The Low-T Epidemic: Hormone Receptors Revealed
Male infertility. Decreased sperm count. Did I grab your attention? These are just two of the symptoms of Testosterone Deficiency (TD), more commonly referred to as Low-T.
TD has become such a widespread problem that one study (The 20-Year Public Health Impact and Direct Cost of Testosterone Deficiency in U.S. Men) projects over the next 20 years TD will:
- Be involved in the development of approximately 1.3 million new cases of cardiovascular disease;
- Be involved in the development of 1.1 million new cases of diabetes mellitus;
- Be involved in the development of over 600,000 osteoporosis-related fractures; *create medical-related costs, in the first year, of approximately $8.4 billion;
- And be directly responsible for approximately $190–$525 billion in inflation-adjusted U.S. health care expenditures over the 20-year period.
So if TD is causing such widespread health issues, how will we solve the Low-T problem? As I mentioned in my last post, there are four components necessary for wellness, good physiologic function, and symptom-free living. Let’s take a look at the fourth on the list.
Hormone receptors must appropriately respond to the signal sent by the hormone to your body. To take a closer look at the Low-T problem, let’s look at androgen receptors.
What is a hormone receptor? Hormone receptors are the landing place for hormones inside your cells. Once a receptor receives the hormone and its message, the receptor undergoes a change sending a signal to the cell nucleus and DNA. [Side note: This is one reason that hormone testing via saliva (not just blood) is such an effective way to evaluate hormones in the body. Saliva testing allows a look at hormones at the sight of action, revealing the free, bioactive hormone inside the cell.]
What is an androgen receptor? Androgen receptors play catch to the two most potent androgens, Testosterone and dihydrotestosterone (DHT) which actually compete for the same receptor. These two hormones are present in both males and females but are typically known as male hormones. Both Testosterone and DHT are very important in development, but here’s an unexpected fact – the androgen receptor actually likes DHT better than Testosterone. What?
You heard me correctly. The androgen receptor has an affinity for DHT over Testosterone. So why in the world are we prescribing so much Testosterone to cure the Low-T problem if it’s not the best solution? Here are some DHT facts.
- DHT inhibits estrogen production. Remember estrogen is a major culprit in inflammation, obesity, weight gain, and hormone imbalance.
- DHT is a more potent androgen than Testosterone. DHT is the most potent androgen exceeding that of Testosterone by a ratio of 3:1. Its increased potency is through its greater affinity for the androgen receptor. And that greater affinity is by a ratio of 3:1.
- DHT does not get converted to estrogens. This is a major problem with simply prescribing Testosterone to men…the body is converting much of it to estrogen.
- DHT binds with a higher affinity and longer duration (5 x longer) to the androgen receptor. Testosterone compensates for this by increasing it’s concentration relative to DHT. Only about 5% of testosterone is converted to DHT. So, a smaller amount of androgen (DHT) has a larger signaling effect due to it’s higher affinity and binding time with the receptor.
New Perspectives On Hormone Balance Ahead
Perspective. It affects everything. Take, for example, the beauty of the earth. Some might look at the magnificence of the earth and think of Darwinian theory. But as I stand in my back yard, I am amazed by God’s creation. When I look out of the window on my many plane flights, I am amazed by God’s creation. And when I see the perspective from space as seen by astronauts, I am still amazed at God’s creation.
Perspective colors the way we see everything around us. For those, like myself, who believe in the God of creation, I view the world a certain way. And for those who choose to believe otherwise, they view the world a certain way.
Perspective is an important part of the medical world as well. As technology improves, the amount of information available to me as a physician changes the way I treat my patients because I now have more data than I’ve had in the past helping me make a better decision.
So, let’s talk about how perspective is an important part of evaluating hormones! (And you thought the only important perspective about hot flashes was “where’s the air conditioner”!)
If men were only about testosterone and women were only about estrogen, life would be easy and all would be symptom free. Unfortunately, that is, in a nutshell, the current perspective on treatment of hormone imbalance issues. It is not, however, an accurate perspective based on physiology. Just watch an hour of TV in the evening. The pharmaceutical companies are inundating us with ads about testosterone creams and the like. Regardless of clever marketing, looking at the reality of physiology based on the latest testing methods reveals that hormones are a lot more complicated than treating the level of just one hormone.
When it comes to hormones, there are four important components necessary for physiologic function and symptom-free living.
- Hormone levels need to be in the “normal” range. We don’t need the respective hormone levels too high or too low.
- Hormones need to be balanced. This is where many in the medical field get it wrong since all hormones work together to communicate to the body.
- Your body needs to effectively use the hormones present. Hormone metabolism is a key element in evaluating hormones in the body.
