Apr
16
2023

What you Must Know about Male Hormones

By | andropause, Anti-aging medicine, Cancer, Diabetes, hair loss, heart attack, Infertility, prostate cancer, prostate hypertrophy, Stroke, testosterone

Dr. Pamela Smith, an anti-aging physician gave a talk about what you must know about male hormones. She spoke on Saturday, Dec. 10, 2022 at the Sands Conference Center of the Palazzo Hotel in Las Vegas. The title was “What you must know about male hormones”. She presented 199 slides, so the following can only be a brief summary of what she said. She started by saying that the term “male menopause” goes back in time to 1944. Other terms are andropause and late onset hypogonadism.

Different testosterone levels at different ages

It is important to realize that at age 20 the blood testosterone level is around 900 ng/dL, but this declines after age 30. It is 550 ng/dL at the age of 40. At the age of 50 the testosterone level is 350 ng/dL. And at the age of 70 the testosterone level has shrunk to 200 ng/dL or less. With this in mind, there are also seasonal variations with higher levels of testosterone occurring in summer and early fall, and low levels happening in winter and early spring. A healthy male produces the following male hormones: Testosterone, 5-6 mgs/day; Androstenedione, 3 mgs/day; DHT, 0.300 mgs/day; DHEAS, 50 mgs/day; and DHEA, 15 mgs/day.

Functions of testosterone

In other words, testosterone is the male hormone responsible for the male body characteristics. Every male body cell has testosterone receptors on it. Truly, this way testosterone is involved in protein manufacture and muscle maintenance. In fact, bone formation depends on testosterone and oxygen uptake as well. It is also controlling blood sugar together with insulin. In addition, normal sperm production depends on testosterone. To clarify, testosterone also regulates cholesterol and the immune system. By all means, it also helps to improve mood, is important for mental concentration and helps protect against Alzheimer’s disease. Finally, there is stimulation of platelets and megakaryocytes by testosterone, which makes blood clotting easier.

Symptoms of andropause

It must be remembered, towards the end of their 60’s many men get symptoms of tiredness, loss of energy and depression. Specifically, they may get a bad temper, present with irritability, anxiety and nervousness. Specifically, they complain of a loss of memory, loss of sex drive and libido. Certainly, their erections are getting weak or they lose them altogether. There is a decreased intensity of orgasm and they are gaining weight. All this should prompt their physician to have a total testosterone blood test done. When the testosterone level is less than 500 ng/dL the person should see their physician for replacement testosterone therapy.

Other signs of testosterone deficiency

There are other signs and symptoms of testosterone deficiency: backaches and joint pains, loss of fitness, being overstressed. In addition, testosterone-deficient males experience a decrease in job performance and a decline in physical fitness. They have bone loss, elevation of their blood cholesterol and an increased risk of heart disease. They often also have increased insulin resistance, diabetes and metabolic syndrome. Mortality in men with low testosterone is much higher than in controls with normal testosterone. Several dozens of literature references were provided to support the above statements.

Testosterone replacement and hormone balance

When a patient is on testosterone replacement, a digital rectal exam should be performed to check for the size of the prostate gland. A PSA should be done every year (in former prostate cancer patients every 3 months). PSA should stay below 4.0 ng/mL. If the PSA rises by 1.5 ng/mL in one year or by 0.75 ng/mL in two consecutive years, a urologist should be consulted to rule out prostate cancer.

Men produce small amounts of estrogens, which are important for memory function of the brain and for strong bones. Androgens and testosterone aromatize into estrogen via the enzyme aromatase in fatty tissue. There are a few reasons why aromatase increases: obesity, excessive alcohol intake, chronic inflammation and high insulin levels.

The following medications lower estrogen levels: phenobarbital, carbamepazine, trazodone, chlordiazepoxide and sulcrafate.

Side effects from elevated estrogen levels

Increased estrogen levels in males cause gynecomastia (colloquially called “beer tits”), decreased sex drive, heart attacks, strokes and benign prostate hypertrophy. Elevated estrogen levels also cause insulin resistance, rheumatoid arthritis and prostate cancer. Dr. Smith referenced all of these statements again with many literature quotations.

Dihydrotestosterone (DHT)

This metabolite of testosterone is 3-times stronger than testosterone. It is formed from testosterone by the enzyme 5-alpha reductase. It is responsible for the male-specific characteristics, the male genitalia and the prostate gland. Low levels of DHT cause reduced sexual function, decreased libido and weakened muscle function. On the other hand, elevated DHT causes male pattern baldness, hirsutism and benign prostate hypertrophy (BPH). There are two 5-alpha reductase inhibitors, namely finasteride and dutasteride, that clinicians use to lower elevated DHT levels. This can reduce the risk of prostate cancer by about 50%. Dr. Smith provided many literature quotations to support these statements.

