For more than 50 years, it has been thought that men should avoid
testosterone replacement therapy because testosterone increases the
risk of prostate disease, including BPH and prostate cancer. A look at
the published literature, however, reveals that this long-standing
belief is actually a myth.
In fact, a review of studies on the National Institutes of Health
database reveals that high testosterone levels are not associated with
increased risk of prostate cancer and, conversely, that low
testosterone levels are not protective against prostate cancer
(Morgentaler A 2006). In one study (with a 7-year follow-up) of more
than 500 men, high levels of androgens were associated with a decreased
risk of aggressive prostate cancer, while there was no change in the
risk of nonaggressive prostate cancer. Overall, levels of any steroid
hormones (except estrogen) had no correlation to the risk of prostate
cancer (Severi G et al 2006).
Elevated estrogen levels, however, are frequently associated with
BPH. As readers of vitamin depot online magazine learned in late 1997,
estrogen has been identified as a factor behind the enlargement of the
prostate gland that affects so many older men. Compared to younger
males, older males have much more estradiol (a potent form of estrogen)
than free testosterone because of aromatase activity. These rising
estrogen and declining androgen levels are even more sharply defined in
the prostate gland. With aging, estrogen levels increase significantly
in the prostate gland. Estrogen levels in prostate gland tissues rise
even higher in men who have BPH (Shibata Y et al 2000; Gann PH et al
1995; Krieg M et al 1993).
Based on research, high levels of testosterone are not implicated in
an increased risk of developing either prostate cancer or BPH. However,
among men who already have these conditions, testosterone replacement
therapy will likely cause increased disease activity. For these
reasons, it is important that men who are considering hormone
replacement therapy undergo frequent screening for prostate cancer
(with PSA testing and digital rectal exams). If cancerous cells are
present in the prostate, testosterone therapy will likely produce a
spike in PSA levels that will lead to a diagnosis of prostate cancer.
Once a man actually has prostate cancer, testosterone therapy cannot
be recommended because most prostate cancer cells use testosterone to
promote the growth of the cancerous cells. Similarly, men with BPH
should approach testosterone replacement cautiously. It may be prudent
for men with BPH who are undergoing testosterone replacement therapy to
also use a 5-alpha-reductase inhibitor (such as finasteride or
dutasteride). These drugs inhibit the synthesis of dihydrotestosterone
(DHT), a metabolite of testosterone that causes BPH. 5-Alpha-reductase
inhibitors are a standard part of prescription therapy for BPH. For
more information on natural ways to suppress BPH, please see the
chapter on Benign Prostatic Hyperplasia.
vitamin depot online Foundation Recommendations
Hormone therapy for aging men can be a complicated topic. While many
books talk about the dangers of low testosterone levels, there are few
sources that can help men safely embark on a program of testosterone
replacement therapy. The vitamin depot online Foundation offers a
step-by-step program to safely restore youthful hormone levels in aging
men.
Step One: Testing
It is critical that men undergo comprehensive medical testing before
embarking on a hormone modulation program. First, a baseline blood PSA
must be taken to rule out existing prostate cancer. (For more
information, please see the chapter on Prostate Cancer.) Then free and
total testosterone and estradiol tests are needed to make sure that too
much testosterone is not being converted into estrogen. If estrogen
levels are too high, the use of aromatase inhibitors can keep
testosterone from converting into estrogen in the body. Follow-up
testing for estrogen, testosterone, and PSA are needed to rule out
prostate cancer and fine-tune your program. Additional tests that
should be considered include:
Complete blood cell count and chemistry profile to include liver
and kidney function, glucose, minerals, lipids, and thyroid-stimulating
hormone (TSH)
DHEA
Homocysteine
Luteinizing hormone (LH) (optional)
SHBG (optional)
Blood for these tests may be drawn at your physician's office or
directly at a laboratory in your area. Information about ordering these
tests on your own may be obtained by calling 1-800-208-3444. These
tests will yield crucial information that can help you design a program
tailored to your unique situation.
