Benign Prostate Hyperplasia (BPH)

Getting old is not for sissies. No matter how good a life style we live now we still “Have to pay the piper” for the many past years we had a different life style. Hopefully we have evolved to a better, healthier life style but certain things still happen to us as it will to any older engine. For men, it is Benign Prostate Hyperplasia; an enlargement of the prostate.

Normally the prostate is the size of a walnut. But as men age the prostate enlarges and causes uncomfortable problems which is designated as BPH (Benign Prostate Hyperplasia): the urgency to “pee”, especially nocturia (the individual has to wake at night more then once to void (i.e. to urinate). This can leave him tired in the AM and maybe throughout the day especially since for some it is difficult to fall asleep immediately again. Besides the urgency to urinate there is the dribbling. This can be embarrassing if it is in the underwear or even coming through certain colored pants like khaki. It can limit the male to activities where he would be away from a bathroom. There is the slowing down of the stream so that he ends standing over a urinal for excessive time, often when there is a line behind him.

All the latter is because as the prostate increases in size it pinches the flow of urine from the bladder to the penis and not only causes the slow flow and dribbling but also stops the bladder from emptying on the first try. The latter can be just from the pinching or causing a backflow of some of the urine as if it was making a “U” turn. This leaves excess urine in the bladder which needs emptying sometimes soon after the first try or at least in the near future. This partially empty bladder leads to the uncomfortable feeling of urgency. This leads to the stress of feeling old, unmanly, loss of confidence for going to places where you have to sit for long periods of time like out to dinner or a movies. It can also increase the occurrence of urinary tract infections since the urine left in the bladder can be like stagnant swamp water to breed unwanted bacteria. This is specially true if the male does not want to frequently interrupt a meeting often to excuse himself to urinate.

In previous blogs and in my book I write a lot about the advantages of testosterone and enumerate the laboratory tests a male should undergo to check his testosterone levels and the hormones that are also necessary to check at the same time. Dihydrotestosterone (DHT) is a very strong testosterone – like hormone that derives from testosterone. This is especially true with very high levels of testosterone and/or with aging. In many cases I do not at first check the DHT unless I feel there are signs or symptoms that require the test. One of these is signs and symptoms of BPH. This is because DHT is believed to be a main causal factor for the enlargement of the prostate. Baldness is also attributed to DHT along with other evolutionary and DNA factors This does not mean that a man on testosterone needs to stop the advantages of it. There are many natural and pharmaceutical ways to interfere with this conversion of testosterone to block higher levels of DHT. Since we know the enzyme 5-alph reductase is what converts testosterone to DHT we can block this process either naturally or with pharmaceuticals.  I do not like to give medical treatments without seeing and examining a client but typically one can try combinations of saw palmetto, zinc with copper, pumpkin seed, beta sterols (which are plant steroids without the negative side effects),pygeum and a few other herbs. A good supplement for BPH will have most in one capsule. Remember each person is an individual so one does not always get the results wanted by following the instructions on the bottle. I usually recommend a loading dose higher then the bottle states. I may maintain this dose according to the results and then tweak them or let the client do so.

I also refer those reading this to my other blogs on prostate and also on testosterone and especially for easy clarification and greaat information to my book; Emotional Vampires and Your Hormones: an holistic physician’s view of how stress affects your well-being and what you can do about it.

Deet – Deadly

6360111794379178901307450605_9-3044841-toxic_t620How How does one defeat the “bottom line – $?” I was listening to NPR on zika by 3 Ivy league medical experts. They definitely touted the benefits and safety of deet insecticides, One question from a mom was answered with a yes for use on her 15 month old. I shoot archery on a 10 acre wooded range often with standing water and mosquitoes. I often got nauseous, headaches, muscle aches and general fatigue . After much analyze started to attribute this to deet insecticide. Experiment: I used deet on my left side and natural mosquito repellent on the right. No difference in bites. So I tried the natural on two other people and deet on another. No difference in bites. Put the deet on myself 2 more times and each time I had the same previously mentioned symptoms for 36 hours. I conversed with other archers and 5 of them had the same symptoms as myself when using deet (which is being made stronger now). Being a physician for 50 years I knew that the skin is the bodies largest organ and absorbs many toxic elements from our environment; so why would deet not have an adverse affect on some of us especially children.

