The Latest Guidelines: Male Hormones | Part 1

Introduction

Hormones in the body control the organs and the entire body system, from the endocrine system to the body’s temperature. When hormones get out of balance, they can lead to chronic problems.   Over the last decade, many of our patients have asked great complex and insightful questions about hormone replacement therapies. We refer patients to skilled and qualified providers specialized in hormone wellness services.  To that end, and when appropriate, we advise our patients to refer to our associated medical providers based on their examination.  We find that education is the key to asking good questions to our providers. We provide this information as an educational service only. Disclaimer

What Is Hormone Replacement Therapy?

Hormone replacement therapy can help older males replenish testosterone hormone levels. Another thing that hormone replacement therapy can provide is that it can reduce the levels of androgens in the body to prolong the process of prostate cancer while also lowering adrenal gland over-production.

Low T: The Clinical Problem

Hypogonadism affects 30% of men aged 40-79

– A gradual, age-associated decline in serum total testosterone levels begins in men
in their mid-30s and continues at an average rate of 1.6% per year

• Symptoms
  – Fatigue / Cognitive function decline
  – Decreased libido
  – ED
  – Depression, irritability, decreased sense of well-being
  – Decreased muscle mass / increased body fat
  – Decreased bone mineral density

Pregnenolone

• Synthesized directly from cholesterol
  – Precursor to all other sex hormones
• Levels start to decline around age 30
• Functions to:
  – Enhance nerve transmission and memory
  – Improve energy and sleep
  – Increase stress resistance
  – Mood elevation– Reduce pain and inflammation
•  Deficiency associated with:
  – Depression
  – Fatigue
  – Inability to deal with stress
  – Insomnia
  – Lack of focus
  – Memory decline

Pregnenolone Dosing

• Pregnenolone SR to start at 10mg per day and
  titrate up slowly until you reach a blood level of 100
  which is optimal
• SR form more physiological
• Can cause agitation and anxiety if titrate too fast or if
  the dose is high for patient

Progesterone

• Made by the adrenal glands
• Precursor to androstenedione
• Levels start to decline in men around age 60
• Functions to balance estrogen
  – Inhibits aromatase and 5-alpha reductase
  – Antagonizes stimulatory effects of estrogen on the prostate gland
  and lowers PSA
  – Stimulates anti-tumor antigen, p53, to prevent prostate cancer

Progesterone Dosing

• In men, you start with 3-5mg topically daily
• Usually added to testosterone/Chrysin cream
  topically
• Can use capsule form if the patient has sleep
  issues. Dose range 5-15mg oral

DHEA

• Made by the adrenal glands
• The precursor to estrogen and testosterone
• Production declines with age
• Protective effect against:
  – Cancer, diabetes, obesity, high cholesterol, heart disease, and
  autoimmune diseases
• Symptoms of deficiency:
  – Decreased energy & muscle strength, difficulty dealing with stress,
  increase risk of infection, irritability, joint soreness, and weight gain

Actions of DHEA

• Prohormone for sex steroids
• Anti-glucocorticoid
• Immune supporting
• Anti-atherogenic lowers serum triglycerides
• Enhances insulin sensitivity; anti-obesity effect
• Maintains tissue strength and repair, supports bone density
• Neuroprotective; enhances memory
• Promotes a sense of well-being
• Libido enhancing

DHEA Dosing

Replacement linked with an improved libido, mood, erectile function

• Improves neural protection, especially when Cortisol is high
• Men need 25-50mg per day
• SR form is more physiological
• DHEA is a large molecule, and therefore, it is not well absorbed topically
• Side effects include oily skin, hirsutism, acne
• K-DHEA form can be used if concerned for cancer and want to bypass
  hormonal byproducts

Androstenedione

• Common precursor of male and female sex hormones
  – Converted to testosterone through 17?-hydroxysteroid
  dehydrogenase
  – Converted to estrogen through the aromatase
• Found in testes and adrenal glands
• Short half-life
• No reliable studies on benefits

Dihydrotestosterone (DHT)

