Functional Approach to Men’s Health

Functional Approach to Men’s Health

Of the many health issues that are
important to men, most result from hormone imbalance. Focus on
individual symptoms, such as hair loss, erectile dysfunction and
prostatic enlargement tend to divert attention to the underlying
pathology that directly, or indirectly results in each of these three,
prevalent problems.

Between the ages
of 21 and 50, a man’s testosterone level can be expected to drop
approximately 1% per year.  That is, the average 50 year old, barring
any alcohol intake, medication consumption or weight gain, will
experience a decrease of 50% in serum testosterone levels.  If the man
has any significant weight gain, alcohol consumption, blood pressure or
cholesterol medicine use, the decrease may be substantially more.

a man ages, estrogen levels typically climb, as the testosterone
decreases, causing a common but distressing decrease in ‘vitality,’
manifesting as diminishing intimate performance, loss of interest and


As women age past early adulthood,
estrogen levels tend to decrease. The symptoms that result are well
known to most medical practitioners. In men, however, estrogen levels
tend to increase with age. Around the age of 40 years, the total
estrogen level in an average male equals or exceeds the female of the
same age. After this middle-aged crossing point, male estrogen levels
tend to significantly exceed those in females. It is the increase in
estrogen level that tends to cause many of the age-related medical
complaints in men, particularly those related to prostatic enlargement
and erectile dysfunction.

Worse yet,
estrogen increase induces increases in SHBG, or sex hormone binding
globulin.  This protein is manufactured by the liver and binds to
testosterone in the blood stream.  This further decreases available or
‘free’ testosterone, worsening the situation, considerably.


Testosterone levels peak, in men and
women, in early adulthood, and in both men and women, testosterone
levels decrease, linearly, with age. The testosterone level in a man of
50 years of age will be approximately 50% of what that level was when
the man was 25 years of age.


Dihydroepinandosterone (DHEA) is the
most prevalent hormone in human physiology. Sometimes referred to as
the “fountain of youth hormone,” DHEA is a precursor to progesterone,
testosterone and estradiol. DHEA levels predictably drop with age, but
in a significant number of persons, these levels can fall to ‘levels of
detection,’ and below. That is, DHEA can be observed to drop off the
chart, entirely. Low levels of DHEA has been identified as factor in
depressive illness, low levels result in loss of libido in men and
women, and low levels of this hormone are related to the development of

The Ratio Effect

Steroidal hormones act to trigger
genetic switches in cell nuclei. The effector sites at the cell nucleus
most often involve multiple hormones, some stimulatory, some
inhibitory. The ratio of these hormones, relative to each other,
triggers cellular events. That is, the ratio of testosterone to
estrogen, or estrogen to progesterone determines cellular effect. It is
for this reason that the ‘level’ of the hormone is only significant in relation to the other hormones
that effect the same genetic trigger. In short, it is the testosterone
to estrogen ratio that will indicate the state of balance. Other
hormones, such as pregnenolone, androstendione, thyroxin, and cortisol
are important, and attention to these is important, as well.

Hormone Replacement

Restoration of hormone balance is the
goal of therapeutic intervention, and this intervention takes place on
several levels. Replacement of depleted hormones must reflect diurnal
and seasonal cycles. Testosterone, for example, normally peaks in the
very early morning hours, and drops as the day progresses. Testosterone
replacement is best accomplished with daily application, transdermally.
When testosterone is used, it should be administered so that it peaks
in the morning and drops, as occurs in nature. Sustained release
patches are not as physiologically satisfactory as an immediate release
cream. Consideration must be given as to where the cream is applied, as
well, so as to avoid lipid tissues that chemically convert testosterone
to estradiol. Further, these testosterone creams can be given in such a
way as to diminish this testosterone to estradiol conversion, through
the skin.

When given in an unthoughtful way,
testosterone will convert to estradiol, and the It is patient will see
worsened gynecomastia, hair loss, axial obesity and worsening of the
erectile complaints. This is seen most commonly in athletes, weight
lifters, and amateur athletes that use intramuscular testosterone. The weekly I.M. bolus results in very high estrogen levels and systemic problems invariably follow.

DHEA is relatively inexpensive and
easily administered. Diurnal variations in DHEA are not as pronounced
as with testosterone, so timing is not as tricky. DHEA can be
administered orally. The main issue with DHEA is absorption due to
lipid solubility, and liver enzyme induction when given in high doses.
These pitfalls are avoided by administering the DHEA simultaneously
with a fish oil capsule.

Non-prescription Intervention

Reduction in serum estrogen levels is possible through the use of
inexpensive, commonly available supplements. Testosterone levels can be
increased with the proper use of Saw Palmetto, indole-3-carbinol, and
zinc. Estrogen levels can be decreased with the proper use of
silymarin, fiber, and D-glucaric acid. Pharmaceutical-grade products
are available, at reasonable cost to the patient.

Quality is never guaranteed by high price, but one rarely gets high
quality without some expenditure. It is important for the practitioner
to understand how to guide the patient through the maze of available
OTC products, some of which are of exceptional quality, and some are of
little use, at all. Further, timing of when to take the medicines and supplements is essential to successful treatment.

Improvement in erectile dysfunction, nocturia and depression can be
seen in as little as 2-3 weeks. Restoration of hair growth can be seen
in 4-6 weeks. Reversal of gynecomastia and axial obesity can take 6-12

Comprehensive treatment consists of testosterone
administration, guided by periodic blood work, combined with oral
nutraceutical intake.  Nutraceutical choice is influenced by age,
disease state, medication use and weight of the patient. How the
medicines are used, when they are administered is extremely important
and should be guided by the physician.

About David S Klein, MD 149 Articles
David S. Klein, MD, FACA, FACPM was born in Washington, DC, and was raised in Chevy Chase, Maryland. He completed his undergraduate education at the University of Maryland with degrees in Chemistry and Psychology. Medical School was completed at the University of Maryland at Baltimore, followed by Internship in General Surgery at the University of North Carolina and Residency in Anesthesiology at the Duke University, Durham, North Carolina. Dr Klein has been practicing medicine since 1983, concentrating in Pain Medicine, Minimally Invasive Medicine and Surgery, and Neuroendocrinology. Earning Board Certification in Anesthesiology, Dr. Klein was elected Fellow in the American College of Anesthesiology, and he was elected Fellow in the American College of Pain Medicine. He is currently an adjunct Associate Professor at the University of Central Florida, School of Medicine. He has focused his private practice on treating patients with hormone imbalance issues, nutritional deficiency related medical problems as well as pain related issues and impairment. With a highly-complex, CLIA licensed laboratory in-house, he has been able to provide rapid-turn around analysis efficiently and cost-effectively. Lecturing extensively nationally as well as internationally, Dr. Klein has authored many articles on topics relating to pain, injury and nutritionally modulated illness. His radio show, “Pain Free Living,” received top ratings during the 6 years it was on the air. Currently practicing in Longwood, Florida, Dr. Klein practices entirely in the office setting.