May
10
2014

The Full Story About Testosterone

Much has been written about what happens when women get into menopause. This begs the question: do men experience a change of life? As a matter of fact, they do. It is called “andropause”, and they can experience problems as a result. Here is a study from the Massachusetts General Hospital in Boston, MA, which was published in the New England Journal of Medicine (Sept. 2013) describing in detail what happens when men get into andropause (the male equivalent of the menopause).

We know from other studies that in obese men testosterone is converted into estrogen because of the enzyme aromatase that converts testosterone into estrogen resulting in erectile dysfunction and loss of sex drive. In lean men above the age of 55 there is a true testosterone reduction because the testicles produce less testosterone. This results in less sex drive, moodiness and lack of energy. But these men will do well with bioidentical testosterone replacement.

Main findings of the Massachusetts General Hospital study:

  1. Testosterone was responsible for thigh muscle development and leg press strength, for erectile function and sexual desire.
  2. Surprisingly, estradiol (the main estrogen component in both sexes) plays a significant part in sexual desire in the male. This became particularly apparent in the post-andropause male who desired hormone replacement. When bioidentical testosterone is used to replace what’s missing there was no problem with sexual desire or erectile function as a small amount of the testosterone was aromatized into estradiol. The researchers were able to measure both testosterone and estradiol levels.
  3. Here is a surprising fact: a lack of estrogen leads to abdominal obesity. This could also be verified by hormone measurements.
  4. In the past doctors used synthetic testosterone products like methyltestosterone, danazol, oxandrolone, testosterone propionate, testosterone cypionate or testosterone enanthate. The problem with these synthetic testosterone products is that the body cannot metabolize a portion of them into estrogen that is desirable for a normal sex drive, so the testosterone compounds alone are not doing their job as well as the bioidentical testosterone that the body can aromatize.

In obese men the problem is that there is too much estrogen in the system, which leads to a disbalance of the hormones in the male with a relative lack of testosterone. Overweight and obese men produce significant amounts of estrogen through aromatase located in the fatty tissue. Aromatase converts testosterone and other male type hormones, called androgens, into estrogen. Excessive levels of estrogen cause breast growth, muscle weakness, lead to abdominal fat accumulation, heart disease and strokes. Dr. Lee described what happens in men who enter andropause years ago as indicated under this link.

The Full Story About Testosterone

The Full Story About Testosterone

Testosterone to estrogen ratio:

Dr. Lee indicated that in his opinion saliva hormone testing is more reliable than blood tests (Ref. 1). One of the advantages of doing saliva hormone tests of estrogen and testosterone is that you can calculate directly the ratios of these two hormones. In hormonally normal younger males the testosterone to estrogen ratio is larger than 20 – 40 (Ref.2). The testosterone to estrogen ratio in obese men is typically less than 20 meaning it is too low. But lean men in andropause produce too little testosterone and their testosterone to estrogen ratio is also less than 20, because they may still have enough estrogen in their system from aromatase in the fatty tissue, but they are lacking testosterone due to a lack of its production in the testicles (Ref. 1 and 2).

When a man in andropause is given bioidentical hormone replacement with a testosterone gel or bioidentical testosterone cream this is absorbed into the blood and body tissues and then partially metabolized into a small amount of estrogen. This can be seen when saliva hormone tests are done; a higher level of testosterone is detected and much lower estrogen level so that the testosterone to estrogen ratio is now 20 to 40 or higher and the affected person will no longer be the “grumpy old man” that had been a source of distress to his partner before.

This New England Journal of Medicine study is important because it confirmed what anti-aging physicians had been saying for years: a small amount of estrogen is necessary for the male for bone health as estrogen receptors will regulate the bone density, it also helps for a normal sex drive. The same is true for women: a small amount of the opposite hormone (testosterone) will help a woman’s sex drive, but she needs the right mix of progesterone to estrogen (a progesterone to estrogen ratio of 200:1 using saliva tests) to feel perfectly normal as a women.