Now to get into scientific reasoning

Acetylcholine (ACh) is is the neurotransmitter released to activate muscles. Acetycholine affects both the automatic nervous system and the parasympathetic nervous system,therefore it hasnumerous functions.You need the biological amount for this transmission at the synapeses; too much and you overstimulate and can cause burnout and Ach resistence eventually. Therefore nature provides cholinesterase to do away with excess Ach. This property means that drugs that affect cholinesterase (cholinergic) systems can have very dangerous effects ranging from paralysis to convulsions and other numerous functions listed below.

Deet is a acetylcholinesterase inhibitor (AChEI): meaning it inhibits cholinesterase causing an overaboundance of actycholine and therefore overstimulation of ACh systems. There are so many symptoms so I only listed some beloew besides the ones I and other archers were getting.

Since toxic insecticides are being aerial sprayed (atrazine, carbamates) and affecting the mammalian systems there is no sense in having a synergistic effect by adding Deet. If one cannot do a lot of health things due to $ you can still by non-deet repellent!

Stress & Obesity-The Fallacy of Medical Treatment

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As pointed out in my book, a lot of obesity or being overweight is due to stress. It is obvious that so many of us that are stressed turn to fast foods and high caloric foods for comfort (comfort foods). We also overeat (snack) as a coping mechanism since a lot of junk food is high in sugar which stimulates the serotonin centers. Unfortunately this stimulation only lasts a short time with these foods so more of the high sugar foods need to be consumed to keep this happy (but guilty and guilt causes more stress) feeling. Very important is that stress stimulates cortisol (see my other blogs or book on stress for a simple but extensive explanation) which ultimately leads to the liver constantly putting out sugar for the “fight or flight” response. This outpouring of sugar which cannot be used ends up being stored as triglycerides (fat) and therefore weight gain and insulin resistance and then finally the Metabolic Syndrome (another blog on this Syndrome). This is true even if one has dieted and lost weight, the probability of gaining it back is high since the stress still exists.

Synthetic substitutes are even worse then sugar for causing weight gain and evidence suggests strongly many are carcinogenic. There is scientific evidence that diet drinks and sugar substitutes (aspartame, saccharin and others) surpass the detrimental effects of regular table sugar. Here we get into leptin resistance; leptin hormone (Greek for thin) regulates appetite and fat burning and tells us to stop eating.  Fat tissue produces leptin. Therefore the more fat the more leptin which leads to leptin resistance and therefore the appetite is not suppressed. Leptin actually signals the brain’s hypothalamus to signal the body to stop eating and start to burn fat and glucose. This gives more storage space to renew storage of glucose in the muscles thereby taking it out of the blood.  Therefore, the pancreas does not have to produce more insulin and the body is burning more fat and avoiding insulin sensitivity to sugar cell receptors. Obese people have leptin resistance because the fat cells (adipocytes) have produced so much leptin and therefore desensitized the mechanism to stop eating. Red meat and dairy also seem to halt the leptin signaling. There is more complicated biochemistry to leptin but not for this blog. A good source for information is Perter Kash’s book Freedom from Disease.

There is no way of avoiding stress, it is part of our lives:  But it is not the stress itself but how an individual deals with stress. The response to stress is an individual one; something that really freaks out one person may be no big deal for another. As said, it is not the stress itself that is the problem but how we cope with it. There are ways of responding to stress that are not detrimental. I believe that stress is the cause for almost all illnesses as I point out and reference with evidence based scientific research in my book. Eating as healthy as one can and exercising is a must (as now is seen in our children where I of 3 is overweight or obese); but it is not the full solution. One must uncover the reason for their overeating and especially of “dead foods.” Some people are prescribed pharmaceutical(s) for the stress problem especially antidepressants which can cause the side effects of weight gain, depression and sexual dysfunction obviously causing more stress. It is now known they have a possibility of suicide and aggressive dangerous behavior.

Taking pharmaceuticals for obesity or choosing surgery too often gives the patient false belief they can continue a poor life style since they are on medication or had some type of stomach-intestinal intervention. I believe that finding the cause is especially important even before a person is persuaded into doing one of the many stomach procedures such as bypass stomach surgery or balloons: and the education that they still have to deal with their life style. If they keep eating the same way they may not gain weight (or they may) but are still clogging their arteries leading to cardiovascular problems and high glucose consequences such as the Metabolic Syndrome (see my blog or book on this) or diabetes. After all, the sugar and fats have to go somewhere. Also, shortening the digestive tract will not allow for normal absorption for instance certain vitamins like ADEK which depend on fat for their absorption.

