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June 2005
Andropause
Options
by
James Biddle, MD
As
men age, they may have declining levels of testosterone, the
male sex hormone. Just as women go through menopause
around age 50, men also go through andropause, or male
menopause, but usually later in life and over a longer period of
time. Many men between the ages of 50 and 70 will
experience symptoms of testosterone deficiency, including loss
of muscle mass, increasing fat mass, fatigue, loss of libido,
erectile dysfunction, penile shrinkage, gynecomastia (breast
growth), and prostate problems. This may occur more
frequently after vasectomy, due to the production of anti-sperm
antibodies.
Testosterone
deficiency, also called hypogonadism, is present in about 5% of
males at age 50, but in up to 70% of males older than 70 (1).
How important is this for overall health? Well, declining
testosterone levels predict both physical frailty and declining
cognitive function, while testosterone replacement can improve
cognitive function in older men (2), and testosterone
replacement for men may protect against Alzheimer’s dementia
(3).
As
men produce less testosterone, they often also make excess
estrogens, or female hormones. Testosterone is converted into
estrogens by the enzyme ‘aromatase’ in fat cells.
Therefore, more body fat creates excess female hormones.
Estrogens cause prostate tissue to grow and contribute to BPH
(benign prostatic hypertrophy) and prostate cancer. While
testosterone itself may cause a prostate cancer to grow faster,
it does not seem to actually initiate prostate cancer.
Testosterone
can also be converted into DHT, or di-hydro-testosterone.
In excess, DHT also contributes to prostate enlargement, as well
as male-pattern baldness.
Interestingly,
testosterone itself is probably quite safe and good to have at
strong levels. Even though conventional doctors have
blamed testosterone for causing BPH, prostate cancer, and even
heart disease, the evidence suggests that the culprit is really
the shift towards deficient testosterone but excess estrogens
and excess DHT. Therefore, to age gracefully, a good
strategy is to keep testosterone strong, and prevent it from
being changed into estrogens and DHT.
To
delay andropause, we utilize strategies that support a man’s
own production of testosterone, that slow the conversion into
estrogens and DHT, that lower the body fat, that increase muscle
mass, and that support the levels of other important hormones,
such as thyroid, adrenals, and growth hormone. Proper nutrition
and exercise are fundamental to this process, with the addition
of specific nutritional supplements.
If,
even after supportive measures, a man’s system fails to make
enough testosterone, then testosterone replacement
is in order. However, testosterone replacement should
never be entered into lightly, because once this step is taken,
it inhibits the man’s own production of testosterone even
further, so that he may need testosterone replacement
indefinitely. Below are some of the specific strategies we
utilize to prevent and treat andropause. We suggest that
you apply these only under the guidance of a qualified licensed
practitioner.
Control
your weight, decrease your fat mass,
and increase your muscle mass thru proper nutrition and
exercise.
Reverse
insulin resistance,
which lowers testosterone and causes insensitivity of the
gonadal response to pituitary and LH stimulation of testosterone
production (4).
Tribulus
terrestris (puncture vine) is an herb that can boost LH
production by up to 72% and boost testosterone production by up
to 41%. It also boosts libido and sperm production (5).
Use 500 mg, 2-3 times daily.
Block
aromatase, the enzyme which converts
testosterone into estrogen:
Arimidex
(anastrazole by prescription) 0.5 mg twice weekly, or DIM
(di-indole-methane), I3C (indole-3-carbanol), and/or ½
cup of broccoli sprouts daily (6).
Reduce
alcohol consumption, boost zinc
levels, and reverse obesity.
Block
5-alpha-reductase, the enzyme which
converts testosterone into DHT (di-hydro-testosterone):
Saw
palmetto (Seronoa repens)
160-320 mg per day (7).
Pygeum
africanum (containing 14 % B-sitosterol
or phytosterols) 30-100 mg, twice daily (Lancet
1995;345:1529-32).
Stinging
Nettles (Urtica dioica) 300
mg, 2-3 times daily.
Progesterone,
5-10 mg in cream topically or 10-25 mg capsule orally at
bedtime.
If
estrogen levels are excessive, lower them with:
Ground
flax seeds, 2-4 Tbsp daily (8).
Calcium-D-Glucarate
500 mg, 2-3 times daily (9).
Testosterone:
avoid injections, as they use a synthetic methyl-testosterone.
Androgel is a topical gel of natural testosterone, but quite
expensive. A compounding pharmacy can make a
less-expensive topical cream of natural testosterone, to use
25-100 mg daily.
Trans-D
Tropin to support your own release of
growth hormone. Within 6 weeks, it can boost the release
of endogenous hGH by up to 1700% (17 times baseline). This
works best when used with an aggressive exercise program,
especially muscle-building exercises such as lifting weights.
Available only thru a physician’s office.
1.
J of Gerontology 2001;Series
A56:M263-5.
2.
J Cog Neurosci 12:407-414. Behav
Neurosci 108:325-332.
3.
J Clin Epidemiol 44:671-684. Proc
Natl Acad Sci USA 200;97:1202-1205.
4.
Diabetologia 1992;35:173-177. Psychoneuroendocrinology
1992;17(4):375-383.
5.
Chemical Pharmaceutical Institute literature.
6.
J Nat Cancer Inst 1997;89:718-23.
7.
Cur The Res 1994;55(7):776-85.
8.
Cancer Epidemiol Biomarkers prev
1998;7(12):1101-8.
9.
Cancer Detec Prev 1997;21(2):178-90.
