Life Extension Suggestions
Step One: Testing
It is critical that men undergo comprehensive medical testing before embarking on a hormone modulation program. First, a baseline blood PSA must be taken to rule out existing prostate cancer (for more information, please see the chapter on prostate cancer). Then, free and total testosterone and estradiol tests are needed to make sure that testosterone is not being excessively converted into estrogen. If estrogen levels are too high, the use of aromatase inhibitors can reduce the rate at which testosterone converts to estrogen in the body. Follow-up testing for estrogen, testosterone, and PSA levels are needed to rule out prostate cancer and fine-tune your program. Additional tests that should be considered include:
- Complete blood cell count and chemistry profile, including liver and kidney function, glucose, minerals, lipids and thyroid-stimulating hormone (TSH)
- Luteinizing hormone (LH) (optional)
- SHBG (optional)
- Dihydrotestosterone (optional)
Blood for these tests may be drawn at your physician’s office or directly at a laboratory in your area. Information about ordering these tests on your own may be obtained by calling 1-800-208-3444. These tests will yield crucial information that can help you design a program tailored to your unique situation.
Step Two: Interpreting the Results
Free testosterone: The Life Extension Foundation believes that direct testing for free testosterone is the best way to test for testosterone activity, as free testosterone is the active form of the hormone and comprises only about 2% of total testosterone.
The Life Extension Foundation recommends that men strive for a free testosterone level that is in the upper one-third range for men aged 21 to 49 years. The range of free testosterone serum level is 20 to 25 picograms per milliliter (pg/mL), using our current testing methodology.
There are five reasons that free testosterone levels may be low:
- Too much testosterone is being converted to estrogen through the activity of aromatase.
- Too much free testosterone is being bound by SHBG. This would be especially apparent if a man’s total testosterone level is in the high normal range but his free testosterone level is low.
- The pituitary gland, which controls testosterone production through the production of luteinizing hormone (LH), is not secreting enough LH to stimulate gonadal production of testosterone. In this case, total testosterone would be low.
- The testicles (gonads) have lost their ability to produce testosterone, despite adequate amounts of LH. In this case, the level of LH would be high despite a low testosterone level.
- DHEA level is abnormally low.
Estrogen: Measured as estradiol, should be kept in a range of 20 to 30 pg/ml. If a man’s estrogen level is elevated, it could be associated with:
- Increased aromatase activity, often caused by increased abdominal fat.
- The liver is failing to remove excess estrogen, possibly because of heavy alcohol intake. In men, heavy alcohol intake has been shown to boost estrogen levels within the liver (Colantoni et al 2002).
If a man’s estradiol level is higher than 30 pg/mL, it should be reduced by using aromatase-inhibiting drugs or nutrients. (Optimal estradiol levels are between 20-30 pg/mL.)
Step Three: Correcting Abnormal Levels
Ultimately, the ideal program will depend on the results of various tests. Below are some common scenarios and solutions to correct hormone imbalances.
Low Free Testosterone, High Estradiol, Mid Total Testosterone: This situation suggests excessive aromatase activity, which converts free testosterone to estrogen. Inhibition of aromatase and reduction in aromatase-containing tissue (fat) is indicated. Suggestions include:
- Chrysin: 1500 mg daily
- Piperine: 10 mg daily to enhance absorption of chrysin
- Zinc: 50 – 90 mg daily
- Muira puama: 850 mg daily
- Quercetin: 500 – 1000 mg daily
- Lose weight to reduce aromatase activity.
- Reduce or eliminate alcohol intake to enable excess estrogen removal by the liver.
- Review all current medications to see if they might be interfering with healthy liver function. Common medications that affect liver function are nonsteroidal anti-inflammatory drugs (NSAIDs) (e.g., naproxen, ibuprofen, and aspirin); the pain relief medication acetaminophen; the statin class of cholesterol-lowering drugs (e.g., simvastatin, atorvastatin); some heart medications; some blood pressure-lowering medications; and some antidepressants. Drugs being prescribed to treat the symptoms of testosterone deficiency (such as the statins and certain antidepressants) may actually aggravate the testosterone deficit, thus making the cholesterol problem or depression worse. However, do not discontinue any prescription medicine without consulting your physician.
- If all of the above fail to increase free testosterone and lower excess estradiol, consider discussing with your physician the use of the aromatase inhibitor anastrozole (Arimidex) at the very low dose of 0.5 mg twice per week.
Low Free Testosterone, Low Estrogen, High Total Testosterone: This situation suggests excessive SHBG levels, making sufficient testosterone unavailable to target tissues. The elevation of SHBG explains why some older men who are on testosterone replacement therapy do not report a long-term beneficial effect, that is, the administered testosterone becomes bound by SHBG and is not bioavailable to cellular receptor sites where it would normally produce an effect. Suggestions include:
- Inhibit aromatase by following some of the recommendations in the previous section, since low testosterone and high estrogen are involved in excess SHBG activity.
- Take the following supplements:
Low Free Testosterone, Low Estrogen, Low Testosterone: This situation suggests low production of testosterone, with resultant low conversion to estrogen. Suggestions include:
- Use testosterone patches or creams. If tests reveal low levels of LH, ask your physician about the possibility of using human chorionic gonadotropin (HCG). HCG functions in a manner similar to that of LH, thus helping to stimulate the leydig cells of the testes to produce more testosterone.
- Take DHEA: 25 – 75 mg daily, followed by blood tests in 3-6 weeks; consider starting at a lower dose and increase as indicated. For additional information on DHEA, refer to the DHEA Restoration Therapy protocol.
- Tribulus fruit extract (40% saponins): 450 mg daily
General Nutrients to Boost Sexual Function
A number of nutrients have been studied for their ability to boost testosterone and/or treat conditions such as erectile dysfunction and loss of libido. This nutrient group includes antioxidants, which may function by reducing oxidative damage to testosterone-producing tissues.
In addition, the following blood testing resources may be helpful: