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Men's Health

by Ralph J. Luciani D.O., M.S., PhD., M.D.(H)

Part 1: Prostate Cancer

With the current epidemic of breast cancer in women, lots of attention is being paid to women’s health issues and rightly so. Until more recent years such health problems, such as perimenopausal symptoms and proper hormone balance, took a back seat to prevention of breast and ovarian cancer. Somehow though, they may all be related and proper attention is now being paid to these interconnected health problems. After all, women have two major hormones which govern their cycles, moods, attitudes and may affect the growth of certain cancers.

Men, on the other hand, have one major hormone that can govern their aggressions, attitudes and may affect the growth of certain cancers. But no real attention is being paid to men’s age related hormone problems. The common belief is that we don’t have to worry about testosterone unless we’re treating prostate cancer, which has also become epidemic in men in the past several years. But believe it or not men have a phase in life similar to the female menopause, called andropause. Testosterone levels drop off along with its anti-aging effects after age 40.

Prostate Cancer

Prostate cancer seems to be more prevalent in recent years than in the past. The cause is still unknown but treatment has improved significantly. There is evidence that the children of males, who develop prostate cancer prior to age 70, have a higher risk of developing prostate cancer themselves. Hormone therapies and radiation seem to curtail the growth of most prostate cancers successfully. Surgery is often recommended if the cancer is felt to be isolated in the prostate with no metastases. None of these treatments is without some side effects including impotency. But the alternative is not desirable either.

Prevention and early detection make outcomes more favorable. Firstly men older than 40 should begin to baseline their Prostate Specific Antigen (PSA) blood levels. PSA becomes elevated during an inflammation of the prostate and also if there is cancerous tissue present in the prostate. Rectal prostate exams are wise choice also, especially after age 50, and if there is a strong family history of prostate cancer.

In my opinion, all men over the age of 40 should also begin taking extra zinc daily (about 30-50 mg), a combination of the herbs saw palmetto (serenoa repens) 320mg and pygeum africanum, and essential fatty acids containing conjugated limoleic acid. Prostate tissue requires zinc to maintain healthy cells. The herbal combination blocks the degradation of testosterone to dehydrotestosterone (DHT) which is 5 times more powerful than testosterone alone in promoting cancer cell growth. Conjugated limoleic acid (CLA) has been shown to inhibit prostate cancer growth and metastases in animal models. The preventive use of these nutrients on a daily basis may possibly give a male an edge against development of prostate cancer.

If prostate cancer develops, therapy should be discussed with the Urologist or Oncologist. The literature also supports some adjunctive therapies in addition to traditional therapies. An herbal formula called PC- Spes is being taken by several men with diagnosed prostate cancer with great success in decreasing the PSA to normal levels in most patients. PC-Spes contains extracts of seven Chinese herbs plus sereno repens. The combined mixture contains flavonoids that have antioxidant activity, anti-inflammatory and anti-carcinogenic actions. It also includes isoflavones that have some estrogen like activity. It also contains components that interfere with testosterone metabolism and prevent testosterone from binding to prostate cells.

Another nutrient that seems to slow down prostate cancer growth is modified citrus pectin. It has been shown to slow down PSA doubling time in clinical studies probably by interfering with cancer cell metastatic target site interaction.

Another extremely promising adjunct to prostate cancer treatment is the use if extremely low dose Naltrexone, a prescription drug approved in 50mg tablets for the treatment of alcohol and opiate addiction. Dr. Bihari of New York has done significant research on the relationship of opiate receptors and cancer cells and has found that certain cancer cells have large amounts of these receptors. His research shows that a daily dose of 3mg of Naltrexone can actually inhibit tumor growth in these cases.

These therapies can be added to conventional treatments. For the most part, prostate cancer is usually a slow growing tumor. The earlier it is detected the quicker treatment can begin, and therefore the better the outcome. Males over 40 need to become more health conscious because men in general don’t visit physicians as often as they should. Get a check-up annually. Next month Male Hormone Replacement Therapy for quality of life enhancement.