- Hormone receptors must appropriately respond to the signal sent by the hormone to your body.
The past (and current) perspective of the medical community is that the absolute levels of individual hormones are what is important and little attention is given to balance between hormones. Very little attention is given to the balance between hormones. For example, women, post-hysterectomy, are prescribed estrogen only. But we know that prior to the hysterectomy, all hormones are needed for a normal, functioning cycle, not just estrogen alone.
Some of the risks associated with estrogen therapy pertains to how the individual metabolizes or detoxifies the estrogen. Hormone metabolism can be affected by internal factors like genetic variations, or SNPs (single nucleotide polymorphisms), located in the detoxification pathways. These are small genetic coding errors. Hormone metabolism can also be affected by external factors such as magnesium and zinc, co-factors in those same internal detoxification pathways of hormone production and metabolism. Just the presence of the detoxification pathways does not a functional detoxification pathway make.
Finally, and the purpose of this post, are the receptors. Hormone receptors determine how the hormone’s signal to the body is then interpreted. Here’s an analogy to help you understand hormone receptors. I have four beautiful children. As with any parent, getting them to clean their room is an ongoing battle. The signal I give them is a verbal instruction such as “Kids, it’s time to get your rooms cleaned.” How that signal is interpreted is quite different. That signal may be interpreted differently based on the environment or pre-existing conditions. If my children are in one of their “moods” (side note: all four of my kids are redheads), then they may just not clean their rooms out of defiance. There is a reason we call the youngest one “the spicy tomato.”
All this to illustrate one important fact — how the signal is interpreted is just as important as the signal that is to be interpreted.
Scientifically speaking, hormone receptors are defined as “a large family of ligand-activated nuclear transcription regulators, which are characterized by organization into different functional domains and are conserved, to differing degrees, between species and family members.”
Was that as clear as mud? In plain English, hormone receptors are how the external signal, hormones, provide to the internal genome a message to turn genes on or off. There is also non-genomic signaling, but a large portion of signaling is actually done with your DNA. This is what hormones do — interact and turn on and off the expression of your DNA. Pretty amazing, huh? And you just thought hormones floated through your blood causing hot flashes in women or ED in men. That is the way most, including physicians, see hormones. However, that just couldn’t be more further from the truth. There’s so much more to it than that.
Hormone receptors are being used in the medical vocabulary today. If you know someone with breast cancer, you might be familiar with the term ER/PR positive or negative. This is in reference to estrogen receptors and progesterone receptors. This evaluation occurs from an actual tissue sample from the tumor itself and allows the medical team to determine the best course of action for that particular individual. In ER/ PR positive tumors, hormone therapy is used in contrast with ER/PR negative tumors where no hormone therapy is used.
The medical community is addressing the realities of hormone receptors and the role they play in disease. But what about those individuals with hormone imbalance symptoms like hot flashes or erectile dysfunction? Stay tuned. This testing hasn’t made it to the clinical setting yet, but animal testing holds great promise in helping to complete the full picture and improve the perspective that we have on hormones and all their related issues and factors.
Hormone receptors are my current area of research, and I’m writing articles on estrogen, progesterone, and androgen (male hormones) receptors as part of that research. Visit the Seasons Wellness Clinic blog often in the upcoming months so that YOU can become more educated on the body’s communication system — hormone and their receptors.
Navigate Your Health Journey With Good Reading
Because Tennessee ranks 39th in overall health of its citizens [according to America’s Health Rankings], we are passionate about educating the community on how to improve their health. I spend time daily reviewing the latest findings from scientific studies related to health and wellness topics to insure that Seasons is always offering the latest and best solutions for pursuing wellness.
Contrary to the belief of many, good health is not something that can be mandated from government or given to you by a physician. Health is a personal journey acheived only through education and self-awareness. At Seasons, our goal is to provide you with the resources you need to improve the health of you and your family.
Here are five books that are easy reads and are rich in good information for your health journey.
Inflammation Nation by Floyd H. Chilton, PhD
Inflammation Nation was written by Dr. Floyd H. Chilton in 2005. While the book goes back a few years, it is still incredibly relevant. Inflammation is one of the primary problems/obstacles to health today. Inflammation, in the short term, is a necessary part of the healing process. When you are cut, the “inflammation” present through redness, pain, and swelling works to protect the body from invasion and to start the process of healing. But the inflammation subsides quickly. However, in some, inflammation rages on and promotes disease.
It would make sense that if something, certain types of food for example, were causing inflammation in our body and ultimately leading to disease, we would want to eliminate the problem, reduce the inflammation and prevent disease, right? Dr. Chilton discusses the immune system and how our diet affects it. The old adage “you are what you eat” definitely applies here.
