that people above the age of 60 have no appreciable secretion of melatonin from the pineal gland. But when they replace their melatonin deficiency by taking a nighttime dose of 3 mg at bedtime, they will sleep better and longer. They may need a second dose of melatonin in the middle of the night. We need 7 to 8 hours of sleep at night for our diurnal hormone rhythm.

This will also slow down our aging clock.

Myth 4: Your brain slows as you age

Dementia is common when you get older. 13.9% have it at age 71 and older. 37.4% have dementia over the age of 90. But the majority, namely 86.1% in the 71+ age group and 62.6% above the age of 90 do not have dementia. A Mayo Clinic study showed that when the person engaged in artistic activities in midlife or later in life the risk for mild cognitive impairment (MCI) development was reduced by 73%, involvement in crafts reduced it by 45% and engagement in social activities by 55%. In a surprise finding the use of a computer late in life was associated with a 53% reduction in MCI development. These are very significant observations.

Physical activity reduces risk for dementia

Apart from stimulating your brain, physical activities also significantly reduce the risk for dementia. A synopsis of 11 such studies showed that dementia is reduced by 30% when physical activity is started in midlife and the person is aging compared to non-exercisers.

Myth 5: Osteoporosis occurs only in women

There is a serious misunderstanding about osteoporosis. Several factors work together that can cause osteoporosis. Women in menopause are more likely to develop it due to the missing ovarian hormones estrogen and progesterone. These hormones work together and stimulate vitamin D induced calcium deposition into bone as well as decreasing bone resorption.

Vitamin K2 also deposits calcium into the bone. In postmenopausal women who take bioidentical hormone replacement, vitamin D and K2 the bone density remains strong. Unfortunately, the opposite is true in postmenopausal women who take synthetic hormones. Synthetic hormones have side chains that do not fit the natural hormone receptors of a woman. This is why osteoporosis persist. And, yes, men get osteoporosis, but typically 10 years later. Typically, they get into andropause where testosterone production declines 10 years later.

Myth 6: People stop sex as they age

With age men can develop erectile dysfunction (ED) and women vaginal dryness, both of which can interfere with having sex. A large study showed that only 0.4% of men in the age group 18-29 had ED. In the age group of 60-69 there were 11.5% who suffered from ED. What this means though is that 88.5% of men age 60-69 did not suffer from ED. Fortunately for those who have ED drugs like Cialis and Viagra can correct their problem and they can have regular sex. What a change from 25 years ago when none of these drugs were available (approval of Viagra by FDA in 1998 and of Cialis in 2003).

Bioidentical hormone replacement beyond menopause and andropause preserves your normal sex drive as well. There are additional benefits of bioidentical hormones. They have positive effects on the heart, brain, bones and the muscle mass.

Myth 7: It is too late to stop smoking now

One of the myths that many older smokers like to say is that it would be too late to stop smoking. They think the damage to heart and lungs is permanent and quitting now is too late. Fact is that quitting smoking immediately improves your blood circulation and gives you more oxygen. In just 1 year the risk of getting a heart attack is cut into half. In 10 years, the risk of a heart attack or stroke is the same as that of non-smokers. There is a reduction of getting lung cancer by half.

Medical Myths about Aging

Conclusion

There are all kinds of medical myths about aging. We may think that physical deterioration is inevitable. Or we believe that older people cannot exercise. And we cannot help it, but our brain slows down as we get older. And there is the question whether we need less sleep as we age. Osteoporosis is a disease of women, is it not? These older couples, they don’t have sex any more, do they? And is it too late to stop smoking now that I am 65 years old? All of these myths exist, but there is a need to debunk them.

The truth behind the medical myths about aging

I explained in detail what the medical truths are behind these questions. Many of these myths have developed in the past. But with regular exercise, balanced nutrition (Mediterranean diet) and a positive attitude much of these old myths can be overcome. Bioidentical hormone replacement when hormones are missing is another powerful tool. Yes, we all age. But we are still living and can enjoy life as long as it lasts.

Mar

2020

Telomeres are Important

By Ray Schilling | Alzheimer’s disease, andropause, Anti-aging medicine, Cancer, Cardiovascular disease, Diabetes, exercise, fasting mimicking diet, fish oil, Fitness, food, heart attack, High Blood Pressure, Hormones, Menopause, Nutrition, Obesity, omega-3 fatty acids, Smoking, Stress management, telomeres

In the first place, Dr. Joseph Raphaele reviewed why telomeres are important at a Conference in Las Vegas in December 2019. This was at the 27th Annual World Congress on Anti-Aging Medicine in Las Vegas from Dec. 13 to 15, 2019. The actual title of his lecture was: “Telomeres in 2019; clinical developments and cutting-edge applications”.

Notably, Dr. Raphaele reviewed how various animals have quite different life expectancies. First, the Aldabra giant tortoises, for instance can live up to 152 years. Second, the house mouse can at the most live up to 6 years, but its predator, the cat lives up to 38 years. Finally, humans can live up to 122.5 years.That is to say, the average mortality rate doubling curve of man is 8 years. Dr. Raphaele introduced the terms “lifespan” and “health-span”.

Lifespan versus health-span

The first thing to remember is that our lifespan is defined by the number of years we live. On the contrary, the health-span is defined by the number of years you do not have any disease and your physical and mental health are good. Dr. Raphaele explained that for the most part the body’s organs have a limit of functioning after 80. For this reason the kidneys, the maximum heart rate, the maximum breathing capacity and the maximum work rate (oxygen uptake) all decline after the age of 80. It is important to realize that in 1961 Dr. Leonard Hayflick showed that there is a limit of how often cells can divide. After 60 doublings cells in tissue culture either die or just stop dividing. The built-in molecular clock resides in the telomeres. The telomeres are the caps at the end of the chromosomes in the cell’s nucleus.

