Men often rationalise the symptoms as due to aging, stress and the pressure in mid-life.
Testosterone deficiency is easily diagnosed through laboratory tests and resolved through natural hormone replacement of testosterone and DHEA. The tests cover total testosterone, free testosterone and DHEA-Sulfate. It is also good to have reference levels of PSA, Estradiol and cholesterol.
Diseases of the blood vessels are one of the main causes of premature death in Australia. Conventional medicine has not yet accepted that male menopause or more particularly decreased androgen levels increase the risk atherosclerosis. There is evidence dating back half a century that
- Testosterone is a primary factor in the health of the heart and blood vessels
- Testosterone levels decline with age
- Restoring testosterone (and DHEA) to youthful levels can yield significant health benefits, including protection against various manifestations of arterosclerotic disease
Looking at the normal high fat diet eaten by most males one can see that this type of diet leads to the clogging of the arteries. If, and more likely when, these arteries go into spasm an occlusion follows and a stroke or heart attack follows. To remedy this situation one must look at dietary considerations and the taking of anti-oxidants as blood vessels with high levels of anti-oxidants have some protection.
Consider cholesterol – the LDL cholesterol protein carrier is more prone to oxidation. When this happens the body sees this as foreign and the immune system sends out macrophages that engulf the oxidised LDL in a foam cell that is then deposited on the arteries to form plaque that in turn clogs up the arteries.
Antioxidants reduce the likelihood of this chain reaction. Vitamin E is one of the best anti-oxidants for cardio-vascular tissue. There have been several studies that show that by taking vitamin E the risk of heart attack drops by 40%, and it will also help to remove plaque from artery walls.
Testosterone is produced in the testes and when too much testosterone is produced there is a feedback loop to the hypothalamus to make excess testosterone into estradiol. This estradiol then feeds back to the pituitary gland that then indirectly makes the hypothalamus shut down any more production of testosterone.
Other extraneous factors also influence the testosterone levels. If we eat too much meat that contains estrogens, the feedback is started and testosterone production is shut down – if we drink too much alcohol the loop is also activated, as alcohol is an estrogen producer. Fat cells also produce estrogens, so it can be seen that lots of us have too much estrogen and not enough testosterone.
There may be a biological point of no return when the normal balance of testosterone and estradiol starts tilting towards estradiol. When this happens the equilibrium between the two is put out of balance and estradiol seems to dominate. It is important that it is not the absolute value of each hormone but more likely the ratio between testosterone and estradiol. It has been found by various researchers that increased estradiol is directly linked with myocardial infarction – the opposite to women.
Although focusing primarily on testosterone, mention should be made of the beneficial effects of DHEA (dehydroepiandrosterone). Produced in the adrenal glands, DHEA lies at the heart of the steroid family tree. DHEA is descended from cholesterol by way of pregnenolone and is a direct precursor of androstenedione and androstenediol both of which are directly metabolised to testosterone.
DHEA normally reaches peak levels in the early twenties and then declines gradually so that by age eighty we have about 5% left. It has beneficial testosterone-like effects such as:
Looking at the steroid family tree – we can see that cholesterol is at the top and it breaks down through various pathways to estradiol, testosterone and many other molecules. By simply adding a precursor we could assume that it slots itself in and things go on further down the pathway – for instance we take some DHEA and the testosterone level goes up accordingly. It’s not so simple, as sometimes this will work in some individuals and not in others. Hence constant monitoring of the situation must be performed to see if what we want to occur is actually occurring.
Once the testosterone levels drop so does general well-being.
- Decreased libido and potency.
- Early senility – as testosterone loss leads to brain cell memory failure.
- Reduced mental agility.
- Loss of ability to concentrate.
- Moodiness and emotionality – grumpy old man syndrome caused by the imbalance in the testosterone/estradiol ratio.
- Depression – this is a major problem for men who don’t talk about their problems.