Health and well-being of a man depend on normal testosterone levels:

It is important to realize that testosterone is not only supporting a man’s sex drive and libido, key organs like the heart, the brain and blood vessels contain testosterone receptors as well. The body of a man was designed to respond to testosterone all along. It is when testosterone production is no longer keeping up that premature aging becomes apparent, as the target organs do no longer receive the proper signals.

A healthy heart in a man depends on regular exercise and testosterone stimulation whether he is young, middle aged or old. The same is true for the lining of the arteries where testosterone receptors are present to help with the normal adjustment to exercise and relaxation. The brain cells have receptors for all of the sex hormones and in a man they are used to higher levels of testosterone and lower levels of progesterone and estrogen. If you take the balance away, the aging man will feel miserable and grumpy. Depression will set in. Here is a brief review how one man’s life has been changed by testosterone replacement.

So, bioidentical hormone replacement is not just a matter of replacing one hormone, you need to pay attention to all of the hormones. Lifestyle issues enter the equation as well. I have reviewed the issue of bioidentical hormone replacement for women and men in this blog.

Conclusion:

When a man reaches the age of 55 or older there comes a point where a lack of testosterone and estrogen sets in. It is wise to start doing intermittent blood or saliva hormone tests before this point is reached in order to gage when bioidentical hormone replacement treatment should be given. Along with an assessment regarding the hormone status it would be wise to also assess lifestyle issues as often other factors play a role in premature aging. I have reviewed these factors systematically in a recent publication (Ref. 3). It is best to combine bioidentical hormone replacement with life style interventions to achieve optimal preservation of a man’s health.

More information about male menopause (=andropause): http://nethealthbook.com/hormones/hypogonadism/secondary-hypogonadism/male-menopause/

References:

  1. John R. Lee, MD: “Hormone Balance for men- what your doctor may not tell you about prostate health and natural hormone supplementation”. 2003 by Hormones Etc.
  2. George Gillson, MD, PhD, Tracy Marsden, BSc Pharm: “You’ve Hit Menopause. Now What?” 2004 Rocky Mountain Analytical Corp. Chapter 9: Male Hormone Balance (p.118-148).
  3. Dr.Schilling’s book, March 2014, Amazon.com:“A Survivor’s Guide To Successful Aging: With recipes for 1 week provided by Christina Schilling”.

Last edited Nov. 8, 2014

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Aug
10
2013

Bioidentical Hormone Replacement

In many previous blogs I have mentioned that bioidentical hormone replacement prolongs life. Here is a more detailed look at what such hormone replacement looks like for both women and men. Before I get into details I want to stress that I am talking about replacing what is missing and replacing only with natural hormones, not some artificial hormone derivative produced by a drug company. The reason this is immensely important is that hormone receptors in the body are distributed all over our vital organs including bones, blood vessels and the nervous system. If there is no lock and key fit (bio-identical hormone fitting the hormone receptor), there is trouble as the Women’s Health Initiative in 2002 has shown. Unfortunately they had used synthetic hormones for HRT that were not fitting the hormone receptors, and this caused many problems (heart attacks, strokes, osteoporosis, cancer).

Physiology of aging

As we age, we gradually produce fewer hormones in our hormone glands, but the various hormone glands deteriorate in their functions at different rates. Beyond the age of 30 we produce less melatonin and less growth hormone. As a result our sleep pattern may change, as melatonin is necessary for a deep sleep. The decreasing growth hormone production means that we are losing some of our muscle mass and accumulate more fat in the subcutaneous tissues. Our adrenal glands produce less DHEA at the age of 35 to 40, a hormone that is a precursor to our sex hormones in males and females. The gonads (testicles and ovaries) also produce fewer hormones, a process which already starts 5 years before menopause and about 5 years before andropause (the male menopause equivalent).

