Archive for the ‘Men’s Health’ Category

What’s Up With Testosterone Replacement?

It’s no longer a secret that an adult man’s testosterone levels will decline with age.  This natural process, called male menopause or andropause, has gotten recent press with the advent of erectile dysfunction drugs like Viagra and Proscar.  The billions of dollars these drugs have generated for pharmaceutical companies demonstrates that men are clearly looking for a boost in their sexual prowess as they age.  But, as usual, these drugs are focused on treating the symptom and not the cause.

It is now widely accepted that bioidentical hormone replacement therapy (BHRT) is beneficial for women in the prevention of many age-related conditions like osteoporosis and heart disease.  BHRT has also been demonstrated to improve several quality of life factors as women go through menopause and it preserves mental acuity into later life.  Men do not have the cessation of menses as a physical marker to signify a transition into declining hormone levels, but nonetheless, they are going through a very similar process with testosterone as the dwindling culprit.  It therefore stands to reason that in select cases, men will benefit from BHRT with testosterone the same as women have benefitted from estrogen and/or progesterone.


In fact, research has shown that to be just the case.  Recent studies have shown energy, muscle mass, mood, cholesterol profiles, weight, mental acuity, and heart disease have all improved with normalizing testosterone levels in men who have tested low.  That’s not even mentioning the positive effects it has on both sexual function and libido, the latter of which does not improve with Viagra, Cialis, or Proscar.

Testing

There are two major problems with the way many practitioners test for testosterone.  Either they are testing the wrong type, they are only taking a snapshot, or (most commonly) they are taking a snapshot of the wrong type.  97% of total testosterone circulating in the blood is bound to proteins.  Once bound it becomes totally inactive and can no longer influence the body.  The remaining 3% of circulating testosterone is unbound or free testosterone.  This is the only form of testosterone that is active in the body and is therefore the only type that should be tested when suspecting a deficiency.

The other major flaw in testing has been to only look at one reading throughout the day.   Testosterone readings vary dramatically depending on what time of day it is tested.  A normal testosterone cycle peaks at mid-morning then again in the late afternoon and again between 3-5am (when it is at its highest for the day).  It is therefore best to take multiple readings throughout the day with saliva samples or with a twenty-four hour urine collection to get an accurate portrayal of a man’s free hormone production.

Treatment

Although natural testosterone has been proven far safer, cheaper, and more beneficial than synthetic attempts to resemble it, the pharmaceutical industry markets and influences many practitioners to use injectable products called testosterone esters (t. propionate, t. cypionate, etc.).  These injectable drugs mimic natural testosterone but have had their molecular structure altered so that they will last longer and (more importantly) so that they can be patented and lead to greater profits.

Injectable testosterone esters pose a few problems.  First, they do not follow the natural daily cycle as mentioned above.  Instead, they are injected once a week or every two weeks causing a huge spike one day and then a gradual decline until the man is deficient for the days leading up to his next injection.  This method greatly disturbs the other hormones in the body that respond to testosterone via feedback signaling.  Also predictably, it results in huge swings in mood, libido, etc.

As a better option for most men, natural testosterone is taken as a sublingual tablet or is applied as a cream or gel multiple times a day in an attempt to follow the normal daily cycle.  It is usually isolated from plants, either soy or Mexican yam.  Because it is an exact replica of the testosterone molecule naturally made by the body it is not patentable and is therefore cheaper.  The body is able to process it as if it was produced from within the body and it does not adversely affect other hormones.

Summary

To improve sexual function and the other diverse aspects of men’s health known to deteriorate with age, natural testosterone along with healthy diet, specific vitamins, herbs, and a healthy lifestyle are demonstrably more effective and safer than synthetic hormones and pharmaceutical drugs.  Used in doses to match levels present in a healthy man and on a schedule that closely follows the naturally occurring daily cycle, natural testosterone has been shown to improve sex drive, improve ability to achieve and sustain erections, protect against heart disease, increase energy, build stronger bones and muscles, relieve depression, improve cholesterol ratio’s, reduce weight, and prevent age-related losses in mental acuity.

Ryan Sweeney, NMD

Naturopathic Medical Doctor

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Hypothyroidism: How To Feel Happy, Healthy, and Energetic

Hypothyroidism

The thyroid gland controls metabolic rate and is the energy powerhouse of every cell in your body.  Proper thyroid function influences digestion, circulation, brain chemistry, skin quality, energy, and much more.  Think of thyroid hormone essentially being the gas pedal that drives metabolism.  If that gas pedal eases off, it slows down the function of your whole body.