- Reduced activity in general – the couch potato syndrome. As the testosterone goes down you feel less energetic so you sit on the couch. This leads to putting on weight. Fat makes more estrogen. The estrogen tells the brain that you’ve got enough testosterone (remember the loop) leading to a downward spiral.
- Less aggression, more passive – again think of the loop.
- Nervousness, general tiredness, feeling weak, no oomph, anxiety etc.- these are all due to the estrogen/testosterone ratio being out of balance.
Vascular disease stroke or heart attack which is a major medical condition in Australian men and women. Testosterone addresses vascular disease in a number of ways.
Low testosterone affects us in the following ways
- High blood cholesterol
- High blood triglycerides
- High blood pressure. High body mass index (obesity).
Testosterone has a major effect on changing the way your body processes insulin. High insulin levels lead to vascular disease, as it causes an increase in triglycerides, a decrease in HDL cholesterol that leads to clogging of arteries etc. Testosterone lowers LDL, raises UDL, reduces triglycerides (because of its effect on insulin)., reduces blood pressure, and changes the body mass index as it converts fat to muscle. It is worth noting that the two sexes tend to look alike as we get older and that’s because of the relative increase in estrogen.
It was, in fact found in a post-war study by Danish physician Jans Moller, that cholesterol levels dropped 83% in a study of 300 men. The average drop was 26%.
Dr. Moller was decades ahead of his time and tried to treat the cause of cardiovascular disease rather than its symptoms. Then, as now, the symptoms are, high cholesterol, hypertension, atherosclerosis, thrombosis, intermittent claudication, angina and other manifestations. The standard treatment has been to lower cholesterol, reduce blood pressure, and dilate coronary arteries (as well as replacing clogged arteries surgically as if they were clogged pipes). “This theory does not have anything to do with prevention and treatment of cardiovascular disease” wrote Moller.
Moller basically believed that the normal condition of living organism is a balance between anabolic (protein building) and catabolic (protein destroying) processes. The primary anabolic hormone is testosterone and the primary catabolic hormone is cortisol. Cardiovascular disease results when catabolic influences come to predominate, leading to an excess of cholesterol, impaired carbohydrate metabolism, decreased fibrinolysis and other symptoms.
Lowering cholesterol by reducing dietary intake and by use of drugs, can lead to impotence and impaired cardiac function. This is logical when one remembers that testosterone is made from cholesterol and testosterone improves libido and protects the heart.
There are two components to developing an erection. Firstly thoughts stimulate the production of testosterone, which in turn stimulates blood vessels in the penis to fill and thus form an erection. To maintain the erection the testosterone level goes down which stimulates the production of nitrous oxide which develops a couple of other products that dilate the vessels.
So to sustain an erection, simple testosterone supplementation will not work unless the blood vessels are free and clear to dilate effectively. This can be one of the first signs of coronary artery disease as this starts before the angina.
Thus as we get older, the gap between libido and potency gets wider.
Testosterone is found in the bloodstream in two forms, namely as free testosterone which is active, and the form bound to a steroid binding globulin, SHBG. As we get older the bound version rises but the free version falls. Blood results of total testosterone may show a small drop, when in fact from about 40 years of age free testosterone levels drop a lot, hence test both. Note that as the estrogen levels go up relatively so too does the SHBG, thus less free testosterone.
Testosterone supplementation increases the level of both total and free testosterone, and over a 12 month period the symptoms are reversed, the risk of coronary artery occlusion goes down, angina episodes go down, as do the other symptoms of testosterone deficiency.
Di-indolylmethane is an extract found in cruciferous vegetable s that has a number of actions:
1. it increases the portion of testosterone that is free in serum (by altering the free: bound ratio)
2. it alters the metabolism of estrogens in favour of the safer estrogens
3. it increase the progesterone binding
On a daily basis men get a pulse of testosterone about midday, another about 3pm, and a big pulse between 3-8am. Thus the best way to mimic this is by using troches, taking them three times a day, or at least twice a day. Since the major secretion is in the morning and to improve compliance a single morning dose has proved to be adequate.