Typically a woman will get into menopause at the age of 45 to 55 at which time the periods stop and postmenopausal symptoms are interfering with her well-being.  Men get into andropause (the male equivalent of menopause) at the age of 55 to 65 at which time erectile dysfunction occurs and often the individual will become the “grumpy old man”.

Other hormones such as thyroid hormones are also affected by the slow down. Hypothyroidism is common in people above the age of 50.

Bioidentical Hormone Replacement

Bioidentical Hormone Replacement

Baseline laboratory tests

In order to know what is going on, the physician or naturopath needs to order a number of tests to assess whether there is inflammation, how your key hormone levels are; the cardiovascular system markers should also be checked, the liver enzymes and vitamin D3 level. Inflammatory markers are fasting insulin levels and C-reactive protein (CRP). Fasting cholesterol and subfractions (HDL, LDL, VDLP, small LDL) and fasting triglycerides are also measured. Thyroid hormones (T3 and T4, TSH) are measured to rule out over or under function. Typically hypothyroidism is found, which would have to be rectified by taking Armour (a mix of T3 and T4 thyroid hormones).

At this point I need to explain that long time ago the research by Dr. Lee has shown that progesterone hormone levels are notoriously unreliable when blood tests are done. All of the other sex hormones, and cortisol are also not that reliable with blood tests. For this reason the saliva hormone tests have been invented that conveniently report a panel of 5 hormones from one saliva sample: DHEAS (which is the storage form of DHEA), estradiol (the major estrogen in a woman), progesterone, testosterone and cortisol. The saliva hormone tests correlate very well with the actual tissue hormone levels. You can order the saliva tests through Dr. Lee’s website. Another longstanding lab in the US is Dr. David Zava’s lab. In Canada the Rocky Mountain Analytical Lab can process your saliva tests.

Women’s hormone replacement

Let us assume that a woman is getting postmenopausal symptoms and bioidentical hormone replacement is being discussed. The physician will want to first rule out that insulin resistance is not present by ordering a fasting insulin level. If this is normal and the other baseline tests are normal as well except for missing estrogen and progesterone, the physician will usually start to replace progesterone first using a bioidentical hormone cream to be applied once or twice per day. If estrogen levels were also low, the next step in 4 weeks or so is to add Bi-Est, a bioidentical estrogen replacement cream. After 8 weeks of hormone replacement the saliva hormone test is repeated to see whether the estrogen and progesterone levels have come up and also, whether the ratio of progesterone to estrogen is at least 200 or more. Dr. Lee has extensively researched this and found that women with a ratio of less than 200 to 1 (progesterone/estrogen ratio) were more prone to breast cancer. He also stated in this link that there are 3 basic rules with regard to bioidentical hormone replacement:

1. only replace hormones, when they were measured to be low.

2. use only bioidentical hormones (never synthetic hormones) and

3. only replace with low doses of bioidentical hormones to bring hormone levels to physiological levels (body levels that were experienced to be normal before).

Many women who are not replaced in menopause have estrogen dominance meaning that the progesterone/estrogen ratio is less than 200:1, which puts these women at risk of developing breast cancer. Women who are overweight or obese also are estrogen dominant (from estrogen produced in excess through aromatase in the fatty tissue, explained further below), which makes them more prone to breast cancer, uterine cancer and colon cancer. Without bioidentical hormone replacement inflammatory processes take place in the joints (causing arthritis), in the nervous system (causing Alzheimer’s and dementia) and in the blood vessels (causing heart attacks and strokes). Rebalancing your hormones to a youthful state by paying attention to the hormone levels and the hormone ratios mentioned will remove the inflammatory reactions and reduce the risk for cancer.

Men’s hormone replacement

Males enter andropause 10 to 15 years later than women are entering menopause. Typically testosterone production slows down leading to hair loss, erectile dysfunction, loss of muscle mass, osteoporosis and Alzheimer’s/dementia. Blood tests (bioavailable testosterone) or saliva tests are both reliable in determining a deficiency. Replacement with bioidentical hormone creams once per day is the preferred method of treatment. Overweight and obese men produce significant amounts of estrogen through an enzyme localized in fatty tissue, called aromatase.

