Testosterone Replacement, Natural & Unnatural Part 5
RESTORING HORMONAL FUNCTION (you made it! Well almost…)
Assuming you have maximized your blood flow and ability to digest, and are no longer deficient in magnesium or iodine, and have detoxified and removed chemical inhibitors of the hormone receptors and still have low testosterone, you are ready to address the hypothalamic-pituitary-testicular axis.
As discussed above, the hypothalamus causes human growth hormone (HGH)to be released from the pituitary. A 1960’s study of patients whose breast cancer, diabetes, acromegaly and pituitary tumors were treated with surgical excision of the pituitary and whose thyroid, adrenal and sex hormones were replaced (but not HGH), demonstrated continued low basal metabolism, hardening of arteries, reduced blood volume, impaired heart and kidney function, diminished libido, low self-esteem, fatigue, and were more prone to go onto disability. HGH was then administered with dramatic improvement in most cases. Dr. Klatz, the founder of The American Academy of Anti-Aging Medicine (www.a4m.com), authored the book “Grow Young with HGH” in which he describes the sequential declines associated with diminishing HGH levels. It first begins with pituitary decline, then sex hormones, then thyroid dysfunction quickly followed by adrenal dysfunction. The A4M is a non-profit entity and has trained 26,000 practitioners at this point and HGH is a major focus of research and treatment due its role in cell regeneration and reproduction. As such, it is responsible for formation of blood cells, bone and muscle formation and maintenance, the size of our organs, the healing of tissues following injury, and blood sugar regulation.
“Somatopause” is the term used for the age-related decline in HGH and this is when our tissues and organs begin to atrophy, our skin sags and thins, and healing becomes delayed. This hormone peaks after our full growth is achieved around age 15-18, dropping approximately 1% per year, and by age 60 we make approximately one-quarter the amount we did in our youth. Because HGH deficiency can be directly responsible for low testosterone, it is very important to address this prior to taking any medication for low T. The best ways to assess for HGH deficiency are clinically by assessing the patient’s appearance compared to their biological age, and via laboratory testing. HGH stimulates the liver to produce IGF-1 (Insulin-Like Growth Factor), and if IGF-1 is low, we can infer HGH is low.
Treatments include HGH injections which are not without potential risks, including continued dependence on the injections, acceleration of hidden cancers, and others, so please discuss any course of action with your doctor. Natural ways to increase include the ever-present recommendation of a quality diet and exercise, intermittent fasting, and amino acid supplementation. Oral sprays have also been developed which provide the essential nutrients the pituitary needs to manufacture HGH. Improvements in muscle mass, sense of well-being and improved sleep have all been reported, and IGF has been shown to increase with regular monitoring. If low T was caused by HGH deficiency, it should reverse as well.
It is beyond the scope of this article to fully discuss thyroid dysfunction, however, in his book Hypothyroidism Type 2, Dr. Mark Starr notes hypothyroidism is severely underdiagnosed and is essentially a hidden epidemic. It declines slowly with age as well as due to the toxins mentioned. Deficiency, as with HGH deficiency, can cause cholesterol elevation and hardening of the arteries, and once the thyroid and liver are supported cholesterol will normalize. Statin drugs (cholesterol medications) deplete coenzyme Q10 in the body which is responsible for energy levels at a cellular level. TSH blood tests are insufficient for diagnosis, instead signs and symptoms and body temperature are important indicators. Please read Dr. Starr’s book for a full discussion. It is very possible that hypothyroidism is contributing to low T as hypothyroidism slows us down physically and mentally and contributes to cold intolerance and depression as well as elevated cholesterol and heart disease. Treatment should be with desiccated hormones, not synthetic, and both T4 and T3 from porcine or plant sources.
Similarly, a full discussion of adrenal fatigue is beyond the scope of this book. Neither it nor type 2 hypothyroidism is officially recognized as a medical diagnosis, but this doesn’t mean they don’t exist. Adrenal fatigue from chronic stress probably leads to Takotsubo cardiomyopathy, or broken heart disease, first described in Japan. A great resource is Healing is Voltage by Dr. Jerry Tennant. He describes the thyroid and adrenals as working together, like a team of horses, to generate energy and when the thyroid begins to fail, the adrenals do their best but are quickly overcome (as would one horse now forced to double its load). Symptoms include fatigue, quickness to anger, low blood pressure, high sense of stress and diminished relative intolerance to stress, intolerance to exercise, hypoglycemia and better energy at night. www.adrenalfatigue.org is also a very helpful resource, including options for lifestyle and diet remedies. Adrenal fatigue does not always require thyroid dysfunction, and can be driven by high amounts of stress alone, but if the thyroid is implicated, it is imperative to assess the adrenals and have them optimized because once thyroid function improves, the adrenals will be pressed back into active service.
RESTORING TESTOSTERONE
In the event that all of the above has been addressed and you continue to have low testosterone and many or all of the symptoms that prompted medical investigation initially, then you may require testosterone supplementation. In order to qualify as having low T, you need to have measured less than 300 ng/dL on two separate occasions with blood draws occurring in the early morning.
Replacement is not to be entered into lightly as risks are present. However, as humans live longer (average life expectancy of males in 1900 was 47 years old, for women it was 49 and now it is approximately 75 and 80 respectively) we are more familiar with the consequences of aging and the discomfort and disability that can be experienced is now having to be endured longer and longer. If you were diabetic, we would consider treating you with the hormone insulin, and if low testosterone is causing early death through multiple disease states, then we should treat- that is why the medical community exists. There is no more noble calling than helping people live more vibrant lives with a higher quality of living.