Above link in: Website – DocumentationMain MenuKnowledge BaseDocumentsArticlesArticle 17 – ID 95 – Troches.doc
The actual dosage with troches varies, between 10-50mg twice daily, with age basically dictating the dose (i.e. the older the higher the dose). Sometimes doses as high as 200mg a day are necessary for such problems as vascular occlusion but this is rare. If there is an artery problem, often the last symptom to be corrected is erectile function, as that needs to be corrected before an erection can be maintained.
Take our HORMONAL TEST and determine if you are suffering the symptoms of an imbalance.
Since the mid 1990s, excellent results have however best achieved with a combination of natural nutritional supplementscombining glucosamine and chondroitin sulphate.
Firstly healthy cartilage needs three things: water for lubrication and nourishment, proteoglycans to attract and hold the water, and collagen to keep the proteoglycans in place.
Proteoglycans are like a rope that threads itself through the collage and are essential as they hold many times their own weight of water, which both lubricates and nourishes the collagen. If the cartilage is damaged the thread of rope becomes weak and ‘leaks’ out and thus the collagen loses its nourishment as the proteoglycans lose their grip and float away. Thus the cartilage cannot withstand shocks, cracks and may wear out completely.
Glucosamine is a major building block of the water- loving proteoglycans. In addition its presence acts as a stimulus to the cells that produce proteoglycans – in fact glucosamine is a key factor in determining how many proteoglycans are produced by the cells. Glucosamine has been shown to speed up production of both proteoglycans and collagen and it normalises cartilage metabolism which helps keep cartilage from breaking down.
Thus because of the affect of glucosamine on cartilage metabolism it can help the body to repair damaged or eroded cartilage.
Besides stimulating cartilage production, glucosamine also reduces joint pain and inflammation.
Where glucosamine helps form the proteoglycans that sit within the space in the cartilage, chondroitin sulphate acts like ‘liquid magnets’. Chondroitin is a long chain of repeating nigans that attracts fluid into the proteoglycan molecules. This is important for two reasons:
- the fluid acts as a spongy shock absorber
- the fluid sweeps the nutrients into the cartilage. Joint cartilage has no blood supply thus all of its nourishment and lubrication comes from the fluid that ebbs and flows as pressure is applied and released to the joint. Without this fluid, cartilage would become malnourished, drier, thinner and more fragile.
Chrondoiton Sulphate is a long chain molecule with a negative charge attached to it. As these chains wrap around proteoglycans they repel each other and thus create spaces between each proteoglycan. These are what are known as matrixes within the cartilage and this is where the fluid flows. There may be as many as 10,000 of these chains on a single proteoglycan molecule – thus we have a super water retainer as these chains make sure all these molecules are away from each other and cannot clump together.
Besides drawing in precious fluid, chondroitin :
- protects cartilage and stops it from breaking down and inhibits certain ‘cartilage chewing’ enzymes
- interferes with the metabolism of other enzymes that will starve the cartilage of fluid
- stimulates production of proteoglycans, glucosamine and collagen.
Available on prescription only
- To protect the skin from the environment and permit skin rejuvenation
- To provide for skin an emollient or hydration effect
- To provide a means of conveying medication to the skin for a specific effect either systemically or, as in this case, locally.
The cream is elegant, nonallergic, nonsensetising, low-irritant and stable.
The coincidence of climacteric symptoms and the beginning of skin ageing suggests that estrogen deficiency may be a common and important factor in both the peri- and menopausal woman. Often hormones have been considered important in endogenous ageing of skin. Thus by using topical application of estrogens this ageing may be reversed eg by either estradiol 0.01% cream for the menopausal and postmenopausal woman, or estriol 0.3% cream for the premenopausal woman- available only on prescription. From research we have found that elasticity and firmness was markedly improved after a period of six months, and wrinkle depth and pore size had decreased by 61-100%. Furthermore, skin moisture, type III collagen and the number of collagen fibres all improved dramatically. With all these external benefits no systemic absorption was found, and thus no estrogenic side effects occurred. From studies done it has been found that at the and of a six month clinical trial, marked improvement of skin ageing symptoms was noted.
