PT 4

Steroids and Testosterone - Peak Testosterone

I get an email about every week from a young guy that has sabotaged his health and erections through steroid use.  And that is the tragic irony:  most guys take steroids to look and feel better about themselves with the girls, yet steroids, in fact, often do the very opposite.

By the way, I actually don’t think a well done steroid program probably causes many issues in the short or medium term. However, the problem is that a pretty big percentage of young men on steroids really don’t know what they are doing and/or do not monitor properly and either of these can get them into trouble.

Most young men think of cancer as the only real risk with steroid use and they figure, “I’m just going to do a cycle and see what happens.  Six weeks can’t hurt anything!”  Of course, that’s an illusion, because 1) cancer is the least of their worries and 2) most diehard weight lifters are balls-to-the-wall kind of guys anyway.  They’re not about to stop after one cycle!

Regardless, very nasty things can happen to your sex life with even ONE cycle of steroids.  Consider these Four Ways that Steroids Can Hammer Your Sex Life and Erections:

2.  Shrunken testicles. Shrunken testes are a common part of steroid usage and, as I covered in #1, is often irreversible.  I don’t know anyone that argue that small nuts on the tree is going to get you a lot of squirrels if you know what I mean. (In fairness, steroid users often counteract this by taking HCG.)

3.  Bitch Tits and Leaky Nipples. Steroid users almost always exceed the normal phyiological range for testosterone and some of this excess testeosterone is aromatized into estrogen.  Experienced steroid users look for the warning signs of inflamed or leaky nipples and then take an estrogen blockers such as Arimidex to help counteract the results.  The problem is that this is tricky to control at times for an HRT guy at normal testosterone levels. Steroids users seem to have a rougher time and often leave their estradiol too high or drive it too low, both of which cause them problems.

4.  Liver Damage. This is tragically common, especially with the oral steroids.  These are metabolized in the liver and are notoriously hard on this organ.  Even some injected steroids make a second pass from the blood stream into the liver and can damage in that way.  Again, the insanity of steroid use is shown by the fact that many steroid users actually take liver herbs such as milk thistle in the hopes of preventing liver damage instead of simply not taking the steroid.

1.  Permanent Loss of Testosterone. It is surprisingly common for steroids to shut down or almost shut down the body’s natural production of testosterone.  Essentially the testes say to themselves, “We don’t have to work anymore – somebody is doing the work for us.”

Seasoned steroid users have elaborate rituals, called PCT (Post Cycle Therapy), to jump start their body’s own natural testosterone production. This generally includes LH-FSH-stimulators such as Clomid, but in some cases requires a bigger and more dangerous gun: HCG.

However, here is the important point:  it is very possible to completely and irrevesibly shut down your testosterone production, i.e. HCG and Clomid simply do not do the trick. Again, I get many emails from young guys whose testosterone is stuck below 200 ng/dl when it should be around 700.  I advise them to go to an endocrinologist, but there is no guarantee that even a good doctor who know what he’s doing can resolve the issue.

Sublingual Compounded Cialis - Cheaper Alternative - Peak Testosterone

A lot of men are inerested in sublingual compounded Cialis on the Peak Testosterone Forum and for good reason. In my opinion sublingual Cialis is the best PDE5 product out there when you consider cost and half life issues.  Consider just a few reasons to go with compounded Cialis rather than the brand:

1. Cost and Flexible Deliver Systems! Compounded medications here in the U.S. are completely legal and provide some much needed competition to some of the ridiculously overpriced medications out there.  Cialis is a prime example of that and one compounded Cialis is MUCH cheaper than the brand itself:  you will pay a fraction of the cost of brand Cialis and it is legal and guaranteed to be pharmacy grade – 99% or above.

Jasen Bruce, President of our site sponsor Defy Medical, gave me some great information about the costs and types of troches available:

“Tadalafil can be purchased by a pharmacy to compound into a sublingual troche, capsule, or rapid-dissolve tablet. The dosage can be customized, however the most common dosage for compounded tadalafil is 25mg per sublingual troche and 2.5mg-25mg per capsule. The cost for compounded tadalafil is typically between $4.50-$9.00 per troche or capsule. This is also the same price range for compounded sildenafil (Viagra) and vardenafil (Levitra), which are also both available at many compounding pharmacies in customizable forms.

2. Less Stomach Upset. I often get some heartburn from Cialis, which is a common side effect, and other men on Peak Testosterone Forum have complained of the same thing. However, I have noticed that my stomach upset from sublingual Cialis is definitely less. In my mind, this is a sign that some of the medication is indeed absorbed beneath the tongue and spares your lower GI tract.

3. More Rapid Absorption. This is something that I cannot prove, but sublingual Cialis seems to absorb faster. Of course, that is the whole purpose in having it sublingual in the first place, but it does seem to work.  Regular brand oral Cialis takes a couple of hours before the onset of improvements in erectile strength which can make timing things in the bedroom a bit tricky.  In my opinion sublingual can help.

4. Custom Dosing and “Pill” Splitting. The troches that I received were basically soft, gummi-like round pills that were easy to cut into smaller sizes. This is in contrast to the odd tear drop-shaped 20 mg Cialis tablet that is very difficult to cut up in equal pieces unless you happen to be a veteran jewel cutter or something. Many of us, including myself, are trying to take lower doses of Cialis in the 2.5-3.5 mg range.  Try to split a 20 mg brand Cialis pill into 6 different pieces. Good luck with that!  Several of us on The Forum have confessed to biting off chunks of it as a half-hearted attempt to accomplish this task.

5. Just to Get Even with Lilly! Unless you own Lilly stock, it’s hard not to want to retaliate against the cutthroat and extortionistic pricing tactics of Lilly.  Did you know that Lilly launched Cialis in November of 2003 at $8.10 per pill?! Basically, the company keeps doubling the prce as demand increases!  What a friend to men everywhere, eh? In 2015 Lilly doubled the price of Cialis once again and it is now over $60 per pill (20 mg)!  This is over a 700% increase.

Here are some pictures of the troches that I received, and a special thanks to site sponsor Shaun Noorian of Empower Pharmaceuticals for ordering and supplying the troches for this review:

What are these troches like? Basically, they are a Gummi like lozenge. The nice thing about it is that, because they are relatively soft and have a symmetric shape (a circle), they can easily be cut into smaller dosages. And they taste very good as well, which is nice since they are intended to be used sublingually and to slowly dissolve in the mouth.

HOW CAN A DOCTOR WRITE A SCRIPT FOR COMPOUNDED CIALIS? You doctor can write a prescription for sublingual Cialis using many justifications for a special order with a compounding pharmacy, including most of the reasons above – excluding #5 of course!  Some of you with incomplete or no insurance coverage for Cialis can greatly benefit from this option.

And all your doctor needs to do is write a prescription something like this: “tadaladil 20mg troche Take troche poqd.”  This means “take 5mg orally each day.”

If your doctor does write you a prescription for Cialis from a compounding pharmacy here in the U.S., then this compounder will take the exact same drug (tadalafil) that is in Cialis and do a manual preparation of it to meet your doctor’s specifications. Compounding is done all the time by GP’s, specialists and hospitals for a wide variety of medicaitons and applications. The key concept is that it cannot be identical to the original drug assuming the drug is still under patent protection: you must meet some kind of medical need or somehow distinguish yourself from the original medication.

REFERENCES:

1)  https://www.cbsnews.com/news/the-price-of-lillys-cialis-has-doubled-since-its-launch/

Axiron Review - Peak Testosterone

“Now,why would anyone want to apply testosterone into their armpit area.  Isn’t there enough going on there already?”  The reasons, we suspect, mostly have to do with the Two A’s:  Attorneys and Absorbability.

For example, a signfiicant problem for Androgel and Testim has been absorbing enough of the product to boost T levels significantly. Axiron attempts to overcome this through application to the relatively thin skin “down under.”  However, there is limited surface area in the armpits obviously and so it looks like this may have been that the makers of Axiron boosted the concentration to 2%, double that of the original 1% Androgel, for increased absorption.

NOTE:  Androgel now comes in a 1.62% concentration.  Don’t ask me what pointy-headed wizard came up with that figure.

However, Axiron’s major plus is its inaccessibility:  contact by family members with the armpit area is much less likely for obvious reasons.  One big issue for the topicals, such as Testim and Androgel that are applied to the upper body, is such contact with family members. (You can read the warnings right on the front page of Androgel’s web site.[1])

Children who have come into contact with these topical, in particular, have been documented to almost spontaneously go through precocious puberty.  Granted – this is almost always from a man that is simply not being careful and giving skin-to-skin contact, but, regardless, it is very dangerous and, undoubtedly, there are great concerns over potential litigation issues.  Even adult females, because they generally only have about a tenth of the testosterone levels of their middle-aged plus men, are at potential health risks from repeated exposure.  A product like Axiron removes much of this concern.

Axiron also gives Lilly another “big gun” in its arsenal for treating men’s sexual health issues:  it is owner and operator of the blockbuster PDE5 inhibitor, Cialis. By acquiring Axiron (from an Australian company) [2], it now has treatment options for the two primary underlying causes of post middle-age erectile dysfunction, age-onset low testosterone (hypoganadism) and endothelial dysfunction (decreased nitric oxide).

So how has Axiron been received? So far doctors seem to be very receptive to the product.  Users seem to like it except for the strange solution that requires pumping the right number of pumps and getting it into an applicator.  For example, one man wrote me and described the application as:

“It’s an alcohol based liquid that you apply to your armpits. Ever tried putting a liquid on your pits without using a roll on applicator? It’s not easy. The liquid feels fine, however. They give you a cup with a flexible rim. You fill the cup and slowly (or you lose everything) begin to slide it across your skin until the cup is empty. You really have to keep the cup perpendicular to the ground because you can lose it all when you try to go vertically into your pits. It’s the one pain in the…with their product. ”

Below is a question and answer review that one reader gave about his experience with Axiron:

Q. You applied the Axiron to your arm pits, correct? Or did your doctor recommend it in the thigh area? thigh area?

A. Yes, you apply under arms only – doctor said no other place.

Q. Do you use deodorant before or after application of Axiron?

A. You apply deodorant about 5 mins after.

Q. It is a solution, correct? Did you have trouble with it dripping or running during application?

A. Yes it is a solution,and if you are not careful it will run.Its a learning experience.

Q. That s a delicate area. Did it dry your skin or irritate it in any way or lead to redness, nodules, skin tags, etc.?

A. At first no problems but after 6wks I noticed it left a white dry flaking material under my arms. But it caused no other problems – no redness,no tags, nothing.

Q. I know that you tried a variety of testosterones unsuccessfully, including Androgel and Testim. Why did your doctor put you on Axiron?

A. As for the Testim, I was on it for 18 months and my levels were not going up and staying up. When I started, my total was 150.  At one point my total went to 475 but just two months later down to 172.  That’s when my doc said lets try axiron.  I was on axiron for three months and now I went to see endo who said it was an absobtion problem. The endo said lets try androgel 1.6 which I have been on now for three months. I go back in Dec for levels.  Hope this works.  I can not get a straight anwser on why it can only be applied on the upper chest and arms.  My wife applys her hrt to inner thighs – why cant I?

Q. My understanding is that Axiron is given in dosages between 30 and 120 mg. What was your dosage level?

A. My levels were 60mg per arm,but I went to 120mg per arm on my own to see if it would make me feel better but not.

Q. Do you want to share any experiences about HRT? Any words of advice for other guys out there?

A. I know a lot of us guys struggle with this issuse,my only advice is to pressure the doctors for answers if you do not get the results change docs.

A. I know a lot of us guys struggle with this issue. My only advice is to pressure the doctors for answers if you do not get the results change docs.

REFERENCES:

1)  https://www.androgel.com/

2) https://www.lilly.com/news?releaseid=452131

Testosterone and Morning Erections - Peak Testosterone

I get emails all the time from men that have lost their morning erections for months or even years.  This is a tragic situation, because morning erections, through oxygenation, help maintain healthy erectile tissues. Without that oxygenation, researchers have noted that “fibrosis” sets in, which means a hardening and aging of the structures. [1]

This is why I insist that men, if they no longer have morning erections, must somehow, someway make sure they get several erections during the day. By the way, this is one of the reasons that sex is so good for males:  it literally helps to maintain their sex life.  “Use it or lose it” as they say.

NOTE:  Morning erections, or the lack thereof, can be a good way to begin troubleshooting if you have psychological (or psychogenic) erectile dysfunction.  The idea is that if you can achieve an erection by any means, nightime or otherwise, then your issue is probably not physical (organic). In fact, this has been used by diagnosticians for literally decades as an starting point tool. [4] In fact, one study noted that “the single best predictor was the presence or absence of early morning erections as reported by the patient.” [5] (Now my opinion, and I cannot back this up with a study, is that this might be confounded by depression and other mood disorders. Perhaps depression can suppress morning erections before an underlying testosterone or nitric oxide issue has developed.)

So what causes morning erections?  They seem quite mysterious in many ways and even “automatic” and “random” at times, i.e. they occur even without an erotic or sexual dream involved. However, researchers have noted many lines of evidence and studies that show morning erections are primarily androgen-dependent, i.e. they are regulated by testosterone and DHT. [3]

In My Book on Testosterone I point out that several studies have shown that when testosterone falls far enough, you are likely going to lose and/or greatly diminish the number of your morning erections. That doesn’t necessarily mean that you won’t still be able to “get it up” during the day, however.  The reason is that a normal erection is achieved through a different pathway involving the senses of touch, sound and sight. However, if you allow your testosterone to remain at low enough levels for a long enough period of time, you are opening the door to Venous Leakage and other erectile difficulties.

CAUTION: Some men think that DHT (dihydrotesteosterone) doesn’t really matter and just causes hair loss.  However, DHT is an incredibly important androgen and has been shown to be partially responsible for morning erections. [2]  Before you take any DHT-blocker, be it Saw Palmetto or a drug, read this link on Propecia Risks.

And that leads to this important question:

“What can one do to get his morning erections back?”

Below we give you few ideas:

1.  Testosterone. This may seem obvious, but many men don’t make the connection:  you have got to have adequate testosterone levels in order to fire off those morning erections during REM sleep.  One’s “morning wood” is really linked to a different system than standard waking erections and requires adequate testosterone as a sort of fuel.  For example, one study showed that when levels fall below about 200 ng/dl, men can expect issues. [7]

Further verification comes from the fact that several studies show that testosterone therapy (Hormone Replacement Therapy or HRT) steadily restores nocturnal erections in men with low testosterone. In fact, one interesting study took a bunch of hypogonadal men and gave them a hefty shot of testosterone cypionate. They then monitored the men over the coming weeks during sleep and watched the morning erections spike and then slowly decrease to about half the frequency. [9].  The researchers (somewhat cruelly) let the men’s testosterone levels shrink to almost nothing and by the end of 8 weeks, the men’s rigidity had gone from 770 to 590 g, a loss of almost 25%! Yes, these men lost their superpowers and their nocturnal erections at the same time.

Of course, there one doesn’t necessarily have to go on HRT (TRT) if you find that you are low testosterone and lacking in morning erections.  Check out my pages on Common Causes of Low Testosterone and How to Increase Your Testosterone Naturally for more information.

NOTE: It can take time for the restorative process.  One study noted a year of continuous improvement in REM-related erections. [8] Read this link on Venous Leakage to understand how testosterone helps erections via two primary pathways: 1) increasing eNOS (the “nitric oxide enzyme) activity and 2) restoring the internal structures and tissues of the penis.

In fact, improving nitric oxide can have dramatic effects on nocturnal erections as one Cialis study showed.  Cialis has a long half life and its efficacy is considered to be about 36 hours in most men.  One study showed that men who used 20 mg every other day had dramatically increased morning erections. [6] The authors commented that “chronic treatment also produces a dramatic increase in morning erections, which determines better oxygenation to the penis, thus providing a rationale for vascular rehabilitation.” (The PDE5 Inhibitors like Cialis also have a long list of side effects, some very serious.  We have had men on the Peak Testosteorne Forum with long term and probably irreversible hearing and vision damage.)

A Viagra study using 100 mg nightly for three nights showed some impressive results as well on men with erectile dysfunction. [10] The primary change seen in the case of this PDE Inhibitor were prolonged morning (nocturnal) erections – in fact, about 60% longer.

Am I advocating taking PDE5 Inhibitors in order to get your morning erections back?  That, of course, is between you and your doctor, but every attempt should be made to take only the minimal dose necessary and ideally for only the short term.  Remember, one can also experience PDE5 Inhibitor Resistance and PDE5 Inhibitor Dependency, so you want to be careful with these medications.  Finally, it is important to rely as much as possible on Exercise, Erectile Foods, gradual Weight Loss and Sleep to boost your nitric oxide and restore you endothelium.

3.  Sleep. The importance of sleep to morning erections is often ignored.  Nocturnal erections occur during REM sleep and some men with erectile struggles report that they seem to be able to achieve nocturnal erections if they sleep long and thus get that last all-important REM cycle.

4.  Sitting. One reader has a novel approach, where he sat slightly erect, and found that his morning erections re-commenced.  See this link on A Novel Approach to Morning Erections for an example.

5. Pycnogenol. Studies of Prelox, which is just Pycnogenol with a low dose of L-Arginine, show an increase in morning erections. [9] Of course, Pycnogenol is known for improving erectile dysfunction, increase nitric oxide and decreasing inflammation.  See my links on Pycnogenol and Erectile Strength and The Pros and Cons of Arginine for more information.

6. Stress.  Anecdotally, men have reported to me increased morning erections after taking any of the cortisol reducers (Vitamin C, S-PS, etc.)  As you know, if you have been looking around the site, I frequently recommend regular (non-religious) medititation and/or Progressive Muscle Relaxation for the same reason.

1)  The Journal of Sexual Medicine, Nov 2005, 2(6):771 784, “Testosterone and Sleep-Related Erections: An Overview”

2) The Journal of Clinical Endocrinology & Metabolism, Apr 1 2002, 87(4):1467-1472, “The Effects of Transdermal Dihydrotestosterone in the Aging Male: A Prospective, Randomized, Double Blind Study”

3) Journal of Sex & Marital Therapy, 1983, 9(1), “Serum testosterone and prolactin levels in erectile dysfunction”

4) Journal of Sex & Marital Therapy, 1975, 1(4), “The assessment of nocturnal REM erection in the differential diagnosis of sexual impotence”

5) ARCHIVES OF SEXUAL BEHAVIOR, 1987, 16(2):125-137, “Use of sexual history to differentiate organic from psychogenic impotence”

6) International Journal of Impotence Research, 2007, 19:200 207, “Relationship between chronic tadalafil administration and improvement of endothelial function in men with erectile dysfunction: a pilot study”

7) Journal of Andrology, 18(5):522-527, “Relationship between sleep-related erections and testosterone levels in men”

8) Journal of Andrology, 13(4):297-304, “A long-term, prospective study of the physiologic and behavioral effects of hormone replacement in untreated hypogonadal men”

9) Phytotherapy Research, Mar 2009, 23(3):297-302, “Improvement of seminal parameters with Prelox : a randomized, double-blind, placebo-controlled, cross-over trial”

9) The Journal of Clinical Endocrinology & Metabolism, Mar 1 1990, 70(3):792-797, “Testosterone Replacement Therapy and Sleep-Related Erections in Hypogonadal Men”

10) Urology, Dec 2000, 56(6):906-911, “Sildenafil taken at bedtime significantly increases nocturnal erections: results of a placebo-controlled study”

Fast Food and Your Sex Life - Peak Testosterone

I wish I had a dollar for every burger and fry that I’ve eaten at a fast food place.  Actually, what I really wish is that I could wind back the clock and never step foot in another fast food place – I know I would be a very different person.  I can remember as a kid – and I grew up when fast food was just forming – being so excited to go to McDonald’s.  It was a whole family event.

Now a lot of us eat at fast food regularly, especially younger males who feel indestructable.  Well, nothing could be further than the truth:  we are destructible and I will show you why fast food will do just that.

In fact, I will go a step further and show you six key ways that fast food will take out your sex life, erectile strength and libido in short order. I think you will surprised at just how nasty the whole industry really is:

1)  Trans Fats.  Most of you already know about this.  If you eat anything like a fry or nugget that is fried, you are getting a monster dose of trans fats.  Trans fats are not complicated:  they are simply regular vegetable oils that have been burned and heated for so long that they have become tangled, mangled, elongated lipids that are a physiological nightmare:  they lower HDL (good cholesterol), raise LDL (bad cholesterol) and increase blood pressure.  And all good Peak Testosterone readers know that those three will eventually take out your sex life.

2)  Saturated Fats.  If you don’t get a boat load of trans fats when you eat fast food, you’ll more than likely get a nice dose of saturated fat.  Saturated fat temporarily hardens your arteries decreasing blood flow to the penis.  As you age, you’ll find that you get increasingly sensitive to this effect.  After a good dose of saturated fat, you can feel the difference downstairs if you know what I mean.  Saturated fat is also highly associated with increased cholesterol and arteriosclerosis, both of which will eventually limpify your penis.

4)  Hetercyclic Amines.  Fast food grills are extremely high heat and create that nice black residue on the meat that we all so enjoy.  Unfortunately, that nice black residue is packed with HCA’s (Heterocyclic Amines) that travel through the blood stream straight to your precious prostate and lead to prostate cancer.  NOTE: Please read about How to Protect Yourself from Prostate Cancer .

5)  Chicken. Some of you try to be good and get chicken when you go to fast food.  Well, this is a disaster as chicken is generally packed with excitotoxins.  Kentucky Fried Chicken is known for being probably the worst offender and Burger King’s Tender Grill is stuffed with Autolyzed Yeast Extract and even glazed with it!  And if your privates survive the MSG, chicken is intrinsically loaded with inflammatory messengers that will slowly lead to heart disease and erectile dysfunction.

6) Blood Pressure. Just one fast food meal can increase blood pressure [1] and, again, if you’ve hung around Peak Testosterone for long, you know that high blood pressure is a huge risk factor for erectile dysfunction and cardiovascular disease. NOTE:  Please read about How Blood Pressure Affects the Penis.

Well, did you notice?  Fast food looks as if it is almost designed to short circuit your sex life.  It attacks the testes (glutmates), prostate (hetercyclic amines) and blood flow to the penis (saturated, trans fats and inflammation).  I don’t think Ray Kroc, Dave Thomas and his colleagues sat around asking, “How can we neuter America?” back in the 50’s and 60’s, but it remarkable what a gonad-killing menu they came up with, eh?

Bottom line:  Don’t eat fast food.  Not one meal. Your gonads will not escape alive…

REFERENCES:

1) Jakulj F, Zernicke K, Bacon SL, et al. A high-fat meal increases cardiovascular reactivity to psychological stress in healthy young adults. J Nutr. 2007 Apr;137(4):935-9

Vitamin C: Sabotaging Your Workouts? - Peak Testosterone

I have taken Vitamin C for several years, because I just feel better when I take it.  It can boost nitric oxide and has a lot of great properties that I document in my page on Why Take Vitamin C? However, a couple of recent studies have really made me reconsider.  In fact, some of you may have heard or read about a very recent study where Vitamin C was coupled with Vitamin E and produced some quite negative results. Normally, training leads to an increase in mitochondrial content within the muscles and this is a normal training adaptation since mitochondria are the power and energy manufacturers within your cells.  However, the Vitamin C and E group had a lower mitochondrial response than the control group, exactly the opposite of what most of us would expect. [1] Clearly if you’re working out, you don’t want your supplements sabotaging  your results and that is exactly what the Vitamin C and E seemed to be doing.

1) J Physiol, 2014 Apr 15, 592(Pt 8):1887-901, “Vitamin C and E supplementation hampers cellular adaptation to endurance training in humans: a double-blind, randomised, controlled trial”

2)  Am J Clin Nutr, Jan 2008, 87(1):142-149, “Oral administration of vitamin C decreases muscle mitochondrial biogenesis and hampers training-induced adaptations in endurance performance”

Unfortunately, it is hard to draw any specific conclusion about Vitamin C from this study, because, for reasons unknown the researchers did not study each vitamin separately.  And that’s not the first time that has happened.  In 2005 a similar and older study that I mentioned in my page on The Potential Dangers of Antioxidants showed combining Vitamin C and Grapeseed Extract led to a ~5 mm rise in systolic blood pressure! And three years later a study showed that a combination of Vitamin C and an SOD-like molecule led to a decreased oxygen supply to muscle tissue.

As you can see, the storm clouds had been gathering, but in every case, Vitamin C fanatics could blame the other molecule and avoid blaming Vitamin C.  However, that all changed when a lesser known, but very well done study on both rats and humans came out the same year as the SOD study mentioned above.  In this study researchers gave men a gram per day of Vitamin C, which is a very reasonable and common dose, and then monitored how it affected their exercise results. [2] Many of you know that one measure of cardiovascular fitness is VO2max.  What happened is that in the 8-week training period the non-supplemented men increased their VO2max by 20% and, counterintuitively, the Vitamin C supplemented group only increased it by 10%.  There was an even greater differential in the animals study.  In other words, Vitamin C decreased the training effect instead of increasing it – not good.

What made the results so damning was that the scientists documentedWHY Vitamin C had this negative impact on exercise:  it muted key transcription factors that rely on free radical formation.  A transcription factor is a protein that is used to convert DNA into RNA.  Another way to put this is that free radicals (ROS or reactive oxygen species) actually activate key antioxidant systems.  Vitamin C actually stopped this activation in muscle tissue and thus produced the exact opposite of what was intended.

And it didn’t stop there:  the researchers did a fantastic job of also showing many other transcription factors that were negatively impacted.  Many of you know that SOD and glutathione are the two master antioxidants in the human body.  Vitamin C lowered the expression of both SOD and glutathione post-exercise.  You can see the irony:  a health-conscious man takes Vitamin C to promote antioxidant status and instead likely lowers it in many key ways. This was really the final nail in the coffin for me.

For those of you who are have been health-consciour for decades, this will come as quite a shock.  In the 80’s there was a huge life extension movement that was supposed to cure diseases and extend lifespans and much of the hope was built around antioxidants.  However, antioxidant research has been less than spectacular to say the least and has actually received many black eyes, all of which was counterintuitive until a few years ago.

Is there any way out of all of this for Vitamin C?  I know a number of guys on the Peak Testosterone Forum have subscribed to “Pauling Theory.” For those who don’t know, Linus Pauling was the Apostle of Vitamin C and he had a theory that was built on the fact that virtually all animals except man manufacture their own Vitamin C.  Therefore, we have much lower levels of Vitamin C than all other creatures around us and have not been able to fully adapt or compensate.  His theory, called Pauling Theory, was that man simply needed to replensih these lost stores of Vitamin C by megadosing Vitamin C.  He claimed this could cure many cancers, stop arterial plaque in its track and many other things as well.

Someone still clinging to Pauline Theory could still claim that megadosing Vitamin C, while lowering training beneftis, still provides so many other positives that it is a net gain.  This seems like a weak argument to me, since it is essentially lowering the body’s own natural antioxidant systems.  Vitamin C, as powerful as it is, should not be lowering the master antioxidants, SOD and glutathione.  And it doesn’t unless you start megadosing of course.

REFERENCES:

How to Meditate without the Mumbo Jumbo - Peak Testosterone

There are dozens of life-changing reasons to meditate but most men won’t do it for one simple reason:  they associate it with religious or spiritual beliefs (or the lack thereof) that do not match their own.  And, almost without exception, if you pick up a book on the subject, you will be bombarded with religious terminology that can make it a barrier for most men.  Another problem can also be the fact that meditation is actually quite simple, but many articles and books add pages and pages of “fluff” that you really don’t need to know.

But fear not!  Below I am going to give you some very simple step-by-step approaches to meditation.  In fact, before I go on, let me just mention that there are really just three basic approaches to meditation:  concentration, mindfulness and mantra.  These three overlap and are not perfectly separate as you’ll see below, but do not be concerned because all 3 of these have stellar research records as far as cortisol control, psychological improvement, cardiovascular health and – it’s true! – brain building.

Many guys also struggle with just sitting there.  It seems a tad bit unmanly to just sit their doing nothing and it just seems like a big waste of time.  However, nothing could be further from the truth and secular meditation can helpyou directly with your sex life, career and other things that are important to virtually any man on planet earth.  Stress, especially in modern societies, is a root cause for almost every nasty medical condition that plagues us.  We have to learn approaches that will help us overcome this enemy and secular meditation should certainly be a the top of the list in this category.

Here are just a few examples as to why meditation should be front and center to every man and why meditation is actually downright manly:

1.  Cortisol Reduction and Visceral Fat. Cortisol accelerates the most dangerous kind of fat:  visceral or stomach fat. This kind of fat is associated with insulin resistance, endothelial dysfunction, heart disease and, ultimately, that’s not going to be good for your erections.

2.  Muscle Preservation. This could go under #1, but anything that controls cortisol will help keep your precious muscle mass.  Testosterone buildeth;  cortisol taketh away.

3. Erections. Remember:  one of the stress hormones puts the brakes on erections, in order to prevent priapism.  Lowering stress will, in general, increase your libido and optime your erectile strength.

4. Anxiety. Meditation helps with a host of anxiety-related psychological issues.  Many of you need to admit you’re overly stressed out and this is impacting your relationships and/or family.

5.  Repetitive Thoughts. Meditation teaches you to control runaway and repetitive thoughts.  This is a HUGE problem for many men.  When the consequences of something seem too horrible to bear, just about the only thing that can help is meditation.  It teaches you to control your thoughts

So I urge you to get over your bias against meditation – it’s mostly cultural after all – and try it out.  I can’t emphasize this enough, but it takes time – usually a few weeks.  Meditation is just exercise for the brain.  And when you start working out for the first time in your life, it can be painful when you start.  Keep that in mind when you start to meditate.

Again, you will be plagued with thought flooding your head, sleepiness and various other distractions.  But stick it out:  you won’t regret.  As a motivator, look at this summary as well:  The Many Benefits of the Relaxation Response.

NOTE:  PMR (Progressive Muscle Relaxation) is a related technique but not really true meditation.  It is, however, uniquely powerful and has some distinguising properties, such as being a nice cure for insomnia.  It is VERY good at lowering cortisol and stress and is also known for improving many of the worst psychological issues.  However, it does not yet have the documented brain building benefits of meditation and I would also argue that it may not help as much with learning to control your thought life.  But it is VERY powerful and can produce a relaxation response any time and anywhere!

Concentration Meditation

1) Choose an Object. You have to start by choosing something to focus on. The most common is your breathing.  If you choose breating, it can either be the sound of your breath or the feeling of the breath entering/exiting your nostrils. Other common meditiation “objects” are the end of your nose or the forehead at the top of your nose between your eyebrows, called cosmically the “third eye point” by some.

2) Close Your Eyes. I recommend closing your eyes as you will find it much easier to relax and concentrate.  However, you certainly do not have to and many practioners meditate sometimes with their eyes open.  If you leave your eyes open, you can either concentrate on your breath or on an object in the room, preferably something neutral.  Leaving your eyes open can be a useful technique for those who easily fall asleep.

3) Counting or Alarm. I’m a numbers guy and love to count.  It really helps me with each breath to count up from 1 to some preset number.  I usually find that when I hit about 50, the relaxation response kicks in.  For some of you, setting an alarm – preferably your phone on a gentle vibration mode – is what you need.  I encourage this, though, so that you know there is a time limit and won’t be stressed out about time management-related issues.  Many studies show just two times of 15 minutes per day will achieve the benefits mentioned above.

4) Distractions. The most important thing to remember when you start meditation is that you will initially have great trouble with distracting thoughts.  The normal person will think of a 100 different things besides your breath in a relatively short amount of time. But do NOT get frustrated with this.  It is natural and is part of the learning curve.  When you notice your mind off on a tangent, just gently bring it back to your breating (or whatever other object you decided to focus upon). You will get better as time goes on and may take weeks before you can focus consistently.  However, it is well worth the patience and effort. Also, you will notice that if you do 15 minutes of meditiation, your mind will slowly calm down and enjoy the peace and quiet after a few minutes. It will get easier and easier later in your meditation session.

One of the big advantages that I see with Concentration Meditation is its ability to quickly bring about a relaxation response.  With just a few weeks practice, you should be able to produce significant stress reduction after just a few minutes.  This is worth gold.

Here are a few other items that you may wonder about:

a) Posture. Forget about posture or whether you are sitting or standing or what position your hands are in.  All that matters is that you focus your mind.

b) Mudras.  Forget about finger and hand position.There is some interesting research that ties the standard “lotus” finger positions to brain activity, but this is for the advanced class.  You will get 90% of the benefit from just the above simple techniques.

NOTE:  Just to give you an idea how bad most meditational guides are, I remember one that was carefully giving directions on how to do meditational breathing.  Their advice?  “First in, then out.” Okay, I guess there are a couple of alternatives, such as non-stop exhaling, but, really, did we need that reminder?  How many of their students continuously inhale until they hyperventilate or pass out?  I doubt it’s very many…

Mindfulness Meditation

The apostle of Mindfulness Meditation here in the U.S. is a man named Jon Kabat-Zinn, an M.I.T. Ph. D. molecular biologist that left behind his original training to study meditation and its effects on the brain and body in an M.I.T.-based research center. He has authored many books and scientific papers on the subject and is considered one of the foremost experts on meditation in the world.  For those interested, some of his lectures are on YouTube and are enjoyable for their lucidity and unpretentiousness.

I find Mindfulness Meditation to be the easiest, but some say it is the opposite.  Regardless, it is packed with proven benefits to one’s health and well-being.  Here is all you have to do:

1.  Close Your Eyes.  Again, it’s not a requirement, but I recommend closing your eyes, especially when you are first learning this technique. However, you can engage in Mindfulness Meditation anywhere, even when you are on a stationary bike at the gym for example.  But start with your eyes shut.

2.  Be Aware (~33%). Sound like I’m giving Stranger Danger training to your kids? Well, Mindfulness Meditiation requires you to actually be aware of your environment and not try to tune it out as you do in large part with Concentration Meditation. The noise of air blowing through a vent, your son dropping his PS3 controller in the room above you or the neighbor talking outside are all to be “embraced” instead of dismissed.  However, this is the key:  you pay attention to these outside noises only briefly for a few seconds and then return to “being aware”.

3.  Stray Thoughts (~33%). One unique thing about Mindfulness Meditation is that it actually emphasizes the fact that you will have stray thoughts entering your brain as you meditate.  It’s part of being a stressed-out human in the 21st century, eh? However, rather than dwelling or analyzing or attaching emotion to these thoughts, you simply “look at them” and pass onto something else.

The power of this technique cannot be overestimated.  It takes several weeks to really be able to do it effectively, but, eventually, you learn to not react with dread or anxiety or panic at thoughts entering your brain.  I think Mindfulness Meditation is the most powerful technique to show you how to control repetitive and destrutive thought patterns.  Some day the light bulb just seems to go off and you realize, “Everything is going to be okay.  The world isn’t going to melt down if X happens.”

4.  Breathing (~33%). Mindfulness also encourages you to go back and listen to your breathing.  No intense concentration here.  The idea is that you let your mind gently go back between focus on your breathing, stray thoughts and sounds and stimuli around you. You are merely an “aware onlooker” and spend no more than a second or two on each.

This may sound like the most useless activity that you’ve heard of, but trust me:  Mindfulness Meditation produces big results.  If you stop to think about it, you end up building up the ability to, in a relaxed and focused way, deal with whatever crosses your path throughout the day.  And you learn to control your mind and thought patterns.  That is something that can help your health, your career and your relationships.

Mantra Meditation

Ever heard of Transcental Meditation? You probably have, but it is nothing more than an expensive and popularized version of one of the oldest meditational techniques on planet earth, Mantra Meditation. TM is a licensed, trademarked program that will set you back a few grand from what I have read.  Now this may seem like a bad thing to some – making money on something like meditation – but the truth is that it was very good to increase our understanding because it led to a slew of studies that greatly advanced our knowledge of meditation.  Mindfulness and TM Meditations have accumulated the greatest number of studies over the decades, both with great success.

So is taking a TM course worth it? My take on it is that it is analagous to hiring a personal trainer in the gym. In other words, if you need one-on-one attention and learn better with a tutor or mentor, then TM may be right for you. However, I should point out that some people claim that Transcental Meditation display many cult-like qualities and you can read some of them at Suggestibility.

Reall there is no reason not to just get started with the techniques below. It is VERY simple and easy to get powerful resuls almost right away and will cost you nothing but a little time each day:

1.  Choose a Mantra. TM practitioners receive a “special” mantra.  Now it is true that chanting of any sort likely stimulates the pituitary and hypothalamus which are very near the back of the throat.  However, I think it’s a real stretch to say that we have evidence that certain vowels or consonants produce differing results.  Even if that is true, I doubt that TM instructors have any idea what those sounds would be.  So pick short phrase of about three syllables, such as “Wah tah hey” and you’re done.  You want something that is easy to say, flows well and will produce a nice vibrational effect at the back of your throat.

2.  Say the Mantra. You knew I was going to say that?  Yes, you have to repeat the mantra and the key here is for it to slow, repetitive and monotonous – er, excuse me – soothing.  You want to say each syllable about every half second or second.  In other words, you want a pattern that will produce a relaxed, calming effect on the mind – no reggae beats here please.

3.  Return to the Mantra. If you are human, you will have stray thoughts.  As in concentration meditation, you simply return your mind, without stress or self-judgement, to repeating the mantra.

NOTE: You may not realize it, but you should really thank me for this simple three step procedure. I just read a 15 step procedure that included as step five: “Take bath in holy river.”

Mantra Meditation for some people will produce a relaxation response even more pronounced and rapid than standard Concentration Meditation.  One could argue, actually, that Mantra Meditation is actually just a subcategory of the Concentration anyway.  However, I see them as separate entities because of the powerful effect of chanting and sound upon the brain in many people.  So try all three techniques and see which one works best for you.  If you can, do about a half hour per day.

NOTE:  Some say that stimulating the pituitary through Mantra Meditation could in turn stimulate signaling to the testes and increased testosterone and androgen output.  As far as I know, this has not been verified by any studies however.

Why does meditation work so well?  Well, no one really knows the answer to that yet. It somewhat reminds me of laughter, which has incredible and poorly understood benefits, such as Increasing Growth Hormone. The bottom line is that meditation just plain works you’ll want to use its superpowers in your life while scientists take another decade or two to figure out its source of powers.

Now there are actually several kinds, such as Zen, (certain exercises in Kundalini Yoga and so called “loving kindness” meditation.  These all have value, but, again, the above three meditational techniques (Concentration, Mantra and Mindfulness) have heavy backing in the research and literally dozens and dozens of studies backing up their value.

Hibiscus Tea: Will Help Most Men With Erectile Dysfunction

As I write this, I am actually drinking hibiscus tea. There is no doubt that it is Mother Nature’s gift to every man on the planet (especially if you are over about 40). It’s quite bitter, but then so is beer, eh? My experience is that you get used to the bitterness and actually enjoy the taste after a few days.

So what’s all the hibiscus hype?  Well, it’s not hype and let me prove it to you with a number studies from the research that should get your attention. Remember that erections are all about your arteries – nitric oxide in your arteries and nice low blood pressure levels (which indicates higher blood flow):

1. Increased eNOS Activity and Nitric Oxide. We get most of our arterial nitric oxide from the endothelium and this is governed by the eNOS enzyme.  It turns out that the polyphenols in hibiscus tea activate this enzyme and cause your endothelium to produce more nitric oxide. [6]

Now you may object and say, “Well, this was in the lab and not in actual human subjects.”  That is true. However, one of the big tests for any possible NO-increasing compounds is whether or not it can produce big drops in blood pressure.  As you’ll see below, this has been demonstrated in at least five studies, three of which I have documented below.

Also, I do not need to point out that boosting arterial nitric oxide, which is what we are talking about here, will generally help significantly with mild to moderate erectile dysfunction. No one can promise you it will solve it, but you have little to lose, eh?  Hibiscus tea is very easy to find and prepare, something I discuss here:  How to Make Hibiscus Tea.

2. Endothelial Function.  Remember this formula:

1) Journal of Human Hypertension, 2009, 23, 48 54, “The effects of sour tea (Hibiscus sabdariffa) on hypertension in patients with type II diabetes”

2) Journal of Hypertension, Apr 2009, 27(4):774 781, “Black tea consumption dose-dependently improves flow-mediated dilation in healthy males”

3) J Ethnopharmacol, 1999 Jun, 65(3):231-6, “The effect of sour tea (Hibiscus sabdariffa) on essential hypertension”

4) J. Nutr, Feb 2010, 140(2):298-303, “Hibiscus Sabdariffa L. Tea (Tisane) Lowers Blood Pressure in Prehypertensive and Mildly Hypertensive Adults”

5) Phytomedicine, Feb 2010, 17(2):83 86, “The effectiveness of Hibiscus sabdariffa in the treatment of hypertension: A systematic review”

6) https://ddd.uab.cat/pub/tfg/2015/143857/TFG_victorfarrealins.pdf

7) Mol. Nutr. Food Res, 2014, 58:1374 1378, “Hibiscus sabdariffa extract lowers blood pressure and improves endothelial function”, https://onlinelibrary.wiley.com/doi/10.1002/mnfr.201300774/pdf

Erectile function = Endothelial function

The endothelium is the thin layer of cells on the inside of your arteries that are responsible for controlling their expansion and contraction and the nitric oxide that governs the process.  Researchers refer to this ability to relax the arteries as “endothelial function,” and, generally speaking, endothelial function governs how well and how fast your erections are.  (There are exceptions, of course, as low dopamine, venous leakage and other systems can negatively impact erections as well.) In any event, you can probably guess where I am headed:  hibiscus tea has been shown to significantly help with endothelial function:

“Diuresis and inhibition of the angiotensin I-converting enzyme were found to be less important mechanisms than those related to the antioxidant, anti-inflammatory, and endothelium-dependent effects to explain the beneficial actions. Notably, polyphenols induced a favorable endothelial response that should be considered in the management of metabolic cardiovascular risks.” [7]

Notice that these researchers boldly told physicians to consider using hibiscus in their practices.  Amen!  Oh course, how many physicians actually consider natural solutions to chronic disease, even though 99% of the time, chronic disease results from unnatural lifestyles?

Again, an improvement in endothelial function will help the solid majority of men with mild to moderate erectile dysfunction.  This is especially true if coupled with a high nitric oxide-based lifestyle, something I explain in great detail my my book: The Peak Erectile Strength Diet.

3. Hypertensive Type II (Adult Onset) Diabetics. This study did a black tea versus hibiscus tea study.  (Black tea is known for also improving endothelial function, although this study found the opposite.)  The results were very impressive for hibiscus tea:

A 20+ point drop in systolic blood pressure should get everyone’s attention.  Of course, this means that the participants arteries relaxed or dilated and blood flow increased.

Admittedly, the number of patients was small (60) and another study found that black tea decreased blood flow in a dose dependent manner [2] instead of restricting it.

4. Moderate Essential Hypertension. Patients with essential are often the toughest to treat, because they have no known cause.  In a small study, hibiscus provided solid results in just this situation:

“Statistical findings showed an 11.2% lowering of the systolic blood pressure and a 10.7% decrease of diastolic pressure in the experimental group 12 days after beginning the treatment, as compared with the first day. The difference between the systolic blood pressures of the two groups was significant, as was the difference of the diastolic pressures of the two groups. Three days after stopping the treatment, systolic blood pressure was elevated by 7.9%, and diastolic pressure was elevated by 5.6% in the experimental and control groups.” [3]

5. Prehypertion and Mild Hypertension.  Again, this was a fairly small study (65 participants) but provided solid results:

“A standardized method was used to measure BP at baseline and weekly intervals. At 6 wk, hibiscus tea lowered systolic BP (SBP) compared with placebo (-7.2 11.4 vs. -1.3 10.0 mm Hg). Diastolic BP was also lower, although this change did not differ from placebo (-3.1 7.0 vs. -0.5 7.5 mm Hg).” [4]

This group is particularly relevant in my opinion, because we clearly have quite a few prediabetic men on the Peak Testosterone Forum.

CAUTION: Do not drink too much hibiscus tea.  One of the men on the forum said that Dr. Greger advises less than a quart to make sure you don’t get too much manganese.  The bottom line is that more is not always better.  Also, if you have low blood pressure or are on blood pressure medications, please discuss with your doctor first.

6. Protection Against Arterial Plaque. One thing that can lower your nitric oxide and endothelial function over time is a buildup in plaque in your arteries.  Why?  Because plaque represents actual damage and “scarring” of the lining of your arteries.  Keep in mind that blood supplied to your penis is done so via the pudendal artery and you have actual penile arteries as well.  Things simply are not going to work right in the bedroom if you have significant atherosclerosis.  I have a page that covers the association between the buildup of plaque and the loss of erectile strength:   Evidence That a Loss in Morning Erections Is Due to a Buildup of Arterial Plaque.

SOUR GRAPES: Meta-Analysis.  Oy vay is all I can say for what these researchers concluded:

“Results Four trials, with a total of 390 patients, met our inclusion criteria. Two studies compared Hibiscus sabdariffa to black tea; one study compared it to captopril and one to lisinopril. The studies found that Hibiscus had greater blood pressure reduction than tea but less than the ACE-inhibitors. However, all studies, except one, were short term and of poor quality with a Jadad scoring of <3 and did not meet international standards. Conclusion The four randomized controlled studies identified in this review do not provide reliable evidence to support recommending Hibiscus sabdariffa for the treatment of primary hypertension in adults.” [5]

The authors above know that no one except large pharmaceutical companies can afford massive, large scale trials.  So, sure, it’s obvious that hibiscus tea has not been held up to FDA-style scrutiny, and it never will.  But it’s been a solid performer in multiple studies on multiple subpopulations, so why not just try it?  It’s a common drink in many countries, and so it’s safety profile should be considered stellar compared to virtually any phamraceutical.

CONCLUSION:  Hibiscus tea provides solid results for increasing blood flow and lowering blood pressure and should be considered by men with erectile dysfunction as a potential significant help.  It should also be consumed in my opinion regularly to help prevent atherosclerosis.

REFERENCES:

HRT: Why Not Just Take Viagra or Cialis Instead?

A recent study came out that essentially sent the message that Viagra was just as powerful as HRT (testosterone therapy) in several key areas. I covered this study and some more by the same researcher in my page on Does Testosterone Therapy Even Work?? Essentially what this researcher has been trying to show is that you can give a man Viagra and see him improve in erectile function and mood and then, when you add HRT on top of it, you get no additional improvement.  The conclusion that the comes to is that HRT is, therefore, not really necessary and is an unneeded solution for most men.

However, let me give you 10 Reasons That Testosterone Therapy Will Usually Beat Out Viagra 24/7 365 (for men with low testosterone of course):

1. Venous Leakage. Penis tissues need testosterone and, when your testosterone gets low enough, the insides of your penis will literally start to wither. Connective tissue and nerves begin to atrophy. This can make it hard to close off an erection which means that as much blood leaks out of the penis as is getting pumped in, a condition I discuss in my link called Venous Leakage 101. Usually, HRT can partially or totally reverse this condition and, of course, the reason is that a fresh supply of testosterone literally brings the penis back to life and restores normal function. Now Viagra (and Cialis / Levitra) can help with this indirectly:  they work by creating extra penile pressure, thus helping somewhat with the sealing off process. But clearly, this is a workaround solution and not getting at the root cause.

2. Insulin Sensitivity. A big percentage of males in the West have insulin resistance (prediabetes) and the suite of symptoms that usually accompany it called Metabolic Syndrome.  Low testosterone actually accelerates Metabolic Syndrome and prediabetes by raising insulin levels and increasing insulin resistance.  Furthermore, giving a low T guy testosterone will always lower his insulin levels.  This effect is so powerful that at the HRT clinic I am going to they have been able to get virtually every Type II diabetic completely off of insulin. You can read about this more in my page on Testosterone and Diabetes. Taking Viagra or Cialis will have little impact in this area.

3. Decreased Hardening of the Arteries. Men who go on anti-androgens (for prostate cancer) have many nasty cardiovascular changes and one of them is an increase in arterial stiffness. [2] Furthermore, a study on dialysis patients showed a strong correlation between arterial stiffness and testosterone levels. [1] And, finally, giving men testosterone has been shown to actually reverse this arterial stiffness in large part or even totally in some cases. [3] There have been a couple of studies – and this is all quite controversial and discussed quite a bit on the Peak Testosterone Forum – that have shown that HRT increases cardiovascular risk. This makes no sense considering that testosterone has such a positive effect on arterial stiffness. How can you make arteries more stiff and improve CVD outcomes? However, for more information, see my page on The New Testosterone (HRT) Class Action Lawsuits.

NOTE: Testosterone therapy and Viagra / Cialis can work synergistically. Anything that gets a man to have more sexual intercourse will lead to increase baseline testosterone. And raising testosterone activates the enzyme (eNOS) that controls nitric oxide. So PDE5 Inhibitors can help testosterone and vice versa.

5. Brain Health.  One of the reasons that testosterone is so successful in my opinion is that it is so good for the male brain.  Testosterone (and the ensuing rise in estradiol) increases dopamine and other critical neurotransmitters, something I document in my link on Testosterone and the Brain.  On a practical level, this is extremely important.  Low testosterone has been shown to disturb sleep and it is very often associated with anxiety, depression and fatigue.

Now the researcher mentioned above tried to challenge the use of HRT by noting that Viagra can improve mood just as much as HRT.  Now, while it is true that Viagra can improve mood and various psychological parameters – nitric oxide improves blood flow to the brain and is a neurotransmitter in its own right:  there simply is no substitute for testosterone.  Working memory can be negatively impacted in a low testosterone man.  Researchers also found that exercise has such a profoundly positive effect on the brain through it’s increase of cerebral testosterone and that it can actually spawn neurogenesis.  So it is very naive thinking to assume that by just popping a PDE5 inhibitor that you can solve a man’s low T brain-related issues.

Did you know you can inexpensively do your own testing for most hormones? The industry leader is Discounted Labs..

6. Natural. Many men and physicians feel that HRT is “unnatural.” To them it seems on par with taking steroids and feels like “cheating.”  Some even think that it is just an excuse to try to jack up one’s waning sex life and/or muscle mass. The same crowd would tend to feel that Viagra is a much less invasive and non-aggressive solution to a male’s problems.  However, I would argue the opposite:  testosterone is actually one of the most natural male substances and is bsolutely critical for a man’s health.

Would you replace your thyroid hormones if you were hypothyroid?  Sure.  Would you replace your CoQ10 levels if they were low?  Sure.  What if you were deficient in Vitamin D?  Same thing.  So why not replace testosterone in the same way to more youthful levels?

And remember:  many forms of HRT actually administrer bioidentical testosterone.  Although injectibles such as testosterone cypionate and enanthate require a simple ester chain to be broken off, this a very simple process for your body to do and one is left, again with bioidentical testosterone afterwards.  So, essentially, all the major forms of testosterone are delivering bioidentical or extremely close-to-identical bioidentical and natural testosterone into your system. Speaking as a guy who was just miserable with low testosterone for decades and whose life was completely turned around from HRT, I can assure you that HRT has no comparison with taking steroids and I had no motivations to put on muscle or anything similar.  I just wanted to feel human again.

7. Osteropenia and Osteoporosis.  A man’s estradiol comes from the conversion of some of his testosterone via the aromatase enzyme.  Surprisingly, many men have such low testosterone that they simply cannot build up enough estradiol to maintain their bone mass.  If your estradiol is below 15-20 pg/ml, then this is probably something to discuss with your doctor.  See my page on Testosterone and Bone Mass for details.

CONCLUSION:  This list could actually go on and on, but I believe I have painted an adquate picture here.  Testosterone is simply too critical to just ignore and pop a PDE5 inhibitor. Basically, the above researcher is attacking testosterone therapy by going after the easy stuff.  He knows that Viagra cannot help with osteoporosis.  He knows that Viagra cannot reverse someone’s diabetes.  And he knows that Viagra cannot heal venous leakage or hardening of the arteries.  So, in my opinion, he likely picked the one or two areas where Viagra excels and then used it to build an anti-HRT storyline.

I can only say that those who suggest this have clearly never had to suffer with low testosterone or experiencedits nasty side effects.  I was just miserable during my low testosterone days and will only go back kicking and screaming – let me tell you.  You can read about it in  My Personal Health Story.

Furthermore, ignoring low T can actually be a very dangerous philophophy and could get some men hurt. Why?  Because low testosterone increases your risk factors for so many diseases!  This is the subject of my book Low Testosterone By The Numbers, which discusses how a man whose testosterone is between 250 and 400 ng/dl is at increased risk for all the conditions above.

Again, Viagra and Cialis have their place for some men, especially in the short term in low dosages. But to suggest that they can be a replacement for the very low hormone levels seen in the typical hypogonadal male is very risky in my opinion.

REFERENCES:

1) Baylor College of Medicine, “Men with low testosterone, erectile dysfunction may improve sexual function with testosterone gels”

2) Clinical Science, 2003, 104:(195 201), “Testosterone suppression in men with prostate cancer leads to an increase in arterial stiffness and hyperinsulinaemia”

3) Eur J Endocrinol, May 1 2009, 160:839-846, “Effect of testosterone replacement therapy on arterial stiffness in older hypogonadal men”

IMT: What Are Normal Levels? - Peak Testosterone

What is an IMT?  It is a carotid (neck artery) ultrasound that has been used in many studies to monitor atherosclerosis (arterial plaque) and has a rich and broad research history behind it.  According to Track Your Plaque, it has about a 60-80% correlation with cardiac plaque so, while it’s not perfect, it does have some solid association.  The beauty of an IMT is that, as of this writing (in most states), you can order one through Lifeline without a doctor’s orders and it is only $70.  (I have no affiliation.)

Why would anyone go to all this trouble to measure their atherosclerosis?  Isn’t arterial plaque just a part of life?  No, it does not have to be.  Several  men, that I call the Plaque Regressers have founds consistent ways to reverse atherosclerosis and part of this, obviously, requires the ability to monitor your progress.  I have a significant amount of coverage on my site on the topic and you can start with my Links for Improving Erectile Strength for more information.

a)  Erectile Dysfunction. The fact is that it doesn’t take a lot of plaque in your penile arteries before erections start taking a little longer and things start becoming a little softer. And even if you are young, that does not mean you are completely immune.  In my page on Young Men and Erectile Dysfunction, I discuss how many studies have shown that about half up to even two thirds of men in their 20’s and 30’s already have significant arterial plaque.<

If you have plaque, you probably want to focus on reversing it and clearing out those penile arteries. This will improve blood flow and improve  nitric oxide levels, all of which will help you in the bedroom.  See my page on  How to Clear Your Arteries for more information. One of the things that I see on the Peak Testosterone Forum is men with erectile dysfunction who simply refuse to believe that their issues could be caused primarily by atherosclerosis. But the fact is that aterial plaque is the root cause of most erectile dysfunction in modern cultures.

b) Heart Attack Risk.  As the plaque mounts and/or if it grows quickly, you are at an ever-increased risk of a heart attack or stroke.  In the U.S. alone, there are about 735,000 heart attacks per year, resulting in 370,000 deaths.  And another 240,000 will die each year of other heart-related issues.

Okay, so let’s say that you are on board and decided to actually measure your arterial plaque via an IMT.  How do you know if your readings are normal? Or, better yet, how do you know if they are ideal?  It turns out that there has been quite a bit of research on the subject and they are even published full studies in the public domain, clearly for the purpose to help us with attacking heart disease. Here is a sampling of that material:

NOTE:  A Heart Scan is actually the initial route I chose and you can read about it here:  My Heart Scan Results. (Next time I will get an IMT as my Heart Scan showed zero cardiac plaque and I don’t want any more radiation unless absolutely necessary.)

CAUTION: Always go by the results and analysis provided by your specific lab and/or physician.  Techniques and methodologies can vary testing results.

Here are the results from this study by age bracket for men only and the purpose is to give us a picture of relatively health aging of the arteries:

2. Patients Without “Obvious” Atherosclerosis. This study eliminated all patients with obvious narrowing the arteries.  Doing so yielded a nice picture of a more “healthy” age progression: [4]

Their concept was to give us a pattern for healthy arterial aging. As you can see, in this case even late seniors were able to keep their IMT below 1.00 mm. Keep in mind that the above values are women and men grouped together and, as I mentioned, men tend to be a bit higher. Notice, though, how similar the results are to #1.

3. Rome, Italy General Population Study. One clinic just kept track of 1,600+ patients in a row.  Interestingly enough, the results were quite similar to #1.  Unfortunately, the did not break it out by gender and women tend to have lower IMT’s than men. However, the general pattern and slope of the Spanish was definitely confirmed. [3]

What Is an Ideal IMT Score?

As you can see from the above, there is a “natural” progression of aging in IMT scores even in those living a relatively heart-healthy lifestyle.  Of course, many of the supercultures likely have little to no atherosclerosis and so their scores are probably even a bit lower.  One such people are the Tarahumara Indians of Mexico and I give coverage to them here if you are interested:  The Tarahumara Diet.

However, the point is that researchers have looked at all this data and the above studies and come to some conclusions:  By looking at the above stats, you can see for yourself how they came to these conclusions:

1. 1.0 mm Is Somewhat Risky for Old and Young; 1.2 mm is High Risk.  The authors were clear that “it is common practice to call a CCA IMT >1.0mm as being abnormal, and >1.2mm as being high risk. There is general agreement that the presence of obvious plaque indicates high risk at any age. However, when there is only CCA IMT thickening and no plaque then the normal values need to be adjusted for age, gender and perhaps even ethnicity. [4]

Very similar thinking was echoed by researchers when they stated that “we defined plaques nonarbitrarily as a localized area of thickening of >1.2 mm because we believe that plaque should be considered to be qualitatively different from general increases in wall thickness. Plaques were very common in both men and women, and, in contrast to IMT, the presence of plaques was strongly associated both with cardiovascular risk factors and with prevalent cardiovascular symptoms and diagnosed disease. [2].”

Notice that both sets of scientists noted that arterial wall thickness increases with age and so your IMT score must take this into account.  Thus, if you exceed the average progression by age, then you likely have plaque and are at risk.  However, if you are over 1.2, you definitely have significant plaque according to their research and, clearly, anything over 1.0 likely is indicative of problems as well, because even senior-aged healthy individuals have IMT’s less than that number.

2. An Increase Over .02-.05 mm Per Year. According to some guidelines, you should also watch the rate of change in IMT.  Notice that 1.0 and 1.2 figures from #1 are supported as well:

“It was suggested that an average thickness of the combined intima and media ranging between 0.5 and 1.2 mm is considered to be normal, and that >1.2 mm is used to define the presence of a plaque. It was also reported that the abnormal range of IMT is age dependent, and an IMT >1.00 mm is considered highly abnormal in younger patients, and is sometimes used as the cutoff in clinical trials (Feinstein 2002). The estimated progression of atherosclerosis per year is 0.02 to 0.05 mm (Feinstein 2002). IMT may be a potential useful marker for coronary atherosclerosis, as well as an indicator for its progression or regression, on the condition that the carotid atherosclerosis reflects coronary atherosclerosis.” [5]

SUMMARY:  Ideally, one would work with a qualified cardiologist or other physician that has a passion for plaque reversal.

1) Rev Esp Cardiol, 2010;63:97-102, “Carotid Intima-Media Thickness in Subjects With no Cardiovascular Risk Factors”

2) Stroke. 1999; 30: 841-850, “Carotid Plaque, Intima Media Thickness, Cardiovascular Risk Factors, and Prevalent Cardiovascular Disease in Men and Women”

3) J Ultrasound Med, 2007, 26:427–432, “Common Carotid Artery Intima-Media Thickness Determinants in a Population Study”

4) https://www.pulsus.com/journals.html, “NORMAL VALUES FOR COMMON CAROTID INTIMAL MEDIAL THICKNESS SHOULD BE ADJUSTED FOR AGE”, MF Matangi, DW Armstrong, M Nault, D Brouillard

5) Group Health Cooperative, Clinical Review Criteria, “Carotid Intima Media Thickness (IMT or CIMT) for Coronary Artery Disease Screening and Monitoring”

6) https://www.cdc.gov/heartdisease/facts.htm

Long Term Weight Loss - Peaktestosterone

Yes, there’s a right way and wrong to do almost everything and long term weight loss is no exception.  Let’s face it:  Americans (and almost every other industrialized society) is losing the war with obesity:  currently 32% of all adult males are obese and that percentage is growing every year. [1]  And remember that medically defined obesity doesn’t just mean “chunky thighs” – it means almost Sumo-level fat.  Let’s face it – looking at from the outside, it almost seems as if this is an “Unwinnable War”.

Furthermore, the stats show that over 80% of overweight people cannot even keep off 10% of their body weight for one year!  In other words, four out of five people that need to lose weight have very short term success at best.  Furthermore, we all know people – maybe even ourselves – that have lost weight and regained it many times in their life.  This sort of yo yo dieting is the antithesis of long term weight loss success.

The desperation to control weight is shown in the rise of cosmetic procedures such as liposuction, gastric banding and lipodissolve as an “instant fix”.  These are less than desireable for many reasons, including the fact that gastic banding frequently leads to malnutrition and lipodissolve can lead to scarring and nasty complications if done incorrectly.  Liposuction is even more insidious, because it does not lead to any reductions in cardiac risk factors. This has surprised researchers, because the fat tissue is removed and yet heart outcomes do not change. [2]

None of this is rocket science. Almost anyone can keep off the pounds – it’s really just a matter of applying successful principles and being consistent.  Most people self-medicate with food and nothing could be more of a mistake when it comes to long term weight loss.

By the way, it is worth noting that exercise has fallen out of favor with the pop press when it comes to long term weight loss. TIME MAGAZINE, for example, in an apparent move to eliminate some of the dead wood and kill off the weakest of its subscriber base, attacked exercise in an article entitled “Why Exercise Won’t Make You Thin”.  [9]  Silly us! We thought exercise was actually good for the masses. Apparently not as Time disparages the concept of exercise with great fervor and points out that a 2001 Obesity Research study found that muscle burns 6 calories/day and fat 2. This means, according to Time’s resident mathematician, that if you convert 10 pounds of fat to muscle, you’ll only burn 40 more calories per day.  And clearly, the article points out, this is hardly enough to keep that spare tire from inflating.

Time then reinitiates the attack and quotes a PLoS study [10] that shows no weight loss amoung moderate exercisers and only mild weight loss amongst pretty darn heavy exercisers.  They even go on to quote one embittered couch-potato-grudgingly-turned-exerciser, “Why am I doing this anyway?”

Our only comment is simply to say, “How could anyone so educated be so ignorant?!?” Again, study after study shows exercise is probably the biggest key to long term weight loss success.  Remember, besides burning calories, exercise generally adds muscle, decreases insulin resistance and increases lipase circulation, all of which turn us into an efficient fat-burning machine.

And, if we look beyond weight loss maintenance, exercise is, quite simply, the staff and stuff of life for us guys.  It helps dramatically with erections, builds new neurons, lowers inflammation, improves your HDL and LDL, lowers blood pressure, improves mood, releases endorphins and lowers your overall risk of death. It’s also a part of every super-healthy culture around the world.

We could go on and on rather sarcastically, of course, but will encourage you instead to read this link on the Incredible Power of Exercise (In Spite of What Time Magazine Says). Remember:  long term weigh loss does not have to be as hard as everyone says if you just do what the research says.

REFERENCES:

1) JAMA, Jan 20 2010, 303(3), “Prevalence and Trends in Obesity Among US Adults, 1999-2008”

2) Obesity, 2008, 16(12):2648 2651, “Long-term Effects of Large-volume Liposuction on Metabolic Risk Factors for Coronary Heart Disease”

3) Obes Res, 1998, 6(Suppl 2):S51 S209, “Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults The Evidence Report”

4) N Engl J Med, 2001, 344:1343 1350, “Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance”

5) Obes Res, 1994 Nov, 2(6):587-99, “Physical activity and long-term maintenance of weight loss”

6) American Journal of Clinical Nutrition, Nov 2001, 74(5):579-584, “Long-term weight-loss maintenance: a meta-analysis of US studies”

7) American Journal of Clinical Nutrition, 1997, 66:239-246, “A descriptive study of individuals successful at long-term maintenance of substantial weight loss”

8) American Journal of Clinical Nutrition, Jul 2005, 82(1):222S-225S, “Long-term weight loss maintenance”

9) Time Magazine, 8/17/2009, p. 44.

10) PLoS Hub for Clinical Trials, “Changes in Weight, Waist Circumference and Compensatory Responses with Different Doses of Exercise among Sedentary, Overweight Postmenopausal Women”, Timothy S. Church, et. al.

This is in marked contrast to losing even a modest amount of weight (10%) gradually through dieting and exercise which lowers virtually every risk factor for heart disease and diabetes. [3] [4] In spite of all these health benefits, Americans (and most other wealthy socieities) are failing miserably at long term weight loss and are clearly losing the Battle of the Bulge.

So is all hope lost?  Of course not and, as you might expect, we can look to the research to show us what works and doesn’t work.  The number one “technique” for losing weight according to numerous studies is – you may have guessed it – Brother Exercise.  One literature review found that exercise was a very consistent key to long term maintenance of weight loss.  [5] And one meta-analysis also found that those who exercise more intensely were much better at keeping the pounds off and were clear that “our study confirmed the important role of exercise in weight-loss maintenance. Although persuasive prospective clinical trials have not been done to evaluate the long-term benefits of regular exercise for weight-loss maintenance, the 6 studies analyzed in this report and other extensive evidence emphasize the importance of exercise in long-term weight maintenance”. [6]

Yet another study examined a group, the National Weight Control Registry, that is considered the biggest cohort of those successful at long term weight loss.  The secrets of this group were are outlined below: [8]

Clarence Bass Interview: Senior Bodybuilding - Peak Testosterone

I’m not sure why exactly, but I’ve noticed on The Peak Testosterone Forum a lot of guys 50+, like myself, who want to lift weights, put on muscle and look good in their senior years. Well, I had the privilege of interviewing one of the undisputed kings of bodybuilding who has written many articles for the biggest bodybuilding publications and web sites, Clarence Bass. Many of you will recognize his name as some of what he has written has become bedside reading in the bodybuilding community over the years. And, if you do not believe that Clarence walks the talk, check out these Pics of Clarence Over the Decades. He is clearly in an elite few who has stayed healthy, avoided major injuries and build mass year after year. Check out the interview with him below:

NOTE: By the way, one of the very interesting things about Clarence Bass is his hormone profile: he is NOT a high testosterone guy and is NOT on HRT. You’ll see that he built his house with testosterone right around 500 ng/dl. I see guys all the time saying that they cannot build muscle any more with T levels right around that. I grew some muscle in my late 40’s with testosterone in the 300’s. It’s definitely more difficult, but it can be done. So, once again, there are no excuses for avoiding the gym, pavement or pool time.

Q. I saw your pics and was just stunned with what you achieved in your senior years. Guys like you, Jack LaLanne and Bob Delmonteque give me hope that I can look good through my senior years! I’ll start by asking you which of your books and web pages are most relevant for guys who want to try to achieve muscle mass?

A: My 3-book Ripped series is aimed at hard core bodybuilders. Ripped 2 focuses on building muscle without fat. I would also suggest Great Expectations, which was written when I was 70 and has a broader focus. More about each of our books and our website follow.

Q. And one follow up question that I have is if you trained any differently after, say, 50 than in your younger years? More volume? Less heavy compound lifting? Less/more intensity? Or did you continue with “business as usual?”

A: I trained just as hard, but less often. Biggest mistake older bodybuilders make is training too much and too often. The key is to find a proper balance of stress and rest. You ll find a good discussion of this in my book Challenge Yourself.

Q. Looking at your pics, it seemed like you actually added muscle from your mid-50s to mid-70s. Is that true? If so, do you think you are just gifted genetically or do you believe all guys can put on a lot of mass in their senior years, i.e. “it’s never too late?”

A: Muscle can be added after 50 and much older. No question about it. You ll find case histories in Biomarkers by Evans and Rosenberg. Everyone, of course, responds best in the early stages of training. My physique came along quite nicely after 50. I kept my workouts short, hard and infrequent and continually challenged myself. Diet is also a factor; I never starved myself. My photos from 15 to 75 are in the training pictorial on our website.

Q. One of the common complaints of aging men is that it is so easy to put on weight, especially that gut fat. Of course, there isn’t anyone, senior or not, that does a better job of maintaining a low body fat percentage year round than yourself. So can you give us a couple of tips and point us to the right place to find out how you did it?

A: It is true that excess calories are more likely to be stored as visceral fat when you are older. Regular training, strength and endurance, and calorie control (bulking up usually adds fat) is the best way to combat the trend. I started training when I was 13 and never stopped. I also paid attention to my diet, more so when I turned to bodybuilding in my late 30s.

My 10 books cover my training over a 35 year period, from 40 to 75. Each book has a different focus; as I changed the books change. The core ideas of my diet and training stay the same, but the application becomes more focused on fitness, health, and the aging process. Importantly, I never stopped learning and trying to improve. If you want the whole story, read the books in the order they were written. Each book stands on its own. Our first book, Ripped, has sold over 50,000 copies and just went into its 12th printing.

Q. To me it seems that joint and connective tissue stress is a stronger limiting factor as you age. Any supplements or tips to overcome this issue?

A: My rule is: If it hurts don t do it. You have to be more careful about your joints as you grow older. That s one of the reasons why I switched from Olympic lifting to bodybuilding as I approached 40. I also switched from running to biking to save my joints. Making small changes as I went has allowed me to keep training a very high level.

I focus on sensible training and healthy eating and don t rely on supplements for joint health.

Q. A lot of the guys on my site were hypogonadal and are now on HRT like I am. However, you have never been on HRT and have been natural your whole career, correct?

A: My book Ripped tells about my brief experiment with steroids. It explains what happens when you take steroids and more importantly what happens when you stop. I decided that steroids were counterproductive for lifetime fitness and never took them again. I have never used HRT.

Q. Do you have any idea what your testosterone and estradiol levels have looked like over the last 10 years? I’m asking, because many of the men will be interested to know your stats.

A: My health and fitness have been evaluated regularly at the Cooper Clinic in Dallas since 1988, when I was 50 years old. My testosterone was measured for the first time in 2000, when I was 62; it was normal at 483 ng/dl. The reference range was 241-827. Interestingly, my latest test, in May of this year, at 76, was slightly higher, at 514. My doctor calls my testosterone readings quite healthy.

I ve written a number of articles about HRT on our website; the latest and most comprehensive was added in our current update: Clarence Bass Article on HRT.

Q. My impression is that very few of the professional bodybuilders made into their 60’s and 70’s in good shape. The exceptions are, I believe, yourself, the names above, Steve Reeves and Bill Pearl. So what is the reason that so few last into the senior decades? All the chemicals? Past injuries? Chronic disease?

A: It varies from case to case. Those that keep training and take care of themselves do pretty well. The more consistent you are with training and healthy eating the better you do.

Q. So what is your take on protein requirements for senior lifters? Do you believe that the standard 1 gram per pound of body weight is ideal or is that too much or too little protein?

A: Your body can only use so much protein at each meal. The important thing is to include some high quality protein (eggs, milk and fish, for example) in each meal. Excess calories from any source, including protein, are deposited as fat. I focus on eating a balanced diet of whole foods and don t count calories or macronutrients.

Q. And should 50+ guys be taking any of the standard bodybuilding supplements such as creatine and BCAA’s? Or is that really necessary (or possibly detrimental) in your opinion?

A: I take creatine before and after workouts, but don t take bodybuilding supplements otherwise. Again, I rely on eating a balanced diet of whole foods.

Q. I know you try to stay as natural as possible, but you eventually went on a statin. Did you struggle with any myopathy-related issues while on a statin and do you take supplemental CoQ10?

A: I take a low dose statin and haven t had any trouble. I do take CoQ10 along with the statin, as recommended by my doctor.

Q. I know that many men would benefit and enjoy reading your articles and books. Can you point us all to the best location to find these?

A: I write one or more articles each month for our free website, 396 in 10 different categories to date. Our books are available directly from us or on Amazon; they can also be ordered at your local bookstore. You ll find details on each of our books and DVDs on our website: Clarence Bass Home Page.

INTERVIEW WITH CLARENCE BASS

Clarence Bass:Low Body Fat Percentages Year to Decrease Estradiol

Clarence Bass is one of those authors where I constantly say to myself, “Oh, why O why didn’t I read this twenty years ago?!?”  Ripped 2 is my most recent read of his books and it’s a jewel:  he answered a dozen key questions I have had for what seems like forever.  In fact, this book is one of the biggest myth-busting books out there if you ask me, and I believe his principles for muscle mass retention during weight loss are crtical in the battle for your health and your confidence in the bedroom.

First of all, let’s be honest here:  the Western lifestyle is designed to make us look awful.  Sure, your wife or girlfriend is polite to you about how good you look as a “hunk” – that’s a code word for the spare tire around your gut – and so “rugged,” i.e. wrinkled and sagging.  But the truth is that the same things visually attract her today as they did when she was a teen:  a lean, trim, muscular body.  So put on some muscle and fill in those sags and iron out those wrinkles.  And get your body fat percentage down and give her something decent to look at!  Clarence Bass, in Ripped 2, shows you how to get a youthful physique with low body fat percentages and great musculature in a sane, non-painful and reasonable way.  (Don’t forget to check out my interview with him on my other page called Clarence Bass: Senior Bodybuilding.)

MEN ON HRT:  One of the motivations for getting my body fat percentage down was to reduce estradiol as much as possible.  I have beefy, youthful testosterone levels (through HRT), but estradiol of 27 pg/ml without Arimidex! And my Tanita bioimpedance scale now shows my body fat percentage below 10 percent using Clarence’s methods.

Virtually every other trainer that I have read about builds himself up as a guru and deliberately creates an artifical and complex protocol to do the same thing that Clarence Bass does with ease, dignity and clear science.  Just check out the silly myths about this whole field that he shatters in this book:

1. A Low Body Fat Percentage Cannot be Maintained Year Round? Wrong! Clarence is now decades older in his mid 70’s than when he wrote Ripped 2 in his mid 40’s. And through all those decades, he has maintained very low body fat percentages by the typical American’s standards. And, even at the time of his writing Ripped 2, he wrote:

  “In my case, I’ve reduced my body fat below three percent every year since 1977.  Except for a few months in 1979, my body fat has remained below six percent for the last five years. I’ve had no problems.  In fact, I’m more energetic when I’m extremely lean.  I walk faster and am more active.  I don’t require as much sleep My resting heart rate is lower, in the low 50’s, indicating that my body operates more efficiently when I’m lean.” [1]

Is this any shock?  Do any of us still believe that we feel better when we have a bunch of “healthy fat” around our guts (and internal orgams!).

2. A Low Body Fat Percentage is Unhealthy? Wrong! This hurts to write and the reason is that I accepted this as an absolute truth without ever researching it.  I had someone on The Peak Testosterone Forum state that it was impossible to get under 12% body fat without going through an elaborate protocol, which I will discuss below. He said I would lose all my muscle mass and slam into “leptin resistance”, etc. Clarence points out that if you just follow a few simple rules, such as losing weight slowly, etc., you can continue to lose body fat all the way down to around 5%!

Oy vay!  I cannot tell you the number of articles that I have read that insist that you must do elaborate cutting and bulking routines, etc. I have been following his principles for a month now and already have my body fat below 10% and, by the way, have added some muscle mass at the same time. (This may be due to the fact I am on HRT and thus have an “unfair” advantage over most purely natural guys. But by following Clarence’s principles, you can still keep your muscle mass.)

3. A Low Body Fat Percentage Is Impossible Without Carb Backloading? Wrong! Carb backloading is the rage right now with American men trying to lose weight.  As I mentioned above, I have been told by a number of men on The Peak Testosterone Forum that this is the only to lose weight and maintain your muscle mass down to the single digits.  This was very disturbing, because I don’t want to eat like that.  I’m into making the bulk of my diet nitric oxide-boosting plant foods and this is exactly how Clarence eats.  Everyone that I know on carb backloading has low triglycerides but high LDL, something I do not want to risk.  I’ve worked hard to clear out my arteries and don’t want to take two steps backward.

For those who don’t know, carb backloading is basically an elaborate system where you don’t eat carbs in the morning and then you eat a ton of them later in the evening.  I never saw the point in all of this and found it hard to believe this was essential in order to get down to low body fat percentages. Clarence Bass shows that is indeed in the case.  Again, he has been sub-5% body fat for decades with no ill effects whatsoever.

NOTE:  You can buy this classic off on Amazon.  Check it out here:  Ripped 2 by Clarence Bass.

4.  You Can’t Build Muscle Mass With Low Body Fat Percentages? Wrong! This IS the subject of this book and, again, Clarence discusses directly just how to do it without any of the ridiculous constraints and systems that are out there.  If you stop and think about it, many of the supercultures are very lean and have achieve a low body fat percentage without any sort of education or any particular effort.  It just comes naturally because of their lifestyle.  What a concept!

5. A Low Body Fat Creates Metabolic Disturbances? Wrong! Without mentioning names, there is a popular and very well-educated trainer that discusses all the problems that competitive fitness models and bodybuilders have metabolically with lower body fat percentages.  This left me with the with the impression that it was dangerous to go this low in body fat percentage.  Again, Clarence Bass shatters these myths and he does it by doing weight loss S-L-O-W-L-Y (and with good nutrition).  There are no dramatic cutting phases.  There are no nutritional deficiencies or drugs or weird supplements – just a good dose of common sense instead.

CAUTION: There is theory out there that have some body fat helps you through times of extreme illness as a reserve. If you are concerned about this and believe it to be valid, then my two cents is stop around 12% body fat.  12% body fat will leave the typical 180 pound man with almost 22 pounds of fat reserve which is about 75,000 calories.  If that doesn’t get through a dark night, then you’re probably in trouble anyway!

6. A Low Body Fat Percentage Requires a Ph.D. Guru Teacher? Wrong! The most popular leaders (in the U.S. at least) seem to fit this category and I have seen many men fall into the trap that you need an advanced degree in order to accomplish this feat.  Clarence Bass is clearly a very smart guy – he’s a retired attorney – and, again, shattered that myth by coming up with a simple, clear and practical way to accomplish the same thing.

NOTE 2:  Don’t forget to stop by Clarence Bass Home Page – he has tons of great articles and tips on there.

7. A Low Body Fat Percentage Requires Large Amounts of Protein. You do need to consume a decent amount of protein in order to not lose your precious muscle as you slowly drop the pounds.  However, in several of his books, Clarence Bass talks about how he consumes relatively small amounts of protein compared to the typical “bro science” that is out there.  I had been studying simultaneously for my CPT certification, when I noticed in their study materials the same thing:  you do NOT need a gram per pound of body weight that I have repeatedly heard on bodybuilding forums. Again, Clarence was a succcessful bodybuilder and fell much more into the typical NASM guidelines of 1.2 – 1.7 gram/kg of body weight for strength athletes and bodybuilders.  And he lost weight and gained muscle using these “lower” levels of protein.

This was a big relief to find out about as it takes a lot of time (and money) to try to consume the oft-advised gram of protein per pound of body weight.  Again, thanks Clarence for being one of the few sane voices out there!  As I mentioned, I have gained muscle mass while losing weight consuming the lowest protein levels ever and near about 1.5 g/kg number (and I am using almost entirely lower quality plant proteins).

8.  A Low Body Fat Percentage Cannot Be Done Without Supplementation? Wrong! Clarence uses almost no supplements. In fact, about all he uses is a multivitamin. But he definitely does NOT use or recommend any fat burning or weight loss supplements.

CONCLUSION: Here you have a relatively simple, easy way to look the best in your life.  It’s inexpensive, does not require costly trainers, equipments or supplements.  All you have to do is spend a few bucks on a book.  (I also highly recommend another book of his and wrote about here in my page on Challenge Yourself by Clarence Bass.)

REFERENCES:

1) Ripped 2, Clarence Bass, p. 49.  (Clarence Bass Ripped Enterprises, 1982.)

DHT: Creatine Raises It - Peak Testosterone

REFERENCES:

1)   The Journal of Physiology, Jun 2006, 573(2):525-534, “Creatine supplementation augments the increase in satellite cell and myonuclei number in human skeletal muscle induced by strength training”

2) EBS Lett, 2004 Jan 16, 557(1-3):243-7, “Creatine increases IGF-I and myogenic regulatory factor mRNA in C(2)C(12) cells”

3) Med Sci Sports Exerc. 2005 May, 37(5):731-6, “Increased IGF mRNA in human skeletal muscle after creatine supplementation”

4) Mol Nutr Food Res, 2009 Sep, 53(9):1187-204, “Creatine supplementation prevents the inhibition of myogenic differentiation in oxidatively injured C2C12 murine myoblasts”

5) https://www.brjb.com.br/files/brjb_128_4201012_id2.pdf, “Benefits of creatine supplementation in older adults”

6) Amino Acids, 2011 May, 40(5):1349-62, “Use of creatine in the elderly and evidence for effects on cognitive function in young and old”

7) Clinical Chemistry, 1989, 35(8), p.1802

8) Kidney International, 2003, 64:1331 1337; “Creatine supplementation decreases homocysteine in an animal model of uremia”

10) Behaviour, Appetite and Obesity, Received February 03 2010, “The influence of creatine supplementation on the cognitive functioning of vegetarians and omnivores”

11) Nutrition, 2004 Jul-Aug, 20(7-8):696-703, “Nutritional considerations for vegetarian athletes”

12) Int J Sport Nutr Exerc Metab, 2002 Sep, 12(3):336-48, “Effect of creatine supplementation and a lacto-ovo-vegetarian diet on muscle creatine concentration”

The advantages of plant-based eating are many and include everything from improved mortality rates to potentially short term and long term testosterone. (See my link on Plant-Based Nutrition and Vegetarians and Testosterone for some basic information.) I also eat a plant-based diet, because it the foundation of what I call Orgasmatarianism, eating to maximize nitric oxide and erectile strength and minimizing the chance for future erectile dysfunction.

NOTE: I actually do eat a little meat, which is why I actually prefer the label plant-based.  My own dietary regimen includes the consumption of abundant egg whites along with some undenatured whey – what I call the Whey of Life – and nonfat milk.

Eating plant-based has really helped me and I would never go back, but I do have to admit something:  there are some nutrients that are predominantly in meats and animal products that have incredible advantages.  Examples of this are Vitamin B12, Choline and the subject of this page:  creatine.

Many men, especially those involved in sports or bodybuilding, have heard of some of the common advantages of creatine.  I would like to quickly cover some of these that, although well-covered in the popular health press, many men may not have heard of them:

CAUTION: Creatine has a lot of nice properties, but may put some men at risk. For example, did you know that one study says creatine raises DHT levels and may put some men at risk who have kidney issues? For more information, see my link on Potential Creatine Dangers.

1. Satellite Cells. One of the most important things you can do for your long term health is maintain your muscle mass over the decades. And, actually, most men will slowly lose muscle mass over the years from poor diet, loss of testosterone and a sedentary lifestyle. To build (and repair) muscle, you need a certain kind of specialized cell called “satellite cells”.  Testosterone, the amino acid leucine – present in Branched Chain Amino Acids and whey – and IGF-1 are all well-known to the bodybuilding and athletic communities.  And all three of these have part of their reputation based on the fact that they increase muscle satellite cell counts.

However, it’s not just these big boys that will increase satellite cells:  creatine has been shown in a few animal and human studies to do the same thing. [1]  Again, this is absolutely critical for “hypertrophy” or “muscle-building.”

2.  IGF-1.  Everyone has heard of testosterone, but IGF-1 is another hormone absolutely critical for muscle growth and development.  IGF-1 and Growth Hormone often go hand-in-hand and have many important properties for maintaining a youthful physique. This is where creatine comes in again:  it increases the activity of muscle IGF-1 according to both in vitro and in vivo studies. [2][3]

3.  Muscle Oxidation. Weight lifting and strength training can put a significant oxidative (free radical) load on the body.  And is it any wonder consider that cells are damaged and must be rebuilt?  It turns out that creatine actually is highly protective of muscle tissue by increasing oxidative protection. Researchers have discovered that it does this not only by acting as an antioxidant but by stimulating other metabolic antioxidant activities. [4]

Furthermore, the benefits of creatine supplementation probably increase as you age.  The reason is probably most that muscle mass is so cardioprotective as the years go by.  As mentioned, most men (and women) slowly lose muscle – about 10 pounds per decade! – and replace it with fat.  Let’s say that you are one of the few that still weight the same as you do in college.  You may be feeling good about yourself not realizing that you have probably lost at least 10 pounds of muscle and replaced it with 10 pounds of fat (unless you are a pretty avid exerciser).

Studies on seniors and the elderly have found one benefit after another from creatine supplementation:  muscle building, increased strength, increased fat free mass and so on. [5] However, one very interesting benefit is improved cognition. One study on seniors found this from dosages of “about 20 g/day for 5 days or about 2 g/day for 30 days.” [6]

These benefits to both young and old are actually remarkable when you consider that there is considerable creatine in meat and most people in modern societies eat a lot of meat. However, to even get a 5 gram dose of creatine would require one to eat 2.5 pounds of raw beef as cooking the beef removes most of the creatine. Fish has more creatine per unit weight, but, again, cooking removes most of it.

Regardless, carnivores have higher muscle creatine levels on average than vegetarians, because, even after cooking, their dietary consumption of creatine is much higher.  For this reason, one study that compared vegetarians to carnivores found on average that meat-eaters had about 60% higher plasma creatine levels for example. [7]

NOTE:  One nice benefit of creatine supplement is that it likely lowers homocysteine levels in some populations, at least according to some animal studies. [8]

And this leads to an important question that researchers decided to study:  would vegetarians actually get the most benefit from creatine supplementation, since they tend to get the least amount in their diet? The studies have been somewhat limited, but, so far, the results seem to show that vegetarians would definitely benefit in certain key areas from additional supplemental creatine.  Here are a few examples from the research:

1. Cognition.  Two studies now have shown that creatine supplementation significantly helps the brain. It all started with a study of male and female vegetarians that showed improvements in both working memory and intelligence from creatine supplementation. [9] A follow-up study on female vegetarians found that they signficantly improved memory (and choice reaction time in certain ways). [9] Again, most men think of creatine as helping muscles only, but it profoundly improves mitochodrial function and that, in turn, help the brain and all its heavy processing activities.

2.  Exercise Performance. There is evidence that lower creatine levels affect max level exercise performance and that vegetarians would benefit from supplementation. [11]

3.  Muscle Benefits.  Vegetarians should get all the muscle benefits of omnivores, because with creatine supplementation, their muscle creatine levels quickly equal that of meat-eaters.  This is because muscle can only store so much creatine anyway, so supplementation quickly “levels the playing field”.  So, if you’re plant-based or vegetarian, get ready to “rock” with creatine.

4.  Lowering Post-Exercise Inflammation. Creatine does a nice job of lowering both TNF alpha and CRP (C-Reactive Protein) according to one recent study. See #21 on my page on How to Lower Inflammation for more details.

CAUTION: Creatine was fairly recently studied by Brazilian scientists, who monitored kidney function in young men who consumed higher dosages (10 grams/day) of creatine for about 90 days.  Their conclusion?  Creatine caused absolutely no issues in kideny function.  However, a little more caution is definitely in order, perhaps, for middle-aged and beyond men with kidney issues.  It is probably wise to drink some extra water when consuming creatine and, of course, talk to your doctor as there have been reports of men with kidney issues having trouble with creatine.

9) Proc. R. Soc. Lond. B, Oct 2003, 270(1529):2147-2150, “Oral creatine monohydrate supplementation improves brain performance: a double blind, placebo controlled, cross over trial”

DHEA: Possible Dangers? - Peak Testosterone

Testosterone Replacement Therapy (TRT) has been a large success to date and improved the lives of many hypogonadal men (such as myself), so why not some of the other hormones? DHEA is an example of a hormone with considerable promise. One study shows, that when combined with HIIT (High Intensity Interval Training), it can boost free testosterone levels substantially. (See my page How to Increase Your Testosterone Levels Naturally for details.) And, as I mentioned in my page on How to Increase DHEA, we had one man claim that DHEA restored his morning erections. And DHEA seems to have very powerful anti-diabetes, anti-Metabolic Syndrome properties.

So DHEA definitely has some excellent properties, but is there a dark side?  I think the argument is weak against DHEA, assuming it is taken within physiological dosages.  To protect against taking too much, what I see the savvy doctors doing is the following:

a) Testing a man’s DHEA-S first and making sure he is in the lower part of the lab’s range.  Many men are actually high in DHEA-S, so taking DHEA makes no sense in that case.

b) Giving a man low dose (usually oral) DHEA-S in order to hit a DHEA-S target that is usually in the upper mid range of DHEA-S.

c) Making sure with continuted monitoring that the man does not go too high in DHEA-S on an ongoing basis.

I believe the above precautions will avoid almost all problems, but, of course, it’s always best to consult with a physician or naturopath first.

NOTE:  A combination of DHEA and pregnenolone got rid of my lifelong struggle with some anxiety.  Read more about here:  Low Dose DHEA and Pregnenalone.

1.  Arrhythmia. Ray Sahelian has stated that many users of DHEA, especially in medium and higher dosages, have experienced arrhythmias. [1] It is too early to tell in what subpopulations and circumstances this occurs.  Adding to the confusion is the fact that one study showed that the higher the (non-supplemented) levels of DHEA, actually DHEA-S, the lower the risk of atrial fibrillation, which is the most common kind of arrhythmia. [5] However, the fact that someone naturally has high levels of DHEA does not necessarily equate to the same physiological situation as someone being low and then supplementing.  An underlying, predisposing condition could remain.  Or it could be that those who are already high and supplement occasionally have an arrhythmia.

2. Negative Brain Effects?  Ray Peat warns against overly elevated DHEA levels:

“One study has found that the only hormone abnormality in a groupt of Alzheimers patients’ brains was an excess of DHEA. In cell culture, DHEA can cause changes in glial cells resembling those seen in the aging brain. These observations suggest that DHEA should be used with caution. Supplements of pregnenolone and thyroid seem to be the safest way to optimize DHEA production.” [2]

Again, holding DHEA-S levels to mid range values should alleviate these kind of concerns, but keep in mind that there are no long term studies with DHEA that I know of.

3.  Possible Increasing PSA?. In general, DHEA is thought to be anti-cancer.  However, there are reports of men taking DHEA who have spiked their PSA’s. [3][4] Is this coincidence?  Well, without some study work, it is difficult to say.  But you may want to take your PSA before and after to make sure.  And, if you have had issues with your PSA, discuss with your doctor.  Again, this should not be an issue with the lower dosages that I am used to seeing.  See my page on DHEA Dosages for more information.

4. Possible Gynecomatia. The steroid boards have quite a few posts of men getting gyno from taking larger doses of DHEA.  However, from what I can tell, this is from taking very large dosages of DHEA – 500 mg +.

5. Increased IGF-1. DHEA has done fairly well in the cancer studies from what I have read. However, one distrubing property:  it increases IGF-1.  IGF-1 is the growth factor that is ground zero for a lot of anti-aging research, i.e. elevated IGF-1 levels are associated with accelerated aging.  In addition, abundant research shows that higher levels tend to fuel epilthelail cancers and adult onset diabetes. Of course, one would not want to go too low since IGF-1 is anabolic and supports many key metabolic processes. In any event,  there are several studies that show that DHEA supplementation increases IGF-1 in men. [6] The good news is that it seems to minimally raise IGF-1, assuming one is using a reasonable dose <= 25mg.  I discuss that the research that shows in my page on DHEA and IGF-1.

FINAL COMMENT: Many experts point out that the great majority of side effects with DHEA occur at higher dosages. For this reason, they recommend much lower dosage of DHEA, such as Ray Sahelian who believes 5 mg is the most appropriate dosage considering our bodies only make 10-15 mg/day probably..

NOTE:  Keep in mind that most people who take DHEA do not test to see if they are low. You can test your DHEA levles very inexpensive here:  Inexpensive Testing Labs (Mostly U.S.). I make this comment, because boosting a little very low DHEA levels is probably a different thing that a man with high levels pushing his DHEA even higher. Deficiencies usually need correcting and pushing yourself supraphysiological is often not a good thing when it comes to hormones.

REFERENCES:

1)   https://www.tldp.com/issue/175-6/Caution.html

2) https://raypeat.com/articles/articles/three-hormones.shtml

3) https://www.nasw.org/users/nbauman/dhea.htm

4) https://www.medhelp.org/posts/Prostate-Cancer/Sudden-PSA-Rise–Hormonal-changes/show/1781895

5) Eur J Prev Cardiol. 2014 Mar;21(3):291-8, “Dehydroepiandrosterone sulfate levels and risk of atrial fibrillation: the Rotterdam Study”

6) The Journal of Clinical Endocrinology & Metabolism, Published Online: July 01, 2013, “Effects of replacement dose of dehydroepiandrosterone in men and women of advancing age.”

Is Testosterone good for Anemia - Peak Testosterone

Testosterone affects many different hormonal and metabolic systems in us men, and one of them is blood cell production.  Although red blood cell creation is done primarily in the bone marrow, it is also strongly influenced by a renal (kidney) hormone called erythropoietin that is responsible for triggering stem cell involvement. Who would have guessed that the kidneys are sending messages to the bones, which in turn build red blood cells, eh?  And, if you stop and think about, this means that testosterone is responsible, albeit indirectly, for delivering oxygen to every cell in your body.

Here is the key point though:  when testosterone falls due to hypogonadism (clinically low testosterone), red blood cell counts usually fall as well due to the kidney hormone issue. Because of this, anemia is a fairly common side effect for men with low testosterone and can explain some of their low energy levels and general fatigue.  Having your sex life go down the toilet is misery enough, but anemia will make you so tired you don’t care!

NOTE: Low testosterone also profoundly affects the male brain, perhaps more so than any other factor.  It can also disturb sleep.  Testosterone is the “passion hormone” and, without it, a man often feel unmotivated and zombie like. All of these factors can also affect a man’s energy levels.

Of course, physicians often see this issue in some of the extreme cases.  For example, when men with a pituitary adenoma are receiving anti-androgen (testosterone blocking) medications, they will often develop anemia. [4]  And men that have chronic kidney disease and low testosterone have been found to be less responsive to erythropoietin-stimulating agents. [3]

For these kind of reasons, researchers were not surprised to find, then, that senior men in the lowest quartile of testosterone had a much more significant – about double – chance of having anemia when compared to those in the highest quartile. The range for the lowest quartile was 346 ng/dl (11.8 nmol/l) and below. [5]

This brings up a very important point.  Many doctors and labs are still using 260-280 ng/dl as their standard for hypogonadism.  But the above study shows that issues with anemia may start to arise at around 350 ng/dl or even higher. This underscores the importance, if you have low T, of getting your red blood cell count checked.  Remember that anemia is potentially a serious issue:  besides the fatigue and lethargy, it can lead to a racing heartbeat, dizziness, shortness of breath and muscle cramps. Anemia can even cause an enlarged spleen.

How do doctors usually test for anemia?  Usually, they will order a CBC, which is a complete blood cell workup that includes things like hematocrit, hemoglobin and red blood cell counts.  It’s a common test that is usually covered by insurance, so discuss this with your physician. The doctor may also order a ferritin and other tests to make sure the underlying cause of your anemia is determined. Yes, if you are low or lowish T, that is probably the reason. But it could be other medical issues, such as an immune attack on your blood cells, vitamin deficiencies and so on.

To test their theory of the tie in between testosterone and anemia, researchers looked at what happens to red blood cell counts with men on Testosterone Therapy.  As expected, administration of testosterone therapy improved red blood cell counts. [6]

CAUTION:  Men on Hormone Replacement Therapy can have as a side effect overly elevated red blood cell counts, polycythemia, that can increase the risk for stroke. This is why it is very important that your red blood cell counts be monitored regularly by your doctor if you are on testosterone therapy. Discuss this with him or her. I discuss this issue in my link on Ways to Lower Hemoglobin levels.

REFERENCES:

3) Nephrol. Dial. Transplant, 2011), “Testosterone deficiency is a cause of anaemia and reduced responsiveness to erythropoiesis-stimulating agents in men with chronic kidney disease”

4) J of Neurosurgery, May 2003, 98(5), “Anemia, testosterone, and pituitary adenoma in men”

5) ARCH INTERN MED, JUL 10 2006, 166:1380-1387, “Low Testosterone Levels and the Risk of Anemia in Older Men and Women”

6) American Journal of Kidney Diseases, Feb 2006, 47(2):251-262, “”Transdermal Androgen Therapy to Augment EPO in the Treatment of Anemia of Chronic Renal Disease”

Testosterone and AnemiaSTEP 4A. Is low testosterone making you anemic? Yes, it can happen and, in fact, is actually quite common. Hypogonadism is known for causing fatigue and anemia can contribute.

Blood Pressure and Testosterone - Peak Testosterone

Well, like I always say: “Testosterone affects EVERYTHING in men.”

Sure, that’s an exaggeration.  But not by much and a great example of that is blood pressure. A muscle-building, libido-increasing hormone androgen like testosterone might seem completely unrelated to arterial blood pressure but nothing could be further from the truth.  Testosterone not only can lower your blood pressure a little in the short term but can definitely protect it long term and the studies show this quite clearly.

Now we’ll discuss just why in more detail, but let me say that if you have hypertension (or prehypertension), testosterone is not going to be a miracle cure for you. Getting your testosterone to respectable levels will probably help though, but for much more powerful solutions, see my pages on Natural Ways to Lower Blood Pressure and How I Lowered High Blood Pressure.

CAUTION: It is important to mention that a side effect for a small minority of men on HRT (TRT) is elevated blood pressure however. Many doctors do not realize this, so get him or her measuring your blood pressure.

However, if your testosterone is low and you boost it sufficiently, you can lower your blood pressure. The reason is that testosterone boosts the activity of eNOS (endothelial nitric oxide synthase) and, if you’ll recall, eNOS is the same enzyme that Viagra and Cialis affect.  While testosterone does not have as powerful of an effect as these pharmaceauticals, it does make a difference. And this effectively means higher nitric oxide levels which means more relaxed arteries and lower blood pressure.

Is there any evidence for this phenomenon? One 1988 study found that the higher the testosterone, the lower the blood pressure. Of course, the first thing one might suspect is that the this relationship had only to do with the weight of the participants of the study. However, the researchers had the foresight to look at this and found that not all of the decrease in blood pressure with increasing testosterone could be explained by BMI (obesity levels). [1] A follow-up study year later verified the same result:  testosterone was strongly correlated with blood pressure and only part of it could be explained by extra body fat levels. [2]

One test that researchers have done is looking at the reverse direction, that is whether or not testosterone therapy can improve blood pressure.  If testosterone impacts blood pressure directly, then lower testosterone men who receive HRT should find their blood pressure lowered. One older (1992) study on obese men receiving testosterone therapy noted that “insulin resistance … improved and blood glucose, diastolic blood pressure and serum cholesterol decreased.” [4]

A follow-up study a few years later found similarly remarkable results, which included “decrease of visceral fat mass…, by increased insulin sensitivity…, by a decrease in fasting blood glucose, plasma cholesterol and triglycerides as well as a decrease in diastolic blood pressure.” [5]

Notice the incredible changes in multiple cardiovascular risk factors that were improved with testosterone therapy, including the lowering of blood pressure.  Blood pressure is dangerous to many tissues of the body, because even small increases can lead to “scarring” of arteries and damage to smaller blood vessels and even connective tissue. The kidneys, eyes and brain are very vulnerable and often incur long term damage.

A more pronounced effects is testosterone’s ability to protect men from high blood pressure and hypertension in the long term. The reason is simple:  testosterone is inversely correlated with arteriosclerosis and hardening of the arteries. [3] Again, one might not think that testosterone would protect arteries, but that is, in fact, the case.  Testosterone’s ability to raise nitric oxide levels helps protect arteries.  Just as important, it also 1)  lowers insulin levels, which significantly reduces the risk for insulin resistance and 2) helps men maintain and even lose weight.  Both #1 and #2 are good for the entire cardiovascular system and help prevent hypertension and prehypertension.  It also can help prevent erectile dysfunction as well.

Did you know you can inexpensively do your own testing for most hormones? The industry leader is Discounted Labs..

NOTE: Hormone levels, especially testosterone and estradiol, can powerfully affect a man’s sex life and much of it centers around how this hormone affects our blood pressure:  for more information, see my link on Testosterone and Erectile Dysfunction.   Hormone levels, especially testosterone and estradiol, can powerfully affect a man’s sex life and a little of it probably centers around how this hormone affects our blood pressure. In most men, testosterone will have a slight blood pressure lowering effect, raising nitric oxide, boosting libido and decreasing hardening of the arteries. Again, the biggest signs of low testosterone have been found to be sexual in nature, as I document in my link on Hypogonadism and Testosterone.

CAUTION: Not all researchers are as positive about testosterone and blood pressure.  In fact, one recent study coming from the standpoint of the kidneys, which are front and center in the regulation of blood pressure, stated that “in sum, net effects of androgen action seem to be vasoconstriction, atherosclerosis and stimulation of the renin-angiotensin-aldosterone system.” [6]

1)  Journal of Hypertension, 1988, 6(4):329-332, “Blood pressure and endogenous testosterone in men: an inverse relationship”

2) Eur J Endocrinol, Jan 1 2004, 150:65-71, “Association of endogenous testosterone with blood pressure and left ventricular mass in men. The Tromso Study”

3) The Journal of Clinical Endocrinology & Metabolism, Feb 1 1997, 82(2):682-685, “Association between Plasma Total Testosterone and Cardiovascular Risk Factors

4) International Journal of Obesity and Related Metabolic Disorders : Journal of the International Association for the Study of Obesity, 1992, 16(12):991-997, “The effects of testosterone treatment on body composition and metabolism in middle-aged obese men”

5) Obes Res, 1995 Nov, 3 Suppl 4:609S-612S, “Testosterone and regional fat distribution”

6) Kidney and Blood Pressure Research, 2008, 31(2), “Testosterone and Blood Pressure Regulation”

Protecting Your Family While On Testosterone Therapy

Most guys on testosterone therapy, a.k.a. Hormone Replacement Therapy (HRT), will start on one of the blockbuster gels, Androgel or Testim. These gels are generally applied to the upper body and often are poorly absorbed.  And what absorption they do have must be sustained for many hours.  For example, one study showed that men who removed the gel by showering 15-30 minutes after application reduced their testosterone levels by 60%. [1] This is a huge decrease and so most men leave the gel on for 4 hours or even more.

And this is where the risk to one’s family comes into play. Some men, either through forgetfulness or ignorance, leave these gels on their upper body and sometimes expose family members. [2]  This is very dangerous for young boys, who have been reported to go through early puberty, and wives/girlfriends, who can potentially experience increased facial hair and other androgen-related side effects. (You can read the warnings right on the front page of Androgel’s web site.[2])

NOTE: Men are supposed to wash off or shower any treated areas before coming into contact with any family members.  Could there be a risk from poor washing or residue gel? I have heard studies are being undertaken to address these issues.

So how can a man protect his family?  Is there any way for him to receive testosterone without risk to those around him?  Below are a few ideas:

1) Pharmacotherapy, (31):248-252, “Reduction in 24-Hour Plasma Testosterone Levels in Subjects Who Showered 15 or 30 Minutes After Application of Testosterone Gel”

2) https://www.androgel.com/

3) Diabetes Care, Apr 2011, 34(4):828-837, “Testosterone Replacement in Hypogonadal Men With Type 2 Diabetes and/or Metabolic Syndrome (the TIMES2 Study)”

1.  Axiron.  I covered this in my link on A Review of Axiron, but there is a new topical testosterone delivery system that actually recommends application to the arm pit. Of course, this location should put any and all family members out of harm’s way!

2.  Foresta. This product can be a partial help as it is often applied to the thighs, leaving out inaccessible to many members of the family. [3]

3.  Pellets (Testopel). Imagine your physician inserting time-release capsules under your skin that last for four to six months:  this describes the new pellet technology. Obviously, this delivery method keeps the testosterone from your family completely. NOTE:  There are other considerations with this procedure, which requires a minor medical procedure to place these pellets under the skin in the hip area.

If you and your doctor have decided to put you on HRT, and you are concerned about the safety of your family, you may want to discuss some of the above options.

REFERENCES:

Testosterone (Hormone Replacement) Therapy.

If your testosterone levels are above about 350, you should look at the Testosterone Lowering Factors, Mind, Sleep and Sex links to see if you can make some simple lifestyle changes and boost your testosterone naturally. These methods may boost your testosterone 20-50% and, if you’re sitting in at about 350-400 ng/dl (or greater), may put you into safe territory without even going on testosterone therapy.

But odds are that if you’re reading this link, your testosterone is quite low:  350 or less.  If that is the case, then I recommend investigating testosterone therapy with your doctor. ( Free testosterone readings are critical as well, but most doctors test for both, at least initially.) Discuss with your doctor, but my experience is that guys begin to suffer erectile, mental and other distrubances once they starting getting into the 350 ng/dl and below range and this seems to match well with the studies as well.

Testosterone Therapy – Safety

So let’s say you find you have low testosterone – it’s a simple blood test ordered by your doctor – and he recommends testosterone (hormone replacement) therapy?  Can it cause prostate cancer or other serious medical conditions?  Well, the good news is that they have been studying this for years and the studies show no correlation with testosterone therapy and prostate cancer. [6] (Talk to your doctor, though, of course.)

The Oncology Times [1] summarized by stating that they “reviewed decades of research and found no compelling evidence that testosterone replacement therapy increases the incidence of prostate cancer or cardiovascular disease”. And, if you have heard stories of men having their prostate cancer treated with low testosterone levels, consider what else the authors had to say:

“It has been known since the 1940s that severe reductions of testosterone can cause shrinkage of metastatic prostate cancer, and therefore there has been a concern that raising testosterone levels might cause growth of any hidden prostate cancers. But the study by Dr. Morgentaler and his coauthor, Ernani L. Rhoden, MD, found no connection between higher testosterone levels and prostate cancer, nor did they find evidence that testosterone treatment causes prostate cancer.”

There were theories for awhile that “fast converters”, i.e. guys that converted to DHT and estrogen easily, could develop prostate cancer.  But, again, the research has not born this out as far as I know. In fact, one huge metanalysis that aggregated multiple studies and thousands of HRT participants found found no risk for high DHT, estrogen or testosterone. [7]  (Again, talk to your doc for the latest info.)

CAUTION: Many doctors are still very cautious about the safety of HRT, because they know that if a patient gets prostate cancer, reducing testosterone is one of the proven, time-tested treatment protocols.  In other words, if you have prostate cancer, testosterone exacerbates and accelerates it progression.  However, most doctors do regular prostate exams along with PSA screening and, therefore, feel they can avoid putting patients on testosterone if they already have a latent cancer.

