Andropause, Erectile Dysfunction, Premature Ejaculation, Prostate Health

Andropause - A Testosterone Deficiency

Healthy young men produce on average 7mg of testosterone every day. Normal male aging is accompanied by a decline in testicular function resulting with a fall in testosterone production and thus a decline in free testosterone levels which may also be accompanied with a rise in estrogen levels also. Around the age of 40 the level of free testosterone begins to decline about 1% a year. Age related decreasing levels of free testosterone and/or increasing estrogen levels may cause a deficiency known as Andropause or “male menopause”.

Symptoms of Testsosterone Deficiency or Andropause include: decreased libido, erectile dysfunction, ejaculatory problems, decreased energy and strength, increase in body fat, loss of muscle mass, prostate enlargement, osteoporosis, depression, inability to concentrate, reduced mental agility and loss of enthusiasm.

Men with low testosterone levels also tend to have these heart disease risk factors: angina, atherosclerosis, diabetes, high blood glucose, high cholesterol, high triglycerides, high blood pressure, high level of blood clotting factors, low blood clotting inhibitors and a high body mass index.

The reasons why free testosterone levels decline with age include:

• A protein called SHBG (Sex hormone binding globulin) rises as we age and more testosterone is bound up to it, reducing the amount of free and available testosterone.

• More testosterone may be converted into estradiol (an estrogen) by an enzyme called aromatase which susequently may then be converted into another estrogen called estrone. Estrone is the strongest of all estrogens and tends to accumulate in the body. Increasing estrogen levels negatively feeds back onto the brain slowing down further testosterone production.
  

• More testosterone may be converted into dihydrotestosterone (DHT) by an enzyme called 5 alpha reductase.

• Less  testosterone is made by the aging testicles.
  

Unfortunately for many men traditional orthodox medicine ignores the importance of testosterone in men's health. There are thousands of men in this country alone that have been treated for this deficiency and experienced a significant improvement in all their symptoms which will all testify to the importance of this hormone.

Testosterone deficiencies do not only occur in aging men and are occasionally seen in younger men also. This may be due to a variety of reasons including:

• Adrenal exhaustion results with a decrease in DHEA production which in turn reduces testosterone production.
• Xenoestrogens - exposure to estrogen like pollutants in the environment such as certain pesticides (DDT, DDE), petrolum based chemicals (PCB's, benzene), plastics (PVC), metals (cadmium, arsenic) and hormones from food sources may all cause a negative feedback in the brain which in turn reduces testosterone production.

There is no need for men to suffer through these symptoms as Individualised Bioidentical Hormone Replacement Therapy (IBHRT) is able to effectively treat many of these symptoms. 

What are bioidentical hormones?

In contrast to traditional synthetic hormones bioidentical hormones have a molecular structure which is an exact match of the hormones found in the human body, hence we call them bioidentical. Because bioidentical hormones are structurally identical to the hormones our bodies produce they are more consistent with our bodies biochemistry.

Bioidentical hormones such as testosterone, DHEA and cortisol are all synthesized from a hormone precursor extracted from either soy beans or wild yam called diosgenin. Diosgenin has a molecular structure very similar to all these closely related hormones. Once the diosgenin has been extracted from the soy beans and purified its molecular structure is then modified in order to convert it into the appropriate hormone. Once the appropriate hormone has been made it is purified to a pharmaceutical grade purity and then micronized to maximise absorption. Although these hormones are synthesized it should not be mistaken that they are synthetic. Synthetic refers that the molecule does not exist naturally but has been designed and made by man to produce a totally new molecule that never existed before in nature.

The approach taken in IBHRT is to use a combination of appropriate bioidentical hormones in individualised doses in order to restore optimal physiological levels of each hormone thus ensuring an appropriate balance of hormones occur. The doses used should ideally be based on hormone test results to ensure physiological levels are obtained in conjunction with signs and symptoms. We only ever recommend low physiological doses as opposed to high pharmacological dosing which are unnecessary and potentially dangerous. Ongoing monitoring while on any hormones is also essential in order to ensure the doses you are taking maintain ongoing optimal physiological levels.

How are bioidentical hormones administered?

(1) Transdermal Gels provide the most physiologic route of administration providing continual and steady release of testosterone so is therefore the preferred method. It is safe, effective and easy to adjust the dose. The hormone is absorbed directly into the bloodstream bypassing the stomach and liver. This allows lower doses to be administered thus placing less stress on the liver and decreasing the chance of side effects. Once absorbed the hormones are stored in body fat under the skin which release the hormones into the blood stream over time thus maintaining steady levels in the blood. Commercially available gels are available but only provide a 10% absorption rate. The liposomal gel base used in our laboratory increases the absorption of testosterone when compared to commercially available gels. In addition they are made more concentrated so less gel is applied to the skin providing the same dose which is more patient friendly. 

