Most patients are told by their doctor that high testosterone is risky for prostate cancer. And it was taboo to treat a patient with prostate cancer with testosterone since it was similar to ” pouring fuel on a fire”. The New England Journal of Medicine performed an extensive review and found no evidence thAt men with higher testosterone were at increased risk of prostate cancer.
Dr Morgentaler who is a Harvard urologist has preformed research with his colleagues to unravel the myth of testosterone and prostate cancer. In a large series of prostate biopsies in men with low testosterone, they identified prostate cancer in 15% of men with a ” normal” PSA. Furthermore, the risk was doubled for men with the lowest testosterone compared with men with mildly low testosterone.
In another study done in Italy,the data showed that men with low testosterone were associated with more aggressive prostate cancer. There has been small published data showing no prostate recurrence in men who received testosterone therapy after having been treated for prostate cancer.
Dr Morgentaler followed a small group of men with prostate cancer who chose to have no treatment of their cancers but rather to follow it closely. In these men, they were treated with testosterone and underwent prostate biopsies. None of these men showed any cancer progression and in 54% of the follow up biopsies they were unable to find any cancer.
There is model to explain how testosterone testosterone interacts with prostate cancer. It is called the Saturation Model. Basically, the prostate cancer is sensitive to very low levels of testosterone and short of castration men do not get this low. An analogy is comparing prostate cancer to a house plant. The plant requires adequate amounts of water to grow but it will not grow to the size of a large tree no matter how much water you give it.
The evidence is accumulating that it is important for men to have optimum testosterone levels to have good health and quality of life. It is starting to appear that maintaining optimal levels of testosterone may reduce the chances of developing a worrisome prostate cancer.
However, one must remember that some men will experience cancer recurrence irregardless of whether they were treated with testosterone or not. Many people will be quick to point the finger at testosterone as being the culprit for the recurrence. So men with prostate cancer need to take into consideration all the factors in making a decision on whether to take testosterone or not. But in all aspects of what we do in life we are constantly weighing the pros and the cons. This is no different.
I see a lot of patients with thyroid conditions. While it is extremely important to evaluate all hormones especially the adrenals, it is also very important to evaluate iron status in the body.
Most of my patients that come to see me with a thyroid condition have never had their iron levels evaluated. The most important iron blood test to get is your ferritin level. Ferritin is how your iron is stored in your body. It let’s us know how much iron you have “left in the tank”. You can have normal circulating iron levels in the blood but a low ferritin which can be problematic.
Iron is needed in the production of your thyroid hormones. The enzyme in your thyroid gland called ” thyroid peroxidase” is dependent on iron for it to work. This enzyme basically takes iodine and adds it to the amino acid “tyrosine” to make your thyroid hormones.
There is another important enzyme in your body called “deiodinase” which converts the inactive thyroid hormone T4 to the active hormone T3. The deiodinase enzyme is dependent on iron as well.
As mentioned above the adrenal system play a very important role in how your thyroid hormone functions in your body. Iron also plays an important role in the synthesis of cortisol in the adrenal cortex. So if you have low iron levels you can not make enough cortisol which can lead to the thyorid hormones not getting into the cells effectively as well as adrenal fatigue.
So make sure you ask to get your Ferritin levels checked with your next blood test.
This month is Diabetes awareness month. The statistics are alarming and rising. 12% of men over the age of 20 have diabetes in this country. This rises to 27% for those over 65 years old. It is our North American diet that is to blame. I tell my patients the most important thing they can do for their health is to eat a plant based whole food diet low in sugar and processed food. What a lot of my patients don’t realize is that balancing their hormones especially testosterone will help improve their diabetes or lower their risk for developing the disease.
Testosterone directly improves diabetes by helping improve insulin resistance meaning that your bodies insulin is more affective at the cellular level. Indirectly, It improves your energy and motivation so that you will exercise. It helps lower your body fat which lowers insulin resistance as well.
In one study done in Europe, after taking testosterone for 3 months, these patients were able to lower their HgA1c ( 3 month blood sugar average) form 10.4% to 8.6%. Another study showed a 15% reduction in blood sugars after taking testosterone for 6 months. One hospital supervised study showed that testosterone replacement was more important than oral medications and in some men even more important than insulin.
Therefore, Balancing your hormones along with an aggressive diet and exercise program will help treat and reduce your risk of getting diabetes.
It’s not uncommon for patients to tell me that they went to their doctor to get their testosterone levels checked and were told they are in the normal range. Occasionally, as well, they are told their number looks really good. But they have all the symptoms of low testosterone. So why does this happen. It’s because the proper lab tests were not ordered.
Lets start with what are some of the essential laboratory tests you need to get and what do they mean? (I want to clarify that all the hormones in the body need to be evaluated but these are specific to testosterone)
- CBC - stands for complete blood count. With this you get the number of white blood cells, red blood cells. haemoglobin and hematocrit(H&H) as well as a breakdown of the types of white and red blood cells. Getting a baseline level for your red blood cells and H&H is important because testosterone can cause an increase in red blood cell production which rarely can cause your blood to get “too thick” which can lead to blood clotting. This is important to monitor during any testosterone treatment.
