MALE    ANDROPAUSE

Edward Lichten, M.D., P.C.
555 South Old Woodward Avenue
Suite 700

Birmingham, MI 48009 
248.593.9999

Email: drlichten@yahoo.com

 

 

OVERVIEW:   MALE ANDROPAUSE

“I never thought a man went through men-pause,” I would have said at any age before I hit 45.  Men are virile, men are strong, men fight dragons and don’t worry about getting old.”

But the truth is that men do age, men cannot fight time forever, and every single man will go through a drop in their life-giving hormone, testosterone. With the state of the world, today, the environmental poisons called xeno-estrogens and the estrogen-like pellets injected into our food stock, men will fade faster and die earlier.

Historical Perspective

Until the second half of the 20th century, the level of testosterone in the blood was not often measurable. Although testosterone was discovered and synthesized from plant cholesterol by Leopold Ruzicka in Zürich, Switzerland in 19391, testosterone was not a mainstream medication.  Of course the Nazi’s of Germany experimented with testosterone2 and its derivatives before battle to make over the German soldier as a superman. The allied forces used testosterone to rebuild the wasted concentration camp survivors.  Both efforts were incompletely successful, but, the myth that testosterone gives a man superior powers and maniacal behavior, persists. It is a fact, rather, that the range of testosterone levels are similar no matter what the race.3

Testosterone laboratory tests became available after the Second World War. Only then was there some measure of testosterone deficiency and replacement therapy became more common in Europe than in the United States. It was not until women learned of hormone replacement and the promise of “Feminine Forever” in the 1960’s, did the topic really come up about testosterone replacement for men.  With the physicians inappropriately blaming testosterone for aggressive behavior, they also sought to have men’s lives extended by giving them estrogen.  The disastrous results turned off men who could benefit from appropriate physician intervention for more than 50 years.

But just as the 1960’s saw large numbers of women leave the home to join the work force, men of the 21st century are looking to gain more natural energy to complete with the younger men in the shrinking, employment market. Just as each study of estrogen replacement in women shows an extended and improve overall life style, so should men concur with the aid of studies about testosterone improving their own lifestyle.

Measuring Testosterone

 The standard male’s blood testosterone measured between 400 and 1200 ng/dl in the 1950’s.  The average man’s sperm count was 140,000,000 sperm in one cubic centimeter of seminal fluid.  The incidence of diabetes in men was 1 million in a population of 150,000,000 in 1950 and cardiovascular disease and heart attacks as we knew it then were rare and then most likely related to an inherited or genetic defect.  Today in a population of 300,000,000 the incidence of diabetes in men is 10 million, an increase of 500 percent and 1:14 men will have a heart attack before age 50.  The average sperm count has dropped to 30 million and male infertility has become an epidemic4-5.  Studies show that men with sperm counts under 20 million are rarely able to reproduce without medical assistance.

What happened after WWII?

DDT, Dichloro-Diphenyl-Trichloroethane, was invented in WWII6 and used as a pesticide to clear malaria and typhus and then, after the war as an agricultural pesticide. With the scientific study by Rachel Carson7 that DDT was concetrating and killing higher life organisms like birds, it was banned in the 1970’s.  DDT can still be meaured in signficant amounts in the tissue of half of the population8. DDT is important because as an organic pesticides it has estrogenic properties and is called a xeno-estrogen.

DDT is an organochloride that has weak estrogenic activity and chemically similar enough to estrogen to trigger hormonal responses in contaminated animals9.  TCDD is another organochloride contaminant used with the Agent Orange sprayings in Vietnam.  Di-ethyl Stilbesterol (DES) is a synthetic estrogen used to treat women extensively from 1940 to 1960 and then used to fatten up livestock.  Both synthetic chemicals have hormonal-mimicking activity observed to promote abnormal gene expression when used in laboratory studies involving mice and rats as test subjects. We can suppose from what has happened over the last 50 years, that just like birds, mice and rats, we humans  are being damaged by exposure to these chemical substances that stay in your body for upwards of 15 or more years10.  And the plastic containers we use are also in a related class of xeno-estrogens.11

Having recognized that there are hormone like substances in the water, some countries such as Singapore have taken the necessary steps to filter out hormones from their water supply. Other countries have banned adding hormones12 to the oral animal feed and hormone pellets from being injected into the animals.1

No matter what the cause, there is a major problem for men’s health.  Whether it is too much estrogen, or too much xeno-estrogen, or too much synthetic hormone-like substances like TCDD/agent orange14, the fact is their effect is manifesting itself in the male as too low a testosterone level. Taking away testosterone from a man is like taking away not only his reproductive capacity but also his ability to live a long and healthy life.

