Life Extension Magazine June 2012
As We See It
The Testosterone Controversy
By William Faloon
By William Faloon
Doctors Overlook Lethal Impact of Estrogen Imbalance
When Life Extension® started offering comprehensive blood test panels back in 1996, men did not understand why we were checking their estrogen levels. Back in those days, estrogen was considered a hormone of importance only to women.
We tested estrogen based on published data indicating that when estrogen levels are unbalanced, the risk of degenerative disease in aging men skyrockets.38,47-52 Of concern to us 16 years ago were reports showing that excess estrogen contributes to the development of atherosclerosis.74,75 Human clinical studies conducted more than a decade later confirmed our suspicions. Men with even slightly elevated estrogen levels doubled their risk of stroke and had far higher incidences of coronary artery disease.43,76,77 Our early observations also revealed that men presenting with benign prostate enlargement or prostate cancer had higher blood estrogen levels (and often low free testosterone blood levels).78-81 Subsequent clinical studies help confirm our early observations.82-86
Insufficient estrogen, on the other hand, predisposes men to osteoporosis and bone fracture.87,88
The fact that 99% of men today have no idea what their blood estrogen levels are helps explain the epidemic of age-related disease that is bankrupting this nation’s medical system.
A study published in the Journal of the American Medical Association (JAMA) measured blood estradiol (a dominant estrogen) in 501 men with chronic heart failure. Compared to men in the balanced estrogen quintile, men in the lowest estradiol quintile were 217% more likely to die during a 3-year follow-up, while men in the highest estradiol quintile were 133% more likely to die.39
The men in the balanced quintile—with the fewest deaths—had serum estradiol levels between 21.80 and 30.11 pg/mL. This is virtually the ideal range that Life Extension has long recommended male members strive for.
The men in the highest quintile who suffered 133% increased death rates had serum estradiol levels of 37.40 pg/mL or above. The lowest estradiol group that suffered a 217% increased death rate had serum estradiol levels under 12.90 pg/mL.
The dramatic increase in mortality in men with unbalanced estrogen (i.e., estradiol levels either too high or too low) is nothing short of astounding. It uncovers a gaping hole in conventional cardiology practice that is easily correctable and explains why clinical trials on aging men that fail to measure estradiol have serious shortcomings.
This study revealing the lethal dangers of estrogen imbalance was published in conventional medicine’s Bastille of knowledge—the Journal of the American Medical Association, yet doctors continue to design clinical trials on aging men that measure total and/or free testosterone levels, but fail to account for estradiol, which can sharply increase when large doses of testosterone are administered.
Low Testosterone Increases Prostate Cancer Risk
Fear of prostate cancer is the leading reason why aging men have shied away from restoring their free testosterone to youthful ranges. To dispel this concern, Life Extension long ago analyzed every published study and found there is no basis for asserting that testosterone causes prostate cancer.89-94
Our observations from the thousands of blood tests we perform each year for members confirm this. What we found is that men with low testosterone appear to be more likely to contract prostate cancer.
In the landmark book, Testosterone for Life (McGraw-Hill, 2008), Harvard professor Abraham Morgentaler thoroughly discredited the notion that testosterone causes prostate cancer.95
What came as a bombshell to the medical establishment was the compilation by Dr. Morgentaler of scientific facts showing that men with low testosterone levels have an increased percentage of prostate cancer-positive biopsies.96,97
To further help dispel the myth that higher testosterone levels increase PSA levels (and presumably prostate cancer risk), the two charts (on the next page) compiled from our blood test analysis clearly show that as free testosterone levels decline in aging men, their PSA levels sharply increase.
What are Optimal Free Testosterone Levels?
The number of men who suffer testosterone deficiency is so high that laboratory reference ranges accept ridiculously low levels as “normal.”
We at Life Extension suggest that men maintain their free testosterone in the range of 20 to 25 pg/mL of blood.98 Others with expertise in this area believe free testosterone as low as 15 pg/mL is adequate.70
Conventional blood labs, on the other hand, say aging men are alright with as little as 6.6 pg/mL of free testosterone in their blood—an absurdly low level!
Mainstream medicine’s ignorance regarding the need to maintain free testosterone in the higher ranges is a significant cause of premature disability and death in aging men.
When Life Extension conducted a study of its members free testosterone blood levels two years ago, a startling 86% of the men had less than 15 pg/mL of free testosterone, placing them at high risk for virtually every age-related disease.
Free testosterone is the biologically active form of this hormone measured in the blood. When looking at total testosterone blood levels, one should strive for a moderately youthful range of 700-900 ng/dL, though conventional reference ranges state that levels as low as 193 ng/dL are sufficient, a range that we at Life Extension believe is woefully inadequate.
Low Estradiol and Testosterone Predict Mortality in Aging Men
Sales of testosterone replacement drugs have surged more than 20-fold in response to studies linking low testosterone to a host of common maladies.
In a study of 3,014 men aged 69-80 years, serum levels of testosterone and estradiol were measured during a mean follow-up of 4.5 years. Men with low testosterone had 65% greater all-cause mortality, while men with low estradiol suffered 54% more deaths.40
Those men low in estradiol and testosterone were almost twice as likely to die (a 96% increase in mortality) compared to men in the optimal ranges.40
This large study of aged men corroborates prior published reports linking imbalances of testosterone and/or estradiol with greater incidences of degenerative disease and death.6,7,13-18
How Do Men Naturally Make Estrogen?