Aromatase converts testosterone and other male type hormones, called androgens, into estrogen. Estrogen causes breast growth, weakens muscles, and leads to abdominal fat accumulation, heart disease and strokes.

Similar to women, where the progesterone/estrogen ratio is important, there is another ratio for men, called testosterone/estrogen ratio. This should be in the 20 to 40 range for a man to feel good and energetic. Unfortunately many men above the age of 55 have testosterone/estrogen ratios much smaller than 20. This makes them more prone to heart disease and prostate cancer (Ref.1).

However, a male also does need a small amount of estrogen and normal thyroid hormones as well as all of the other hormones for his “hormonal symphony” (mentioned in Ref. 2) to function at his best.

Safety of hormone replacement

There are still otherwise reputable websites that state that bioidentical hormones are not safer than standard synthetic hormones. This confuses the consumer and does not serve the public well. I much prefer the text of the Wikipedia, which is a more thorough review regarding safety of hormone replacement and explains what the issues are.

In the US there is a collective experience of about 25 years on thousands of patients, but there have not been any randomized studies, as Big Pharma that would have the money to finance such studies is not interested in proving that bioidentical drugs would be safer than their distorted synthetic hormone copies that will not fit the body’s hormone receptors. There are some noble exceptions as Big Pharma is producing bioidentical insulin and human growth hormone that had toxicity studies done and showed safety. In Europe bioidentical hormones have been used since the 1960’s, on a larger scale since the 1970’s. So the European experience of safety of bioidentical hormones is presently about 40 to 50 years.

The FDA is contributing to the confusion of the public as can be seen from this publication. One example where the FDA is confusing the consumer, is the progesterone product Prometrium, a bioidentical micronized progesterone capsule that can be taken by mouth. By law the manufacturer had to put a warning label on the package identical to progestin, which is the synthetic, non-bioidentical hormone having been shown to have severe side effects. As is explained in this last publication Prometrium should not have been required to have a warning label in it ; the paper explains what I have already stated above, namely that bioidentical hormones are the safest form of hormone replacement and administered in the right ratios will actually prevent cancer and prevent premature cardiovascular and joint deterioration. In other words, bioidentical hormone replacement can add many years of useful life when started early enough before permanent organ damage sets in from the aging process (which would be due to missing hormones).

Why bother about hormone replacement?

Nature has a plan of “knocking us off” to make room for the next generation. The only way that you can change nature’s plan of killing us prematurely through cardiovascular disease, arthritis, dementia and loss of your sexual life is by bioidentical hormone replacement. Of course you also need the other ingredients of known life prolongers such as healthy (preferably organic) foods, exercise and detoxification. Many women are scared to treat the hormone deficiencies that cause their menopausal symptoms because of the Women’s health Initiative results with synthetic hormones. Men who would benefit from testosterone are often anxious that they may get prostate cancer, when in reality it is the exact opposite: testosterone prevents prostate cancer (Ref.3).

Conclusion

I wrote this blog about bioidentical hormone replacement in order to clarify this often-misunderstood topic. Don’t get confused by the FDA, by highbrow medical websites (such as the likes I mentioned). Big Pharma has a powerful lobby that attempts to keep the medical profession in the belief that their products are better than those that nature has provided (I call it “defend your patent rights”). We are still in a flux state where anybody who tells the truth about hormones gets much criticism. In another few decades it will be an accepted fact and people will wonder why the Women’s Health Initiative was done without a control with bioidentical hormones. With bioidentical hormone replacement you can add about 20 years of youthful life without disabilities to the normal life expectancy. Exercise, detoxification and organic food with avoidance of wheat, starch and sugar can add another 5 to 10 years to your life. The baby boomers are lucky that they have this new tool to prolong life. I wonder whether they will put it to good use.