Inflammation Nation is an easy read and provides many easy recommendations to incorporate into your daily life.
The Wheat Belly by William Davis
The Wheat Belly is written by William Davis. Very rarely do I encounter clients that have not read or heard of this book. This book touches on a growing problem in America and the world today – an adulterated food supply. Not food supply that is adulterated with parasites or bacteria, but that is adulterated from within. What does that mean? In The Wheat Belly, Dr. Davis touches on the fact that the wheat of today is not the wheat our parents ate. Not only is the nutritional value present in wheat lost, but the genetic modification is likely contributing to inflammatory problems.
The problem with genetically modified foods (GMO) is we have limited knowledge of their impact on the body. And the federal government and its agencies have never done a good job of investigating these items before rushing them to market. Just look at the history of environmental toxins such as phthalates, parabenes, and other volatile solvents, all brought to market labeled as safe only to be removed from the market when revealed as seriously dangerous toxins.
This book is also a very easy read and provides easy dietary recommendations to immediately bring positive changes to your health.
What Your Doctor May Not Tell You About Breast Cancer by John R. Lee, M.D., David Zava, Ph.D., and Virginia Hopkins
This was the very first integrative medicine book I read in 2006. This book goes back to several founding people in the integrative medicine movement like Dr. John Lee, an oncologist who led the movement in bioidentical hormones and saliva testing. Dr. Lee was ostracized by the medical community, but his commitment to his patients and to true scientific evidence is an example for all to follow. In fact, Dr. Zava believed in this movement so much that he started a saliva-testing company.
As it relates to breast cancer, there are few more published than Dr. Lee and Dr. Zava. I have met Dr. Zava personally on several occasions, and there are few that I would put above his in both scientific integrity and commitment to true science.
This book lays out a different approach to breast cancer, one focusing on prevention instead of early detection. Traditional medicine focuses instead on early detection and cancer treatment. Don’t get me wrong. We need that, but true prevention is where we should first focus.
The book is deep at points, but is a good discussion of biochemistry and physiology as it relates to breast cancer. Its focus on more natural ways to prevent breast cancer is based on the scientific research. The book clears up much of the misinformation about hormones and breast cancer and equips the reader to be advocate in the prevention of breast cancer.
The book’s authors were unafraid to take on traditional medicine, but do so with a good foundation of science.
The Blood Sugar Solution by Dr. Mark Hyman
Dr. Hyman is a great proponent of wellness and a pillar in the integrative medicine community. This book, published earlier this year, is an easy weekend read with numerous tools to incorporate into everyday life. The focus of this book is nutrition, sugar, in particular.
Obesity is at epidemic levels in the United States. According to CDC data, 13 states now have an obesity rate greater than 30 percent, while in the year 2000, NO states reported obesity rates greater than 30 percent. This book takes the major culprit head-on: diet.
The Blood Sugar Solution delves into diet, insulin, insulin resistance, and a host of other factors contribute to poor health. The book provides many tools to succeed in the “battle of the bulge,” and even includes recipes to help you succeed in your personal health journey.
What Your Doctor May NOT Tell You About Hypertension by Dr. Mark Houston
If you ever have the chance to meet Dr. Mark Houston, you will surely be impressed. Mark Houston, M.D., is Associate Clinical Professor of Medicine at Vanderbilt University School of Medicine, Director of the Hypertension Institute and Vascular Biology, and Medical Director of the Division of Human Nutrition at Saint Thomas Medical Group, Saint Thomas Hospital in Nashville, Tennessee.
While his list of credentials are a mouth full, to hear him speak will fill your ear! As a cardiologist focused on an integrative approach, there are few that speak so eloquently on the deep biochemical disease found in cardiovascular disease.
While the subject matter might sound intimidating, this book, is a very easy read and focuses on the underlying dynamics of hypertension and associated complications. Dr. Houston defines the problem and lays out solutions with his wildly successful program for treatment of hypertension using an integrative medicine approach.
Dr. Houston also provides a health discussion of hypertension medications, when needed, and the mode of action and side effects of each. This a definite must-read for anyone on hypertension medications. You might just become more informed than your own physician!
While this book is a self-help guide to natural treatments of hypertension, it is based on sound science and the approach has been extremely successful. This book is also heavily referenced, allowing you the option of pursuing deeper learning if desired. This book removes every obstacle to reducing hypertension except you. It’s your job to act on what you read.
The Naturally Healthy Woman: Whole Health for the Whole Woman by Shonda Parker
Yes, I know I said five and this is number six! But this is a very good manual for women and their health. As an OB/Gyn, my first passion was women’s health. The author, Shonda Parker, whom I have met, is a true blessing to know. There are few who have a passion for health that exceeds hers, and she has an ever better spirit. Shonda is a nurse midwife, has authored many books, and speaks nationally on health and other related topics. This book highlights many of the health issues facing women today, and I predict that the edges of this book will become tethered due to your repetitive use after reading it.