Concerns have occasionally risen that topical administration will result with a disproportionately high conversion into estradiol but studies and clinical experience show this is not the case. 

(2)Troches/Lozenges - are held between the cheek and gum and allowed to dissolve. The hormones are claimed to be absorbed directly into the blood vessels that line the buccal area thus avoiding the stomach and liver. However estimates indicate that approximately 50% to 70% of the lozenge is swallowed which inevitably encounters the stomach and liver. Clinical experience shows that doses required for troches are higher than that of transdermals. In addition eratic blood levels result with elevated levels for a short period of time shortly after the dose followed by rapidly declining levels after 4 hours or so which suggests three times a day dosing is required to maintain useful levels throughout the day. Troches are generally only considered useful as an extra boost for those already on transdermals to enhance sexual function.

For more accurate information regarding troches please refer to the article The Truth about Troches.

(3) Injections - involves the use of synthetic derivatives of testosterone. A big drawback has always been erratic release of these injections which are suposed to be administered every 2 to 3 weeks but often have their major effect in the first 7 to 9 days followed by subsequent low levels until the next injection. The rapid release of large doses encourages the conversion into estradiol, via the aromatase enzyme, thus being responsible for the majority of side effects. This method is generally not recommended unless weekly low dose injections are used which are expensive and inconvenient.

What are the risks of Bioidentical Hormones?

Much of the hesitation to use bioidentical testosterone arises from the fear of side effects associated with its synthetic derivatives. Synthetics are known to cause liver damage, promote blood clotting, increase edema and blood pressure, increase cholesterol levels and reduce HDL levels. Bioidentical testosterone on the other hand has been shown to produce the oppersite effects on the cardiovascular system often improving many of these factors.

A major concern for many men is the possibility that supplemented testosterone may  cause prostate enlargement and cancer. There is no evidence or clinical data to suggest supplemented testosterone causes prostate cancer. According to a recent study the author of this study, Abraham Morgentaler, a urologist at Beth Israel Deaconess Medical Center and associate clinical professor at Harvard Medical School said, "We reviewed decades of research and found no compelling evidence that testosterone replacement therapy increases the incidence of prostate cancer or cardiovascular disease.” (Morgentaler, A, “Testosterone and prostate cancer: an historical perspective on a modern myth,” Eur Urol, 2006 Nov;50(5):935-9.).

In addition, Dr. Rhoden, in the January 2004 issue of the New England Journal of Medicine, reviewed 72 medical studies and found no evidence that testosterone therapy causes prostate cancer. (1)   In fact, they note that prostate cancer becomes more prevalent exactly at the time of a man's life when testosterone levels decline.

Dr. Perchersky published a study in the International Journal of Andrology (2002), which examined men with low testosterone levels (2). He looked at multiple parameters, including prostate volume, PSA, and lower urinary tract symptoms like frequency and urgency. Of the 207 men studied, 187 responded favorably to testosterone treatment. These 187 all showed improvement in every parameter measured: Their prostate glands all decreased in size, their PSA numbers went lower, and frequency, urgency, dribbling, and getting up at night all improved. This study indicates that, far from causing prostate trouble, testosterone is actually beneficial for the prostate gland in the vast majority of cases.

A recent study by Leonard Marks, MD in JAMA again shows safety of testosterone therapy.  "No treatment-related change was observed in prostate histology, tissue biomarkers, gene expression, or cancer incidence or severity. Treatment-related changes in prostate volume, serum prostate-specific antigen, voiding symptoms, and urinary flow were slight." (2A)(2B)

In addition the first study to examine the safety and efficacy of testosterone gel for up to 42 months, was conducted at multiple research centers in the U.S under the direction of investigators at the Research and Education Institute (REI) at Harbor-UCLA Medical Center and was published in 2004 in the May issue of the Journal of Clinical Endocrinology & Metabolism. This AndroGel study is the first to show long-term benefits and safety with testosterone gel - that's great news for men suffering from low testosterone," said Ronald Swerdloff, MD, REI Investigator in the Division of Endocrinology, Metabolism & Nutrition. This study shows 3+ years of continued benefits and provides new information on the degree of safety for men treated with testosterone. Nevertheless, doctors must monitor their patients throughout therapy."

Why isn't testosterone therapy accepted by my doctor and the conventional medical system? 

