Thinking Twice About Testosterone Replacement

Testosterone replacement therapy can be a necessary medical intervention in some men for conditions such as sexual dysfunction, depression, and chronic fatigue. However, there are known risks. Popularity of testosterone prescriptions are skyrocketing, but who is it safest for and who is at the greatest risk of early cardiovascular death and heart attack? How do consumers make decisions in combination with their doctor without knowing the consequences? Ultimately you have to rely on the experience and knowledge of your provider, but having the right information in front of you can only help the decision process.

In a recent publication from Endocrine Today, evidence suggests that a new subset of men should not use testosterone replacement therapy. Men with obstructive coronary artery disease have higher risk of death and heart attack when using testosterone replacement therapy.

But that leaves some questions, doesn't it? What if you've had a coronary angiograph which confirmed obstruction or perhaps had an angioplasty or stent to correct obstruction and also have confirmed or suspected low testosterone levels? Are you just out of luck with no therapy for the hormone imbalance?

Symptoms of hormone imbalance in aging men are not limited to sexual dysfunction. Rather, depression, poor sleep, poor recovery from activity, poor stamina, libido (sex drive), lack of energy, and decreased strength and performance may all be symptoms of hormone imbalance. We also note that stress and poor blood sugar control can deteriorate men's hormones at an accelerated rate as well. Does this sound familiar? If so, read on.

We often suggest lifestyle modification such as weight loss, stopping smoking, and increasing exercise, especially activities such as weight training and sprinting to improve hormone balance in aging men, but the reality is that besides stopping smoking, these are quite tall orders for those who have obstructive coronary artery disease. Thirty minutes of weight lifting or daily sprinting probably isn't going to be approved by the cardiologist or cardiac rehab therapist. Not to mention that poor hormone balance often makes losing weight difficult.

Getting back to the basics of health, the pillars of good living, may be the answer along with specific products to support hormone balance.

From a diet perspective, adequate protein is an absolute must to stop the breakdown of muscle in aging men. Supplemental protein shakes are often a good way to go if appetite isn't great or cooking isn't your strong suit. If you can tolerate whey protein, it seems to be one of the best sources. It raises glutathione levels which is important from an antioxidant perspective and also contains branch chain amino acids which support muscle health. Vegan protein powders are a bit easier on the body. These contain hemp, pea, and/ or rice but often times are much lower in protein content. Shoot for 20 grams per shake. Nuts and seeds provide excellent protein from plant sources as well. Vegetable and plant nutrients cannot be understated for general heart health and all doctors and practitioners should be encouraging this behavior.

From a dietary supplement side, Revolution Macalibrium is a tested formula of specific phenotypes of maca (Lepidium peruvianum). Maca has a rich history of supporting men's hormone health; however, research has shown that there are specific phenotypes ideal for men’s hormonal health. Revolution Macalibrium not only has these exact phenotypes but has concentrated levels of the full spectrum of active constituents ten to twenty times higher than the levels found in raw maca which is why doctors and patients are getting such strong results quickly. This is a foundational product that works through the hypothalamus-pituitary-adrenal axis to help a man make his own hormones versus relying on hormones from outside of the body. A man's own hormones made by him is much safer since nothing is more natural than your own hormones.

Omega-3 fatty acids, especially those rich in EPA and DHA are recommended. If a man has high triglycerides, the American Heart Association suggest 2.4 grams of EPA + DHA per day. This seems like a prudent suggestion for all men facing either hormone imbalance, obstructive coronary artery disease, or life in the modern world. Reducing inflammation and supporting cell membrane health are just two well known mechanisms of omega-3 fatty acids and since the human body doesn't make its own omega-3's it has to rely on us to ingest them every day. I prefer high EPA products. Some products contains as much as 1060 mg of EPA and 274 mg of DHA per 2 capsules. Two capsules twice per day is ideal to hit this goal dose of 2.4 grams. Be wary of lower doses or you'll end up taking 8 capsules per day. Many products will contain 180 mg of EPA and 120 mg of DHA. This is perhaps suitable for the percentage of the population that gets nearly adequate dietary omega-3 fatty acids and is already healthy.