Personal Perspective

When Dr. Lichten turned 45 years of age, his hormonal levels seemed to crashed. It seemed like overnight he went from being an enthusiastic, hard working, physically potent man to be a depressed, lethargic, exhausted old man.  His symptoms included night sweats so extreme that he had to take two showers every night.  His colleagues had no idea what to do—one offered to admit Dr. Lichten to the hospital to get an answer.  But as a physician, Dr. Lichten knew the hospital offered no answers.  Rather, the discovery of the cause of his malaise came from the unbiased information offered from his older gynecology patients. Two women told the doctor that their 70 year-old husbands had the same symptoms. So, Dr. Lichten ran my menopausal laboratory tests on his own blood. Lucky!  Dr. Edward Lichten was one of the first recognized ‘menopausal’ males.  With this newfound information, he asked his urologist about testosterone replacement. The urologist told him that no one believed in testosterone for men, it was too dangerous, and the laboratory tests could be best explained by the large number of menopausal women being treating in Dr. Lichten’s practice--they had influenced his tests!

So, Dr. Lichten searched out the literature, found a doctor who believed in testosterone replacement, and started testosterone replacement under physician supervision in 1995.  His life has never been sweeter since he began ‘drinking from man's bio-identical fountain of youth’.

The pictures on Dr. Lichten’s Internet webpage show the dramatic changes in his physical appearance.  At 42, he was tired, wrinkled and full faced— at 51, he was muscular and lean with a renewed enthusiasm radiating from a healthy body and face!  Dr. Lichten reported that his women patients noticed the difference, and since low dose testosterone replacement has been a mainstay of his treatment of menopausal women, they were intrigued.  After questioning, they asked if Dr. Lichten would treat their husbands: not only because of their husband's erection dysfunction and lack of libido, but because they worried that their husbands’ health was being jeopardized, having many of the same symptoms as Dr. Lichten. 

The Declining Testosterone Levels in Western Society

Travison reported that since 1940, men of comparable ages are showing lower levels of total testosterone.5 She reports a decline of testosterone of 1% or more per year for each year in the last two decades.  This equates to a 17% drop every decade of life after age 30.

Men who reached 50 in 1989 had an average total testosterone of 530 ng/dl.  Men who reached 55 in 1997 had an average total testosterone of 475 ng/dl and men who reached 60 in 2004 had an average total testosterone of just 450 ng/dl. 

It is normal for the biological hormones to drop with aging: vitamin D, melatonin, human growth hormone, thyroxine, tri-iodothyronine, DHEA, insulin, estrogen, progesterone and testosterone.  What is alarming is the rapidity in which some environmental factor has wiped out the baseline testosterone levels in just 50 years. Men were programmed for men’pause, but it is coming earlier and earlier and so are the killing diseases: heart disease, stroke and diabetes.

The problem faced by men today is not only the drop in total testosterone with aging but this environmental or unknown factors that are dropping men’s testosterone by an additional 5% every 10 years.

With a drop in testosterone levels, the question is at what level does the drop become significant.  In sperm count, a drop from 140 million to 30 million decreases fertility by 10-20%.  But a drop of sperm count from 30 million to 20 million or less would probably drop fertility another 50 to 75% and truly affect the human race’s ability to reproduce.

Recognizing that the drop in testosterone is a real problem and it correlates to disease in men, what are the steps needed to stem the problem?

Recognizing Testosterone Deficiency:  The St. Louis A.D.A.M. questionnaire

The St. Louis A.D.A.M. questionnaire is a good starting point to ask if testosterone deficiency exists.  If there is a decrease in sex drive or the erection is less strong, it behooves the male to have the appropriate laboratory tests to rule out some organic disease (infection, thyroid, anemia, etc.) and differentiate that from true hypogonadism.  Remember, the drop in testosterone may be temporary during times of peak stress and insomnia, but if a man’s testosterone levels are low, supplementing testosterone will allow him to often overcome the stress. 