Although I am an holistic physician at times pharmaceuticals may be temporarily necessary. Let me explain; if a person has a Urinary Tract Infection (UTI) there are supplements that possibly may cure it; but rather then put the client through the risk of the possibility of getting the sequel of polynephritis or glomerelonephrits I would rather treat that person with an antibiotic to prevent these serious possible problems. What I would do at the same time is double their probiotic and keep them on it (which all people should be forever) for at least two weeks after the infection is gone. Also, I would be seeking the cause of the UTI especially if they get frequent ones. There is room for both types of medical treatments depending on the illness and the client. Discussion and input from the client is essential.

If a stressed person’s belief is in holistic medicine and wants to be off pharmaceuticals like antidepressants they should not spontaneously abort them which can cause withdrawal problems. Also the person may be too scared to stop taking them for fear of the return of depression or other anxieties for which they are using the pharmaceutical. (This is true for all diseases and medications). There are many ways to perform weaning off of a medication and either simultaneously using a supplement or/& an alternative life-style route. But notice how many people on medicines have not changed their life style to help themselves. They believe that the pharmaceutical is their panacea. Also, if on pharmaceuticals it is important to re-examine oneself and for the physician also to do so because If you are one of the smart people, that is pro-active, with your life style you may not need them anymore and can be weaned off of them and on nothing. I have seen this with so many of my clients for many chronic dis-eases. Staying on an unneeded medication or supplement is not only expensive but the chemical may have a long term negative affect.

Now realize that there are some real medical conditions that cause weight gain and obesity. For example, hypothyroidism untreated since one is not metabolizing their food intake. This is not a difficult diagnosis for a physician to make with lab tests and a good interview with an exam of symptoms and signs. But even in this condition a holistic approach can often alleviate or cure hypothyroidism. Again, the patient and the physician must remember that hypothyroidism, and for that matter any illness may carry along with it stress to different degrees depending on the person and the illness. Part of the cure in any illness is the individual’s stress diminution.

I find that hypnosis, learning self – hypnosis, meditation, yoga, exercise etc. are especially helpful. Hypnosis and guided imagery get quickly to the cause of stress, depression and poor dieting problems and is relatively an inexpensive path to follow.

Alan J. Sault MD, AB HM-diplomat

Author: Emotional Vampires and Your Hormones: an holistic physician’s view of how stress affects your well-being and what you can do about it

holisticsecondopinion.net/vampires

Natural Alternatives to Cox Inhibitors

painMany of you were probably among those that found some relief from arthritis or other pain problems with Cox 2 inhibitors. A (COX-2 selective inhibitor is a form of non-steroidal anti-inflammatory drug (NSAID) that directly targets cyclooxygenase-2 [COX-2], an enzyme responsible for inflammation and pain. After several COX-2 inhibiting drugs were approved for marketing, data from clinical trials revealed that certain COX-2 inhibitors caused a significant increase in heart attacks and -Bextra, Viox,  Celebrex were removed.  You  probably were experiencing anxiety and frustration when these drugs had been withdrawn because they contribute to heart problems plus you stil had some degree of pain (mild to severe).  It was already known that Cox-2 inhibitors contributed to ulcers and osteoporosis.  Now there are new anti-pain and arthritic NSAIDS that once again the FDA has approved  to take their place still that are still one of the leading causes of ulcer.

But like so many of the medications used and advertised there are many side affects especially with long term use. For example, opioid addiction and deaths that have become epidemic. Unfortunately the pharmaceutical companies either put the side affects in “quick talk” along with videos of happy grandparents playing joyfully with their grandchildren while skating over all the possible side affects as the CEOs athletically run to deposit their salaries.

The good news is there are natural anti-inflammatory medications -supplements that have been giving relief for hundreds of years. These are some that work well from my own experience and with my clients. I know there are many others including alternatives like going to a qualified and empathetic acupuncturist or chiropractor. Try to choose one that also gives you homework to do so that you learn how you can diminish pain. Also, I like radiographic evidence of what is the pathology to cause the pain. Alleviation is just that-alleviation: we want to try to get to the cause while working to alleviate a health problem.

The following are just two of the natural anti-inflammatory supplements that I have had success with clients, myself and family.