Other interventions and supplements may be indicated given your history and complicating factors, and in that case we recommend working with a doctor who understands your condition and also natural approaches. Click here to find a practitioner close to you.

So, if you know a man considering testosterone replacement and also has obstructive coronary artery disease, arm them with this important information so he can make an empowered decision.

On Your Feet, Thyroid?

If you have a thyroid condition, you probably wish you could  whip it into shape in a few weeks of hard work, like a Boot Camp. But drill sergeants and obstacles courses are not what your thyroid needs. Think of your thyroid gland as your friend who cries at movies and hems and haws over rather small life changes. It is, like your friend, sensitive to feedback. 

When the thyroid is screaming for trouble, don't forget about its compadres (other organs) that offer direction and guidance to the thyroid gland.

• Gall bladder function impacts the thyroid gland because poor gall bladder function keeps the all important fat soluble vitamins from working. (Lots of thyroid sufferers have had gall bladder surgery). The gall bladder secretes bile, a necessary substance to take in vitamins A, D, E, and K.  If your gallbladder is bile deficient or you have had it removed, you may not be absorbing enough fats resulting in a lack of fat soluble vitamins like Vitamins A, D, E, and K. Your thyroid and adrenals needs vitamin A to work correctly and efficiently. Not just beta carotene but good old-fashioned, preformed vitamin A! Check your multivitamin as to the source of its Vitamin A. Post-surgically, I recommend micellized forms of vitamin A, D, E, and K.

• Digestive function modulates thyroid function as well as it is intimately involved with the immune system (lots of gluten sensitivity in thyroid sufferers). If you have any type of digestive dysfunction from heartburn to gas, diarrhea or constipation, addressing the root cause of it is important. Oftentimes, a pH balanced diet, probiotics, and stress reduction are the first steps to fixing a busted digestive system.

• Hormone balance is also key in both men and women with thyroid dysfunction. Low progesterone can actually hide the fact that a sluggish thyroid is actually a more sinister form called Hashimoto's Thyroiditis. As estrogen declines so too does thyroid function. So much so that a reported 30% of postmenopausal women suffer from hypothyroidism.

• Belly fat. That's right, fat is an organ too. Extra weight around the middle negatively impacts thyroid function. The more fat you have on your frame, the more inflammatory signals you release to the rest of your body. 

So where do you start? Well, you can't send your friend to Boot Camp and yell at them to be tough....you have to strengthen them. Revolution Macalibrium for men and Femmenessence for women are ideal foundational products to strengthen the stress response system in addition to meditation, proper sleep, and a diet rich in plant nutrients. Femmenessence has specific formulations for perimenopausal women and reproductive-aged women as well. These products help your thyroid gland but supporting a myriad of hormones in the body. Every hormone imbalance including stress hormone imbalance directly impacts thyroid function.

Realize that this is a place to start with thyroid conditions. Reducing fat through a primarily plant-based diet, resistance training, and supporting all organs through stress reduction and proper supplementation are all pieces to a potentially complex puzzle. For more information about these products or concepts, contact corey.schuler@naturalhi.com

Updated evidence on menopause hormone therapy

A recent panel has re-evaluated the scientific literature since  the 2001 publication of the Women’s Health Initiative in order to determine if hormone replacement therapy is safe long term and for chronic conditions such as bone loss, cardiovascular risk, and / or mood health. The results of this panel are from critical review of 51 published articles and will guide the standard of care for postmenopausal women. Frankly, we’ve learned a lot in the last 11 years and I think this panel did an excellent job of culling the data albeit falling short of offering reasonable and safe solutions to the challenge of increased risk of chronic disease beginning at menopause. But that's okay. It wasn't their goal. 

http://health.usnews.com/health-news/news/articles/2012/05/28/hrt-update-therapy-may-reduce-fractures-boost-some-risks