From
the Staff:
When I call a patient to remind them of a future appointment, I
always ask that they arrive fifteen minutes before their
scheduled appointment time. Fifteen minutes gives us time
to do any necessary paperwork and to get vital signs, all before
your appointment time. This is so you may receive the
benefits of the full appointment time with the doctor or
physician’s assistant. It also helps keep the schedule
flowing as planned so that patients will not have to spend much
time in the waiting room. Arriving fifteen minutes early
makes your time here efficient and most beneficial to you.
We appreciate you arriving early for your appointments.
Come
out to hear Dr. Biddle Speak!
Dr.
Biddle will be lecturing this summer at Pack Library in the Lord
Auditorium. The lectures are free and open to the public.
Please join us.
June
16th will feature
Andropause Options
July
14th will feature
Vascular Disease Options
Lectures
will begin
at 6 PM
Dr.
Biddle is available to speak to your group or organization on a
multitude of topics. For information or to schedule a
talk, please contact Jean at 828-210-0188
Nutrients
Etc.
Nutrients,
Etc. offers
the following products recommended by Dr. Biddle in Asheville
Integrative Medicine’s Andropause Protocol as being helpful
for the treatment of Andropause.
Tribulus
terrestris (puncture
vine), Now Brand 500 mg/100 capsules
$14.98
Tribulus
terrestris is a perennial trailing plant that grows
predominately in India and Africa. Tribulus is mentioned in
ancient Indian Ayurvedic medical texts dating back thousands of
years as a traditional herbal used by indigenous
people. It has become increasingly popular with athletes
and studies into its uses are ongoing.* This herb can
boost LH production by up to 72% and boost testosterone
production by up to 41%. It also boosts libido and sperm
production (Chemical Pharmaceutical Institute literature).
DIM
(di-indole-methane) Young
Again Nutrients 200 mg/60 capsules $25.99
Helps block aromatase, the enzyme which converts testosterone
into estrogen
(J Nat Cancer Inst 1997;89:718-23).
Supplementing the diet with DIM and eating cruciferous
vegetables increases the
specific
aerobic metabolism for estrogen, multiplying the chance for
estrogen to be broken down into its beneficial, or
"good" estrogen metabolites. These "good"
estrogen metabolites are known as the 2-hydroxy estrogens. Many
of the benefits that are attributed to estrogen, which include
its ability to protect the heart and brain with its antioxidant
activity, are now known to come from these "good"
metabolites.
When DIM increases the "good" estrogen metabolites,
there is a simultaneous reduction in the levels of undesirable
or "bad" estrogen metabolites. These include the
16-hydroxy estrogens, which are not antioxidants and can
actually cause cancer.Greater production of these
"bad" estrogen metabolites is promoted by obesity and
exposure to a number of manmade environmental chemicals. These
"bad" estrogen metabolites are responsible for many of
estrogen's undesirable actions in women and men,
including further unwanted weight gain, breast cancer, uterine
cancer, and prostate cancer.*
Saw
palmetto & Pygeum
Africanum
Oregon’s
Wild Harvest 500 mg/90 capsules $17.99
May help block 5-alpha-reductase, the enzyme which converts
testosterone into DHT (di-hydro-testosterone), which is thought
to be a culprit in BPH and male-pattern baldness
(Cur The Res 1994;55(7):776-85). The
Saw Palmetto berries in this formula supply a dose of fatty
acids and sterols similar to the standardized dose used in
recent clinical trials. Added Pygeum and Nettle root contain
many compounds which may provide nutritional support for the
prostate gland. This combination of saw palmetto, pygeum, and
nettle is popular in Europe where it is used for nutritional
support for the male reproductive tract. *
Stinging
Nettles
Oregon’s Wild Harvest 300mg/90 capsules
$17.99
Along with Saw Palmetto & Pygeum, Stinging Nettle may help
block 5-alpha-reductase, the enzyme which converts testosterone
into DHT (di-hydro-testosterone), which is thought to be a
culprit in BPH and male-pattern baldness
(Cur The Res 1994;55(7):776-85).
Traditionally, nettle leaves have been used to help support
joint health and the sinuses at times of allergen exposure. Some
studies have shown nettle leaves to be useful in helping to
maintain healthy fluid balance. Freeze-drying has proven to be
an effective method of capturing and preserving the naturally
occurring acetylcholine, histamine and serotonins that are
present in the fresh stinging hairs of nettle. *
Ground
flax seeds
Now Brand 16 oz (1 lb.)
$2.99
If estrogen levels are excessive, Flax seeds may help to lower
them
(Cancer Epidemiol Biomarkers Prev
1998;7(12):1101-8). Flax seeds are one of the oldest foods known
to man. Flax seeds also provide protein, mucilage,
phytosterols, and plant lignans.*
Calcium-D-Glucarate
Amni/Health Yourself 500mg/90 capsules $44.99
Along with Flax Seeds, Calcium D-Glucarate may help to lower
excessive estrogen levels (Cancer
Detec Prev 1997;21(2):178-90).
Calcium D-Glucarate supports Phase II detoxification of
chemicals and hormones. By supplying a slow-release form of D-glucaric
acid, calcium D-glucarate is an effective agent that enhances
the deactivation of toxic substances and encourages their
elimination from the body. When calcium glucarate is converted
to D-glucaro-1, 4-lactone, it counteracts the enzyme beta-glucuronidase
which conjugation and detoxification of steroid hormones and
potentially carcinogenic compounds. Beta-glucuronidase enzymes
are present in all cells, particularly the liver, kidney, lung,
intestinal epithelium, breast and endocrine organs. By
inhibiting this enzyme, glucaric acid derivatives may exert a
protective, non-antioxidant effect on the immune system.*
*statement
of manufacturer
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