- Clinical improvement of specific skin parameters was evaluated and was seen in 9-19 weeks with estradiol and 7-17 weeks with estriol.
- Improvement in skin elasticity and firmness was noted after 13 weeks with estradiol and 11 weeks with estriol.
Improvement in skin moisture was noted after 9 weeks with estradiol and 8 weeks with estriol.
- Improvement in wrinkle depth was noted after 16 weeks with estradiol and 17 weeks with estriol.
Reduction of pore size was noted after 19 weeks with estradiol and 16 weeks with estriol.
All the above improvements appeared in 61–100% of cases.
In more detail wrinkle depth reduction was significant with estradiol and highly significant with estriol. Side effects were more pronounced with the estradiol group than the estriol group.
Both estradiol and estriol exhibited significant effect on increasing collagen fibre and striking increases in collagen III. This is why skin was firmed and wrinkles reduced. Type I collagen is predominantly in adult skin while type III is although distributed about the body is predominant in fetuses.
The positive effect of the estrogens on hydration was noted in all patients. This may be due to the increase in skin thickness with subsequently elevated amounts of natural moisturising factor.
The root of vasomotor menopausal symptoms is the decline in estrogen levels. When this level is elevated the physical discomforts can be alleviated. Low estrogen may cause hot flushes, night sweats, vaginal atrophy and emotional displays.
Estrogen is in fact a class of hormones made up of three players – Estrone, Estradiol, and Estriol. Estradiol is the primary estrogen produced by the ovaries and is the key to the change in a woman’s body. At puberty it is instrumental in the development of breasts, genitalia and the extra layer of fat under the skin. When menstruation starts other hormones enter the picture, mainly progesterone.
From the beginning of the menstruation cycle to about day 14 estrogen flows, peaks, and then declines. At this stage (day 14) progesterone production starts to increase reaching a maximum at about day 22 after which it starts to fall dramatically (if no fertilized egg) until day 28 when menstruation occurs.
This cycle continues for the next 35-40 years.
Ovarian estrogen and progesterone begin to decline during a woman’s 30’s but do not become evident until her 40-50’s when cycles become irregular and the classic symptoms of menopause appear, i.e. night sweats, hot flushes, etc.
With this decline in estrogen the risk of heart disease, osteoporosis, and memory loss, increase.
Estrogen replacement has profound and immediate effects on menopausal symptoms (hot flushes, vaginal dryness, night sweats, sleepless nights, depression, reduced libido, lack of enjoyment of sex, urinary incontinence, vaginal and bladder infections). However taking estrogen alone increases the risk of uterine cancer. In the body, estrogen does not exist by itself, it is balanced by progesterone. It is crucial to supplement estrogen with progesterone to re-establish the natural hormone balance, because these hormones are antagonistic in many ways and block actions of each other in certain circumstances.
Considering a patient who is not taking any form of HRT, test the serum levels of estradiol, progesterone, testosterone and DHEA to obtain a baseline from which to determine a starting formula. This starting dose calculation is an educated guess as two factors are unknown i.e. the absorption rate and the level of estrogen we are aiming at. We don’t know their estrogen secretion levels in their premenopausal days, hence we don’t know where we’re aiming.
In a patient with severe estrogen deficiency problems and no history of cancer, estradiol will give the most immediate results with hot flushes disappearing within a couple of days. If the dose is too high, breast and nipple tenderness will rapidly appear and the only way to remedy this is to reduce the estradiol dose until the flushes reappear, then incrementally increase estradiol until they cease.
Using triest, which is a combination of all three estrogens (10% estrone, 10% estradiol and 80% estriol) the above problem is less likely to occur. Although a little slower, it is probably the best way to go.