A.D.A.M. Questionnaire: 1 and 2 or any 4 answered as 'yes' is considered suspect for Testosterone deficient!

1.      Decrease in sex drive.

2.      Erections less strong

3.      Lack of energy

4.      Decrease in strength or endurance

5.      Lost height

6.      Decreased 'enjoyment of life'

7.      Sad and/or grumpy

8.      Deterioration in sports ability

9.      Falling asleep after dinner

10. Decreased work performance

 

Recognizing Testosterone Deficiency: the laboratory tests

Because there is confusion over what constitutes the correct laboratory test and at what measure of testosterone should be considered deficient, the following information will first focus on the laboratory tests that are used to measure total testosterone. The amounts of testosterone that are usable are called bio-available and this value is measured or calculated as a separate test.

The effects of various forms of estrogens and xeno-estrogens on bio-available testosterone cannot be measured directly so the information includes the importance of the measurement of Sex Hormone Binding Globulin- SHBG.

Testosterone Measurements

The serum assay of total testosterone has been a standard measurement for more than 40 years.  The Radio-Immune Assay, RIA, is standard. However, different laboratories use different RIA so the value between laboratories may vary by 10 to 25%.  If possible, use the same laboratory to follow sequentially the state of the man’s total testosterone.

Secondly, testosterone is a hormone that is released to a circadian rhythm.  That means that there may be a 10 -15% variance between the peak testosterone at 4:00 AM and that spontaneous erection and the mid-afternoon testosterone crash.  A second peak of testosterone occurs around 8:00 AM to ready the man for the workday.  The doctor prefers to have the testosterone drawn in the morning for consistency.

Third, since measuring testosterone is bundled with the measurement of prostate specific antigen (PSA) which is the screen for prostate cancer, the doctor insists that the male not have sexual intercourse or manual ejaculation for 48-72 hours before the laboratory tests are drawn.  Elevated PSA commit the physician and patient to repeated tests, urologic screening and potentially an ultrasound and biopsy.  Simply, just avoid sex for two days before the laboratory tests are drawn.

The Role of Estrogen

Since estrogen and testosterone are the sex hormones, they compete for attachment to the ligand called Sex Hormone Binding Globulin-SHBG. The coupling of hormone to SHBG is necessary for the hormone to dock against the cell wall, traverse the cell and enter the nucleus command center. When a hormone enters the command center, specific instructions are sent out to the cells.  For the man, these instructions must be manly; he does not need estrogen making his breasts and abdominal love handles bigger.  Measurement of total estradiol by R.I.A. may direct the physician to consider how much of the naturally produced testosterone is being converted to estrogen.

For Estrogen and testosterone not only compete for SHBG and entry into the cell, but they both feedback to the pituitary, the master gland.  The pituitary releases both follicle stimulating hormone-FSH and luteinizing hormone-LH when additional testosterone and estradiol are needed.  The presence of excess estrogens in the male reduces the secretion of FSH and LH, thereby, reducing the production of testosterone.  With increased amounts of aromatized estrogen and xeno-estrogens, the physician may find a low level of FSH and LH paired with low levels of testosterone.  That is the crux of man’s problems: too much bad estrogen and too little good testosterone.

As discussed in Chapter 6, the normal evolution of man is to have high testosterone and high free, biologically available testosterone during the years of peak reproduction. But by the age of 30, the enzymatic conversion of testosterone to estrogen begins. The medical term is aromatization: changing the one molecule on testosterone so it becomes estrogen. 