In fact, from all we know at this point, it looks like the real risk is not going on testosterone therapy if you have low testosterone. One study, for example, found that testosterone therapy actually lowered PSA levels and decreased most of the major symptoms of an enlarged prostate. [5] And, as I mentioned, low testosterone is tied to a number of serious medical conditions.

Furthermore, testosterone therapy will likely help cure, or even permanently cure any Erectile Dysfunction (ED) that you have been experiencing.  For exmaple, one study from Taiwan found that 34% of men with erectile dsyfunction that were unresponsive to Viagra, which is pretty serious impotence, responded well to testosterone supplementation.  And 38% of the man responded to both Viagra and testosterone therapy, so almost three fourths of the men with ED were significantly improved by simply taking testosterone. If you couple testosterone therapy, i.e. hormone replacement therapy, with the advice that I give on boosting nitric oxide here and here, you’ll likely feel about twenty years younger in EVERY way.

Testosterone therapy can also improve your memory, brain, cognition and learning. Yes, testosterone is intimately linked to cerebral function.  Several studies have shown that, in particular, visual spacial skills are tied to testosterone levels.  And hypogonadal (low testosterone) men have been shown in several studies to have lower verbal skills. [2]  You will also likely find that testosterone, and therefore testosterone therapy, improves mental outlook:  low testosterone is correlated to depression, anxiety and other mental struggles.  And by boosting your testosterone levels, you can help reduce your risk for diabetes and many other life-threatening low testosterone maladies.

So what are you waiting for? Get your testosterone read and find out if testosterone therapy is right for you. You can improve your mood, your sex life, your erectile stength and boost your memory and mental abilities.  Yes, it takes several weeks (or even a few months) for testosterone therapy to “take effect”:  your tissues must literally rebuild themselves.  However, once those tissues are rebuilt, the difference can be remarkable.  Some of you will feel strongly that the minute you started taking testosterone was the minute you got your life back.

If you are interested, you should read about some of the More Common Side Effects of Testosterone (Hormone Replacement) Therapy and common Methods of Testosterone Delivery (such as gels and injections).  These links should give you a lot of good talking points with your doctor.

REFERENCES:

1) Mar 25 2004,26(6):30-35

2) Saving Your Brain, Jeff Victoroff, p. 135

3) Clin Endocrin (Ox),1988;28:461-470

4) British J Clin Pharm,2008, 65:253-259

5) Intl J Andrology, 2002 Apr, 25(2):119-25

6) JAMA, 2006 Nov 15, 296(19):2351-61; N Engl J Med, 2004 Jan 29, 350(5):482-92

7) J of the Nat Cancer Inst, 2008, 100(3):170-183, “Endogenous Sex Hormones and Prostate Cancer: A Collaborative Analysis of 18 Prospective Studies”

Testosterone Cypionate Dosage - Peak Testosterone

There are two things that you can say about testosterone cypionate on the Peak Testosterone Forum:

–It is the most common form of HRT (TRT) by far.

–A wide variety of dosages are used

When the public thinks of HRT, they tend to think of Androgel and topicals. However, as of this writing, about half of all the men on the forum that were on HRT (TRT) were using testosterone cypionate or enanthate. [1]  Androgel does not have even close to the popularity.  And it is not wonder, because testosterone cypionate gives men tight control over the their testosterone levels and allows a man to boost his testosterone to almost any level he and his physician desire from high to low.

In fact, that is the next question:  should a man use a high or low dosage with his cypionate?

Testosterone Cypionate Dosage

First of all, virtually all doctors want your peak testosterone after the injection to be less than 1200 ng/dl (unless they doing a ridiculous every-two-or-three-week protocol.)  1200 is considered the peak testosterone level of a very healthy young man, and so, in order to stay physiological or natural, they will try to come up with a program that stays below this number.

So how do you stay below this 1200 number?  Simple.  You simply don’t give more than 100-120 mg of cypionate per week.  And you will see on the forum that almost all the guys doing cypionate are doing right around 100 mg/week.  Sure, a few guys will be using something around 150 mg/week, but they are generally going over the 1200 number.  HRT clinics and anti-aging doctors tend to do this, especially at the beginning, because men like it (initially at least) so much.  But, for reasons that we will explain below, most guys end up drifting downward to about 100 mg/week after a certain period of time.

In fact, consider my story:  the HRT clinic that I went to put me on 150 mg/week.  Wow!  That’s all I can say.  That had me amped and it really showed me the power of testosterone.  It cured my venous leakage, got rid of my mild depression and gave me morning erections for the first time in my life.  So I was happy, or at least I thought I was.

However, a few things started to bother me.  Sure, I was feeling good, but these issues lurked in the background:

(Two times .5 mg per week.)The last straw was a standard physical that I got with my PCP. She pulled my testosterone and it was at 1,354 ng/dl! I just happened to do the blood draw during my PCP s annual physical near my peak. The HRT clinic took my blood draws on the trough day, so my peak testosterone was always estimated. I had no idea I was going so high. I felt good in many ways, but this is when I realized that I needed to tell my clinic that I needed to back down on my dosage. And, basically, I have slowly dropped my dosage down to a level of 100 mg/week over the period of about a year. My current protocol is two divided subQ (subcutaneous) dosages of 50 mg every 3.5 days. In other words, I am now taking about two thirds of my original dosage!

a) Estradiol-Related Symptoms. Bloating, water retention, gyno, moodiness.  These can be hard to control even with Arimidex.  Gyno is particularly problematic as Arimidex just does not always solve the problem .  Arimidex does a nice job of lowering estradiol, but there is more to gyno than just estradiol.

b) DHT-Related Symptoms. These are not very common, but occasionally a guy will have an enlarged prostate or experience accelerated male pattern baldness.

c) Increased Hematocrit/Hemoglobin. This is quite common.  Many men do not realize that testosterone controls red blood cell production.  This is the reason that going high with testosterone can push their hematocrit/hemoglobin to the top of the range or even beyond.  The solution is to donate blood, either in your HRT clinic, if they are equipped,  or at a blood bank, if they will allow it.   However, sometimes men will end up too high even after donating.  This is ugly.  In addition, some men actually experience shortness of breath and other nasty symptoms from these high levels.  Another concern is long term stroke and clotting-related risks.

My take on all of this was that I wanted to get over my gyno and I wanted off of the Arimidex.  In addition, I knew that I would be on HRT for life, so I wanted to be safe. Although my hematocrit has never been high, but I like my levels to be a bit on the lower side.  I think men would generally do well to err on the side of caution when it comes to this, since heart disease is the #1 killer of men here in the West.

And basically I found that 100 mg/week, especially when I went to subQ (subcutaneous) injections, got rid of my gyno.  I also lost about 3-4 more additional pounds – my body fat was probably around 14% – as well, which got my estradiol to 27 pg/ml without Arimidex.  This is ideal in my opinion and I was feeling very good.

Did you know you can inexpensively do your own testing for most hormones? The industry leader is Discounted Labs..

A BRIEF TRY AT 80 mg/week in Divided Doses: However, I noticed one more very strange thing as time went on this 100 mg/week protocol:  my morning erections were always stronger on days 3 and 4. This was not a pattern, that I remembered anyway, when I was on cypionate initially.  Nevertheless, it seemed to be the case at the time.

Now the theory is that cypionate probably peaks on day one – see my page on “Just When Does Testosterone Cypionate Peak?” as to why I believe this. And, if day one was my peak, then days 3 and 4 were my lowest testosterone days.  And this is how I came to conclusion that I needed to try a lower dosage of testosterone cypionate as my next tweak or fine tuning experiment.

Even though I believe in going as low with testosterone as possible and still feel good, have good morning erections / libido and hit your numbers (for A1C and estradiol), I noticed that the opposite began happening as the weeks went by on 80 mg/week. My libido slowly declined and morning erections grew weaker. So I went back to 100 mg per week and have stayed on that ever since. The only change is that I now inject .14 ml (28 mg) of cypionate every other day, but that still works out to 100 mg/week. Also, you may be interested to know that on 80 mg/week subQ, my total testosterone was measured at 667 ng/dl, whereas on 100 mg/week, my last two total testosterone reads have been 700 and 800 ng/dl.

These are not very high levels and I was surprised that I felt so good at that low of a level.  And this brings up a major theory of mine:  the more you (naturally) boost your nitric oxide and lower inflammation, the less testosterone that you need.  Testosterone activates eNOS, the enzyme that controls your endothelial nitric oxide, which is your primary engine for NO.  So I always felt that men with arterial issues probably subconsciously pushed for higher T levels to compensate.  And I have been working very hard on my arteries and feel this may be part of the reason I have been able to live with lower testosterone levels.

LESS THAN 100 mg – ARE YOU CRAZY?  One of our senior posters brought up the fact he is seeing a trend toward lower dosages of testosterone cypionate and posted some interesting commentary:

“Dr. Mark Gordon is one of the heavyweights in TRT; he’s a good friend of Dr. Crisler, and also the guy who invented the phrase “interventional endocrinology” to replace “antiaging medicine”. Turns out both of these guys are moving against the standard 100 mg per week injections. Gordon said he averages about 60-80 mg per week, usually in divided doses, for his patients to reach good levels, and he doesn’t use an AI for this reason…” [2]

EXCEPTION – LOW SHBG MEN:  Based on what I have seen, men with low SHBG need to do the following to compensate:

a) Lower Dosage. The reason for this is that low SHBG leads to higher free testosterone levels and, therefore, they need less total testosterone.  I have also seen evidence that they spike their testosterone, i.e. they can get abnormally high levels of testosterone on day 1 of their injection cycle.

b) More Frequent Dosing.  SHBG binds to testosterone and kind of puts it into a “reserve” if you will.  Without enough SHBG, men rapidly clear their testosterone effectively giving their cypionate a shorter half life.  For this reason, low SHBG guys tend to need more frequent injecting schedule, often every other day for example.  (Thanks Sam!)

REFERENCES:

1) https://www.peaktestosterone.com/forum/index.php?topic=4794.0

2) https://www.peaktestosterone.com/forum/index.php?topic=6172.0

Testosterone & Mike Mahler's Testosterone Booster.

1)  Asian J Androl, 2012 Nov, 14(6):855-9, “Association of 25-hydroxy-vitamin D levels with semen and hormonal parameters”

2) Endocrinology, 2000 Apr, 141(4):1317-24, “Vitamin D is an important factor in estrogen biosynthesis of both female and male gonads”

3) https://press.endocrine.org/doi/10.1210/endo.141.4.7403?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed (Full study of #2)

4)  Reprod Biol Endocrinol, 2015, 13: 127, “Males with low serum levels of vitamin D have lower pregnancy rates when ovulation induction and timed intercourse are used as a treatment for infertile couples: results from a pilot study”

5) J Clin Endocrinol Metab. 2014 Apr;99(4):1461-9, “Evidence for a U-shaped relationship between prehospital vitamin D status and mortality: a cohort study”

6) Mayo Clinic Proceedings, May 2015, 90(5):577 586, “Changing Incidence of Serum 25-Hydroxyvitamin D Values Above 50 ng/mL: A 10-Year Population-Based Study”

7) J Clin Endocrinol Metab, 2012 Aug, 97(8):2644-52, “A reverse J-shaped association of all-cause mortality with serum 25-hydroxyvitamin D in general practice: the CopD study.

8) J Am Geriatr Soc, 2009 Sep, 57(9):1595-603,Epub 2009 Jun 22, “Prospective study of serum 25-hydroxyvitamin D level, cardiovascular disease mortality, and all-cause mortality in older U.S. adults”

9) Am J Epidemiol, 2010 Jul 1, 172(1):81-93, “Circulating 25-hydroxyvitamin D and risk of pancreatic cancer: Cohort Consortium Vitamin D Pooling Project of Rarer Cancers.

It is now fairly well-known in the men’s health community that correcting a Vitamin D deficiency can increase testosterone, something I cover in my page on Testosterone and Vitamin D.  I have seen men on the Peak Testosterone Forum increase their testosterone with the simple supplement.  However, I have also seen other men jump on this and assume, therefore, that the more Vitamin D taken, the better. Below I make the case that this is likely an unwise assumption and even show potential risks of driving your Vitamin D levels too high.

Measuring your Vitamin D levels is a simple, inexpensive test that you can do yourself (here in the U.S.) at any one of these Inexpensive Testosterone Self-Testing Labs. The test is called “25-Hydroxy.”  This is a good idea, because abundant research shows that a Vitamin D deficiency is likely NOT a good thing and has been tied to literally dozens of chronic and autoimmune diseases and conditions.  A deficiency is usually defined as 25-hydroxy levels below 30 ng/ml. (25-hydroxy is just the name of the test for Vitamin D). And, as mentioned above, low Vitamin D can in turn lower testosterone levels . I take Vitamin D every day and am personally targeting 40-50 ng/ml 25-hydroxy levels, but you’ll have to study the research and talk to a good doc and decide for yourself of course.

I would also recommend that you look at the 6 Potential Dangers of Increasing Your Vitamin D Levels Above ~50 ng/ml that I have listed below:

1. Decreased Fertility.  When I first started understanding the importance of Vitamin D, I listened to a Vitamin D supplement representative claiming that 25-hydroxy levels above 140 are common in some indigenous cultures exposed to direct sunlight.  He was clearly arruging for supplementation to very high plasma levels. Like many men, I assumed that I need to really boost my Vitamin D levels to achieve maximum benefits.  However, one of the first clues that there was more to the story came from hearing about the fact that high Vitamin D levels actually lowered male fertility.  One study found that “Sperm concentration, sperm progressive motility, sperm morphology, and total progressively motile sperm count were lower in men with ’25OHD=50 ng ml(-1)’ when compared to men with ’20 ng ml(-1)=25OHD<50 ng ml(-1)’.” [1]

This showed the obvious:  all hormones have a range and Vitamin D was no exception.  (Vitamin D is a considered a hormone by many experts, because it affects so many tissues and systems.)  CAUTION: One study showed that lower levels of Vitamin D likely lower fertility and stated that “the pregnancy rates per patient and per cycle and delivery rates per patient and per cycle were all significantly higher in couples with normal Vit D levels.” [4]  This argued again for a “sweet spot.”

2. Increased Estradiol. While it is true that some hypogonadal men are low in estradiol, the high prevalence of overweight and obese men often leads to unnecessarily high estradiol levels and “estrogen dominance” if you will.  Men in this category do not need more estradiol, and it turns out that Vitamin D is one of the controllers of estradiol levels in both males and females.  Men get their estradiol via the aromatase enzyme conversion of testosterone and Vitamin D governs the aromatase enzyme. One study on mice with deficient Vitamin D levels found greatly reduced aromatase enzyme levels. Estradiol levels were reduced correspondingly by almost 40%. [2][3] Going back to #1, this may explain the decreased fertility in men who take too much Vitamin D:  higher levels of estradiol actually worsen sperm parameters.

3. Poor Study Outcomes. There have been literally dozens of studies giving patients Vitamin D supplementation.  If raising Vitamin D to higher levels was beneficial, it can be (easily) argued that it would have shown up in the research by this point.  However, the studies have actually shown the opposite, i.e. that going above 50 ng/ml either provides no additional benefits or, in some cases, even makes things worse.  This journal summary says it all:

“Even if 25(OH)D values above 50 ng/mL, or even above 100 ng/mL, are unlikely to cause acute toxicity, achieving 25(OH)D values above 50 ng/mL has not been found to be beneficial, especially for the general population.” [6]

4. Increased Mortality Rates. One study showed that death rates increased at either low or high values of Vitamin D.  The authors wrote that “analysis of 24,094 adult patients showed that 25(OH)D levels less than 20 ng/mL and 60 ng/mL or greater before hospitalization were associated with an increased odds of 90-day mortality. Although previous reports have suggested an association between low vitamin D status and mortality, these data raise the issue of potential harm from high serum 25(OH)D levels, provide a rationale for an upper limit to supplementation, and emphasize the need for caution in the use of extremely high doses of vitamin D among patients.” [5]

“In this study from the general practice sector, a reverse J-shaped relation between the serum level of 25(OH)D and all-cause mortality was observed, indicating not only a lower limit but also an upper limit. The lowest mortality risk was at 50-60 nmol/liter. The study did not allow inference of causality, and further studies are needed to elucidate a possible causal relationship between 25(OH)D levels, especially higher levels, and mortality.” [7]

5. Higher Cardiovascular Disease Rates. A 2009 study found that non-institutionalized seniors had an inverse association with cardiovascular disease risk.  In other words, basically the lower the Vitamin D levels, the lower the risk of heart disease! [8] It is hard to know the cause for this but remember that Vitamin D controls the body’s calcium levels and, therefore, potentially Vitamin D could push calcium into soft tissues.  Yes, arterial plaque is calcium, so perhaps this is the mechanism.

6.  Increased Pancreatic Cancer Risk. There is a recent study that shows 5000 IU of Vitamin D regressed prostate cancer.  However, yet another study found that going too high seemed to increase risk:

“No significant associations were observed for participants with lower 25(OH)D status. However, a high 25(OH)D concentration (> or =100 nmol/L) was associated with a statistically significant 2-fold increase in pancreatic cancer risk overall (odds ratio = 2.12, 95% confidence interval: 1.23, 3.64). Given this result, recommendations to increase vitamin D concentrations in healthy persons for the prevention of cancer should be carefully considered..” [9]

CONCLUSION: We now have several studies, some even large and recent, that show that raising 25-hydroxy levels above 50 (or perhaps 60) ng/dl is risky and associated with increased risk of chronic disease.  Results seem to indicate that there is an optimal zone for Vitamin D.

REFERENCES:

Saturated Fat Lowers Nitric Oxide and Blood Flow

Yes, nitric oxide is just as important as testosterone as far as how you feel and your ability to avoid chronic disease.  And, yes, significant saturated fat lowers nitric oxide.  Yet, when I tell most men on the Peak Testosterone Forum that any significant amount of saturated fat will lower nitric oxide, I can tell that they usually don’t believe me.  This always shocks me, because there is such a huge body of research that shows this fact.  Below I will show you study after study that demonstrates that higher saturated fat meals not only lowers nitric oxide but also lower blood flow and endothelial function as well (of course).

1)  https://news.bbc.co.uk/2/hi/6036409.stm

2) Amer J of Cardiology, Feb 1 1997, 79(3):350 354, “Effect of a Single High-Fat Meal on Endothelial Function in Healthy Subjects”

3) Arterioscler Thromb Vasc Biol, 2005 Feb, 25(2):406-10, “Acute Effect of High-Fat Meal on Endothelial Function in Moderately Dyslipidemic Subjects”

4) ADA Diabetes Pro, 2008, “Can a Single High-Fat Meal Impair Endothelial and Autonomic Function?”

5) The Journal of Physiology, 8 SEP 2004, 517(2), “Cholesterol-independent endothelial dysfunction in virgin and pregnant rats fed a diet high in saturated fat”

6) Heart Vessels, 2010 May, 25(3):254-62, “Caloric restriction reverses high-fat diet-induced endothelial dysfunction and vascular superoxide production in C57Bl/6 mice”

7) Circulation, 1997, 96:3287-3293, “Endothelial Dysfunction Is Associated With Cholesterol Levels in the High Normal Range in Humans”

8) Nutrition Journal 2011, 10:8, “Improvements in vascular health by a low-fat diet, but not a high-fat diet, are mediated by changes in adipocyte biology”

9) J Am Coll Cardiol, 2006 Aug 15, 48(4):715-20, “Consumption of saturated fat impairs the anti-inflammatory properties of high-density lipoproteins and endothelial function”

10) European Journal of Applied Physiology, Oct 2006, 98(3):256-262, “The effect of acute exercise on endothelial function following a high-fat meal”

I always get the same objections:

“That’s not right:  I can get an erection just fine, and I eat a ton of saturated fat.”

“I eat a lot of saturated fat, and I never felt better.”

“I get a great pump at the gym.  What are yout talking about?!?”

To those saying, the above, I ask you your age.  If you are under 40, you can still pump out enough endothelial nitric oxide to more than compensate for the negative effects of a saturated fat meal.  But guys in late middle or early senior age will usually know what I am talking about.  Eating a high fat meal can hit them right below the belt.

So let’s look at just 10+ Studies That Whow that Saturated Fat Lowers Nitric Oxide, Blood Flow and/or the Ability of the Arteries to Relax (Endothelial Function):

1.  HACK: Walnuts Needed to Reduce Loss of Arterial Flexibility from Saturated Fat. “Tests showed that both the olive oil and the walnuts helped to reduce the sudden onset of harmful inflammation and oxidation in arteries that follows a meal high in saturated fat…However, unlike olive oil, adding walnuts also helped preserve the elasticity and flexibility of the arteries, regardless of cholesterol level. Arteries that are elastic can expand when needed to increase blood flow.” [1]

2.  STUDY: High Saturated Fat Meal Lowers Vasocactivity (and a Low Fat Meal Did Not). Remember that vasoactivity refers to the ability of the arteries to relax and lower blood pressure and increase blood flow.  “Flow-dependent vasoactivity decreased from 21 5% preprandially to 11 4%, 11 6%, and 10 3% at 2, 3, and 4 hours after the high-fat meal, respectively (all p <0.05 compared with low-fat meal data). No changes in lipoproteins or flow-mediated vasoactivity were observed after the low-fat meal…These results demonstrate that a single high-fat meal transiently impairs endothelial function. These findings identify a potential process by which a high-fat diet may be atherogenic independent of induced changes in cholesterol.” [2]

NOTE: In some of these studies you will researchers reference a “high fat meal” rather than a “high saturated fat” meal.  However, keep in mind that, generally speaking, this are referring to the same phenemenon, because other research has shown that polyunsaturated fats and omega-3’s do not decrease nitric oxide, blood flow or endothelial function.

4. STUDY:  Healthy Patient Crossover Feeding – Effects Within Two Hours.  “In this study, we showed an effect (decrease) on vascular endothelial function only 2 hour after a single HF meal. Forearm BF response after vascular occlusion was 25% lower in the HF meal versus the LF meal. Skin BF response after vascular occlusion was 20% lower in the HF meal versus the LF meal. Therefore, we suggest that cardiovascular impairment, potentially, can start immediately after a single HF meal ingestion.” [4]

5. STUDY: Reduced Nitric Oxide Independent From Cholesterol.  The title of this study says it all:

“Cholesterol-independent endothelial dysfunction in virgin and pregnant rats fed a diet high in saturated fat.”

Researchers found that “endothelial dysfunction was attributable to a reduced nitric oxide component of relaxation in VHF [very high fat] rats, and blunted prostacyclin and endothelium-derived hyperpolarizing factor components in PHF rats.” [5]

6. STUDY: Dieting with Lower Fat Improves Blood Flow; Low Carb Makes It Worse.  “After 6 weeks, the percentage of flow-mediated dilation improved  in the LF [Low Fat] diet but was reduced in the LC [Low Carb] diet versus baseline. Dilation to nitroglycerin and lipid panels was similar at 0, 2, and 6 weeks. Despite similar degrees of weight loss and changes blood pressure, LF diets improved brachial artery flow-mediated dilation over LC diets. LF diets may confer greater cardiovascular protection than LC diets.” [8] By the way, a “low fat diet” to these researchers actually has fat levels similar to Meditteranean levels.  Undoubtedly, a “true” low fat diet would have improved things even further.

7.  STUDY:  Similar Study Shows Even Worse Results for Low Carb. “Body weight decreased (P < 0.05) in both groups (HF: -6.6 0.5 kg, LF: -4.7 0.6 kg). Fat mass and waist circumference were reduced (P < 0.05) in the LF group only (-4.4 0.3 kg; -3.6 0.8 cm, respectively). FMD improved (P < 0.05) in the LF [Low Fat] group (7.4 0.8% to 9.8 0.8; 32% increase) and was impaired in the HF [High Fat] group (8.5 0.6% to 6.9 0.7; 19% reduction). Increases in plasma adiponectin (P < 0.05, 16 5%), and decreases in resistin (P < 0.05, -26 11%), were shown by the LF [Low Fat] diet only.” [8]Notice that the high fat dieters lost more weight, yet still had worse blood flow results.

NOTE:  Recent research has discovered even more disturing research regarding low carb diets, which you are read about here:  The Potential Dangers to Some Men of Low Carb / Ketogenic / Atkins Diets.  (I am NOT saying ALL men will have issues with Low Carb Diets.)

8. HACK: Caloric Restriction Needed to Reverse Endothelial Dysfunction of High Fat Diet in Mice.  “Male C57Bl/6 mice were fed with normal-fat diet (fat 17%) or high-fat diet (fat 60%) for 150 days. After establishment of obesity at day 100, a subgroup of obese mice were put on caloric restriction (CR) (70% of ad libitum energy intake) for an additional 50 days. At day 100, aortic rings from obese mice receiving high-fat diet showed impaired endothelium-dependent vasodilation in response to acetylcholine (ACh). Caloric restriction reversed high-fat diet-induced endothelial dysfunction.” [6]

9. Dose Dependent Increase in Cholesterol Associated with Drop in Endothelial Dysfunction. Although saturated fat does not raise cholesterol by as much as some claim, it does raise cholesterol levels and this study found that “there was a negative correlation between total cholesterol levels and maximal endothelium-dependent vasodilation (total cholesterol).” [7]

10.  STUDY: Impaired HDL and Endothelial Function.  “Consumption of a saturated fat [meal] reduces the anti-inflammatory potential of HDL and impairs arterial endothelial function…These findings highlight novel mechanisms by which different dietary fatty acids may influence key atherogenic processes.” [9]

11. HACK:  Exercise Protects Against the Endothelial Dysfunction Following a High Fat Meal. “These findings suggest that a single aerobic exercise session cannot only counteract the postprandial endothelial dysfunction induced by the ingestion of a high-fat meal, but also increase brachial artery FMD in apparently healthy adults.”

CONCLUSION:  I could go on and on with more studies showing this, but these 10 should be enough for anyone to get a good idea what is going on.

Why isn’t the word getting out?  Well, my theory is that none of the major Paleo or Low Carb bloggers admit the NO-hammering effects of higher fat meals from what I can tell.  In fact, I see quite the opposite where some of these sites make half-hearted attempts to try to refute the mountain of reseach that show the exact opposite of what they are saying.

In fact, one of the studies that I deliverately left out was the “Cake and Shake Study” that showed that coconut oil lowered blood more than safllower oil. One group, who shall remain nameless, had an article that went to great and laborious pains to try to explain away the fact that these Cake and Shake researchers found what several dozen others have, i.e. that saturated fat literally stuns or numbs arteries for hours after a meal.  And the danger is that, unless you are very carefully doing the HACKs above, you are leaving your arteries in that less flexible and vasoreactive state which is associated with the buildup of plaque (atherosclerosis).  In fact, it is even worse than that, because significant saturated fat causes the cells in your blood to tend to clump together, literally “sludging” arteries.

The bottom line is that, if you want to eat a bunch of saturated, then you won’t hear me preaching at you.  Eating is religious, and I certainly don’t want to argue with anyone about it.  The only thing I ask is that you don’t try to convince me that it won’t affect your nitric oxide and blood flow…  flow…

REFERENCES:

Muscle: Testosterone Will Build the House - Peak Testosterone

If you’ve been struggling to gain muscle mass – and a lot of guys do – this subject should interest you. Let me tell you that the results can be spectaculr according to what I hear on The Peak Testosterone Forum.  Look at what these men wrote for example:

“I have always stayed in shape but noticed I had lost strength and muscle mass, and not being able to sustain an erection very well. I am 63. I feel better now [after HRT] than I have in 30 years, have gained 8 pounds of muscle and lost 2 inches in my waist. I am almost as strong now as when I was in my mid 30’s.  Sex, yes, 3-4 times per wk. Would be more but my wife said this is enough.” [8]

“In my situation I believe I have basically borderline low testosterone most of my adult life and even as a teen I was surely low for the norms of my age group. I have struggled with all the normal symptoms, Hard to gain muscle, hard to lose fat, very passive personality, low motivation to follow through and a general apathy towards most things being neither depressed or excited.” [11]

“Hello, I’m a 27 year old male, weigh 168lbs just a few questions i went to the doctor a while back as i dont get morning erections as frequently as i used to and have a hard time building muscle in the gym, always have. i started lifting weights properly about 1 and a half years ago (i was about 144lbs then and could bench press 40kg for a few reps) now my 1 rep max for bench press is 100kg and can bench press my body weight about 10 times, so i have clearly made gains. i asked for a testosterone test, i had a morning test but im in england and they didn’t seem to do all that much, i got my blood test but the ONLY thing they tested for was total testosterone which in my case was 14.6 which i believe is about 430 ng/dl. ” [12]

Of course, these are all anecdotal and very subjective stories.  Nevertheless, this is a common theme that I see on the forum.  However, the most important question is:  “What does the research say?”  Below I will look at three studies that show how increasing testosterone increases muscle, plain and simple (and then one controversial study that says the opposite):

1. Healthy Young Men. One of the most interesting studies was actually on young men where participants were between 18 and 35 years old. The researchers wanted tight control of their testosterone levels and thus suppressed the natural (endogenous) testosterone of the men in the study with an anti-androgen and then grouped them in five different groups based on dosage levels of testosterone therapy (using testosterone enanthate).

2. Seniors. What about us older guys?  Most men over 65 have lost around half or a little more of their youthful, peak testosterone levels.  One study looked at giving men in this age category testosterone patches and then monitoring their body composition.  The changes were remarkable, considering that no other changes were implemented, i.e. no strength or resistance training. Many positive changes occurred, but the one I wish to focus is an increase in “lean mass”. [3]

What is “lean mass”?  Lean mass is essentially muscle + bone.  Of course, your bones do not change significantly and, therefore, an increase in lean mass generally means a nice increase in muscle.  (Now, technically, it includes water weight, but this should not be an issue in this study.) Again, by all indications, the participants gained a nice amount of muscle even though well into their senior years and doing no weight lifting.

3.  Hypogonadal Males. Similar to study #2, this study looked at men with clinically low testosterone, i.e. hypogonadism. Of course, some of the men in #2 would be hypogonadal, just from aging, but here all men in the group were required to have very low testosterone.  Of course, the results were what we would expect:  increases in fat free mass.  The authors concluded that “testosterone replacement in hypogonadal men enhanced skeletal muscle mass by stimulating the muscle protein synthesis rate.”

Did you know you can inexpensively do your own testing for most hormones? The industry leader is Discounted Labs..

REBUTTAL: I should mention that there are a few opposing voices.  For example, one 2012 study showed that testosterone is completely unrelated to muscle gains in young men. [4][6] Interestingly enough, the study showed that cortisol was much more correlated to muscle growth than testosterone. The same author did a similar paper which showed that women, who have much lower testosterone levels, had equal muscle protein synthesis to men and, therefore, that testosterone has little to do with muscle growth. [5] The author was very emphastic and stated that “while testosterone is definitely anabolic and promotes muscle growth in men and women at high doses, such as those used during steroid abuse, our findings show that naturally occurring levels of testosterone do not influence the rate of muscle protein synthesis.”  Time will tell I guess…

Now this brings up an important point:  even at lower levels of testosterone, you can still put on muscle.  It is dose dependent after all.  A little testosterone means a little growth and a lot of testosterone means a lot of growth. However, we will cover below how low T guys can still do quite well.

CAUTION:  I am not advising anyone to go on HRT (Hormone Replacement Therapy) .  You have to do your own research and discuss with your physician depending on your testosterone levels, preexisting medical conditions and other factors such as desire for fertility, etc..

Low Testosterone and Muscle

Now here is a question that some readers will have.  They have found out they are low testosterone and wonder if they can still put on muscle. My answer to that is a strong ‘yes’.  However, if you are low testosterone, it will likely take you longer to recover.

I am an example of this.  I was in the 300’s (ng/dl) for years – perhaps decades – and put on at least 20 pounds of muscle since college.  I always thought to myself, “Well, it doesn’t come on as easily as when I was 20, eh?”  But, nevertheless, I steadily gained both mass and strength even when my testosterone was very low.

And we have had several similar stories on the forum.  Consider what this guy wrote:

“My Total T has ranged from 350-390 the last two years. Morning wood is a thing of the past, and I rarely am interested in sex. I am very healthy and go to the gym a lot and have quite a bit of muscle..” []

Of course, notice that this guy also has quite a bit of muscle even though his testosterone has only been in the upper 300’s. You have to realize that even if your testosterone is 300, it is likely about 10X that of your wife and girlfriend.  So you’re still very much male and capable of gains.  Now you may be a miserable male struggling with erectile dysfunction, low libido and Venous Leakage – been there! – but you can still slowly add muscle.

2) Bhasin S, Woodhouse L, Casaburi R, Singh AB, Bhasin D, Berman N, Chen X, Yarasheski KE, Magliano L, Dzekov C, Dzekov J, Bross R, Phillips J, Sinha-Hikim I, Shen R, Storer TW. “Testosterone dose-response relationships in healthy young men. Am J Physiol Endocrinol Metab. 2001 Dec;281(6):E1172-81

3) The Journal of Clinical Endocrinology & Metabolism, Aug 1 1999, 84(8):2647-2653, “Effect of Testosterone Treatment on Body Composition and Muscle Strength in Men Over 65 Years of Age”

4) https://www.mcmaster.ca/opr/html/opr/media/main/NewsReleases/ Researchdebunksbody buildingmythgrowthpromotinghormonesdontpromotegrowthorstrength.htm

5) European Journal of Applied Physiology, Jul 2012, 112(7):2693-2702, “Associations of exercise-induced hormone profiles and gains in strength and hypertrophy in a large cohort after weight training”

6) Journal of Applied Physiology, Jun 1 2012, 112(11):1805-1813, “Sex-based comparisons of myofibrillar protein synthesis after resistance exercise in the fed state”

7) The Journal of Clinical Endocrinology & Metabolism, Oct 1 1996, 81(10):3469-3475, “Effects of testosterone replacement on muscle mass and muscle protein synthesis in hypogonadal men–a clinical research center study.”

8) https://peaktestosterone.com/forum/index.php?topic=295.msg8512#msg8512

9) https://peaktestosterone.com/forum/index.php?topic=676.msg6176#msg6176

10) https://peaktestosterone.com/forum/index.php?topic=444.msg4051#msg4051

11) https://peaktestosterone.com/forum/index.php?topic=537.msg5021#msg5021

12) https://peaktestosterone.com/forum/index.php?topic=626.msg5765#msg5765

Testosterone and Adrenals-testosterone affect everything in male

Can testosterone affect the kidneys? The answer is’yes’, since testosterone affects everything in a male. In fact, testosterone can affect the kidneys in several counterintuitive ways that most men on HRT (testosterone therapy) may not be aware of.  One is generally positive and the other generally negative.  And, unfortunately,  by negative I mean that in some cases testosterone replacement therapy could actually aggravate or harm the kidneys in certain sensitive men.

In addition, it is one reason many men probably do not want to go too high in their testosterone level if they are on HRT.  Consider this discussion below:

1. Erythropoieten. This kidney hormone is responsible for triggering your red blood cell production in the bone marrow and testosterone ramps both erythropoieten and red blood cell production upwards significantly. In fact, low testosterone men are quite often anemic because of it and men who go on HRT need to monitored to make sure their RBC count, hemocrit or hemoglobin does not go too high. This can have some serious consequences, which I discuss in my link on Ways to Lower Hemoglobin.

Does simply raising erythropoieten cause any issues with the kidneys?  Well, not directly.  However, there is evidence that in some men with hypertension, testosterone therapy can further raise their blood pressure.  And any increase in blood pressure can potentially, over time, injure the delicate vessels in the kidneys. When these blood vessels get injured, the kidneys struggle to do their job and eliminate wastes, etc.  This can lead to an increase in fluids.  Are you sensing a vicious cycle here?  Yes, as the fluids increase, blood pressure increases and so on.  This can be a big problem for diabetics and men with advanced kidney disease.

NOTE: One interesting fact about erythropoitin is that it is also called EPO, a name that may be more familiar to some of you.  Yes, that should bring the name Lance Armstrong to mind.  Lance Armstrong confessed to using EPO as a performance enhancing drug strictly for the purpose of raising his red blood cell counts for racing purposes.  Basically, he was doing a different and very dangerous kind of steroid.  Giving EPO to these racers leaves them vulnerable to dieing in their  sleep from the “sludging” of the blood that occurs.  It does turn them into superhumans however.

2.  Contraindicated for Advanced Kidney Disease.  There are some sources that recommend that testosterone therapy not be given to men with kidney disease, even if they are hypogonadal. [2] The reason for this is that testosterone could potentially aggravate or inflame the kidneys for these men according to their thinking.  Healthy men can hold this process in check without chronic injury, but these experts would not take chances in those who are vulnerable.

1)   https://www.globalpost.com/dispatches/globalpost-blogs/world-at-play/lance-armstrong-oprah-what-is-epo-blood-doping

2) https://www.drugs.com/pro/testosterone-cypionate.html

3) Kidney International, 2004, 65:1252 1261; “Testosterone promotes apoptotic damage in human renal tubular cells”

<4) AJP – Renal Physiol, Nov 1 2005, 289(5):F941-F948, “Testosterone supplementation in aging men and women: possible impact on cardiovascular-renal disease”5) Journal of Biological Chemistry, 279:52282-52292, “Testosterone Is Responsible for Enhanced Susceptibility of Males to Ischemic Renal Injury*”6) https://peaktestosterone.com/forum/index.php?topic=1607.msg15492#msg15492

7) The Journal of Urology, Jul 2006, 176(1):15 21, “Sex Differences and the Role of Sex Steroids in Renal Injury”

The primary reason is that testosterone appears to “promote apoptotic damage in human renal tubular cells.” [3] Several animal studies showed this effect and then researchers repeated the test in vitro. [3][5] Apoptosis basically refers to the “programmed cell death” that many kinds of cells have latent within them.  Testosterone basically accelerates this condition according to the above anyway.

Further study work has identified other key ways that testosterone may be questionable for those with kideny issues:

a) ” increase tubular sodium”

b) “water reabsorption”

c) “activate various vasoconstrictor systems in the kidney, such as the renin-angiotensin system and endothelin.”

d) ” increase oxidative stress.” [6]

Furthermore, I don’t believe we have had a single legitimate complaint of a kideny issue on the Peak Testosterone Forum  related to testosterone therapy. We had one man who thought he had an issue actually:

“Can the shot cause kidney issues?? Ever since I got the shot on Thursday in my right hip. My left kidney lower back has had a constant pain almost like I got a kidney stone.. 1st shot I had issues with my tongue feeling like it was to big for my mouth. Now this.. Any ideas??” [5]

However, it tunred out that he had a small kidney stone!

Bottom line:  get screened before and after for kidney function and discuss with your physician.  How do you check kidney function?  Well, this is a big subject of course, but here are some or all of the standard tests: GFR (Gromurular Filtration Rate) and creatinine clearance.

Shockwave Therapy for E.D. - Peak Testosterone

Some men simply do not respond well to PDE5 Inhibitors and/or standard testosterone therapy to solve their erectile dysfunction.  They need a bigger gun.  Shockwave therapy is one of the new treatments that has come out to help such men.  It is not cheap, but the research look promising at least.  It has the ability to actually create new vascular tissue inside the penis and who can argue with that?

Shockwave therapy as an aid to sexual potency has been pioneered by Yoram Vardi, an Israeli Urologist. Similar technology has been used in other areas of medicine, including treating shoulder or ankle injuries, coronary artery disease, and bone fractures, for more than twenty years; though not all authorities fully accept its effectiveness.

An American company, Medispec, who have made shockwave machines for eighteen years, introduced the ED-1000 to provide erection-enhancing treatment in 2011. This device resembles a wheeled photocopier, with a probe on a flexible tube to deliver the shocks

The Medispec video claims the ED-1000 provides a permanent cure for erectile dysfunction, and works for both those who respond to PDE5i and those who don t, and that half of their patients who once used a PDE5i no longer need to.

The standard ED-1000 therapy consists of two sessions a week for three weeks, three weeks without treatment, and then a repeat of the first three weeks. Each twenty minute session involves 1500 low-intensity shockwaves applied to five points on and under the penis. This is said to encourage miniscule new blood vessels to grow within the flesh of the penis, and to break up plaque that is causing a hardening of the existing arteries, enabling a better blood flow.

Clinical Trial 1. The first of Professor Vardi s trials reported, in 2009, that fifteen of twenty patients (each with an initial IIEF-EF score of between 5 and 19, and who responded to PDE5i) benefited, and their improvement, in Vardi s words, was a huge improvement . At the six month follow-up it was found that ten of the men no longer needed PDE5i. Seven of the twenty had their IIEF-EF score improved by ten or more points. Eleven had at least a seven point improvement; and fifteen had at least a five point improvement (all without PDE5i). Two of the improved fifteen had, at the follow-up, declined a little and needed further treatment. Three of the twenty patients achieved no increase, or a reduction, in score. Only two men on the course had no risk factors (such as high blood pressure, heart disease, or diabetes) and both no longer needed to take PDE5i following the course. Ten men increased their IIEF-EF score between the one-month follow-up and the six- month follow-up, and seven reduced.

Only men thought to have abnormal nocturnal penile tumescence were allowed onto the first trial, as that suggested a arteriogenic cause for their dysfunction. However the npt measurements proved unreliable and difficult to interpret, and this requirement was not part of the screening process in the two later trials.

Clinical Trial 2. The second Vardi trial, on 29 more severely affected men, who suffered generally with poor health (21 being diabetics) and who responded poorly, or not all, to PDE5i, also found worthwhile results. The average increase in IIEF-EF score was 10 points after treatment, – whilst on PDE5i (to which they were now better able to respond). Eight men were normalised (in the words of the report). 22 of the 29 men improved their IIEF score by at least five points.

The patients on both trials were all long-term sufferers. Improvement in erectile function became apparent between the sixth and eighth session.

Clinical Trial 3. More recently Professor Vardi reported, at the European Association of Urology annual conference in 2012, that the first placebo-controlled double-blind trial found that the treated group experienced a significantly greater increase in the IIEF Total Satisfaction category than the sham group. (There were twenty men in the sham group, and forty in the treated group.)

The patients were screened to avoid certain medical conditions and they had to be able to achieve an IIEF-EF score of at least 19 whilst on PDE5i, though no PDE5i was allowed during the trial. Without PDE5i the mean average baseline score was a low 12.6. Only 12.5% of patients were mildly dysfunctional.

The average increase in the IIEF-EF score of the whole treated group was 6.7 by the first follow-up, four weeks after treatment; and was a worthwhile 3.0 in the sham group. You might interpret this as LI-ESWT offering only an average 3.7 point increase over a placebo.

An article on this third trial by Vardi and his associates, in the May 2012 Journal of Urology , reported that 23 of the men (16 from the sham group) elected to have further treatment. The 36 remaining men who attended the 3 month second follow-up, increased their average IIEF-EF score from 20.7 at the first follow-up to 22.1. This from a low baseline was an impressive average improvement.

Possibly the most striking part of the trial related to firmness or erections. The Erectile Hardness Scale measures the firmness of erections on a scale of 1 to 4. Three is just adequate for penetration, and four is the ideal. The sham treatment reduced (by one) the number men who could achieve EHS3. But of the 40 men in the treated group the number able to achieve EHS3 increased from 12 to 31

The trial also used Flow Mediated Dilation tests to measure the penile blood flow in the two groups to give an objective view of the results of the treatment. Only the treated group showed an increase, and it was a large increase.

The report seems to accept that the treatment may not generally offer quite the improvement that PDE5i initially can.

The article stated that no deleterious side effects have been reported, – despite findings that such shock waves may lead to the collagenisation of corporal smooth muscle in rats. The report warned the long term risk of LI-ESWT on penile tissues has not yet been fully elucidated .

Treatment. Several clinics offer this treatment. One is St Peter s Andrology Centre at 145 Harley Street, who has offered the treatment since late September 2012. There is a 300 consultation fee, and the course costs 3500, which includes a follow-up consultation a few weeks after the course. (The cost is significantly cheaper in Hove, Swindon, Manchester and Edinburgh.)

Dr. Philip Kell, of the St. Peter s Andrology Centre, told me in November 2012 that he had completed treatment on ten patients, all of whom had more severe symptoms than I, with most considering of implants as their next step, as PDE5i and/or Muse/Caverject weren t working. He thought about half were significantly improved. Dr. Kell was treating patients with more severe problems than Professor Vardi; and Professor Vardi is surely more instinctively enthusiastic about his own treatment. Furthermore Vardi s patients often seemed to improve for several months after the treatment, whereas the Harley Street patients had only just finished their course.

Rival shockwave machines, from Renova and Vertec, which claim to work faster, with just four thirty-minute sessions, are also available. Mr. Gordon Muir, also of Harley Street, has the first Renova machine, and has a special offer of 1250 for the four sessions, – plus 230 consultation fee)

My Experiences. I started the ED-1000 course on 28th November 2012 (about four weeks after starting Prelox) and finished on 31st January 2013.

Sessions 4, 5 & 6 were slightly uncomfortable, and my penis felt delicate, with reduced erectile function for around 24-48 hours after each session, – which I am told is unusual. I detected little or no general change in erectile function before the sixth session. But during the three week treatment-free period I noticed improvements in nocturnal and p**n-induced erections.

The start of the second treatment period coincided with a significant improvement. I had more npt immediately following session 7 than I ve had for many years; and p$$n-induced erections seemed much easier too. Session 8, two days later, seemed strangely to have the opposite effect, which lasted till sessions 9 & 10 which coincided with restoration of the improvements. However, after session 10, I stopped self-testing , and I ceased seeing my girlfriend, and so can t report on erections on or soon after sessions 11 and 12. Nevertheless, by the end of the course I felt disappointed. I had been to bed with a new girlfriend three times in January and they were three of my worst ever performances. I wasn t even conscious of nerves in my last attempt (between sessions 10 and 11). My real-world performance was worse in January 2013 than ever, but my p__nography-assisted performance better than ever.

Further sexual activity in summer 2013 with a new partner showed no better erectile function, – even though PDE5i assisted.

What I euphemistically call self-testing got out of hand after a couple of failures with a long-term partner in October 2012, and particularly out of hand after the great stress of losing her in November 2012, and there was further excessive self-testing during the nine weeks of shockwave therapy. Perhaps overdosing on p__nography may have overwhelmed the benefit of the shockwaves when faced with a real naked woman loose in my bedroom?

Perhaps more than twelve shockwave sessions could offer greater benefit. Medispec advise that the treatment can be repeated as often as necessary. But if the problem is mainly in my head, then LI-ESWT can have only limited benefit.

Nevertheless I started another six shockwave session on 20th August 2013. The first four sessions felt even more sensitive than before, but there has been significantly more npt than usual.

Now let’s look at the details of some of the research that supports Shockwave Therapy and its effectiveness.

Soy and Men - Peak Testosterone

“Don’t be a soy boy!”  You may have heard that expression if you’ve hung around any of the bodybuilding sites.  Is it true? Is soy bad for us guys?

In my opinion, soy is one of the most complex of all foods to evaluate, because it is like us:  when it is good, iti is very, very good; and, when it is bad, it is very, very bad. Yes, it is truly both angel AND devil.

Let’s start with some of soy’s incredible properties that can help us males.  Here’s just a few that should raise your eyebrows:

1. Nitric Oxide.  A fairly recent animal study showed soy increasing vascular reactivity, i.e. arterial “responsiveness”, and lowering blood pressure. [1] Furthermore, one study on men (and women) with mild to moderate high blood pressure showed a very dramatic reduction in blood pressure after several months of soy milk consumption. [5] Results were striking and showed a 18.4 and 15.9 mm average decrease in systolic and diastolic pressures, respectively. This is because soy affects eNOS favorably and can result in increased nitric oxide. One in vitro study on human endothelial cells found a 70% increase in nitric oxide from genistein. [8]

2. Okinawans. One of the best documented supercultures on the planet are the Okinawans.  They enjoyed incredibly good health and longevity in spite of living in a modern, industrial environment and are famed for their high centennarian and low heart disease and cancer rates. The Okinawans ate considerable amounts of soy, probably an average of 25-50 grams daily.

3. Cardiovascular Disease.  Soy is associated with decreased heart disease in both men and women. One of the reasons, besides its blood pressure lowering effects, is it also decreases cholesterol in men with high cholesterol levels. [2] It also lowers homocysteine and oxidized LDL cholesterol levels, both significant risk factors for cardiovascular disease. [6] Furthermore, it also likely lowers saturated fat consumption for many, simply because it is (for those who like it) a satisfying protein food that lowers dependency on meat and dairy.  Later study work partially verified similar results on cholesterol, by the way, although results were not uniform. [3]

4. All Cause and Cardiovascular Mortality.  One study on Japanese men showed a 23% reduction in all cause mortality for men who consumed soy 4+ times/week compared to those who consumed it once per month. [4] That’s a pretty impressive reduction and cardiovascular mortality was reduced as well, which is the #1 killer of men in modern societies.

5. Quality, Undenatured Protein. Soy is also a good quality protein, in spite of what some bodybuilding sites claim, and is usually inexpensive and easy to obtain.  Even more attractive is the fact that there are now many undenatured brands available both online and in many health food stores. It has become a staple for many vegan and vegetarian bodybuilders because of it.

6. Prostate Cancer.  One of the big worries for middle-aged and older men is prostate cancer.  I just had a friend die of it:  after months of chemo, it still spread to his liver.  Several studies have shown that soy is protects significantly against prostate cancer. [15]

7. Non-alcoholic Fatty Liver Disease (NALFD).  Preliminary studies seem to show that soy reduces fatty liver disease in those who are overweight at least and helps stop the accumulation of fat in the liver. [17]

In spite of all these stellar benefits, I am still very cautious about soy and rarely consume it.  As it turns out, the dangers and risks are just as dramatic:

1. Hypothyroidism. Hypothyroidism, or an underactive thyroid, is a risk factor for low testosterone and can affect erections and relationships as well. The fatigue and weight gain associated with it are not going to help a man in or out of the bedroom. Unfortunately, soy is a powerful inhibitor of a key thyroid enzyme named TPO that liberates iodine to do its job. [9] On the surface, it would seem likely that this inhibition can, in some individuals, lead to hypothyroidism, especially in those with low iodine levels (which is quite common). In addition, many men already have decreased thyroid function and additional soy in the diet may exacerbate this condition as well.  It is also scary that researchers believe that this effect on the thyroid is due primarily to the phytoestrogens present n soy.  These phytoestrogens are quite good at mimicking estradiol, a known promoter of thyroid cancer as well. [9][10]

Are these concerns overblown?  One prominent meta-analysis thinks so:  they looked at multiple studies and concluded that soy had minimal affect on individuals with any kind of normal thyroid function. [11] In fact, there summary was: “Thus, collectively the findings provide little evidence that in euthyroid, iodine-replete individuals, soy foods, or isoflavones adversely affect thyroid function.”  And they did admit there was evidence that thyroid patients might have to increase their dosage due to the effects of soy consumption.

2. Zinc Chelation. Soy is packed with heat-insenstive phytic acid.  Phytic acid has a beneficial propertity in that it lowers cholesterol.  However, one very negative aspect of phytic acid consumption is its uncanny ability to bind to zinc. [7] (It also binds to calcium and iron.) Zinc is critical for testosterone production, estrogen de-aromatization and many other key male pathways. Plus, sexually active men will lose a significant amoutn of zinc in sperm.  For more details, see my page on Zinc and ZMA and my new book, 15 Natural Erectile Dysfunction Cures.

3.  Male Brain Shrinkage. This is the biggee for me. A couple of studies show that soy can lead to brain shrinkage in males. [16] The exact wording in the studies is “brain atrophy” and it only applies to males.  Again, this is likely another negative effect of the phytoestrogens in soy.

Now I should point out the counterargument to this:  one study shows an improvment in memory in Indonesian seniors who regularly consumed soy. [12] This is rather hard to explain if soy is really so brain-toxic as is the very-sharp-through-old-age Okinawans. In short, it looks as if these claims against may be somewhat exagerrated and/or need additional studywork.  However, the rebuttal to this is that a follow-up study showed that tempeh improved memory in the elderly but tofu decreased it. [13] So perhaps the difference is fermented versus non – who knows?

4. Low Testosterone and Hypogonadism. Previous study work was somewhat unequivocal but likely showing a slight decrease in testosterone resulting from soy consumption.  However, one recent study should give every male pause to reflect:  a case report of a male on a high soy diet that developed hypogonadism (clinically low testosterone) and was able to fully recuperate upon cessation. [14]

5.  Hexane. One thing that I don’t think anyone disputes is that modern soys are generally processed with hexane, a toxin that has no business being on your plate. And don’t let anyone fool you:  hexane residues definitely end up on most soy products and many health officials are concerned about it.

In my opinion, soy is impressive but simply not worth the risk, primarily because of risk to the brain and thyroid.  The cardiovascular and endothelial benefits can easily be obtained from other foods – see my book The Peak Erectile Strength Diet – coupled with a Low Fat  and/or Mediterranean Diet. Yes, it’s hard to argue with the Okinawans, but I’d rather be safe than sorry.

1)  The FASEB Journal, 2005, 19:1755-1757, “Dietary soy isoflavone induced increases in antioxidant and eNOS gene expression lead to improved endothelial function and reduced blood pressure in vivo”

2) Circulation, 2000, 102:2555-2559, “Soy Protein and Cardiovascular Disease: A Statement for Healthcare Professionals From the Nutrition Committee of the AHA”

3) European Journal of Clinical Nutrition, 2005, 59″843 850, “Effects of soy supplementation on blood lipids and arterial function in hypercholesterolaemic subjects”

4) Preventive Medicine, Jul 2006, 43(1):20-26, “Soy consumption and mortality in Hong Kong: Proxy-reported case control study of all older adult deaths in 1998”

5) J Nutr, Jul 1 2002, 132(7):1900-1902, “Soy Milk Lowers Blood Pressure in Men and Women with Mild to Moderate Essential Hypertension”

6) American Journal of Clinical Nutrition, Aug 2002, 76(2):365-372, “Effects of high- and low-isoflavone soyfoods on blood lipids, oxidized LDL, homocysteine, and blood pressure in hyperlipidemic men and women”

7) Crit Rev Food Sci Nutr, 1995 Nov, 35(6):495-508, “Phytic acid in health and disease”

8) British Journal of Pharmacology, Feb 2005, 144(3):394-399, “The soy isoflavone genistein induces a late but sustained activation of the endothelial nitric oxide-synthase system in vitro”

9) Environ Health Perspect, Jun 2002, 110(Suppl 3):349 353, “Goitrogenic and estrogenic activity of soy isoflavones”

10) J Clin Endocrinol Metab, 2001 Mar, 86(3):1072-7, “Estrogen Promotes Growth of Human Thyroid Tumor Cells by Different Molecular Mechanisms”

11) Thyroid, Mar 29 2006, 16(3), “Thus, collectively the findings provide little evidence that in euthyroid, iodine-replete individuals, soy foods, or isoflavones adversely affect thyroid function”

12) Brain Research, 16 March 2011, 1379:206 212, “Borobudur revisited: Soy consumption may be associated with better recall in younger, but not in older, rural Indonesian elderly”

13) Dementia and Geriatric Cognition Disorders, 2008, 26(1), “High Tofu Intake Is Associated with Worse Memory in Elderly Indonesian Men and Women”

14) Nutrition, 2011 Jul-Aug, 27(7-8):859-62, “Hypogonadism and erectile dysfunction associated with soy product consumption”

15) Cancer Epidemiol Biomarkers Prev, Jul 2003, 12:665, “Soy and Isoflavone Consumption in Relation to Prostate Cancer Risk in China”

16) Journal of Anti-Aging Medicine, Dec 2003, 6(4):335-336, “Soy-Induced Brain Atrophy?”

Testosterone Lowerers - Peak Testosterone

REFERENCES:

1) Intl J of Impotence Res, 2009, 21:89 98, “Obesity, low testosterone levels and erectile dysfunction”

2) Francis Hayes, The results were presented at The Endocrine Society s 91st Annual Meeting in Washington, D.C. This was not published even online at the time of writing but was covered extensively in the health and medical press.

3) Natl Inst on Alcohol Abuse and Alcoholism, “Alcohol and the Male Reproductive System”, Mary Ann Emanuele, M.D., and Nicholas Emanuele, M.D.

4) Reproduction, 2002, 124:173-180, “Regulation and Perturbation of Testicular Functions by Vitamin A” (Review)

5) Clin Endocrinol (Oxf), 2009 Dec 29, [Epub ahead of print], “Association of vitamin D status with serum androgen levels in men”

6) European journal of applied physiology, 2010 Apr, 108:1125-1131, “Influence of dietary carbohydrate intake on the free testosterone: cortisol ratio responses to short-term intensive exercise training.”

7) Contraception, 73(3):301-306, “Evaluation of the potential antifertility effect of fenugreek seeds in male and female rabbits”

8) Phytotherapy Research, Mar/Apr 1993, 7(2):134-138, “Efficacy of the steroidal fraction of fenugreek seed extract on fertility of male albino rats”

Research has shown that every one of these items can lead to very signficantly lowered testosterone (and libido). I call them the Dirty Dozen.

NOTE:  You may also want to read my link on Common Chemicals That Lower Testosterone as well.

1) Overweight.  Those extra pounds are strongly correlated with lower testosterone [1] and a Lot of Other Bad Stuff as well.

2) Metabolic Syndrome (insulin resistance) and diabetes are both equate to decreased testosterone levels. [1]

3) Chronic and Non-Moderate Alcohol Consumption.  Animal studies clearly show heavy drinking for an extended period of time will lead to lower testosterone. [3]  Always play it safe with Alcohol and limit yourself to one or two drinks per day.

4) Stress.  We males can intuitively feel how hard stress is on our body and mind and the reason is, among other things, simple chemistry:  stress increases cortisol and cortisol has been shown repeatedly to be associated with lowered testosterone levels.  I cover this extensively in my link on Stress, Testosterone and Your Brain.

5) Lack of Sleep.  This actually follows – and many guys don’t know this – as really a subcategory of #4.  Lowering sleep quantiy or quality will leads to increased cortisol and a corresponding testosterone decrease and I cover that extensive in my link on the Nasty Effects of Lack of Sleep.  Sleep can also lead to calcification, or hardening, of the arteries and blood sugar management issues as well.

6) Depression.  Depression is also actually a subcategory of #4 and leads to increased cortisol and inevitably lowered testosterone levels. Depression also can lead to erectile dysfunction and literal brain damage as well. Read my link on Depression for more details.

7) Vitamin A Deficiency.  Being deficient in Vitamin A has nasty results on both sperm and testosterone.  In fact, animal studies show that in Vitamin A-deficient animals, lower testosterone is followed by atrophy of the testes. [4] Don’t forget that you don’t have to directly consume Vitamin A to get your what your body needs:  your body can also build it from betacarotene, the orange phytochemical in yams and carrots.

Did you know you can inexpensively do your own testing for most hormones? The industry leader is Discounted Labs..

8) Vitamin D.  Vitamin D has been correlated with higher total and free testosterone. [5] Vitamin D deficiency is incredibly common, as I cover in this link on Vitamin D, and can result from being indoors, skin color, the seasons and so on.  The solution, of course, is to take Vitamin D as a supplement in order to avoid lower testosterone.  (Read my link on Vitamin D for more information.)

9) Overtraining. If a little exercise is good, then a lot has to be better, right?  Unfortunately, that doesn’t apply when it comes to our hormones.  Overtraining lowers many of our most precious hormones, such as testosterone, and raises still others that ought not to be raised.  You must build up slowly in your training endurance and strength and make sure you have sufficient rest.  Read more in my link about Overtraining’s Powerful Testosterone Lowering Abilities.

10) Toxins.  There’s a lot of what I call “Socially Acceptable Chemicals” that will give you lower testosterone.  In fact, it’s nearly impossible for a modern urban dweller to escape at least some exposure to these nasty hormone killers, which include Pesticides, Excitotoxins and Marijuana.  Read these links:  no one but you can protect your testosterone.

11) Varicocele.  These are nasty distended and/or tangled systems of veins near the testicle that can affect testosterone and fertility. I had one young reader write in who knew exactly when this occurred:  during a squat at the gym. (See my link on Fertility for details.)

12) NEWS FLASH: This is hot off the press:  rapidly increasing blood sugar levels lead to significantly decreased testosterone. [2] In fact, blood sugar elevation can whack testosterone by as much as 25%!  Over 95% of the men in the above study, both with normal glucose clearance and diabetic, had their testosterone significantly lowered for hours by a glucose drink.   Again, you must manage the Glycemic Load of your foods. Read this link on How Sugar Lowers Your Testosterone and Assaults Your Sex Life.

13) NEWS FLASH #2:  The Atkins (or Low Carb Diet) received yet another black eye from scholars at the University of North Carolina.  Researchers there found that a low carb (30%) diet lowered testosterone by about a third and increased cortisol by about a seventh (15%) when compared to a high carb (60%) diet after some intense training. [6] The testosterone to cortisol ratio is incredibly important to male long term health and this hammered it from both ends.

14) Fenugreek.  Watch out for this herb (at least the seeds) that hail from India, China and other parts of Asia.  Several animal studies show a decrease in both testosterone and fertility. [7][8]

Mercury will also lower your androgens, but unless you are eating a lot of fish, this shouldn’t be an issue for you.  Also, I highly encourage you to read about my link regarding Excitotoxins as, unlike Mercury, this is so prevalent in our foods and supermarkets thanks to the FDA and Food Industry and will take out both your Brain AND your hormones.

NOTE:  You should also read my section on Free Testosterone as there I discuss several things that can uniquely lead to lower Free Testosterone as well.  Remember that Free Testosterone  is the bio-available serum testosterone that can actually “do work” in your tissues.

Remember that this is not a cumulative list.  However, it only takes ONE of these to severely reduce your T-levels 30% or more.  Remember that low testosterone is associated with heart disease, diabetes, Metabolic Disorder, depression and osteoporosis in males.

NOTE:  Please read this link on How Marijuana Can Destroy Your Hormones, Fertility and Lead to Impotence.

Vitamin C - The Potential Dangers - Peak Testosterone

I’m a big fan of Vitamin C and feel much better when taking it.  In fact, it is really the only vitamin or mineral that I megadose simply because I feel the RDA / AI is much too low.  I also am a cautious follower of the Pauling Theory, simply because Vitamin C does some spectacular things at a megadose level ( >= 1 gram/day).  It’s hard to argue with a cheap supplement that can boost nitric oxide, improve weight loss, control cortisol, lower blood pressure, decrease inflammation, protect the brain – the list goes on and on.  You can check out my links on 10+ Great Reasons to Take Vitamin C and Vitamin C and Erectile Dysfunction for more information.

CAUTION:  In my link on Garlic and Erectile Dysfunction, I discuss how Vitamin C and garlic coupled together can dramatically increase nitric oxide and lower blood pressure. However, one should always consult with your doctor first if you have any medical condition or are on any medications. For example, lowering your blood pressure too much can have serious consequences.

In spite of all the praise I have for Vitamin C, a few cautions are in order.  In my opinion, Vitamin C’s track record is excellent, but a few potential “dangers” have been uncovered as well and I cover those below:

1. Blood Flow Reduction. One animal study showed that in some cases Vitamin C could possibly contribute to a loss of blood flow.  This study basically demonstrated that Vitamin C could increase a key oxidant, peroxide, that is responsible for supplying blood flow to the muscles and expanding arteries. [15] In my link on Antioxidants and the Heart I discuss how free radicals, supposedly the villains, actually play crucial roles in our health.  For example, nitric oxide is a free radical and dilates our arteries.  Researchers are concerned that taking too many antioxidants, such as Vitamin C, could quench the body’s requirement for these free radicals.

Now the rebuttal to this is that this study actually combined two antioxidants and thus may not really be a realistic scenario.  In fact, as mentioned above, researchers have found that combining garlic and Vitamin C increases nitric oxide by three times!  We have had guy on The Peak Testosterone Forum use this to cure their erectile dysfunction – that’s how powerful it for some men.  Nevertheless, it does beg the question as to whether we fully understand the complete impact of megadosing Vitamin C.

2. Loss of Exercise Benefits. Another disturbing study showed that 1000 mg daily of Vitamin C coupled with 235 mg daily of Vitamin E lowered key benefits of exercise.  The researchers summarized by saying that “daily vitamin C and E supplementation attenuated increases in markers of mitochondrial biogenesis following endurance training.” [18] Of course, some would argue that Vitamin C alone may not do the same and so it is too bad that the study did not also look at each supplement separately.  Again, though, this shows that one can have too much of a good thing.

3. Increase Arterial Plaque?.  And then came the real black eye: one study showed increased arterial thickness from Vitamin C.  This study reported that those who took Vitamin C had 2.5 times the thickening of the arteries compared with those who took none. [3]  This study has been criticized for being relatively small and one can’t help but ask the question, “If Vitamin C causes such accelerated hardening of the arteries, why aren’t its proponents dropping dead like flies?”  Personally, I doubt that Vitamin C causes arterial thickness as this was a small and controversial study, and there are many studies showing that Vitamin C improves arterial health.

1) Journal of Internal Medicine, 2000; 248 (5), 377-386

2) American Journal of Clinical Nutrition, Dec 2004, 80(6):1508-1520, December 2004 Antioxidant vitamins and coronary heart disease risk: a pooled analysis of 9 cohorts Paul Knekt, et al

3)  Reported on March 2, 2000, by Dr. James Dwyer at an American Heart Association meeting in San Diego

7) The Lancet, 2002, 360(9347):1781-1782

8) Gut, 2007; 56:1678-1684, Published Online First: 4 September 2007, “Fat transforms ascorbic acid from inhibiting to promoting acid-catalysed N-nitrosation”

9) J Am Coll Nutr, 2005 Jun, 24(3):158-65

14) https://esciencenews.com/articles/2009/09/09/ study.reveals.new.role.vitamin.c.skin.protection

15) Experimental Physiology, Published Online: 21 Jul 2009, 94(9):961-971, “The effects of antioxidants on microvascular oxygenation and blood flow in skeletal muscle of young rats”

16) Am J Clin Nutr, Nov 2004, 80(5):1194-1200, “Does supplemental vitamin C increase cardiovascular disease risk in women with diabetes?”

17) JAMA, 2008 Nov 12, 300(18):2123-33, “Vitamins E and C in the prevention of cardiovascular disease in men: the Physicians’ Health Study II randomized controlled trial.

18) J of Physiology, Published online before print Feb 3 2014, “Vitamin C and E supplementation hampers cellular adaptation to endurance training in humans: a double-blind randomized controlled trial”

4. Increasing Nitrosamines. One can’t help but wonder why Vitamin C does not fight cancer more effectively.  After all, it is one of our body’s most important antioxidants and it is used extensively throughout the immune system.  It only stands to reason that it should help with cancer outcomes. The reason is very likely that Vitamin C very likely has a dark side:  the journal Gut simulated conditions in the stomach and found that Vitamin C, when fat levels are low, actually inhibits the carcinogenic nitrosamine production but promotes nitrosamines when fat is present. [8] I’m not talking about fat as in overweight:  I’m talking about fat in your meal.  If you eat any fat in your meal – which almost every one in a modern society does – megadosing with Vitamin C will lead to a flood of carcinogenic nitrosamines and this may explain some of Vitamin C’s questionable cancer results.

By the way, did you know that ascorbic acid is sometimes added to meats to lower nitrosamine production.  The point is that there is data that shows the opposite of the above.  As always, it’s too bad there isn’t more study work.

5.  Raising Iron Absorption. Dr. Russell Blaylock and other recommend taking Vitamin C (in a “salt” or “Ester-C” form) in order to make sure that you do not increase iron absorption.  Unfortunately, most men in Western societies consume too much iron and this associated with cardiovascular and neurological disease.  Again, an easy solution is to take it on an empty stomach but not all men know about this.

So everything sounds like a “green light”, right?  Well, unfortunately, there have been a number of studies that have found that Vitamin C has no significant heart benefit.  One of the biggest was The Physicians Health Study II of 14,000 male physicians run by a Harvard professor.  In this study physicians were put on 500 mg Vitamin C and 400 IU Vitamin E daily.  The researchers found that neither vitamin decreased cardiovascular events whatsoever. [17] Then came a study on postmenopausal women with diabetes that showed an increased cardiovascular risk with Vitamin C usage. [16] Critics point that 500 mg of Vitamin C is a fairly low dosage according to Pauling Theory.

Another researcher, Rory Collins, looked at not just heart disease during a huge five year study involving 20,000 people who took daily 600mg of vitamin E, 250mg of vitamin C and 20mg of beta-carotene.  This study [7] in the prestigious journal Lancet found that there was no improvement in heart disease or cancer rates.  Once again, Vitamin C looked like a questionable use of one’s money.  Again, some have criticized this study for only supplementing with 250 mg of Vitamin, but keep in mind that is roughly the Vitamin C found in five oranges.

REFERENCES:

Testosterone Therapy Side Effects - Peak Testosterone

Furthermore, most of us have heard steroid horror stories of man boobs and tiny testicles and we assume that testosterone therapy will do the same.  Of course, nothing could be further than the truth.  Many steroid users have a “if a little is good, then a lot must be better” mentality and push themselves way beyond the normal physiological hormonal ranges.  This often simultaneously pushes their testosterone and estrogen sky high, shrinking their testicles and increasing breast/chest tissue, respectively.  (Man boobs are a rare but reported side effect of testosterone therapy, but it is more likely a cause of low testosterone rather than high. [1] )

So are there any legitimate concerns regarding testosterone therapy? Well, certainly, although none of them are common.  Let’s list some of the ones that should be considered, however, and discussed with your doctor:

1.  Fertility.  Going on testosterone will very likely affect fertility negatively.  I get letters quite often from younger guys asking if they should go on HRT.  Of course, I tell them to talk to their doc about fertility, because there somewhat of a rebound effect if you try to go off of testosterone therapy.  So adding testosterone can affect LH (leutenizing hormone) and FSH (follicle stimulating hormone) levels. LH governs testosterone production in the testes and FSH is responsible for spermatogenesis, i.e. creation of the sperm. (See my link on Fertility for more information.)  But even you older guys that are in a serious relationship with a Younger Woman may need to consider this as well.

3. Acne. Some guys get the joy of going through a second puberty when on testosterone.  Again, this is uncommon but a possibility in sensitive individuals.  See my link on Testosterone and Acne for details and solutions.

4.  Hair Loss. Some have reported hair loss as a side effect, although this does not seem to be common and is difficult to prove.  Some of the testosterone delivery systems, such as scrotal patches, deliver higher levels of DHT, the primary culprit in typical male pattern baldness.

Did you know you can inexpensively do your own testing for most hormones? The industry leader is Discounted Labs..

5.  Soy Allergy.  Some of the topical preparations are actually manufactured from soy and thus should be avoided by those with a soy allergy.

6.  Severe Health Considerations.  There was a recent small study on 219 senior men with poor health (diabetes, obesity, high blood pressure, etc.) and poor mobility that showed a significant increase in cardiovascular events when compared with the placebo group.  The study was halted and researchers basically said that no conclusion could be drawn due to the small study size.  However, you should discuss this study with your doctor, especially if you are an older, sedentary male with a significant health condition.

7.  Liver Problems. One last thing:  almost all testosterones given in testosterone therapy are very well-tolerated by the liver, but you want a doctor that will test your liver function just to play it ultra safe. Liver issues are associated almost exclusively with the old-line oral testosterones that were difficult to metabolize.

8.  Enlarged Prostate. One uncommon side effect occasionally reported with HRT (Hormone Replacement Therapy) is BPH (enlarged prostate).

9. Thickened Blood. A recent meta-analysis found that testosterone therapy significantly increased hemoglobin and hematocrit, which makes blood more thick and likely to clot. [4]

10. Lowered HDL.  The same study above found that that testosterone therapy was associated with a small decrease in HDL as well. [4]

NEWS FLASH:  A recent Newsweek [Nov 9, 2009, p. 56f] article covered how some guys on HRT are either ignorant or being negligent.  They are applying the gel to their chest, shoulders and/or arms and then are in direct skin-to-skin contact with their children (or wives).  This is very serious indeed:  a young child can be developmentally affected by repeated exposure to significant amounts of testosterone, including potentially the brain. In a young boy, for example, the lines on the scrotal sac can be altered and pubic hair thickened and grown.

I was just talking with a pediatric endocrinologist about this and it is imperative that guys wash their hands and keep any areas of application covered. He had only noticed problems in guys who were careless and/or ignorant of the risks involved. There have been enough reports of this problems that the FDA is currently forcing a generic version of Testim to undergo “hand washing studies” to make sure that it is as safe in this regard as the original.  Furthermore, even the original products may have to carry a “black box” warning label.  Keep your family safe!

If you are interested, you should also read my Overview of HRT and common Methods of Testosterone Delivery (such as gels and injections).  These links should give you a lot of good talking points with your doctor.

REFERENCES:

1) https://www.mayoclinic.com/health/testosterone-therapy/MC00030

3) Clin Endocrin (Ox),1988;28:461-470

4) J Clin Endocrinol Metab, Jun 2010; 95:2560-2575, “Adverse Effects of Testosterone Therapy in Adult Men: A Systematic Review and Meta-Analysis”

Testosterone and Nuts (as in Walnuts and Almonds!)

I had a reader write in with the following question having to do essentially with testosterone and nut consumption:

“I normally eat almonds, although I purchased Walnuts …[and]…I noticed that they have a lot of Polyunsaturated fats! Do the benefits of eating the walnuts outweigh the poly fats! Or are the poly fats desired! I thought I read on your website that poly fats decreased testosterone!”

This is actually a very involved subject and one that would take a small book to answer fully.  However, let me give a few key points on the subject:

1.  Yes, polyunsaturated fat is in general associated with decreased testosterone as is total fat. Thus, eating a lot of polyunsaturated fat would probably not be a good idea for most guys not on HRT.  However, eating a small amount of nuts is unlikely to cause a significant reduction in testosterone. This was born out in a study of senior men that found no significant reduction in bioavailable testosterone from eating 75 grams, a little over 1/2 a cup, of walnuts per day. [2]  (A study on women with PCOS showed an increase in SHBG and corresponding decrease in free testosterone. [3] However, PCOS women tend to be overweight with overly high testosterone levels.)

1) Epidemiology,2006,17(1):61-68

2) Nutrition Journal, 2008, 7:13, “The effect of walnut intake on factors related to prostate and vascular health in older men”

3) European Journal of Clinical Nutrition, 15 December 2010, “Differential effects of walnuts vs almonds on improving metabolic and endocrine parameters in PCOS”

2.  Nuts are part of some of the most healthy diets in the world.  The Abkhasians, one of the supercultures of the world with almost no heart disease or cancer, eat a steady supply of nuts.  Nuts are also part of many Mediterrean Diets and the Mediterranean Diet is both pro-erection, pro-brain, pro-testosterone and pro-just-about-everything you hold dear as male.

4.  Nuts are not part of an Ornish-style Low Fat Diet. A Low Fat Diet can literally clear out your arteries and would be appropriate for many middle-aged and beyond guys.  However, eating a few nuts is unlikely to skew results significantly in my opinion.  A typical low fat diet is about 10% of calories as fat and adding a 1/4 cup of almonds, hazelnuts or walnuts to one’s diet will only change one’s diet to about 14% fat.

5.  While it’s true that a Low Fat Diet may in the short term diet lower testosterone a little, there is good evidence that this type of diet actually preserves testosterone decades beyond what someone eating a typical Western Diet achieves.  See my link on How to Avoid Andropause for more details.

6. There are many nitric-oxide-promoting foods and drinks and so there is no need to consume nuts.  Keep in mind, though, that nuts also have an abundance of certain hard-to-get nutrients, such as Vitamin E as well.

So the bottom line is that nuts are likely relatively neutral with regards to testosterone and free testosterone but have many nitric oxide-promoting properties, making them a valuable weapon for most middle aged and beyond guys.  (For those on a strict Low Fat Diet, nuts will not be allowed.)

REFERENCES:

Estradiol: - High Levels Increase Arterial Plaque -

Do you have high estradiol? Consider the evidence that it can accelerate arterial plaque:

One of the very few subjects that I enjoy more than hormones is regressing arterial plaque.  So imagine how excited I got when I found a study that combined both subjects.  A 2006 study in the Journal of Clinical Endocrinology looked at a variety of hormones and lifestyle factors, such as testosterone, estradiol, SHBG, BMI, waist-to-hip ratio, blood pressure and lipids in relation to arterial plaque in men.  And they did not just study association but rather causation.  By that I mean that they measured the above hormonal and lifestyle factors and then watched the participants for three years afterward with the goal of finding which were most predictive of developing arterial plaque. [1] And the results were very interesting on many fronts.

NOTE: Arterial plaque was measured using an ultrasound IMT (intima medial thickness) of the carotid (neck) artery.  This is one the two common ways to check for plaque, the other being a Heart Scan (Calcium Score), the latter being something I discuss in my page called Heart Scan Results. An IMT has no radiation and, as of this writing, can be done without a doctor’s orders in almost all states through Lifeline for $70.

What did the researchers find?  Their results would probably surprise most men:

1.  The only hormone that predicted an increase in arterial plaque was estradiol (both total and free).

2. The only lifestyle factors that predicted an increase in arterial plaque were LDL and HDL.  (This is no surprise.  All the Plaque Regressers set low targets for LDL – see my page Your Target LDL Levels to Regress Plaque – and relatively high values for HDL, the “good” cholesterol.)

Basically, higher estradiol levels meant higher plaque levels three years later.  This is, for many scientists, a complete turnaround in expectations:  for years and years the estrogen in women was seen as heart protective. However, the thinking on that has done an about face. The authors wrote:

1)  J Clin Endocrinol Metab, 2006 Nov ,91(11):4433-7, “Circulating estradiol is an independent predictor of progression of carotid artery intima-media thickness in middle-aged men.”

2) J Mol Med (Berl), 2002 Mar, 80(3):176-80, “Coronary artery wall atherosclerosis in relation to the estrogen receptor 1 gene polymorphism: an autopsy study”

“Our findings of a positive association between serum E2 levels and intima-media thickening supports the notion that estrogens, besides possibly increasing the risk for thrombosis and thereby cardiovascular events, also have an important impact on atherogenesis in men. In the present study, we found a positive association between free E2 and the annual increase in intima-media thickness at higher, but not lower, free E2 levels. This might suggest that high doses of E2 (and possibly other estrogens) should be avoided in clinical trials. Indeed, high-dose parenteral administration of a slow-release preparation of E2 was recently shown to increase the risk of nonfatal ischemic heart disease events in men.”

Notice that in this study lower estradiol was NOT correlated with increased atherosclerosis – only high.  Low estradiol is dangerous for other reasons, such as osteoporosis, but in this study it did not seem to accelerate plaque.  The study also commented that

b)  Researchers have discovered that the estrogen receptors in arterial walls likely play a role in the buildup of arterial plaque directly. [2]

What this means is that researchers now have evidence of  and biological plausability (cause-and-effect) for, a link between higher estradiol levels and arterial calcification.

Estradiol Management and HRT

One key point in my mind is that this study seem to argue for an emphasis on weight loss and reasonable dosages of testosterone for men on HRT, Clomid, HCG Monotherapy or any therapy that increases testosterone levels in order to lower estradiol levels.  Some physicians now – and I have seen this on the  Peak Testosterone Forum – believe that there is no practical upper limit to estradiol for men on HRT. They will double or triple a man’s testosterone levels and, therefore,  roughly double or triple their estradiol levels at the same time. And, as this study shows, boosting those estradiol levels could actually carry a long term risk.

Furthermore, testosterone did not show an ability to improve IMT in this study, so one cannot count on it to protect one’s arteries from the buildup of plaque. Testosterone does some remarkable things for cardiovascular health, such as decrease hardening of the arteries, lower insulin levels, help prevent prediabetes and diabetes, decrease body fat (a little), help improve libido/erectile strength and lower key inflammatory markers.  Put all of these together and I would think that you should generally improve plaque levels.  However, according to this study, testosterone was neutral and estradiol must be monitored independently.

So how do you manage estradiol?  Well, one way HRT clinics and anti-aging physicians do it is with Arimidex (anastrozole).  Arimidex is an aromatase inhibitor and will drop your estradiol levels nicely.  The problem with Arimidex is that it can negatively impact the clotting cascade, and, therefore, may only improve half of the equation.  Now the rebuttal is that the amount of Arimidex usually given to men on HRT is usually quite low.  I was on Arimidex briefly and was given initially 0.5 mg twice per week.  That is a very small amount and I don’t believe there is any evidence that clotting has been an issue with doctors that use it.  You’ll have to discuss risks with your doctors or PA as there are no studies.

I would argue that there is a better way for most men and the following should be their goal:

a) Lower the testosterone dose as much as possible.  This will, in turn, lower estradiol levels.

b) Drop your body fat into the 10-12% range.  (This is easy using Clarence Bass’ approach documented in his book Challenge Yourself.

c) If you are injecting testosterone cypionate or enanthate, go to two or more times weekly (which usually will mean subQ).

This is the approach I took and I got completely off of Arimidex.  My last estradiol read was 27 pg/ml, which is a Youthful and Natural Level of Estradiol.

REFERENCES:

Niacin: Improving Erectile Dysfunction - Peak Testosterone

1. Increased Blood Flow in Men with Lower Niacin Levels. Of course, there is a lot to an erection, but I think just about everyone would agree that the #1 goal is to increase something called endothelial function.  The endothelium is the delicate lining of the arteries that pumps out nitric oxide and relaxes the arteries.  And, of course, a relaxed, i.e. more open artery is one that allows more blood to flow into your arm, your leg or your brain.  And I’m sure I don’t need to explain why increased blood flow into your penile arteries is critical for erectile strength.

This is where a recent (2014) study of 127 healthy adults aged 48 to 77 shed some important light on vitamin B3 (niacin).  This study calculated and compared dietary niacin intake for the participants and then looked at FMD (flow-mediated dilation), which is a clinical measure of blood flow.

In all subjects, brachial (upper arm) arterial FMD was positively correlated to dietary niacin intake, and dietary niacin intake remained a significant independent predictor of FMD. In subjects with above-average dietary niacin intake, FMD was 25% higher compared with the below-average dietary niacin group.

2. Less Oxidized LDL. In the above study niacin was also inversely related to levels of oxidized LDL. [1] Of course, oxidized LDL is the kind that really does the damage to your arteries and can build up plaque.  Improving oxidized LDL is one of the goals of controlling arterial plaque as well.

3. Men With Bad Lipid Readings. One study examined men with both erectile dysfunction and “dyslipidemia.”  Dyslipidemia is medical speak for bad HDL, LDL, triglyceride or some combination of the three.  They gave these men 1.5 grams of niacin, which is a megadosed amount, and is a favorite of Dr. Davis.  (See my  Review of Track Your Plaque for Dr. Davis’ approach to plaque regression.) Besides the above listed benefits, niacin will also a) lower triglycerides, b) boost HDL, c) increase particle size and d) decrease LDL particle counts.  All of these are very anti-atherosclerosis and great for your arteries.

The researchers noted that “when patients were stratified according to the baseline severity of ED, the patients with moderate and severe ED who received niacin showed a significant improvement in IIEF-Q3 scores (0.56 0.96 [P = 0.037] and 1.03 1.20 [P < 0.001], respectively) and IIEF-Q4 scores (0.56 1.03 [P = 0.048] and 0.84 1.05 [P < 0.001], respectively] compared with baseline values, but not for the placebo group…For patients not receiving statins treatment, there was a significant improvement in IIEF-Q3 scores (0.47 1.16 [P = 0.004]) for the niacin group, but not for the placebo group. Niacin alone can improve the erectile function in patients suffering from moderate to severe ED and dyslipidemia.” [3]

These results are remarkable, because it appears that not only can niacin improve short term erectile function in many men, but also can likely help to reverse arterial plaque if a comprehensive program is undertaken.  Of course, neither I nor anyone else knows how safe megadosed niacin is long term, but many experts consider it safe when used under the care of a knowledgeable physician.  You’ll have to do your own due diligence.

Who Can Likely Boost Erectile Strength from Taking Niacin?

a) Some Vegetarians and Vegans. It should be pointed out that certain animal-based foods are known for being the highest providers of niacin. So does this mean that animal-emphasized diets will result in increased blood flow over vegetarians?  My experience on the Peak Testosterone Forum has been the opposite and this is the subject of my book The Peak Erectile Strength Diet. Basically, a great many plant foods directly stimulate nitric oxide and will increase blood flow while lowering blood pressure. In fact, some plant foods can lower blood pressure as much as modern hypertension medications. See my page on Flaxseed and Blood Pressure for an example of that. High nitrate foods, such as spinach, arugula and beets, are yet another example.

In contrast, even moderate amounts of saturated fat in animal foods will lower nitric oxide and actually “stun” arteries.  Researchers have searched for ways to overcome these artery-numbing effects of saturated fat and only exercise and certain nuts, such as walnuts, are powerful enough to overcome this clinical effect.

Futhermore, I have seen many times on the Forum where men have dropped their blood pressure dramatically going on a whole foods, mostly plant-based diet.  One man with essential hypertension, which is nastiest kind, actually dropped his blood pressure by over 20 points switching to plant-based diet! [2]

That said, I think that guys like myself who eat a ton of plant foods have to be consider the fact that they may not always be getting all the niacin they could.  Men with lower niacin status can probably give their erectile strength and cardiovascular health a nice boost by consuming more niacin-rich plant foods.  There are many plant foods, such as broccoli and mushrooms that are quite high in niacin.  I actually consume nutritional yeast and BPA-free sardines daily and get a nice amount of niacin this way on top of my regular diet.  Therefore, I feel that I am likely maximizing my erectile strength by combining the best of both worlds, i.e. some NO-boosting plant foods and high niacin foods as well.  (Both  sardines and nutritional yeast also have a decent amount of protein as well, which is important to me since I enjoy lifting weights.)

b) Men With Digestive Disorders. There are many, many GI disorders that plague modern, urban dwellers:  atrophic gastritis, Crohn’s, diverticulitis, enzyme deficiencies, IBS, ulcerative colities and on and on.  All of these can lower vitamin and mineral absoprtion.  Men struggling with these issues may very well benefit from increased amounts of niacin in the diet or possibly with supplementation.

By the way, even though animal foods have higher levels of niacin, this can backfire:  our intestines are narrow, convoluted and almost identical to that of an herbivore.  We simply were never meant to digest a slow moving, low fiber, high fat animal carcas and many studies on gut flora and intestinal disorders are bearing this out.

c) Men with Poor Libid Readings Who Megadose. According to the above study, megadosing with niacin can be a big help for men with low HDL, high triglcyerides and/or high LDL.  Keep in mind that this must be accompanied by lifestyle changes that focus on diet and exercise to really make it work.

1) J of Applied Physciology, Jan 15 2014, 116(2):156, “Vascular endothelial function and oxidative stress are related to dietary niacin intake among healthy middle-aged and older adults”

2) https://www.peaktestosterone.com/forum/index.php?topic=7236.0

3) J Sex Med 2011 Oct, 8(10):2883-93, “Effect of niacin on erectile function in men suffering erectile dysfunction and dyslipidemia”

Depression: How Men Can Beat It - Peak Testosterone

Many of you know my story: I was low testosterone (almost for sure) since puberty and struggled with dysthmia (mild depression) until age 52 when I got my first testosterone cypionate shot. Bam! I remember thinking, “Wow! I finally know what it feels like to be a normal person.” Of course, not everyone experiences that kind of effect from HRT, but it happens quite often as testosterone has a HUGE impact on us guys right between the ears. (You can read more about the subject in my link on Testosterone and the Male Brain.)

More importantly, I have notice a big percentage of men on The Peak Testosterone Forum are struggling with depression but are getting no useful information – often quite the opposite – from their front line doctors. (Not all physicains are like this, but many are and so I think it is important to highlight this.)  There are a lot of reasons for that, which I will discuss below, but let’s look at some of the comments straight off the the forum that are just downright scary in my opinion:

“Been to all sorts of doctors and all kind of tests, no help from any of them… and thing are bad. taking vitamins and ALC and hope my nerves get better somehow. Stress and depression are killing me. So everyone be gentle with yourself. It’s one of the worst things that can happen to a man. I feel like theres no point to live anymore, I cant concentrate on my work nor sleep. losing my friends because I feel like I’m uncapable to communicate like I did before the stupid accident. I’m screwed. I had perfect body and mind. Now there’s nothing left of me.” [1]

“I’ve been fighting a periodic stress induced problem for about 7 years now starting in 2005. I’ve had 4 “episodes” now. They always start in periods of high stress and last from 1 month to 6 months depending on how long it takes me to get on top of the stress. I get depression, anxiety, and I have a very specific form of insomnia where I wake up many times a night with bladder pain like I need to urinate but little or nothing is actually voided. These episodes are really hard on me, my family and my job.” [2]

“I wanted to see if anyone had any ideas on how to get a more agressive doctor to address my symptoms…I also told him of shortness of breath, elevated pulse rate, and borderline hypertension… I also have depression/anxiety/chronic fatigue.  I don’t know if I should go to a immunologist, neurologist, endo, or that guy from “House” (the old tv show)?” [3]

“The first endocrinologist didn’t offer any help because my testosterone was in the “normal” range and because I “look like an athlete” (I was +20% bodyfat and bloated). He told me to “be confident” regarding my anxiety and depression/mood swings.” [4]

These are just a few quotes, but you get the idea.  Obviously, these men are struggling. Because I see this so often, I am including the subject of depression as Step 10 in my “Peak Testosterone Program”, which deals with the typical symptoms that we see over and over again: fatigue, anxiety, mental fog, low testosterone, erectile dysfunction and so on. Yes, depression can cause all of these and so I want to cover some of The Natural Ways to Overcome Depression that your doctor will probably never discuss with you:

CAUTION: Do not quit any medication without discussing it first with your physician.  Likewise, do not add any supplement without first discsussing it with your doctor if you have an underlying medical condition or any current medicaitons.

1. Testosterone. A few savvy practitioners out there are now screening depressed men for low testosterone levels. Why? Because depression has been shown in numerous studies to be linked to low T and, furthermore, giving a man HRT (testosterone therapy) can often improve his depression.  I am living proof of that one!  To see some of the research, check out my link on Testosterone and Depression. Again, the reason that testosterone is so helpful in this area is that testosterone stimulates many neurotransmitters, including dopamine, and is just good for male brain health as you can see in my link on Testosterone and the Brain.

2. Nutrition, Supplements and Exercise. There are actually many nutrients that, when low, can create or worsen depression. Your brain is a huge energy hog and requires massive amounts of vitamins, minerals, fatty acids, amino acids, antioxidants, anti-inflammatories, etc. in order to run effectively. It is too much to cover here, but I discus all of this in my link Natural Depression Cures. Put these small things together and they can make a huge difference.

3. Meditation and PMR. There is a strong and underemphasized cortisol/stress/anxiety component to depression.  This aspect of depression responds very well to stress management techniques.  These take just a few minutes out of the day and are also just good for general health.  See my links on Secular (Non-Religious) Meditation, Mindfulness Meditation and Progressive Muscle Relaxation for the basics.

4. Thyroid. Hypothyroidism can cause or worsen depression. Unfortunately, most doctors do not do an extensive evaluation and so I urge you to read this link on The Many Causes and Ways to Diagnose Hypothyroidism for some good starter information.

Of course, sometimes depression is severe and incapaciting enough that it requires some kind of medical or psychological intervention.  Don’t put off treatment if you need it:  depression is very hard on the body.  It elevates inflammation levels, cortisol, free radicals and is so hard on the brain that it can damage the hippocampus and possibly other neurological regions as well.  It also may lead to hypgonadism in some cases and can lead to difficulties in the bedroom as I document in my link on Depression and Erectile Dysfunction. Obviously, that is only going to make a bad situation worse.

So, if you are struggling with depression, it’s important to face it and defeat it.  Again, stop by The Peak Testosterone Forum if you have any questions or comments.

REFERENCES:

1) https://peaktestosterone.com/forum/index.php?topic=2217.msg23764#msg23764

2) https://peaktestosterone.com/forum/index.php?topic=785.msg7007#msg7007

3) https://peaktestosterone.com/forum/index.php?topic=1310.msg12503#msg12503

4) https://peaktestosterone.com/forum/index.php?topic=2342.msg22942#msg22942

STEP 8: Treat Your Depression – Hopefully Naturally

Why Take Vitamin C? - Peak Testosterone

Hopefully, you have read about Some Potential Risks of Vitamin C. If so, you know that Vitamin C has definitely not turned out to be the rock star that so many promised.  In spite of that, Vitamin C, in some cases at megadose levels, does merit very strong consideration.

Here are some of the nice benefits from Vitamin C, including some potentially significant help in the bedroom:

1) Intercourse Frequency. Yes, you read that right. One study of healthy young volunteers found that 3 grams/day significantly increased their frequency of sexual intercourse.  Not a bad day’s work for a cheap supplement, eh? [3]  The authors of the study noted that vitamin C improves “catecholaminergic activity, decreases stress reactivity, approach anxiety and prolactin release, improves vascular function, and increases oxytocin release”.  Of course, all of these can improve your bedroom performance, desire and enjoyment.

2) Your Brain. So is there anywhere where megadoses of Vitamin C seem justified?  One good example is in the brain.  As I frequently point out, the brain is a huge energy and nutrient hog and Vitamin C is no exception. Several studies have shown Vitamin C intake correlated with improved cognitive function [4] and neuroprotection. [5]  But it should be noted that there are other studies that show no correlation between Vitamin C intake and cognitive function.  Researchers examining the Rotterdam Study, for example, concluded that “there was no association between cognitive function and intake of vitamins C and E”. [6]  Again, though, the majority of studies show some advantage to Vitamin C supplementation.

3) Blood Flow, Nitric Oxide and Erections. There is good evidence that in men struggling with endothelial and erectile dysfunction that Vitamin C can significantly help their situation.  I show all the latest evidence for this in my link on Vitamin C and Erectile Dysfunction.

4) Weight Loss. Researchers found that “Vitamin C status is inversely related to body mass. Individuals with adequate vitamin C status oxidize 30% more fat during a moderate exercise bout than individuals with low vitamin C status; thus, vitamin C-depleted individuals may be more resistant to fat mass loss”. [9] But remember this is only for Vitamin C deficient individuals and does not justify megadosing.  You can get plenty of Vitamin C from food to overcome these kind of deficits.

1) J Am Col Nutr, 1999, 18:166-70, “The effect of ascorbic acid supplementation on the blood lead levels of smokers”

2) EurJ Cancer Prev, 1998 Dec, 7(6):449-54, “Effects of high dose vitamin C treatment on Helicobacter pylori infection and total vitamin C concentration in gastric juice”

3) Biological Psychiatry, 15 August 2002, 52(4)371-374, “High-dose ascorbic acid increases intercourse frequency and improves mood: a randomized controlled clinical trial”

4) Eur J of Clin Nutr, 2003, 57(Suppl1):S54 S57

5) J. Amer Geriatr Soc, 2000, 48:1285 1291

6) Am J Epidemiol, 1996, 144:275 80

10) Int J Sports Med, 2001 Oct, 22(7):537-43, Peters EM, Anderson R, Nieman DC, Fickl H, Jogessar V., “Vitamin C supplementation attenuates the increases in circulating cortisol, adrenaline and anti-inflammatory polypeptides following ultramarathon running.”

11) Psychopharmacology (Berl),Jan 2002,159(3):319-24

12) J Strength and Conditioning Res,1998,12(3):179-184

13) https://www.sciencedaily.com/releases/1999/08/990823072615.htm

14) Free Radic Biol Med, 2009 Jan 1, 46(1):70-7, “Vitamin C treatment reduces elevated C-reactive protein”

15) Free Radical Biology and Medicine, April 2003, 34(7):881-891, “Vitamin C protects low-density lipoprotein from homocysteine-mediated oxidation”

5) Cortisol and Stress Reduction. Vitamin C has been shown in a number studies to reduce cortisol during times of stress.  For example, one study of ultramarathoners [10] showed decreases in cortisol from those given megadoses of Vitamin C.  Another (almost humorous) study induced stress by forcing subjects into public speaking and mathematical test-taking situations and found that 3000 mg reduced cortisol levels significantly.  [11]  More recent research found that 1,000 mg of Vitamin C reduced cortisol levels in weight lifters for 24 hours after lifting. [12]  Animal studies have shown the same thing on animals under stress. [13]

6) Skin. Vitamin C protects your collagen, a key component to any anti-aging regimen for your Skin and Appearance. Now I know of no study that shows that oral Vitamin C supplementation reduces wrinkling and sagging.  However, it is very likely that Vitamin C does reduce or at least protect your skin from wrinkling on a small scale. In fact, researchers just found that Vitamin C protects skin cell DNA through fibroblast stimulation [14] and think it may help to actually heal the skin. NOTE:  Vitamin C definitely can reduce wrinkling if applied topically.  See this link on Skin and Topical Vitamin C for more details.

7) Immunity. Vitamin C has many immune-boosting properties but hasn’t done quite as well in the studies as one might hope.  However, one thing that most experts agree upon, as I document in my link on Immunity, is that Vitamin C often lowers the effects of colds and flus.  The worst thing about colds and flus is that they last for a week or two and make you miserable with drainage, runny nose and similar symptoms. Vitamin C seems to help significantly with these type of symptoms, thus putting it somewhat in the “pain reliever” category, i.e. making your cold or flu more tolerable while you give your body’s own immune system time to recover.

8) Mood.  The above study, and others as well, have found that Vitamin C often improves mood and reduces depression. [3]

10) Lead. Megadoses of Vitamin C have substantially reduced baseline lead levels in several studies.  For example, one study on smokers showed that a gram daily of vitamin C reduced lead levels by a whopping 80%. [1]

11) Libido. One reader reported to me – this is anecdotal of course – that Vitamin C helps significantly with his ADHD and libido.  I explain why this may be the case for some men in this link on Vitamin C and Libido.

12) Inflammation. There is gathering evidence that Vitamin C may improve inflammation, particularly in at risk men.  One prominent example was a 2009 study showed that CRP (C-Reactive Protein) can be reduced by 25% in men (and women) with levels  > 1.0 mg/L. [14] What is remarkable is that this was achieved with a mere gram per day, which is a fairly low intake by “Linus Pauling” standards.

13) Homocysteine Protection.  Hopefully, you have read my Erectile Dysfunction and Homocysteine page. Basically, that article warns men that even mid normal homocysteine levels can lower nitric oxide and increase the risk of erectile dysfunction (and heart disease).   Vitamin C may actually be a huge help in this battle because it protects against oxidized LDL, which is what can increase atherosclerotic plaque. [15]

Vitamin C – My Current Dosage and Strategy

My strategy is to take 3 500 mg doses of Ester-C or one of the equivalent supplements. And I will take more if I feel as if I might be getting sick. And I always take Vitamin C with no fat in my stomach.  Of course, this is no problem for me as I almost always consume a Low Fat Diet anyway.

NOTE: Regular Vitamin C is acidic and can be hard on the stomach:  you may want to consider the Ester-C (500 mg) , which is neutralized, if you do decide to take it.

REFERENCES:

Psychogenic Aid? Priligy Review - Peak Testosterone

This is a quick review as to how one reader believed Priligy (dapoxetine) overcame his erectile issues.  Now keep in mind that this class of drugs, in general, is filled with negative side effects and will likely cause long term health issues.  Furthermore, Priligy is not even approved yet in the U.S. for any usage whatsoever.

However, I did want to discuss what this reader wrote – I got his permission of course – because his reported results were so dramatic and it brings up some issues with respect to psychogenic (psychological) erectile dysfunction.

Here is what he wrote.  You’ll immediately notice the enthusiasm:

READER: “First let me tell you about Dapoxetine (brand name Priligy). See, I can get a full erection with stimulation, I just can’t keep it for more than 5 seconds without stimulation. I also have to stay on the edge of climax to have and maintain a full erection, problem has been that when I’m inside a woman and I get to the point of climax I have to slow down.”

“The problem with this is that sometimes slowing down means my erection starts to go way, then it becomes clear that I’m losing my erection while inside a woman, it becomes psychological and then the battle is lost.”

“Met a very fun and open minded girl, took a 10mg dose of Cialis and a 30mg dose of Dapoxetine before sex, this time instead of having to slow down and risk losing my erection, I was able to just keep going, and going, and going. It was the first time in about 7 or 8 years that I’ve really been able to knock a woman’s socks off sexually.”

1) Ther Clin Risk Manag, 3(2):277 89. “Dapoxetine, a novel selective serotonin transport inhibitor for the treatment of premature ejaculation”.

2) The Lancet, Sep 2006, 368(9539):929-937, “Efficacy and tolerability of dapoxetine in treatment of premature ejaculation: an integrated analysis of two double-blind, randomised controlled trials”

3) Journal of Clinical Psychiatry, Feb 1993, 54(2):71-72, “Vasoconstrictive effects and SSRIs”

So what is Priligy? Could it really have cured 7 or 8 years of erectile dysfunction?

What is interesting is that Priligy is actually used in much of Europe for premature ejaculation, not erectile dysfunction, and it has several studies behind it in this area. [1][2] Furthermore, Priligy is an SSRI and SSRI’s are notorious for actually causing erectile dysfunction. In fact, seratonin is actually a vasoconstrictor, i.e. it will often contract your arteries and reduce blood flow (to your penis). [3]

CAUTIONS: This drug does have significant reported side effects: “common adverse events (30 mg and 60 mg dapoxetine, respectively) were nausea (8 7%, 20 1%), diarrhoea (3 9%, 6 8%), headache (5 9%, 6 8%), and dizziness (3 0%, 6 2%).” [2] In addition, some experts feel that SSRI’s can raise cortisol and, in the long term, potentially damage arteries.

REFERENCES:

Viagra and Female Libido - Peak Testosterone

As I often point out, in a physical and physiological sense,  sex is good for us males (although we do have to be careful with certain often-deadly STD’s). Of course, sex is good for females, too, and so that leads to some interesting questions:  “Why are there so many drugs that can help males with sexual function?” and “Will those same drugs that help middle-aged and beyond guys possibly help middle-aged and beyond females as well?”

Of course, the drug companies have looked into this, since that would open up a whole new market for them and found that there is some potential there.  This is not surprising since, as we have covered elsewhere, women have some analagous chemical, structural and circulatory similarities to us in their sexual response.  The clitoris and vaginal walls, for example, are dependent on blood flow and nitric oxide during sexual activity to a significant extent. In my article on the G-Spot, I even cover have researchers have discovered erectile tissues in women.

Here’s another important key:  lubrication in women is tied to nitric oxide and blood flow as well. [1] In fact, studies have shown that women with heart disease, and therefore impaired endothelial function, have decreased vaginal blood flow and lubrication, leading sometimes to “sexual arousal disorder”. [2]  Not that disimilar from us guys, eh?

So, then, why not Viagra for women?  Why can’t women achieve the same boost in sexual performance that guys experience?

The answer is that Viagra (sildenafil) has had significant success already in the research.  For example, one study of post-menopausal women found solid improvements in orgasms and clitoral stimulation from taking sildenafil and there was also an increase in mean – as in average – lubrication as well. [3] In fact, it is interesting to note that about one in eight women actually withdrew from this study because of “clitoral hypersensitivity”.  NOTE:  It should be noted that one study of women with Female Sexual Arousal Disorder (FSAD) showed no improvement in sexual outcomes, however. [4]  This may be why Viagra, Cialis and Levitra are not generally prescribed for female sexual dysfunction.

There is also evidence that another large class of women, those on traditional antidepressants, may be helped by sildenafil. Scientific American reported that about 11% of women (in the U.S.) were on an antidepressant [5], and, undoutedly, this is higher in the block of women (over 35+) that would likely consider or need treatment. In this huge category of women, literally tens of millions worldwide, Viagra has been shown to improve overall sexual function significantly. [6]

NOTE: Have her talk to her doc.  Loss of libido and sexual function in women can be the results of various serious medical conditions.

Of course, you can probably guess what I am going to say at this point:  instead of taking a drug, women can very likely experience similar improvement from the non-drug improvement of blood flow and nitric oxide that I recommend for guys.  See this link on How to Improve Erectile Strength to know the kind of things I am talking about.  Any of these items will likely improve clitoral sensitivity and sexual function in a much more natural way that avoids or limits the use of drugs.

In other words, if you’ve made significant lifestyle changes to improve your erectile strength, including exercise, diet and supplements, be sure to include the woman in your life. The changes that you are making will likely help her as well.  Furthermore, not only will it help you grow closer, it will help her become healthier, the rewards of which will likely manifest ifself in the bedroom as well.

CAUTION: Women on Viagra commonly experience many of the same side effects as men, including stomach upset and headache.  As far as I know, the lose-your-hearing and lose-your-sight side effects have not been reported.

REFERENCES:

1) International Journal of Impotence Research, 2003, 15:461 464, “Topical administration of a novel nitric oxide donor, linear polyethylenimine-nitric oxide/nucleophile adduct (DS1), selectively increases vaginal blood flow in anesthetized rats”

2) Eur Urol, 2000, 38: 20 29, “Anatomy and physiology of female sexual function and dysfunction: classification, evaluation and treatment options”

3) Urology, 1999 Mar, 53(3):481-6, “Safety and efficacy of sildenafil in postmenopausal women with sexual dysfunction”

4) Journal of Women’s Health & Gender-Based Medicine, May 2002, 11(4):367-377, “Efficacy and Safety of Sildenafil Citrate in Women with Sexual Dysfunction Associated with Female Sexual Arousal Disorder”

5) Scientific American, Feb 2008, “The Medicated Americans: Antidepressant Prescriptions on the Rise”

6) JAMA, 2008, 300(4):395-404, “Sildenafil Treatment of Women With Antidepressant-Associated Sexual Dysfunction”

Tamoxifen and Prolactin - Peak Testosterone

Tamoxifen (Nolvadex) is a drug that is not widely used for men’s issues based on what I have seen in the Peak Testosterone Forum. I was getting a slight amount of gyno when I first started my weekly testosterone cypionate injections and was offered tamoxifen. (Letrozole is used more by the steroid guys from what I have read, but this is what my clinic offered.) I solved the problems, actually, by losing a little weight and dropping my cypionate dosage. I also had an interesting case on the Peak Testosterone Forum where one man was using it in place of Clomid to raise his testosterone, because he was concerned about Clomid’s potential vision issues. [1] (See my link on Potential Risks of Clomid for more information.) And it reportedly raised his testosterone from 371 to 533 ng/dl, a modest increase at least, which is what any self-respecting SERM would do.

