Longevity & AntiAging · Nutritional Medicine · Menopausal · Andropausal
Natural Hormonal Replacement · Complex Lipid Disorders · Stress Management
Longevity & AntiAging ·
Nutritional Medicine ·
Menopausal ·
Andropausal
Natural Hormonal Replacement ·
Complex Lipid Disorders ·
Stress Management
Our knowledge of physiologic replacement of testosterone and androgen replacement in aging men is newer and, therefore, less widely accepted in conventional medical circles than the choices and arrays of modalities that are now available to women.
To make the problem even more complex, there is a small, but persuasive, body of evidence accumulating that problems with prostate disease are not necessarily testosterone initiated. That in fact they may be due to rising levels of estrogen that men accumulate during the aging process.
In glancing at figure 1, you will see that with increasing age, the levels of testosterone fall while, at the same time, in figure 2, the incidence of prostatic hypertrophy is increasing. They are moving in the opposite directions. Doesn't seem like a tight cause and effect relationship.
Some argue that this is a cumulative effect but if you look at the area under the curve, the years with the highest levels of testosterone (the second, third and fourth decades) are where most of the exposure has occurred. This is associated with the lowest risk of prostate dysfunction.
(See also the recent long term Finnish Study concluding there is a little correlation between testosterone levels and eventual prostate cancer)
figure 1
(redrawn from Vermeulen et al 1991)
figure 2
(redrawn from Guess et al, 1994)
Bruno deLignieres, an impeccable French researcher and Thiery Hertoghe, MD, fourth generation in the most distinguished family of endocrinologists in Belgium, have put forth the notion that rising estrogen levels are more likely to be the initiator of the process and that testosterone and DHT may then be a secondary player (promoter). In fact, phytotherapy (large doses of phytoestrogens - soy) is commonly used in European medical practices to treat BPH.
(Jonathan Wright and Eugene Shippen have written excellent, and popular books, discussing these more far-sighted notions all too commonly overlooked and even rejected in current conventional American Medical thinking.)
Now look at the fig 3 and you will see the true role of testosterone as a "pro-hormone.
figure 3
Testosterone is reduced by the enzyme 5-a-reductase to DHT which is then thought to be the real culprit. The argument between the use of Saw Palmetto, Pygeum and Pumpkin seeds vs Proscar are both directed at blocking this enzyme. Strangely, DHT is most important for sexual vigor, so blocking this step may have some unintended consequences!
On the other hand, Testosterone is also converted into estradiol by aromatase (producing the aromatic ring). This occurs increasingly with age in the liver but most importantly ... in the fat stores.
Now you see the connection. As we age, and frequently gain increasing fat stores, we are feeding the aromatase connection, increasing our estradiol levels and if this theory holds, increasing the promotion of prostate disease.
It also raises the interesting possibility, that we find absent in all other discussions (although certainly not proven), that blocking the 5-a-reductase step may actually exacerbate the problem by further increasing estrogen levels which is the initiator of the problem to begin with.
Schematically, a more complex ... and accurate picture evolves:
figure 4
Here is a more obvious representation of the equal influence of the two major estrogens and testosterone on the prostate gland. Our goal is to re-establish more youthful balance by diminishing the estrogen influence and increasing the testosterone influence, or what we call term "increasing the T/E ratio" to more youthful and vigorous levels.
As with the 25-30 year old issue of estrogen replacement in women, we now see the androgen issue with men with the same risk:benefit issues. Small risk, but potentially very important and consequential benefits.
We here at the Institute now offer our male patients a full array of androgenic support from DHEA to highly specialized combinations of two testosterone topical gel forms in safe and physiologic doses. We are working with small dose aromatase inhibitors to further promote the testosterone connection and modulate the estrogen formation. This achieves our oft-stated goal of re-establishing more youthful testosterone/estrogen balance.
Read on. Final page. Plans and Answers
References
Vermeulen et al, Dehydroepiandrosterone Sulfate and Aging. J Clin Endocrinology and Metabolism 1991: 73:221-1
Heikkila R, Aho K, Heliovaara M, Hakama M, Marniemi J, Reunanen A, Knekt P, Serum testosterone and sex hormone-binding globulin concentrations and the risk of prostate carcinoma: a longitudinal study. Cancer 1999 Jul 15;86(2):312-5