Telomeres and their function in aging

In a word, what is the function of telomeres? In essence, the telomeres protect the integrity of our genes. For the most part, they protect the chromosomes from deteriorating, prevent DNA fusion and massive instability of the genes. In addition, the telomeres allow the cells to divide in an orderly fashion, but only up to the Hayflick limits. In short, the bottom line is that telomeres prevent cells from mutations of the DNA, from senescence and from death.

Shortening of telomere length with age

Dr. Raphaele said that one of the important findings was that telomere length is shortening with age. Notably, he showed a slide similar to this. To clarify, this graph shows telomere length as a function of the lifespan in years. The telomere length is obtained by a blood test. This determines the length of the telomeres in white blood cells. At a young age it has a length of between 8 and 10 kb. kb stands for kilobase. A kilobase consists of 1,000 pairs of nucleic acid sequences. So, 10 kb means 10,000 pairs of nucleic acid sequences. Around the age of 80 people have much shorter telomeres, only 4 to 6 kb. There is an enzyme, called telomerase that can elongate telomeres by approximately 10%. But this may not be desirable as too much telomerase activation can also stimulate cancer growth.

Age changes telomere length

Dr. Raphaele explained further that a telomere loses about 100 base pairs per cell division. But there are other factors that shorten telomeres. Smoking, sedentary lifestyle, high blood pressure, stress and a low antioxidant status all can shorten telomeres. Certain congenital conditions can shorten telomeres by 28%. Dyskeratosis congenita is such a condition where 80% patients die by the age of 30 due to aplastic anemia. This is associated with bone marrow failure. 10% of these patients die from cancer. Apart from age, which shortens telomeres slowly, lifestyle factors are very important. A good lifestyle where you exercise regularly, you don’t smoke and you eat a healthy diet will slow down the shortening of your telomeres. Controlling your stress, sleeping enough hours per night and taking supplements also delays telomere shortening. Certain medications that control diabetes, high blood pressure or thyroid medication that treats hypothyroidism also delay telomere shortening.

Telomeres and shortened lifespan

Researchers could show that good lifestyle practices work by increasing telomerase to a certain degree. This results in lengthening of telomeres and translates into up to 10 years of increased life span. Jerry Shay, PhD said in 2011: “While the aging process is complex and certainly cannot be explained solely on the basis of telomere biology, there is a growing consensus that in some situations telomere biology and telomere tests may have important utility similar to cholesterol assays or blood pressure monitoring measurements.”

Telomeres are not just a biological clock inside our cells. They have a great influence on the function of mitochondria and on how many mitochondria multiply inside cells. This latter process is called mitochondrial biogenesis. In addition, telomeres regulate gene expression.

Chronic diseases associated with shortened telomeres

Here is a list of chronic diseases where all the patients have shortened telomeres.

High blood pressure
Hardening of the arteries (atherosclerosis)
Cancer
Chronic obstructive pulmonary disease (COPD)
Alzheimer’s disease
Diabetes and obesity
Chronic stress
Metabolic syndrome

Telomeres in cardiovascular disease

Telomere length was found to be shortened in those who developed a heart attack. Researchers compared the telomere length in coronary artery disease (CAD) patients to people with no history of heart attacks. In comparison to this normal group the heart attack victims had telomeres typical for people who are chronologically 11.3 years older than the healthy controls. The researchers calculated that people with telomere shortening had a 3-fold higher risk of coming down with a heart attack.

Telomere length enhancers

Lifestyle changes can have positive effects on telomere length. Examples are smoking cessation, weight loss and stress reduction.
Dietary changes: we know that fish oil (omega-3 fatty acids) supplements elongate telomeres as does a low-fat diet.
Supplements like vitamin D3, antioxidants (vitamin C and E) and astragalus (TA-65) elongate telomeres as well. The astragalus supplement, TA-65 showed a significant elongation of telomeres after 12 months while controls lost telomere length.
Exercise: in a 24-week experiment of care workers regular aerobic exercise increased the telomeres by 67.3 base pairs.
Bioidentical hormone replacement in aging people: when hormones are missing after andropause and menopause, the natural hormones need replacing, or the telomeres are shortening.
High cortisol levels cause telomere shortening.
Human growth hormone elongates telomeres via telomerase activation.
The fasting mimicking diet (FMD) was shown to extend life and telomeres as well.

Therapeutic rationale for telomere lengthening in CAD and AD

Patients with coronary artery disease (CAD) are at risk for developing heart attacks and other cardiovascular diseases. Here is an overview of many clinical trials that have been done in humans with CAD. It shows shortening of telomeres in these high-risk patients. But the review also shows that telomeres can lengthen by changing the risk factors of cardiovascular disease. Researchers were increasing the enzyme telomerase that indirectly lengthens telomeres. Both approaches prevent serious cardiovascular disease and increase life expectancy significantly. In severe cases of telomere shortening the physician can consider TERT gene therapy.

Alzheimer’s disease (AD) also is a condition where telomeres are shortened compared to normal controls. Time will tell whether TERT gene therapy is possible to prevent Alzheimer’s disease.

Telomeres are Important

Conclusion

Telomeres are the caps of the chromosomes in our cells. In the past the word “telomere” appeared obscure and only scientists discussed this among themselves. Now we know that telomere shortening is often the reason for chronic illnesses like high blood pressure, hardening of the arteries (atherosclerosis), cancer, chronic obstructive pulmonary disease (COPD), Alzheimer’s disease, diabetes and obesity. Patients who have these conditions often have shortened telomeres in their white blood cells. Over the years we have learnt that lifestyle changes can have positive effects on telomere length. Smoking cessation, exercise, weight loss and stress reduction are elongating telomeres.