This forum poster also had mildly elevated prolactin and was concerned about a prolactinoma.  Of course, prolactinomas actually secrete extra prolactin by definition and can elevate a man’s prolactin levels substantially.  When this occurs, it is very bad for the bedroom since the extra prolactin can lower testosterone and libido.  And, of course, a large prolactinoma can cause other health issues, such as headaches if it grows too large.  And this poster was, indeed, experiencing may of the standard symptoms that accompany elevated prolactin and low testosterone: “erectile dysfuction, fatigue, low motivation, difficulty concentrating, grumpy, barely any morning wood, bad sleep.”

So was the tamoxifen he was taking raising or lowering his testosterone?  Well, there is no great study on men, but what research we do have all seems to indicate the same thing:  tamoxifen, in general, lowers prolactin:

1. Rats with Prolactinomas.  One study implanted prolactin-secreting tumors into rats and found that tamoxifen actually decreased tumor size and lowered prolactin levels. [2] In fact, it did it better than the frontline drug bromocriptine. This is a remarkable result, but, as far as I know, tamoxifen is not used in the battle against prolactinomas by physicians here in the U.S. Cabergoline, bromocriptine and surgery seem to be the standard medical treatments and you can read more the subject in my link on Testosterone and Prolactin.

2. Male Rats with Elevated Prolactin. Another study looked at rats who had their prolactin levels artificially increased with estradiol, which also enlarged the pituitary itself. [3] Remarkably, tamoxifen blocked both of these, i.e. normalized pituitary weight and lowered prolactin levels and, once again, outperformed bromocriptine!  As always, the problem is that this would be an off label use of tamoxifen and most physicians are unwilling to experiment with non-FDA approved usages of a medication.

3. Female Rats without Ovaries.  More verification came from a study of female rats where researchers studied the increase in the uterus and prolactin levels from injected estradiol.  The authors stated that “the results of the present paper showed that tamoxifen reduced estrogen-stimulated prolactin levels in some, but not in other hormonal conditions and that these effects were not mediated by an inhibition of lactotroph cell growth.”  In the female rats, bromocriptine was actually more powerful. Nevertheless, the tamoxifen did have a significant effect.

Of course, one should never self-treat when it comes to elevated prolactin levels or a prolactinoma.  Both can be potentially crippling and, of course, affect one’s sex life and marriage.  So always work with your doctor.

Nevertheless, tamoxifen’s effect on prolactin and related tumors is interesting, because in many men it would have a much better side effect profile. Both cabergoline and bromocriptine are notorious for rather harsh side effects.  Tamoxifen would also have the nice advantage of often raising testosterone levels a little as well as it did for the man above.

CAUTION:  Side effects are very high on higher dosage of tamoxifen used for cancer patients.  See this study for an example. [5] In addition, long term effects are poorly understood.  Discuss with your physician.

REFERENCES:

1) https://peaktestosterone.com/forum/index.php?topic=4303.0

2) J Endocrinol, 1980 Jul, 86(1):109-16, “Tamoxifen suppresses both the growth of prolactin-secreting pituitary tumours and normal prolactin synthesis in the rat”

3) Cancer, 1984 Apr 1, 53(7):1473-7, “Comparative effects of tamoxifen and bromocriptine on prolactin and pituitary weight in estradiol-treated male rats”

4) Horm Metab Res. 1996 Apr, 28(4):171-6, “Effects of tamoxifen on serum prolactin levels, pituitary immunoreactive prolactin cells and uterine growth in estradiol-treated ovariectomized rats”

5) Annals of Oncology, “Retrospective review of male breast cancer patients: analysis of tamoxifen-related side-effects”

The Liver: How It Can Affect Erections - Peaktestosterone

Non-alcoholic fatty liver disease (NAFLD) is nothing short of an epidemic in the U.S. and other modern, industrialized countries. If you read my link on Insulin Resistance and the Liver, you’ll see that NAFLD is very tied to insulin resistance and Metabolic Syndrome, so it is no wonder. Again, it is not unreasonable to assume about half of the men reading this page have NAFLD and that this is a very serious threat to not only their sex life but their life in general.  The moral of the story:  you can’t ignore your liver!

Yes, the liver is important and, as you probably remember from your high school biology, is that the liver performs many critical functions:  detoxification, processing medications, building proteins – the list could go on and on. And here is why you absolutely MUST take fatty liver disease very seriously:

1)   Postgrad Med J, 2006, 82:315-322 “Treatment of non-alcoholic fatty liver disease”

2) World J Gastroenterol, 2006 Dec 28, 12(48):7826-31, “Insulin sensitizers in treatment of nonalcoholic fatty liver disease: Systematic review.

3) World J Gastroenterol, 2007 March 14, 13(10):1579-1584, Nonalcoholic fatty liver disease is a novel predictor of cardiovascular disease”

4) HEPATOLOGY, 2010, 52(5), “Evolution of Inflammation in Nonalcoholic Fatty Liver Disease: The Multiple Parallel Hits Hypothesis”

5) J Clin Invest. 2003, 112(1):91–100, “The fat-derived hormone adiponectin alleviates alcoholic and nonalcoholic fatty liver diseases in mice”

6) The Journal of Clinical Endocrinology & Metabolism, Jun 1 2005, 90(6):3498-3504, “Plasma Adiponectin in Nonalcoholic Fatty Liver Is Related to Hepatic Insulin Resistance and Hepatic Fat Content, Not to Liver Disease Severity”

7) J Mol Med (Berl), 2002 Nov, 80(11):696-702, “Adiponectin: a link between excess adiposity and associated comorbidities?”

8) Ann Med, 2005, 37(5):347-56, “Fat in the liver and insulin resistance”

9) Cancer Cell, 17 Feb 2010, 17(2):115-117, “Obesity, Inflammatory Signaling, and Hepatocellular Carcinoma—An Enlarging Link”

10) Gastroenterology, Jul 2005, 129(1):113–121, “The Natural History of Nonalcoholic FattyLiver Disease: A Population-Based Cohort Study”

1. NASH.  Non-alcoholic steatohepatitis (NASH) is the ugly end point for some men who develop NAFLD.  All men with NAFLD have steatosis, which simply means fatty acids accumulating in the liver cells.  However, in some men this turns very ugly and you end up with steatohepatitis, or a form of liver disease that mimics classic hepatitis.  NASH is basically a condition that includes an inflamed liver with classic cirrhosis that is often debilitating and in some cases life-threatening. [10] Scientists have noted that there is little difference between the damaged liver that results from non-alcoholic fatty liver disease versus alcoholic fatty liver disease – it’s all bad news.

2.  Cardiovascular Risk Factors. NAFLD has become one of the many new risk factors for heart disease.  In other words, if you develop this type of liver disease, you are at increased risk for cardiovascular events and even death.  So one should treat NAFLD as erectile dysfunction, which also is a new predictor of impending heart problems.

3.  Type II Diabetes.  A fatty liver also increases your risk for type 2 diabetes. (The two conditions are highly interrelated.)

NAFLD appears to be such a powerful predictor that one recent study out of Japan found that it even foretold heart disease strongly than Metabolic Syndrome. Furthermore, it was found to be an independent risk factor for cardiovascular disease independent of all others.[3]  Researchers have noted that it is no wonder since “the liver, once fatty, overproduces most of the known cardiovascular risk factors such as very low density lipoprotein (VLDL), glucose, C-reactive protein (CRP), plasminogen activator inhibitor-1 (PAI-1), fibrinogen and coagulation factors.” [8]

All of that said, what makes this type of liver disease so problematic is that it appears benign to the men diagnosed with it. In fact, many men have it and do not even know it. NAFLD is definitely not an immediate death warrant and the great majority of men with this type of liver disease – 90% and above – do not even have symptoms. It is somewhat like most prostate cancers:  it exists for years often before it rears its ugly head.

When one overconsumes calories or has an increased oxidative (free radical) load due to being overweight, the liver begins to accumulate these to protect itself from toxic triglyceride byproducts.  Evidence is mounting in animal studies that endotoxins, which result from out-of-whack intestinal bacteria and dysfunctional TLRs (toll-like receptors), which result from being overweight, increase systemic inflammation and lead to NAFLD. [4]  Several studies have also shown that adiponectin, a key inflammatory cytokine, regulates liver fat. [5][6] As you put on weight, your body lowers adiponectin levels and your liver fat increases – it’s that simple.  Furthermore, adiponectin is strongly (and inversely) correlated to body fat. [7]  And our old archenemies TNF alpha and IL-6 also have been found in animal studies to directly cause liver inflammation, which can accelerate the nasty liver-destroying cirrhosis called NASH mentioned above. [9]

The bottom line is that almost every major inflammatory cytokine involved in disease and cancer plays an active role in the initiation and progression of non-alcoholic fatty liver disease as well.  And these cytokines all become misaligned through growing body fat.  That has lead researchers to observe that your fat (adipose) tissue literally attacks your liver.  Your liver is ground zero when it comes to the battle for your health.

When you put on enough weight, you are literally pitting one organ against the other and creating a sort of internal war on yourself:  the fat tissue makes war on the liver, which in turn assails both the heart and penis.

So what will your physician do if you are diagnosed with non-alcoholic fatty liver disease?  You and your physician need to agree on a course of action andt there are several common elements in current treatment. [1]

1. Treat any underlying diabetes, insulin resistance or Metabolic Syndrome.  This can involve pharmeutical solutions in some cases.  Metformin and thiazolidinediones, insulin sensitizing drugs, have been popular in studies and done quite well. [2]

2. Improve insulin sensitivity by encouraging exercise and weight loss.

NOTE: A higher fat diet will also actually induce insulin resistance and so care must be taken. Although consuming a diet higher than about 40% fat is probably not that common, care should be taken.

3. Protect the liver through antioxidants and other supplements and agents.

Obviously, this is not where you want to be in the sense that you want to stay off of pharmaceuticals if at all possible. Phamaceuticals always have side effects and long term unintended consequences.  It is always better to let the body heal itself if one can and go about things naturally.

Here are some ideas to keep your liver fat free:

1. Insulin Resistance.  Read my link on Insulin Resistance and the Liver and battle the underlying insulin resistance at the same time that you battle the underlying inflammation.

2. Dietary Fat. Be very careful with dietary fat levels.  Remember that high fat diets are used in laboratory animals to induce insulin resistance and high fat diets will often increase inflammation as well.  Fat is also very calorically dense and can lead to weight gain, leading to a viscious cycle of increasing inflammation and insulin resistance. (By the way, this is yet another reason that many of the Atkins, Paleo and Low Carb diets can get you into trouble quickly. They seem like a good idea but can be very hard on the heart and liver.)

3. Weight Loss and a Low Fat Diet.  A whole foods Low Fat Diet can decrease control and even decrease liver fat content.  One study noted that “liver fat content can be decreased by weight loss and by a low as compared to a high fat diet.” [8]

4.  Fructose.  Watch your fructose!  It is known for both increasing insulin resistance and inflammation.  Read my links on

5.  Anti-inflammation. Yes, a little inflammation is a good things for figthing infections and basic immunity.  However, the vast majority of us in modern societies have the opposite problem:  an overactive inflammatory response.  Read this link on How to Control Inflammation for many ideas on how to get out of the inflammation rat race.

REFERENCES:

Potential Dangers of Higher Dose HCG? - Peak Testosterone

HCG is widely used by women as a dietary aide – it supposedly suppresses appetite – and by men for hypogonadism (clinically low testosterone) in various protocols. The usage by men is typically done

a) by itself to boost clinically low testosterone – see my page called HCG Monotherapy for more information – or

b) added 2-3 times per week (low dose) with standard testosterone replacement therapy (TRT). So the question, of course, is whether or not this type of usage of HCG is really safe.

Now, before I go on, I want to clearly say that I think that, generally speaking, HCG is safe.  Many doctors and TRT clinics are giving men HCG and I am not hearing of reported issues. And keep in mind that I am about to go on low dose HCG myself and, in my page on The Benefits of HCG for Men on TRT, make a case for HCG as a nice complementary therapy.  However, I think that some caution is in order when HCG is used in higher dosage amounts for reasons I will discuss below. (I also think you should stay away from dairy if you use HCG for reasons I will discuss below.)

My concerns started with a story that one man (Balderdasher) told on our forum:

“HCG and T together with Adex worked great (in fact, I felt better on the combination than I did on mono T). That said, I ended up getting a really rare (one in several million) benign lip tumor about a year ago (Angioleiomyoma) that continually regrew, leading to three surgeries/procedures to remove it. The Head & Neck guy I worked with was a really solid dude, and did some intensive research into what may have caused this growth. Apparently, a lot of the cases he reviewed wherein males presented with this tumor type also saw the individuals using HCG and PDE5 inhibitors, leading him to conclude that HCG + Viagra/Clomid are what did it for me. Now that you mention the clotting sides of Arimidex, however, I wouldn’t be surprised if that played into it as well. All of this also coincided with a meniscus tear and some weird wrist issues that seemed to present out of nowhere (being a guy who had never broken a bone/torn anything in his life despite a lot of years of bruising and beating).”

REFERENCES:

1)  https://www.peaktestosterone.com/forum/index.php?topic=6591.0

2) J Clin Endocrinol Metab. 1995 Jun;80(6):1967-71, “Human chorionic gonadotropin-dependent expression of vascular endothelial growth factor/vascular permeability factor in human granulosa cells: importance in ovarian hyperstimulation syndrome.

3) Reproductive Biomedicine, 2009, 18(6):743 749, “LH/HCG stimulation of VEGF and adrenomedullin production by follicular fluid macrophages and luteinized granulosa cells”

4) African Journal of Biotechnology, 2011, 10(42), “Overexpression of hypoxia-inducible factor prolylhydoxylase attenuated by HCG-induced vascular endothelial growth factor expression in luteal cells”

5) FASEB J, 2006 Dec, 20(14):2630-2, “Angiogenic activity of human chorionic gonadotropin through LH receptor activation on endothelial and epithelial cells of the endometrium”

6) Biology of Reproduction, Published online before print July 18, 2012, “Human Chorionic Gonadotropin Triggers Angiogenesis via the Modulation of Endometrial Stromal Cell Responsiveness to Interleukin 1: A New Possible Mechanism Underlying Embryo Implantation”

7) J Invest Dermatol, 2013 Jan,133(1):230-8, “Epidermal growth factor facilitates melanoma lymph node metastasis by influencing tumor lymphangiogenesis.

8) The Egyptian Journal of Histology, Jun 2011, 34(2):403-414, “Effect of sildenafil (Viagra) on epidermal growth factor expression in submandibular gland of diabetic male rats: histological and immunohistochemical study”

Before I say anything else, let me just say that the above is quite rare.  That said, notice that Balderdasher was on a standard HRT clinic protocol – I was on it myself for awhile – called “The Trifecta,” which includes testosterone cypionate injections, Arimidex (anastrozole) and low dose HCG.  Balderdasher’s medical condition started shortly after he stopped the Trifecta as reported on  Peak Testosterone Forum:

“Shortly after coming off of TRT I was diagnosed with an extremely rare (and thankfully benign) tumor called an Angioleiomyoma in my lip, which apparently has something to do with your vasculature.” [1]

Notice he mentioned that vasculature – something I will come back to in a minute – played a role.  This tumor caused quite a bit of trouble for him.  He wrote me:

“Re: the tumor – it was a nightmare. Had an ENT who performed an in-office procedure to take it out – twice. Both times it grew back swiftly. Finally, on the third go-round, he referred me to a specialist who knocked it out once and for all with surgery. It probably wouldn’t have been a big deal if I’d gone this route in the first place but, unfortunately, the cumulative effects of three procedures left me with a still slightly swollen lip and a lack of sensation (not too bad, I’m really the only one who could ever tell). Could have been worse but man, definitely not something you want to deal with when you’re already riding the TRT rollercoaster.”

So let’s go back to what his Ear, Nose and Throat specialist said, i.e. that he had been seeing quite a few cases out there with men on HCG and PDE5 inhibitors developing these kind of hypervascularized tumors.   This caught his attention because these tumors are so rare. So then the question becomes: “Is it the HCG, the Cialis / Viagra, or both?”

I suspect that HCG probably does play a role, and let me give you several reasons why I think it could contribute to a hyperstimulation of one’s blood vessels and this type of tumor in some rare cases:

1.  Increasing VEGF. VEGF stands for Vascular Endothelial Growth Factor.  VEGF is very important and stimulates angiogenesis, i.e. the development of new blood vessels.  Of course, one needs some VEGF for tissue repair and maintenance.  However, as we age, we are very vulnerable to endothelial cancers.  The endothelium is the delicate lining of our arteries, blood vessels and lymphatic system, and it is this lining that is the key to many types of cancers.  Cancers need fuel to grow rapidly and angiogenesis via the endothelium is one of the keys.

Because of this, there are now some experts recommending an anti-angiogenic diet.  Basically, the goal of this diet is to consume foods that limit VEGF.  This has also been the source of considerable pharmaceutical research as myself. I myself actually try to generally eat this way, although I don’t think an anti-angiogenic diet will usually actually reverse cancer.  However, I think it is important to make life miserable for any cancer cells and an anti-angiogenic diet can be a great weapon in your anti-cancer arsenal.

So what does that have to do with HCG?  Well, it turns out HCG stimulates VEGF:

“Our results suggest that the effects of hCG on the development and course of OHSS may be mediated by the production of VEGF/VPF by GCs [granulosa cells].” [2]

“Luteinized granulosa cells and macrophages actively secrete vascular endothelial growth factor (VEGF) and adrenomedullin in the human ovulatory follicle. LH/human chorionic gonadotrophin (HCG) directly stimulates VEGF synthesis by granulosa cells while adrenomedullin may play a role in the process of luteinization.” [3]

It should also be added that anything that stimulates nitric oxide, such as PDE5 inhibitors, will also stimulate VEGF. Of course, many men going on PDE5 inhbitors are probably low in vascular growth factors, and so this is probably a good thing.  More study work needs to be done though – this is speculation on my part.  An example of this is that diabetics are actually low in another related growth factor called EGF, or endothelial growth factor, according to an animal study. [8] However, some men due to diet – dairy has a lot of growth factors in it for example – and genetics may have elevated growth factors and HCG or PDE5 inhibitors may throw them over the edge.  Yet another possible example of this is the fact that Viagra has been linked to skin cancer.

UPDATE: I contacted Balderdasher, the man in the story above, and asked him if he was consuming any dairy at the time.  It turns out that he was having yogurt in both the morning and evening when he developed the tumor.  According to my understanding, this could also have contributed, because dairy is quite high in growth factors, especially EGF.  EGF, epidermal growth factor, is not just involved in skin cancer but has been associated with several other cancers, including anal and lung.  One EGF compound, betacellulin, is particularly potent and plentiful in milk.

2. Increasing Angiogenesis. So, if HCG stimulates VEGF, does it actually encourage angiogensis?  The answer is ‘yes!’  There are many studies and reviews that have looked at this:

“Vascular endothelial growth factor (VEGF)-dependent angiogenesis plays a crucial role in the corpus leteum formation and their functional maintenances in mammalian ovaries. We recently reported that the activation of hypoxia-inducible factor (HIF)-1a signaling contributes to the regulation of VEGF expression in the luteal cells (LCs) in response to hypoxia and human chorionic gonadotropin (HCG).” [4]

“In this manuscript, we demonstrate an angiogenic effect of hCG in several in vivo (chick chorioallanto c membrane, matrigel plug assay, aortic ring assay) and in vitro experimental models.” [5]

“Prior exposure to hCG amplified MCP1 secretion by ESCs in response to IL1B and triggered the release of angiogenic activity in vitro in which MCP1 appeared to play a significant role.” [6]

Of course, the significance of this is that HCG stimulates both VEGF and angiogenesis, and so it would seem reasonable that it could contribute to the growths that the above physician is seeing.  Remember that PDE5 inhibitors, such as Cialis and Viagra.  I also think that dairy consumption could play a role as well.

3. Placental Hormone – That Should Tell You Something. One thing that most men on HCG do not know until later is that HCG is NOT LH.  They may also be surprised to know that HCG is actually a placental hormone.  The placenta is the organ in a woman that nourishes and takes care of the fetus.  HCG actually fulfills a very unique purpose for a newborn:  fueling the rapid growth of the unborn child.  Basically, the fetus is put on “turbo growth” mode by HCG.

In other words, more is not always better.

Turbo growth mode is great for the little ones, but not so for us as we age, because it could leave us vulnerable to cancer and other growths.  Another great example of this is IGF-1, interleukin growth factor-1.  You want abundant IGF-1 when you are young to maximize size and development.  However, elevated IGF-1 levels in older adults are associated with rapid aging, diabetes and cancer.  Again, once your body has accumulated decades of DNA damage and toxins along with decreased antioxidant and enzyme levels, extreme caution is warranted in increasing growth factor levels.  “Going back to the womb” is not always a good idea.

4. Epidermal Growth Factor. LH and HCG stimulate another growth factor called Epidermal Growth Factor.  As you may have guessed from the name, overly high levels have been linked to melanoma. [7]

5.  Long Half Life. Most men starting on HCG do not realize that it has a much longer half life than LH – 24 hours versus 20 minutes. They are usually told that HCG is LH and, therefore, is very natural.  Again, this is simply not the case.  HCG is a similar molecule and does trigger the same receptors.  But it is not chemically identical with LH.  Furthmore, one could argue that HCG clearly has a longer half life in order to constantly trigger fetal growth, whereas LH occurs in nice short bursts that are much more safe for an adult.

MY CONCLUSION: Again, I am not trying to be alarmist here.  I believe that HCG will be found to be safe for most men, especially younger, when they do finally study it in long term.  Furthermore, literally hundreds of thousands of men have used it with few reported side effects.  However, I personally will shy away from HCG at my age (55) to play it safe until more study work is done.  Of course, you have to do your own research and talk to your own physician if you are interested in HCG.

Also, remember that I have more concern than most because I had a high PSA value a couple of years ago.    You can read about my story here:  High PSA But No Cancer. While it’s true that I now have my PSA almost down to the levels when I first started cypionate, I have to play it safe due to my age (55) and one time PSA value of 6.3.  (Current PSA:  1.75.)

NOTE: You may be wondering why I left PDE5 inhibitors such as Viagra and Cialis off the hook.  I guess I should also mention that PDE5 inhibitors also stimulate VEGF and angiogenesis according to several studies. So could it be the PDE5 inhibitor more than HCG?  Sure.  Again, until we know more, I am going to wait on HCG since the two may synergistically raise VEGF.

Propecia: An Irreversible 5 Alpha-Reductase Inhibitor - Peak Testosterone

Several studies have now documented the fact that Propecia (finasteride) seems to have persistent hormonal, psychological and sexual side effects. This has also been verified in the practices of many physicians and in a large body of FDA complaints that eventually inspired the FDA to require a label change in 2012. [6] In fact, one could say that the symptoms in some men are “irreversible.”  I use that term deliberatley, because it turns out that Propecia was initially thought to be a reversible enzyme inhibitor but later was found to be an irreversible one.  Below I will explain just exactly what that means and why:

But first let me give a little history and explain that are two general classes of enzyme inhibitor:  reversible and irreversible. In the case of a reversible inhibitor, the medication weakly binds to the enzyme and can be fairly easily backed out, leaving the original enzyme functional and usable.  The irreversible inhibitor acts in the opposite fashion and  binds powerfully and chemically to the enzyme via covalent bonding – remember your high school chemistry – and thus completely takes the enzyme out of commission.  Another term for an irreverisble inhibitor is – and I have a page on this:  Suicide Inhibitors. The term suicide inhibitors sounds a little scary, but perhaps they should be if you stop and think about what they are doing.  Essentially, these type of inhibitors go in and annihilate an enzyme from your system or at least a large percentage and your body is then left with the ominous and all-critical task of rebuilding those enzymes.  More on this below.

1.Originally Thought to Be a Reversible 5-Alpha-Reductase Inhibitor.  According to some reports, it was originally thought to be a more tame reversible enzyme inhibitor as this 1995 book states:

REFERENCES:

1) J Clin Psychiatry, 2012 Sep, 73(9):1220-3, “Depressive symptoms and suicidal thoughts among former users of finasteride with persistent sexual side effects”

2) Current Medicinal Chemistry, June 1995, p. 594

3) CNS Drug Reviews, 12(1):53 76, “A New Look at the 5 -Reductase Inhibitor Finasteride”

4) https://www.peaktestosterone.com/forum/index.php?topic=7760.0

5) J Clin Endocrinol Metab, 2003 Dec, 88(12):5951-6, “Pharmacokinetics and dose finding of a potent aromatase inhibitor, aromasin (exemestane), in young males”

6)

“Finasteride was originally reported to be a competitive, reversible inhibitor of SR [Steroid 5-Alpha Reductase]…Recent work suggests that finasteride is an irreversible inhibitor for the human Type 2 isoform, while it appears to be reversible with the rat Type I isoform.” [2]

I find it a little hard to believe no one knew, but that is the official version anyway.  For those who don’t know, 5-alpha-reductase is the enzyme that converts testosterone into the even more potent androgen dihydrotestosterone (DHT).

2. Reversible versus Irreversible 5-Alpha-Reductase Inhibitor. . Some men may be familiar with Aromasin (exemestane), which is an irreversible aromatase inhibitor that is used quite often in men on HRT (testosterone therapy).  If a man accidently crashed his estradiol with Aromasin, then it can take the body 2-3 weeks to rebuild its stores of aromatase enzymes.

3. Enzymes Are Rebuilt Within Two Weeks (The Great Majority of Times). Research shows that it takes your body two weeks to rebuild the missing enzymes generally.  This is based on the observation that “multiple daily doses for 1 2 weeks led to a similar 65 80% suppression of serum DHT, suggesting that tolerance did not develop to a chronic finasteride regimen in men. It has been reported that DHT concentrations recover within 2-weeks following the cessation of finasteride treatment in men , a finding that would be consistent with the slow turnover for the human Type I and Type II enzyme complexes.” [3] Again, this is similar to the recovery time from Aromasin mentioned above.

4. What If Your 5-Alpha-Reductase is Crashed? There is little evidence of permanent crashes from Aromasin (exemestane), which works on aromatase.  From what I can tell, the steroid community is pro-Aromasin and is not concerned about permanent crashes and they, of course, often take too much Aromasin and leave their estradiol in very low states. However, we did have one man who believed Aromasin permanently crashed his estradiol, and I documented on this page called  Permanent Low Estradiol from Aromatase Inhibitors?

Is this the root cause of Propecia’s issues?  Probably not, but I mention it here, because if you test very low for DHT post-finasteride with solid levels of tesetosterone, it might make one wonder.

My Personal Health Story - Peak Testosterone

I’ve had a number of men on the Peak Testosterone Forum (and in emails) ask why I started this site.  And they’ve asked what has worked for me and what hasn’t.  And they’ve asked how I boosted my testosterone.  Those are all fair questions of course.

When asked a question like this, I scarcely know where to start.  It has been a very long road and I’ve been through about five distinct stages. I’m not trying to bore anyone into a coma, but I think most of the men coming to the site are very much going to relate to one of these and so I am going to do a thumbnail sketch of each:

NEWS FLASH: I was pretty excited to have an interview with Men’s Health Magazine, which was published in a recent 2015 issue, regarding TRT. You can read about it here: My Men’s Health Magazine Interview.

Well, it all started for me in about 2007.  This is when I really hit “the Wall”.  As I’ve described elsewhere, I was absolutely miserable.  Here were some of my symptoms:

Basically, I was just barely able to function at work and in my personal life. Survival was just about my only goal. Work, relationships – everything was a chore.

Of course, I searched for answers.  I began reading on the internet and tried to find what would cause my symptoms.  To my surprise, I found many syndromes that could supposedly cause these symptoms.  This included adrenal fatigue, yeast overgrowth/candididas, celiac’s disease, Lyme Disease, Epstein-Barr, fibromyalgia, Chronic Fatigue Syndrome and several others.  The doctors ran all the standard tests and found nothing.  I even had my colon checked for celiac disease and nothing turned up.  Everything was a dead end.

My doctor at the time was an excellent diagnostician if you had the flu or a stomach ulcer or a rash or broken leg.  But he absolutely did not know what to do with me. When I explained to him that I was beginning to experience a little erectile dysfunction, his solution was simple:  20 mg Cialis horse tabs.  And wow did those bad boys work!  It was like being back in high school!

I should also mention that during this time I tried everything I could think of to try to boost my testosterone naturally.  But nothing worked.  Changes in diet, sleep, etc. just gave me no significant increase in testosterone that I could see what so very.  And so my testosterone story seemed to have deadended.

Fortunately, we did another testosterone blood draw and it dipped into the 280’s.  Suddenly, my doctor was willing to designate me as hypogonadal!  I could not wait to start testosterone therapy but, at the time, knew absolutely nothing about it.  My physician’s solution – and I think this was the only HRT method he knew anything about whatsoever – was to give me Androgel.

Androgel, for those who do not know, is the blockbuster bioidentical testosterone that really brought HRT into the mainstream.  Suddenly, PCPs everywhere had a Big Pharma-backed method of giving a man testosterone that was easy and convenient.  This made testosterone therapy less “steroid like” and more palatable to those in primary care.

Androgel came in bottles with a pump on the top and applying was similar to lotion.  You just rub on the upper body and – voila! – the testosterone absorbs through the skin and you’re cured.

If it was only that easy!  I found out the hard way that Androgel is often poorly absorbed and some men get no boost in testosterone whatsoever.  (See my link on Testosterone and Androgel for more information.) I was one of “those men” and my next reading showed no significant increase in testosterone.  I I knew that I did not feel any better – that was for sure.  My doctor then – reluctantly! – allowed me to increase the number of pumps on my Androgel.  Soon I found I was slathering Androgel all over my upper body.  It was getting ridiculous as my upper body was just covered with the stuff in thick goopy layers.

I thought, “This ought to take care of the problem!” Well, it didn’t.  Strangely, I found that no matter how much Androgel I put on myself, my testosterone did not increase.  Androgel never got me out of the lower 300’s and with all that gel all over my upper body, I was worried about transferrence to my wife and kids.  (On the Forum, this is by far the most common complaint that we get about HRT, i.e. what one might call Androgel Failure.)

This was very disappointing as I felt I may have finally found the root cause of many of my problems. I assumed that HRT was just not going to work for me.  I did not know that there were actually many different forms of HRT that were much more effective than Androgel and just assumed that I was out of luck.  I did, however, ask my doctor if he knew of another physician that dealt with this kind of thing, i.e. “men’s issues”.  I think he couldn’t wait to get rid of me and so he referred me to a urologist that he had heard knew something about testosterone.  I made an appointment as fast as I could!

My urologist read my case and, fortunately, recognized that Androgel just was not going to work with me.  He did not know a lot about HRT, actually, but did know of a good compounding pharmacy.  He said that a compounded testosterone was cheaper and could be made with a stronger strength and absorption than Androgel.

And this turned out to be true.  The compounded testosterone did what I thought could never happen:  it brought up testosterone levels up into the 400’s.  I even had a reading around 550 one time.  But, in general, my testosterone readings during this period were less than 500.  My urologist was very comfortable with me at this level, because he had undoubtedly seen many men struggle and in many cases die from prostate cancer.  I told him how I had read a number of studies showing prostate cancer risk was not increased by giving men HRT.  His response, “Sure until they come up with a study that shows the opposite.”  This just showed his caution and who can blame him?

What I found was that I felt better but certainly not great. However, it was during this time that I had another big breakthrough:  I tried a Low Fat diet.  I had picked up a copy of Dean Ornish’s book and, being experimental, I tried it.  I was shocked at the results.  Within just a few days, it had greatly improved my fatigue and erectile dysfunction. This, coupled with the slight increase in testosterone, finally gave me hope:  I was actually feeling better for the first time in years!

NOTE: I actually follow mostly closely a Low Fat Diet build on the guidelines of another researcher named Neal Bernard, at least to a large part. Dr. Bernard shows how to reverse disabetes and slow down or even reduce your arterial plaque, something I cover in this link on Low Fat Diets and Diabetes and The Best Health Books. I also avoid the heavily GMO’d grains (wheat, corn, soy).

Inside I was anxious to try to raise my testosterone more and was convinced that this would help me considerably.  I had been reading much more about testosterone and realized at this point that the 400’s was still quite low compare to normal youthful levels.  However, my urologist was clearly uncomfortable with the idea and I was very thankful to have found him in the first place, since finally I was at least moving in the right direction.

After being on the compounded testosterone for a couple of years, my doctor actually came to me and asked if I wanted to try pellets.  He had a change of heart and told me that he could probably get me into the mid 600’s with pellets if I was willing to try it.

Of course, I was all over that and, after making sure that my insurance covered it, I scheduled the procedure.  For those who don’t know how pellets work, it’s an interesting procedure where little mini-tubes are inserted into your hip tissue quite close to the surface.  These tubes have the pellets and basically the tube is withdrawn leaving the pellets under your skin.  You can actually feel the pellets after the procedure as a small bump.

The procedure wasn’t too bad.  Sure, you’re partially naked with the nurse and doc staring at your hemorrohoids for about 20 minutes while you lay on your side, but I would have done just about anything to get my testosterone levels up.  Of course, you have a good amount of anasthesia and cannot really feel anything except the pressure of your urologist wiggling the mini-tube (trocar) to get into place.

Now I had read somewhere that getting pellets was no more painful “than drawing blood.”  And that is true if you are just talking about the procedure itself.  However, afterward, I found it to be quite painful.  Basically, I could not exercise or lift weights for about five days afterward, which for me was a fate worse than death, and the area felt semi-infected.  (It was not actually infected – it was just painful and felt inflamed.)

However, after I recoved from the procedure itself, I was one happy guy.  We never measured my testosterone at the peak, but I would guess I went up to close to upper 600’s and so, finally, I had doubled my testosterone levels! The biggest change was “in my head”.  I FELT fantastic.  Testosterone has a big effect on a man’s brain and I definitely felt it right between the ears.  What I noticed in particular was that the anxiety and sense of melancholy that I had experienced for years and years subsided.  Testosterone was simply a fantastic “brain tonic” if you will.

I also noticed that I started to get some morning erections and my erectile strength became even more consistent.  I was sold on the power of testosterone!  Of course, anything to do with erections is always front and center for a guy, but I was particularly struck with the mental aspect.  I noticed feelings – and I don’t know quite how to describe this – that I had not felt since I was much, much younger.  I was always into music growing up and I found that music once again profoundly affected me the way it used to. And there were feelings of elation and joy in the everyday things of life that I just had not experienced for a very, very long time.

I can remember thinking:  “you’re just not really alive if you are low testosterone.”

One other thing I noticed was that my gains in the gym seemed to acclerate.  I had been able to put on muscle even when I was in the 300’s, but it was slow going.  However, during this relatively short time period, I picked up some nice increases in strength and leg and arm size.

But there was a gnawing thought in the back of my head:  could I go through that procedure again?  I’m a very thin guy – a card-carrying Skinny Bastard by any standards – and I had precious little fat tissue as buffer against those trocars.  Plus, my doc wanted me to take antibiotics for a few days before the procedure to insure that I did not get an infection.  This went against my tightly held health beliefs that antibiotics very often attack your all-important good gut flora.  So the whole thing seemed a messy, painful business.  And yet, I had to admit, it was literally a fountain of youth for me.

Another problem that arose was that after a couple of months my testosterone levels began to fall somewhat.  That’s the way the pellets work.  Everyman is a little different, but, depending on the number of pellets and other factors, your testosterone levels will gradually begin to fall and then you need another procedure.  I also found that my urologist seemed to be trying to spread out the time between procedures quite a bit and so I was concerned about having a month+ of lowish testosterone where I felt about like I did with the compounding.

All of my hesitation about pellets finally came to a head one day at work and I did a quick search for HRT clinics.  I noticed one just a couple of miles from my house and went in for an appointment.  By this time, I had become quite knowledge on HRT matters and had been wanting to get on HRT.  This particular clinic was great because 1) they were national and thus should be fairly stable/reliable, 2) they worked with my insurance companies and 3) they used cypionate with Arimidex, which was my preferred delivery system based on the research that I had seen.

NOTE: Injections must be well-managed to avoid most side effects and to be effective. I discuss that here in my link on Testosterone Cypionate .

I was really looking forward to my first shot as my libido was really slipping from being so long on the pellets. I believe that by the time I got into the clinic, it had been almost four months since my pellet procedure.

When I got my injection, the reaction I got was spectacular.  No, I didn’t start getting spontaneous erections like I was 14 again.  What I did get that evening was, as best I can describe it, “fireworks in my brain“.  I felt a little Jim Carrey in The Mask:  the feeling was really powerful between the ears. Not painful.  Not scary.  But I definitely had the sesnsation that there was some “rewiring” going on.

Jumping ahead a little, the injections did something huge for me:  they completely vaporized my dysthymia. I had had mild depression pretty much all of my adult life.  A Low Fat Diet got rid of some of it and exercise still another part of it.  But I could never really defeat it completely. What I noticed a couple of weeks after my injection was that I had absolutely no sense of melancholy about me.

Also, I have always been high anxiety.  I will sometimes call myself Captain Anxiety in front of my family and they always laugh, because they know it is true.  The injections greatly helped with this issue.  It was strikingly noticeable to my boss and he has commented several times to me about just this.  This goes along with a lot of research that shows that, counterintuitively to some, low testosterone animals are actually the ones most likely to fight.

And then I got the best gift of all. In fact, it was like Christmas:  I got my morning erections back.  I got occasional morning erections with a Low Fat Diet and compounding and even a few more with pellets.  But there was no comparison with the injections:  morning erections occurred almost every night.

The return of the morning erections also was a “Aha!” moment for me.  I suddely realized the obvious:  I had not had morning erections probably my entire adult life.  This coupled with the lifelong dysthymia makes me wonder if I was low testosterone my entire adult life.  (I have had zero dysthymia, a.k.a. mild depression, since going on testosterone cypionate.)

When I started cypioante at the HRT clinic, my protocol was the following:

–Testosterone Cypionate (130 mg weekly intramuscular)

–Arimidex (1/2 mg 2 X per week)

It took abou 9-12 months, but I was finally able to get completely off of Arimidex by doing the following:

1.  Dropping my dosage to 100 mg per week.

2.  Doing my cypionate injections subQ (subcutaneous) two times per week.  (50 mg each injection)

3.  Losing weight and getting down to about 12-13%% bodyfat.  (The more bodyfat, the more estradiol is produced.)

And I also faced another realization:  I probably had pretty bad venous leakage and my newfound testosterone levels finally helped me overcome that.  My HRT clinic has me at a trough of about 670 ng/dl and a peak of about 850 ng/dl.  And, because my last estradiol read was 21 pg/ml, I backed off my dosage of Armidex to the 1/4 mg.  One of my goals is to take as few pharmaceutical as possible.

So you can see why I am such a huge fan of HRT:  it literally gave me back the youth back that I never had.  I feel fanstic and have put on some extra muscle by the way.  I am now significantly stronger than I was in college and my physique is better too.

That said, I want to point out that not everyone has such a rosy experience with testosterone therapy and, like everything, there are certain risks and rewards.  I highly encourage every man interested in TRT to read my link on Weird Testosterone Risks for more information:  it has all the things that my doctor should have told me before I went on testosterone.

In the meantime, I am very much enjoying feeling about half of my age!  I seriously feel MUCH better than I did in my 20’s or 30’s and I feel that I owe it all to a Low Fat Diet, exercise, my HRT program and a good woman.

Elevated PSA

At the end of the year in 2013 I had to go off of HRT briefly due to a high PSA reading and even had a prostate biopsy. However, they found that there was no cancer (or even precancer) but did find inflammation. I was able to resume HRT. For details of my whole experience, see this page: My Prostate Scare (High PSA but No Cancer).

I got a PSA at my clinic about a month afterwards and already my PSA had dropped from a peak of 6.3 to 3.9.   This is a very good sign that my new “prostate program” was working, because the urologist said my prostate would be inflamed for several months afterward.  (They take 12 chunks out of the prostate when they do the biopsy.)

One interesting comment is that I implemented a bunch of natural anti-inflammatories (turmeric, quercetin, bromelain and IP6) and flaxseed along with a vegan diet in order to protect my prostate.  To be honest, as much as I love whole grains, vegetables and fruits, I don’t really want to be vegan but am doing it to make sure my IGF-1 levels stay in line.  And it seemed to work:  over about 6 to 9 monts my PSA dropped down to a low of 1.9, which is close to my early HRT levels.

In mid 2015 my PSA bumped jumped back up a bit to 2.9.  My urologist suggested that I try the new 4kScore test, which is able to tell with solid accuracy whether or not you have the aggressive form of prostate cancer.  I took this test and it found that I have a very low probability of having the aggressive form of prostate cancer, something I cover in more detail here:  My 4kScore to Test for Aggressive Prostate Cancer.

Stage I.  Pain and Suffering

There was one problem though:  Cialis gave me tremendous heartburn.  I knew that this was not going to be a good long term solution.  At the time I did not understand that Cialis and the other PDE5 inhibitors have issues with other similar enzymes in the ear, eyes and stomach and can cause very severe side effects.  I would occasionally get mild ringing in my ears as well and cut back on the dose. Plus, I found that Cialis was somewhat ingermittent (The PDE5 Inhbititors are notorious for decreasing in efficacy, something I discuss in this link on Viagra Failure.)

Stage II.  Diagnosis and Non-Treatment (Androgel)

I can’t remember for sure, but I am almost positive that I asked my doctor for a testosterone test.  I had run across an article that stated low testosterone symptoms and I had a lot of them.  Nothing else had worked, so maybe, just maybe it could be hormonal.  My testosterone reading came back in the low 300’s – I don’t remember the exact number – and my doctor told me I was fine.

In those days all the labs had the lower range at about 260 or maybe 280 ng/dl.  And I was around 320, so my doctor concluded I was okay.  Well, I’m a numbers guy and I was thinking things to myself like, “That’s only a little over 10% above this magic threshold.  So maybe I’ve got about 90% of the symptomology and not 100%, but that’s still bad!”

My reasoning was not bad if you think about it.  No man hits a magic number and then all of his low testosterone symptoms appear, right?  Obviously, as his testosterone lowers more and more symptoms appear at a greater and greater degree.  However, I really didn’t know any better and so I just let it lie, although I did bug him for another test or two and they were always in the 300-350 ng/dl range.  Unfortunately, he would not budge and I probably suffered for a year like this, going back and forth with him.

Stage III.  A Change in Diet and an Almost Effective Treatment (Compounding)Stage IV.  Painful But Effective Treatment (Testopel Pellets)Stage V.  Finally!  Testosterone Injections and Arimidex

Binge Drinking and Testosterone-High prolactin lead to lowered dopamine,

We had an 18-year-old man on our Peak Testosterone Forum who reported huge swings in prolactin:

“Prolactin was: 6.5 ng/ml, 33ng/ml, 16ng/ml, 7ng/ml, 7.1 ng/ml (2-17ng/ml).” [1]

The top of the normal range for prolactin is usually around 15, and so these are clearly big swings.  This isn’t the first time that we’ve seen that on the forum. What would cause these kind of wild swings in prolactin?  I believe that the root issue may be fluctuations in thyroid hormone output, and below I cite some evidence that this may be the case. In fact, this man had had four TSH reads, and three of them were over the new hypothyroidism threshold of 3.0 mUI/l.  He did have a read of 2.2, but many alternative practitioners consider 2.0 to be the true cutoff for hypothyroidism.  The bottom line is that much of his history indicates low thyroid function.

NOTE:  High prolactin can lead to lowered dopamine, lowered libido, occasional gynecomastia and lowered testosterone levels.  See my page on Testosterone, Prolactin and Prolactinomas for some information. And keep in mind that elevated prolactin should always be discussed with a doctor as some tumors (prolactinomas) secrete prolactin.

“The serum prolactin level was found to be elevated (>14.0 ng/ml) in 39 per cent of patients with untreated primary hypothyroidism, none of whom were receiving drugs known to affect serum prolactin levels.” [2]

Clearly, that seem just a bit beyond coincidental, eh?  (However, this study did not find nearly as significant of a link with male patients.  As I’ll show below, this is likely still significant for many men.)  It would take years before resarchers discovered the mechanism underlying this correlation.  Did hypothyroidism cause elevated prolactin or the other way around?

3.  2011 Study on Subclinical Hypothyroid Patients. Probably the most important population one could examine are those with subclinical hypothyrodism, defined as men and women with TSH < 10.0 mui/l,, since we get very few men on the Peak Testosterone Forum who have a TSH over 10.  On the hand, low grade hypothyrodism, treated and untreated, is very common.  This is the conidition that one 2011 study looked at and found:

“Sixty-two (13%) patients were males and 419 (87%) were females. The mean age of the patients was 32.53 10.13 years. Ninty-eight patients (91 females 7 males) had high prolactin. Prevalence of hyperprolactinemia in subclinical hypothyroidism was 20.4%. (11% in men and 22% in women).” [4]

MECHANISM OF ACTION:  So which is the chicken and which is the egg?  It turns out that TRH stimulates both TSH and prolactin. TRH is the upstream hormone secreted by the hypothalamus that in turn triggers the pituitary to secrete TSH which in turn tells the thyroid to produce T3 and T4.  So clearly any type of hypothyroidism that would lead to elevated TRH levels would likely cause increased prolactin.  And this is indeed the case generally with primary hypothyroidism for example.

Finally, let’s look at the original case mentioned above where the man had wild swings in prolactin on the Peak Testosterone Forum. Could this man be experiencing some kind of primary hypothyroidism?  His antibody counts were negative, so it would not appear to be Hashimoto’s.  There is one other fairly common cause of prmary hypothyroidism in men:  an iodine deficiency.  This actually does occur suprisingly often according to several studies.  One study on school girls in the U.K. found that “urinary iodine measurements indicative of mild iodine deficiency were present in 51%  of participants, moderate deficiency in 16%, and severe deficiency in 1%.” [5] (Children are usually studied, because an iodine deficiency lowers IQ.)

Therefore, if you are seeing big changes in prolactin, it may be prudent to talk to a (knowledgeable) practitioner in thyroid hormones and an endocrinologist (in case of a tumor) as well.  (CAUTION: Be very careful with supplementing iodine:  it can lead to improved symptoms for a few months and then a severe crash of your thyroid hormones.  Dosage is important and co-supplementing with selenium as well.)

NOTE:  You may also be interested in my page on How to Lower Prolactin Levels as well.

REFERENCES:

1)  https://www.peaktestosterone.com/forum/index.php?topic=8871.15

2) Amer J of Medicine, May 1978, 64(5):782 787, “Serum prolactin levels in untreated primary hypothyroldism”

3) Prolactin: Physiology and Clinical Significance, 1973, D.F. Horrobin, p. 133.

4) Caspian J Intern Med. 2011 Spring; 2(2): 229 233, “Hyperprolactinemia in association with subclinical hypothyroidism”

5) Lancet, 2011 Jun 11, 377(9782):2007-12, “Iodine status of UK schoolgirls: a cross-sectional survey”

So let’s look at the research evidence for the same thing – that hypothyroidism can cause elevated prolactin and just why this occurs.  Here are a few studies that show just this:

1. Several Hypothyroid Disorders Linked Very Early to High Prolactin. Patients and physicians were reporting that often low thyroid function was linked to hyperprolactinemia (high prolactin).  Furthremore, physicians had noted that this occurred frequently with several medical conditions:

“Two clinical syndromes have now been clearly shown to relate primary hypothyroidism (and therefore probably TRH hypersecretion) with excess prolactin secretion. These are the association of galactorrhea, amenorrhea, and primary hypothyroidism in post-pubertal individuals and of precocious puberty, glactorrhea and primary hypothyridism in children.” [3]

2. 1978 Study on Men and Women with Primary Hypothyroidism.  Notice this statement in one study from the same time period:

Inexpensive Testosterone Labs for Self-Testing.

One of the things that I have discovered as I have begun to research and monitor my own health is that my physicians – God love ’em – do not always test everything they should test nor monitor as frequently as is necessary. This is nothing against them, of course, as they have limited time and are under obligation to insurance companies and fellow physicians to minimize costs as much as reasonably possible. I know that in my own life I was low testosterone for years before I convinced my PCP to finally pull my T.  And it was years after that that anyone pulled my prolactin, estradiol and TSH. These all should have been looked at, but it simply never happened. And I could have probably avoided a great deal of heartache and suffering if I had simply had done these tests myself and shown them the results.

I am NOT suggesting that you become your own doctor, but in the U.S. and many other countries, there is considerable medical freedom and one has the right to monitor one’s health.  Think of this: your body and mind are an incredibly complex and highly tuned machine. It makes a combustion engine look like a play toy. Does your doctor really have the time to see if you need a tune up? 99% of the time your doctor is too busy just trying to keep patients alive and semi-functional.

This is the reason that I compiled a list of testosterone labs that pull various hormones for men based on Peak Testosterone Forum posts that I have received over the years. I have also included some commentary about what some of these specialize in and what they can and can/cannot be used for. I am NOT suggesting that you become your own doctor, but in the U.S. and many other countries, there is considerable medical freedom and one has the right to monitor one’s health.

NOTE: There are four states that will not let you pull your own labs. Yes, you read that right.  Even if you PAY CASH, you cannot pull your own labs.  Now please tell me that America is a free country when many of its citizens cannot even monitor their OWN health when they pay for service with their OWN money.

Think of this: your body and mind is an incredibly complex and highly tuned machine. It makes a combustion engine look like a play toy. Does your doctor really have the time to see if you need a tune up? 99% of the time your doctor is too busy just trying to keep patients alive and semi-functional? Consider my situation:

–I have never had homocysteine pulled by any doctor.

–I have had ferritin pulled only once.

–I have never had any thyroid hormones pulled except TSH and total T4.

–I have had CRP pulled maybe twice.

–I never had LH, FSH or prolactin pulled in my hypogonadal days.

Is my situation unusual? Certainly not. There just aren’t the financial and time resources available for decent testing in the great majority of insurance-backed systems. The bottom line is that you are probably going to have to do some yourself, or perhaps find a doctor or naturopath on a cash basis that can help you do the same.

For all these reasons I compiled a list of testosterone labs that pull various hormones for men based on Peak Testosterone Forum posts that I have received over the years. I have also included some commentary about what some of these specialize in and what they can/cannot be used for. Almost all of these labs are U.S. only, but there are a couple of exceptions as you will see:

1. DiscountedLabs.com.  If you are looking for the best prices for self-testing with the biggest, most respected lab (Lab Corp) in the country, then Discounted Labs is a good starting point. Nelson Vergel started Discounted Labs, and many of you will recognized his name as one of the most established names in the TRT/HRT community. He sent me an email where he promised to beat anyone else’s prices, and it sure seems to be the case! NOTE:  I have used Discounted Labs and had a good experience. Again, one big advantage is that the use Lab Corp, which is the largest lab here in the U.S. (NOTE: Discounted Labs is a site sponsor.)

2 Health Tests Direct.  I first found out about this lab company, because one of our longtime posters used them with great success.  They were unique for a long time, because they offered not only LabCorp pricing but also Sonora Quest. NOTE:  I have used them and had a good experience.

3.  Life Extension Foundation. One of the older and more respected supplement companies, LEF is known for its in depth articles and good support staff.  One very interesting thing that you can get, through them, a wide variety of lab panels at some of the big labs.  They have for example an Inflammation Panel and a Cardiac Panel that I have wanted to get myself that includes many of the key heart disease risk factors such as “Chemistry Profile (Complete metabolic panel with lipids) Complete Blood Count (CBC), C-Reactive Protein (high sensitivity), Fibrinogen, Homocysteine Vitamin D 25-OH.”  They also have some more specific blood draws for things like CoQ10, anemia and cortisol. The prices are quite reasonable and, of course, it’s nice to deal with a well-established company. NOTE:  I have used them and had a good experience.

One of the panels many men would be interested in is the Male Panel, which includes the “Chemistry panel (complete metabolic panel with lipids), CBC, DHEA-S, DHT, Estradiol, PSA, Pregnenolone, Total and Free Testosterone, Sex Hormone Binding Globulin (SHBG), TSH, Free T3.”  So in one shot you’ve got a lot of questions answered dealing with male hormones, especially the ones that can directly impact your sexual health.  The cost as of this writing was about $224 for members and $399 for nonmembers where a one year membership cost $75.

NOTE: You’ll want to check out that the above test uses the correct estradiol test for males. If you happen to be low estradiol, then the standard test will often not give you correct results based on what I have seen. Talk to the lab and make sure you are getting the correct test.

Also, they use LabCorp, which is I believe the biggest general lab in the U.S. and most states are available to LEF members.  For general information, see these LEF FAQ’s and LEF Blood Test Descriptions.

4.  ZRT Labs. This is another reasonably priced lab.  The offer both saliva and blood spot testing. One of our senior posters used them several times to examine some standard male hormones as well as adrenal and thyroid function. One intriguing panel is called the Female/Male Saliva Profile I and includes the following: “five (5) tests: Estradiol (E2), Progesterone (Pg), Testosterone (T), DHEA-S, and morning Cortisol (C1)” for $170 as of this writing. [1] Blood spot testing tends to be a little more but is still (relatively) inexpensive.

6. (U.K. Testing) Private Blood Tests.  U.K. guys, from what I have seen on the Peak Testosterone Forum, have a notoriously difficult time getting treatment and testing.   “I’ve found a useful website here in the UK, www.privatebloodtests.co.uk , this allows you to run bloods at a local hospital without going through your GP, which is useful for tracking things like Clomid.” [5] Again, I do not know anything about them, other than what was mentioned in this post, so do your own research.

7.  (U.K. Testing) Blood Tests London. One of our posters also recommended bloodtestslondon.com.  His comments were that “the prices were very competitive, and they turned my thyroid blood work around in less than 1 working day. If any of the blood results are out of range then they get a doctor to comment on them (included in the price).” Again, I do not know anything about them, so do your own research.

8.  PrivateMDLabs.  This lab, according to one of our veteran posters, uses blood draws through LabCorp.  This one has been used by a couple of men and the only negative comment was that “they have a male panel that is not as comprehensive as I’d like, but includes some things that are worth monitoring.” [7]

9.  Genova.  One of our posters that has been around awhile used Genova labs for a metabolic and digestive panel. [8] One of the established Paleo media personalities has used them.

10.  Rhein Labs. This lab specializes in testosterone and estrogen-related metabolites and can really help you diagnose the root cause of your hormonal issues.  Check out this thread for sample results and costs from one of the senior posters on the Peak Testosterone Forum.

11.  Direct Labs.  I have used this lab for hair testing.  However, they have many other tests available as well.

1) https://store.zrtlab.com/index.php?option=com_content&view=article&id=106&Itemid=612

2) https://peaktestosterone.com/forum/index.php?topic=1250.15

3) https://www.saveonlabs.com/Dr-Mark-Hyman-Saveonlabs-com-s/1889.htm

4) https://www.saveonlabs.com/product-p/361648.htm

5) https://peaktestosterone.com/forum/index.php?topic=571.msg5346#msg5346

6) https://peaktestosterone.com/forum/index.php?topic=456.30

7) https://peaktestosterone.com/forum/index.php?topic=1453.0

8) https://peaktestosterone.com/forum/index.php?topic=1431.0

The Relaxation Response: Cortisol Killer and Manliness Build - PT

So what is the #1 thing a man can do to improve his sex life, general health and cognition.  Well, there are many top candidates:  exercise, a whole foods diet (Low Fat, Mediterranean, etc.), sleep, sexual intercourse and possibly losing weight if one is overweight or obese.  But there is another top contender and the great majority of men not only do not practice it but are not even aware that it exists.

Of course, what I am talking about is implementing the Relaxation Response into your daily lifestyle. Most men – and I admit myself included until recently – do not want to hear about relaxation.  It’s boring, a waste of time and on and on.  But medical researchers, when they use the term Relaxation Response, are not referring to a nice vacation in Maui, a good round of gold or even “relaxing” in front of the television.  Researchers are referring to a very profound physical and measurable clinical response that occurs when you do certain activities.  And, usually, these activities include various forms of meditation, Progressive Muscle Relaxation, autogenic training and a few other similar practices.

NOTE:  Pursuing the Relaxation Response through meditation or Progressive Muscle Relaxation need have NOTHING to do with religious practice. I personally practice what is called “secular mediation” as much as possible, which has absolutely no spiritual connotations.  No offense to anyone who does incorporate the spiritual into their meditation, but my point is simply that everyone should meditate, do PMR, autogenic training, etc.

These effects are stunning to say the least and include short term changes including a drop in blood pressure, a decrease in stress hormones and so on.  However, as we’ll document below, these changes are much more far-reaching than simple reversal of the “fight or flight response”.

So what is the formula for achiving a Relaxation Response.  Well,  the easiest is probably Progressive Muscle Relaxation, which simply involves tensing and relaxing the muscles in a quiet environment. It has a vast clinical and research track record proving its worth and utility.  However, one study points out that any technique that follows these four simple points will produce the Relaxation Response:

The authors also noted that “sitting quietly with the eyes either open or closed failed to produce the same changes.”  So, yes, you can keep it simple – just not too simple.  But, again, there are many other techniques, especially meditation, that will produce a Relaxation Response.  (And there are even many types of meditation.)

Below I will present evidence that getting the Relaxation Response to work for you is one of the biggest things that you can do and is the b>missing ingredientnbsp; Don’t believe me?  Check out these reasons to get busy Relaxin’!

1. Blood Pressure.  The Relaxation Response can have a profound effect on blood pressure, especially in hypertensive patients.  In fact, average responses can be about as much as some standard blood pressure medications.  For example, one study on patients with high blood pressure who were already on medications lowered average blood pressure from 146 and 92 mm to 135 and 87 mm, respectively. [1] This is an impressive drop for patients who had already been corrected via pharmaceuticals. Admittedly, this was an older study but a number of follow-up studies have verified similar results and I include one of those in my page on Progressive Muscle Relaxation.

Of course, high blood pressure is a leading risk factor for erectile dysfunction, stroke and men with high blood pressure have been found very often to have low testosterone as well. (Low testosterone probably tends to cause hypertension rather than the other way around though.)  See my link on High Blood Pressure and Erectile Dysfunction for more information.

2.  Nitric Oxide. Meditation undoubtedly lowers blood pressure by several mechanisms, including the diminishing of a variety of stress hormones. However, there is another property of meditation that should be of interest to men everywhere:  it increases nitric oxide according to a study on Zen meditation. [22] Of course, nitric oxide is the key molecule involved in initiating erections (and dilating arteries) and it is remarkable that both movement (exercise) and sitting quietly with focused attention (meditation) can both increase NO.

3. Anti-Aging and Telomerase. If you meditate for just one reason, do it to to slow down aging.  Sound too good to be true?  Well, one the core theories of aging centers around the shortening of your chromosomes, i.e. tlomeres through the action or inaction of the telomerase enzyme.  Meditation was found in a 2011 study to actually increase telomerase activity which will protect your chromosomes. [8] Many things that increase stress have been found to shorten telomeres and thus likely accelerate aging, so this was no major surprise to researchers.  See my link on Telomeres and Telomerase for more information.

3. Brain Size (Density). Don’t you wish there was a supplement that would increase the size of your brain? Well, why not meditate instead?  There is strong evidence that meditators increase the size (density of neurons) in many key parts of their brain. It is not wonder since meditation a) decrease cortisol which is very hard on the brain and b) increases blood flow to many importants of the brain owing to the requirement for concentration and focus.

What areas of the brain are affected positively by meditation?  Well, there have been a number of studies on this.  One of them summarize by saying that meditation affected the “dorsolateral prefrontal and parietal cortices, hippocampus / parahippocampus, temporal lobe, pregenual anterior cingulate cortex, striatum, and pre- and post-central gyri.” [21] Notice the hippocampus in that list, which is the seat of one’s memory and is one of the parts of the brain attacked by Alzheimers and dementia.

4. Risk of Dying (Mortality). There are indications that meditation can, for many people at least, increase your life span by decreasing your risk of dying.  For example, one study of seniors with hypertension found significantly decreased mortality rates. [25]  Study authors noted “a 23% decrease in the primary outcome of all-cause mortality…, a 30% decrease in the rate of cardiovascular mortality and a 49% decrease in the rate of mortality due to cancer.”  Not bad for 15-20 minutes of work per day, eh?

5.  Cortisol Reduction. As I have pointed out in a number of places on this site, Meditation and PMR are famed for decreasing cortisol.  Of course, high cortisol lowers testosterone, decreases muscle mass and injures the brain.  For more information, see this link on Stress Management.

6.  Intelligence. This one is hard to prove, but a couple of studies have shown that meditation may actually increase general intelligence – that’s how good it is for the brain. [4]

7. DHEA. Meditation should increase testosterone, because of its cortisol-lowering actions but there is no hard evidence of that. However, one hormone that does seem to be affect positively by meditation is DHEA. Practitioners of TM were found to have increased levels of DHEA [7] and, although study results have been somewhat inconclusive, it is safe to say that DHEA helps some men at least with libido, memory and energy levels.

8.  Work Performance. One very easy relaxation technique is simple to say the word “one” whenever you exhale and “passively disregard other thoughts.”  One study found a significant increase in work performance based on things like energy, concentration, problem-handling, etc. [6]

9. Neurotic Behavior, Panic Disorder, OCD (Obsessive Compulsive Disorder) and Anxiety. Progressive Muscle Relaxation has a solid research and clinical track record with all of these stress-related disorders.  See my link on The Miracle of PMR for details.  And considering how well PMR does with neurotic behavior, this study of Transcental Meditation on African American adults is interesting:  researchers found that there was less neurotic behavior resulting from TM than PMR. [20]

10. Depression.  One very common theme on the Peak Testosterone Forum is depression. Of course, sometimes depression results from low testosterone. However, sometimes depression can lead can cause men many issues, including loss of libido and erectile strength. (See my link on Depression and Erectile Dysfunction for some basic information.)  I list many Depression Cures and Helps, but one that will be a big help for certain subpopulations of men:  Progressive Muscle Relaxation. This form of The Relaxation Response has been shown in studies on men recovering for cardiovascular disease and cancer to help improve depression. [26][27] NOTE:  Mindfulness meditation was shown in one meta-analysis to not be significantly helpful with depression. [28]

11. Immunity (Colds and Flus). Yes, it looks like the Relaxation Response can even help prevent the common cold according to one study on college students. [16] A recent study on children looks like this may be the case for meditation as well. [17] Mindfulness meditation is associated with increased Natural Killer Cell activity as well. [18] Meditation has also been found to increase antibody response to the flu, which should translate to increased protection. [19]

12. Insomnia.  Many studies have shown that the Relaxation Response can help in many cases with insomnia.  PMR has done particularly well. [12][13][14] but meditation also has studies as well. [15] For other research-backed information, see this link on Practical Sleep Aids.

13.  Norepinephrine (noradrenaline). This stress hormone actually puts the brakes on erections. [3] One study found that a standard Relaxation Response produced reduced stress in a way that is typical of decreased noradrenaline. [3] However, one smaller, older study found that noradrenaline increased post-meditation. [10]

14. Headache. Studies have shown that meditation can be a powerful tool in the treatment of headache relief.  One study noted good results with cluster and migraine sufferers for example. [11]

15. Arthritis. A very common and debilitating condition is arthritis and research has shown that the Relaxation Response can help with this condition.  For example, one study using PMR and guided imagery showed that they significantly improved both mobility and pain in female patients. [23]  This study was on those with osteoarthritis but meditation has been shown to help with rheumatoid arthritis as well. [24]

REFERENCES:

1) S03(7852):289–291, “DECREASED BLOOD-PRESSURE IN PHARMACOLOGICALLY TREATED HYPERTENSIVE PATIENTS WHO REGULARLY ELICITED THE RELAXATIONRESPONSE”

2) https://www.peaktestosterone.com/Progressive_Muscle_Relaxation

3) Science, 8 Jan 1982, 215(4329):190-192, “Reduced sympathetic nervous system responsivity associated with the relaxation response”

4) Personality and Individual Differences, 1991, 12(10):1105–1116, “Transcendental meditation and improved performance on intelligence-related measures: A longitudinal study”

5)

6) AJHP, Oct 1977, 67(10): “Daily Relaxation Response Breaks In a Working Population: 1. Effects on Self-reported Measures of Health, Performance, and Well-being”

7) Biological Psychiatry, Feb 1 1997, 41(3):311-318, “Dehydroepiandrosterone (DHEA) treatment of depression”

8) Psychoneuroendocrinology, June 2011, 36(5):664–681, “Intensive meditation training, immune cell telomerase activity, and psychological mediators”

9) Psychosomatic Medicine, Jul/Aug 2003, 65(4):564-570, “Alterations in Brain and Immune Function Produced by Mindfulness Meditation”

10) JOURNAL OF NEURAL TRANSMISSION, 1979, 44(1-2):117-135, “Sympathetic activity and transcendental meditation”

11) Headache: The Journal of Head and Face Pain, Apr 1974, 14(1):49–52, “The Usefulness of the Relaxation Response in the Therapy of Headache”

12) APPLIED PSYCHOPHYSIOLOGY AND BIOFEEDBACK, 1976, 1(3):253-271, “Biofeedback and progressive relaxation treatment of sleep-onset insomnia: A controlled, all-night investigation”

13) Journal of Behavior Therapy and Experimental Psychiatry, Sep 1983, 14(3):251-256, “Treatment of insomnia in cancer patients using muscle relaxation training”

14) Journal of Abnormal Psychology, Jun 1974, 83(3):253-260, “A comparison of progressive relaxation and autogenic training as treatments for insomnia”

15) Behavior Therapy, May 1976, 7(3):359–365, “Meditation training as a treatment for insomnia”

16) Journal of Psychosomatic Research, Dec 2001, 51(6):721-728, “The effects of stress management on symptoms of upperrespiratory tract infection, secretory immunoglobulin A, and mood in young adults”

17) Ann Fam Med, Jul/Aug 2012, 10(4):337-346, “Meditation or Exercise for Preventing Acute Respiratory Infection: A Randomized Controlled Trial”

18) J Altern Complement Med, 2010 May, 16(5):531-8, “Enhanced psychosocial well-being following participation in a mindfulness-based stress reduction program is associated with increased natural killer cell activity”

19) Psychosomatic Medicine, Jul/Aug 2003, 65(4):564-570, “Alterations in Brain and Immune Function Produced by Mindfulness Meditation”

20) Intl Journal of Neuroscience, 1989, 46(1-2):77-86, “The Effects of the Transcendental Mediation Technique and Progressive Muscle Relaxation on Eeg Coherence, Stress Reactivity, and Mental Health in Black Adults”

21) Neuroreport, 15 May 2000, 11(7):1581-1585, “Functional brain mapping of the relaxation response and meditation”

22) Progress in Neuro-Psychopharmacology22) Progress in Neuro-Psychopharmacology and Biological Psychiatry, Feb 2005, 29(2):327–331, “Effect of Zen Meditation on serum nitric oxide activity and lipid peroxidation”

23) Pain Management Nursing, Sep 2004, 5(3):97–104, “A pilot study of the effectiveness of guided imagery with progressivemusclerelaxation to reduce chronic pain and mobility difficulties of osteoarthritis”

24) Arthritis & Rheumatism, Sep 1990, 3(3):127-131, “Pain management in the older adult with rheumatoid arthritis or osteoarthritis”

25) The American Journal of Cardiology, 1 May 2005, 95(9):1060-1064, “Long-Term Effects of Stress Reduction on Mortality in Persons ≥55 Years of Age With Systemic Hypertension”

6) JCO, June 1991, 9(6):1004-1011, “A randomized clinical trial of alprazolam versus progressive muscle relaxation in cancer patients with anxiety and depressive symptoms”

27) Psychother Psychosom 2008;77:119-125, “Effects of Progressive Muscle Relaxation Training on Anxiety and Depression in Patients Enrolled in an Outpatient Pulmonary Rehabilitation Program”

28) The Canadian Journal of Psychiatry / La Revue canadienne de psychiatrie, Apr 2007, 52(4):260-266, “Does mindfulness meditation improve anxiety and mood symptoms? A review of the controlled research”

Inflammation Explodes with Low Testosterone - Peaktestosterone

Low testosterone ages a man.  There are many reason for this – one of them is the Low Testosterone-Induced Rise in Insulin Levels – including increased inflammation.  As men we think of testosterone as mostly the “muscle” or “sex” hormone, but it is much, much more than that.  If you begin to lose your testosterone, you pay the price in many more ways that just simply losing your muscle mass and libido.

As it turns out, one of the key ways that testosterone protects us men is by “modulating inflammation”, i.e. keeping inflammation in check. Runaway inflammation is the curse of modern living (from poor diet and excess calories and body fat primarily) and is a root cause for heart disease, cancer and autoimmune diseases.  So low testosterone is a big deal as inflammation ages and damages tissues in many ways as the decades roll by and we will show examples of this below.

In addition, it should be noted that excessive inflammation can also affect Leydig cell function and reduce testosterone. One study states that “There is evidence from many experimental studies that IL-6, TNF-alpha and IL-1beta inhibit T secretion by their influence on the central (hypothalamic-pituitary) and peripheral (testicular) components of the gonadal axis.”  IL-6, TNF-alpha and IL-1 are molecules called cytokines that control inflammation levels in your body and they are all-important.

Can this inflammation cause the hypogonadism and early andropause epidemic that we see in Western societies?  I don’t know of any proof of that, but it certainly is in the realm of possibility.  On this page, though, I want to cover what we do know much more clearly:  that low testosterone is correlated with high inflammation and that testosterone therapy can lower inflammation levels.  Below are some of the major inflammatory markers affected in this way:

1)   Eur J Endocrinol, 2007 May, 156(5):595-602, “The effect of testosterone replacement therapy on adipocytokines and C-reactive protein in hypogonadal men with type 2 diabetes”

2) Obes Rev, 2005 Feb, 6(1):13-21, “Adiponectin: action, regulation and association to insulin sensitivity”

3) Journal of Andrology, January/February 2005, 26(1), “Testosterone Administration Suppresses Adiponectin Levels in Men”

4) https://www.fasebj.org/content/early/2011/06/20/fj.11-182758.full.pdf

5) Clinical and Experimental Rheumatology, 1993, 11(2):157-162, “Effect of gonadal steroids on the production of IL-1 and IL-6 by blood mononuclear cells in vitro”

6) Endocrinology September 1, 1991 vol. 129 no. 3 1305-1311, “Interleukin-1 Inhibits Cholesterol Side-Chain Cleavage Cytochrome P450 Expression in Primary Cultures of Leydig Cells*”

7) Journal of Endocrinological Investigation, 2005, 28(11 Suppl Proceedings):116-119, “The relationship between testosterone and molecular markers of inflammation in older men”

8) Journal of Andrology, Jan/Feb 2009, 30(1), “The Dark Side of Testosterone Deficiency: II. Type 2 Diabetes and Insulin Resistance”

9) Cellular Physiology and Biochemistry, 2007, 20:847-852, “Effects of Testosterone on Cytokines and Left Ventricular Remodeling Following Heart Failure”

10) Nature Reviews Endocrinology 5, December 2009, “Testosterone deficiency, insulin resistance and the metabolic syndrome”

1. Adiponectin. Adiponectin is not an inflammatory cytokine like all the other markers I will discuss on this page.  However, I put it first, because it affects inflammation and is SO important, although the relationship is complex. But here is the key takeaway:  as a man loses insulin sensitivity (usually through weight gain and other aspects of a modern lifestyle), adiponectin levels will begin to drop and testosterone administration raises adiponectin levels. [2][3]

2.  Phospholipase D.  In 2011, scientists discovered one of the major reasons that testosterone may keep inflammation at bay.  It turns out that your T actually slows down the activity of an enzyme related to inflammation called Phospholipase D. [4]

4. TNF Alpha.  The most infamous of the inflammatory cytokines is undoubtedly TNF alpha as it has been singled out to be the root cause for so many nasty medical conditions including cardiovascular disease. See my page on Natural TNF Alpha Inhibitors for some additional information. And testosterone therapy has been found to lower TNF alpha levels in an animal study on rats following heart failure. [9]

Did you know you can inexpensively do your own testing for most hormones? The industry leader is Discounted Labs..

5. IL-6. Although this is not uniform, some studies show that testosterone administration will actually decrease IL-6. [7] IL-6 is associated with many conditions, including diabetes, certain cancers, Alzheimer’s and arterial plaque, etc.

6.  CRP (C-Reactive Protein). Most middle-aged and senior men reading this page will have prediabetes, Metabolic Syndrome or full-fledge type II diabetes.  For men suffering from these maladies relating to loss of insulin and blood sugar control, low testosterone had been found to correlate with higher CRP levels. [1] If testosterone actually causes this state of affairs, this is very bad indeed.  C-Reactive protein is now a common test given by doctors to measure systemic inflammation and it is very correlated to the risk for heart disease, Alzheimer’s, and many other medical conditions.

NOTE: The above study found that testosterone therapy did not actually lower CRP values, so low testosterone may not cause low CRP. When you see all the other ways below that testosterone negatively impacta inflammation, one cannot help but be skeptical however.

Now the short term data, which I outlined above, clearly shows that low testosterone affects some of the pro-inflammatory molecules in the body negatively and that testosterone therapy can help significantly.  However, keep in mind that the long term picture is much more negative.  The reason?  Low testosterone promotes several medical conditions that are known to be pro-inflammatory.

For example, one research summary wrote:

“We suggest that androgen deficiency is associated with IR [insulin resistance], T2D [type II diabetes], Met-S [Metabolic Syndrome], and with increased deposition of visceral fat, which serves as an endocrine organ, producing inflammatory cytokines and thus promoting endothelial dysfunction and vascular disease.” [8] Basically, low testosterone generally ages a man and puts his body in a pro-inflammatory state that is very difficult to escape from.[9]

Other researchers have made the same observation, nothing that testosterone seems to have a protective effect on your Beta cells (that make insulin) through controlling these inflammatory messengers. [10]

REFERENCES:

Nitric Oxide Solution: A Review - Peak Testosterone

If you have been on the internet in the last few months, you’ve undoubtedly seen the ads for Neo-40, the new nitric oxide boosting supplement co-created by Dr. Nathan Bryan.  I gave some coverage to this interesting new supplement in My Interview with Dr. Bryan, but here I want to discuss his new book, The Nitric Oxide (NO) Solution

My other favorite molecule, testosterone, has been extensively covered on the web and in books and magazines over the decades, primarily because of interest by bodybuilders and athletes the world over.  Nitric oxide, though, has taken a back seat and it is hard to find good information on the subject.  This is where Dr. Bryan – and my site if I don’t say so myself – can step in and fills in many of the missing gaps. And who is better qualified than Dr. Bryan?  Nobody since he happens to be one of the foremost researchers on NO on planet earth.

He offers many invaluable insights and shows how ubiquitous and all-encompassing nitric oxide is, serving as a neurotransmitter, immune cell weapon, cardiovascular healer, etc.  It is very analagous to testosterone, which affects the brain, blood cells, libido, cardiovascular health and on and on.  And, like testosterone, if your nitric oxide levels are depleted, you are going to suffer both in the bedroom and out.

Again, here’s where having one of the world’s leading gurus comes into play.  It turns out that this is the key for us middle-aged guys:  consumption of nitrates. These get converted to nitrites on your tongue by friendly bacteria and then into nitric oxide in the gut and – voila! – you’ve got yourself the nice boost that you’ve been looking for.

This book has literally hundreds of other nitric oxide facts and tips, including many practical ways to boost nitric oxide. So dump those expensive NO supplements and set The Nitric Oxide (NO) Solution by your bedside.  This is how you’ll really boost this wonder molecule and so something remarkable under the covers.

Dr. Bryan also does a nice job of documenting the key chemical players involved.  For example, The Nitric Oxide (NO) Solution covers many of the mysteries of nitric oxide.  One of them has centered around L-Arginine.  For years, supplement manufacturers have based their nitric oxide-boosters on L-Arginine.  As it turns out, this is not only an ineffective approach in most cases but also a dangerous one for many men (as I have covered in my link on Arginine). Dr. Bryan explains that the L-Arginine pathway is a poor one for middle-aged and beyond men as it loses its efficiency as we age.  Furthermore, he explains why it  can even get you hurt (due to overstimulation or NO byproducts, i.e. metabolites). (6 men with heart disease died in a study using heavy doses of L-Arginine.)

LDL-P: Values for Plaque Control and Reversal .

I also want to mention that LDL-P is merciless and the reason is that it is a gradient-driven chemical process. This is why it is so important to pay attention to this number.  If you had high school chemistry, you may remember what I am talking about here.  A gradient refers to the situation where the concentration of a molecule, in this case an LDL particle, is higher than on the other side of the membrane.  If the membrane is porous, there will be a “force” or “pressure” to try to equalize both sides of the membrane.  What this means is that LDL, when the Particle Count is too high, is driven into your arterial walls by simple chemical processes, where they can do little except cause inflammation and plaque.

So how do we keep those LDL particles floating along in our blood instead of imbedding themselves in our endothelium?  Basically you have to somehow lower your LDL-P enough to keep that from happening.  Unfortunately, as far as I know, no one has studied an exact level of LDL-P to target for plaque reversal.  Does this make LDL-P useless?  For example, I have a page on my site where I discuss HDL, LDL and Triglyceride Levels for plaque reversal according to the men that I call The Plaque Reversers. However, there are no such guidelines (with one exception) for LDL-P.

1. Dr. Davis’ Target (700 nmol/l).  I recommend every man read this book on plaque about ten times.  You can read my praise and appraisal of it here:  A Review of Track Your Plaque. It has the best coverage of cardiovascular markers for the layman that I have read and is just great info. And one of the sections in the book covers Dr. Davis’ recommended LDL-P for plaque reversal which is 700. Now my one comment is that Dr. Davis tends to have very aggressive thresholds compared to either Dr. Gould or Dr. Esselstyn.  I think the reason for that is that Dr. Davis wants to make sure that virtually every man and woman that tries for plaque reversal actually achieves it and thus sets aggressive targets.

The bottom line is that, if you want to play it very safe, then you should probably shoot for his target.  However, as an example, Dr. Davis recommends LDL-C levels below 60 mg/dl and I have seen other reliable sources recommend between 70 and 80 for plaque reversal. Basically, Dr. Davis wants to save as many lives as possible and that is certainly admirable!

2.  Aim For the 2nd or the 5th Percentile. In a person who is diabetic or prediabetic, using LDL-C (the traditional LDL value) is risky. The reason for this is that those individuals often have a high LDL-P even though the LDL-C is much more reasonable.  Studies show that having high LDL-P even with low LDL-C places you at high risk for heart disease. And odds are that a high percentage of men who make it to my site are probably prediabetic or diabetic, since those go hand-in-hand with erectile dysfunction and low testosterone so often.

Nevertheless, pretend just for a minute that LDL-C is always valid.  The Plaque Reversers do this in their patients by insisting that they have low triglycerides and reasonably high HDL, something that is uncommon in those with insulin resistance. Thus, if you properly control these other two lipid markers (HDL and triglycerides), LDL-C is usually going to be a decent target value for you and the Plaque Reversers want your LDL-C between 60 mg/dl and 85 mg/dl.

Now what is the corresponding LDL-P number?  The same Framington Offspring Data showed the 5th percentile of LDL-P to be 850 nmol/l. [2] Therefore, I suspect that 850 is a very good starting number to shoot for for many men, but, again, there is no data to prove or disprove this.

Therefore, to play it safe you may want to target the 2nd percentile. The 2nd percentile of LDL-C was 70 mg/dl.  70 is an excellent LDL number and when accompanied with low triglycerides (less than about 90) and would give you a high probability of plaque reversal.  What LDL-P does this correspond to?  It turns out that the 2nd percentile of LDL-P is 720 nmol/l, which is almost exactly Dr. Davis’ target value. Obviously, being in the top 2% of Americans or any modern culture is a much, much safer place to be, considering the rampant heart disease (and complications such as erectile dysfunction) that dominate the general population.

CONCLUSION:  700-850 nmol/l is probably a good range to target for LDL-P, depending on your existing plaque levels and cardiovascular risk.  Using a knowedeable cardiologist to assess risk is the way to go, but there are few that are knowledgeable in plaque reversal according to what I have seen.

Get an IMT or Heart Scan – generally speaking you will not need a doctor’s order and can get this done yourself – and see how much plaque you have.  (A Heart Scan does involve some radiation, so you have to research that.)  If you have a significant amount of plaque, then you want to probably get as close to that 700 number as possible, since the only recommendation that I know of for arterial plaque reversal is Dr. Davis’ 700 number.

Again, it is always better to find a cardiologist or physician that knows about plaque reversal and can help you out.  (Most doctors are uninterested in this subject yet and will just hand you a statin and some Cialis and send you on your way.)

I also recommend that you read pages on How to Clear Your Arteries and The Importance of LDL-P For Plaque Reversal.. LDL-P is the best number to use. In the case of the latter, I make the case that LDL-P is a much better number to use than LDL-C, because so many men in modern cultures are prediabetic. If you do not have access to testing for LDL-P, which is common in other countries and in certain (Gestapo-like) states in the U.S., then you can use the a combination of LDL-C, triglycerides and HDL like the Plaque Regressers to approximate LDL-P. See my page on HDL, LDL and Triglyceride Levels.

1)  J Clin Lipidol,m 2011 Mar-Apr, 5(2):105-13, “Clinical implications of discordance between low-density lipoprotein cholesterol and particle number”

2) American Assoc of Clinical Chemistry, 2009, 55:3, “Apolipoprotein B and Cardiovascular Disease Risk: Position Statement from the AACC Lipoproteins and Vascular Diseases Division Working Group on Best Practices”

Cheapest Testosterone Tests - Peak Testosterone

It is no secret that doctors do not test as much as they should.  The primary reason is simple:  insurance premiums and partner physician agreements.  The bottom line is that they have to keep their costs in line and, of course, this isn’t all bad or our insurance premiums would be sky high.  The downside is that doctors often leave out valuable lower-probability tests.  In this case, it is up to the consumer to do his own testing if it is going to be done.

For the record: I have no relationship with any of these labs and I am not officially recommending any of them. You must do your own due diligence as a consumer. I can tell you that these labs have been used successfully by at least one of our senior members. Prices are not controlled by me and are strictly as reported as of 11/17/2013. You can read a little more about some of these in my link on Testosterone Labs.

NOTE: None of these labs do the actual testing. They actually contract out the actual work to LabCorp, which is the largest lab here in the U.S.

LEF (membership req’d $5 per month)

WalkInLab, LabsMD, HealthOneLabsHealthOneLabs (Uses LabCorp)

Fix Your Testosterone Naturally - Peak Testosterone

Many men find out they have low testosterone and want to immediately jump on HRT (TRT or testosterone therapy), because they just want some relief. However, this is not always the smart way to go.  Let me give you just one just real-life scenario that really does occur:

A man has lowish total testosterone of say 340 ng/dl.  He finds out at the same time that he is hypothyroid.  He then corrects the hypothyroidism and boosts his testosterone to 450 ng/dl.  Most of his “low testosterone” symptoms actually go away and he decides to wait before going on HRT, because he is doing pretty well.

Here are 10 Practical Ways to Fix Low Testosterone Naturally to boost testosterone 25% or more and/or often eliminate low T symptoms.   Remember that these could potentially be additive as well:

1. HRT (Hormone Replacement Therapy). (100-1000%) Could HRT be considered a “natural” solution? It depends on your definition of course.  Personally, I would say that it is a natural solution when you use a) bioidentical testosterone (or an esterized testosterone) and b) you stay within normal ranges.  For example, let’s take the case of a man that goes on testosterone pellets:  the testosterone in the pellets is bioidentical and it will raise this man’s T to around 600 ng/dl on average, which is a often a nice level for a man in his 40’s and possibly 30’s.

What kind of an increase can you expect from testosterone therapy?  With injections you can take a man to whatever level you want.  He can go from an abysmal 150 ng/dl and be 1500 ng/dl a few days later:  it just depends on how much is injected. (Generally speaking, a man should not go over 1200 ng/dl, which is considered the peak testosterone of a very healthy young male. And most men should be under this to avoid side effects – more on that later.)

2.  Anticipation and Sex. (25-70%) The mere anticipation of sex can send your testosterone through the roof. One study of men that attended a sex club found that those who actually participated experienced up to a 70% increase. [3] Even more interesting is the fact that this huge boost in testosterone occurred for men of all ages. Now I’m not encouraging sex clubs to boost testosterone.  But you get the point:  if you can figure out some way to increase the excitement and anticipation, your testosterone is very like to climb and possibly in a huge way.  In fact, still other studies have shown that even hanging around an attractive woman elevates a man’s testosterone.

Another example of this is the Cialis study where testosterone levels climbed by 24%.  The reason is very likely the fact that men had more anticipation of and actual engagement in sexual intercourse, a proven testosterone booster as I show in link on Sex and Testosterone.

3.  Weight Loss. (60%) Sorry to put a “boring” one at the top of the list, but weight loss can potentially give a man the biggest gains in baseline testosterone levels. If you are significantly overweight, your body fat may be aromatizing so much testosterone into estradiol (the “bad” estrogen) that it is actually signaling to your hypothalamus to shut off testosterone production. This is actually a form of lifestyle-induced secondary hypogonadism. So, if you take the time to lose the weight, it can yield big gains. I have seen a couple of cases of this on the forum and one study clearly shows it as well: men who lost about 60 to 280 pounds had an average increase of 60% in their testosterone levels. [1] Usually lifestyle changes will not cure hypogonadism, but this could very well do it.  I have other studies listed in my page on Testosterone and Weight Loss as well.

Also it should be pointed out that these men generally dropped their estradiol levels significantly, thus greatly improving their testosterone-to-estradiol ratios.  Some gains in testosterone are made but not enough to really get into safe territory. However, there is one exception: massive weight loss. ] Another study looked at a more general cross section of obese men that lost a much more significant amount of weight (between 57 and 283 pounds) and found, as one might expect, even more significant changes in testosterone. Total T levels went from an average of 240 to 377 before and after weight loss, respectively. This is a whopping 58% increase on average and is impressive to say the least. Free testosterone increased almost as much: 41%. (Free estrogen also decreased significantly as well.) [39]

This is verified by a couple of the studies on Aromatase Inhibitors, which basically reduce estradiol levels directly.  One example was a study of hypogonadal  seniors who were given Arimidex and experienced a 62% increase in testosterone levels. [4] Again, getting estrogen under control can have a monumental impact on testosterone levels.

4. Elevated Prolactin. (50-100%) If you have elevated prolactin, it can suppress both your testosterone and libido.  This can be from a tumor or other factors:  see my page on Testosterone and Prolactin for more information

5.  Lab Testing.  (30%) How can lab testing stimulate testosterone production?  Well, it can’t directly of course.  However, you can get a nice testosterone boost if your doctor finds you are deficient in any of these three tests:  a) Vitamin D, b) Prolactin and/or c) Thyroid Hormones. These are inexpensive tests and all three can lead to nice testosterone boosts, again if you are low, of around 30%.  Correcting prolactin can lead to potentially even bigger gains.

NOTE: There is one way that supposedly can lead to a 100+% increase in testosterone:  abstinence.  That’s right – one study showed monstrous increases in testosterone right at the 7th day for men who could hold out from ejaculating for that long.  I outline why I don’t think this is a good idea for most men in my link on Testosterone and Abstinence.

6.  Sleep and Sleep Disorders. (30-35%) Sleep and sleep disorders can have a profound affect on your testosterone and there are several reasons for it. For one thing, rising prematurely early can raise cortisol levels, which could lead to a drop in testosterone levels. Sleep also leads to lower libido, worsened mood and anxiety and other things that will affect your relationships negatively and that means less Sexual Intercourse, a Proven Testosterone Raiser. How much can sleep affect testosterone levels? The upper limit is probably defined by sleep apnea, the disorder where the breathing passageway is blocked and the sleeper is woken up multiple times during the night consciously or unconsciously. Studies show that apnea drops testosterone by about 30-35% and fixing your apnea will raise it by about the same. So this probably gives us an upper limit on what sleep improvements can do for your testosterone, since apnea is such a severe condition.  See my links on Apnea and Testosterone and Sleep and Testosterone for more information.

7.  Herbs and Supplements. (30%) Many men immediately turn to supplements and herbs for stimulation of their testosterone levels. Can these help? Well, first of all, we have to realize that there are two types of testosterone supplements: 1) fairly well-tested and well-studied supplements and herbs such as Tribulis Terristris and D-Aspartic Acid and some of the synthetic, laboratory-based stuff that is out there. If you read the list of ingredients and have no idea what is in there and you can locate no or virtually no studies on the compounds, then it is in the latter category. These kind of supplements I do not consider because they are, of course, very risky and there is little data. Pharmaceuticals are dangerous enough after a few stages of clinical trials. Can you imagine the risks of something cooked up in a lab somewhere? I just don’t think it is worth the risk

Now, going to D-Aspartic Acid, this has been shown to increase testosterone by about 30% on average in one study. (Unfortunately, it can raise estradiol disproportionately though.) Other herbs and supplements have been found to increase testosterone at levels a little below this, i.e. provide a boost in the 10-25% range and I cover those in my Testosterone Herbs links.

8. Varicocele Repair. (~30%) A couple of studies show that in some cases – not all varicoceles are created equal – a man can get a nice boost in testosterone from the procedure that does the repair of this condition.  For more details, see my page on Testosterone and Varicoceles.

9.  Competition and Winning. (20-30%) Research shows that competition can raise testosterone levels surprisingly significantly.  For example, one study found that men who watched a winning World Cup soccer team raised their salivary testosterone levels by almost 30%. [2]

10.  Vitamin D.   (25%)  Can you believe that simply correcting a Vitamin D deficiency could boost your testosterone by 25%?  Well, that is what one study showed.  See my link on Testosterone and Vitamin D for more details. And keep in mind that correcting a Vitamin D deficiency can improve your immunity, protect from many diseases and condition, increase your energy levels and on and on.  It is an incredibly important vitamin and will increase your long term health in a 100 different ways.

NOTE: Trying to correct testosterone levels through diet is still in its infancy as far as understanding in my opinion.  There was one very old study that implied that going on a vegetarians diet could reduce testosterone levels by 30+%.  However, a more recent study showed that vegans have higher testosterone levels than carnivores. See my link on Testosterone and Vegetarianism for additional information.

CAUTION: You should always treat low testosterone as a medical condition.  In my book, Low Testosterone by the Numbers, I document how low testosterone is a risk factor for a host of nasty health disorders, including diabetes, Metabolic Syndrome, erectile dysfunction, osteoporois/osteopenia, weight gain, depression – the list goes on and on.

REFERENCES:

1)   The Journal of Clinical Endocrinology & Metabolism, May 1 1988, 66(5):1019-1023, “Effect of Massive Weight Loss on Hypothalamic Pituitary-Gonadal Function in Obese Men”

2) Physiology & Behavior, Aug 1998, 65(1):59-62, “Testosterone changes during vicarious experiences of winning and losing among fans at sporting events”

3) Arch Sex Behav. 2011 Oct;40(5):921-6, “Salivary testosterone levels in men at a U.S. sex club”

4) Clin Endocrinol (Oxf), 2008 Jun 25, [Epub ahead of print], “Effects of aromatase inhibition in hypogonadal older men: a randomized, double-blind, placebo-controlled trial”

How To Fix Low Testosterone NaturallySTEP 6A. See if you can fix your low testosterone naturally by correcting one of the common causes of hypogonadism (clinically low testosterone):

Did you know you can inexpensively do your own testing for most hormones? The industry leader is Discounted Labs..

Cialis, Tinnitus and Risks to Vision - Peak Testosterone

Most of my readers know that I urge caution when it comes to the new PDE5 inhibitors (Levitra, Cialis and Viagra) because a little known but relatively common side effect are vision and hearing disturbances.  Many men experience symptoms such as blurred vision, tinnitus, partial or total loss of hearing and so on.  (Stomach upset is also very common.) The reason for these disturbances is that there are other PDE enzyme systems in the stomach, ears and eyes and these drugs can affect them as well.

Researchers recently found, for example, that these drugs decrease blood flow to the optic nerve. This cannot be a good and will undoubtedly have long term effects. [1] Do you really need to trade blood flow to your eyes for blood flow to your penis? And what are the long term effects of decreased blood flow to the eye over the decades – it cannot be good!

Damage to the ears seems no less likely.  One senior reader wrote in with a story a very tragic story of possible long term vision damage and certain permanent tinnitus, i.e. ringing in the ears after Cialis usage. Here is his story exactly as written:

“I used the levitra at 10 mg and then the cialis at 20 mg. and they worked wonderfully just as advertised but about 3 weeks ago I developed tinnitus in my left ear the day after using the 20mg of cialis and my eyes were blurry for a bit. the ringing is still in my ear but the blurry vision is getting better. needless to say the chemical experiement is done for me.”

This man likely almost lost his vision and may experience some permanent vision loss from tadalafil usage.  Again, some people are more sensitive than others, but as I point in other links:  what are these drugs doing to you long term even if you don’t experience this kind of dramatic initial symptoms?

I asked him a few more questions and the response of the doctors was even more remarkable:

“hi lee and thanks for your input and time. the tinnitus i am afraid is permanent. I have been to ent doctor and he was very callous and actually said I will just have to learn to live with it. there is nothing he can do. I had a mri of the brain to see if there was a tumor or anything and he said it was clean. no tumor no stroke but i don’t have alot of faith in him or any doctor I have seen.

“I then went to an audiologist who said a hearing aid would help the hearing and lent me one. it did help mask some ringing in the daytime and he also said I will learn to tune it out eventually. dont know how that works in the quiet of the night however. I called and talked to the doctors office about getting another blood test for testosterone etc and they have yet to get back to me. “

“Both the family doctor and the urologist were interested in nothing but pushing their meds. when i told the family doctor about the tinnitus he said, really? you can get that from taking cialis? then he told me as did the urologist i should maybe switch to levitra and cut the dose down. the problem is trying to find a good and doctor who knows and cares really. i’ve been to quite a few and have yet to find one who does more than dispense meds. my vision blurriness is not a constant and seems to come and go and not as much as time passes”

A doctor that does not know Cialis can cause tinnitus?!?  Oy vay! This is one of Cialis’ primary side effects and virtually all drugs have side effects.  I can’t help but believe the physician was really trying to say, “You are such a rare case that I’ve never heard of it.”  However, that is simply NOT the case:  vision and hearing disturbances are quite common and well-documented in the literature.  Studies have even numerically evaluated the effect on other enzyme systems of these drugs. (I cover this in other links on my site.)

It is also important to comment, which I point out in my link on Viagra Resistance, many men become resistant to these drugs and have to increase their dosage over time.  This puts them at even greater risk of long term damage.

I’ll say the obvious:  get yourself on a good clean diet that promotes endothelial health.  The Mediterranean, DASH, Low Fat and Vegetarain diets are all good candidates.  Start exercising and get active.  Start cleaning out your arteries and improving your blood flow as all meds have risks.

NOTE: I have many other links on Viagra, Cialis and the PDE5 Inhibitors.  If you are interested, use the Search button at the top of the page.

REFERENCES:

1) https://www.drugs.com/viagra.html

Brain Assault - Peak Testosterone

It’s a scary world out there for you and your brain. Your grey matter is under assault from a host of almost bizarre attackers, from primitive protozoans to byproducts of living in the industrial age. Remember: if you’re reading this, it’s not too late. Once you begin to show signs of neurodegenerative disease, significant damage has already been done.

Below are a few of the nastiest and most toxic of the neuron and brain cell killers – the ones that never make the paper but likely are affecting hundreds of millions of us around the globe – that you should be aware of.

NOTE:  One sign of neurodegenerative disease may be your dreams. Yes, how you dream may actually be the sound of your neurons screaming.  Males, in particular, are vulnerable to certain neurological disorders that can display literally decades ahead of time in violent dreams. [1]

1.  Drinking Water and Copper. Yes, isn’t that nice? We build our homes with non-corrosive copper pipes, not realizinng that this mineral, in excess, has been found in several studies to significantly increase the risk of Parkinson’s Disease. [2][3] Of course, Parkinson’s is the disease where the dopamine-producing cells in the brain are killed, eventually leading to the incapcitating tremors and shaking associated with this disorder.  Certain pesticides are linked with Parkinson’s as well, but the strongest associated seem to be copper (and manganese).  Copper actually misfolds a key protein that accelerates certain misfolded proteins in the brain associated with Parkinson’s.

NOTE:  The aluminum in water has also been associated with Alzheimer’s.  See my link on Aluminum and the Brain for more details.

2.  Toxoplasma Gondii. Imagine a protozoan that makes its way up into your brain and lodges in your neurons, causing extensive damage (in some people), including increased risk for brain cancer and Parkinson’s.[8][9] Well, imagine no longer.  This critter lives in about 15 percent of all of us and recent reserch shows it is a brain-changer.  It is very hard to eradicate, even if you know you have it. It has been show to affect mood and even lead to traffic accidents. [10] One way that it injures the brain is by increasing dopamine levels.

CAUTION:  Domesticed cats and uncooked foods are considered the most common way to get this pathogen.

3. Pesticides Of course, fruits and vegetables are very brain-protective.  Unfortunately, many pesticides are not. Ziram, for example, has been linked to elevated Parkinson’s risk. [1] See my link on Pesticides and Parkinson’s for other examples.  So far, most of the risk seems to be tied to actually working with the chemicals occupational  However, there is some evidence that simple consumption in some cases may increase risk.  The bottom line:  go organic if you can afford it.

4.  Iron. One rule for guys:  “pump iron but don’t eat it.”  First, iron was found to increase risk for heart disease. [5][6] And now it likely increases the risk for Parkinson’s Disease. [4] Why is iron so male-toxic?  It increases mitochondrial oxidative (free radical) damage.

5.  Whey and Diet Drinks. Trying to be healthy with diet drinks? Lifting weights and consuming whey powder/drinks to put on muscle?  If so, you’re flooding your system with Excitotoxins.  Read here about The Dangers of Excitotoxins. There is an additional risk, by the way, with diet drinks: about ten percent of the aspartame breaks down into methanol, a known neurotoxin. [7]

So how do you protect yourself? First of all, almost anything that protects your erections, your cardiovascular system and even your skin, will very likely protect your brain. You need to bathe your brain in abundant nutrients from a balanced, whole foods diet and push those nutrients upstairs with exercise. Cortisol is a proven brain killer, so managing stress is also critical.  Many foods, such as blueberries, have superpowers to protect the brain.  Read my link on The Brain  for more information.

REFERENCES:

1) https://www.sciencenews.org/view/generic/id/61774/title/ Violent_dreams_may_predict_illness_in_advance

2) https://news.ncsu.edu/releases/tp-rose/

3) Lancet, 1987 Aug 1, 2(8553):238-41, “Raised cerebrospinal-fluid copper concentration in Parkinson’s disease”

4) JOURNAL OF MOLECULAR NEUROSCIENCE, 28(2):125-141, Coenzyme Q10 provides neuroprotection in iron-induced apoptosis in dopaminergic neurons”

5) JAMA, 2007, 297(6):639-641, “The Iron-Heart Hypothesis”

6) Arch Intern Med. 1999, 159:1542-1548, “Iron, Atherosclerosis, and Ischemic Heart Disease”

7) https://www.examiner.com/disability-in-dallas/aspartame-linked-to-brain-cancer

8) Biology Letters, Published online before print July 27, 2011, “Incidence of adult brain cancers is higher in countries where the protozoan parasite Toxoplasma gondii is common”

9) Neurosci Lett, 2010 May 21, 475(3):129-31. Epub 2010 Mar 27, “The probable relation between Toxoplasma gondii and Parkinson’s disease”

10) BMC Infect Dis, 2009 May 26;9:72, “Increased incidence of traffic accidents in Toxoplasma-infected military drivers and protective effect RhD molecule revealed by a large-scale prospective cohort study”

11) https://www.newsinferno.com/ziram-pesticide-exposure-increases-parkinson%e2%80%99s-disease-risk/

Antioxidants That Can Boost Testosterone? - Peak Testosterone

There’s a lot going on in those testes of yours, including sperm and testosterone production. Yeah, it’s a big factory down there and researchers have found increasing evidence that “oxidative stress”, i.e. free radical damage, is one of the leading causes of lowered testosterone.  Damage to the mitochondria appears to play a key role. [4]  In an eye-opening study, researchers found that the Vitamin E, a antioxidant that quenches several free radicals, actually slowed down the age-related decline in testosterone in lab rats. [1] This may mean that one can significantly slow down andropause if one starts at a young enough age. Life is full of regrets, eh?

Researchers have also discovered reduced levels of key antioxidants, such as the heavy hitters SOD and glutathione, in aging rat Leydig cells, thus adding weight to the above oxidative stress theory and the need for adequate antioxidant dietary support. [2]  However, here is what should really catch your attention:

1.  Pomegranate Juice.  We have aleady covered how Pomegranate Juice Boosts Erectile Strength, but did you know that a study on rats showed a nice boost to testosterone as well? [3]  In fact, the rats drinking the most pomegranate juice got a nice 27% in testosterone! In my link on Pomegranate Juice and Testosterone, I show just what dosage may achieve these kind of gains.

Of course, the problem with this is that for the typical 160 pound male, you are talking about a megadose of over 3 grams of quercetin in us humans. Nevertheless, it shows the power of some antioxidants to power up testosterone production in the ol’ Leydig cells.  NOTE:  I do not know the human-to-equivalent ratio for the rats used in this study.

3. Onion Juice. Based on #2, it probably will be no surprise that onions, if consumed in large enough quantities, can boost testosterone.  Of course, the question of the day becomes “how in the world do I eat an onion or two and still live in polite society”?  Researchers came up with a nice solution:  onion juice. They just blended one standard onion and – shazam! – the juice boosted rat testosterone by 300+%. [5]

The only problem is that the amount of onion juice these rats consumed was 1 gram per kilogram, which translates to about 73 grams of onion juice for the typical 72 kg guy.  However, it should be noted that even taking half that amount of onion juice created a nice testosterone boost as well, so it is likely dose dependent, i.e. even a smaller amount of onion juice may give you a little lift.  NOTE:  I do not know the human-to-equivalent ratio for the rats used in this study.

Did you know you can inexpensively do your own testing for most hormones? The industry leader is Discounted Labs..

4. Melatonin.  Data is very limited but the antioxidant and hormone melatonin appears to protect testosterone in Leydig cells as well. [1]

So should you start gulping gallons of juice?  Well, that’s a little premature for a variety of reasons. First of all, all of the above studies are on animals and may not translate to humanoids such as ourselves.  Furthermore, perhaps it’s possible to overdo antioxidant consumption.  For example, some experts have posited that if you overdo ingestion of antioxidants, it shuts down the body’s own natural antioxidant production.  In fact, some studies have shown that antioxidants in supplement form may actually be dangerous to your heart or promote cancer as I document in my links Antioxidants and Your Heart and The Dangers of Antioxidant Supplements.

However, a solid diet loaded loaded with ample antioxidants will likely protect and possibly boost your testosterone and give you multiple additional health benefits as well.

1) Experimental Gerontology, Aug-Sep 2005, 40(8-9):728-736, “Vitamin E, aging and Leydig cell steroidogenesis”

2) The Journal of Steroid Biochemistry and Molecular Biology, Jan 2004, 88(1):61-67, “Aging alters the functional expression of enzymatic and non-enzymatic anti-oxidant defense systems in testicular rat Leydig cells”

3) https://www.ergo-log.com/pomegranate.html

4) Endocrinology, 2002, 144(7):2882-2891, “Reactive Oxygen Disrupts Mitochondria in MA-10 Tumor Leydig Cells and Inhibits Steroidogenic Acute Regulatory (StAR) Protein and Steroidogenesis”

5) https://www.ergo-log.com/onionjuice.html

6) J Endocrinol, 2004 Jun, 181(3):493-507, “Reduction of rat prostate weight by combined quercetin-finasteride treatment is associated with cell cycle deregulation”

Testosterone, Heart Disease and Arteries - Peak Testosterone

Of course, the significance of this is that heart disease is the #1 killer of men in modern, Western societies, and nothing else really comes close. It is no exaggeration to call it an epidemic and statins are a weak and I believe sometimes dangerous attempt to correct the problem, something I discuss here: The Dangers of Statins. I believe that right under our noses is an additional tool, testosterone replacement therapy, to fight cardiovascular disease in the solid majority of men with low or lowish testosterone levels.

Why do I say the “solid majority?”  Why not all men?  Well, there are likely exceptions, such as men with clotting disorders, certain men with hypertension or arrhythmias and men with high red blood cell counts, hematocrit or hemoglobin.  Men should be screened before going on TRT and, of course, any issues discussed with a knowledgeable physician. But on this page I will present the evidence, and there is a lot of it, that, generally speaking for most guys, boosting low testosterone will be a big help in the fight against heart disease.

NOTE:  The #1 way is to  Regressing Atherosclerosis.  If your diet and lifestyle is putting plaque in your arteries, then testosterone is not going to save you.

Here are just some of the benefits to the cardiovascular system associated with improved testosterone levels:

2. High Blood Pressure. Testosterone therapy can also lower blood pressure in men.  The change is usually not huge, but it is significant nonetheless.  The reason is that testosterone actually affects nitric oxide – yes the stuff that makes your erections possible.  I document all this in my link on Testosterone and Blood Pressure . By the way, one of the Peak Testosterone Forum members saw a huge drop in blood pressure from going on HRT.   He went from about 120/80 to  87/67! [5]

3.  Weight Maintenance. Study after study has shown that HRT will help hypogonadal men gain muscle and maintain or even lose weight. For example, one study even showed an increase in fat free mass, essentially muscle, and a decrease in fat mass in men with low normal testosterone. [6] Of course, testosterone will not keep you from overeating, but it is definitely another tool in your arsenal against the slow and steady weight gain that plagues men in modern societies. And, yes, those extra pounds are a risk factor for cardiovascular disease.

5.  Decreased Anxiety and Improved Depression. Anxiety and depression are both stressors and can increase cortisol and cause a host of direct and indirect cardiovascular-related issues. Testosterone can often help greatly with both of these and is a proven mood booster, something I talk about in my link on Testosterone and Depression . Psychologists are starting to admit the interrelationship of hormones and depression and perhaps one day getting your testosterone and estradiol checked will be a part of any psychological evaluation. On the Peak Testosterone Forum I have had a couple of low T men completely turned around from depression by going on HRT. Of course, it doesn’t always work that way as depression is a complex, multi-faceted condition. But having low testosterone is likely only going to make the condition worse and be very hard on one’s cardiovascular system.

6. Diabetes. It is no secret that type II, adult onset diabetes is an epidemic in the U.S. And it is no secret that, once a man gets diabetes, his chances of cardiovascular disease sky rocket. One study showed that men with diabetes tripled their chance of another heart attack if they had already had one. And, if they had not yet had a heart attack, they increased their risk six fold! [8] Testosterone therapy can be a HUGE boost in men with low or lowish testosterone in this area. As I mention in my link on Testosterone and Diabetes, I have spoken with one large HRT clinic where ALL of their men got off of insulin by going on testosterone cypionate injections to youthful levels. This is an incredible stat and, hopefully, more credence will be paid to it over the next decade by the medical community.