The Role Of SHBG

Recognizing that estrogens have a negative effect on man’s health is clear.  Not only does estrogen compete with testosterone for penetration into the cell; compete for production from the pituitary stimulating hormones; but also affects the production of the binding protein, SHBG directly.  More than 30 years ago, D.C. Anderson15 in 1972 in Nature showed that estrogen stimulates SHBG production.  The highest levels of SHBG are seen during pregnancy when there are tremendous levels of estrogens produced. Similarly, SHBG is an estrogen amplifier as SHBG tightly binds testosterone making it inactive. Bound testosterone is inactive so there is a strong correlation between unbound testosterone with high total testosterone and low SHBG.  In young virile males, individuals will have both high values of total serum testosterone concentrations and low levels of SHBG concentration.  Anderson proposed the measurement be called the Free Androgen Index (FAI) and it be calculated as the ratio of total testosterone concentration divided by SHBG concentration. The formula is [Total Testosterone]/[SHBG].  Since testosterone is measured as ng/dl and SHBG as pmol/liter, the calculation of FAI= .03x[TT]/[SHBG].  The [0.03] is the factor for the conversion of ng/dl divided by mol/l.  A young male should have a FAI of 0.8 to 1.2; an older male 0.5, and a male diabetic on dialysis may have a FAI of 0.1 or less.  This is, in Dr. Lichten’s opinion, the measurement used to make the diagnosis of testosterone deficiency.

The New Free Insulin and Testosterone (F.I.T. test)

One of the most important concepts that Dr. Lichten has advanced is that the high free sex hormone states correlate directly to health and that low free hormone states correlate with disease states like diabetes.  What others have documented is that this SHBG molecule, when combined with the proper gender-specific hormone, works with insulin to protect against diabetes.

Male-healthy

high testosterone

low estradiol

low SHBG

Male- not so

low testosterone

high estradiol

high SHBG

Testosterone is good for men and estrogen is good for females.  The corollary is also true, too much of the wrong sex hormone and the wrong amount of SHBG will be found in an individual who is or will be at risk for diabetes and disease.

The New F.I.T. Test for Women

So, to digress for a moment, consider two women.  One is shorter, heavier set, has increased facial hair and a stout body build.  We will call her Rosie. Rosie will typically have a ‘Female-not so healthy’ laboratory profile: high testosterone, low estradiol, low SHBG and a higher statistical risk of diabetes, obesity and heart disease. If she is in the reproductive age, the gynecologist may diagnose her as polycystic ovarian disease, PCO.  But, what is bad for Rosie is excellent for the majority of men, relatively speaking: high testosterone, low SHBG.

Female-healthy

low testosterone

high estradiol

high SHBG

Female- not so

high testosterone

moderate estradiol

low SHBG

While another woman, called Gwen will have what is generally considered a healthy female body composition, her laboratory tests will show a low testosterone, high estradiol and high SHBG. The same results are typical for the laboratory tests of an unhealthy male with testosterone or heart disease.

The term is Gender-Specific Medicine. Target the medical treatments to match the hormonal levels ideal or specific to their gender.

While others will argue about the testosterone tests, Dr. Lichten’s position is that any abnormal test of testosterone is important. Measure total testosterone, measure the free testosterone or measure some aspect of bio-available testosterone. Dr. Lichten has relied on the Free Androgen Index because of its long-term use in Europe and because of the true science behind the measurement. The fallacy of using a non- FAI index is that the physician may not realize that SHBG is directly linked to insulin resistance. And that is the key to preventing disease; keep the insulin resistance low as showed by G.W. Reaven, M.D. in articles published out of Stanford.  Conditions that elevate the fasting insulin level or increase insulin resistance will increase the risk of every disease, including diabetes, heart disease and even cancer.

Dr. Lichten and others have determined that an elevated SHBG in a man is paramount in importance to raising the insulin resistance in the afflicted male.  Therefore, understanding the prevention of disease or the ‘anti-aging’ aspect of medicine in a male is as simple as—

High TestosteroneLow SHBHLow Fasting Insulin Low risk of disease

Elevated F.A.I.       ►►►   plus  Low Fasting  Insulin ►Low risk of disease

Elevated F.I.T. test  ►►►►►►►►►►►►►►    ►Low risk of disease

Before Anderson’s work on establishing the measurement of bio-available testosterone as a ratio of total testosterone over SHBG, the doctors had to understand what appears on the first line of the box: men need high levels of testosterone and it needs to be free, not bound. The F.I.T. test goes one step further in incorporating the insulin levels into the calculation. This allows the F.I.T. test to be unique in determining risk of disease.