Additional factors elongating telomeres

In addition, supplements like antioxidants (vitamin C and E), vitamin D3 and astragalus root (TA-65) elongate telomeres as well. By elongating telomeres, a person can add 10 to 11 years of disease-free life to the normal life expectancy. Researchers showed that telomerase activation by human growth hormone increased telomere length without causing cancer. Dr. Thierry Hertoghe, an endocrinologist from Belgium spoke about HGH replacement in aging people on other occasions. He said that cautiously treating patients with low doses of HGH when blood tests showed deficiency, adds about two decades of life-expectancy to these patients’ lives.

Aug

2019

The Best Ways To Prevent Cancer

By Ray Schilling | alcohol, andropause, breast cancer, Cancer, Cardiovascular disease, coffee, Diabetes, diet, exercise, fiber, food, green tea, heart attack, Hormones, lifestyle, lung cancer, Menopause, Nutrition, Obesity, omega-3 fatty acids, Prevention, Processed food, prostate cancer, sleep, Smoking, Stroke, sugar, testosterone, Vitamins and supplements

Cancer is the second leading cause of death, that’s why it is important to learn about the best ways to prevent cancer. Generally speaking you want to remove cancer-producing substances (carcinogens) from your diet. But diet is only part of your lifestyle that can contribute to cancer. I shall list some of the more important dietary factors below and briefly touch on important other factors.

Avoid burning your meat

When you use the BBQ, you should avoid burning your meat. Even though the marks of “charring” are considered desirable on meat from the grill, this is really burnt! As a matter of fact it is a lot better to use a slow cooker at low heat and simply cook your food longer. This way you don’t create carcinogens. Avoiding to burn your meat is particularly important for the red meats.

Sugar and an overabundance of starchy foods can cause cancer

You never thought that sugar and an overabundance of starchy foods could cause cancer, but they do. The reason is that the metabolism of cancer cells is using 10- to 12-times more sugar than the metabolism of normal cells. The worst thing a cancer patient can do is to over-consume sugar. Replace sugar by stevia, which is a harmless, plant-based sweetener and does not lead to an insulin reaction. Avoid all other sugar substitutes, as there are other heath problems with most of them.

Avoid phthalates

Those who have a craving for macaroni and cheese are out of luck. This food contains phthalates that are part of the ingredients of almost every sample of cheese powder used to manufacture macaroni and cheese. Phthalates can cause infertility and breast cancer. So you must definitely avoid macaroni and cheese, at least the stuff from the box. Prepare your own!

A high fat diet

What does a high fat diet do? It increases the risk for breast cancer. But it can also increase colorectal cancer risk. Limit your fat intake to about 10% of saturated fat. That is the recommendation of the FDA. Increase your consumption of fish and seafood. Only one proviso: predator fish like shark, marlin, tilefish, swordfish and grouper are high in mercury. But wild salmon, sardines and oysters are low in mercury. You can also enjoy shrimps and prawns.

Take high dose vitamin D3 supplements

High dose vitamin D3 supplements help you to avoid cancer. There are strong statistics showing that vitamin D3 is a powerful tool to lower your risk of developing cancer. Your family doctor should take a blood test called 25-hydroxy vitamin D level to make sure that you absorb enough vitamin D3. There are slow and fast absorbers and the only thing to know how well your gut absorbs vitamin D3 is in doing this blood test.

Also, curcumin (turmeric) 500 mg once per day is good for cancer prevention.

Take enough fiber

Make sure you take enough fiber, which does not only reduce colorectal cancer, but also many other cancers. When you eat plant-based food, you automatically get fiber in it. North Americans are not consuming enough fiber in their diet.

Avoid processed meat and too much red meat consumption

Processed meat and red meat cause cancer.

Beef, lamb and pork seem to contribute to causing cancer according to the WHO. Use common sense and eat fish, chicken and turkey. Reduce your beef consumption. My grandmother served beef as a Sunday dish.The rest of the week simple, plant-based foods appeared on the table. Ask your grandmother, what she used to cook. Or ask your mother what she ate as a child.

Eat moderate amounts of fruit and vegetables

The claim that fruit and vegetables would protect you from cancer is not as solid as researchers thought of in the past. Newer research has shown that a basic intake of fruit and vegetables is needed for nutrients, but consuming more than that will NOT protect you from cancer.

This link explains that eating more vegetables or fruit beyond a certain point will not do harm, but will not protect you further from cancer.

Drink green tea or black tea

If you like tea, drink green tea or black tea. Sweeten it with stevia, but not with sugar. Tea has been shown to have cancer prevention properties.

Avoid alcohol consumption to prevent cancer.

Coffee is a healthy drink and it has mild anti-cancer effects as well. It does not matter whether you drink it caffeinated or decaffeinated.

Other lifestyle issues

Quit smoking

If you are still smoking, quit smoking! Smoking is by and large the biggest risk for developing lung cancer, throat cancer, esophageal cancer and pancreatic cancer.

Watch your calorie intake

Eat smaller meals more often. This way the production of your digestive juices will consume some calories. In addition your taste buds are satisfied, so your hunger for food is more controlled. The end result is that you will not gain weight.

Prevent obesity and type 2 diabetes

This will help prevent obesity and type 2 diabetes, both of which are established risk factors to develop cancer. Here is a review that shows you, which cancer types are caused by obesity. With regard to diabetes, there is a strong association to developing liver cancer, pancreatic cancer and endometrial cancer (=uterine cancer). There is a lesser risk (only 1.2 to 1.5-fold) to develop cancer of the colon and rectum, breast cancer and bladder cancer.