Did you know you can inexpensively do your own testing for most hormones? The industry leader is Discounted Labs..

7. Insulin and Inflammation. Probably the two biggest root cause killers of men are what I call The Two I’s: insulin and inflammation. As insulin levels and resistance increase, tissues begin aging and a host of nasty metabolic conditions set in, especially in the arteries. Testosterone therapy dramatically decreases both insulin and inflammation levels, something I document in my links on Testosterone and Inflammation and Testosterone and Insulin Resistance.

8. Visceral Fat. Visceral fat is the stomach fat that plagues so many men and is linked to Metabolic Syndrome and heart disease.  In one study of hypogonadal diabetic men, testosterone therapy decreased visceral fat. [3] This will very likely be the case for many of you because diabetes and prediabetes account for a huge block of modern societies.

9. Atherosclerosis. There is now in vitro evidence that testosterone (and estradiol, DHT and DHEA) can inactivate white blood cell activity in the arterial walls, which is so critical in the plaque formation process, and thus help a man prevent atherosclerosis. I cover this in my page on Testosterone, Arterial Plaque and Atherosclerosis.

All of the above are big risks for heart disease and so it would be tragedy to ignore all this research when heart disease is the #1 killer of us guys.  However, a big question remained in the eyes of researchers:  could testosterone therapy (for men with hypogonadism)  improve heart disease outcomes.  We all know of research that should have been positive but turned out to be the opposite. Would HRT fall into this category?

The good news is that testosterone therapy has done very well in the studies so far and has actually improved outcomes in a variety of studies.  Here are a few examples:

1.  Moderate Heart Failure. One study looked at men with moderate heart failure. It found significantly improvement from Androderm therapy even though not all the men were hypogonadal to begin with. [1]

2. Angina.  Heart patients with angina often suffer tremendously with chest pain.  One study gave men with stable, chronic angina low dose testosterone in the form of a patch. [2] The study, which was double blind and placebo-controlled, improved pain scores.  And, as expected, in men with lower bioavailable testosterone, the pain scores were improved even more dramatically.

3. Myocardial Ischemia. One (admittedly small) double blind, crossover study showed that testosterone helped heart patients’ myocardial ischemia, or insufficient blood flow to an organ or tissue. In this case, the researchers were concerned with proper blood flow to the heart muscle, which can limit tissue damage before and after a heart attack. [7]

What is remarkable about the above studies, if you stop and think about it, is that no lifestyle modifications were usually required of the participants. In general, cardiovascular disease is a disease of a Western lifestyle, and so it is rather surprising that testosterone can help so much just on its own. Imagine if testosterone therapy is combined with proper diet, exercise and general good, clean livin’? So, if your testosterone is low, talk to your doctor about the pros and cons of HRT. I have many links on the subject including ones on HRT, Pellets, Compounding and so on.

I also highly recommend that one read these two pages for other very important research on the subject:  Testosterone Therapy and the Recent VERY Postive Research and Profound Lowering of Cholesterol in Men through HRT.

NOTE: Erectile dysfunction often goes hand-in-hand with cardiovascular disease as well.  Your erections, just like your heart and arteries, are dependent on soft, expandable vascular tissues and ample nitric oxide that is not overly aged, injured and covered with plaque.  It will be no surprise, then, to learn that testosterone very often improves erectile strength as well, nor that hypogonadism is often a root cause of erectile dysfunction.  For more information, see my link on Testosterone and Erectile Dysfunction.

1)   European Heart Journal, 27(1):57-64, “Testosterone therapy in men with moderate severity heart failure: a double-blind randomized placebo controlled trial”

2) Circulation, 2000, 102: 1906-1911, “Low-Dose Transdermal Testosterone Therapy Improves Angina Threshold in Men With Chronic Stable Angina”

3) Eur J Endocrinol June 1, 2006 154 899-906, “Testosterone replacement therapy improves insulin resistance, glycaemic control, visceral adiposity and hypercholesterolaemia in hypogonadal men with type 2 diabetes”

4) J Endocrinol, Sep 1, 2003, 178:373-380, “Testosterone as a protective factor against atherosclerosis–immunomodulation and influence upon plaque development and stability”

5) https://peaktestosterone.com/forum/index.php?topic=1077.msg9810#msg9810

6) The Journal of Clinical Endocrinology & Metabolism, Jan 1 2008, 93(1):139-146, “Testosterone Therapy Prevents Gain in Visceral Adipose Tissue and Loss of Skeletal Muscle in Nonobese Aging Men”

7) The American Journal of Cardiology, 1999, 83(3):437-9, A9, “Effect of acute testosterone on myocardial ischemia in men with coronary artery disease”

8) N Engl J Med, 1998; 339:229-234, “Mortality from Coronary Heart Disease in Subjects with Type 2 Diabetes and in Nondiabetic Subjects with and without Prior Myocardial Infarction”

Salt (Too Much) Can Be Deadly - Peak Testosterone

Most health-conscious people have grown up with the idea that salt is only bad for those who are “salt-sensitive.”  What is meant by this is that there is research that shows that the blood pressure in a certain minority of people will increase with salt.

However, what has emerged in the last ten years is a much more ugly picture of salt.  Salt is not just a problem for the “sensitive” but for the population at large and, furthermore, it does not just elevate blood pressure but results in increased risk for a host of medical conditions.

NOTE: Read my link on How to Defeat Inflammation for more details

Consider what that all that extra salt in your diet, primarily from added salt and processed foods, will do to you according to the latest research:

1) Adiponectin.  Many people have heard of the inflammatory markers TNF-alpha and C-Reactive protein.  However, one lesser known inflammation-controlling protein is Adiponectin:  the less you have, the higher your inflammation.  Adiponectin can be whacked by being overweight and – you guessed it! – by salt intake. [1]  Adiponectin levels likely play a role “in type 2 diabetes, obesity, atherosclerosis, non-alcoholic fatty liver disease (NAFLD) and an independent risk factor for metabolic syndrome”. [2]

Perhaps more scary is adiponectin’s correlation to stomach (gastric), prostate, and colon cancers as well as leukemia.  In women, it has also been tied to endometrial and breast cancers  [5]

REFERENCES:

1) Journal of Hypertension, Jun 2010, 28:36, “Salt Intake and Inflammation in Essential Hypertension: 1B.05”

2) https://en.wikipedia.org/wiki/Adiponectin

3) European Journal of Cancer Prevention, Mar 2011, 20(2):132-139, “Salt, processed meat and the risk of cancer”

4) British Journal of Cancer, 2004, 90:128 134, “Salt and salted food intake and subsequent risk of gastric cancer among middle-aged Japanese men and women”

5) British Journal of Cancer, 2006, “Adiponectin and cancer: a systematic review”

6) BMJ, 2009; 339:b4567, “Salt intake, stroke, and cardiovascular disease: meta-analysis of prospective studies”

What makes adiponectin so toxic and an apparent precursor to so many deadly conditions?  The likely root cause is its role in increasing insulin resistance, a key factor in type II diabetes and Metabolic Syndrome.

2. Stomach, Colon, Testicular and Bladder Cancer. Higher salt intakes are now correlated with all four of these nasty cancers.  [3]  This likely also explains the previously mysterious link between GI cancers and processed meats, which are high in salt. [4]

4. Stroke and Cardiovascular Disease.  A large, recent meta-analysis found that salt significantly increased the risk for both stroke and cardiovascular disease. [6] The authors pointed out that the risk was likely actually underestimated by the their study results as well.

Evaluate Common Problems Men Face & Doctors Dont Know

Overall I have had a very good experience with HRT (Testosterone Therapy) and it has been a real life changer for me.  If you’re interested, you can read the details in My Personal Health Story page. However, not everyone has a great experience on HRT and below I discuss some of the reasons why. As you will see, most of the issues are preventable, which is why I wrote this page.  HRT gone bad can be quite stressful and disappointing for a man that wants to get back on this feet again and has been promised by some commercial or advertisement that it would be a quick and easy fix. So please check these out and ask any questions you have on the Peak Testosterone Forum.

1. Elevated Estradiol. TRT (Testosterone Replacement Therapy) is actually a misnomer in my opinion, because it implies that testosterone is the only hormone that needs to be worked with.  This is simply not the case and the reason is that, as you increase testosterone, some of it will aromatize, via aromatase, into estradiol.  It is very common, for example, for a man to experience some nice benefits from testosterone for a couple of weeks and then the effect fades.

One of our forum posters (PRSArtist) is the perfect example of this.  Look how he describes what HRT did for him in the first two weeks of treatment:

“1st thing I “noticed” were morning erections (that’s every morning!) after about 2 weeks of treatment. Didn’t think too much about that. After 4 weeks my sex drive is “Thru the roof” Wasn’t ready for it to hit me this hard! Like some guys on here, my low T ruined past relationships to the point where I’ve had no interest in sex for the past 5 years so I have no outlet for these urges! And had to ” take matters into my own hands”! Now I think about sex all the time!!! All day, every day! (multiple times a day!) This may be a little much??” [1]

HRT Problems

Some people call this the “honeymood period.”  Some guys notice miraculous results during these first couple of weeks.  But notice how quickly it turns south just two weeks later:

“I’m concerned because erections are absolutely impossible now, and that the only thing I could think of? Sex drive is back, this is NOT a good combination To live with for a month. I’m more than a little concerned.”

Bascially, his libido was still high, but he had rather extreme erectile dysfunction.  Sure enough his estradiol was very high – 58 pg/ml!  From what I’ve seen, most HRT clinics try to keep a man somewhere between 20 and about 35, which is a youthful level.  So this man’s readings were about double.  His doctor helped him pull it down with an aromatase inhibitor and then he wrote:

“This post scares the crap outta me! E2 of 78 should not be passed over! Everyone is different, but I could NOT get an erection with My E2 levels above 30! I had struggled with this for the past 6 months, and I’m on a pretty high Dose of arimidex .75mg EOD. If your noticing lack of morning wood, and your continuing the same treatment dose and schedule? That # will only get higher. Sooner or later your lack of morning wood Could turn into “lack of ANY wood”! Even my Dr. Would treat an E2 level of 78! This really isn’t OK to be that high!” [2]

Guys often retain water and have gyno when levels get this high as well.

Now you may wondering, “What does low estradiol have to do with HRT?”  That’s a good question.  In general, as you raise a man’s plasma testosterone levels via HRT, some of it will be converted to estradiol. In fact, if you push a man’s total testosterone up over about 800 ng/dl, there is a good chance that he will end with high estradiol.  So why am I worried low estradiol then?  The answer lies in the fact that some HRT clinics manage elevated estradiol with Arimidex (anastrazole). It’s cheap and well-tolerated with short term side effects.  (It can effect the clotting cascade in some men.)

Quite a few men are very sensitive to Arimidex and their estradiol ends up getting slammed down too low.  You’ll hear guys on The Forum talk about an “estrogen crash” when this happens and it’s not fun.  It can take several weeks to pull out of it and often has accompany erectile and libido issues.

NOTE:  Savvy physicians have ways around the Arimidex issue, including compounded and liquid anastrazole.

3. Low SHBG. Men with low SHBG often have accompanying (concomitant) insulin and liver (NAFLD) issues.  And the problem with low SHBG is that the hormones are just cleared out very rapidly from the blood when a man is given testosterone therapy.  For example, the typical guy given an intramuscular injection of cypionate will peak 3 or 4 days later.  However, a low SHBG male will peak on the first or second day and will have the testosterone clear out of his system rapidly.  This rapid rise and fall of both testosterone and estradiol make HRT problematic and difficult for men with this condition.

From what I have seen, these men have to do a lot of experimentation before they find a protocol that helps them to feel better.  Proprionate and topicals seem like they work best for this population but only after a fair amount of protocol failures.  Researchers are still trying to find practical solutions for these guys and patience is an absolute must when beginning standard testosterone therapy.

4. A Rise in PSA.  This is one I know about first hand.  My PSA reads post-HRT had always been less than 1.5.  (Ideally, your PSA is below 1.0.)  My HRT clinic pulls my PSA number regularly and in late 2013 the lab reported a value of 6.3!  I abstained from you-know-what and exercise and repulled the number a week later and it had only gone down to 5.0.  And, to my horror, my clinic dropped me from HRT the next day. At that point, I had just become a big legal liability and was out the door until I got my urological clearance to go back on HRT.

I found that my HRT levels dropped rapidly, the details of which are outlined on my page entitled My High PSA But No Cancer. I had always had testosterone levels prior to testosterone therapy in the low to mid 300’s. However, one month after going off of HRT, my levels were 121! This is because there is a “rebound effect” after being on HRT with your natural production partially shut down. When you go off of HRT, it takes a few months for your own natural baselines levels of T production to resume. Obviously, this can be a very unpleasant problem for men on HRT who have to suddently quit due to prostate issues.

BPH, prostatitis and inflammation can all dramatically raise PSA and so it seems a tad unfair to suddenly pull a man off of HRT. However, it is the clinic’s only way to force a man to talk to a urologist and get a biopsy if necessary. I was able to get back on testosterone about a month after stopping. However, I was lucky. What if I had had some PIN (precancerous) cells? What if I had had prostatitis and needed months of antibiotic treatments? How one handles these situations depends on the urologist and this is not in the fine print when you sign up for T therapy.

5. A Rise in Hematocrit. Another common problem that can occur with HRT is an increase in red blood cells. Testosterone stimulates a kidney hormone called erythropoietin (EPO) that increases red blood cell counts and, therefore, hematocrit and hemoglobin. If these values get high enough and out of range, you will probably have to donate blood or lower your testosterone dose. Again, this is a problem that can occur that not many men know about when they go on HRT. Usually, from what I have seen, men can donate blood regularly and pull their hematocrit/hemoglobin back in range. And it is critical to do so, because high hematocrit/hemogolobin can increase the risk of stroke as I discuss in my page on Ways to Lower Hemoglobin.

There is also the risk of having to go off of HRT altogether and we had one poor guy who had to do just that.  You can feel the stress in some of the member’s posts:

“This one makes me a little bit nervous. Red blood cells 6.18 Hemoglobin 18.5 Hematocrit 55.5 Two months ago I gave blood and started drinking more water I read that helps to get it down. I told my doctor about this. So were keeping an eye on this in about three months I will have a another blood test will make sure what to do.” [4]

“Last blood work had hemoglobin at 17, and now 18 and that is just too high. Does anyone have any links or info on the hemoglobin being so high? they said T therapy can raise it as well. The super low E2 score tells me something as well. progress, but still.. PS: I gave blood about 6 months ago and swore I would never do it again as I almost pass out when I do. Damn. I would rather self-inject than donate blood.” [5]

Again, one can lower their testosterone, but this would be considered a big problem for most men.

NOTE:  There are also certain out and outright potential dangers for some subpopulations of men and I discuss those in my link on The Risks of HRT.

Again, most of the above problems of HRT can be overcome by the following:

a) An anti-cancer, anti-inflammatory diet and lifestyle. I have many ideas presented in Prostate and PSA Summary Page and my link on Natural Ways to Lower Inflammation.

b) Careful monitoring of estradiol and conservative prescription of any aromatase inhibitors.

c) Losing weight and getting your abs back.  Lowering your weight will decrease your need for an aromatase inhibitor.  Weight gain is a risk factor for Metabolic Syndrome and diabetes, both of which will increase your likelihood for a PSA-increasing prostate enlargement.

Please discuss with your doctor any concerns.

REFERENCES:

1) https://peaktestosterone.com/forum/index.php?topic=433.0

2) https://peaktestosterone.com/forum/index.php?topic=919.0

3) https://www.lef.org/magazine/mag2010/may2010_Why-Estrogen-Balance-is-Critical-to-Aging-Men_01.htm

4) https://peaktestosterone.com/forum/index.php?topic=2420.0

5) https://peaktestosterone.com/forum/index.php?topic=1616.0

Antioxidants That Can Boost Testosterone? - Peak Testosterone

There’s a lot going on in those testes of yours, including sperm and testosterone production. Yeah, it’s a big factory down there and researchers have found increasing evidence that “oxidative stress”, i.e. free radical damage, is one of the leading causes of lowered testosterone.  Damage to the mitochondria appears to play a key role. [4]  In an eye-opening study, researchers found that the Vitamin E, a antioxidant that quenches several free radicals, actually slowed down the age-related decline in testosterone in lab rats. [1] This may mean that one can significantly slow down andropause if one starts at a young enough age. Life is full of regrets, eh?

Researchers have also discovered reduced levels of key antioxidants, such as the heavy hitters SOD and glutathione, in aging rat Leydig cells, thus adding weight to the above oxidative stress theory and the need for adequate antioxidant dietary support. [2]  However, here is what should really catch your attention:

1.  Pomegranate Juice.  We have aleady covered how Pomegranate Juice Boosts Erectile Strength, but did you know that a study on rats showed a nice boost to testosterone as well? [3]  In fact, the rats drinking the most pomegranate juice got a nice 27% in testosterone! In my link on Pomegranate Juice and Testosterone, I show just what dosage may achieve these kind of gains.

Of course, the problem with this is that for the typical 160 pound male, you are talking about a megadose of over 3 grams of quercetin in us humans. Nevertheless, it shows the power of some antioxidants to power up testosterone production in the ol’ Leydig cells.  NOTE:  I do not know the human-to-equivalent ratio for the rats used in this study.

3. Onion Juice. Based on #2, it probably will be no surprise that onions, if consumed in large enough quantities, can boost testosterone.  Of course, the question of the day becomes “how in the world do I eat an onion or two and still live in polite society”?  Researchers came up with a nice solution:  onion juice. They just blended one standard onion and – shazam! – the juice boosted rat testosterone by 300+%. [5]

The only problem is that the amount of onion juice these rats consumed was 1 gram per kilogram, which translates to about 73 grams of onion juice for the typical 72 kg guy.  However, it should be noted that even taking half that amount of onion juice created a nice testosterone boost as well, so it is likely dose dependent, i.e. even a smaller amount of onion juice may give you a little lift.  NOTE:  I do not know the human-to-equivalent ratio for the rats used in this study.

Did you know you can inexpensively do your own testing for most hormones? The industry leader is Discounted Labs..

4. Melatonin.  Data is very limited but the antioxidant and hormone melatonin appears to protect testosterone in Leydig cells as well. [1]

So should you start gulping gallons of juice?  Well, that’s a little premature for a variety of reasons. First of all, all of the above studies are on animals and may not translate to humanoids such as ourselves.  Furthermore, perhaps it’s possible to overdo antioxidant consumption.  For example, some experts have posited that if you overdo ingestion of antioxidants, it shuts down the body’s own natural antioxidant production.  In fact, some studies have shown that antioxidants in supplement form may actually be dangerous to your heart or promote cancer as I document in my links Antioxidants and Your Heart and The Dangers of Antioxidant Supplements.

However, a solid diet loaded loaded with ample antioxidants will likely protect and possibly boost your testosterone and give you multiple additional health benefits as well.

1) Experimental Gerontology, Aug-Sep 2005, 40(8-9):728-736, “Vitamin E, aging and Leydig cell steroidogenesis”

2) The Journal of Steroid Biochemistry and Molecular Biology, Jan 2004, 88(1):61-67, “Aging alters the functional expression of enzymatic and non-enzymatic anti-oxidant defense systems in testicular rat Leydig cells”

3) https://www.ergo-log.com/pomegranate.html

4) Endocrinology, 2002, 144(7):2882-2891, “Reactive Oxygen Disrupts Mitochondria in MA-10 Tumor Leydig Cells and Inhibits Steroidogenic Acute Regulatory (StAR) Protein and Steroidogenesis”

5) https://www.ergo-log.com/onionjuice.html

6) J Endocrinol, 2004 Jun, 181(3):493-507, “Reduction of rat prostate weight by combined quercetin-finasteride treatment is associated with cell cycle deregulation”

Psychogenic (Psychological) Erectile Dysfunction

Erections are actually quite complex and involve decent function from your cardiovascular, neurological and psychological systems. The psychogenic – the term the medical community prefers for “psychological” – aspect of an erection almost always plays some role in your hardness factor for several critical reasons:

1.  Nerves and Neurotransmitters. It’s no secret that erections are initiated by a nervous system response. Sexual stimulation fires up various neurotransmitters, such as epinephrine, acetylcholine, oxytocin and nitric oxide for starters.  These, in turn, fire up the ol’ neurons and you know the rest of the story.

Thus, any nerve-related issues, such as neuropathy, i.e. “nerve damage”, can be a partial contributor toerectile dysfunction [1].  Diabetics, who often have accelerated neuropathy, can struggle with this in particular. Researchers can even induce an erection in dogs simply by stimulating the perineal nerves directly. [2]

One of the beautiful things about PDE5 Inhibitors, such as Viagra and Cialis, is they actually do not work unless the patient is stimulated visually or by touch in a sexual manner.  This is because the nervous system must first be stimulated which in turn fires by the endothelial nitric oxide response that these drugs are famous for.  And that is a good thing, because otherwise you could get guys getting a spotaneous erection at almost any time of the day!

1) International Journal of Impotence Research, 2002, 14:433-439, “The neuropathy of erectile dysfunction”

2) International Journal of Impotence Research, March 1997, 9(1):11-16, “Perineal nerve stimulation: role in penile erection”

3) J Sex Med, 2007, 4:1117-1125, “Integrated Sildenafil and Cognitive-Behavior Sex Therapy for Psychogenic Erectile Dysfunction:  A Pilot Study”

4) Intl J of Impotence Res, 1998, 10:211-314, “Short term use of intracavernous vasoactive drugs in the treatment of persistent psychogenic erectile dysfunction”

5) Journal of Sex & Marital Therapy, 1975, 1(4), “The assessment of nocturnal REM erection in the differential diagnosis of sexual impotence”

6) ARCHIVES OF SEXUAL BEHAVIOR, 1987, 16(2):125-137, “Use of sexual history to differentiate organic from psychogenic impotence”

7) Int J Impot Res, 2007 Jan-Feb ,19(1):104-7, “Cabergoline treatment in men with psychogenic erectile dysfunction: a randomized, double-blind, placebo-controlled study”

2.  Failure. Generally,  erectile dysfunction for middle-aged and beyond guys is endothelial (artery-related) in nature.  In addition, low testosterone often exacerbates the condition. These underlying physical conditions often lead to a few performance failures, which can create tremendous anxiety for most guys (and often for their spouses and/or partners as well). This can bring the psychological (psychogenic) part of an erection to the forefront very quickly.

Tragically, all of this can be made worse by visiting the doctor. The doctor will often do nothing or imply it’s just a natural part of aging.  The patient is left to struggle alone.

Psychogenic Erectile Dysfunction – Diagnosis

So how do you know if you have psychogenic (pscychological) erectile dysfunction?  Well, the gyst of the diagnosis has to do with whether or not a man can achieve a normal erection under some circumstances but just not in the bedroom.  Here are a few of the things that they will look at:

1.  Morning Erections.  Odds are if you can achieve a firm morning erection that you’re physically functioning fine.  In fact, this has been used by diagnosticians for literally decades as an excellent tool. [5] In fact, one study noted that “the single best predictor was the presence or absence of early morning erections as reported by the patient.” [6]

2.  Rigiscan.  Doctors will sometime use the Rigiscan device, which essentially measures your “hardness factor”, i.e. the firmness of your erection.  Again, if you can get hard when you’re not under pressure, then you’ve likely got psychogenic erectile issues.

Psychogenic Erectile Dysfunction – Solutions

Solving psychogenic impotence can be difficult indeed.  Many guys, after repeated failures in the bedroom, dread another attempt and risking failure.  In addition, sex is about as personal of a subject as one can come up with and, for most males, is tied to their maleness and manhood.

Fortunately, there are reasonable solutions with solid success rates, which are discussed below.  One methodology that I won’t discuss is sex therapy with a sex therapist, which is the mainstay of such sexological leaders as Masters and Johnson.  This methodology has a reasonable success rate but most guys are just not going to do it.  (This methodology requires a sex therapist to be present during the meetings with or without your partner.  For many, this is just too uncomfortable and/or may not reconcile with one’s religious beliefs.

Other solutions include the following:

1.  PDE5 Inhibitors. Viagra alone produced a 66% success rate in getting men over their psychogenic erectile dysfunction. [3]  Of course, this is likely because erections come so easily and quickly with Viagra that there is less time for anxiety. However, sexual satisfaction was significantly increased with Cognitive-Behavorial Therapy, which include working with their partner to “identify positive aspects of themselves and their parter; review positive relationship experiences;  recall past, present and future ways to share and show love and affection and then prepare a surprise from the list”, etc.

2. Intracavernous Injections. In some men the performance anxiety and fear of failure is very high and PDE5 Inhibitors and Therapy just do not work.  In these cases physicians can actually give men a set of preloaded syringes for pre-bedroom use.  The men has to actually inject his own penis – it doesn’t hurt as much as you might think – that literally forces an erection.  Men involved in this sort of treatment have “no worries” as the medicine keeps him erect through almost any emotional state. Although it sounds very painful, only one fifth of the men in one study complained of pain and this was correctable in all cases. [4]

3. Dostinex (Cabergoline). This medication is used to treat men with high prolactin and/or prolactinoma and can, in those cases, boost testosterone and improve the refractory period.  Dostinex belongs to the class of medications called dopamine agonists and has a study behind it showing that it may also improve psychogenic E.D. [7]

The success rate for this strategy is very high.  For example, in one study of couples with “honeymoon impotence”, 93% of the couples achieved success and only a few needed long term use.  The 7% that were unsuccessful, by the way, was due to vaginismus, or vaginal pain.

REFERENCES:

Prozac (Fluoxetine): Frequent Testosterone Lowerer -

I had read about a Prozac-to-testosterone connection, but what he wrote really prompted me to study it in more depth:

“I ask because I’ve been doing some thinking on when things got bad for me back in February before I was diagnosed with low testosterone. It all started with insomnia that finally “snapped” into a chronic fatigue state, including moderate-high brain fog, memory, and concentration issues…Then after a week of this I went to my previous doc and got prescribed fluoxetine (Prozac), after which things went to s__t: insomnia got a lot worse, as did anxiety, I started having a leg twitch, ED, intense brain fog and concentration (I could barely read), feeling hot/flushed for short periods of time, and a few other things.”

Basically, he had a lot of apparent side effects from the Prozac and he asked if it could lower testosterone. Of course, I had no doubt that Prozac sometimes lowers testosterone, because anything that decreases the frequency of sexual intercourse and lowers dopamine will likely lower your T a little.  (For more information, see my page on Testosterone and Dopamine.) And, sure enough, I found that in the last five years a group of papers have come out showing that Prozac often negatively alters our “man juice” as I have heard it called.

Consider the following studies:

“Sperm motility and density were also significantly reduced in cauda epididymides and testes of the treated group. The weights of reproductive organs (testes, epididymides, ventral prostrate and seminal vesicle) were decreased considerably. The hormonal assay also showed significant decrease in testosterone levels and FSH levels. Testicular cell population dynamics also demonstrated a decrease in the number of both primary and secondary spermatocystes and spermatids in the treatment group.”

Does it get much worse than that?  Shrunken testes?  Sperm reductions?  This was definitely not good news.

2.  Early Studies Deny Change in Testosterone. A couple of studies even came out that said, in spite of the fact that Prozac can negatively alter libido and sexual function, there was no significant change in testosterone.  One of these was on animals [3] and one on humans. [4] However, the latter study admitted that a) their study was small, b) some patients did experience a loss in testosterone and c) that there were published case studies of testosterone reductions.

Therefore, the conclusion is that Prozac will likely negatively alter almost of your “male sexual parameters,” including testosterone, libido and fertility, especially if given enough time.  Now does this mean that you should not use an SSRI, especially considering the fact that they have been shown to be little better than placebo for mild to moderate depression?  Of course, that is something that you must discuss with your doctor.  Some men, especially those with more serious and severe depression, gain significant improvement from Prozac and other SSRI’s.  So “any port in a storm” as they say.

NOTE: See also my page on How Prozac Often Increases Prolactin, which can lower testosterone in and of itself potentially. More importantly, this will often impact libido.

However, I would discuss other options with your doctor.  Perhaps Wellbutrin (which can have nasty side effects) or some other medication will work just as well without the side effects.  You may also be able to gain substantial relief by going a more natural route.  See my page on  Natural Depression Cures  for more information.

CAUTION:  Few men realize just how serious depression is.  Depression can lead to actual brain and neuron damage:  it sets off a wave of inflammation, oxidation and (often) elevated cortisol that can literally shrivel key lobes between your ears including the hippocampus.  It’s also associated with heart disease and lowered testosterone.  (See my page on Depression In Men for more details.)  So do NOT just quit an SSRI without discussing it with your doctor first.  Furthermore, some experts believe that they are very dangerous during transitional phases, i.e. when you are starting up or stopping an SSRI or when you are switching from one SSRI to another.  Their research and clinical experience shows that this can lead to suicide and other extreme psychological behavior.

1) https://peaktestosterone.com/forum/index.php?topic=4264.0

2) Neuro Endocrinology Letters, 2007, 28(3):321-325, “Effects of long-term use of fluoxetine on fertility parameters in adult male rats”

3) Physiology & Behavior, Mar 1996, 59(3):479 485, “Male reproductive systems under chronic fluoxetine or trimipramine treatment”

4) Annals of Clin Psychiatry, 2006, 18(1):19-22, “Fluoxetine Treatment and Testosterone Levels”

5) Amer J of Psychiatry, 2010, “Treatment of Resistant Depression in Adolescents (TORDIA): Week 24 Outcomes”

6) Archives of General Psychiatry, 2010, “Recovery and Recurrence Following Treatment for Adolescent Major Depression”

7) J. Pharm. Biomed. Sci., 2012, 2(7):87-93, “The Effects of Fluoxetine Usage on the Concentration of Testosterone Hormone”

Proof That High Cholesterol Is NOT Natural - Peak Testosterone

To show you how far we have deviated from our natural physiology, I am going to start with a quote from Loren Cordain, the founder of the modern Paleo movement:

“The normal low-density lipoprotein (LDL) cholesterol range is 50 to 70 mg/dl for native hunter-gatherers, healthy human neonates, free-living primates, and other wild mammals (all of whom do not develop atherosclerosis). Randomized trial data suggest atherosclerosis progression and coronary heart disease events are minimized when LDL is lowered to <70 mg/dl. No major safety concerns have surfaced in studies that lowered LDL to this range of 50 to 70 mg/dl. The current guidelines setting the target LDL at 100 to 115 mg/dl may lead to substantial undertreatment in high-risk individuals.” [1]

Yes, the father of modern Paleo wrote a journal article explaining that ALL Paleo/primal cultures had LDL between 50 to 70! He also admitted that arterial plaque (atherosclerosis) was minimal in these cultures.  Also, all of these cultures had total cholesterol below 150.

Of course, you can call yourself anything you want – I don’t care.  But you get my point:  there is no evidence that Paleo people had cholesterol over 150 consistently.  And from Dr. Cordain’s study we can clearly come to the conclusion that total cholesterol below 150 and LDL below is 70 is actually natural for human beings on this planet.

And don’t let this slip escape your notice:  these Paleo cultures had the LDL levels of higher dose statin users.   I’m not here to preach statins due to their side effects.  But this shows you how high our cholesterol and LDL is due to eating unnatural industrial meats and oils.  We have to go on big gun statins just to get our numbers down to where the primal cultures are.

And please don’t say “but LDL that low is dangerous!”

Really?  So every single Paleo/primal culture was living dangerously?!

Doesn’t that strike you as odd?  I have read many times Paleo leaders state that low cholesterol and LDL is dangerous not realizing that the father of their movement proved that it is actually natural and healthy.  I wonder how many of their followers have had heart attacks, because they got the idea that high cholesterol, LDL and even LDL-P are critical for good health??

Let me tell you what is NOT good for your brain:  calcification.  There is a lot of evidence that calcification, i.e. plaque buildup, in the delicate capillaries and tissues of the brain play a role in Parkinson’s and Alzheimers.  Your brain needs you to keep it clean and clear.  Dumping a bunch of industrail oil and meat into your non-carnivore gut/intestine is risky unless you are one of the lucky guys with lower LDL-P levels on that kind of diet.

Again, I realize that LDL-P is a much more important number than LDL and total cholesterol, and I cover that extensively on my site:  Regressing Penile and Arterial Plaque Pages. But I also recognize that high cholesterol and LDL are just not something that men experienced here on planet earth until recently.

Please don’t object that some men have cholesterol > 150 and have good LDL-P numbers.  I know that.  However, these men are not common and that is the tragedy.  Yes, you can theoretically be okay with medium cholesterol, but the odds are stacked against you.  And with irresponsible Paleo bloggers out there telling you that none of this matters, you probably will never even get your LDL-P checked.

The bottom line is that I am putting my money on the primal (“Paleo”) cultures with no heart disease.

Erectile Dysfunction - Go Natural or Get Drugs -

Most men living a Western lifestyle will reach a critical decision point – I see it all the time in the emails I get – where they have to decide if they will go natural or go with the more traditional drug regimen prescribed by their physicians.  Here is a typical scenario that occurs with many men:

Step 1.  Man develops the beginnings of arteriosclerosis and high blood pressure, often with accompanying prediabetes.

Step 2.  Man has damaged endothelium with reduced nitric oxide output and vasoreactivity occurring from step 1.

Step 3.  Man begins to experience erectile dysfunction, eventually leading to a crisis event in the bedroom.

Step 4:  Man goes to doctor, who implies that Steps 1-3 are a normal part of aging.  Doctor puts patient on an ACE Inhibitor or other high blood pressure medication for high blood pressure and a prescription for Viagra or Cialis.

1)  Medscape, “The Erectile-endotheliam Dysfunction Nexus: Reversal of Endothelial and Erectile Dysfunction:  Reversal of Endothelial and Erectile Dysfunction”

Step 5. Man develops even higher blood pressure that is no longer contained by the ACE Inhibitor.  Beta blockers, diuretics and statins are added over the next five years to try to control the ongoing cardiovascular and endothelial issues related to arterial inflammation, hardening and plaque buildup.

We all have friends and family members who have through these steps and it is the current SOP (standard operating procedure) for doctors, at least here in the U.S.  Of course, there are many problems with all of this and, underneath, all men know instinctively that there has got to be a better way.

Futhermore, the drugs are full of side effects.  In fact, some blood pressure medications, especially beta blockers and diurectics, are reported by many men to cause erectile dysfunction. And the other side effects are certainly not going to help your sex life:

ACE Inhibitors are known for causing a persistent cough and beta blockers are packed with side effects, such as wheezing, dizziness, fatigue, loss of blood sugar control and on and on the. Furthermore, most heart and/or hypertension patients will end up on multiple medications, which only increases further their risk of erectile dysfunction, side effects and/or drug interactions.

Of course, there is another way, but the other choice takes time, effort and research. The other choice is to let the body health itself as much as possible with a natural lifestyle that is based on 1) ample exercise, 2) a Low Fat (Ornish) and 3) maybe a couple of the most safe, well-studied herbs.  (CAUTION:  Always talk to your physician before making any changes.)

Why do I say this? Well, as I document in my link on Erectile Dysfunction and Exercise, getting your bod moving helps your penis in literally every major endothelial category. It can literally build new vessels where there were none before and that’s just what you need!

A Low Fat (Ornish) will actually clear out arterial plaque and significantly reduce blood pressure. A DASH Diet will dramatically lower blood pressure. Many men can significantly reduce their medication requirements or even go off of meds by simply “going natural”. And, of course, the same thing with erectile dysfunction: my experience is that almost all men can dramatically improve their erections with lifestyle changes alone and sometimes even cure it completely.

The fact that the body can often heal itself was shown recently in a program looking at obese individuals where their inflammation was decreased and endothelial function increased.  Futhermore, many of them noted a significant improvement in their erectile dysfunction as well and as expected. [1]  How did they do this?  Simply by losing weight and exercising!  If they had followed one of the solid plant-based diets above, they would have endoubtedly experienced even more significant changes as well.

NOTE:  Going natural takes time. Men usually usually experience steady improvement that continues for years.

The bottom line is that the body can heal itself and often entirely. All you have to do is live the way you were born to live and go natural. Remember:  any reasonable whole food, plant-based diet will boost your nitric oxide and drop your blood pressure.  And any reasonable exercise program will increase blood flow and nitric oxide as well.

REFERENCES:

Testosterone: Can Walking Boost It Long Term? - Peaktestosterone

If walking the best exercise on the planet?  Yes and I’ll prove it below.

Can walking boost your testosterone? Probably for the majority of men on this site, the answer is a resounding ‘yes’. “How?” you ask. Let me give you three ways that walking can give most men a very significant boost in testosterone even if they do nothing else for their health:

Walk weight loss 27100 = 900 per day

1.  Weight Loss. Let’s say you are the typical overweight male that weighs about 200 pounds.  And let’s say you really dislike gyms, biking, jogging and almost all forms of exercise.  Nevertheless, you decide that you can walk for an hour.  And you even decide that you can keep up a decent pace of about 4.0 mph.  That’s a brisk pace but doable for most males – a 15 minute mile.

This is not unreasonable and most men can do a half hour in the morning and a half hour at either lunch of dinner. (A walk with your woman will get her health and libido going too.) And here’s the beauty of an hour of walking:  it will burn 400 calories per day.  Now if you can bump up the time just a bit more, you can burn 500 calories per day.  Of course, the significance of 500 calories per day is that it is 3,500 per week which is 1 pound of fat.

That may not sound like much, but losing one pound of fat per week would be 50 pounds in one year. What does this have to do with testosterone?  Just keep that 50 pound number in mind below and consider these studies:

1) The Journal of Clinical Endocrinology & Metabolism, May 1 1988, 66(5):1019-1023, “Effect of Massive Weight Loss on Hypothalamic Pituitary-Gonadal Function in Obese Men”

2) The Journal of Clinical Endocrinology & Metabolism, Dec 1 1977, 45(6):1211-1219, “Low Serum Testosterone and Sex-Hormone-Binding-Globulin in Massively Obese Men”

3) Int J Obes (Lond), 2007 Dec;31(12):1786-97, “A dose-response relation between aerobic exercise and visceral fat reduction: systematic review of clinical trials”

4) Journal of Applied Physiology, Feb 1 1976, 40(2):155-158, “Effects of exercise on excretion rates of urinary free cortisol”

5) Journal of PHYSIOLOGICAL ANTHROPOLOGY, 2007, 26(2):123-128, “Physiological Effects of Shinrin-yoku (Taking in the Atmosphere of the Forest) Using Salivary Cortisol and Cerebral Activity as Indicators “

6) Journal of Psychosomatic Research, May 1992, 36(4):361 370, “Efficacy of Tai Chi, brisk walking, meditation, and reading in reducing mental and emotional stress”

7) Life Sciences, May 17 1996, 58(25):2337 2343, “50-mile walking race suppresses neutrophil bactericidal function by inducing increases in cortisol and ketone bodies”

8) Comparative Biochemistry and Physiology Part B: Biochemistry and Molecular Biology, May 2002, 132(1):37 55, “Interactions between aromatase (estrogen synthase) and dopamine in the control of male sexual behavior in quail “

9) Brain Research Bulletin, 1997, 44(4):327 333, “Testosterone, Preoptic Dopamine, and Copulation in Male Rats”

a) One study of men that lost 50+ pounds found an average increase in total testosterone of almost 60%. [1] This is a huge number and even exceeds the increase seen in men with apnea.

b)  It is possible that some men may even experience more dramatic increases. One study compared the average testosterone of very obese men and compared them with age-matched controls and found the difference in testosterone was over double! [2]

In other words, depending on how overweight you are, you can very significantly boost your testosterone.  Again, normally when someone tries to lose weight, they cut calories rather significantly which causes a big problem:  if you drop calories too rapidly, you will also likely greatly reduce your testosterone.  See this link on Dieting and Testosterone for more information.

NOTE: You do have to make sure to lose weight though.  And if you think you have low testosterone:  get tested!  Low testosterone can carry with it certain serious health issues such as anemia and osteoporosis, so work with your doctor.

2. Cortisol.  One of the big objections that some knowledgeable people will put out there to this page is something along the lines of:

“Walking can’t increase cortisol, because all aerobic exercise increases cortisol and cortisol will lower testosterone.”

There is some truth to this statement.  However, what is not so well known is that walking can actually lower cortisol. This is remarkable if you think about it:  exercise is normally considered a stressor because it increases the oxidative and cortisol load on the body.  However, that is a generalization that is NOT always true.  Some exercises (Judo) can actually increase improve oxidative status.  And some exercises can actually lower cortisol as strange as it may sound.

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One of those exercises is walking if done correctly.  Of course, it probably won’t surprise you that both the duration and intensity has been found to affect post-exercise cortisol levels. [3] One could call that a “no brainer.” However, what one Japanese study showed is that young, healthy men who walked in a forest setting actually experienced a significant drop in cortisol. [5] The walk was actually relaxing for these men and produced an anti-stress response and this was in contrast to walking in the city.

Other studies have shown that you don’t have to be in nature to get a nice drop in cortisol post-exercise. [6] This same study showed that brisk walking – in other words you don’t have to walk leisurely to avoid a cortisol rise – resulted in both lowered cortisol and improved mood.  Of course, you can “go crazy” with walking and a couple of studies have shown that lengthy walks  can lead to elevated levels of cortisol.  The most extreme example is probably a study of those on a lengthy and intense walking race where the participants experinced both a rise in cortisol and a decrease in immune function. [7]

So the bottom line is:  just walk.  Enjoy yourself.  Break it up into several times per day and make sure you feel good afterward.  This will have huge health benefits.  Remember:  we were born and build to walk.

3.  Estrogen.  Why does losing weight increase testosterone so much?  Well, there are likely a number of reasons, but the primary one is the reduction in testosterone.  The more fat you have, the more aromatase you have which is the enzyme that converts testosterone to estrogen. So think about the beauty of walking:  it can decrease cortisol and decrease estrogen  Both of these are going to increase testeosterone for many men in and of themselves.

So think about this:  walking is considered the most boring, lowliest form of exercise by a big percentage men and probably the least manly.  (I guess ballet in a pink tutu might rank a little higher.)  Yet men that walk are usually boosting erections, raising  the “male” hormone testosterone, lowering the “female” hormone estadiol/estrogen and decreasing the muscle-wasting hormone cortisol.  What gets more manly than that?  (Actually, weight lifting is very similar, but almost all other forms of exercise will increase cortisol and in many cases decrease testosterone.)

Again, what else could you ask for?  Every minute that you are walking will help supercharge you in the bedroom.

4.  Dopamine. In #2 above we covered how walking can lead to improved mood if done correctly.  This is probably from the increased dopamine that comes from reasonable exercise.  (See this link on Natural Dopamine Increasers for more general information.) So what does increasing dopamine have to do with testosterone?

Well, dopamine is highly tied to sexual desire and activity and has been shown in multiple studies to be so linked.  In fact, many studies have shown that testosterone, for example, works its wonders by increasing dopamine in the brain, which then leads to increased copulations. [8][9]

However, the reverse is very likely true in the long term as well.  Remember:  anything that increase sexual intercourse frequency is likely to increase testosterone as well.  Thus, anything that decreases cortisol and increases dopamine (both of which will improve mood and libido) will very likely lead to medium term testosterone increases.  Nice! Read my link on Sex and Testosterone to see the research that shows that this is indeed the case.

5.  Erections.  I’ve already covered this in detail in my link on Walking and Erections. Every minute you spent walking will increase your hardness factor.  I’m a gym rat and love it, but I have to admit something:  99% of people hate the gym and won’t last over two months.  But everyone can find a place to walk:  in a mall; in a park; over lunch at work. And this will improve erectile dysfunction in many. many ways.  And the same logic applies as in #2:  anything that increases the frequency of sexual intercourse is likely to increase testosterone over time.

5.  Overtraining and Injuries. As I’ve shown in my link on Weight Training and Testosterone, pushing that iron can lead to long term testosterone gains according to several studies.  But does it always?  I doubt it and I’ll tell you why in one word: overtraining and injuries.

I meet one guy after another in the gym recovering from torn biceps and shoulders, bad backs, etc.  And they all have one thing in common:  it’s touch to exercise!  And without exercise many health problems begin to set in and, no, this is not likely to be good for your testosterone.

Overtraining is a stressor and can lead to elevated cortisol and decreased testosterone – many studies have shown this.  And, if the overtraining is bad enough, can take the person out of commission for months with decreased immune function, sleep disorders and so on.  (See my link on The Problems of Overtraining.)

6. Time With Your Woman.  If you can talk her into it, walking is one of the best exercise to build up your relationship.  Yes, if you don’t walk too fast and are in half way decent shape, you can actually talk and carry on a conversation – yes, the way Mother Nature intended it – with the the woman you love.  And you’ll both be increasing your nitric oxide, slimming your waists and stimulating blood flow.  And that always translates to increased activity in the bedroom, eh Walking Man?

So, again, there is no study that proves that walking increases testosterone, but, if you do it right, it will likely give you a little boost. So get out and hit the pavement, the sidewalks, the parks and the treadmill and walk, walk, walk, walk…

REFERENCES:

Lose Weight Gradually - Peaktestosterone

Many of us guys have a simple philosophy in life:  “More is always better”. And we apply it even to weight loss. Let’s face it:  dieting can be literally painful and so we just want to “get it over with”.  That’s when many of  push the pedal to the floor and try to lose weight rapidly.

I want to give you a few reasons why this is a bad idea – a very bad idea.  Losing weight is a grand and noble endeavor and I spend a lot of time on this site showing you just how hard those extra pounds are on your body and sex life.

If you are extremely overweight – it happens! – then you may need to lose weight fairly rapidly for health reasons.  Discuss with your doctor.  He can examine your physical results and let you know how urgent the situation is.  But, all of that said, keep in mind that losing weight rapidly can be every bit as hard on you as the pounds were in the first place and below I explain just why:

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Or do you need the most comprehensive testosterone book in Amazon? Here it is: Natural Versus Testosterone Therapy

1) Testosterone. Rapid weight loss will annhiliate your testosterone and any reduction in testosterone will make weight loss that much harder since testosterone will help maintain your muscle mass.

2) Muscle. If you lose weight too rapidly, you can very easily lose muscle as well, which again makes it harder for you to maintain your weight.

3) Uric Acid.  Rapid weight loss can lead to increased uric acid levels, a known risk factor for heart disease, and even kidney stones. [1]

4) Appetite. The more you cut back on calories, the more gherlin is stimulated and gherlin is the appetite-stimulating hormone.  This is one of the reasons that dieters seldom keep the weight off after a year or two:  they are fighting against their body’s own appetite safety mechanisms.  And Mother Nature usually wins…

REFERENCES:

1) https://www.nlm.nih.gov/MEDLINEPLUS/ency/article/000422.htm

Common Things That Lower Testosterone - Peak Testosterone

1) Are my testosterone levels normal for a male?

2) What should male testosterone levels be?

Well, normal is relative as we all know. But, even so, we can come up with some solid guidelines that will help you know where you stand.

However, I first want to encourage you to throw out the completely lame and utterly useless normal range that your doctor or lab technician will give you. A typical normal male testosterone level range given is 260 -1080 ng/dl as (which corresponds to about 8.8 – 36.7 nmol/l). Well, to that I can only say that you can call any level you want normal, but 260 is nothing but ugly. In fact 300 and 350 are ugly testosterone levels for a male. Virtually every email that I get where a guy is struggling is from some guy with total testosterone under 400 ng/dl. And younger guys, again based on numerous emails that I have received, struggle with testosterone less than 500.  I have never received any email from someone complaining with testosterone levels over 500.

CONVERSION FACTORS: On this page I am only talking about total testosterone and in all cases I use values given in ng/dl. If you want to convert to, say, nmol/l, you must use a conversion factor of 29.4 or .034 going the other direction. Yes, that high school chemistry may pay off for you if you re from a country or reading a journal article that uses moles. If you are interested in normal free testosterone levels, please see this link on Free Testosterone.

So the normal testosterone pain threshold is about 500, depending on a male s age and history. (Below 400 is almost always a free pass to hormonal hell.) That is why I am so disgusted with the medical profession when they tell one of my fellow male brothers that a total testosterone level of 290 is fine and normal. (Please read my link on Testosterone Symptoms if you do not know how dangerous low testosterone levels are to your health.)

That said, I want to make several important points about male testosterone levels and lab readings. First of all, you should keep in mind that it s unwise to go by one reading, because your testosterone fluctuates considerably from week to week and even from day to day. Stress, lack of sleep and many other things that are a normal part of life for us males see my link Common Things That Lower Testosterone can whack testosterone levels. It is entirely possible, for example, for your testosterone to be 400 one week and 525 the next. Lifestyle issues can whack even normal testosterone 20-30% or more.

You should also try to get your testosterone levels read in the morning if at all possible. Male testosterone levels peak in the morning and then steadily decline until late evening. This decline from am to pm is, on average, about 35% for most younger guys and about 10% for seniors. (See my link on Daily Testosterone for more information.)

In addition, it s worth pointing out that labs aren t perfect either. I had one testosterone reading that was three times any previous reading that I had ever received! Of course, there is no reasonable explanation for that reading and it was surely an outlier from normal as they say in the stats world.

All cautions aside, though, we can come to some conclusions and you can assess your testosterone levels against the average for males. For example, there was a 1999 study that examined 4,393 men between the ages of 32 and 44 and found that their average testosterone level (at 8 a.m.) was 679 ng/dl. [1] It should be noted that in this study the men with testosterone levels slightly above 800 were 42% and 72% less likely to have high blood pressure and a heart attack, respectively, than those with testosterone a little less than 400. Again, solid testosterone is good for you!

So you may be wondering what exactly are normal male testosterone levels? Well, again, let s go to another study, the NERI (New England Research Institute) study. [2] This study examined, amoung other things, men in the age bracket of 65-69 and found that in 1988 average testosterone levels were 503 ng/dl but in 2003, fifteen years later, the average levels had fallen to 423.  This corresponds to what other studies have found:  I speculate that the leading factors for such a decline are diet, mitochondrial damage, excitoxins and pesticides.  See my links to the left for more information on what can sabotage normal testosterone. Or maybe you just watch too much Barney as a kid – I don’t know.

So if you put these studies together you can start to get a good picture of reasonable values by age.  Studies have found that total testosterone levels decrease, in the average male, by about 1.0-1.2% per year and free testosterone by about 1.2-1.3% per year. This decline, by the way, is normal and a part of aging the great majority of us guys.  What you don’t want is to venture significantly below these normal numbers – low testosterone is “nuthin’ but trouble” for us males.

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NOTE ABOUT EXCITOTOXINS: Some researchers, suspecting excitotoxin damage, have shown evidence of rates greater than this in the last two decades.  Read here for evidence of Rapid Excitoxin Damage and my link on Testosterone and Excitotoxins as well.

Even so, let me throw out an “average” testosterone level table by age to start out with simply by starting with a peak of 700 and decreasing by 50 ng/dl each decade:

As a verification, one can look at this link and find a normal or average testosterone level chart by age. [3]

If you do enough research, you will find other similar results and average values can indeed get a good feel for the age-related decline in testosterone levels.

Now let’s jump to some important points when comparing your numbers to these kind of average or “normal” male testosterone levels.  First of all, you must remember not to panic if your testosterone is a little below what is given above.  For example, there are many guys with testosterone in the 400’s that are doing great with solid libido, erections and heart health.  In fact, guys like this probably have no idea that their testosterone is below “normal” and are doing just fine.

Although let me jump in and say that many young guys have written in that are struggling with testosterone levels in the 400’s as I mentioned.  Young males seem to be particularly sensitive or perhaps it’s the relative value compared to age that really counts.  Regardless, I have known several younger guys who have reported dramatically improved erections and libido when given supplemental testosterone even though they were in the 400’s and were supposely “normal”. (Giving young men TRT is a questionable practice, however, and some doctors will not do it but will instead use alternative therapies that we discuss elsewhere in this book.)

So if your testosterone level is below average, regardless of whether you as a male are experiencing classic Low Testosterone Symptoms, , you may want to natural methods, dietary and lifestyle factors, that can naturally boost. I cover many dietary and lifestyle factors on my site that can naturally boost testosterone.  Read this link, for example, on How to Boost Your Testosterone Naturally.  And, yes, that even includes Sex! It may be possible to boost your testosterone levels 20-40%, and possibly get them into the normal and acceptable range, simply by changing certain lifestyle factors.

REFERENCES:

1. J of Behavioral Med, 1999, 22(1):1-19

2. J of Clin Endocrinology Metabolism, 2007, 92(1):196-202

3. Vermeulen A. Declining androgens with age – an overview, In: Androgens and the ageing male. Eds. Oddens B. Vermeulen A. Parthenon Publishing. New York. 1996

Horny Goat Weed: Your Wife or Girlfriend Will Thank You

Supplements, especially herbs, scare me.  However, there are a few herbs, such as Korean Ginseng and Pycnogenol, that have very, very positive benefits and research results.  For example, Ginseng’s performance has been so outstanding that one could really qualify it as a food in terms of safety and beneficial properties.  Furthermore, and as we’ll show below, Ginseng seems tailor-made for the middle-aged and beyond guy battling some aging-onset maladies, including loss of erectile strength, mental sharpness and insulin resistance.  It’s not an inaccurate characterization to say that Ginseng is a turn-back-the-clock supplement in most of the key areas of health that males are interested in.  NOTE:  American Ginseng has many excellent properties as well, but we are only talking about the Korean variety here.

Side effects are rare with Ginseng.  Really the only major caution is that some supplement manufacturers have allowed lead contamination into their Ginseng products.  However, this can be avoided by buying brands, such as Solgar – Korean Ginseng Root Extract, 60 veggie caps , which have been tested for lead and pesticides (and deliver the active ginsenocides specified on the label).

CAUTION: Ginseng does have a few drug interactions, such as with blood thinners, etc., so check with your doctor first as always.

What can Ginseng do for you?  Consider these benefits:

1) Erectile Strength and Libido.  As I document in my link on Ginseng and Erectile Dysfunction, Ginseng has been proven in many studies to boost your all-important Nitric Oxide and has even been shown to have a solid cure rate (two thirds to three fourths) for guys with erectile dysfunction.  In the same link, I also document Ginseng’s aphrodisiac qualities.

2) Blood Sugar Control.  Early work found that Ginseng had the admirable quality of lowering blood sugar in type II diabetics. [1] Of course, this was an important benefit of Ginseng considering that such a large percentage of individuals in industrialized societies struggle with blood sugar control.  Follow-up research showed that Ginseng lowered blood glucose even in non-diabetics. [2]  Many animal studies have shown Ginseng’s protective effects against insulin resistance, diabetes and hyperglycemia. [9][10][11]  This is a desireable property indeed, considering the erectile and health-damaging effects of Diabetes and Metabolic Syndrome.

4) Cancer.  Almost all males will get prostate cancer, a common and generally slow growing cancer.  One of ginseng’s many benefits, according to an in-vitro study, is likely protection against the most aggressive forms. [12] Other studies show significant protection against stomach and lung cancer [13] and cancers of all kinds. [14]

5) Blood Pressure.  Ginseng yields a small but significant blood-pressure lowering benefit. [15]

These are the major advantages that most guys are particular interested in.  However, it is important to note that Ginseng has also been found to benefit the central nervous system and battle certain neurodegenerative diseases and has excellent anti-inflammatory and antioxidant properties as well.  Again, as with Pycnogenol, the list of Ginseng’s benefits is difficult to summarize in one short page.

REFERENCES:

1) 1) Diabetes Care October, 1995, 18(10):1373-1375, “Ginseng therapy in non-insulin-dependent diabetic patients”

2) Arch Intern Med, 2000, 160:1009-101, “American Ginseng (Panax quinquefolius L) Reduces Postprandial Glycemia in Nondiabetic Subjects and Subjects With Type 2 Diabetes Mellitus”

3) Curr Ther Res Clin Exp, 1996, 57:959 68, “A double-masked study of the effects of ginseng on cognitive functions”

4) J Ethnopharmacol, 1986;16:15 22, A double-blind, placebo-controlled clinical study on the effect of a standardized ginseng extract on psychomotor performance in healthy volunteers”

5) Int J Clin Pharmacol Res, 1999, 19:89 99, “Effects of a standardized ginseng extract on quality of life and physiological parameters in symptomatic postmenopausal women: a double-blind, placebo-controlled trial. Swedish Alternative Medicine Group”

6) Physiology & Behavior, Apr 2002, 75:739-751, “Modulation of cognition and mood following administration of single doses of Ginkgo biloba, ginseng, and a ginkgo/ginseng combination to healthy young adults”

7) Physiology & Behavior, Apr 2002, 75:739-751, “Modulation of cognition and mood following administration of single doses of Ginkgo biloba, ginseng, and a ginkgo/ginseng combination to healthy young adults”

8) Neurochemistry International, Jul 1992, 21(1):1-5, “Actions of ginsenoside Rb1 on choline uptake in central cholinergic nerve endings”

9) Horm Metab Res, 2005, 37(3): 146-151, “Improvement of Insulin Resistance by Panax Ginseng in Fructose-rich Chow-fed Rats”

10) ARCHIVES OF PHARMACAL RESEARCH, 27(7):790-796, “Wild ginseng prevents the onset of high-fat diet induced hyperglycemia and obesity in icr mice”

11) Acta Pharmacologica Sinica, Sep 2005, 26(9):1104-1110, “Antihyperglycemic effects of total ginsenosides from leaves and stem of Panax ginseng”

12) Life Sciences, Aug 8 2000, 67(11):1297-1306, “Anti-proliferative effect of ginseng saponins on human prostate cancer cell line”

13) Int. J. Epidemiol, 1998, 27 (3): 359-364″Non-organ specific cancer prevention of ginseng: a prospective study in Korea”

14) Int. J. Epidemiol, 1990, 19(4):871-876, “A Case-Control Study of Ginseng Intake and Cancer”

15) Annals of Pharmacotherapy, Published Online, 6 December 2005, “Systematic Review of the Effects of Ginseng on Cardiovascular Risk Factors”

Wild Rice and Erections - Peak Testosterone

I had a reader write in and ask if wild rice was as good for erectile strength as brown rice.  This is an interesting question, because these two grains are pretty close cousin in the botanical world and you would expect them to have similar properties.

Brown rice is an excellent food for increasing erectile strength as it has been shown in several studies to increase nitric oxide, the stuff of erections and Viagra and smiling happy males the world over. [1]  Brown rice works its magic, among other things, by having a relatively high L-Arginine to L-Lysine ratio.  Arginine is an amino acid that is used as a substrate for nitric oxde.  Lysine actually puts the brakes on nitric oxide.

REFERENCES:

1) Brit J of Nutr,July 2003,90(1):13-20

2) Brit J of Nutr,2007, 97(1):67-76

One way this is evidenced is by the fact that foods with a high enough lysine to arginine ratio are actually recommended to those struggling with herpes viruses.  Conversely, the herpes virus can be awakened, or activated by foods with a higher L-Arginine to L-Lysine ratio. And brown rice is one of the foods that herpes sufferers are told to avoid for just this reason.

So what about wild rice and nitric oxide?  Wild rice, although botanically similar, actually is the opposite of brown rice in this critical way:  it has a much higher ratio of lysine to arginine and, therefore, likely is not a strong erection promoter.  Of course, as far as I know, there is no direct study of wild rice on erections or nitric oxide.  However, it is a safe assumption that this may be a net negative for those seeking to optimize their endothelial output.  Of course, those concerned about herpes-related issues may need to be cautious

NOTE:  Wild rice and rye have historically sometimes been contaminated with the the fungus ergot.  Ergot has some nasty side effects such as mania, seizures and dilation of blood vessels that leads to massive fluid buildup in the extremeties.  The good news is that you’ll probably be hallucinating by then as it is a precursor to LSD and has been suspected as a root cause in some early cases of demon possession. Modern agriculutural practices have all but eliminated this as a concern.

Aromatase Inhibitor Arimidex: The Problems - Peak Testosterone

Arimidex (anastrozole) is an aromatase inhibitor that now has widespread adoption by both women and men.  Arimidex was originally developed to help in the battle against breast cancer but was heavily used by male steroid users and, shortly after, fertility and sports medicine physicians.  These off label usages have been steadily growing, especially among the steroid community, whose supraphysiological testosterone levels often require the brakes be put on their heavy aromatization and all its ensuing side effects such as gynocomastia, mood changes, loss of libido and erectile dysfunction.

There are also a couple of additional usage relating to testosterone levels that have caused its usage among men to acclerate even further:

1) Pseudo-HRT. Arimidex can boost testosterone and the testosterone-to-estradiol ratio very significantly.  This can make it a viable short term solution for many men with low testosterone since it preserves fertility and can solve some estrogen-related problems.  An even bigger driver is the fact that at least half the male population is overweight or obese.  In my link on Testosterone and Arimidex, I cover how one study in senior men showed an average testosterone increase of 62% and a boost in the testosterone-to-estrogen ratio of 112%!  Not bad for just popping a pill, eh?

REFERENCES:

1)   Experimental Gerontology, Jun-Jul 2009, 44(6-7):398-405, “Immoderate inhibition of estrogen by anastrozole enhances the severity of experimental polyarthritis”

2) Breast Cancer, 2006;13(3):284-8, “Joint symptoms: a practical problem of anastrozole”

3) The Journal of Urology, Feb 2002, 167(2 Part 1):624 629, “AROMATASE INHIBITORS FOR MALE INFERTILITY”

4) https://news.wustl.edu/news/Pages/6902

5) https://www.peaktestosterone.com/forum/index.php?topic=765.0

5) Arthritis Rheum, 2004 Jan, 50(1):72-7, “Vitamin D intake is inversely associated with rheumatoid arthritis: Results from the Iowa Women’s Health Study”

6) https://www.peaktestosterone.com/forum/index.php?topic=7787.0

2) Estradiol Dampening on HRT. Men with low (hypogonadal) testosterone levels can end up with overly low estrogen levels such that they actually begin to experience bone loss and, eventually, osteopenia.  (Quite a few men will even go to full-fledged osteoporosis.)  However, the opposite situation is actually occurring  with some men going on the new testosterone therapies where testosterone is pushed well above 800 ng/dl, i.e. weekly injections or pellets.  In these cases, many men who are (generally but not always) carrying extra weight will find that their estradiol shoots way up at the same time.  So you may have a man with testosterone of a 1000 and estradiol of 100 that nullifies the effect of the raised testosterone.  E2 levels this high will usually put the brakes on erectile strength, libido and are a risk factor for many nasty conditions.

The solution?  Many practitioners are now relying on Arimidex to handle the elevated estradiol issue, so it is becoming increasingly common for men to be on high dose testosterone and low dose Armidex to lower one’s bloated estradiol levels.  And, from what I have seen, the physician does not think of Armidex as a short term solution while he insists on weight loss with his or her male patient.  Instead, Armidex is considered part of a package HRT solution.

As always, I am very concerned about packaging Arimidex as a long term, “natural” solution.  Arimidex is a pharmaceutical and it has many potential long term problems associated with it.  Here are a few of the sobering health issues that you should discuss with your doctor before you consider this as a rest-of-my-life option:

1. Negative Alterations of Inflammatory Cytokines.  One study showed that “anastrozole induced the increased levels of proinflammatory cytokines, IFN-gamma, IL-12, and the decreased levels of IL-4, IL-10 secretion. We further found that anastrozole suppressed the differentiation of naive T cells to Treg cells, and it blocked the balance of IgG2a/IgG1 in peripheral blood.” [1] This is potentially ugly as I would argue that Inflammation is Enemy Number One.  The last thing most guys need to accelerate systemic inflammation by even a small amount.

2. Joint and Arthritis Risk. One very common risk of Arimidex treatment is joint pain and/or arthritis. The study above concluded that “anastrozole potently promote the progression of arthritis.” One study on women showed that Arimidex users had a higher than expected number of complaints about joint issues. [2]  (Just because this was on women does not mean it does not apply to men. Many men complain of joint issues while on Arimidex.) Now I should mention that most of the study work has been done on women who are on Arimidex for breast cancer treatment.  Their estrogen is brought down very low.  Men who have moderate estradiol adjustment into youthful E2 levels are obviously a different animal altogether. In other words, men on low dose Arimidex will probably not have this concern, unless their doctor does not monitor and unwittingly pushes his patient’s estradiol too low.  I have see this happen on The Peak Testosterone Forum.

3. Liver Toxicity. Arimidex is mildly liver toxic in some individuals. For example, one study of men found that liver enzymes were raised in about 7% of men. [3] Now, admittedly, this is generally not a major issue, but liver function is extremely critical.  See my links on https://www.peaktestosterone.com/ and The Liver and Inflammation for examples. Again, is this going to be good over decades??  NOTE:  This is probably not an issue for men on low dose Armidex.

NOTE:  In my link on Arimidex and HRT, I discuss a number of other important reasons that men on HRT may want to limit their Arimidex usage as well. You may also want to check out my link Natural Estrogen Blockers if you want, under your doc’s supervision of course, to go to a more supplement or lifestyle-based approach.

4. Possible Clotting Issues. Arimidex can interfere with the clotting cascade. See my page on The Risks of Testosterone for more information. It is possible that men with certain clotting or cardiovascular risk factors could get themselves in trouble.

5. Vitamin D Depletion. Some researchers speculate that Arimidex depletes Vitamin D as they have found that patients with muscle and joint pains on Arimidex have lower than expected levels of Vitamin D, although this is not proven yet.  Practitioners have also noted that taking extra Vitamin D helps with a variety of side effects and one study in women even verified this. [4]  One Forum poster on Arimidex was put on high dose Vitamin D and my guess is that this is the reason. [5] Extra Vitamin D has also been known to help with rheumatoid arthritis. [6] NOTE:  This is not an issue for men on low dose Armidex who also have their 25-hydroxy levels monitored.

6. Estradiol Crash. Some men on the forum have reported that even small amounts of Arimidex have crashed their estradiol levels.  These men seem sensitive to even very small dosages and often have to go to compounded Arimidex.  However, we also had one troubling story on the Peak Testosterone Forum, where a man took Arimidex as part of an HRT (TRT) protocol and found his estradiol had tanked to below 5 pg/ml in two separate blood draws.  Furthermore, both blood draws showed his total testosterone to be above 850 ng/dl, so it was definitely not due to a lack in testosterone.  Something about the Arimidex seemed to completely shut him down. [6]

CONCLUSION: As you can see, generally the side effects of Arimidex are usually negligible assuming one is taking relatively small dosages.  However, there are several nagging concerns that, hopefully, will one day be addressed.  My opinion:  if you are going on testosterone therapy, get those abs back!  Yes, you can try Armidex short term.  But do what it takes to lower your body fat percentage to where you can  see a nice line down those abs:  this usually will dramatically lower your aromatiziation and, therefore, estradiol levels even on high dosages of testosterone therapy.  I have seen estradiol greatly reduced in men who have gotten their weight way down.

CAUTION:  Natural aromatase inhibitors are few and far between at this point.  I do not recommend chrysin, because it can affect the thyroid, nor too much zinc, as it can lead to copper depletion potentially

Miraforte Review - Peak Testosterone

Super Miraforte is the Life Extension Foundation’s libido, anti-estrogen and testosterone supplement. Life Extension is one of the oldest and most reputable of the supplement manufacturers out there, specializing in anti-aging in particular, and with Miraforte they have taken aim at many of the hormonal issue that so often accompany the middle age and beyond years.

What is interesting is that Super Miraforte is very often sold to bodybuilders, because of its powers to decrease estrogen and likely slightly increase testosterone.  Chrysin has a questionable history of decreasing estrogen.  However, Life Extension seems to have supercharged it with the addition of piperine for increased absorption. This is likely the reason that Super Miraforte has been very well-received and reviewed and is used by bodybuilders in many cases.  (I have even read that some doctors are recommending it.)

Could Super Miraforte possibly increase testosterone?  One of the key things that most older men need is Estrogen Control and Miraforte does just that.  The reason that this is so critical is that, not only will estrogen “crowd out” testosterone, but it also can directly put the brakes on the testosterone output from your Leydig cells. [1][2]  This means that Super Miraforte , by decreasing estrogen, could lead to a T increase for middle-aged and beyond males that are struggling with inflated levels of the female hormones.

ARE YOU LOW SHBG? Miroforte contains Nettle and Nettle lowers SHBG. This is usually a good thing, unless you are a Low SHBG guy. Low SHBG is a fairly common condition, linked to insulin resistance, that makes HRT tough for example. Low SHBG should be cautious about using Nettle products in my opinion. I am talking about SHBG below about 18 by the way.

1. Chrysin. Chrysin is a known estrogen lowerer and it works by inhibiting the aromatization of testosterone to estrogen. As males age (and gain weight), an increasing percentage of their precious T is converted to E and chrysin can help.

CAUTION: Supermiraforte has been around quite awhile. However, it should be noted that one study showed Chrysin inhibiting the conversion of T4 to T3 and thus negatively impacting thyroid function. [3] This could potentially lead to weight gain, which would sabotage estrogen control.

2. Nettle. Nettle is a well-known liver protector. What is not so well known is that it also fights aromatization of testosterone to estrogen as well.

3. Zinc. Zinc remains a controversial testosterone booster as I cover in link on Zinc and ZMA. However, for those who are zinc deficient, this will likely give a boost. Remember that if you ejaculate, about a third of your zinc goes with it, so this can potentially help those who are sexually active as well.

4. Muira Puima. This herb is an aphrodisiac with a long history and some of its effects have even been documented in a few small studies. [1] Another study reported improved morning erections as well.

5. Maca.  This plant is another libido booster that I cover extensively in my link on The Superpowers of Maca.  Maca has actually been used as a food for centuries with an admirable safety profile.

6. Piperine. This compound from pepper, as in black, boosts the absorption of many supplements and compounds. Life Extension Foundation, by including, some piperine is essentially “supercharging” their supplement for better efficacy.

NOTE:  Increasing testosterone in men can also lead to increases in nitric oxide as well as testosterone works positively on NOS (Nitric Oxide Synthase).

1. Presented at the First International Congress on Ethnopharmacology, Strasbourg, France, Jun 5-9, 1990, Contributions to the clinical validation of the traditional use of Ptychopetalum guyanna.

2) J Clin Endocrinol Metab, 1978 Dec, 47(6):1368-73, “Direct inhibition of Leydig cell function by estradiol”

3) Prog Clin Biol Res, 1986, 213:359-71, “Iodothyronine deiodinase is inhibited by plant flavonoids”

Cosmetic Surgery for Males - Peak Testosterone

In my link on Skin and Appearance, I tell you about how to dramatically improve your appearance and decrease wrinkles using non-surgical methods, i.e. lifestyle and supplement-related solutions.  However, for some of you middle-aged and beyond guys out there, this may not be good enough for you.

You may have extensive skin issues from smoking damage or sun exposure.  Or maybe you are entering the market again and just want to look as good as possible.  You may even want to Date Someone Younger.

Any of these reasons, and a dozen more that we could name, may require you to consider surgical alternatives.  Below I have compiled a list of procedures that are tailor-made for males.  It is a complete myth that cosmetic surgery and plastic surgery are for females only.

Yes, we’ve probably all known a female or two that have been obsessed with the subject. You may even know a female or two that have over-cupped themselves to the point of the absurd.  Well, I’m not talking about anything weird here:  I’m just talking about wrinkle-reduction so that you look and feel your best for whatever reason.  Cosmetic surgery is about looking good and us males should want to look and feel just as good as the females in our lives.

Besides surgery, cosmetic or not, is science.  Philosophically, what is the difference between taking Vitamin C or Alpha-lipoic acid to look and feel youger than using surgery?  Obviously, one can go to an extreme here – think Michael Jackson – but the great majority of guys are not going to spend their money on cosmetic surgery unless it’s really necessary.  If you’ve got a lot of sun damage, your much more likely to consider foregoing a new set of clubs or that trip to Cabo in order to get a new face.

CAUTION:  The only cosmetic surgery I caution you on is bariatric, or weight loss surgeries such as liposuction. These are the most common cosmetic surgery procedure for males by the way.  In 2007 almost 60,000 guys had one!  So why do I caution against it?  Liposuction, or other weight loss procedures, can bypass your investigation into the root cause of your overweight condition if you have one. Peak Testosterone readers know that extra fat can be result from low testosterone, low growth hormone, overeating, underexercising, insulin resistance, an underactive thyroid or some combination of the above.  These are all deadly and you need to know exactly what has caused you to put on those extra pounds.  In addition, liposuction does not lead to any reductions in cardiac risk factors. This has surprised researchers, because the fat tissue is removed and yet heart outcomes do not change. [6] However, losing weight the “old fashioned way”, i.e. gradually with diet and/or exercise, improves EVERY cardiovascular risk factor.

In addition, bariatric surgeries actually carry significant risks.  A recent study [1] found that “about 4% had at least one serious complication (a life-threatening blood clot, the need for more procedures related to the weight loss surgery, or death)”. [2] That’s a 1/25 chance of a near death experience!  Again, talk with you doctor, but wouldn’t it be better to lose weight through exercise and proper diet with little to no risk of death?  Regardless, realize that being Overweight is Deadly and it is literally life and death to defeat this issue in your life.

Below is a list of great cosmetic surgeries for guys, depending, of course, on your situation.  I have also documented How Common Cosmetic Surgery is For Males.

1) Thermage. Thermage is a “monopolar radiofrequency” procedure.  It essentially cooks your skin so that the skin rebuilds.  Thermage for about two thirds of individuals does something magical:  it actually can reduce facial and neck sag.  The downtime is minimal, a couple of days on average although it can be longer, and the cost is in the medium range (~ $1,500).  Again, most people get younger looking skin with less sagging but not dramatically so.  CAUTIONS:  Thermage can “boil away” subcutaneous fat and it can leave small burns that are slow to heal.  Talk to your doctor about risks.

2) Bipolar Radiofrequency Plus Pulsed Light. Bipolar radiofrequency does not heat the skin as deeply as Thermage but when combined with Pulsed Light does achieve good results. Again, this can actually decrease skin sagging on the face and neck, although results are generally somewhat less than with Thermage. CAUTIONS:  Side effects can still take place but are generally less than Thermage.  Repeated treatments are usually require.

2) Dermal Fillers. This involves injecting substances into a wrinkle to reduce the appearance of the wrinkle, kind of autmotive putty for the face one might say.  The classic use of dermal fillers is on the nasolabial fold, i.e the lines beside your mouth.  The beauty of dermal fillers is that results last a long time, e.g. 18-24 months, and downtime is minimal.

3) Eyelid Surgery or Blepharoplasty. The eyes are the most revealing aspect of your body.  Women stare into them longingly – well, hopefully – and few can argue that they are the “window to the soul”.  They also reveal your age better than any other part of the body.  This is because the skin is very thin and easily damaged from the sun, lack of sleep and so on.  The eyes instantly flash whether you are tired or well-rested. Blepharoplasty can remove the excess skin from upper and lower eyelids and remove the bags from the lower lids and, if done well, take ten years off your appearance in a matter of a few hours.  You may want to read this link which has many reviews of those who have undergone the procedure.

4)  Microdermabrasion. This one may be worth a try. It is, after all, the #1 procedure for Hollywood-types.  Some stars have this procedure done every two weeks (or even more frequently) while filming. Lighting directors apparently go ga ga over the smooth finish that it gives skin. The important thing for guys to know is that it is sometimes called the “lunchtime peel”, because there is almost no downtime. Better yet, the cost is low:  just a few hundred dollars per session normally. It consists essentially rubbing a sandy material over the skin of your face in order to cause mild skin damage which then forces regeneration of new, improved skin.  Unfortunately, the results are often not spectacular, but  if you are one of the lucky individuals that respond well to microdermabrasion, it is an excellent alternative, especially for the price.  CAUTION: It is uncommon but you should know that a few individuals respond with excess tissue inflammation and can come out looking a little worse, i.e. with increased wrinking in certain areas.

In addition, sagging on upper and lower eyelids is extemely common.  And, unfortunately, once skin has sagged in a major way in the eye area, there is no good non-surgical way to re-firm it.  (Thermage can do some firming in the eye area for some people but it generally not going to do a major improvement.)  This is where an “eye lift” or blepharoplasty can come into play.  It will take you out of commission for awhile, but there really is no substitute.

5) Peels, Laser Resurfacing and Face Lifts. These are much more invasive procedures with a more significant list of side effects.  Of course, if you have significant skin damage or sag, then you may want to consider these.

6) Botox. The above procedures, for the most part, will only be partially successful on “motion wrinkles and lines”.  These lines, such as crows feet and glabellar lines (between the eyebrows), are caused by the expressions you make.  Botox works by injecting a Botulin toxin into the muscle area involved, which “deadens the muscle” that causes the wrinkling.  It works remarkably in many people and seems to actually allow the body to heal the wrinkles in many cases. Botox treatments generally last about four months and cost $300-400 per treatment. MONEY SAVER: New research shows that after you are a veteran, i.e. have had Botox for two years, you can go to treatments every six months (instead of the usual three) and still have reduced facial wrinkles. [7]

CAUTION 1: One should be aware that researchers recently found, to their surprise, that a minute amount of the Botulin toxin did actually migrate down the nerve.  Most doctors do not believe the small amounts involved will cause any kind of permanent issue, but no one knows for sure of course.

CAUTION 2:  Botox, if done incorrectly, can actually cause “new wrinkles” and can lead to ptosis (sagging).

CAUTION 3:  One recent study found that Botox can actually lead to decreased emotional responsiveness. [5] The reason is simple:  your facial expressions actually provide feedback that increases and validates your emotions.  Without facial expressiveness, emotional responses are blunted and dampened.  For this reason, still other research indicates that treating crows feet with Botox can increase feeling of depression due to the loss of neural feedback. [8]

CAUTION 4:  2009 study found that Botox results in an immune response, at least in mice. The long term consequences of this immune response have not been studied. [4]

CAUTION 5:  Some individuals actually become Botox resistant over time.

CAUTION: Watch out for the new GFX procedure to handle facial wrinking, especially in the area between the brows.  It has been approved for “overactive muscles” by the FDA but has not yet been approved for cosmetic purposes yet.  And that may be with good reason:  it works via the same radiofriequency used to Thermage, except in this case it’s used to actually temporarily stun the local nerve. This produces a Botox-like effect, except that in the case of GFX, one does not know for sure if nerve function will be fully restored.  In other words, if you don’t like the results, it may be too late.

7) REX. There is another very new procedure called REX, or Relaxed Expressions Toxin-Free RF Treatment, that works by inserting a small needle and using radio frequency waves (kind of like Thermage) to deaden nerve function, essentially accomplishing the same thing as Botox, but without using any nerve toxins.  It is first being pushed for glabellar lines between the eyebrows, but its proponents say it can be used for crow’s feet and even forehead lines.  Its practitioners claim that results are better and more natural.  CAUTIONS:  Results last for a year or more, which is both good and bad.  If you like the results, its great.  If you don’t like the results for some reason, you’re going to be waiting for awhile.  This is still not FDA approved and no one knows long term effects.

8) Dysport. This is a brand new replacement for Botox and the results look promising. One recent study showed legitimate wrinkle reduction for frown (or motion) facial lines in 85% of participants. [3] Results appear to initiate and last in roughly the same time frame as traditional Botox.  (Dysport is, like Botox, a botulinum neurotoxin type A.)  Hopefully, this will drive down costs due to competitive pressures. (There are also a couple of other Botox competitors coming down the pike as well.)

9.  Hyaluronic Acid Fillers. These, as the name implies, reduce wrinkles by “filling in the valleys”.  However, hyaluronic acid is a natural is a natural substance of skin and WebMD reports that there is some evidence that it actually promotes collagen formation. Collagen formation is the “backbone” of your skin and almost anything that promotes the protection or renewing of it is a good thing for your appearance.  In other words, repeated injections of hyaluronic acid may very well help your body actually reduce its own wrinkles. Costs vary depending on the amount of filler used and are typically in the $400 to $1000 range with one treatment lasting, in general, for 6 to 12 months. Common brands are Juvederm, Restylane and Captique. Results in the brow area are excellent and can last up to two years in many cases.  CAUTION: You want to get someone with good experience (and board-certified) because, if done incorrectly, you can get tiny mini-bumps on the skin.

10. Fraxel Laser. Traditional ablative laser treatments were effective but fraught with side effects:  the problem being that these older lasers heated both the top and deeper layers of the skin.  The Fraxel Laser changed all that by  heating only the deeper layers of the skin which allowed for decreased side effects and downtime.  However, there is generally downtime of several days to a week as the patient has an actual “sunburned” look during that time period. If you get treated on a Friday, for example, you might be ready by Monday. The good news is that the new skin that emerges is usually well worth the wait:  wrinkling, blotching, age spots, pigment spots and other skin problems are usually substantially improved.  If you want a new face to jump start your career or a relationship, Fraxel laser is definitely worth considering. It is one of the few treatments that is accepted as getting rid of fine lines around the eyes. Keep in mind, though, that it is quite expensive:  about a grand per treatment and 3-5 treatments are usually recommended over the course of about a month.  If you truly want a new face, though, the cost and inconvenience may well be worth it.

11) Tri-Luma. One of the most popular and successful treatments for skin discolorations is prescription-only Tri-Luma.  If you have melasma and/or age spots on your face, you may want to talk to your dermatologist about Tri-Luma.  It does have a fair number of side effects, but for the most part, are what you might expect, including peeling, dryness, redness and so on. In a small minority of people, it can create a bluish tint and, of course, should be discontinued immediately.

12) Liquid Face Lift. If you’ve got the money, then this procedure gives you the power to take ten years off your face in one afternoon. There is also minimal downtime, lengthy persistence and possible collagen-boosting properties as well.  For more details, see this link on the Liquid Face Lift.

NOTE:  Read here about the Most Common Cosmetic Surgery and Procedure for Guys.

REFERENCES:

Thanks to SmartSkinCare and Dr. Todorov for much of the above information.

1) Flum, D. NEJM, Jul 30 2009, 361:445-454; Robinson, M., NEJM, Jul 30 2009; 361:520-521

2) https://www.medicinenet.com/script/main/art.asp?articlekey=104221

3) UT Southwestern Medical Center (2009, August 3). Dysport Deemed Safe, Effective Anti-wrinkle Treatment, Plastic Surgeons Say. ScienceDaily. Retrieved August 4, 2009, from Science Daily Dysport coverage .

4) Aesthetic Surgery Jour, Sep 2009, 29(5):414-418, “Type A Botulinum Toxin Induced Antibody Production: A Murine Model of Antibody Response”

5) Emotion, 2010 Jun, 10(3):433-40, “The effects of BOTOX injections on emotional experience”

6) Obesity, 2008, 16(12):2648 2651, “Long-term Effects of Large-volume Liposuction on Metabolic Risk Factors for Coronary Heart Disease”

7) https://www.sciencedaily.com/releases/2010/04/100426141504.htm

8) https://medicalxpress.com/news/2013-04-laughter-lines-patients-depressed.html

Sugar : Testosterone Killer Extraordinaire - Peak Testosterone

REFERENCES:

1) Diabetes Care, 2003 Dec, 26(12):3215-8

2) Diabetes Res Clin Pract, 2003, 62:139-48

3) Diabetes Metab, 2004 Feb,30(1):29-34

4) Endocrine Abstracts, 2007, 13:P286, “Effect of Glycaemic index of the diet on salivary cortisol and testosterone levels in females”

Just this week (6/22/2009) one of the most important testosterone-related discoveries was uncovered, although it was one of those things many of us were saying, “I always wondered!” It was found that glucose lowered testosterone. As you may know, a glucose drink is often given before a fasting blood sugar test and researchers, commissioned by the Endocrine Society, administered the standard 75 gram glucose test and monitored testosterone after ingestion of the drink  The results surprised everyone:  testosterone was whacked for hours after the glucose drink.

The extent of the hormonal effect was shocking. First of all, testosterone was diminished by up to 25% regardless of whether the men were diabetic, prediabetic or healthy.  In other words, glucose greatly decreased testosterone in everyone.  Secondly, 98.6% of the study participants had significantly lower testosterone two hours after taking the glucose!  Finally, 15% of the subjects were actually driven into the hypogonadal range, i.e. their testosterone would have been flagged as clinically low.

Many bodybuilders drink a high glycemic drink with protein after a weight lifting workout in order to produce an insulin spike to push amino acids into their cells for muscle building.  In light of the above, this may not be such an enlightened practice.

NOTE:  There’s another reason that you may not want to drink that sugary drink:  Fructose Sabotages Weight Loss. Another interesting fact is that this same effect probably holds true with females as well.  Scientists put a group of females on low and high glycemic load diets with a washout period in between.  What they found was that females produced on average 22% less testosterone on the high glycemic diet versus the low. [4]

Okay, so testosterone is diminished significantly by glucose – but what about the table sugar and corn syrup that are in almost everything that we eat?  The answer is that these will almost for sure affect testosterone in a similar way because table sugar is one half glucose, one half fructose.  Corn syrup is similarly proportioned.

This is also supported by the fact that scientists have already established that elevated insulin levels are correlated with lower testosterone. However, the researchers in the above study found that testosterone seemed to fall independently of insulin levels suggesting that it was blood sugar, i.e. glucose levels that actually depressed testosterone.  For example, blood sugar levels are best measured by what is called the hemoglobin A1c test.  This A1c test has shown that the worse the blood sugar, i.e. blood glucose (in diabetics) the lower the testosterone. [3] Therefore, it is very likely that any sugar or high glycemic meal will lower testosterone to varying degrees for hours afterwards.  Therefore, the best advice we have at this point is to play it safe and avoid all sugars and simple carbs if you value your testosterone.

For additional protection, there are a couple of other things that you can do:

1) Vinegar.  As I document in this link on How Vinegar Can Help Weight Loss, vinegar has a profoundly positive affect on blood sugar metabolism and decidedly dampens the body’s glucose and insulin responses after a meal with significant carbs.  Just have a tablespoon or two with any carb meal and you will lower your blood glucose and insulin rises post-meal, which should help to protect your precious testosterone.

Anti-Viagra: Glucose (and therefore sugar) now has been shown to take down your testosterone.  You should keep in mind that sugar assaults your sex life in many other ways as well.  I intend to do a page or two on this sometime but haven’t had a chance, but I will summarize by saying that sugar also does a full frontal attack on your erections.  Remember:  sugar is half glucose AND half fructose and the fructose component directly lowers Nitric Oxide. That’s right:  fructose directly affects the liver and hits your erections right where they count.  They really should call sugar and corn-syrup Anti-Viagra!

It’s hard for me to think of too many things that are worse for your sex life in the short term (and long term for that matter).  Sugar and corn syrup wreak immediate havoc on several key components of your sexual strength and function.  These nasty effects can last for hours and all for what?  Sugar and corn syrup add little to no nutritional benefits – in fact, quite the opposite.

Did you know you can inexpensively do your own testing for most hormones? The industry leader is Discounted Labs..

Quite a few guys would be reluctant to admit it but have a strong sweet tooth, not realizing what a profound effect this can have on their sex life.  Remember that sugar, almost immediately upon hitting the taste buds and saliva, creates an endorphin rush.  What I’m trying to say that sugar can make you no brighter than Pavlov’s dogs if you’re not careful.  For a few minutes blast of endorphins, you can basically castrate yourself.

I freely admit this is one of my biggest areas of weakness.  It is easier for me not to eat than to eat without at least some sweetness in my meal.  It tooks weeks of work to break this addiction but it is well worth the effort!

By the way, I just want to point out that, once again, Jack LaLanne was way ahead of his time.  As usual, he foresaw about 75 years ahead of his time these research results for how horrendous sugar is for the body. He has for decades preached against sugar and has never consumed a gram of it since he gave it up in his teens.  Undoutedly, this is yet another key to his good health and fitness.

2) Cinnamon.  Cinnamon’s glucose lowering action seem to be based on methylhydroxychalcone polymer, or MHCP.  MHCP is actually a mock insulin and ushers glucose into the cells in much the same that insulin does.  One study gave diabetic patients 1, 3 or 6 gram daily doses of cinnamon.  Even at the 1 gram dose, the results were particularly impressive:  particpants after six weeks of use had glucose levels reduced by 16%. [1] By the way, it should be mentioned that cinnamon also seems to improve insulin sensitivity [2], which is one of the hallmark symptoms of a long-term testosterone killer:  Metabolic Syndrome.  Again, this has not been proven by any study, but cinnamon should help protect your precious testosterone post-carbs just as Vinegar does. CAUTION: There is a certain type of “mock” cinnamon (Cassia) commonly sold in stores that has significant couramin, which is known to cause liver and kidney problems. You only want to buy true cinnamon, which is Ceylon Cinnamon.

Increase Nitric Oxide Boosting Foods (and Some Supplements).

Most men simply do not realize the massive difference that boosting your nitric oxide levels can make. You just feel better.  You exercise better.  You think more clearly.  Your blood pressure lowers.  And, perhaps best of all, your erectile strength increases. Of course, increased nitric oxide is the house upon which Viagra was built.

Of course, the huge problems that most men over the age of 40 have in the West is the lining of their arteries are now covered with atherosclerosis and scar tissue.  And I’ll just state the obvious: if your arteries go downhill and arterial plaque lowers your nitric oxide levels, you feel worse. That should come as no surprise. Many men with erectile dysfunction, libido, mental fog and fatigue do not realize how much those would be improved simply by increasing their nitic oxide levels.

Many men try to improve these kind of symptoms with HRT.  But HRT is not a miracle cure for atherosclerosis and low nitric oxide levels.  That must be worked on separately and there is no substitute for beefy NO levels.  Dr. Nathan Bryan has pointed out that many middle-aged men have less than half their youthful nitric oxide levels. Ouch!

And just because you are young, don’t think that you are immune. A number of studies have shown young men in their 20’s and 30’s with very significant artherosclerosis. Sure, you’re gonna be better off than most guys in their 60’s, but that may not be saying much!

So why not just take a PDE5 Inhibitor and call it a day? Although PDE5 Inhibitors (Cialis, Viagra and Levitra) have had considerable success at raising nitric oxide levels, they are fraught with side effects.  Tinnitus, hearing loss, visual disturbances, headaches and my personal favorite:  stomach upset and nausea.  These medications also can lead to what I call Viagra Resistance and Cialis Dependency. In addition, they do not work that well in men with a lot of arterial plaque.  Clearly, there has to be a better way!

This is where more natural solutions can step in and, in most cases, provide excellent results with many less side effects and issues.  I go into more detail in my book, The Peak Erectile Strength Diet, but below I give a nice summary of 10+ Ways to Increase Your Nitric Oxide Naturally:

CAUTION: Always check with your doctor before taking any new supplements or even fruit juices if you are on any medications or have any medical conditions.

1. Nitrates (in Foods). There are a number of foods that have high nitrate content, including carrots, lettuce, spinach and, of course, beets. I give substantial coverage to this in my links on Nitric Oxide Replacement Therapy, An Easy NO Boost Through Food, Beet the Odds and Beetroot Juice, but the beautiful thing about nitrates is that they give a man an alternate pathway to raise his NO levels even if he has significant atherosclerosis.  The way it works is this:  nitrates in one’s food are converted to nitrites by the bacteria on your tongue (assuming you haven’t killed it all off with mouthwash), which then are converted to nitric oxide in your gut.

NOTE:  An even better source of nitrates is arugula – thanks Dr. Greger – and several guys on the Forum including myself swear by the stuff.

2.  Citrulline. Citrulline is one of the more recent erectile supplement superstars.  Of course, it’s been around awhile, but it suddenly dawned on everyone that this was a nice way to boost arginine levels without The Potential Side Effects of Arginine. Basically, what I have read is that taking Citrulline bypasses the normal metabolic pathways and, again,  allows men with significant atherosclerosis to gain some of their nitric oxide back by bypassing the normal arterial pathway.  Quite a few men on The Peak Testosterone Forum swear by Citrulline and take 1.5-3 g/day. (Always talk to your doctor first.)

The research has really backed this up by the way: one study on senior men showed that taking 5 grams daily improved the stiffness of their arteries.  Nice!  These were healthy senior men, and this study also showed that arterial stiffness was improved independent of blood pressure. [3] Yet another study in the following year verified these promising results directly in erectile dysfunction patients by showing that half of study participants increased their hardness factor significantly by taking only 1.5 grams/day of L-Citrulline daily. [4] Again, these were senior men (average age 57 years) and, it should be noted, that their frequency of intercourse increased as well. What else could you ask for, eh?

3. Pomegranate Juice. Pomegranate Juice is the new heavy weight juice when it comes to improving your bedroom prowess.  And part of the reason is that it is a darn good nitric oxide booster.  It also lowers blood pressure, improves your cholesterol and, at least in some patients, clears out plaque!  For more information, see my link on The Many Benefits of Pomegranate Juice. CAUTION: Pomegranate juice can interact negatively with some medications, including Viagra (and perhaps other PDE5 Inhibitors).

CAUTION:  Erectile supplements should be combined very carefully and with the lowest dosage possible, because they can interact negatively with certain medications and medical conditions, and could potentially cause priapism, an erection that does not go away and can damage the penis permanently.  See my link on Common Causes of Priapism for more information on the latter. If you ever have an erection that will not go away after an hour or two, go to the E.R. immediately. Example: There have been several cases of pomegranate juice combined with Viagra leading to priapism.

4. Avoid High Fat Meals. Here is a quote from the lead author of a study on walnuts and olive oil: “The inner lining of the arteries produces a substance called nitric oxide that is needed to keep the arteries flexible,” Dr. Ros said. “When we eat high-fat meals, the fat molecules temporarily disrupt the production of nitric oxide, preventing the arteries from increasing blood flow in response to physical activity.” [3] The authors go on to explain that the higher fat in the meals creates an inflammatory response that walnuts (and not olive oil) can overcome.  Walnuts have both arginine, ALA and various antioxidants in them that actually helps overcome this arterial stiffness that follows a higher fat meal.

Low carbers may wonder if this applies to them.  Actually Low Carb does fairly well, according to a couple of studies I have seen, as long as you are losing weight.  However, the minute that you are on maintenance, i.e. no longer losing weight, you lose blood flow, vasoreactivity and, therefore, nitric oxide according to one study. [4] The moral of the story is that over the long haul you want to avoid high fat meals.  I outline many other issues in my link on The Dangers of a High Fat Meal, which includes a discussion of lowering testosterone.

5. Vitamin C.  Many men do not realize that Vitamin C can relax arteries by a different mechanism:  it protects your precious nitric oxide from being destroyed by free radicals. [3] Further evidence of Vitamin C’s powers in this regard are it’s ability to lower blood pressure and reduce arterial stiffness. (CAUTION: One study showed that Vitamin C actually constricted arteries.  However, this is when combined with another powerful antioxidant, so it is uncertain how applicable it is to practical situations.  See my link on Antioxidants and the Heart for more information.

6. CoQ10. If you are hypertensive, have diabetes (and probably prediabetes), CoQ10 is a proven improver of blood flow and lowerer of blood pressure. For example, one meta-analysis of hypertension studies came to the incredible conclusion that “coenzyme Q10 has the potential in hypertensive patients to lower systolic blood pressure by up to 17 mm Hg and diastolic blood pressure by up to 10 mm Hg without significant side effects.” [6] The effect is so strong that scientists believe CoQ10 must be working on nitric oxide to help preserve it from oxidative stress.  Or it may act on eNOS. Either way it can have an excellent effect for many men struggling with E.D.  Typical dosages in the studies are in the 100 – 200 mg/day range.

7. Moderate Exercise.  Brisk walking, which basically just means over 3.0 mph, is a great way to boost your baseline nitric oxide levels.  Of course, exercise increases NO for a couple of hours afterward very significantly, but the practical application is that your overall nitric oxide levels can increase as well as long as you do it daily for around 30+ minutes.  See my link on The Benefits of Brisk Walking for the research. (It unstiffens arteries and lowers blood pressure also!) And, of course, other forms of exercise can help as well. I just mention brisk walking, because it is so well studied and avoids overtraining, a big issue for many men (including myself from time to time).

8. Ginseng. One supplement that has a successful erectile dysfunction study under its belt is Korean Ginseng.  This herb has been used for centuries for many medical conditions, and scientists have found one of its secrets:  it does a nice job of increasing nitric oxide.  I cover this in detail in my link on Erectile Dysfunction and Ginseng. NOTE: Ginseng can thin the blood a bit, so always talk to your doctor if you are on any medications.

9. Pycnogenol. Pycnogenol, which is a standardized extract of French maritime pine bark, is another supplement with a successful erectile dysfunction study. It works by increasing the activity of eNOS, the enzyme that Viagra and Cialis act upon. [13] For more information, see my page on Pycnogenol and Erectile Dysfunction.

10. Saturated Fat.  One of the big controversies on health blogs and even among experts centers around how much saturated fat really contributes to heart disease.  But here is one thing that most of the men arguing on both side of the discussion do not realize:  saturated fat very often lowers nitric oxide. One study summarized this issue by saying that “because diets with a high saturated fat content induce high plasma fatty acid levels, endothelial nitric oxide production is often impaired due to a reduction in nitric oxide synthase 3 phosphorylation.” [7]

This is one of the primary reasons that a high fat meal, as mentioned above, also usually lowers nitric oxide levels. Remember: you don’t need saturated fat to boost your body’s cholesterol levels, because your body makes its own just fine without you sucking down modern oils and butters and corn-fed cows and pigs. Also, virtually every primal culture on planet earth, regardless as to how much meat they consumed, had total cholesterol below 150 and they are much, much healthier than us.

TIP: A lot of people like the taste of olive oil and it’s part of Mediterranean cuisine. However, olive oil will actually reduce nitric oxide in many cases and canola oil will not. Furthermore, canola oil is much better regarding inflammation than olive oil. [12]

11. Raw Cocoa or Dark Chocolate.  The flavonoids in dark chocolate or raw cocoa can significantly raise nitric oxide levels.  For example, one study gave 44 hypertensive seniors just 30 grams of dark chocolate – a fraction of the typical chocolate bar – and found that it significantly lowered their blood pressure. [8]

As I point out in my link on The Kuna People, they have incredibly low rates of hypertension and they are regular consumers of raw cocoa. This is the surest way to make sure that you get your flavonol content as processing can reduce flavonols. By the way, the Kuna have average blood pressure readings of 110/70 and very little increase with age! [10] For more information, see my page on Raw Cocoa Powder.

NOTE: Hopefully, you’re noticing a pattern here:  many, many plant foods increase nitric oxide and animals are either neutral or lower nitric oxide, depending on their saturated fat content.  This is why the DASH Diet, a clinically proven way to eating to lower blood pressure in hypertensive patients, is almost entirely plant-based.

12. Quercetin. This phytochemical is found in many plants, particularly citrus fruits, onions, apples, parsley, wine and tea.  It works to boost nitric oxide by decreasing a peptide called endothelin-1.  Endothelin-1 is a very strong vasoconstrictor and is actually released by the cells in your endothelium and quercetin controls this effect. [10]

13. Icariin (Horny Goat Weed).  Horny Goat Weed has also been used for centuries to help erectile dysfunction and the primary component with it has been found to contain a natural PDE5 inhibitor called Icariin.  There are now extracts of Icariin in the 40+% range, which is usually desirable because Icariin is much less powerful gram-for-gram than the pharmaceutical Viagra.  (I have read 50 times less so.)

Again, there are many other fruits, fruit juices, drinks and vegetables that I cover in my book that will help you increase nitric oxide levels. But, again, the key is to eat a well-rounded plant-based diet packed with a variety of fruits and fruit juices. [9] Yes, you can eat some meat.  However, if you are a bit older and your endothelium is damaged, you will find that you do much better following some of the tips above.

TIP:  Did you know that just one cup of raisins can lower blood pressure (and slash TNF alpha levels)?  Anything with grapes – even many wines – can do the same thing.

REMEMBER:  Being overweight, being sedentary and smoking hammer your endothelium.  All the food and supplements in the world cannot overcome these.

REFERENCES:

1) Int J Cardiol, 2010 Nov 8, “Short-term effects of l-citrulline supplementation on arterial stiffness in middle-aged men”

2) Urology, 2011 Jan, 77(1):119-22, “Oral L-citrulline supplementation improves erection hardness in men with mild erectile dysfunction”

3) https://www.sciencedaily.com/releases/2006/10/061010022750.htm, “Eating Walnuts With High-Fat Meals Helps To Protect Arteries Against Short-Term Damage”

4) Circulation, 2007; 116:II_819, “Abstract 3610: Comparative Effects of 3 Popular Diets on Lipids, Endothelial Function and Biomarkers of Atherothrombosis in the Absence of Weight Loss”

5) Journal of Biological Chemistry, 274, 8254-8260, “L-Ascorbic Acid Potentiates Nitric Oxide Synthesis in Endothelial Cells”

6) Journal of Human Hypertension, 2007, 21:297 306, “Coenzyme Q10 in the treatment of hypertension: a meta-analysis of the clinical trials”

7) Curr Opin Clin Nutr Metab Care, 2010 Jan, 13(1):97-104., “Regulation of nitric oxide production in health and disease”

8) JAMA, 2007 Jul 4, 298(1), “Effects of Low Habitual Cocoa Intake on Blood Pressure and Bioactive Nitric Oxide: A Randomized Controlled Trial”

9) Lipids Health Disease, 2008, 7(14), “Raisins and additional walking have distinct effects on plasma lipids and inflammatory cytokines”

10) Int J Med Sci, 4(1):253-258, “Does Flavanol Intake Influence Mortality from Nitric Oxide-Dependent Processes? Ischemic Heart Disease, Stroke, Diabetes Mellitus, and Cancer in Panama”

11) International Journal of Clinical Pharmacology and Therapeutics, 2002, 40(4):158-168, “A review of the French maritime pine bark extract (Pycnogenol), a herbal medication with a diverse clinical pharmacology”

12) https://www.pritikin.com/your-health/health-benefits/reverse-heart-disease/331-sex-nitric-oxide-and-your-heart.html

Drugs and Medication for Lower Testosterone - Peak Testosterone

Yes, almost all  recreational drugs (and alcohol) can lower testosterone, which is something I cover in the following links:

—Alcohol and Testosterone

—Beer and Testosterone

—Cocaine, Heroin and Testosterone

—Ecstasty (MDMA) and Testosterone

—Marijuana and Testosterone.

Painkillers lower testosterone as well.  Of course, there are legitimate uses for painkillers, but there are also tons of men addicted to them as well and hammering their hormones while they are at it.

Intuitively, I think that many men realize that these supposed “feel good” drugs are hard on our hormones, so the above is probably no surprise.  However, what I often find on The Peak Testosterone Forum, is that many guys do not realize that legitimate, FDA-approved pharmaceuticals can also significantly lower testosterone as well.  Why in the world would the FDA approve a drug that lowered testosterone without a warning label, right?  Well, it just doesn’t work that way.  There a MANY drugs out there that lower testosterone and, making matters worse, most doctors do not know about it.

In modern, urbanized societies, it is very common for men over 40 to be on more than one medication and, of course, this just increase one’s odds even more.  Here are the 13 Major Classes of Drugs that can Decrease Baseline Testosterone Levels (and there are undoubtedly more):

CAUTION: Do NOT discontinue any medication without discussing it first with your doctor.  In many cases, dosage can be reduced or an alternative medication found, but this should be discussed with your physician first.

Testosterone and DrugsSTEP 6C.  Examine any medications, recreational drugs or alcohol for potential testosterone-lowering qualities.

1.  Antipsychotics. These are especially hard on testosterone through a variety of pathways but are notorious for raising prolactin levels.  Of course, prolactin fights testosterone and libido and if it goes too high will lead to sexual dysfunction in many ways. For more information, see my link on Testosterone and the Antipsychotics.

2.  Opiate Paikillers (Percocet, Vicodin, Morphine, etc.). These all will tend to lower testosterone via inhibition of LH (Luteinizing Hormone), the molecule released by the pituitary to signal the testes to increase testosterone production.  One review noted that “a large majority of men consuming sustained-action opioids have symptomatic androgen deficiency which apparently responds to replacement therapy. Opioid-induced androgen deficiency is frequently overlooked.” [4]

3.  Antifungal (Clotrimazole, Nizoral and Ketoconazole). Even something as simple as trying to get rid of a fungal infection can lower testosterone levels appreciably. [9] We have had a number of complaints on our forum about clortrimazole, especially when applied directly to the scrotum or penis.  Look at what these posters wrote:

“The doctors claimed that I would not need to get circumcised and that I could use this cream as long as I needed to. I was never warned about any possible side-effects. At about the one year mark of daily clotrimazole use, I began applying the clotrimazole cream to my scrotum and the surrounding areas as I began to get jock itch. About a year and 8 months into this, I began to lose lean weight for unknown reasons. I noticed that I had lost about 24 lbs of lean weight with basically zero change in diet or exercise routine (or lack thereof). I also noticed that my strength had also decreased quite a bit. Doors that were once light became heavy and my 112 lb girlfriend seemed to be harder to pickup. I chalked all of this up to stress from a new job and aging (I was 26 at the time – too young for any of this stuff to start happening). I asked doctors what was happening and they had no answers…At about the 2.4 years mark, I started doing research on the relationship between testosterone and clotrimazole. The first journal article I found indicated that clotrimazole is a potent inhibitor of the P450 cytochrome enzyme. P450, as I’m sure you all know, is an enzyme directly involved in testosterone metabolism.” [15]

“I just wanted to post saying the same thing about clotrimazole cream. I used it for only a few weeks back in July last year for jock itch, but it was applied near the scrotum. After using the cream for a few weeks I noticed my scrotum had shrunk in size! My testicles don’t hang low anymore (about half as low as they used to), even in a hot shower they just do not hang low anymore, even 7/8 months later! For me I have no doubt it was caused by the cream, it was such an obvious change after 2 weeks of use! 🙁 but fortunately I didn’t get any other side effects. Its a shame the anti androgenic side effects are so potent because it did clear up the fungal infection a treat. I’ve had some sort of weird non itchy fungal infection on the head of my penis for years now, but I’m scared to treat it with anymore antifungal creams because the clotrimazole cream permanently shrunk my scrotum! I wish I never used the stuff!” [15]

I don’t see a lot of reports like this out on the web, but there is some scary research on the subject.  Check this out the title of this journal article: “Clotrimazole is a selective and potent inhibitor of rat cytochrome P450 3A subfamily-related testosterone metabolism.” [16]

4.  Arrhythmias (Amiodarone). This drug for heart arrhythmia has high iodine content and can interfere with thyroid function, which, in turn, could lower testosterone. [1]

5.  Lithium.  Of course, lithium can be a life saver for someone with bipolar disorder.  [2]  However, this can interfere with the thyroid and lead to hypothyroidism, which in turn can interfere with testosterone production. [1]

6.  Diabetic (Sulfonylurea). These drugs sometimes used to treat type II diabetes can result in hypothyroidism and, therefore, potentially, a drop in testosterone. [2]

7.  Oxycodone (Oxycontin). This pain medication tends to raise prolactin and in some men may lower testosterone. [3] It also can have a side effect of very significantly lowering testosterone in some sensitive men as well.