CURCUMIN: (ALSO KNOW AS TUMERIC:  This is the yellow pigment in curry dishes. It is as effective as cortisone and COX 2 inhibitors in reducing inflammation without causing the side effects such as ulcers and osteoporosis. It works by inhibiting the major inflammatory factors ( leuktrienes and thromboxanes) that Bextra and the other Cox 2 inhibitors did not, thus causing the heart problems that made them dangerous. Curcumin  may not take away acute pain but over a short time will bring down the inflammation that is contributing to the pain. That is why at times I will start the client on a stronger pain medication (opioid) along with the curcumin and then in 2-3 days  take them off or wean them off the opioid. That I do only for certain cases if the injury is obviously causing augmented pain. There is now evidence based medicine that curcumin may help prevent certain cancers and help along with cancer treatments when the cancer is already established.

GINGER: – This natural remedy also stops the production of the inflammatory chemicals mentioned above.  It is also a strong antioxidant. Another application of ginger is its use in nausea and vomiting. That is why physicians are recommending it for nausea during pregnancy and for people with moti good gut health but  like any thing that makes the body function properly (hormones, enzymes etc) there exists an optima amount.

These suggestions are effective natural solutions that have no real side effects unless one is allergic to them. There are many more natural ways to inhibit different  arthritis-like problems that also have other benefits for the  cardiovascular system; such as exercise, different types of yoga, different types of meditation. Remember, as I wrote above, there is a place for alternative body work wither by itself or in conjunction with allopathic medicine or your supplements. Just be sure there is a correct diagnosis. It is beneficial to talk to your doctor about the right way to  take them and helpful activities for your specific malady since each person is different.

Self hypnosis and  imaging:   With these techniques one can learn to decrease pain and tension in a very short time. All it takes is a good instructor and practice. Do not forget about the healing effects on arthralgias (rheumatoid arthritis, osteoarthritis, etc.) that the gentle forms of yoga can provide. I believe I have been saved from a shoulder prosthesis operation for more then 20 years doing yoga.

The introduction to  my book: Emotional Vampires and Your Hormones: an holistic physician’s view of how stress affects your well-being and what you can do about it, tells my story how I was introduced to hypnosis and imagery 25 years ago and have been using to this day.  I have even sutured  little children just using hypnosis. Both can alleviate pain and cure the cause so often.

 

 

 

 

 

 

But as always whether it be allopathic pharmaceuticals or natural that alleviate inflammation or pain the cause needs to be searched and investigated.

Real Men Eat Quiche and Do A Lot More

real men

This great article written by my wife, Jennifer Sault, MFA,MD/Eds, LMHC, Guided  Imagery Guide, Certified Hypnotherapist, taught me so much that I feel the need to put it on my blog site. Some of the ideas she taught me I have also included in my book.

We All, men and women, are made up of both masculine and feminine energy. Yang, or masculine energy is the archetype of focus, direction and goal orientation. It is assertive, logical, left-brain and linear, and it is associated with doing. Yin, or feminine energy is the archetype of openness, flow, intuition, and creativity and is associated with the state of being. It is compassionate, and nurturing and right-brain and holistic. These energies are both  necessary! Purely yin energy might be highly intuitive and creative, but the ideas never make it into physical form. Purely yang energy is full of zip and enthusiasm, but lacks the creativity to give it structure. All of us, men and women, are somewhere along the continuum of yin and yang dominance, and a rare few have found the place of balance in the middle.

Until relatively recently, society has assigned masculine and feminine roles according to gender, without understanding that our physical and emotional health, as well as our spiritual development, depends upon creating a balance of the masculine and feminine energies within us, whether we are male or female.  The archetype of the male was the provider, the decision maker, a strong, largely silent, dependent presence, Fatherhood was mostly a matter of setting an example of what the male was expected to do and to be, a somewhat distant role rather then an intimate daily involvement with his children.

The women’s movement of the nineteen seventies was a drive towards creating a more healthy balance within women. The feminist pioneers were dissatisfied and unfulfilled with being limited to a traditional feminine role of wife and mother and being dependent. Assertiveness training, one of the tools of the movement is about developing healthy yang energy, to complement,not replace, the highly developed yin.

A generation latter there is a sizable movement towards the development of healthy yin energy within men. There are fathers who want to be a nourishing presence in their children’s lives, husbands who want a balanced partnership and shared responsibilities,, men who want the freedom to express a full range of emotion. There are other men who are feeling lost, who don’t know any more what their role is or what is expected of them. As women began to explore their power of choice, these men were faced with a situation for which they had no models and no experience. Traditional man, the provider and protector, the head of household and primary decision maker, began to be something of an anomaly.