Pollution

Poor air quality with pollution can also be a factor in causing cancer. Pollution does not stay local, but travels through the stratosphere around the globe. The result is that now 10 to 15% of lung cancer in the US occurs in patients who never smoked. This translates into 16,000 to 24,000 deaths annually of never-smokers in the US. In certain cities such as Beijing lung cancer rates have doubled in 9 years between 2002 and 2011. Lung cancer in non-smokers can be caused from exposure to radon, to second-hand tobacco smoke, and other indoor air pollutants.

Bioidentical hormone replacement

When males do not replace missing testosterone in andropause they are much more prone to develop prostate cancer. Similarly, when women are menopausal and do not get progesterone supplementation, they develop a higher amount of breast cancer due to estrogen dominance. It follows from this that bioidentical hormone replacement in menopause and andropause will help to prevent prostate cancer and breast cancer.

The Best Ways To Prevent Cancer

Conclusion

There is strong evidence that certain foods can cause cancer. Other foods including supplements like curcumin and vitamin D3 can help prevent cancer. Basically, you want to avoid all that is known to cause cancer and eat more of the healthy foods that do not cause cancer. This will help to decline your cancer risk. I suggest that in addition you should quit smoking, avoid pollution as much as possible, reduce excessive alcohol intake and watch your calorie intake. By doing this you prevent obesity and type 2 diabetes, and you will move into the low-risk cancer group. We all need to work on this on an ongoing basis.

Practical hints regarding the best ways to prevent cancer

The best ways to prevent cancer is to avoid processed red meat and all other processed foods. Eat more vegetables, fruit, wild salmon and other seafood. Don’t eat red meat more often than once a week and make it red meat from grass fed animals. In addition exercise regularly, get enough sleep and practice some form of relaxation (yoga, Tai Chi, self-hypnosis etc.). This lifestyle will not only prevent heart attacks and strokes, but also the majority of cancers.

Previously published here.

Feb

2019

Combatting Hair Loss

By Ray Schilling | andropause, hair loss, laser therapy

Dr. Alan Bauman gave a talk about combatting hair loss. This talk was part of the 26^th Anti-Aging Conference of the American Academy of Anti-Aging Medicine in Las Vegas from December 13 to15, 2018.

Dr. Bauman is the owner of many hair loss clinics around the US. Dr. Bauman said that the baldness gene is present in 4 out of 7 men. The gene codes for male alopecia, which means hair loss. We are all familiar with it. First it causes only a receding hairline in the front. Later it causes thin hair and baldness at the crown. But in later years this gene causes baldness in males. One of the metabolites of testosterone, DHT (dihydrotestosterone) causes hair follicles to miniaturize. The result is that hair is no longer covering the scalp skin as much as it used to.

Mild hair loss

In the case of mild hair loss local application of 5% Minoxidil will often make a big difference. The physician will want to order a testosterone blood level. It this is low, replacement with testosterone will restore his libido, normalize his erectile dysfunction and give him more energy. Often his hair growth will also recover to a certain extent. Together with Minoxidil 5% he may be doing well for 5 or 10 years.

But eventually the persistence of DHT as the end metabolic product of testosterone gets the upper hand and causes more hair loss.

Low-level laser therapy is another method how to re-stimulate the atrophied hair follicles to grow to full hair again. Dr. Bauman showed amazing before and after images that documented vigorous new hair growth with low-level laser therapy.

Moderate hair loss

Those men who have the baldness gene will experience more severe hair loss by the age of 30 to 40. More effective methods are necessary to help him. Oral finasteride is one medication the doctor can prescribe. But one of the side effects can be a decrease in libido, which many men will not like. But the patient can apply finasteride 0.25% topical to the hair. This reduces systemic side effects, but helps the hair to grow. Minoxidil 5% can be combined with topical finasteride.

Platelet rich plasma

One step further is the use of platelet rich plasma. Blood is collected from the patient. A dual-spin procedure produces platelet rich plasma. This was tested in the laboratory and showed about 7-fold the amount of lymphocytes, 3-times the amount of monocytes and 6.3-fold more platelets than whole blood. This PRP preparation is injected into the areas where hair growth is missing. If there are still atrophied hair follicles present in the scalp, lush new hair growth will develop following PRP injections. The effect of the PRP injections can also increase by additional low-level laser therapy. PRP is especially useful for the treatment of alopecia areata, which otherwise would be difficult to treat. To a certain degree PRP injections will also serve a male well that has androgenic hair loss.

Severe hair loss

When a male with the baldness gene enters the late 50’s or 60’s there may no longer be viable atrophied hair follicles present in the bald areas. This is when you have to make a decision whether to shave your whole head and embrace baldness or whether you are using the more expensive hair transplant method. The occipital hair, even in bald people is not responding to DHT. This is why occipital hair is the ideal donator site for a hair transplant. This consists of harvesting DHT-resistant hair follicles from the occipital scalp and transplanting them into the areas that are in need to be cosmetically improved. It is a time consuming procedure, transplanting one follicle at a time.

Hair transplant

The technique is either manual transplantation or robotic-assisted hair transplant surgery. As only parts of the occipital hair follicles are useful material, there is no scar or baldness from the surgery. In 7 days the occipital area has healed over. A man may require 3 or 4 hair transplants in a lifetime to cover up areas of the scalp that were balding because of the baldness gene. But the end result is natural looking hair that now is resistant to DHT as it was transplanted from the occipital scalp. A total of four hair transplants are possible without denuding the scalp region. Dr. Bauman showed many before and after photos of men who had hair transplants.