Approximately 30 million women and 15 million men in this country have been diagnosed with hypothyroidism, a condition in which the thyroid gland does not produce enough thyroid hormone.  Common symptoms of hypothyroidism include fatigue, weight gain, poor memory, difficulty concentrating, constipation, low libido, intolerance to cold, dry skin, hair loss, depression, gynecologic issues, cardiovascular conditions, skin problems, and lots more.

There are several theories as to why hypothyroidism is so prevalent.  Potential contributing factors include environmental toxins like Bisphenol A (BPA) from plastics, heavy metals like mercury and lead, living in our fast-paced high stress society, and pesticides and fungicides in our food supply.

Subclinical Hypothyroidism

Currently, the most accurate way to diagnose hypothyroidism is to measure the amount of thyroid stimulating hormone (TSH) in the blood.  For overt cases of hypothyroidism the TSH is a reliable test.  The problem with this test however is that it does not identify people in the grey area with less pronounced disease.  Hypothyroidism is not a condition of you either have it or you don’t.  Many people have an under-functioning thyroid gland with many symptoms of hypothyroidism but their lab tests come back normal.  We classify these people as having “subclinical hypothyroidism.”  In my experience, people experiencing hypothyroid symptoms with a TSH between 3.0 and 5.0 (within the normal range) often profoundly benefit from thyroid treatment.

Hashimoto’s

Hashimoto’s Thyroiditis is the most common cause of overt hypothyroidism.  It is an autoimmune condition where the body’s own immune system is attacking the thyroid gland and through this destruction, causes a decrease in thyroid hormone production.

Anyone newly diagnosed with hypothyroidism should be screened for Hashimoto’s with a simple blood test looking for thyroid peroxidase antibodies (TPO) and thyroglobulin antibodies.  If you have Hashimoto’s make sure your physician is working with you to not only replace your thyroid hormone, but also to decrease your thyroid antibodies.

Treatment Options

To understand your treatment options for hypothyroidism you must first understand how thyroid hormone works in the body.  T4 is the less active thyroid hormone and constitutes the majority of thyroid gland secretion.  As T4 circulates throughout the body it is converted to T3, the more active form of thyroid hormone which drives metabolism.  Along with T4, the thyroid gland also secretes some T3 as well as the less recognized hormones T1 and T2.

The most widely used treatment for hypothyroidism is replacement with synthetic T4 hormone.  Some people do fine on this replacement and never need another option.  Others will see their labs normalize, but they do not feel significant improvement in their symptoms.  I have found the majority of these people will feel much better with desiccated thyroid hormone that contains 80% T4 and 20% T3 as well as trace amounts of T1 and T2.

Conclusions

If you are experiencing fatigue, brain fog, difficulty losing weight, or other symptoms of hypothyroidism and your thyroid labs have always been within the normal range, you may have “subclinical hypothyroidism.”

If you are taking synthetic thyroid replacement but still do not feel well, you may benefit from a trial of dessicated (natural) thyroid hormone which contains all four thyroid hormones instead of just T4.

Hashimoto’s is a very common cause of hypothyroidism and can sometimes be overlooked in the initial work-up of hypothyroidism.  If you are hypothyroid make sure your physician has tested for thyroid antibodies.  If you have Hashimoto’s make sure your physician is working with you to decrease your autoimmune response as well as treat your low thyroid function.

In Health,

Dr. Ryan Sweeney

Naturopathic Medical Doctor at Root Natural Health, Flagstaff, Arizona

Preventing Heart Disease- Beyond Cholesterol

Heart disease is the number one cause of death in the United States.  There is a growing body of research demonstrating that cholesterol levels are no longer the best indicator of a person’s risk for a heart attack or stroke.  In fact, half of the people who suffer a heart attack have completely normal cholesterol levels.  Recent studies have shown that lowering cholesterol alone had no benefit on preventing a person’s first heart attack or stroke.  Medical research is showing that far better indicators for risk of heart attack or stroke are oxidative stress, size of lipid particles, and inflammation status.

Cholesterol

Cholesterol plays several important roles in the body.  It is the backbone of all steroid hormones including testosterone, estrogen, cortisol, and vitamin D which are responsible for blood sugar regulation, mineral balance, blood pressure regulation, libido, and much more.  Cholesterol is a component of bile salts which help us to properly digest fats and it’s role in the brain makes it vital for learning and memory.  Cholesterol is the major component of the cell wall and is responsible for maintaining the integrity of every cell in the body.  It is so vital for health that every cell in the body has the ability to produce cholesterol and we could not survive without it.