• Most potent naturally occurring androgen
  – 3 times more potent than testosterone
• Synthesized from the conversion of testosterone
  through 5-alpha reductase
• Responsible for formation of male sex-specific
  characteristics and development of male genitalia and
  prostate
  – Low levels can affect sexual function and libido, muscle
  tone
• Elevated levels can cause:
  – Hirsutism
  – Male pattern baldness
  – BPH
  – Prostate cancer
• 25% secreted by testes, 75% from
  bioconversion from T in liver, kidney, muscle,
  prostate, and skin
• The blood concentration of DHT is 10% that of T but at least twice as potent due to increased affinity
  for androgen receptor; cannot be aromatized to
  estrogen
• Produced in utero is responsible for the development
  of male sex characteristics
• A primary contributing factor in androgenic
  alopecia, benign prostatic hypertrophy, hirsutism
  in women

Estradiol/Estrone

• Made in muscle, skin, and adipose tissue
• Adequate levels protect against bone fractures,
  and maintain cognitive function
• Excess associated with:
  – Gynecomastia
  – Decreased sex drive/erectile dysfunction
  – The doubled risk of stroke
  – Higher rates of heart attack, peripheral artery disease,
  and coronary atherosclerosis
  – Insulin resistance
  – Rheumatoid arthritis
  – BPH
  – Prostate cancer

Testosterone

Testosterone is the principal male hormone in males that are important for normal males’ sexual development and functions.

• Principal male hormone
• Anabolic steroid produced from cholesterol
• Primarily secreted in the testes and small amounts secreted
  from the adrenal glands
• Functions:
  – Anabolic effects: increased muscle mass, bone density, and
  bone maturation
  – Androgenic effects: development of sex organs, deepening
  of voice, hair growth

Factors Contributing to Testosterone Decline

Many factors can contribute to the decline in male testosterone levels in the body.

• AGE
• Diet and insulin resistance
• Stress levels/cortisol demand
• Toxin exposure
• Depression
• Insomnia
• Decreased muscle mass and strength
• Osteoporosis
• Decreased hair density
• Erectile dysfunction

Male Diminished Libido

•  Low Bioavailable Testosterone
  • Age-Related Testosterone Decline
    – (Leydig Cell Dies Every 4 Seconds)
  •  Obesity – Lowers Testosterone
  • Beta-Blockers, Statins, NSAIDs, SSRIs
  • High SHBG
    – Excess Prolactin
  • Inhibits Dopamine Release
  • Responsible for the Refractory Period

Andropause Contributes to Many Diseases

• Diabetes/Metabolic Syndrome
• Brain (Dementia, Alzheimer’s)
• Heart (MIbs)
• Frailty Syndrome/Sarcopenia
• Bone (Osteoporosis)
• Inflammation

Testosterone Decline

• Testosterone declines with age, beginning in the
  early 30bs
• By age 40, levels naturally decline by >1% per
  year
• Testosterone production declines due to:
  – Increasing SHBG
  – Decreasing LH
  – Decreased Leydig cell activity
• During the time between 25 to 75 years old:
  – 30% decrease in Total Testosterone
  – 50% decrease in Bioavailable Testosterone
• Half of the healthy men between the ages of 50-70 years will
  have a bioavailable testosterone level below the lowest
  level was seen in healthy men who are 20-40 years of age.

TD and Metabolic Syndrome

When the testosterone hormone levels are low in a male’s body, it can also cause the body to develop metabolic syndrome.

•  The increased risk of insulin resistance and
  metabolic syndrome is not due to changes in SHBG as the
  inverse relationship with low testosterone persists when
  looking at free T
• Weight loss improves levels of both free and
  total T proportionate to the amount of weight
  loss
• TD is associated with weight gain; weight loss
  improves T levels
• ADT is associated with increased BMI and
  decreased lean body mass (compared to men
  who had surgery and no ADT for prostate cancer)

Things That Can Increase Insulin

• High carbohydrate diet
• Increased stress
• Decreased estrogens
• Increased testosterone
• Insomnia
• Increased DHEA
• Decreased thyroid hormone
• Excessive progesterone
• Lack of exercise
• High chronic stress causes low DHEA and low testosterone
• Cortisol will act as an anti-testosterone in the body

Conclusion

All in all, the effects of a healthy male’s hormone levels can be affected when the body is not taken care of or due to natural causes. Low testosterone levels can cause prolonged effects like metabolic syndrome and insulin resistance. By combining a healthy diet and regular exercise can help the body achieve its overall wellness.

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