Part 2: Problems of Aging -
The Male Andropause

Yes, men do go through hormonal changes in midlife, as do women, that can affect their lives significantly. As men approach the age of 40, testosterone levels begin to drop off slowly causing a slow, insidious drop in energy and stamina, an increase in body fat with a decrease in lean body mass (muscle), mood changes, and a decrease in sex drive and performance ability. There is also evidence that lowered testosterone levels are associated with an increase risk for heart disease, and supplementing with testosterone can be cardio-protective. Unlike women, who have telltale signs of hormone changes through noticeable changes in their menstrual cycle, men don’t realize that problems are lurking ahead as they age. Therefore, I recommend that men over 40 begin to check their testosterone levels periodically every several years.

Testosterone can be checked with a simple routine blood test. A free testosterone should be done as well as a total testosterone. Testosterone, as other hormones, can be found by protein in the bloodstream, which makes this bound form inaccessible to cells. The free testosterone level gives an indication of the amount of hormone available for use by the body. Often a normal total testosterone level is accompanied by a very low free testosterone, If this is so, testosterone replacement may be indicated. This can be done in several ways; long lasting injections, transdermal patches, sublingual or oral hormone tablets and by natural hormone topical gels or creams. Hormone levels can also be improved by other means such as taking testosterone-enhancing agents such as androstenedione and DHEA on a regular basis, or taking Growth Hormone or its precursors, which help stimulate hormone production. All these methods have been shown to enhance sex hormone levels.

Before embarking on a customized treatment program based on your symptoms and problems, a PSA blood test and digital prostate exam should be obtained as a baseline to ensure that the prostate is healthy and no evidence of cancer exists. Testosterone or its precursors does not cause prostate cancer, but cancer cells, if present, seem to be more active under the influence of testosterone. If hormone replacement continues, annual PSA tests and prostate exams should be done routinely.

Dealing with Sexual Dysfunction

Males don’t like to complain much about physical problems (not the macho thing to do). And in fact most visits to physicians are made by women. But the one thing that gets a man’s attention is his inability to perform sexually the way he did at age 21. The introduction of the drug Viagra has brought the issue of erectile dysfunction out of the closet and into the doctor’s office. Viagra works by preventing the destruction of Nitric Oxide, increasing its levels in the blood, thereby promoting blood flow to the penis producing normal erectile function. Since it does tend to dilate blood vessels, it can cause headaches, blood shot eyes and burning of the eyes. Since nitroglycerine for heart pain results in enlarging blood vessels and dropping blood pressure, Viagra should never be used with nitro. It should not be used if one has heart disease. An alternative method of increasing nitric oxide is the daily use of large doses of L-Arginine. A 1000mg loading dose followed be 500mg twice daily on an empty stomach can give dramatic results. Enhancement of sexual desire and performance can be obtained by using Yohimbine in 500 to 1000mg doses. Yohimbine can increase blood pressure in some men. When initiating treatment make sure the blood pressure remains stable. Muira puama, avina sativa and tribulis terrestis are other herbs that have been shown to improve libido and performance. A combination of these supplements along with androstenedione can result in significant improvements in sexual function. DHEA may also be added if blood levels are low.

Maintaining a Youthful Body

Aside from sexual performance maintaining strong a healthy, muscular body slows the aging process. I recommend that growth hormone precursors be taken regularly to promote lean body mass, improved energy and cellular vitality. The positive anti-aging effects of growth hormone have been well documented. Recently, a Growth Hormone Releasing Hormone is available by topical cream. Used 4 days a week, this has been shown to greatly enhance muscle strength and vitality within the first three days of use. It tends to increase the craving for protein probably due to its anabolic or body building effects. Along with these supplements, exercise is important. A routine of muscle toning and aerobic exercises promotes maximum daily energy and youthful vitality. A grumpy middle aged male can be transformed into a happier, younger thinking person with just a few of these changes.