More information about bioidentical hormone replacement: http://nethealthbook.com/hormones/anti-aging-medicine-women-men/

References:

1. John R. Lee: “Hormone Balance for Men – What your Doctor May Not Tell You About Prostate Health and Natural Hormone Supplementation”, © 2003 by Hormones Etc.

2. Suzanne Somers: “Breakthrough” Eight Steps to Wellness– Life-altering Secrets from Today’s Cutting-edge Doctors”, Crown Publishers, 2008

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

Last edited Nov. 7, 2014

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Jun
08
2013

Breast Cancer Due To Stress

The medical profession is of the opinion that breast cancer is multi-factorial, where genetics, body weight, hormonal and other factors play a role in causing it (details see Ref. 1). The Wisconsin Longitudinal Study (United States) showed in May 2012 that girls from families of lower socioeconomic status have a higher risk of breast cancer later in life. The study also showed that girls from families with a higher socioeconomic status had a low risk of breast cancer later in life.

The same cohort of women was the subject of another study, which was just published in April of 2013. In this study the question was asked whether stress in career women could cause a higher rate of breast cancer. Using 1957–2011 data showed that 297 of the 3682 White non-Hispanic women of the Wisconsin Longitudinal Study developed breast cancer. Details of the study showed that the peak of the age for breast cancer to develop was around 55 to 65. Women working with the lowest job authority had the lowest rate of breast cancer. High job authority, being the “boss”, was associated with a 1.57-fold (range 1.12 – 2.18-fold) increase in breast cancer. There was also a striking difference between the lengths of job stress exposure, 5 years versus 15 years with both groups, high and low job authority. The lowest risk of breast cancer was for the low stress group of women who worked under these conditions only for 5 years, followed by the same group who had worked there for 15 years. Slightly above that latter group was the breast cancer risk for the 5-year employed high job authority. The highest group of breast cancer risk, rising above all other groups, was the group with high job authority, exposed to this for type of stressful situation for 15 years (see Fig. 1 of the above link). The researchers interpreted their data to say that the majority of the breast cancer risk in these groups of women was due to the stress hormone (cortisol). Minor contributions were thought to be due to the carcinogenic effect of estrogens.

Breast Cancer Due To Stress

Breast Cancer Due To Stress

 

Review of the literature regarding this study

Dr. Lee had been publishing about estrogen dominance for many years (Ref. 2 and 3). When women age, their ovaries do not produce as much progesterone during the luteal phase as in younger years and above the age of 30 to 35 anovulatory cycles are common. During anovulatory cycles ovulation (=release of an egg) does not occur and there is no formation of a corpus luteum that would produce progesterone for 2 weeks. The end result is that there is a lack of progesterone as a woman ages. This has been discussed in detail in Ref. 3. Dr. Lee called this disbalance of estrogen and progesterone “estrogen dominance”. This is one of the important causes of breast cancer as explained in Ref.2. This can be caused by aging, xenoestrogens from exposure to artificial fertilizers, insecticides and cosmetics, but also taking the birth control pill for prolonged periods of time. However, stress by itself can also produce a state of estrogen dominance. Dr. Lee explained (page 180 of Ref. 2) that the cortisol-binding globulin (CBG), which binds both cortisol and progesterone, is a storage form for both of these hormones. As a person is under chronic stress the CBG is increased binding both cortisol and progesterone. This means that less of these hormones are preliminarily available in their free form for body consumption as CBG binding is a storage form for these hormones. The free progesterone, which is the only biologically active progesterone portion, is lowered as a result of stress causing estrogen dominance. If estrogen is not opposed by progesterone, it is cancer causing for breast tissue and the uterine lining, which translates into being at risk for breast and uterine cancer. Only supplementation with bioidentical progesterone cream as described in Ref. 3 will rebalance the hormones (progesterone/estrogen balance) and reduce the cancer risk. The symptoms of estrogen dominance according to Ref. 4 (p. 29) are fatigue, weight gain, less ability to handle stress, headaches, mood swings, loss of sex drive, irregular periods, uterine fibroids, fibrocystic breasts, fluid retention (particularly around the ankles), irritability and depression.

