Testosterone replacement therapy has a significant role in protecting aging men’s health, including greater protection against heart disease, diabetes, and obesity.123 However, it naturally increases estrogen levels in men, which has brought the benefits of testosterone therapy into question.
You may have heard the warning that high estrogen levels cause prostate cancer in men, but research supporting this claim is unclear. Some studies indicate that high estrogen levels can increase the development of prostate cancer cells, while other research finds high estrogen levels are not found in men with prostate cancer. High estrogen levels may be considered a health risk, but low estrogen levels can also be detrimental to men’s health. The body needs estrogen to avoid cardiovascular disease, type 2 diabetes, osteoporosis, and metabolic syndrome.45
Let’s take a look at the two different arguments to understand the effects of raising estrogen levels via testosterone therapy.
As men age, circulating levels of estradiol increase and free testosterone levels decrease in the body. This sharp increase in estrogen has been related to prostate cancer. Prostate cancer has been suggested to originate from the presence of androgens, because testosterone is converted into estrogen by the enzyme aromatase.6 This depletes free testosterone levels and increases estrogen levels. However, the active form of testosterone, 5alpha-dihydrotestosterone, is not aromatized into estrogen and does not increase prostate cancer risks.7 Estrogen treatment has been shown to damage prostate DNA in animal studies and it is suggested that androgens act as a strong tumor promoter when estrogen, or specifically estradiol-17beta, is present.7 However, a closer look at these claims shows testosterone actually plays a significant role in sustaining prostate health and that androgens do not cause prostate cancer.
While it has been argued testosterone therapy increases the risk of prostate cancer by raising estrogen levels, research has also shown the opposite is true. Low levels of testosterone increases prostate cancer risks. A literature review found that there is a limited capacity for androgens to stimulate the growth of prostate cancer cells.8 Another review of research did not find a significant association between testosterone or estrogen levels and prostate cancer.9 Only men that currently have prostate cancer should avoid testosterone therapy, as this is the time when androgens may further proliferate cancer cells.
Several studies indicate that low estrogen levels in men can be detrimental and raising estrogen levels has protective benefits, such as strong bones, sustained cognitive function, and cardiovascular health. In fact, increasing estrogen levels is not harmful when optimal testosterone levels are present. The ratio of estrogen to testosterone is what matters most, as low testosterone and high estrogen blocks testosterone receptor sites.10 Testosterone therapy is a beneficial way to restore healthy testosterone levels and balance the testosterone/estrogen ratio. Testosterone therapy was given to 207 men between the ages of 40 to 83, finding the therapy had a significant decrease on prostate volume, prostate-specific antigens (PSA) levels, and lower urinary tract symptoms.11
So, what is the final verdict? Estrogen is not harmful to men. This can best be explained by Dr. Neal Rouzier, who in his most recent webinar stated,“Many conclude that estrogen may be responsible for the high prevalence of prostate cancer in men. That has been extrapolated to [imply that] estrogen causes cancer in men and now everyone thinks that it’s bad and everyone is on this kick to lower estrogen in men to protect against that. What does the literature say?...All of the studies to-date, 50 years of studies, where testosterone has been utilized to increase estrogen levels, show it aromatizes to estradiol and all of these levels [testosterone, estradiol and estrogen] are increased. There is no study to support any increased risk of cancer of the prostate when estrogen levels are raised.”
It is only when estrogen levels are too high and testosterone levels are too low that negative effects can occur in men’s health [Estrogen Dominance in Men]. Testosterone levels should be restored to their optimal range to avoid the detrimental effects of this imbalance. “Again, 50 years of studies demonstrate that testosterone administration, which raises serum estrogen levels, does not cause prostate cancer.”10
While experts agree estrogen has far reaching benefits in menopausal women, researchers tend to disagree on how estrogen therapy should be administered.
The current trend is to prescribe transdermal estrogen cream. Why do some physicians choose transdermal instead of oral estrogen therapy? Many are worried about the health risks associated with oral estrogen. These concerns were initiated by the Women’s Health Initiative that found oral estrogen increases the risk of myocardial infarction, stroke and blood clots in menopausal women. Therefore, transdermal estrogen is commonly prescribed in lower doses to avoid the damaging atherosclerotic effects of oral conjugated equine estrogen (CEE). Furthermore, it is applied topically and absorbed through the skin. This route of administration bypasses the liver and directly enters the bloodstream to prevent circulatory risks.
