John A. Tafel, MD Integrative Medicine
Prevent “andropause” by restoring youthful testosterone levels and reducing excessive estrogen and SHBG levels.
My goal is to re-establish a more youthful balance of hormones in your body by increasing the testosterone influence and diminishing the estrogen and SHBG influence, or ”increasing the T/E ratio” for your optimal health and functioning.
I use a 5% testosterone cream, a trandermal testosterone from the Medicine Shoppe 200 mg/ml (20 drops per ml) 5 drops BID 800-286-2014, or the Abrams micronized testosterone capsule 200 mg/day.
The average human male begins to feel some of the signs of aging after age 40, with rapid deterioration of testosterone levels after 40 to 50 years of age. (Ottinger, 1998).
The lower testosterone levels are associated with decreased muscle mass, increased body fat, reduced physical energy and endurance, a gradual decrease in libido, loss of bone density, circulatory system changes, and an increase in cholesterol.
Some have difficulty taking DHEA because of benign prostatic hypertrophy but who took chrysin and were then able to take the DHEA. DHEA will metabolize to estrogen excessively, and chrysin inhibits that process, thus removing the stress it imposes on the prostate gland.
Testosterone Replacement and Balance with Estrogens: Keep lab value of estrogens around 35-40
Replacement therapy with testosterone considerably improves the quality of life in a great number of men after middle age.
Low testosterone may also reduce the severity of age-associated diseases like osteoporosis and cardiovascular disease,which are among the leading causes of disability and death.
Lower testosterone levels can be associated with higher sex hormone-binding globulins (SHBG). These bind to testosterone and reduces its ability to act on tissues. Fortunately, there are natural products which can reduce the SHBG levels if they rise too much.
Finally, and very importantly, with aging there can be more and more conversion of testosterone to estrogen via the enzyme aromatase.This can occur increasingly with age in the liver but most importantly in the fat stores. I counsel those with weight problems to utilize lifestyle measures to reduce their fat stores which will reduce their increasing activity of aromatase activity and estrogens.
To avoid the health problems of excessive aromatase, I use natural or medicinal ”aromatase inhibitors.” By monitoring the testosterone to estrogen ratio, and making use of aromatase inhibitors to improve this ratio, patients can optimize their testosterone, SHBG and estrogen levels.
Regarding the controversial issue of the causes of prostate cancer with increasing age, the levels of testosterone fall while, at the same time, theincidence of prostatic hypertrophy increases. Because they are moving in the opposite directions, many researchers believe that with aging, it is the excessive increase in estrogens, and not the increase in testosterone that promotes prostatic hypertrophy.
Some argue that this is a cumulative effect but if you look at the area under the curve, the years with the highest levels of testosterone (the second, third and fourth decades–where most of the exposure has occurred) are associated with the lowest risk of prostate dysfunction.
(See also the recent long term study (Cancer 1999 Jul 15;86(2):312-5 Serum testosterone and sex hormone-binding globulin concentrations and the risk of prostate carcinoma: a longitudinal study.) In this study, Heikkila R et al concluded that there is little correlation between testosterone levels and eventual prostate cancer.
My goal is to re-establish the more youthful balance of hormones in your body by increasing the testosterone influence and diminishing the estrogen and SHBG influence, or ”increasing the T/E ratio,” to more youthful and vigorous levels for your optimal health and functioning.
For even more detailed evaluation for high-intensity athletes, the amount of testosterone relative to cortisol can distinguish over-training from optimal training.
Aromatase Inhibitors: The one that appears to be the most potent, and is also bioavailable, is a flavonoid called chrysin. It is a natural substance that comes from the passionflower. I’ve had a number of male patients whose tests showed too little testosterone and too much estrogen, but after taking chrysin for as little as one month, the proper ratio was restored. Chances are very good that those men, who are mostly in their 50s and above, will need to take chrysin for the rest of their lives in order to maintain a proper balance.
Medical Center Pharmacy can add Chrysin to creams.
Other Products: Chrysin with piperines to increase bioavailabilty: Life Extension
Chrysin in BLA in oral form from Belmar
Naringenin, found in oranges and tangerines, also inhibits aromatase, but it’s not quite as effective as chrysin, so the latter is better known and more widely available.
Other natural substances that may help to reduce prostate cancer risk.
Isoflavones (genistein, biochanin A) inhibit the activity of aromatase (CYP19)
Flavones (chrysin, baicalein, and galangin)
Some have difficulty taking DHEA because of benign prostatic hypertrophy but who took chrysin and were then able to take the DHEA. DHEA will metabolize to estrogen excessively, and chrysin inhibits that process, thus removing the stress it imposes on the prostate gland. Also on the male list is lycopene, a carotenoid that gives tomatoes their color.
Lycopene: n a meta-analysis (a critical review) of over 100 studies, it was found that a large majority of them did indeed indicate an association between processed tomato products (and very likely lycopene) and a reduced risk of prostate cancer. More recently, a study was done by a urologic surgeon – creating a bit of a sensation – who had a number of patients who were to have their prostate glands removed because of proven prostate cancer. For 30 days before the operation, half of these men took lycopene, and the other half did not. Then their prostate glands were removed – which was too bad, really. A postoperative study of the tissue specimens showed that, whereas the prostate cancers in those men who had not received lycopene had progressed, the cancers in those who had received lycopene had actually shown a regression.