• Synthetic Testosterone of the 1940s - A major reason is the debacle in the 1940s and 1950s, when pharmaceutical companies sold a synthetic testosterone derivative called methyltestosterone. After a few years of taking this synthetic form men developed liver cancer and heart disease. The experts proclaimed that testosterone therapy was dangerous, so testosterone research ceased until the late 1980s with the use of safer, bio-identical testosterone.
• Bad Reputation from Abuse in Sports
• Orthodox Medicine is Opposed to the Idea -The official stance of the medical community erroniously delares that "existing scientific evidence does not justify claims that testosterone treatments can relieve or prevent certain age-related problems in men."  There are literally dozens of studies in the medical literature showing health benefits and safety of testosterone therapy.
  

How to get started?

Ask your doctor to organise the appropriate hormone tests. If they are unaware of bioidentical hormones but are open to learn how to prescribe them they can contact us directly for a physicians information pack.

If your doctor refuses to co-operate you can contact us for a phone consultation where we can arrange the hormone testing and make recommendations based on your history, symptoms and test results. We will then put you into contact with a sympathetic doctor if you require any scripts for bioidentical hormones.

Want More Information?

For practitioner advice on how to optimize bioidentical hormone treatment, monitor hormone levels and for specific hormone information you will be required to log into the restricted members area of this site which is free of charge. Click on either Existing members or Set up a new account to enter restricted area. 

For information about Chrysin and its roll in balancing hormones you will need to log into the members section of this website.

References

(1) Rhoden, E.L,  Risks of Testosterone-Replacement Therapy and Recommendations for Monitoring Ernani Luis Rhoden, M.D., and Abraham Morgentaler, M.D. NEJM Volume 350:482-492 Jan 29, 2004.

(2) Perchersky AV et al. "Androgen administration in middle-aged and aging men: effects of oral testosterone undecanoate on di-hydrotestosterone, oestradiol, and prostate volume." International J Androl 2002; 25(2): 119

(2A) Marks, Leonard S., Effect of Testosterone Replacement Therapy on Prostate Tissue in Men With Late-Onset Hypogonadism A Randomized Controlled Trial. , MD  JAMA. 2006;296:2351-2361.

(2B) Press Release for JAMA , Leonard Marks MD article

Links

Dr Crisler - expert in low dose testosterone replacement for men.

Erectile Dysfunction or Male Impotence

Erectile Dysfunction (ED) or male impotence is the inability to attain or sustain an erection satisfactory for sexual intercourse. Surveys show at least 30% of men over the age of 50 have ED although it is not inevitable with age. ED may be caused by several factors:

• Psycological factors such as fear of intimacy, depression, low self esteem and stress. Psychic factors are implicated if the patient has situational ED, has morning erections, or can achieve a firm erection with masturbation. This type of ED can usually be treated by receiving some form of counseling.
• Disease factors such as metabolic syndrome, diabetes, high cholesterol, heart disease, vascular disease, neurological damage, following certain surgical procedures and the use of certain drugs such as antidepressants, tranquillisers, amphetamines, antihypertensives, opioids, alcohol and tobacco.
• Hormonal factors such as low testosterone levels, high estrogen levels, high prolactin and thyroid disease.
• Pyronies Disease - curvature of the penis reducing circulation.

Age related ED is just one symptom of a larger syndrome known as andropause or male menopause. This syndrome is caused by decreasing levels of free circulating testosterone and/or increasing estrogen levels. Symptoms include: decreased libido, erectile dysfunction, ejaculatory problems, decreased energy and strength, increase in body fat, loss of muscle mass, prostate enlargement, osteoporosis, depression, inability to concentrate, reduced mental agility and loss of enthusiasm.

Testosterone plays a fundamental roll in producing erections, but it is not the whole story. An adequate penile blood supply, neural control, and the presence of two erection building chemicals (nitric oxide and cyclic GMP) are also essential. Boosting testosterone levels can restore libido (sex drive) in men whose testosterone output is deficient. It can also restore their ability to achieve and sustain an erection.

Diagnosis

A general medical evaluation should include a history of drug use, examination of the genitalia, and a search for vascular or hormonal dysfunction.

Laboratory tests requested should include: free testosterone, estradiol, luteinizing hormone (LH) and follicle stimulating hormone (FSH), cholesterol, glucose tolerance and prolactin (taken at 9 am to avoid diurnal variations).

Treatments for ED include:

(1) Treat any underlying problem such as diabetes, cardiovascular disease or hormonal deficiencies.

If there are no underlying problems found or you still suffer from ED symptoms despite treating them then you are left with treating the symptoms. Our laboratory produces a range of treatments which include:

(2) Penile injections - we supply a range injections containing various combinations and concentrations of medications in order to treat anything from very mild to severely resistant cases. 

(3) Lozenges  - we supply a number of drug combinations in lozenge form to provide a faster onset of action and less side effects as lower doses are required when compared to oral dose forms.