Combatting Hair Loss

Conclusion

Hair loss is common, perhaps more so in men than in women. However, in both cases a lot of therapeutic approaches are possible. Milder hair loss responds to treatment with Minoxidil 5%. In addition finasteride in a local 0.25% topical application is a choice. When hair loss is more severe, PRP (platelet rich plasma) injections into the scalp area are a possibility, but only where viable, but atrophied hair follicles are not growing enough hair. This may give a very acceptable result.

But the aging male who has genetic baldness working against him needs to consider a hair transplant with DHT resistant hair follicles from the occipital scalp into the bald areas.

The beauty is that there is a solution for every one. Due to extensive research of the various methods you can trust that they will give you the results you want.

Incoming search terms:

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Dec

2018

Biological Age Is Different From The Chronological Age

By Ray Schilling | alcohol, Alzheimer’s disease, andropause, blood test, cholesterol, diet, exercise, food, Health, heart attack, lifestyle, osteoarthritis, stress, Stroke, telomeres

Biological age is different from the chronological age said professor Morgan Levine from Yale Medical School. She is working in the department of pathology. She has found in her research that people of the same chronological age have very different biological ages. From a biological standpoint they may be much younger or older than their chronological age. When people are younger than their chronological age, they have less disease and less mortality. This article has reviewed the facts.

Measuring biological age

Dr. Levine also has developed tools how to determine the biological age. And when the biological age is higher than the chronological age, she recommends lifestyle changes that will set back the biological clock. We age differently according to what we eat, how our genetic make-up is, which we cannot change, whether we are physically active and what environmental toxins we are exposed to. So, the biological age determines our health status and what our final life expectancy will be.

Biomarkers for biological age

A simple blood test that your family doctor can order consists of the following. A fasting blood sugar, kidney and liver tests, immune tests and inflammatory tests. In addition the doctor will want to know whether you are smoking or not, how much alcohol you consume and how much red meat and processed meat you eat. A computer program processes these results, which determines your biological age.

Lifestyle improvements can lower biological age

Biological age testing has a strength built in. By changing your lifestyle you can lower it. When you exercise more regularly and switch to eating a Mediterranean diet you can lower your biological age. Other studies have shown that the Mediterranean diet is anti-inflammatory. A telomere test, which also determines the biological age, is fixed. It is not easily changed by dietary measures and increasing your exercise.

Dr. Levine said: “I think the most exciting thing about this research is that these things aren’t set in stone.”

Putting the biological age to the test

Dr. Levine was curious what her own biological age was. She entered her blood test data and lifestyle facts into the computer. She was surprised that her biological age was not as good as her first assumption. Now she is trying to get more sleep, has increased her exercise level and improved her diet.

Her research team is working on getting the algorithm online so that everyone will be able to put one’s blood tests and other data into the computer program and calculate the biological age. The program will also recommend what steps are likely most helpful to increase one’s health and decrease the biological age.

Lower your biological age

No one wants to live a long life, if they are in pain and have various illnesses like arthritis or Alzheimer’s. But things are different, if they can change lifestyle factors and maintain a low biological age for a long time. Now they can stay active, have no pains and are able to contribute to society.

“By delaying the onset of diseases and cognitive and physical functioning problems people can still be engaged in society,” Dr. Levine said. “I think that is the ideal we should be striving for.”

Other literature about biological age

Inflammation increases the biological age

In this publication the authors stressed that inflammation is the common denominator for developing disease and premature aging. The authors stress further that it is mandatory to change one’s lifestyle to lower the biological age and live longer.

Diastolic blood pressure predicts mortality

In an older study the diastolic blood pressure was related to mortality. The higher the diastolic blood pressure was, the higher the mortality. The authors also noted that it was the persons with the higher biological age who were at the highest risk of dying.

Scientific study about the predictors for the biological age

Here is a scientific study that examines predictors for the biological age. This is not easy reading, but I placed it here for completeness sake.

Link to a site that can calculate your biological age

Here is a link to a site that calculates your biological age. It is probably not as good as Dr. Levine’s computer analysis will be when it is available. However, it is a good approximation to what it will be like.

Biological Age Is Different From The Chronological Age

Conclusion

The dream of staying younger for longer is not new. Research has shown that we actually can do something about it. If we look after our lifestyle, don’t smoke, don’t drink excessively, eat a sensible Mediterranean-type diet and exercise regularly, our biological age will be less than our chronological age. It is the biological age that determines how old we get and whether or not we will suffer from age-related illnesses. Researchers also found out that when your biological age is younger than your actual age mortality will occur later. The math is simple. Let’s assume that your biological age is 15 to 20 years younger than your chronological age. As the average life expectancy presently is 80 years, your life expectancy can increase to 95 or 100 years.

Nov

2018

When you are sleepless

By Ray Schilling | andropause, Anxiety, Drugs, Insomnia, Menopause, Mortality, sleep, stress, telomeres, testosterone

You are not alone when you are sleepless. Insomnia is a widespread problem in society.

Previous review of the topic of insomnia

I have reviewed the topic of insomnia before in a blog.

Briefly I pointed out that in some people there is a mutation of the gene that controls the circadian sleep rhythm. It is called the CRY1mutation. Some people have sleep disturbances from working night shifts. I mentioned the blue light of electronics that is produced by the TV screens or computer screens. The more you are exposed to it, the more it stimulates the brain to produce serotonin. This undermines the melatonin production, and as a result the person finds it extremely difficult to fall asleep. Children playing with i-phones, tablets or watching children’s programs on television can have sleep disturbances from the blue light. Blue has the frequency that over stimulates the brain and interferes with melatonin production. Drug and alcohol abuse can also interfere with the normal circadian sleep rhythm and cause insomnia.