Eighty percent of the cholesterol in your blood was actually produced by your own body,  the other twenty percent comes from the diet.  As more cholesterol is consumed in the diet, the body makes less.  Studies have actually shown very little correlation between the amount of cholesterol consumed in the diet and blood cholesterol levels because of this regulatory system.

That is not to say that eating an unhealthy diet full of greasy burgers and french fries will not lead to heart disease, quite the contrary.  But the cause is not about the amount of cholesterol so much as how these foods effect blood sugar regulation, fat deposition, inflammation, lipid particle size, and oxidization of fats.

Oxidative Stress

When oxygen is processed by the body, reactive oxygen species (free radicals) are formed.  Under healthy conditions, the body neutralizes the majority of these metabolites with circulating antioxidants.  When there is not a sufficient quantity of antioxidants available to limit oxidative damage, reactive oxygen species can cause damage to local tissues.  In the cardiovascular system this is especially important because when vessels are damaged plaques can form leading to atherosclerosis and heart disease.

Methods of reducing oxidative stress include eating a colorful whole foods diet, reducing inflammatory substances like trans-fats, cigarettes, alcohol and sugar and, when necessary, taking antioxidant supplements.

Size of Lipid Particles

Low Density Lipoproteins (LDL) are often referred to as the “bad cholesterol.” Under oxidative or inflammatory conditions, LDL particles can embed into vessel walls and form plaques that lead to heart disease.  Gathering evidence is demonstrating that assessing the size of LDL particles is a far better predictor for heart disease than the shear amount of LDL in the blood.  Smaller denser LDL particles have been strongly correlated with heart disease risk where larger “fluffier” LDL particles are not.  Two people with the same LDL levels can have much different risks of developing atherosclerosis depending if their LDL particles are small and dense or large and fluffy.

Inflammation

Inflammation is the body’s attempt to repair.  Think about what the healing process looks like when you cut yourself.  The skin gets red around the cut and slowly over time lays down new tissue until eventually the wound is closed and healed.  The same process happens when internal organs experience injury from extraneous sources.  A poor diet, chronic stress, smoking, inactivity, and poorly controlled blood sugar are just a few sources of chronic inflammation and repair deficit which greatly increase the chance of developing atherosclerosis and heart disease.

Summary

Anyone still taking a cholesterol lowering drug should discuss with their doctor whether it is still appropriate given the lack of evidence to support the efficacy of these drugs in preventing first time cardiovascular events.

The following tests can help determine individual risk of heart attack or stroke with better predictive value than cholesterol alone:  CRP-hs (inflammation), Homocysteine (detoxification and methylation), Oxidized HDL and LDL, and LDL Subfractions (lipid particle size).

References

1. Austin MA, Breslow JL, Hennekens CH, Buring JE, Willet WC, Krauss RM. Low-density lipoprotein sublass patterns and risk of myocardial infarction. JAMA 1988;260(13):1917-21.

2. Ridker PM et al. N Engl J Med. 2002;347:1557-1565.

3. Libby P. Inflammation and cardiovascular disease mechanisms. Am J Clin Nutr. 2006;83(suppl):456S-60S.

4. J Korean Med Sci 2009; 24 (Suppl 1): S115-S120

5. G Ital Cardiol (Rome). 2007 Jun;8(6):327-34. [High sensitivity of C-reactive protein in primary prevention]. Dipartimento di Medicina Interna, Malattie Cardiovascolari e Nefrourologiche, U.O.C. di Cardiologia, Cattedra di Malattie Cardiovascolari, A.O.U.P. Paolo Giaccone, Palermo.

6. Fernandez ML. Dietary cholesterol provided by eggs and plasma lipoproteins in healthy populations. Curr Opin Clin Nutr Metab Care. 2006; 9(1): 8-12.

7. New York Times, “Drug Has No Benefit in Trial, Makers Say,” January 14, 2008

8. New York Times, “Cardiologists Question Delay of Data on 2 Drugs,” November 21, 2007

9. BusinessWeek.com, “Do Cholesterol Drugs Do Any Good?” January 17, 2008

Screening Prostate Specific Antigen (PSA) Causes More Risk than Benefit

Prostate specific antigen (PSA) is a protein measured in the blood that is produced by the prostate gland. It is used as a marker for the early detection of prostate cancer.  Currently the American Cancer Society recommends all men to begin screening their PSA at age 50 with annual tests thereafter.  Since the implementation of this screening protocol, the number of men who unnecessarily undergo invasive diagnostic and treatment procedures, including radical prostatectomy (complete removal of the prostate), has increased dramatically.

