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"Dr.
is
one of the leading
physicians in the United States/'
holistic
— Joseph
Wright
E.
Pizzorno, N.D., President, Bastyr University
Maximize
i For
Men Over 40
Natural testosterone and to reverse the effects
other supplements
of aging
Also includes natural alternatives
to
Viagra and Proscar
\MZ iP'
Jonathan V. Wright, M.D Lane Lenard, Ph.D.
Digitized by the Internet Archive in
2012
http://www.archive.org/details/maximizeyourvitaOOjona
About the Authors Jonathan V. Wright, M.D., is the author of Natural Hormone Replacement for Women Over 45 and several other best-selling health books (over 600,000 copies sold). He is medical director of the Tahoma Clinic in Kent, Washington, and has treated over 2,000 patients with natural hormone replacement since 1982. Dr.
Wright has also been a monthly medical columnist
in
Prevention (1976-1986) and Let's Live (1986-1996) magazines. Dr.
Wright graduated from Harvard University and got his med-
ical training at
University of Michigan Medical School.
Lane Lenard, Ph.D., has been for
more than 22
years.
During
of Science Digest Magazine,
a medical/science writer and editor
that time,
he has been Articles Editor
Managing Editor of Sexual Medicine
Today, and editor of several newsletters devoted to nutritional sup-
plements and other health-related topics.
He
has also worked on
countless educational and promotional projects for pharmaceutical industry clients. Prior to becoming a writer, he earned a doctorate psychopharmacology and worked for several years as a researcher drug development for a major pharmaceutical company.
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Acknowledgements for his scholarship
Lane Lenard, Ph.D. and exceptional ability
to critically evaluate
hundreds of research papers, extracting their basic meaning
John Morgenthaler who encouraged and made possible the production of this book Jennifer Morganti, N.D. scholar, physician,
Holly
and gifted organizer
Hamm
ever-helpful co-ordinator
and
detail person
Lara Pizzorno for fixing all our spelling, grammar,
and
and punctuation
especially to
Holly (my wife) for her patience, support,
and love
— Jonathan V Wright, M.D. Tahoma
Clinic, Kent, Washington,
and
1998
to
Jonathan Wright, M.D. for your informed
common
sense views of science and medicine,
without which this book
would never have happened
Phyllis and
Katy
for vour patience, understanding, encouragement, and advice during the preparation of this
book and for your love always
— Lane Lenard, PhD Shrewsbury,
New Jersey, 1998
•
•
Maximize Your
Vitality
&
Potency For
Men Over 40
Jonathan V. Wright, M.D. Lane Lenard, Ph.D.
TM
SMART PO
Box 4667
Petaluma, fax:
CA 94955
707 763 3944
www.smart-publications.com
™
Maximize Your For
Vitality
&
Potency
Men Over 40
by Jonathan
V. Wright,
M.D. and Lane Lenard, Ph.D.
Published by:
Smart Publications"
PO Box 4667 Petaluma, fax:
CA
94955
707 763 3944
www.smart-publications.com
No part of this book may be reproduced form without written permission from Smart Publications.
All rights reserved.
Copyright
©
any
1999 by Smart Publications™
Library of Congress Catalog Card First Printing
in
Number: 98-86841
1999
Printed in the United States of America First Edition
ISBN: 0-9627418-1-7
Warning
-
$14.95 Softcover
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is in
Table of Contents Preface
9
1
The Day Impotence Became Hip
13
2
The Male Hormone
31
3
Testosterone:
41
Hormone
...
Steroid
...
Androgen
4
The Ups and Downs of Male Sexual Arousal
67
5
Re-Igniting the Sexual Fires:
83
Testosterone
6
Re-Igniting the Sexual Fires:
99
Beyond Viagra® 7
8
Hormone
of the Heart
Protecting the Prostate:
119 153
The Role of Androgens 9
Protecting the Prostate:
173
Natural Alternatives to Proscar® 10
Keeping Bones and Muscles Strong
207
11
Improving Mood, Attitude, and Feeling of Weil-Being
219
12
How
237
Obtain Natural Testosterone (and Other Natural Hormones) to
Afterword
247
Index
253
Preface Now
and it was a bit of an up in my spirits, a bit more optimism, maybe, and yet, and yet wasn *t it all what the pessimistic I'd been on [testosterone pills] a year, faithfully;
seemed as
if there
doctors call suggestion ?
I
my
and had to admit that testosterone had authentic power.
mulled back over
biological sense,
hens crow and act
notes
like roosters;
humans
it
in the
deepest
could make
It
could transform feeble and fuzzy -
and hard-working males; it could put a healthy tan on human skin that was wrinkled and old and gray and pasty; it could make certain dwarfish boys grow into nearly normal young men; it could actually spark the human body's building of indispensable proteins; it could swell and harden feeble and flabby muscles in eunichoid men as well as in guinea-pigs; it witted eunichoid
into alert
could put sap of life into certain aging men.
—
Paul
De
Kruif
The Male Hormone, 1945 no longer
It's decline Some
a secret that an adult
with age.
decline rapidly,
man's testosterone
follows his
relatively high "peak," others at a relatively later,
though, the result
is
the
same
Eventually, nearly every
for
man
testosterone no longer drives his sex
and
levels
own individual pattern. some more slowly. Some start out at a
Each man
(just as importantly, but less
low "peak." Sooner or
all.
reaches a point where his life
as well as he might like,
well-known) no longer supports
wide variety of non-sexually related organs and
a
tissues in an opti-
mal way.
The
relationship between gradually declining testosterone
and a fading sex
woman,
too!),
life is
even
if
well-understood by every
man
he or she doesn't have a degree
What's not generally appreciated by most men, and
(and every
in is
medicine.
just begin-
Maximize Your
1
ning to be appreciated by
many
Vitality
&
practicing physicians,
Potency
is
that
declining testosterone also shares a large part of the responsibility for a variety of other
symptoms and
diseases long thought to be part
of "normal aging." These include heart disease, prostate disease
(benign or cancerous), muscle and bone weakness, depression, high cholesterol,
abdominal weight gain, and loss of mental
acuity.
For years, the media have promoted "hormone replacement" for
women,
tial
portion of such serious age-related conditions as heart disease
repeatedly reminding us that
and osteoporosis. We're also starting
mone replacement" may too, not only stabilizing
will prevent a substan-
to read
and hear
women's mental
preserve
that "hor-
functioning,
emotions and "nerves" during menopause,
but also preventing a significant disease at older ages.
it
It's
amount of senility and Alzheimer's
simply
common
sense
confirmed by volumes of scientific research
—
—
increasingly
that if declining
female sex hormones (estrogens and progesterone) contribute to these
symptoms and diseases
in
women,
declining male sex hor-
mones, especially testosterone, might do the same
in
men.
Although the conventional medical wisdom hasn't quite
come around
gests that, like
more and more evidence sughormone replacement in women, replacing men's
testosterone as
it
to that point of view,
declines can protect
men from
a variety of age-
related conditions, including: •
Preventing the decline in sexual interest and ability or reinvigorating sexuality even
•
if
it
has already begun to diminish.
Preventing atherosclerosis, angina, heart attacks, strokes, and high blood pressure.
•
Normalizing cholesterol and blood sugar.
•
Keeping prostate glands healthy.
•
Preventing the "low-grade" depression and "sour disposition" so
common
It is
many
in
men
becoming
other "normal"
as they
become
grandfathers.
clearer and clearer that the risks of these and
symptoms of aging can be
significantly less-
ened by appropriate replacement of testosterone, as well as by a
Preface
1
variety of other natural means. There
testosterone replacement
"male menopause." For
is
is
no question
central to the treatment of
this reason,
clinical uses of testosterone.
most of
this
that natural all
facets of
book concerns
But please don't forget
1
the
that, for the
best results, reversing or staving off the ravages of aging
must
involve a multifaceted strategy that includes an excellent diet, vita-
min and mineral supplements, appropriate
herbs, regular exercise,
limited alcohol intake, complete elimination of tobacco and other
drugs, stress reduction, and any other measures that promote "general
good
health."
Natural Testosterone
vs.
Viagra® and Proscar® Natural Testosterone
Viagra®
Enhanced
erectile ability
yes
yes
Enhanced
libido
yes
no no no no no no no no no no
Prostate protection
yes
Cardiovascular protection
yes
Lower cholesterol
yes
Energy and
yes
vitality
Feeling of well-being
yes
Reduced body
yes
fat
Stronger bones/muscles
Depression
relief
Cognitive improvements
Unwanted
side effects
Reduced
libido
Reduced
erectile ability
Score
yes
maybe maybe
Proscar®
no no
maybe no no no no no no no no
no no no
yes
yes
no no
yes
9/11
1/11
-3/11
(-0/3)
(-1/3)
(-3/3)
yes
Scorecard for natural testosterone compared to Viagra® and Proscar®. Natural testosterone has far more advantages and none of the disadvantages of the others.
Chapter
1
The Day Impotence
Became Hip
"At
my
age, I
want two
girls at once; if I fall asleep, they
have each
other to talk to."
