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Testosterone - Men's stuff

The male essence you might say is testosterone. But remember that male bodies also carry significant amounts of oestrogen. Since we don't really understand why it's there, the boffins have tended to say it's unimportant. But when I was a medical student they said that about the thymus gland ­ we now know it is one of the most important organs in the body and regulates T-cells (T for thymus!).

Similarly, women have traces of testosterone. Amongst other things, it drives their libido, so it's pretty important to us guys.

Testosterone gets a bad press. It's supposed to make us harsh, aggressive and insensitive. I'm sure it does ­ in excess. But lack of it leads to torpor, depression and negativity. That's not having a "feminine side"; it's sickness. The fact is, we need testosterone.

Not the least because it protects us from heart disease. For years the stupid myth was that since women have fewer heart attacks, testosterone causes cardiovascular disease. Probably it raises blood pressure, because it makes men energetic and goal driven; that's stress, right?

Another example of scientific bovine excrement. One day, somebody got to wondering if this myth is actually true. He studied the testosterone levels of men lying in intensive care units, having suffered stroke or a coronary infarction. What was found was that men with cardiovascular problems had far lower levels of testosterone than average, not higher. It emerged that testosterone actually protects from heart disease; totally the opposite of what "science" had said. Incidentally, that's true also for women. When their testosterone levels drop later in life, they eventually assume a similar risk to males.

Testosterone also generates strength and stamina. It regulates youthful protein synthesis, lowers cholesterol, reduces blood sugar levels and fortifies bone density. Dr Eugene Shippen MD, author of The Testosterone Syndrome, points out that this is not just a "sex hormone". Testosterone is a whole body hormone.

So we need that stuff. Enough to feel good, to protect our arteries and live longer; but not enough to make us road freaks and intolerant bullies, right! Otherwise, lacking it, we slide into a male equivalent of the menopause, which has been dubbed the andropause. Characteristically the man begins to loose energy and drive; depression, demotivation and loss of libido follow. Physical decay is soon part of the picture. It's bad news for the wife or partner. Men are hard to live with even when they feel good about themselves; it's ten times worse when their virility deserts them!

A word of enlightenment: it is important to recognize there are two phenomena which can strike a man, at about the same age, the andropause and the so-called mid-life crisis. They are not the same, though they can become inextricably mixed. The mid-life crisis is more of a psychological slump: it is a time of questioning and a looming sense of failure that might strike a man who hasn't yet achieved the things he dreamed of when younger. Possibly a shattered marriage or relationship and the impending sense of being over the hill career-wise adds to the picture of gloom. This too will lead to depression, demotivation and a sharp fall off in sex drive. So the two effects may looks similar.

The important difference is that one is caused by drop in testosterone and the other is brought on by dissatisfaction with life goals. They have different causes and therefore different treatment modalities. If there is any real doubt, after consultation with a knowledgeable physician, blood levels of free and bound testosterone will usually settle the matter.

Supplementing testosterone has been around for a surprisingly long time. Pioneer work by Dr Tiberius Reiter and his followers in the 1950s showed dramatic results. As a result there were queues of men outside his door and scientific orthodoxy, typically, ignored the new breakthrough in healing. The know-alls went on decrying the idea of such a thing as the andropause (the majority still do), When the drug industry finally got into the act the result was a disaster. True-to-form, a synthetic patentable analogue of natural testosterone, called methyl testosterone, was brought onto the market. It worked allright but caused a lot of cancers. As a result, testosterone supplementation was discredited and even today ignorant reactionaries cite this tale with dire prognostications. So not only is there no such thing as an andropause but apparently treating it will probably kill you anyway!

It's a double whammy of yesterday's pseudo-science. For optimum health, you must move with the times.

The fact is there are safe ways to supplement testosterone these days; Restandol or testosterone undecoanate is one (curiously, methyl testosterone is still licensed in the US by the FDA). Capsules, patches and implants are available, each with relative merits and problems. If you are hesitant, take only the natural testosterone molecule and avoid any modified patented compounds. At the clinic we supply a gel formulated from pure natural testosterone, just as nature makes it.

