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 health.
David S. Klein, M.D., FACA, FACPM, FAAMIMS
Stages of Life Medical Institute
1917 Boothe Circle
Longwood, FL 32750