- Rodney Dangerfield
Attitudes
about the existence of and treatments for the age-
related decline in
male sexuality have been slowly chang-
some time, but the FDA's approval of Pfizer Labs' new drug Viagra" (known generically as sildenafil citrate) on March 28, 1998 must stand out as a major milestone. We say this, not because FDA approval is all that monumental or because Viagra* is such a breakthrough drug. As we will show in the pages that follow, Viagra'- may have its place, but it leaves much to be desired, and there are numerous natural alternatives that may be just as good and far safer. March 28, 1998 marked a turning point because that was the day that impotence, for ages the darkest and ing for
most shameful of the secrets held by the male
became
sex,
suddenly
"hip."
With the introduction of Viagra*, after years or even decades of pent up sexual frustration and disappointment, millions of men burst forth literally overnight from the closet of impotence. This
4
Maximize Your
1
phenomenon was not
lost
on the folks
Vitality
&
Potency
Knowing
at Pfizer.
a
little
something about the law of supply and demand, they have heavily advertised their
new drug while
Although Viagra®
men
pricing Viagra® pills at $10 a "pop."
is officially
woman).
on page
1
of
middle-aged
widespread recognition that
man
(not to mention the ages of
Just days after Viagra's approval,
a major article
at
is
with erectile dysfunction, there
appeal transcends the ages of
its
marketed only
The New York Times ran
Business Section entitled
its
"New
Means To Make Men Feel Younger." The
article predicted that
men
but will also be used
Viagra®
"...will
by baby boomers longing
recreationally
What
not only aid impotent
48-year-old man, after
to recapture their youth.
would not want
18-year-old again?" wrote the Times reporter.
ile
In addition to
benefits for
due
it
a large part of Viagra's success
man
And
some
admit
to
much
in essence, psychological.
it
up" and "keep
it
up,"
it
this
Before Viagra®,
often meant he
important, almost spiritual, way.
was
It
weakness would weaken him further
Viagra's message ure so
probably
— not to mention their physicians and sexual partners —
couldn't "get
lacking in
is
represents a medical solution to a problem that
had always feared was, a
to feel like a vir-
1
easily obtainable (apparently) prosexual
its
many men,
to the fact that
most men if
all,
was
that
his fault.
still.
impotence was not a personal
as a physiological problem, not
much
was
different
fail-
from
high blood pressure or heartburn. With most of the shame stripped
away,
men once
to themselves, to
too embarrassed to admit sexual inadequacy even
have shown that they are not only willing, but eager,
pay $10 for an erection. Physicians,
who
also
know
a
good thing when they see
it,
haven't been able to write Viagra® prescriptions fast enough.
Thanks
in part to Viagra®, Pfizer is
enjoying unprecedented
profits.
In anticipation of Viagra's approval, Pfizer's stock price soared
almost 30%. After approval, ly to Viagra®, urologists,
it
rose even higher.
once a shadowy
the dreaded gloved finger responsible for
And
thanks large-
specialty, best ...
shudder
...
known
as
the digital
prostate exam, not to mention prostate surgery and treatment of kid-
The Day Impotence Became Hip
1
A Viagra® Success From I
Story
the Internet...
used Viagra
for the first time last night,
were everything you could hope
for.
and the results
I'm 43, an insulin-
dependent diabetic for many years. I'm impotent. Have
vacuum
tried
therapy, Prostaglandin E-l and later switched to
Caverject [an injectable (into the penis) drug that immediately
produces an
artificially hard, long-lasting, erection].
take testosterone shots because
my
testicles
I
crapped out
years ago. Luckily, I'm married to a wonderful, beautiful,
and very understanding wife.
I
took 50 mg.
And
unlike
Caverject shots, where in 10 to 20 minutes you get a very rigid erection, this is
from
my
loving wife,
I
more
natural.
As
I
became aroused
achieved a very nice erection that
felt
Not rock hard like you get from Caverject. After orgasm, my erection went down like a normal erection would. My wife made the statement that she felt like she was natural.
screwed by a man. Not by superman with a rock hard dick. It
felt better to her.
I
haven't
felt like this for years.
Pfizer has
a hit!
I ney stones, have suddenly become a "glamour" specialty, the purveyors of easy, discrete, painless sexual satisfaction In a curious sort of
way, the
arrival
in a pill.
of Viagra* has dragged
impotence up from the depths of male shame and thrust it under the harsh floodlights of media exposure as a kind of anti-status symbol, even lending
it
an aura of geriatric hipness. In the midst of a tawdry
sex scandal in which President Clinton ing his
still
youthful sexual agility
at
was apparently demonstratevery available opportunity,
his recent electoral opponent, septuagenarian
Bob Dole, proudly
6
Maximize Your
1
Vitality
&
Potency
proclaimed - on national television - that he, too, was a Viagra® success story.
This
may be
post-Viagra
"macho"
a
hard to fathom, but
little
world we now
to rise
inhabit,
—
—
30 Viagra®
many
as
as 15 to
limit
that in the
somehow become
pills a
month. (Many insurance
drug
at all, in effect,
pills a
month, and oth-
placing a de facto finan-
value on the role of sex in health and quality of life. Such
in the
age of managed care.) Beyond its sociological
perfect
many
implications, though, Viagra®
is life
is
the
example of how the pharmaceutical industry approaches
diseases and disorders
profits
that
and your insurance company pony up for
reimbursement to about six
ers refuse to cover the cial
seems
up out of impotence and demand (see box)
your doctor prescribe
companies
has
it
it
-
as an opportunity to reap
from a patentable (and therefore, by
human-body) drug
to influence the
enormous
definition, alien-to-the-
problem, without doing any-
thing to correct the underlying cause of the disease.
(No disease
is
ever caused by the lack of a patentable drug.)
Age-associated impotence
is
really just
one symptom of a
much larger syndrome,* known commonly as "male menopause." As we will discuss later on, male menopause in many ways closely
resembles the more familiar "female menopause." The box on
page 24 shows
that the
menopausal symptoms men and
experience are more similar than they are different. ly that, just as virtually all
It is
women
highly like-
women's menopausal symptoms grow
out of an age-related decline in the "female hormones," the estro-
gens and progesterone, men's menopausal symptoms (although they
"come on" much more slowly and
comparable decline
A
syndrome
together.
It is
example, the
is
in the
variably) are related to a
"male hormone," testosterone.
medicalese for a collection of symptoms that tend to occur
common for all these symptoms to have a common root. For common cold, a syndrome characterized by such symptoms as
runny nose, sneezing, achiness, sore throat, and sometimes fever, single viral infection.
is
caused by a
The Day Impotence Became Hip
"I
My Viagra,
Want
From
the Internet...
What
boggles
my mind
could possibly not be up to to see it
my
and
I
Want
It
Now"
how any self-respecting uro speed by now on Viagra. went
is
I
primary doctor today, and she refused to prescribe
same
for the
1
Her eyes lit up when I mentioned it; amount of interest and had a
reason.
said she had seen tremendous lot
of requests for
f...
haven't
it.
My
you educated yourself about
it
yet???"
I'm too respectful to actually ask the question.
appointment with see
him
(which
my
the 27th.
is
I
swear,
visit. It
took 3 in
had been medically diagnosed with
was
when
lem with
I
first
ED
and he
I
was long
can
will I
after
[erectile disorder].
didn't
consulted him about
his conservatism but
I
and $400 before
hand. This
I
his first Caverject subject,
by experience),
visits
I
it
made an
he uses the same excuse
if
had a prescription for Caverject
about
I
uro yesterday, and the soonest
entirely possible, judging
is
refuse to pay for the
why the Of course,
unasked question was, "So
it.
I
know
a thing
have no prob-
no understanding
at all
of his
ignorance. There's just no excuse.
For
all
symptom of
its
apparent value, though, Viagra* treats only one
whole-body decline in functioning increasingly recognized as "male menopause." In
treats
may
the
that has fact,
been
Viagra*
symptom of age-related sexual dysfunction! Viagra' man back his erections, but it won't increase his sexual
only one
give a
desire. If there's
no flame burning already, Viagra"
isn't likely to
spark one. If a
man
has other symptoms of male menopause, such as
depression, insomnia, progressively wasting muscles and bones, rising blood cholesterol levels,
and an expanding waistline, Viagra*
8
Maximize Your
1
won't do him any good his heart
either. If his prostate is
and blood vessels are beginning
sclerotic disease. Viagra
5
won't help
what other drugs he may be taking tions of the
take Viagra
Potency
larger, or if
signs of athero-
depending on
a bit. In fact,
to treat these other
manifestato
5 .
If
Viagra- relieves only one of the
symptoms of male menopause, full
growing
show
&
male menopause syndrome, he may not even be able
Fear not. though.
houses
to
Vitality
the drug
many
companies have ware-
of drugs for the other symptoms, too. from antidepres-
sants, to antihypertensives, to anticholesterol agents, to weight-loss
drugs,
others es of
sleeping
to
designed
to
pills,
prostate-shrinking
one individual symptom -
to treat
- but none
is
designed
drugs.
in isolation
Each from
is
the
underlying cause or caus-
to treat the
male menopause.
