Men in "Men-O-Pause"
By John Maher, DC, DCBCN, BCIMFemale sex hormone replacement is probably the most well known hormone therapy. Synthetic estrogen and progesterone are commonly prescribed to menopausal women to prevent osteoporosis, heart disease, and relieve menopausal symptoms. Not as well known is the male "andropause," which occurs concomitantly with declining circulatory levels of bioavailable free testosterone.
For males, testosterone helps prevent osteoporosis, heart disease, and relieves the symptoms of male andropause. Clinical symptoms suggestive of declining testosterone levels in middle aged men or older include declining libido and decreasing sexual performance and enjoyment, along with declining stamina, muscle strength and lean body mass. The latter is often manifested by increasing difficulty at losing weight, especially that last five, 10 or 15 pounds around the waist! Uncharacteristic moodiness; fatigue; irritability; loss of confidence; vitality and aggressiveness; increasing aches pains and stiffness; and even "night sweats" are all possible andropausal signs.
Blood tests and exams may show low "normal" RBCs (red blood cell counts); rising blood pressure; increasing levels of "bad" LDL cholesterol; insulin resistance; diabetes; syndrome X; and hardening of the arteries. All these signs and symptoms when occurring around the "mid-life crisis" time of life are strongly suggestive of suboptimal free testosterone.
If blood or salivary tests show suboptimal levels of free testosterone, along with clinical signs of andropause, the anti-aging doctor may prescribe testosterone or its precursor, androstenedione. Although labs differ, the optimal range for free testosterone is in the "high-normal" range, usually in the blood at 30 to 40ug/ml in males; for saliva the higher ranges of normal are usually 140 to 200 pg/ml in males, and 35 to 50 pg/ml in females.
Synthetic testosterone shots have generally given way to human testosterone transdermal creams, still a prescription item. That's because too much testosterone can aggravate, and perhaps even cause, benign and malignant prostate disease. Although testosterone is very protective of the heart, it may also lower HDL, the "good" cholesterol. Furthermore, taking testosterone tends to shut down your body's own production.
Fortunately, there is a safer, nonprescription way to increase testosterone by supplementing its precursor, androstenedione, a metabolite of DHEA. It is produced naturally by the gonads and adrenal glands. Available over the counter, it has become well known because of its use by home run champion Mark McGwire. One hundred to 200 mg orally can raise testosterone levels by over 200 percent. Sublingual sprays can briefly raise testosterone by 300-600 percent within 30 minutes.
Transdermal forms and sprays bypass the filtering liver, which is generally preferred. It is best to follow the instructions on the label and not exceed them for more than a week. A "double-dose" the first week may be helpful in getting the best effect. Taking a week or two respite from androstenedione every four to six weeks works better, followed by another double-dose week, then three to five weeks of the label dose, then stopping for another few weeks. This is common practice in natural hormone replacements and is referred to as cycling. The idea is to maximize long-term effectiveness.
Androstenedione and "diol" are generally best taken 30 minutes before exercise. They are derived directly from DHEA, a better-known hormone made in the adrenal glands. The androstenes are then converted to the sex hormones estrogen and testosterone, but conversion generally favors testosterone. DHEA supplementation is best determined by measuring the relative salivary levels of DHEA and cortisol, the stress hormone.
Two other supplements will also help raise testosterone. One is the herb tribulus terrestris, the puncture vine believed to enhance testosterone levels by increasing a pituitary hormone, LH, which turns on natural testosterone production and sperm motility. The suggested dose is 750 mg/day divided among two or three meals, probably best for four weeks on and four weeks off at this dose.
The other supplement is chrysin, or flavone X, which comes from the herb passiflora coerulea. The body can favor the conversion of DHEA, androstenedione and testosterone to estrogen if the male hormone levels get too high. Chrysin works by preventing testosterone's and androstenedione's conversion to estrogen, thereby increasing or maintaining high testosterone levels. When testosterone levels get too high from steroid abuse, it may cause gynecomastia, producing fat masses commonly seen in the breasts of male weight lifters. Dosage is 500 mg before workouts and before sleep. It should be cycled with tribulus as above.
As testosterone promotes lean body mass, i.e., more muscle and less fat, particularly when combined with weight lifting, it has become quite popular. However, raising testosterone levels to higher than optimal levels may be as dangerous as taking anabolic steroids, which are illegal in all sports, though abuse is still very common in strength sports. Major League Baseball has not banned androstenedione, but its use is illegal for Olympic athletes, NFL players, and in many other sports organizations. This is for fear of overuse and abuse, and also because it interferes with screening tests for illegal anabolic steroids.
Most anti-aging professionals restrict the use of testosterone to those over 40 that demonstrate need via clinical signs and lab tests, usually through saliva or free unbound testosterone in blood. The goal is to erase the clinical signs and to raise salivary or blood levels to approximating youthful (25-30-year-old) levels. Home salivary tests by mail order are available. (Optimal ranges for salivary testosterone are 140 to 200 pg/ml in males and 35 to 50 pg/ml in females.)