In our culture, which sex we are largely conditions our gender identification and therefore the dominance of yin or yang. The people around us are likely to encourage certain behaviors based on whether we are little boys or little girls. A girl, for example, born to parents with traditional ideas of gender roles, may be called a “little princess” from the moment she emerges into the harsh lights of a delivery room. She may be coddled and protected and given overt and covert messages conveying the impression that she deserves and requires protection. She may internalize those messages and grow up believing that it’s not okay to develop and express her masculine energy. A small boy gets the message that it’s not manly to cry, which often becomes internalized as a belief that it is not acceptable to express., or even to feel the tender emotions, He learns to channel that energy into physical activity, or violence. As a culture we may not like or want to encourage anger in males, but we do not say it is unmanly to cry or to be afraid.

Jennifer (one of my preceptors to life writes: I had a conversation with an attorney once at a neighborhood party. His specialty, he said, was “to make money

Criminal law: drug dealers and DUIs.” I recently had my first experience to the legal system with a client who was a battered wife, and I wondered how in the world attorneys and others who work at the courthouse deal with the toxic energy there. “By shutting down,” he said. He mentioned several times that his shutting down had created difficulties in his marriage.

A shutting down of the emotions often resulting in marital discord is not a monopoly of the legal profession.  “E” was married to an emergency department physician, and over five or six years she watched him shut down his compassion and empathy because he had never learned how to be compassionate and detached at the same time. The only way he knew how to protect himself from the cruelty and pain he experienced every day was to cut himself off.

The inner yearning for balance is manifest in our relationships. Our choice of partner indicates the qualities that we believe, at a deep level of mind, we are lacking. We are seeking wholeness and completion in another person, when in fact we need to find wholeness within ourselves.  A woman, who lacks the self confidence to make her own decisions and take care of  herself will remain emotionally immature if she seeks a mate to take care of her instead of developing her yang aspect. Likewise, a man who denies his feminine aspect – the nurturing , compassionate, intuitive aspect of his being-and allows his partner to express all the emotions in a relationship, will not  be healthy and whole, emotionally or physically.

Client T was in his early forties. In terms of the success criteria of our culture the had it all, respect, wealth, attractive home, lovely wife, handsome son. Yet, he was desperately unhappy and suffering physical and mental problems of increasing severity.  Yin and yang roles within his marriage were clearly defined along traditional lines. He was the provider,, the decision-maker, and head of the household. His wife was his helpmeet, his dependent, the homemaker and nurturer.  As her due, as part of their contract, she enjoyed the fruits of his successful professional life, and he felt it was his duty to continue to provide them for her.

T reached the very bringk of physical and mental breakdown before he was willing to question the foundations upon which he had built his life. Through courageous self-exploration he healed the wounded yin, the feminine side of himself that had been locked away since he was a small child undergoing male acculturation from his father. He had been taught that  a real man, first of all, makes a lot of money. He never shows weakness, fear or indecision. There had been no room in T’s life for art or music; there was no” woman’s intuition” in his way of being, no “woman’s touch” in the stark white walls and utilitarian furniture of his office. As he integrated his feminine aspect, his physical and emotional health improved dramatically and he experienced a spiritual awakening that gave his life deep meaning.

Yin and Yang speak different languages. Learning to speak each others language, learning to empathize with each others world view, is part of development on all levels and vital to creating not only an intimate relationship with another, but a deeper understanding of self. It is not that any relationship ever reaches the point where he speaks fluent yin and she speaks fluent yang and they live happily ever after finally.  It is a journey not a destination, rediscovered at each way station. It is the journey itself that nourishes growth and wellbeing. When partners in a relationship fail to understand that, each partner can become locked into  the misery of misunderstanding and feeling misunderstood.

 

P was an ex-marine in his early 50s. He had tried his best to be what our culture and time, and no doubt the Marines, had taught him a man should be. Strong!

Taking responsibility! Making decisions! Doing his duty~ He had done his duty, providing for ones wife’s children by another man, paying off various wives’ debts and being the family provider while pushing his personal dreams onto the back burner.
Underneath the John Wayne façade he was wounded. Wanting and needing to love and be loved but not having any idea how. He had a pattern of choosing women who were needy, wanting to be taken care of, wanting to abdicate responsibility for their lives, probably younger, probably very attractive. But he never managed to create the satisfying relationship that he wanted.

Opening the heart can be a terrifying experience for such as P, because it means exploring realms of emotion that have never before been acknowledged. He had always disregarded pain, physical or emotional. He was proud of his ability to go back to work  immediately after knee surgery or a serious accident. When a wife let him down he left her, secure in the belief that that he had done his duty and she was wrong. He nursed his pain in solitude, never sharing it with anyone, never nurturing himself in any way.