Progesterone replacement is not as tricky and as long as the dose is high enough to hold the estrogen proliferation. From experience, a dose of 150-200mg of progesterone per day is usually adequate, with a Triest : Pg ratio of 1:100.
Testosterone is also very important, and not only for the libido consideration. Testosterone may also be considered a weak estrogen as it also breaks down to estrone and estradiol. Also it is a natural antidepressant – particularly noticeable in women who have had hysterectomies.
DHEA, is also a good addition for several reasons, the main being that because DHEA itself is metabolised to testosterone, estrone and estradiol, it helps to balance the formula if it is not exactly “spot-on”. The independent effects of DHEA, namely that feeling of well being, should not be overlooked.
The form that we make our Natural hormone replacement in is called a troche and a typical female HRT dose is:-
Don’t give up on hormone replacement therapy after a month. Some women on HRT will notice results immediately while others may not for several months. In these cases spend 3-4 months noting symptoms and adjusting hormone doses to devise a personalised HRT program.
Exercise has a decidedly beneficial effect on hormone balance and women who participate in regular physical activity have an easier transition through menopause with noticeably fewer hot flushes. At least three to four hours per week of moderate exercise is recommended.
Bone is a living structure made up of very specialised cells that constantly model and remodel the state of the bones. It is a honeycomb of cells that in the extreme osteoporotic state looks like a torn fishing net. Thus, from a dense mass the breakdown of these cells leaves a most unstable structure that will fracture very easily.
The two types of cells are, osteoclasts that control the modeling/remodeling of the bone by absorbing calcium. Osteoclasts travel through bone tissue and when they come across old bone they dissolve and resorb it, leaving tiny spaces or pores in its place. The second type are the osteoblasts that follow on, lay down new bone, filling the defects caused by the osteoclasts. This goes on through youth to middle age. When the number of osteoblasts outnumber the number of osteoclasts, osteoporosis begins. Thus the whole idea is to increase the number of osteoblasts at the expense of the osteoclasts.
Treatment for osteoporosis should be started sooner rather than later. To expand on this consider the following facts:
|AGE RANGE||FRACTURE ANYWHERE||FRACTURE OF HIP|
Risk of osteoporosis also varies according to genetic and controllable factors. If you have a body weight less than 60kg, had menopause before 45, do less than 4 hours exercise each week, smoke, drink more than two alcoholic drinks per day, and have a low calcium diet, then you are at a high risk to suffer from osteoporosis.
With lifestyle modifications in place, the addition of hormones will have a major impact on the result. The hormones that are required are estrogen, progesterone and testosterone and even DHEA to a lesser extent. Osteoclast activity is decreased by all these hormones.
In osteoporosis, bones lose calcium as well as other minerals and become weaker and increasingly prone to fractures, even after mild impact. The most susceptible bones are those in the hip, shoulder, wrist and spine.
Women’s bones reach their peak in their mid-thirties when a slow decline begins until menopause, when it accelerates at a rate of 1-1.5% per year. As osteoporosis accelerates so rapidly after menopause (or surgical removal of the ovaries), it is apparent that both estrogen and progesterone must play a part in this complex procedure. Bone density rises because estrogen and progesterone act directly on bone tissue to enhance mineral deposition. As their levels drop, bone loss occurs and bone density decreases. If estrogen and progesterone are replaced, bone loss can be reversed. The earlier this replacement therapy is started the better the results.
It should be noted that estrogen acts mainly to stop further bone loss and, as at this point in time, estrogen in itself does not promote bone regrowth. Other studies with regards to the role of testosterone, indicate that it plays a part in the reversal of osteoporosis.
Dr John Lee states “Postmenopausal osteoporosis is a disease of excess bone loss caused by progesterone deficiency and secondly a poor diet, and lack of exercise. Progesterone restores bone mass. Natural Progesterone is an essential factor in the prevention and proper treatment of osteoporosis.”