So if low SHBG is good when coupled with high testosterone, then high SHBG and low testosterone in men implies disease; specifically diabetes and metabolic syndrome. And as discussed in Chapter 5, both diabetes and metabolic syndrome share common components that include obesity, diabetes, heart disease, hypertension and abnormal cholesterol.  Not measuring FAI, TT, E2 and SHBG is to not measure necessary information about the individual’s hormonal milieu. Not to measure HgbA1c (glycogenated hemoglobin) and fasting insulin is to measure the metabolic pre-diabetic state.  These and other laboratory test values in our hands may help predict the development of disease up to 20 years before it is set to develop.

It has been Dr. Lichten’s most recent work that ties testosterone levels in men directly to the diabetic state. The failure of the FAI as an ‘anti-aging test’ is that it fails to consider the role of insulin levels and insulin resistance in causing disease. This has been rectified in the development of the F.I.T.-- Free Insulin-Testosterone test. By adding both estradiol and insulin lab values to the calculation, the F.I.T. test simplifies the full gambit of information analyzing automatically the hormonal factors that might warn of diseases yet to develop.

Personal Perspective

TT is a 43 year-old male who has been able to stay in very good physical shape by eating right, not smoking, actively lifting weights and 30 minutes of cardiology 3-5 times per week.  But TT noted that his workouts were flat, that he was unable to get pumped and then not even to feel good after a workout.  He developed a ‘gut’ and added 20 pounds around his waist, his sexual performance started to fade and he had more and more episodes of restless sleep.  Exhausted in the morning, he sought out medical assistance from Dr. Lichten.

 “Doctor, tell me why I sweat so much at night?” started the discussion. “The sweating is so intense that it wakes my wife. She feels like she is at the water’s edge.  I have been taking two showers a night but the sweating continues.  Exhausted and emotionally drained, what am I going to do?”

Dr. Lichten explained that the night sweats are not unusual in men who are going through andropause or male men’pause.  The problem is that the pituitary gland (brain master gland) senses a low level of testosterone so it puts out a lot of its hormones, FSH and LH. These surges of pituitary hormones, in an attempt to raise testosterone levels, are the direct cause of the change in core temperature and the release of sweat.  The only way to stop sweating is to have your hormonal production of testosterone increase and stabilize, then the body will naturally lower the release of FSH and LH.

After suitable laboratory tests confirmed the problem and defined other issues, TT and Dr. Lichten discussed testosterone replacement.  There are five forms of testosterone available in the United States, five not available in the United States, while all are restricted to prescriptions by physicians with State and Federally licensure.  They are:

Product

 

dosage

cost/ month

testosterone gel

Androgel®

 1pack to chest

30pk/$ 228.99

testosterone patch

Androderm®

1 applicator/dy

 30/ $   225.00

testosterone injection

cyprionate

100mg IM week

10ml/$   50.00

testosterone pellet

Testopel®

inject 4-10/mo

insert 6 pellets       $400- $600.00

testosterone cream

compounded

1 pump/ day

1 oz/   $ 60.00

testosterone capsule

Oxandrin

10mg/ day

30/$     621.65

The European have specific actions that would complement the U.S. products if F.D.A. approval could be secured. Stanazolol, for example, has complementary and unique anti-diabetic and anti-thrombic properties that would work well for both men and women in the over 50 population.

Product: not available

in US

 

 

 testosterone oral

Primobolan

 

 

 testosterone oral

Anadrol

 

 

testosterone injection

stanazolol

 

 

testosterone pellet

Organon 3-month

 

 

discontinued

trenbolone

 

 

 

 

 

 

Problems with Testosterone Gel

In the United States, testosterone gels are most popular with Androgel by Solvay Pharmaceuticals reaching sales well over one-billion dollars per year. Prescriptions for testosterone were written for 17 million men. These cream and gels have a major problem: the human body is not well equipped to take in hormones through the skin.  When estrogen is applied to a woman’s skin, it is absorbed and processed as estrogen. The problem with testosterone applied to the skin is that the skin contains so much aromatization potential that it converts testosterone to estrogen in very high amounts.  And higher estrogen levels are contra-productive to a man’s health.

Estrogen is the first derivative of testosterone. Just by sniping off one extra molecule, life-giving testosterone for men becomes life-giving estrogen for women. But what gives life to women will damage men.