In full disclosure, I’m an advocate of natural products so my first inclination is the cheer the panel’s recommendation. It has been my read of the last decade of literature as well. However, it is oversimplified to come to the conclusion that HRT is good or HRT is bad. That binary way of thinking is ruinous. I strongly believe there is a definite place for Hormone Replacement Therapy. I also believe it cannot be used as the panacea it once was thought to be. In the case of bone health, we must be ever mindful of the complete physiology. Sure, estrogen inhibits osteoclastic activity and helps to maintain bone mineral density, but other hormones have a role in osteoblastic activity such as progesterone and testosterone. Growth hormone and cortisol have their own effects partially independent of sex hormones and partially dependent on their levels.  Furthermore, we now have evidence that bone morphogenetic proteins, progenitor cells for bone, have cross talk with estrogen and there may be other unknown interactions to other hormones and signals. Some authorities now place osteopenia and osteoporosis, especially precocious bone loss in the inflammatory disease marker, causing us to work through the contribution of cytokines and prostaglandins whose pathways are influenced by estrogen levels. And this is just bone health, not to mention cardiovascular health and other quality of life issues that are also influenced by hormone status. Why is this important to say? Because, we haven’t heard the last of HRT. We will likely come to understand a further undeclared subpopulation that has little to no risk of cancer and cardiovascular incident. However, we aren’t there yet and we have patients in front of us that need our help. This panel’s recommendation brings us one step closer to the truth. What is missing from the conversation and really outside the scope of this article is the reason for hormone imbalance and potential less risky recommendations that clinicians can make today to support not only the symptoms of menopause but also the long term consequences of hormone loss. Personally, I’ve been involved in understanding this exact mode of action. That is, improving the function of what has become known as the HPA or hypothalamus-pituitary-adrenal axis. In fact, there are several axes that we should be aware of that are influenced by an aging hypothalamus. These axes, but particularly the HPA, when supported can stimulate the body’s own production and balance of hormones. In essence, improving this system allows the feedback and control of hormone production to be self-regulating without the burden to liver biotransformation that exogenous hormones appear to have. When a post-menopausal woman can improve her ability to produce her own hormones with changes in menopausal symptoms, bone mineral density scores, and cardiovascular support, then we have something to write about. This approach can be used in conjunction with hormone therapy in order to be in line with the recommendation of smallest dose, shortest duration of time. This is the question that should be asked. “What can we do, today, for women to be on the smallest dose of hormone replacement for the shortest amount of time and still retain quality of life?” The question should not be “is HRT good?”. More research into patient selection criteria is warranted. However, what I’m afraid will happen, at the expense of quality patient care, is disregard for these recommendation with some clinicians refusing to prescribe and others continuing to over-prescribe. We want something with a broad therapeutic window with no history of safety concerns. Something that supports endogenous hormone production so that lowest dose, shortest duration can be honored. We want something that has clinical trials that support efficacy in a broad spectrum of conditions the way HRT does. What we want exists and is available on the market as a natural product. Femmenessence (Maca-GO®) is that commercially available natural product. The following is a technical/ White Paper on the evidence of Femmenessence (Maca-GO®) http://naturalhi.com/downloads/WhitePaper_MacaGO.pdf and links to the abstracts of the peer-reviewed journal articles referenced http://naturalhi.com/Post-Menopause.aspx

Are you using the right type of Maca

By Peter Bablis D.C., N.D., LAc, Dip. Medical Herbalist, Homeopathy, Dip. Clinical Nutrition, PhD
As a college lecturer, integrative doctor, and medical herbalist, I have used as well as keenly followed the research into the herb Maca (Lepidium peruvianum) over the past five years. In my practice, and in keeping with the research of the late nineties, my focus has always been Maca’s use for men in relation to fertility and energy. I used a standard Maca powder for this application with fair success but had never really seen strong or consistent results in women except for improved general energy and wellbeing. However over the last five years, the focus of my lectures and use of particular products has shifted as I have become aware that not all Maca is the same.