The series Star Trek in its various incarnations, examined the issues of our time in the context  of a future culture that has survived the nuclear age and learned to transcend the eye-for-an -eye ethos. One of the ways in which the series confronted contemporary challenges was to take some of our cultural archetypes and express then in extreme form. Vulcans are pure Yang, our cultural veneration for reason untempered by yin. But where our culture simply disparages emotions and considers them a sign of weakness, Vulcans banished them completely to a deep and heavily fortified region of the psyche and live solely according to the dictates of logic and reason. They believed themselves superior to humans because their decisions were uncontaminated by emotion, or yin energy.

Subsequent variations on this theme, as the series developed were Commander Data and the Doctor, a machine and a computer-generated hologram respectively. Unlike Mr. Spock they recognized  their lack of wholeness and tried, in ingenious and often entertaining ways, to become “more human” by exploring and developing the non-rational aspects of humanity: emotions, or yin. So far we are able to program a computer to do left brain functions, but the right brain includes intuition and inspiration qualities that are indefinable and unprogrammable and a vitalpart of who we are.

The first men in space were scientists, engineers, fighter pilots, pure yang. And yet as they gazed on the ineffable beauty of our planet, a blue glowing jewel against the black infinity of space, they became poets and mystics.  There is no language in yang for the response of the soul to such experiences, and yin finds a way – at those moments of transcendence – to make her presence and power felt.  Most of us have known such moments, however fleeting, as we read a poem, heard a particular piece of music, or watched a sunset; moments when we knew, deep within, the harmony of creation. Whether we heed the call, whether we pay attention and work to integrate the moment of balance into a lifetime of harmony once the moment passes, that is our choice and our challenge.

Alan J. Sault MD, ABHM-Dpl

Author: Emotional Vampires and Your Hormones: an holistic physician’s view of how stress affects your well-being and what you can do about it

holisticsecondopinion.net,vampires

 

Myth:Testosterone causes cancer

The belief that testosterone causes cancer of the prostate is a myth from the old school. I was also taught this myth 50 testpsterone mythsyears ago in medical school. If it were true then men at twenty when testosterone is highest would have prostate cancer or at least starting to show differentiation of cells that could be a precursor to cancer. It is now known that it is estrogen [especially in excess] that contributes to the cause of prostate cancer in men and not testosterone: and of course life style. There are many reasons that a male can have higher then normal estrogen levels which I wrote about in my book and in a blog on anti-aging (holisticsecondopinion.net/vampires).

All fetuses at first are female and have a uterus until the genetics kick in to change an individual to a male. At this point the prostate becomes the organ instead of a uterus. However what would have been the uterus now exists inside the prostate as a vestige of the uterus called a utricle that has estrogen receptors. (This is the same hormone that contributes to  breast and uterine cancer in women ). This is why we need to get estrogen levels prior to initiating testosterone therapy and then again months latter to see if the client is converting the testosterone to estrogen, called aromatization due to the aromatase enzyme that does this. We do this even sooner if there are any signs or symptoms that suggest this aromatization so that we can stop it.

While there is a continuing difference of opinion among doctors as to whether testosterone will speed the growth of an already existing cancer of the prostate, since it is a growth hormone (anabolic hormone), it does not cause the original cancer (www.medaus.com, “Testosterone and prostate cancer: an historical perspective on a modern myth”, April 13, 2007).

I believe a short history of how the myth of Testosterone replacement therapy (TRT) and prostate cancer (pCA) evolved. It started in 1941 with a poorly unscientific study by C. Huggins and CV Hodges (Cancer Res. 1941; 1:293-297) in a study on two men. One being castrated and the other on estrogen therapy. They stated that the administration of testosterone (of coarse it was synthetic testosterone) caused the pCA to grow. Actually what they showed was that acid phosphatase increased in these two men when a daily injection of testosterone propionate was given. There was no following of PSA or free PSA in 1941. (Acid phosphate being a product of the prostate that goes up with pCA). Therefore, their conclusion was based on acid phosphatase and not other evidence. Another fault in this paper was the men already had very aggressive and metastatic pCa. For another these studies were able to be duplicated. Unfortunately from this non-evidence based study and (no control done with it) the medical community has traveled down a path that is  definitely contra to the scientific method.