The Problem with Estrogen in Men

For example, it was recognized in the 1950’s that women lived longer than men and that the removal of the ovaries from women and their live-giving estrogen would double their rate of heart attack in the next 10 years.  So some bright researchers convinced a number of men who had had heart attacks to take Premarin®.  By giving these men more estrogen, they were able to kill all the volunteers with heart attacks in the next two years.  No -- estrogen for men is not just bad, it is deadly.16-18

In Europe, estrogen replacement is used in treating some men with prostate cancer. Tivesten recorded in those men on ERT, dramatic thickening of the lining of the carotid arteries, which increases the risk of stroke. The higher doses of estrogen used were correlated directly to more thickening noted.19

The Problem with Having Insufficient Testosterone

The physicians and general public have missed the magnitude of the problem that results from men developing the syndrome of hypogonadism from insufficient testosterone. The article by M. Shores showing doubling of deaths for all reason in the ten years following identification of low testosterone in a Veteran population.20

Conclusion #1: Lack of testosterone results in an increase in unwarranted deaths add back testosterone to faltering and aging men.

The connection that has eluded the physicians and general public to date is that adequate testosterone protects against diabetes.  In Dr. Lichten’s practice, some men with true diabetes and abnormal glucose tolerance tests revert entirely to normal on testosterone injections.

 Conclusion #2: Lack of testosterone results in an increased probability of being afflicted with diabetes. Diabetes and high insulin are the key risk factors to heart disease.  So, add back testosterone to faltering men. Men who are deprived of testosterone show a 50% incidence of metabolic syndrome or pre-diabetes.21

The treatment and prevention of cardiac disease in men has eluded the physicians and general public because of the ignorance about testosterone.

Conclusion #3: Add back testosterone to heart failing men, and those suffering with angina, heart attacks and heart failure. Treat aggressively and treat often.22

The science strongly links lack of testosterone in men to osteoporosis23, Alzheimer’s disease42 and development of chronic muscle wasting53.

Prostate cancer is strongly linked to low not high levels of testosterone.

Testosterone and Prostate Cancer

It has been a misconception that testosterone is a harbinger of prostate cancer. Marks25 established that testosterone by itself was not a cause of prostate cancer when given for replacement to aging males. High doses of testosterone for a half-year failed to induce negative or precancerous changes in the prostate cells. 

In a study published by Morgentaler26 in 2006, a careful prostate examination, ultrasound and biopsy was performed on men whose total testosterone levels were under 300 ng/dl. The incidence of prostate proven cancer was 17.5% in the group whose PSA was less than 2.5; those whose PSA was between 2.5 and 4.0 had an incidence of 32% proven prostate cancer. In fact, the presence of low levels of testosterone, defined as less than 250 ng/dl, identified prostate cancer in 20% and put that male at a 2-fold or greater risk than the male with a higher total testosterone level.

Conclusion: Prostate cancer is a definite risk of 1:7 in males with testosterone levels less than 300 ng/dl. Yet, once the cancer is removed, the benefits of testosterone replacement outweigh the risk. Testosterone replacement is indicated in the male successfully treated for prostate cancer.27 “Furthermore, this historical perspective reveals that there is not now-nor has there ever been a scientific basis for the belief that Testosterone causes prostate cancer to grow.”28

Testosterone and Erectile Dysfunction

Since the peak of reproductive capacity is associated with the highest levels of testosterone and biologically free testosterone in the young adult, it is logical to consider erectile dysfunction in the aging male as a sign of testosterone deficiency.29 Furthermore, the erectile dysfunction-ED associated even with the use of the most potent PD-5 inhibitors, Viagra®, Cialis® and Levitra® can often be treated by adding back inexpensive androgen therapies.30

What is presently known about sexual or erectile dysfunction is that there are three centers that must be functioning normally. The limbic center of the brain must have the ‘idea’ to respond to a sexual stimuli. This is called libido or sexual desire.  Secondly, the penis must dilate the arteries leading to the corpora cavernosa and fill the two chambers with blood to become erect. This is possible because of the local release of nitrous oxide (NO) sent from brain stimuli. cGMP causes the local arteries to dilatation and quickly fill the penile blood channels.  Lastly, there must be a block of the enzymes that cause the penis to deflate. The enzyme that destroys cGMP is called phosphodiesterase (PDE).  The PDE-5 inhibitors, such as Viagra®, work only at the last step.

