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Male Hormone Restoration - Testosterone, Estrogen, Prostate - Life Extension Health Concern
The significance of testosterone for male sexual function is apparent to most Life Extension customers. New insights, however, underscore the critical role testosterone plays in maintaining youthful neurological structure, alleviating depression, as well as inducing fat loss in those who are unable to reduce body weight regardless of diet and exercise.
Restoring testosterone to youthful ranges in middle-aged, obese men resulted in an increase in insulin sensitivity as well as a reduction in total cholesterol, fat mass, waist circumference and pro-inflammatory cytokines associated with atherosclerosis, diabetes, and the metabolic syndrome Kapoor et al , Malkin et al , Heufelder et al Testosterone therapy also significantly improved erectile function Fukui and improved functional capacity, or the ability to perform physical activity without severe duress, in men with heart failure Malkin et al Dehydroepiandrosterone DHEA is a hormone produced from cholesterol that then follows one of two pathways, both involving two-step enzymatic conversions, to yield either estrogens or testosterone.
Thus, levels of DHEA can have a role in determining levels of estrogen and testosterone, though DHEA alone is seldom enough to sufficiently restore testosterone levels in aging men. One of the most important factors that affect testosterone levels and the ratio between testosterone and estrogen is the aromatase enzyme. Aromatase converts testosterone to estrogen, further depleting free testosterone levels and increasing estrogen levels.
Obesity and associated hyperinsulinemia suppress the action of luteinizing hormone LH in the testis, which can significantly reduce circulating testosterone levels Mah and Wittert , even in men under the age of 40 Goncharov et al In addition, increased belly fat mass has been correlated with increased aromatase levels Kalyani and Dobs In this cycle a low testosterone level results in increased abdominal fat, which in turn leads to increased aromatase activity.
This enhances the conversion of testosterone to estrogens, which further reduces testosterone and increases the tendency toward abdominal fat Cohen , Tishova and Kalinchenko Sex hormone-binding globulin SHBG: Morales et al Consequently, only albumin-bound testosterone and free testosterone constitute the bioavailable forms of testosterone, which are accessible to target tissues and carry out the actions of the essential hormone Morales et al Thus the bioavailability of testosterone is influenced by the level of SHBG.
Aging men experience both an increase in aromatase activity and an elevation in SHBG production. The net result is an increase in the ratio of estrogen to testosterone and a decrease in total and free testosterone levels Lapauw et al As will be discussed below, it is crucial that this skewed ratio be balanced.
The liver is responsible for removing excess estrogen and SHBG, and any decrease in liver function could exacerbate hormonal imbalances and compromise healthy testosterone levels. Thus it is important that aging men also strive for optimal liver function. The exact cause of the age-related reduction in testosterone levels is not known; it is probably the result of a combination of factors, including:. Body Composition and Inflammation: Testosterone affects fat cell metabolism and fat loss in several ways: All of these effects promote lean body mass and reduce fat mass Naharci et al , Saad et al Placebo-controlled trials have demonstrated both significant increases in lean body mass and decreases in fat mass after varying courses of testosterone treatment in older men.
In these studies, the greatest favorable changes in body composition were seen in participants with low baseline testosterone levels who received testosterone therapy for 12 months or longer Allen et al Emergent evidence suggests that maintaining youthful testosterone levels may help aging men avert a variety of inflammation-mediated disease, such as atherosclerosis and arthritis.