Long term clinical trials using synthetic estrogen and progesterone showed a result of a 3-5% increase.
However it must be emphasized that taking progesterone is not the complete answer, as diet, weight bearing exercise and lifestyle play a major role in the big picture.
These symptoms should not be present for more than fourteen days prior to menstruation, as this is the number of days from ovulation until menstruation, and they must be noted for a minimum of two cycles. The complete absence of symptoms after menstruation should be at least seven days. It is this absence of symptoms after menstruation that makes the diagnosis of PMS complete.
The duration of PMS varies enormously. It may be a black depression that lasts fourteen days, to migraines that last a day or two, to an epileptic seizure that may last only a few minutes. Symptoms are always at their worst immediately prior to menstruation as this is the time when progesterone is most required.
Although the average menstrual cycle is considered to be 28 days, PMS treatment must take the length of the individual’s menstrual cycle into consideration.
It is important to note that PMS can occur in a cycle when ovulation does not take place as well as in normal ovulatory cycles. PMS may also recurr after recovery from the trauma of hysterectomy, with or without removal of both ovaries.
PMS is universally recognised and is treated in many and varied ways – from aspirin to antidepressants, with symptoms both physical and psychological. With the advent of molecular microbiology and the discovery of progesterone receptors, a whole new protocol for the treatment of PMS has evolved. With this advanced medical knowledge and the acceptance of these receptors, treatment should be aimed at ensuring their maximum function. To do this effectively a three pronged approach is required. By this we mean that lifestyle adaptations may be required – stress, if present must be relieved, the blood sugar level must be maintained, and finally the appropriate progesterone therapy must be applied.
1. Establish a full hormonal medical background (eg. ability to tolerate the pill)
2. Keep a menstrual chart for at least two months, as the timing of the symptoms is essential.
1. It is essential to maintain blood sugar levels.
2. Consider the patient’s normal diet (weekdays and weekends)
3. Check the BMI and gauge fluid retention.
Consider the quality and duration of sleep.
The Three Hourly Starch Diet
If there is a drop in blood sugar, progesterone receptors cannot bind to or transport progesterone. Thus even if your serum progesterone levels are normal, progesterone deficit symptoms will be evident.
As blood sugar levels fall, adrenaline is released which causes sugar to be transported from within the cells to the bloodstream. As this sugar goes into the blood it is replaced by water. This in turn causes fluid retention and bloating and subsequent weight gain.
To make the situation even worse, consider the effects of this adrenaline in the blood. Adrenaline is the hormone that causes the “fight, flight or fright” response- the emotions that are exacerbated by PMS.
It has also been established that progesterone levels drop after a large meal, thus women with PMS should eat smaller meals more frequently. This is why the three hourly starch diet has been established. If it is not followed, buckets of progesterone will not help.
Starchy foods are the ones containing wheat, potatoes, oats, rice, rye and corn. The starch diet does not mean that you stop eating healthy, varied and nutritious food. It simply means that you modify it by adding starchy snacks every three hours, eat within an hour of going to bed and within an hour after rising. By doing this your main meals will be reduced as your hunger will be less and many people on this diet actually lose weight.
It will take seven days to feel the benefits of this diet and another seven if you break it by going for long periods without eating. Often it has been found that by simply following this diet PMS symptoms disappear.
Treatment of PMS using Progesterone
The pet that refuses to take medication because of the taste is often a prime candidate for compounding. Cats don’t like pills, but most like tuna. Dogs don’t appreciate a traditional solution of amoxycillin being squirted into their mouths, but will gladly take it when it’s part of a tasty biscuit or treat. Take a look at the list of available flavours here.
By working closely with veterinarians, a compounding pharmacist can prepare medicines into easy-to-give flavoured dosage forms that animals devour, whether the animal is a cat, dog, ferret, bird or snake.
Sometimes manufacturers will discontinue a medication used in veterinary applications. A compounding chemist may obtain the pure bulk pharmaceutical and prepare a prescription for the discontinued product.
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