Step Two: Interpreting the Results
Free testosterone. Most conventional physicians
accept testosterone levels that are far too low. Normal ranges usually
reflect population averages among men of a particular age. This
assumes, however, that decreasing hormone levels are acceptable and
normal. The vitamin depot online Foundation recommends that men strive for a
free testosterone level that is in the upper one-third range for men
aged 21 to 49 years. These ranges can be found in the Blood Testing
appendix at the back of this book.
There are five basic reasons that free testosterone levels may be low:
Too much testosterone is being converted to estrogen through the
activity of aromatase, and/or the liver is failing to remove excess
estrogen, possibly because of heavy alcohol intake.
Too much free testosterone is being bound by SHBG. This
would be especially apparent if a man’s total testosterone level is in
the high normal range but his free testosterone level is low.
The pituitary gland, which controls testosterone production
through the production of LH, is not secreting enough LH to stimulate
gonadal production of testosterone. In this case, total testosterone
would be low.
The testicles (gonads) have lost their ability to produce
testosterone, despite adequate amounts of LH. In this case, the level
of LH would be high despite a low testosterone level.
DHEA level is abnormally low.
Estrogen. Estrogen (measured as estradiol) should
be kept at 30 picograms per milliliter (pg/mL) or lower. If a man’s
estrogen level is more than 30 pg/mL, it should be reduced by using
aromatase-inhibiting drugs or nutrients. If a man’s estrogen level is
elevated, it could be associated with:
Increased aromatase activity, often caused by increased abdominal fat.
Heavy alcohol intake. An animal study has shown that high
alcohol intake results in increased aromatization and decreases the
ability of the liver to clear excess estrogen (Purohit V 2000). In men,
heavy alcohol intake has been shown to boost estrogen levels within the
liver, possibly as a protective mechanism, resulting in the
“feminization” of the liver (Colantoni A et al 2002).
Total testosterone. The vitamin depot online Foundation
believes that direct testing for free testosterone is the best way to
test for testosterone activity, as free testosterone is active
testosterone and consists of only 1 to 2 percent of total testosterone.
However, some men have their total testosterone measured also.
Step Three: Correcting Abnormal Levels
Ultimately, the ideal program will depend on the results of various
tests. Below are some of the common scenarios and solutions to correct
hormone imbalances.
Low Free Testosterone, High Estradiol, Mid Total Testosterone
This situation suggests excessive aromatase activity, which converts
free testosterone to estrogen. Inhibition of aromatase and reduction in
aromatase-containing tissue (fat) is indicated. Suggestions include:
Reduce or eliminate alcohol to enable the liver to better remove excess estrogen.
Review all current medications to see if they are interfering
with healthy liver function. Common medications that affect liver
function are nonsteroidal anti-inflammatory drugs (NSAIDs) such as
naproxen, ibuprofen, acetaminophen, and aspirin; the statin class of
cholesterol-lowering drugs; some heart medications; some blood
pressure–lowering medications; and some antidepressants. Drugs being
prescribed to treat the symptoms of testosterone deficiency (such as
the statins and certain antidepressants) may actually aggravate the
testosterone deficit, thus making the cholesterol problem or depression
worse. However, do not discontinue any prescription medicine without
consulting your physician.
If all of the above fail to increase free testosterone and
lower excess estradiol, consider discussing with your physician the use
of the aromatase inhibitor anastrozole at the very low dose of 0.5 mg
twice per week.
Low Free Testosterone, Low Estrogen, High Total Testosterone
This situation suggests excessive SHBG levels, making testosterone unavailable to target tissues. Suggestions include:
Inhibit aromatase by following some of the recommendations in the
previous section. Many of the same factors are involved in excess SHBG
activity.
This situation suggests low production of testosterone, with resultant low conversion to estrogen. Suggestions include:
Use testosterone patches, pellets, or cream. Do not use
testosterone injections or tablets. If tests reveal low levels of LH,
ask your physician about the possibility of using human chorionic
gonadotropin (HCG). HCG function is similar to LH function, and HCG can
restart gonadal production of LH.