2008 lastest testosterone study and comment.

The study, published in JAMA, enrolled 237 healthy men aged 60 to 80. All men had a testosterone level below 13.7 nmol/L (rather low). The men were randomly assigned to be either in a group that received a twice daily oral 80 mg testosterone supplement or a placebo. The researchers measured hand strength, time to stand/sit, cognitive functioning (how well your brain is working), bone density, body composition, cholesterol, insulin, quality of life and other factors.

Bone densitiy, metabolic and quality-of-life measures were no different except for one hormone-related quality-of-life measure that improved.

If you read the skeptics, they say there was no real difference in the groups. Yet there was, definitely! For one thing, the testosterone group had a significant improvement in lean body mass. Also their insulin resistance lessened. These are both factors which we know for sure increase longevity (hundreds of supporting studies)

Paradoxically, 47.8% in the testosterone group vs 35.5% in the placebo group developed the metabolic syndrome (P = .07). Since one of the definitions of metabolic syndrome is insulin resistance and one of its measures is LOSS OF LEAN BODY MASS, one can say the results are paradoxical and therefore the study pretty worthless.

No negative effects on prostate safety were detected, which is good and puts paid to the usual squawking argument that testosterone is DANGEROUS and increases the risk of prostate cancer etc etc.

[Ref: Marielle H. Emmelot-Vonk, MD; Harald J. J. Verhaar, MD, PhD; Hamid R. Nakhai Pour, MD, PhD; André Aleman, PhD; Tycho M. T. W. Lock, MD; J. L. H. Ruud Bosch, MD, PhD; Diederick E. Grobbee, MD, PhD; Yvonne T. van der Schouw, PhD. Effect of Testosterone Supplementation on Functional Mobility, Cognition, and Other Parameters in Older Men A Randomized Controlled Trial. JAMA. 2008;299(1):39-52.]

CAUTION aromataze

The picture isn't quite as simple as a sounds. This is due to the fact that some testosterone is converted into an unwanted oestrogen form, by an enzyme called aromataze. More so in later life. A 59-year old man has, on average, more estrogen then a 59-year old woman.

It is this male oestrogen or xeno-oestrogen (measured as sex hormone binding globulin or SHBG) which leads to prostatic enlargement and NOT testosterone itself, as you may have been led to believe. Male oestrogen also adds to the risk of heart disease.

Dosing is therefore not a matter for self-treatment. Blood tests are required to learn the existing levels of SHBG. If it's high, this tricks the pituitary and interferes with the secretion of LH (luteinising hormone), which then scores low. LH is meant to stimulate the testes to secrete testosterone. If LH is high and testosterone low, the regulation pathway is probably OK but the testes are not responding to the signal.

We also need to block the aromataze pathway, to prevent the convertion into male xeno-oestrogen, which is otherwise bad news. Failure to grasp the importance of this side path is the chief reason for ineffective and mis-managed male hormone supplementation. Even if you are not contemplating testosterone supplements, this build up of male ostreogen can put you in danger, through heart disease and through prostate cancer. At the very least you will tend to feminize, as older men do.

Known antagonists of aromataze are saw palmetto and zinc. If you are supplementing testosterone, you MUST take at least 300 mgm of saw palmetto and 50 mgm of zinc daily. Saw palmetto may also block metabolism of testosterone to androstenedione, another potent androgen which has been implicated in prostate disease. Also good news is that plants in the crucifer family (cabbage, kale, brocolli and brussel sprouts) contain large amounts of an oestrogen antagonist called indole-3-carbinol, I3C for short. This has been shown to be very helpful against women's hormone dependent cancers, such as breast and cervical cancers. We men can benefit from the same breakthrough. Eat plenty from this group.

Chrysin (passion flower), available as capsules or cream also has a definite beneficial effect in this context. Avena sativa (oats) is also said by some to increase free testosterone.

If the SHBG cannot be brought down to safe levels, it may be wise to consider a drug called Arimidex (anastrozole). It is prescribed to breast cancer patients, to eliminate the oestrogen problem. For a male using it in this way, the correct dose is no more than 0.5 mgm 2- 3 times a week. Obviously, this is a prescription-only matter.

