Category Archives: testosterone

Myth:Testosterone causes cancer

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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

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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.

holisticsecondopinion.net/vampires

 

 

Antiaging and testosterone

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testosterone word in letterpressIt is obviously true that we all have to get older, but I believe we do not have to age. This last statement is true for aging physically, mentally and spiritually. I have been an M.D. 45years and doing anti-aging and holistic medicine for 25 years using Human Bio-identical Hormones (HBIH). These hormones are made by a compounding pharmacist for each individual according to the clients laboratory reports along with the client sitting for about 2 hours and telling me their symptoms and signs. Why? Because each person is an individual with their own unique physiology and listening to a client is as important (or as I think more important) as the laboratory tests.

There is so much scientific evidence based documentations on the benefits of hormone replacement therapy (HRT). Unfortunately, there exists so many myths about HRT. (please read blog on testosterone Myths). In this blog I will just explain the benefits of testosterone since progesterone and estrogen presentations have been written about so much and less about testosterone. I do have a blog on progesterone (Progesterone the brain protector). When I write about hormones I am referring only to Human Bio-identical Hormones.  a hormone with the exact molecular structure of that produced by the human ovaries and testes that nature has intended for our body’s use. They can be reproduced by a compounding pharmacist without changing the biochemical structure as is done with synthetic pharmaceutical hormones. It is the synthetic Testosterone which the media writes and talks about negatively without doing the research. The ivy league researchers and physicians also use synthetics instead of bio-identical hormones. There is a big difference between the two types of hormones. Also it is important that the dose be the physiological dose for the individual – that is the amount that nature intended for that individual person to function optimally; not the same pharmaceutical packaged dose for everyone.  The lack of testosterone in the male is called andropause (mens’ menopause) which can be equated to womens’ menopause. In fact, the symptoms and signs that the male has are very similar to the symptoms and sign of the menopausal female. (Except females do not get enlarged prostates). Some males even have hot flashes and night sweats. (See blog on Andropause compared to menopause)

So here are some facts about testosterone:

  • It has been shown that there exists 3-4 more testosterone receptors in the heart of males and females then in the male gonads (testosterone therefore is not just there to bother women). This means that it is heart protective since we know that nature always has a purpose and rarely creates biological states haphazardly.

  • Testosterone also helps stimulate the production of nitric oxide which is necessary to dilate the arteries. This helps prevent high blood pressure and for the male more consistent erections.

  • Testosterone is necessary to prevent osteoporosis. It is true for women that estrogen and progesterone help prevent osteoporosis but it is testosterone that really keeps the bones strong for both men and women That is why men do not get osteoporosis until they are much older then women. Men have been building strong bones and muscles for so long due to their higher amount of testosterone. (The Testosterone Syndrome by Eugene Shippen M.D.) Men can get osteoporosis eventually and therefore like women should after 60 get a bone density test. Even before this age if symptoms and signs suggest this deterioration is happening; such as loss of height, hunched back or even pain of the back or hips.

  • Testosterone is necessary for firm and strong muscles. This also means a flatter abdomen (not necessarily a six-pack). A 50 year old can work out hard in the Gym but if the foundation building blocks are not there (testosterone) they probably will not build hard muscles. Like a pretty house with a poor foundation eventually it will collapse even after many trials of repair.

  • Testosterone has now been shown to have receptors in the brain. Many studies have shown statistically the lower the testosterone level in men and women the more likely that these people get dementia. In fact, in one study they gave testosterone to Alzheimer men (synthetic in this study) and although it did not cure the Alzheimer Disease it dramatically slowed it down. (Pike, C., PhD. & et al (Dec. 20, 2006). “Testosterone therapy may prevent Alzheimer’s Disease.” Science Daily (abstract from the University of Southern California) & (Resnick, Susan PhD. & Moffat,Scott PhD.(2007). Low Testosterone Levels Linked to Alzheimer’s Disease in Older Men. Journal of Neurology.) They have also shown by using functional MRIs (fMRI) that testosterone is needed by the brain. These are MRIs that show different colors for the active and inactive parts of the brain. When testosterone is low it showed lower memory capacity in these areas. In fact, with really low testosterone levels these people were not able to fantasize.

  • Although I did not want to get into testosterone myths in this blog I know some people will have the question of testosterone causing prostate cancer. It has been evaluated by many prominent physicians and researchers that have come up with the same answer that testosterone does not cause prostate cancer but rather it is estrogen. This is because all fetuses start as females and have small uteri.  When the potential male fetus reaches a certain embryological maturity the prostate develops around the uteri (which remains inside the prostate called a utricle). It is estrogen that hits the utricle to cause the cancer as it would cause cancer of the uterus in a female. Also if testosterone was the cause of prostate cancer we would see more of it when males are young bucks with higher levels of testosterone then at the low testosterone levels when men are older and get prostate cancer. The argument against this is that is takes testosterone more then 50 years to cause the cancer. Well, if a man is more then 50 and it takes another 30-50 years for this to happen it will be happy years.There are numerous reasons why a male can build up too much estrogen but again this could be another blog or answer to FAQs.

  • It has now been shown that testosterone does not cause clotting of the blood as  was once thought (but never proven). Because testosterone may mildly raise the hematocrit and hemoglobin that the blood was thickened and therefore clotting would occur. This elevation does not even occur in most males using bio-identical testosterone and when elevated they are still usually within the normal limits for a male.  This was all speculation. In the following research article testosterone clotting was shown not to be the case. (Smith, A. M. et al. (2005). “Testosterone Does Not Adversely Affect Fibrinogen or Tissue Plasminogen Activator (tPA) and Plasminogen Activator Inhibitor-1 (PAI-1) Levels in 46 Men with Chronic Angina.” European Journal of Endocrinology, 152 (2), 285-291.)

It is really a shame that testosterone has been vilified for such a long time because of traditional ignorance and not up-to-date healers. A lot of these myths are due to athletes and wanna be athletes taking huge doses of synthetic testosterone. It is true that any natural or unnatural product that is used in non-physiological doses can cause harm. That is why one goes to a physician that is up-to date, non-prejudicial about bio-identical hormones, and willing to listen to you and any new findings and questions that you have for him/her.

Choices are not easy for a client in choosing anti-aging hormones since there are so many prejudicial myths built up for so long in the medical community. That is one of the reasons I  have written 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). I present to the public medical information that is known but not promoted to let the person make their own educated decisions.

Myth:Testosterone causes cancer

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male-testosterone-myth - CopyThe belief that testosterone causes cancer of the prostate is a myth from the old school. I was also taught this myth 45 years ago in medical school. If it were true then men at twenty when testosterone is highest would have prostate 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.

All fetuses at first are female and have a uterus until the genes 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 women to have breast and uterine cancer ). 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, so that we can stop this aromatization.
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, 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 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. These are:
1.CBC
2.PSA (if male)
3.Liver function tests (the 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
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.
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) with a 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 proprionate 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. For another the men already had very aggressive and metastatic pCa. For another these studies have never been able top 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 in definitely contra to the scientific method.

This pCA as stated already is rare in 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 tor testosterone to cause pCA then obviously there should be no problem in offering it to men 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, ciprioantaen or ethonate which are commonly used in studies.

The studies so far have been scant and synthetic T is the T of choice. 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.”

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
2.Control groups were not incorporated too often in the different studies.
3.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.
4.Synthetic T is the testosterone that is used in studies which of itself could cause pathologies. Human Identical Testosterone (HIT) made by a an experienced compounding pharmacist is what our bodies have evolved to recognize and use.
5.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.