I always recommend certain tests before beginning a person on testosterone and then repeating them in the near future. The latter depends on the client and circumstances. After a long interview I determine if other laboratory tests are necessary besides those below. These are:

  1. CBC with differential

  2. PSA (if male)

  3. Liver function tests (a healthy liver detoxifys any excess estrogens which can occur with a poorly functioning liver.)

  4. Estradiol (for men and women)

  5. Testosterone – both free (to see what will get into the cells) and total. A total T is a waste by itself since like any hormone it is what gets into the cells (free T) that is important.

  6. SHBG-(sex hormone binding globulin)-which can tie up the testosterone if too high. I often get this when I repeat these tests in about 4-6 weeks.

This pCA as stated already is rare in men in their younger years when testosterone is at peak levels. The rebuttal or thought about this may be that it takes many many years for the cancer to manifest itself. This latter statement maybe true but because of the restraint of doing research on this by the National Cancer Institute and the US National Institutes of Health we do not know the answer to this. But if it does take 30-40 years for testosterone to cause pCA then obviously there should be no problem in offering it to men ( especially if they have no symptoms nor signs of pCA) in their 60s and older if they are manifesting the symptoms and signs of testosterone deficiency which could be quite depressing both mentally and physically (see other blogs on testosterone therapy). Also, I wish the reader to keep in mind when I write about hormone replacement therapy I only use human bio-identical hormones and not synthetics such as testosterone proprionate, ciprioante or ethonate which are commonly used in studies.

The studies so far have been scant and synthetic T is the T of choice for the studies.. Also the studies are most often done with men that already have invasive pCA or even metastatic pCA. There have been, however, some studies showing that pCA is not related to the use of T hormone therapy. For example, Prout and Brewer (Cancer. 1967;20:1871-1878) showed that T injections on men with pCA “Most of these individuals experienced an increase in sense of well being and some noticed vague diminution in pain.” The same two also stated that the acid phospahtase response to T injections was “extremely variable.”  Remember that men not taking T supplementation get pCa. There now is  a lot of literature suggesting  that in most cases surgical intervention is not necessary. Still I believe that certain tests should be done if the patient and the physician have any doubts if pCa is present and of the aggressive type.  (See blog on BPH and prostate cancer at holisticsecondopinion.net/vampires).

As I wrote in my book, T developed a bad reputation for side effects because of athletes taking huge doses of synthetic T with other growth enhances. A good holistic physician does the appropriate lab work and studies it so that he can individualize the dose and have it made by a compounding pharmacist so the it is a bio-identical testosterone for the individual.

So to summarize why T is scary to the medical profession and the myth is the following:

1. No reliable marker was used that started this myth such as PSA

    1. Control groups were not incorporated  often in the different studies.

    2. In the past 25 years there have been no studies that replicate the findings that have brought the original myth into the medical field showing that T causes pCA.

    3. Synthetic T is the testosterone that is used in studies which of itself could cause pathologies. An example of this is the Woman’s Health Initiative study done on women with synthetic estrogen and progestin. Progestin  is not a really progesterone) which had to be stopped very early due to all the dangerous cardiovascular and cancer side effects that the  women were getting. The study was stoped early with these synthetics but the FDA still has them on the market and physicians are  using them instead of bio-identical hormones. Human Identical Testosterone (HIT) made by a an experienced compounding pharmacist is what our bodies have evolved to recognize and use.

    4. More studies using bio-identical testosterone on men with pCA both new pCA and advanced and also in men without pCA (the latter in long term studies to see its effects compared to long term non users of testosterone) need to be done.

       Alan J. Sault MD, ABHM-Diplomat

Book: Emotional Vampires and Your Hormones: an holistic physician’s view of how stress affects your well-being and what you can do about it

What! MEN HAVE MENOPAUSE?? More

andropause IILike any other hormone deficiency (thyroid, insulin, estrogen-progesterone) deficient testosterone in men will interfere with a healthy and vigorous life. Natural, bio-identical testosterone is available but is often avoided because of misunderstandings and myths about the role of this vital hormone. Please see my other blog: Testosterone and anti-aging.

A lot of men do not realize why they are experiencing certain symptoms and signs as they age; why they seem to have gained weight even though they exercise, or why their breast are larger and flaccid.  Other symptoms can be depression, irritability, mood swings, loss of morning erections. erectile dysfunction, poor focus and concentration. loss of incentive both for work and for things that thy once enjoyed, loss of muscle tone and yes, some even experience night sweats. (See my blog on comparing menopause to andropause or my book: Emotional Vampires and Your Hormones: an holistic physician’s view of how stress affects your well-being and what you can do about it.

