Sarcoidosis

Another Potentially
Testosterone Deficient State!

Edward Lichten, M.D., PC
555 South Old Woodward Suite #700
Birmingham, MI 48009 
248.593.9999

 

BREAKTHROUGH in TREATMENT of SARCOIDOSIS!

PATHOPHYSIOLOGY:

The Pathophysiology or cause of Sarcoidosis is unknown bu thought to be due to exposure to environmental toxins in a genetically susceptible individual. Women may be slightly more affected then men. The disease is more p;revalent in the American blacks and Puerto Rican populations.   Nodules can form in the lung or other tissue. As an inflammatory condition, it may be hypothesized that the cause is the individual’s body response to outside Endocrine Disrupting Chemicals (EDC).  Laboratory testing will show not only inflammatory markers such as abnormal serum levels of angiotensin-converting enzyme (ACE) in both sexes, but in men also low  levels of bio-available testosterone.

LABORATORY MEASUREMENTS

  • The standard laboratory measurements of inflammation include:

  • Sedrate

  • C-reactive protein

  • A.C.E.

DIAGNOSTIC TESTING

  • EKG (cardiogram)

  • Chest X-ray

  • Pulmonary Function

ADDITIONAL LABORATORY TESTS to calculate bio-available testosterone:

  •  Total serum testosterone

  • Total serum Estradiol

  • Sex Hormone Binding Globulin

ADDITIONAL ENDOCRINE DISRUPTION with these laboratory tests:

  • Hypothyroidism: low TSH, low T4 and T3 RIA: Hypothyroidism (low thyroid) is quite common in women with sarcoidosis

  • Elevated Vitamin D 1,25 dihydroxyvitamin D

  • Prolactin

  • Sarcoidosis is aggravated by high levels of estradiol and prolactin in pregnancy: women with sarcoidosis may show hypercalciuria (high serum calcium) and/or resultant or  compensatory hypoparathyroidism (low parathyroidism). .

 

TREATMENT

In this author’s experience, initial treatment with Stanozolol to lower SHBG and the addition of injections of  testosterone injections or implantations of Testopel® pellets have been helpful in reducing signs, symptoms and the lab tests of inflammation. Whether this will improve pulmonary function is yet to be determined. Male patients report improved feelings of well-being and improvement in sexual function; i.e. erectile dysfunction is lessened.

An over-the-counter preparation called gingko biloba has been helpful in high doses to reduce the skin tightening in some individuals in our practice. Although not reported in the literature, gingko biloba has shows effects of circulation in human and animal studies.

An article from Yale reports on the use of 600-800mg of ketonazole to control the elevated vitamin D 1,25 and calcium levels although having no effect on the ACE or sarcoidosis.2

 

For ADDITIONAL INFORMATION ABOUT STANDARD THERAPY, go to:

MAYO CLINIC                     www.MAYOCLINIC.org

MERCK MANUAL               www.merckmanual.com

National Institute of Health Public Library [pubmed.org]

 http://www.nhlbi.nih.gov/health/dci/Diseases/sarc/sar_whatis.html

 

REFERENCES:

1. Spruit MA, Thomeet MJ, et al. Hypogonadism in male outpatients with sarcoidosis.  Respiratory Medicine 2007 Dec; 101(12): 2502-10  PMID: 17855065 

 2. Bia MJ, et al. Treatment of sarcoidosis-associated hypercalcemia with ketoconazole. Am J Kidney Dis. 1991 Dec; 18(6): 702-5. PMID: 1962657 

 

Editor:  Edward Lichten, M.D., F.A.C.S., F.A.C.O.G.

Assistant Clinical Professor, Wayne State University, College of Medicine


 

 

PUBMED.ORG medical literature search:

Respir Med. 2007 Dec;101(12):2502-10. Epub 2007 Sep 12.

Hypogonadism in male outpatients with sarcoidosis.

Spruit MA, Thomeer MJ, Gosselink R, Wuyts WA, Van Herck E, Bouillon R, Demedts MG, Decramer M.

Department of Research, Development & Education, Centre for Integrated Rehabilitation of Organ failure (CIRO), Hornerheide 1, 6085 NM, Horn, The Netherlands. martijnspruit@proteion.nl

Abstract

Hypogonadism is assumed to be present in sarcoidosis. Nevertheless, a comparison of circulating sex hormone concentrations of male sarcoidosis patients with those of healthy men has never been done. Moreover, it remains unknown if hypogonadism may contribute to a reduced muscle function, exercise intolerance, diminished vitality and depressed mood in male sarcoidosis patients. Pulmonary function, muscle function, exercise tolerance, vitality, mood, circulating sex hormone concentrations and C-reactive protein were assessed in 30 male sarcoidosis patients and 26 age-matched men with a normal pulmonary function. On average, patients had a restrictive pulmonary function, worse inspiratory and quadriceps muscle function, functional exercise intolerance, diminished vitality, depressed mood and increased systemic inflammation.

Moreover, patients had significantly lower circulating (free) testosterone concentrations, while circulating sex hormone-binding globulin tended to be lower (p=0.0515). Circulating gonadotrophin concentrations were comparable. Non-significant relationships were found between sex hormones, clinical outcomes and C-reactive protein in patients with sarcoidosis. A significant number of male outpatients with sarcoidosis (46.7%) had low circulating testosterone concentrations, which was most probably caused by hypogonadotrophism. The clinical relevance of hypogonadism in male outpatients with sarcoidosis, however, remains currently unknown. Indeed, poor inspiratory and quadriceps muscle function, exercise intolerance, diminished vitality and depressed mood were not related to hypogonadism in these patients.  PMID: 17855065 

____________________________________________________________________________

 

 

 

Lichten's Pearls to determine Testosterone Deficient States

1. Measure a man's laboratory tests to determine his standard risk factors.

2. Bio-available testosterone is measured as the Free Androgen Index (FAI). Raw FAI is calculated as [total testosterone]/ [sex hormone binding globulin]. Calculate final FAI by multiplying the raw FAI by 0.03 conversion factor.

3. Normal range greater than 0.7. Most men are at 0.3.

4. Replace testosterone with pellets or injections as the topical preparations raise the estrogens and SHBG.

5. High SHBG correlates directly to insulin resistance and pre-diabetes. Suppress SHBG with Deca-Durabolin 100mg intramuscularly weekly instead of testosterone..

6. IF all fails, check with Dr. Lichten about his recent discoveries with the Endocrine blocker therapy. It will drop the SHBG by two-thirds.

7. The goal is to reach a testosterone level between 450-800 ng/dl; an estradiol less than  25mg/dl and a SHBG at 15-20 nmol/L.