Of
course, taking multiple powerful drugs
is
almost always
problematic. Most of these powerful drugs can have disturbing.
even dangerous, unwanted effects
by law. patentable drugs must be dangerous,
human
to the
all
by themselves. (Remember,
alien,
and therefore intrinsically
body... otherwise they can't be patented!)
new avenues
Put two or more of them together, and
quently open up. Take finasteride, which
is
of trouble fre-
marketed both as
Proscar" (for treating benign prostate enlargement) and.
at a
lower
dose, as Propecia 1 (for treating male pattern baldness). Finasteride
may slow benign in
some men.
prostate growth, and
but
it
In
other words,
Proscar-- Propecia*.
may even grow
a little hair
also causes several adverse effects, including
reduced libido and erectile
men.
it
if
difficulties in a significant
number of
you didn't need Viagra* before taking
you may well need
it
afterwards.
Taking Viagra 5 along with certain heart medications
(e.g..
nitroglycerin and other nitrates) can cause a dangerous drop in
blood pressure that has already killed several people. ly
knows what happens
men
No
one
real-
(especially over months and years) when
take Viagra* and Proscar 5 Propecia 5 together.
The Day Impotence Became Hip
19
Viagra® and Male Menopause For
all
its
(which
faults
we
enumerate
will
Viagra® has
later),
focused a new light on impotence, directly, and on other aspects of
male menopause, ity to
some
indirectly.
It
men
has allowed
to see their inabil-
achieve and maintain a satisfactory erection as due, not to "failure"
on
their part, but to a disruption in their physiology,
by taking a
a dysfunction that can often be easily fixed
Viagra®
doing for impotence exactly what the wildly successful drug,
is
Prozac s did for depression, shining a bright light on a
pill.
new acceptance,
physicians have a
if
new
condition to treat
company,
ED
-
-
officially called erectile
for which, coincidently, they
"cure."
One important
benefit of this
male sexuality has been a foot tence and other aspects of male to
it
not respectability. Suddenly, thanks to Viagra®,
new
disorder, or in polite also have a
and giving
it
new
in the
post- Viagra attitude toward
door for the idea that impo-
menopause may be due
in large part
an age-related decline in the "male hormone," testosterone.
Although
this idea
has been around in one form or other for thou-
sands of years, until very recently, the existence of a hormonally driven male menopause analogous to that experienced by women was widely denied by the forces that rule mainstream medicine. Officially in this country,*
it still
does not
exist,
although incontro-
vertible scientific evidence to the contrary has finally shift in attitude.
The
a
slow
idea that replacing testosterone could help
restore sexual function has generally at
begun
been dismissed as "unproven"
best and "dangerous" at worst.
The unprecedented success of Viagra® may be ignites the transformation.
companies
all
One
thing
is
certain.
over the world will be soon,
spending billions
researching
the
if
they are not already,
various
menopause and developing new drugs designed No
the spark that
Pharmaceutical
aspects to
of
male
meet the sexual
drugs are FDA-"approved" for treating male menopause, per
se,
although
hundreds of drugs are approved for treating the various ailments associated with male menopause.
Maximize Your
20
Vitality
&
Potency
and other needs of aging men. As the Times reported, "The market for satisfying
male ailments
like
impotence
is
largely untapped.
Even though an estimated 30 million men suffer at one time or another from some degree of male erectile dysfunction, only 2.76 million visited doctors last year with the complaint... Of that number, 628,000 were new patients." If you add in the other aspects of male menopause, almost every man becomes a potential candidate 1
for treatment.
While we applaud the to the brink of
awareness in
aimed a
at
little
fact that Viagra® has
helped propel us
an unprecedented explosion in knowledge and
this area, the fact that
much
of this research will be
developing the next generation of Viagras and Proscars
is
apparent that conventional medicine
is
discouraging.
It
is
attempting to do for male menopause what
female menopause
— turn
it
it
has already done for
into a disease that can be treated only
with expensive patented drugs. According to William Regelson,
M.D., professor of medicine
at
Virginia
Commonwealth
University,
and best-selling author of The Superhormone Promise and The
Melatonin Miracle, research on treatments for menopausal today
is
men
about where such research on female hormone replacement
was about 15 years path that
women
2
ago. If
men
same
are going to be traveling the
have already followed,
we may
be
in for a
bumpy
ride.
Better Safer, In this book,
we
More Natural Ways suggest better, safer, more natural ways to restore
sexual function without expensive or dangerous drugs by correcting the underlying causes of
male menopause.
on natural for a reason. As
we
We
place the emphasis
demonstrate repeatedly
in the
pages
that follow: •
Scientific research, clinical experience,
mon
and ordinary com-
sense, confirm that sexual dysfunction as well as virtu-
ally all the other
symptoms of male menopause can be
at least in part, to
traced,
an age-related decline in testosterone.
The Day Impotence Became Hip
21
\\i^J^ W^'
rving.
remember when
we ueed to chaee after young like
•
"Oh, sure,
doing
I
it....
I
remember just can't
remember wh^F
'chicks'
that?"
Replacing testosterone with natural testosterone (not some other preparation masquerading as "testosterone"), as well as
when needed, and adding
replacing other natural hormones
various nutritional, herbal, and botanical products, can be least as effective, is
almost always
less than conventional
Man's Worst Kept For
many men,
in sexual desire
the
safer,
and invariably costs
pharmaceutical solutions.
Secret...Finally
Exposed!
most disturbing sign of aging
and
ability.
Rarely do
we
"normal" milepost on the road from
cles that slowly lose their strength
is
the slow decline
recognize
male menopause, however. Instead we consider er
at
cradle to
it
to
it
as a sign of
be just anoth-
grave
...like
and resilience and refuse
mus-
to for-
Maximize Your
22 give overwork as they once did,
...like
ingly brittle and prone to fracture, lesterol levels that rise
stroke, ...like
live
long enough.
...like
that
become
Potency
increas-
blood pressure and cho-
along with the risk of heart disease, and
the prostate gland,
which seems
ranging from discomfort to death
he
bones
&
Vitality
And
—
to
—
cause problems
for nearly every
man, should
then there are the more subtle changes of
aging, like depression, and the loss of energy and vitality and
mental acuity.
middle-aged or
Scientific evidence strongly suggests that if a
older
man
losing interest in sex and/or
is
is
having
performing sexually, his problems probably go a
mere "sexual dysfunction." In likely also to
lot
fact, it's a safe bet that
difficulties
deeper than
such a
man
is
be experiencing one or more of the physical and
mental changes
now known
to
be directly related
to a decline in
testosterone.
We them. We
shrug these changes ignore them.
We
stuff
our consciousness. Worst of
Not only
are
we
all,
We
off.
them
deny them.
We
minimize
into the farthest recesses of
though,
we
accept them.
reluctant to talk about these problems, so are
our doctors. Historically, medical science has largely ignored them, at least as
manifestations of male menopause. If the roaring flames
of energy, enterprise, and enthusiasm have
glowing ember;
if
dimmed
sexual passion seems like a distant
to a faintly
memory;
if
getting and maintaining an erection, once one of life's great pleasures,
now
feels like just another
growing weaker and bones has offered
little
real help
getting older, aren't this
household chore;
if
muscles are
thinner, conventional medical
and even
wisdom
less consolation: "Well, you're
you? What do you expect? Anyhow, what's
all
got to do with testosterone?"
The changes associated with .male menopause are complex phenomena with a wide variety of possible causes. These can range from subtle hormonal imbalances,
to atherosclerotic plaque clog-
ging the arteries that serve the heart, brain, and penis, to an emotional "mid-life crisis," to the ity:
unholy
worry, stress, and depression.
trinity
of American masculin-
The Day Impotence Became Hip
Whatever ing,
23
their causes though, their effects
many men,
both physically and psychologically. For
means
undermine the very foundation of what
it
strength
health
...energy
...vitality
...physical
...ambition, ...drive ...determination ...sexuality.
up and
erful talismans to give
And
still
make matters worse,
to
can be devastat-
to
they
be a man: acuity
...mental
These are
all
pow-
think oneself a "man." these losses tend to feed on one
another, accelerating the decline. Chronic stress and worry can sap a
man's strength as much as physical
way
muscles, paving the
which
and
almost certain to squelch any remaining sparks of
are
sexual desire.
And though
changes and keep them their relationship
it
is
common
for
men
to
deny these
to themselves, they inevitably reverberate in
with their spouse, piling on
and loneliness
stress,
illness or painful joints
for depression and even impotence, all of
still
more
tension,
can just hasten the skid into illness and
that
eventually death.
The "Male Menopause" Syndrome Although most men would prefer something
that only
says otherwise.
We
happened
have chosen
book, even though
in this
we
to think that
menopause was
to their wives, scientific to use the
recognize
it
evidence
term "male menopause" as a bit of an
oxymoron.
The word "menopause" refers to the end of menstruation, a uniquely female condition. To avoid this confusion, some authors have chosen to use the name "andropause," "viropause," or even, redundantly, "male andropause." Thus, they make the obvious analogy to the female condition but add a distinctly
male element. These
approaches are perfectly valid and acceptable, and as
concerned,
all
Nevertheless, in this
book
First,
these
we have
names decided
refer
to
to use the
the
far as
we
are
same syndrome.
term "male menopause"
for three primary reasons:
most men have
at least a
vague idea what menopause
What men may not realize is that their experience, while different from women's in some ways, is also very similar in many other ways. We think the term "male means
for the female sex.