8.  Dopamine Antagonists (Chlorpromazine, Compazine, etc.).  Anything that interferes with dopamine levels can easily diminish T levels.  These psychotropics are no exceptions.

NOTE:  I cover some of the famous “anti-aphrodisiac”, libido-reducing medications at the bottom of my link on Male Libido Supplements.

9.  Antihypertensives (Beta Blockers). Several studies have shown that beta blockers, a very common class of medications for high blood pressure can lower testosterone. For example one study found that atenolol, metoprolol, pindolol and propranolol all led to decreased testosterone levels.  Propranolol was found the above study to be the worst. [5][7]

Did you know you can inexpensively do your own testing for most hormones? The industry leader is Discounted Labs..

10.  Valium (Diazepam). One theme you may have noticed:  almost any medication that affects the brain and/or brain function significantly tends to lower testosterone. Valium, the famous tranquilizer, is no exception and appears to tranquilize the testes as well. [6]

CAUTION:  There are a wide variety of toxins, pesticides, endocrine disruptors, xenoestrogens, excitotoxins and other chemicals that can be considered “drugs” even though they are not pharmaceuticals.  I give significant coverage to these on my site at this link on Nasty Chemicals That Can Lower Testosterone.

11. Anticonvulsants. These drugs commonly used to treat epilepsy lead to an interesting phenomenon: an increase in total testosterone but a decrease in free testosterone. [8] This situation arises from an increase in SHBG. So who wins?  The increased total T or the decreased free?  Unfortunately, in the above study, the loss of free testosterone correlated well with decreased sexual activity levels.

12.  Tagamet (Cimetidine). Strange as it may seem, this H2 Agonist Blocker for stomach issues actually directly lowers testosterone production. [10] In fact, one animal study labelled it as an antiandrogen. [11] Can’t be any more clear that that, eh?

13.  Antidepressants (SSRI’s).  SSRI’s are notorious for lowering libido and leading to sexual dysfunction in both men and women.  Depression itself is notorious for lowering testosterone, something I discuss in my link on Depression and Testosterone, likely due to its increase in cortisol levels as a stressor.  This makes it difficult to tease out if SSRI’s actually lower testosterone, since it is a side effect of the very illness these medications are trying to treat.  And, indeed, one study actually found that SSRI’s may increase T levels in men. [12]

However, more recent research showed very much the opposite.  Some studies have shown that most SSRI’s significantly affect liver enzymes and thus some postulate that they slow down the time to clear estrogen (estradiol), i.e. allow for estradiol to build up. [13] One report noticed a wide variety of SSRI’s that resulted in lower free T levels as well. [14]

But the most damning evidence came from studies on Prozac, which shows that, particularly in those who use it longer term, that testosterone levels do tend to drop.  See my page on Testosterone and Prozac for more information.

REFERENCES:

1) https://www.umm.edu/patiented/articles/ what_causes_hypothyroidism_000038_2.htm

2) https://health.nytimes.com/health/guides/disease/drug-induced-hypothyroidism/overview.html

3) Journal of Pain and Symptom Management, Feb 1994, 9(2):126 131, “Altered sexual function and decreased testosterone in patients receiving intraspinal opioids”

4) Current Opinion in Endocrinology & Diabetes, Jun 2006, 13(3):262-266, “Opioid-induced androgen deficiency”

5) https://www.jpathology.com/Issues/Previous%20Articles/9(3).html

6) Systems Biology in Reproductive Medicine, 1979, 3(1):31-35, “Effect of diazepam on serum testosterone and the ventral prostate gland in male rats”

7) Arch Sex Behav, 1988 Jun, 17(3):241-55, “Beta-blocker effects on sexual function in normal males”

8) J Neurol Neurosurg Psychiatry, 1983, 46:824-826, “Sex hormones, sexual activity and plasma anticonvulsant levels in male epileptics”

9) Eur J Clin Pharmacol, 1985, 29(4):489-93, “Effect of a single administration of ketoconazole on total and physiologically free plasma testosterone and 17 beta-oestradiol levels in healthy male volunteers”

10) Arch Intern Med. 1985;145(5):920-922, “Cimetidine Blocks Testosterone Synthesis”

11) Gastroenterology, 1979, 76(3):504-508, “Cimetidine is an antiandrogen in the rat”

12) Journal of psychosomatic research, 03/2012, 72(3):205-13, “Salivary testosterone: associations with depression, anxiety disorders, and antidepressant use in a large cohort study”

13) European Neuropsychopharmacology, Apr 2006, 16(3):178 186, “The effect of tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs) and newer antidepressant drugs on the activity and level of rat CYP3A”

14) https://www.mental-health-today.com/rx/testos.htm

15) https://www.peaktestosterone.com/forum/index.php?topic=2931.0

16) Drug Metab Dispos, 2001 Jun, 29(6):837-42, “Clotrimazole is a selective and potent inhibitor of rat cytochrome P450 3A subfamily-related testosterone metabolism”

High Estradiol? Can it Increase Arterial Plaque.

STEP 3A: Do you have high estradiol? Consider the evidence that it can accelerate arterial plaque:

One of the very few subjects that I enjoy more than hormones is regressing arterial plaque.  So imagine how excited I got when I found a study that combined both subjects.  A 2006 study in the Journal of Clinical Endocrinology looked at a variety of hormones and lifestyle factors, such as testosterone, estradiol, SHBG, BMI, waist-to-hip ratio, blood pressure and lipids in relation to arterial plaque in men.  And they did not just study association but rather causation.  By that I mean that they measured the above hormonal and lifestyle factors and then watched the participants for three years afterward with the goal of finding which were most predictive of developing arterial plaque. [1] And the results were very interesting on many fronts.

NOTE: Arterial plaque was measured using an ultrasound IMT (intima medial thickness) of the carotid (neck) artery.  This is one the two common ways to check for plaque, the other being a Heart Scan (Calcium Score), the latter being something I discuss in my page called Heart Scan Results. An IMT has no radiation and, as of this writing, can be done without a doctor’s orders in almost all states through Lifeline for $70.

What did the researchers find?  Their results would probably surprise most men:

1.  The only hormone that predicted an increase in arterial plaque was estradiol (both total and free).

2. The only lifestyle factors that predicted an increase in arterial plaque were LDL and HDL.  (This is no surprise.  All the Plaque Regressers set low targets for LDL – see my page Your Target LDL Levels to Regress Plaque – and relatively high values for HDL, the “good” cholesterol.)

Basically, higher estradiol levels meant higher plaque levels three years later.  This is, for many scientists, a complete turnaround in expectations:  for years and years the estrogen in women was seen as heart protective. However, the thinking on that has done an about face. The authors wrote:

1)  J Clin Endocrinol Metab, 2006 Nov ,91(11):4433-7, “Circulating estradiol is an independent predictor of progression of carotid artery intima-media thickness in middle-aged men.”

2) J Mol Med (Berl), 2002 Mar, 80(3):176-80, “Coronary artery wall atherosclerosis in relation to the estrogen receptor 1 gene polymorphism: an autopsy study”

“Our findings of a positive association between serum E2 levels and intima-media thickening supports the notion that estrogens, besides possibly increasing the risk for thrombosis and thereby cardiovascular events, also have an important impact on atherogenesis in men. In the present study, we found a positive association between free E2 and the annual increase in intima-media thickness at higher, but not lower, free E2 levels. This might suggest that high doses of E2 (and possibly other estrogens) should be avoided in clinical trials. Indeed, high-dose parenteral administration of a slow-release preparation of E2 was recently shown to increase the risk of nonfatal ischemic heart disease events in men.”

Notice that in this study lower estradiol was NOT correlated with increased atherosclerosis – only high.  Low estradiol is dangerous for other reasons, such as osteoporosis, but in this study it did not seem to accelerate plaque.  The study also commented that

b)  Researchers have discovered that the estrogen receptors in arterial walls likely play a role in the buildup of arterial plaque directly. [2]

What this means is that researchers now have evidence of  and biological plausability (cause-and-effect) for, a link between higher estradiol levels and arterial calcification.

Estradiol Management and HRT

One key point in my mind is that this study seem to argue for an emphasis on weight loss and reasonable dosages of testosterone for men on HRT, Clomid, HCG Monotherapy or any therapy that increases testosterone levels in order to lower estradiol levels.  Some physicians now – and I have seen this on the  Peak Testosterone Forum – believe that there is no practical upper limit to estradiol for men on HRT. They will double or triple a man’s testosterone levels and, therefore,  roughly double or triple their estradiol levels at the same time. And, as this study shows, boosting those estradiol levels could actually carry a long term risk.

Furthermore, testosterone did not show an ability to improve IMT in this study, so one cannot count on it to protect one’s arteries from the buildup of plaque. Testosterone does some remarkable things for cardiovascular health, such as decrease hardening of the arteries, lower insulin levels, help prevent prediabetes and diabetes, decrease body fat (a little), help improve libido/erectile strength and lower key inflammatory markers.  Put all of these together and I would think that you should generally improve plaque levels.  However, according to this study, testosterone was neutral and estradiol must be monitored independently.

So how do you manage estradiol?  Well, one way HRT clinics and anti-aging physicians do it is with Arimidex (anastrozole).  Arimidex is an aromatase inhibitor and will drop your estradiol levels nicely.  The problem with Arimidex is that it can negatively impact the clotting cascade, and, therefore, may only improve half of the equation.  Now the rebuttal is that the amount of Arimidex usually given to men on HRT is usually quite low.  I was on Arimidex briefly and was given initially 0.5 mg twice per week.  That is a very small amount and I don’t believe there is any evidence that clotting has been an issue with doctors that use it.  You’ll have to discuss risks with your doctors or PA as there are no studies.

I would argue that there is a better way for most men and the following should be their goal:

a) Lower the testosterone dose as much as possible.  This will, in turn, lower estradiol levels.

b) Drop your body fat into the 10-12% range.  (This is easy using Clarence Bass’ approach documented in his book Challenge Yourself.

c) If you are injecting testosterone cypionate or enanthate, go to two or more times weekly (which usually will mean subQ).

This is the approach I took and I got completely off of Arimidex.  My last estradiol read was 27 pg/ml, which is a Youthful and Natural Level of Estradiol.

REFERENCES:

Nitric Oxide and Testosterone - Peak Testosterone

What’s more important, testosterone or nitric oxide? I couldn’t answer that one and I doubt you can either – both of these molecules just impact too many functions and systems to declare a clear victor. What is important to note, though, is the INTERACTION of these two on each other and how they partner to improve men’s health in, literally, a hundred different ways. Both of these have been found by multiple studies to impact endothelial function, i.e. nitric oxide and blood flow, sexual health, brain function, sleep, mood, exercise and athletic performance and so on. Yes, they affect almost everything we hold dear as males.

Let’s start with testosterone and its role in protecting nitric oxide. Having ample testosterone levels is a key, researchers have found, to maintaining arterial health. I cover this in my page on Testosterone and Heart Disease. The quick summary is that testosterone actually optimizes and even boosts nitric oxide levels through action on eNOS, the same enzyme that Viagra works on.  Testosterone also lowers arterial inflammation according to a couple of studies. [8] Its actions are so important to your cardiovascular system that low testosterone levels have been shown to be a significant risk factor for many chronic cardiovascular diseases, a fact I will go into in more detail below. And this is one of the things I found so exasperating when doctors are unwilling to treat low testosterone: they put their male patients at risk for many nasty medical conditions, especially heart disease.

And then let’s examine the most glaring example:  low testosterone tends to accelerate hardening of the arteries and arteriosclerosis.  And these conditions can definitely affect your nitric oxide levels in the medium and long terms.  How?  Simple:  arteries covered with plaque cannot produce sufficient nitric oxide for things like erections and safe blood pressure levels.  Of course, there are other problems with hardening and narrowing of the arteries – like a heart attack or stroke! – but this limiting of nitric oxide output is one of the symptoms that a man will generally first notice.  As many of you know, it first shows up often as erectile dysfunction.  And it is very common in the U.S. for a man in his 40’s or 50’s to begin to experience the beginnings of prehypertension/hypertension as well.

1)  The Journal of Urology, Aug 2000, 164(2):371-375, “TESTOSTERONE SUPPLEMENTATION FOR ERECTILE DYSFUNCTION: RESULTS OF A META-ANALYSIS”

2) The Journal of Neuroscience, 15 Jan 1997, 17(2):774-785, “Pontine Nitric Oxide Modulates Acetylcholine Release, Rapid Eye Movement Sleep Generation, and Respiratory Rate”

3) AJP – Regu Physiol, Jan 1, 1994, 266(1):R151-R157, “Inhibition of nitric oxide synthesis suppresses sleep in rabbits”

4) Brain Research, Jan 1999, 816(1):209 219, “Endogenous nitric oxide in the rat pons promotes sleep”

5) Sleep Medicine Reviews, Apr 2005, 9(2):101 113, “Nitric Oxide and sleep”

6) BJU International, Dec 2005, 96(9):1323 1332, “An open-label, multicentre, randomized, crossover study comparing sildenafil citrate and tadalafil for treating erectile dysfunction in men na ve to phosphodiesterase 5 inhibitor therapy”

7) Neuroscience, Jan 1998, 83(3):867 875, “Nitric oxide synthase-containing neurons in the human hypothalamus: reduced number of immunoreactive cells in the paraventricular nucleus of depressive patients and schizophrenics”

8) Mol. Hum. Reprod, 2010, 16(10):761-769, “Endothelial regulation of eNOS, PAI-1 and t-PA by testosterone and dihydrotestosterone in vitro and in vivo”

All of this explains why so often on The Peak Testosterone Forum, I see men with BOTH testosterone and nitric oxide related issues.  They likely tend to snowball downward together.  And I believe this is shown in the studies, where a significant percentage of men given HRT (testosterone therapy) are not cured of their erectile dysfunction, a subject that I cover in my link on Viagra Failure.

Likewise, HRT often fails to cure erectile dysfunction on its own.  One meta-analysis, where researchers aggregate or pool studies together, showed that about 57% of patients with erectile dysfunction responded to testosterone therapy. [1] Of course, that implies that in about 43% of patients, HRT did not really help. NOTE: My guess is that there would probably have a higher response rate if it was properly managed, i.e. testosterone levels were raised significantly and estradiol levels were managed as well.

So testosterone, in particular low testosterone, can affect nitric oxide.  What about the other way around?  Well, let’s look at what I call The Three Main Natural Engines of Testosterone Production. In all three cases, I will show that low nitric oxide levels can negatively impact every one of them:

2.  Sexual Intercourse.  Of course, sexual intercourse and nitric oxide go hand in hand and Viagra proved that forever by putting million of men “back in the game”.  Viagra works, of course, by slowing the breakdown of endothelial nitric oxide, allowing levels to build up more quickly.  One study found that both Viagra and Cialis increased the frequency of sexual intercourse in men by a little over 40%. [6] One study of Cialis usage showed that it did, indeed, give a modest increase in testosterone and a nice boost to the T/E2 ratio.  See my link on The Testosterone-to-Estradiol Ratio for more information.

3.  Mood and Attitude. I document many cases where the mind and Testosterone are very related.  Competition and victory can very substantially raise testosterone.  Depression can lower it  Once again, this ties in with the fact that low nitric oxide levels can definitely affect mood.  In its extreme form, it has been implicated as being a factor at times in clinical depression and schizophrenia. [7] For more information, see my links on Testosterone and the Mind and Testosterone and Depression for more information.

Did you know you can inexpensively do your own testing for most hormones? The industry leader is Discounted Labs..

So, although I do not have a study to prove it, it is very likely that low nitric oxide can lower testosterone and low testosterone can lower nitric oxide levels over time.  Clearly this could create a viscous circle and is part of the explanation as to how men living a Western lifestyle spiral downard in health terms so rapidly after about the age of 40 or 45.

The good news?  There is hope if you’re willing to go natural, because there are natural ways to actually reverse, or at least significantly partially reverse these simultaneous decreases in nitric oxide and testosterone.  Here are some examples:

1.  Testosterone. There are literally dozens of ways to naturally reverse some of the smaller losses in testosterone through lifestyle changes and I have outlined these in my link on How to Increase Your Testosterone Naturally. Now by far the biggest of these is weight loss. Men who lose massive amounts of weight can in some cases literally more than double their testosterone levels. Some men, though, simply cannot increase the testosterone enough through lifestyle changes alone and will have to consider HRT (Hormone Replacement Therapy).   However, in my opinion if this is well-managed and well-monitored and the patient is brought to normal levels of testosterone, then this can still be considered a natural solution. The reason is that one is simply replacing testosterone that is missing from normal aging or from damage.

2.  Nitric Oxide. Again, there are dozens of ways to boost your nitric oxide.  One is through consumption of high nitrate foods, something I discuss in My Review of Beet the Odds . (This methodology is ultracritical for you 40+ men.) Still another is through following the principles of my book, The Peak Erectile Strength Diet , which is all about foods that will increase nitric oxide and blood flow.  If you go through the links listed here in my Improving Your Erectile Strength section, you will come across many other strategies as well.

I should also add that you can heal you arteries by actually reversing some of that arterial plaque.  I cover this in my link on How to Clear Your Arteries.

The important thing is that if you raise testosterone, you will also likely raise nitric oxide levels.  And, if you raise nitric oxide, you will be improving sleep, the frequency of sexual intercourse and mood, all of which will very likely boost testosterone.  Yes, you should be able to not only halt the decline, but actually turn back the clock significantly.

REFERENCES:

What If You Have to Stop HRT (TRT)? - Peak Testosterone

That is the lowest testosterone reading I have ever had in my life and I’ve had some pretty low ones before.  This was obviously way below the standard hypogonadal thresholds out there for adults males:  280ish (non-LabCorp) or 350 (LabCorp).  Why was it so low?  Because I had stopped HRT (testosterone therapy) a few weeks before.  I often get asked what happens to a man when he stops testosterone therapy cold turkey and now you know!

Here are the dates and numbers, so you can get an idea as to exactly why I stopped HRT and how rapidly my testosterone fell:

What this means is that in 24 days my total testosterone dropped from a weekly average of about 900 ng/dl to 111 ng/dl! Before I began HRT – admittedly years ago – my testosterone levels were always in the low 300’s, so this 111 read was very likely a rebound effect.  I talked to my clinic director about it and he stated that, from what he has seen, the following rules usually apply for men quitting HRT cold turkey for whatever reason:

2.  Restoration of Baseline Testosterone Levels.  Recovery time usually takes 3-4 months. Of course, baseline levels are usually quite low for men on HRT and, in some cases, it takes longer than 3-4 months. Yes, this is a long time, especially if you are in a relationship, but it’s survivable.

As a side note, I did surprisingly well during these last three weeks and did not notice the symptoms.  In fact, I actually had morning erections most nights, something I normally do not have unless my testosterone is > ~600.  I attribute this to the fact that I had started on POM pomegranate juice – no affilliation whatsoever – and a series of anti-inflammatories. which I discussed in my link How I Attacked my High PSA.

Did you know you can inexpensively do your own testing for most hormones? The industry leader is Discounted Labs..

Notice that my PSA did indeed fall appreciably from a high of 6.3 to 3.6 in about a month, which is a 43% reduction.  You might be thinking that my PSA dropped simply because my prostate shrank.  However, I have never had an enlarged prostate and, again, all my reads before a month ago were less than 1.5.  I feel certain that I have improved the inflammation or prostatitis that was likely causing the underlying problem.

I will also say that the last few days had become quite miserable though.  This is probably when my testosterone fell below 200.  I found my libido to be very low and I was having joint aches and terrible sleep.  (Libido has been found to be dose dependent on testosterone levels, which you can read about in my link on Testosterone and Libido.) In my low testosterone days I remember that that was one of the worst aspects of being hypogonadal:  miserable sleep and waking up feeling awful no matter how long I stayed in bed.  Also, I developed some venous leak from the years and years of low testosterone, so, needless to say, I was anxious to get back on HRT.

UPDATE:  I am officially back on HRT and what a difference!  Testosterone cypionate made a huge mental difference for me almost immediately.  I feel much more relaxed with minimal anxiety and slept much better last night.  (I got my shot yesterday afternoon.)

Stopping Testosterone with Less Pain

Does stopping testosterone have to be a very painful experience, where one loses sexual function?  The answer is probably not. Here are Four Ways to (Likely) Stop Testosterone Therapy With Less Pain. (Discuss with your doctor of course.)

1.  Clomid. Now, first of all, do NOT consider this option if you are going off of HRT due to possible prostate cancer or a high PSA.  Clomid will very likely raise your testosterone and so you need to follow your urologist’s advice and, if he/she says to lower your testosterone levels, then go with that.  However, some men go off of HRT for different reasons, such as a) wanting to try to go natural or b) wishing to get their fertility back, etc.

These men can often consider Clomid as an option.  Clomid basically works on the hypothalamus and “tricks” your body into thinking it needs to signal for more testosterone.  This will work assuming that your pituitary and testes are functioning reasonably well.  However, clomid is notorious for working full strength for a month or two and then starting to lose its potency, i.e. testosterone levels begin to drop.  However, even if you fall into this category, you should get a couple of months of relief.  My impression from the Peak Testosterone Forum is that about 75% of men will respond to Clomid for at least 2-3 months reasonably well.

So Clomid will solve all your problems? Unfortunately, one of Clomid’s two active compounds is estrogenic and this fact causes men a lot of problems:  headaches, moodiness, depression and low libido are very common.  I would say that 80-90% of men have one or more of these symptoms.  And think how discouraging it is to see that you have nice beefy testosterone levels but your libido is almost nonexistent, a more-often-than-not occurrence on Clomid.  Also, Clomid has a number of rare, but serious side effects, so discuss with your doctor..

2. Boost Nitric Oxide (Assuming #1 Does Not Happen). Testosterone actually activates the eNOS enzyme and thus can increase nitric oxide in men (who have decent baseline NO). When those testosterone levels collapse, it’s beneficial to keep your nitric oxide levels up as much as possible. I have a lot of ideas in my link Increase Your Nitric Oxide Levels Naturally.

3. Increase Insulin Sensitivity (Assuming #1 Does Not Happen). As testosterone levels fall, insulin levels and insulin resistance rises as I document in my links on Testosterone and Insulin and Testosterone and Diabetes. To insure that elevated glucose levels do not cause you problems as your T slides downward, you will want to a) exercise more, b) eat more low glycemic foods and possibly c) add some supplements for protection (cinnamon, green coffee bean extract, carnosine, etc.).

4. Self-Monitor Your Glucose and Nitric Oxide. Your doctor will probably not care about #2 or #3 and so you may have to self-monitor. There are many labs who do extremely inexpensive lab testing: Reasonable Lab Testing. You can do a decent job of monitoring your nitric oxide levels with Nitric Oxide Test Strips.

Pomegranate Juice: Side Effects - Peaktestosterone

Pomegranate juice has been an erectile dysfunction miracle worker on the Peak Testosterone Forum and has rescued many guys from bedroom difficulties. What is particularly amazing is how it seems to really help some of the young guys out, who supposedly have clean arteries and should be without erectile issues. For example, check out what this young man recently wrote in:

1) https://peaktestosterone.com/forum/index.php?topic=5101.0

2) Neurobiology of Aging, May 2014,  35(5):1162 1176, “Pomegranate juice exacerbates oxidative stress and nigrostriatal degeneration in Parkinson’s disease”

3) Neurobiology of Disease December 2006, 24(3):506 515, “Pomegranate juice decreases amyloid load and improves behavior in a mouse model of Alzheimer’s disease”

4) Urol Ann, 2012 May-Aug, 4(2):108 110, “Priapism, pomegranate juice, and sildenafil: Is there a connection?”

5) DMD, February 2007, 35(2):302-305, “Effects of Pomegranate Juice on Human Cytochrome P450 2C9 and Tolbutamide Pharmacokinetics in Rats”

6) https://www.rxlist.com/pomegranate-page3/supplements.htm

7) DMD, May 2005, 33(5):644-648, “EFFECTS OF POMEGRANATE JUICE ON HUMAN CYTOCHROME P450 3A (CYP3A) AND CARBAMAZEPINE PHARMACOKINETICS IN RATS”

7) Phytother Res. 2009 Aug;23(8):1123-7. doi: 10.1002/ptr.2759. Pomegranate extract mouth rinsing effects on saliva measures relevant to gingivitis risk.

“Pomegranate juice is the bomb. I’m 35 and was suffering from weak erections for about a year. I then read Peak’s articles on pomegranate juice, especially how it could possiblly reverse plaque buildup, and I figured I’d give it a whirl. Generally a 1/2 hour after consuming it I notice that I have no erection issues. Consuming 4-8 oz. before bed results in morning wood most mornings. This stuff has improved my relationship with my girlfriend, and it’s all natural! I was afraid that I would have to start taking Viagara.” [1]

And this is just one of probably a dozen guys that have written in and said how pomegranate juice has helped them dramatically.  Of course, the temptation with anything that is so effective is to take a lot.  Us guys will do just about anything to get back in the game, right?  And the studies on pomegranate look very, very good:  as I document in my page on The Benefits of Pomegranate Juice, it helps nearly every arterial parameter you can conceive of from lipids to inflammation to plaque, etc. It’s just a cardiovascular wonder worker.

However, you have to step back and ask yourself if something that powerful could actually cause some issues for some men potentially.  For example, caffeine can be miracle worker as well, but in some men it can cause arrythmias and other issues.  Although research is very preliminary, pomegranate juice may end up falling into this same category for some men, although I suspect the real issue will be dosage.

In any event, check out these studies for some potential concerns with Pomegranate Juice that are poorly understood and understudied.  I currently consume pomegranate juice but have cut back my dose.  My take on it is that pomegranates have been consumed heavily for hundreds of years, so I find it hard to believe that reasonable amounts of of pomegranate juice that correspond to a couple of pomegranates would cause major issues.  But who knows?  Again, look at these studies and do your own research:

1. Potential Damage to Neurons (a mock Parkinson’s)?  One study on mice sought to verify Pomegranate’s protective effect in a mouse model of Parkinson’s Disease. Parkinson’s basically occurs when one loses too many of the dopamine-producing cells in the brain’s substantia nigra region (80-90%).  Now Pomegranate has powerful antioxidant effects and, undoubtedly, for this reason it has shown some protective effects from Parkinson’s (in animal models). [3] However, pomegranate juice is also a potent stimulator of nitric oxide, a free radical.  So, theoretically, any stimulator of nitric oxide could create too much NO and cause actual oxidative damage.  This is exactly what a later study found and the researchers noted the following:

“The present study was assigned to examine the potential neuroprotective effects of PJ [pomegranate juice] in the rotenone model of PD [Parkinson’s Disease]. Oral administration of PJ did not mitigate or prevent experimental PD but instead increased nigrostriatal terminal depletion, DA neuron loss, the inflammatory response, and caspase activation, thereby heightening neurodegeneration.” [2]

So you have one study showing it may help with Parkinson’s and another that says it might worsen it.  Again, I suspect it is a matter of dosage, but there is no doubt that more studywork and research needs to be done.

3. Interaction with Medications.  Pomegranate juice can affect literally dozens of different medications – not just PDE5 Inhibitors.  The reason is that it inhibits several of the liver’s cytochrome enzyme families. Check with your doctor first if you are on any medications. [5]

4.  Mouth and Gum Issues. I know that after a few weeks of taking pomegranate juice, my mouth begins to develop sores.  The tongue and gums will be painful to the touch and then I’ll quit pomegrante and the problem will go away within 48 hours.  I have repeated this experiment several times, so I do not doubt that pomeranate is the root cause.   And realize that pomegranate completely changes many oral (mouth) properties.  (Yes, you have mouth flora just like you have gut (intestinal) flora and both are very important to your health.)  One study considered thise changes to be positive and the researchers concluded that:

“The changes were: reduced total protein (which can correlate with plaque forming bacteria readings), reduced activities of aspartate aminotransferase (an indicator of cell injury), reduced alpha-glucosidase activity (a sucrose degrading enzyme), increased activities of the antioxidant enzyme ceruloplasmin (which could give better protection against oral oxidant stress) and increased radical scavenging capacity (though this increase was significant only by nonparametric statistical analysis). A placebo of cornstarch in water did not affect these measures. These data raise the possibility of using pomegranate extracts in oral health products such as toothpaste and mouthwashes.” [7]

So this sounds positive, but I cannot help but wonder if pomegranate is too powerful in some people, thus causing some oral issues in some men (like myself).  And I am not the only one reporting this effect.  Just do a search on “pomegranate mouth ulcers” or “pomegrante mouth sores” and you’ll see dozens of entries come up.

REFERENCES:

Supplements, Dangers - Peak Testosterone

Erectile dysfunction is something to be taken very, very seriously.  And, no, not just because it takes the life out of your sex life.  Erectile Dysfunction is almost always a warning shot over your bow, a warning of impending heart disease.  In other words, if you do not take care of your erectile dysfunction now, you almost for sure have a life of angina, angioplasties and MIs just around the corner.

What is tragic is that so many doctors treat erectile dysfunction as if it is purely psychological.  How many guys have walked out of a physician’s office with the idea planted in his mind that it must “all be in his head”.

Well, if you have few to no morning erections and difficulty even getting or staying erect, you do not need some Ph. D. to imply that it is all in your mind:  you know different.  And the reason is simple:  the veins and arteries in the penis are smaller than those in the heart area and thus tend to have trouble first.  And problems downstairs are “non-ignorable” for us guys, because it effects our sex life.  We will limp along with half clogged arteries that are blocking circulation to our brains and legs, but if the ol’ penis is affected we take notice immediately!

But in some ways we should be thankful.  For many of you erectile dysfunction is going to give you a second chance on life so that hopefully a heart attack will not suddenly kill you in five to ten years. By the way, I am not exagerrating to make a point:  one study found that erectile dysfunction preceded cardiovascular events by five years on average. [1]

Let me put that in plain terms:  you guys out there with erectile dysfunction have five years, on average, to straighten yourself out physically or there is a freight train coming your way.  And remember that five years was the middle point – it could be much less.  Are you going to gamble with your future?

NOTE:  For more information, see my page on How Arterial Plaque Is The Number One Factor in Most Erectile Dysfunction.

Furthermore, one study found that “that a single question on erectile rigidity proved to be a predictor for the combined outcome of acute MI, stroke and sudden death”. [2] In other words, men were given a questionaire about erectile function and if they answered a problem on just ONE of those problems, it strongly predicted some of the nastiest things that can happen to a human including heart attack, dying instantly and a clot damaging (usually) the brain.

So don’t think that just because your erectile dysfunction is “mild” that you can avoid the consequences.

Another study “showed [that] men with a history of ED had a 40% greater risk of subsequently developing CVD over the seven-year course of the study than those with normal erectile function.” [3] Yet another study found a 26% and 43% increase in all-cause and cardiovascular mortality rates, respectively. [4] And this was after adjusting for “age, body mass index, alcohol consumption, physical activity, cigarette smoking, self-assessed health, and self-reported heart disease, hypertension, and diabetes.”  In other words, erectile dysfunction was found to be a potential death warrant  not just because the underlying population was “diseased” or “sickly.”

So what’s a fella to do?  Are you supposed to just give up and die and let the clock tick down until your time is up?  Of course not.  Below I give you the top links that can save your erections AND your heart and your life.

1)  Low Fat Diet.  A Low Fat Diet can actually reverse heart disease and that means reversing the plaque that has built up in the veins and arteries of your penis.

2) I have a link called Sexercise and for good reason:  exercise can give you your sex life back!

3) Please read this link on Improving Your Erectile Dysfunction. It has many research-proven ideas to help your heart and penis.

4) Finally, you need to learn the dangers of Inflammation, Metabolic Syndrome, High Blood Pressure and being Overweight – these are all strongly correlated with heart disease.

REFERENCES:

1) International Journal of Clinical Practice, 2007, 61(12):2019-2025

2) International Journal of Impotence Research, 2008, 20:(1):92-9

3) Nursing Times, 2008, 104(46):26 27

4) The Journal of Sexual Medicine, Sep 2009, 6(9):2445-2454, “Erectile Dysfunction and Mortality”

Diabetes and Erectile Dysfunction - Peak Testosterone

The classic first signs of diabetes are extreme thirst and hunger coupled often with excessive urination and inability to heal.  However, if you let it get to that point, those symptoms are just the beginning of your problems: significant damage has likely been done to your arteries and endothelium and that’s bad news for your health and your sex life.

Diabetes is a plague in almost every modern industrialized society.  In America, for example, studies have shown that 14% of males have diabetes. That is about one out of every seven guys struggling with a major illness that is literally eating their arteries and organs from the inside out.  And this does not even take into account all the males, probably an additional 3-6%, depending on age, that have diabetes and do not even know it.

Diabetes is a huge risk factor for erectile dysfunction and one study estimates that as high as 50% of men with diabetes have significant erectile dysfunction. [1]  The study explains that “in addition to the disease’s effect on small vessels, it may also affect the cavernous nerve terminals and endothelial cells, resulting in deficiency of neurotransmitters Additionally, in diabetics, corporal smooth muscle relaxation in response to neuronal- and endothelial-derived nitric oxide (NO) is impaired, possibly due to the accumulation of glycosylation products .” [2]

REFERENCES:

1) Population Health Metrics, 2009, 7:16, “Diabetes prevalence and diagnosis in the US states: analysis of health surveys”

2) Urol Clin North Am, 2005 Nov, 32(4):379-95, “Physiology of penile erection and pathophysiology of erectile dysfunction”

3) Diabetes Care, Apr 2003, 26(4)1093-1099, “Do Impotent Men With Diabetes Have More Severe Erectile Dysfunction and Worse Quality of Life Than the General Population of Impotent Patients?”

4) Eur Heart J, 2004, 25 (21):1861-1862, “The prevalence of abnormal glucose regulation in patients with coronary artery disease across Europe”

In other words, diabetes is very hard on erections in almost every way possible, attacking the endothelium, nitric oxide, nerves and neurotransmitters.  What is left when those are damaged or depleted after all?  Even worse, diabetes is known for resulting in even more severe erectile dysfunction than normal. [3]  Diabetics score worse in almost every major category including erectile function, intercourse satisfaction, sexual desire, overall satisfaction, and psychological impact.

NOTE: Yes, testosterone has miraculous effects on male insulin levels, i.e. it lowers them significantly, a fact I cover in my book Low Testosterone by the Numbers.  This effect of this appears to be much more powerful than I realized.  I recently spoke to to a worker in an HRT clinic and she said that ALL of their Type II diabetic patients were able to totally eliminate their need for insulin.  This is astonishing.  Yes, a few had to keep taking Metformin, but nevertheless, this is a remarkable reversal.  This clinic increases testosterone via weekly injections ito around 1000 ng/dl.

And it’s no wonder:  diabetes is brutally hard on the heart and arteries.  Diabetics suffer significantly more strokes, heart attacks and high blood pressure than non-diabetics.  Much of this has to do with the fact that arteriosclerosis is accelerated with diabetes due to elevated inflammation, oxidation, fibrinogen, arterial plaque and weight around the midsection.  Diabetes raises almost every risk factor for cardiovascular disease and, as I often mention, the Heart and the Penis are intimately linked.  Even worse, diabetes can be a silent killer:  one European study found that about one third of heart attack patients were diabetic and didn’t know it. [4]

Diabetics can get into trouble even with relatively normal LDL levels because their LDL molecules are the smaller, more deadly kind.  They also usually have worse HDL and triglyceride levels to go along with it.  In other words, the whole lipid profile is skewed negatively.

All of this is generally leads to severe erectile dysfunction.  Yes, diabetics can get some relief from PDE5 inhibitors such as Viagra and Cialis according to the studies, but the studies also show that the results are not as long-lasting.  And who wants to be dependent on a pill for their sex life?

So the bottom line is to keep your blood sugar and glucose under control and do everything within your power to avoid diabetes in the first place. This is especially important if you have a family history of diabetes.

What’s a fella to do?  Fear not:  I’ve got a great list of preventative measures in my link on Metabolic Syndrome Solutions. But start now:  don’t wait until the damage has already been done.  In addition, read my link on Natural Ways to Prevent Diabetes and consider the book Reversing Diabetes, an M.D.’s program to dramatically help and sometimes even completely things.

Look Into Fertility Concerns - Peak Testosterone

Unfortunately, many doctors forget to tell their patients just one little detail:  HRT dramatically lowers sperm counts!  For example, one of our posters asked forum member the following story:

“I went to my GP about 9 months ago with the usual symptoms and tested at total T of 360. (I’m 35.) He gave me a 400mg shot “to try” and I seemed to respond. Retested about 3 months later at 280, got another huge 400mg shot and seemed to respond again. So he went ahead and prescribed me test enanthate, and I’ve been shooting about 50mg every 5 days* with so-so results.” [3]

Then he asked this question: “I still want kids. Have I sterilized myself? My doc said that fertility is likely to be off already with low T and that replacing to physiologic levels won’t suppress it further — and may help. If I understand what I’ve read here, this is NOT the consensus view.”

So this doctor not only did not tell him about the issue, but actually said that HRT might improve his fertility!  Apparently, this doctor did not realize that testosterone is actually a pretty significant contraceptive. (Don’t rely on it though!) For example, one study of Chinese men looked at testosterone undecanoate, which is now approved as Nebido here in the U.S., and found that it was incredibly effective as a contraceptive:  “the mean serum testosterone concentration increased 131%, and the mean serum LH and FSH concentrations decreased 72% and 70%, respectively, after TU injections during the treatment period.”  [1]

And sure there are men who successfully get their woman pregnant while on HRT.  It only takes one little swimmer to do it, eh? However, it is more the exception than the rule. Any loss of fertility can be a huge stressor for some couples.  Women in particular can become despondent and depressed, but the stress can really hit the male as well.  One study on infertile couples showed that ACTH levels rose in the guys, indicating HPA difficulties.  And this increased stress caused  lower sperm counts and motility in the study participants. [4] Thus, infertility can create even greater infertility and create a downward spiral.

CAUTION:  Because of all this, you want to do all you can to stack the cards in your favor if you want kids. Below I give you some of the standard treatment methodologies to handle low testosterone and preserve or increase fertility, so that you can discuss things with your doctor and ask all the right questions.  Don’t forget that there are both “production issues” and “obstruction issues.”  Male factor infertility is not always just a hormonal issue and sometime you can get “blockage” issues.  It’s always smart to talk to a fertility specialist if you can afford it.  Some urologists even handle fertility and have built up this expertise. Take some of the discussion points on this page to him or her.

So, if HRT causes such a loss in fertility, then how can a man boost his T and preserve his fertility at the same time?  Or does he have to choose between one or the other?

It turns out that there are a number of options for men in this category that can solve these sorts of issues.  Let’s take a minute and look at each:

1.  HCG Monotherapy (with HMG as needed).  One option that I see is an increasing number of men undergoing HCG Monotherapy, as opposed to the standard “HRT Trifecta” of testosterone cypionate, HCG and Arimidex.  HCG is commonly given now to men in conjunction with testosterone to preserve testicular size/volume primarily.  However, HCG can also be given by itself in order to stimulate the man’s own natural testosterone production.  The reason that this works is that most men with low T actually have secondary hypogonadism where the pituitary or hypothalamus is the broken link.  As it turns out, HCG is an LH (leutinizing hormone) analog and will mimic the effects of LH on the testes, i.e. stimulate them to produce testosterone, assuming the testes are in good shape of course.

I should also mention that usually some low dose Arimidex needs to be taken with this kind of treatment, because estradiol levels can ramp up significantly.  So it is monotherapy in the sense that no testosterone is given, but, in reality, there is often a second pharmaceutical involved.  For more information, see my link The Hows and Whys of HCG Monotherapy.

Did you know you can inexpensively do your own testing for most hormones? The industry leader is Discounted Labs..

And, actually, sometimes HMG is added to the regimen as well if a man’s fertility parameters (from a semen analyis) have not responded after a few months.  HMG is actually a combination of FSH (follical stimulating hormone) and LH, with each brand being a little different formulation.  The FSH actually much more directly stimulates sperm production than HCG, which primarily induces testosterone production.

The HCG/HMG combination can take awhile to work, usually around 6-9 months before you begin to see reasonable increases in sperm counts and so on.  This method is not foolproof and has a mixed track record. [5] Your fertility doctor can give you a good idea as to whether or not you are a good candidate.

2. HCG + HRT.  Dr. Lipshultz has several studies under his belt showing that most men on HRT can maintain their fertility if they add in low dose HCG.  One study put men either on injections or daily transdermal (topical) testosterone gels and then added in 500 IU every other day of HCG.  The abstract states the remarkable results that “no impact on semen parameters was observed as a function of testosterone formulation. No patient became azoospermic during concomitant testosterone replacement and human chorionic gonadotropin therapy. Nine of 26 men contributed to pregnancy with the partner during followup.” [6] Fertility is so important that I encourage you to talk to fertility specialist and come up with a treatment plan that will work for your situation rather than just go by this one study.  But, yes, it looks like you can have your cake and eat it too!

3) Clomid. When you think of fertility medications, Clomid is probably the name that first pops into most everyone’s mind.  It is used by both men and women, of course, and is often the first line medication because of it’s convenience,  relatively low cost and ability to stimulate sperm production.  What could be simpler?  No injections.  No needles.  Just take a pill.

And it works very well for some men, who get both nice boosts in testosterone, sperm counts and libido.  We had a man on Peak Testosterone Forum whose testosterone went up to 1500 ng/dl on Clomid!  Sot it can give a substantial boost.  One study found more modest, yet significant increases from 248 to 610 ng/dl with a 25 mg daily dosage.  (See my link on Clomid and Testosterone for details.) And sperm counts can go from a couple million to a 100 million in just a couple of months as well.

However, the reality regarding Clomid is far from the ideal generally speaking and there are a number of persistent issues that plague this medication:

a) There is very often no libido boost whatsoever in men taking Clomid.  Their testosterone may triple and yet they have no real increase in sexual desire.

b) It often stops working or at least loses efficacy after a few months.  Some women interested in getting pregnant bypass this concern by trying to “harvest” their husband’s sperm during those few months for a future IVF.  Yeah, that probably won’t be the last time you’re milked…

c)  Clomid can display estrogen-like effects in the brain and increase moodiness and other related symptoms.

d)  There are some concerns about long term effects and I outline these in my link on Potential Long Terms Risks of Clomid Therapy.

Again, some men seem to thrive on it and do very well and, unfortunately, there is no good way to predict who will do well and who will not.

4. Armidex Monotherapy. This is not very common from what I have seen, but some fertility specialists will put young men on Armidex by itself.  Men get their estradiol, the most potent estrogen, through an enzyme called aromatase (that is stored primarily in fat cells) that converts some testosterone into estradiol.  Arimidex (anastrozole) is an aromatase inhibitor and thus slows down this conversion of testosterone into estradiol.  Therefore, it will raise both testosterone and lower estradiol simultaneously and can preserve fertility.  (It doesn’t seem to have a good reputation for actually raising fertility, but talk to your doctor about this.)

How much can Armidex raise testosterone?  You can read about it more in my link on Testosterone and Arimidex, where I discuss a study where Arimidex increased testosterone by 62% and decreased estradiol by 24%.

5. Combinations of the Above. You can find every combination imagineable.  HCG + Arimidex; Clomid + Arimidex; HCG + Clomid + Arimidex.  And some doctors use letrazole instead of Arimidex (anastrozole).  If you go to a fertility specialist, he will test you in every way – ultrasounds, hormone blood draws, genetic and semen analysis, etc. – and then will decide on the best course of action.

1) The Journal of Clinical Endocrinology & Metabolism, Feb 1 2003, 8(2):562-568, “A Multicenter Contraceptive Efficacy Study of Injectable Testosterone Undecanoate in Healthy Chinese Men”

2) The Journal of Clinical Endocrinology & Metabolism, Oct 1 1993, 77(4):1028-1032, “Body composition and muscle strength in healthy men receiving testosterone enanthate for contraception”

3) https://peaktestosterone.com/forum/index.php?topic=701.0

4) Neuroendocrinology Letters, 2005, “Levels of plasma ACTH in men from infertile couples”

5) Andrologia, 1981 May-Jun, 13(3):187-97, “A modern approach to the gonadotropin treatment in oligozoospermia”

6) The Journal of Urology, February 2013, 189(2):647 650, “Concomitant Intramuscular Human Chorionic Gonadotropin Preserves Spermatogenesis in Men Undergoing Testosterone Replacement Therapy”

-Supplements, Five Pro-Erection with a Solid Track Records.

One thing that I find rather shocking is that most guys experiencing a decline in bedroom performance generally have no idea that there are erectile supplements with solid research behind them and a good safety profile as well. Most males turn immediately to the PDE5 Inhibitors, Cialis, Levitra and Viagra, without even considering that there are much less expensive alternatives available that, in some cases, have been used by men effectively for decades or even centuries.

REFERENCES:

4) Phytotherapy Research 2002,16:1-5; Nutrition Research,2001,21:1251-1260;Nutrition Research, 2003,23: 1189-1198;Life Sciences,2004,74:855-862

5) J Urol 2002; 168:2070-3

6) Asian J Androl 2007;9(2):241-4

7) Intl Journ Cardio 2005 Feb 28, 98(3):413-9

8) Eur Heart Journ 2007 28(18):2249-2255

9) Urology 2004 Apr,63(4):641-646

10) Curr Med Res Opin, 2004 Sep,20(9):1377-1384

11) Amer Jour Clin Nutr, 2007 Sep,86(3):610-7

12) Amer Jour Cardio,2007 Aug 1,100(3):455-8

13) Am Jour Clin Nutr, Apr 2007, 85(4):1068-74

15) J Cardiovasc Pharmacol,1998,32:509-515

16) Hum Psychopharmacol,2002,17:279-284

17) Gen Pharmacol,1982,13:169-171;Gen Pharmacol,1982,13:225-230;Gen Pharmacol,1983,14:277-280

18) J Clin 17) Gen Pharmacol,1982,13:169-171;Gen Pharmacol,1982,13:225-230;Gen Pharmacol,1983,14:277-280

18) J Clin Endocrinol Metab,1991,73:4-7

19) Eur J Clin Nutr, 2008 Dec, 62(12):1426-31, Epub 2007, “Fish oil supplementation improves large arterial elasticity in overweight hypertensive patients”, Wang, et. al.

20) Journal of Andrology, Sep/Oct 2008,(29):5

21) JAMA,2007,297:2351-2359932-40

24) Circulation, 1998 Jun 9, 97(22):2222-9

25) Intl J Impotence Res, 2008, 20:173-180

24) Circulation, 1998 Jun 9, 97(22):2222-9

225) Intl J Impotence Res, 2008, 20:173-180

26) Eur J Clin Nutr, 2008 Dec, 62(12):1426-31, Epub 2007, “Fish oil supplementa26) Eur J Clin Nutr, 2008 Dec, 62(12):1426-31, Epub 2007, “Fish oil supplementation improves large arterial elasticity in overweight hypertensive patients”, Wang, et. al.

27) Journal of Chromatography A, 17 June 2005, 1078(1-2):196-200, “Determination of citrulline in watermelon rind”

28) Brit J Sports Med, Oct 2003, 37: 464–70. “The Ergogenic Effects of Eurycoma Longifolia Jack: A Pilot Study”

29) https://www.prelox.com/pdf/prelox_research.pdf

The potential tragedy of this is that PDE5 Inhibitors such as Cialis and Levitra are full of side effects and it is highly questionable that these can be used for decades without some sort of negative lasting effects.  (See my link on The Side Effects of PDE5 Inhibitors for more details, especially regarding how PDE5 inhibitors often effect the eyes, ears and stomach.)

Science has shown us many inexpensive supplements that can help improve erectile dysfunction and significantly eliminate impotence very quickly, within a matter of a week or two in some cases. Furthermore, some of these supplements increase libido and my give a little boost to testosterone as well.

NOTE: If you have any medical condition or are on any medication, check with a doctor before taking a supplement.  Also, for potential side effect, please go to any links mentioned below which have a more detailed information page. I also recommend implementing one new supplement per two weeks and not all at once.

1) L-Citrulline.  Citrulline is the new wonder supplement on the block. The beauty of Citrulline is that even small amounts will increase baseline nitric oxide levels, especially in men with endothelial dysfunction. This is absolutely critical, because most middle-aged and beyond men with erection-related issues are in this catgory. Viagra and Cialis often will not work for them, because they simply do not have enough nitric oxide produced by their arteries and vessels for these medications to act upon.

For this reason many men seem to be finding Citrulline downright miraculous, restoring morning and/or daytime erections. Furthermore, there is now a study showing that this supplement significantly increases hardness factor for many men with erectile dysfunction. L-Citrulline is typically sold in 1 gram tablets and men will take 1-2 grams daily: Source Naturals L-Citrulline 1000mg. (I would not take more than that.) For more information, see this link on The Benefits of L-Citrulline.

2) Pycnogenol. Pycnogenol is a proprietary extract of a French maritime pine bark extract, whose remarkable powers have been known for over a century.  Pycnogenol has been shown to stimulate the enzyme nitric oxide synthase (NOS) [15] which in turn stimulates Nitric Oxide production. Furthermore, research shows, which I document in my link on Pycnogenol and Erectile Dysfunction, that it is a supplement, when coupled with L-Arginine, that improves erectile strength and heals erectile dysfunction in around 75% of guys!

This is an incredible track record if you stop and think about it and, furthermore, the studies show no side effects.  What a contrast with Viagra and Cialis!

You can do what was done in the studies by taking between about 50-150 mg of Pycnogenol, such as TwinLabs Pycnogenol Capsules, 50 Mg, 60-Count Bottle, along with about 1.5 grams daily of L-Arginine per L-Arginine (500mg).  This is much less expensive than any of the PDE5 inhibitors and, again, there have been no reported side effects in any of the studies. [29]

Research has shown that pycnogenol also lowers bad cholesterol (LDL), raises good cholesterol (HDL), decreases inflammation and lowers blood pressure, which will very likely protect a guy from future erectile dysfunction as well. (High blood pressure and inflammation are both major risk factors for erectile dysfunction.) [4]

3) Korean Ginseng. Ginseng has been one of the big guns in erectile research and has a fairly established track record.  In facit, it has been used literally for centuries. It’s (generally) potent sexual powers come from its abilities to directly boost nitric oxide, a fact that has been verified in multiple animal and human studies. Furthermore, several studies have showed that it actually helps with erectile dysfunction.  And, as I document in my link on Ginseng and Erectile Strength, it improved the sex life of almost two thirds of men directly.  It is also a libido booster and in some cases may boost testosterone as well.  Some Ginseng brands are careless and have been found to be contaminated with lead and/or pesticides. Solgar, however, sells a Korean Ginseng that passed on all accounts in recent Consumer Labs testing: Solgar – Korean Ginseng Root Extract, 60 veggie caps. (It can thin the blood a little: discuss with your doctor.)

4) Maca. Maca is not actually a direct erectile supplement, but I mention it here, because it has many studies (animal and human) that show it is agood, old fashioned – and legitimate – aphrodisiac. It probably doesn’t directly improve erectile dysfunction or cure impotence, but is a good bedroom buddy nonetheless. Many guys struggle with passion and desire and this is where Maca excels.  It also has the advantage of being consumed as a food for decades in South America and thus has a strong safety record.  The “gold standard” brand is Navitas Organic “Gelatinized” Maca. Find out more detail in my Maca Link as well.

Research has shown that pycnogenol also lowers bad cholesterol (LDL), raises good cholesterol (HDL), decreases inflammation and lowers blood pressure, which will very likely protect a guy from future erectile dysfunction as well. (High blood pressure and inflammation are both major risk factors for erectile dysfunction.) [4]

5) Neo40. One of the new kids on the block is Neo-40, the creation of one of the top nitric oxide researchers in the world.  The approach of Neo40 [Daily 30 Lozenges] – Nitric Oxide Supplement is really fairly simple and is based on utilizing two different metabolic pathways via L-Citrulline and a Hawthorn Berry Extract for nitrate/nitrite production. You can read more about here in my Interview with Neo40 Founder Nathan Bryan.

Beetroot Extract has also done very well in the studies, particularly in the area of fighting cancer interestingly enough. The good news is that jt is dirt cheap and should boost nitric oxide a little as well for beleaguered middle-aged and senior men everywhere: Nature’s Way Beet Root Powder Capsules.

7) Icariin Extact. Icariin, the chief phytochemical in Horny Goat Weed, gives this herb its erectile superpowers.  Viagra and Cialis are PDE5 Inhibitors and Icariin is one as well.  It is significantly less powerful than Viagra and Cialis but the 10+% extracts give a significant dosage and generally with many less side effects.  Icariin also has antioxidant and other properties that seem to give it actual healing properties. Many men have had excellent results with products such as Source Naturals Horny Goat Weed Extract (Epimedium) 1000mg, which has 10% Icariin. For additional information, see this link on Icariin for more information.

8) CoQ10. CoQ10 has many excellent properties and has been extensively studied.  It is well-known for its mitochondrial protective powers and is used in alternative medicine for a variety of conditions, including gum disease.  But what few men know is that it helps the body preserve nitric oxide and, yes, that has been shown in several studies to increase blood flow. The benefit is mostly for those men 40 and older and especially those with endothelial dysfunction.

9) Fish Oil. Fish Oil is not directly an erectile supplement, but I mention it here becuase one European study found that it helped endothelial function and nitric oxide output (in diabetic patients) and that is just what the doctor ordered. [14] Yet another study found that fish oil increased the elasticity of arteries, i.e. their “expandability”. [26] Yes, we males want nice expandable blood vessels that allow blood to flow into the penis. Fish oil also protects against inflammation, a huge erection-fighter, and triglycerides, which will clog up penile arteries faster than you can say, “Pass the bacon.”  It may even optimize free testosterone while it’s at it!  For more information about fish and fish oil and how it benefits the heart and penis, please read The Many Benefits of Fish and Fish Oil here. CAUTION.: It’s very easy to buy rancid fish oil, which will do more harm than good, and fish can have mercury and PCB’s. Read my link on Fish and Fish Oil for how to consume your omega-3’s safely.

CAUTION: Gingko. Gingko, like Pycnogenol, strengthens the activity of Nitric Oxide Synthase (NOS), making it a viable erectile dysfunction supplement. [16] Furthermore, animal studies have shown that Gingko relaxes in a dose-dependent fashion arteries, including those all-important ones supplying blood to the penis.[17] Direct evidence that Gingko improves erectile dysfunction and impotence in a significant way is still lacking, but any herb that increases Nitric Oxide will help males struggling in this area. (This is an herb can be purchased inexpensively even in places like Wal Mart.)  NOTE:  Gingko Biloba is often tauted as improving erections in men with erectile dysfunction that had resulted from taking antidepressants.  However, the studies have actually shown mixed results in this area.  CAUTION:  Care should be exercised with this supplement as Gingko thins the blood and has several drug interactions including NSAIDs and anticoagulants.

Concentrace: Just What Is It? - Peak Testosterone

Many men have been asking me, “What is Concentrace?”  Concentrace Trace Mineral Drops is a product that I have used from time to time, because it a source of 1) ionized minerals for maximum absorption and 2) a broad array of minerals, including the trace ones that the body needs in minute amounts.

Our modern soils are so depleted of minerals of virtually all types that this certainly seems attractive, since there are many common issues that can interfere with mineral absorption, including low hydrochloric acid levels in the stomach, black tea, soy, etc., etc.  In other words, quite easy to still end up deficient even if you are conscioustious and eat a well-rounded, whole foods diet.

The problem that you’ll find with Concentrace Trace Minteral Drops is to out just exactly how much of what minerals is actually contained in the standard dosage prescribed on the bottle. However, in an obscure location of their site, I did find the Concentrace Analysis Summary, which has a complete list of mineral concentrations. [1] You can see some of this in Table I below at the bottom of this page.

So the bottom line is that their concentrations may have changed a little over time, but I still think we can draw some interesting conclusions, both positive and negative:

1.  Magnesium.  Concentrace is clearly a FANTASTIC choice of easily absorbed  magnesium.  Magnesium can help with sleep, which in turn can improve testosterone levels.  Magnesium can also help improve heart disease, which can help erections.  Magnesium is simply a ubiquitous molecule that is involved in 100’s of different metabolic pathways.

2.  Boron.  Getting about a mg of ionic Boron is excellent as well.  As I document in my link on Testosterone and Boron, you get about 1.5 mg/day of boron on average probably and the experts recommend up to about 3 mg/day.  So this amount should be a nice addition to your (hopefully) well-rounded, whole foods diet.

3.  All Other Minerals. What was surprising is the very low amounts of virtually all other standard minerals.  For example, the daily requirement for potassium is about 4,700 mg, but 40 drops will only provide about 5 mg.  Calcium and selenium are also less than a mg.  Thus, with the exception of magnesium and boron, Concentrace Trace Mineral Drops provides very low amounts, well below 1% of RDA or AI.

4. Exotic Minerals.  Concentrace does provide some of the more exotic minerals that the body does need in trace amounts.  Rubidium is a classic example.  There is no RDA or AI for rubidium, yet your body does use it in trace amounts for, among other things, the CNS (Central Nervous System).  Studies have shown that low rubidium levels can negatively lead to mood disorders and depression in dialysis patients, who are known to have depleted rubidium levels. [2]

However, even here, it seems hard to get excited, because Concentrace provides such a low dosage.  We eat between 1 mg and 5 mg per day of rubidium in our foods.  Even coffee and tea have a good supply.  The very minute amounts in 40 drops seem, quite frankly, to be almost negligible.

5. Heavy Metals. CAUTION:  And here is where I see the problem with the Trace Mineral formulation:  it has a number of heavy metals, including cadmium, arsenic lead, mercury and aluminum. Now, admittedly the amounts are very small.  But I do not think of all the dosages can be so easily dismissed. For example, the dosage of arsenic in Concentrace is about 2.07 parts per million, which is in the area of rice, something that many experts are concerned about.

So, yes, it is a great source of magnesium, but you could simply use ZMA as a well-absorbed alternative and get a nice dose of zinc as well.  I simply do not see the big advantage in using Concentrace daily and risk some of the heavy metal exposure.

TABLE 1:

REFERENCES:

1) “Concentrace Analysis Summary”, https://themineralfoundation.com/documents/ research/ConcenTrace%20Analysis%201.pdf

2) Kidney International, 2001, 60:1201 1201, “Depression in dialysis patients: Rubidium supplementation before other drugs and encouragement?

3) https://chriskresser.com/arsenic-in-rice-how-concerned-should-you-be/

Eyes: Your Key to De-Aging Your Appearance - Peak Testosterone

If you want to look younger, you’ve got to start with the eyes.  I have read that studies show that when people look to examine age, they look first in the eye area and I don’t doubt it.  Let’s face it:  the eyes are not just the window to your soul but to your biological age as well.

The eyes generally have three issues that make you look older.  The first is wrinkling from normal aging processes.  The skin around the eye ages from free radical damage, sun and AGE’s just like the rest of your skin.  The eyes, though, are particularly susceptible to another kind of wrinkling:  motion or movement lines.  Motion wrinkles occur from daily activities such as squinting and all the other expressions that you do throughout the day – it’s simple “wear and tear” on the skin.  Finally, many of us guys have those bags under the eyes.  These can have that purple, tired-out shade to them and can be large enough to actually stretch and sag the eye skin.

You put all of these together and you start looking older very quickly.  Fortunately, there are some excellent solutions out there, most of which can be done in the privacy of your own home or with considerable secrecy and stealth – always important to us guys.

Here’s a few of the big guns that can dramatically help your appearance in the are of your eyes:

1) Sleep. It’s no secret that lack of sleep can make you look tired and increase the bags under your eyes. Some scientists believe that the reason is that the extraocular eye muscles are literally exercised when you are in your REM sleep cycle stages throughout the night.  The less sleep, the less REM cycles and the more these bags build up. [1]

2) Haloxyl. Haloxyl is a combination of Matrixyl, a collagen builder, and Chrysin/Hesperin, which break down “leaking blood” in the eye area. Haloxyl has some clinical backing and works for some people (and others not).  It may be worth a try since it is relatively inexpensive and completely private.

3) Preparation H. You read that right:  to remove puffiness in the undereye area, you can always try this old standby.  Do not use more than 2 or maybe 3 times per week. Some people swear by it and others think it’s kind of anal.

4) Topical Vitamin K and Retinol. One study showed that “Topical application of the gel containing 2% phytonadione, 0.1% retinol, 0.1% vitamin C and 0.1% vitamin E was fairly or moderately effective in reducing dark under-eye circles, especially in cases of haemostasis, over a short treatment period in healthy Japanese adults. This treatment also slightly decreased wrinkles”. [2] Dark circles and wrinkles in one shot?  This is good news, plus Vitamin K creams are availble in many products including moisturizers.  One manufacturer combined all of these ingredients, except retinol, into one product NeoStrata Bionic Eye Cream,.  However, the retinol can be purchased in other products over the counter products.  NOTE: Retinol is converted to retinoic acid, i.e. Retin-A, and therefore is generally less irritating to the skin.

5) Retin-A (Tretonoin). Retin-A can help in the eye area as well.  However, you do have to be careful, because the skin in area of the eye socked is thinner with less fat than other places on your face. So if you irritate and inflame this area, you can cause more damage than harm.  Some people use a lower strength in the eye area (.05 or .025) and some people do every other day to play it safe.  REMEMBER: Retin-A will not help with “motion wrinkles”.

6) At Home LED Treatments.  LED light treatments have been done for several years now in doctor’s offices (a.k.a. Gentlewaves) and were approved by the FDA for the more delicate skin in the eye socket area.  The reason is that LED treatments are gentle and have “no pain, side effects or downtime”.  However, you can now buy the above system for over the counter home use and is sold as the OmniLux New-U.  The beauty of this is that no one ever needs to know.  These systems works through the application of infrared and red light to the skin which then stimulates collagen production.  This is beautiful, because the eyes are very difficult to treat effectively without injuring and inflaming the thin skin around the eye socket.  Yet it is critical if you want to shave years off your appearance as studies reveal that people look at the eyes to discern the age of someone they meet.  The eyes are the “window to the soul” and to your biological age as well. The general consensus is that LED treatments tend to work well to remove fine lines and wrinkes in the eye and some surrounding areas. There are a couple of studies showing its effectiveness. [2]

7) Botox. If you have motion wrinkles in the eye area – and it is very likely to one degree or another if you are middle aged or beyond – then Botox is king.  Read about Cosmetic Surgery for Males for the good, the bad and the ugly regarding Botox.

8) Hyaluronic Acid Fillers. In some cases fillers can be injected into the eye area to diminish the appearance of lower eye bags.  This, of course, must be repeated and thus is not “curative”.  However, it can work quite well.  Again, read about Cosmetic Surgery for Males for more details.

9) Blepharoplasty. A blepharoplasty can remove the excess skin from upper and lower eyelids and remove the bags from the lower lids and, if done well, take ten years off your appearance in a matter of a few hours. Of course, like so many things in life, the primary issues are time and money:  this surgery takes 7-10 days to recover and you may need a few days after that for the redness to completely disappear. The cost is in the thousands depending on what you have had done.  You may want to read this link which has many reviews of those who have undergone the procedure.

The bottom line is that there is no excuse not to look better – a lot better.

REFERENCES:

1) Men’s Health, Sep 2009, p. 134.

2) J of Cosmetic Dermatology, 3(2):73-75, Published Online: 19 Nov 2004, “The effects of topical application of phytonadione, retinol and vitamins C and E on infraorbital dark circles and wrinkles of the lower eyelids”

Vitamin D Can Boost Nitric Oxide - Peak Testosterone

Vitamin D is really a hormone, has its own independent receptors and affects dozens of systems and tissues. Furthermore, deficiencies in Vitamin D are extremely common and can result in lowered testosterone levels. Correcting a deficiency can raise your testosterone by about 30% and make you feel a lot better with increased alertness and energy. (For the studies, see my link on Testosterone and Vitamin D.) One not-so-well-known property of Vitamin D is its ability to boost nitric oxide and endothelial function in some men. Below we’ll quickly summarize some of the research showing this and just how Vitamin D works its magic.

1)   The Journal of Physiology, Oct 1 2011, 589:4777-4786, “Vitamin D insufficiency is associated with impaired vascular endothelial and smooth muscle function and hypertension in young rats”

2) Mol Endocrinol, 2014 Jan, 28(1):53-64, “Vitamin d is a regulator of endothelial nitric oxide synthase and arterial stiffness in mice”

3) Circulation, 1997, 96:1755-1760, “Active Serum Vitamin D Levels Are Inversely Correlated With Coronary Calcification”

4) Nature Reviews Cardiology, Oct 2009, 6:621-630, “Vitamin D status and arterial hypertension: a systematic review”

5) The Journal of Steroid Biochemistry and Molecular Biology, May 2004, 89-90:387 392, “Vitamin D: a negative endocrine regulator of the renin angiotensin system and blood pressure”

Researchers began noticing that men (and women) with Vitamin D deficiencies had a host of symptoms that appeared to be related to decreased nitric oxide output: “hypertension, left ventricular hypertrophy, increased arterial stiffness, and endothelial dysfunction in normal subjects and in patients with chronic kidney disease and type 2 diabetes.” [2]  This was verified by a fairly recent animal study showing that Vitamin D deficient rats in the womb and early life were much more likely to develop hypertension and had a decreased ability to create nitric oxide. [1] A 2014 study on mice showed that mice that have a genetic defect that causes them to produce insufficient Vitamin D have a reduced expression of eNOS. [2] This is the enzyme that Viagra and Cialis affect and this explains why the animals have decreased nitric oxide and increased arterial stiffness.

Of course, us guys like nitric oxide due to its artery-expanding and erection-improving abilities.  The goal is that as the arteries – penile or otherwise – expand, blood pressure is lowered and blood flow is increased.  Vitamin D can actually positively influence both blood flow and blood pressure throught a completely different system:  the kidneys.  Vitamin D also includes “renoprotective effects and suppression of the renin angiotensin aldosterone system.” [4] Animal studies back this up showing that lack of Vitamin D results in “elevated production of renin and angiotensin (Ang) II, leading to hypertension.” [5]

Depression: Natural Cures - Peak Testosterone

Depression is very hard to watch or live through if you have experienced it yourself. People who are depressed are just trying to survive and to function.   The tragedy is that while a depressed person is stuggling just with daily life, they are unknowingly self-destructing physiologically.  Depression is extremely hard on the body and mind, arguably as hard as being overweight or smoking.

We’ve already covered how Depression Can Lead to Erectile Dysfunction and I’ve even discussed how depression lowers testosterone. The problem is that depression raises cortisol and cortisol lowers this critical hormone.  Of course, lowered testosterone is bad for the male brain in general in and of itself, but you should all realize that elevated, long term cortisol actually shrinks the brain.

It’s true:  individuals with long term depression actually have a shrunken hipposcampus, the seat of memory for us human beings. I am bringing this up, because depression is very, very serious stuff – I’ve been there by the way – and should be treated with the highest priority.

CAUTION: Antidepressants are known for having erectile dysfunction as a side effect.  Even worse is the fact that evidence is mounting that they are little better than a placebo at curing depression.  Edronax was recently found in the British Medical Journal to be ineffective (and studies doctored). [16]  A recent, more extensive meta-analysis of twelve different antidepressants found the same thing:  drug companies were not submitting unfavorable study results leading to a misleading bias. [17] However, do not quit an SSRI or antidepressant without discussing it with your doctor first.

Below I’ve written some of the ways that science has shown that depression can be treated and helped.  If you (or someone you love) has mild to moderate depression, these may actually lead to a complete cure.  (Please see your doctor as well , of course, as depression is a serious medical condition.)  I am certainly not saying that one just make a few lifestyle changes, snap your fingers and get over major clinical depression. No, we humans are very complex creatures and some of us have had a nasty past.

However, I do want to help and believe that science has shown that the items below will help almost anyone with depression regardless of severity.  Some of you will be shocked at the results that can be achieved.  It is important to start right away, because depression is a viscious circle:  the lowered testosterone and erectile dysfunction often lead to more depression which then leads to increased stress and cortisol and so on.

NOTE: Depression can have very deep roots.  Childhood sexual abuse, for example, leads often to adult-onset depression particularly in females, but also in males as well.  See my page on Dysregulation of the HPA Axis for more examples.

Here is what the research has shown:

1. Weight Loss. Researchers just recently found that weight loss can significantly improve depression. [1]  A weight reduction of just 8% resulted in a significant loss of depressive symptoms.  In a 200 lb male that’s just 16 pounds.

2. Exercise. Numerous studies have shown that moderate exercise can very significantly help with depression. The results have often been just a little short of miraculous and every person with depression should consider exercise in their arsenal.  [2]  Furthermore, one study on females showed an improved hormonal – cortisol and norepinephrine – response thus demonstrating that exercise combats the most degenerative aspect of depression. [3]

3.5 Magnesium Therapy. Know anyone with severe, untreatable depression?

3. Folic Acid and Vitamin B12. Folic acid (or folate) helps builds a molecule called SAM that is imperative for neurological function.  Low folate levels are quite common and can be a major contributor to depression. One study concluded, “There is now substantial evidence of a common decrease in serum/red blood cell folate, serum vitamin B12 and an increase in plasma homocysteine in depression…On the basis of current data, we suggest that oral doses of both folic acid (800 g daily) and vitamin B12 (1 mg daily) should be tried to improve treatment outcome in depression”. [4] Furthermore, severe depression has even been linked to low folate levels based upon a study of Finnish middle-aged men. [13]

CAUTION: You must be careful not to take too much folate as folate is also used in DNA replication and repair, which is why it is so critical for pregnant mothers.  However, it also looks like too much folate stimulates cancer in some case for this same reason and it has been implicated in various GI cancers.  The problem is that we are supplementing many of our (more trashy) cereals and breads leading to, for some individuals that eat that kind of food, over-supplementation of folic acid. You can also take too much Vitamin B12 as well to where it actuallyis destructive to neurological function.

4. Fish Oil. The studies have been somewhat mixed, but study after study in the last few years has show quite consistently that fish oil improves mood and often helps with depression as well. For example, one study of heart patients found significantly more patients with depression when comparing those with the lowest levels of omega-3’s versus those with the highest. [5]  Furthermore, children with major depression showed significant improvement when put on fish oil compared with the control group. [6]  And a 2009 study of menopausal women found the same thing. [7]  Please read these pages about How Fish Oil Helps the Heart, How Fish Oil Helps Testosterone and How to Buy Fish Oil.

5. Food and Seratonin.  I also recommend that you read this link on How to Boost Seratonin and Other Neurotranmitters Through Food for additional help.  Depression is often linked to seratonin receptors and many of the modern medications target this neurotransmitter.

6. Sunlight. Scientists have recently found that sunlight has a significant impact on cognition, especially in depressed individuals. [8] The lead researcher, Shia Kent, pointed that light has actually been shown to affect not only melatonin but brain blood flow.  Bottom line:  open the drapes and go for a walk if you live in a non-sunny climate for the sake of your brain. Of course, sun exposure is also a major source of Skin Damage, so indirect exposure is best.

7. Moderate Drinking. This may be counterintuitive for some, but moderate drinking, one to two drinks per day, is associated with decreased rates of depression according to a recent study. [9] This backs up previous work that showed that ending moderate drinking was tied to increased depression rates as well. In other words, moderate drinking may be depression protective and possibly curative as well. [10] Read my link on Alcohol for more information. CAUTION: It may be unadvisable for someone who is depressed to begin drinking and, of course, if you have any history of alcohol issues, this will only make matters worse.  Heavy drinking is associated with increased depression and even shinkage of the brain.

8. Concussions. A surprising number of guys have had several concussions in sports such as football, soccer, biking accidents and so on. The evidence is coming out almost monthly on the damage that this does to the brain.  Concussions are very common:  a NeuroSurgery Today article estimates that between 4 and 20% of football players will end up with a concussion during the course of a season for a total of 300,000 per year in American alone! Concussions, especially repeated ones, create multiple kinds of damage including “neurofibrillary tangles” that are found in NFL players who have problems with depression, erratic behavior, suicide and quasi-dementia. If you’ve suffered a lot of sport-related head injuries, depression can surface in later years as a major issue.  A recent American College of Sports Medicine study found that 20% of retired NFL players who had had three or more concussions were experiencing depression.

9. Processed Foods. Processed foods have just been linked to depression. [11] This is not surprising since they are full of excitotoxins, transfats, high glycemic foods and who-knows-what-chemicals and low in vitamins, antioxidants and minerals.  Your brain, more than any other organ in the body, needs an abundant supply of vitamins and minerals as well as protection from free radical damage and poor blood flow.  You will only get the opposite effect from processed foods.

10) Low Fat Diet.  A Low Fat (Ornish) Diet has been found to boost mood in multiple studies.  For more information, read this link on How to Control Appetite and Boost Mood through Diet.

11) Saffron. An extract of saffron, the expensive yellow spice valued from antiquity, has been found to be an antidepressant as powerful as Prozac. [12]

12) Potatoes.  No one has shown that potatoes are a cure for depression, but they may well help. Studies show that they actually stimulate seratonin production. [14]

13) Vitamin D. Vitamin D deficiency was recently found to increase the risk of depression by 85%. [15] This is no wonder since Vitamin D is ties into feelings of energy and alertness.

14) Light Therapy. Researchers have noted that light therapy helped with depressed patients and a recent study verified the same. [18]  If you’re depressed, light and lots of it, is your friend.

15) Low Testosterone. Testosterone profoundly affects the male brain and the lack of it can lead to mood issues and depression. One research summary points out that men with testosterone below about 290 ng/dl (10 nmol/l) are at increased risk for depression.[19]

15) Progressive Muscle Relaxation. A number of studies have shown this simple relaxation technique can help with depression.  For more information, see this link on Progressive Muscle Relaxation (#4).

16) Mindfulness Based Cognitive Therapy (MBCT). Mindfulness Meditation is incredibly powerful and, when combined with a form of cognitive therapy, results in a clinically effective strategy called Mindfulness Based Cognitive Therapy.  And it has built up an excellent research track record with depression.  One meta-analysis concluded that it prevented relapse into major depression at a rate of between 34-43%. Statistically, this are very good results for something as serious and difficult to treat as major depression. [20] The authors also noted that “in two studies, MBCT was at least as effective as maintenance antidepressant medication.”

REFERENCES:

1) Society for the Study of Ingestive Behavior, July 29 2009, Faulconbridge, Weight Loss Improves Mood In Depressed People, Annual Meeting of the Society for the Study of Ingestive Behavior (SSIB), July 28 – August 1, 2009.

2) J of Affective Disorders, 93(1):79-85, “Physical activity, exercise coping, and depression in a 10-year cohort study of depressed patients”

3) The Eur J of Pub Health, 2006, 16(2):179-184, “Effects of physical exercise on depression, neuroendocrine stress hormones and physiological fitness in adolescent females with depressive symptoms”

4) Journal of Psychopharmacology, (2005), 19(1):59-65, “Treatment of depression: time to consider folic acid and vitamin B12”

5) Journal of Psychotherapy and Psychosomatics, news release, June 2009

6) Am J Psychiatry, June 2006 , 163:1098-1100, “Omega-3 Treatment of Childhood Depression: A Controlled, Double-Blind Pilot Study”

7) Universit Laval, Feb 1 2009, “Omega-3 Fatty Acids Ease Depressive Symptoms”

8) Environmental Health, 2009, 8:34 (28 July 2009), “Effect of sunlight exposure on cognitive function among depressed and non-depressed participants: a REGARDS cross-sectional study”, Shia T Kent, et. al., Environmental Health (in press)

9) Addiction, Aug 3 2009, 104(9):1519-1529, “Anxiety and depression among abstainers and low-level alcohol consumers. The Nord-Tr ndelag Health Study”

10) https://www.sciencedaily.com/releases/2008/07/080708104521.htm

11) The Brit J of Psychiatry, 2009, 195: 408-413, “Dietary pattern and depressive symptoms in middle age”

12) Journal of Ethnopharmacology, Feb 2005, 97(2):281-284, “Hydro-alcoholic extract of Crocus sativus L. versus fluoxetine in the treatment of mild to moderate depression: a double-blind, randomized pilot trial”

13) Psychother Psychosom, 2004 Nov-Dec, 73(6):334-9, “Dietary folate and the risk of depression in Finnish middle-aged men. A prospective follow-up study”

14) YourHealth, Mar 2009, p. 29.

15) International Archives of Medicine, Nov 11 2010, 3:29, “Serum vitamin D concentrations are related to depression in young adult US population: the Third National Health and Nutrition Examination Survey

16) https://www.telegraph.co.uk/health/8051470/Antidepressant-ineffective-and-potentially-harmful.html

17) https://health.msn.com/health-topics/depression/articlepage?cp-documentid=100203204

18) Archives of General Psychiatry, 68(1), January 2011, “Bright Light Treatment in Elderly Patients With Nonseasonal Major Depressive Disorder”

19) Asian Journal of Andrology, 2010, 12:136 151, “Androgens and male aging: current evidence of safety and efficacy”

20) Clinical Psychology Review, Aug 2011, 31(6):1032 1040, “The effect of mindfulness-based cognitive therapy for prevention of relapse in recurrent major depressive disorder: A systematic review and meta-analysis”

Wheat Belly Review: How Modern Wheat Can Kill.

I’m sorry to be sensational, but I can’t help myself:  Wheat Belly by William Davis is one of those books that can save your life – this book is that importat. The first 40 pages of this book, in particular, are just packed with mind-bending information that can literally save your life. I had already become cautious about eating wheat and reading this book confirmed my suspicions.  In fact, because of reading this book, I rarely eat wheat now.

One of the things that made me very cautious about wheat was the fact that I have eaten it in significant quantities before sleeping on several occasions and woken up in the middle of the night feeling horrible, almost as if I have a cold or the beginnings of a flu.  Of course, it may be coincidence or some other factor, but it got me to investigating.

Regardless, it should strke you as a bit odd that I would be warning you about wheat:  aren’t a grain-lovin’, plant-based health fanatic?  Yes, indeed – but I know rely on other grains and only eat wheat during certain social situations. That may sound a little fanatical to some, but let’s go into some of the reasons that Dr. Davis outlines so well in his book:

However, Dr. Davis says that the reactions to wheat go way beyond these known issues.  At the time the book was written, he was a working cardiologist in Milwaukee and he says his patients were cured of all sorts of diseases and conditions by going off of wheat. He mentioned near-miraculous cures of Irritable Bowel Syndrome, asthma, rheumatoid arthritis – all immune-related diseases.

And besides noticing the profound effect of going off of wheat, he makes some convincing genetic arguments that it is actually the genetic modifications that have turned wheat into a Frankengrain.

DISCLAIMER: From what I can tell, Dr. Davis is a Paleo Diet advocate.  As you may know, I am not a big fan of Paleo Diets, because it is so easy for men to get themselves into trouble by eating meat.  It is possible to eat meat successfully, but not easy and I’ve summarized my concerns in this link on The Risks of Eating Meat.

2.  Weight Loss. Another interesting insight given in this book is that Davis has found that many people can lose weight dramatically simply by cutting wheat out of their diet.  The reasons are many, but one is that it is ubiquitiously in foods, many of them “bad” and high calorie foods and so eliminating wheat gets rid of a big source of calories for many people.  It creates an easy-to-follow dietary program for most people.

However, the other reason is that wheat is a high-glycemic food and can lead to insulin and glucose spikes/crasheds and visceral fat gain as well. So dropping wheat can melt of that “beer belly” that has been plaguing you as well according to Davis.

3.  Blood Sugar Levels and Diabetes. Wheat is a grain with a very disturbing property, and one that concerned Davis to a great deal as a cardiologist:  it has a Glycemic Index (GI) higher than table sugar!  That’s right – both whole and regular wheat breads will actually elevate your blood glucose significantly higher than good ol’ sucrose. Now this is no secret, but what Davis does a nice job of explaining is why:  adiponectin.

It runs out that wheat is very high in amylopectin-A, which is rapidly converted by the digestive enzyme amylase, into glucose.  Table sugar is half fructose, which slows down post-meal blood sugar rises to a certain degree.  But the main point here is that eating wheat means you are likely going to get a tissue-damaging boost in glucose – yes, glucose is the sugar they give you in a lab to spike your blood sugar – and this is undoubtedly contributing to the epidemic of prediabetes, Metabolic Syndrome and Diabetes that we see in our society today.

NOTE: Although fructose doesn’t spike blood glucose significantly, that’s where the good news ends.  Fructose has it’s own risks, which you can read about in my links on The Dangers of Fructose.

Of course,  has been out for awhile and is available on Amazon:  Wheat Belly: Lose the Weight.  So why do I want to highlight this book?  Well, many men turn to Erection Friendly Grains, when they start trying to get their health back and that is a good thing.  However, wheat has morphed in recent history into a frankenfood that now has very questionable health values.  There are many other excellent grains with much better health properties – Quinoa, millet, oats, etc. – that should be considered first in my opinion.

And this isn’t easy for me to say: I ate wheat literally at every meal growing up.  However, I have found that it’s quite easy to give up and don’t regret it one bit.  Anyway, hats off to Dr. Davis for writing a great review of a food that, until recently, everyone assumed was a near superfood and excellent addition to a health diet.

1.  GMO-based Wheat Reactions. As you hopefully know from poking around my site, there are three grains that have been heavily genetically engineered in the last half century:  soy, corn and, yes, wheat. These have received heavy attention for both altruistic reasons – feeding a growing planet ad solving world hunger – and not so altruistic, i.e. profit.

Davis explains that it was the Rockefeller Foundation that established an agricultural center east of Mexico City a little after World War II to study ways to modify wheat in order to increases its yield and increase its durability.  Unfortunately, they have been incredibly successful and have made literally hundreds of changes to the wheat genome. Furthermore, they have come up with literally thousands of variations of wheat that are sold around the globe.

Some of you may be saying, “So what?”  Well, to that I can only say that you must read this book:  Davis builds a convincing case that all these modifications are responsible for many of the nasty immune responses that men are getting from consuming modern wheat. It is no secret that many people have “wheat intolerance”, “gluten intolerance” and celiac disease.

Brain and Exercise - Peak Testosterone

Researchers have been stunned to find the remarkable linkage between exercise and your brain. The brain is incredibly dependent upon exercise, but it actually goes far beyond simple dependence: exercise can help you both maintain and even rebuild your brain. We all need improved memory, retention and learning and exercise is king when it comes to natural solutions.

Aerobic exercise raises levels of a brain chemical called BDNF, which can actually promote the formation of new synapses. [1] As you may recall, synapses are the connections between neurons and so the more synapses, the more interconnectedness that your brain has. This interconnectedness is one of the major factors that makes our brain the incredible computing and processing machine that it is.

However, it doesn’t just stop there.  Exercise can actually cause the rebirth of new neurons in the hippocampus, which is the seat of short term memory. One study on mice showed that aged mice could still experience 50% of the neurogenesis (in the hippocampus) of younger mice!  [14] This is astonishing for all you middle aged and beyond guys out there: if you stop and think about it, your brain is anything but dead if you will but exercise.

One question researchers asked themselves was if these new neurons that resulted from exercise were actually able to grow into fully functional, mature, usable neurons.  Again, the research has extended a very encouraging affirmation and one study of mice showed that adult neurogenesis does in fact lead to functional neurons that can be used by the brain. [13]

This is born out by many studies on humans which show the tremendous benefits of exercise to the brain.  One of the most amazing occurred on 59 individuals aged 60 to 79. These individuals did brisk walking (NOT relaxed, lazy-paced walking) only three times a week and after six months actually significantly increased the grey and white matter content of their brains. [2]  This is an incredible discovery: you can literally, through intense exercise, re-grow your precious grey matter!

How could such an incredible transformation occur?  Exercise does its magic through many different pathways.  First of all, it creates what I would call a super-neurotransmitter cocktail.  There is strong evidence that it increases dopamine [15], seratonin [16] and acetylcholine [17], all of which are known to improve learning and/or memory.  Researchers from the University of Illinois believe that exercise works its wonder through these mechanisms by “1) increasing capillary growth around neurons, 2) increasing synaptic density and 3) promoting positive cholinergic effects”. [10]  In other words, exercise feeds neurons, increases the cross linking between neurons and boosts the brain’s key neurotransmitter.  If you’ve looking for a Cognitive Fountain of Youth, you’ve just found it!

Exercise also boosts what some researchers an all-critical brain chemical named BDNF, which has been shown to “stimulate neurogenesis, increase resistance to brain insult and improve learning and mental performance”. [18] Researchers have also found that exercise significantly increases blood flow in the brain, thus bathing it in critical nutrients, and blood flow is correlated to neurogenesis. [22]  You don’t need Gingko to increase blood flow – you just need to get your butt moving!

Exercise improves so many abilities in the brain that it’s difficult to even keep up with all the research.  For example, one researcher found that it greatly increases something called “P3 latency”, which is kind of like your attention speed.  Normally, this declines with age but one study showed that exercise actually decreased the P3 latency levels of older adults to better than that of young, sedentary individuals! [19]  All you seniors out there should also take note of a meta-analysis that showed that exercise conclusively improved cognition, i.e. thinking and learning in your age group. [21]

Exercise is also known for boosting working memory, especially after aerobic exercise. [20] And on a Creative Note, exercise also increases creativity. It has long been known that exercise lifts mood and mood enhances creativity.  However, one study in the British Journal of Sports Medicine [12] showed that exercise enhances creativity independently of mood.  Exercise is also known for improving concentration, recall, productivity, test/exam speed – the list goes on and on.

Finally, exercise is also one of the few proven natural ways to prevent  Alzheimer’s and dementia. [11] One study from the Canadian Study of Health and Aging, for example, found that “Compared with no exercise, physical activity was associated with lower risks of cognitive impairment, Alzheimer disease, and dementia of any type. Significant trends for increased protection with greater physical activity were observed. High levels of physical activity were associated with reduced risks of cognitive impairment, Alzheimer disease, dementia of any type“. [3] And this appears, by the way, to occur not just because of exercise’s neuron-building and neuron-promoting properties.  A study at the University of Chicago showed mice that exercised had 80% less Alzheimer’s plaque than mice that did not exercise.

REFERENCES:

1) Newsweek, 2/10/07, p.68-72]

2) The Jour of Gerontology 6) Cardiovasc Res,Apr 2002,54(1):25-35

3) Arch Neurol,2001,58:498-504

4)  Saving Your Brain, Jeff Victoroff, p. 135

5) Rev Endocr Metab Disord,Dec 2006,7(4):225-35

6) Cardiovasc Res,Apr 2002,54(1):25-35

7) PNAS, 2009, 106:1255 126, “Correction for Caloric restriction improves memory in elderly humans”, appeared in issue 4, January 27, 2009 of Proc Natl Acad Sci USA and first published January 26, 2009

9) Achieving Optimal Memory, Aaron Nelson, Ph. D, p.48, McGraw-Hill, 2005

10) Achieving Optimal Memory, Aaron Nelson, Ph. D, p.152, McGraw-Hill, 2005

11) Ann Intern Med,2006,(144):73 81; Am J Epidemiol,2005,161:639 651; Arch Int Med,2001,161:1703 1708; J Am Med Assoc,2004,(292):1454 1461

12) British Journal of Sports Medicine, 1997, 31:240-245, “Exercise enhances creativity independently of mood”

13) The Journal of Comparitive Neurology, 2001, 435:406-417, “Adult Neurogenesis Produces a Large Pool of New Granule Cells in the Dentate Gyrus”

14)  The Journal of Neuroscience, Sep 21 2005, 25(38):8680-8685; “Exercise Enhances Learning and Hippocampal Neurogenesis in Aged Mice”

15) Exp Neurol, 2003 Nov;184(1):31-9, “Can the brain be protected through exercise? Lessons from an animal model of parkinsonism”

16) Acta Physiol Scand, 1989 Jul, 136(3):473-81, “Effect of sustained exercise on plasma amino acid concentrations and on 5-hydroxytryptamine metabolism in six different brain regions in the rat”

17) Behav Brain Res, 1991, 46:123 133, “Enhancement of spatial learning in F344 rats by physical activity and related learning-associated alterations in hippocampal and cortical cholinergic functioning”

18) Trends Neurosci, 2002 Jun, 25(6):295-301, “Exercise: a behavioral intervention to enhance brain health and plasticity”

19) Psychophysiology, 2002, 39:3:303-312, “The relationship of age and cardiovascular fitness to cognitive and motor processes”

20) Med Sci Sports Exerc, 2009 Apr, 41(4):927-34 “The effect of acute aerobic and resistance exercise on working memory”

21) J Appl Physiol. 2006 Oct, 101(4):1237-42, Epub 2006 Jun 15, “Exercise, cognition, and the aging brain”

22) PNAS, Mar 27 2007, 104(13):5638-5643, “An in vivo correlate of exercise-induced neurogenesis in the adult dentate gyrus”

Turmeric: Heart & Erection Healer and Protector .

I recently had a high PSA scare and started taking turmeric (curcumin) and several other anti-inflammatories.  You can read about it if you are in a similar situation in my page on My Elevated PSA with No Cancer. During this time I had to go off HRT which dropped my testosterone from a peak of about 1200 ng/dl to 111 ng/dl in less than a month. What I noticed, though, was that there was little effect on my erectile strength.  Of course, that made me wonder if the turmeric was somehow protective.

This would be surprising, though, because turmeric is not really known for stimulating nitric oxide or dropping blood pressure significantly.  (There is one study on hypertensive rats that shows it can drop blood pressure in that case. [9]) However, after doing a little research, I found something interesting:  turmeric has research strongly suggesting that it improves almost every major cardiovascular risk factor.  And, of course, anything that improves your arteries is very likely going to improve your erections.

Here are Ten Ways That Turermicc (Curcumin) Extracts Can Improve Erectile Dysfunction:

1.  Raises HDL. Turmeric (curcumin) increased HDL by 29% in one human study using 500 mg/day. [1] This is a substantial increase and would take you months or years of cardiovascular training to achieve.  Of course, you should still do the cardio, but my point is that this seems to have incredible powers in this area.

2. Increase Plasma Nitric Oxide. One study found that plasma nitric oxide was increased in “in healthy middle aged people (40-60 years old) with a low dose of curcumin (80 mg/day) in a lipidated form expected to have good absorption.” [10]

3. Lowers Cholesterol.  The same study that showed an increase in HDL also showed a drop in cholesterol of about 12%. [1] Remember: both small and large particle LDL particales can contribute to arterial plaque and so any non-statin lowering of LDL numbers is likely to help you.  (Statins decrease CoQ10 and increase arachidonic acid.)

1) Indian Journal of Physiology and Pharmacology, 1992, 36(4):273-275, “Effect of oral curcumin administration on serum peroxides and cholesterol levels in human volunteers”

4. Antioxidant Strength. One of the processes that contributes to arteriosclerosis is the oxidation of LDL and turmeric, at least in an animal study, reduced this destructive process. [2]

CAUTION:  I’m not sure how much of an effect this is, but there is study out there that shows that turmeric extract can lower ferritin.  Low ferritin men may want to do some research and discuss with their physician.

5. Fibrinogen. One of the less known but most deadly cardiovascular risk factors is fibrinogen.  This blood chemical increases the risk of clotting, which is, of course, a key step in both stroke and heart attacks.  One study showed that even small amounts of turmeric dropped fibrinogen levels “like a rock” in partipants with elevated fibrinogen. [3]

6. Arteriosclerosis Prevention . The researchers who conducted the study for #3 did an additional study and found that both HDL and LDL oxidation were again signicantly lowered in those with high levels. [4] Their conclusions?  “This preliminary experiment suggests that the Curcuma phenolic antioxidants, because of their high antioxidant activity and lack of toxicity, might be a useful complement to standard hypo-lipidemic drugs in the prevention and treatment of atherosclerosis.”  Of course, no one listens on this side of the ocean, because it’s not an expensive pharmaceutical solution!

8. Arterial Protection Against Nitric Oxide Deficiency. How many of us middle-aged guys that have eaten a Western Diet all of our lives have nitric oxide deficiency?  Well, I do know that Dr. Nathan Bryan said most of us have less than half of our nitric oxide by age 50.  I don’t know the exact definition of NO deficiency, but the lion’s share of us are very low and one animal study showed that turmeric protects against the oxidation, hypertension and loss of elasticity that occurs when nitric oxide drops significantly. [6]

9. Arterial Protection Against Homocysteine. Homocysteine is yet another risk factor for the cardiovascular systems that has received a lot of air time lately.  And, yes, turmeric protects against its effects as well. [8]

10. Lowers Triglycerides. The same study that showed that turmeric could increase plasma nitric oxide also found that it lowered triglyceride levels as well. [10]

So what is the pattern?  If you’ll notice, turmeric is, in my opinion, the perfect compliment to many of the nitric oxide-boosting supplements that you are already probably consuming.  Let me explain why:

Many of the research-backed supplements  – Korean Ginseng, Pycnogenol, Citrulline, Icariin, etc – increase nitric oxide directly (or indirectly through action on eNOS) – but do not actually protect your arteries or cardiovascular system from damage.  Turmeric helps those arteries stay supple and softened and un-hardened. Stiff arteries cannot expand and allow increased blood flow and that includes the ones in your penis.  This is where turmeric comes in:  it helps keep your arteries youthful, at least according to all the above research.

Of course, you cannot eat horrendously, sleep little, smoke, be sedentary and expect turmeric to magically protect you.  But, for those making the effort, turmeric is a nice insurance policy.

There is also evidence that turmeric will keep you alive and “in the game” in a hundred other ways:  it protects, prevents and sometimes even helps with arthritis, IBS, prostate cancer, (some forms of) prostatitis, Alzheimer’s, enlargement of the heart, diabetic neuropathy – the list just goes on and on.  Basically, every guy knows that offense brings in the crowds, but you win games with a good defense, eh?

CAUTION: Of course, multigrams of turmeric are eaten regularly – daily in many cases – in Asian cultures all over the world and side effects are quite rare. This gives turmeric one of the most safe and undisputed anti-inflammatory records of all the superfoods. That said, it can increase oxalates according to one study and thus could potentially increase the risk of a kidney stone in sensitive individuals. It also does effect one of the liver enzyme systems somewhat and so it is a good idea to check with your doctor if you are on any medications.

REFERENCES:

e/ Viagra Resistance - Peak Testosterone

Just how big of a problem is this?  Well, no large studies have been done to date, but one smaller study showed clearly this is a serious issue.  Researchers looked at men with erectile problems that had taken Viagra successfully and continued use over an extended period of time. Of these men, fully 37% had to increase their dosage by 50 mg!  In a second cohort 50% of the Viagra users discontinued due to the decreased effectiveness of the drug. [2]

CAUTION:  Do not quit any medication without consulting your doctor.  Viagra and Cialis can lower blood pressure slig

This also creates a path to dependency as well. Imagine this all-too-common scenario:  you start on Viagra or Cialis and notice some slight side effects, maybe mild ringing in the ears, visual issues or stomach upset.  You are so happy to get your erections back that you ignore any negative aspects.  However, as the months roll on, the nagging doubts increase:  “What is this ringing in my ears doing to my hearing long term?”  Or maybe the stomach upset  or headache just gets worse over time to the pont where “the cure is worse than the disease.”

What is the solution?  Again, consult with your doctor, but read my link on Eliminating Cialis and Viagra Dependency for practical suggestions to discuss with him or her.

REFERENCES:

1) Curr Vasc Pharmacol, 2006 Apr, 4(2):89-93, “The management of phosphodiesterase-5 (PDE5) inhibitor failure”

2) The Journal of Urology, Sep 2001, 166(3):927-931, “LONG-TERM EFFICACY OF SILDENAFIL AND TACHYPHYLAXIS EFFECT”

Natural Cure For Grey Hair (At Least For Me) - Peak Testosterone

Okay, it’s time to admit something:  I hated having completely white hair.  I felt it made me look at least five years older than I really was (at age 56), and so it was time to fight back tooth and nail against Mother Nature.  So, from the privacy of my own home, I tried a natural cure for white hair.  I chose a cure that was low risk – essentially it was like putting salad dressing in your hair once a day or so – and low cost.  What did I have to lose, eh?

Well, to my utter astonishment, it worked!  My wife was stunned as well and has been telling her friends and the women where she gets her hair done about it.  And the best news of all:  it took a good five years off of my appearance.  My hair now is 2/3rd dark – not black but much darker – and about 1/3rd white. Again, before I was TOTALLY white.

My wife said the color looked very natural, ie no weird colors.  We’ve all seen men in their senior years color their hair in desperation, and usually it looks freaky and unnatural. (God bless them for trying of course.) This cure, however, basically regressed me back to when I first started getting some grey hair. A part of me wishes this would give me my blond hair back from college, but let’s face it:  that would be downright scary anyway!  In my opinion this probably gives me about the best possible look that I can achieve at my age.

Anyway, this is not my invention – I would have never guessed it would work in a thousand years actually – but came off the web and, if you poke around, you’ll see it is quite popular online  Literally dozens of sites cover it, but it hasn’t (as you might expect) made over to the men’s world yet.  So, for those of you willing to do a little work to knock out some of that grey hair, here is the Natural Recipe to (Hopefully) Eliminate Your Grey Hair:

Subsequent to writing this article, I experimented a little to see how I could increase the effectiveness of the above formula and here are a few of my impressions.  No, this is not scientific – just eyeballing it along with the opinion of my wife:

a) Don’t Overcook the Sage. One day I made a batch where I boiled the sage for about 30 minutes and then let it sit for about 12 hours.  This actually seemed to do very little color changing on my hair.  I did not have any apple cider vinegar in the batch, but I doubt that was the reason.

b) Add Some Rosemary. The most effective batch that I was one where I added romemary using my original procedure above.  This wasn’t my idea by the way:  you’ll see it posted it out on the web as something to add to the sage.  (As an aside, I add rosemary to my food several times a day as it may be one of the longevity secrets of the Acciaroli people of Italy.)

c) Why The Apple Cider Vinegar. This makes application onto your hair much faster, so it does actually serve a useful purpose besides making you smell like you salad dressing.

Good luck!

Q. How does this work?

A. I have no friggin idea.

Q. Can you just use sage powder in a spice bottle?

A. I have no friggin idea, but let me know on the forum if it worked for you.

Q. Is it the sage or the apple cider vinegar that is most effective?

A. I have no friggin idea, but I am pretty sure it is the sage.

Q. Then why do we even use the apple cider vinegar?

A. As mentioned above, I think the apple cider vinegar just makes application easier.

CAUTION: Please try this on a small section of your head first. I only know what this did to me and can’t say what it will do to you.

Grey Hair Formula UpdatesFrequently Asked Questions

Brain Supplements - Peak Testosterone

With a few notable exceptions such as Vitamin D and Magnesium, supplements have done poorly in studies on heart disease, cancer and other conditions. The medical profession is justified in its lack of enthusiasm as the miraculous claims and expectations have, for the most most part, turned out to be nothing but hype. There is, however, a notable exception: the brain. The brain is the most complex machine – nothing theological meant by that – in the universe and is a huge energy and biochemical hog. It requires huge inflows of vitamins, nutrients and benefits greatly from antioxidants and other phytoprotective foods.

Study after study have showed that your brain is at risk if you are low on many key nutrients.  Here are some examples:

REFERENCES:

1) https://news.bbc.co.uk/2/hi/health/8058183.stm

2) Journal of Neurology, Neurosurgery, and Psychiatry, 2009;80:722-729, “Association between 25-hydroxyvitamin D levels and cognitive performance in middle-aged and older European men”

3) Am J Epidem, 1999, 150(1):27-44

4) J of Nutr,Aug 1996,(126)8:1992-1999

5) Amer J of Clin Nutr,Sep 2005,82(3):627-635

6) Am J Med,2005;118:161 7; Psychosomatic Medicine,2006,68:547-554

7) Neurology,Mar 28 2000,54(6):1265-72

8) J Am Geriatr Soc,Jun 1997,45(6):718-24

9) https://www.medicalnewstoday.com/articles/61555.php Lancet, 2007 Jun 2, 369(9576):1876-82, “Efficacy of folic acid supplementation in stroke prevention: a meta-analysis.”

10) Lancet, 2007 Jan 20, 369(9557):208-16, “Effect of 3-year folic acid supplementation on cognitive function in older adults in the FACIT trial: a randomised, double blind, controlled trial”

Testosterone and Heart Disease - Peak Testosterone

Of course, the significance of this is that heart disease is the #1 killer of men in modern, Western societies, and nothing else really comes close. It is no exaggeration to call it an epidemic and statins are a weak and I believe sometimes dangerous attempt to correct the problem, something I discuss here: https://www.peaktestosterone.com/. I believe that right under our noses is an additional tool, testosterone replacement therapy, to fight cardiovascular disease in the solid majority of men with low or lowish testosterone levels.

Why do I say the “solid majority?”  Why not all men?  Well, there are likely exceptions, such as men with clotting disorders, certain men with hypertension or arrhythmias and men with high red blood cell counts, hematocrit or hemoglobin.  Men should be screened before going on TRT and, of course, any issues discussed with a knowledgeable physician. But on this page I will present the evidence, and there is a lot of it, that, generally speaking for most guys, boosting low testosterone will be a big help in the fight against heart disease.

NOTE:  The #1 way is to  https://www.peaktestosterone.com/.  If your diet and lifestyle is putting plaque in your arteries, then testosterone is not going to save you.

Here are just some of the benefits to the cardiovascular system associated with improved testosterone levels:

1.  Hardening of the Arteries. Many studies have shown that not only does testosterone protect a man’s arteries from hardening, but it also can partially reverse existing issues in many cases. [4] For more information, see no. 1 is this link on https://www.peaktestosterone.com/.  (Testosterone is not a miracle cure, of course, for poor diet, being overweight and a sedentary lifestyle.)

2. High Blood Pressure. Testosterone therapy can also lower blood pressure in men.  The change is usually not huge, but it is significant nonetheless.  The reason is that testosterone actually affects nitric oxide – yes the stuff that makes your erections possible.  I document all this in my link on Testosterone and Blood Pressure . By the way, one of the Peak Testosterone Forum members saw a huge drop in blood pressure from going on HRT.   He went from about 120/80 to  87/67! [5]

3.  Weight Maintenance. Study after study has shown that HRT will help hypogonadal men gain muscle and maintain or even lose weight. For example, one study even showed an increase in fat free mass, essentially muscle, and a decrease in fat mass in men with low normal testosterone. [6] Of course, testosterone will not keep you from overeating, but it is definitely another tool in your arsenal against the slow and steady weight gain that plagues men in modern societies. And, yes, those extra pounds are a risk factor for cardiovascular disease.

5.  Decreased Anxiety and Improved Depression. Anxiety and depression are both stressors and can increase cortisol and cause a host of direct and indirect cardiovascular-related issues. Testosterone can often help greatly with both of these and is a proven mood booster, something I talk about in my link on Testosterone and Depression . Psychologists are starting to admit the interrelationship of hormones and depression and perhaps one day getting your testosterone and estradiol checked will be a part of any psychological evaluation. On the Peak Testosterone Forum I have had a couple of low T men completely turned around from depression by going on HRT. Of course, it doesn’t always work that way as depression is a complex, multi-faceted condition. But having low testosterone is likely only going to make the condition worse and be very hard on one’s cardiovascular system.

6. Diabetes. It is no secret that type II, adult onset diabetes is an epidemic in the U.S. And it is no secret that, once a man gets diabetes, his chances of cardiovascular disease sky rocket. One study showed that men with diabetes tripled their chance of another heart attack if they had already had one. And, if they had not yet had a heart attack, they increased their risk six fold! [8] Testosterone therapy can be a HUGE boost in men with low or lowish testosterone in this area. As I mention in my link on Testosterone and Diabetes, I have spoken with one large HRT clinic where ALL of their men got off of insulin by going on testosterone cypionate injections to youthful levels. This is an incredible stat and, hopefully, more credence will be paid to it over the next decade by the medical community.

Did you know you can inexpensively do your own testing for most hormones? The industry leader is Discounted Labs..

7. Insulin and Inflammation. Probably the two biggest root cause killers of men are what I call The Two I’s: insulin and inflammation. As insulin levels and resistance increase, tissues begin aging and a host of nasty metabolic conditions set in, especially in the arteries. Testosterone therapy dramatically decreases both insulin and inflammation levels, something I document in my links on Testosterone and Inflammation and Testosterone and Insulin Resistance.

8. Visceral Fat. Visceral fat is the stomach fat that plagues so many men and is linked to Metabolic Syndrome and heart disease.  In one study of hypogonadal diabetic men, testosterone therapy decreased visceral fat. [3] This will very likely be the case for many of you because diabetes and prediabetes account for a huge block of modern societies.

9. Atherosclerosis. There is now in vitro evidence that testosterone (and estradiol, DHT and DHEA) can inactivate white blood cell activity in the arterial walls, which is so critical in the plaque formation process, and thus help a man prevent atherosclerosis. I cover this in my page on Testosterone, Arterial Plaque and Atherosclerosis.

All of the above are big risks for heart disease and so it would be tragedy to ignore all this research when heart disease is the #1 killer of us guys.  However, a big question remained in the eyes of researchers:  could testosterone therapy (for men with hypogonadism)  improve heart disease outcomes.  We all know of research that should have been positive but turned out to be the opposite. Would HRT fall into this category?

The good news is that testosterone therapy has done very well in the studies so far and has actually improved outcomes in a variety of studies.  Here are a few examples:

1.  Moderate Heart Failure. One study looked at men with moderate heart failure. It found significantly improvement from Androderm therapy even though not all the men were hypogonadal to begin with. [1]

2. Angina.  Heart patients with angina often suffer tremendously with chest pain.  One study gave men with stable, chronic angina low dose testosterone in the form of a patch. [2] The study, which was double blind and placebo-controlled, improved pain scores.  And, as expected, in men with lower bioavailable testosterone, the pain scores were improved even more dramatically.

3. Myocardial Ischemia. One (admittedly small) double blind, crossover study showed that testosterone helped heart patients’ myocardial ischemia, or insufficient blood flow to an organ or tissue. In this case, the researchers were concerned with proper blood flow to the heart muscle, which can limit tissue damage before and after a heart attack. [7]

What is remarkable about the above studies, if you stop and think about it, is that no lifestyle modifications were usually required of the participants. In general, cardiovascular disease is a disease of a Western lifestyle, and so it is rather surprising that testosterone can help so much just on its own. Imagine if testosterone therapy is combined with proper diet, exercise and general good, clean livin’? So, if your testosterone is low, talk to your doctor about the pros and cons of HRT. I have many links on the subject including ones on HRT, https://www.peaktestosterone.com/, Compounding and so on.