Hormone factors of insomnia

For natural sleep to occur, we need melatonin which the pineal gland releases in the evening. It initiates and maintains sleep during the night. The natural opponent of melatonin is cortisol, the stress hormone, from the adrenal glands. Both hormones need to be in balance to allow you to sleep normally. Shortly before we wake up in the morning melatonin production goes down and cortisol production is up. Cortisol levels are low at night and high during the day. So it is cortisol that keeps us going throughout the day. But an excess of cortisol from chronic stress can also interfere with falling asleep and sleeping through the night.

Stress and insomnia

When we feel stressed, cortisol production goes way up. This has consequences regarding our sleep pattern. It can interfere with falling asleep, causes us to wake up from a deep sleep in the middle of the night and can give us problems falling asleep again. Chronic stress exposure leads to high cortisol production by the adrenal glands, which in turn will lower melatonin and cause sleep disturbances. Older people (above the age of 50) have very little melatonin production left, as there is an age-related decline of melatonin production. The melatonin production is highest in younger years and lowest in older age.

What to do when you are sleepless

There are several over-the-counter remedies, which in combination can be quite effective.

Melatonin for when you are sleepless

Melatonin (3 mg at bedtime) is a good start to see what it does for your sleeplessness. Taking a small amount of melatonin at bedtime we can re-establish the balance between cortisol and melatonin, which helps the circadian hormone rhythm and sleep pattern to come back. Some people wake up in the middle of the night and find it difficult to fall asleep again. If this happens at 3 AM, a good remedy at this time is to take another 3 mg of melatonin. Melatonin stays in the system for about 4 hours. Light during the day de-activates the effect, when light hits the retinas upon opening your eyes. You should not exceed 6 mg of total melatonin overnight. Otherwise it will interfere with the balance of cortisol and melatonin, lowering cortisol levels, which would rob you of energy during the day.

Phosphorylated serine (Seriphos)

A supplement that is freely available in the US (but not in Canada) consists of a simple amino acid. As this link shows (second item in the link) phosphorylated serine Seriphos) helps to down-regulate cortisol levels (lowering them). This means that melatonin gets the upper hand and you can sleep again.

The dosage for phosphorylated serine (Seriphos) varies from person to person, but will be in the range of 1000 mg to 3000 mg in the evening. After about 30 days the circadian rhythm may have recovered and you can stop the Seriphos. A one-day pause is required once a month for resetting the hormone receptors. Should you still have problems sleeping, you can continue with it for another month and pause again for a day. Seriphos has very few side effects.

Valerian root capsules

Another useful sleep aid is valerian root (as capsules). 500 mg to 1000 mg will help you to relax. It does not have the side effect of feeling groggy the next morning.

Other considerations when you are sleepless

Hormone problems like thyroid abnormalities (too much or too little thyroid hormones) are issues that your doctor has to investigate. Women in menopause often have sleep disturbances due to a lack of estrogen and progesterone. A knowledgeable healthcare professional is able to take care of that by prescribing bioidentical hormone creams.

When men approach andropause (the equivalent of menopause in women), they lose testosterone production. This can cause insomnia. The doctor can verify the hormone loss by a blood test. Replacement with either bioidentical testosterone cream or injections will rebalance testosterone levels. Insomnia may disappear. It is essential not to overdose testosterone, as this can also cause insomnia.

Sleep lab for when you are sleepless

When home remedies do not help, it may be time to check into one of the sleep labs to diagnose the kind of sleep disorder you are suffering from. Here is an overview what is happening there.

Essentially you get hooked up to monitors and are encouraged to just sleep as you would normally do. The physician in charge of the lab will later explain to you what the monitors showed, and tell you what type of sleep. According to the findings your doctor will recommend what measures are appropriate to remedy the situation.

Treatment for insomnia when over-the-counter remedies fail

Short acting benzodiazepams

When anxiety is not a problem, but only insomnia is (falling asleep or staying asleep) lorazepam 1 mg (Ativan) or temazepam 10 mg (Restoril) are shorter acting benzodiazepams that will help. It is not a permanent but a short “emergency break” for intermittent use, so that the GABA benzodiazepine receptors have time to recover. Otherwise, with continuous use tolerance would set in. This means higher and higher doses of the sleep medication would be necessary to achieve the same effect. Another non-benzodiazepine is Zolpidem 5 mg (Ambien). Even though this medication is not a benzodiazepine, it works on stimulating the same GABA benzodiazepine receptors.

Longer acting benzodiazepams combined with antidepressant Trazodone

For several years the combination of a small amount of the longer acting benzodiazepams, clonazepam (Rivotril) at 0.5 mg combined with a small amount of the anti-depressant trazodone (Oleptro or Desyrel) at 50 mg at bedtime has been has been in use quite successfully.

But there is a concern of drowsiness caused by Rivotril as this link shows.

Trazodone, which is an antidepressant has a sleep cycle restoring effect at low doses and has less side effects, because it is used at ¼ the dose for a full-blown depression. Males are often complaining that it reduces their sex drive, and it may cause erectile dysfunction.

Clonazepam side effects

Rivotril was originally in use to control epileptic seizures and anxiety. The combination therapy for sleep disorders uses Rivotril at ¼ of the regular dose. Although it is good as a sleep aid, it has a long half-life and stays in the system well into the next day. This may present as sleepiness and cause falls in elderly patients because of clouded attention. Replacement by one of the medium long acting benzodiazepams could be the solution. A drug pause for 1 day will help to reset the GABA benzodiazepine receptors and prevent tolerance from happening. Knowing all those effects and side effects it is wiser to reserve the use of these medication strictly when everything else has failed!

When you are sleepless

Conclusion

As I mentioned before, you are not alone when you are sleepless. Insomnia can present as having problems to fall asleep, but it may present in others as a problem in the middle of the night waking up and having problems going back to sleep again.