Maximize Your
24
Vitality
&
Potency
Menopausal Symptoms and Associated Conditions in Men and Women
Women
Men
•
Irregular menstruation
•
Reduced
•
Hot flashes
•
Erectile dysfunction
•
Reduced
•
Ejaculatory problems
•
Vaginal thinning/ dryness
•
Disturbed sleep
•
Depression
•
Heart disease
libido
•
Painful intercourse
•
Disturbed sleep
•
Depression
•
•
Fatigue
•
•
Irritability
•
Heart disease
libido
&
atherosclerosis
Osteoporosis Prostate enlargement/
cancer •
Muscle weakness
atherosclerosis
•
Fatigue
•
Osteoporosis
•
Irritability
•
Breast cancer
•
Thinning skin
•
Endometrial (uterine) cancer
•
Slow wound healing
•
Poor concentration/
&
memory
•
Thinning skin
•
Slow wound healing
•
lapses
Reduced testosterone
Poor concentration/
memory •
•
lapses
Reduced estrogen progesterone
menopause" helps
&
to focus
more on
the similarities than
on the
differences. (See box)
Second, using the word "menopause" helps emphasize the
hormonal basis of the changes
that
men
undergo, which
all
too
The Day Impotence Became Hip
often goes overlooked. In
25
women, of course, menopause
is
most
the
obvious manifestation of the end of the ebb and flow of the "female
hormones," the estrogens and progesterone,
that
began
adoles-
in
cence and has driven the monthly menstrual cycle ever since.
men, the gradual decline
in
"male hormones" (or androgens), par-
ticularly testosterone, that begins in a
coming
to
In
man's
late
be seen as the prime mover for nearly
40s or 50s, all
the
is
now
symptoms
of male menopause.
some words, although originally gender-specific, eventually come to transcend gender. One common example is "nurse." There is nothing more oxymoronic than "male nurse," yet every hospital has them. We believe menopause now falls into the same category. As shown in the "Menopausal Symptoms and Associated Third,
Conditions" box, the hormonal fluctuations during the female
menopause cause a
variety of
symptoms, such
as hot flashes, sleep-
lessness, emotional swings, urinary incontinence, and thinning of
the vaginal tissue that can cause pain during sexual intercourse.
After menopause,
women
experience sharp increases
heart attack, stroke, osteoporosis, breast cancer, and
Men
in their risk
memory
of
loss.
go through an age-related process of hormonal change that can profoundly affect their health and happiness. Unlike women, though, men who pass this way encounter no clear also
landmarks comparable
to the cessation of menstruation, only a
slow, almost imperceptible decline in various bodily functions.
Like women, though,
men
often suffer subtle physical, mental, and
emotional symptoms, including insomnia and depression, as well
women,
as a decline in sexuality and mental acuity.
And
also like
menopausal men face
risk
of serious "age-
a
rapidly growing
related" diseases, including heart attack, stroke, and even osteoporosis. is
Although breast cancer
is
very rare
in
men, prostate cancer
extremely common, and benign prostate enlargement
is
almost
universal.
hormones involved are the "female hormones," estrogens and progesterone. In men, of course, it is the "male hormone," testosterone. In
women,
the key
Maximize Your
26
Vitality
&
Potency
The hormonal nature of "female menopause" has been recognized in medical circles for decades. Virtually all the symptoms and associated risks of menopause in women are now known to be directly or indirectly related to a decline in the estrogens
and prog-
which occurs as the ovaries shut down production between the ages of 45 and 55 years. Awareness of the mechanisms esterone,
involved has
made
it
possible to develop various medical, herbal,
and nutritional measures
to counteract this
hormonal
loss, thus
helping to minimize the discomforts and risks associated with
menopause.*
Where conventional medicine has been more than embrace the
fact
that
women go
willing to
through important hormonal
changes that can profoundly affect their mood, health, sexuality,
and quality of
life, it
has historically been extremely reluctant to
admit that the same might also be true of men.
"macho" about believing we have
lots
(Is there
something
of testosterone flowing
through our blood vessels?)
Although
menopause
attitudes are changing, the existence of a
is still
tional physicians, attribute
far
from established
fact
who, as we mentioned
among many conven-
earlier,
usually prefer to
men's sexual dysfunction and other menopausal comand
that old stand-
view (and
treat) prostate
plaints to factors like stress, worry, depression, by,
male
"normal" aging. They also prefer
to
enlargement, benign and otherwise, as well as cardiovascular disease and osteoporosis as independent "age-related" diseases that
have
little
or nothing to do with male menopause.
In fact, though, scientific evidence has
been accumulating
more than half a century that males aged 40 and over do undergo a hormonal transformation analogous to that experienced by females. Where female menopause results from a relatively abrupt decline in the estrogens and progesterone, the symptoms of male menopause are caused by a more gradual fall off in testosterone. for
Hormone Replacement for Women Over 45, by Jonathan M.D., and John Morgenthaler. Petaluma, CA: Smart Publications.
Please see Natural V. Wright,
The Day Impotence Became Hip
27
The Trouble With Female "Hormone" Replacement In
women,
the
standard
pharmaceutical
approach
to
menopause has long been "hormone replacement therapy" (HRT). HRT "replaces" the natural estrogens and progesterone the body has been making since puberty with a patented combination of horse estrogens
and
a synthetic progesterone-like
By mimicking these foreign (to the relieve
drug
Premarin®)
(e.g.,
(e.g.,
Provera®).
the effects of the missing
human body)
hormones,
agents are often able to
many menopausal symptoms. But, at what cost? As Hormone Replacement for
described in the book, Natural
Women Over 45\ because these drugs and hormones are foreign to the human physiology, they do an incomplete job at best, and at worst, they may cause serious, even deadly, unwanted
effects.
Consider, for example, that Premarin® relieves
common menopausal symptoms
(i.e.,
many
hot flashes, vaginal
thinning), protects against heart disease, and slows the pro-
gression of osteoporosis. At the
same
time, though,
motes the growth of uterine and breast cancers. es a
wide variety of unpleasant
be countered by taking
comes with
its
still
effects,
It
it
pro-
also caus-
many of which may
other drugs, each of which
own baggage.
I growing arsenal of natural hormones, herbal remedies, and nutritional supplements
Even more exciting
is
the fact that there
is
a
men can safely use to help restore sexuality while many of the discomforts and minimizing many of the
that
this transformation.
alleviating
dangers of
Maximize Your
28
Trapped
in the
Vitality
&
Potency
Pharmaceutical Model
Conventional medicine has finally begun to address these problems
and hesitantly to accept the possibility that
men
really
do experi-
ence a form of hormonally driven menopause. In addition to
some physicians
Viagra®,
are even beginning to prescribe the
new
natural testosterone patch (as well as natural testosterone creams,
and sublingual
gels,
tablets) for
men
with sexual dysfunction.
good news. For the most part, though, conventional medicine remains firmly trapped in the pharmaceutical model of medical treatment when it comes to the male menopause syndrome, preferring to treat the various symptoms as unrelated diseases. Briefly, that model works like this: Identify a troublesome symptom; isolate it; understand its biochemical mechanisms; and then develop a chemical that specifically targets those mechanisms; patent the chemical; That's the
market
symptom
(and never mention that the
it
did not occur
because of a deficiency of the patentable chemical). The results of this
extremely successful
macy
seriously flawed
- strategy
fill
phar-
shelves and medicine cabinets the world over.
As more and more symptoms ally
- but
due
to
physicians
come
to recognize that
many
presently attributed to aging (and other causes) are actu-
"male menopause," perhaps the use of these patentable
drugs will decline. Informed patients will very likely encourage physicians to
move
in this direction.
Male Hormone Replacement One
of the brightest lights in the treatment of male menopause
today
is
the use of testosterone
replacement therapy. Having
apparently learned something from
women
its
unhappy experience with
(see box), the pharmaceutical industry
ventional medical practice in this country
ural testosterone as not to do the
same
its
for
- and with
- has begun
standard. (In our opinion,
women.)
to
it's
it,
con-
adopt nat-
malpractice
The Day Impotence Became Hip
29
Although male hormone replacement
way
go before
to
it
becomes
ing that the testosterone
(MHR)
on the market, from testosterone creams and gels tech patches
is,
in fact,
to patented high-
natural (identical-to-human) testosterone.
The various chemical analogues of testosterone their
way
out.
has a long
commonplace as HRT, it is gratifybeing used in all new products appearing as
Known
are finally
on
as testosterone esters (e.g., testosterone
enanthate, testosterone propionate, and testosterone cypionate) and
oral anabolic steroid drugs
(e.g.,
methyltestosterone), they have
served as the only "legitimate" source of exogenous "testosterone" for treating last
50
to
menopausal men with sexual and other problems
60
years.
for the
These synthetic "hormones" are actually man-
made drugs based on
the molecular structure of natural testosterone
make them more
but modified slightly to
active or longer-lasting
than natural testosterone and, of course, patentable. Like Premarin®
and Provera s
in
women,
hormonal environment
mood swings
these drugs produce a grossly unnatural
in
men's bodies
that is associated with wild
along with other serious and even deadly unwanted
effects.
Male Menopause, the Natural Way There
is
no more important message
in this
book than
this one:
For restoring sexuality and the diverse aspects of men s health f
known
to deteriorate with age, natural testosterone,
(and other
and more effective herbal and botanical products are demonstrably and safer in the human body than any synthetic u hormones and pharmaceutical drugs. Used at physiologic doses (doses that produce levels in our bodies within the range naturally present) and on a schedule that closely follows nature's own timing, these natural products have been shown in study after scientific study to: natural androgens), as well as specific vitamins, amino acids,
fy
•
Enhance sex drive
•
Restore the ability to achieve and sustain erections
•
Protect against heart disease and stroke
(libido)
.
