Men are getting tested for testosterone, but are they getting tested for that other hormone?
Men are going to doctors in droves to have their testosterone levels checked. Often, these men receive the answer they expected, that their lack of sexual satisfaction is, in fact due to a low testosterone level.
Testosterone levels normally begin declining after age 40, and in some men, the decline is more rapid and extreme. But what most men don’t know is that another process is going on along with their declining testosterone, a process that may ultimately be responsible for more symptoms and problems than their low testosterone level. That other process is a steady increase in estrogen levels with age, that parallels the decrease in testosterone.
Just as a low testosterone levels cause fatigue, reduced sexual satisfaction and erectile dysfunction, as well as weight gain and metabolic syndrome, the effects of increasing estrogen levels are very similar.
The problem is that by simply putting a patient on testosterone, we are in many if not most cases worsening their estrogen problem. Why? Simply, because supplemental testosterone, once inside the body can be turned into estrogen by an enzyme called aromatase. This enzyme is always present in men, and we make more of it as we get older. Thus every year, more and more of our dwindling testosterone gets turned into estrogen – a hormonal, double whammy.
What does all this have to do with the prostate? A lot. Early theories about prostate disease tended to assume that testosterone must be the culprit in causing enlargement of the gland, or even the promotion of cancer. One thing that puzzled researchers looking for a root cause is that the incidence of prostate cancer and also prostatic hypertrophy (enlargement) increases with age, at the same time that testosterone is decreasing. But when researchers go around to looking at the association between estrogen and the prostate, the lights went on: estrogen is a much more powerful stimulus for prostate growth than testosterone, especially prostate cancer cells.
Furthermore, the incidence of prostate disease (both cancer and hypertrophy -- BPH) goes up right along with the estrogen increase caused by aging (and increased aromatase)!Besides prostate problems, Estrogen can be implicated in virtually every unwanted symptom commonly experienced by men over 40. Love handles, “man boobs,” excessive moodiness and “loss of drive,” weight gain that becomes harder to shed, soft erections and reduced libido, even memory loss. The list is a long one. That said, men clearly have a need for a small amount of estrogen, but amounts above this limited quantity become harmful very rapidly.
I think this level is between 30 and 50. I have yet to find a man over 40 with levels that were too low. In fact, I have generally found men -- especially those given well-intentioned testosterone supplementation by other doctors – to be way too high. A couple of these patients had levels higher than some of my female patients. One of my male patients, who came to me as a sort of “hormonal wreck,” had a total estrogen level over 200! After I got both his estrogen and testosterone regulated (Total Testosterone 750 and Total Estrogen 33), he was like a new person, and felt about 20 years younger. Over the next 2 years he lost weight, gained muscle mass, regained his libido, and most importantly, regained his sense of power and purpose. Over ten years later, he is still doing well. These hormonal wreck stories are all too common, and they underscore the need to manage estrogen and testosterone in tandem. We must bear in mind that men do have a need for some estrogen, so regulation is the key, not eradication.
What has increasingly concerned me since I began to look at estrogen levels in my male patients is the hidden crisis of xenoestrogens. What the heck does that term mean? Xenoestrogens are chemicals in the environment that mimic estrogen, but are many times more potent! What is even more scary is that these compounds are all too common. From the Styrofoam cup you drank your morning coffee out of at work, to the bottled water you drank after your mid-day run, to the insecticide you sprayed around your house in the evening. These “super hormones” are at the center of increasing concern among epidemiologists (the doctors who study disease patterns among large populations). Unfortunately, the clinical doctors (i.e. your family doctor) are pretty much ignoring them, due to either lack of knowledge, or a sense of futility, because they think “the horse is already out of the barn;” i.e., “they are everywhere, so why try to avoid them?” But avoid them we must, because it is very likely that they are responsible for the lion’s share of prostate cancer, and probably most breast cancer as well. In another article, I will try to cover this subject in more detail in another article. Suffice it to say that I am avoiding all bottled water, and plastic food storage vessels. And, I never, ever heat food in a plastic or Styrofoam container.
Food plays a role in hormone balance, and there are both helpful and harmful foods in this regard. Some excellent food choices include cabbage, Brussels Sprouts and broccoli. These foods contain DIM (Diindolylmethane), a substance that blocks some of the harmful effects of estrogen, and has a limited inhibitory effect on the aromatase enzyme, preventing it from turning testosterone into estrogen. Further research will be needed to determine just how helpful DIM can be in this regard.
Testosterone supplements must be prescribed, so this “supplement” falls into the category of a prescription drug. It may surprise readers to know that I am not a fan of testosterone supplementation, as I have not yet found a single patient whose testosterone couldn’t be moved into the optimal range using more natural means. There are some prescription drugs that I have found useful, however, when it comes to controlling estrogen levels. These medications, called aromatase inhibitors, do just what you would think from their name: they keep the aromatase enzyme from turning testosterone into estrogen. Used by themselves, they are pretty much guaranteed to lower a man’s estrogen level. These medications were developed for women (to help treat diseases in women that are helped by reducing estrogen levels, like breast cancer). Since women have several orders of magnitude more aromatase enzyme than men, it is actually possible to create a whole month’s supply of one of these medications for a man out of a just two tablets. This is done by a competent, compounding pharmacist. Letrazole is the one I prefer, but there are at least two other good medications in this category, and they all work well. Ask your anti-aging specialist about this exciting option for regulating estrogen.
As I said earlier, I have not yet found a single patient whose testosterone could not be moved into the optimal range without using a testosterone supplement. While it may sound surprising, it is a fact. Managing testosterone and estrogen levels in men is quite simple, really. By combining a testosterone “precursor” – in this case DHEA in just the right dose -- and a prescription aromatase inhibitor, such as letrazole (trade name Femara), in a single capsule, it is possible to accomplish both testosterone boosting and estrogen limiting in a single, once-daily capsule. Any compounding pharmacist can make this up for you on the orders of your anti-aging specialist. Over the past 12 years, I have not had a single male patient fail to reach the twin goals of testosterone enhancement and estrogen control. In fact, the DHEA dose must be individualized; too much DHEA can easily lead to testosterone levels well over 1200, when combined with the Letrazole! A good starting dose is 50mg of DHEA and 50mcg of Letrazole. This formula has been a great boon to men who were frustrated with the gels and shots.
Why is this a better way of managing sex hormone levels in men than simple testosterone supplementation? First, there are no shots, and no messy gels or creams. Second, the body gets to make it’s own testosterone in little bursts, every 10 minutes or so, the way it likes to, rather than the huge slug every two weeks with the shots, or the daily slug with the creams. Third, unlike oral testosterone supplements, there is no worry about liver toxicity. Finally, it usually ends up being a lot cheaper than the expensive, brand name testosterone supplements, and is about the same cost as the generic, compounded creams. If you do, for whatever reason insist on direct testosterone supplementation, by all means have your doctor prescribe an aromatase inhibitor along with the testosterone, and have them track both testosterone and estrogen levels on at least an annual basis, after getting a baseline level before starting therapy.
What are the benefits a man can expect from well-regulated sex hormone levels? The list pretty much mirrors the list of chronic dissatisfactions that most men over 50 list when asked to discuss their bodies; improved memory, stamina, muscle mass, exercise tolerance, body mass index, body fat content, glucose tolerance, and of course, improved libido, erections and sexual performance. Beyond all that, by taking control of your hormone levels, you begin taking control of your biological age, and stacking the odds in favor of a long, healthy life, free of the all-too-common diseases of our time.