By powerfully suppressing the activity an enzyme called 5-lipoxygenase , testosterone calms a fundamental pro-inflammatory pathway involved in the synthesis of signaling molecules known as leukotrienes Pergola Leukotrienes are derivatives of the pro-inflammatory omega-6 fatty acid arachadonic acid; these molecules underlie much of the inflammatory development of asthma and bronchitis, and play a role in the pathology of cardiovascular disease and diabetes as well Parlapiano ; Riccioni Moreover, when compared to men who received a placebo control, men receiving testosterone replacement exhibited significant decreases in body weight, and BMI, and waist circumference Kalinchenko The reduction in waist circumference indicates that testosterone reduces fat accumulation around the trunk of the body; this is particularly important since central fat mass and is strongly associated with increased susceptibility to inflammatory diseases and mortality Coutinho Bone integrity rests upon a balance between bone formation and bone resorption, which is controlled by multiple factors - including levels of estrogen and testosterone Tok et al , Valimaki et al In a clinical trial, testosterone increased bone mineral density in elderly men Kenny et al Testosterone supplementation also has a positive effect on muscle metabolism and strength Herbst This positive effect is undiminished with age.
Key to aging well is an optimistic outlook on life and the ability to engage in social and physical activity. However, low levels of testosterone have been associated with depression and other psychological disorders Almeida et al To make matters worse for aging men, many conventional antidepressant medications suppress libido.
Some experts suggest that testosterone therapy might reduce the need for the antidepressant medications entirely Morley , Carnhan and Perry Furthermore, testosterone treatment often increases feelings of well-being Orengo et al Low testosterone levels have been shown to correlate with lower scores on various psychometric tests Moffat et al , and similar effects have been reported in men undergoing androgen male hormone -deprivation therapy for prostate cancer Salminen et al Testosterone also acts as an endogenous neuroprotective agent, able to support neuron integrity against a variety of toxic insults, including oxidative stress Ahlbom et al , Pike et al Testosterone improves neuron survival in brain regions vulnerable to neurodegenerative disease.
This may explain the association of low testosterone levels in men with neurodegenerative diseases Hogervorst et al , Ready et al Glucose and Lipid Metabolism: Testosterone also has been linked to metabolic function in the body.
Specifically, studies have found inverse associations between the severity of metabolic syndrome, a condition characterized by excess abdominal fat, high cholesterol and high blood pressure that predisposes one for cardiovascular disease, and low plasma testosterone Allan et al , Saad et al There also appears to be an inverse relationship between low testosterone levels and diabetes in men Saad and Gooren Men with diabetes have lower testosterone levels compared to men without a history of diabetes Stanworth and Jones While conventional thought has been that because more men die from heart attacks than women, the disparity must have something to do with testosterone.
However, research is pointing out that, in fact, the opposite may be true. Low levels of testosterone appear to be correlated with several cardiovascular risk factors, including atherogenic lipid profiles, insulin resistance, obesity, and a propensity to clot Jones et al In addition, recent research is showing a clear relationship between low testosterone levels and increased incidence of cardiovascular disease and mortality in men Malkin et al Compared to younger men, older males have much more estradiol a potent form of estrogen than free testosterone circulating in the body.
These rising estrogen and declining androgen levels are even more sharply defined in the prostate gland. Estrogen levels increase significantly in the prostate with age, and estrogen levels in prostate gland tissues rise even higher in men who have BPH Shibata Y et al ; Gann PH et al ; Krieg M et al An important study indicates that testosterone is beneficial for the prostate gland in the vast majority of cases.
In this study researchers looked at multiple parameters, including prostate volume, prostate-specific antigen PSA levels, and lower urinary tract symptoms in a group of men with low or low-normal testosterone levels Pechersky et al Of the men studied, responded favorably to testosterone treatment. Millions of aging men have the dual conditions of low testosterone and high cholesterol. Researchers at Life Extension have successfully treated high cholesterol levels through a program of bioidentical hormone replacement therapy.
Life Extension believes that most aging men would prefer not to accept the loss of youthful vigor as normal. Instead, we suggest that a more valid optimal level for all men would be in the upper one-third of the reference range used for men aged 21 to 49 years, and that any supplementation should aim to restore hormone levels to that range. When measuring testosterone levels, it is critical to determine the levels of both free and total testosterone to understand the cause of any observed symptoms of deficiency Khosla et al Because of difficulties with equipment standardization and inter-laboratory variability, it is recommended that physicians consistently use the same local laboratories and gain familiarity with the accuracy, precision and definition of normal values for the assays offered in their communities Morales et al It is also important to remember that blood levels of both free and total testosterone vary widely among individuals, making it difficult to establish a general baseline on which to prescribe a standardized treatment protocol.