Maximize Your
30
Reduce
Vitality
&
Potency
the risk of prostate disease (benign or cancerous)
Increase energy
Build stronger bones and muscles Relieve depression
Lower
cholesterol while raising
HDL ("good") cholesterol
Reduce weight Prevent age-related losses in mental acuity In the remainder of this book, scientific research.
We
we
will review
will also suggest
much
of this
which natural products
would be most appropriate for which aspects of male menopause and how to use them to reap the greatest benefits with the least risk. Finally,
how
we
will explain
to find a
and guide you
how
to obtain these products, including
knowledgeable physician
to prescribe
them
for
you
in their use.
References 1
Morrow D. New means
to
make men
feel younger.
The New York Times. March 31,
1998:B1-B2. 2.
Regelson W, Colman C. The Superhormone Promise. Schuster: 1996.
New
York: Simon
&
Chapter 2
The Male Hormone
u
For
it is
be men,
the semen,
hot,
when possessed of vitality, which makes us
to
well-braced in limbs, well-voiced, spirited, strong to
and act. For when the semen is not possessed of its vitality, persons become shriveled, have a sharp tone of voice, lose their hair and their beard and become effeminate, as the characteristics think
of eunuchs prove."
— Aretaeus of Cappadocia, Testosterone
is
mones known
synonymous with as androgens,
masculinity.
is
New York
City
wouldn't
know
subway system
that testosterone is the stuff that
hormone, the chemical
women,
but also from
that
little
be
Boss
the endocrine system from the tell
makes men
certainty the
male
so different, not only from
And as we shall soon see, it is that may be partly responsible
boys.
gradual decline in testosterone
to
Numero Uno.
you with absolute makes a man a man. It is
will
the hor-
the Big Cheese, the
of Bosses, the Alpha Male, the Big Kahuna,
who
Of
which are considered
"male" hormones, testosterone People
150 AD
turning strong, vital, healthy, alert, vigorous, sexually active
the for
young
Maximize Your
32
men
into frail, chronically
Vitality
We may it
Potency
who
mentally dull, old codgers
ill,
haven't had an erection in decades and couldn't care less
but once
&
if
they did.
take the existence of testosterone for granted today,
was
Holy The hormone
a great mystery, the key to eternal youth, the
Nobel Prize. we now call testosterone was first identified and isolated only about 70 years ago. Until then, while it was clear that something important resided in the testicles, no one had the vaguest idea what it was. The science of hormones, known today as endocrinology, Grail of medical science, the path to the
was born
in the quest for the
in prehistory
when some
essence of maleness. This quest began
proto-endocrinologist
first
noticed that
men who had been castrated were quite different from ordinary men. As the quotation above from the Roman physician Aretaeus suggests,
humankind has long posited
the existence of a
Remove
essence that appeared to dwell in the testicles. tures,
and maleness seems If
to rapidly
melt away.
some "essence of maleness" does
essence to another person
reside in the testicles,
you might be able
not too great a leap to think that
male
these struc-
who might be
it's
to transfer that
in relative lack
of
it.
From
about 1000 A.D. on, the Chinese were regularly processing urine
from young men (and women)
to
produce an extract which they
used for treating impotence, prostate enlargement, and
infertility.
1
By 1400 A.D. an Indian doctor named Susruta was recommending that impotent men add testicles (presumably from animals) to their ,
diet.
2
While
this idea
was
intriguing,
it
took another 3 to 4 centuries
During the
late
18 and 19 centuries, researchers began conducting legitimate
sci-
for
anyone
th
to take
it
seriously
enough
entific
it
out.
experiments in which they transplanted testicles (usually
from roosters) into other animals (castrated roosters)
Paul
that
had no
testicles, like
capons
and hens.
de Kruif, in his wonderful
Hormone, pinpoints to
to test
th
the birth of
1945 book, The Male
hormone science (endocrinology) in 1849 by a German physiolo-
one such experiment conducted
gist
named Arnold
Hunter
is
Berthold. (The great Scottish physician John
also reported to have performed similar experiments in
The Male Hormone
33
The Day of the Eunuch
Eunuchs —
men
and glorious the
lacking testicles
—
especially
in
history,
have had a long ancient
China,
Rome, and the Middle East. Because they lacked both means and usually the desire to engage in sexual activity,
kings, emperors, and lesser nobility, trusted eunuchs to safe-
guard the chastity of the
women
living in
their
harems.
Eunuchs also functioned as chamberlains to these powerful men. A few eunuchs even used their position of trust and closeness to powerful men to gather great power for themselves. One Chinese eunuch, named Wei Zhongxian, is considered to be the most powerful of them all. Wei rose from being a butler in the
Emperor's household
to
completely dominate his
teenaged Emperor and soon the entire Chinese government.
Between 1624 and 1627, he controlled the palace with a division of eunuch troops, while ruthlessly exploiting and terrorizing the population. When the emperor died unexpectedly in 1627, Wei quickly fell from power and ended up hanging himself to avoid prosecution.
At various times during early Christian
history,
it
became
fashionable for religious zealots to demonstrate their purity of spirit
and servitude
to
God by
recently as the late 1800s,
it
was
castrating themselves. still
As
a practice in Italy for
parents to have their prepubertal boys castrated in order to train them to be adult singers but with a child's soprano voice. The voices of castrati, as these singers were called, were trea-
sured for their eerie, otherworldly, high-pitched purity that resulted
from an adult diaphragm and lungs driving
through a prepubertal larynx.
air
Maximize Your
34
London during
Vitality
&
Potency
the late 1700s, but he never published his results,
thus abandoning his claim to scientific immortality.) Berthold
removed
the testicles
from four
He then restored the testicles to As de Kruif describes it, "While no
testicle grafts
became
first
them into capons. abdomens of two of the birds. two caponized birds who'd got
roosters, turning
the
the
fat pacifists,
these other two with the
They crowed. They Their bright red combs
grafted testicles remained every inch roosters. battled.
They chased hens
and wattles kept growing."
enthusiastically. 2
With Berthold 's remarkable success, visions of returning youth began appearing
One
minds of other
scientists of the day.
of these was the eminent French physiologist Charles-Edouard
Brown-Sequard, venation, and his
in the
own
who
saw
in
at the
age of 72, was feeling the need for reju-
Berthold 's roosters, one
long-lost youth. In 1889,
chance to restore
last
Brown-Sequard
set
about remov-
ing the testicles from dogs and guinea pigs, grinding
brewing them into a soup with
salt water,
soup under his skin. Before long, he announced
world day,
in
an
article
them
up,
and then injecting the to the scientific
published in the premiere medical journal of the
The Lancet, the miraculous return of
endurance, muscular strength, and mental
Brown-Sequard's
his energy, physical
agility.
3
results took the scientific
world by storm.
Here was one of the world's most respected biomedical researchers, the disciple of the great lier
Claude Bernard, and the
discovered the significance of the adrenal
man who had earglands, now pro-
claiming that he had apparently uncovered the long-sought pathway to extended, if not eternal youth.
Unfortunately for poor old Brown-Sequard, his return to
youth quickly proved to be an illusion, leaving him the butt of endless jokes and derision.
When
he died a few years
reputation as one the leading scientific
later, his
th
minds of the 19 century
lay
in ruins.
Even more unfortunately, while research on other newly discovered hormones, including those produced by the thyroid, adrenals, pituitary, and pancreas, burgeoned, further work on testicle extracts
became
the "cold fusion" of the day.
No
scientist
who
val-
The Male Hormone
ued
35
his reputation dared
go near
it,
lest
he be tarred with the same
brush that did in Brown-Sequard. Another 30 to 40 years would
made a serious attempt. man was a University of Chicago organic chemist by the name of Fred C. Koch, who dared to resurrect the work of Berthold during the 1920s. Koch was the beneficiary of two fortunate circumstances. The first was his proximity to the pass before anyone
That courageous
Chicago stockyards, a ready and inexpensive source of
The second was
cles.
was
Lemuel C. McGee, who
a medical student,
willing to endlessly
and extract the contents of those
distill
tes-
search of the elusive male hormone.
ticles in
From about 40 pounds
Eventually, their persistence paid off.
of bulls' balls, tiny
bull's testi-
—
amount
Koch and McGee found 20
mg
—
that they could
when
of a substance, which
produce a
injected into
capons over a period of weeks, could restore the birds' roosterhood, at least
Even more remarkable,
temporarily.
worked not
their testicular extract
just in capons, but in castrated guinea pigs
and
rats as
well. In the years that followed, other scientists further isolated the active ture,
hormone, now called testosterone, defined
and actually produced crystals of
occurred
in
who worked
Ruzicka,
ognized
when
1935,
that,
for a
A
little
of
it.
testosterone gets produced,
major breakthrough
named Leopold pharmaceutical company in Zurich, reca
Yugoslav
scientist
The reason it
exits
its
is
some of them,
glandular birthplace, hitches for various parts of
like the brain, a substantial distance away.