I also highly recommend that one read these two pages for other very important research on the subject:  Testosterone Therapy and the Recent VERY Postive Research and Profound Lowering of Cholesterol in Men through HRT.

NOTE: Erectile dysfunction often goes hand-in-hand with cardiovascular disease as well.  Your erections, just like your heart and arteries, are dependent on soft, expandable vascular tissues and ample nitric oxide that is not overly aged, injured and covered with plaque.  It will be no surprise, then, to learn that testosterone very often improves erectile strength as well, nor that hypogonadism is often a root cause of erectile dysfunction.  For more information, see my link on Testosterone and Erectile Dysfunction.

REFERENCES:

1)   European Heart Journal, 27(1):57-64, “Testosterone therapy in men with moderate severity heart failure: a double-blind randomized placebo controlled trial”

2) Circulation, 2000, 102: 1906-1911, “Low-Dose Transdermal Testosterone Therapy Improves Angina Threshold in Men With Chronic Stable Angina”

3) Eur J Endocrinol June 1, 2006 154 899-906, “Testosterone replacement therapy improves insulin resistance, glycaemic control, visceral adiposity and hypercholesterolaemia in hypogonadal men with type 2 diabetes”

4) J Endocrinol, Sep 1, 2003, 178:373-380, “Testosterone as a protective factor against atherosclerosis–immunomodulation and influence upon plaque development and stability”

5) https://www.peaktestosterone.com/forum/index.php?topic=1077.0

6) The Journal of Clinical Endocrinology & Metabolism, Jan 1 2008, 93(1):139-146, “Testosterone Therapy Prevents Gain in Visceral Adipose Tissue and Loss of Skeletal Muscle in Nonobese Aging Men”

7) The American Journal of Cardiology, 1999, 83(3):437-9, A9, “Effect of acute testosterone on myocardial ischemia in men with coronary artery disease”

8) N Engl J Med, 1998; 339:229-234, “Mortality from Coronary Heart Disease in Subjects with Type 2 Diabetes and in Nondiabetic Subjects with and without Prior Myocardial Infarction”

Testosterone (Hormone Replacement) Therapy.

If your testosterone levels are above about 350, you should look at the Testosterone Lowering Factors, Mind, Sleep and Sex links to see if you can make some simple lifestyle changes and boost your testosterone naturally. These methods may boost your testosterone 20-50% and, if you’re sitting in at about 350-400 ng/dl (or greater), may put you into safe territory without even going on testosterone therapy.

But odds are that if you’re reading this link, your testosterone is quite low:  350 or less.  If that is the case, then I recommend investigating testosterone therapy with your doctor. ( Free testosterone readings are critical as well, but most doctors test for both, at least initially.) Discuss with your doctor, but my experience is that guys begin to suffer erectile, mental and other distrubances once they starting getting into the 350 ng/dl and below range and this seems to match well with the studies as well.

Testosterone Therapy – Safety

So let’s say you find you have low testosterone – it’s a simple blood test ordered by your doctor – and he recommends testosterone (hormone replacement) therapy?  Can it cause prostate cancer or other serious medical conditions?  Well, the good news is that they have been studying this for years and the studies show no correlation with testosterone therapy and prostate cancer. [6] (Talk to your doctor, though, of course.)

The Oncology Times [1] summarized by stating that they “reviewed decades of research and found no compelling evidence that testosterone replacement therapy increases the incidence of prostate cancer or cardiovascular disease”. And, if you have heard stories of men having their prostate cancer treated with low testosterone levels, consider what else the authors had to say:

“It has been known since the 1940s that severe reductions of testosterone can cause shrinkage of metastatic prostate cancer, and therefore there has been a concern that raising testosterone levels might cause growth of any hidden prostate cancers. But the study by Dr. Morgentaler and his coauthor, Ernani L. Rhoden, MD, found no connection between higher testosterone levels and prostate cancer, nor did they find evidence that testosterone treatment causes prostate cancer.”

There were theories for awhile that “fast converters”, i.e. guys that converted to DHT and estrogen easily, could develop prostate cancer.  But, again, the research has not born this out as far as I know. In fact, one huge metanalysis that aggregated multiple studies and thousands of HRT participants found found no risk for high DHT, estrogen or testosterone. [7]  (Again, talk to your doc for the latest info.)

CAUTION: Many doctors are still very cautious about the safety of HRT, because they know that if a patient gets prostate cancer, reducing testosterone is one of the proven, time-tested treatment protocols.  In other words, if you have prostate cancer, testosterone exacerbates and accelerates it progression.  However, most doctors do regular prostate exams along with PSA screening and, therefore, feel they can avoid putting patients on testosterone if they already have a latent cancer.

In fact, from all we know at this point, it looks like the real risk is not going on testosterone therapy if you have low testosterone. One study, for example, found that testosterone therapy actually lowered PSA levels and decreased most of the major symptoms of an enlarged prostate. [5] And, as I mentioned, low testosterone is tied to a number of serious medical conditions.

Furthermore, testosterone therapy will likely help cure, or even permanently cure any Erectile Dysfunction (ED) that you have been experiencing.  For exmaple, one study from Taiwan found that 34% of men with erectile dsyfunction that were unresponsive to Viagra, which is pretty serious impotence, responded well to testosterone supplementation.  And 38% of the man responded to both Viagra and testosterone therapy, so almost three fourths of the men with ED were significantly improved by simply taking testosterone. If you couple testosterone therapy, i.e. hormone replacement therapy, with the advice that I give on boosting nitric oxide here and here, you’ll likely feel about twenty years younger in EVERY way.

Testosterone therapy can also improve your memory, brain, cognition and learning. Yes, testosterone is intimately linked to cerebral function.  Several studies have shown that, in particular, visual spacial skills are tied to testosterone levels.  And hypogonadal (low testosterone) men have been shown in several studies to have lower verbal skills. [2]  You will also likely find that testosterone, and therefore testosterone therapy, improves mental outlook:  low testosterone is correlated to depression, anxiety and other mental struggles.  And by boosting your testosterone levels, you can help reduce your risk for diabetes and many other life-threatening low testosterone maladies.

So what are you waiting for? Get your testosterone read and find out if testosterone therapy is right for you. You can improve your mood, your sex life, your erectile stength and boost your memory and mental abilities.  Yes, it takes several weeks (or even a few months) for testosterone therapy to “take effect”:  your tissues must literally rebuild themselves.  However, once those tissues are rebuilt, the difference can be remarkable.  Some of you will feel strongly that the minute you started taking testosterone was the minute you got your life back.

If you are interested, you should read about some of the More Common Side Effects of Testosterone (Hormone Replacement) Therapy and common Methods of Testosterone Delivery (such as gels and injections).  These links should give you a lot of good talking points with your doctor.

REFERENCES:

1) Mar 25 2004,26(6):30-35

2) Saving Your Brain, Jeff Victoroff, p. 135

3) Clin Endocrin (Ox),1988;28:461-470

4) British J Clin Pharm,2008, 65:253-259

5) Intl J Andrology, 2002 Apr, 25(2):119-25

6) JAMA, 2006 Nov 15, 296(19):2351-61; N Engl J Med, 2004 Jan 29, 350(5):482-92

7) J of the Nat Cancer Inst, 2008, 100(3):170-183, “Endogenous Sex Hormones and Prostate Cancer: A Collaborative Analysis of 18 Prospective Studies”

Clomid: Preserve Your Fertility While Raising Your Testosterone

REFERENCES:

1) J Sex Med, 2005 Sep, 2(5):716-21, “Clomiphene citrate effects on testosterone/estrogen ratio in male hypogonadism”

2) Fertility and Sterility, Jan 2003, 79(1):203-205, “Use of clomiphene citrate to reverse premature andropause secondary to steroid abuse”

3) https://www.peaktestosterone.com/forum/index.php?topic=229.msg2032#msg2032

What is a SERM?  It means that it will in some tissues act as an estrogen and in others block estrogen. However, the bottom line is that in males it generally works its hormonal magic by blocking or inhibiting estrogen at the hypothalamus which, in turn, stimulates GnRH and, further downstream, LH (leutinizing hormone) in the pituitary.  Males can see their low testosterone levels double or more, especially in the case of secondary hypogonadism.

Some decent research and years of clinical practice have born this out. For example, one study put 36 men with average total testosterone of 248 ng/dl on 25 mg/day of Clomid and after 4-6 weeks the men’s average testosterone was a much improved 610 ng/dl. [1] This is a nice boost indeed, especially for what is considered a relatively low dose of Clomid.  The authors also point out that the all-important testosterone to estrogen ratio was raised from 8.7 to 14.2.

We have had a couple of Peak Testosterone Forum member who were enthusiastic Clomid users.  Look at what this guy wrote:

“Yep, seems like I ‘passed’ the Clomid challenge. February I had a reading of total T at 270 ng/dl. Today’s results, after 5 1/2 weeks on Clomid: 627 ng/dl!! Wow, so that was really good news…” [3]

Clomid also has certain advantages over standard testosterone therapy.  HRT requires shots or topicals that require time and potential risks.  It’s nice just to take a simple pill, as is the case with Clomid. And the good news is that Clomid seems to generally raise testosterone in the younger men who try it, which is still more evidence that the great majority of men have secondary hypogonadism.  Also, it is worth pointing out that a significant percentage of men have what I would call an “HRT-like” experience from Clomid, i.e. it improves libido and erectile strength and they feel better as well.

However, many have th opposite experience where their testosterone increases but they get no increase in libido.  We have had men shoot up into the 800’s  or higher on Clomid and yet have absolutely no increase in sexual desire.  This shows just how Clomid can negatively impact the male brain due to its sometimes estrogenic qualities.  And there is simply no way to know if you will be one of the lucky or unlucky ones.

So how safe is this convenient Clomid? In the short term, Clomid seems quite safe it can have side effects such as visual disturbances and headaches that should be discussed with your doctor – and that is one reason that some doctors are increasingly prescribing it for hypogonadism. Clomid has been taken for years by males as a fertility treatment due to its testes-stimulating powers. So it has a reasonable track record considering that it has been out for awhile.

Did you know you can inexpensively do your own testing for most hormones? The industry leader is Discounted Labs..

One other crowd that has used Clomid for an extended period of time are steroid users and certain athletes.  Steroid men will use Clomid to get their testosterone back, a common issue with steroid abuse. It is commonly used upon completion of a steroid cycle to “jump start” testosterone.  Often testosterone will collapse after steroid use and Clomid is the only thing that will bring back testosterone and estrogen within normal physiological ranges.  This was documented when one study discussed Clomid’s effective use to do just this with a “steroid abuser”. [2]

The bottom line is that Clomid has been used extensively by many men off label and even non-legal users and all have found it to be reasonably well-tolerated with low side effects for short term use as long as low doses are used and certain procedures are followed. I discuss some of the side effects below, and, of course, you should talk to your doctor first before going on Clomid and discuss risks/rewards. NOTE: Clomid does not always work. If you are primary hypogonadal, for example, Clomid will do nothing for you. And the same is true if you have pituitary damage..

CAUTION: Many men now want to use Clomid long term.  Talk to your doctor, but I think this is unwise for a variety of reasons that I go into detail about in my link on Your Risks with Long Term Clomid Usage.  Below I give a quick summary, though, of the issues involved:

1) Vision. A surprisingly common side effect of Clomid is blurred vision and some would add floaters.  However, one important point is that this risk is greatly reduced with low dose Clomid. By low dose, I mean 12.5 mg MWF or maybe 25 mg MWF at the most. Now you have to talk to your doctor about risks, but the general advice that I have seen is that one must quit Clomid and call your doctor’s office immediately if you experience any visual disturbances.

2) Moodiness and Estrogen. Clomid is actually estrogenic in some cases and  moodiness and mood swings are fairly commonly reported.  The bottom line is that Clomid’s effects are poorly understood and likely vary from individual to individual.

3) No Increase In Libido. Many men will see their testosterone double or even triple on Clomid. With that kind of increase in testosterone, you would expect a nice boost in libido. However, this often does not happen, and the reason is that the estrogenic effects of Clomid probably outweight the increase in testosterone in these men. Unfortunately, you just don’t know if you’re one of the lucky ones until you try.

4) Thyroid.  Some of Clomid’s common side effects match up quite well with those encountered during various thyroid issues.  This has some wondering if Clomid does subtely affect thyroid function in some way.

5) Nausea or Headache. These are fairly common side effects with Clomid. Again, your doctor should be called immediately if this is an issue.

6) Clomid. Clomid raises SHBG enough to where it could be an issue for some men with high SHBG. As SHBG rises, the percentage of free testosterone can fall. Ideally, you want this range to be 1.5-2.5 percent of total testosterone. See this link on High SHBG for more information.

Metabolic Syndrome (Prediabetes) Solutions

Okay, so you’ve read my link on Metabolic Syndrome and think you may have it.  Or maybe you want to avoid dealing with it and its destructive force on your testosterone and erectile strength?  Either way, this is nasty stuff and below I give you many research-based solutions to prevent or even eliminate its hold on your life.  Science has come so far in its understanding of Metabolic Syndrome that there is simply no reason to let it take out your heart, brain and penis.

Below are 20 solutions to prevent and defeat Metabolic Syndrome.  Put these all together and you have handily defeated what is probably Pubic Enemy Number One.  (Yes, I meant Pubic.)

1)  Magnesium. Magnesium is one of the few supplements that I would recommend for most people and one of the reasons is the close relationship between Magnesium and Metabolic Syndrome.

2) Low Fat (or Ornish) Diet.  A Low Fat or (Ornish) Diet will lower blood pressure, dramatically decrease cholesterol and even clean out your arteries.  In short, it will reverse almost every negative aspect of Metabolic Syndrome.  Please read this link on a Low Fat or (Ornish) Diet for more details.

3) Exercise had done very well in defeating Metabolic Syndrome.  For example, one study of sedentary but healthy subjects with Metabolic Syndrome resulted in “30.5% (32 participants) [who] were no longer classified as having the metabolic syndrome after the exercise training. Among the 32 participants who improved their metabolic profile, 43% decreased triglycerides, 16% improved HDL cholesterol, 38% decreased blood pressure, 9% improved fasting plasma glucose, and 28% decreased their waist circumference.” [6] In other words, even without any dieting or even baseline dietary changes, exercise made very significant improvements in a large number of patients.

4)  Being Overweight is another huge risk factor for insulin resistance and Metabolic Syndrome. In fact, recent research shows that fat tissue is the number one cause of insulin resistance. [30]  The reason?  When you get fat enough, macrophages (white blood cells) actually move in and take residence in your fat and begin to pump out pro-inflammatory cytokines and this inflammation response leads to the nasty insulin resistance that causes so many problems.  The good news is that the same study [31] showed that participants that dropped the pounds sent the macrophages running out of their fatty tissues and reversed their insulin resistance (and diabetes) risk.  I advise reading my link on How to Lose Weight the Right Way, as you can easily depress your testosterone levels if you are not careful.

5) Vinegar and Cinnamon. Both vinegar and cinnamon [18] help with glucose and insulin metabolism.  Try to include a tablespoon or two of vinegar prior to any meal with a significant amount of carbs.  Read about How Vinegar Can Help Keep the Pounds and Decrease Insulin and Glucose. Remember:  Anything that blunts the glucose spike that occurs after a meal should also blunt the insulin spike as well. CAUTION: There is a certain type of “mock” cinnamon (Cassia) commonly sold in stores that has significant amounts a liver and kidney toxin called couramin. You only want to buy true cinnamon, which is Ceylon Cinnamon.

6) Whole Grains. Whole grains lower insulin resistance simply because they are broken down by our digestive systems more slowly and thus spike blood sugar much less.  Several studies have shown that Whole Grains lower insulin resistance. [4]  See this link on Grains for more details.

REFERENCES:

1)  Magnesium. Magnesium is one of the few supplements that I would recommend for most people and one of the reasons is the close relationship between Magnesium and Metabolic Syndrome.

2) Low Fat (or Ornish) Diet.  A Low Fat or (Ornish) Diet will lower blood pressure, dramatically decrease cholesterol and even clean out your arteries.  In short, it will reverse almost every negative aspect of Metabolic Syndrome.  Please read this link on a Low Fat or (Ornish) Diet for more details.

Need to boost your Nitric Oxide naturally through food, drink and supplements? Check out Lee Myer’s book here: The Peak Erectile Strength Diet

Or do you need the most comprehensive testosterone book in Amazon? Here it is: Natural Versus Testosterone Therapy

3) Exercise had done very well in defeating Metabolic Syndrome.  For example, one study of sedentary but healthy subjects with Metabolic Syndrome resulted in “30.5% (32 participants) [who] were no longer classified as having the metabolic syndrome after the exercise training. Among the 32 participants who improved their metabolic profile, 43% decreased triglycerides, 16% improved HDL cholesterol, 38% decreased blood pressure, 9% improved fasting plasma glucose, and 28% decreased their waist circumference.” [6] In other words, even without any dieting or even baseline dietary changes, exercise made very significant improvements in a large number of patients.

4)  Being Overweight is another huge risk factor for insulin resistance and Metabolic Syndrome. In fact, recent research shows that fat tissue is the number one cause of insulin resistance. [30]  The reason?  When you get fat enough, macrophages (white blood cells) actually move in and take residence in your fat and begin to pump out pro-inflammatory cytokines and this inflammation response leads to the nasty insulin resistance that causes so many problems.  The good news is that the same study [31] showed that participants that dropped the pounds sent the macrophages running out of their fatty tissues and reversed their insulin resistance (and diabetes) risk.  I advise reading my link on How to Lose Weight the Right Way, as you can easily depress your testosterone levels if you are not careful.

5) Vinegar and Cinnamon. Both vinegar and cinnamon [18] help with glucose and insulin metabolism.  Try to include a tablespoon or two of vinegar prior to any meal with a significant amount of carbs.  Read about How Vinegar Can Help Keep the Pounds and Decrease Insulin and Glucose. Remember:  Anything that blunts the glucose spike that occurs after a meal should also blunt the insulin spike as well. CAUTION: There is a certain type of “mock” cinnamon (Cassia) commonly sold in stores that has significant amounts a liver and kidney toxin called couramin. You only want to buy true cinnamon, which is Ceylon Cinnamon.

6) Whole Grains. Whole grains lower insulin resistance simply because they are broken down by our digestive systems more slowly and thus spike blood sugar much less.  Several studies have shown that Whole Grains lower insulin resistance. [4]  See this link on Grains for more details.

7) Saturated Fats and Total Fats. Researchers have used a high fat diet [20] and saturated fats [21] (on animals) to induce insulin resistance!  That’s how potent these are at generating Metabolic Disorder symptoms.  You definitely want to keep saturated fats and total fat to a minimum unless you are going to be extremely careful.

8) Fish Oil.  Many studies have shown that fish oil protects against insulin resistance.

9) Blood Pressure. High blood pressure is one of the hallmarks of Metabolic Syndrome and there are excellent strategies to lower your blood pressure.  See this link on How to Lower Your Blood Pressure for details.

10) Mediterranean Diet with Nuts.  The Mediterranean Diet probably help with erectile dysfunction is that a recent study [11] found to improve Metabolic Syndrome . Metabolic Syndrome is a set of conditions (high blood pressure, insulin resistance, poor lipids, etc.) that plague Western societies.  There are several interesting things about this study.  First of all, the participants were seniors, all of whom were at risk for heart disease including about two thirds who already had developed Metabolic Syndrome . The study found that the Metabolic Syndrome was actually reversed for 14% of the participants. (NOTE:  Nuts were also a part of the most succesful cohort in this study.)

11) Juvenon.  This is a supplement that is basically a combination of Acetyl-L-Carnitine, the mitochondria booster, and ALA (Alpha Lipoic Acid), the powerful antioxidant. One study showed a nice reduction in blood pressure in those with Metabolic Syndrome of 139 to 130. [14]

12) Alpha-lipoic Acid.  Alpha-lipoic acid, one of the components of Juvenon, has been shown in a study to improve insulin resistance.  [17]

13) Testosterone. Researchers castrated rats which made them much more insulin resistant. [19] They then administered supplemental testosterone which helped reverse the insulin sensitivity resulting from castration. This, of course, implies that testosterone plays a strong role in both insulin resistance and sensitivity.  Again, see my link on How to Improve Testosterone Naturally or Testosterone Therapy for ways to boost your testosterone. Also, one well-known HRT clinic has actually reversed ALL of their Type II diabetics.  In other words, all of their patients with Type II diabetes have been able to get off of insulin by simply raising their testosterone into the 800-1000 ng/dl range!

14) Stress.  Stress has been associated with Metabolic Syndrome.  Stress negatively affects hormones (cortisol and testosterone) and leads to behaviors such as increased smoking and drinking and decreased exercise. [22]

15) Black Tea.  Tea, like cinnamon and vinegar, seems to dampen the post-meal glucose and insulin responses according to one study. [23] The research is new but looks very promising: tea was actually found to mimic the Diabetes drugs Precose and Glyset. Again, this is a rather conusing result to many, because the the school of thought has always been that caffeine causes significant sugar spikes not amerliorations of the same.

16) Dark Chocolate (Cacao).  A recent study found that dark chocolate improved insulin sensitivity. [26]  Of course, the secret is not the sugar or milk – it’s the cacao, which is one of the staples of the ultra heart healthy Kuna peoples. Eating a small bar per day (dark only) is a heart healthy idea.

17) Sleep. Studies have shown that lack of sleep leads to greatly reduced glucose clearance, i.e. you become much more insulin resistant, and your immunity is whacked. [24] In one recent study scientists placed 11 participants in a closed environment where  sleep, calories and physical activity could be carefully controlled.  The researchers found that as those in the study went from 8.5 hours of sleep to 5.5 hours, their blood sugar was significantly higher and their insulin resistance significantly worse. [25]

18) Fructose.  One 2009 study found that men put on a high-fructose (200 g/day) diet significantly increased the number of men with metabolic syndrome (and their blood pressure).  In addition, putting them on a uric acid blocker almost eliminated the increase. [27] You don’t need to worry about the small amount of fructose in fruit:  200 g is a LOT of fructose.  But you should definitely limit sweets and cokes and anything with a substantial amount of sugar or corn syrup.

19) High-Intensity Training.  If you can take the pain, High-Intensity Training, a close relative of Interval Training, has also been shown to do a nice job of lowering insulin levels. Intensity is a technical term that basically refers to the amount of effort in a certain amount of time or the amount of “sweat and burn” the exercise induces.  Researchers put (female) participants on a repeated cyle of “sprinting” on a stationary bike for 12 seconds and then pedaling much more slowly for 12 seconds and so on for twenty minutes three times per week. [29]  This very minimal amount of exercise significantly reduced insulin levels.

20) Leucine / Branched Amino Acids (BCAA’s). Leucine is the heavy-hitter amino in Brached Chain Amino Acid supplements and is responsible for many of the muscle-building effects of whey.  And it turns out that leucine may be one of your potent weapons for fighting insulin resistance and prediabetes.  See my link on Branched Chain Amino Acids for more details.

21) Sugary and Sweet Drinks. It will probably come as no surprise that these have been found to accelerate Metabolic Syndrome (and type II diabetes). [32]  Of course, it could’t have anything to do with the extra fructose and empty calories…

22) Coffee.  Many men do not know that coffee has a strong “glucose-limiting” compound in it and supplement manufacturers have pulled out and put into an extract due to its potency. This is one of the reasons that coffee can so be so healthful for some men and several studies have shown its ability to put the brakes on Metabolic Syndrome. [33]

REFERENCES

1) Jour Urol, 2007 Feb,177(2):651-4; Jour Clin Endocrin Metab 1990 Oct,71(4):929-31

2) Hypertension,1998;31:780-786

3) Obesity Reviews,Jul 2008,9(4)340-354(15)

4) Am J Clin Nutr,2003 Nov,78(5):965-71

5) J of Mens Health, Sep 2008, 5(1):S40-S45

6) Med Sci Sports Exerc, Oct 2003, 35(10):1703-9

7) Tex Heart Inst J, 2005, 32(3): 387 389

8) Am J Cardiol, 2008 Feb 15,101(4):497-501

9) Diabetes Care, 2005, 28:1636-1642

10) Kobe J Med Sciences, 2007, 53:99-106

11) Diabetes, 2005, 54:1926-1933

12) J Clin Invest, 2007, 117(712) J Clin Invest, 2007, 117(7): 1995-2003

13) Yale University (2004, February 23). Young People Prone To Type 2 Diabetes Exhibit Alterations In Mitochondrial Activity

14) J of Clin Hypertension, May 9 2007, 9(4):249-255

15) Circulation, 2005, 111(11):1448-1454; Lupus, 2005, 14(9):760-764

17) Henriksen EJ, et al. Chronic thioctic acid treatment increases insulin stimulated glucose transport activity in skeletal muscle of obese zucker rats. Diabetes (Suppl.) (1994) 1:122A

18) Diabetes Res Clin Pract, 2003, 62:139-48

19) Physiologica Scandinavica, 1992, 146:505 510

20) Science, 1987, 237(4817):885-888

21) J. Nutr, Nov 2005, 135:2634-2638

22) European Heart Journal, Advance Access published online on January 23, 2008, “Work stress and coronary heart disease: what are the mechanisms?”, Received 1 August 2007; revised 14 November 2007; accepted 22 November 2007.

23) “Alpha-Glucosidase Inhibitors for Type 2 Diabetes.” Chen, H., Journal of Food Science, published online June 30, 2009.

24) Obesity Reviews,Jul 2008,9(4)340-354(15)

25) J of Clin Endocrin & Metab, Nedeltcheva, A.V. , published online ahead of print, June 30, 2009

26) Amer J of Clin Nutr, March 2005, 81(3):611-614, “Short-term administration of dark chocolate is followed by a significant increase in insulin sensitivity and a decrease in blood pressure in healthy persons”

27) Perez-Pozo S, et al “Excessive fructose intake raises blood pressure in humans” AHA BPRC 2009; Abstract P127

28) J Endocrin Invest, Jun 2007,30(6):451-8; Journal Andrology, 2009, 30:10-22

29) International Journal of Obesity, 2001, 25:332-339, “Impact of high-intensity exercise on energy expenditure, lipid oxidation and body fatness”

30) Diabetes, Published online before print March 31, 2010, “Pro-inflammatory CD11c+CD206+ adipose tissue macrophages are associated with insulin resistance in human obesity”

31)  Sciencealert.com, “Meddling Fat Causes Diabetes”, Aug. 16, 2010

32) Diabetes Care, Nov 2010, 33(11):2477-2483, “Sugar-Sweetened Beverages and Risk of Metabolic Syndrome and Type 2 Diabetes”

33) Diabetes Research and Clinical Practice, Jun 2007, 76(3):383 389, “Habitual coffee but not green tea consumption is inversely associated with metabolicsyndrome: An epidemiological study in a general Japanese population”

Arginase Inhibitors and Erectile Dysfunction - Peak Testosterone

Most men know that L-Arginine plays a role in the production of erectile strength-promoting nitric oxide, something I cover in my link on The Failures and Successes of Arginine. Viagra and Cialis works on an enzyme called NOS (Nitric Oxide Synthase) and, of course, has been quite effective.  So why would going farther upstream and targeting arginase help? The reason is simple:  NO synthase and arginase compete for the same substrate (L-arginine). [1]NOTE:  It is arginase II that is actually involved in endothelial dysfunction.

“Since NO synthase and arginase compete for the same substrate (L-arginine), over-expressed arginase can affect NO synthase activity and NO-dependent smooth muscle relaxation by depleting the substrate pool of L-arginine that would otherwise be available to NO synthase.” [1]

Around a decade ago, researchers began to speculate that arginase inhibitors could be used to improve erectile function. One 2004, study, for example, wrote that “We present data to suggest that arginase may regulate NO production by competing for endogenous pools of L-arginine. In this fashion, arginase is an indirect regulator of penile and vaginal blood flow and specific arginase inhibitors may improve genital blood flow during sexual arousal.” [2] Notice that they said “may” and so, basically, this was a feasability study with a call to action. Subsequent animal studies showed that endothelial function was improved with arginase inhibitors but none studied erectile tissues as far as I know.

This was addressed in 2009 when a study examined in vitro the effects of four arginase inhibitors on human penile erectile tissues from the corpus cavernosum.  Their results were lackluster and the authors concluded that “arginase inhibitors appeared to be ineffective in reversing the adrenergic tension and increasing the electrically induced relaxation of isolated HCC.” [3] Therefore, it would appear that these are probably not going to be the next “big gun” in the fight against erectile dysfunction.

So more research needs to be done, but early results do not appear to be promising.  In addition, I have not been able to find any legal, approved arginase inhibitors.  There is nor-NOHA, which is available commerically.  One supplier is very clear that “this product is not for human or veterinary use.”

However, arginase inhibitors are likely to be forthcoming due to an interesting application:  protecting diabetics from heart and arterial disease.  Diabetics simply do not respond to normal cardiovascular interventions and scientist recently found out why:  diabetics have elevated arginase levels. [5] Several lines of evidence point to this being a root cause issue for many of the debilitating effects of diabetes and arginase inhibitors look promising.

However, at this point, I do not see any physicians using arginase inhibitors for treatment of erectile dysfunction.

REFERENCES::

1)  Nitric Oxide. 1999 Dec, 3(6):427-38, “Effects of the new arginase inhibitor N(omega)-hydroxy-nor-L-arginine on NO synthase activity in murine macrophages”

2) Nutr, 2004 Oct, 134(10 Suppl):2873S-2879S; “Role of arginase in the male and female sexual arousal response”

3) World J Urol, 2009 Dec, 27(6):805-10, “Effects of arginase inhibitors on the contractile and relaxant responses of isolated human penile erectile tissue”

4) Br J Pharmacol, 2009 January, 156(1):84–93, “The vascular effects of different arginase inhibitors in rat isolated aorta and mesenteric arteries”

5) https://www.emaxhealth.com/1020/arginase-inhibitors-might-prevent-diabetic-heart-disease

Stress Can Raise Inflammation - Peak Testosterone

We all know that stress suppresses immunity and, therefore, inflammation, right? For example, one of the very well-known side effects of corticosteroid medications is suppression of the immune system, which can leave patients more vulnerable to infections. It turns out that it is not that simple and now there is considerable evidence that chronic stress actually boosts “humoral immunity,” and nasty systemic inflammation along with it. [1]

Humoral immunity is the part of your immune system that deals with antibodies and fighting against foreign invaders such as germs. Of course, this is critical for our survival against infections of all sorts, but the problem is that humoral immunity is also associated with increased inflammation. For example, we know of a number of infections that likely to lead to heart disease, including urinary tract infections, influenza and possibly periodontal disease. This link between infection, inflammation and heart disease has been noted many times in the research of the last twenty years and is now widely accepted. Inflammation has also been linked to erectile dysfunction! See my page on Inflammation and Erectile Dysfunction for more information.

But a connection between stress and inflammation seems much more subtle. How could stress, especially the chronic, day-to-day kind, trigger such a silent, background process as inflammation that is designed to work against foes such as diptheria, west nile virus and malaria?

NOTE:  I have a link on How to Lower Your TNF Alpha Naturally for those interested.

The study above [2] was also instructive, because it was on medical students before and after exams.  Basically, it was covering the kinds of everyday stress that we experience as human beings in modern societies:  worrying about how we’re going to pay the mortgage; worrying about a relationship that is falling apart; worrying about medical bills that we can pay; worrying about losing your job, etc.  These kind of seeming “do or die” situations can really take a toll on us, not just psychological but physically as the above study shows us.

The same study had the foresight to study two very important psychological states that were found to really increase inflammatory cytokine levels:  1) high stress perception and 2) a high anxiety response. Some men “just roll with the punches.”  Some guys can sleep like a baby even when the pressure is on.  But most of us cannot and so, if you were one of those guys who is actually the opposite, you are probably sending these inflammatory messengers through the roof.

And the studies have looked at a little older crowd as well.  One study on seniors contrasted caregivers – those who were taking care of a very sick spouse – with those who weren’t.  What they found was incredible:  “caregivers’ average rate of increase in IL-6 was about four times as large as that of noncaregivers.” [7] Again, IL-6 can kill you in a dozen different ways and is a huge source of chronic disease. So, ironically, the task of caring and empathizing over the health of a loved one can destroy your own

So what can you do about stress?  Much, much more than you might think.  Of course, time and people management skills can help tremendously.  But one thing that many men do not realize is that there are ways to actually manage the stress (and cortisol) throught simple techniques that you can do at home..  Basically, you can teach your mind not to overreact during times of stress through a variety of techniques, which I cover on these pages:  (Non-religious) Mindfulness Meditation, Progressive Muscle Relaxation and Secular Meditation.

There are many other techniques that work.  There is a study that shows that self-hypnosis lowers the humoral immunity that I mentioned above [4] or you can go with your wife to her yoga classes, since it is a proven stress buster.  There is also guided imagery, biofeedback, Tai Chi, etc.  However, I prefer the above, because you can do them in your home in perfect privacy – no one really has to know – and they do not require another person.  You can start today after doing just 20 minutes of reading.

In addition, 1) progressive muscle relaxation almost forces your body to relax and is easy to do and 2) meditation forces you to learn how to control your mind and many men struggle with stray and repetitive thoughts under stress.  Again, read the above links and you will find that these techniques can actually 1) grow back parts of your brain, 2) lower cortisol, 3) lower blood pressure, 4) improve many psychological issues including anxiety and depression.

NOTE: The research also shows that depression is linked to inflammation.  One of the cytokines, for example, has been found to actually induce depression! [6]

REFERENCES:

1) Trends in Endocrinology & Metabolism, Nov 1 1999, 10(9):359-368, “Stress Hormones, Th1/Th2 patterns, Pro/Anti-inflammatory Cytokines and Susceptibility to Disease”

2) Cytokine, April 1998, 10(4):313 318, “THE EFFECTS OF PSYCHOLOGICAL STRESS ON HUMANS: INCREASED PRODUCTION OF PRO-INFLAMMATORY CYTOKINES AND Th1-LIKE RESPONSE IN STRESS-INDUCED ANXIETY”

3) Eur Heart J, 2007, “The role of infection in cardiovascular disease: more support but many questions remain”

4) International Journal of Psychophysiology, Aug 2001, 42(1):55-71, “Cellular and humoral immunity, mood and exam stress: the influences of self-hypnosis and personality predictors”

5) Circulation Research, 1993, 73:205-209, “Tumor necrosis factor downregulates an endothelial nitric oxide synthase mRNA by shortening its half-life”

6) Trends in Immunology, Jan 2006, 27(1):24-31, Cytokines sing the blues: inflammation and the pathogenesis of depression”

7) PNAS, Jul 22 2003, 100(15):9090-9095, “Chronic stress and age-related increases in the proinflammatory cytokine IL-6”

The answer is that the body does not really differentitate that well between a deadly superpathogen and the worry we experience night after night about your mortgage payment.  These both trigger a very similar inflammatory response as I will show below, and it can be deadly.

Has this been verified in humans? One study monitored medical students under psychological stress and found that the following inflammatory cytokines increased: [2]

NOTE: Furthermore, some students had a lower response of the immunoregulatory cytokines IL-10 and IL-4, so, basically, the brakes were removed and the accelerator pushed full throttle in some students.

The importance of the above cannot be overestimated.  Inflammation is considered the “root of all evil” by many authorities.  It has been found to be a root cause of many cancers, autoimmune diseases including diabetes and arthritis, heart disease, Alzheimers – the list goes on and on.  Almost all of the nasty chronic medical conditions that plague us in Western societies have inflammation as a root cause.  You can read about all of this in more detail in my link on The Evils of Inflammation. TNF alpha can also downregulate eNOS, which will leave you with much less nitric oxide according one one study. [5] Yes, this helps explain why an increase in inflammation can lead to a loss in erectile strength.

Beer and Testosterone - Peak Testosterone

REFERENCES:

1) Journal of Endocrinology, 2006, 191:399-405, “The hop phytoestrogen, 8-prenylnaringenin, reverses the ovariectomy-induced rise in skin temperature in an animal model of menopausal hot flushes”

2) J Clin Endocrinol Metab, 2000 Dec, 85(12):4912-5, “The endocrine activities of 8-prenylnaringenin and related hop (Humulus lupulus L.) flavonoids”

3) https://www.newswise.com/articles/hops-compound-may-prevent-prostate-cancer

4) Biochem J, 1983 January 15, 210(1): 29 36, “Inhibition of testosterone biosynthesis by ethanol. Relation to hepatic and testicular acetaldehyde, ketone bodies and cytosolic redox state in rats”

5) Med Sci Sports Exerc, 2013 Sep, 45(9):1825-32, “Postresistance exercise ethanol ingestion and acute testosterone bioavailability”

6) Nutrition, Sep 2013, 29(9):1122-1126, “Acute effects of beer on endothelial function and hemodynamics: A single-blind, crossover study in healthy volunteers”

NEWS FLASH: There was a recent study that showed that beer consumption post-workout (weight lifting) increased testosterone levels (free and total) by about 20 percent. [5] This should be interpreted with great care as a number of past studies have shown that alcohol consumption is hard on muscle recovery and repair. It is interesting, though, because yet another recent study found that alcohol reduces arterial stiffness, which is a problem (potentially) associated with weight lifting that I discuss in my page on Weight Lifting and Your Arteries. [6] A more natural solution in my opinion is to cardio after lifting weights to “de-stiffen” your arteries.

There’s no sign of consumption dropping:  there are a good 10 billion bottles of the stuff consumed worldwide annually and no sign of that diminishing any time soon.

Here’s five reasons to avoid or limit your intake of your next brewski:

1. 8-PN. 8-Prenylnaringenin (8-PN) in hops is such a potent phytoestrogen that it has been reproted to reduce menopausal hot flashes! [1] This study points out that some women who pick hops by hand have menstrual disturbances (from the estrogens) and used it to reduce the skin temperative in rats, i.e. anti-hot-flash.  Furthermore, other researchers expressed concern about the unrestricted concern about the unrestricted use of hops in herbal preparations for women because of 8-PN’s “very high estrogen activity”. [2]  (I knew there was a reason I liked tequila.)

2. Xanthohumol. This compound in beer has researchers excited:  it has potent anticancer properties.  Unfortunatly, it also blocks testosterone. [3]

3. Estrogen. Ethanol in beer or any other alcoholic beverage will slow down the P45 enzyme system in the liver allowing estrogen to stay in your system much longer.  And the more estrogen, in general, the less testosterone.  See my link on Alcohol Consumption for more details.

4. Testes. Alcohol also lower testosterone levels in the testes yourself.  [4]  In other words, it goes directly after the engine of your testosterone production.  If that’s not hitting below the belt, I don’t know what is.

5. Weight Gain. They don’t call it a “beer gut” for no reason.  Those extra few hundred calories every day add up and, next thing you know, you’ve got a nice big spare tire around your middle that is associated with reduced testosterone levels.

I know beer consumption is religious for a lot of guys, but “eyes wide open” I always say…

Propecia: Did It Take Out My Health? - Peak Testosterone

Let me tell what is a bad idea – a VERY bad idea:  giving a low testosterone man Propecia.  I think that I am living proof of that and I’ll explain why below.  In fact, I’ll start by saying that one thing that has always puzzled me about my health past is why I had such a sudden onset of nasty symptoms.  I am reasonably sure that I have always been low testosterone based on the fact that I do not ever remember having morning erections and I suffered from dysthymia my entire adult life.  Adding weight to my theory is the fact that both of these symptoms almost instantly disappeared when I went on testosterone cypionate.

One thing that has puzzled me, though, is why I had a sudden onset of nasty symptoms when I was probably always low T?   If I had truly been low testosterone for decades, why all of a sudden did a wave of erectile dysfunction, low libido, fatigue, achiness, mental fog and high anxiety hit me like a storm suddenly?

To try to find the answer to that I got hold of my old medical records – that wasn’t easy by the way – and found the first onset of these symptoms.  I believe that it started in 2001, because I found that a GI exam for celiac disease then.  Basically, I was feeling terrible and had many different theories at the time as to the cause.  (I knew next to nothing about testosterone at the time.) I had read about celiac disease, and thought, “I’ve got to be celiac!”.  My physician did not know what to do with me, and so he sent me to a GI doctor who scoped me and found that I was not celiac.

So, assuming this all started in 2001, then the burning question in my mind is what happened in 2000 that might have precipitated all these problems in 2001?  The answer may lie in the fact that I had prescriptions for Propecia in August 2000, September 2000 and February of 2001.  I was concerned with hair loss and do remember taking it for a period of time.

At the time, no one really knew of the long term side effects of Propecia.  In fact, even some of the basic pharmacological properties were not known:  it wasn’t until the late 90’s that information came out that it was a suicide inhibitor, something I discuss in my page on Propecia: An Irreversible 5-Alpha-Reductase Inhibitor.  The bottom line is that neither myself nor my doctor would have thought of my issues stemming from Propecia at the time.

NOTE:  Propecia was approved in 1992 and it was not until 2012 that the FDA required labelling changes. [6]

So why do I think Propecia caused my health issues?  Well, I would argue that common sense dictates that Propecia issues thrown on top of existing low testosterone would often be a nasty combination and would very likely lead to the exact symptoms that I was having.  Assuming I was low testosterone, then my depression likely stemmed from that and I was likely in a “weakened” psychological state.  (I was diagnosed as hypogonadal about 5 years after this.)  I’m not trying to be dramatic here, but low testosterone is hard on neurotransmitter as you can read about in my page on Testosterone and the Brain.  Now, if you throw in Propecia, which greatly lowers my 5-alpha-reductase enzymes and the ensuing fall in my (likely) already low DHT levels, it is no wonder that I struggled.  Propecia also lowers allopregnenalone, which decreases GABA levels.  Common symptoms of a GABA deficiency include increased anxiety, depression, difficulty staying asleep and pain. These all definitedly applied to how I felt at the time, and so, while I cannot prove it, I did seem to fit the profile for post-finasteride syndrome and a GABA deficiency.  I also had the very common sexual side effects.

Again, the reason that I highlight this is that I do not think anyone should take Propecia, but, in particular, low or lower testosterone men should be particularly wary. (One could make a case that it is necessary for BPH (enlarged), but there are other alternatives that one discuss with one’s doctor.)  A Low T Guy simply has no buffer to handle decreased hormones and neurotransmitters.

I also am discussing this, because it is quite common on The Peak Testosterone Forum for men to comment that their health went down rapidly in just a few months. Basically, the men in this category feel like they were sucker punched and never knew what hit them. One minute they had a strong libido and high erectile strength and energy.  And a few months later, everything is virtually the opposite – a total struggle. Of course, there can be many reasons for this from gut issues to toxins to the onset of autoimmune disorders, etc. However, I suspect that one of the more common causes of a downward spiral in male health is “post-finasteride syndrome (PFS).

So, if you feel you have issues that stemmed from your use of Propecia (finasteride), then I would recommend that you begin pulling  your basic hormone levels (testosterone, dht, estradiol, prolactin, thyroid, etc.) and find a doctor that can help you get treated and feeling better.  Some PFS men feel better going on TRT (testosterone therapy) for example.  I discuss some other ideas here as well:  Propecia Cures. As you’ll see on that page, men have used a blend of diet, exericse and supplement – sometimes hormones as well – to recover successfully from it.

REFERENCES:

1)  https://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm299754.htm

LDL: How Do You Lower It Naturally? - Peak Testosterone

If you want to control or regress plaque, then in my opinion it is best to stick with the guidelines of the Plaque Regressers, who all require LDL to be below 80 mg/dl.  For more information, you can read my page on Anti-Plaque LDL Levels. Of course, getting below 80 naturally is not the easiest thing in the world, but dropping below 90 is not particularly hard.  My last read was in the upper 80’s for example.

So, to get yourself below 80, should you take a statin?  I don’t think that will be necessary, and the way to avoid doing that is from a combination of lifestyle choices and foods.  Let’s start with the Big Three Ways to Lower Your LDL:

2. Correct Hypothyroidism. Hypothyroidism will drive up LDL levels with a vengeance.   And correcting hypothyroidism with medication can lower LDL by an average of 12.8 mg/dl according to one study. [1] One study even suggested that high cholesterol couple with high normal TSH be considered for thyroid medications just to lower high cholesterol (and, therefore, LDL) levels. [2]

3. Plaque Reversing Diet. I recommend, as a starting point, choosing one of the diets offered up by the Three Plaque Reversers, Drs. Gould, Esselstyn and Davis. Here is quick overview of each and links to their book reviews. In my opinion, every guy over the age of 25 should have all three of these books and should have them just about memorized:

Read these books and choose one of the diets and you’ll see your LDL dropping in no time.  I do want to point out that none of these diets by themselves will probably get you below 80, especially if you are not losing weight.  And this is the reason that all three of the above physicians will use various supplements and/or statins in order to get a man in complaince.

So is there any way to avoid taking a statin then?  I believe so and the answer lies in the foods and supplements below, which can significantly lower cholesterol and LDL.

1. Tomato.  Researchers gave men and women 400 ml of tomato juice and 30 ml of ketchup daily and watched their cholesterol drop by 13%!  [5] Of course, this translated to a nice drop in LDL as well from an average of 94 to 84 mg/dl.  This is particularly important for me, because these were individuals with pretty good LDL levels and yet tomato products still dropped their LDL significantly.  In my case, I would like to drop my LDL by about 10 points and, of course, that is exactly what occurred in this study.

CAUTION:  Some men may be sensitive to consuming a lot of “nightshade” foods.

2. Oat Bran. Many men know that “oats lower cholesterol.”  Multiple studies actually show this, at least in men with high cholesterol.  One study found that giving men just 1 oz (28 g) of oat bran did the following:

“Blood lipid studies demonstrated significantly greater reductions in total cholesterol (average -2.2%) and LDL cholesterol (average -3.9%) in the oat-bran groups than in the wheat-cereal groups.” [3] That’s not bad for a small amount of the bran of one grain, eh? Larger amounts appear to yield even more impressive results.

Another study found that oat bran also decreased the LDL particle count, which is probably your most important lipid number.  Oat bran also lowered LDL particle size – also incredibly important – along with triglycerides and LDL!  Hard to beat that, eh? [10]

Bumping the amount up to 100 gram dropped cholesterol and LDL 13% and 14%, respectively. [6] Again, these were in men and women with high cholesterol, so it’s hard to know how much of a drop someone with lower LDL levels would experience.

It is important to not that this was out bran and not oatmeal.  Oatmeal can spike post-meal blood sugar in some sesnsitive individuals.

3. Raisins.  One study found that a cup of raisins every day dropped LDL-C by 3.5%. [7] The authors explained that there are many ways raisins probalby lower LDL:

“The addition of raisins to the diet may decrease CVD risk, as they contain dietary fiber to lower LDL-C, as well as a significant amount of polyphenols. Raisin polyphenols may interfere with cholesterol absorption, as shown with red wine polyphenols. Raisins and red wine are both derived from grapes; however, the drying process causes loss of polyphenols in raisins. Despite this, there is still a substantial amount of polyphenols on a per weight basis [13]. Raisin polyphenols can potentially decrease plasma TG by reducing apo E, as shown with lyophilized grape powder (LGP) supplementation in women. LGP also decreased VLDL particle secretion from the liver, possibly via MTP inhibition, which would contribute to reduced plasma TG and LDL-C ”

NOTE:  TG = triglycerides; LDL-C = the standard LDL number you are used to.

4. Strawberries. One study, admittedly in mostly women (with Metabolic Syndrome), found that 50 grams of freeze dried strawberries per day reduced LDL by about 12%. [8] This is an impressive drop, because it is the equivalent to about 3 cups of fresh strawberries.

5. Flaxseed.  Just 20 grams of flaxseed reduced LDL by about 4% in patients with high cholesterol. [9] Two recent studies also show that Flaxseed Fights Against Prostate Cancer and Flaxseed Helps Clear Out Your ARteries.. Not bad, eh/

6.  Garlic. Not only does garlic lower LDL, but it keeps it from being oxidized, giving it a double punch in the fight against atherosclerosis. [4] Garlic will also drop your blood pressure and, when combined with Vitamin C, really boost your arterial nitric oxide levels.  What’s not to like?!? (See my page on Garlic and Erectile Dysfunction for more information.)

PLANT-BASED FOODS. If you’ll notice, all of these LDL-lowering foods are plant-based.  I put some of the heavy hitters above, but keep in mind that many plant foods will lower LDL via their fiber, polyphenol and sterol content.

1)  The Journal of Clinical Endocrinology & Metabolism, 2001 Oct, 86(10), “TSH-Controlled l-Thyroxine Therapy Reduces Cholesterol Levels and Clinical Symptoms in Subclinical Hypothyroidism: A Double Blind, Placebo-Controlled Trial (Basel Thyroid Study)”

2) Eur J Endocrinol, Febr 1 1998 138 141-145, “High serum cholesterol levels in persons with ‘high-normal’ TSH levels: should one extend the definition of subclinical hypothyroidism?”

3) The Journal of Family Practice, 1991, 33(6):600-608, “Randomized, controlled, crossover trial of oat bran in hypercholesterolemic subjects.”

4) Am J Clin Nutr, Oct 1981, 34(10:10 2100-2103, “Effect of garlic on blood lipids in patients with coronary heart disease”

5) British Journal of Nutrition, Dec 2007, 98(06):1251-1258, “Tomato juice decreases LDL cholesterol levels and increases LDL resistance to oxidation”

6) Am J Clin Nutr, May 1981, 34(5):824-829, “Oat-bran intake selectively lowers serum low-density lipoprotein cholesterol concentrations of hypercholesterolemic men”

7) Lipids in Health and Disease, 2008, 7:14, “Raisins and additional walking have distinct effects on plasma lipids and inflammatory cytokines”

8) Nutrition Research, Jul 2010, 30(7):462 469, “Strawberries decrease atherosclerotic markers in subjects with metabolic syndrome”

9) Revista Medico-chirurgicala a Societatii de Medici si Naturalisti din Iasi, 2005, 109(3):502-506, “Flaxseed supplementation in hyperlipidemic patients.”

10) Am J Clin Nutr, Aug 2002,76(2):51-358, “High-fiber oat cereal compared with wheat cereal consumption favorably alters LDL-cholesterol subclass and particle numbers in middle-aged and older men”

Vitamin C and Erectile Dysfunction - Peak Testosterone

Sometimes I think Vitamin C should be called the Sex Vitamin. The reason is simple:  it helps in so many ways with bedroom performance, including increasing oxytocin, lowering stress hormones and increasing mood just for starters. However, on this page I want to concentrate on how Vitamin C improves nitric oxide, or the ability of the arteries to dilate and allow more blood to flow.

As we’ll show below, Vitamin C actually excels in these areas, which can best be termed as endothelial function. So what just what does “endothelial” refer to? If you’ve browsed through my site much, you already knows that this refers to damage to the delicate inner lining of your arteries. Classic endothelial dysfunction comes from the typical Western diet and lifestyle that leads to hardening of the arteries and arteriosclerosis. The reason that this is SO critical is that the lining of the arteries are what pumps out nitric oxide. This is critical for heart health, blood pressure control and, yes, erections.

Ascorbic acid improves the endothelial output through five different mechanisms according to one research summary:

“1) decreases in low-density lipoprotein (LDL) oxidation,

2) scavenging of intracellular superoxide,

3) release of NO from circulating or tissue S-nitrosothiols

4) direct reduction of nitrite to NO, and

5) activation of either endothelial NO synthase.” [4]  (A recent study, though, argued against option e. [5])

Now I know these are pretty heady items, but trust me, this is all a beautiful fantasy for us men. And, to make things even better, I would add a couple of other pro-Vitamin C blood flow boosting properties on top of these:

6.  Vitamin C will likely help with maintaining and/or increasing acetylcholine levels, something I talk about in my link on Vitamin C and S-PS (Phosphatidylserine). Acetylcholine is also a vasodilator.  Although it is not quite as potent as nitric oxide, it is important nonetheless for allowing your penile arteries to relax and let blood flow in.

7. Vitamin C (ascorbic acid) “stimulate endothelial nitric oxide (NO) synthesis in a time- and concentration-dependent fashion.” [12] This basically means the more the Vitamin C, the more the nitric oxide.  Woo hoo!

Could this all really be true?  Could such an inexpensive molecule as Vitamin C actually be a significant partner in helping men with their erectile dysfunction by boosting nitric oxide output, lowering blood pressure and increaseing blood flow? The answer is a definitive ‘yes’.

1) https://www.cdc.gov/nchs/data/nhsr/nhsr013.pdf

2) Circulation, 1999, 99:3234-3240, “Long-Term Ascorbic Acid Administration Reverses Endothelial Vasomotor Dysfunction in Patients With Coronary Artery Disease”

3) Circulation, 1996, 93: 1107-1113, “Ascorbic Acid Reverses Endothelial Vasomotor Dysfunction in Patients With Coronary Artery Disease”

4) Free Radic Biol Med, 2000 May 1, 28(9):1421-9, “How does ascorbic acid prevent endothelial dysfunction?”

5) Free Radic Biol Med, 2004 Jan 1;36(1):123-30, “Coronary endothelial dysfunction is not rapidly reversible with ascorbic acid”

6) Am J Physiol Heart Circ Physiol, 2001 Feb, 280(2):H528-34, “Effect of ascorbic acid treatment on conduit vessel endothelial dysfunction in patients with hypertension”

7) J Cardiovasc Pharmacol, 1999 Nov, 34(5):690-3, “Oral vitamin C reduces arterial stiffness and platelet aggregation in humans”

8) American Journal of Hypertension, Apr 2007, 20(4):392 397, “Supplementation With Vitamins C and E Improves Arterial Stiffness and Endothelial Function in Essential Hypertensive Patients”

9) Clin Cardiol, 2002 May, 25(5):219-24, “Vitamin C preserves endothelial function in patients with coronary heart disease after a high-fat meal”

10) Am J Clin Nutr, 2004 Dec, 80(6):1508-20, “Antioxidant vitamins and coronary heart disease risk: a pooled analysis of 9 cohorts”

11) Biological Psychiatry, 15 August 2002, 52(4)371-374, “High-dose ascorbic acid increases intercourse frequency and improves mood: a randomized controlled clinical trial”

12) Journal of Biological Chemistry, 276, 40-47, “L-Ascorbic Acid Potentiates Endothelial Nitric Oxide Synthesis via a Chemical Stabilization of Tetrahydrobiopterin”

Now you may wonder why you have not heard about this?  Well, this research is a relatively new development, coming mostly out of studies in the last 10-15 years  (See below.)  And there is little profit in Vitamin C, so supplement manufacturers are not spending money marketing this fact.  Yet just look at how many categories of men that Vitamin C is likely to help:

1. Men with Heart Disease. One study of men with existing cardiovascular disease, specifically Coronary Artery Disease (CAD), showed a 53% in FMD (flow mediated dilation, the clinical measurement for blood flow) after a single 2 grams dose.  Even better news followed in the second part of the study where they found that long term administration of a mere 500 mg/day led to a sustained 33% increased in blood flow. [2] Vitamin C likely does this by neutralizing the potent free radical superoxide anion that has been implicated in arterial disease.

Yet another study on CAD patients found similarly astonishing results after a 2 g oral dose of Vitamin C:  “ascorbic acid produced marked improvement in dilation (2.0 0.6% to 9.7 2.0%), whereas placebo had no effect (1.1 1.5% to 1.7 1.5%, P=.003).” [3] Of course, 2 grams in one dose is quite high, but patients would very likely get substantial benefit in vasodilation, i.e. opening or relaxing fo the arteries, from even the more common 500 mg dose.

2.  Men with Hypertension. One study on patients with hypertension (clinically high blood pressure) found that a relatively small dose of 500 mg daily lowered blood pressure significantly. [6]  While it is true that the study found no improvement in blood flow, it is notable that Vitamin C helped these patients with what they needed help with – their high blood pressure.   In other words, Vitamin C seems to help with exactly what is needed in men with artery disease and in men with hypertension.

4.  Men Eating High Fat.  One of the rules on The Peak Testosterone Forum is no pushing of high fat diets.  My reasons for this are many, but the primary ones are that high fat meals induce insulin resistance and endothelial dysfunction, the polar opposite of what men need who are coming to my site.  One example of this is a study where researchers gave men a high fat meal (50 grams of fat) and then 2 grams of Vitamin C to try to compensate for the artery-numbing effects of all the blubber then men has just eaten. Amazingly enough, it worked! [9] Am I suggesting that you megadose Vitamin C in order to handle eating a bunch of fat? Of course not as the obvious solution is simply to not consume all that fat in the first place.

Many other conditions from Metabolic Syndrome to intermittant claudication to homocystinuria also show improvements in endothelial dysfunction and/or some related parameters, testifying to Vitamin C’s miraculous ability to “help just where needed.”  For all of the above reasons – endothelial function, lowered blood pressure, decreased arterial stiffness and vasodilation, Vitamin C shoud be a significant help in improving erectile dysfunction as well.  Of course, the question is this:  is there an actual study showing Vitamin C as improving erectile dysfunction similar to the  Well-Documented Erectile Supplements I discuss elsewhere on my site?

So now comes the all-important question:  has Vitamin C been shown in the studies to improve erectile dysfunction directly?  The answer is ‘no’ – at least as far as I know.  So the hard evidence is not there.  However, there are some good signs and research that point vigorously to such a conclusion;

a) Heart Disease Reduction.  One study found a 25% reduction in heart disease when comparing those taking greater than 700 mg/day versus those who took no supplemental Vitamin C.  This is a significant difference for just one vitamin and is more remarkable considering the fact that the authors used a pool of 7 studies to come up with results. [10] Again, anything that improves heart disease is very likely to improve one’s erections and hardness factor.

b) Frequency of Sexual Intercourse. One study of healthy young males found that Vitamin C increased the intercourse frequency.  The dosage was definitely in the megadose range (3 grams/day), but who cares?!?

Finally, Vitamin C very likely protects your arteries not just with shorter term endothelial dysfunction but in the long term as well. Examples of this abound, including the recent discovery that Vitamin C can lower inflammation (C-Reactive Protein) in at risk men. See my link on How to Reduce Inflammation for more information. There are many other properties of Vitamin C that will do the same, including its ability to lower cortisol and boost mood, all documented in The Many Benefits of Vitamin C.

CAUTIONS: Are there any cautions associated with Vitamin C use?  Well, any supplement as studies as Vitamin C is bound to have a few black eyes along the way and discuss those in my link on Are There Risks with Vitamin C?

DOSAGE: As of this writing, I take 1.5 grams of Vitamin C divided in three doses of 500 mg via Ester-C.  (There are now “generic” versions of Ester-C that are less expensive, but Vitamin C is inexpensive to begin with.  This dosage is definitely megadosing, something I normally do not like to do.  However, my justification for this is that humans are one of the only animals that does not make its own Vitamin C and, therefore, it looks like this was a “bad” mutation that severely decreased our levels of this all-important molecule.  Again, though, read my discussion of Vitamin C – Angel or Devil? for the counterargument.

REFERENCES:

Diet & ED - Peak Testosterone

There are basically two reasons to eat a Low Fat (or Ornish) Diet: 1) your penis and 2) your penis. You can probably guess the third reason as well.

The reason I say this is that a typical  High Fat Diet/Low Carb Diet has negative short term AND long term effects on your blood flow.  First, let’s talk about the short term reasons.  Researchers compared for six weeks a Low Carb (or High Fat) Diet versus a Low Fat (or Ornish) Diet.  The study clearly showed less Nitric Oxide and decreased blood flow for the Low Carb (or High Fat) Diet. [4] The lead researcher of this study warned that “the reduced production from the endothelium of nitric oxide, a specific chemical, puts the vessel at higher risk of abnormal thickening, greater clotting potential, and cholesterol deposition, all part of the atherosclerosis process”.  That’s a scienfically polite way of saying that a Atkins Diet will clog your arteries, slow blood flow and make your arteries less elastic, i.e. temporarily hardened.  This, of course, is the antithesis of what you need for a good sex life.  (Read my Why Satured Fat Can Be Bad for Men link for even more details.)

Now this is very bad:  you want lots of Nitric Oxide and lots of blood flow between your legs if you know what I mean!  The typical Low Carb (or High Fat) Diet will not do this for you.  He also warned that the Low Carb (or High Fat) Diet had much less folic acid, which could easily lead to increased homocyteine levels.  (Homocysteine is a leading risk factor for heart disease.)

Besides these short term blood flow and nitric oxide issues are long term issues that will definitely effect your sex life.  First of all, cholesterol levels are directly and almost linearly associated with Erectile Dysfunction. And guess what study after study has shown raises cholesterol?  You got it – saturated fat. And saturated fat is normally the fat associated with most High Fat Diets.

And here is my point:  cholesterol levels are directly and almost linearly associated with Erectile Dysfunction. For example, researchers found that for about every 35-40 points of increase in total cholesterol, there was a 0.38 times increase in erectile dysfunction risk! [1] That makes sense, because many studies have reavealed that men with cholesterol at or below 150 have virtually no heart disease. That this should translate to better erectile function was shown in a study where researchers studied a group of men with erectile dysfunction whose only risk factor was high cholesterol.  These men were given a statin drug and erectile function improved significantly. [2] Furthermore, one study showed that exercise coupled with a low fat diet led to great improved blood flow and that that will do nothing but improve your erections. [3]

Many of you will find drastic improvements in your erectile dysfunction if you’ll just adopt a Low Fat Diet.  For more information, read my links on the The Many Benefits of a Low Fat Diet and https://www.peaktestosterone.com/. Some of you will get almost immediate relief by simply breaking the High Protein and High Saturated Fat habit.

High Protein and High Saturated Fat usually go hand in hand due to meat and dairy consumption. High Protein diets have now been implicated as well, decreasing blood flow in a recent study.Furthermore, the authors pointed out that “fibrinogen, Lp (a), and C-RP increased by an average of 14%, 106%, and 61% respectively”. [5] This is a one way ticket to heart and penis problems – avoid it like the plague. Also, remember that saturated fat raises your cholesterol and literally hardens your arteries temporarily.  I know that high saturated fat diets are the rage right now, but for most guys, this is nuthin’ but trouble for their sex life.  We know many guys who after a week on a plant-based diet cured their erection problems. If you just gotta have fat, use olive oil or have a few almonds and walnuts.

NOTE: Don’t believe the bad press that is floating around the web: read about How Incredibly Healthy Grains Are for you.

REFERENCES:

1) Am J Epidemiol 1994;140:930 7

2) J of Urology,2004,172(1)255-258

33) Circulation, 1995, 92:197-204

4) Hypertension 2008; 51: 376-82

5) Angiology, 2000, 51(10):817-826

Triglycerides: How to decrease Them Naturally.

Ready to control and/or reverse arterial plaque? I hope that is the case, because doing so will greatly improve your cardiovascular health and erectile strength.  As those arteries, arterioloes and capillaries begin to fill up with plaque and the entire body and brain calicifes, it gets ugly very fast.  Some of the lesser known issues showing up in the research related to atherosclerosis are Alzheimer’s and Parkinson’s, which appear to be partially related to the calcification of the brain.

Research by Dr. Gould has shown us that there are two primary factors leading to the buildup of arterial plaque:  [1]

a) Fasting cholesterol levels. These are the lipid numbers that you typically pull when get them pulled first thing in the morning after fasting for 12 hours.

b) The Post-Meal Lipid Surge.  This is basically the sudden increase in triglycerides and cholesterol that occur after you eat.

Now I have already covered ways to naturally lower your fasting cholesterol in my page on How to Lower LDL Naturally (Without Statins), so you can read that if you are interested. On this page I will discuss ways to clean up the other side of the house, i.e. quenching baseline and  post-meal triglycerides.  Realize that triglycerides are most related to refined carbs.  Wheat, white rice and many processed foods are notorious for increasing triglycerides.

Researchers found the most natural way to lower the triglyceride portion of the lipid wave that occurs after eating (besides avoiding refined carbs of course) is post-meal low intensity exercise.  A recent study found that if you simply walked for a short period of time after a meal – details are below – that triglycerides dropped from 172 to 131 mg/dl!  That’s a huge 24% drop just by doing a very simple activity. [3]  And this solution is rather obvious if you stop and think about it:   the typical day of those in our ancestral past included lots of low intensity exericse, the majority of which was walking.  This is the foundation that our physiologies were built on.  In fact, I would make the argument that the supplements that we use to pull down triglycerides are simply crutches to hide our unnaturally sedentary lifestyles.

Now keep in mind that these participants were put on a high fat diet to skew their lipid results, so if you have lower triglyceride levels, you will probably not get that big of a drop.  However, even if your triglyceride levels are significantly lower, you still need to shave off that surging wave of lipids coursing through your arteries after you eat.

How to Decrease the Post-Meal Triclyceride Surge

a) Exercise was 1 hour after the meal.

b) Walk at low intensity, which is definied as brisk walking.  Low intensity does not mean slow walking by the way:  you need to keep up a decent pace to meet this requirement.

c) Walk for 2 km = 1.24 miles, which is about 16-19 minutes for most of us

What is more simple than walking or doing about 15 minutes of exercise 2 or 3 times per day, ideally about an hour after eating?  Furthermore, I am sure that you do not have to go walking.  You can run into a room and do a treadmill / stationary bike, or work out with some dumbells or resistance bands.  The point is that you just need to fire up your metabolism and utilitize your muscles for a short period of time.<

The rewards for doing this are huge:  arteries that are clean and clear of plaque.  (You also need a proper diet of course!) And you get another huge benefit:  restored endothelial function.  Endothelial function is a scientific way of saying that your blood vessels and arteries can relax and increase blood flow.  This is absolutely critical for erectile function and heart health.

Here is what this study on endothelial actually found:

Again, you’ve got to get up and move!  It doesn’t matter than much how or why – just that you do it.

How to Decrease BaselineTriclycerides via Diet and Exercise

Another way to indirectly help the post-meal triglyceride is via lowering your baseline triglyceride levels.  In other words, if you have a post-meal surge, at least you are starting from a lower point. Here are some natural ways to pull that off:

1. Lose Weight.  Weight loss resutls in a reduction of baseline triglyceride levels, as well as a lowering baseline cholesterol levels.  The rule on the latter is about a point reduction for each pound of weight lost. [5]

2. Exercise (60 min).  One study showed ~20% reductions in baseline triglycerides for those doing a kind of cross training (weight + endurance exercse) or just endurance alone. [6] The participants in this study were sedentary adults, so, obviously, a more healthy individual will probably not experience as large of a reduction.  But the point is that you can very significantly reduce triglycerides using longer term exercise:  the endurance portion was 60 minutes at a low medium intensity.  However, participants only did this three times per week.  (I would recommend an hour per day of moderate exercise however.)

Also, this study seemed to indicate that it was endurance training that was responsible for most of the decrease in triglycerides.  However, another study on sedentary adults showed similar drops in those who were only using weight training. [7] Again, the point is to exercise for probably somewhere around an hour at least three times per week (with overtraining)

3. Drop the High Glycemic Carbs.  Many men think that all carbs raise triglycerides.  As metnioned above, the truth is that it is only refined carbs, such as wheat, white rice, etc., that significantly raise triglyceride levels.  Low glycemic carbohdrates, such as beans, lentils, vegetables, etc., have a marginal impact.  Therefore, there is no reason not to eat good carbs, but every reason to be cautious about processed foods.

4. Flaxseed.  Reportedly flaxseed can produce a nice drop in triglycerides.  Animal studies certainly back this up. [9]

.

Other Ways to Decrease Triclycerides with Supplements levels.

i) Niacin. A common methodology – and one of the pillars’s of Dr. Davis’ methodology – is megadosed Niacin.  This is best done under a physicians supervision as liver function shoud be tested and side effects evaluated.  It results are impressive:  a solid lowering of triglycerides and increase in HDL. Long term effects are unknown.

ii) Pantethine (Downstream of Vitamin B5).  900 mg is usually taken and this supplement has the remarkable ability to raise HDL, lower triglcyerides and lower LDL:  it does everything one could hope for.  However, this also appears to be using non-physiological dosages.  The adult male RDA for pantothenic acid, which is the standard form of Vitamin B5, is just 5 mg and pantethine is downstream of it.  Although pantethine is composed of two molecules of pantothenic aicd and a cysteamine molecule, i.e. is a heavier molecule, and thus 900 mg is still undoubtedly a non-physiological dose. However, it has been used in Japan and Europe as a choesterol-lowering medication actually and so it does have some history of safety. [2].  From what I understand, side effects are virtually non-existent.  However, long term effects are unknown.

iii) Fish Oil.  Fish oil can lower triglycerides by up to 30% in diabetics and by a significant amount in prediabetics, which includes a high percentage of men reading this. [8]

CAUTION:  If you have any medical conditions or are on any medications, discuss with your physician first.

REFERENCES:

1)  Heal Your Heart, Dr. K. Lance Gould, p. 59.

2) https://lpi.oregonstate.edu/mic/vitamins/pantothenic-acid#ref14

3) Med Sci Sports Exerc, 2013 Feb, 45(2):245-52, “Combined light exercise after meal intake suppresses postprandial serum triglyceride.

4) https://news.indiana.edu/releases/iu/2014/09/slow-walking-sitting-study.shtml

5) Metabolism, Feb 1997, 46(2):217 223, “Effect of prolonged exercise training without weight loss on high-density lipoprotein metabolism in overweight men”

6) Medicine & Science in Sports & Exercise, Sep 1997, 29(9):1170-1175, “Effects of cross-training on markers of insulin resistance/hyperinsulinemia”

7) JAMA, 1984, 252:504-506, “Changes in Lipid and Lipoprotein Levels After Weight Training”

8) Diabetes Care, Apr 98, 21, “Fish Oil and Glycemic Control in Diabetes: A meta-analysis”

9) The Journal of Nutritional Biochemistry, Nov 2002, 13(11):684 689, “Differential effects of dietary flaxseed protein and soy protein on plasma triglyceride and uric acid levels in animal models”

Tests Before HRT - Peak Testosterone

Below is a list of the tests that I would request or do myself if I had it to do all over again. For those who don’t know, you can pull many of your own tests if you live in the U.S. or other countries that have more medical freedom and I list them here on this page: Self-Testing Testosterone Labs.

1. Detailed Thyroid Exam. Not only does hypothyroidism produce symptoms similar to low testosterone, but it also lowers testosterone, something I cover in my page on Testosterone and the Thyroid. Furthermore, hypothyroidism is quite common and can take out the libido and erectile strength of even younger men. So this is a no-brainer in my opinion and should really be done, in my humble opinion, at every annual or well-being check (if a guy has hypothyroid symptoms of course). But, hey, no one asked me!  The big problem is that money is so tight right now that physicians are reluctant to pull all the tests that you really need to check for hypothyroidism (TSH, T4, T3, free T4, free T3, rT3, antibodies, etc.).

2. Prolactin. One of the big mysteries in my mind is the fact that most physicians do not immediately pull prolactin when a man is diagnosed as hypogonadal. Elevated prolactin is a surprisingly common cause of low testosterone and, to get to the root, you’ve got to find the root cause, eh?  I cover this issue in my page called Testosterone, Prolactin and Prolactinomas. And some of the symptoms overlap with classic hypogonadism, especially lowered libido. This is an obvious case, where if you don’t correct the underlying problem, you are really swimming upstream.

3. Zinc Deficiency. Although I have seen this only once on the forum, correcting a deficiency in this all important nutrient and mineral can lead to tremendous increases in testosterone, something I cover in detail in my page Testosterone and a Zinc Deficiency. How do you know if you are deficient? I plan on doing a page on this soon, but one fairly common way now is to use one of the “Zinc Taste Tests” out there.

4. Varicocele. Varicoceles are very common and are essentially a cluster of varicose veins that affect the testicle(s).  They can, among other things, lower testosterone.  Correcting a varicocele is done through a relatively simple urological procedure, but, of course, discuss risks and rewards with your doc. Men on the Peak Testosterone Forum have reported just plain feeling better after the procedure, improved sleep and increased testosterone.  See my page on Varicoceles and Testosterone for more information.

5. Sleep Disorders. Does your wife or girlfriend insist that you snore? Do you have restless legs at night or wake up gasping for air? Or are you just depriving yourself of sleep? If so, a significant body of research shows that you could be lowering your testosterone and raising your insulin and inflammation. See my pages Sleep and Testosterone and Apnea and Testosterone for more information. There are apps for your phone and oximeters that you can do at home to give you a rough idea, but the gold standard is a sleep study. Often insurance will pay for it.

7. High or Low Cortisol. Of course, stress in modern life is inevitable.  Can you say career, mortgages, relationships, sick family members and car problems?.  Some men walk around in a constant state of anxiety almost full time.  And many men fall into ruminative (repeating the same thing over and over) thinking.  All of these can raise levels of cortisol and other stress hormones such as adrenaline and noradrenaline.  Cortisol can also dampen serotonin, which only makes matters worse.  And the stress hormone noradrenaline literally puts the brakes on erections, so that you don’t battle priapism.  However, too much can keep you from a decent erection at any time.

Lifestyle issues can contribute to problems as well. For example, many men do not realize that low carb diets work by raising stress hormone levels.  Some guys can handle the elevated stress hormone levels than others.  Infections, overtraining and illness can also do it.  For natural ways to handle this, see my Summary Page on Stress and Cortisol Management. Is it important also to monitor yourself and the typical way to do that is with a 3 or 4 point cortisol test, i.e. take your cortisol reads at 3-4 different times of the day. If your doc will not test you, you can do it at my of these Testosterone Labs.

8.  Overtraining. Unfortunately, a big percentage of guys that exercise overtrain.  In fact, this is the only way they know how to train.  I remember one guy I met who despised the word “jogging.”  He said, “I run.  I don’t jog.”  And how many guys go into a gym and throw on 20 more pounds than they can really lift?  Added to that is the fact that we are taught to ignore pain and many of the workout videos emphasize very brutal workouts.  The end of the story is that many guys drive themselves into a hormonal ditch.  You can only whip a horse so long before it gives out.  There are many signs of overtraining and things like recovery pulses, disturbed sleep, mental fog, frequent upper respiratory infections, etc.  Of course, the solution is moderate exercise with a lower pulse rate until you are completely recovered.

9.  PSA. The PSA test is controversial and that is because it can increase from prostate cancer, prostatitis / inflammation and also BPH (enlarged prostate). In my opinion, it is still a valuable test and most endocrinological guidelines insist that a PSA be taken and monitored for men on HRT (TRT). When you go on HRT, your prostate size will increase a little (due to the increased DHT) and thus your PSA may rise a little. However, this change is usually small. Because the PSA test is now so cheap, I think it’s a good idea to pull it before and after.

10.  DHEA. HRT (TRT) can lower DHEA in some men and so I think it is a good idea to take a read before you start HRT beforehand so that you can monitor the actual change that occurred.

MISCELLANEOUS TESTS: Other tests of interest could be DHT, SHBG, estradiol, blood pressure, PSA and hematocrit / hemoglobin.  These are all effected by testosterone and so it’s nice to know the net change that is produced oftentimes.

NOTE: There are also some rather major reasons – things like genetic disorders as an example – for hypogonadism and I cover those in my page Major Causes for Low Testosterone.  You might also browse through those and discuss with your physician if appropriate.

Overtraining: Destroying Testosterone level with Enthusiasm

A low testosterone guy needs to be careful about his training program: study after study has shown that overtraining significantly reduces testosterone levels for 1-4 days afterward! And, by the way, it doesn t matter whether it’s endurance or weight training the downward effect on testosterone levels is the same.

Then why do the bodybuilding and exercise magazines say that testosterone is increased with intense exercise? Many studies have shown that after intense exercise, testosterone levels are elevated for about an hour. Both weight lifting and endurance exercise like running and biking will produce this phenomenon. What the mags don t mention is that this effect is due almost entirely due to “hemoconcentration” and “decreased clearance” which is a polite way of telling you that the increase in testosterone is NOT coming from your testes (or adrenal glands).

Now it is important to note that Weight Training Can Boost Testosterone in the long term if done correctly.  In addition, there are other GREAT reasons to exercise, such as dramatically improving your erectile strength and rebuilding your brain. For details, see this Sexercise link.

However, many of us males have to admit that we often overdo things and overtraining is a prime example.  And what many men do not realize is that some research shows that overtraining can do the following:

a) Lower testosterone

b) Raise cortisol

c) Decrease the testosterone-to-cortisol ratio

Now not all studies show this, but some do and let me cover a few of them below:

1.  Rugby Players. One study on rugby players took testosterone reads and compared them with questionnaires filled out by the players.  What they found was that overtraining synptoms correlated nicely with total testosterone levels.  How much did overtraining lower testosterone in these athletes?  Well, if you look at the data points, about a fourth of the players that were significantly into the overtraining zone had drops in testosterone of 20-30%.

However, the most important stats were probably in an athlete on the very end of the spectrum, whose questionnaire showed him to be the most overtrained.  His testosterone was about half of his previous level, a very significant drop obviously. The authors concluded that “the questionnaire may be a useful tool for screening subjects at risk of overtraining. Testosterone concentration is influenced by tiredness, and is therefore a valid marker of tiredness.” [10]

2. Elite Basketball Players. One study found that there was an actual cutoff in game playing time that could generally be associated with hornonal disruptions:

“Players who played between 13 and 25 minutes per game showed the highest values of TT (22.8 6.9 nmol L-1) and TT/C (47.1 21.2). March and April showed the most catabolic or stressed hormonal state (low TT/C values and high ones of cortisol) and that is necessary to take into account according to PT (>25-minute per game) and specific playing position. Monitoring plasma TT and cortisol is recommended to prevent excessive stress caused by professional basketball season requirements.” [8]

3. Elite Football Players. This also used a questionnaire with elite athletes and found that morning testosterone was associated with the training syndrome:

“The results of data analyses showed that the overtraining score from questionnaire correlates with cortisol concentration at 8,11 am and mean cortisol concentration on rest day respectively (r=0.71, r=0.62, r=0.61; p 0.01), testosterone concentration at 8 am (r=0.42; p=0.05) and testosterone/cortisol ratio at 8 am (r=-0.42; p 0.05). Result show that, the questionnaire may be a useful tool for monitoring and preventing of overtraining syndrome.” [9]

NOTE:  If you know someone who may be overtraining, check out my page on The Best Signs of Overtraining.

Several recent studies have come out showing that overly intense exercise whacks your bodies ability to fight colds and infections.  [1]  This is bad for many reason, but especially because it is self-defeating.  One cold or flu can keep us out of the gym for a week or longer.

One study on rats found that overexercise slammed immunoglobulin-A. [5]  And another researcher pointed out that overtraining can lead to “reduced catecholamine excretion, frequent illness, disturbed sleep and alterations in mood state… decreases in neutrophil function, serum and salivary immunoglobulin concentrations and natural killer cell number and possibly cytotoxic activity in peripheral blood”. [6] Some have even speculated that chronic overtraining and the ensuing compromised immune system could lead to cancer. This is nasty, scary stuff!

Overtraining will, by the way, likely whack your sperm count while it’s at it.  Spanish researchers found that sperm levels went down by 50% on young, healthy cyclers. [2]  (It took three days for sperm levels to return to normal levels.) No telling what it does to us “more mature” guys!

Intense training has even been found to affect the liver in healthy men!  Researchers found abnormally elevated levels of many critical liver proteins. [3] Of course, that’s not to say that intense exercise will kill you, but it does point out that intense exercise stresses the body in ways that we do not even understand yet.  I also mention it because if you are on HRT, they should test liver function.  If you get an abnormal reading, you may want to go easy on the workouts and get retested. They recently found that, at least in women, moderate levels of exercise were helpful for long term memory and cognition, but strenuous, long term exercise (such as marathons) were actually damaging to long term memory! [3] Of course, it could be some unknown factor in these women’s lifestyle, but the odds are that elevated cortisol is wreaking its usual havoc on the brain in this case.

If you want to do intense workouts, I highly recommend SLOWLY building up.  Personally, I have found that the key (for me) is to start with a moderate workout and then slowly increase the intensity as the weeks go by.  This gradual pattern does not seem to disturb my testosterone levels or libido.

ATHLETES:  Overtraining can seriously affect performance.  Researchers have identified several short term key markers that result from overtraining, including “impaired anaerobic lactic acid performance and a reduced time to exhaustion”. [7] The same study discusses many other soon-to-follow issues including problems with uric acid levels, ammonia, creatine kinase, free testosterone/cortisol, growth hormone and so on. More subjective issues include excessively sore muscles and sleep and mood disorders.  Again, overtraining is real and leads to real physiological issues.

REFERENCES:

1) Jour Appl Physio, 2007, 103:693-99

2) JAMA. 2006;296:2307

3) British J Clin Pharm,2008, 65:253-259

4) Alzheimer’s Association 2009 International Conference on Alzheimer’s Disease, Vienna, Austria, July 11-16, 2009. Mary C. Tierney

5) Scandanavian J Med Sci Sports, 2008, 18:367-372

6) Immunology and Cell Biology (2000) 78, 502 509; “Overtraining effects on immunity and performance in athletes”, Laurel T MacKinnon

7) Sports Medicine, Feb 1 2002, 32(2):95-102, “Diagnosis of Overtraining: What Tools do We Have?”

8) Journal of Strength & Conditioning Research, February 2015, 29(2):368 378, “Using Testosterone and Cortisol as Biomarker for Training Individualization in Elite Basketball: A 4-Year Follow-up Study”

9) FALL 2009 , Volume 17 , 3(47):127 To 137, “Paper: THE RELATIONSHIP BETWEEN SALIVARY TESTOSTERONE AND CORTISOL CONCENTRATIONS WITH PSYCHOLOGICAL OVERTRAINING SYMPTOMS IN ELITE FOOTBALL PLAYERS”

10) Br J Sports Med, 2004, 38:260-263, “Salivary testosterone and cortisol in rugby players: correlation with psychological overtraining items”

Other Ways That Overtraining May Lower Testosterone in the Long Run

When Does Testosterone Cypionate Peak? - Peak Testosterone

The answer was (likely) given in a study of 9 Japanese men who were put on 125 mg of testosterone enanthate. [1] For those who don’t know, testosterone enanthate has a very similar dosage and half-life profile to cypionate and so the results from the enanthate study will apply to cypionate as well.  The testosterone levels posted by this study are very revealing: **

**NOTE:  These are estimates based on my read of a chart within the study.

Notice also that the peak does seem to occur on day 1 and steadily decline a bit for a few days after. However, you’ll notice that day 5, for no apparent reason, shoots back up to the peak or very close. (Day 6 and beyond are much lower – something I discuss in my page Should Testosterone Cypionate Be Taken Weekly or Every Two Weeks?)

The reason for this could also be that some guys are peaking on day 1 and some on day 2 and some on day 3.  Regardless, I think the key thing to notice is that the testosterone values were all within about 15% of each other for the first four days and, therefore, you are unlikely to experience any substantial difference during those days.  This is especially true when you consider the fact that the average young male experiences a diurnal (daily) cycle of about 35% from morning to evening testosterone levels. (See my page on The Daily Cycles of Testosterone for more information.)

Another point worth making is that day 5 shows the variability currently inherent in testosterone testing.  Unfortunately, it is simply not that exact and depends on many factors.  Cornell urologists recently outspokenly criticized the lack of standardization and consistency in lab testing:

“Despite advances in technology, inconsistent laboratory practices, among other issues, leads to unreliable blood test results. “In some cases, testosterone (T) levels, tested on the same day from a blood sample taken from a single patient, differed by as much 30 percent from one lab to the next,” says the study’s lead author, Dr. Paduch, a urologist and male sexual medicine specialist at NewYork-Presbyterian/Weill Cornell Medical Center and associate professor of urology and reproductive medicine at Weill Cornell Medical College.” [2]

If you’ll notice, the above underscores yet another reason to rely on symptoms as much as lab results!

The maximum level that I have seen at least – at least from what I have seen with most HRT clinics – is to not go over about 1200 ng/dl.  This is considered the highest “physiological” level that you’d see in a healthy, young male.

Of course, to find your trough total testosterone, you simply get a lab read on the day you go in for your injection.  However, if you want to find your maximum testosterone, do you test on day 1, 2, 3 or 4?

My answer, based on the above, is that it probably does not matter.  Basically, if you look at the data above, the day 1-4 values are all within the range of the typical lab’s accuracy anyway.  So there simply is no need to stress out over it and you can likely get a read on day 1-3 and be just fine.

CAUTION: There is an exception to this.  Men with low SHBG often “clear out” hormones notoriously rapidly from what I have seen.  So if you are a Low SHBG Man, then you may probably want to test on day one. Low SHBG is SHBG < ~15. Talk to your doc, of course, and get his/her practical experience (assuming they even know anything about the subject).

REFERENCES:

1)  Endocrine J, 2006, 53(3):305-310, “Hormone Profiles after Intrasmuscular Injection of Testosterone Enanthate in Patients with Hypogonadism”, https://www.jstage.jst.go.jp/article/endocrj/53/3/53_3_305/_pdf

2) https://weill.cornell.edu/news/pr/2014/03/study-calls-for-standardization-in-measuring-testosterone-levels.html

DHT (Dihyrdotestosterone) and Zinc - Peak Testosterone

In my link on Zinc and Testosterone, I cover the controversial and often contradictory results relating zinc to testosterone. I don’t think that anyone has any doubts that a zinc deficiency is going to be helpful to testosterone levels, but the studies just aren’t there showing zinc as a testosterone booster. What about zinc and DHT (dihydrotestosterone)? Of course, DHT is the “other androgen” and is involved in many “male” function including libido. Does taking zinc raise DHT even though it has lackluster results with resepect to T?

One study on infertile men indicates that that may be the case. [1] In this (small) study, they split the men up into two groups:  a lower T group with total testosterone < 480 ng/dl and a higher T group with testosterone > 480 ng/dl.  What they found was interesting:

1.  Testosterone, sperm count and DHT were increased by zinc in the under 480 ng/dl cohort.

2.  Testosterone and sperm count were not increased but DHT was increased by zinc in the over 480 ng/dl cohort.

Of course, what is noticeable is that in both groups zinc increased DHT.  Keep in mind, though, that this is just one small study on specific subpopulation. Also, isn’t it interesting that the lower testosterone group increased in testosterone.  Perhaps this explains some of the discrepancies we have seen in the testosterone-zinc studies?

Unfortunately, the situation is probably a bit more complicated than just that.  One study indicates that the amount of zinc is very critical.  At lower levels, 5-alpha-reductase activity is increased, which means that more testosterone would be converted to DHT and at higher levels the opposite was true. [2] Yet another study showed that, if you went high enough with zinc, it completely shut down 5-alpha-reductase activity.

Also, keep in mind that, if your DHT is low, creatine has been shown to increase DHT in one study.  You can read about this in my link on the Potential Risks of Creatine. Finally, remember that raising your DHT if you already have solid levels could potentially lead to side effects such as hair loss.  Again, testing and monitoring is always a great idea when using supplements.  Read my link on Zinc Dangers for important cautions with regard to zinc use:  more is NOT always better with zinc.

REFERENCES:

1) Systems Biology in Reproductive Medicine, 1981, 7(1):69-73, “Effect of Zinc Administration on Plasma Testosterone, Dihydrotestosterone, and Sperm Count”

2) J Steroid Biochem, 1984 Feb,20(2):651-5, “The effect of zinc on the 5 alpha-reduction of testosterone by the hyperplastic human prostate gland”

3) Br J Dermatol, 1988 Nov, 119(5):627-32, “Inhibition of 5 alpha-reductase activity in human skin by zinc and azelaic acid”

What Are Normal Testosterone Levels For Your Age? - Peaktestosterone

1) Are my testosterone levels normal for a male?

2) What should male testosterone levels be?

Well, normal is relative as we all know. But, even so, we can come up with some solid guidelines that will help you know where you stand.

CONVERSION FACTORS: On this page I am only talking about total testosterone and in all cases I use values given in ng/dl. If you want to convert to, say, nmol/l, you must use a conversion factor of 29.4 or .034 going the other direction. Yes, that high school chemistry may pay off for you if you re from a country or reading a journal article that uses moles. If you are interested in normal free testosterone levels, please see this link on Free Testosterone.

So the normal testosterone pain threshold is about 500, depending on a male s age and history. (Below 400 is almost always a free pass to hormonal hell.) That is why I am so disgusted with the medical profession when they tell one of my fellow male brothers that a total testosterone level of 290 is fine and normal. (Please read my link on Testosterone Symptoms if you do not know how dangerous low testosterone levels are to your health.)

That said, I want to make several important points about male testosterone levels and lab readings. First of all, you should keep in mind that it s unwise to go by one reading, because your testosterone fluctuates considerably from week to week and even from day to day. Stress, lack of sleep and many other things that are a normal part of life for us males see my link Common Things That Lower Testosterone can whack testosterone levels. It is entirely possible, for example, for your testosterone to be 400 one week and 525 the next. Lifestyle issues can whack even normal testosterone 20-30% or more.

You should also try to get your testosterone levels read in the morning if at all possible. Male testosterone levels peak in the morning and then steadily decline until late evening. This decline from am to pm is, on average, about 35% for most younger guys and about 10% for seniors. (See my link on Daily Testosterone for more information.)

In addition, it s worth pointing out that labs aren t perfect either. I had one testosterone reading that was three times any previous reading that I had ever received! Of course, there is no reasonable explanation for that reading and it was surely an outlier from normal as they say in the stats world.

All cautions aside, though, we can come to some conclusions and you can assess your testosterone levels against the average for males. For example, there was a 1999 study that examined 4,393 men between the ages of 32 and 44 and found that their average testosterone level (at 8 a.m.) was 679 ng/dl. [1] It should be noted that in this study the men with testosterone levels slightly above 800 were 42% and 72% less likely to have high blood pressure and a heart attack, respectively, than those with testosterone a little less than 400. Again, solid testosterone is good for you!

So if you put these studies together you can start to get a good picture of reasonable values by age.  Studies have found that total testosterone levels decrease, in the average male, by about 1.0-1.2% per year and free testosterone by about 1.2-1.3% per year. This decline, by the way, is normal and a part of aging the great majority of us guys.  What you don’t want is to venture significantly below these normal numbers – low testosterone is “nuthin’ but trouble” for us males.

Did you know you can inexpensively do your own testing for most hormones? The industry leader is Discounted Labs..

NOTE ABOUT EXCITOTOXINS: Some researchers, suspecting excitotoxin damage, have shown evidence of rates greater than this in the last two decades.  Read here for evidence of Rapid Excitoxin Damage and my link on Testosterone and Excitotoxins as well.

Even so, let me throw out an “average” testosterone level table by age to start out with simply by starting with a peak of 700 and decreasing by 50 ng/dl each decade:

As a verification, one can look at this link and find a normal or average testosterone level chart by age. [3]

If you do enough research, you will find other similar results and average values can indeed get a good feel for the age-related decline in testosterone levels.

Now let’s jump to some important points when comparing your numbers to these kind of average or “normal” male testosterone levels.  First of all, you must remember not to panic if your testosterone is a little below what is given above.  For example, there are many guys with testosterone in the 400’s that are doing great with solid libido, erections and heart health.  In fact, guys like this probably have no idea that their testosterone is below “normal” and are doing just fine.

Although let me jump in and say that many young guys have written in that are struggling with testosterone levels in the 400’s as I mentioned.  Young males seem to be particularly sensitive or perhaps it’s the relative value compared to age that really counts.  Regardless, I have known several younger guys who have reported dramatically improved erections and libido when given supplemental testosterone even though they were in the 400’s and were supposely “normal”. (Giving young men TRT is a questionable practice, however, and some doctors will not do it but will instead use alternative therapies that we discuss elsewhere in this book.)

So if your testosterone level is below average, regardless of whether you as a male are experiencing classic Low Testosterone Symptoms, , you may want to natural methods, dietary and lifestyle factors, that can naturally boost. I cover many dietary and lifestyle factors on my site that can naturally boost testosterone.  Read this link, for example, on How to Boost Your Testosterone Naturally.  And, yes, that even includes Sex! It may be possible to boost your testosterone levels 20-40%, and possibly get them into the normal and acceptable range, simply by changing certain lifestyle factors.

1. J of Behavioral Med, 1999, 22(1):1-19

2. J of Clin Endocrinology Metabolism, 2007, 92(1):196-202

3. Vermeulen A. Declining androgens with age – an overview, In: Androgens and the ageing male. Eds. Oddens B. Vermeulen A. Parthenon Publishing. New York. 1996

1) Are my testosterone levels normal for a male?

2) What should male testosterone levels be?

Well, normal is relative as we all know. But, even so, we can come up with some solid guidelines that will help you know where you stand.

CONVERSION FACTORS: On this page I am only talking about total testosterone and in all cases I use values given in ng/dl. If you want to convert to, say, nmol/l, you must use a conversion factor of 29.4 or .034 going the other direction. Yes, that high school chemistry may pay off for you if you re from a country or reading a journal article that uses moles. If you are interested in normal free testosterone levels, please see this link on Free Testosterone.

So the normal testosterone pain threshold is about 500, depending on a male s age and history. (Below 400 is almost always a free pass to hormonal hell.) That is why I am so disgusted with the medical profession when they tell one of my fellow male brothers that a total testosterone level of 290 is fine and normal. (Please read my link on Testosterone Symptoms if you do not know how dangerous low testosterone levels are to your health.)

That said, I want to make several important points about male testosterone levels and lab readings. First of all, you should keep in mind that it s unwise to go by one reading, because your testosterone fluctuates considerably from week to week and even from day to day. Stress, lack of sleep and many other things that are a normal part of life for us males see my link Common Things That Lower Testosterone can whack testosterone levels. It is entirely possible, for example, for your testosterone to be 400 one week and 525 the next. Lifestyle issues can whack even normal testosterone 20-30% or more.

You should also try to get your testosterone levels read in the morning if at all possible. Male testosterone levels peak in the morning and then steadily decline until late evening. This decline from am to pm is, on average, about 35% for most younger guys and about 10% for seniors. (See my link on Daily Testosterone for more information.)

In addition, it s worth pointing out that labs aren t perfect either. I had one testosterone reading that was three times any previous reading that I had ever received! Of course, there is no reasonable explanation for that reading and it was surely an outlier from normal as they say in the stats world.

All cautions aside, though, we can come to some conclusions and you can assess your testosterone levels against the average for males. For example, there was a 1999 study that examined 4,393 men between the ages of 32 and 44 and found that their average testosterone level (at 8 a.m.) was 679 ng/dl. [1] It should be noted that in this study the men with testosterone levels slightly above 800 were 42% and 72% less likely to have high blood pressure and a heart attack, respectively, than those with testosterone a little less than 400. Again, solid testosterone is good for you!

So if you put these studies together you can start to get a good picture of reasonable values by age.  Studies have found that total testosterone levels decrease, in the average male, by about 1.0-1.2% per year and free testosterone by about 1.2-1.3% per year. This decline, by the way, is normal and a part of aging the great majority of us guys.  What you don’t want is to venture significantly below these normal numbers – low testosterone is “nuthin’ but trouble” for us males.

Did you know you can inexpensively do your own testing for most hormones? The industry leader is Discounted Labs..

NOTE ABOUT EXCITOTOXINS: Some researchers, suspecting excitotoxin damage, have shown evidence of rates greater than this in the last two decades.  Read here for evidence of Rapid Excitoxin Damage and my link on Testosterone and Excitotoxins as well.

Even so, let me throw out an “average” testosterone level table by age to start out with simply by starting with a peak of 700 and decreasing by 50 ng/dl each decade:

As a verification, one can look at this link and find a normal or average testosterone level chart by age. [3]

If you do enough research, you will find other similar results and average values can indeed get a good feel for the age-related decline in testosterone levels.

Now let’s jump to some important points when comparing your numbers to these kind of average or “normal” male testosterone levels.  First of all, you must remember not to panic if your testosterone is a little below what is given above.  For example, there are many guys with testosterone in the 400’s that are doing great with solid libido, erections and heart health.  In fact, guys like this probably have no idea that their testosterone is below “normal” and are doing just fine.

Although let me jump in and say that many young guys have written in that are struggling with testosterone levels in the 400’s as I mentioned.  Young males seem to be particularly sensitive or perhaps it’s the relative value compared to age that really counts.  Regardless, I have known several younger guys who have reported dramatically improved erections and libido when given supplemental testosterone even though they were in the 400’s and were supposely “normal”. (Giving young men TRT is a questionable practice, however, and some doctors will not do it but will instead use alternative therapies that we discuss elsewhere in this book.)

So if your testosterone level is below average, regardless of whether you as a male are experiencing classic Low Testosterone Symptoms, , you may want to natural methods, dietary and lifestyle factors, that can naturally boost. I cover many dietary and lifestyle factors on my site that can naturally boost testosterone.  Read this link, for example, on How to Boost Your Testosterone Naturally.  And, yes, that even includes Sex! It may be possible to boost your testosterone levels 20-40%, and possibly get them into the normal and acceptable range, simply by changing certain lifestyle factors.

1. J of Behavioral Med, 1999, 22(1):1-19

2. J of Clin Endocrinology Metabolism, 2007, 92(1):196-202

3. Vermeulen A. Declining androgens with age – an overview, In: Androgens and the ageing male. Eds. Oddens B. Vermeulen A. Parthenon Publishing. New York. 1996

Prozac (Fluoxetine): Prolactin Increaser In Some Men - Peak Testosterone

Depression is one of the largest health issues in the U.S.  The CDC estimates the prevalence at about 10% of the general population. [1] (The rate is even higher in middle-aged adults.)  Of course, it will come as no surprise, then, that antidepressant medication usage is also at an all-time here as well.  A 2011 Harvard Health newsletter reported back in 2011 that:

“14% of non-Hispanic white people take antidepressants compared with just 4% of non-Hispanic blacks and 3% of Mexican Americans” [2]

As a side note, an amazing stat from the same newsletter was that almost one in four American women in their 40’s and 50’s are taking an antidepressant.  Probably the biggest player is this new movement is Prozac, the blockbuster drug whose name is synonymous with antidepressants.  Even though it is a fairly old drug, around 25 million prescriptions are still fulfilled each year!

Now the percentage of men may be relatively small, but keep in mind that a) the study was small and b) the threshold was 16.5 ng/ml. This is fairly high prolactin in my opinion.  The abstract also points out that the average prolactin level actually increased from 6.4 to 10.0, a 56% increase. Now, from what I have seen on the forum, often men with even modest increases in prolactin sometimes experience lowered libido and some erectile dysfunction with similar numbers.

Remember that, in general, increasing prolactin means decreasing dopamine and that is what an orgasm is all about, eh?  I have a page on men that Cannot Orgasm that explains how elevated prolactin can cause anorgasmia. So, yes, only 5% of the men went over the arbitrary threshold of 16.5, but a much higher percentage likely experienced some issues from the prolactin increase.

Why does Prozac increase prolactin so consistently?  It likely has to do with serotonin.  It is no secret that Prozac and other SSRI’s raise serotonin levels and, in turn, sertotonin controls prolactin. Researchers found out very early, via an animal study, that Prozac increases prolactin not by decreasing dopamine but by but stimulating secretion of prolactin releasing factor. [4]

CAUTION:  Do not go off any medication without discussing it first with your doctor.  SSRI’s can be particularly problematic as some researchers have noted extreme depression during transitional phases, i.e. stopping treatment, switching medications, etc.

NOTE: Depression can definitely have a major hormonal component.  Hypothyroidism and hypogonadism are common root causes of depression and can worsen existing depression as well.  See my page on Testosterone and Depression for more information. Also, I have a page on Natural Depression Cures that can greatly help most men struggling with moderate or mild depression.

REFERENCES:

1) https://www.cdc.gov/features/dsdepression/

2) https://www.health.harvard.edu/blog/astounding-increase-in-antidepressant-use-by-americans-201110203624

3) https://www.peaktestosterone.com/forum/index.php?topic=4705.msg39155#msg39155

4) J Clin Psychiatry, 2006 Jun, 67(6):952-7, “Serum prolactin levels among outpatients with major depressive disorder during the acute phase of treatment with fluoxetine”

5) Life Sciences, Jun 1978, 22(24):2209 2213, “Evidence that serotonin neurons stimulate secretion of prolactin releasing factor”

Unfortunately, tweaking the brain is not an easy thing to do and these medications are rife with side effects, including sexual, hormonal and erectile.  We have had a number of men visit the Peak Testosterone Forum and complain about these kind of issues.  One of our senior posters himself had a very bad experience Prozac for example:

“Now, the worst case here wouldn’t be 50:50 (although that would arguably have pretty bad sides for males or females), but when both T and E approach zero, which is where I was for a few weeks after a doctor fucked up and put me on fluoxetine, which zipped my already virtually nonexistent T level, and with it my E2. Ungodly terrible sides, including anxiety, suicidal depression, fatigue, and insomnia like you wouldn’t believe. ” [3]

So what causes all the sexual (and in men erectile) dysfunction with Prozac (and undoubtedly some of the other antidepressants)?  Number one on the list may be the fact that it apparently often decreases testosterone levels, something I discuss in my page on Testosterone and Prozac. However, another root cause is that Prozac often increases prolactin in men (and women).  In fact, one study found the following:

“Specifically, 2 (4.5%) of 44 men and 8 (22.2%) of 36 women with normal prolactin levels at baseline developed hyperprolactinemia following treatment with fluoxetine.” [4]

More Frequent Injections Leads to Increased Total Testosterone

We have a small group of guys, for example, that swear they do better with weekly intramuscular injections.  And we have had a couple that say their testosterone is higher doing this.  For example, check out what this guy wrote:

“I decided to go back to IM injections a month ago. I noticed my T levels were dropping slowly on subq…The biggest thing I notice is the huge jump in free testosterone. It’s such a big difference that I’m wondering if there’s a misreading. Not sure. Anyways, feeling great on IM injections.” [1]

Another poster wrote that “the differences I’ve seen on the hard-to-find models I’ve run across is that subq takes off about 40% of the peak compared to IM, which is huge — this means you have 40% lower estradiol and probably DHT, and having high estradiol is one of the worst side effects of TRT.” [2]

So are the above statements true?  Does going to more frequent subQ injections really lower testosterone?  Stories on the Forum are pretty hard to verify for consistency and timing, i.e. it is hard to know if the person measured a weekly injection at peak or trough.  Lab results can vary by 20% or so pretty easily as well. That why I decided to ask Dr. Justin Saya of Defy Medical to let us know what he sees in his practice, since he deals with these issues on a daily basis.  And he graciously wrote me a couple of emails with his comments starting with the following:

“We’ve seen with testosterone cypionate that smaller more frequent dosages are GREATER in cumulative effect than larger less frequent injections (i.e. Daily > TIW > BIW > once weekly). In fact, it appears most patients are able to achieve approximately the same testosterone levels with daily T cypionate dosages of 15-18mg daily (105mg – 126mg weekly) as patients who do BIW or TIW doses in the 120mg – 160mg range (i.e. 60mg BIW – 80mg BIW) and the once weekly guys doing 140mg – 180mg once weekly (though these guys have wide variation in their levels in comparison to daily/BIW/TIW over the 7 day span). Obviously results can vary and everyone is unique, but these patterns have emerged.”

I then asked him if  this comment applied whether the person is doing more frequent doses IM (intramuscular) or subQ (subcutaneous)? I added that “we have guys on the forum that swear frequent subq leads to increased T over weekly IM and the other way around. I think a lot of it has to do with when they get their test done, but I’d love to get your take on it.”

“I switched to daily SubQ injections at 140mg per week. I was previously injecting IM on MWF at 140mg per week. Here are the shocking results:

IM: Testosterone,Free and Total 1151 ng/dL 348 – 1197

Free Testosterone(Direct) 20.4 pg/mL 7.2 – 24.0

SubQ: Testosterone,Free and Total 1500 ng/dL 348 – 1197

Free Testosterone(Direct) 44.3 pg/mL 7.2 – 24.0

Various members went on to discuss and postulate why this may occur. It’s important to note that for the MWF injection routine, the patient had labs on Mon (after last injection Friday- no injection Sat, Sun, or Mon prior to lab draw). The daily SC lab draw was on the day after a daily SC injection (prior to the next injection).”

This was a 25% jump by going from MWF to daily injections (although timing of labs did play some role).  Dr. Saya said that his response was the following:

“This is very common with DAILY injections, regardless of if it’s SC [subcutaneous] or IM [intrasmuscular]. Most folks don’t have the desire or wherewithal to stick to a daily injection routine in the LONG term without developing ‘injection fatigue’ or becoming noncompliant. For those that can (and actually WANT to inject daily), they can often (with a few exceptions for unique cases) get away with lower cumulative weekly dosages than folks who do once weekly, twice weekly, or even three times weekly injections.

Did you know you can inexpensively do your own testing for most hormones? The industry leader is Discounted Labs..

Again, this happens with both SC and IM (I have seen both) and is really a factor of the frequency of injections more than the location/technique of injections. The complicated reasoning is due to the pharmacological parameter of TERMINAL half life, accumulation, and steady state. In simplest terms, T cyp does not reach a TRUE steady state with once weekly, twice weekly, or three times weekly dosages (although twice weekly and three times weekly come close enough for our purposes, but there is STILL variation).

On the other hand, daily injections, at least pharmacologically speaking, are capable of achieving a TRUE steady state (even less fluctuation than BIW/TIW) and consequently can often use smaller dosages. Now this comes with the obvious trade off of poking yourself 365 times per year vs 156 (three times weekly) vs 104 (twice weekly)…in the real world and clinical practice, the subjective/symptomatic difference usually isn’t large enough to outweigh the increased hassle (except for a select few, especially low SHBG fellas). Hope this isn’t too complex or technical, but hope it helps with understanding! Indeed an interesting phenomenon.”

CONCLUSION:  Based on what Dr. Saya has seen in his clinical practice, we can come to the following conclusions:

1. More frequent injections, especially daily, can lead to significantly increased total testosterone levels.

2. This holds true for both IM and subQ.

3. Low SHBG guys may do particularly well with daily injections.

REFERENCES:

1)  https://www.peaktestosterone.com/forum/index.php?topic=7026.0

2) https://www.peaktestosterone.com/forum/index.php?topic=5739.0

Depression: How Men Can Beat It - Peak Testosterone

Many of you know my story: I was low testosterone (almost for sure) since puberty and struggled with dysthmia (mild depression) until age 52 when I got my first testosterone cypionate shot. Bam! I remember thinking, “Wow! I finally know what it feels like to be a normal person.” Of course, not everyone experiences that kind of effect from HRT, but it happens quite often as testosterone has a HUGE impact on us guys right between the ears. (You can read more about the subject in my link on Testosterone and the Male Brain.)