I described non-conventional methods to help you to sleep using melatonin, Seriphos and valerian root capsules. If this fails, a sleep lab investigation may be necessary to get to the bottom of your insomnia problem. Physicians often prescribe short acting benzodiazepams like lorazepam (Ativan) and temazepam 10 mg (Restoril).

Other possibilities to treat insomnia

There are other possibilities to treat insomnia, with a combination of a low-dose antidepressant (trazodone, brand name Oleptro in the US) and low-dose anti-seizure and anti-anxiety drug clonazepam (Klonopin or Rivotril). Anxiety can often be a big component in insomnia and this treats both. On the other hand, anxiety is a separate problem, which needs professional treatment. There can be side effects of sleepiness from clonazepam and men complain of a lack of sex drive and erectile dysfunction from trazodone. Help is available when you are sleepless. But you need professional help to work on the problem and find the solution.

Incoming search terms:

https://www askdrray com/when-you-are-sleepless/

Mar

2017

What’s new about testosterone?

By Ray Schilling | andropause, blood test, Heart Disease, Men's Health, testosterone

Dr. Gary Huber recently gave a lecture on what’s new about testosterone. He presented his talk at the 24^th Annual World Congress on Anti-Aging Medicine (Dec. 9-11, 2016) in Las Vegas that I attended. It was entitled “Evolution of Testosterone – Dispelling Myths & Charting a Future”.

History of testosterone

There are some notable historic landmarks with respect to the discovery of testosterone.

1869: Dr. Charles Brown-Sequard suggested that the “feebleness of older men” was due to a lack of testosterone. He injected himself with testicular extracts from dogs and guinea pigs.

1912: The Danish physician Dr. Thorkild Rovsing transplanted the testicles of a young soldier killed in battle into an old man with gangrene. The gangrenous wound healed completely.

1918: Dr. Leo Stanley sampled fresh testicles from executed prisoners at the San Quentin Prison and transplanted them to prison inmates. Some regained their sexual potency.

1930’s: Professor Adolf Butenandt collected 25,000 liters of urine from willing policemen. He was able to isolate a breakdown product of testosterone, androsterone. Eventually he isolated both progesterone and testosterone. He received the Nobel prize for his work with sex hormones in 1939.

Historical detours and misguided opinions about testosterone

1935: Because natural hormones cannot be patented, Big Pharma came up with the idea of modifying testosterone by adding a methyl group at the 17-alpha position of testosterone. This new substance, 17 alpha-methyltestosterone, was a new compound. The FDA could patent it. Men liked it, because they could swallow this testosterone derivative as a pill. However, the liver changed 17 alpha-methyl-testosterone into 17 alpha-methyl-estradiol, a strong estrogenic compound. The body could not metabolize this testosterone compound too well. Shortly after introduction into patients it became evident that 17 alpha-methyl-testosterone caused liver cancers. This “testosterone equivalent” was on the market for 50 years before the FDA outlawed it because it caused liver cancer. It also caused suspicion among physicians about any testosterone replacement, even the bioidentical hormones that are safe.

Prostate cancer myths

Prostate cancer myth

Conventional medicine teaches (and I have believed this for many years) that testosterone would be the cause for prostate cancer. This was based on old observations by Dr. Huggins, a Canadian born surgeon who practiced in Chicago, that orchiectomy improved the survival of advanced prostate cancer patients a bit. Dr. Lee pointed out that Dr. Huggins neglected to realize that testicles make both testosterone and small amounts of estrogen. The belief that testosterone production was the culprit of prostate cancer led to the practice of physicians to do orchiectomies. This inadvertently removed the real cause of prostate cancer, an estrogen surplus. This improved the survival of these patients somewhat. Nowadays we have more sophisticated testing methods.

Estrogen causes prostate cancer, testosterone does not

Dr. Abraham Morgentaler (Ref. 1) has compiled a lot of evidence about the importance of testosterone in men. He proved, based on a lot of more modern references, that it is not testosterone that is the cause of prostate cancer. We know now that estrogen dominance is responsible for prostate cancer and that this develops as stated above because of the low testosterone and low progesterone during the male menopause (also called “andropause”).

It is important, when testosterone deficiency is present in an aging man, to replace the missing testosterone with bioidentical testosterone.

Some physicians still practice the old method of hormone depletion therapy in advanced prostate cancer cases. But Dr. Morgentaler and other researchers have shown that it is wrong to do hormone depletion therapy or orchiectomies.

10% absorption rule myth

For years there has been a persistent myth that the skin would only absorb 10% of testosterone. There was never any proof of this and newer studies showed that indeed the skin absorbs about 90% of testosterone.

Misleading science created myths

Unfortunately three key medical journals, JAMA, NEJM and PLOS ONE have published misleading studies. The content did not discuss physiology, mechanism of actions, appropriate dosing or true science. But they concluded that testosterone therapy was causing heart attacks and strokes. There was an outcry about this particular study in the medical community. Unfortunately there were more similar false “studies”. The problem with these was that the controls were wrong or they compared unequal groups that were not comparable. It is reminiscent of previous effort of the tobacco industry wanting to cover up that cigarette smoke causes lung cancer.

Testosterone replacement treats the cause of the deficiency

Here we have the problem that testosterone cures so many conditions for which the Pharma industry has many patented medicines that control the symptoms. But testosterone can actually treat the cause of the illness, testosterone deficiency, which leads to a cure of many other symptoms.

For a long time confusion plagued the older physician generation. But younger physicians are replacing the older generation and they treat testosterone deficiency with bioidentical testosterone in the proper dose.

