Hormone Replacement for Men
Healthy aging men will have a predictable decline in the male sex hormone, testosterone, leading to decreased energy and fatigue, weight gain, loss of muscle mass, and loss of sex drive or erectile function. They will also have increasing risk for heart disease, diabetes, osteoporosis and dementia. Yikes…
Have heart, men, for there is something you can do about it! Men can supplement their hormones, just like women. The decline in male hormones is called andropause, with a decline in hormones similar to menopause in women, but it occurs over 10-15 years instead of the few years it takes for menopause.
Men don’t usually have hot flashes or night sweats and unlike the mood swings noted with the wildly fluctuating hormone levels during menopause, men tend to just get more and more apathetic, with decreasing motivation, security, and confidence. Feeling so blah causes many men to feel anxious or depressed. Insomnia is also common with low testosterone.
Testosterone Replacement Therapy (TRT) is a well established science and there are hundreds of studies documenting the safety and effectiveness of TRT. Some of the largest studies simply observe that men who are low in testosterone have about a 50% increased death rate over the subsequent decade when compared to men with normal testosterone levels.
Heart disease is the number one killer in men. Testosterone helps prevent heart disease by improving the cholesterol profile, discouraging blood clots, and by keeping blood vessels open and elastic. Testosterone can be given to men with advanced heart disease and is shown to improve their functional ability to stress the heart.
Sarcopenia is the age-related loss of muscle mass, strength and function. Muscle is replaced by fat and fibrous tissue. Hormone decline - particularly androgens like testosterone - is one of the biggest reasons for sarcopenia in men and women. Maintaining muscle mass means less frailty, more energy and more stamina.
Testosterone indirectly prevents diabetes by preventing sarcopenia. But, TRT also has a direct effect on helping insulin work better. Several studies show men who replace testosterone need about 50% as much insulin. Adding TRT to an exercise program results in much better blood sugar control than exercise alone. I consider TRT in all my patients with type 2 diabetes or metabolic syndrome X.
Osteoporosis or “brittle bones” is not as common in men as women, since men build stronger bones in the first place because of testosterone. However, the mortality and disability caused by osteoporosis in men in worse than in women. Again, TRT has a direct stimulating effect on bone – testosterone will build bone!
Dementia and depression are much higher in men with low testosterone levels. Testosterone has both protective and growth stimulating effects on nerve tissue in the brain, and is shown to have a regulating effect on the plaque that accumulates in the brain with Alzheimer’s dementia. TRT improves cognition and mood, especially abstract and spatial skills such as reading a map, coordination and balance, and motor control.
The myth of testosterone causing prostate cancer has been thoroughly debunked. In fact, at the time of diagnosis, men with prostate cancer tend to have a lower testosterone level than average. Men with low testosterone also tend to have more aggressive forms of prostate cancer. TRT does not increase the risk of cancer and recent studies show it is even safe to use TRT after treatment of prostate cancer.
This all sounds great – but what are the risks of TRT? The main risk is if a man already has an existing prostate cancer then TRT will stimulate the cancer. We monitor this through routine blood testing and it is very rarely an issue. TRT will also cause an increase in the production of red blood cells, which alone does not cause blood clotting like other syndromes of increased bone marrow cells, so this is not a big issue.
Still sounds great – how does one go about starting TRT? First of all, check blood levels of testosterone, and if they are low then you can start TRT. I recommend getting the “free” T level in addition to the “total” T as the free portion is the active portion. With aging the free portion tends to get smaller and smaller in proportion to the total and more accurately determines if T levels are low.
You can raise T levels with a few natural supplements. DIM is derived from cruciferous vegetables such as broccoli and can effectively raise free T levels by improving the metabolism of estrogens. Other natural supplements are known to raise T levels 10-30%, such as Tribulus terrestris, chrysin, nettle root or muira puama.
When replacing T directly only use bioidentical hormones, which simply means they are 100% identical to our biology – that is, the molecular structure is exactly the same as that found in our body. Simply taking a pill that one swallows does not work and we recommend either a tablet that melts under the tongue or a cream that is absorbed through the skin. Some men prefer a weekly injection.
