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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
AAPI’S NUTRITION GUIDE TO OPTIMAL HEALTH: USING PRINCIPLES OF FUNCTIONAL MEDICINE AND NUTRITIONAL GENOMICS Mead is the co-author of the newly released book: Slim, Sane and Sexy; Pocket Guide to Natural, Bioidentical Hormone Balancing. Dr. Mead speaks at national and international conferences on topics including: Best Practices for State-of-the-Art Hormone Testing; Best Practices for Men’s Hormone Health; Beyond Testosterone…Progesterone for men, Youth’s Best Kept Secret; Vitamin D The Forgotten Hormone; Neurodegenerative Disease and Endocrine Balancing; an Integrative Approach; Thyroid Health and Prostate Health. Contact Jay H Mead at jay.mead@labrix.com or 877-656-9596 Website: www.labrix.com References: i ii iii iv Moskowitz, D. (2006). A comprehensive review of the safety and efficacy of bioidentical hormones for the management of menopause and related health risks. Altern Med Rev., 208-23. JR. Lee, MD. (Revised 2004). What Your Doctor May Not Tell You About Menopause. New York, NY: Warner Wellness. J Mead, MD and E Lommen, ND. (2008). Slim, Sane and Sexy. Oregon City, OR: Calaroga. Chang, K. (1995). Influences of Percutaneous Administration of Estradiol and Progesterone on Human Breast Epithelial Cell Cycle in Vivo. Fertil Steril, 64(4): 785-91. v Mead, J. (2008). vi Lemon, H. (1972). Genetic predisposition to carcinoma of the breast: Multiple human genotypes for estrogen 16 alpha hydroxylase activity in caucasians. J Surg Oncol., 255-273. vii Lee, JR. (1999). What Your Doctor May Not Tell You About Premenopause. New York, NY: Time Warner. viii Lee, JR. (1999). ix Speroff, L. (2005). Clinical Hynecologic Endocrinology and Infertility. Philadelphia, PA: Lippincott Williams & Wilkins. 167 x Fournier, A. (2005). Breast cancer risk in relation to different types of hormone replacement therapy in the E3N-EPIC cohort. Int J Cancer, 448- 54. xi Women's Health Initiative Investigators. (2002). Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal Women. JAMA, 321- xii 333. Speroff, L. (2005). xiii Tavaniotou, A. (2000). Comparison between different routes of progesterone administration as luteal phase support in infertility treatments. Hum. Reprod. Update, 139-148. xiv O'Leary, P. (2000). Salivary, but not serum or urinary levels of progesterone are elevated after topical application of progesterone cream to preand postmenopausal women. Clin Endocrinol, 615-20. xv Cano, A. (1999). Effect of menopause and different compbined estradiol-progestin regiments on basal and growth hormone, insulin-like growth factor- 1, insulin-like growth factor binding protein (IGFBP)-1, and IGFBP-3 levels. J. Fertil Steril, 261-7. xvi Mead, J. (2008). xvii Feldman, H. (2002). Age trends in the level of serum testosterone and other hormones in middle-aged men: longitudinal results from the Massachusetts Male Aging Study. . J Clin Endocrinol Metab, 589-898. xviii Pitteloud. (2005). Increasing insulin resistance is associated with a decrase in Leydig cell testosterone secretion in men. J. Clin. Endocrin. Metab., 2636-2641. xix Mohamed-Ali, V. (1998). Adipose tissue as an endocrine and paracrine organ. International Journal of Obesity, 1145-1158. xx C Meletis, ND and S Wood, ND. (2009). His Change of Life: Male Menopause and Healthy Aging with Testosterone. Westport, CT: Praeger Publishers. xxi Morley, J. (2006). Validation of salivary testosterone as a screening test for male hypogonadism. The Aging Male, 165-169. 2012
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