As a nurse midwife, the author’s first passion is pregnancy. This book begins by touching and then builds into many other health issues affecting women. The author provides many natural remedies at the end of each section for the different health issues discussed. The book not only provides natural therapies for the mother/wife, but also for the rest of the household.
Every pathway to health is different. Every journey to wellness is unique. At Seasons, our desire for wellness for all begins with education and knowledge for you. I hope that these books will become additions to your library and provide you with the knowledge you need in your personal journey toward wellness.
Evaluating Hormones Requires More Than Just a Blood Test
Dr. Nathan Goodyear
“I just don’t feel right.” These are frequently the first words I hear a patient say. “I’m so hormonal…I know I’m not balanced. I’m tired, cranky….” and so goes the list of symptoms, all of which indicate hormone imbalance.
It’s amazing to me that most patients know intuitively that they don’t feel good and it has something to do with hormones, but they’ve had a blood test by their physician and everything checked out “okay.” That blood test, however, didn’t change the fact that they still feel terrible.
There is a lot of debate these days regarding the different methods of evaluating hormones: blood, saliva, and urine (oh my). In a few short weeks, school will start. So to get back in the swing of things, today school is “in session” and a science lesson is the order of the day. The topic? How are hormones evaluated and which is the best test for you?
Hormone Delivery and FedEx?
Understanding complicated topics is often made simple with a great analogy. My good friend, Dr. Eldred Taylor, uses the analogy of FedEx trucks to explain hormones and their delivery to the cells of the body. And I especially like this analogy because my dad has been a pilot for FedEx for many years!
FedEx trucks are everywhere during the month of December. It wouldn’t be unusual for a lot of trucks to pass your house during that month. But, if the FedEx trucks don’t stop at your house, it doesn’t really matter how many trucks have driven by your house or how many packages each truck contained. The fact remains that none stopped for delivery. It only takes one FedEx truck to stop at your house and the Christmas tree is full.
I’ll take it one step further. The day after Christmas, the boxes and wrapping paper are piled up at the road-side for pickup. You might comment as you drive by your neighbor’s house “It looks like the Jones’ had a good Christmas” based on the curbside aftermath. You can even make out what the gifts were based on the leftover boxes and debris on the curb.
What does it all mean? The FedEx trucks symbolize hormones in transport in the blood. It doesn’t matter how many hormones are transported through the blood (FedEx trucks), they are inactive (the truck didn’t stop at your house). When the FedEx truck stops at your house, it symbolizes when hormones are dropped off for action inside the cell. One truck can drop off 100 packages or 100 trucks can drive by, dropping off no packages. Finally, the post-Christmas driveway debris represents the hormones after the body has broken them down into metabolites.
Hormones can be evaluated through three different testing methods: blood, saliva and urine. Blood testing evaluates the number of FedEx trucks in your neighborhood. Saliva testing evaluates the number of packages delivered at your house. And urine testing evaluates the post-Christmas driveway debris to identify what packages were delivered and opened.
So what does the science say about the hormone testing methods of blood, saliva, and urine?
Blood Testing
Testing hormones present in the blood has been used to develop the current reference norms that we use in the diagnosis and management of many diseases. It has been around a long time. This kind of testing is effective in the disease model of medicine. However, in the wellness model of medicine, we are looking for dysfunction, not just disease. And this is where the effectiveness of blood testing breaks down. By identifying physiologic dysfunction, we hope to prevent disease. It is the move into true preventative medicine, not just early detection, the wellness model of medicine has found the blood testing of hormones to be lacking.
There are three main problems with blood hormone testing.
- First, is the whole idea of a needle. If we can evaluate hormone levels without puncturing the skin, then we should.
- Blood testing evaluates hormones in transport. This is typically reported as “total” hormone levels and the “free” active levels are calculated. Transported hormones are inactive. Hormones in the blood are bound to proteins (estimated at 95-99%) and inactive. Going back to the FedEx truck analogy, blood testing tells me how many FedEx trucks there are and how many packages they have to deliver. But it doesn’t tell me how many packages were delivered at your house. And that’s a very important piece of information. Are your hormones coming or going? And is your body utilizing the hormones you have?
- It is not the most accurate form of testing. Saliva testing is proving to be superior to blood testing for measuring hormones (see Saliva below).
Urine Testing
The use of urine to evaluate cortisol has been present for awhile. And this is a valid method to test cortisol, one of your body’s hormones. The problem with this form of testing is that most people don’t want to carry a jug around collecting urine for 24 hours.