Testosterone replacement therapy

Based on more than 3 dozen literature quotations Dr. Pamela Smith outlined the following:

  • Most men tolerated transdermal testosterone application very well.
  • Erectile dysfunction affects 1 in 5 older men.
  • Erectile dysfunction in association with low blood testosterone and low libido responds to transdermal application of testosterone very effectively.
  • It may take 14-25 weeks before transdermal testosterone treats erectile dysfunction successfully, more than 50% of men respond to this.
  • Testosterone replacement prevents beta amyloid precursor protein production, which increases memory and decreases the risk of Alzheimer’s development.
  • High stress produces high cortisol levels in the blood, which affect the hippocampus, where memory is located. Testosterone is neuroprotective, and it preserves memory.
  • Transdermal testosterone decreases coronary heart disease by relaxing coronary arteries. This prevents heart attacks and strokes.
  • Testosterone decreases inflammation and lowers LDL cholesterol.

More facts about testosterone replacement therapy

  • Testosterone lowers inflammatory cytokines and stimulates interleukin-10 production. This has anti-inflammatory and anti-atherogenic actions, which prevents heart attacks.
  • There was a reduction in mortality from heart attacks in the testosterone treated group of between 66% and 92%. In addition, 30 nonfatal strokes and 26 nonfatal myocardial infarctions occurred in the control group, but none in the testosterone group. Testosterone deficient heart failure patients responded very well to testosterone replacement therapy.
  • Prostate cancer or benign prostate hypertrophy do not increase with transdermal testosterone replacement therapy.
  • A Meta-analysis showed that older men with the highest risk for prostate cancer have the lowest testosterone blood levels.
  • Type 2 diabetics with a high insulin resistance respond well to testosterone replacement therapy. They increase insulin sensitivity and lower their blood sugars. This improvement peaks after 3 months and the effect stays for 12 months.

Further facts about testosterone replacement therapy

  • Testosterone replacement is safe. It provides significant benefits for erectile dysfunction, for muscle mass, prevention of Alzheimer’s disease, prevention of heart attacks and strokes. Testosterone treatment is for males above the age of 50, there is no cut-off for higher ages. There are many controlled clinical trials spanning over 70 years, which support all of what is presented here.
  • Testosterone can’t be taken orally, because it is rapidly metabolized in the liver. Instead, patients use transdermal testosterone gel or cream. Gels are commercially available and very expensive. Compounding pharmacies can provide testosterone creams for you, which are considerably cheaper and can be dosaged according to the patient’s needs. Testosterone esters in oil are available for subcutaneous or intramuscular injection twice per week. This ensured a steady testosterone level.

Improvements after testosterone replacement therapy

  • Timing of improvements: cholesterol reduction occurs by 12 months, for triglycerides it takes 22 months. Testosterone levels take 4 to 12 weeks to normalize. Fasting blood sugars and Hemoglobin A1C come own within 3 months with further improvements by 12 months. Sexual desire and energy are back to normal within 3 to 6 weeks.
  • It is important that you go for blood tests to measure testosterone levels every 3 months initially (blood level). If the levels are stable, the physician may decide to only order tests every 6 months.
What you Must Know about Male Hormones

What you Must Know about Male Hormones

Conclusion

The goal in the aging male is to maintain optimal male hormone levels. This achieves optimal health and prevents diseases of older age. First, it is important to preserve his erections, but at the same time testosterone replacement therapy prevents Alzheimer’s disease and memory loss. It also prevents heart attacks and strokes. Testosterone helps to preserve muscle mass. Hormone replacement therapy keeps lipids like cholesterol and triglycerides under control. Testosterone replacement reduces blood sugars and prevents type 2 diabetes mellitus. Replacement therapy also reduces elevated insulin levels. The end result is that testosterone replacement therapy maintains the health of the aging male.

Feb
23
2019

Combatting Hair Loss

By | andropause, hair loss, laser therapy

Dr. Alan Bauman gave a talk about combatting hair loss. This talk was part of the 26th Anti-Aging Conference of the American Academy of Anti-Aging Medicine in Las Vegas from December 13 to15, 2018.