Improved mood, energy, sleep, sex drive and general outlook will usually start within a few weeks of TRT. It may take a few months to fully appreciate the improved stamina, muscle building, fat burning and erectile function effects of TRT.
There are a few caveats to testing and monitoring TRT. Once on TRT one should get a “free” testosterone blood level, and monitor the normal by-products, estradiol and DHT. I suggest only considering TRT with a physician who is familiar with the process.
TRT prevents disease and helps maintain quality of life, and like other age management strategies, it is changing the paradigm of normal aging!
Inset
The next free seminars are “Under the Tongue Allergy Drops”, Monday, May 7th, and “Bioidentical Hormone Replacement for Men”, Monday, May 21st both at 6pm, at the IMC. Seating is limited so RSVP at 245-6911 or online at rsvp@imcwc.com.
Bio
Scott Rollins, MD, is Board Certified with the American Board of Family Practice and the American Board of Anti-Aging and Regenerative Medicine. He specializes in Bioidentical Hormone Replacement, thyroid and adrenal disorders, fibromyalgia and other complex medical conditions. He is founder and medical director of the Integrative Medicine Center of Western Colorado (www.imcwc.com). Call (970) 245-6911 for appointments or more information.
Hormone Balance with the Remarkable DIM
Lower your risk of cancer, help lose weight and build muscle – all remarkable benefits of a simple food supplement called DIM. For men or women, DIM is something to consider as part of an overall supplement program.
DIM, or diindolylmethane, is a plant based compound found in cruciferous vegetables, such as brussel sprouts, cabbage, broccoli and cauliflower. DIM has been shown in studies to reduce the risk of certain cancers, especially those driven by abnormally high estrogen levels, such as breast, uterus and prostate cancer. DIM can also stimulate the breakdown of fat while encouraging muscle development.
Estrogen Overload
Estrogen hormones are naturally found in men and women and have many benefits such as preserving artery health and brain function while fighting oxidative free radical damage. Higher estrogen levels found in women cause the female body shape with breast and hip development. Many women are estrogen dominant however, meaning they have too much estrogen accumulating in the body for the complementary progesterone to balance.
Natural estrogen dominance occurs as women near menopause, starting even ten years prior to menopause, where they often don’t make as much progesterone to balance their estrogen. Symptoms such breast pain, water retention, heavy painful menstrual cycles, or irritable anxious moods are typical bothersome symptoms. Estrogen’s over-stimulation of breasts and uterus tissue can lead to breast cysts or adenomas and uterine growths – both unpleasant and potentially dangerous physical outcomes are too often accompanied by worrisome mammograms and hysterectomies.
Some women have estrogen dominance throughout their life for various reasons, such as low thyroid, high cortisol, exposure to environmental estrogen-like chemicals, or impaired detoxification pathways for estrogen.
Men often suffer from estrogen overload as well. With normal aging our testosterone levels drop as the conversion to estrogen increases, leading to a falling ratio of testosterone to estrogen. Higher estrogen levels in men lead to weight gain, loss of muscle mass, feminization of the body, further decreases in already falling testosterone levels, and increase the risk of diseases such as heart disease and prostate cancer. The enzyme that normally converts testosterone to estrogen is most abundant in fat, so as men put on weight the cycle of falling testosterone and rising estrogen simply picks up steam!
How does DIM work?
There are two main pathways in the liver for our estrogen to be normally metabolized and excreted. One pathway leads to very good metabolites called 2-hydroxy estrogens. The other pathway leads to bad metabolites called 4 or 16-hydroxy estrogens. DIM stimulates the favorable 2-hydroxy pathway for estrogen metabolism and this is how DIM works to improve our health.
DIM is not a hormone, nor is it a hormone replacement. It is a plant compound that will improve our hormone balance. By improving the metabolism of our natural estrogens DIM will help lower high levels of estrogen in the body. This alone can help remedy estrogen dominant conditions and restore a healthy estrogen/testosterone ratio in men and women.