Women synthesize most of their estrogen in their ovaries and other reproductive tissues.
Since men lack this female anatomy, they need to produce estrogen through a process involving an enzyme called aromatase that transforms testosterone into estradiol.
Aging men sometimes have too much aromatase activity, which causes their testosterone to convert to excess estradiol. This results in depletion of vital testosterone while spiking estradiol to unsafe ranges.
Some men lack aromatase and suffer an estrogen deficit. Other men produce so little endogenous testosterone that there is not enough to convert into estrogen, which causes low levels of both free testosterone and estradiol.
Fortunately, no matter what the underlying cause, aging men can easily achieve optimal free testosterone and estradiol serum levels.
Free testosterone is the unbound form that is biologically available to cell receptor sites throughout the body. Measuring free testosterone blood levels is the most accurate way of assessing testosterone status in aging men.
How Aging Men Can Control Their Estrogen Levels
An epidemic problem we at Life Extension observe in aging male members is insufficient free testosterone, i.e., less than 15-20 pg/mL of serum. When accompanied by excess estradiol (over 30 pg/mL of serum), this can signal excess aromatase enzyme activity.
Excess aromatase robs men of their testosterone while exposing them to higher than desirable estradiol.99 Aromatase can be suppressed with absorbable forms of chrysin (a plant flavonoid) and/or lignans such as those extracted from the Norway spruce tree (HMRlignan™).100-104
If these nutrients fail to reduce estradiol adequately, then we suggest that men ask their doctor to prescribe a low-cost generic aromatase-inhibiting drug like anastrolzole in doses as low as 0.5 mg twice a week.
When aromatase is properly suppressed, estradiol levels are reduced to safe ranges, while free testosterone often increases, since less testosterone is being aromatized into estradiol.
Why Some Men Need Topical Testosterone Creams
Most testosterone in a man’s body emanates from the testes. Aging results in a decline in testicular output, thus necessitating the topical application of a testosterone cream to restore this vital hormone to youthful levels. Ideal free serum testosterone levels for most aging men are between 20-25 pg/mL.
As you may surmise, a man who produces too little testosterone risks a lethal deficiency of both free testosterone and estradiol. That’s because men need testosterone to synthesize estradiol in their bodies. In the presence of insufficient testosterone production, some aging men are vulnerable to low free testosterone and low estradiol that according to the latest study almost doubles their risk of dying over a 4.5 year period!40
Testosterone Decline and Aging
Aging is accompanied by reduced levels of hormones required to sustain life.
As testosterone levels decline in men, their risk of dying markedly increases.105-107
Heart disease,7,19,63,73,108 osteoporosis,109-111 and muscle wasting112-114 are strongly linked to testosterone deficiency, as are chronic inflammatory 13,115and neurodegenerative disorders.18,116 Most doctors are surprised to learn that men with low testosterone show an increased incidence of prostate cancer.117-121
Long before life prematurely ends, testosterone deficit can manifest in the form of psychological disturbances such as depression,122-125 reduced sexual desire,126-129 and a loss of sense of well-being.125,130
The encouraging news is that restoring testosterone to youthful ranges can easily be accomplished at minimal cost.
Critical Importance of Blood Testing
Today’s conventional physicians prescribe blood tests to check glucose, cholesterol, and triglycerides, but rarely check their male patients’ free testosterone and estradiol levels.
When looking at the horrifically high mortality rates associated with imbalances of these critical hormones, it becomes strikingly apparent that a significant number of heart attacks, strokes, bone fractures, and other degenerative diseases are easily preventable.
One reason these hormone blood tests are not normally prescribed is their high retail cost, and the fact that many insurance companies refuse to pay for them.
As a member of the Life Extension Foundation®, you don’t have to be victimized by conventional medical ignorance, high prices, or insurance company indifference.
Take Charge of Your Health with Low-Cost Blood Testing
An all-inclusive blood test panel that includes free testosterone and estradiol can retail for $1,000 at commercial labs. Life Extension members can obtain these same tests for only $199 during the Blood Test Super Sale.
If your blood test result reveals an imbalance of free testosterone and/or estradiol, you are in a position to initiate immediate corrective action. Not only can restoring youthful hormone balance save your life, but men (and women) often experience an enhancement in their quality of life after their hormones are adjusted to optimal ranges.
A complete description of the Male and Female Panels can be found at the end of this article. As you’ll readily see, these panels contain many important tests (such as total and free testosterone, estradiol, homocysteine, C-reactive protein, and DHEA) that mainstream doctors seldom check for.
You’ll also see that we added the 25-hydroxyvitamin D test to the low-priced Male and Female Panels, so members can easily attain optimal vitamin D levels in their body.
When you order these tests, a requisition form is sent listing blood drawing stations in your local area. Appointments are usually not necessary, meaning you can have your blood drawn at your convenience.
To order a comprehensive Male and/or Female Blood Test Panel, just call 1-800-208-3444. It is the single most important step you can take to ensure your continued good health.
The Blood Test Super Sale ends June 4, 2012, so you should order your tests soon and have your blood drawn any time thereafter at your convenience.
For longer life,
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