Dr. Bauman is the owner of many hair loss clinics around the US. Dr. Bauman said that the baldness gene is present in 4 out of 7 men. The gene codes for male alopecia, which means hair loss. We are all familiar with it. First it causes only a receding hairline in the front. Later it causes thin hair and baldness at the crown. But in later years this gene causes baldness in males. One of the metabolites of testosterone, DHT (dihydrotestosterone) causes hair follicles to miniaturize. The result is that hair is no longer covering the scalp skin as much as it used to.

Mild hair loss

In the case of mild hair loss local application of 5% Minoxidil will often make a big difference. The physician will want to order a testosterone blood level. It this is low, replacement with testosterone will restore his libido, normalize his erectile dysfunction and give him more energy. Often his hair growth will also recover to a certain extent. Together with Minoxidil 5% he may be doing well for 5 or 10 years.

But eventually the persistence of DHT as the end metabolic product of testosterone gets the upper hand and causes more hair loss.

Low-level laser therapy is another method how to re-stimulate the atrophied hair follicles to grow to full hair again. Dr. Bauman showed amazing before and after images that documented vigorous new hair growth with low-level laser therapy.

Moderate hair loss

Those men who have the baldness gene will experience more severe hair loss by the age of 30 to 40. More effective methods are necessary to help him. Oral finasteride is one medication the doctor can prescribe. But one of the side effects can be a decrease in libido, which many men will not like. But the patient can apply finasteride 0.25% topical to the hair. This reduces systemic side effects, but helps the hair to grow. Minoxidil 5% can be combined with topical finasteride.

Platelet rich plasma

One step further is the use of platelet rich plasma. Blood is collected from the patient. A dual-spin procedure produces platelet rich plasma. This was tested in the laboratory and showed about 7-fold the amount of lymphocytes, 3-times the amount of monocytes and 6.3-fold more platelets than whole blood. This PRP preparation is injected into the areas where hair growth is missing. If there are still atrophied hair follicles present in the scalp, lush new hair growth will develop following PRP injections. The effect of the PRP injections can also increase by additional low-level laser therapy. PRP is especially useful for the treatment of alopecia areata, which otherwise would be difficult to treat. To a certain degree PRP injections will also serve a male well that has androgenic hair loss.

Severe hair loss

When a male with the baldness gene enters the late 50’s or 60’s there may no longer be viable atrophied hair follicles present in the bald areas. This is when you have to make a decision whether to shave your whole head and embrace baldness or whether you are using the more expensive hair transplant method. The occipital hair, even in bald people is not responding to DHT. This is why occipital hair is the ideal donator site for a hair transplant. This consists of harvesting DHT-resistant hair follicles from the occipital scalp and transplanting them into the areas that are in need to be cosmetically improved. It is a time consuming procedure, transplanting one follicle at a time.

Hair transplant

The technique is either manual transplantation or robotic-assisted hair transplant surgery. As only parts of the occipital hair follicles are useful material, there is no scar or baldness from the surgery. In 7 days the occipital area has healed over. A man may require 3 or 4 hair transplants in a lifetime to cover up areas of the scalp that were balding because of the baldness gene. But the end result is natural looking hair that now is resistant to DHT as it was transplanted from the occipital scalp. A total of four hair transplants are possible without denuding the scalp region. Dr. Bauman showed many before and after photos of men who had hair transplants.

Combatting Hair Loss

Combatting Hair Loss

Conclusion

Hair loss is common, perhaps more so in men than in women. However, in both cases a lot of therapeutic approaches are possible. Milder hair loss responds to treatment with Minoxidil 5%. In addition finasteride in a local 0.25% topical application is a choice. When hair loss is more severe, PRP (platelet rich plasma) injections into the scalp area are a possibility, but only where viable, but atrophied hair follicles are not growing enough hair. This may give a very acceptable result.

But the aging male who has genetic baldness working against him needs to consider a hair transplant with DHT resistant hair follicles from the occipital scalp into the bald areas.

The beauty is that there is a solution for every one. Due to extensive research of the various methods you can trust that they will give you the results you want.

Oct
30
2015

There Is Help For Hair Loss

By | Anti-aging medicine, Cosmetic surgery, hair loss

It is good to know that there is help for hair loss. One area where aging shows is the head! Often people who are aging are experiencing hair loss. Some individuals have a genetic trait that makes them vulnerable to early hair loss, while others are keeping their hair until a ripe old age. With regard to hair pigment it is similar: some people keep their own hair color well into their 40’s or 50’s, but later the grey hair shows. Loss of hair color is about loss of hair pigment. One or more genes regulate whether or not we lose the hair pigment early or not. While there is not much we can do about our hair pigment other than coloring our hair every 3-4 weeks, there is something we can do about hair loss on our scalp.

