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testosterone

Low T Symptoms: Should you Believe the Commercials?

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low T symptoms heart disease
Irina Karlova/Dollar Photo Club

Despite the complete lack of evidence about whether it has any benefit, a day does not go by that I don’t hear a commercial on the radio for male sexual dysfunction.

By the end of the commercial, you are led to believe that the only reason for male sexual dysfunction is low T.  Even worse, this low testosterone level seems to come out of nowhere and there is nothing you can do about it.  Except, of course, come in for an appointment for testosterone cream, pills or injections.

Regular readers of the Rantings of course know that low testosterone levels are merely a symptom of a poor quality lifestyle and not the problem itself.

To put it plainer, smoke (while not good for you to inhale) is not the problem—the house fire is.  The local fire department doesn’t rush to the scene of a house fire only to suck out the smoke and leave the fire raging.

And yet this is what the “testosterone movement” has led you to believe.  There really is no other way to describe it.  The past few years have seen a massive increase in the prescriptions for testosterone replacement therapy given to men (and women) based purely on low testosterone levels found on bloodwork.

Personally, it is incredibly rare for me to check testosterone levels in the blood, despite knowing a substantial amount about what contributes to low testosterone levels and how to fix low T problems.

Just because I don’t check for low testosterone does not mean that I don’t feel that low T is  a problem.  This particular study drives this point home.  In it, researchers looked at 115 male patients with type 2 diabetes and divided them up between normal (≥12.1 nmol/L) and low (≤12.1 nmol/L) testosterone levels.  They then compared levels of several markers of heart disease, including hsCRP, carotid artery carotid intima-media thickness (IMT) and atherosclerotic plaque by high-resolution B-mode ultrasound as well as assessing the health of the blood vessels (endothelial function) by brachial artery flow-mediated dilation.

Here’s what they found:

  • Lower testosterone was linked to poorer carotid IMT.
  • Those with low T had a 641% higher likelihood of a carotid IMT of 0.1 cm or greater (80% vs 39%).
  • Low T patients had a 260% higher risk of having plaques in the arteries (68.5% vs 44.8%).
  • Those with low T were 577% more likely to have endothelial dysfunction (80.5% vs 42.3%).
  • Low T patients had higher hsCRP levels (2.74 vs 0.89 mg/L).

While some of this may be a little technical, the bottom line is that low levels of testosterone is a marker of incredibly bad health, especially as it relates to heart disease.

But this does NOT mean that supplementing with testosterone is the answer.  Rather, the entire spectrum of lifestyle changes that include exercise, diet and stress management is the answer.  As a matter of fact, the most recent concerns over the use of testosterone replacement therapy had to do with actually increasing the risk of heart disease.  And this is on top of the well-accepted increased risk of developing prostate cancer.

This alone should YET again prove that we cannot find a single marker in the bloodstream and treat just that marker using artificial means (drugs, hormone therapy, surgery, etc…).

 

Aggressive Prostate Cancer; How to Tell if You’re at Risk

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It’s become clear that only a small portion of prostate cancers will ever become aggressive.  The ultimate question is, will YOUR prostate cancer become aggressive?

The same situation applies almost exactly for breast cancer.

I have always felt that the key to cancer research is to determine which cancers will progress.  We have done a poor job of spending our money in this direction, instead choosing to spend billions of research dollars on drugs that do little to extend cancer survival at an extreme cost.  These “costs” are made up of dollars for treatment as well as side effects.

And so many of the treatments given are for cancers that were never going to progress anyway.  How real is a “cure” when the condition was going to either resolve on its own or never progress?  And what about treatments like cancer surgery, which may actually promote cancer spread due to the massive stress on the body?

My position has remained strong on this matter.  It is clear that widespread cancer screenings like PSA and mammography are far more likely to identify cancers that will never progress.  However, if someone does undergo testing and finds they have breast or prostate cancer, this person should be educated as much as possibly about lifestyles that will increase survival.  At the same time would should be spending a greater portion of cancer research dollars on determining factors that will identify those cancers that are going to progress.

Luckily, the factors that increase survival are closely related to the factors that indicate a cancer will progress.  I have covered many of the protective factors for prostate cancer in a previous article that can be read by clicking here.

This particular article begins to address the other side of the equation:  what factors are associated with prostate cancer progression?

Hormones play an important role in the development of sex-specific cancers like breast, uterine and prostate, with estrogen and testosterone being on the top of the list.  In the study researchers looked at several aspects of hormones in aggressive prostate cancer (stage III or IV and/or Gleason ≥7) including:

  • Estrone
  • Estradiol
  • Thirteen breakdown products of estrogen (in the 2-, 4-, or 16-hydroxylation pathways)
  • Testosterone
  • Sex hormone-binding globulin

When it comes to the breakdown products of estrogen in the male body, the wrong metabolites can be quite toxic to the cells of the prostate.  Specifically, the “16” and “4” pathways are considered bad, while the “2” pathway is considered friendly.  The same goes for breast cancer.