The favorable 2-hydroxy metabolites promoted by DIM are potent anti-oxidants and help prevent muscle breakdown after exercise, as evidenced by female athletes having less muscle tissue breakdown after intense exercise than men. By reducing the estrogen dominance and also reducing the accumulation of cancer-promoting 4/16-hydroxy metabolites DIM can help lower the risk of cancer.
The 2-hydroxy metabolites help increase the active testosterone levels in men and women by displacing inactive protein-bound testosterone to its active “free” portion. This leads to significant improvements in the ability to build muscle and enjoy the benefits of testosterone including better mood, increased stamina, endurance, sex drive and erectile function.
The accumulation of fat around the belly, hips and buttocks is partly due to excess estrogen levels combined with falling testosterone levels. DIM will help lower excess estrogen and promote the fat-burning 2-hydroxy metabolites. This can help you achieve a leaner body with less body fat.
Hormone balance with DIM
How do you supplement DIM and how much should you take? First of all, only the “micro-encapsulated” forms of DIM are well absorbed. For women, doses of 100-200mg daily are typical, and after menopause, whether taking hormone replacement therapy or not, doses of 50-100mg daily will improve estrogen metabolism. For men, doses of 200-400mg daily are sufficient during intense exercise or weight loss efforts. For general healthy aging a dose of 100-200mg daily is sufficient. Doses as much as a thousand times higher have been shown to be safe in animal studies and there has never been a reported complication with DIM usage in humans.
How do you know if DIM is working? Aside from the improved clinical circumstance we often measure the good and bad estrogen metabolites with a simple blood test. We routinely observe increases in the good 2-hydroxy metabolites with the use of DIM. As an aside, correction of low thyroid conditions also improves estrogen metabolism.
I recommend DIM instead of its precursor compound known as I3C or indole-3-carbinol. Two I3C molecules combine in the body to make DIM. But I3C is variable in its absorption, reacts with other supplements such as vitamin C, and can convert to unhealthy compounds. As much as 10 times amount of I3C is needed to get levels comparable with straight DIM supplementation.
I start many women on DIM in their early 40s when there are signs of falling progesterone levels early in the peri-menopause. For many this alone can help the estrogen dominance while also increasing a low testosterone level. Sometimes we add progesterone to further balance the estrogen. We also routinely add the health-promoting adrenal hormone known as DHEA during this time which helps with weight loss, strength, sex drive and more.
We strategically combine DIM with other supplements to help with athletic conditioning or with overall healthy detoxification. During weight-loss or athletic training we might add creatine and a higher-protein diet, combined with targeted workout and recovery drinks that maximize insulin and muscle building. My favorite DIM supplement also contains curcumin, green tea and wasabia for a broad detoxification effect.
DIM can be used at any age as part of a weight-loss or strength training program. DIM promotes healthy hormone balance that can help you achieve peak exercise efficiency and healthy aging. Hormone balance can help you stay healthy, resist aging and get the most from your exercise or weight-loss efforts.
Inset
The next free seminars are “Bioidentical Hormone Replacement for Women”, Monday, April 23rd, and “Under the Tongue Allergy Drops”, Monday, May 7th, both at 6pm, at the IMC. Seating is limited so RSVP at 245-6911 or online at rsvp@imcwc.com.
Bio
Scott Rollins, MD, is Board Certified with the American Board of Family Practice and the American Board of Anti-Aging and Regenerative Medicine. He specializes in Bioidentical Hormone Replacement for men and women, thyroid and adrenal disorders, fibromyalgia, weight loss and other complex medical conditions. He is founder and medical director of the Integrative Medicine Center of Western Colorado (www.imcwc.com). Call (970) 245-6911 for an appointment or more information.
He is also medical director of Integrative Weight Solutions, a holistic, physician supervised HCG weight loss program that incorporates expert evaluation for hormone and digestive health imbalances, exercise physiology, and behavioral support for a powerful and balanced journey to weight loss. For more information see www.integrativeweightsolutions.com or call 245-0373 to arrange a free consultation.