About Maca

Maca is an adaptogenic herb cultivated exclusively in the central Peruvian Andes at 12-14,000 feet under harsh natural growing and weather conditions. Adaptogens are an extremely rare class of herb that modulates the body’s response by supporting it in dealing with physiological, biochemical, and psychological stressors1. So rare in fact that Russian researchers studying the mode of action of over 4000 plants found only 12 true adaptogens amongst them. Other common adaptogenic plants include Ginseng, Ashwagandha, Eleuthero, Holy Basil, Licorice, Rhodiola and Schisandra.

Maca has a wide range of active constituents including amino acids, glucosinolates, phytosterols, and alkaloids. But rather than trying to break down and standardize individual active constituents within Maca, it is more interesting to investigate the full spectrum of active constituents of specific phenotypes (Phenotype: the observable physical or biochemical characteristics of an organism, as determined by both genetic makeup and environmental influences) and the natural synergies of all the active constituents that exist in the individual
phenotype. Research has demonstrated that there are in fact 13 different phenotypes within the species Lepidium peruvianum (Maca) that exhibit different colors, have different analytical profiles and even in some cases elicit different physiological effects on the body2.The Importance of the Phenotypes of Maca Dr. Gustavo F. Gonzales from the Universidad Peruana Cayetano Heredia in Lima, Peru has published some very interesting research regarding different Maca phenotypes in relation to men’s health1. As an example, his research has demonstrated that while the red Maca phenotype will reduce the size of a prostate, other phenotypes won’t, or may even increase the size, while black Maca is considered the strongest in energy-promoting properties3. In addition, Dr. Henry Meissner (Director of Research and Development at Natural Health International San Francisco CA) has published some potentially ground breaking papers on specific, concentrated Maca phenotype combinations. Known as Maca-GO® (or commercially
as Femmenessence), these combinations specifically affect hormone levels in post menopausal women4,5. In the double blind, placebo crossover human trials conducted by Meissner, he found that specific phenotype combinations and concentrated levels of all the active ingredients are critical to ensuring actual, measurable physiological effects on hormones, lipids and bone density6,7. Meissner’s research has further evolved this concept of different phenotypes by introducing three concentrated phenotype combination products for women depending on their stage of life. The Femmenessence MacaPause phenotype combination is designed to improve a
post menopausal women’s hormone production. This combination has resulted in statistically significant increases in estradiol (P<0.001), increases in progesterone and reductions in FSH (P<0.05), with highly significant reductions in menopausal symptoms as well as increases
in HDL “good cholesterol”, reductions in LDL “bad cholesterol”, triglycerides and body weight as well as increases in bone density8. The Femmenessence MacaLife phenotype concentrated combination is designed to reduce menopausal symptoms and modulate mood associated with peri menopause and the fluctuation of hormones during this stage of life and Femmenessence MacaHarmony is for younger women to address hormone imbalance and PMS and improve fertility9,10,11,12.

My Clinical Experience

In my clinic, I have seen first-hand the effect of using specific Maca phenotypes for specific populations. As opposed to just “feeling better”, my female patients have experienced actual physiological changes in hormone levels after using the different Femmenessence phenotype combinations. Addressing conditions ranging from amenorrhea, PMS and adrenal fatigue to menopausal symptoms and heart and bone health6. It is within this range of benefits, derived from combining individual phenotypes in specific ratios and concentrating the full spectrum of active constituents, that I have found surpasses normal adaptogenic Maca products, which are generally random combinations of the different phenotypes mixed together. Furthermore they are not concentrated, which may be beneficial for general wellbeing and energy but not for specific clinical uses. Alternatively, I have also used a different phenotype combination in men to reduce prostate size and another combination to counter adrenal fatigue2.