To understand why this test causes more harm than good, when used alone as a general screening guideline, we must first establish that there are aggressive and non-aggressive forms of prostate cancer.  Aggressive prostate cancer was responsible for approximately 32,000 deaths in the U.S. in 2010, making it the second most common cause of cancer related deaths in U.S. men second only to lung cancer.  Localized prostate cancer (also known as benign or slow growing cancer) is far more common.  Research has shown localized prostate cancer is present in approximately 8% of men in their twenties and 83% of men in their seventies.1

The PSA test does not differentiate between these two types of cancer.  Neither does it differentiate from other very common prostate conditions like Prostatitis or Benign Prostatic Hyperplasia (BPH) which is found in 50% of men over age fifty and 80% of men over age eighty.2 It is very common for a man with normal enlargement of his prostate to have an elevated PSA that warrants further investigation like an invasive biopsy.

One study published in the New England Journal of Medicine in 2010 demonstrated that for every one case of diagnosed aggressive prostate cancer 1,410 men will undergo prostatic biopsy and 48 will have additional invasive treatments (radiation, chemotherapy, or prostatectomy).3 Common side effects associated with these invasive procedures that up to 50% of patients will experience include urinary incontinence, erectile dysfunction, and bowel problems.4 Clearly this is a case where the risks far exceed the benefits.

A series of large clinical trials in 2003 came to the conclusion that “serum PSA between 2.5 and 10 ng/ml is unrelated to prostate cancer and is most surely caused by benign prostatic hyperplasia.”5 Despite these conclusions, the current screening guidelines and many urologists will still recommend prostate biopsy with a PSA > 4 ng/ml.

There is no single alternative for the screening PSA test.  Each man must work with his physician to decide what is appropriate given his risk factors.  As a minimum, I recommend that my patients have annual digital rectal exams (DRE) starting at age 50, preferably following up with same doctor every year thereafter so that doctor can recognize changes.  If they have a family history of aggressive prostate cancer, I would start screening at age 45.

A transrectal ultrasound can reliably determine the volume of the prostate and help the clinician make a more informed decision about whether a biopsy is necessary.  A larger prostate as demonstrated by ultrasound could be expected to correlate with a higher PSA whereas a smaller prostate should expect to have a lower PSA.  A smaller prostate correlating with a higher PSA value is a good candidate for biopsy whereas a larger prostate with the same PSA value may not be.

Other analytical tools that have shown some promising initial results are a free to total PSA ratio, PSA velocity, and a urine PCA-3 test.  The urinary PCA-3 test has a much higher specificity for prostate cancer than do the related PSA tests.  It is not affected by BPH or prostatitis, so a higher result can help the patient determine their need for biopsy much more confidently than with PSA alone.

For my patients with prostate issues, I will generally recommend dietary modifications along with a healthy exercise regimen and stress reduction.  I also utilize a variety of herbs and nutritional supplements aimed at supporting the immune system to target potential cancer cells and decrease the growth rate of the prostate.

While PSA may be prostate specific, it is not disease specific.  Most elevated PSA does not result in aggressive prostate cancer.  As with all important medical decisions, a clinician should take into account the individual patient’s history, risk factors, and their overall health status.  No single lab value should determine the course of care recommended by the physician.  This ideal is especially true when considering a screening PSA.

In Health,

Dr. Ryan Sweeney, Naturopathic Physician at Root Natural Health, Flagstaff Arizona

  1. Stamey TA (2003) “Editorial: More information on prostate specific antigen and prostate cancer” J Urol 170, 457Ð458, August 2003
  2. Data from Berry, SJ, Coffey, DS, Walsh, PC, et al. The development of human benign prostatic hyperplasia with age. J Urol 1984;132:474.
  3. Schröder FH, Hugosson J, Roobol MJ, et al. Screening and prostate-cancer mortality in a randomized European study. N Engl J Med 2009;360:1320-8.
  4. Stanford JL, Ziding F, Hamilton AS, et al. Urinary and sexual function after radical prostatectomy for clinically localized prostate cancer. JAMA 2000;283:354-360
  5. Stamey TA (2002) “Limitations of serum PSA below 10 to 12 ng./ml” AUA News 7:31.