Stop the Sniffling and Sneezing
Sick and tired of allergies? Fed up with the eye drops, antihistamines and inhalers? Frustrated with how much you are spending each month trying to manage the symptoms of allergies? Help is here! Under the tongue allergy drops is the easiest and most effective treatment for allergies and it is available now.
Immunotherapy (IT) is recognized as the only curative treatment for allergies. By exposing the immune system to slowly increasing concentrations of an allergen it will eventually stabilize and regain control of the portion that is hypersensitive to the allergen. The exact mechanisms of how IT works are not fully understood, but they involve shifting a patient's immune response to an allergen from a predominantly "allergic" T-lymphocyte (TH2) response to a "non-allergic" T-lymphocyte (TH1) response.
IT started in the early 1900s and was based on the idea of the vaccine against infectious agents. Along those lines, the first IT efforts started as injections into the skin, were found to be very effective and thus remain the standard method of delivery. Even in those early years there was also interest in other routes of administration, such as oral, bronchial and nasal, but these methods were never adopted due to cost, mixed success and side effects.
Subcutaneous immunotherapy (SCIT) is the common technique here in the US, which requires having to go the doctor’s office for weekly injections – a procedure that is expensive, time consuming and also dangerous. In 1986 The British Committee for the Safety of Medications reported several deaths caused by SCIT, and raised serious concerns about the safety and the risk/benefit ratio of SCIT. About the same time cheaper and more effective drugs, such as anti-histamines and inhaled steroids, were becoming widely available. Amidst this backdrop, the interest in non-injected immunotherapy increased.
Sublingual immunotherapy (SLIT) involves taking “allergy drops” under the tongue where the allergens are absorbed in the oral mucosa. This was first tested by randomized controlled trial (RCT) in 1986 and confirmed to be safe and effective. In 1990 the first pediatric study appeared, and since then over 60 double-blind RCTs have confirmed the safety and effectiveness of SLIT.
In 1993 the European Academy of Allergy and Clinical Immunology (EAACI) stated in its position paper that SLIT was “a promising route” for immunotherapy. In 1998 the World Health Organization stated that SLIT “may be considered as a viable alternative to the injection route in adults.” The same year EAACI put forth a position paper stating “the use of SLIT in clinical practice is justified because of the ascertained efficacy and the favorable safety profile.” In recent years several meta-analyses of these studies have appeared in numerous allergy journals, concluding that SLIT is significantly efficacious compared with placebo for rhinitis and asthma in children and adults.
With concern to safety, all clinical trials have consistently agreed that SLIT is safe with most side effects being local and mild. Irritation in the mouth is by far the most common reaction, occurring in as much as 75% of SLIT users. Other side effects included mostly gastrointestinal symptoms, congestion of the eyes or nose, or itching, and occur in 10-20% of users. In over 20 years of use only 6 cases of anaphylaxis have been reported with SLIT, and some of these were using non-standardized allergen extracts. In the SLIT comprehensive review, there were no deaths or anaphylaxis events reported.
By comparison, according to the World Allergy Organization, it is estimated that 3.4 fatal and 22.8 near fatal reactions occur every year with SCIT. Local reactions at the injection site, such as redness, swelling, and warmth, are common, with about 10-20% of users experiencing large (>25mm) reactions. Because of the risks most doctors are not routinely treating children under the age of 12 with SCIT. This is a shame since IT has been shown to lower the risk of developing asthma.
SLIT is currently commercialized and widely used throughout Europe, Asia, Australia and South America. In a 2006 report, from the Journal of Allergy and Clinical Immunology, the US scientific community finally acknowledged the safety and efficacy of SLIT. The use of SLIT is perfectly legal here in the US, but is considered “off-label” by the FDA (like many drugs), and clinical trials for FDA registration in the US are ongoing. Further research is needed to fine-tune issues of effective dosing, treatment schedules, and overall duration of treatment.
In 2003 the respected Cochrane review found that SLIT was safe and effective for treating allergies and the updated 2010 review reinforces the conclusion that SLIT is effective for allergic rhinitis and has been proven to be a safe route of administration.