We can reasonably conclude that eating a lot of processed tomato products (the equivalent of 20 lbs of fresh tomatoes per week) or taking about 30 mg of lycopene per day is likely to have a favorable effect in preventing prostate cancer, and, if you already have it, in retarding its rate of progression. But, of course, primary prevention is best, not therapy after the fact.
Some of the studies showed that cooked tomatoes were more cancer-preventive than fresh tomatoes, and when the tomatoes were combined with cheese, a la pizza, they had even more potency. That makes sense because lycopene is fat-soluble, so it’s more easily absorbed by the gut when taken with fatty foods. We recommend only lycopene that has been made readily absorbable through a lipidation process, such as that from Hoffman-La Roche.
Arimidex®, that was designed specifically for inhibiting aromatase activity. It does that, but with undesirable side effects. Fortunately, there are natural aromatase inhibitors that do not have a long list of side effects
There are three I’d like to talk about. The first is DHEA, mentioned earlier, which appears to be very strongly supported by the scientific literature for preventing premenopausal – and I want to emphasize premenopausal – breast cancer. There is enough literature from both experimental animal studies and from basic human biochemistry to say that DHEA is a risk reducer for all types of cancer. But here we’re talking specifically about sex-hormone-related cancers.
The second item is selenium, which has been shown, epidemiologically, to be associated with lower levels of prostate cancer, along with lung and colon cancer. Even though we don’t know its mechanism of action, it does appear to reduce the risk. In one study, 200 mcg of selenium per day lowered the risk of prostate cancer by about one-third.4
The third item is one that I like to recommend, although there is very little literature on it, and that’s simply a very small amount of iodine. It turns out that the prostate gland is the male body’s second-greatest repository for iodine – after the thyroid gland, of course. In women, the second greatest accumulation of iodine is in the ovaries.
It has been my clinical observation, not published in the scientific literature, that when women have low estriol and more estrone and estradiol – remember Dr. Lemon’s theory that low estriol levels represent a cancer risk – added iodine helps to raise the levels of estriol and concomitantly lower the levels of estrone and estradiol (which are more procarcinogenic). I don’t know how it works, but I’ve seen it work enough times since I first observed it in the 1970s that I know it’s true.
1. Aromatase inhibitors needed in only a minority of men:
C. Improve estrogen metabolism and conversion from testosterone and DHEA: Convert “bad” estrogens to “good” estrogens and drastically reduce estrogen production from testosterone as well as from DHEA, resulting in a rise in testosterone and DHEA levels.
1. I3C: In addition to the Brassica vegetables’ metabolic modifier I3C, which affects the “good/bad” estrogen ratio, there are substances that can induce the formation in women of more estriol, which, according to early theories, is a good estrogen.
a. A word of caution: Brassica vegetables in excess can cause goiter – an enlarged thyroid – so it’s probably best to monitor that possibility if we become big fans of these vegetables and eat them every day. But chances are that three or four servings a week won’t do this
2. DIM: Another metabolic modifier that alters the 2/16-alpha-hydroxyestrone ratio is a substance called 3,3′-diindolylmethane (DIM). DIM is a naturally occurring dimer, or coupled pair, of I3C molecules. Like I3C, DIM occurs naturally in broccoli, cabbage, etc., and it’s rather innocuous. Dr. Bell has told us that her next study, which will again be double-blind and placebo-controlled, will focus on DIM rather than I3C, because it’s been observed that DIM is considerably more potent in changing the 2/16-alpha-hydroxyestrone ratio, so studying it certainly makes sense. It also might be beneficial to use the two – DIM and I3C – together, perhaps resulting in an even better estrogen ratio.
3. Ascorbigen: Said to be the most common of the indoles found in the Brassica vegetables – about which there has not been as much research, and that is ascorbigen, which you earlier called to my attention, “Dr.” Block. The name calls to mind ascorbic acid (vitamin C), and indeed, when ascorbigen breaks down, it generates ascorbic acid as well as I3C. But that’s not the point here. The idea is to use ascorbigen as a source of I3C, which improves the 2/16-alpha-hydroxyestrone ratio. Research does appear to show that if we combine ascorbigen with I3C (which is, of course, the situation in nature), their effect will be synergistic. Both are what are known as “mixed-function oxidases,” which help to render carcinogens harmless before they cross the barrier to the lungs or bloodstream. Together, I3C and ascorbigen have been observed to produce up to an 80-fold increase in intestinal mixed-function oxidase activity.2 Ascorbigen is also known to operate as an immunomodulator, or immune-system enhancer.3
Figure Below: Eating Brassica vegetables tends to promote the desired ratio of the two hydroxyestrones shown in this diagram: high in 2, low in 16-alpha. Men who ate three servings of these vegetables (containing I3C) per week had a 41% lessened risk for prostate cancer. (Adapted from Nutrition & Healing; reprinted by permission.)