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For practitioner advice on how to treat this condition you will be required to log into the restricted members area of this site which is free of charge. Click on either Existing members or Set up a new account to enter restricted area. Alternatively contact us for details.

Premature Ejaculation

Premature ejaculation occurs when men ejaculate too early. There's no medical standard for how long it should take for a man to ejaculate however it occurs before both partners intend it to, in the majority of sexual encounters, causing concern or distress. It is a very common problem in men of all ages being the most common form of male sexual dysfunction.

Our laboratory produces a range of combination capsules, nasal sprays and local anesthetic sprays used to treat this condition.

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Prostate Health

Benign enlargment of the prostate gland effects most men over the age of 60. Those afflicted with benign prostate hyperplasia (BPH) have trouble urinating and voiding and are overly sensitive to any residual urine left in the bladder resulting in a feeling that they have not completely emptied their bladder. Men with BPH are also at a higher risk of developing prostate cancer.

According to conventional views BPH/prostate cancer develops due to the presence of a metabolite of testosterone known as dihydrotestosterone (DHT). Testosterone is converted into DHT by an enzyme known as 5-alpha-reductase. When DHT binds to receptors in the prostate gland it activates growth factors that stimulate cell proliferation. Although this is the most widely accepted theory there is insufficient scientific evidence to support it. If indeed this was the case we would expect the highest  incidence of prostate problems to occur when either testosterone levels were at their peak (ages 18 to 25) which is obviously not the case, or alternatively when DHT levels rise. There is no evidence which suggests an increase in 5-alpha-reductase activity occurs with the aging process as DHT levels remain fairly constant throughout life for most men. In addition it has been shown that there is no accumulation of DHT in the prostate gland with the aging process. This theory therefore does not adeqately account for an increase in prostate problems with age.

Recent evidence and a new emerging theory suggests estrogen dominance may be responsible for BPH/prostate cancer, not DHT as previously believed. It is accepted fact that as men age their testosterone levels decline reducing their testosterone/estrogen ratio thus allowing estrogens to adhere to receptors on the prostate due to a lack of competition with testosterone causing prostate growth. In addition German researchers have clearly documented a dramatic, age-related accumulation of estrogen in human prostate glands. This work correlated age, estrogen accumulation, and the presence of benign prostatic hypertrophy. This finding  highlights the role of estrogen as a growth promoting hormone in prostate. Recent work also shows that estradiol provokes increases in prostate specific antigen (PSA) production in human prostate tissue. This increase in PSA is as great as that seen with testosterone. In addition it was found that PSA production was specifically inhibited by 2-methoxyestradiol, the beneficial estrogen metabolite whose production is promoted by DIM (see below).

In addition recent research findings also suggests that prostate cancer may be caused not by the estrogens themselves but by one of their metabolites. Research on the minor metabolites of estrogens, specifically the metabolites 2-hydroxyestrone and 16-alpha-hydroxyestrone has revealed the 2-hydroxyestrone metabolite is a "good" estrogen, while the 16-alpha-hydroxyestrone metabolite is a "bad" estrogen because it tends to damage DNA and cause abnormal cellular proliferation. In a variety of animal models, it is definitely associated with a higher risk of cancer and with the progression of that cancer. In these same animal models, if the proportion of 16-alpha-hydroxyestrone can be made to go down and that of 2-hydroxyestrone to go up, the incidence of cancer is reduced.

At this stage until more research is done to determine a definite cause BPH/prostate cancer should be considered to be the result of possibly a combination of increasing DHT levels, estrogen dominance and unfavourable estrogen metabolism. In addition an age related decline in progesterone levels may cause an increase in DHT in some men as progesterone is a potent 5-alpha-reductase inhibitor. 

Diagnosis Testing

Obviously a lot more research is needed before a definite physical cause can be identified. However if you suffer increased frequency of urination, hesitation before urination or increased dribbling make sure you have the following tests:

(1) A prostate exam - you should also have your urologist evaluate the size of your prostate gland.

(2) PSA test - Prostate-Specific Antigen (PSA) testing, although not totally reliable, still remains the primary screening test to differentiate between BPH and prostate cancer.

(3) Hormone tests - in addition you should have your estradiol, estrone,free  testosterone, dihydrotestosterone, DHEA and progesterone levels checked by either urine/serum or saliva tests to determine if any imbalances exist.

(4) Urinary estrogen metabolite tests are also available to measure the levels of the 2- and 16- hydroxyestrone to determine if there is an unfavorable balance between the two which may be feeding the prostate proliferation.

Treatment

The treatment of BPH should include optimising hormone levels and balance including estrogen metabolism in conjunction with ceratin beneficial supplements.

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Contact Us

In order to arrange a consultation or alternatively to obtain more information you can contact us.