The problem with treating erectile dysfunction initially with PDE-5 inhibitors, is that the potential cause of the problem, hypogonadism is not addressed.  So, although the literature is filled with references to men with ED having heart disease, diabetes, osteoporosis, strokes and Alzheimer’s disease, no one addresses the simple, safest treatment that offers the greatest over all health potential: treat with testosterone first!

Urologists general agree that “screening for hypogonadism in all men with ED is necessary to identify cases of severe hypogonadism and some cases of mild to moderate hypogonadism, who may benefit from testosterone treatment.”31

So before you reach for that $14 pill in an attempt to maintain your ‘manly’ erection, think how much better off your whole body will be if the manly hormone testosterone is circulating to every organ in your body. In Dr. Lichten’s practice, less than 10% of men on testosterone and without cardiac or diabetes disease, rely even occasionally on that ‘little blue pill.’  The side effects of testosterone include increased muscle mass, clarity of thought, stronger bones, glucose control and increased heart power and dilation of the coronary arteries are all positive versus the headaches and vision changes associated with PDE-5 therapy.

Who should Be Tested?

Based on the recent analysis of Mohr32 in analysis of the Massachusetts Male Aging Study-MMAS, the normal range of testosterone for 95% of the population will be between 251-914ng/dl for men in their 40’s; 216-876ng/dl for men in their 50’s; 196-859ng/dl for men in their 60’s; and 156-818 ng/dl for men in their 70’s.  What this means is that only 2.5% of the population is expected to have testosterone levels below 200 ng/dl. 

Statisticians use this 2.5% number, called two-standard deviations below the mean, to define abnormal.  However, if one wants to be considered just average, just 50%, then the mean testosterone level would be 580 ng/dl for 40-year olds, 550 ng/dl for 50-year olds, 525 ng/dl for 60-year old, and 490 ng/dl for 70-year olds.

As Dr. Lichten explains the testosterone threshold, “If testosterone is the breath of life, I do not want to be at any less than 50%!”

It makes no sense to be less than average, in a medical sense so Dr. Lichten replaces testosterone levels in all individuals who have symptoms or signs of any disease related to hypogonadism and a total testosterone level less than 500 ng/dl which is the statistical ‘average.’ Furthermore, he tailors the form of testosterone to the individual’s body type, estradiol and Sex Hormone Binding Globulin-SHBG level.  Men with elevated estradiol or SHBG are treated first with Deca-Durabolin, a synthetic testosterone that suppresses natural testosterone production and its aromatization to estradiol.  If the estradiol and SHBG levels fail to drop into the normal range (Chapter 6), then an aromatization inhibitor such as generic tamoxifen or Arimidex® is used.  The key in Dr. Lichten’s protocols is to follow the changes in treatment described by the patient with sequential laboratory tests.  Natural prostate formulations from over-the-counter supplement houses with saw palmetto, pygeum, stinging neetles, D.I.M. and chrysin are not to be discounted but cannot offer the power of medical intervention described above.

The Last Word
After everything has been said and done, the most conservative of professors, M.M. Miner33 confirms that testosterone replacement “may help” and is “unlikely to pose major health risks.” 
Say “Yes” to Testosterone! 
 Recent studies have demonstrated that hypogonadism in men may be more prevalent than previously thought, is strongly associated with metabolic syndrome, and may be a risk factor for type 2 diabetes and cardiovascular disease. Clinical studies have shown that testosterone replacement therapy in hypogonadal men improves metabolic syndrome indicators and cardiovascular risk factors. Maintaining testosterone concentrations in the normal range has been shown to contribute to bone health, lean muscle mass, and physical and sexual function, suggesting that testosterone replacement therapy may help to prevent frailty in older men. Based on current knowledge, testosterone replacement therapy is unlikely to pose major health risks in patients without prostate cancer and may offer substantial health benefits. Larger, longer-term randomized studies are needed to fully establish the effects of testosterone replacement therapy.33
 
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