Currently, the interesting research on urinary testing of hormones is in the measurement of metabolites. Think back to our analogy. Urinary testing is best used for looking at the curbside debris to see what presents were opened at Christmas. By measuring metabolites, we can see how effectively your body is metabolizing hormones. If your body is ineffectively metabolizing hormones, the resulting symptoms and conditions can include Chronic Fatigue Syndrome, obesity, fatigue, and increased breast cancer and prostate cancer risk to name a few. These issues are all treatable at Seasons Wellness Clinic with a customized wellness plan based on your test results.
Saliva Testing
Saliva testing for hormones first appeared in the medical research literature in the early 1980′s. Saliva is becoming the testing method of choice for many different reasons. Going back to our analogy, saliva testing measures the number of packages that are delivered by the FedEx truck at your house.
- Saliva testing evaluates the “free” (active) hormone levels. A hormone has to be unbound to elicit a physiologic action. Saliva testing looks at the active hormone inside the cell, at the site of action. Saliva testing has been validated as a testing method for measuring the hormones cortisol, estradiol, progesterone, DHEA, and testosterone to name a few.
- Second, saliva testing requires no needles.
- Saliva testing has been shown to be well validated and superior than blood, with sensitivities and specificities exceeding 100% and 97.4% respectively. Other than perfection, you can’t get much better than that.
- According to the National Institute for Health, saliva testing is useful in “detecting various cancers, heart disease, diabetes, periodontal disease…”
- Saliva testing is also useful in disease evaluation. Saliva testing of cortisol has been recommended as the first-line test for Cushing’s syndrome due to “high diagnostic accuracy.”
Saliva testing gives me the information I need to diagnose what’s going in your body. And while that is my opinion based on my training, it’s also opinion based on scientific fact according to hundreds of research articles (see links to additional articles below). Saliva testing is now considered the “gold standard” for hormone evaluation.
Today you have learned about the three methods physicians use for evaluating hormones: blood, saliva and urine. You’ve also learned that each test is useful for measuring different things. We can evaluate hormones many different ways at Seasons and determine not only the amounts of a specific hormone in your body, but also how effectively your body is actually using (or not using) those hormones with saliva and urinary testing.
Most important is the clinical relevance of each test. Testing the hormones at the site of action provides the best physiologic approach (saliva testing). Testing the hormone metabolites provides the next best approach (urine testing). Through the evaluation of the body’s metabolism of hormones, the physiologic mechanisms of how the body removes hormones can be evaluated. The evaluation of hormones in transit (blood testing) provides the least physiologic assessment.
While each test provides an appropriate measure, the question is, does that measure provide insight into physiologic dysfunction? And, can an appropriate therapeutic intervention be undertaken to effect a change? At Seasons, we provide answers using those test results, creating a customized wellness plan that will put you on the road to a life with more energy, balance, and, ultimately, happiness.
Cheers to the pursuit of wellness.
Man vs. Estrogen: It’s Not Just A Woman Thing!
Nathan Goodyear, M.D.
Testosterone is the defining hormone of a man. Estrogen is the defining hormone of a woman.
So when we talk about estrogen, it’s that word men whisper in secret when the women in their lives seem a little hormonal, right? When people find out that my wife and I have 3 daughters, the resulting comment is usually, “Wow, that’s a lot of estrogen in your household!” (Thankfully, I have a son, too, who helps balance the estrogen to testosterone ratio at our house!)
I’m sorry to burst your bubble, guys, but estrogen is not exclusive to women. We make estrogen, too. In fact, some of us make a LOT of estrogen. Too much, in fact. And it creates some serious problems.
But before we talk about estrogen, we need to talk about testosterone. Testosterone levels in American men are at an all-time low! There are four major reasons for that: stress, weight, endogenous estrogens, and xenoestrogens. In this post, I’ll address three of those – stress, weight, and endogenous estrogen.
So let’s get started learning four important facts about testosterone, estrogen, and men!
What problems do high estrogen levels create in men?
1. High estrogen = low testosterone. One of the primary causes of low testosterone is a high estrogen level. Estrogens can be endogenous (produced by your body) or exogenous (from the environment, also known as xenoestrogens). Estradiol and Estrone (two of the three kinds of estrogen produced by your body) feed back to the hypothalamus and pituitary and shut off testosterone production.
2. High estrogen = inflammation. Not only do high estrogen levels decrease testosterone in men, they also increase inflammation. And this is VERY significant. Inflammation, just like stress, is a biochemical process.