There are no testosterone reserves stored earlier scientists
almost as soon as
that
on the nearby blood stream, and takes off
the body,
chemical struc-
although the testes produced testosterone, they really
contained very
a ride
it.
its
in the testes to tap into, as
had assumed.
Rather than extracting these minuscule amounts of hormone
from
testicular tissue, Ruzicka,
Nobel Prize
for his
work with
who was
eventually awarded the
testosterone, discovered that
dant substance, cholesterol. In fact, that's
it
was
much more abunbasically how the body
possible to produce testosterone de novo from a
Maximize Your
36
does
The
it.
testosterone Ruzicka produced
identical to that
Vitality
&
Potency
from cholesterol was
which the body produces.
Ruzicka 's discovery opened the door
to large scale testos-
The ready availability of high quality natural seemed to promise answers to questions about mas-
terone research. testosterone
youth,
culinity,
and
longevity,
sexuality
that
had
haunted
dawn of time. The only problem was that this natural testosterone was difficult to administer in amounts that would produce a physiological effect. Whether taken by mouth or humankind since
the
would be quickly neutralized by the body's normal metabolic processes, in exactly the same way that endogenous testosterone is metabolized. (In order to promote their patentable and highly profitable synthetic "testosterones," drug companies until very recently - emphasized this "drawback" to the use of natinjected,
it
ural testosterone.)
Nevertheless,
it
appeared that the curse of Brown-Sequard
had been banished for good. As they began ble profits to be
made from
this
awaken to the possinewly discovered male hormone, to
pharmaceutical companies, as they are prone to do, set out to
"improve" on nature. Thus were born a long testosterone esters
-
line of drugs, like
testosterone propionate, testosterone cypi-
onate, testosterone enanthate, and testosterone undecanoate. class of drugs
testosterone tive
is
known
try
as oral anabolic steroids, of
A
which methyl-
the most notorious example, were particularly
attrac-
because they could be taken by mouth. All but one of the testos-
terone esters required an injection.
This in this
is
book: the distinction
thetic Ipatentable •
we
come back to time and again between natural hormones and syn-
a vital point that
will
hormone-like drugs:
Natural hormones are identical in molecular structure to those the body produces. Even though they may be synthesized in a laboratory, sometimes from vegetable sources, the
hormone molecules so produced cannot be distinguished from the inborn hormone, and the body treats them natural
The Male Hormone
37
as such. Like other naturally occurring substances, such as
water, and vitamins, natural
air,
ed.
Anyone can
hormones cannot be
synthesize them and
sell
patent-
them.
Synthetic, patentable drugs that masquerade as natural hor-
•
mones
are similar in molecular structure, but are never exact-
same
ly the
molecule attempt to
as the natural molecule.
By
altering the natural
some way, pharmaceutical company chemists improve on nature by making a drug that is more
in
potent, longer-lasting, easier to administer, and patentable.
Unfortunately,
because drug molecules are necessarily
from natural molecules, the body treats them differently, which usually leads to adverse and even dangerdifferent
ous side
effects.
Research Explosion Following Ruzicka's discovery research exploded, most of the
new
it
testing
testosterone-like drugs, rather than natural testosterone,
which enjoyed only a brief moment on the
scientific stage of the
day. Beginning in the early 1940s, scores of studies and clinical
observations were published demonstrating the potential value of "testosterone" replacement in patients with angina pectoris (chest
pain caused by partially occluded coronary arteries, often a precursor to heart attacks), hypertension (high blood pressure), age-relat-
ed muscle and bone atrophy, and prostate enlargement. They also
appeared quite promising for treating tion
was impaired due
tion.
A few
to a congenital
studies even
replacement
in
men whose anomaly,
testicular func-
illness, or castra-
reported positive effects of "testosterone"
men going
through male menopause, known
in
those days as "male climacteric." In
one such study, published
in
1942, 24 menopausal
were treated with injections of 10 or 25
mg
men
of testosterone propi-
onate every other day (except Sunday). The men, whose complaints included fatigue, memory loss, lack of confidence, depression.
insomnia,
irritability,
and various circulatory disturbances,
all
Maximize Your
38
reportedly
Vitality
"greatly improved," sometimes after only a
felt
&
Potency
week
or
two of treatment. 4 Granted that these early studies were often poorly controlled, generally included relatively few subjects, and utilized synthetic "testosterone" at wildly unphysiological doses,
still
suggested that "testosterone" replacement
not testosterone
(if
their results
replacement, using the natural hormone) could have important clinical benefits.
It
(HRT
utilizing patentable rather than natural
became commonplace
estrogen)
was decades before "hormone"
Interestingly, this
replacement therapy
menopausal women.
for
didn't take long before the early bubble of
was
tation burst, however. This time, the reason
hope and expec-
toxicity.
The wide-
spread use of the synthetic testosterone-like drugs, particularly, methyltestosterone and related drugs, resulted in an alarming
num-
ber of cases of liver disease, including jaundice, hepatitis, and hepatic cancer,
many
of which were
by
the irresponsible use steroid drugs to build
fatal.
Beginning
in the 1960s,
and body builders of anabolic
athletes
muscle strength appeared
to
confirm the dan-
gers of "testosterone" replacement. Despite unequivocal
many men when
of health benefits for
strations
demon-
testosterone
replacement was used responsibly, research in the area once again fell
on hard times.
These unhappy circumstances
still
haunt the practice of med-
icine today, yet interest in testosterone replacement therapy for
has been undergoing a
welcome renaissance of late. This has
men
result-
ed from the confluence of several important trends: •
A growing acceptance by the medical community of the reality
•
of a hormonally based male menopause.
The ready
availability of high quality, inexpensive natural
testosterone, biosynthesized
from plant precursor sources
(such as soy and Mexican yam), but molecularly identical to that •
produced by the human body.
The increasing offers
realization
that
important health benefits,
menopausal symptoms
like
testosterone
replacement
ranging from relief of
insomnia,
mood
disorders,
mem-
The Male Hormone
39
ory loss, to restoration of libido and protection against heart
muscle and bone wasting, cognitive deterioration,
disease,
and prostate enlargement, with •
The development of
relatively
little risk.
testosterone delivery systems, such as
creams, gels, patches, and sublingual (under the tongue) tablets, that
permit the easy and safe administration of phys-
iologic doses of natural testosterone
on a close-to-natural
timetable. •
The recognition by many physicians
that the natural testos-
terone formulations available today are far better, safer, and
more convenient than those used by
earlier generations.
References 1.
Needham
J.
Science and Civilization
in
China
(Vol. 5).
Cambridge: Cambridge
University Press; 1983.
The Male Hormone.
New York:
Harcourt, Brace and
Company; 1945.
2.
de Kruif
3.
Brown-Sequard C. The effects produced on man by subcutaneous injections of liquid obtained from the testicles of animals. Lancet. 1889;2:105-107.
4.
Werner A. J Urol. 1942;49:872.
P.
a
40
Maximize Your
Vitality
&
Potency
Chapter 3
Testosterone:
Hormone
Steroid
Androgen
We've
...
been talking about testosterone
terms so
Now
far.
it's
Like other substances
By
various identities.
terms of ily.
molecular structure,
its
it
is
it
is
a
bit
more
specific.
body, testosterone maintains
definition, testosterone
In terms of its function,
in rather general
time to get a
in the
...
is
member
hormone.
a
In
of the steroid fam-
considered an androgen.
What do
mean?
these terms
There
is
so
much misinformation and misuse
of terms like
"hormone," "steroid," and "androgen" dispensed both by the lay and medical media, to
that
it's
keep the true meanings
hard, even for the most well-informed
straight.
To avoid being misled when
cussing hormone replacement regimens,
it
is
dis-
vitally important to
understand what these terms actually mean and
how
they can be
and are misapplied.
Testosterone
Is
a
Hormone (Drugs Are
Not)
Borland's Illustrated Medical Dictionary, the classical definition of a hormone is "a chemical substance, produced in the body by an organ or cells of a certain organ, which has a spe-
According
to
Most hororgans called endocrine glands, which
cific regulatory effect
on the
mones
in
are
produced
activity of a certain organ."
Maximize Your
42
&
Vitality
Potency
secrete their product directly into the blood stream. In addition to
hormones include adrenalin (also called epinephrine), which is secreted by the inner part (medulla) of the adrenal glands; cortisone, from the outer part (cortex) of the adrenals; thyroid hormone, from the thyroid gland; insulin, from the pantestosterone, other familiar
creas; the estrogens
which
esterone,
are
—
estriol, estrone,
and estradiol
—
produced primarily by the ovaries
(and to a lesser extent, by the adrenals and testes in
and progin
females
men and by
the
women), and several others. In men, testosterone is produced primarily in glands called the testes from which it spills into the local blood supply. A small amount of testosterone is also produced in the adrenals. Carried by the blood stream, testosterone - or its metabolite, dihydrotestosterone (DHT) - binds to specific target cells all over the body, adrenals in
where sue.
it
can exert a variety of
These
effects fall into three
anabolism terone
effects,
(tissue building),
depending on the
broad categories: masculinization,
and sexual arousal. Although
generally considered to be a "male hormone,"
is
does produce
all
these effects in both
Borland's goes on
target tis-
it
testos-
can and
men and women.
to point out that the definition of
hormone
has been loosened in recent years (by some) to apply to any substance that
duced
may
in the
act like a hormone, even though
body by
it
in
some ways
otherwise — will not give
most people
worked very hard it
it
may
to
stances under the
promote sell
the
this
hormones.
pharmaceutical industry has
expanded definition of hormone,
enormously profitable patentable sub-
"hormone"
has been wildly successful.
be
a second thought. Typically, these pseu-
1900s,
allows them to
still
— medically learned or
are patented drugs designed to function like
Since the early
because
that act like hor-
(but not necessarily in others)
referred to as "hormones," and
do-hormones
not be pro-
the specialized glands that normally produce
and secrete hormones. In other words, substances
mones
may
label. Suffice
Do
it
to say, this strategy
a quick scan of the scientific litera-
seem to describe the use of "testosterone" or other "androgens." Look closely, though, ture,
and you'll find hundreds of
articles that
and you'll almost always find that identical-to-human testosterone
Testosterone:
Hormone
...