Arimidex is NOT used routinely with testosterone supplements.

Vitamin K and Prostate

This is much more important than most doctors recognize. An EPIC study at Heidelberg (it really was an epic: 11,000 men over an average of 8.6 years) showed conclusively that vitamin K gives critical protection against prostate cancer. It showed that K1, the plant derivative, was not helpful but K2, menaquinone as it's known, did the job well. K2 lasts far longer in the body.

Moreover K2 is known to protect our arteries and be helpful in preventing osteoporosis.

The current recommended intake of vitamin K in Japan is 55 mcg for women and 65 mcg per day for men. In the US and Canada it is 120 mcg per day for men and 90 mcg per day for women. These figures are disastrously low (as usual) and need to be at least tripled. I repeat K1 will just NOT do the job.

Take 300 mcg daily, minimum of you are a man (or woman) over 55.

CAUTION: Do not use external applications of testosterone if you have physical contact with children: there is a case on record of a male child going into premature puberty through contact with testosterone cream on his father's body. Do not use testosterone if you have a raised PSA or known prostate cancer.


As a medical student, I heard male patients being told "If you get a cancer, choose the prostate". This tumour is a very slow killer and survival for 20 or more years, even without treatment, is not unusual. Many men die of something else, without ever realizing they had an invader, munching away slowly!

Nevertheless, that's a pretty stupid reason to accept it when cancer of the prostate is among the most preventable of all malignancies. It's appearance is all but confined to later years in life and the cause, apart from the general causes of malignancy (DNA decay, nutritional factors and chemical carcinogens), is the steady build up of male oestrogen. This leads first to benign prostatic hypertrophy (BPH) and sometimes then on to cancerous growth.

Prostate specific antigen (PSA) is the usual screening test but hardly a gold standard. It may be negative in the presence of cancer and may be positive when there is none. Nevertheless, to not have regular PSA checks from middle-age onwards is walking blind. Checks are mandatory as a preliminary to supplementing either growth hormone or testosterone on an anti-ageing programme.

Where there is clear enlargement of the gland and a problem SHBG level, it is vital to raise free testosterone (as opposed to bound testosterone) as a protection and at the same time block the conversion to oestrogen. Saw palmetto and zinc are given, as above. While restoring testosterone levels to a normal healthy level (25- 40 pg/mL) does not cause prostate cancer, it has been suggested that it may induce faster growth in an existing tumour. However a study from Santa Barbara in California showed that testosterone actually killed the tumour cells. That's more in keeping with the physiology outlined here.

Skullcap (Scutellaria baicalensis)

A better idea is Chinese skullcap. It has been shown to block the effect of the enzyme 5 alpha-reductase. This is the one that creates dihydrotestosterone (DHT), the “male estrogen”, which is strongly associated with the development of prostate enlargement (benign prostatic hyperplasia) and prostate cancer.


The male prostate is an estrogen-sensitive organ. Yet men accumulate estrogens as they age, as I said above.

A good tip to block those estrogen receptors is to take the new wonder herb from Thailand: Pueraria mirifica. We call this HRT - meaning "herbal remedy from Thailand"!

Miroestrol, the active ingredient in Pueraria mirifica has a stronger affinity for estrogen receptors than estrogen itself and 3000 times more than soy isoflavones. It is so powerful that the region in Thailand where it is grown has the lowest incidence of breast cancer in the world.

What's the point? To block those receptors by having them bound by miroestrol. It has other great anti-aging properties too:

  • Serves as an anti-wrinkle agent for aged and wrinkled skin
  • Darkens white hair, and increase hair growth
  • Helps with memory loss
  • Increases energy and vigor, more reflexive bodily movements
  • Alleviates sleep disorders

Men should take 80 mgms a day (half the female dose). Beware of fake Pueraria. Almost everybody is claiming to have it - even China. These are the wrong Pueraria. The only safe source I know of, guaranteed the real plant, is from Their product is "Beyond HRT".

However Pueraria does not take the place of good diet, exercise, cutting down on alcohol and losing plenty of weight.