The protocol for SLIT is simple. After a medical history and exam, tests for allergies are done, either by a blood test or skin testing. The SLIT drops are then started in a highly diluted form and increased daily until a maintenance dose is achieved. Drops are continued daily, at home, usually for three years. Relief from symptoms is often achieved in the first few months, but is takes 2-3 years for the immune system to reset enough to allow long lasting relief. If the results are not permanent, most of the time they will last 8-10 years before more treatment is needed.
Our clinical experience with SLIT the last few years has been dynamite with patients finding allergy relief during the first few months. And given the safety profile we are comfortable treating children down to age 3 which is just phenomenal given that we are giving relief to these kids while preventing asthma from developing in many of them.
SLIT is a safer, easier and less expensive option than SCIT. We are working with Greer (www.greerlabs.com) and Wellness Pharmacy (www.wellnesshealth.com) to bring SLIT to Western Colorado, offering a complete SLIT treatment program at a cost of $100 per month, which includes necessary office visits and the allergy drops. We also offer quick and painless testing for allergies by using the skin-prick or blood draw methods. Put an end to allergies once and for all – call today to get started on the under the tongue allergy drops.
Inset
The next free seminars are “Bioidentical Hormone Replacement for Women”, Monday, April 23rd, and “Under the Tongue Allergy Drops”, Monday, May 7th, both at 6pm, at the IMC. Seating is limited so RSVP at 245-6911 or online at rsvp@imcwc.com.
Bio
Scott Rollins, MD, is Board Certified with the American Board of Family Practice and the American Board of Anti-Aging and Regenerative Medicine. He specializes in Bioidentical Hormone Replacement for men and women, thyroid and adrenal disorders, fibromyalgia, weight loss and other complex medical conditions. He is founder and medical director of the Integrative Medicine Center of Western Colorado (www.imcwc.com). Call (970) 245-6911 for an appointment or more information.
He is also medical director of Integrative Weight Solutions, a holistic, physician supervised HCG weight loss program that incorporates expert evaluation for hormone and digestive health imbalances, exercise physiology, and behavioral support for a powerful and balanced journey to weight loss. For more information see www.integrativeweightsolutions.com or call 245-0373 to arrange a free consultation.
Supplements in the News
Omega-3 oils help with mood
We already have research showing that the artificial “trans-fats” found in a variety of processed foods lead to increased risk of heart disease and cancer. A new study now shows an association between trans-fats and aggressive, impulsive behavior.
Naturally occurring fatty acids generally have a “V” shape. The trans-fat configurations look more like a straight line. Trans-fats are not natural yet when consumed they are incorporated into cell membranes and alter the normal functions of the cell. They raise cholesterol and increase the risk of heart disease. They also have a detrimental effect on the brain and nervous tissue, altering nerve cell communications and causing nerve degeneration.
Lead author, Beatrice A. Golomb, MD, PhD, from the University of California, San Diego, states "there were studies showing that omega-3 fatty acids were associated with increased agreeableness and reduced impulsivity, and there's evidence that trans fats adversely affect ability to create the long-chain omega-3 fatty acids that are favorable for your brain, and that prompted us to study this further".
The researchers noted that higher intake of trans-fats was associated with significant increases in aggression, impatience, and irritability. Public health initiatives such as that in New York City, have implemented laws to limit the amount of trans-fats used by restaurants.
To avoid trans-fats, simply avoid processed, packaged and fast-foods, instead focus on filling your pantry with high quality oils that do not contain trans-fats or hydrogenated oils. Use the highly stable, healthy coconut oil for cooking. Use the “gold-standard” extra-virgin olive oil in salads and for dipping – be careful cooking with olive oil as it is moderately delicate and under heat can turn into the trans-fat structure. When eating out start by staying clear of the fried stuff!
Here yet again is evidence that we might all do well to supplement with an omega-3 oil. Fish oil still tops the charts as the best source. Krill oil is a bit better but I question if the difference is worth the price. Flaxseed is great, but in capsule form not nearly as potent of source for omega-3 oils – I prefer to just eat flaxseed in cereals and baked goods.