With this in mind, here are the results from the study:

  • The risk of aggressive prostate cancer was 73% lower in those with the highest estradiol:testosterone ratio
  • On the other side of the coin, the risk was 244% higher with higher 2:16α-hydroxyestrone ratios.

To put this in English, having a higher ratio of estradiol to testosterone was incredibly protective against the development of aggressive prostate cancer.  Given that this is a ratio, there are two sides to the equation.  The first would be low testosterone, which should come as no surprise.  Testosterone will directly stimulate the cells of the prostate to reproduce, so higher levels are not good.  That is why testosterone therapy can be such a bad idea.

The other side of the equation is the estrogen one.  The effects of estrogens on prostate cancer are not quite as well-known and it may be, based on the results of this study, that estrogen has some type of strong protective effect against prostate cancer.

Ironically, mainstream medicine has focused on the prostate side of this equation almost exclusively, without much success (I recently reviewed this evidence in a prior blog article that can be found by clicking here).  Maybe they’ve had the right theory but the wrong approach.

The results of the 2:16α-hydroxyestrone ratio have me a wee bit more confused.  As I already mentioned, the 2:16α-hydroxyestrone ratio has been shown to be protective against hormonal cancers, included breast, uterine and prostate cancer.  Further, intake of cruciferous vegetables like broccoli and cauliflower increase the ratio, so the ratio goes up with lifestyle choices well-known to be good for us.

But, the results of this study find that higher ratios led to increased risk of aggressive prostate cancer.

I can’t say that I have a readily available answer that makes sense for this finding.  I could postulate that anything that promotes a stronger estrogenic activity (like the 16 hyroxylation product would) is going to slow prostate cancer growth.

It could be possible that an elevated 2:16α-hydroxyestrone ratio might be protective against the development of prostate cancer, but that once prostate cancer has begun, this same elevated ratio now promotes the growth of the cancer.

For now, I am not about to recommend lower intakes of things like cruciferous veggies to keep the ratio low, but I will keep my eyes peeled for more info on this topic.

The take-home message applies to men who have been diagnosed with prostate cancer and are unsure of what to do.  Knowing that there is a factor that can easily be checked in the blood stream that will increase or decrease the risk of conversion to an aggressive cancer can be critical in making a treatment decision.

Given that the decision to progress or forgo treatment could be one of the most critical in a man’s life, any information to help make a decision is welcome.

Testosterone Replacement Therapy: Hogwash or Fountain of Youth?

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As I round middle age, I want to do everything possible to maintain my youthful exuberance. Testosterone therapy seems like the answer.

And it’s such a simple answer.  It’s natural.  After all, testosterone is something a man’s body already makes, it’s just that levels decline with age.  Just pop a pill, rub on some cream or inject in the hormone (good thing the suppository never caught on…) and you’re good to go.  Back to feeling 20 again with all the virility you could hope for.

All of the commercials would have you believe that low T (the hip term for having low levels of testosterone) is just a consequence of aging and has little to do with the choices we make. The image here gives you just a brief idea of how complicated the regulation of testosterone production is.  Given that it is one of the more powerful hormones, the feedback loops that turn on and turn off testosterone production are a massively complicated mess of arrows pointing every which way.

T supplementation completely destroys your body’s ability to regulate its own production.  And here’s the biggest kicker–low testosterone does NOT come from an inability to make testosterone.  Rather, it is the body screaming that there is a bigger problem present that needs to be fixed.  This, of course, boils back down to things like good dietary choices, exercise, stress management, avoiding certain environmental chemicals (BPA and phthalates top the list) and getting a good night’s sleep.

Surely by now you have seen the attorney ads on TV asking you to call if you or a loved one experienced a heart attack while taking prescription testosterone.  All of this hoopla was the result of a single study that found an increase in the rate of heart attacks in men taking prescription testosterone.

While this is certainly not a good thing, I have always considered using testosterone to fix low T levels a very bad idea any, regardless of whether or not it increases the risk of a heart attack.  Just like every other damn marker we think is the holy grail, low T levels are just one sign that the body is out of whack.  No different than high cholesterol, high blood pressure or obesity.

Just to further demonstrate that trying to fix low T levels with prescription testosterone, this particular review looks at a serious of case studies identifying links between increased clotting in the blood (thrombosis) and testosterone use.  While this is only a handful of cases, given that hormone use in women (birth control) is clearly linked to an increase in clotting, it should really come as no surprise.  Here are the details of the cases identified in the study:

  • There were 38 men and 4 women
  • 27 with deep venous thrombosis that led to a pulmonary embolism
  • 12 with osteonecrosis (a blood clot that led to destroyed bone)
  • 1 with central retinal vein thrombosis, 1 with amaurosis fugax (vision loss due to a blood clot) and 1 with spinal cord blood clot.
  • In 8 men whose TT was continued (don’t ask me why…), second thrombotic events occurred despite the use of Coumadin.

