TRT for Men: Part Two
n our first blog I talked about the male andropause and symptoms associated with it. In the andropause we see a decline in Testosterone and DHEA levels as well as a rise in Estradiol levels. These changes result in decreased levels of function in hormone responsive tissues which lead to symptoms.
Many men are told that their symptoms of fatigue, depression, reduced muscle mass, brain fog, poor exercise tolerance/results and erectile issues are in their head. Because the onset and progression of these symptoms are so slow, it seems reasonable to them that there is in fact no problem. That is blatantly not true. I like to think of these ill-defined symptoms as signposts in the fog, pointing us in the right direction to improve our well being.
There are 3 critical concepts that must be grasped to fully understand the situation.
Hormone receptors are intracellular structures found in trillions of your body’s cells. These receptors are not found in all tissues, just the ones that require hormone stimulation for optimal function. For Testosterone, these receptors are in brain, heart, muscle, blood vessel lining, bone, ligaments and the testicles to name a few. Nature is quite clever and only places hormone receptors where they can make a difference. This economy is an inherent part of the plan… energy to make and maintain receptors must have a net benefit to the organism. The nature of these intracellular receptors has been something clouded in mystery. In fact, even in post-graduate hormone training, little effort is put in by the conventional medical system to discuss these receptors other than in vague generalities. It is only through extensive BHRT and Functional Medicine training, that I was able to learn these concepts well enough to explain them to others.
Sex hormone receptors are very specific and only one hormone can stimulate the precise receptor it was designed for. Testosterone receptors are only responsive to Testosterone, not Estradiol, Progesterone or DHEA. It is like a key in a highly specific and intricate lock. One size does not fit all! The hormone receptors reside in the nucleus of cells which are in tissues that are responsive to that hormone.
These hormone receptors are part of the DNA of each cell in that hormone sensitive tissue. Hormone binding to a section of DNA in the promoter region of a gene, via it’s specific receptor, either turns on or off expression of that gene. Remember, gene expression is always through the production of a protein. The specific protein determines the net function of that gene.
I will give 2 brief examples of negative and positive hormone binding gene expression effects:
- We know that Testosterone and DHEA turn off production of the inflammation cascade through tumour necrosis factor alpha. This cascade is normal for prevention of serious infections and pathogen invasion and helps keep us healthy when functioning properly. However, overactivation of the inflammatory cascade contributes to many of the diseases seen in developed countries. These diseases include heart disease, diabetes, hypertension, Alzheimer’s Disease and cancer.
- Testosterone can turn on genes that are responsible for creation of muscle mass with exercise as an example of increased gene expression due to hormone binding.
As you can see, Nature has designed a very specific amplification system for the hormone target organs. Add to this the presence of natural antagonists, and you have a robust system when all works well. Estrogen is the natural antagonist of Testosterone. Many young men have high Testosterone levels with low Estrogen levels, which lead to an abundance of energy and feeling great. As men age, our Testosterone levels fall and Estrogen levels rise due to obesity and the increased conversion of Testosterone and DHEA to Estrogen. This is a process called aromatization and one that increases as a man ages and is aggravated by weight gain. I like the concept of a Testosterone to Estrogen ration…. When high, all is good. When low, there are problems in the body.
I believe in the concept of a Testosterone set point which is established in the adolescent male. If the ratio is high, all efforts are expended in the pursuit of a sexual partner. If the ratio is low, these young men can be friends to the gender of attraction. A man with a high ratio set point really misses the physical, mental and emotional benefits of that set point as it deteriorated with aging. A man with a low set point of this ratio experiences no real change as he gets older.
I believe a properly conducted hormone replacement program is the foundational tool for optimal body function as we get older. Our next blog will discuss the misconceptions of HRT as they relate to heart disease and cancer.
Dr. Ron Brown