Maximize Your Vitality & Potency for Men Over 40 0962741817

Citation preview

"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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Each

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have succeeded where conventional medicine has

tional therapies

packed with information you can put

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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

Disclaimer

Smart Publications has designed subject matter covered.

It is

this

to provide information in regard to the

sold with the understanding that the publisher and

the author(s) are not liable for the

provided. Every effort has been rate as possible.

book

misconception or misuse of the information

made

The purpose of

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to

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book

is

this

book

to educate.

as complete and as accu-

The

author(s) and Smart

Publications shall have neither liability nor responsibility to any person or entity with respect to any loss, damage, or injury caused or alleged to be caused directly or indirectly

sented herein

by the information contained in this book. The information preno way intended as a substitute for medical counseling.

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

/—

J £ 1& e s—

5.0

"**

o —

s r*

H£

qa 93

\

\

/

09

\

/

2.5

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/

/

/ /

\

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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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LDL cholesterol

HDL cholesterol

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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