More importantly, I have notice a big percentage of men on The Peak Testosterone Forum are struggling with depression but are getting no useful information – often quite the opposite – from their front line doctors. (Not all physicains are like this, but many are and so I think it is important to highlight this.)  There are a lot of reasons for that, which I will discuss below, but let’s look at some of the comments straight off the the forum that are just downright scary in my opinion:

“Been to all sorts of doctors and all kind of tests, no help from any of them… and thing are bad. taking vitamins and ALC and hope my nerves get better somehow. Stress and depression are killing me. So everyone be gentle with yourself. It’s one of the worst things that can happen to a man. I feel like theres no point to live anymore, I cant concentrate on my work nor sleep. losing my friends because I feel like I’m uncapable to communicate like I did before the stupid accident. I’m screwed. I had perfect body and mind. Now there’s nothing left of me.” [1]

“I’ve been fighting a periodic stress induced problem for about 7 years now starting in 2005. I’ve had 4 “episodes” now. They always start in periods of high stress and last from 1 month to 6 months depending on how long it takes me to get on top of the stress. I get depression, anxiety, and I have a very specific form of insomnia where I wake up many times a night with bladder pain like I need to urinate but little or nothing is actually voided. These episodes are really hard on me, my family and my job.” [2]

“I wanted to see if anyone had any ideas on how to get a more agressive doctor to address my symptoms…I also told him of shortness of breath, elevated pulse rate, and borderline hypertension… I also have depression/anxiety/chronic fatigue.  I don’t know if I should go to a immunologist, neurologist, endo, or that guy from “House” (the old tv show)?” [3]

“The first endocrinologist didn’t offer any help because my testosterone was in the “normal” range and because I “look like an athlete” (I was +20% bodyfat and bloated). He told me to “be confident” regarding my anxiety and depression/mood swings.” [4]

These are just a few quotes, but you get the idea.  Obviously, these men are struggling. Because I see this so often, I am including the subject of depression as Step 10 in my “Peak Testosterone Program”, which deals with the typical symptoms that we see over and over again: fatigue, anxiety, mental fog, low testosterone, erectile dysfunction and so on. Yes, depression can cause all of these and so I want to cover some of The Natural Ways to Overcome Depression that your doctor will probably never discuss with you:

CAUTION: Do not quit any medication without discussing it first with your physician.  Likewise, do not add any supplement without first discsussing it with your doctor if you have an underlying medical condition or any current medicaitons.

1. Testosterone. A few savvy practitioners out there are now screening depressed men for low testosterone levels. Why? Because depression has been shown in numerous studies to be linked to low T and, furthermore, giving a man HRT (testosterone therapy) can often improve his depression.  I am living proof of that one!  To see some of the research, check out my link on Testosterone and Depression. Again, the reason that testosterone is so helpful in this area is that testosterone stimulates many neurotransmitters, including dopamine, and is just good for male brain health as you can see in my link on Testosterone and the Brain.

2. Nutrition, Supplements and Exercise. There are actually many nutrients that, when low, can create or worsen depression. Your brain is a huge energy hog and requires massive amounts of vitamins, minerals, fatty acids, amino acids, antioxidants, anti-inflammatories, etc. in order to run effectively. It is too much to cover here, but I discus all of this in my link Natural Depression Cures. Put these small things together and they can make a huge difference.

3. Meditation and PMR. There is a strong and underemphasized cortisol/stress/anxiety component to depression.  This aspect of depression responds very well to stress management techniques.  These take just a few minutes out of the day and are also just good for general health.  See my links on Secular (Non-Religious) Meditation, Mindfulness Meditation and Progressive Muscle Relaxation for the basics.

4. Thyroid. Hypothyroidism can cause or worsen depression. Unfortunately, most doctors do not do an extensive evaluation and so I urge you to read this link on The Many Causes and Ways to Diagnose Hypothyroidism for some good starter information.

Of course, sometimes depression is severe and incapaciting enough that it requires some kind of medical or psychological intervention.  Don’t put off treatment if you need it:  depression is very hard on the body.  It elevates inflammation levels, cortisol, free radicals and is so hard on the brain that it can damage the hippocampus and possibly other neurological regions as well.  It also may lead to hypgonadism in some cases and can lead to difficulties in the bedroom as I document in my link on Depression and Erectile Dysfunction. Obviously, that is only going to make a bad situation worse.

So, if you are struggling with depression, it’s important to face it and defeat it.  Again, stop by The Peak Testosterone Forum if you have any questions or comments.

REFERENCES:

1) https://peaktestosterone.com/forum/index.php?topic=2217.msg23764#msg23764

2) https://peaktestosterone.com/forum/index.php?topic=785.msg7007#msg7007

3) https://peaktestosterone.com/forum/index.php?topic=1310.msg12503#msg12503

4) https://peaktestosterone.com/forum/index.php?topic=2342.msg22942#msg22942

STEP 8: Treat Your Depression – Hopefully Naturally

Sex and Testosterone - Peak Testosterone

I’m going to start this out with some shocking news: sex is good for you. (Of course, it can also get you in a lot of trouble, but that s another story.) Why? There are many reasons, but chief among them is undoubtedly the fact that researchers have uncovered the fact that sex is actually an excellent way to boost testosterone. That s right it’s time to party!

For example, one 1992 study examined four couples on days that they did and didn’t have sexual activity.  As you can probably guess, they found that testosterone levels increased on nights after sexual activity and did not on nights where there was no intercourse. [1]  The authors noted that their study showed that it was likely sex that increased testosterone and not the other way around.

This was verified in a study of senior men that found that more sex corresponded to higher testosterone (although there is a chicken-and-egg issue here). [3]  Regardless, studies show that just the anticipation of sex in animals will increase testosterone levels. [2] Other researchers clearly state that “lack of sexual activity due to erectile dysfunction (ED) decreases testosterone (T) levels through a central effect on the hypothalamic-pituitary axis.” [4]

NOTE:  You may also be interested in my pages on Common Causes of Low Testosterone and How to Increase Your Testosterone Naturally for more information.

It is interesting because as erectile dysfunction sets in, many guys believe they have overdone this area of their life and fall prey to the strange underworld of “overmasturbation” sites and such.  However, barring extremes, it is actually lack of sexual activity that can cause middle aged males problems.  You can go too far, of course, and aggravate the prostate and pelvic floor muscles, so some maturity and moderation is always warranted.

In fact, this was verified in the same study above [4] by giving males either Viagra or Cialis and the Cialis group had significantly higher testosterone levels than the Viagra group. Of course, both of these drugs are PDE5 inhibitors and, therefore, boost nitric oxide, allowing more blood to flow into the penis.  However, Cialis has a significantly longer half life.  The rule of thumb is that Cialis is effective for about 36 hours for most guys and Viagra for one evening.  The researchers noted that sexual intercourse frequency was significantly higher in the Cialis group.  This means that the higher testosterone levels of the Cialis cohort was likely because they had more confidence and better erections on most nights than the Viagra group.  The researchers concluded that “as it is unlikely that the two drugs have a different direct effect on the pituitary-testis axis, this effect is probably due to the higher frequency of full sexual intercourse.”

So the bottom line is that multiple lines of evidence point to the fact that sex actually increases testosterone through mechanisms that are not thoroughly understood and should be considered one of the engines of increasing one’s androgens naturally.

However, that is just half of the story. Increasing testosterone can significantly improve your sex life and lowering it can do the opposite. Testosterone could be called The Sex Hormone for good reason: it is critical to literally every step in the love making process and can even play a role in relationships, your physical appearance and many other important bedroom factors.

Below are 10 Critical Testosterone-Related Sex Life Factors where testosterone has a strong and significant impact. Many men struggling in the bedroom are struggling because they have low testosterone. When you read the list below, you will see exactly why:

1.  Sexual Desire. Many studies over the years have shown that testosterone is critical to sexual desire. [5] One of the most common and revealing Symptoms of Low Testosterone Males is a loss of libido.  Many males write in saying that at one time in their life they had trouble not thinking about sex and now they almost never do.  This can be very hard on relationships.

2. Nocturnal Erections. Low testosterone does not just attack your sex life in the day but at night while you are sleeping as well:  morning erections are very dependent on testosterone levels, especially ones in the hypogonadal range, and  a number of studies have correlated low T levels with decreased “morning wood”. [8] The significance of this is that the penis requires regular oxygenation (from blood) or the internal structures can be negatively impacted. For more information, see my link on The ABC’s of Morning Erections.

3.  NOS (Nitric Oxide Synthase). One thing that many doctors do not realize:  testosterone levels directly impact NOS activity.  Animal studies have shown that castration decreases eNOS’s superpowers by about half [6] and testosterone restores it back to normal [7] Of course, the significance of eNOS is that it is the all-important enzyme that governs how much nitric oxide is in your arteries and blood vessels, including those in your penis.

4.  Anxiety and Mood. If you’ve poked around this site much, you know that testosterone strongly affects the male brain. And low T can make you just plain hard to live with. A number of studies have shown what just about every hypogonadal guy describes: anxiety, nervousness, irritability, mental fog, etc. [10][11] It also can make you forgetful – always a favorite trait with women, eh? [12] Again, this makes relationships very difficult and puts yet another barrier in one’s sex life.

5.  Depression. A significant amount of research has shown that low testosterone can also cause or make worse existing depression.  [10] Many physicians are now noting the very important role that hormones, especially testosterone, play in treating depression.  Of course, depression makes relationships and sex very difficult.

6. Venous Leakage. What literally rots the inside of your penis? If you guessed “lack of testosterone,” you’d be right on. If this goes on too long, it can result in a nasty condition called venous leakage, where as much blood leaks out of the penis as leaks in.  For more information, read my link on Venous Leakage.

7. Hardening of the Arteries. Low testosterone often attacks every artery in your body, including those in your penis. [13][14] Several studies have shown that it raises risk for arteriosclerosis. And that’s never good for your sex life. There are many reasons for this by the way, including the fact that low T increases weight gain, insulin and inflammation – a truly wicked combination.

8. Penile Muscle Atrophy. The muscles at the base of penis are particularly important for erections.  And they are particularly vulnerable to drops in testosterone levels. For more information, see my link on The Importance of Kegel Exercise for Men.

9. Diabetes, Metabolic Syndrome and High Blood Pressure. These three bad boys are some of the biggest risk factors for erectile dysfunction (and many other medical conditions). And it may come as no surprise that low testosterone increases the risk for every one of them.  For more information, see my book Low Testosterone By The Numbers.

10. Sleep and Fatigue. Inadequate testosterone can also lead to poor sleep quality, which means that the only thing you’ll want to do under the covers is put your head on the pillow and crash.  Testosterone deficiencies decrease the all-important recuperative REM sleep and other critical sleep parameters. One study showed that low T did this not only by increasing weight gain, which negatively impacts sleep in and of itself, but also through other mechanisms that we do not yet understand. [11] And none of this should be a surprise considering how much that testosterone affects the brain.

And, by the way, all of this underscores the fact that the PDE5 Inhibitors will not always solve a man’s problems if his testosterone is low enough.  A man is definitely swimming upstream without his hormones cooperating.

NOTE:  Viagra and Cialis often do not work for other key reasons as well.  See my link on Viagra and Cialis Resistance and Why Viagra and Cialis Do Not Always Work for more information.

1) Physiology & Behavior, Jul 1992, 52(1):195-197, “Male and female salivary testosterone concentrations before and after sexual activity”

2) Science, Nov 28 1980, 210(4473):1039-1041, “Classical conditioning: induction of luteinizing hormone and testosterone secretion in anticipation of sexual activity”

3) Journal of Gerontology, 1982, 37(3):2880-293, “Relationship of Serum Testosterone to Sexual Activity in Healthy Elderly Men”

4) Clin Endocrinol (Oxf), 2004 Sep, 61(3):382-6. “Type V phosphodiesterase inhibitor treatments for erectile dysfunction increase testosterone levels”

5) The Journal of Clinical Endocrinology & Metabolism, Jul 1 2006, 91(7):2509-2513, “The Relationship between Libido and Testosterone Levels in Aging Men”

6) Fertil Steril, 1995 May, 63(5):1101-7, “The effect of androgen on nitric oxide synthase in the male reproductive tract of the rat”

7) Int J Impot Res, 1995 Dec, 7(4):209-19, “Nitric oxide mediated erectile activity is a testosterone dependent event: a rat erection model”

8) Journal of Andrology, 18(5):522-527, “Relationship between sleep-related erections and testosterone levels in men”

9) Asian Journal of Andrology, 2010, 12:136 151, “Androgens and male aging: current evidence of safety and efficacy”

10) ARCH GEN PSYCHIATRY, MAR 2008, 65(3):283-289, “Low Free Testosterone Concentration as a Potentially Treatable Cause of Depressive Symptoms in Older Men”]

11) J Clin Endocrinol Metab , 2000, 85(8):2839-2853, “Transdermal testosterone gel improves sexual function, mood, muscle strength, and body composition parameters in hypogonadal men”

12) Oregon Health & Science University. “Testosterone Deprivation Makes Men Forget.”ScienceDaily, 22 Oct. 2004. Web. 23 May 2011

13) Nephrol Dial Transplant, 2011, “Low serum testosterone, arterial stiffness and mortality in male haemodialysis patients”

14) The Journal of Clinical Endocrinology & Metabolism, Feb 1 1997, 82(2):682-685, “Association between Plasma Total Testosterone and Cardiovascular Risk Factors in Healthy Adult Men: The Telecom Study”

15) J Clin Endocrinol Metab, 2008 July, 93(7):2602 2609, “The Association of Testosterone Levels with Overall Sleep Quality, Sleep Architecture, and Sleep-Disordered Breathing”

Prelox Review: An Erectile Supplement with a Proven Track Record

There are thousands of natural alternatives to Viagra, but Prelox seems to be the only one supported by independent clinical trials. It is available, without prescription, from companies such as Boots. The literature states that the ingredients, L-arginine and Pycnogenal (made from bark of the French Marine Pine) acting in combination, increase Nitric Oxide levels and hence cGMP, – which is, in a way, what Viagra does.

During the second month on Prelox, and a month into the LI-ESWT course, I noticed no further improvements. I continued with four tablets a day for the first month, and then reduced to two a day.

However, my three real girlfriend tests showed no improvement. .

I restarted Prelox in a casual way on 30th July (average two a day) and stopped four weeks later in order to better judge the effect off the additional shockwave course.

L-arginine is a precursor to Nitric Oxide – which forms the cGMP, and the French Marine Pine bark is related to the West African Yohimbe pine tree, the bark of which known for its pro-sexual effect. The two ingredients are said to combine to produce greater effect together than each on its own could produce.

A Bulgarian clinical trial reported normal erections returned to 92% of impotent men after two months of twice daily doses. The claim is vague, as even men considered impotent experience normal erections , – usually alone at 6 am. But the report states that average speed of erection decreased from 10 minutes for men taking just L-arginine for a month, to two minutes after the two months on Prelox. And duration of erection increased from two minutes to fifteen.

The University Hospital of New York also did a trial, which claimed 81% of the patients, after six weeks on Prelox, had improved sexual ability. Their daily dose was four tablets a day throughout the course. (The dose recommended on the Prelox box is four tablets a day for the first fortnight and, and two or four a day thereafter.)

Only 70% of the New York men estimated an improved IIEF-EF score. So, oddly, 11% of men had an increased ability but not an increased score. Disappointingly the average increase in IIEF-EF score was only 10%. Perhaps 1.5 points? This improvement is about half the increase of the men undergoing Professor Vardi s sham Shockwave therapy.

Most unimpressive fact was that just ten of the 37 men s partners noticed an improvement. So perhaps Prelox little no better than a placebo. Oddly, of the men themselves, 27 of the 37 thought it was easier to initiate an erection, and 26 thought it easier to sustain an erection. Why did the partners not notice?

The New York study also reported that Viagra gave a dramatically enhanced effect when both products are taken in combination . But Viagra on its own can give a dramatically enhanced effect .

I started Prelox on 2nd November 2012. The instruction leaflet states you should experience maximum sexual wellness after approximately four weeks . In the first few weeks I noticed a strange taste that stayed with me most of the time, a slightly upset stomach and an increased need to visit the lavatory; but this reduced after a month. The reported side effects of flushing or headaches were just detectable, occasionally. In addition there is a slightly dehydrated dry mouth feeling, and I generally awoke with a sweat-soaked pyjama top. Dehydration is also a side effect of yohimbine.

Aromatase Inhibitor Arimidex & its Use in HRT.

My current HRT (testosterone therapy) protocol is 120 mg/week of testosterone cypionate. And it has worked wonders for me as I document in My Personal Health Story. The cypionate takes me up into youthful testosterone levels of about a 600 ng/dl trough and roughly a 1100-1200 peak. That’s about a 900 average and is considered “physiological,” because it is a level that is very typical for a young male in his 20’s. (Steroid guys commnonly go “supraphysiological” to 2500 ng/dl and even significantly higher.)

Unfortunately, there is one big difference between myself at age 53 on HRT and the young guy in this 20’s:  I need low dose Arimidex (anastrozole) to pull down my estradiol levels.  Unfortunately, extra body fat, aging and certain stressors make most men higher converters than they were in their younger days and they need a little help from an AI (aromatase inhibitor) to keep those estradiol levels from going overly high.  The dosages that I have been on are fairly typical of what I see on The Peak Testosterone Forum: either a 1/4 or a 1/2 mg two times per week, i.e. 1/2 – 1 mg/week.

Now is this dosage of Arimidex dangerous?  If you ask at your HRT or anti-aging clinic, they will probably tell you that the dosage is so low that it will never cause any long term issues.  And, in one sense, they have a good point:  the dosages taken by cancer patients are usually on the order of 1 mg/day or 7 mg/week, which is obviously an order of magnitude higher than what I am taking.  Furthermore, virtually all of the side effects from taking Arimidex are associated with the low estradiol levels from taking these higher dosages.  Guys on low dose Arimidex just don’t seem to get these kind of side effects, at least from what I have seen.

That said, there are Four Pretty Good Reasons Not to Take Arimidex even at the lower dosage in my opinion:

REFERENCES:

1)  https://www.drugs.com/arimidex.html

2) https://www.peaktestosterone.com/forum/index.php?topic=3160.0

3) https://www.peaktestosterone.com/forum/index.php?topic=2016.msg19068#msg19068

1  Pharmaceutical.  Arimidex is a pharmaceutical and virtually every pharmaceutical I can think of has one big problem:  they affect non-targeted systems. In other words, Arimidex is aiming at the aromatase enzyme and should affect only that particular enzyme in an ideal world.  However, from what I have seen, that is a very naive assumption and usually, a decade or two later, news comes out about how this medication is influencing something else in the body negatively.  Yes, this is low dose, but if taken for decades, will there be absolutely no effect?

2. Clotting Cascade. One of the side effects of the higher dose Arimidex is clotting. [1] According to my HRT clinic, Arimidex can affect the clotting cascade in some heart patients – one could argue that 95% of the people in modern societies are heart patients! – and so it is considering ways to lower their dependence on Arimidex.  Again, HRT levels are low dose, but some think this could be potentially be a concern.  One has to ask if it is a good idea as the decades roll on or you reach your senior years as well.

3. Increased Estradiol Requirements.  I know that the doctors of some of the men on HRT on the The Peak Testosterone Forum have been increasing their estradiol targets.  My own clinic told me that their current estradiol targets for men are 20 to 30 pg/ml but that they were considering upping that to about 25 to 35 pg/ml.  There has been recent study work – I haven’t seen the numbers yet – that suggests that a little more estradiol may be good for middle-aged and senior men in particular.

4. Arimidex Sensitivity.  Also, some men on the forum simply cannot take Arimidex (anastrazole).  They have what I would call “Arimidex Sensitivity”, which means that even small doses crash their estradiol.

If you put #1-3 together or, of course, if you have #4 (Arimidex Sensitivity), you can see that it may be desireable to reduce your Armidex dosage in one way or another.  (Always talk to your doctor before making any changes in medications of course.)  Here are several possibilities for example:

1.  Dosage Lowering.  Reduce your Arimidex (anastrazole) dosage (with doctor approval).

2.  Compounded Anastrazole. Go to a compounded, lower dose anastrazole.  For example, one of the posters took 0.2 mg per day of the same when he was on HCG. [2] There are some liquid formulations as well, although it may not always be easy to get approval for it according to one of our senior posters:

“Contacted local compounding pharmacy. They promised to make liquid arimidex, but first they have to go thru doctors office and see if this is ok, then insurance, etc. So it is not going to be tomorrow.” [3]

3.  Go Natural. Choose a more natural way to lower estradiol.  There are actually many ways to do this and I cover it in my link on Natural Estrogen Blockers for some of the pros and cons. These are mostly supplements and one has to to realize that they generally do not have the power of an Arimidex.

Sex and Erectile Dysfunction - Peak Testosterone

What lifestyle change makes a fivefold difference in your odds of having erectile dysfunction?  Eating brocolli?  Jogging?  The answer is probably not the first thing that comes to your mind:  it’s having regular sexual intercourse.

I hate to keep repeating myself, but males need to have sex! A life of asceticism and denial is hard on the male body. Once again, a major study showed that for guys to be healthy, they need to have sex.  Finnish researchers found that the risk of erectile dysfunction was inversely related to the number of times of intercourse per week. [1] In other words, the more sex you have, the less likely you are to have erectile dysfunction.  Or as they say on the streets – use it or lose it!

1)   The Amer J of Med, 2008, 121(7):592, “Regular Intercourse Protects Against Erectile Dysfunction: Tampere Aging Male Urologic Study”

2) J of Andrology, Mar/Apr 2007, 28(2):223-228  ,”Penile Oxygen Saturation in the Flaccid and Erect Penis in Men with and without Erectile Dysfunction”

Notice the drastic reduction in erectile dysfunction between men who had sex and men who did not: the rate is almost five times different! The lead researcher wrote “Regular intercourse has an important role in preserving erectile function among elderly men, whereas morning erection does not exert a similar effect. Continued sexual activity decreases the incidence of erectile dysfunction in direct proportion to coital frequency.”

There are probably a great meany reason that sex actually improves erectile dysfunction.  One of the minor reasons is that sex exercises, perhaps as nothing else can, those penile muscles. Another minor reason is that the penis needs “oxygenation”.  One study states that “oxygenation of the cavernous tissue is important in regulation of local mechanisms of erection.  Blood flow aterialization during erections is felt to be crucial in providing the free oxygen necessary for formations of NO by neuronal and endothelial nitric oxide synthase.”  [2]  These same researchers documented that males with erectile dysfunction demonstated “severe hypoxia” in the arterial penile chambers, where hypoxia simply means “lack of oxygen”.  They then point out that “chronic hypoxia leads to less NPT [nocturnal erections] with eventual corporal fibrosis and progressive and irreversible ED [erectile dysfunction]”.  In other words, the penile tissues can actually deteriorate without this oxygenation to where the erectile dysfunction can be irreversible.

The researchers in the first study I cited alluded to something much more mysterious and powerful than simple penile oxygenation. Yes, sex will help oxygenate the penis, but the it’s erection-curing powers seem to go far beyond that.  Again, this study highlighted the fact that sexual activity helped significantly with erectile dysfunction even though morning erections could not do the same thing.

The reason undoubtedly that sexual intercourse is very different from morning erections on many fronts.  An orgasm leads to the release of a flood of hormones and neurotransmitters that simply do not occur from a simple morning erection.  Somehow these differences make all the difference in the world and can actually heal and protect.

NOTE: A lot of middle aged guys will find that sexual intercourse will actually give them morning erections when they had none before. Sex can help with “maintenance” if you will.

So get out the To Do list and cross off everything except you know what tonight…

NOTE:  I know that some of you need some practical ideas for how to get more sex from the woman in your life.  Well, it’s not as hard as you might think in most cases.  Here are a few ideas that will definitely help:  Oxytocin, Massage, Pelvic Angle, Tease Her and Increase Her Libido.  Treating her right isn’t a bad idea either!

REFERENCES:

Testosterone and Accelerated Aging - Peaktestosterone

It turns out my gut feelings were right:  low testosterone negatively alters almost every key marker of aging.  In my case I am pretty sure I was low testosterone for decades and, as I’ll show below, this was very likely very hard on my body.

Many people wonder why I very carefully watch what I eat and maintain a disciplined exercise routine. One of the primary reasons is that I am relatively certain that I was low testosterone for decades. Because of that, I think it is likely that I aged myself considerably and must now try to compensate for those years of “hard livin'”.

1. Telomerase. As you may know from My Link on Telomerase, there is a whole theory of aging that centers around our telomeres.  Basically, our cells divide over the course of our lifetime and the lion’s share of them suffer a slight shortening of the end of their chromosomes, the telomere, each time.  This slight shortening eventually leads to aged, barely-functioning tissues.  Furthermore, this area of research is considered one of the most promising ways to actually extend maximum human lifespan, although that is too big of a subject to include here.

One of the keys to slowing down the erosion of our telomeres is increasing the activity of the key enzyme involved in this process, telomerase.  In the Above Link on Telomerase I clearly outline many natural strategies to increase telomerase.  However, testosterone (and estradiol) has been shown to do just this as well in a number of studies and on a number of cells.  Here are just a few examples:

b) Stem Cells.  Researchers took human stem cells and found the estradiol (E2) turned on and off TERT and telomerase. [3] In this study they even examined which type of estrogen receptor was involved.  Again, this shows the estrogen to telomerase connection. (This has been seen in various cancer cells as well.) [4]

c) Testes. A study on rats shows a correlation at least between the lowered testosterone levels of aging with a decrease in telomerase activity. [2]

How does testosterone work its magic.  Well, we get a double benefit, because testosterone and estradiol boost telomerase activity.  Estradiol was found to do this through TERT expression.  (You don’t want to go too high on TERT activity based on what I have read.) Check out this summary of the situation:

“Their novel studies demonstrate that androgens increased telomerase activity via a transcriptional mechanism in normal peripheral blood lymphocytes, bone marrow CD34+ cells, and lymphocytes from patients harboring heterozygous telomerase mutations. Interestingly, estradiol had a similar effect. Further investigation of the molecular basis for increased telomerase activity demonstrated that androgens undergo aromatization to estradiol, which then binds to the estrogen receptor-a to increase TERT expression. This is likely through estrogen response elements in the TERT promoter.” [9]

Did you know you can inexpensively do your own testing for most hormones? The industry leader is Discounted Labs..

2. Insulin.  One of the things I emphasize on this site is that as testosterone falls, insulin levels rise. And men that are low testosterone have been found to be greatly at risk for diabetes and Metabolic Syndrome (or prediabetes).  The problem is this increase in insulin levels is accompanied with increasing insulin resistance.

Once insulin resistance sets in, the body cannot push the glucose into the cells and blood glucose levels begin to rise.  And this is what will age many tissues in the body.  Elevated blood glucose levels are very hard on the body and why diabetics almost always have a shorter-than-average lifespan.

NOTE:  For more information, see my links on Testosterone and Insulin, Testosterone and Diabetes and Testosterone and Metabolic Syndrome.

3. Inflammation. Is there anything more dangerous to a man’s long term health than inflammation?  Elevated inflammation has been linked to heart disease, many cancers and many autoimmune diseases, so it has to be near the top of the list. In addition, inflammation is part of one of the primary theories of aging.  One research summary stated that “we have proposed the theory of oxidation-inflammation as the main cause of aging.” [5]

The key regulators of inflammation in the body are the “inflammatory cytokines” such as tnf alpha, IL-1, IL-6 and so on.  As I show in my link on Testosterone and Inflammation, low testosterone is associated with rising levels of almost all of these inflammatory messengers.

4. Boosting the Body’s Natural Antioxidants.  One recent study found the following very important result:

“Extending our previous results, we show that treatment with testosterone, both in intramuscular or bioadhesive buccal formulations, increase plasma levels of Coenzyme Q10, lipophilic antioxidant, and total antioxidant capacity, measured with colorimetric method, in patients with secondary hypogonadism. Hypogonadism could represent a condition of oxidative stress, in turn related with augmented cardiovascular risk in such patients.” [8]

5. Oxidation. As mentioned in #3, one of the primary theories of aging deals with oxidation (coupled with inflammation). An increased oxidative load, for example is highly associated with “immunosenescence”, which is the steady decline of the immune system with aging. [6] As you may have guessed, some oxidative systems have been associated with decreasing testosterone levels.  For example, castrated rats have been found to have greatly increased oxidative stress levels in the prostatic epithelium.

In my page on The Causes of Andropause, I point out that mitochondrial damage may be a cause of the age-related loss of testosterone.  If so, this could be explained by the heavy oxidative load and increase of reactive oxygen species from falling testosterone levels, in part anyway.  (Mitochondria, as the energy producers, are particularly vulnerable to free radical damage.)

1)   Blood, Sep10 2009, 114(11):2236-2243, “Sex hormones, acting on the TERT gene, increase telomerase activity in human primary hematopoietic cells”

2) Mol Cells, 1999 Jun 30, 9(3):286-91, “Downregulation of telomerase in rat during the aging process”

3) Molecules and Cells, 2008, 26(5):454-458, “Estrogen receptor-alpha mediates the effects of estradiol on telomerase activity in human mesenchymal stem cells”

4) Cancer Res, Dec 1 1999, 59:5917, “Estrogen Activates Telomerase”

5) Curr Pharm Des, 2009, 15(26):3003-26, “An update of the oxidation-inflammation theory of aging: the involvement of the immune system in oxi-inflamm-aging”

6) https://www.discoverymedicine.com/ Nancy-S-Jenny/2012/06/25/inflammation-in-aging-cause-effect-or-both/

7) The American Journal of Pathology, Dec 2003, 163(6):2513 2522, “Androgenic Regulation of Oxidative Stress in the Rat Prostate : Involvement of NAD(P)H Oxidases and Antioxidant Defense Machinery during Prostatic Involution and Regrowth”

8) J Steroids Horm Sci, Published Jul 30 2013, 4:117, “Effects of Intramuscular or Bioadhesive Buccal Testosterone Treatment on Antioxidant Systems in Secondary Hypogonadism”

9) Blood, Sep 10 2009; Blood: 114(11), “HEMATOPOIESIS & STEM CELLS: TERTrific hormones promote hematopoiesis,” by Laura S. Haneline

Tests After HRT (Testosterone Therapy) - Peak Testosterone

SHORT TERM:

The following labs are usually run every three months and sometimes every six once the patient has stabilized:

1.  PSA. This test is controversial and some feel it is so inaccurate that it only makes things worse.  Personally, I think it still provides good information.  It is true that usually a rising PSA signifies inflammation rather than cancer, but this is still good information and gives the patient something to work on.  Regardless, virtually all doctors will pull this number and watch for two metrics:

a) PSA < 2.5 (or some other threshold)  [NOTE:  The PSA should really be below 1.0 ideally for anti-aging purposes or perhaps 1.5 for some men on HRT.]

b) PSA < 1.0 within any rolling year.  In other words, your doctor will also likely watch that PSA does not rise more than one point in any one year time period.

If the above values are exceeded, you may be forced off of HRT until you get urologicial clearance.  I know, because it happened to me.  See my story High PSA But No Cancer if you are interested.

3. Hematocrit, Hemoglobin and/or RBC Counts. Doctors will pull various combinations that basically check to make sure that the extra testosterone is not causing you to overproduce red blood cells.  (See my page on Testosterone and Anemia for details.) This is extemely important, because if these go too high, your blood essentially starts to “sludge” and you are at increased risk of stroke and heart attack.  You will also likely feel lousy and can experience light-headedness, dizziness and shortness of breath.  We have had a couple of guys experience very serious issues from this, the most extreme discussed in this case here of Testosterone Abuse.

3. Estradiol. It is always good in my opinion to monitor estradiol levels, especially if your testosterone levels have been boosted significantly from your TRT protocol.  This is probably the biggest thing that sabotages TRT results and makes guys feel lousy even though they have significantly boosted their low testosterone.  The problem, generally, is that we gain weight as we age and end up significantly overweight.  That extra fat tissue is high in aromatase and converts a significant percentage of your new testosterone into estradiol.  And, as estradiol goes up, mood, erectile strength and libido go down; water retention and bloating can increase, etc.  And, in the long term, high levels of estradiol can increase arterial plaque and prostate issues potentially.  See my pages on https://www.peaktestosterone.com/ for more information.

I should add that the majority of physicians know little to nothing about estradiol in men.  They will not monitor it and do not think it causes any issues.  Of course, I could not disagree with this more strongly as I believe both high (and low) levels can cause both short and long term issues.  This should change over the next five to ten years as some study work is now being done on men.

4. HDL. Reasonable doses of testosterone are not supposed to significantly lower HDL, but they probably do in some men.  Nor are they supposed to negatively alter LDL either.  But we’re all individual and some studies show negative lipid results, so it’s a good idea to monitor this and make sure you are moving in the right direction.  See my page on Testosterone and HDL for additional information.

5. Blood Pressure. It’s always a good idea to monitor blood pressure before and after T therapy.  An elevation of blood presure is probably the most common serious side effect that I see and can increase long term risk of erectile dysfunction, stroke and heart disease if left untreated.  In addition, some men with existing high blood pressure could be at risk for hospitalization or worse by ignoring this.

6. Liver and Kidney Function. These should be periodically monitored.  HRT seems to rarely cause issues with these, but it is possible, especially if there are undelrying issues.

Several of the online physicians that have done HRT for years have observed a partial shutdown effect.  Basically, HRT bypasses the pituitary in some ways and this can lead to some atrophy according to this school of thought.  Because of this, the following hormones can partially be shut down:

1.  Thyroid Hormones.  (See Thyroid Tests.)

2.  DHEA.  (See my https://www.peaktestosterone.com/.)

3.  Cortisol.  (See my https://www.peaktestosterone.com/ .)

4. Progesterone.  (See my https://www.peaktestosterone.com/)

NOTE: Of course, fertility is almost always shut down considerably on HRT.  Some doctors are now adding HCG to their regimens to maintain fertility levels.

Testosterone and Accelerated Aging - Peaktestosterone

It turns out my gut feelings were right:  low testosterone negatively alters almost every key marker of aging.  In my case I am pretty sure I was low testosterone for decades and, as I’ll show below, this was very likely very hard on my body.

Many people wonder why I very carefully watch what I eat and maintain a disciplined exercise routine. One of the primary reasons is that I am relatively certain that I was low testosterone for decades. Because of that, I think it is likely that I aged myself considerably and must now try to compensate for those years of “hard livin'”.

1. Telomerase. As you may know from My Link on Telomerase, there is a whole theory of aging that centers around our telomeres.  Basically, our cells divide over the course of our lifetime and the lion’s share of them suffer a slight shortening of the end of their chromosomes, the telomere, each time.  This slight shortening eventually leads to aged, barely-functioning tissues.  Furthermore, this area of research is considered one of the most promising ways to actually extend maximum human lifespan, although that is too big of a subject to include here.

One of the keys to slowing down the erosion of our telomeres is increasing the activity of the key enzyme involved in this process, telomerase.  In the Above Link on Telomerase I clearly outline many natural strategies to increase telomerase.  However, testosterone (and estradiol) has been shown to do just this as well in a number of studies and on a number of cells.  Here are just a few examples:

b) Stem Cells.  Researchers took human stem cells and found the estradiol (E2) turned on and off TERT and telomerase. [3] In this study they even examined which type of estrogen receptor was involved.  Again, this shows the estrogen to telomerase connection. (This has been seen in various cancer cells as well.) [4]

c) Testes. A study on rats shows a correlation at least between the lowered testosterone levels of aging with a decrease in telomerase activity. [2]

How does testosterone work its magic.  Well, we get a double benefit, because testosterone and estradiol boost telomerase activity.  Estradiol was found to do this through TERT expression.  (You don’t want to go too high on TERT activity based on what I have read.) Check out this summary of the situation:

“Their novel studies demonstrate that androgens increased telomerase activity via a transcriptional mechanism in normal peripheral blood lymphocytes, bone marrow CD34+ cells, and lymphocytes from patients harboring heterozygous telomerase mutations. Interestingly, estradiol had a similar effect. Further investigation of the molecular basis for increased telomerase activity demonstrated that androgens undergo aromatization to estradiol, which then binds to the estrogen receptor-a to increase TERT expression. This is likely through estrogen response elements in the TERT promoter.” [9]

Did you know you can inexpensively do your own testing for most hormones? The industry leader is Discounted Labs..

2. Insulin.  One of the things I emphasize on this site is that as testosterone falls, insulin levels rise. And men that are low testosterone have been found to be greatly at risk for diabetes and Metabolic Syndrome (or prediabetes).  The problem is this increase in insulin levels is accompanied with increasing insulin resistance.

Once insulin resistance sets in, the body cannot push the glucose into the cells and blood glucose levels begin to rise.  And this is what will age many tissues in the body.  Elevated blood glucose levels are very hard on the body and why diabetics almost always have a shorter-than-average lifespan.

NOTE:  For more information, see my links on Testosterone and Insulin, Testosterone and Diabetes and Testosterone and Metabolic Syndrome.

3. Inflammation. Is there anything more dangerous to a man’s long term health than inflammation?  Elevated inflammation has been linked to heart disease, many cancers and many autoimmune diseases, so it has to be near the top of the list. In addition, inflammation is part of one of the primary theories of aging.  One research summary stated that “we have proposed the theory of oxidation-inflammation as the main cause of aging.” [5]

The key regulators of inflammation in the body are the “inflammatory cytokines” such as tnf alpha, IL-1, IL-6 and so on.  As I show in my link on Testosterone and Inflammation, low testosterone is associated with rising levels of almost all of these inflammatory messengers.

4. Boosting the Body’s Natural Antioxidants.  One recent study found the following very important result:

“Extending our previous results, we show that treatment with testosterone, both in intramuscular or bioadhesive buccal formulations, increase plasma levels of Coenzyme Q10, lipophilic antioxidant, and total antioxidant capacity, measured with colorimetric method, in patients with secondary hypogonadism. Hypogonadism could represent a condition of oxidative stress, in turn related with augmented cardiovascular risk in such patients.” [8]

5. Oxidation. As mentioned in #3, one of the primary theories of aging deals with oxidation (coupled with inflammation). An increased oxidative load, for example is highly associated with “immunosenescence”, which is the steady decline of the immune system with aging. [6] As you may have guessed, some oxidative systems have been associated with decreasing testosterone levels.  For example, castrated rats have been found to have greatly increased oxidative stress levels in the prostatic epithelium.

In my page on The Causes of Andropause, I point out that mitochondrial damage may be a cause of the age-related loss of testosterone.  If so, this could be explained by the heavy oxidative load and increase of reactive oxygen species from falling testosterone levels, in part anyway.  (Mitochondria, as the energy producers, are particularly vulnerable to free radical damage.)

1)   Blood, Sep10 2009, 114(11):2236-2243, “Sex hormones, acting on the TERT gene, increase telomerase activity in human primary hematopoietic cells”

2) Mol Cells, 1999 Jun 30, 9(3):286-91, “Downregulation of telomerase in rat during the aging process”

3) Molecules and Cells, 2008, 26(5):454-458, “Estrogen receptor-alpha mediates the effects of estradiol on telomerase activity in human mesenchymal stem cells”

4) Cancer Res, Dec 1 1999, 59:5917, “Estrogen Activates Telomerase”

5) Curr Pharm Des, 2009, 15(26):3003-26, “An update of the oxidation-inflammation theory of aging: the involvement of the immune system in oxi-inflamm-aging”

6) https://www.discoverymedicine.com/ Nancy-S-Jenny/2012/06/25/inflammation-in-aging-cause-effect-or-both/

7) The American Journal of Pathology, Dec 2003, 163(6):2513 2522, “Androgenic Regulation of Oxidative Stress in the Rat Prostate : Involvement of NAD(P)H Oxidases and Antioxidant Defense Machinery during Prostatic Involution and Regrowth”

8) J Steroids Horm Sci, Published Jul 30 2013, 4:117, “Effects of Intramuscular or Bioadhesive Buccal Testosterone Treatment on Antioxidant Systems in Secondary Hypogonadism”

9) Blood, Sep 10 2009; Blood: 114(11), “HEMATOPOIESIS & STEM CELLS: TERTrific hormones promote hematopoiesis,” by Laura S. Haneline

HCG Is Not Actually LH - Peak Testosterone

REFERENCES:

1) Molecular and Cellular Endocrinology, Mar 2014, 383(1-2):203-213,”Luteinizing hormone and human chorionic gonadotropin: Origins of difference”

2) Oncology, 2005, 69 Suppl 3:4-10, “VEGF as a key mediator of angiogenesis in cancer”

3) “Vascular Endothelial Growth Factor (VEGF) and Its Role in Non-Endothelial Cells: Autocrine Signalling by VEGF”, Angela M. Duffy, David J. Bouchier-Hayes, and Judith H. Harmey.

a) Secondary hypogonadal men on TRT (testosterone replacement therapy)

b) Secondary hypogonadal men on HCG Monotherapy

c) Men interested in improving their fertility

I myself have used low dose HCG for about six months to a year and plan to go on it soon.  The reason is that HCG can keep the testes active and in working order.  Normally, straight TRT shuts down the testes, and they essentially go dormant.  Should you ever have to go off of TRT for some reason, such as high PSA or hematocrit, you should (according to this school of thought) have no trouble restarting your testosterone if you have taken HCG and responded to it.  (Talk to your doctor of course.)

How would a man on TRT know if he has responded to HCG?  The easiest way is to see if the size of your testes have increased.  In fact, this is probably the #1 reason that men on TRT use HCG:  they don’t like the testicular shrinkage that can occur where their body’s own production of testosterone shuts down.  HCG can add back in volume to the testes usually in 3-4 weeks.

So with all the benefits of HCG, I think it is worth noting some of the very significant differences between HCG and LH.  Yes, HCG and LH bind to the same receptor, but that is where the similarity ends.  As you will see below, I believe it is wise to go lower dose with HCG for reasons outlined below.  (Some of the endocrinology dosages are VERY high.  See my page on Common Dosages for HCG.

1. Longer Half-Life. HCG has a much longer half life than LH. Remember that LH is secreted by the pituitary in pulses that stimulate the Leydig cells in the testes to produce testosterone.

2. Placental versus Adult Stimulation. HCG is a very powerful placental hormone for a developing fetus.  It has a powerful stimulatory effect on multiple systems and is long-lasting in order to achieve a more stable and powerful effect.  LH is actually an older molecule, present in all vertebrates, and is critical to adults.

3. Receptor Binding.  Greater receptor binding affiinity to the LH receptor. [1]

4. Increased VEGF and Angiogenesis. HCG is considered safe and is used by thousands of men for the above purposes, but one potential concern, especially at higher dosages in older men, could be stimulation of VEGF and angiogenesis.  Basically, these term refer to HCG’s miraculous powers to simulate vascularity and tissue growth in a growing and developing fetus.  The problem is that VEGF in older individuals (and angiogenesis) is associated with the initiation and spread of cancer. [2][3] Cancers are the kings of unstoppable growth and feed off of VEGF. One study commented that “it is now believed that hCG is involved in placentation through activities such as maintaining angiogenesis of the uterine vasculature and promoting differentiation of cytotrophoblasts into syncytiotrophoblasts.” [1]

5. Different Gene Expression and Signaling. Both HCG and LH bind to the same receptor and thus produce similar physical effects, right?  Interestingly enough, the answer is that, while both do bind to the receptor, they produce some very different downstream results.  The reason for this appears to be that they initiate differing patterns of gene expression, i.e. trigger different proteins used metabolically by the body. This should actually not be a surprise when you consider that HCG and LH serve very different functions and purposes.

CONCLUSION:  In my opinion, dosage with HCG is critical.  This is a very powerful hormone, and research is ongoing as to exactly what effects it produces in adults.  In men, HCG is particularly poorly understood outside of its effects on testosterone and fertility.  And, as always, I will comment that, if a little is good, more will not always be better.

IMT: Measure and Monitor Your Arterial Plaque.

1) Rev Esp Cardiol, 2010;63:97-102, “Carotid Intima-Media Thickness in Subjects With no Cardiovascular Risk Factors”

2) Stroke. 1999; 30: 841-850, “Carotid Plaque, Intima Media Thickness, Cardiovascular Risk Factors, and Prevalent Cardiovascular Disease in Men and Women”

3) J Ultrasound Med, 2007, 26:427–432, “Common Carotid Artery Intima-Media Thickness Determinants in a Population Study”

4) https://www.pulsus.com/journals.html, “NORMAL VALUES FOR COMMON CAROTID INTIMAL MEDIAL THICKNESS SHOULD BE ADJUSTED FOR AGE”, MF Matangi, DW Armstrong, M Nault, D Brouillard

5) Group Health Cooperative, Clinical Review Criteria, “Carotid Intima Media Thickness (IMT or CIMT) for Coronary Artery Disease Screening and Monitoring”

6) https://www.cdc.gov/heartdisease/facts.htm

What is an IMT?  It is a carotid (neck artery) ultrasound that has been used in many studies to monitor atherosclerosis (arterial plaque) and has a rich and broad research history behind it.  According to Track Your Plaque, it has about a 60-80% correlation with cardiac plaque so, while it’s not perfect, it does have some solid association.  The beauty of an IMT is that, as of this writing (in most states), you can order one through Lifeline without a doctor’s orders and it is only $70.  (I have no affiliation.)

Why would anyone go to all this trouble to measure their atherosclerosis?  Isn’t arterial plaque just a part of life?  No, it does not have to be.  Several  men, that I call the Plaque Regressers have founds consistent ways to reverse atherosclerosis and part of this, obviously, requires the ability to monitor your progress.  I have a significant amount of coverage on my site on the topic and you can start with my Links for Improving Erectile Strength for more information.

a)  Erectile Dysfunction. The fact is that it doesn’t take a lot of plaque in your penile arteries before erections start taking a little longer and things start becoming a little softer. And even if you are young, that does not mean you are completely immune.  In my page on Young Men and Erectile Dysfunction, I discuss how many studies have shown that about half up to even two thirds of men in their 20’s and 30’s already have significant arterial plaque.<

If you have plaque, you probably want to focus on reversing it and clearing out those penile arteries. This will improve blood flow and improve  nitric oxide levels, all of which will help you in the bedroom.  See my page on  How to Clear Your Arteries for more information. One of the things that I see on the Peak Testosterone Forum is men with erectile dysfunction who simply refuse to believe that their issues could be caused primarily by atherosclerosis. But the fact is that aterial plaque is the root cause of most erectile dysfunction in modern cultures.

b) Heart Attack Risk.  As the plaque mounts and/or if it grows quickly, you are at an ever-increased risk of a heart attack or stroke.  In the U.S. alone, there are about 735,000 heart attacks per year, resulting in 370,000 deaths.  And another 240,000 will die each year of other heart-related issues.

Okay, so let’s say that you are on board and decided to actually measure your arterial plaque via an IMT.  How do you know if your readings are normal? Or, better yet, how do you know if they are ideal?  It turns out that there has been quite a bit of research on the subject and they are even published full studies in the public domain, clearly for the purpose to help us with attacking heart disease. Here is a sampling of that material:

NOTE:  A Heart Scan is actually the initial route I chose and you can read about it here:  My Heart Scan Results. (Next time I will get an IMT as my Heart Scan showed zero cardiac plaque and I don’t want any more radiation unless absolutely necessary.)

CAUTION: Always go by the results and analysis provided by your specific lab and/or physician.  Techniques and methodologies can vary testing results.

Here are the results from this study by age bracket for men only and the purpose is to give us a picture of relatively health aging of the arteries:

2. Patients Without “Obvious” Atherosclerosis. This study eliminated all patients with obvious narrowing the arteries.  Doing so yielded a nice picture of a more “healthy” age progression: [4]

Their concept was to give us a pattern for healthy arterial aging. As you can see, in this case even late seniors were able to keep their IMT below 1.00 mm. Keep in mind that the above values are women and men grouped together and, as I mentioned, men tend to be a bit higher. Notice, though, how similar the results are to #1.

3. Rome, Italy General Population Study. One clinic just kept track of 1,600+ patients in a row.  Interestingly enough, the results were quite similar to #1.  Unfortunately, the did not break it out by gender and women tend to have lower IMT’s than men. However, the general pattern and slope of the Spanish was definitely confirmed. [3]

What Is an Ideal IMT Score?

As you can see from the above, there is a “natural” progression of aging in IMT scores even in those living a relatively heart-healthy lifestyle.  Of course, many of the supercultures likely have little to no atherosclerosis and so their scores are probably even a bit lower.  One such people are the Tarahumara Indians of Mexico and I give coverage to them here if you are interested:  The Tarahumara Diet.

However, the point is that researchers have looked at all this data and the above studies and come to some conclusions:  By looking at the above stats, you can see for yourself how they came to these conclusions:

1. 1.0 mm Is Somewhat Risky for Old and Young; 1.2 mm is High Risk.  The authors were clear that “it is common practice to call a CCA IMT >1.0mm as being abnormal, and >1.2mm as being high risk. There is general agreement that the presence of obvious plaque indicates high risk at any age. However, when there is only CCA IMT thickening and no plaque then the normal values need to be adjusted for age, gender and perhaps even ethnicity. [4]

Very similar thinking was echoed by researchers when they stated that “we defined plaques nonarbitrarily as a localized area of thickening of >1.2 mm because we believe that plaque should be considered to be qualitatively different from general increases in wall thickness. Plaques were very common in both men and women, and, in contrast to IMT, the presence of plaques was strongly associated both with cardiovascular risk factors and with prevalent cardiovascular symptoms and diagnosed disease. [2].”

Notice that both sets of scientists noted that arterial wall thickness increases with age and so your IMT score must take this into account.  Thus, if you exceed the average progression by age, then you likely have plaque and are at risk.  However, if you are over 1.2, you definitely have significant plaque according to their research and, clearly, anything over 1.0 likely is indicative of problems as well, because even senior-aged healthy individuals have IMT’s less than that number.

2. An Increase Over .02-.05 mm Per Year. According to some guidelines, you should also watch the rate of change in IMT.  Notice that 1.0 and 1.2 figures from #1 are supported as well:

“It was suggested that an average thickness of the combined intima and media ranging between 0.5 and 1.2 mm is considered to be normal, and that >1.2 mm is used to define the presence of a plaque. It was also reported that the abnormal range of IMT is age dependent, and an IMT >1.00 mm is considered highly abnormal in younger patients, and is sometimes used as the cutoff in clinical trials (Feinstein 2002). The estimated progression of atherosclerosis per year is 0.02 to 0.05 mm (Feinstein 2002). IMT may be a potential useful marker for coronary atherosclerosis, as well as an indicator for its progression or regression, on the condition that the carotid atherosclerosis reflects coronary atherosclerosis.” [5]

SUMMARY:  Ideally, one would work with a qualified cardiologist or other physician that has a passion for plaque reversal.

REFERENCES:

Determine if You Are Hypogonadal - Peak Testosterone

REFERENCES:

1)  https://peaktestosterone.com/forum/index.php?topic=713.msg7551#msg7551

2)  https://peaktestosterone.com/forum/index.php?topic=802.msg7146#msg7146

3) Eur J Endocrinol, 2009 May;160(5):839-46. Epub 2009 Jan 27, “Effect of testosterone replacement therapy on arterial stiffness in older hypogonadal men”

4) The Journal of Clinical Endocrinology & Metabolism, Aug 1 1999, 84(8):2647-2653, “Effect of Testosterone Treatment on Body Composition and Muscle Strength in Men Over 65 Years of Age”

5) Neurology, Jul 10 2001, 57(1):80-88, “Testosterone supplementation improves spatial and verbal memory in healthy older men”

6) The Journal of Urology, May 1996, 155(5):1604-1608, “Improvement of Sexual Function in Testosterone Deficient Men Treated for 1 Year with a Permeation Enhanced Testosterone Transdermal System”

7) Journal of Affective Disorders, Mar 1998, 48(2-3):157-161, “Testosterone replacement therapy for hypogonadal men with SSRI-refractory depression”

8) Journal of Andrology, Nov/Dec 2008, 29(6), “Testosterone Improves Erectile Function in Hypogonadal Patients With Venous Leakage”]

17) J Clin Endocrinol Metab, 1996, 81:3578 3583, “Testosterone replacement therapy improves mood in hypogonadal men a clinical research center study”

18) J Clin Endocrinol Metab, 2004, 89(5): 2085-2098, 2004, “Long-term testosterone gel (AndroGel) treatment maintains beneficial effects on sexual function and mood, lean and fat mass, and bone mineral density in hypogonadal men”

21) J Urol, 2003 Nov, 170(5):1808-11, “The effects of combined androgen blockade on cognitive function during the first cycle of intermittent androgen suppression in patients with prostate cancer.”

22) Asian Journal of Andrology, 2010, 12:136 151, “Androgens and male aging: current evidence of safety and efficacy”

23) Oregon Health & Science University. “Testosterone Deprivation Makes Men Forget.”ScienceDaily, 22 Oct. 2004. Web. 23 May 2011

24) ARCH GEN PSYCHIATRY, MAR 2008, 65(3):283-289, “Low Free Testosterone Concentration as a Potentially Treatable Cause of Depressive Symptoms in Older Men”]

25) Am J Psychiatry, Jan 2003, 160:105-111, “Testosterone Gel Supplementation for Men With Refractory Depression: A Randomized, Placebo-Controlled Trial”

26) Journal of Psychiatric Practice, Jul 2009, 14(4):289-305, “Testosterone and Depression: Systematic Review and Meta-Analysis”

27) J Clin Endocrinol Metab, 1996, 81:3578 3583, “Testosterone replacement therapy improves mood in hypogonadal men a clinical research center study”

28) J Clin Endocrinol Metab, 2004, 89(5): 2085-2098, 2004, “Long-term testosterone gel (AndroGel) treatment maintains beneficial effects on sexual function and mood, lean and fat mass, and bone mineral density in hypogonadal men”

29) BJU Int 91(1):69-74, “A novel testosterone gel formulation normalizes androgen levels in hypogonadal men, with improvements in body composition and sexual function”

30) J Clin Endocrinol Metab , 2000, 85(8):2839-2853, “Transdermal testosterone gel improves sexual function, mood, muscle strength, and body composition parameters in hypogonadal men”

64) Circulation, 2004, 110:1245-1250, “Impact of the Metabolic Syndrome on Mortality From Coronary Heart Disease, Cardiovascular Disease, and All Causes in United States Adults”

65) JAMA, 2002, 288(21):2709-2716, “The Metabolic Syndrome and Total and Cardiovascular Disease Mortality in Middle-aged Men”

66) Diabetes Care. May 2004 v27 i5 p1036(6), “Testosterone and sex hormone-binding globulin predict the metabolic syndrome and diabetes in middle-aged men”

The second step in evaluating your testosterone is to match yourself up with the medical definition of hypogonadism, a term that simply means clincially low testosterone, i.e. “treatable.”  A big percentage of physicians out there, especially (and ironically) endocrinologists, believe that hypogonadal testosterone levels are in the 250 to 280 ng/dl range.  As I will show below, there is an abundance of research that shows this threshold should be significantly higher.  In addition, other related parameters, such as symptoms and free testosterone levels, should also be considered.  See my page on Free Testosterone Levels for more information, because quite often a man will have low free and bioavaialable testosterone and low medium total testosterone due to high SHBG.

Now, before I dive into the research and shows that the hypogonadal threshold should not be set as low as it is, I think it is important to clearly state that there is no such thing as a hypogonadal threshold in real life.  In fact, the whole concept is just ridiculous and here are just a few reasons why:

1.  Symptoms are just as important as the testosterone number(s) that your lab pulls.  (If your doctor does not ask you about symptoms – or seems to care less – then you are probably in trouble.)

2.  Every man has a different hypogondal level and there is considerable variation.  There are men who do great in the 300’s (ng/dl) with absolutely no low T symptoms.  And there are still other men (like me) that are just miserable in the 300’s.

3.  Most men have multiple low testosterone symptoms, the most well known being mental, sexual and medical.  In any given man, these different symptoms will begin to manifest at different testosterone levels. So which symptom do you pick as the threshold?!

OKAY, BUT AT WHAT LEVEL DO THE DOCTORS TREAT YOU?

I think most of us can agree that there is no magic testosterone number out there, but the fact is that doctor’s believe it, and they are the ones who can diagnose and treat you. And so one can argue that what they think is what really matters. Well, here is what I have found in the U.S.: almost any man can receive insurance-based testosterone replacement therapy if his testosterone is about 370 ng/dl or below. That is just what I see on the Peak Testosterone Forum. Other countries can be much more stringent. I would add that, if you are willing to pay for your own treatment, then there is considerable more flexibility (and costs are dramatically reduced here in the U.S. already for cash-paying customers).

Again, though, I am going to provide research-backed evidence that total testosterone in the 400’s should be considered hypogonadal for some men (assuming they have low testosterone symptoms of course).

“I got ahold of the lab results from my first testosterone test.

Total Testosterone 194 —— reference range ——-> 241-827ng/dL”

Now this man will have no trouble getting treatment simply because his total testosterone reading of 194 is well below the bottom range value of 241.  Basically, the physician trusts the labs definition of what low testosteorne is and treats accordingly.  However, if the man had a value of 242, most physicians would not treat him.  However, this is unfair in my opinion as some of the labs are using incredibly low levels for hypogonadism.

The labs and physicians are simply not using common sense in my opinion.  Why do I say that?  Testosterone in the 200’s is below that of the average 80 year old man!  Stop and think about it.  Why would we definie clinically low testosterone based on the levels of sickly seniors of a very advanced age?!?  You can check the numbers out for yourself on my page on Average Male Testosterone Levels by Age.

Evidence as to just how “old school” this is can be shown by the fact that there is one forward thinking lab, LabCorp, that has raised their reference ranges anyway.  And LabCorp is the biggest lab in the nation, so, hopefully, others will follow some day.  Look at what this poster on the Peak Testosterone Forum wrote:

“It may just be placebo although I doubt it but since having taken the thyroid medication for this little bit it seems I am seeing far less hair on my pillows and noticeably less in my hands after washing my hair. Metabolism seems to have picked up some as well.

Testosterone serum 343 L labcorp range=gold standard (348-1197 ng/dl)

Did you know you can inexpensively do your own testing for most hormones? The industry leader is Discounted Labs..

Labcorp changed their entry level range for what is regarded as hypogonadal serum T levels from 240 ng/dl to 348 ng/dl in October 2011. This has helped many men get a more serious consideration from their otherwise unsympathetic GP’s. This new standard has been long overdue for many many years, but finally something has been done about it and labcorp should be commended. Had this change been made 7 months earlier to when I first had a lab taken at 294 ng/dl in March 2011 my experience regarding testosterone deficiency and the effect it has had on my quality of life may have been very different from what it has been for the past two years.”

I think that one can make a good case that 348 is even a bit low, but at least it is a starting point.  And, on a practical level, I can tell you that almost all men writing into the Forum with classic low testosterone symptoms are below this level.  We do get quite a few young guys with levels even higher than this struggling however.

Hypogonadism Between 350 and 450 ng/dl in the Literature:

Again, it is important to note that there is no guarantee that raising testosterone will correct the underlying issues.  However, the pont is that it may and, furthermore, many studies show that correcting hypogonadism in the 350-400 ng/dl range will often help alleviate symptoms.  And this begs the question:  if you can fix a man’s symptoms at 350 ng/dl, then why isn’t 350 ng/dl the threshold for hypogonadism?

Unfortunately, many doctors are not aware of this.  They still believe that testosterone is just something you give to the patient to make him feel better about himself but really does very little.  Hopefully, the studies below will shatter that myth, and I encourage you to show some of them (in a polite way) to him or her:

1) Arterial Stiffness. Low testosterone greatly increases cardiovascular risk, which can, of course, manifest in many different forms. High blood pressure, low vasoreactivity (arterial responsiveness), atherosclerosis (arterial plaque) and endothelial dysfunction are some of the primary culprits. As we ll show below, low testosterone is associated with almost all of these.

Another very dangerous cardiovascular risk factor is arterial stiffness, or hardening of the arteries, and low testosterone has been shown in several studies to be correlated with this condition. [17][18] For example, one study of dialysis patients found that men with total testosterone below 235 ng/dl (8 nmol/l) had increased arterial stiffness. Although this study was on a unique subset of the population, it was controlled for a number of important cardiovascular risk factors including BMI (a measure of body fat) and C-Reactive protein (a measure of systemic inflammation). Another example comes from prostate cancer patients, who are often pharmaceutically driven into a hypogonadal treatment state. These men, who are already undergoing cancer treatment, also experience increased arterial stiffness due to the anti-testosterone therapies.

Why is hardening of the arteries so dangerous? The root causes of arterial stiffness are generally loss of flexible connective tissues, decreased vascular muscle tone and plaque buildup. Of course, the latter is famous for also narrowing arteries and raising the potential for higher blood pressure, blockages and stroke. And low testosterone definitely accelerates plaque buildup in the arteries.

Hardened arteries are also dangerous, because they can result in some unexpected phenomenon, such as creating a greater blood pressure spike that can do damage over time. Even worse, stiffened tissues are less able to absorb this pressure spike and thus allow more injury to surrounding tissues, especially in the brain and kidneys.

Does supplemental testosterone help improve arterial stiffness in men with low T? One study tried to answer this question by examining two groups of men, a hypogonadal group with average arterial stiffness of 8.9 and a control group with a lower reading of 6.78. Within 48 hours of testosterone therapy, the low T men were improved to an average arterial stiffness of 8.24 (measured as PWV).[21] The units actually are not important: the point is that testosterone therapy overcame in two days about a third of the arterial stiffness on average that these men had accumulated from years of basement level hormones.

2) Depression. Most men will will not talk about it, but depression is a huge and common issue with men. Again, I see it all the time on the Peak Testosterone Forum. And many guys with low testosterone have experienced firsthand the fact that testosterone profoundly affects the brain. Several studies have verified this and shown that low testosterone can lead to mood issues and depression. The threshold at which this becomes statistically significant appears to be around 350 ng/dl (10.2 nmol/l). [22] Researchers have also found that testosterone does not just affect how you feel but also how you think. One study observed that low testosterone men experienced memory issues in a manner very similar to that experienced by Alzheimer and dementia patients. [23]

Free testosterone levels may play even more of a role in this case. One group of scientists rediscovered the 300 ng/dl (10.2 nmol/l) threshold for depression but found that the free testosterone level was 10 ng/dl. This is a little above what is normally considered hypogonadal, about 5 ng/dl, in some of the studies. The odds of depression were found to be between 1.5 and 3.0 times more for the lower quintile guys, depending on whether one used total or free testosterone numbers. The bottom line is that if either free or total testosterone is low enough, get ready for a bumpy emotional and mental ride. [24]

NOTE: It is extremely critical to get depression under control. Not only does it tend to lower testosterone, it is also a physical stressor than can literally destroy neurons and raise your risk of cardiovascular disease due to elevated cortisol levels.

As anticipated, testosterone therapy benefits men with low testosterone and depression. One study looked at depressed men with testosterone below 350 ng/dl (11.9 ng/dl) and found that when these men were given testosterone therapy (gel), there was substantial improvement. [25] Of even more weight is the fact that a recent meta-analysis examined seven different studies and found that not only did testosterone therapy improve depression in hypogonadal men, but in men with a broad range of testosterone levels. [26] One can t help but wonder how many men out there are struggling with depression who do not realize that low testosterone is playing a role.

In addition, testosterone has been found in several studies to be related to mood. [29][30] Mood may seem a somewhat subjective word, but, as expected, researchers have studied the subject in considerable psychological detail. For example, one study found that testosterone replacement improved energy, well/good feelings, and friendliness and decreased negative mood parameters including anger, nervousness, and irritability . [27] Furthermore, when studying the use of Androgel, scientists found that mood parameters improved rapidly and were maintained throughout T treatment. [18]

3. Metabolic Syndrome. Prediabetes, when one begins to lose insulin sensitivity, is an absolute epidemic in the U.S. and other modern cultures right now.  The current prevalence is about a fourth of the population. Common symptoms, such as visceral (belly) fat, low HDL, high triglycerides and blood pressure, often accompany it in a suite of symptoms called Metabolic Syndrome (Met-S).  My guess is that around a half of the guys that show up to my site over the age of 400 probably have Met-S.  Researchers have found that Met-S has been tied to an increased risk of developing cardiovascular death and all-cause mortality. [64][65] It also increases the risk of erectile dysfunction, since it ages the arteries and accelerates plaque buildup.

What does Metabolic Syndrome have to do with low testosterone? As discussed, low testosterone raises insulin levels very significantly and thus directly worsens or initiates Metabolic Syndrome. For example, one study of middle-aged men found that those in the lowest fourth of total testosterone were 1.9-2.5X more likely to develop Metabolic Syndrome over the next 11 years. The threshold for the quartile of total testosterone was 450 ng/dl (15.6 nmol/l). [66] 450 ng/dl would be considered reasonable testosterone by most doctors and yet this study indicates that many men may be getting into trouble near this threshold.

NOTE:  The above 3 examples were actually excerpts from my book Low Testosterone by the Numbers. Again, these three examples of widely prevalent chronic diseases should be enough to make physicians realizes that the threshold for hypogonadism should be adjusted upwards. Below I give some other examples of conditions that are similar. (For the complete listing, see my book.)

4) Muscle and Fat.  A number of studies have shown that testosterone will add muscle and subtract fat.  For example, one study on senior men (over age 65) found that fat mass decreased and lean mass increased in the testosterone treated men. [4] This is truly remarkable considering that the men were put on no special diet or exercise program:  their body composition just magically improved for the better with the additional testosterone.  It should be noted that these were not large improvements in body composition: it will always boil down to diet and exercise in the end, but testosterone can clearly be a help.

5) Memory.  Doubling – actually a little more than doubling – senior males’ testosterone levels led to significant improvements in visual and spatial memory.  I can tell you on a practical level that I very often get comments from men on testosterone therapy of the incredible effect that testosterone has on the brain.  In fact, some executives now are going on testosterone just to improve their careers!  I’m not advising that, of course, but the phenomenon is interesting and you can read about it in this Forum Post.

6) Diabetes. Great improvements in type II (adult onset) diabetes can often be achieved with testosterone therapy in middle-aged and senior men via HRT.  Again, I relate the story of one HRT clinic who told me that ALL of their diabetic patients had completely eliminated their need for insulin after testosterone therapy.  A couple still had to take Metformin, but, nevertheless, this is a dramatic improvement.  Of course, the reason is that increased testosterone led to decreased insulin levels and improved insulin sensitivity in general.  Nice!

7) Erectile Dysfunction and Libido. Many studies have shown the positive effect of additional testosterone for men with low T in the area of sexual health.  For example, one study on hypogonadal men found that morning erections, total erections and libido were all improved after increased T levels. [6] The authors wrote: “all had a rapid and dramatic recovery from major depression following testosterone augmentation.” Wow!  How many psychological disorders have a 100% success rate?!?

CAUTION:  Do not stop any medications or treatments without first talking to your doctor.

8) Venous Leakage. This is an ugly condition that afflicts men, young and old.  It very often has a root cause of low testosterone levels.  The reason is simple:  low testosterone leads to a decay of the internal structures of the penis.  This decay does not allow the veins to be closed off during an erection and thus the outflow from the penis is as great as the inflow and erections are either quickly lost or, in the worst case, impossible to even achieve. For more information, see my link on Venous Leakage.  And several studies have shown the benefit of testosterone levels to men with venous leakage.  One study showed that well over half of men were either partially or fully cured of their venous leakage from testosterone therapy. [8]

This list could be greatly extended.  The point is that eliminating a testosterone deficiency and restoring more youthful levels can significantly or even completely reverse many key symtpoms. Should this not be the defiintion of a true deficiency?  And is this something to discuss with your physician?

Does Testosterone Therapy Cause Prostate Cancer? - Peak Testosterone

Another huge question in the minds of many men on TRT (testosterone therapy) such as myself is whether or not it will increase risk for prostate cancer.  Several large, well done studies – see below – have showed this not to be the case and that testosterone therapy does not appear to increase prostate cancer risk. Of course, since I am on HRT, this is what I want to believe, especially since I feel so much better with subQ cypionate injections.  However, nothing in this life is usually that clean cut and so I want to start out by issuing several cautions:

1. There are standard contraindications to TRT, such as liver problems and high RBC’s/hematocrit/hemoglobin.  However, probably front and center would have to be prostate issues, including an enlarged prostate or past/existing prostate cancer that need to be discussed with your physician.

2. Some of the pro-testosterone has been funded by those who have received money from testosterone manufacturers.

3. My urologist, who is a smart guy and graduated from an Ivy League university, absolutely insists that TRT (testosterone therapy) increases risk by 3-4% in men and that he has seen this in his practice.  Some urologists feel this way.

REFERENCES:

18) Cancer, Epidemiology, Biomarkers Preview, v.6, 1997, p967-9

19) Prostate, v.27, 1995, p. 25-31

20) Journal of Clinical Endocrinology and Metabolism, v82, 1997, p571-5

21) Int l Journal of Andrology, v.25,2002, p119-125

22) Cancer Research v.59,1999, p4161-4; Amer Journal of Clinical Oncology v20,1997,p605-8;Journal of urology, v163, 2000,p824-7; Prostate v47, 2001, p52-8; Journal of the American medical Assoc, v276, 1996, p1904-6

23) Am J Clin Nutr. 2007 Feb;85(2):523-9

24) UUrology,2007,70:672-676

25) Amer J of Epidem,2008,167(1):71-77

26) PLoS ONE, 2008, 3(7):e2568

27) Cancer Epidemiology, Biomarkers & Prev, Nov 1, 2007, 16:2213, “Cholesterol-Lowering Drugs and Advanced Prostate Cancer Incidence in a Large U.S. Cohort”

28) Cancer Epidemiol Biomarkers Prev 2009, 18:2807-2813, “Men with low serum cholesterol have a lower risk of high-grade prostate cancer in the placebo arm of the Prostate Cancer Prevention Trial”

29) Cancer Epidemiol Biomarkers Prev 2009; 18:2814-2821, “Prediagnostic total and high-density lipoprotein cholesterol and risk of cancer”

Cancer Epidemiol Biomarkers Prev, 2009;18:2805-2806, 2807-2813, 2814-2821

31) Harvard Men’s Health Watch, June 2007

32) CA Cancer J Clin, 2004, 54:68,”TOMATOES BEAT LYCOPENE ALONE FOR PROSTATE CANCER PROTECTION”, https://caonline.amcancersoc.org/cgi/content/full/54/2/68

33) https://www.northwestern.edu/ newscenter/stories/2010/11/soy-prostate-cancer.html, Northwestern University Newscenter, Nov 8 2010, “Soy May Stop Prostate Cancer Spread: Experimental soy-based drug shows benefits in men with localized prostate cancer”

34) The Lancet, 1 January 2011, 377(9759):31-41,”Effect of daily aspirin on long-term risk of death due to cancer: analysis of individual patient data from randomised trials”

35) https://www.dailymail.co.uk/health/article-2359466/Taking-omega-3-fish-oil-supplements-increase-risk-aggressive-prostate-cancer-70.html

36) JAMA, 2011, 306(14):1549-1556, “Vitamin E and the Risk of Prostate Cancer The Selenium and Vitamin E Cancer Prevention Trial (SELECT)”

37) J Natl Cancer Inst, 2000 Dec 20, 92(24):2018-23, “Association between alpha-tocopherol, gamma-tocopherol, selenium, and subsequent prostate cancer”

38) https://www.medicalnewstoday.com/articles/260338.php

39) European Urology, Jan 2015, 65(1):115-123,”A New Era of Testosterone and Prostate Cancer: From Physiology to Clinical Implications

40) EUROPEAN UROLOGY, 2012, 62:765 767, “Goodbye Androgen Hypothesis, Hello Saturation Model”

41) Journal of Urology, Accepted: May 29, 2015; Published Online: June 08, 2015, “Long-Term Exposure to Testosterone Therapy and the Risk of High Grade Prostate Cancer”

There are many problems with the TRT-causes-prostate-cancer way of thinking and considerable research data began to cast doubts in the minds of many.  Let’s look at some of the research that show the exact opposite of the testosterone-fuels-prostate-cancer theory

1. STUDY: Higher Testosterone = Lower Prostate Cancer.  A huge epidemiological study of 28,000+ men found that the higher the T-levels , the lower the incidence of prostate cancer. [18] John Hopkins researchers found men without prostate cancer had average T-levels of 636 ng/ml while prostate cancer patients average levels of 473. [19] Again, if increasing testosterone is dangerous to the prostate, one would not expect this result.

2. STUDY: Testosterone Therapy Does Not Increase the Risk of Aggressive Prostate Cancer. What you really care about is avoiding the aggressive from of prostate cancer, which can spread easily and kill you in a matter of months. [40]  A recent (2015) study by the Journal of Urology showed no increase the nasty form of prostate cancer, again completely counterintuitive to the standard model. [41] By the way, this study looked over a fairly long time frame of five years.

NOTE:  You should also check out my page How to Lower Your PSA, which shows the latest research on how to lower your PSA, and my page that discusses the research on How to Prevent Prostate Cancer.

3. STUDIES: High Testosterone Increases Survival from PC.  Several studies have shown that the higher one s testosterone, the better the chance of survival from prostate cancer. [22] Why would higher testosterone protect men from prostate cancer if testosterone is what causes and spreads it in the first place?  Again, that does not seem to add up.

4. STUDIES:  Low Testosterone Increases the Risk of Prostate Cancer.  A recent research summary pointed out that most studies show that low testosterone, and not high testosterone, increase the risk of more advanced forms of prostate cancer and the likelihood of developing cancer even after the prostate has been removed. [39] From this data, one can only argue that testosterone appears to be protective not harmful.

5. STUDY: Natural Testosterone Shrinks the Prostate. The University of Utah studied 214 identical twins and found that the size of the prostate one of the curses of middle and older aged males was inversely related to T-levels. [20] Does somthing that decreases prostate size really increase prostate cancer risk?  I guess anything is possible, eh?  (Prostate size does NOT necessarily have anything to do with prostate cancer.  You can have a small prostate and nasty aggressive prostate cancer.  My point is that usually things that are natural and healthy for the body come in packages and improve health in many complementary ways.)

6. STUDY: Supplemental Testosterone Shrinks the Prostate. Similar to #2, one study showed that men given supplemental testosterone actually shrank their prostates! [21] Again, testosterone seems generally prostate friendly and not the opposite.

NEW MODEL: The Saturation Model.  All of the above data lead a small group of researchers to come up with a completely different model relating testosterone to PC and dubbed it The Saturation Model. The pioneers were Drs. Muller and Morgentaler, who point out that the data seems to point out that testosterone has a finite, limited ability to fuel prostate cancer.  Dr. Morgentaler, in my opinion, argues eloquently for this view and develops it fully in a landmark paper in the journal European Urology. [40] There he states that testosterone can stimulate prostate cancer growth at very low levels of testosterone and then additional testosterone makes no difference.  This is why the pharmaceutical lowering of testosterone to essentially castrate a man does help with prostate cancer:  Furthermore, this is why raising testosterone past, say, a 100 ng/dl makes no real difference in prostate cancer rates.  It simply does not matter any more, because testosterone has done all the prostate stimulation that it is going to do back at 100 (or whatever the very low T number is).

Did you know you can inexpensively do your own testing for most hormones? The industry leader is Discounted Labs..

CAUTION: Of course, I encourage you to talk to your doctor:  it is his job to stay up on the latest research and, of course, he will have experience in his own practice as well.  Perhaps some subpopulation of men is at risk for prostate cancer and he or she is aware of this link.  In general, though, the saturation model makes a lot of sense to me.  However, I do want to point out that some men go on testosterone therapy and increase their testosterone quite high and estradiol increases with it of course.  Furthermore, many men, at least here in the U.S., are overweight or obese and so their estradiol levels shoot up to unnaturally high levels, much greater than during their youth generally.  And most doctors ignore these high levels of estradiol and do not encourage their patients to lose weight, lower their dosage or perhaps manage their estradiol.  The reason that I bring this up is that there is some evidence that higher estradiol levels are linked to prostate cancer risk, something I outline in my page High Estradiol, Prostate Cancer and BPH (Enlarged Prostate), although it does not show up in the above studies as far as I know. Again, discuss with your doctor.

NOTE:   I have struggled with a mildly elevated PSA after going on TRT, but so far there is no evidence of prostate cancer but rather inflammation.  You can read about this in my pages High PSA But No Cancer and My Recent 4kScore Test Results.

Soy and Men - Peak Testosterone

“Don’t be a soy boy!”  You may have heard that expression if you’ve hung around any of the bodybuilding sites.  Is it true? Is soy bad for us guys?

In my opinion, soy is one of the most complex of all foods to evaluate, because it is like us:  when it is good, iti is very, very good; and, when it is bad, it is very, very bad. Yes, it is truly both angel AND devil.

Let’s start with some of soy’s incredible properties that can help us males.  Here’s just a few that should raise your eyebrows:

1. Nitric Oxide.  A fairly recent animal study showed soy increasing vascular reactivity, i.e. arterial “responsiveness”, and lowering blood pressure. [1] Furthermore, one study on men (and women) with mild to moderate high blood pressure showed a very dramatic reduction in blood pressure after several months of soy milk consumption. [5] Results were striking and showed a 18.4 and 15.9 mm average decrease in systolic and diastolic pressures, respectively. This is because soy affects eNOS favorably and can result in increased nitric oxide. One in vitro study on human endothelial cells found a 70% increase in nitric oxide from genistein. [8]

2. Okinawans. One of the best documented supercultures on the planet are the Okinawans.  They enjoyed incredibly good health and longevity in spite of living in a modern, industrial environment and are famed for their high centennarian and low heart disease and cancer rates. The Okinawans ate considerable amounts of soy, probably an average of 25-50 grams daily.

3. Cardiovascular Disease.  Soy is associated with decreased heart disease in both men and women. One of the reasons, besides its blood pressure lowering effects, is it also decreases cholesterol in men with high cholesterol levels. [2] It also lowers homocysteine and oxidized LDL cholesterol levels, both significant risk factors for cardiovascular disease. [6] Furthermore, it also likely lowers saturated fat consumption for many, simply because it is (for those who like it) a satisfying protein food that lowers dependency on meat and dairy.  Later study work partially verified similar results on cholesterol, by the way, although results were not uniform. [3]

4. All Cause and Cardiovascular Mortality.  One study on Japanese men showed a 23% reduction in all cause mortality for men who consumed soy 4+ times/week compared to those who consumed it once per month. [4] That’s a pretty impressive reduction and cardiovascular mortality was reduced as well, which is the #1 killer of men in modern societies.

5. Quality, Undenatured Protein. Soy is also a good quality protein, in spite of what some bodybuilding sites claim, and is usually inexpensive and easy to obtain.  Even more attractive is the fact that there are now many undenatured brands available both online and in many health food stores. It has become a staple for many vegan and vegetarian bodybuilders because of it.

6. Prostate Cancer.  One of the big worries for middle-aged and older men is prostate cancer.  I just had a friend die of it:  after months of chemo, it still spread to his liver.  Several studies have shown that soy is protects significantly against prostate cancer. [15]

7. Non-alcoholic Fatty Liver Disease (NALFD).  Preliminary studies seem to show that soy reduces fatty liver disease in those who are overweight at least and helps stop the accumulation of fat in the liver. [17]

In spite of all these stellar benefits, I am still very cautious about soy and rarely consume it.  As it turns out, the dangers and risks are just as dramatic:

1. Hypothyroidism. Hypothyroidism, or an underactive thyroid, is a risk factor for low testosterone and can affect erections and relationships as well. The fatigue and weight gain associated with it are not going to help a man in or out of the bedroom. Unfortunately, soy is a powerful inhibitor of a key thyroid enzyme named TPO that liberates iodine to do its job. [9] On the surface, it would seem likely that this inhibition can, in some individuals, lead to hypothyroidism, especially in those with low iodine levels (which is quite common). In addition, many men already have decreased thyroid function and additional soy in the diet may exacerbate this condition as well.  It is also scary that researchers believe that this effect on the thyroid is due primarily to the phytoestrogens present n soy.  These phytoestrogens are quite good at mimicking estradiol, a known promoter of thyroid cancer as well. [9][10]

Are these concerns overblown?  One prominent meta-analysis thinks so:  they looked at multiple studies and concluded that soy had minimal affect on individuals with any kind of normal thyroid function. [11] In fact, there summary was: “Thus, collectively the findings provide little evidence that in euthyroid, iodine-replete individuals, soy foods, or isoflavones adversely affect thyroid function.”  And they did admit there was evidence that thyroid patients might have to increase their dosage due to the effects of soy consumption.

2. Zinc Chelation. Soy is packed with heat-insenstive phytic acid.  Phytic acid has a beneficial propertity in that it lowers cholesterol.  However, one very negative aspect of phytic acid consumption is its uncanny ability to bind to zinc. [7] (It also binds to calcium and iron.) Zinc is critical for testosterone production, estrogen de-aromatization and many other key male pathways. Plus, sexually active men will lose a significant amoutn of zinc in sperm.  For more details, see my page on Zinc and ZMA and my new book, 15 Natural Erectile Dysfunction Cures.

3.  Male Brain Shrinkage. This is the biggee for me. A couple of studies show that soy can lead to brain shrinkage in males. [16] The exact wording in the studies is “brain atrophy” and it only applies to males.  Again, this is likely another negative effect of the phytoestrogens in soy.

Now I should point out the counterargument to this:  one study shows an improvment in memory in Indonesian seniors who regularly consumed soy. [12] This is rather hard to explain if soy is really so brain-toxic as is the very-sharp-through-old-age Okinawans. In short, it looks as if these claims against may be somewhat exagerrated and/or need additional studywork.  However, the rebuttal to this is that a follow-up study showed that tempeh improved memory in the elderly but tofu decreased it. [13] So perhaps the difference is fermented versus non – who knows?

4. Low Testosterone and Hypogonadism. Previous study work was somewhat unequivocal but likely showing a slight decrease in testosterone resulting from soy consumption.  However, one recent study should give every male pause to reflect:  a case report of a male on a high soy diet that developed hypogonadism (clinically low testosterone) and was able to fully recuperate upon cessation. [14]

5.  Hexane. One thing that I don’t think anyone disputes is that modern soys are generally processed with hexane, a toxin that has no business being on your plate. And don’t let anyone fool you:  hexane residues definitely end up on most soy products and many health officials are concerned about it.

In my opinion, soy is impressive but simply not worth the risk, primarily because of risk to the brain and thyroid.  The cardiovascular and endothelial benefits can easily be obtained from other foods – see my book The Peak Erectile Strength Diet – coupled with a Low Fat  and/or Mediterranean Diet. Yes, it’s hard to argue with the Okinawans, but I’d rather be safe than sorry.

1)  The FASEB Journal, 2005, 19:1755-1757, “Dietary soy isoflavone induced increases in antioxidant and eNOS gene expression lead to improved endothelial function and reduced blood pressure in vivo”

2) Circulation, 2000, 102:2555-2559, “Soy Protein and Cardiovascular Disease: A Statement for Healthcare Professionals From the Nutrition Committee of the AHA”

3) European Journal of Clinical Nutrition, 2005, 59″843 850, “Effects of soy supplementation on blood lipids and arterial function in hypercholesterolaemic subjects”

4) Preventive Medicine, Jul 2006, 43(1):20-26, “Soy consumption and mortality in Hong Kong: Proxy-reported case control study of all older adult deaths in 1998”

5) J Nutr, Jul 1 2002, 132(7):1900-1902, “Soy Milk Lowers Blood Pressure in Men and Women with Mild to Moderate Essential Hypertension”

6) American Journal of Clinical Nutrition, Aug 2002, 76(2):365-372, “Effects of high- and low-isoflavone soyfoods on blood lipids, oxidized LDL, homocysteine, and blood pressure in hyperlipidemic men and women”

7) Crit Rev Food Sci Nutr, 1995 Nov, 35(6):495-508, “Phytic acid in health and disease”

8) British Journal of Pharmacology, Feb 2005, 144(3):394-399, “The soy isoflavone genistein induces a late but sustained activation of the endothelial nitric oxide-synthase system in vitro”

9) Environ Health Perspect, Jun 2002, 110(Suppl 3):349 353, “Goitrogenic and estrogenic activity of soy isoflavones”

10) J Clin Endocrinol Metab, 2001 Mar, 86(3):1072-7, “Estrogen Promotes Growth of Human Thyroid Tumor Cells by Different Molecular Mechanisms”

11) Thyroid, Mar 29 2006, 16(3), “Thus, collectively the findings provide little evidence that in euthyroid, iodine-replete individuals, soy foods, or isoflavones adversely affect thyroid function”

12) Brain Research, 16 March 2011, 1379:206 212, “Borobudur revisited: Soy consumption may be associated with better recall in younger, but not in older, rural Indonesian elderly”

13) Dementia and Geriatric Cognition Disorders, 2008, 26(1), “High Tofu Intake Is Associated with Worse Memory in Elderly Indonesian Men and Women”

14) Nutrition, 2011 Jul-Aug, 27(7-8):859-62, “Hypogonadism and erectile dysfunction associated with soy product consumption”

15) Cancer Epidemiol Biomarkers Prev, Jul 2003, 12:665, “Soy and Isoflavone Consumption in Relation to Prostate Cancer Risk in China”

16) Journal of Anti-Aging Medicine, Dec 2003, 6(4):335-336, “Soy-Induced Brain Atrophy?”

Your LDL Levels - Peak Testosterone

Very few Westerners escape the rapid acceleratio of plaque buildup.  One huge issue this causes is damage to the endothelium.  What eventually happens is that the lining of your arteries, the endothelium, becomes so covered with plaque that it cannot pump out any signficant amount of nitric oxide.  This leads to a host of issues including erectile dysfunction, high blood pressure and at times angina.

So one of the huge tasks facing most men is the get their arteries back.  How can they do that?  Simple:  lowering LDL.  Many studies and clinicians have recognized the importance of lowering LDL to reverse plaque.  Yes, your arterial plaque can be actually reduced and blood flow increased.

NOTE: It’s not just the Low Fat folks who insist on and outline how to decrease arterilsclerosis:  it’s also leading cardiologists such as William Davis and the Asteroid Study researchers mentioned below.  (You can read more about the subject in my link on Clearing Your Arteries.)

“But wait!”, you ask, “Isn’t LDL cholesterol and I thought cholesterol doesn’t matter?”  Okay, admittedly, it doesn’t matter to a healthy, younger male with little arterial plaque. However, the rest of us need some help and some arterial repair and need to face the facts.  Consider the current evidence on the subject:

1.  Your level of arteriosclerosis is related to cardiovascular events.  And, yes, cardiovascular ‘events’ are not a good thing.

2.  Decreasing arterial plaque (arteriosclerosis) improves cardiovascular risk.

3.  Decreasing LDL to a certain threshold will reverse arteriosclersosis.

And that’s the subject of this page.  Just what LDL threshold does one need to go to actually begin to reverse his arteriosclerosis?  Below I’ll show you the levels given by various experts and researchers.

Want your arteries back?  Want increased blood flow?  Then focus on your LDL and quit listening to the “Cholesterol Myth” people.  Remember that heart disease is the #1 killer of men in modern societies. Lowering LDL levels could almost completely eliminate this plague.

1.  Dr. Caldwell Esselstyn. This physician was one of the early pioneers who showed that arterial plaque could indeed be reversed.  In another link I reviewed his book, Prevent and Reverse Heart Disease, and in this book on page 67 he writes his target LDL levels with his patients:

“Here, once again, is the basic message of my research:  no one who achieves and maintains total blood cholesterol of 150 mg/dl and LDL levels below 80 mg/dl – using strict plant-based nutrition and, where necessary, low doses of cholesterol-reducing drug – experiences progression of heart disease.”quot;

2.  Dr. Neal Bernard.  I have also reviewed Dr. Bernard’s low fat book on Reversing Diabetes (with a Low Fat, low glycemic diet) – another excellent book! – and Dr. Bernard suggests therein that some men may need to go even lower (p. 105):

“…many scientists are now pushing for stricter standards, including reductions to below 70 mg/dl (1.8 mmol/l) for high risk patients.  Some authorities have called for lowering your LDL by 30 to 40 percent regardless of what your starting level is.” [1]

3.  2007 Circulation Study. The journal Circulation looked at three different diets and found that the more the fat, the less the blood flow: “BART testing revealed a significant inverse correlation between flow-mediated vasodilation and intake of total fat (r2= 0.29; P=0.03), saturated fat (r2= 0.31; P=0.02) and monounsaturated fat (r2= 0.35; P=0.01).” [2] I am inserting this comment, because it’s important to realize that fat slows down blood flow.  A lot of you middle-aged guys are going to get big benefits in erectile strength from this.  Can I hear an Amen, brother?  And in this study, the Low Fat participants went down to an average LDL of 84.6 ng/dl.

4.  Dr. Ornish. Probably the most famous Low Fat researcher is Dean Ornish.  His landmark studies in the 80’s showed that a Low Fat Diet could reverse heart disease and arteriosclerosis.  In his bestselling book The Spectrum (p. 204) he wrote:

“If that’s enough to bring it down to an LDL level less than 100 mg/dl, preferably below 70 mg/dl if you have heart disease, that may be sufficient.”

NOTE: A Low Fat Diet has also been found improve to telomere aging, turns off 100’s of prostate cancer genes, etc. and I discuss all of the list in link on The Incredible Health Benefits of a Low Fat Diet .

Now why would Dr. Ornish even mention an LDL as high as 100 mg/dl?  The reason is that this book, The Spectrum, is built on the idea that one does not HAVE to be on a Low Fat Diet unless you have heart disease.  If you do not have major cardiovascular problems, then you can get by more than likely with a more moderate approach.

But then notice the LDL target that Dr. Ornish gives after that:  70 mg/dl.This is low LDL indeed but underscores the importance of taking aggressive action if you have heart disease. Ornish’s Low Fat programs can have a profound impact on men with heart disease.  For example, one of his studies showed angina decreasing by 91% – a very impressive result to say the least. (p. 9)

5.  Asteroid Study.  This study gave patients high doses of statins and then tracked, based on their LDL levels, cardiovascular outcomes.  LDL of 70 mg/dl was the level at which the authors felt that all cardiovascular goals were achieved.  However, other commentators have noted that this study showed plaque reversal at about 60 mg/dl.

Now, because plaque reversal has been achieved at higher levels, one cannot help but wonder if some negative aspect of statins require one to go even lower than is necessary with Low Fat.  This seems reasonable to me considering that statins decimate CoQ10 levels and raise arachidonic acid levels, both of which are heart unhealthy. [5] For more negatives, see my link on https://www.peaktestosterone.com/.

6.  Dr. William Davis. Some people will trust Dr. Davis a little more, because he a) hates wheat, b) is not in love with Low Fat Diets and c) likes some fat in the form of omega-3’s and monos. He has kind of been adopted by some in the Paleo crowd because of it, but what they don’t realize is that in his book, Track Your Plaque, he advocates an LDL of 50-60 for those who want to decrease arteriosclerosis! [6]

Choosing and LDL Level

As you can see there is some variation in what  level of LDL you should shoot for.  85 mg/dl is the highest number advocated by someone who has actually achieved plaque reversal.  But there is some evidence for men with serious issues that it needs to be lower, probably between 60 and 70.

So you (and your physician if he/she knows anything about the subject) have to decide for yourself.  There are many unanswered questions:

How much does exercise play a role?  Can certain superfoods (pomegranate juice, berries, etc.) play a role?

We will not know the answers to these kind of questions for probably years to come, so, in the meantime, one has to make an educated guess.

REFERENCES:

1)   Diabetes Care, 2006, 29(suppl1):S4-S42, American Diabetes Assocation, “STandards of Medical CAre in Diabetes – 2006”

2) Circulation, 2007, 116:II_819, “Abstract 3610: Comparative Effects of 3 Popular Diets on Lipids, Endothelial Function and Biomarkers of Atherothrombosis in the Absence of Weight Loss”

3) American Journal of Cardiology, 2009, 104(1):29-35, “Safety and Efficacy of Achieving Very Low Low-Density Lipoprotein Cholesterol Levels With Rosuvastatin 40 mg Daily (from the ASTEROID Study0”

4) https://www.trackyourplaque.com/library/fl_05-002ldl60.asp

5) Nutr Metab Cardiovasc Dis, 2001 Apr, 11(2):88-94, “Statins enhance arachidonic acid synthesis in hypercholesterolemic patients”

6) Track Your Plaque, Dr. William Davis, p. 106.

LDL: What Must Your LDL Levels Be? - Peak Testosterone

Very few Westerners escape the rapid acceleratio of plaque buildup.  One huge issue this causes is damage to the endothelium.  What eventually happens is that the lining of your arteries, the endothelium, becomes so covered with plaque that it cannot pump out any signficant amount of nitric oxide.  This leads to a host of issues including erectile dysfunction, high blood pressure and at times angina.

So one of the huge tasks facing most men is the get their arteries back.  How can they do that?  Simple:  lowering LDL.  Many studies and clinicians have recognized the importance of lowering LDL to reverse plaque.  Yes, your arterial plaque can be actually reduced and blood flow increased.

NOTE: It’s not just the Low Fat folks who insist on and outline how to decrease arterilsclerosis:  it’s also leading cardiologists such as William Davis and the Asteroid Study researchers mentioned below.  (You can read more about the subject in my link on Clearing Your Arteries.)

1.  Your level of arteriosclerosis is related to cardiovascular events.  And, yes, cardiovascular ‘events’ are not a good thing.

2.  Decreasing arterial plaque (arteriosclerosis) improves cardiovascular risk.

3.  Decreasing LDL to a certain threshold will reverse arteriosclersosis.

And that’s the subject of this page.  Just what LDL threshold does one need to go to actually begin to reverse his arteriosclerosis?  Below I’ll show you the levels given by various experts and researchers.

Want your arteries back?  Want increased blood flow?  Then focus on your LDL and quit listening to the “Cholesterol Myth” people.  Remember that heart disease is the #1 killer of men in modern societies. Lowering LDL levels could almost completely eliminate this plague.

1.  Dr. Caldwell Esselstyn. This physician was one of the early pioneers who showed that arterial plaque could indeed be reversed.  In another link I reviewed his book, Prevent and Reverse Heart Disease, and in this book on page 67 he writes his target LDL levels with his patients:

“Here, once again, is the basic message of my research:  no one who achieves and maintains total blood cholesterol of 150 mg/dl and LDL levels below 80 mg/dl – using strict plant-based nutrition and, where necessary, low doses of cholesterol-reducing drug – experiences progression of heart disease.”quot;

2.  Dr. Neal Bernard.  I have also reviewed Dr. Bernard’s low fat book on Reversing Diabetes (with a Low Fat, low glycemic diet) – another excellent book! – and Dr. Bernard suggests therein that some men may need to go even lower (p. 105):

“…many scientists are now pushing for stricter standards, including reductions to below 70 mg/dl (1.8 mmol/l) for high risk patients.  Some authorities have called for lowering your LDL by 30 to 40 percent regardless of what your starting level is.” [1]

3.  2007 Circulation Study. The journal Circulation looked at three different diets and found that the more the fat, the less the blood flow: “BART testing revealed a significant inverse correlation between flow-mediated vasodilation and intake of total fat (r2= 0.29; P=0.03), saturated fat (r2= 0.31; P=0.02) and monounsaturated fat (r2= 0.35; P=0.01).” [2] I am inserting this comment, because it’s important to realize that fat slows down blood flow.  A lot of you middle-aged guys are going to get big benefits in erectile strength from this.  Can I hear an Amen, brother?  And in this study, the Low Fat participants went down to an average LDL of 84.6 ng/dl.

4.  Dr. Ornish. Probably the most famous Low Fat researcher is Dean Ornish.  His landmark studies in the 80’s showed that a Low Fat Diet could reverse heart disease and arteriosclerosis.  In his bestselling book The Spectrum (p. 204) he wrote:

“If that’s enough to bring it down to an LDL level less than 100 mg/dl, preferably below 70 mg/dl if you have heart disease, that may be sufficient.”

NOTE: A Low Fat Diet has also been found improve to telomere aging, turns off 100’s of prostate cancer genes, etc. and I discuss all of the list in link on The Incredible Health Benefits of a Low Fat Diet .

Now why would Dr. Ornish even mention an LDL as high as 100 mg/dl?  The reason is that this book, The Spectrum, is built on the idea that one does not HAVE to be on a Low Fat Diet unless you have heart disease.  If you do not have major cardiovascular problems, then you can get by more than likely with a more moderate approach.

But then notice the LDL target that Dr. Ornish gives after that:  70 mg/dl.This is low LDL indeed but underscores the importance of taking aggressive action if you have heart disease. Ornish’s Low Fat programs can have a profound impact on men with heart disease.  For example, one of his studies showed angina decreasing by 91% – a very impressive result to say the least. (p. 9)

5.  Asteroid Study.  This study gave patients high doses of statins and then tracked, based on their LDL levels, cardiovascular outcomes.  LDL of 70 mg/dl was the level at which the authors felt that all cardiovascular goals were achieved.  However, other commentators have noted that this study showed plaque reversal at about 60 mg/dl.

Now, because plaque reversal has been achieved at higher levels, one cannot help but wonder if some negative aspect of statins require one to go even lower than is necessary with Low Fat.  This seems reasonable to me considering that statins decimate CoQ10 levels and raise arachidonic acid levels, both of which are heart unhealthy. [5] For more negatives, see my link on The Hidden Risks of Statins.

6.  Dr. William Davis.  Some people will trust Dr. Davis a little more, because he a) hates wheat, b) is not in love with Low Fat Diets and c) likes some fat in the form of omega-3’s and monos. He has kind of been adopted by some in the Paleo crowd because of it, but what they don’t realize is that in his book, Track Your Plaque, he advocates an LDL of 50-60 for those who want to decrease arteriosclerosis! [6]

Choosing and LDL Level

As you can see there is some variation in what  level of LDL you should shoot for.  85 mg/dl is the highest number advocated by someone who has actually achieved plaque reversal.  But there is some evidence for men with serious issues that it needs to be lower, probably between 60 and 70.

So you (and your physician if he/she knows anything about the subject) have to decide for yourself.  There are many unanswered questions:

How much does exercise play a role?  Can certain superfoods (pomegranate juice, berries, etc.) play a role?

We will not know the answers to these kind of questions for probably years to come, so, in the meantime, one has to make an educated guess.

1)   Diabetes Care, 2006, 29(suppl1):S4-S42, American Diabetes Assocation, “STandards of Medical CAre in Diabetes – 2006”

2) Circulation, 2007, 116:II_819, “Abstract 3610: Comparative Effects of 3 Popular Diets on Lipids, Endothelial Function and Biomarkers of Atherothrombosis in the Absence of Weight Loss”

3) American Journal of Cardiology, 2009, 104(1):29-35, “Safety and Efficacy of Achieving Very Low Low-Density Lipoprotein Cholesterol Levels With Rosuvastatin 40 mg Daily (from the ASTEROID Study0”

4) https://www.trackyourplaque.com/library/fl_05-002ldl60.asp

5) Nutr Metab Cardiovasc Dis, 2001 Apr, 11(2):88-94, “Statins enhance arachidonic acid synthesis in hypercholesterolemic patients”

6) Track Your Plaque, Dr. William Davis, p. 106.

Hypogonadism, Testosterone and Your Sex Life.

One of the reasons I find this study so fascinating is that there are SO many doctors out there who still think that low testosterone makes little difference. I get letters all the time with horror stories from guys who have struggled for years while their doctor completely ignored (or didn’t know how to handle) their problem.

This means that low testosterone should simply be called The Great Sex Life Killer: it removes sexual desire, makes you limp and destroys the long term health of your penis by reducing morning erections.  What’s left, eh?  And, if you’ve read my site at all, you know that Sex is Very, Very Good for Males, regardless of age.

So here’s the bottom line, at least according to the study:  if you have the above symptoms, you should ask to get tested for low testosterone since these are by far the most strongly correlated.  Of course, I cover some of the other studies in my link on Low Testosterone Symptoms, but according to the NEJM, your sex life is the best indicator.

Furthermore, realize that doctors are often reluctant to identify and treat low testosterone.  Consider this fairly recent 2007 study where the researchers 1) defined low testosterone as total below 300 ng/dl and free below 5 ng/dl. [2]  These are very low numbers and guys will very often experience problems in the 300’s and even 400’s in some cases.

This is also what I find disturbing about the study.  The researchers had a Clinical Practice Guideline from the Endocrine Society that had the following very rigorous guideline for treating low testosterone or hypogonadism:

Low total and free testosterone plus the presence of

plus two or more of the following symptoms:

This seems much too conservative to me.  I mean you might as well just say that you don’t want to treat hypoganadism, because you’ve set the testosterone level astronomically low, required osteoporosis and other questionable and ill-defined symptoms before you treat.  I ask the question:

If a guy has a couple of low testosterone readings, what else do you need, especially considering the many dangers of low testosterone, including increased risk of Metabolic Disorder, heart disease and Diabetes?

REFERENCES:

1) “NEJM, 2010; 363:123-135, “Identification of Late-Onset Hypogonadism in Middle-Aged and Elderly Men”

2) https://www.sciencedaily.com/releases/2007/09/070907233610.htm

Intramuscular Testosterone Injection Sites - Peak Testosterone

As of 2016, testosterone cypionate is the most popular form of testosterone therapy out there on the Peak Testosterone Forum – significantly ahead of other injectibles, transdermal testosterones and Low Dose Clomid Therapy / HCG Monotherapy. And, in my opinion, it has one of the hightest success rates, assuming good early and followup protocols are implemented. However, a rather controversial debate that goes with the use of cypionate is whether intramuscular or subcutaneous is better. I won’t go into the details of that debate here, because I want to cover a very practical matter instead: where is the best place(s) for a man to self-inject IM (intramuscular) cypionate? And I bring up self-injection, because very few doctor’s offices or TRT clinics require their patients to come in for an injection any more.

There are basically three choices, and I will discuss the pros and cons of each:

a) Quad. The quadricep (large front leg muscle between the knee and groin) is a time-tested location for a man to give himself an IM injection.  In fact, I would argue that it is really the only place where you can give yourself a larger volume IM injection. 1 inch needles are typically used for leaner men and up to 1.5 inch for men with quite a bit of leg fat. One of our longtime members explains how he found the best location for giving his shot:

“Hopefully your doctor or his nurse gave you instruction on how to best perform the injection. Basically the three things that minimize the discomfort are:

1) With your opposite hand (from the hand holding the syringe) gently spread the skin a bit taught by expanding the distance between your index finger and thumb.

2) Enter the injection spot pretty close to 90 degrees with respect to the skin surface.

3) It seems best if you quickly sort of “stick” the needle all the way in without slamming it of course.

As far as injection sites I have tried both sides of the glute and I have tried my upper outer right quad (that location is better suited for self injection). So for me none of the injections have been very painful.” [1]

CAUTION:  Always go with recommendations given by your healthcare provider.

“However, when I did the thigh, I thought “hey that didn’t hurt at all!” And then the next day came and I had a helluva charlie horse for about a day and a half. Then I went back to dear wifey for the glute injections.” [1]

b) Deltoid. Injecting in the delt (shoulder) muscle has become increasingly popular.  It also is easily accessible and in many ways ideal for men who are doing more frequent, smaller volume IM injections.  One of our forum moderators wrote that he handles his delt injections in the following way:

“I use 1/2″ needles for my injections (mostly quad, delt, and VG) and they work great. BD offers a few 5/8″ options. If I recall they come in 28g, 27g, and 25g. They don’t make smaller gauges in this length because they become a little too flexible. Lately I’ve been using BD 28g 1/2″ insulin syringes. I like them a lot.” [2]

c) CAUTION:  Glute.  Some men inject IM into the glute.  However, there are a number of risks:

1) To get the right angle, you have to be a 3rd generation yoga master.

2) It is possible to hit the sciatic, an experience you will likely never forget.

The solution around this?  Get your partner to inject for you.  My wife did this for me for a few months and did a fine job.  She hates needles, so I was proud of her!

1)  https://www.peaktestosterone.com/forum/index.php?topic=1178.0

2) https://www.peaktestosterone.com/forum/index.php?topic=10797.0

Whey, Undenatured - Peak Testosterone

Whey is an incredible protein.  It 1) increases glutathione, the body’s master detoxifier and antioxidant, 2) boosts immunity and 3) is the gold standard for muscle building and strength.

Or does it?  As it turns out, even something lauded by the health and bodybuilding communities can be corrupted by food processing and that is exactly what happened to whey.  As I warn in my link on Whey and Excitotoxins, supplement and food manufactureres, in an effort to pasteurize and purify whey, heat it to very high temperatures.  These hydrolyzed isolates and concentrates that account for the lion’s share of they whey out there are full of excitotoxins.  Just as nasty, all the glutathione-boosting properties of the whey are destroyed as well.

One concern that you may have about having undenatured or “raw” whey is bacteria. Pasteurization and heating, after all, is what protects us from illness.  There is another more expensive methodology that can be employed:  microfiltering to literally screen or sift out all the bacteria.  This is the method used, sometimes called a “cold press”, for undenatured or biologically active wheys.  Every manufacturer has their own twist on how to do it. As far as I know, these processes do not free up any additional glutamine, which should leave the whey in its natural state with low levels of excitotoxins.

Where can you get the stuff and how much does it cost?  It used to be very expensive, because, frankly, the suppliers could get away with it.  Now, though, a number of inexpensive, high quality products have hit the market place, even on discounters like Amazon.  There is a popular brand available in stores such as Vitamin Shoppe, called Biochem. For more information, see my links on Biochem Undenatured Whey. Here are a couple of other examples that I have not used: ImmunPlex Undenatured Whey Protein and ImmunoPro Powder..  Amazon also sells ImmunoPro, but this is over three times the price.

CAUTIONS: Start out slowly with undenatured whey. The boost in glutathione will actually begin to detox your tissues and move mercury around where it can be removed.  This is a good thing as long as you do not move too much too quickly.  Individuals who have had substantial mercury poisoning should speak to a doctor first.

So I started by saying, “No whey!”  Now I say, “Yes, whey!”  Well, as long as it is undenatured…

How Sitting Kills Heart and Erections and How To Overcome

Have you heard of latest risk factor for death, heart disease and cancer?  It’s got to be something exotic, right?  Maybe a new form of cholesterol or a hidden retrovirus?  No, I’m afraid it’s called sitting.

Yes, sitting can be dangerous, very dangerous for your health and heart. That’s right – researchers have found that few things in your lifestyle can influence your survival as how often your butt is on a chair or couch. One study, for example, found that every hour in front of the television was associated with an increased risk of death by heart disease, cancer and all causes of 18 percent, 9 percent and 11 percent, respectively. [1] Other work has shown that for every two hours sitting per day, your risk of diabetes goes up by 7% because your body uses less blood sugar. [6]

NOTE:  Remember that anything hard on the heart is also hard – or should I say limp? – on your erections as well.

This was really sobering for someone like myself who is a computer jockey by day.  The study went on to state that for those who watch four or more hours of television per day have an 80 and 46 percent increased risk of dying from cardiovascular disease and all causes, repectively.  These are monster numbers.  The television and the computer, if you sit at them for extended periods of time, are the equivalent of a multi-pack smoking habit!