As men grow older we produce less testosterone. This actually begins to happen at the age of about 30-35, but in men it is a slow, subtle, process until about 50-60 years of age (unlike women who go through a more rapid menopause in 1-8 years).

Many people think of testosterone as a man’s hormone created to annoy women, but much academic work shows  the remarkable physiological role testosterone plays in our lives in both males and females. Obviously men have  much more testosterone then females. Because it is the main muscle and bone builder it is why men do not get osteoporosis until  much later than women – but we do get it. Evidence shows that there exists 3-4  times more testosterone receptors in the heart cells than in the gonads, showing that nature intends for testosterone to give the heart protection. Testosterone also helps to produce more nitric oxide, which, like synthetic nitroglycerin helps to expand the vessels and give better circulation.

There are also testosterone receptors in the brain. Using functional MRI (fMRI which shows what part of the brain is being used for a specific function) it has been shown that men (and women) with low testosterone levels were more ” foggy brained.” In fact, when the levels were real low the ability to fantasize was lost.  Other studies have shown that lower testosterone levels are a factor to increase the  likelihood of developing Alzheimer’s disease. A study of men with Alzheimer’s demonstrated that taking testosterone dramatically  slowed the progression of Alzheimer’s although it did not cure it. All these studies demonstrate that there are receptors for testosterone in the brain. (All these facts are documented as evidence based medicine in my book’s biography).

Studies have indicated that as much as 65%-70% of depression in men over 50 could be due to low testosterone levels, so there is often no need for antidepressants  and their possible side effects. I believe it is necessary to always check testosterone levels when a man has consistent depression.

Testing for testosterone is a simple blood test, but it’s important to get the right tests and interpret them properly.  One not only wants to know the total testosterone but also the amount getting into the cells (free testosterone).  Obviously if a hormone is not getting into the cells it is like not being there. Also, testosterone can bind to a protein called Sex Hormone Binding Protein (SHBG) ; so this test should be done if the physician believes this is one of the problems. If the testosterone levels seem good but the SHBG is high the testosterone is not going to perform its job since it is being tied – up.  A man’s estrogen level must be examined since testosterone can convert to estrogen  (aromatization)  through an enzyme called aromatase.  This enzyme is found in adipose tissue and as men get older they gain more fat (often because of the lack of testosterone). Also, other tests may be appropriate, but certainly a PSA (prostate specific antigen) is necessary. (See my blog or book on prostate evaluation).

Testosterone levels in the “low Normal” range can be misleading (400ng-1000ng).  For a real low level the physician may say they are in the norm. They may be normal for an eighty year old, but the signs and  symptoms presented by an eighty year old are not particularly desirable.

The belief that testosterone causes cancer is a myth and of the old school.  If it were true then men at twenty when testosterone levels are the highest would be more prone to prostate cancer or have signs of future development of the cancer.  It is now known that it is estrogen that contributes to prostate cancer (the same hormone that contributes to breast and uterine cancer in women) along with life style. This is  because inside the prostate is a vestige of the uterus called a utricle  that has estrogen receptors. To simplify, all fetuses begin as female but may change to male due to genetics but this vestige gets locked inside the prostate. If the utricle is constantly hit by estrogen excess cancer may occur. Statistically overweight men have a higher rate of prostate cancer, probably aromatization contributes to this.

There are several ways to take testosterone, one should always and only use bio-identical hormones. These are made by a compounding pharmacist (not a big chain pharmacy) and are made specifically for the individual since each person is different then another. The two ways I prefer are creams that are absorbed through the skin, and tiny pellets that are inserted into the buttocks and  last for about  5-6 months. I do not use  oral testosterone since the levels fluctuate too much and they can be harmful to the liver as can injectable testosterones. I must repeat her that I only believe in bio-identical hormones since this is what nature has put into our bodies.

So one does have to get older but one does not have to age. It is not only longevity but also quality of life.

I have written out all tests for both males and females that are necessary for hormone testing in the appendices of my book along with many other helpful charts pertaining to hormones. The book and charts will help you have intelligent discussions with your physician. Also this subject is expanded in layman’s terms for a more didactic but easily understood education.

Alan J. Sault MD, ABHM-Diplomat

Author: Emotional Vampires and Your Hormones: an holistic physician’s view of  how stress affects your well – being and what  you can do about it.

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