Green coffee beans help with weight loss
Research headed by Joe Vinson, PhD, professor of chemistry at the University of Scranton, has reported preliminary results that unroasted-green coffee beans can help with weight loss. The scientists are not sure exactly which compounds in the unroasted beans facilitated weight loss, but they do not think it is from the caffeine alone. Vinson says “it may be from the chlorogenic acid found in coffee beans”. Chlorogenic acid is a plant compound and it may have some effect on keeping down glucose absorption, which in turn would help reduce weight.
This may be similar to many studies showing that green tea will also help with weight loss. The health benefits of green tea are well known and are due to the high content of plant derived antioxidants called flavonoids. Catechins are the main flavonoid in tea and are more powerful than vitamin C and E for controlling oxidative damage to the body.
The main catechin in green tea that seems to provide the weight loss benefits is a compound called epigallocatechine (EGCG). The EGCG boosts norepinephrine which is an energy producing and appetite suppressing neurotransmitter. Green and black teas have also been shown to reduce the risk of heart disease, presumably in part due to keeping bad LDL cholesterol from oxidizing, increasing the good HDL cholesterol and improving artery function.
A Chinese study published in the Archives of Internal Medicine showed a 46%-65% reduced risk of high blood pressure in people who regularly drank oolong or green tea, compared to non-drinkers of tea. I’ll never forget reading the results from the 1999 Boston Area Health Study, printed in the Journal of Epidemiology, which showed a 48% decreased risk of heart attack in patients drinking one or more cup/day of tea. That struck me then as simply powerful medicine!
I recommend enjoying black and green teas, along with modest coffee consumption. Ditch the sodas or energy drinks and go for the gold standard – just plain old unsweetened green tea. If you don’t particularly like tea, there are numerous supplements that have concentrations of the health promoting flavonoids found in tea.
Chocolate helps with weight loss
Here’s a study to make you smile… Beatrice A. Golomb, MD, PhD, the same author of the study mentioned above, also released data this month from a study showing that increased frequency of chocolate intake was associated with a lower body mass index. Now you’re interested!
The study authors note "the connection of higher chocolate consumption frequency to lower body mass index is opposite to associations presumed based on calories alone, but concordant with a growing body of literature suggesting that the character — as well as the quantity — of calories has an impact on metabolic syndrome factors".
This study points out some of the health benefits of cocoa beans but it also implies that the quality of what we eat is just as important as the quantity. For a treat, I do highly recommend chocolate, especially those with high cocoa concentrations of 70% or more.
How to choose supplements
How do you know what supplements to take? Which ones have evidence for safety and effectiveness? How in world can you make sense of the many different brands? Is brand X really worth the increased cost compared with brand Y?
My free seminar on “Supplements: Why you need them and how to choose them” reviews the literature on evidence based supplements that prevent disease, what you should look for in a multi-vitamin and how to evaluate brands for quality. Come learn which supplements and brands may be right for you.
Inset
The next free seminars are “Supplements: Why you need them and how to choose them”, Monday, April 9th, and “Bioidentical Hormone Replacement for Women”, Monday, April 23rd, both at 6pm, at the IMC. Seating is limited so RSVP at 245-6911 or online at rsvp@imcwc.com.
Bio
Scott Rollins, MD, is Board Certified with the American Board of Family Practice and the American Board of Anti-Aging and Regenerative Medicine. He specializes in Bioidentical Hormone Replacement for men and women, thyroid and adrenal disorders, fibromyalgia, weight loss and other complex medical conditions. He is founder and medical director of the Integrative Medicine Center of Western Colorado (www.imcwc.com). Call (970) 245-6911 for an appointment or more information.
He is also medical director of Integrative Weight Solutions, a holistic, physician supervised HCG weight loss program that incorporates expert evaluation for hormone and digestive health imbalances, exercise physiology, and behavioral support for a powerful and balanced journey to weight loss. For more information see www.integrativeweightsolutions.com or call 245-0373 to arrange a free consultation.