Clinical observations about a lack of testosterone

There is evidence that men have lower testosterone as they age and this has worsened when we compare data from early 2000 to the 1980’s and 1990’s. As this paper shows, men investigated in the 1980’s were still having higher testosterone levels in older age. But in the 1990’s and more so in 2004 these values have declined even more. This fact coincides also with other studies, showing decreased sperm health and increased infertility. The reason for this is also a lack of testosterone!

Causation of low testosterone

Dr. Huber pointed out that many studies have pointed to a variety of causes for low testosterone levels in men.

BPA, toxins and pesticides

BPA, toxins and pesticides that occupy testosterone receptors and interfere with the hypothalamus/pituitary hormone function that stimulates the Leydig cells to produce testosterone.

The more stress, the less testosterone

The more stress men are under, the less testosterone production there is. Sleep deprivation below 5 hours per night leads to a significant lower testosterone production. Most testosterone production occurs during the sleep in the early morning hours.

Less testosterone from weight gain and sugar overconsumption

Weight gain and sugar overconsumption poison the testosterone producing Leydig cells.

Poly-pharmacy can lower testosterone

Poly-pharmacy. Many drugs lower testosterone production: statins, diuretics, metformin, spironolactone, opiates, antidepressants, verapamil, alcohol, chemotherapy for cancer, antihistamines, ketoconazole, beta blockers, H2 blockers, finasteride, estrogens and alpha methyldopa.

Many references were provided that support these data. One paper reported that the risk of a heart attack climbs to 4 times the risk of normal, when the man sleeps less than 6 hours per night. As sleep hours lower, the risk for metabolic syndrome increases by 42% and this leads to heart attacks. Testosterone replacement can reverse this risk as it is a lack of testosterone production that caused the risk.

Link of low testosterone to cardiovascular disease

The literature is overwhelming that low testosterone has adverse effects on the cardiovascular system. To be more specific, the metabolic syndrome, heart disease (and strokes), diabetes and high blood pressure have their root in low testosterone.

Metabolic syndrome

Inflammation is mediated by cytokines such as IL-6. Dr. Huber mentioned one study where healthy men received IL-6. This promptly suppressed testosterone levels. He said that there are many cytokines that work in concert to suppress testosterone. One useful clinical test for inflammation is the C-reactive protein, which indicates whether or not inflammation is present in a person. Metabolic syndrome is common in obese patients. In a study CRP was found to be significantly associated with obesity. When CRP is high, testosterone levels are low. When the CRP level is high, there is a risk of getting the first heart attack.

Testosterone treatment and inflammation

On the other hand, when men with high inflammatory markers from low testosterone levels were replaced with testosterone, the tumor necrosis factor was reduced by 50%, IL1b by 37%, triglycerides by 11% and total cholesterol by 6%.

In the Moscow study a group of obese men with low testosterone levels were treated with testosterone injections. There was an impressive reduction of insulin (17%), CRP (35%) weight reduction of 4% and TNF-a reduction of 31% within 16 weeks.

Heart disease (and strokes)

Hardening of the arteries (medically called atherosclerosis) is due to chronic inflammation. Researchers developed a new heart attack/stroke specific biomarker. It is a ratio of oxidized LDL, divided by HDL. This has an odds ratio of 13.92 compared to a control without a risk for a heart attack or stroke.

Administration of testosterone hormone led to dilatation of coronary arteries. The Rotterdam study showed that low testosterone levels were associated with high risk for heart attacks and strokes, but that treatment with testosterone removed this risk. Testosterone increases AMP kinase for energy production in heart muscle cells, but also dilates coronary arteries for more blood supply to the heart.

Diabetes

Among men with diabetes 20-64% have low testosterone levels. In another study men with higher testosterone levels had a 42% lower diabetes risk. Testosterone levels are inversely related to body mass index and insulin resistance. Men with diabetes have lower testosterone levels than men who were not diabetic and were weight-matched. Most diabetics have high CRP values.

High blood pressure

Experience with androgen deprivation therapy for prostate cancer has shown that blood pressure gets elevated due to testosterone deficiency. Testosterone increases LDH, the protective subunit of cholesterol, and decreases LDL cholesterol and triglycerides. Testosterone also lowers inflammatory markers and reverses clotting factors making blood thinner. All of this leads to a widening of the arteries and lowering of blood pressure.

Treatment options for low testosterone

It is important to support the hypothalamic /pituitary/adrenal gland axis and remove other causes, such as stress and lack of sleep. Younger men can be stimulated in the pituitary gland through Clomiphene. Men older than 60 likely have true secondary hypogonadism and need testosterone replacement. Topical testosterone creams are available commercially or from compounding pharmacies. Injectable testosterone preparations that can be metabolized by the body are available. One such preparation is Delatestryl. A small dose (like 50 mg) is self-injected subcutaneously twice per week, which keeps the testosterone level stable. The last resort, if the creams or injections don’t work, is the use of testosterone pellets that a physician can implant under the skin.

What’s new about testosterone?

Conclusion

At a recent Anti-Aging conference in Las Vegas that I attended, Dr. Huber gave an overview of testosterone. There has been an objective reduction of testosterone levels in men since the 1980’s due to pollutants in our environment. Testosterone plays a key role for heart and brain function. It affects sex drive, fertility and potency. But it also prevents diabetes, high blood pressure and weight gain. On top of that it prevents prostate cancer and likely many other cancers. The key with low testosterone is to replace it to high normal levels. Blood levels should be measured every two months, when replacement has been instituted, in order to ensure adequate levels.

References Ref.1 Abraham Morgentaler, MD “Testosterone for Life – Recharge your vitality, sex drive, muscle mass and overall health”, McGraw-Hill, 2008