Steroid
was
or other androgen
...
Androgen
43
not used, but rather a synthetic drug, like
methyltestosterone or testosterone propionate. Yet, so infused with the
company
line are
the various drug
most medical researchers and physicians,
that
names and testosterone/androgen have become
virtually interchangeable.
The same thing physicians, Premarin®
is
on
true
estrogen. In fact, Premarin®
fit
the unique needs of the female horse.
ent in structure and function
human
the female side,
where to most (known gener-
conjugated equine estrogens) has evolved over billions of
ically as
years to
is
When
female's ovaries.
Premarin
s
quite differ-
It is
from the estrogen produced by a placed in a woman's body,
accomplishes many of the functions of natural human
estrogen, but
it
also
becomes
a potentially
dangerous drug with a
high propensity to cause a variety of unwanted adverse effects up to
and including endometrial (uterine) and breast cancer.
While the
this cavalier attitude
human physiology has
pharmaceutical
industry,
1
toward the subtle complexities of
resulted in billions in profits for the
it
has also led to
consequences for many of the people
some unfortunate
who have
used these drugs
under the mistaken impression that they were, in
fact,
natural
human hormones. them what you will, hormone-like drugs are most definitely not hormones, and they never work exactly like natural hormones. While the differences may sometimes be subtle, they can all Call
too often be deadly.
Women
first
learned this lesson even before
men, when physicians encouraged them
to take a synthetic "estro-
gen" called diethylstilbestrol (DES) during the
late
1930s and early
1940s as a means of preventing miscarriages and alleviating
menopausal symptoms. The disaster,
took
it,
DES
causing cancer not only
experiment was an unmitigated in the
unfortunate
women who
but also in their soon-to-be-born daughters.
Unbelievable as
it
sounds, a few years after the unfortunate
experience with anabolic steroids forced to relearn the
same lesson
in
men, menopausal
all
over again (because prescrib-
ing physicians and the pharmaceutical failed to learn
it),
when
women were
industry
had obviously
they were encouraged to use "estrogen"
Maximize Your
44
&
Vitality
Potency
replacement. This time conventional medicine chose not to prescribe a synthetic drug, but instead "estrogen" that
"natural" but It
was
natural only for female horses
was promoted
(i.e.,
as
Premarin®).
took a several years of "estrogen" replacement therapy
(ERT) before physicians
started noticing that an alarming
number of
their patients were developing endometrial cancer. Their response was (and continues to be) to add another hormone-mimicking drug — usually medroxyprogesterone (Provera®), which is promoted as
being equivalent to natural progesterone
—
"oppose" the car-
to
cinogenic effects of horse estrogen. While this combination,
known
misleadingly as "hormone" replacement therapy (HRT), can reduce the risk of endometrial cancer due to Premarin®,
unpleasant and dangerous side effects, that
many
as half the
women who
start
on
it
it's
HRT
has so
many
no wonder
other
that as
discontinue treatment.
Since natural estrogens, progesterone, and testosterone work better than these drugs and with far less risk of dangerous or unpleasant
adverse effects, the logic of these drug therapies makes sense only their
main goal
is
if
not improved health for their users but enhanced
profits for their manufacturers.
Testosterone Is a Steroid Steroids are a large group of lipids (fat-like substances) that play vital roles in
known
many
different biological systems.
Among
the best
steroids, in addition to testosterone, are dihydrotestosterone
(DHT), progesterone, cortisone, the estrogens, pregnenolone, androstenedione, and dehydroepiandrosterone (DHEA). The mother of all steroids is a substance
well-known
to
most people these
days: cholesterol/ Figure 3-1 illustrates in a simplified
Although cholesterol has developed a rather unsavory reputation due
connection with atherosclerosis,
to its alleged
ingredient to
good
health. For
and drugs
that drastically
actually be doing rials
is
A growing body
in recent years
an absolutely essential
example, without cholesterol,
pable of producing steroid hormones. diets
it
way how
we would be
reduce the level of cholesterol in the body
more harm than good,
in
from which steroids can be produced.
inca-
of evidence suggests that
may
part because they limit the raw mate-
Testosterone:
Hormone
...
Steroid
...
Androgen
45
Cholesterol
Pregnenolone
Progesterone
17a-Hydroxypregnenolone
17a-Hydroxyprogesterone
Androstenediol
Testosterone (5
a- Reductase)
16a-Hydroxydehydroepiandrosterone
Dihydrotestosterone
(DHV iSa-Hydroxy-
Estrone
/£
androstenedione
16a,19-Ditrydroxy-
androstenedione
16a-Hydroxyestrone
Estradiol
Estriol
t Figure
3-1.
.4 simplified schematic illustration of the anabolic side of the steroid showing the relationship of testosterone and the estrogens. Words in parentheses are enzymes required to comert testosterone to either estradiol or DHT. Note that all steroid hormones descend from cholesterol.
family
tree,
some of
the
major steroids descend from cholesterol and are
ed to each other.
relat-
Maximize Your
46
There
is
no need go too deeply
into the
Vitality
&
Potency
extreme complexities
of steroid biochemistry, but a couple of points should be empha-
some testosterone is metabolized (chemically converted) to estradiol. The enzyme that accomplishes the feat of changing the male hormone into the female hormone is sized. First is the fact that
called aromatase, and the conversion process
Second
tion.
is
the fact that
dihydrotestosterone (DHT).
enzyme 5a-reductase.
We
loosely by
industry,
This conversion
metabolized to
controlled by the
in the
two important
pages that follow.
"steroid" also gets tossed around
and the media, causing
performance.
is
medical profession, the pharmaceutical
the
obscured. For example, "steroids" to help
is
called aromatiza-
will be returning to these
word
Unfortunately, the
is
testosterone
metabolism often
steps in testosterone
rather
some
we
its
true
meaning
to
become
frequently hear about athletes taking
them build bigger muscles and enhance
Which
their
steroids are they taking? Certainly not cho-
lesterol or estradiol. In this instance, the "steroids" are usually not
even true hormones but rather one of the many different synthetic "anabolic steroid" drugs. Developed mostly during the late 1940s
and 1950s as attempts
to
produce synthetic "testosterone," these
drugs were based on the molecular structure of natural testosterone but are, in fact, quite different.
As
the
name
suggests, they were
designed to mimic the muscle- and bone-building (anabolic) property of natural testosterone.
Unlike natural testosterone, though,
they can be extremely toxic, especially at high doses and/or with
long term use.*
So concerned
are
government regulators about abuse of anabolic steroids
they have passed the Anabolic Steroids Control Act which classifies
Schedule
III
is
shown
to
used
at
as
drugs (along with other potentially dangerous drugs, such as
codeine, hydrocodone, and
which
that
them
virtually never
some
barbiturates). Curiously, natural testosterone,
used by athletes
in this
way and has
rarely, if ever,
cause the toxic side effects associated with anabolic steroid drugs
been
when
physiologic doses, has nevertheless been caught up in the same govern-
ment net
as the synthetics. This
naturally in the
human body
to
makes
testosterone the only
hormone occurring
be so restricted by the government.
Testosterone:
We
Hormone
Steroid
...
...
Androgen
47
also hear about steroids being used to treat various
inflammatory diseases, ranging from severe asthma and
arthritis to
simple itching. In these cases, the steroids being used are usually
one of many synthetic drugs designed
hormone
actions of the steroid
hormone produced by
tory
to
mimic some of the normal
cortisone, a natural anti-inflamma-
the cortex of the adrenal glands. If a
physician prescribes "cortisone," you can be virtually certain
it's
not a natural hormonal product, but instead a powerful synthetic
drug
(eg, triamcinolone,
molecule but modified and, of course, to
make
prednisone) based on the natural cortisone to it
enhance
its
patentable.
Testosterone Is an
Androgen
Androgens
hormones
are
steroid
(also called virilization)
the
major androgen
DHT,
effects). In
humans,
DHEA.
enzyme 5a-reductase acts on testosterone, many androgen-sensitive tissues, DHT androgen receptors about 10 times more tightly the
formed. In
is
can bind
to
than testosterone, giving
DHT is
promote masculinization
and growth (anabolic
androstenedione, and
DHT
that
testosterone. Other important androgens are
is
DHT. When
potency or other properties
it
far greater
androgenic potency.
believed to be responsible for such androgenic effects
body
as facial and
hair,
acne, male-pattern baldness, and
prostate enlargement, although there's increasing evidence that •
DHT may
not be solely responsible for the
Androstenedione. Androstenedione androgen.