- Prolactin - this is a hormone released from your pituitary gland in your brain. Rarely, a patient will present with a high prolactin level from a benign tumor of the pituitary gland (Prolactinoma). Having a high prolactin interferes with testosterone synthesis and causes a low testosterone level on lab testing. Therefore, it is important to have this checked one time to make sure this is not the case.
- PSA – stands for prostate specific antigen. This test is used for screening for prostate cancer. There are transient causes of PSA elevation. Sexual activity, prostate infections, digital rectal exam and bike riding to name a few. Therefore it is important that you abstain from these for at least 72 hours prior to getting the test.
- Estradial - this is the main estrogen. Yes, men have estrogen as well and it is important for bone health, brain health and libido as well as other functions in the male body. The problem is that as men age, the level of estrogen rises while the level of testosterone declines. It is this imbalance that is thought to be one of the main culprits in prostate cancer development. There is an enzyme in the body called aromatase that converts testosterone to estrogen and in my practice we will prescribe both natural and prescription medications to help block this enzyme to keep the estrogen in the safe range.
- SHBG - stands for sex hormone binding globulin. This is a carrier protein that binds up testosterone and estrogen and carries them throughout the body. The problem is that when testosterone is bound to SHBG it can not enter the cell and carry out its function. Therefore, if there is more SHBG then there is more testosterone that is bound and less that is “free” to enter the cell.
- Testosterone - this is the hormone in men that is the cause of andropause. Typically, all that is measured is the Total Testosterone. This is measuring all the testosterone in the body including the testosterone that is bound to SHBG and another protein called Albumin as well. However, the important measurement of testosterone levels is the Free Testosterone and Bio-available Testosterone. This is the measurement of the amount of testosterone that is able to enter into the cells and carry out the functions of testosterone. When the Free Testosterone levels drop to a low-level it causes all the symptoms of andropause.
I use an analogy with my patients to help them understand the different testosterone measurements. I tell them that pretend you have a football team. All the players on the team is the same as the total testosterone. Only the players that are on the field are contributing to the game and this is the free testosterone. Now with these players they can either be on the field are on the bench. The players would prefer to be on the bench. Now the size (0r the length)of the bench is equivalent to SHBG. In some people the size of the bench is much longer and can fit more players on it. So even though the total number of players (Total testosterone) may to be a good number, the actual amount of players playing on the field (Free testosterone) can be quite low.
I will then explain to my patients that there are a few different ways we will try to increase the players on the field (free testosterone). We can increase the total number of players (by adding testosterone or increasing the body’s production of testosterone). We can also try to shorten the bench ( decrease the amount of SHBG by different methods – usually very difficult) and we can also put some “dummy players” (herb called Nettle Root) on the bench to block a spot so that one of the actual players (testosterone) can not sit on the bench.
As you can see there is more to testing your “Testosterone” than getting a simple Total testosterone level. Therefore, it is very important to work with a doctor that is fellowship trained in hormones like myself and my colleagues at BodylogicMD. Have a healthy day!!!
I recently wrote and article about adrenal fatigue awareness. In this I explain what is Adrenal Fatigue, what are the symptoms, how common this is, as well as how to treat. Many people and doctors as well have never heard of this syndrome. Most of us will experience some degree of adrenal fatigue in our lifetimes.
If you feel extremely tired, complain of “brain fog”, insomnia, mood problems, increased infections or cravings for salty or sweet food then you will need to check out my article to see if you are suffering from adrenal fatigue. Adrenal Fatigue Awareness
http://www.bodylogicmd.com/hormone-articles/overcoming-adrenal-fatigue
Have a healthy day!!
A lot of female patients in their 30′s and 40′s come into my office complaining of not feeling as well as they used to. They are moody, irritable, not sleeping and tired all the time. They have lost their zing in the bedroom and are tired of other doctors telling them that nothing is wrong with them. Does any of this sound like you? Well, welcome to perimenopause! Your hormones are changing!
But they tell me that they are too young for hormone problems! How can this be? Well, perimenopause starts about 10 – 15 years before menopause. Today, women in their 30′s are extremely busy with children, running a household, working outside of the home and still trying to look and feel good. They don’t have time for these hormone imbalances!
Not only are these hormone imbalances causing you to feel bad they are vital to your long term health and prevention of illness.
So if any of this is sounding like you, what do you do? You need to get your hormone levels checked. The two most common hormone imbalances during this time are called estrogen dominance and adrenal fatigue. Let’s talk about estrogen dominance. What’s happening is that your body has more estrogen in relation to progesterone. Progesterone is the hormone of tranquility, calmness and sleep. It also helps protect against breast cancer. Adrenal health will be in my next blog.
You can ask your regular physician to check your hormones but most of them don’t have the proper training and expertise in hormones to understand and be able to treat you. A hormone expert like my colleagues and I at BodyLogicMD, will focus first and foremost on balancing your hormones with bioidentical hormone replacement therapy (BHRT). Once your hormones are balanced, you will see drastic improvements in all of your symptoms.
Your health begins with you. You are the CEO of your body. You are the one who ultimately needs to know and understand what’s going on inside your body. So take charge! Work on your diet and exercise and find the right physician for you that understands hormones and how to achieve wellness.
Have a healthy and balanced day!!