Transdermal estrogen may seem like a better choice for estrogen therapy, but oral estrogen offers more cardiovascular benefits. In fact, many studies claim transdermal estrogen does not provide any cardiovascular protection. It is estimated that 50-75% of estrogen’s benefits are on LDL and HDL cholesterol, fibrinogen, and fatty acid esters, because oral estrogen passes through the liver to improve cholesterol health. Since transdermal estrogen bypasses the liver to directly enter the bloodstream, it cannot provide advantageous lipid effects. To prevent a large majority of women from succumbing to coronary artery and cardiovascular disease, it is sensible to prescribe an oral estrogen therapy for maximum cardiovascular protection.
Hormone educator, Dr. Neal Rouzier states that “the medical literature does not support the use of creams and patches over oral bioidentical estrogen. Oral estrogen is far better at protecting women against cardiovascular problems as many studies show a significantly reduced incidence of both heart attacks and strokes with the use of oral as compared to the use of transdermal estrogen creams or patches. Transdermal estrogen has only a minimal effect on improving blood lipids (good and bad cholesterol and blood fats) — whereas oral estrogen has a much stronger value in doing this. Many medical studies have demonstrated that oral estrogen's effect on total cholesterol, LDL and HDL-cholesterol provide greater overall protection, whereas transdermal provides much less protection and therefore they provide less cardiovascular protection in the long run. The patch and transdermal creams are not entirely without value. There are a few women with certain types health histories, where oral estrogen is contraindicated and transdermal estrogen replacement may be appropriately recommended. However, this is not the case for the great majority of women. Oral estrogen have many more health protective benefits than does transdermal estrogen and therefore the preferred form of estrogen.” (Dr. Rouzier's webinar thoroughly discusses Estrogen in Women)
When it comes to oral estrogen, medical studies have found that oral e2 estradiol is the safest and most effective form, because it avoids inherent side effects related to oral CEE. The Women’s Estrogen for Stroke Trial (WEST) found oral estradiol was not associated with increased blood clots, but an increase in blood vessel inflammation and clotting was due to ten biologically active estrogens that are in CEE (Premarin). These active estrogens are not found in estradiol.
Prescribing the right form of estrogen should be considered on an individual basis. Older women (age>60) that have never taken oral estrogen are advised to take transdermal estrogen to avoid the risk of myocardial infarction or stroke. Additionally, transdermal estrogen is the best choice for women that have a history of clotting disorders. For women that do not have these established factors, oral estradiol is the best choice for protecting the heart from cardiovascular disease and hypertension risks that increase dramatically in menopausal women.
Since the 2002 report known as The Women’s Health Initiative (WHI) Trial, Prempro sales have fallen to $161 million annually and more than 10,000 lawsuits have been filed against Pfizer by women, who declared the company’s HRT drug lead to their development of breast cancer and other health ailments. Pfizer Inc. recently set aside $772 million to settle these cases.
Hormone replacement therapy (HRT)- a $2.2 billion industry, has been promoted by the medical establishment as a means to reduce vasomotor symptoms and decrease postmenopausal health risks. During the 1990’s, Pfizer and Wyeth had a strong hold on the HRT industry by selling Premarin, Provera, and Prempro (a combination of the two) to more than six million women.
Fears of Hormones and Cancer- It wasn’t until 2002 that the WHI trial found these synthetic hormones increased breast cancer, heart disease, and stroke risks among menopausal women. Researchers admonished women to stop taking HRT, while critics asserted these results were inaccurate declaring HRT benefits outweighed the risks. With two opposing views, confusion escalated among physicians and patients.
Re-analysis of the WHI data and findings from other studies demonstrated that the health risks did not apply to women under 60 years old. While breast cancer risks increased when estrogen and progesterone were combined, further analysis of the WHI trial found that the estrogen-only group didn’t have an increase in breast cancer risks. In fact, breast cancer risks decreased in this group.
