functional medicine and nutritional genomics - American Association ...

AAPI’S NUTRITION GUIDE TO OPTIMAL HEALTH: USING PRINCIPLES OF FUNCTIONAL MEDICINE AND NUTRITIONAL GENOMICS
(controversial in prostate cancer) have all been
shown to raise androgen levels in men and help
counter andropause symptoms xx
. The ‚trick‛ is to
know how much testosterone is required for each
individual male. This is where knowing the salivary
testosterone levels come into play. Initial salivary
testing and following salivary monitoring are crucial
for determining the most optimal prescription xxi
.
Free testosterone can also be calculated in serum
using total testosterone and SHBG. With these
levels one can calculate the Free Testosterone
Index (FTI) – Total Testosterone/SHBG X
0.0347. The normal FTI range is 0.7-1.0. If
one’s FTI is below 0.7, testosterone therapy
should be initiated. The final dosage will be the
amount required to correct the FTI ratio.
Prior to initiation of testosterone therapy the PSA
level needs to be within the expected range.
There is no evidence that testosterone increases
the risk of prostate gland cancer; however, if
cancer has already developed, testosterone may
accelerate its growth xxii
. The PSA test is a good
guide as to presence or absence of cancer and is
a good indicator of inflammation within the prostate
gland.
In addition to declining testosterone levels, many
men also experience rising estrogen levels as they
age. The mechanism behind this is similar to
what we often see in women, the aromatase
enzyme converts testosterone into estradiol. This
process often creates a state of relative estrogen
dominance in men and this state is particularly
important as it relates to prostate health xxiii
.
Prostate cells are very susceptible to fluctuating
hormone levels and respond to estrogen in a
similar way to endometrial cells in the woman. In
both cases, estrogen causes growth and
proliferation, particularly when not governed by
adequate progesterone levels. While progesterone
is a hormone that is primarily associated with
women, its role in men’s health should not be
overlooked. In addition to protecting the prostate,
progesterone is protective to the cardiovascular
system by governing cell adhesion molecules and
preventing plaque formation and is
neuroprotective xxiv .
166
A complete hormonal analysis of male patients is
recommended to evaluate and identify important
deficiencies, such as inadequate testosterone
production and lack of sufficient progesterone to
balance estrogen. Just as with female patients,
treatment should be limited to replacement with
physiologic doses of bioidentical hormones.
Testosterone:
Men: USP testosterone: 10 mg in a transdermal
base (e.g. Vanpen) applied daily. Rotate
application daily to a ‚thin‛ region of the body:
inner wrist, behind knees, upper inner arm or
upper chest. Example scripts: Testosterone
10mg/ml, #30, Sig: ½ml bid or 1ml qd. You
may want to give 2 refills, which will take the
patient up to the 2 month retest interval. Note: It
is important to monitor PSA and CBC levels
during the treatment interval.
Progesterone:
Andropause (Men): USP Progesterone 5 to 10
mg in a transdermal base (e.g. Vanpen) applied
daily. Rotate application daily to a ‚thin‛ region of
the body: inner wrist, behind knees, upper inner
arm or upper chest. Example script: P4 10mg/ml,
#30, Sig: ½ml qd. You may want to give 2
refills, which will take the patient up to the 2
month retest interval.
Jay H. Mead is the President and Medical
Director of Labrix Clinical Services, Inc. and a
visionary for innovative testing for discerning
practitioners. He is a leading expert in Salivary
hormone and Urine iodine testing. Dr. Mead has
been practicing as a clinician for over twenty
years and understands the need and value of
accurate, reliable laboratory testing. Dr. Mead is a
board certified pathologist (AP/CP), a retired
USAF Flight Surgeon and cofounder of a
progressive full-service complementary and
alternative medical clinic. He also has board
certification in blood banking and led the Pacific
Northwest Region of the American Red Cross as
the Chief Medical Officer for over 10 years. Dr.
2012