Inflammation is the natural result of the immune system. Remember the last time you got a paper cut? It was incredibly painful, probably red, warm and swollen, all cardinal symptoms of inflammation. Inflammation, in the right setting, is actually the body protecting itself. However, when the immune system becomes imbalanced or chronically activated, the immune system causes damage through inflammation. For example, chronically activated immune cells in the brain (glial cells) play a pivotal role in the development of Alzheimer’s, Parkinson’s, and Multiple Sclerosis.
Inflammation is a SERIOUS issue. Chronic inflammation has been linked to many of the chronic diseases of aging: Type II Diabetes, obesity, hypertension, and cancer. In fact, a new term has been coined to describe inflammation arising from the gut which results in many of the above listed disease states - metabolic endotoxemia.
We’ve established that high estrogen levels are bad for men, shutting down testosterone production and causing chronic inflammation leading to disease.
What causes high estrogen levels in men?
1. High aromatase activity = high estrogen. First, high endogenous estrogen levels in men come from high aromatase activity. Aromatase is the enzyme that converts androstenedione and testosterone into estrone and estradiol respectively. Aromatase is present in many different tissues. But in men aromatase is highly concentrated in that mid-life bulge.
Unfortunately, aromatase activity in men increases as we age due to stress, weight gain, and inflammation. None of us are going to get away from aging (it’s right there with death and taxes). And who do you know that has NO stress? (Remember, it is estimated that 90% of doctor visits are stress-related.) Typically, as we age we gain weight and have more inflammation.
That “age-related” tire around the mid-section is more than just unsightly. It is a hormone and inflammation-producing organ. Remember metabolic endotoxemia, the disease-producing state I mentioned earlier? Metabolic endotoxemia is inflammation arising from the GI system which causes obesity and then turns right around and produces inflammation. It’s a vicious cycle! And guess what is concentrated in fat? If you guessed aromatase activity, then you are absolutely correct. Aromatase activity in men accounts for 80% of estrogen production.
Hormones are not just about numbers, but balance and metabolism as well (read my recent post on the topic).
2. Overdosage of testosterone = high estrogen. As mentioned earlier, testosterone levels in men are at an all-time low. And the mass solution for this problem with most physicians is to increase testosterone without evaluating or treating the underlying causes for low testosterone. Unfortunately, this complicates the entire low testosterone problem. Overdosage of testosterone increases estrogen production.
What? You mean you can dose too high on testosterone? Yes, and most of the patients I see who are being treated with testosterone have been, in fact, overdosed.
In fact, at Seasons Wellness Clinic and Seasons of Farragut, we have seen many men must donate blood due to excess production of hemoglobin and hematocrit, a by-product of testosterone overdosage. A 20-22 year old male normally produces 5-10 mg daily of testosterone. It is during this age range that men are at their physical peak of testosterone production. For me, this was during my college football years.
Does it make sense for 40-and-up men currently taking testosterone, that they did not need to donate blood monthly during their peak years of natural testosterone production, but are currently required to donate blood regularly with their current regimen of testosterone? Of course not. So, if you didn’t have to donate blood with your peak testosterone production in your 20′s, you shouldn’t have to donate with testosterone therapy in your 40′s and beyond either. Something is wrong here, right?
The starting dosage for one of the most highly-prescribed androgen gels is 1 gram daily. Men, we didn’t need 1 gram of testosterone in our early 20′s, and we don’t need it in our 30′s and beyond.
80% of a man’s testosterone occurs from aromatase activity, and aromatase activity increases as we age. So high doses of testosterone don’t make sense. Doctors are just throwing fuel on the fire with these massive doses. More is not better if it’s too much, even when it is something your body needs.
Then, there is the delivery of testosterone therapy. The body’s natural testosterone secretion follows a normal diurnal rhythm. Testosterone is known to be greatest in early morning and lowest in the evening. But with many prescribing testosterone therapy today, it is very common to get weekly testosterone shots or testosterone pellets. This method of delivery does NOT follow the body’s natural rhythm. The shots and pellets delivery method of testosterone produce supra physiologic (abnormal) peaks. If the purpose of hormone therapy is to return the body to normal levels, then that objective can never be reached with this type of testosterone therapy.
The effects of Testosterone to estrogen conversion in men and women are different. That’s certainly no surprise. In men, high aromatase activity and conversion of testosterone to estrogen has been linked to elevated CRP, fibrinogen, and IL-6.
Are these important? CRP is one of the best indicators of future cardiovascular disease/events (heart attacks and strokes), and is associated with metabolic syndrome. And yes, it is more predictive than even a high cholesterol level. Fibrinogen is another marker of inflammation that has been associated with cardiovascular disease and systemic inflammation. IL-6 is an inflammatory cytokine (immune signal) that has been implicated in increased aromatase activity (conversion of testosterone to estrogen) and at the same time is the result of increased testosterone to estrogen activity.