It is
is
last
two.
considered a weak
a precursor of testosterone,
which means
the body makes testosterone from androstenedione.
testosterone
There
may •
is
is
that
Some
also converted back into androstenedione.
evidence that taking supplementary androstenedione
help increase testosterone levels naturally.
DHEA. Once functions of
considered a mere intermediary steroid with no
its
own,
DHEA
is
coming
to
having a wide range of important functions
be recognized as in the
body.
One
v'
Maximize Your
48
DHEA, which
reason
produced
is
out to be so important
&
Vitality
Potency
in the adrenal glands, turns
it
occupies a central position in
the steroid hierarchy (Fig. 3-1).
Produced from cholesterol by
way
that
is
DHEA
of pregnenolone,
androstenedione, which
peak
levels
metabolized to form
converted directly to testosterone.
is
Like testosterone, estrogen
DHEA
is
(in
women), and other hormones,
second or third decade of
in the
then begin a long decline. In men, about half of
life
and
DHEA is lost
by age 40; by age 80, only about 15% of youthful levels remain. Reduced levels of DHEA can translate into reductions in androstenedione, testosterone,
Although
it
DHT, and
estradiol.
metabolized to produce other steroid hor-
is
mones, evidence
accumulating that
is
numerous important health
benefits.
DHEA
by
itself
has
2
Although androgens are generally thought of as "male hormones," they are also present
in females, albeit in smaller
amounts
than in males. Similarly, the "female" hormones, estriol, estrone,
Pubertv
Neonate
Fetus
Adult
Elderlv
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J £ 1& e s—
5.0
"**
o —
s r*
H£
qa 93
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\
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51
n / 1
2
3
Trimester
i
•
1
10
17
Age
40
60
80
(years)
L Figure 3-2. The changing levels of testosterone over a conception to old age.
man 's
lifetime,
from
Hormone
Testosterone:
...
Steroid
Androgen
...
49
and estradiol (the estrogens), are also found
in
males, again in
smaller quantities than in females. In fact, in males (as well as
females) estradiol
produced
is
(in part) directly
from testosterone
(Fig. 3-1).
We
should emphasize again that androgens are natural hor-
mones, having specifically evolved plex jigsaw puzzle that
human
the
is
to
seamlessly into the com-
fit
many
physiology. Although
physicians and medical researchers routinely refer to various drugs as androgens (or estrogens) because they act in
some ways
like
their natural counterparts, this practice is incorrect, misleading,
and
ultimately hazardous. Like pieces designed for another puzzle, these drugs never
fit
perfectly into the
human
physiology. To the
degree that they stick out, they can cause unwanted, unpleasant, and possibly dangerous side effects.
It is
doubtful that a natural andro-
gen, administered in doses and on a schedule that mimics the
body's normal physiology, would have such adverse
Testosterone
Through
the Ages of
effects.
Man
About 95% of the testosterone in the male body is produced in the testes by Leydig cells (also called interstitial cells). The remainder is
produced
in the adrenal glands. (In
females, both the ovaries and
adrenals produce a small amount of testosterone.)
The concentration of distinct periods of a
man's
life (Fig. 3-2).
during the second trimester, ferentiate into a after birth
testosterone rises and falls during three
at
During gestation,
which time
it
male rather than a female.
and then
falls
back
to near zero,
it
peaks
causes the fetus to It
dif-
rises again shortly
where
it
remains
until
puberty. Beginning at age 10 or 11, an accelerating increase
in
testosterone production stimulates the development oi secondary
sexual characteristics, such as facial and body hair, enlarged penis.
and scrotum, deepening voice, and sperm production. Testosterone is also responsible for a post-pubertal growth spurt prostate,
and, of course, an appreciation for the wonders of the female sex.
men, testosterone levels remain funcabout age 50 or 60, at which point they begin
In the large majority of tionally
normal
until
50
Maximize Your
Vitality
&
Potency
Figure 3-3. The release and feedback of testosterone and other hormones
in the
hypothalamus-pituitary-testicular axis. T=testosterone; DHT=dihydrotestosterone; estradiol; -luteinizing hormone; FSH-follicle stimulating
E=
LH
hormone; GnRH-gonadotropin-releasing hormone.
Testosterone:
Hormone
Steroid
...
a gradual final decline.
...
As we
Androgen
discuss
51
later, this
age-related decline
is
responsible for a wide range of bodily changes that are
to
be recognized as elements of "male menopause."
No hormone works
by
itself.
Testosterone
is
coming
secreted by the
testes in response to a signal that originates in the brain, as in
shown
Figure 3-3: •
Specifically, a region near the base of the brain called the
hypothalamus releases a substance called gonadotropinreleasing hormone (GnRH), which is carried to the nearby pituitary gland. ter
The
gland because
it
pituitary
is
releases so
regarded as the body's mas-
many
different
other substances that affect the function of
hormones and the other
all
endocrine glands. •
The
arrival of
GnRH
in the pituitary serves as a signal for the
master gland to release two other hormones
—
luteinizing
hormone (LH) and follicle stimulating hormone (FSH)
—
into the general circulation.* •
When LH
reaches the Leydig cells of the testes,
it
initiates a
series of biochemical steps that culminates in the synthesis
and secretion of testosterone into the blood stream. This complex hormonal system regulates
itself, in part,
via a
negative feedback loop: •
Testosterone can be metabolized via any one of three primary
pathways
(Fig. 3-1), to
weak androgen), (the •
DHT
form
either
androstenedione
(a
(a very strong androgen), or estradiol
"female hormone").
When
molecules of estradiol, and
to a lesser extent
reach the hypothalamus, they inhibit the release of initiating a classic negative
These two hormones
exist in both
their function only in females.
DHT,
GnRH
-
feedback loop.
males and females, but
their
names
reflect
Maximize Your
52
Vitality
&
Potency
Free vs Bound Testosterone
Free Testosterone
Albumin-bound"
SHGB-bound
T Figure 3-4. Relative proportions of free and bound testosterone
human
in the
blood stream.
•
GnRH reaching the pituitary results in a reduction in the release of LH and FSH, and consequent-
The reduced amount of ly,
a
slowdown
from the •
in the
production and release of testosterone
testes.
As men age and
slow the production of
their testes begin to
testosterone (in part due to the loss of itary senses this
slowdown (because
Ley dig
less estradiol
are produced to inhibit the release of
secretion of
LH
in order to
The production of sperm hormonal cycle.
FSH
cells), the pitu-
LH) and
and
DHT
increases
its
compensate.
in the testes is closely tied to this
released from the pituitary binds to specific
receptors in another part of the testes, called the Sertoli cells,
which
are located in the seminiferous tubules, the structure that compris-
es about
80
to
90%
of the mass of the
testicles.
production of a protein that binds androgens,
By
stimulating the
FSH promotes
a high-
which stimulates the maturation of sperm cells (spermatogenesis). Each day from puberty to death, the testes produce about 30 million new sperm.
er concentration of testosterone in this region,
Hormone
Testosterone:
...
Steroid
...
Androgen
53
Bound?
Testosterone: Free or
Testosterone circulates in the blood in two different forms: free and
bound
(Fig. 3-4).
bound
to a protein
About 70
80%
to
of circulating testosterone
is
named sex hormone binding globulin (SHBG).
Testosterone bound to
SHBG
is
essentially out of action.
It
is
locked up and can have no physiological effect on tissues. Another
20%
more of circulating testosterone is bound albumin. Testosterone bound to albumin may be or
to another protein,
biologically avail-
able under certain conditions. Finally, only about lating testosterone is free, ly available
When
which means
and potentially active
at
The Decline and One reason
it
bound
of circu-
completely biological-
is
extremely important to Here's why.
varieties.
for the historic confusion regarding the reality of a
menopause has been
testosterone levels do not decline very
you consider only
Indeed,
if
seem
be a safe assumption, because
tle
3%
Fall of Testosterone
testosterone-related male
to
is
to
testosterone target cells.
referring to testosterone levels,
distinguish between the free and
it
1
the assumption that
much with advancing
years.
total testosterone levels, this
many
may
studies have found
How
or no change in total testosterone with age.
lit-
can such a
small decline in total testosterone translate into the profound
changes attributed
to
male menopause, the reasoning goes. But
since the only testosterone that really matters in terms of biological activity in the
human body
is
total testosterone
free testosterone,
can be a misleading measure.
The best way to document a decline in testosterone levels would be to follow a group of men from youth (or at least middle age) to old age and test them at regular intervals along the way. This would be a "longitudinal" study. Unfortunately, longitudinal studies are
extremely expensive and
difficult to run, so not surprisingly,
only one major longitudinal study of testosterone levels ever been carried out.'
It
followed 66 men, aged
the start of the study), for 13 years.
Among
in
men
has
41 to 61 years (at
the
many important
Maximize Your
54 findings of this study
was
total testosterone levels
Vitality
&
Potency
a small but significant gradual decline in
with advancing age. Free testosterone was
not measured. (See Chapter 7 for further discussion of this important
epidemiologic study.)
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HDL cholesterol
r
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Figure els
Diastolic
Triglycerides Systolic
BP
BP
,
7-4. Significant correlations
and HDL-cholesterol and
longitudinal study. *
between endogenous
triglycerides in middle-aged
p