Practical recommendations for women in stressful jobs

Above the age of 35 it is wise to have a saliva hormone test done, checking the levels of 5 hormones (cortisol, DHEAS, estrogen, progesterone and testosterone). This establishes the baseline values for these hormones. The relationship between the levels of these hormones determines whether they are balanced or not. For instance, if the ratio between progesterone and estrogen (divide the level of progesterone by the level of estrogen) is less than 1 in 200 the patient has estrogen dominance (see Ref. 5). You may need to get a naturopathic physician or an A4M physician who is knowledgeable in interpreting these results and treating the patient with bioidentical hormones. Some women may need to start bioidentical hormone replacement at this point if a hormone deficiency is noticed.

In order to counterbalance stress you need to schedule some time for yourself regularly where you can relax, do yoga exercises, meditation, and/or self-hypnosis. Make sure you get enough sleep. Avoid alcohol, if you can as it interferes with a restful sleep, or reduce alcohol to the absolute minimum. Alcohol causes decreased hormone production of both ovaries. It also weakens the adrenal glands contributing to hormone disbalance. Usually the first hormone to show a decline with stress and aging is progesterone. It has to be measured by the saliva test. Ref. 2 and 3 explain why: progesterone is fat-soluble and is transported through the blood in its free form through red blood cells. However, a progesterone blood test measures the serum progesterone level after the red blood cells have been spun down in the centrifuge, which leads to misleading results; only the saliva test gives reliable results in terms of bio-available progesterone levels. Many conservative physicians blindly insist on blood progesterone levels, which will lead to false results. This is why you need a naturopathic physician or A4M physician to help you with the proper interpretation of the test results.

If saliva progesterone levels are low, progesterone cream (bio-identical, as explained below) is applied daily in a concentration that will normalize the levels. Physicians who have been influenced by drug company representatives may suggest to use Provera (or another progestin, which are synthetic hormone substances) as a “supplement”, but this is known from the Women’s’ Health Initiative to cause breast cancer, heart attacks and strokes.

Do the proper monitoring tests with saliva testing and only substitute what is missing with bioidentical hormone creams. Otherwise a low fat, low refined carbohydrate diet, exercise and other good health habits as I have summarized in this link will be very beneficial to prevent stress as a cause of breast cancer. Ref. 6 is also a useful text written for the layperson explaining what to do when stress leads to adrenal fatigue.

References

  1. A review of the causes of breast cancer: http://www.nethealthbook.com/articles/causesofbreastcancer.php
  2. Dr. John R. Lee, David Zava, Ph.D. and Virginia Hopkins: “What your doctor may not tell you about breast cancer”. 2002 Hachette Book Group, New York,NY, USA.
  3. Dr. John R. Lee: “Natural Progesterone”.  2nd edition. Jon Carpenter Publishing, 1999 Charlbury, England.
  4. George Gillson, M.D., Ph.D.: “You’ve hit menopause. Now what? 3 simple steps to restoring hormone balance” 2nd edition, 2004, Rocky Mountain Analytical Corp., Calgary, AB, Canada.
  5.  John R. Lee, M.D. and Virginia Hopkins: “Dr. John Lee’s Hormone Balance Made Simple- The Essential How-to Guide to Symptoms, Dosage, Timing, and More”. Wellness Central Hachette Group USA, New York, NY 10017. Published 2006. Page 57 discusses saliva testing and states: “The healthy ratio of progesterone to estradiol is at least 200 to 1 and can go up to 1,000 to 1 in women using transdermal (delivered through the skin with cream, gels, oils) progesterone.”
  6. James L. Wilson, ND, DC, PhD: “Adrenal Fatigue, the 21sty Century Stress Syndrome – what is it and how you can recover”; Second printing 2002 by Smart Publications, Petaluma, Ca, USA

Last edited Nov. 6, 2014