However, levels are quite consistent within individuals, and thus it is important that men have multiple tests over time to determine trends and individual thresholds for treatment. Finally, during the initial testing, it is also imperative to test estrogen levels.
Compared to men in the balanced estrogen quintile, men in the highest quintile serum estradiol levels of Those in the lowest estradiol quintile serum estradiol levels under The men in the balanced quintile—with the fewest deaths—had serum estradiol levels between This is the ideal range that Life Extension has long recommended male customers strive for.
An epidemic problem we at Life Extension observe in aging male customers is insufficient free testosterone, i. Integrative physicians typically prescribe bioidentical testosterone creams available from compounding pharmacies. All forms of bioidentical testosterone have the same molecular structure and will increase free and total testosterone in the blood.
The major difference is that prepackaged versions could cost up to 10 times more per dose than compounded versions. Furthermore, prepackaged testosterone gels are sold only in a limited number of doses, whereas compounded testosterone can be formulated at virtually any dose the physician feels is clinically necessary and useful.
If a man opts for testosterone therapy available orally or as an injection, subcutaneous implant, topical cream, gel, or skin patch , he should keep several facts and precautions in mind Schaeffer et al , Cunningham and Toma This supplement should be taken in conjunction with a healthy diet and regular exercise program.
Individual results are not guaranteed and results may vary. The information provided on this site is for informational purposes only and is not intended as a substitute for advice from your physician or other health care professional or any information contained on or in any product label or packaging.
You should not use the information on this site for diagnosis or treatment of any health problem or for prescription of any medication or other treatment. You should consult with a healthcare professional before starting any diet, exercise or supplementation program, before taking any medication, or if you have or suspect you might have a health problem.
You should not stop taking any medication without first consulting your physician. These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease. Effects of Age-Related Decline in Testosterone Levels and Testosterone Therapy The exact cause of the age-related reduction in testosterone levels is not known; it is probably the result of a combination of factors, including: Increasing body fat especially belly fat, and therefore increasing aromatase activity Oxidative damage to tissues responsible for the production of testosterone Reduction in testicular testosterone synthesis Declining levels of precursor molecules, such as DHEA Nutritional status and liver function The consequences of declining testosterone levels are striking.
The Importance of Hormone Testing Millions of aging men have the dual conditions of low testosterone and high cholesterol. Using Hormone Replacement Wisely If a man opts for testosterone therapy available orally or as an injection, subcutaneous implant, topical cream, gel, or skin patch , he should keep several facts and precautions in mind Schaeffer et al , Cunningham and Toma Hormone replacement should not be initiated without comprehensive testing. The patterns and trends over time of multiple hormone levels, for instance free testosterone, total testosterone, and estrogen , determine the specific hormone replacements required.
It may not be safe to use large amounts of testosterone in any form without also using aromatase-inhibiting supplements or medications. Because of the risk of worsening prostate cancer, careful screening, including a digital rectal examination and prostate specific antigen PSA screening, must be done before starting any hormone replacement program. However, recent research indicates that low endogenous testosterone levels may present a greater risk for prostate cancer than higher levels Morgantaler , Rodman et al If a man already has prostate cancer, however, testosterone replacement should be delayed until the underlying cancer is eradicated.
A man contemplating hormone replacement, whether through a prescription or supplements, should work closely with a qualified physician to plan a rational treatment approach that includes continued monitoring and screening. Individuals vary, and hormone replacement can be a simple or complex process and often requires careful attention to signs and symptoms, as well as laboratory testing.