So, what’s the big deal? The studies are not 100% conclusive, but it is clear that inflammation increases the testosterone to estrogen conversion through increased aromatase activity. And the increased estrogen conversion is associated with increased inflammation in men. It’s a vicious cycle that will lead to disease states such as insulin resistance, hypertension, prostatitis, cardiovascular disease, autoimmune disease, and cancer, to name a few.
You may be thinking, “Is the testosterone I need leading me to disease?”
The answer is, “Yes, it sure can.” If your testosterone therapy includes prescription of supra physiologic levels of testosterone, lack of follow-up on hormone levels, and no effort to balance hormones and metabolism, then yes, it sure can.
Is there a safe and effective way to balance hormones, lower estrogen and increase testosterone for men?
Effectively administering hormone therapy requires the following:
- A physician with extensive training in hormones and body biochemistry.
- The best and most accurate testing possible to determine current hormone levels and to track hormone levels after therapy is administered.
- Hormones that most closely replicate the natural ones produced in your body — bioidentical hormones.
- A therapy plan with the objective of returning your body to normal, not super-charging the body with unnatural levels of testosterone or any other hormone.
At Seasons of Farragut, Nan Sprouse and I are fellowship-trained (or completing fellowship training) specifically in the areas of hormone therapy and wellness-based medicine.
Our patient experience begins with an initial consultation to evaluate symptoms and develop an evaluation plan.
The next step is testing. In the case of hormone imbalance, we evaluate hormones with state-of-the-art hormone testing via saliva, not just blood. As stated in a 2006 article, “plasma levels of estradiol do not necessarily reflect tissue-level activity.” Saliva has been shown to reveal the active hormone inside the cell at the site of action.
After initial testing and a therapy program, hormone levels are re-evaluated to ensure the progression of treatment and necessary changes are made to the treatment program. Testing and follow-up are key to proper balance of hormones (read my recent post). At Seasons of Farragut, our approach to treatment and therapy is fully supported in the scientific research literature, and we’re happy to share that research with you if you’d like to educate yourself.
The way estrogens are metabolized plays an equally pivotol role in hormone risk and effect. At Seasons of Farragut, our system of testing, evaluating, and monitoring is the only way to ensure that testosterone therapy for men is raising the testosterone and DHT levels instead of all being converted to estrogen. Hormone therapy is safe, but for it to work effectively, it must be properly evaluated, dosed, followed, and re-evaluated.
If you have questions or comments, please post them below and I’ll respond as soon as possible. What is your experience with testosterone therapy? How has your physician tested and re-evaluated your therapy program?
For more information about the Seasons approach to wellness or to schedule an appointment, please contact our office at (865) 675-WELL (9355).
From The Doctor’s Desk: Wellness Is Not Band-Aid Medicine
Dr. Nathan Goodyear
So you wake up one day and you have symptoms. You select a doctor, make an appointment, recite your symptom list, receive a diagnosis, get a prescription, take the prescription and hope that the prescription gets rid of the symptoms.
But the question is this: Are you well?
Symptom relief medicine is great, but it is reactive medicine. I call this band-aid medicine. Just throw a band-aid on it in 5-10 minutes and ignore the real underlying cause. You can relieve symptoms with band-aids, but if the cause is left unchecked (usually an imbalance of some sort), then disease will be the result.
I like to use symptoms as clues to finding the cause. I call it proactive medicine. Symptoms are the result of imbalance. Disease is the result of ignoring the symptoms. It is a progressive cycle: imbalance, symptoms, disease.
Balance is the key. As I said above, symptoms are the result of imbalance. Medicine today has lost site of this. In the fast pace of the typical doctor’s office (even mine many years ago), all we have time for is symptom focus and treatment. There is no time for focus on cause.
You don’t have to look to far to see the importance of balance. Look at our bodies. They are all about balance: two eyes, two ears, two legs…you get the picture. This balance is by design. We should not lose sight of the fact that symptoms are the body crying out for help.
Symptoms reveal imbalances, and the imbalances can be quite diverse. They can include hormones: Estrogen/Progesterone, Thyroid/Cortisol, Growth Hormone/Cortisol, just to name a few. But imbalances can involve more than just our hormones. Neurotransmitters can be imbalanced. Have you ever heard of anxiety or depression? Neurotransmitters involve serotinin, glutamic acid, and nor-epinephrine just to name a few. And no, anxiety and/or depression are not the result of a SSRI deficiency.