Quality Matters

Another factor in relation to Maca is the bioavailability and concentration of the active ingredients required to elicit physiological effects4,5,13. Quality of seed sources and soil content, as well as organic or biodynamic growing strategies and drying methods, all play a part in maximizing the quality of all active constituents. Interestingly, the higher elevation, region-specific quality soil (not necessarily from certain regions of the depleted Junin Plateau), and traditional sun-drying the crop at elevation over a period of three months (not in tobacco dryers in Lima), have all been shown to contribute to the highest quality raw material. In relation to manufacturing, Maca is a tuber and is naturally hard to digest raw. For that reason the native Peruvians traditionally cooked Maca the same way we would a potato. Scientifically this process of improving bioavailability has been addressed through gelatinization, with Meissner (Natural Health International) and La Molina University being the leaders in developing their own processes. Meissner has perfected the process to such a degree that Maca-GO® (Femmenessence) is 99.9% water soluble4.

As the natural products industry continues to evolve, it is critical that we combine the best of traditional knowledge, organic and biodynamic-type farming practices with the highest levels of science, manufacturing and quality control. All herbs are not created equal therefore it is important to investigate them in detail, support their use with pharmacology, toxicology and human placebo controlled clinical trials and use efficacious products with therapeutic levels that elicit real health benefits.

Reference:
1 Winston D, et al. Adaptogens. Herbs for Strength, Stamina, and Stress Relief. Healing Arts Press 2007
2 Gonzales GF, et al. Red Maca (Lepidium meyenii) reduced prostate size in rats. Reproductive Biology and Endocrinology 2005, 3(5) 14
3 Skyfield Tropical: Free Online Botanical Encyclopedia Maca (lepidium peruvianum): Botanical Characteristics
4 Meissner H.O., Mrozikiewicz P.M., Bobkiewicz-Kozlowska T. et al. Hormone-balancing effect of pre-gelatinised organic Maca (Lepidium peruvianum Chacon):
(I) Biochemical and pharmacodynamic study on Maca using clinical laboratory model on ovariectomised rats. I. J. B. S., 2006; 2: 260
5 Meissner H.O., Kapczy_ski W., M_cisz A. et al. Use of Gelatinised Maca (Lepidium peruvianum) in Early--Postmenopausal Women - a Pilot Study. I. J. B. S., 2005; 1: 33
6 Carter R. Clinical Effects of a Proprietary, Standardized, Concentrated, Organic Lepidium Peruvianum Formulation (Maca-GOÆ) as an Alternative to HRT 2007
7 Meissner HO, et al. Use of Gelatinized Maca (Lepidium peruvianum) in Early Postmenopausal Women—a Pilot Study. IJBS 2005, 1(1):33-45
8 Meissner HO, et al. Hormone-Balancing Effect of Pre-Gelatinized Organic Maca (Lepidium peruvianum Chacon): (II) Physiological and Symptomatic Responses of Earlypostmenopausal
Women to Standardized Doses of Maca in Double Blind, Randomized, Placebo-Controlled, Multi-Centre Clinical Study. IJBS 2006, 2(4):360-374
9 Gonzales GF, Cordova A, Gonzales C, et al. Lepidium meyenii (Maca) improved semen parameters in adult men. Asian J Androl 2001, 3(4):301
10 Obregon LV. “Maca” Planta Medicinal y Nutritiva del Peru. 1 Edition Lima: Instituto de Fitoterapia Americano. 2001, 1-182
11 Chacon de Popovici, Gloria. Maca (Lepidium peruvianum Chacon), Millenarian Peruvian Food Plant, With Highly Nutritional and Medicinal Properties. 1st Edition.
Universidad Nacional Mayor de San Marcos. Lima, Peru. 2001, 1-337
12 Chacon G. Pytochemical study on Lepidium meyenii. PhD Thesis. Universidad Nacional Mayor de San Marcos. Lima, Peru. 1961, 1-46
13 Meissner H.O., Kedzia B., Mrozikiewicz P.M., et al. Short- and Long- Term Physiological responses of Male and Female Rats to Two Dietary Levels of Pre-Gelatinised Maca
Lepidium peruvianum Chacon). I.J.B.S., 2006; 2: 15