These are not good events, especially since all of these people were likely taking the testosterone in an attempt to improve his or her health.  Didn’t quite turn out that way.

 

Polycystic Ovary Syndrome Is Associated With Endothelial Dysfunction – (04-09-01)

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Polycystic Ovary Syndrome Is Associated With Endothelial Dysfunction

In view of recent findings that insulin resistance can be a contributor to endothelial dysfunction; and knowing that high insulin levels can shunt hormone production into too much testosterone in the female to contribute to PCOS…then this study is merely proving that A=B and B=C so A must =C. But it’s nice to see the studies done to prove what clinicians in the trenches use empirically every day.

Circulation — Abstracts: Paradisi et al. 103 (10): 1410

Read entire article here

Elderly show severe impairment of DHEA-S – (08-27-01)

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Elderly show severe impairment of DHEA-S

Given the number of articles appearing related to the topic of adrenal function, a quick review is in order. The medulla (inside) of the adrenals produce epinephrine and norepinephrine…key players in the adrenaline response. The cortex (outside) produce three hormones from cholesterol…aldosterone (regulates blood pressure), cortisol (the body’s stress hormone) and DHEA (which goes on to ultimately become estrogen and testosterone). In the body’s initial response to stress, the body will produce more cortisol at the expense of DHEA (a phenomena known as pregnonolone steal…). Chronic stress will result in both lowered cortisol and DHEA…basically the adrenals “poop out.” All these levels are easily, safely and accurately measured with salivary testing. Synergy : Clinical Endocrinology 55 (2), 259-265

Read entire article here

Ultra-Low-Dose Oral Contraceptive Effectively Treats Acne – (09-10-01)

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Ultra-Low-Dose Oral Contraceptive Effectively Treats Acne

Many times, acne can be caused by excess testosterone. In today’s lifestyle patterns, high insulin levels can effect the conversion of estrogen into testosterone effectively increasing testosterone levels. One of the best ways to approach acne actually comes from within…balancing insulin levels, restoring health of the GI tract (probiotics, glutamine…), Vit A, essential fatty acids… Giving estrogens in this study may work by blunting the difference between estrogen and testosterone levels in the body, but does not actually work by lowering the excess testosterone.

Fertil Steril. 2001;76(3):461-468 An ultra-low-dose oral contraceptive has been shown to be just as effective in treating acne as pills with higher doses of estrogen, according to a study published in the September issue of Fertility and Sterility. “Our study confirms that an oral contraceptive containing only 20 micrograms of estrogen — the lowest dose on the market today — is effective in suppressing androgen production and reducing acne lesions,” said Diane Thiboutot, MD, lead study investigator and associate professor of medicine at Penn State College of Medicine in Hershey, Pennsylvania. “This clinical trial is good news for women because it shows that we now have more birth control choices that are not only 99% effective in preventing pregnancy, and offer numerous other health benefits, but can also treat acne lesions without causing a change in weight — a common estrogen-related side effect,” said Dr. Thiboutot.”In addition, the choice of a low-dose contraceptive resulted in a low occurrence of estrogen-related side effects like nausea, headaches, and breast tenderness, in addition to weight gain,” she added. “If women experience fewer side effects and can treat their acne, they may be less likely to discontinue pill use, to switch to a less effective method of birth control, or to use no birth control at all.”

Transdermal Dihydrotestosterone in Older Men with Androgen Deficiency – (09-10-01)

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Transdermal Dihydrotestosterone in Older Men with Androgen Deficiency

We get into a topic that always gets me a little concerned. I am usually against adding hormones to a patient’s body, especially when alternatives are available. This study uses DHT to affect these patient’s “youthful” status. A few things to consider here… DHT has been implicated in prostate cancer risk and this study only checks values at 3 months–hardly an adequate time frame in my opinion. Balancing the body is the key here; especially making sure that the adrenal glands are functioning optimally so they can provide adequate levels of testosterone. Next, how do we know, in our laughingly poor overall understanding of biochemistry, that lowered hormone levels in old age is bad?? There is much evidence that suggests that this is indeed a protective mechanism done deliberately by the body to protect from diseases such as cancer. Personally, in a bet of nature vs science being right, I’d put my money on nature…

JCEM — Abstracts: Ly et al. 86 (9): 4078

Read entire article here

Mushroom Inhibit Aromatase, Breast Cancer Cell Proliferation – (12-10-01)

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Mushroom Inhibit Aromatase, Breast Cancer Cell Proliferation

Aromatase is the enzyme that converts testosterone to estrogen at the cell. This study demonstrates one particular mushroom’s ability to block this enzyme and potentially lover risk of breast cancer. This may also be effective with estrogen dominant PMS as well.

nutrition.org — Abstracts: Grube et al. 131 (12): 3288

Read entire article here