Stress and overtraining can bring about suboptimal levels of testosterone or androstenedione even in those under 35. Most bodybuilders know that testosterone is the most potent stimulator of muscle building and fat-burning. Keeping testosterone in the high normal ranges, without exceeding them, through cycling natural testosterone enhancers, is very popular among young athletes. The all-too-common uninformed misuse and abuse of androstenedione, its pre-cursor (DHEA), and certain herbs by otherwise healthy young people is a definite concern. Short-term side effects of inappropriate use and abuse include: acne; hostility; extreme sexual desire; paranoia; and fat masses. These occur especially in males under 28, because their testosterone is already at an optimal level. The excess is converted to estrogen, which, besides stimulating breast growth, will not make the male patient stronger. (Bodybuilders who "stack" andro, DHEA and tribulus terrestris add chrysin for just this reason.)
Long-term side effects from unmonitored abuse, especially by the young, are much more serious. Male and female patients over 35 that follow our guidelines are very unlikely to experience problems related to too much testosterone. Retesting hormone levels after two cycles is a great way to check responses and adjust accordingly.
Females also need testosterone, and may experience low levels, especially at (and past) middle age. A key sign is uncharacteristic loss of sexual interest, especially loss of sexual fantasy, dreams, daydreams, or "just looking." This may be accompanied by loss of vitality, muscle mass and healthy aggressiveness and confidence. Suboptimal progesterone is usually the culprit, and progesterone replacement for three months should be considered first.
Females may also suffer from too much testosterone. Apple-shaped women; those with middle-age acne; facial hair; polycystic ovary syndrome; hyperinsulinism; high blood pressure; heart disease; and high sex drive should likely avoid DHEA, androstenedione and testosterone. (7-Keto DHEA may be recommended in these cases, as it does not increase the level of sex hormones.) Salivary testing in such cases is mandatory if these hormone replacements are being considered. The cause of the symptoms must be determined medically, but the most common cause is some form of carbohydrate intolerance, especially in females who put on weight in the back of their arms. The solution is usually a low- carbohydrate diet, exercise, and supplementation with chromium; magnesium; zinc; niacin; and vanadyl sulphate. Hyperin-sulinemia (syndrome X) and hyperglycemia (diabetes) are diagnosed with the aid of blood tests.
Middle-aged men can suffer from too much testosterone also, usually the "bad" kind, called dehydroxy-testosterone (DHT). This is a bound form of testosterone thought to be related to hair loss, benign hypertrophic prostate disorder (BHP) and, perhaps, prostate cancer. Therefore, formulas which include herbs that lower DHT and free up bound testosterone are preferred. Oat straw (avena sativa) and nettle root are two such herbs; saw palmetto is another.
Because BHP and prostate cancer are so common in men over 50, medical rectal exams and prostate-specific antigen tests (PSA) are strongly recommended for those taking products that increase free testosterone. (Prevention is so important that Medicare covers most of these tests. See www.medicare.com, but don't wait till you're 65!) These include not only human growth hormone (HGH), testosterone and DHEA, but to a lesser extent the herbs damiana; ginseng; and raw orchic (testicular) glandular products.
Also, because BHP and prostate cancer are so common, anyone interested in prevention and anti-aging should take definite steps, including the above medical examinations whether they utilize hormone replacements or not! First, studies suggest that diets high in soybean products and lycopenes (anti-oxidants found mostly in tomato products and watermelon) are protective against prostate cancer. Also protective is 400 IU daily of vitamin E and 200mcg of selenium.
Signs of BHP include increasingly frequent urges to urinate, especially at night, with lessening volume and stream of flow, and generally greater difficulty and discomfort voiding. Backache and loss of libido often accompany the above symptoms. If medical exam signs or frequent symptoms suggest BHP, then herbal formulations with saw palmetto; nettles; pyrigeum; and the nutrients B6, zinc, glycine, L-alanine and L-glutamic acid are to be strongly considered as an alternative to current medications.
Although raising low testosterone levels in men and women will almost always increase sex drive and enjoyment, performance difficulties related to erectile dysfunction are usually vascular or neurological/psychological in nature. Cigarette smoking is probably the greatest offender in the former, followed by alcohol abuse and the standard American diet. Both of these cause hardening of the arteries, and impotence is often one of the first signs! Fifty-two percent of American males from the age of 40 to 70 suffer some degree of impotence. Heart disease from hardening of the arteries, known as atherosclerosis, is also the main cause of death in this group!
The best herb for increasing blood flow to the extremities because of hardening of the arteries is ginkgo biloba. For frank dysfunctions, 240 mg/day of a standardized extract for nine months, then 120 mg per day maintenance, if results are satisfactory, is often recommended. The best herb for erectile dysfunction related to nerve dysfunction is yohimbine HCL from the yohimbe tree. This contains nerve messengers (alpha2 adrenergic agonists) that stimulate the nerves to increase blood flow to the penis, while simultaneously restricting out-flow. This is what maintains an erection. It also thins the blood and increases fat burning. The best dosage is 500 mg, three times per day for frank erection difficulties. Patents should be aware, however, that most yohimbe products are bogus, and should stay with professional brands when possible. The herb also includes contraindications similar to caffeine and ephedra. As both of these herbs thin the blood, those on other blood thinners must discuss such self-help endeavors with their doctors.
Although these products are available to the general public, it behooves your patients to take some time to study their use or to consult a professional familiar with these new natural approaches.
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