In addition, men are urged to consider:

Zinc, at least 15 mgms daily. Increases testosterone levels.

Chrysin (from the passion flower), which is well known to inhibit an enzyme called aromatase (Kellis JT Jr et al 1984). Aromatse converts testerone to male estrogen. Bodybuilders have used chrysin as a testosterone-boosting supplement because, by inhibiting the aromatase enzyme, less testosterone is converted into estrogen (our state governor Arnie can’t be wrong – can he?).

Carnitine. Both testosterone and carnitine improve sexual desire, sexual satisfaction, and nocturnal penile tumescence, but carnitine is more effective than testosterone in improving erectile function, nocturnal penile tumescence, orgasm, and general sexual well-being. Carnitine was better than testosterone at treating depression (Cavallini G et al 2004)

Cruciferous vegetables. Cruciferous vegetables, such as broccoli and cauliflower, contain isothiocyanates and glucosinolates, which act as antioxidants and potent inducers of phase 2 proteins believed to suppress prostate cancer formation (Kris-Etherton PM et al 2002; Talalay P et al 2001).

One extra tidbit, before we close: In males, estrogen is present in low concentrations in blood, but can be extraordinarily high in semen and as high as 250 picograms/ml in testicular fluids, which is higher than serum estradiol in the female.

see also this page: Pueraria mirifica for details of a gum you can chew.


Men could reduce their risk of developing prostate cancer through regular masturbation, researchers suggest. BBC News Site, 16 July, 2003, 23:11

They say cancer-causing chemicals could build up in the prostate if men do not ejaculate regularly.

And they say sexual intercourse may not have the same protective effect because of the possibility of contracting a sexually transmitted infection, which could increase men's cancer risk.

Australian researchers questioned over 1,000 men who had developed prostate cancer and 1,250 who had not about their sexual habits.

They found those who had ejaculated the most between the ages of 20 and 50 were the least likely to develop the cancer. The protective effect was greatest while the men were in their 20s.

Men who ejaculated more than five times a week were a third less likely to develop prostate cancer later in life.

Fluid emission could be the key

Previous research has suggested that a high number of sexual partners or a high level of sexual activity increased a man's risk of developing prostate cancer by up to 40%.

But the Australian researchers who carried out this study suggest the early work missed the protective effect of ejaculation because it focussed on sexual intercourse, with its associated risk of STIs.

Graham Giles, of the Cancer Council Victoria in Melbourne, who led the research team, told New Scientist: "Had we been able to remove ejaculations associated with sexual intercourse, there should have been an even stronger protective effect of ejaculations."

The researchers suggest that ejaculating may prevent carcinogens accumulating in the prostate gland.

The prostate provides a fluid into semen during ejaculation that activates sperm and prevents them sticking together.

The fluid has high concentrations of substances including potassium, zinc, fructose and citric acid, which are drawn from the bloodstream.

But animal studies have shown carcinogens such as 3-methylchloranthrene, found in cigarette smoke, are also concentrated in the prostate.

'Flushing out'

Dr Giles said fewer ejaculations may mean the carcinogens build up.

"It's a prostatic stagnation hypothesis. The more you flush the ducts out, the less there is to hang around and damage the cells that line them."

A similar connection has been found between breast cancer and breastfeeding, where lactating appeared to "flush out" carcinogens, reduce a woman's risk of the disease, New Scientist reports.

Another theory put forward by the researchers is that ejaculation may induce prostate glands to mature fully, making them less susceptible to carcinogens.

Dr Chris Hiley, head of policy and research at the UK's Prostate Cancer Charity, told BBC News Online: "This is a plausible theory."

She added: "In the same way the human papillomavirus has been linked to cervical cancer, there is a suggestion that bits of prostate cancer may be related to a sexually transmitted infection earlier in life."

Anthony Smith, deputy director of the Australian Research Centre in Sex, Health and Society at La Trobe University in Melbourne, said the research could affect the kind of lifestyle advice doctors give to patients.

"Masturbation is part of people's sexual repertoire.

"If these findings hold up, then it's perfectly reasonable that men should be encouraged to masturbate," he said.

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