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Saturday, July 18, 2009

Nutritional Intervention in the Middle-Aged Male Patient

While it is both natural and desirable to grow older, it is neither natural nor
desirable to feel or perform ‘older.’ Only a few short years ago, discussions
of erectile difficulties were unlikely topics for the average middle-aged male
patient. Frankly, few men were at all likely to admit to difficulties, at all.
Only after the introduction of Viagra® did the topic of erectile dysfunction
(ED) become regular or routine. Now, not only are these discussions routine,
but the topic is advertised on the side of a popular NASCAR race car.

Before we had Viagra®, impotence in the younger male was generally
considered to be a psychosomatic dysfunction. It is an interesting commentary
that only after a pharmacological intervention is introduced do many disease
states change from psychosomatic to physiologic in nature. While we now have
several good choices in medications with which to help reduce the symptoms of
ED, little is done to deal with the underlying conditions that lead to ED.
After elimination of the many common causes of iatrogenic and neurovascular
causes of ED, the typical patient is given the option of which pill to take.
This is indeed unfortunate because there are many interventions that the
physician can entertain that deal with the ED on a functional basis.

Male Hormonal Changes with Age
As men age past the age of 25, or so, testosterone levels can be expected
to drop, approximately 2% per year. Men at the age of 25 do not consider that
getting older, on a personal level. By the age of 50, testosterone levels have
dropped by 50%, and many men wonder where their youth and vitality went. This
is a well understood phenomenon, and many well-meaning physicians consider
testosterone replacement in this context. Testosterone will be metabolized into
estradiol. Treatment with testosterone without inhibiting this degradation will
result in elevations in serum estrogen.

What is less well recognized is the elevation in estrogen levels that
result during this same aging time-line. By the age of 40, many men will
demonstrate estrogen levels that exceed those of their spouses. The factor that
results in ED results more from the ratio of testosterone to estrogen than from
either hormone level, alone. That is, without addressing the elevation in
estrogen that is a normal, anticipated result from aging, the treatment of ED
with testosterone is likely to result in temporary, if any positive results. In
order to restore a healthy testosterone to estrogen ratio, the clinician must
inhibit the pathways that involve degradation of testosterone to estrogen. When
combined with enhancement of estrogen elimination, cholesterol levels can be
reduced, and weight loss can be anticipated.

The main metabolic pathways of testosterone to estrogen conversion involve
the enzymes 5-alpha reductase and aromatase. Both of these enzymes can be
effectively inhibited with inexpensive, available nutriceuticals. The
thoughtful balance of enzymatic inihibition with hormonal supplementation
results in restoration of healthy testosterone to estrogen ratios, and the
result is improvement or abatement of the symtoms of ED, reduction or
elimination of the problems seen with prostatic hypertrophy, and reduction in
serum cholesterol.

As with most other areas of interventional medicine, it is best to know
baseline hormonal levels before entertaining empiric intervention. Elevations
in estrogen can be treated with di-indol methane and indole-3 carbinol. When
combined with agents that stimulate biliary excretion, estrogen levels can be
lowered in a matter of a few weeks. The addition of saw palmetto and nettle
extract increases testosterone levels, relative to estradiol through the
inhibition of the 5 alpha reductase and aromatase enzymes. The reduction of
serum (total) estrogens can result in weight loss, and results in reduction in
depressive symptoms.

None of this is particularly difficult, and it is affordable to the vast
majority of the patient population. Sadly, the patient population has seen need
for these sensible approaches to health, but these same patients turn to lay
magazines, catalogues and self-serving marketers to provide the guidance that
they need. The general medical community has not taken the necessary steps to
educate ourselves in this vital area of preventive medicine. Until such time as
we collectively arm ourselves with the necessary understanding of functional &
nutritional medicine, the public will turn, in large numbers, to the clerk at
the vitamin store, the pharmacy technician and well-meaning neighbor for vital
(mis)information on the value of nutritional & nutraceutical maintenance of


For male Natural Hormone Replacement Therapies contact Dr. Saleeby via

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