Clearing the Confusion- A review of the WHI trial may clarify the risks of synthetic HRT, but it doesn’t mean these hormones are harmless. According the National Institutes of Health, long-term use is not recommended, but taking HRT at the lowest possible dose for the shortest amount of time can provide some benefit for menopausal women, including a reduction in osteoporosis risks.
This statement, combined with media attention and the WHI study itself, have sparked extensive concern that hormones are harmful and should be taken for the shortest time necessary to control perimenopausal symptoms. Dr. Neal Rouzier has clarified this concern through intensive study, stating that, “I agree with this statement ONLY if the hormones are synthetic, like Premarin and Provera. The combination Premarin and Provera have demonstrated an increased risk of breast cancer, strokes and heart attacks. However, do not extrapolate the harm of synthetic hormones to bioidentical HRT. Natural progesterone has never been demonstrated, in any study, to increase these risks whereas Provera has definitely been shown to increase these risks. Natural progesterone has been shown to decrease the risk of breast cancer, whereas Provera increases breast cancer in every study to date. Natural estradiol has been proven to not have the clotting or inflammatory properties as does Premarin.”
The Natural Answer- Fortunately, there are sharply contrasting alternatives to synthetic HRT which actually have shown to help protect against cancer. Bioidentical HRT is a substantially effective treatment for menopausal symptoms that also protects women from the many other risks associated with low hormone levels. Over 50 years of studies indicate that restoring hormones to premenopausal levels protects women from health risks and encourages well-being. Bioidentical hormones are the safest and most effective way to ensure optimal hormone levels. Bioidentical hormones should not be confused with synthetic HRT, as they are far superior to their synthetic counterpart.
Dr. Rouzier recently provided some tips in response to an online publication writer who asked the question, "What are some tips on how to avoid sleep disruptions when season's change?" I thought it would be appropriate to post here and expand on natural sleep in general. Read the tips below and feel free to provide your own based on your knowledge and experience.
Wake up at the same time EVERY morning and NEVER sleep-in to make up loss of sleep. Although your sleep may be slightly thrown off by a 1 hour time change, this will only have a minimal effect if your body already has a strong backbone of healthy sleep hygiene. What this means is if you wake up at the same time every morning, despite if you got 8 hours of sleep or 5 hours of sleep, your body will eventually fall into a natural sleep/wake cycle based on that wake up time. This will eventually turn into a regular 8 hours of sleep, or whatever amount your body naturally requires. This behavior modification is the most important component of strengthening your “body armor” against seasonal time changes.
There are a variety of sleep medications out there that will certainly get you to sleep, but will make your body more dependent on them than that of seasonal change. Taking such medications will only contradict your body’s natural sleep wake cycle mentioned in tip #1.
Melatonin is a natural hormone that is already produced by our bodies, and we depend on this hormone in order to fall asleep and stay asleep. Studies have shown that taking melatonin for sleep not only helps you to fall asleep, but also puts you into a deeper level of sleep, which is crucial to feeling rested during the day. Also, melatonin is non-addictive and will certainly make seasonal change less disruptive. If your Health Care Provider is not familiar with melatonin, then search for one who is well versed in natural hormones. This will determine what your optimal dose should be and to make sure you are taking a high quality melatonin supplement, typically dispensed by a compounding pharmacy. Melatonin is also a bio identical, natural hormone that is not a drug or addicting, only a healthy supplement that possesses many other health benefits. Recent studies demonstrate its protection against many different cancers.
If a woman is newly menopausal, then she may be suffering sleep deprivation as the result of loss of her hormones, which also results in significant health detriments, as well as feeling poorly. We never advocate hormone replacement with chemically altered synthetic hormones which studies have shown to be harmful to a woman's health. However studies demonstrate that loss of hormones is also very harmful to one's health and well-being. Replacement must be in the form of the identical hormones that the body makes normally, commonly termed bio identical or natural hormones.
Drinking coffee or caffeinated sodas during the day, particularly after 12pm, is likely to make falling asleep more difficult. If you drink too much alcohol at night, this will do one (or all) of three things: 1. Make you fall asleep at a lower quality of sleep 2. Make you become dependent on alcohol for sleep, which will of course defeat the purpose of maintaining a healthy sleep/wake cycle 3. May have an adverse effect and keep you awake.
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