Mon – Fri 9am – 5pm
(closed Public Holidays)

Level 1, 76 Spring Street,
Bondi Junction NSW 2022

All mail correspondence to
Po Box 2109 Bondi Junction NSW 1355

(02) 9387 3205

Male Menopause


The major worry with taking supplemental testosterone seems to be the theory that testosterone causes prostate cancer. If this were so, why wouldn’t more young males, between 18 and 25 (when testosterone levels are at their peak), be developing prostate cancer?

Diseases of the blood vessels are one of the main, if not the main cause 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 atherosclerotic disease.

Blockages of various arteries cause various problems, namely blockage of the coronary arteries leads to coronary atherosclerosis, blockage to the arteries that supply the brain leads to a cerebrovascular occlusion and, if this is not rapidly cleared, a stroke results and restricted blood flow to the legs is claudication which can ultimately lead to gangrene.

Rather than undergoing surgery would it not be better to treat some causes?

Atherosclerosis – its causes and some solutions

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-oxidant have some protection.

Now one must consider cholesterol – all cholesterol is good but it’s what we do with it that determines the good and bad results. It’s all about keeping things in balance. The LDL cholesterol protein carrier is more prone to oxidation. When this happens the body sees this as bad 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.

To stop this chain reaction an anti-oxidant should be taken. The best choice would be vitamin E as this 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.

Male Testosterone – its auto-shutoff mechanisms

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 oestradiol. This oestradiol then feeds back to the pituitary gland that then indirectly makes the hypothalamus shut down any more production of testosterone. It is important to understand this loop, as it is the key to why a lot of other things happen.

By understanding this mechanism we can see why other extraneous factors 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 also, 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 oestradiol starts tilting towards oestradiol. When this happens the equilibrium between the two is put out of balance and oestradiol seems to dominate. It is important that it is not the absolute value of each hormone but more likely the ratio between testosterone and oestradiol. It has been found by various researchers that increased oestradiol is directly linked with myocardial infarction – the opposite to women. This in itself is interesting, as the ratio must be the opposite for men (testosterone dominance).

DHEA and the Heart

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 androstendione and androstendiol, both of which are directly metabolised to testosterone.

DHEA has been found in recent years to be one of the most powerful tools in enhancing and extending life. DHEA normally reaches peak levels in the early twenties and then declines rapidly so that by age eighty we have about 5% left. It has beneficial testosterone like effects such as:

  • Feeling of energy and wellbeing.
  • Improved insulin sensitivity and glucose tolerance.
  • Reduced death from coronary heart disease.
  • Lower obesity/waist to hip ratio.
  • Slowed progression of atherosclerosis.
  • Enhanced libido and erectile ability. Reduced depression and enhanced cognition.

Let’s look at the steroid family tree – we can see that cholesterol is at the top and it breaks down through various pathways to oestradiol, 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 and not in others. This is why constant monitoring of the situation must be performed to see if what we want to work is actually working. This is why doses vary person to person, as apart from following the correct pathway absorption rates vary person to person.

Total and Free Testosterone

Testosterone is found in the bloodstream in two forms, namely as free testosterone and bound to a steroid binding globulin. As we get older the bound version rises but the free version fails. So by doing blood tests we measure total testosterone when in fact we need to know the level of free testosterone. So although seeing blood results that show a small drop, the fact is that from about 40 free testosterone levels drop a lot. Testosterone levels drop about 1% per year so from 40 – 50 we see a 10% drop.

Effects of Low Testosterone

Once the testosterone levels drop so does general well-being. All this information is not new and has been known for years.

  • Decreased libido and potency.
  • Early senility – as testosterone has on brain cell memory failure.
  • Reduced mental agility.
  • Loss of ability to concentrate.
  • Moodiness and emotionality – grumpy old man syndrome. A lot of this is caused by the imbalance in the testosterone/oestradiol ratio.
  • Depression – this is a major problem. Men don’t talk about their problems because it’s not a blokey thing, they just bottle it up.
  • 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). The situation gets worse and spirals ever downward.
  • 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.

Testosterone and Heart Disease

Vascular disease stroke or heart attack – is the major medical condition in Australia. The prognosis is often death and it affects both men and women. Testosterone addresses vascular disease in a number of ways.

Low testosterone affects us in the following ways:

  • Angina
  • Atherosclerosis
  • 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 (clots), 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.

Consider cholesterol by lowering the level 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.

Testosterone and Libido/Potency

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 really make the vessels dilate.

So it can be seen that to sustain an erection testosterone alone will not work as the blood vessels must be free and clear so that they can dilate effectively. Therefore in cases where the arteries are clogged up testosterone treatment alone will not be all that effective. This can in fact be one of the first signs of coronary artery disease as this starts before angina.

Thus it can be seen what happens as we get older, the gap between libido and potency gets wider. In other words, the mind is willing but the flesh is weak.

The testosterone in our bloodstream is of two types, namely free and bound. The free testosterone is relatively small but is what is actually active. The bound form is attached to sex hormone binding globulin or albumin, as with all hormones, thus when we measure serum testosterone we get the whole thing. Thus as the estrogen levels go up relatively so too does the SHBQ thus less free testosterone.

Thus as one takes testosterone the level of free testosterone increases and the symptoms are reversed. What we are doing is increasing testosterone to youthful levels.

As the level of testosterone is increased it can be seen that coronary artery occlusion goes down, angina episodes go down, as do all the other symptoms of testosterone deficiency. These symptoms do not drop overnight, it’s not like taking an aspirin and the headache goes away, we’re talking about a much bigger time span – something like twelve months.

Dosage of Testosterone

To make us as youthful as possible what better lead is there to follow than Nature herself. As with women’s hormones being cyclic over a monthly period so too are men’s. 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 using a cream or gel twice a day.

The actual dosage with troches varies between 10-50mg two to three times daily, with age basically dictating the dose (ie the older the higher the dose). Sometimes doses as high as 2OOmg three times a day are necessary for such problems as vascular occlusion but this is rare. As doses can be adjusted minimally it is important to get a dose/symptom ratio worked out. A lot of times the last thing to get corrected is the sex drive, as if there’s an artery problem that’s got to be fixed before an erection can be maintained.

Testosterone and Prostate and Prostate Cancer

Contrary to what we’ve thought before testosterone actually decreases prostate size, and strengthens the muscular tissue around the urethra that is associated with the prostate. One prostrate problem, nocturia, is usually caused by the enlarged prostate pressing on the urethra and constricting it causing incomplete emptying of the bladder as the flow diminishes to a trickle. However, this can happen even if the prostate is normal size if the cluster of tissue in the surrounding area malfunctions.

Testosterone works on both types of nocturia as it inhibits the adherence to prostate receptors Os estrogen, which is now thought to be the main cause of prostate growth. It also re-establishes the function of the muscular tissue. Research shows that testosterone does not increase prostate size even though with added testosterone one would think that more dihydrotestosterone would cause prostate enlargement this does not happen.

It has also been found that men taking testosterone replacement have a reduced risk of prostate cancer. Why? As mentioned at the beginning if testosterone caused prostate cancer in males 18-25 would be prime targets and this simply is not so. As we age the testosterone/estrogen ratio reduces and the “extra” estrogen can adhere to the prostate receptors and that’s when we get prostate cancer.

A lecture by Roby D Mitchell MD
Maximise your Vitality and Potency for men over 40
Jonathon V Wright MD and Lane Leonard PhD