However, because of the risks involved, many are rightfully hesitant to receive replacement. To review, common risks of testosterone replacement in any form include cardiovascular problems such as heart attack and stroke (one study was halted due to heart problems) due to increased prevalence of plaque formation. In a study of 2.2 million men, the British Medical Journal reported a 63% increase in blood clot formation within 6 months of replacement, afterward the risk disappeared. The Journal of the American Medical Association (JAMA) reported a study that showed improvement of bone density and increased hemoglobin of approximately 40% in anemic patients, and no improvement in cognition. Some studies have suggested that prostate cancer is linked to low testosterone. Another consequence of replacement is that once treated, the body stops making it, so you are somewhat committed to replacement once started, depending on what deficiencies led to the problem.
You should not have hormone replacement if you have a history of significant heart failure, prostate or breast cancer, a high red blood cell count, untreated sleep apnea, a nodule on your prostate, an elevated PSA, or severe lower urinary tract symptoms. If there is any uncertainty on the part of your provider, they may recommend a prostate biopsy.
In light of the dangers, many (patients and doctors) choose suffering through without replacement. We’ve seen though that low T can possibly create disease states, so this may seem unattractive, as is fatigue, low sex-drive and erectile dysfunction. If so, or if your symptoms are severe enough to require replacement, you have two options: standard dosing or rhythmic bioidentical dosing.
Standard forms for replacement include injections, cream, gel, pills, and patches. The pills are extremely toxic to the liver and aren’t recommended.
Rhythmic dosing was made famous through the use of “The Wiley Protocol”. This approach uses daily and seasonal variations in testosterone and DHEA cream in order to mimic our naturally occurring rhythms, and is purported to reduce heart disease and cancer risks. This protocol is available for hormone replacement therapy (HRT) for women as well.
Irrespective of how you receive your HRT, you should be monitored regularly with annual digital rectal examination and PSA.
After successful testosterone replacement (the right treatment was given for the right problem), most men are satisfied with the results and note substantial improvement in their symptoms and often feel as though they were given their life back. They then have the energy to live the life they felt they deserved. Your life is too important to live in deprivation, and if any of these symptoms sound familiar to you, please get the help you need to regain the life that has temporarily slipped away. The natural ways to restore testosterone and the steps and considerations listed above are a great place to start and discussion with a medical provider is always encouraged.
As you can tell, I am a strong proponent of you being informed and taking a leadership role in your health. If you’re not getting the traction you need from your provider, get another. After working in healthcare for 14 years, I know some healthcare providers are better than others- just as in any walk of life. Medical care is increasingly about the bottom-line and providers and patients have suffered for it. Because time is precious, health care is increasingly practiced in a rote and habitual manner with curiosity and learning on the part of providers often taking a backseat to recovery from the day, frustration, and burnout. I have found Integrative Medicine to be a refreshing alternative to this traditional model. It emphasized diet, exercise, personal responsibility, science, and a wellness model as opposed to a disease model. Disease models focus on signs and symptoms and making them go away- sometimes at the expense of your health. The treatment of acid reflux is a great example. Once your symptoms abate, usually with medication, you’re often considered cured. The root cause is often not addressed, and collateral damage does occur. A wellness model encourages patient health to the extent that disease occurrence becomes very unlikely, and takes into consideration the whole person- the physical, emotional, mental and spiritual fitness of the patient- because they are intertwined and trouble in one can cause trouble in the others. This approach relies on your body to heal itself, and not medication. If your insurance covers an Integrative Medicine provider, I encourage you to investigate. If your insurance doesn’t cover one, I still strongly encourage you to investigate and see what they have to say- many offer a free consultation. The solution to our health care problems may be Integrative- you and your provider working together and omitting insurance companies. Gym memberships, organic food, supplements, a high-deductible/low premium policy and rare, out-of-pocket but enjoyable and effective doctor visits may be cheaper in the long run than traditional care with its expensive medications, side-effects, unaddressed root causes, low-deductible plans and short unsatisfying visits. Food for thought.
Throughout all of this, it is important to have realistic expectations. You are getting older and there is no fountain of youth. Restoring hormone function or replacing hormones won’t return you that stud you used to be- rock hard everywhere you needed to be with energy to spare. It may help you live longer, prevent disease, and improve your cognitive ability, or it may not. My recommendation is to find an excellent provider whom you can trust and whom is able to spend the time necessary to listen to you and treat you as you deserve to be treated. This is almost as important as YOU taking full responsibility for your health and getting in the driver’s seat. If you’re not getting the traction you need in the realm of your health, or other aspects of your life, then make it happen! Choose it, commit to it, and create it! There really is no down side to eating healthy meals and exercising regularly. At the minimum, you will be stronger, more resilient, and happier and we all need more of that these days- for ourselves and for those we love and who love us!
That’s it, you made it! Hopefully you don’t have any questions after all of that, but if you do, please feel free to reach out. One question that wasn’t answered was posed in the Forbes article I referred to initially: “What about the men the economy is leaving behind?”
In the era of COVID-19, this is an even more pressing question with unemployment projected to be 25% even in one to two years. You will have to look in my other blog articles for my feelings on that matter, but I will say this: Jobs and opportunity need to be readily available, and if not, you will need to create that opportunity, and hopefully those jobs. The good news is you are here on this planet to create, and we only realize our true potential through struggle!