Even Fats can be imbalanced. Everybody has heard of Omega 3. Omega 3’s are anti-inflammatory, they lower cholesterol and are good for the skin. But have you heard of Omega 6 fats. Omega 6’s are pro-inflammatory. Americans have excessive Omega 6’s in our high processed diets. The typical American diet is 24 to 1 ratio of Omega 6 to Omega 3. A healthy ratio should be 3 to 1.
Symptoms are the body’s way of asking for help. Let’s start listening.
From The Doctor’s Desk: The Moral of the Story? Hormone Balance Key To Reducing Breast Cancer Potential.
Dr. Nathan Goodyear
I have four kids that range in age from four to eleven. One of my favorite things to do is read them a great story. So today, let’s talk about some very important stories and the moral each one presents.
The story about breast cancer potential has more characters than just estrogen and progesterone as we discussed in my last post. There are other hormones that are integral characters in that story also. As you will learn in this post, the moral to the breast cancer story is balance — balance between all the hormones in your body.
The Story On Dehydroepiandrosterone (DHEA) — Say That One Three Times Fast!
DHEA, a testosterone precursor, is a hormone produced by the adrenal glands and plays a part in breast protection. DHEA plays an important role in supporting the immune system. DHEA stimulates the production of good T-helper lymphocytes-1 and their associated good cytokines: interferon, Interleukin-2 and Tumor Necrosis Factor-beta. This is in contrast to the bad T-helper lymphocytes-2 and their bad cytokines. DHEA levels typically decline as we age. The decrease in DHEA levels are inversely correlated with increasing age-related disease. The strength of this correlation is yet to be determined, but the decline in immune system due to low DHEA is clear. So where does that leave DHEA? Individuals with low DHEA levels have more disease, and in this case, more breast cancer. The moral of this story? Low DHEA = a compromised immune system = breast cancer vulnerability.
Melatonin is the hormone that regulates your sleep cycle. It is produced from the pineal gland in the brain. Low melatonin levels have been linked to breast cancer through the additional benefits of melatonin. Melatonin boosts the immune system, decreases estrogen and progesterone production, and acts as an anti-oxidant. Bench studies (non-human studies) have shown significant increase risks of breast cancer with low melatonin levels. Can you guess what happens as we age? Yes, you guessed it. Our melatonin levels fall. Ever talk to a post-menopausal woman? Most women of that age have sleep-related complaints. The moral of this story? Low melatonin = a compromised immune system = breast cancer vulnerability.
The Story on Thyroid — The Energy Hormone.
How about the thyroid hormone? The breast cancer link reaches to all hormones and everything seems to involve the thyroid these days! T4 (or better known as synthroid, levoxy, levothryoixine) is one of the most prescribed medicines today. But T4 is a very weak thyroid hormone. In fact, the body is looking for T3, a result of T4 to T3 conversion. The problem is that many individuals don’t convert T4 to T3 well. (Very often I see patients who have been on synthroid for years without symptomatic improvement even though their “levels” are said to be “good”. I digress. That’s a subject for another post. Let’s get back to the breast cancer link.) Low T4 and T3 levels result in low sex hormone binding globulin levels (SHBG). SHBG is how some hormones are transported. When SHBG levels drop, the free availability of the hormone it transports goes up. In this case, the levels of free estradiol go up. Remember the negative breast implications of estrogen dominance from last weeks post (link)? The moral of this story? Low thyroid = low SHBG = high estradiol = estrogen dominance = breast cancer vulnerability.
The Story On Insulin — The Sugar Storer
Finally, Insulin. Insulin’s primary role is in the storage of glucose. However, due to the large percentage of simple or refined sugars in our diet, insulin resistance has become a major epidemic, and, yes, insulin resistance increases the risk of breast cancer. How, you ask? High simple sugars leads to insulin resistance and PCOS (Polycystic Ovarian Syndrome). As a result, estrogen dominance and excess testosterone are produced which leads to weight gain. Remember that fat cells produce even more estrogen and estrogen stimulates breast cell growth (link). Young women will start their cycles at an earlier age and thus will increase their lifetime exposure to estrogen without appropriate progesterone balance. And to make matters worse, traditional therapy with birth control pills for these young women increases the breast cancer risk even further. The moral of this story? Insulin resistance = estrogen dominance = breast cancer vulnerability.
Change The Ending Of The Story.
Just because any of these hormone deficiencies might produce in you symptoms which you recognize in this post doesn’t mean that you are going to have breast cancer. However, the sooner you seek hormone balance, the quicker you are going to lower your breast cancer vulnerability/potential. As you can see, the hormonal symphony is what is important. Balance! When your hormones are balanced, the result is a symphony, and in turn, your body is in tune and makes beautiful music. But when your hormones are not balanced, then…well, you know the ending of that story.