Androgenic alopecia

Physicians call male and female hair loss “androgenetic alopecia”. It occurs in individuals who are genetically exposed. Interestingly baldness is rare in Chinese, Japanese and in Native American populations. Baldness more commonly affects men of Caucasian descent.

Onset of hair loss

In people who are prone to hair loss baldness typically starts in the temporal areas.

The genetic factors that lead to baldness can be inherited either from father or mother’s side. They are polygenic, meaning that there is not only one cause of hair loss. Gene frequency is most commonly associated with Caucasians. In Africans the frequency is lower and lower still in American Indians, Asians, and the Inuits.

Types of hair loss

The Norwood scale is used as classification of hair loss in men. In women hair loss is classified using the Ludwig and Savin scale. This helps to record the findings of a hair examination and is useful for research purposes as well.

Hormonal factors regarding male pattern baldness

There are several hormonal factors that are involved in the development of male pattern baldness. 5-alpha reductase converts testosterone (T) to dihydrotestosterone (DHT). DHT is more powerful than testosterone, causes shortening of the hair cycle and miniaturization of hair in the balding areas. After several years those who have genetically predisposed androgen receptors in balding areas come down with baldness. There are two isoenzymes of 5-alpha reductase, type 1 and type 2. Individuals born without type 2  5-alpha reductase do not develop androgenic baldness.

Aromatase can cause baldness

Another factor for baldness can be an enzyme, aromatase, located in the fatty tissue that converts testosterone into estrogenic hormones. A lack of testosterone can lead to baldness by this mechanism. Many men in their 50’s and 60’s who are overweight or obese are balding because of this mechanism. The other mechanism, as explained above is via DHT in genetically susceptible men. This process starts to occur mostly in individuals who are in their forties.

Treatment of hair loss

Mild cases of hair loss

This may respond to topical treatment with minoxidil that can be used on the scalp as liquid or hair foam. Systemic treatment in men is possible with finasteride (Propecia) or Dutasteride (Avodart). It helps to block the hormonal pathways regarding 5-alpha reductase and DHT that leads to baldness. In aging men in their 50’s and 60’s it may be that testosterone levels are low. Blood tests can test for this: the total testosterone level should be above 500 ng/dL. If it is less, testosterone replacement by bioidentical testosterone cream or by injection should be considered and usually works quite well with respect to regrowth of scalp and body hair.

Moderately severe hair loss

This can be treated with PRP (platelet rich plasma). This treatment modality cures about 30% of hair loss. There have to be enough hair-rejuvenating stem cells around the bald skin to stimulate hair growth. However, when baldness has set in for some time in an area of the scalp with previous hair growth, there comes a point where the hair follicles die off and even stimulation with PRP will not help. When dermatologists used extracellular matrix (called “A cell”) in combination with PRP the success rate for hair growth in a bald area jumps up to 70 to 80%. The A cell material recruits stem cells from the blood that create hair follicles in the bald skin starting hair growth again.

Severe hair loss

A cell and PRP treatment are not sufficient for this. It requires more invasive treatment: the bald skin usually does not contain any hair follicles. So, what can one do in such cases? Dermatologists detected that dense hair from the back of the head (nuchal area) is transplantable to a bald skin area. It will usually grow very well there. In the beginning of doing hair transplants little discs were transplanted and this looked at times like checkered hair growth in the previously bald area. Newer research showed that miniaturized transplants with perhaps three hair follicles harvested under the microscope from the dense area and transplanted into the bald area give a smooth, natural looking appearance. These are “follicular unit hair transplants”. Nowadays hair transplant physicians will only do this type of hair transplant procedure because of the superior cosmetic result.

There Is Help For Hair Loss

There Is Help For Hair Loss

Conclusion

Baldness is no longer a stigma in today’s society, particularly with males. So many men just shave off whatever hair they still have and live with baldness. However, other men and women want something done about the bald scalp; they can do so in various stages, first treat topically with minoxidil, then by trying PRP or PRP with the A cell treatment. Finally follicular unit hair transplants can restore a full head of hair where there was baldness before. In women with crown baldness follicular unit hair transplants can be very useful. This elegant method gets rid of this annoying crown baldness, and women who went for this procedure seem to be very happy with the results.

More info on hair restoration.

More info on hair loss.

References

Ref. 1: Hair disorders, from: “Lookingbill and Marks’ Principles of Dermatology” Fifth Edition: James G. Marks MD and Jeffrey J. Miller MD, Copyright © 2013, Elsevier Inc.