Take 15 to 75 mg/day of DHEA.
General Nutrients to Boost Testosterone
A number of nutrients have been studied for their ability to boost
testosterone and/or treat conditions such as erectile dysfunction and
loss of libido. This nutrient group includes antioxidants, which may
function by reducing oxidative damage to testosterone-producing tissues.
Vitamin E—400 IU/day with at least 200 mg of gamma-tocopherol
Product Availability
All the nutrients and supplements discussed in this section are
available through the vitamin depot online Foundation Buyers Club, Inc. For
ordering information, call anytime toll-free 1-800-544-4440, or visit
us online at www.LifeExtension.com.
The blood tests discussed in this section are available through vitamin depot online National Diagnostics, Inc. For ordering information, call
anytime toll-free 1-800-208-3444, or visit us online at
www.LifeExtension.com.
Male Hormone Restoration Safety Caveats
An aggressive program of dietary supplementation should not be
launched without the supervision of a qualified physician. Several of
the nutrients suggested in this protocol may have adverse effects.
These include:
Acetyl-L-Carnitine
Acetyl-L-carnitine can cause gastrointestinal symptoms such as nausea and diarrhea.
Chrysin
Do not take chrysin if you have prostate cancer.
Chrysin can increase the effects of aromatase inhibitors such as aminoglutethimide, anastrozole and letrozole.
DHEA
Do not take DHEA if you could be pregnant, are breastfeeding, or could have prostate, breast, uterine, or ovarian cancer.
DHEA can cause androgenic effects in woman such as acne, deepening of the voice, facial hair growth and hair loss.
Piperine
Piperine can inhibit drugs such as: propanolol, theophylline,
phenytoin, sulfadiazene, rifampicin, isoniazid, ethambutol,
pyrazinamide and dapsone that are metabolized by cytochrome P450
enzymes.
Quercetin
Quercetin can cause headache, mild tingling of the extremities, and gastrointestinal symptoms such as nausea.
Saw Palmetto
Consult your doctor before taking saw palmetto if you have any form of cancer that is stimulated by hormones.
Selenium
High doses of selenium (1000 micrograms or more daily) for prolonged periods may cause adverse reactions.
High doses of selenium taken for prolonged periods may cause
chronic selenium poisoning. Symptoms include loss of hair and nails or
brittle hair and nails.
Selenium can cause rash, breath that smells like garlic, fatigue, irritability, and nausea and vomiting.
Vitamin A
Do not take vitamin A if you have hypervitaminosis A.
Do not take vitamin A if you take retinoids or retinoid
analogues (such as acitretin, all-trans-retinoic acid, bexarotene,
etretinate, and isotretinoin). Vitamin A can add to the toxicity of
these drugs.
Do not take large amounts of vitamin A. Taking large amounts
of vitamin A may cause acute or chronic toxicity. Early signs and
symptoms of chronic toxicity include dry, rough skin; cracked lips;
sparse, coarse hair; and loss of hair from the eyebrows. Later signs
and symptoms of toxicity include irritability, headache, pseudotumor
cerebri (benign intracranial hypertension), elevated serum liver
enzymes, reversible noncirrhotic portal high blood pressure, fibrosis
and cirrhosis of the liver, and death from liver failure.
Vitamin E
Consult your doctor before taking vitamin E if you take warfarin (Coumadin).
Consult your doctor before taking high doses of vitamin E if you have a vitamin K deficiency or a history of liver failure.
Consult your doctor before taking vitamin E if you have a
history of any bleeding disorder such as peptic ulcers, hemorrhagic
stroke, or hemophilia.
Discontinue using vitamin E 1 month before any surgical procedure.
Zinc
High doses of zinc (above 30 milligrams daily) can cause adverse reactions.
Zinc can cause a metallic taste, headache, drowsiness, and gastrointestinal symptoms such as nausea and diarrhea.
High doses of zinc can lead to copper deficiency and hypochromic microcytic anemia secondary to zinc-induced copper deficiency.
High doses of zinc may suppress the immune system.
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