1) Circulation, Published Online Jan 11 2010, “Television Viewing Time and Mortality. The Australian Diabetes, Obesity and Lifestyle Study (AusDiab)”

2) Medicine & Science in Sports & Exercise, May 2009, 41(5):998-1005, “Sitting Time and Mortality from All Causes, Cardiovascular Disease, and Cancer”

3) Arteriosclerosis, Thrombosis and Vascular Biology, May 2009, 41(5):998-1005, “Overexpression of Human Lipoprotein Lipase Protects Diabetic Transgenic Mice From Diabetic Hypertriglyceridemia and Hypercholesterolemia”

4) American Journal of Epidemiology, Advance Access published online on July 22, 2010, “Leisure Time Spent Sitting in Relation to Total Mortality in a Prospective Cohort of US Adults”

5) https://www.medicalnewstoday.com/articles/195697.php

6) Women’s Health, Nov 2009, p. 133.

7) https://www.medscape.com/viewarticle/725341_3, “Too Much Sitting: The Population Health Science of Sedentary Behavior: Objective Assessment of Sedentary Time: New Findings”

8) Exercise & Sport Sciences Reviews, Jul 2010, 38(3):105-113, “Too Much Sitting: The Population Health Science of Sedentary Behavior”

9) https://www.sciencedaily.com/releases/2016/07/160727194405.htm

10) https://news.indiana.edu/releases/iu/2014/09/slow-walking-sitting-study.shtml

11) Med Sci Sports Exerc. 2015 Apr; 47(4):843-9, “Effect of prolonged sitting and breaks in sitting time on endothelial function”

So is this just a television thing?  We all know that television sucks the life out of your brain, so perhaps it hits the rest of the bod just as hard?  Actually, it’s not the television – it’s the act of sitting that does it.  For example, researchers divided people into groups that sit 25, 50, 75 and 100 percent of the time and then followed them for 12 years.  The results were remarkable:  a dose-dependent rise in death from all causes and cardiovascular disease. [2]  In other words, the more sitting, the more likely the participants were to die from cardiovascular disease or all causes.

Also, an interesting twist is that a recent study found that sitting, independent of activity level, was strongly correlated with total all cause mortality.  Of course, the authors emphasized that physical activity is important, but they also pointed out that even physical activity cannot overcome a lifestyle of sitting around. [4]  Men who sat more than 6 hours per day were 18 percent more likely to die (and women 37 percent). [5]

The answer to the above question  probably has many question but here are two key ones:

a) Lipase Activity. It shuts off the activity of a key enzyme called lipase.  Lipase is the enzyme that breaks down fat and, after an extended time of sitting, lipase activity plummets to as low as one tenth of its normal rate.  One study showed that if lipase levels were increased in diabetically induced mice, they completely avoided elevated low cholesterol and triglycerides. [3] In other words, lipase activity is a powerful cardiovascular protection and may explain why rural, third world lifestyles are so heart protective.

b) Endothelial Dysfunction. Researchers have found that after two hours of sitting, your arteries literally begin to “numb.”  By that I mean that they lose their ability to expand which lowers blood pressure and increases blood flow.  And I would add that endothelial dysfunction is the most common cause of erectile dysfunction.

How Much Exercise Will Compensate for Sitting?

Here are two likely solutions. Choose one and you should be able to spare yourself from the extreme negative impacts of sitting:

A. 60-75 Minutes of Moderate Exercise Daily. Does your gut tell you that the common sense solution to the negative health effects of sitting would be exercise? If so, your gut would be exactly right. The question, though, would be “how much?” This was debated and some of the early research showed that you cannot make up for extended periods of sitting time through daily exercise unless that exercise is broken up into increments throughout the day regardless of fitness or exercise levels.  In other words, if you sit almost nonstop at work, commuting and/or in front of a television/computer, then an hour of exercise at the gym cannot compensate. [7] [8]

However, a more recent review examined multiple studies and found that 60-75 minutes of moderate exercise per day could eliminate the negative health effects of sitting. This is fantastic news, because you have a relatively easy solution to a huge health issue associated with the Western lifestyle.

I do realize, however, that for some of you, 60-75 minutes may sound like a lot. However, keep in mind that “moderate exercise” includes brisk walking. You can go to the gym and walk and get something done on a treadmill. You can walk through your neighborhood – hopefully not in a pollute urban city though – and benefit. You can get an inexpensive treadmill for home use and get a little reading done. [9]

B. Five Minutes Every Hour. Previous study work indicated that the endothelial dysfunction issues could be overcome with just five minutes of walking every hour.  The study found that even in health subjects sitting for one hour lowered endothelial function by 50%! Again, this will be hard on erections as well.  However, the researchers discovered that they could completely overcome this effect by having the subjects walk five minutes of every hour.  [10][11]

REFERENCES:

Testosterone-Killers - Prolactin and Prolactinomas

Some hormones just don’t tend to play well with your testosterone.  Cortisol and estrogen are examples.  Another hormone that can whack your testosterone and your sex life is prolactin.

Prolactin is a fine hormone and great for sleep, but, unfortunately, it makes a lot of other important things go to sleep, including your testosterone and fertility if levels are high enough. It is, not too surprisingly, often devasting to erections due to decreased testosterone levels and because it antagonizes dopamine and leads to an increased refractory (recovery post-erection) period. [4]  Excessive prolactin is also associated with gynecomastia, i.e. “male boobs”. [2] And probaby most dangerous of all in the long term, prolactin is probably an inflammatory cytokine (TNF alpha, IL-6, etc.) and has been linked to various inflammatory diseases, especially lupus. [7]

In females, hypothyroidism is a common cause of elevated prolactin levels.  In males, hypothyroidism likely raises prolactin

Consider the fact that one study noted that previous research found an “overall prolactin greater than 20 ng./ml. in 1.86% of 1,821 patients, prolactinomas in 7, 0.38%.” but found only five out of about a thousand men had prolactin exceeding 20, i.e. about 0.5%. [6]  In other words, high prolactin is generally not a root cause of low T, but it certainly can be and at a rate of somewhere around 1 out of a 100 hypogonadal men.  However, the researches still concluded that “prolactin should be determined only in cases of low sexual desire, gynecomastia and/or testosterone less than 4 ng./ml.”  This is an amazing statement because it recommends that prolactin be pulled for testosterone less than 400 ng/dl, something that is simply NOT done from all I have seen.  My impressions from the  The Peak Testosterone Forum is that probably one out of every ten men has their prolactin pulled.

NOTE: You can have very high prolactin and yet still not be hypogonadal.  The same study found that “testosterone was low in less than 50% of cases with prolactin greater than 35 ng./ml.” [6]

So how do males get very elevated levels of prolactin then? One all-to-common cause is a prolactinoma, a benign tumor of the pituitary that begins secreting, sometimes in great quantities, prolactin. This can have devastating effects.  Look at the description of this reader in his mid 40’s:

“I started experiencing longer and longer periods between being able to have sex starting about 4 years ago. It is to the point now that I don’t know when I can get it up. It has been very hard on my marriage and my wife has since moved out because she felt unloved and unattractive because of my lack of sexual desire. As you can imagine now that she has moved out I am taking this very serious. Here are my issues. I was going to a family doctor and wasn’t liking the results I was getting. He told me I had low testosterone and put me on Andogel packets.”

His low testosterone was devastating as you can tell. How tragic that a physical malady could lead to the undoing of a marriage.  However, he did write me back with some good news:

“Are you sitting down for my Prolactin reading? It was 200. Normal from what the doctor told me is 1 – 12. This is supposed to be curable from what I have heard so I am very exited as you can imagine. Thanks again.”

Elevated prolactin is very anti-testosterone and often leads to hypogonadism. [3]  His levels were astronomical and thus it is not surprising that his testosterone was so adversely affected.  (He was correct, of course, that normal prolactin levels are less than 12 ng/ml or maybe 15 ng/ml.) In his case, they did not find a prolactinoma or other tumor from an MRI, but put him on the standard medication and he got immediate results.

So, if you are wondering where your testosterone levels went, you may want to ask your doctor about getting a prolactin reading.

OTHER READING:  I have another page that covers Causes of Low Testosterone and it covers the frequency of pitutitary tumors in men with low testosterone.  Suffice it to say that the frequency is surprisingly high.  I also want to point out a must read journal article called “Long-Term Management of Prolactinomas” that is must-read for anyone with a prolactinoma. It looks about long term safety and issues, both positive and negative, with the dopamine agonists that are standard therapy.

CAUTION:  Read my link on The Importance of Avoiding Excitotoxins.  Animals studies show that prolactin levels can be negatively affected due to excitotoxin damage to the hypothalamus. In addition, minoxidil is suspected of causing prolactinomas and elevated prolactin levels. [5] Minoxidil (Rogaine) is a common over the counter hair loss treatment.

REFERENCES:

1) The American Journal of Medicine, May 1978, 64(5):782-787, “Serum prolactin levels in untreated primary hypothyroldism”

2) Psychiatr Serv, 51:983-985, Aug 2000, “Psychopharmacology: Galactorrhea and Gynecomastia in a Hypothyroid Male Being Treated With Risperidone”

3) N Engl J Med 1978; 299:847-852, “Prolactin-Secreting Tumors and Hypogonadism in 22 Men”

4) Rev Urol, 2000 Winter, 2(1):39 42, “Hyperprolactinemia and Erectile Dysfunction”

5) https://en.wikipedia.org/wiki/Hyperprolactinaemia

6) The Journal of Urology, 1997, 158(5):1764-1767, “Endocrine screening in 1,022 men with erectile dysfunction: clinical significance and cost-effective strategy.”

7) Rheum Dis Clin North Am, 2000 Nov, 26(4):713-36, “Roles of prolactin and gonadotropin-releasing hormone in rheumatic diseases”

Did you know you can inexpensively do your own testing for most hormones? The industry leader is Discounted Labs..

The Many Links to Cancer and Inflammation - Peak Testosterone

One of the men I was exchanging emails with last year told me that his doctor told him that if he drank a lot of milk growing up, it wasn’t matter of if he would get prostate cancer but when.  I thought that was remarkable at the time, because rarely do mainstream doctors get excited about anything nutritional.  Since then, I have kept my eyes out for anything related to the subject and was shocked to find out just how many possible milk-related links there were to cancer.  And, by the way, this is not something that I wanted to hear.  I love nonfat yogurt and didn’t want to give that up and non-fat dairy is part of some low fat diets.  But the evidence below is just too overwhelming in my opinion, especially if you’re 55 like me.

Here are Four Significant Links of Milk and Dairy to Cancer or Cancer Formation:

1. Not For Adults. I don’t need to tell anyone that anything that comes out of a mammary gland is NOT designed for adults.  Milk is for infants and it is designed to be highly stimulatory and make sure the baby (cow, human or whatever) grows fast and grows strong.  Yes, mammary milk is designed to drive growth – growth at all costs – and infants can grow tissues like weeds, because they are almost entirely impervious to cancer.  That is not true with an adult.  See #2 below:

2.  Growth Factors (VEGF and EGF). Some of you may have heard of the Anti-Angiogenic Diet.  There is a well-known Ted Talk on the subject by Dr. William Li. [1] Basically, Dr. Li talks about eating a variety of plant foods that inhibit growth factors that feed the growth and spread of cancerous tumors. The most infamous of these growth factors are Epidermal Growth Factor (EGF) and Vascular Endothelial Growth Factor (VEGF).

REFERENCES:

1)  https://www.ted.com/talks/william_li?language=en, “Can We Eat to Starve Cancer?”

2) The Egyptian Journal of Histology, Jun 2011, 34(2):403-414, “Effect of sildenafil (Viagra) on epidermal growth factor expression in submandibular gland of diabetic male rats: histological and immunohistochemical study”

3) Oncology, 2005, 69:4 10, “VEGF as a Key Mediator of Angiogenesis in Cancer”

4) https://proteinpower.com/drmike/2006/12/19/421/

5) Eur J Nutr, 2014 Jun, 53(4):1039-49,, “Comparative evaluation of cow -casein variants (A1/A2) consumption on Th2-mediated inflammatory response in mouse gut”

6) Cancer Epidemiol Biomarkers Prev,2006,15(2):203-10

7) Eur J Clin Nutr, 2009 Sep, 63(9):1076-83, “Differential effects of casein versus whey on fasting plasma levels of insulin, IGF-1 and IGF-1/IGFBP-3: results from a randomized 7-day supplementation study in prepubertal boys”

8) Br J Cancer, 1990 Mar, 61(3):456 459, “Milk consumption and cancer incidence: a Norwegian prospective study”

9) Cancer Causes & Control, December 1998, 9(6):559-566, “Dairy products, calcium, phosphorous, vitamin D, and risk of prostate cancer (Sweden)”

10) Am J Clin Nutr, October 2001, 74(4):549-554, “Dairy products, calcium, and prostate cancer risk in the Physicians’ Health Study”

We all need some EGF and VEGF, of course, for tissue repair and wound healing.  Furthermore, there is (an animal) study that shows, for example, that diabetics can become deficient in these growth factors.  However, generally speaking, you don’t want to deliberately stimulate VEGF and EGF – that’s asking for trouble – and is source of considerable research.  Look what this research summary says:

“Angiogenesis is essential for cancer development and growth: before a tumor can grow beyond 1 2 mm, it requires blood vessels for nutrients and oxygen. The production of VEGF and other growth factors by the tumor results in the angiogenic switch , where new vasculature is formed in and around the tumor, allowing it to grow exponentially. Tumor vasculature formed under the influence of VEGF is structurally and functionally abnormal. Blood vessels are irregularly shaped, tortuous, have dead ends and are not organized into venules, arterioles and capillaries. They are also leaky and hemorrhagic, which leads to high interstitial pressure. These characteristics mean that tumor blood flow is suboptimal, resulting in hypoxia and further VEGF production. This central role of VEGF in the production of tumor vasculature makes it a rational target for anticancer therapy.” [3]

Now what is the one thing that most people over 40 should probably NOT do? You guessed it – we would not want to drink something that actually contained significant VEGF and EGF, right?  Well, milk contains both of these growth factors and in significant quantities. Why?  Because milk is designed for calves.  Mother Nature wants that calf to put on a couple of hundred pounds in just a few months and those growth factors are her magic recipe.

As you might imagine, the Paleo leaders are jumping all over this, since a classic Paleo Diet is not supposed to contain dairy.  Loren Cordain, the founder and chief apostle of the modern Paleo movement, recently showed that, not only does milk have EGF, but it has a beefy – no pun intended – quantity of it.  Look at this quote from him regarding the amount of  betacellulin, a form of EGF, in milk: [4]

“So what what if a little betacellulin from cow s milk gets into your bloodstream does it matter? You bet it matters. A liter of whole milk (633 kcal) contains 1,930 nano-grams of betacellulin whereas the amount of EGF that your salivary glands secrete is only 35.3 ng per day. The binding affinity of betacellulin to the EGF receptor is greater than that for EGF; consequently betacellulin can displace EGF from the EGF receptor. The amount of betacellulin that you get from drinking even a single cup of milk (457 nanograms) has the capacity to stimulate the EGF receptor 10 times more than what normally would occur during a 24 hour period from EGF in saliva.”

Remember that research shows that about half of men over 40 have small cancer nodules in their prostate. Everything is fine as long as these nodules stay small.  But throwing a boatload of growth factors into your bloodstream and just begging that nodule to turn into a full-fledged tumor is just not a good idea.

2. Casein and Dr. Campbell. Many of you may have heard of Dr. Colin Campbell and The China Study.  His book has been very controversial, but I want you to forget about all of that for a second.  Dr. Campbell actually did an impressive set of animal studies well before The China Study.  His early work showed that casein, the cheif milk protein, could induce liver cancer in animals.  He did a number of studies that showed that, if you went above a certain percentage of casein in the diet, that the risk of liver tumors greatly increased.

Since Dr. Campbell is so controversial with American meat eaters, I want to jump past his research and fast forward to more recent scientific history.  Evidence had been assumulating that casein, specifically the A1 beta-casein in milk and diary, is pro-inflammatory.  And, in fact, a 2014 study found that it was not just a little inflammatory, but rather highly inflammatory.   They found HUGE increases in IL-4 and summarized their findings by saying that “It is reasonable to conclude that consumption of A1 “like” variants of -casein induced inflammatory response in gut by activating Th2 pathway as compared to A2A2 variants. The present study thus supports the purported deleterious impacts of consumption of A1 “like” variants of -casein and suggests possible aggravation of inflammatory response for etiology of various health disorders.” [5]

That’s an incredible assertion if you stop to think about it:  these researchers were willing to go on record saying that milk could cause other medical conditions.  Keep in mind that this was not in a backwater journal, but rather the European Journal of Nutrition.

Because many health leaders are finally – hallelujah! – emphasizing the importance of gut health and flora, this will likely rise to prominence.  Notice that A1 beta-casein appears to literally inflame the gut and thus could cause a host of issues. One thing to warn friends and family about:  the primary issue with A1 beta-casein is that it causes gut bacteria to release a molecule name BCM-7.  There is accumulating evidence that BCM-7 is the driver of autism, SIDS (Sudden Infant Death Syndrome) and other childhood disorders.

Now let’s jump back to Dr. Campbell’s research.  What does inflammation have to do with cancer?  Everything!  Cancer has been linked to inflammation time and time again and inflammation is considered one of the leading causes of inflammation, along with elevated growth factor levels and DNA damage.  Clearly, Dr. Campbell’s earlier work makes a lot of sense in retrospect.

A HACK?  As an fyi, there are a couple of companies that have developed A2 beta casein milk, which appears to be much more benign.  I don’t know where or if you can purchase it.

3. High Calcium.  Guys who love milk usually drink a lot of it.  I used to have a huge bowl of cereal in the morning and in the evening through most of my early adulthood – just loved the stuff.  Guys who do this end up consuming unnatural levels of calcium and this has been linked to prostate cancer due to the fact it supresses the body’s production of calcitrol, which is involved in the body’s fight against cancer. [6]

4. Elevated IGF-1. Milk also stimulates IGF-1, another growth factor that many bodybuilders and strength athletes are familiar with.  IGF-1 can help build muscle, repair tissue, etc.  However, it has, like EGF and VEGF, been linked to many types of cancer.  Furthermore, lower levels of IGF-1 is now being extensively studied in anti-aging research, because doing so appears to extend lifespan and powerfully protect against diabetes and cancer.  Look at what this paper said about casein, the primary milk protein:

“The main milk protein fractions exhibit important but different growth-promoting effects by increasing either fasting insulin (whey) or IGF-1 (casein) levels.” [7]

By the way, milk defenders will often raise up a straw man claiming that the IGF-1 in milk gets denatured in the digestive tract and does not make its way into the plasma.  That is irrelevant, however, because casein stimulates our own IGF-1 production.

SO IS THERE EPIDEMIOLOGICAL DATA LINKING MILK and DAIRY TO CANCER?  Let’s look at a couple of examples:

“However, a strong positive association with milk consumption was observed for cancers of the lymphatic organs (odds ratio 3.4 for greater than or equal to 2 glasses per day vs less than 1; 95% confidence interval 1.4-8.2). An inverse association was found for cancer of the bladder. Kidney cancer and cancers of the female reproductive organs (except the uterine cervix) showed weak positive associations with milk intake.” [8]

“Our results support the hypothesis that high calcium intake may increase risk of prostate cancer, and this relation may underlie previously observed associations between dairy products and prostate cancer.” [9]

“These results support the hypothesis that dairy products and calcium are associated with a greater risk of prostate cancer.” [10]

REBUTTAL? Interestingly enough, there was a large pooled study that found that low fat dairy actually lowered colon cancer risk.  Also, a couple of prominent studies found that non-fat dairy was protective and regular fat dairy promoted cancer.  My personal take on this is that this is probably because low fat dairy can help with Met-S (Metabolic Syndrome or prediabetes).  It is possible that the beneficial effect of improving Met-S may in some populations improve cancer outcomes.  However, in healthier populations, I simply cannot foresee how lowering calcitrol, boosting IGF-1, inflammation, VEGF and EGF is going to possibly help with cancer, especially in the 40+ crowd.

Losing Weight and Hormones - Peaktestosterone

What does losing weight have to do with hormones?  Everything! Well, that’s a slight exagerration, but don’t let anyone tell you a calorie is a calorie. Hormones can make or break almost any weight loss program as I’ll show below.

The problem is this:  if you are young with ample hormonal levels, weight loss is straighforward:  a little exercise and reduction in calories and the pounds melt off.  How many of us in middle age and beyond, though, have cut back in calories and increased exercise only to find not much happened?

One of the reasons for this is that so many of us in modern, industrialized societies have hormonal deficiencies.  The power of hormones over our health and weight maintenance cannot be overestimated and the studies show this conclusively.

This is a big subject, of course, but below we outline some of the key studies that show the intimate link between certain hormones and the body’s response to dieting.

So the bottom line with testosterone is that weight loss can be substantial, depending on your baseline testosterone before and after treatment.

2. Growth Hormone. Men rapidly lose growth hormone with aging and this hormone can have just as significant of an impact on losing weight as testosterone. For example, one study in senior men showed a 15% drop in body fat from administration of growth hormone. [4]  That’s a lot of fat to lose with no other real lifestyle change accompanying it.

Admittedly, the bodies of these men had very little natural growth hormone production, but many other studies have showed significant positive change in body fat and muscle from administration of growth hormone. [5][6]  See my link on How to Increase Growth Hormone Naturally for additional information.

NOTE:  Growth hormone will likely have little affect on young, health males with strong growth hormone production. [7]

3. Thyroid. “It’s got to be my thyroid.” We’ve all heard that excuse, eh?  Well, of course, it is true that an underactive thyroid can lead to significant weight gain.  A slow thyroid means a slow metabolism and to study how much of an effect thyroid function has on weight gain, reseearchers recently examined patients in the well-known Framingham Offspring Study.

They grouped participants into quartiles of increasing TSH (Thyroid Stimulating Hormone), which is a strong predictor of thyroid function. In general, if you have high TSH, it means you have an underactive thyroid. Researchers found that in men, there was a almost a three pound difference in body weight from the lowest to highest TSH quartiles over a 3.5 year period.  The authors noted that even “modest changes” in TSH could result in weight gain.

Of course, it’s possible to be deficient in one or more of these above three hormones, which only compounds the problem. Anyone at or past middle age and experiencng weight gain may want to consider going to an endocrinologist or other knowledgeable physician for a brief workup.  If you do have a hormonal issue, it’s something you want to know about.

NOTE:  Appetite is controlled by other key hormones, which I discuss in my link on Weight Loss and Appetite Hormones.

1. Sleep. Lack of sleep will lower both testosterone and growth hormone.  (Apnea sufferers can find their testosterone dropping by up to 40 percent for example.)  See my link on percent for example.)  See my link on Sleep and the Appetite Hormones as well:  poor sleep virtually forces us to overeat.

2. Vitamin D. This quasi-hormone has recently been discovered to have a profound impact on both testosterone and thyroid function, particularly if deficiencies are present. See my link on Vitamin D for more detail.

3. Cortisol. This stress hormone can affect both testosterone and thyroid function negatively. In addition, cortisol is famous for increasing belly, or visceral fat.  If that spare tire inflates rapidly, you may want to get your cortisol levels checked.  For more information on the cortisol-visceral fat connection, see my link on Visceral Fat.

SOBERING FACT: All of this can create a vicious circle: put on enough extra weight and it can significantly lower both testosterone and growth hormone.

The bottom line:  untreated medical conditions, poor lifestyle choices and ignorance can lead to decreased hormone levels, which in turn make weight management and loss much more difficult.

REFERENCES:

1) The Journal of Clinical Endocrinology & Metabolism, Aug 1 1999, 84(8):2647-2653, “Effect of Testosterone Treatment on Body Composition and Muscle Strength in Men Over 65 Years of Age”

2) The Journal of Clinical Endocrinology & Metabolism, Dec 1 1996, 81(12):4358-4365, “Increase in bone density and lean body mass during testosterone administration in men with acquired hypogonadism”

3) Metabolism, Jun 1985, 34(6):571-573, “The effect of anabolic steroids on lean body mass: The dose response curve”

4) Hormone Res in Pediatrics, 1991, 36(Suppl. 1):73-81″Effects of Human Growth Hormone on Body Composition in Elderly Men”

5) Clinical Endocrinology, Jul 1992, 37(1):79 87, July 1992″The effect of growth hormone administration in growth hormone deficient adults on bone, protein, carbohydrate and lipid homeostasis, as well as on body composition”

6) Annals of Internal Med, Dec 1 1996, 125(11):883-890, “Effects of Physiologic Growth Hormone Therapy on Bone Density and Body Composition in Patients with Adult-Onset Growth Hormone Deficiency”

7) Acta Endocrinol, Apr 1 1993, 128 313-318, “Effect of growth hormone treatment on hormonal parameters, body composition and strength in athletes”

8) Archives of Internal Med, Mar 24 2008, 168(6):587-592, “Relations of Thyroid Function to Body Weight”

1.  Testosterone. One study of senior men looked at changes in body composition after medium term (3 year) testosterone administration.  These men lost nearly a kg per year, or 2.2 pounds, in fat mass just from the testosterone. [1] In other words, after three years these men had lost on average about seven pounds of fat without modifying their lifestyle.  Furthermore, these were not hypogonadal men necessarily, where testosterone administration would have produced even more pronouned results.

In hypogonadal men, i.e. if your testosterone is considered to be clinically low, results can be dramatic.  For example, one study of such men found that average fat loss was 14%! [2] Again, this is with no other change in lifestyle – nothing except letting this one hormone do its work. (Of course, muscle mass increased substantially as well.)  An earlier study showed that there was a dose dependent increase in body composition.  In other words, the more the additional testosterone given, the greater the change in lean body mass. [3]

Bioidentical Testosterone - Peak Testosterone

Bioidentical – who cares, right?  Actually, the difference between bioidentical testosterone and non bioidentical is all the difference in the world.  Bioidentical simply means that a molecule matches exactly in shape, structure and atomic quantities the molecule utilized in the body.

Testosterone is not a horrendously complex molecule:  it has 19 carbons, 28 hydrogens and a couple of oxygen molecules arranged in four “chicken wire” ringlets.  And, oh, what a powerhouse bioidentical testosterone is for the male:  as I have documented in my Symptoms page, it controls brain, muscle, sexual, libido, bone and blood functions for us guys. It is the elixir of life for men and I ask the question, “Why would you use anything other than the original bioidentical testosterone that works so perfectly and powerfully??”

But the problem (originally) was money:  drug companies can’t patent testosterone.  So they will remove a carbon here or add a methyl group there to make it similar but not identical and then slap a patent on it.  Bye bye bioidentical.  As a side note, probably the ultimate story of greed and corruption occurs in the female hemisphere:  women actually do not have access (from Big Pharma) to bioidentical estrogens.  Trust me – this bioidentical issue has caused many of the females in your life a host of issues that you should be aware of, including loss of sexual desire.  You can read more in my link on Female Libido.

That’s why many on-the-street guys are slowly damaging their health. I have seen bodybuilding sites recommending to guys to back off a steroid when their “nipples start tingling”.  This is madness and is too late, because their estrogen levels are obviously grossly elevated. Going too high with any testosterone can lead in some cases to an overproduction of estradiol and DHT, leading to bizarre feminization and hair loss/acne effects, respectively.  Remember that both estrogen and DHT are converted from testosterone, so if you pump too much testosterone, whether it is bioidentical or not, into your system, you end up with an excess of these downstream hormones.

My wife knew of a guy who grew such large man boobs from steroid abuse that he could grab his chest and squirt milk.  Yes, he had to have the breast tissue surgically removed. Again, stick with bioidentical testosterone at a reasonable dose!

Contrast all of these problems with doctor-prescribed, bioidentical testosterones such as Androgel and Testim:  they have been extensively studied and issues good and bad are well known. Compounded testosterone are almost always bioidentical as well (and much cheaper). (Yes, anyone can have side effects:  read my link on HRT (Hormone Replacement Therapy) for details.)

So, if your testosterone is low, most doctors are willing to provide you with bioidentical testosterones, such as Androgel and Testim. You can also your doc if you can use a compounding testosterone instead: testosterone is not actually that expensive. Androgel and Testim cost more, because the drug companies were able to get a patent on the delivery system of these bioidentical testosterones.

ESTERS: What about the injectable esterized testosterones such as testosterone cypioante, enanthate, undecanoate and propionate?  (Undecanoate now comes in an oral form in some countries.)  These appear to be are safe because, while an ester has been attached to a bioidentical testosterone, it is quickly broken off by the body.  And the key point is that once the ester is broken off, then you are left with bioidentical testosterone.

CONCLUSION:  Again, I cannot think of any good reason not to use the same stuff your body uses:  bioidentical testosterone.

Bioidentical Testosterone

This same issue has surfaced for males who use steroids, which are essentially mock testosterones that are not bioidentical.  The pharmaceutical manufacturers of many of the common steroids have made their steroids sound like bioidentical testosterones (or DHT), when, in fact, they are nothing of the sort.  The bottom line is that all of these are testosterone with something modified just so the drug company could get a patent. And artibrarily screwing with Mother Nature is not a good idea and the side effects of steroids are numerous:

1)  Liver damage, particularly from the oral steroids, is quite common.

2)  Liver tumors, usually benign, are not uncommon.

3) Atrophy of the testes are not uncommon with certain steroids, especially with those who “stack”, i.e. use more than one steroid at a time.

4)  Negative lipid changes are common with some steroids:  chol4Kscoreol is increased and HDL decreased.

5)  Hypertension, i.e raised blood pressure.

6)  Enlargement, or hypertrophy, of the left ventricle (heart chamber) which results in less blood to the heart.

This list could go on and on, but brings up a very important point:  these side effects are notably absent when using bioidentical testosterone. The tragedy is that attacking your lipids, your liver, your heart are all going to eventually adversely effect one’s sexual function and performance.  Contrast that with bioidentical testosterone, which will, except in certain relatively unusual circumstances, helps the heart and sexual function.  Good, clean bioidentical testosterone (at a reasonable dosage of course) can build muscle, including those at the base of your penis, and improve libido and brain function without destroying your heart or liver!  So why bother with anything else??

Did you know you can inexpensively do your own testing for most hormones? The industry leader is Discounted Labs..

Vitamin C and Phosphatidylserine: Libido and Erection Boosters

I recently recevied a very interesting email from an ADHD reader who had done a lot of research on supplements to help with his condition.  What he found was that some of these significantly helped with libido and/or erectile strength.  The first of these was the granddaddy of all supplements:  Vitamin C. He also mentioned phosphatidlyserine and fish oil as well.

As you can see below, his general comments were that all three increased libido but phosphatidlyserine also improved his erectile strength:

“I haven’t tried all three together so far, but definitely will later on. If I have fish oil alone, libido goes quite noticeably – so far as erections go, I’ll have to let you know when I resume taking it (I’m testing other substances these days and don’t want any interference from other supplements). On fish oil, I feel a little calmer, but don’t really notice much from a mood perspective, but libido does go up for sure. On PS, libido, mood, well-being and erectile function all go up noticeably. This is the single best OTC substance I’ve found to work for me so far – depends on your natural state as I mentioned in my previous email. Other guys feel horrible on fish oil or PS.”

CAUTION:  Always talk to a physician first, especially if you are on medications or have any kind of medical condition.

1) J. Nutr, Nov 1 2001, 131(11):2951-2956, “Oral Administration of Soybean Lecithin Transphosphatidylated Phosphatidylserine Improves Memory Impairment in Aged Rats”

2) Prog Neuropsychopharmacol Biol Psychiatry, 1989;13 Suppl:S77-88, “Nootropic drugs and brain cholinergic mechanisms”

3) Climacteric, 2003 Sep, 6(3):238-47, “Vitamin C improves endothelial function in healthy estrogen-deficient postmenopausal women”

4) J. Nutr, Sep 1 2002, 132(9):2506-2513, “Dietary Fish Oil Increases Acetylcholine- and Eicosanoid-Induced Contractility of Isolated Rat Ileum”

5) Diabetes Metab, 2003 Jun, 29(3):289-95, “Fish oil prevents the adrenal activation elicited by mental stress in healthy men”

6) J Int Soc Sports Nutr, 2008; 5:11, “The effects of phosphatidylserine on endocrine response to moderate intensity exercise “

Why would these help so much with libido and/or erectile strength?  I believe – and thanks to the reader who pointed out the beneficial effect on the HPA Axis/Cortisol of these three – that there are two primary reasons, which I have listed below.

1.  Acetylcholine.  It turns out all three of these can boost or restore acetylcholine (at least in some circumstances) and acetylcholine actually helps dilate arteries. [1][2][3][4] Of course, nitric oxide is the big gun, but acetylcholine plays a role as well. The research has concentrated on the nitric oxide connection – can you say Viagra and Cialis? – but acetylcholine can help relax those penile arteries and get blood flowing.

So is there any evidence that these three will improve help with erectile dysfunction? Well, there certainly is and I outline these in my page on Vitamin C and Erectile Dysfunction. As it turns out, Vitamin C is a pretty good Blood Flow Increaser and is worth considering in your arsenal.

Phosphatidylserine, by the way, is a famed nootropic, i.e. “brain booster”.  It is present in many foods.  The reader took 100 mg/day, in order to keep it line with what you might get through diet.  It is a somewhat expensive supplement but you can get it through Amazon: Natural Factors Phosphatidylserine 100mg 60-Count.

The reader also uses Ester-C (500 mg), same as myself.  The fish oil that I use is Ascenta Nutrasea Omega-3s, which comes to the health food supermarket where I buy it in refrigerated trucks.  I always bite open the first capsule in the container and have never had a fishy or rancid taste. In fact, two of my children actually take it by biting open the capsule since they are not too good on swallowing pills whole yet.

CAUTION:  You should also read about Some Potential Risks of Vitamin C as well.  To play it safe, it should probably be consumed only when you eating low fat.

REFERENCES:

Estrogen, Dangers - Peak Testosterone

Much of this site focuses on ways to increase testosterone. But this emphasis on testosterone can be somewhat misleading for some men, because it implies that testosterone is the only hormone in any of the problems they might be experiencing. In reality, there is another major player, especially for overweight, middle-aged and steroid-using guys.

In fact, it is interesting that some middle aged and beyond males have normal testosterone yet they have most of the symptoms of andropause or low testosterone. How can this happen?  Because, more often than not, males with normal testosterone and andropause symptoms have overly high estrogen levels.  The reason is simply that it is the ratio of testosterone to estrogen that is ultra-critical for us guys and so increased estrogen can be just as physiologically negative for us as low testosterone.

It may surprise you to know that testosterone and estrogen are actually chemically very similar: they differ by only a carbonyl and a methyl group.  But, oh, what a difference a subtle chemical alteration can make!  Testosterone is responsible in us guys for a bigger larynx, thicker hair shafts, larger organs, augmented bone density and other traits that differentiate us from members of the fairer sex.  In contrast, estrogen in females leads to breast development and enlargement, less body hair and a more nurturing attitude.

The problem for us males is that increasing estrogen can lead to decreased libido and erectile strength. In other words, too much estrogen can literally turn you into a girly man and take your sexual legs right out from under you.  As you may know, estrogens are even associated with the “man boobs” that you see many overweight, middle aged guys struggling with. Yes, you have got to get estrogen under control!

So why do estrogen levels increase with age?  Researchers have observed is that, in general, adipose fat levels increase with aging while muscle mass decreases.  [2] As we have mentioned elsewhere, this increase in fat tissue results in increasing tissue levels of aromatase which converts testosterone to estrogen.  In fact, this conversion of testosterone is the only reason we males have any estrogen.  But this increased conversion to estrogen leaves us with less testosterone which decrease our muscle mass which makes it easier for us to gain weight and on and on the cycle goes.

NOTE: This is yet another reason why exercise is even more critical as we age: it preserves (or even builds) muscle mass and burns off fat at the same time.

So notice that one of the ugly facts of middle age is this rise of aromatase leads to a simultaneous decrease in testosterone and increase in estrogen.  The sword cuts both ways one might say.  Woe is us because we are simultaneously stripped of our primary male hormone and injected with the primary female hormone. And that means both numerator and denominator move in the wrong direction in the all important ratio of testosterone/estrogen.

This, by the way, leads to a perilous tissue accumulation of estrogen.  Researcher have discovered this in the prostate. [12] In fact, that same study concluded that “the prostatic accumulation of DHT, estradiol, and estrone is in part intimately correlated with aging”.  Estradiol and estrone are two forms of estrogen, neither of which do you want accumulating in your tissues. In other words, male menopause or andropause is as much about estrogen as it is about testosterone.

I should mention, though, that some estrogen is essential for bone health. In fact, one of the major issues that low testosterone males can have is also having low estrogen (since estrogen is made from testosterone). Low estrogen, at least in the long term, will actually lead to osteoporosis which is yet another reason to keep your testosterone up through HRT (Hormone Replacement Therapy).

Do you know the foods and drinks that boost Nitric Oxide and repair the veins and artieries to your penis?  Then check out the Peak Erectile Strength Diet Program where I show you how to dramatically improve your erectile strength.

Estrogen: Side Effects

That said, we males only need small and youthful amounts of estrogen for optimum health. The overabundance of estrogen in middle and old age is simply a bad dream. Here are just a few of the nasty things estrogen can do to us:

So how can you keep the female hormone in check?  Read my links on How to Control Estrogen. You should also ehck out How to Increase Your Estrogen (Estradiol) Levels as well for some of the good, bad and ugly things that can increase T and E2.

REFERENCES:

2) Medical Hypotheses, Jun 2001, 56(6):702-708, “Aromatase, adiposity, aging and disease. The hypogonadal-metabolic-atherogenic-disease and aging connection”

12) J Clin Endocrin Metab, 1993, 77: 375-381, “Effect of aging on endogenous levels of 5-alpha-dihydrotestosterone, testosterone, estradiol and estrone in epithelium and stroma of normal and hyperplastic human prostate”

Testosterone or Viagra? - Peak Testosterone

A recent study came out that essentially sent the message that Viagra was just as powerful as HRT (testosterone therapy) in several key areas. I covered this study and some more by the same researcher in my page on Does Testosterone Therapy Even Work?? Essentially what this researcher has been trying to show is that you can give a man Viagra and see him improve in erectile function and mood and then, when you add HRT on top of it, you get no additional improvement.  The conclusion that the comes to is that HRT is, therefore, not really necessary and is an unneeded solution for most men.

However, let me give you 10 Reasons That Testosterone Therapy Will Usually Beat Out Viagra 24/7 365 (for men with low testosterone of course):

1. Venous Leakage. Penis tissues need testosterone and, when your testosterone gets low enough, the insides of your penis will literally start to wither. Connective tissue and nerves begin to atrophy. This can make it hard to close off an erection which means that as much blood leaks out of the penis as is getting pumped in, a condition I discuss in my link called Venous Leakage 101. Usually, HRT can partially or totally reverse this condition and, of course, the reason is that a fresh supply of testosterone literally brings the penis back to life and restores normal function. Now Viagra (and Cialis / Levitra) can help with this indirectly:  they work by creating extra penile pressure, thus helping somewhat with the sealing off process. But clearly, this is a workaround solution and not getting at the root cause.

2. Insulin Sensitivity. A big percentage of males in the West have insulin resistance (prediabetes) and the suite of symptoms that usually accompany it called Metabolic Syndrome.  Low testosterone actually accelerates Metabolic Syndrome and prediabetes by raising insulin levels and increasing insulin resistance.  Furthermore, giving a low T guy testosterone will always lower his insulin levels.  This effect is so powerful that at the HRT clinic I am going to they have been able to get virtually every Type II diabetic completely off of insulin. You can read about this more in my page on Testosterone and Diabetes. Taking Viagra or Cialis will have little impact in this area.

3. Decreased Hardening of the Arteries. Men who go on anti-androgens (for prostate cancer) have many nasty cardiovascular changes and one of them is an increase in arterial stiffness. [2] Furthermore, a study on dialysis patients showed a strong correlation between arterial stiffness and testosterone levels. [1] And, finally, giving men testosterone has been shown to actually reverse this arterial stiffness in large part or even totally in some cases. [3] There have been a couple of studies – and this is all quite controversial and discussed quite a bit on the Peak Testosterone Forum – that have shown that HRT increases cardiovascular risk. This makes no sense considering that testosterone has such a positive effect on arterial stiffness. How can you make arteries more stiff and improve CVD outcomes? However, for more information, see my page on The New Testosterone (HRT) Class Action Lawsuits.

NOTE: Testosterone therapy and Viagra / Cialis can work synergistically. Anything that gets a man to have more sexual intercourse will lead to increase baseline testosterone. And raising testosterone activates the enzyme (eNOS) that controls nitric oxide. So PDE5 Inhibitors can help testosterone and vice versa.

5. Brain Health.  One of the reasons that testosterone is so successful in my opinion is that it is so good for the male brain.  Testosterone (and the ensuing rise in estradiol) increases dopamine and other critical neurotransmitters, something I document in my link on Testosterone and the Brain.  On a practical level, this is extremely important.  Low testosterone has been shown to disturb sleep and it is very often associated with anxiety, depression and fatigue.

Now the researcher mentioned above tried to challenge the use of HRT by noting that Viagra can improve mood just as much as HRT.  Now, while it is true that Viagra can improve mood and various psychological parameters – nitric oxide improves blood flow to the brain and is a neurotransmitter in its own right:  there simply is no substitute for testosterone.  Working memory can be negatively impacted in a low testosterone man.  Researchers also found that exercise has such a profoundly positive effect on the brain through it’s increase of cerebral testosterone and that it can actually spawn neurogenesis.  So it is very naive thinking to assume that by just popping a PDE5 inhibitor that you can solve a man’s low T brain-related issues.

Did you know you can inexpensively do your own testing for most hormones? The industry leader is Discounted Labs..

6. Natural. Many men and physicians feel that HRT is “unnatural.” To them it seems on par with taking steroids and feels like “cheating.”  Some even think that it is just an excuse to try to jack up one’s waning sex life and/or muscle mass. The same crowd would tend to feel that Viagra is a much less invasive and non-aggressive solution to a male’s problems.  However, I would argue the opposite:  testosterone is actually one of the most natural male substances and is bsolutely critical for a man’s health.

Would you replace your thyroid hormones if you were hypothyroid?  Sure.  Would you replace your CoQ10 levels if they were low?  Sure.  What if you were deficient in Vitamin D?  Same thing.  So why not replace testosterone in the same way to more youthful levels?

And remember:  many forms of HRT actually administrer bioidentical testosterone.  Although injectibles such as testosterone cypionate and enanthate require a simple ester chain to be broken off, this a very simple process for your body to do and one is left, again with bioidentical testosterone afterwards.  So, essentially, all the major forms of testosterone are delivering bioidentical or extremely close-to-identical bioidentical and natural testosterone into your system. Speaking as a guy who was just miserable with low testosterone for decades and whose life was completely turned around from HRT, I can assure you that HRT has no comparison with taking steroids and I had no motivations to put on muscle or anything similar.  I just wanted to feel human again.

7. Osteropenia and Osteoporosis.  A man’s estradiol comes from the conversion of some of his testosterone via the aromatase enzyme.  Surprisingly, many men have such low testosterone that they simply cannot build up enough estradiol to maintain their bone mass.  If your estradiol is below 15-20 pg/ml, then this is probably something to discuss with your doctor.  See my page on Testosterone and Bone Mass for details.

CONCLUSION:  This list could actually go on and on, but I believe I have painted an adquate picture here.  Testosterone is simply too critical to just ignore and pop a PDE5 inhibitor. Basically, the above researcher is attacking testosterone therapy by going after the easy stuff.  He knows that Viagra cannot help with osteoporosis.  He knows that Viagra cannot reverse someone’s diabetes.  And he knows that Viagra cannot heal venous leakage or hardening of the arteries.  So, in my opinion, he likely picked the one or two areas where Viagra excels and then used it to build an anti-HRT storyline.

I can only say that those who suggest this have clearly never had to suffer with low testosterone or experiencedits nasty side effects.  I was just miserable during my low testosterone days and will only go back kicking and screaming – let me tell you.  You can read about it in  My Personal Health Story.

Furthermore, ignoring low T can actually be a very dangerous philophophy and could get some men hurt.  Why?  Because low testosterone increases your risk factors for so many diseases!  This is the subject of my book Low Testosterone By The Numbers, which discusses how a man whose testosterone is between 250 and 400 ng/dl is at increased risk for all the conditions above.

Again, Viagra and Cialis have their place for some men, especially in the short term in low dosages. But to suggest that they can be a replacement for the very low hormone levels seen in the typical hypogonadal male is very risky in my opinion.

REFERENCES:

1) Baylor College of Medicine, “Men with low testosterone, erectile dysfunction may improve sexual function with testosterone gels”

2) Clinical Science, 2003, 104:(195 201), “Testosterone suppression in men with prostate cancer leads to an increase in arterial stiffness and hyperinsulinaemia”

3) Eur J Endocrinol, May 1 2009, 160:839-846, “Effect of testosterone replacement therapy on arterial stiffness in older hypogonadal men”

Hair Testing and Arsenic - Peak Testosterone

11/10/2015: Recently I had a hair test done on myself. I had already done my wife’s hair test, but now it was my turn.. I  had several things that I wanted to check out that really only hair testing can do (unless you have a boatload of cash to spend with a toxicologist).  The first of the things that I wanted to check  out was whether or not I was possibly ingesting too much arsenic from a rice protein powder that I had been taking for several years.

The reason that I was concerned is that it is impossible to know if my protein powder had been properly monitored or if the rice used in production was purchased from the United States.  Rice from the United States has been shown to often have high levels of arsenic and numerous articles and exposes have been done on the topic. This occurs because crops and fields have been contaminated with pesticides that are arsenic-based.  This is very unfortunate, of course, as brown rice is a staple of some of the healthiest peoples in the world.  Brown rice also increases nitric oxide – need I say more?

For those who may be wondering why I would consume rice protein of all things, considering that it does not excel in bioavailability or other standard protein quality measures.  My reasoning is the following:

I  have more to say about these results but will cover that in some other pages.  As you can see, my arsenic is on the high side. I am at about the 70th percentile, and it is one of my highest scores. Now I certainly cannot prove that it was the rice protein. Arsenic can be in water for example. But I think it is very likely it was the rice protein and will test it by quitting the rice protein and then testing again after a few months.  If my arsenic score goes down, then the evidence is even stronger that the rice was probably the culprit.

The report that comes with Doctor’s Data is packed with interesting information and here is an example:

“In general, hair provides a rough estmate of exposure to Arsenic (As) absorbed from food and water. However, hair can be contaminated externally with As from air, water, dust, shampoos and soap…As can cause malaise, muscle weakness, vomiting diarrhea, dermatitis, and skin cancer. Long term exposure may affect the peripheral nervous, cardiovascular and heatopoietic systems. As is a major biological antagonist to selenium.” [4]

The latter is particularly concerning to me as I am a flexitarian, i.e. I consume a largely plant-based diet but eat a little bit of animal-based protein.  I have calculated my selenium and it came out on the low side.  The last thing I need, apparently, is arsenic!  (I have started taking supplemental selenium recently.)

I know some guys out there feel like you cannot worry about everything and a few toxins can’t hurt you if you just “live healthy.”  I have to respectfully disagree with point.  Heavy metals are “kryptonite” and can take down the best of us.  Let me give you just a couple of sobering examples:

1. Cancer. A lot of research has shown arsenic as a potent carcinogen.  Those of you who have been digging into some of the recent genetic research will understand the gravity of the mechanism by which arsenic can accelerate cancer:

“Exposure to arsenic, an established human carcinogen, through consumption of highly contaminated drinking water is a worldwide public health concern. Several mechanisms by which arsenical compounds induce tumorigenesis have been proposed, including oxidative stress, genotoxic damage, and chromosomal abnormalities. Recent studies have suggested that epigenetic mechanisms may also mediate toxicity and carcinogenicity resulting from arsenic exposure.” [1][2]

2. Neurotoxicity. Researchers have noted the pesticides and environmental factors seem to play a role in Parkinson’s disease and the destruction of dopaminergic neurons in the brain.  Recent research shows that arsenic and dopamine can synergistically acclerate this type of neurotoxicity and, therefore, arsenic-based pesticides may be one of the root causes of Parkinson’s. [3]

CONCLUSION:  Hair testing can provide valuable information on potential toxins in your system including arsenic.  I agree that a couple of months of elevated arsenic exposure may not make that much of a difference.  But consuming excess arsenic in concentrated protein powders for decades could end up unraveling all the hard work you have to put into improving your health.

REFERENCES:

1) Journal of Toxicology, Volume 2011 (2011), “Arsenic Exposure and the Induction of Human Cancers”

2) Environ Health Perspect 119:11-19 (2011), “An Emerging Role for Epigenetic Dysregulation in Arsenic Toxicity and Carcinogenesis”

3) TOXICOLOGICAL SCIENCES, 2007, 102(2):254 261, “Synergistic Neurotoxic Effects of Arsenic and Dopamine in Human Dopaminergic Neuroblastoma SH-SY5Y Cells”

a) Rice protein powder is one of the few proteins out there that a man can purchase undenatured, i.e. CFM or cross flow microfiltered such that the protein is not overheated. If you overheat any protein, it will release significant amounts of free glutamine, which is, effectively, “MSG.”  I have written quite a bit about this on my web site, but here is one example:  Whey, Excitoxins and Free Glutamine. (NOTE:  All wheys have glutamic acid listed on the label.  What varies, depending on the heating, is how much free glutamine is released.  Free glutamine is NOT listed on the label.)

b) Vegan proteins are generally less stimulatory of IGF-1, which is very important from the anti-aging standpoint. Young guys don’t worry about this, but I’m in my mid 50’s and have a little different perspective.  And, yes, I know IGF-1 is good for building mass.  However, IGF-1 revs up mitochondria and increases free radical production.  See my page on How to Lower IGF-1 for some basic information on the subject.

Even if you disagree with the above, you can see that I am trying to protect my health and should not have to worry about a buildup of arsenic in my tissues!  Again, this is primary reason I had a hair test done: it is an inexpensive way to find out if arsenic and other heavy metals have been possibly building up in my tissues. The hair test cost me a little over $100, and I did it through Direct Labs and Direct Labs uses Doctor’s Data. (I have no affiliation.) Here are my results:

Maca and Its Effects - Peak Testosterone

However, Maca’s superpowers go well beyond simple reproductive effects.  Maca seems to it definitely helps with some of the things that plague us in our modern lifestyles and middle age, including energy, libido, vitality, stress management and so on.  And for guys that take care of themselves with diet and exercise as well, it can give you that old I-want-to-rip-her-clothes-off feeling.

So how does Maca work its powerful effects?  One would immediately expect it to be a testosterone or leutinizing hormone increaser, but studies have not shown that to be the case.  The answer probably lies in its effect on our central nervous system.  For example, a 2010 study in vitro, i.e. “test tubes”, and on rats found that maca was neuroprotective. [1]  Furthermore, it has (at least in women) been found to overcome SSRI-induced sexual dysfunction. [2]  SSRI’s, the largest and most popular class of anti-depressant drugs currently on the market, are famed for their “relaxing and calming” effect, which, unfortunately, can translate to an overly tranquilizing effect on sexual desire.  Maca, again at least in women, helps overcome this neurotransmitter soup and reignites passion.

CAUTION:  We’ve had a couple of posters on the Peak Testosterone Forum have pretty negative experiences with Maca. One man said that it gave him E.D. and another lower testosterone levels. Please read this thread for more information. I’m not sure what to think as I have had many positive comments and it is a widely used supplement, but I want to include this information.

In addition, Maca also increased glucose tolerance in these rats and definitely lowered glucose levels in their blood.  This means Maca may help with Metabolic Syndrome, which is one of the biggest enemies of our sexual lives and a common source of erectile dysfunction.  Maca may also partially do its work by improving some of the basic risk factors that plague modern, industrialized lifestyles.  For example, the same study on rats fed high-sucrose diets found that Maca lowered bad cholesterol, total cholesterol and triglycerides. [3]

I also noticed something very interesting once I started taking Maca:  I instantly started gaining muscle..  It is unlikely that Maca did this through increasing testosterone levels, but there is another possible mechanism:  Maca has been reported to very significantly lower cortisol levels, at least in animals, [4] and cortisol is a known mucscle-destroyer.

Of course, all of these impressive qualities need to be better verified in human studies, but the results so far are remarkable by all counts.  Maca may be on track to be the next Pycnogenol, which is well-known for lowering multiple heart disease risk factors all the while improving inflammation, blood pressure and erectile strength.

Almost all Maca has the advantage of being organic, so you do not have to worry about some of the issues that plague other plants.  It is grown at such a high altitude in the Andean mountains that it has no real competitors and spraying is simply not necessary.  I take it in its most natural form from Navitas: Navitas Naturals Organic Raw Maca Powder and I always cook it as that is how the Peruvians have almost always eaten it as well.  (For cautions regarding Maca, see the bottom of this page on The Power of Maca.)

Of course, do not make any changes without talking to your doc, hopefully a good and knowledgeable one.

REFERENCES:

1) Annals of the New York Academy of Sciences, Published online Apr 29 2010, “Neuroprotective effects of Lepidium meyenii (Maca)”

2) CNS Neuroscience & Therapeutics, Aug 13 2008, 14(3):182-191, “A Double-Blind, Randomized, Pilot Dose-Finding Study of Maca Root (L. Meyenii) for the Management of SSRI-Induced Sexual Dysfunction”

3) Journal Plant Foods for Human Nutrition (Formerly Qualitas Plantarum), Jun 2007, 62(2), “The Influence of Maca ( Lepidium meyenii ) on Antioxidant Status, Lipid and Glucose Metabolism in Rat”

4) International Journal of Biomedical Science, Feb 15, 2006, 2(1):15-29, “Short and Long-Term Physiological Responses of Male and Female Rats to Two Dietary levels of Pre-Gelatinized Maca (Lepidium Peruvianum Chacon)”

Testosterone Therapy Side Effects - Peak Testosterone

Furthermore, most of us have heard steroid horror stories of man boobs and tiny testicles and we assume that testosterone therapy will do the same.  Of course, nothing could be further than the truth.  Many steroid users have a “if a little is good, then a lot must be better” mentality and push themselves way beyond the normal physiological hormonal ranges.  This often simultaneously pushes their testosterone and estrogen sky high, shrinking their testicles and increasing breast/chest tissue, respectively.  (Man boobs are a rare but reported side effect of testosterone therapy, but it is more likely a cause of low testosterone rather than high. [1] )

So are there any legitimate concerns regarding testosterone therapy? Well, certainly, although none of them are common.  Let’s list some of the ones that should be considered, however, and discussed with your doctor:

1.  Fertility.  Going on testosterone will very likely affect fertility negatively.  I get letters quite often from younger guys asking if they should go on HRT.  Of course, I tell them to talk to their doc about fertility, because there somewhat of a rebound effect if you try to go off of testosterone therapy.  So adding testosterone can affect LH (leutenizing hormone) and FSH (follicle stimulating hormone) levels. LH governs testosterone production in the testes and FSH is responsible for spermatogenesis, i.e. creation of the sperm. (See my link on Fertility for more information.)  But even you older guys that are in a serious relationship with a Younger Woman may need to consider this as well.

3. Acne. Some guys get the joy of going through a second puberty when on testosterone.  Again, this is uncommon but a possibility in sensitive individuals.  See my link on Testosterone and Acne for details and solutions.

4.  Hair Loss. Some have reported hair loss as a side effect, although this does not seem to be common and is difficult to prove.  Some of the testosterone delivery systems, such as scrotal patches, deliver higher levels of DHT, the primary culprit in typical male pattern baldness.

Did you know you can inexpensively do your own testing for most hormones? The industry leader is Discounted Labs..

5.  Soy Allergy.  Some of the topical preparations are actually manufactured from soy and thus should be avoided by those with a soy allergy.

6.  Severe Health Considerations.  There was a recent small study on 219 senior men with poor health (diabetes, obesity, high blood pressure, etc.) and poor mobility that showed a significant increase in cardiovascular events when compared with the placebo group.  The study was halted and researchers basically said that no conclusion could be drawn due to the small study size.  However, you should discuss this study with your doctor, especially if you are an older, sedentary male with a significant health condition.

7.  Liver Problems. One last thing:  almost all testosterones given in testosterone therapy are very well-tolerated by the liver, but you want a doctor that will test your liver function just to play it ultra safe. Liver issues are associated almost exclusively with the old-line oral testosterones that were difficult to metabolize.

8.  Enlarged Prostate. One uncommon side effect occasionally reported with HRT (Hormone Replacement Therapy) is BPH (enlarged prostate).

9. Thickened Blood. A recent meta-analysis found that testosterone therapy significantly increased hemoglobin and hematocrit, which makes blood more thick and likely to clot. [4]

10. Lowered HDL.  The same study above found that that testosterone therapy was associated with a small decrease in HDL as well. [4]

NEWS FLASH:  A recent Newsweek [Nov 9, 2009, p. 56f] article covered how some guys on HRT are either ignorant or being negligent.  They are applying the gel to their chest, shoulders and/or arms and then are in direct skin-to-skin contact with their children (or wives).  This is very serious indeed:  a young child can be developmentally affected by repeated exposure to significant amounts of testosterone, including potentially the brain. In a young boy, for example, the lines on the scrotal sac can be altered and pubic hair thickened and grown.

I was just talking with a pediatric endocrinologist about this and it is imperative that guys wash their hands and keep any areas of application covered. He had only noticed problems in guys who were careless and/or ignorant of the risks involved. There have been enough reports of this problems that the FDA is currently forcing a generic version of Testim to undergo “hand washing studies” to make sure that it is as safe in this regard as the original.  Furthermore, even the original products may have to carry a “black box” warning label.  Keep your family safe!

If you are interested, you should also read my Overview of HRT and common Methods of Testosterone Delivery (such as gels and injections).  These links should give you a lot of good talking points with your doctor.

REFERENCES:

1) https://www.mayoclinic.com/health/testosterone-therapy/MC00030

3) Clin Endocrin (Ox),1988;28:461-470

4) J Clin Endocrinol Metab, Jun 2010; 95:2560-2575, “Adverse Effects of Testosterone Therapy in Adult Men: A Systematic Review and Meta-Analysis”

The HCG Diet: Fact and Fiction - Peaktestosterone

Here is your health and wellness trivia question:

“What hormone, found only in the urine of females, is connected with an almost $40 million fine of a famous informercial hypester, numerous suspended athletes and a bounty of modern fertility clinics?”

If you answered HCG, you were dead on. It is also connected to a pop fad diet called the “HCG Diet” that is decades old.  For example, I recently ran across a middle-aged female who swore by the HCG Diet.  What was interesting is that the husband was a doctor and fully behind her new program.

So what does the science say?  One early double-blind study found that patients felt better, had less appetite and lost more weight when on HCG. [1]  So case closed, right?  Well, three years later the same journal came out with additional research showing the exact opposite. [2] In fact, the study concluded “HCG per se offered no advantage over placebo injections in regard to weight loss, distribution of fat lost or hunger index during weight reduction”.  The following year five obese women were put on the standard 500 calorie diets and injections of 125 IU of HCG with no results and, again, the authors concluded that it offered no advantage over straight calorie reduction. [3]  Study after study thereafter left HCG for weight loss in an ever-weakening position.

Finally, in 1995 a meta-analysis was undertaken that definitively concluded that “there is no scientific evidence that HCG is effective in the treatment of obesity; it does not bring about weight-loss of fat-redistribution, nor does it reduce hunger or induce a feeling of well-being”. [4] The bottom line is that the great majority of studies show no benefit from HCG, making it a big waste of time and money.  Yes, females can lose weight from an “HCG Diet” but it is almost for sure from the low calories that she is consuming and not the injections themselves.

And that leads to a big question:  why would a doc, the acquaintence I spoke of above, knowing full well that study after study has shown HCG to be completely useless for weight loss, push his wife to take the same?  My guess is simple:  the low calorie diet.  Most HCG diets are very low calories and so he knew that his wfie would lose weight anyway.  So the hundreds or thousands that he would spend would be well worth the investment.

Well, you know what I am going to say:  HCG diets, crash dieting, liposuction or any other very rapid way to take off pounds will not lead to long term health and vitality.  I cover the struggle with this sort of lifestyle in my link on Why Crash Dieting Often Does Not Work. In other words, Fix the underlying root problem or eventually you will put back on the pounds.  Remember:  a man with about a 40 inch waist or a woman with a 35 inch waist has substantially more heart attack risk (and often sexual dysfunction to go along with it). Gradual weight loss with a steady dose of exercise are always the answer (unless you have been diagnosed with thyroid, testosterone or other hormonal issues).

What about safety?  Well, in men it seem to have a good track record, although no long term studies have been done as far as I know, assuming an experience physician and adequate monitoring.  In women it does have some potentially nasty side effects, but it is fairly widely used for fertility treatments at significantly higher dosages, so some women will think, “What do I have to lose (except some extra pounds)?”  And prices have really come down at least in the HRT clinics.  I have heard that weight loss treatments charge much more for HCG however.

REFERENCES:

1) American Journal of Clinical Nutrition, Feb 1973, 26:211-218, “Effect of human chorionic gonadotrophin on weight loss, hunger and feeling of well-being”

2) American Journal of Clinical Nutrition, Sep 1976, 29:940-948, “Ineffectiveness of human chorionic gonadotropin in weight reduction: a double-blind study”

3) Arch Intern Med, 1977, 137:151-155, “Human Chorionic Gonadotropin (HCG) Treatment of Obesity”

4) Br J Clin Pharmacol, 1995 Sep, 40(3):237-43, “The effect of human chorionic gonadotropin (HCG) in the treatment of obesity by means of the Simeons therapy: a criteria-based meta-analysis”

But first a little history:  HCG is short for Human Chorionic Gonadotrophin.  HCG comes from the placenta and the embryo and is found, as I mentioned, in the urine of females. Interestingly enough, the biggest users of HCG have actually been male professional athletes.  HCG is similar to Leutenizing Hormone which stimulates testosterone output.  It is often coupled with steroids to maximize testosterone production.  A number of prominent athletes have been suspended for using HCG, including Manny Ramirez.

NOTE:  Many of the men on the Peak Testosterone Forum are using HCG as part of their HRT (testosterone therapy program).  A typical program will include testosterone cypionate, Arimidex (anastrazole) and HCG.  HCG, in this case, is used not to boost testosterone but rather preserve testicular volume and/or fertility and improve mood.  HCG is also used completely on its own, something I cover in my link on HCG Monotherapy. If you go too high with HCG, it creates a negative feedback loop that shuts down the body’s own endogenous testosterone production and it also can really ramp up aromatization to estradiol and so this must be carefully monitored.

In females, though, its initial use was primarily in the weight loss world.  The typical “HCG Diet” is a combination of weekly HCG injections coupled with very low calorie levels, typically in the 500-1000 range.  The HCG injections are supposed to do everything a woman could want in these circumstances, including accelerated fat reduction, decreased appetite and so on.

Here’s a few reasons to be suspicious of such claims:

1) If HCG really accelerated fat loss effectively, it would be a multi-million dollar industry and one would be reading about it constantly

2) Kevin Trudeau was a huge promoter of the HCG Diet.  Trudeau is the felon, conspiracy wacko – “I’ve been a member of the Trilateral Commision and FBI” – and infomercial wild man.  He was fined tens of millions for his overstatements regarding HCG.

Androgel Patient Assistance Program - Peak Testosterone

In any event, there is a way to stop the bleeding for some men, and it is a program that AbbVie calls their Patient Assistance Program. Basically, if you fill out enough paperwork and can justify financial need, you may get some of your Androgel paid for.  How do you get started?  Here are some links that can should help:

AbbVie Patient Assistance Foundation Application for AndroGel (testosterone gel) 1.62%

AbbVie Patient Assistance Foundation

Phone Numbers for AbbVie Patient Assistance Foundation if you have questions

I can’t help but add that, if you get tired of all this extra paperwork for a second rate product, then consider finding a physician that will prescribe a compounded testosterone.  You can read more about it here:  Compounded Transdermal (Topical) Testosterone. If you read this page, you’ll see that testosterone creams and gels can be compounded up to a concentration of 20%! This is why often men on Androgel do not experience any increase in their testosterone levels – it simply is not concentrated enough.  I will also add that Testosterone Cypionate (or Enanthate overseas) Injections are also MUCH less expensive than Androgel as well. So there are lots of options out there for men who need to save money on their TRT (testosterone therapy).

And, finally, pick up some AbbVie stock, as shareholders are the only ones benefitting from the exhorbitant costs of Androgel!

The Many Links to Cancer and Inflammation - Peak Testosterone

One of the men I was exchanging emails with last year told me that his doctor told him that if he drank a lot of milk growing up, it wasn’t matter of if he would get prostate cancer but when.  I thought that was remarkable at the time, because rarely do mainstream doctors get excited about anything nutritional.  Since then, I have kept my eyes out for anything related to the subject and was shocked to find out just how many possible milk-related links there were to cancer.  And, by the way, this is not something that I wanted to hear.  I love nonfat yogurt and didn’t want to give that up and non-fat dairy is part of some low fat diets.  But the evidence below is just too overwhelming in my opinion, especially if you’re 55 like me.

Here are Four Significant Links of Milk and Dairy to Cancer or Cancer Formation:

1. Not For Adults. I don’t need to tell anyone that anything that comes out of a mammary gland is NOT designed for adults.  Milk is for infants and it is designed to be highly stimulatory and make sure the baby (cow, human or whatever) grows fast and grows strong.  Yes, mammary milk is designed to drive growth – growth at all costs – and infants can grow tissues like weeds, because they are almost entirely impervious to cancer.  That is not true with an adult.  See #2 below:

2.  Growth Factors (VEGF and EGF). Some of you may have heard of the Anti-Angiogenic Diet.  There is a well-known Ted Talk on the subject by Dr. William Li. [1] Basically, Dr. Li talks about eating a variety of plant foods that inhibit growth factors that feed the growth and spread of cancerous tumors. The most infamous of these growth factors are Epidermal Growth Factor (EGF) and Vascular Endothelial Growth Factor (VEGF).

REFERENCES:

1)  https://www.ted.com/talks/william_li?language=en, “Can We Eat to Starve Cancer?”

2) The Egyptian Journal of Histology, Jun 2011, 34(2):403-414, “Effect of sildenafil (Viagra) on epidermal growth factor expression in submandibular gland of diabetic male rats: histological and immunohistochemical study”

3) Oncology, 2005, 69:4 10, “VEGF as a Key Mediator of Angiogenesis in Cancer”

4) https://proteinpower.com/drmike/2006/12/19/421/

5) Eur J Nutr, 2014 Jun, 53(4):1039-49,, “Comparative evaluation of cow -casein variants (A1/A2) consumption on Th2-mediated inflammatory response in mouse gut”

6) Cancer Epidemiol Biomarkers Prev,2006,15(2):203-10

7) Eur J Clin Nutr, 2009 Sep, 63(9):1076-83, “Differential effects of casein versus whey on fasting plasma levels of insulin, IGF-1 and IGF-1/IGFBP-3: results from a randomized 7-day supplementation study in prepubertal boys”

8) Br J Cancer, 1990 Mar, 61(3):456 459, “Milk consumption and cancer incidence: a Norwegian prospective study”

9) Cancer Causes & Control, December 1998, 9(6):559-566, “Dairy products, calcium, phosphorous, vitamin D, and risk of prostate cancer (Sweden)”

10) Am J Clin Nutr, October 2001, 74(4):549-554, “Dairy products, calcium, and prostate cancer risk in the Physicians’ Health Study”

We all need some EGF and VEGF, of course, for tissue repair and wound healing.  Furthermore, there is (an animal) study that shows, for example, that diabetics can become deficient in these growth factors.  However, generally speaking, you don’t want to deliberately stimulate VEGF and EGF – that’s asking for trouble – and is source of considerable research.  Look what this research summary says:

“Angiogenesis is essential for cancer development and growth: before a tumor can grow beyond 1 2 mm, it requires blood vessels for nutrients and oxygen. The production of VEGF and other growth factors by the tumor results in the angiogenic switch , where new vasculature is formed in and around the tumor, allowing it to grow exponentially. Tumor vasculature formed under the influence of VEGF is structurally and functionally abnormal. Blood vessels are irregularly shaped, tortuous, have dead ends and are not organized into venules, arterioles and capillaries. They are also leaky and hemorrhagic, which leads to high interstitial pressure. These characteristics mean that tumor blood flow is suboptimal, resulting in hypoxia and further VEGF production. This central role of VEGF in the production of tumor vasculature makes it a rational target for anticancer therapy.” [3]

Now what is the one thing that most people over 40 should probably NOT do? You guessed it – we would not want to drink something that actually contained significant VEGF and EGF, right?  Well, milk contains both of these growth factors and in significant quantities. Why?  Because milk is designed for calves.  Mother Nature wants that calf to put on a couple of hundred pounds in just a few months and those growth factors are her magic recipe.

As you might imagine, the Paleo leaders are jumping all over this, since a classic Paleo Diet is not supposed to contain dairy.  Loren Cordain, the founder and chief apostle of the modern Paleo movement, recently showed that, not only does milk have EGF, but it has a beefy – no pun intended – quantity of it.  Look at this quote from him regarding the amount of  betacellulin, a form of EGF, in milk: [4]

“So what what if a little betacellulin from cow s milk gets into your bloodstream does it matter? You bet it matters. A liter of whole milk (633 kcal) contains 1,930 nano-grams of betacellulin whereas the amount of EGF that your salivary glands secrete is only 35.3 ng per day. The binding affinity of betacellulin to the EGF receptor is greater than that for EGF; consequently betacellulin can displace EGF from the EGF receptor. The amount of betacellulin that you get from drinking even a single cup of milk (457 nanograms) has the capacity to stimulate the EGF receptor 10 times more than what normally would occur during a 24 hour period from EGF in saliva.”

Remember that research shows that about half of men over 40 have small cancer nodules in their prostate. Everything is fine as long as these nodules stay small.  But throwing a boatload of growth factors into your bloodstream and just begging that nodule to turn into a full-fledged tumor is just not a good idea.

2. Casein and Dr. Campbell. Many of you may have heard of Dr. Colin Campbell and The China Study.  His book has been very controversial, but I want you to forget about all of that for a second.  Dr. Campbell actually did an impressive set of animal studies well before The China Study.  His early work showed that casein, the cheif milk protein, could induce liver cancer in animals.  He did a number of studies that showed that, if you went above a certain percentage of casein in the diet, that the risk of liver tumors greatly increased.

Since Dr. Campbell is so controversial with American meat eaters, I want to jump past his research and fast forward to more recent scientific history.  Evidence had been assumulating that casein, specifically the A1 beta-casein in milk and diary, is pro-inflammatory.  And, in fact, a 2014 study found that it was not just a little inflammatory, but rather highly inflammatory.   They found HUGE increases in IL-4 and summarized their findings by saying that “It is reasonable to conclude that consumption of A1 “like” variants of -casein induced inflammatory response in gut by activating Th2 pathway as compared to A2A2 variants. The present study thus supports the purported deleterious impacts of consumption of A1 “like” variants of -casein and suggests possible aggravation of inflammatory response for etiology of various health disorders.” [5]

That’s an incredible assertion if you stop to think about it:  these researchers were willing to go on record saying that milk could cause other medical conditions.  Keep in mind that this was not in a backwater journal, but rather the European Journal of Nutrition.

Because many health leaders are finally – hallelujah! – emphasizing the importance of gut health and flora, this will likely rise to prominence.  Notice that A1 beta-casein appears to literally inflame the gut and thus could cause a host of issues. One thing to warn friends and family about:  the primary issue with A1 beta-casein is that it causes gut bacteria to release a molecule name BCM-7.  There is accumulating evidence that BCM-7 is the driver of autism, SIDS (Sudden Infant Death Syndrome) and other childhood disorders.

Now let’s jump back to Dr. Campbell’s research.  What does inflammation have to do with cancer?  Everything!  Cancer has been linked to inflammation time and time again and inflammation is considered one of the leading causes of inflammation, along with elevated growth factor levels and DNA damage.  Clearly, Dr. Campbell’s earlier work makes a lot of sense in retrospect.

A HACK?  As an fyi, there are a couple of companies that have developed A2 beta casein milk, which appears to be much more benign.  I don’t know where or if you can purchase it.

3. High Calcium.  Guys who love milk usually drink a lot of it.  I used to have a huge bowl of cereal in the morning and in the evening through most of my early adulthood – just loved the stuff.  Guys who do this end up consuming unnatural levels of calcium and this has been linked to prostate cancer due to the fact it supresses the body’s production of calcitrol, which is involved in the body’s fight against cancer. [6]

4. Elevated IGF-1. Milk also stimulates IGF-1, another growth factor that many bodybuilders and strength athletes are familiar with.  IGF-1 can help build muscle, repair tissue, etc.  However, it has, like EGF and VEGF, been linked to many types of cancer.  Furthermore, lower levels of IGF-1 is now being extensively studied in anti-aging research, because doing so appears to extend lifespan and powerfully protect against diabetes and cancer.  Look at what this paper said about casein, the primary milk protein:

“The main milk protein fractions exhibit important but different growth-promoting effects by increasing either fasting insulin (whey) or IGF-1 (casein) levels.” [7]

By the way, milk defenders will often raise up a straw man claiming that the IGF-1 in milk gets denatured in the digestive tract and does not make its way into the plasma.  That is irrelevant, however, because casein stimulates our own IGF-1 production.

SO IS THERE EPIDEMIOLOGICAL DATA LINKING MILK and DAIRY TO CANCER?  Let’s look at a couple of examples:

“However, a strong positive association with milk consumption was observed for cancers of the lymphatic organs (odds ratio 3.4 for greater than or equal to 2 glasses per day vs less than 1; 95% confidence interval 1.4-8.2). An inverse association was found for cancer of the bladder. Kidney cancer and cancers of the female reproductive organs (except the uterine cervix) showed weak positive associations with milk intake.” [8]

“Our results support the hypothesis that high calcium intake may increase risk of prostate cancer, and this relation may underlie previously observed associations between dairy products and prostate cancer.” [9]

“These results support the hypothesis that dairy products and calcium are associated with a greater risk of prostate cancer.” [10]

REBUTTAL? Interestingly enough, there was a large pooled study that found that low fat dairy actually lowered colon cancer risk.  Also, a couple of prominent studies found that non-fat dairy was protective and regular fat dairy promoted cancer.  My personal take on this is that this is probably because low fat dairy can help with Met-S (Metabolic Syndrome or prediabetes).  It is possible that the beneficial effect of improving Met-S may in some populations improve cancer outcomes.  However, in healthier populations, I simply cannot foresee how lowering calcitrol, boosting IGF-1, inflammation, VEGF and EGF is going to possibly help with cancer, especially in the 40+ crowd.

Magnesium and Your Sleep - Peak Testosterone

If there is a more important and ubiquitious nutrient than magnesium, I don’t know about it. (Vitamin D is a close second if you ask me.) This mineral is used in 300+ enzyme systems and indirectly affects almost every system, organ and tissue in the body. When you go low on magnesium, everything suffers. And going low on magnesium is very easy to do:  studies show that less than half of all Americans get their RDA of magnesium and up to 20% of seniors are deficient. [1][2] This is why a number of men on the Peak Testosterone Forum swear by magnesium before bed: it helps them fall to sleep and it helps them sleep better. (See my page on So You Can’t Sleep? for some of their stories.)

And the research supports the use of magnesium for improved sleep in MANY different ways.  Here are just some of the reasons you should consider some magnesium an hour or two before bed:

1.  Seratonin. Magnesium is a driver of seratonin metabolism and, especially for those deficient, can restore this key neurotransmitter to normal levels.

2.  Wakefulness. Animal studies have shown that a magnesium deficiency leads to increases in dopamine and increases in walkefulness.  This may seem good but can lead to disturbed sleep. [4]

CAUTION: Always dicuss with your physician any new supplement, especially if you are on medications or have any sort of medical condition.

5. Pain. Many adults have trouble sleeping due to pain, such as from arthritis or an injury.  Magnesium has been shown in many studies to help with pain and lower the need for pain medications. [7]

6. Muscle and Nerve Relaxation. Magnesium allows muscles and nerves to rela by helping regulate calcium flow in nerve cells, for example, as calcium is like the “switch” that turns on and off the nerve. [8]

7. Testosterone.  Magnesium can increase testosterone and testosterone increases several key neurotransmitters, including dopamine as I document in my link on Testosterone and the Brain. This inexpensive supplement was found in a study of seniors to be tightly associated with T levels. [9] Can magnesium supplementation increase testosterone?  One study noted that magnesium levels increased testosterone when combined with exercise. [10] (They received 10 mg per kg of body weight.)

8. Depression. Magnesium is powerful enough that it can have a clinical effect on some patients help with depression. [3] In fact, one study showed that magnesium therapy can cure severe, untreatable depression! Depression leads to disturbed sleep quality and sometimes lowers the quantity as well.

9. Blood Flow and Blood Pressure. There are literally dozens of studies showing that magnesium can improve blood flow and lower blood pressure.  No, magnesium is not as powerful as a Viagra or a Cialis, but it can definitely help, especially if your levels are low like so much of the population.  And good flow will not only help erections but the brain and also sleep.  In addition, high blood pressure (hypertension) is also associated with low magnesium levels.

10.  Metabolic Syndrome (Prediabetes) and Diabetes Prevention. Both of these epidemics are correlated with low magnesium levels.  Since we know that magnesium helps improve two of the major components of these condition – dyslipidemia and high blood pressure – it is entirely reasonable to assume that low magnesium is often causative. [12] One study found that giving magnesium helps. [12]

NOTE: You always want to make sure that you are getting more than adequate Vitamin B6 levels when taking magnesiu, since it is Vitamin B6 that regulates the amount of magnesium that can actually be absorbed.  There are many excellent form of magnesium, but the one that is probably the least absorbable is magnesium oxide.  This can even have a laxative effect

REFERENCES:

1)  https://www.ars.usda.gov/Services/docs.htm?docid=15672

2) Clin Chem, 1987 Apr, 33(4):518-23, “Prevalence of magnesium and potassium deficiencies in the elderly”

3) Magnes Res, 2013 Feb 1, 26(1):9-17, “Platelet serotonin and magnesium concentrations in suicidal and non-suicidal depressed patients”

4) Magnesium, 1984, 3(3):145-151, “Vigilance states and cerebral monoamine metabolism in experimental magnesium deficiency”

5) Neuropsychobiology, 1993, 27:237 245, “Effects of a Magnesium Deficient Diet on Sleep Organization in Rats”

6) Sleep, 1998, 21(5):501-505, “Magnesium therapy for periodic leg movements-related insomnia and restless legs syndrome: an open pilot study”

7) PAIN, Sep 2002, 99(1-2):235 241, “Magnesium bier’s block for treatment of chronic limb pain: a randomised, double-blind, cross-over study”

8) https://www.healthline.com/health/restless-leg-syndrome/link-between-magnesium-and-rls

9) Int J Androl, 2011 Dec, 34(6 Pt 2):e594-600, “Magnesium and anabolic hormones in older men”

10) https://www.ergo-log.com/mucunatest.html

11) Acta Diabetologica, Dec 2002, 39(4):209-213,”Low serum magnesium levels and metabolic syndrome”

12) Molecular Aspects of Medicine, Feb 2003, 24(1-3):39 52, “Role of magnesium in insulin action, diabetes and cardio-metabolic syndrome X”

High Hemoglobin/Hematocrit from HRT? - Peak Testosterone

It can quite stressful for a man who has finally gotten on HRT, feels better and then finds out that his hemoglobin is high. Of course, he can always lower his testosterone dosage to try to solve the problem, but this may not be a solution that either doctor or patient want to pursue.  Many men have found that their erectile dysfunction is greatly helped and/or morning erections and libido have returned.  The last thing they want to do is lower their dose.

So why even worry about a high hemoglobin or RBC count?  What’s a few extra red blood cells anyway?

Unfortunately, high hemoglobin (or RBCs) is a risk factor for ischemic stroke, i.e. the standard kind of stroke where there is a loss of blood supply to tissues such that permanent damage is usually incurred. [1] Of course, a stroke can be a life-changing (or life-ending) event and should be avoided at all costs.  There is also a longer term risk as well:  elevated hemoglobin could lead to unhealthy iron store levels which is associated with heart disease and dementia. Iron in tissues can lead to oxidative damage.

Just look at what some recent studies have concluded:

“Low and high hemoglobin concentrations in older persons are associated with a lower level of cognitive function in old age, particularly in semantic memory and perceptual speed.” [2]

“In older persons without dementia, both lower and higher hemoglobin levels are associated with an increased hazard for developing AD [Alzheimers Disease] and more rapid cognitive decline.” [3]

NOTE: There are several standard ways to measure red blood cells: hematocrit, hemoglobin and RBC (red blood cell count). All of these are related and doctors will usually look at two or more. Hematocrit is the volume measurement, i.e. the percentage of blood that is taken up by the red blood cells. Hemoglobin, on the other hand, is a density or concentration measurement and is expressed in grams per liter or deciliter. (Hemoglobin is, if you will recall from your high school biology, the iron-based protein that transports oxygen.) RBC is a simple count and is usually expressed as the number of million red blood cells that you have per microliter.

1. Give Blood. This is a time-proven technique for men on testosterone therapy to lower their hemoglobin levels.  And you are helping out someone else while you’re doing it!  Look at what one of our senior posters wrote about this:

Notice that he dropped his hemoglobin by about 12%.  Not bad for about an hour of time, eh?

2. Lower Your TRT Dose. If you have high hemoglobin or hematocrit from testosterone therapy, then your doctor may require you to lower your dose.  This is not always a bad thing as some men are actually taking more than they actually need, which can lead to side effects in both the long and short term.  See my page on The Side Effects of Testosterone Therapy for more information.

3. Drink Water. It is important to remember that hemoglobin is very dependent on your hydration levels.  If you were dehydrated when you had your blood draw, this could have made things worse. If you think you were dehydrated, discuss a retest with your doctor.

4. Hyperthyroidism. Hypothyroidism can lower your RBC counts and hyperthyroidism can raise them some. [8]  If you haven’t checked your thyroid function lately, this might be wise.  And don’t forget to get a full workup, including antibodies, if you can afford it.  See my page on Testosterone and the Thyroid for more details.

5. Transdermal (Topical) Testosterone?  One research summary stated that topical lead, in general, to lowered levels versus intramuscular injections:

“Intramuscular testosterone is the only form that significantly increases hematocrit above normal levels. However, it does so strongly, with up to a 6% change from baseline. The runner-up is testosterone gel, with an average increase of 2.5% over baseline levels.” [9]

Therefore, if you are on intramuscular injections and struggling with high hematocrit or hemoglobin, going on topicals may help a little.  Discuss with your physician.  NOTE:  A cheap alternative is Compounded Testosterone Creams and Gels.

6. Avoid Red Meats. It is interesting because one of the criticisms that meat eaters level against vegetarians is that plant foods have many “anti-nutrients” that can slow down or bind with minerals such as iron. For example, organizations like Weston Price love to castigate vegetarians for their phytic acid consumption.  Phytic acid is present in plant foods and binds to iron, magnesium, phosphorous and calcium.  It can, if overconsumed, lead to mineral deficiences.  However, Dr. Bernard points out that usually it is likely very health protective for most people, because  these minerals, as in the case of zinc and iron, have been found to be neurotoxic at even relatively low levels of tissue accumulation.  Research has also shown that too much iron also contributes to heart disease and there may be a link to colon cancer as well. [7]

So avoiding red meats, which are high in heme iron, stands a good chance of lowering your hemoglobin scores and protecting your long term health unless some other preventative action is taken (such as giving blood).  For other cautions about meat consumption, especially red meat, seemy link on The Risks of Meat Consumption.

As a verification, one study of vegetarians and non-vegetarians found that females had significantly lower hemoglobin levels.  Males had lower levels but it may not have been statistically significant. [5] However, another study was more definitive and concluded: “It was found that hemoglobin, hematocrit, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, white blood cells, neutrophils, serum ferritin and serum vitamin B12 in vegetarian were significantly lower than control subjects.” [6] The ferritin is a key measure, by the way, because it indicates that tissue levels of iron are lower and thus will likely cause less permanent damage. (This study did show that some vegetarians were iron deficient it should be noted.)

7. Fix Sleep Apnea.  One of our senior posters was told that sleep apnea tends to thicken the blood in this Peak Testosterone Forum thread. And, sure enough, the studies confirm this as well. [10] So, if your hematocrit, hemoglobin or RBC’s are running high, think about getting tested for sleep apnea.  A recent study commented that “one possible explanation is that repeated episodes of nocturnal hypoxia lead to a hypercoagulable state that predisposes patients to thrombotic events. There is evidence supporting a wide array of hematological changes that affect hemostasis (eg, increased hematocrit, blood viscosity, platelet activation, clotting factors and decreased fibrinolytic activity).”

8. Inflammation. Hepcidin activity can be governed by inflammation.  Checking for infections, CRP levels, etc. and then treating the underlying cause may help. [11]

REFERENCES:

1)  Eur Neurol, 1996, 36(2):85-8, “A positive relation between high hemoglobin values and the risk of ischemic stroke. Progetto 3A Investigators”

2) Neuroepidemiology, 2008 December, 32(1): 40 46, “”Relation of Hemoglobin to Level of Cognitive Function in Older Persons”

3) Neurology, 2011 Jul 19, 77(3):219-26, “Hemoglobin level in older persons and incident Alzheimer disease: prospective cohort analysis”

4) https://peaktestosterone.com/forum/index.php?topic=1616.msg15511#msg15511

5) International Journal of Natural and Applied Sciences Vol. 2 (3) 2006: pp. 174-177, “Comparative study of the hemoglobin concentration of vegetarian and non-vegetarian subjects in Ogun state, Nigeria”

6) J Med Assoc Thai, 1999 Mar, 82(3):304-11, “Hematological parameters, ferritin and vitamin B12 in vegetarians”

7) World J Gastroenterol, 2006 September 21, 12(35): 5644-5650, “Hemoglobin induces colon cancer cell proliferation by release of reactive oxygen species”

8) Iran J Ped Hematol Oncol, 2013; 3(2):73 77, “Effect of Thyroid Dysfunctions on Blood Cell Count and Red Blood Cell Indice”

9) https://www.clinicalendocrinologynews.com/specialty-focus/men-s-health/single-article-page/aua-testosterone-may-not-deserve-its-reputation-as-a-cardiovascular-culprit/ea4d29a9ef50946413c64616369785cc.html

10) Can Respir J. 2011 Nov-Dec; 18(6): 338 348, “Coagulability in obstructive sleep apnea”

11) https://www.medscape.com/viewarticle/759688_4

12) https://www.peaktestosterone.com/forum/index.php?topic=5672.msg47476#msg47476

Testosterone and Appetite - Peak Testosterone

A few men on the Peak Testosterone Forum who have started HRT  have reported increased appeitite  and have wondered if the two are related.  The answer, it turns out, is surprisingly involved. First of all, testosterone definitely affects the two most well-known appetite and hunger hormones, gherlin and leptin.

Let’s start with leptin.  Leptin is proportional to body fat and, therefore the more overweight you are, the higher your leptin levels.  And rising leptin levels slowly turn off your appetite, which, of course, is a good thing if you have put on some extra weight. However, the reverse situation can really cause men difficulty when dieting:  as you lose weight, your leptin falls and hunger increases.  This, of course, makes it significantly more difficult to stick with a diet (along with a dozen other nasty hormonal changes including plummeting testosterone levels that I discuss in my link on Why Crash Dieting Usually Does Not Work).

So how does testosterone tie into this?  Simple:  researchers have noted that leptin goes down if you put a man on testosterone.  One study found that the “serum leptin concentration correlated inversely with that of testosterone in elderly men. This inverse correlation was still present when body mass index and plasma insulin were included in the analysis. The administration of testosterone to young men suppressed serum leptin from the pretreatment level of 3.4 ± 1.4 to 1.9 ± 0.6 μg/L during the therapy. After cessation of testosterone injections, serum leptin concentration returned back to the pretreatment level.” [1]

Well, it turns out that is probably not the case and here is why:  hypogonadal men tend to have overly high leptin levels and giving them testosterone merely brings them back to where they should be.  One study stated that “we conclude that hypogonadal men exhibit elevated OB [prolactin] levels that are normalized by substitution with T.” [3]

And this is verified by the fact that many stuidies have shown that men who go on HRT (testosterone therapy) actually lose weight.  In fact, they lose weight without making any other change except increasing testosterone. In addition, they gain muscle as well.  So even if testosterone does increase appetite a little through leptin reduction, this is apparently more than compensated for by something else, including things like a) increasing a man’s desire to workout due to mood elevation and improved recovery, b) lower insulin levels and c) lower cortisol “reactivity.”  (The latter two should help a guy better manage visceral fat.)  Again, though, testosterone in hypogonadal men more than just returns them to their baseline levels.

Gherlin is the opposite of leptin in the sense that, as body fat increases, gherlin levels tend to decrease as shown by the fact that weight loss through dieting increases gherlin levels (in obese individuals). [2] Furthermore, ghrelin levels increase significantly right before a meal and drop shortly after.  In other words, increasing gherlin means increasing appetite.

One study found that control-matched men has significantly lower gherlin levels and that giving them testosterone restored their gherlin levels to normal. [4] Now this may seem like a bad thing, because one would want gherlin as low as possible to suppress appetite, right?  Well, not so fast.  It turns out gherlin is VERY important for the brain and having adequate levels may be critical for protecting the all-important hippocampus. Researchers noted that

Did you know you can inexpensively do your own testing for most hormones? The industry leader is Discounted Labs..

“Here we report that circulating ghrelin enters the hippocampus and binds to neurons of the hippocampal formation, where it promotes dendritic spine synapse formation and generation of long-term potentiation. These ghrelin-induced synaptic changes are paralleled by enhanced spatial learning and memory. Targeted disruption of the gene that encodes ghrelin resulted in decreased numbers of spine synapses in the CA1 region and impaired performance of mice in behavioral memory testing, both of which were rapidly reversed by ghrelin administration.” [5]

In other words, artificially lowering gherlin is NOT a good idea and, once again, testosterone is protecting your brain.  (See other examples in my page on Testosterone and the Brain.)

Thus, generally speaking, testosterone should not increase your appetite to unhealthy levels but rather just return them to your normal, youthful baseline levels.  And I suspect that the reported increase in appetite from testosterone therapy is usually resulting from the longer, harder workouts from finally feeling good.

1)   The Journal of Clinical Endocrinology & Metabolism, Sep 1 1998, 83(9):3243-3246, “Inverse Correlation between Serum Testosterone and Leptin in Men”

2) N Engl J Med, 2002 May 23, 346(21):1623-30, “Plasma ghrelin levels after diet-induced weight loss or gastric bypass surgery”

3) The Journal of Clinical Endocrinology & Metabolism, Aug 1 1997, 82(8):2510-2513, “Testosterone Substitution Normalizes Elevated Serum Leptin Levels in Hypogonadal Men”

4) Testosterone therapy J Clin Endocrinol Metab. 2003 Sep;88(9):4139-43, “Testosterone replacement therapy restores normal ghrelin in hypogonadal men”

5) Nature Neuroscience, 2006, 9:381 – 388, “Ghrelin controls hippocampal spine synapse density and memory performance”

Saturated Fat: Why Is It Bad For You? - Peak Testosterone

“What is saturated fat bad for you?” One reader wrote in with essentially this question.

Many men have heard from their doctors and others that saturated fat is the root of all dietary evil. However, then they find many sites that claim the exact opposite:  saturated fat is not only good for you but will boost testosterone and improve your health.  When all is said and done, most guys just walk away from the subject figuring that there is no resolution.  Now, before I go on, let me say that I am actually talking about the excess saturated fat that is in the typical American Diet.  So keep that in mind as you read the detailed response I gave tto a reader, but the bottom line is this:

While saturated fat is slightly pro-testosterone – see my page on   – it has many studies showing that it will lower nitric oxide levels, clump together cells in the blood and lower blood flow.

Of course, it DOES matter how much saturated fat that you have.  But, if you have too much, it will hamper the ability of your arteries to relax unless you diligiently exercise post meal, and, yes, that will be bad for erections for men over about 45+.  So this is the primary reason that you will see me opposed to higher saturated fat levels in the diet for most men in modern, urban settings.  I am not saying saturated fat is consummate evil, but it can definitely be problematic for middle-aged and senior men, and this is the reason I flag it on this site.

Again, For those interested, read below my response to this reader:

QUESTION:

Hi thanks for the quick reply. I’ve read through alot of articles lately that saturated fat is actually good for you, and that it was a “myth” that it was bad. Just curious… have you seen these articles?

ANSWER:

This is a great question and one that I actually cover in depth on my site. However, Peak Testosterone has grown so large over time that it is probably difficult for guys to find out my coverage on the subject.

Below is a bullet point summary of the position that I take on the rather involved issues of saturated fat, cholesterol, diet, testosterone and the like:

CAUTION: Please talk to your doctor before making any changes, especially if you have any medications or medical conditions.

1. Constant Exercise Required. Some cultures do very well on a high saturated fat diet. These cultures, however, have very high activity and exercise levels and low stress levels.  Studies have shown that post-meal exercise can overcome the negative arterial effects of high saturated fat diets.  However, most men in Western societies do not exercise after every meal, so this is a moot point, except to those extremely athletic.

2. Decreased Blood Flow and Nitric Oxide.  I’ll let the research speak for itself:

a) “Consumption of a meal containing saturated fat reduced the antiinflammatory potential of HDL and impaired arterial endothelial function, whereas the antiinflammatory potential of HDL improved after consumption of polyunsaturated fat.” [1] NOTE: Endothelial function is what you need for good erectile, because it refers to the ability of arteries to relax and allow lowered blood pressure and improved blood flow.

b) “Serum lipoproteins and glucose were determined before eating and 2 and 4 hours postprandially. Serum triglycerides increased from 94 55 mg/dl preprandially to 147 80 mg/dl 2 hours after the high-fat meal (p = 0.05). Flow-dependent vasoactivity decreased from 21 5% preprandially to 11 4%, 11 6%, and 10 3% at 2, 3, and 4 hours after the high-fat meal, respectively (all p <0.05 compared with low-fat meal data). No changes in lipoproteins or flow-mediated vasoactivity were observed after the low-fat meal.” [2] NOTE:  Again, vasoactivity refers to the ability of the arteries to relax or dilate and allow increased blood flow.

c) “The saturated fat diet was associated with enhanced noradrenaline sensitivity in small mesenteric arteries from VHF rats (VHF vs. VC, P < 0 05) and blunted endotheliumdependent relaxation in VHF and PHF rats (VHF vs. VC, P < 0 001; PHF vs. PC, P < 0 05). Endothelial dysfunction was attributable to a reduced nitric oxide component of relaxation in VHF rats, and blunted prostacyclin and endothelium-derived hyperpolarizing factor components in PHF rats.” [3]

Again, if you’re a young guy, you’ll probably never notice.  However, as you age, you’ll probably see that these higher fat meals simply do not work for you.

3. High LDL-P and apoB In Some Men. As many of you know, LDL-P is the most important cholesterol number and NOT the standard LDL-C that your doctor pulls during your annual physicial.  (Alternatively, you can use apoB, which is cheaper.)  However, often high LDL-C and high LDL-P go hand in hand.  And what often happens with men consuming a lot of saturated fat is their LDL-C and their LDL-P jump to overly high levels.  High LDL-P can lead to deadly arterial plaque buildup (atherosclerosis) and so this is another reason I oppose high saturated fat levels, unless you are going to carefully monitor LDL-P (or apoB).  I have many pages on the subject here:   How to Regress Arterial Plaque and Reverse Atherosclerosis. (NOTE:  I am not saying that all men on high fat diets have this issue.) Remember that plaque in your penile arteries means less nitric oxide down there and you know what that means.

One myth is that only small LDL particles will cause plaque.  This is simply not true and abundant research shows that large LDL particles also cause hardening of the arteries: Large Particle LDL and Arterial Plaque Buildup.

By the way, some of you may protest and say, “What about the Masai?”  The poster children for high fat diets are the Masai, who eat copious amounts of saturated fat. However, their cholesterol is around 150.  The Masai have very low body fat levels and each pound of fat lost leads to a drop in cholesterol of about a point.  One third of Americans are overweight and another third obese, so eating this much saturated fat will often lead to artificially elevated cholesterol levels – saturated fat does boost cholesterol and LDL-C.  There are studies that show that saturated fat does not boost LDL by much.  However, all I can tell you is that men on Low Fat Diets like myself see their LDL and cholesterol drop like a rock.

And virtually all primal societies had cholesterol of 150 or below and they had no heart disease. In contrast, in the U.S. and most modern societies, heart disease is, by far, the number one killer.  Again, it’s not actually not the total cholesterol number that is most important.  It is your LDL-P that really counts and, to date, almost all studies showing plaque reversal involve very low LDL numbers.  I give some thresholds in my link the LDL Levels Required to Lower Arteriosclerosis. And, by the way, the Masai actually were found to have significant atherosclerosis and are not known for tremendous longevity like the cultures that eat lower saturated fat levels, such as the Tarahumara, Hunza, Abkhasians, Vilcabambans, etc.

4. Insulin Resistance.  If you consume enough carbs, consuming a lot of saturated (and total) fat will lead to massive insulin resistance.  Researchers use high fat and high saturated fat diets to induce insulin resistance in research animals all the time! This link has been known for awhile and has been verified in humans on (nondiabetic) participants. [2] Insulin resistance is a male curse and is associated with Metabolic Syndrome, which in turn is associated with decreased testosterone, heart disease and erectile dysfunction. Again, if you exercise like a wild man, you can probably overcome insulin resistance.  But how many of us can commit to walking four hours per day or spending two hours in the gym?

Also, guys who eat Low Carb may or may not have insulin resistance, due to their extremely low carb levels, and should test their post-prandial (post meal) blood sugar levels according to this page:  Normal Postprandial Blood Glucose Levels.

REFERENCES:

1) Lipids And Cardiovascular Disease, August 2006, “Consumption of Saturated Fat Impairs the Anti-Inflammatory Properties of High-Density Lipoproteins and Endothelial Function”

2) Amer J of Cardiology, Feb 1 1997, 79(3):350 354, “Effect of a Single High-Fat Meal on Endothelial Function in Healthy Subjects”

3) The Journal of Physiology, 8 SEP 2004, 517(2), “Cholesterol-independent endothelial dysfunction in virgin and pregnant rats fed a diet high in saturated fat”

Testosterone Supplements: Read This Before You Purchase

6.  Levels. Most guys who begin to experieince low testosterone symptoms, from what I have seen in my emails, are in the 150-350 ng/dl range.  These men need a very significant boost in T and they’re probably not going to get it from any of the legal herbs (at least here in the U.S.). This leaves these men at risk for all the nasty conditions that can results from hypogonadal T levels, including diabetes, metabolic syndrome, erectile dysfunction and heart disease. In other words, let’s say you’re a man with testosterone of 250 and you buy a mildly powerful testosterone booster that bumps you up 30% to 325.  You are still very low and very much at risk for significant health issues but may be completely unaware because you think you are taking a T-boosting supplement..

So am I saying that there are no herbs or supplements that will raise testosterone?  As I mentioned above, there are definitely some testosterone supplements that will work and I cover the interesting ones in my link on Testosterone and Herbs.

The answer is simple:  the science just isn’t there.  In fact, I’d have to go a step farther:  not only is the science not there, but these supplements can be dangerous in some circumstances.

Below are some of the reasons that I think men should be cautious about the testosterone supplement industry as a whole.

1. Added Steroids. Several of the supplement manufacturers have been caught selling untested and/or unsafe steroids to the general public. I have several examples of this including the horror story of Tren Extreme and Liver Damage, Testosterone Loss by Cyclo Bolan and so on.

2.  Debatable Results. Many vitamin shop and health food stores carry testosterone boosters that contain Forskolin or Tribulis.  I give these coverage on my site – just use the search at the top – as being legitimate T boosters in some circumstances.  The problem is that none of these boost testosterone much and are of debatable value for in many or even most cases.  For example, Tribulis probably does not work as well for the middle-aged and older. All of this is the reason that the FDA does not regulate them:  they simply don’t raise T enough to make it worth their while. NOTE: Supplement manufacturers may also add zinc, which has debatable testosterone-raising powers. For a man with a zinc deficiency maybe. As I cover in my link on Zinc and ZMA, there is also the danger of copper depletion and arterial inflammation from taking too much zinc as well.

3.  Side Effects. A few of these supplements are known for having a strong enough side effect profile to bear mentioning.  For example, D-Aspartic Acid is known to increase aromatization and thus some men seem to experience estrogen-related side effects, yet you see few supplement sites mentioning this.  See #35 in my discussion on How to Increase Your Testosterone Levels for more details.

4.  Proprietary Ingredients. Most of these “testosterone supplements” do not even list the ingredients.  Are you really going to trust your long term health to a random supplement manufacturer that is hiding their ingredients from you?? How do you know they are not hammering your copper levels with excess zinc?  adding excitotoxins?  The bottom line is that there is simply no good reason to hide the ingredients from the customer.  Quality should sell their products if they really work, right? Seriously, any legitimate T booster will be used by every athletic campus in the country.

5.  Bioidentical Testosterone. The bioidentical testosterone that you will get in your doctors office has many advantages. First and foremost, it is as natural of a substance as one could hope for, since it is the testosterone that is naturally teeming through your veins and residing in your tissues. Secondly, it has been heavily studied. Do we know everything about testosterone therapy? Of course not. Are there no side effects to testosterone therapy? Of course not. However, we do have extensive physician usage over the last twenty years and literally dozens of studies looking at its effects. What herb or supplement can you say this for? And any decent physician is going to carefully monitor your prostate, PSA, blood counts, liver function and so on, so you are under actually modern monitoring and control.

Stress and Testosterone - Peak Testosterone

We all joke around about being under stress, but, as you’ll see below, it’s really not that funny. There are many definitions of stress, but here I am primarily talking about the kind of stress that produces elevated cortisol levels. When you are under stress, your body releases increased levels of adrenaline and other “fight or flight” hormones and chemicals.  The adrenaline does a certain amount of damage, raising pulse rates and blood pressure (especially in Type A personalities).  But it is the cortisol that comes shortly after that does the most devastating long term damage.

Fatigue: Testosterone to the Rescue - Peak Testosterone

One of the things I remember about my low testosterone days was the mind-numbing fatigue.  Excruciating is the word that comes to mind actually.  In the afternoons I was always so tired that I could barely function.  One man on the Peak Testosterone Forum with abysmally low testosterone of 144 ng/dl described it as “crushing fatigue.” [1] Cleaning up my diet helped significantly, but HRT (testosterone therapy) made the biggest difference without question. This poster described the same thing:

“Unless it is just placebo or psychological…. I just gotta say- two big symptoms I have had for months has been ‘fuzzy’ thinking – you know, forgetful and just not as sharp, mentally? Not good especially as a lawyer if I screw up I am liable for it. Also, this terrible fatigue which made me wake up exhausted and then super-tired after doing anything – like ready to call it a day at 2:00 and take a nap. Okay, so when I went to the doctor on Tuesday he gives me a 160mg shot of testosterone sub cutaneous and said a weekly shot might take about 10 weeks before I might feel anything …… So, I woke up the next day without fatigue or brain fog. Is this in my mind? How could it be? It is very real physically.” [2]

Again, notice that he had painful fatigue that was removed with HRT.  Of course, rapid results like this are not everyone’s experience, but fatigue is definitely a hallmark symtpom of hypogonadism. One set of researchers wrote that “testosterone replacement therapy or androgen replacement therapy (ART), in hypogonadal men has been well studied. Symptoms associated with male hypogonadism are sexual dysfunction, fatigue, loss of energy, mood depression, change of body composition and osteoporosis.” [3] Still other authors stated that “andropause, a syndrome in aging men, consists of physical, sexual, and psychological symptoms that include weakness, fatigue, reduced muscle and bone mass…sexual dysfunction, depression, anxiety, irritability, insomnia, memory impairment, and reduced cognitive function.”  [4] For many of you reading this, those will sound very familiar.  I had every one of those symptoms, except for bone loss, for literally decades before finally figuring out I was low testosterone.

“Have any of you other low T guys been experiencing fatigue even days after orgasm? Is it a low T symptom? I have a pattern that has been repeating itself. Orgasm once a day for three days. After the last one I am experiencing strong fatigue, even taking on the clothes the day after feels heavy. Standing, sitting, moving, anything feels heavy…If I bend my legs my thigh muscles almost start to shake a little, like they are exhausted, even though I haven t done anything.” [5]

1. Oral Testosterone Undecanoate. The early forms of oral testosterones tended to be hard on the liver, but oral testosterone undecanoate avoids this issue and a product named Andriol has been around since the 80’s according to my understand.  Researchers not that “using a one-tailed test of significance, ‘fatigue’ was lower and ‘vigour’ higher on TU.” [6]

2. Testosterone Enanthate (Supraphysiological). Going supraphysiological, i.e. above normal youthful levels, is not a good idea for many reasons.  However, some guys do it for a short while when they begin HRT and for reasons unknown researchers examined this with testosterone enanthate, which is very similar to testosterone cypionate.  The found that “significant reductions in negative mood (tension, anger, and fatigue) followed by an increase in vigor were found in response to T treatment in the hypogonadal group.” [7] In other words, this proved to be a rapid fatigue blaster as one would expect.  However, it also increases the risk of side effects…

Did you know you can inexpensively do your own testing for most hormones? The industry leader is Discounted Labs..

3. Testosterone Undecanoate Injection (Long Term).  There is documented evidence that the benefits of HRT have a long term lasting effect as well against fatigue, i.e. this isn’t just a short term effect that goes away.  One study on Klinefelter patients showed that even after 3.6 years patients “showed better mood, less irritability, more energy and drive, less tiredness, more endurance and strength, less need for sleep, better concentration ability and better relations with others during testosterone treatment…Treatment was characterized mainly by more endurance and strength, less fatigue.” [8]

CAUTION: Some men on testosterone therapy will actually experienced increased fatigue. This may be from unmanaged estradiol, but the cause is not always known. And some men will have the opposite experience: they will feel SO good that they “go crazy” in the gym and end up with strained ligaments and tendons!

1)  https://www.peaktestosterone.com/forum/index.php?topic=6319.msg52850#msg52850  

2) https://www.peaktestosterone.com/forum/index.php?topic=2361.15

3)  International Journal of Impotence Research, 2007, 19:411 417, “Transdermal testosterone gel increases serum testosterone levels in hypogonadal men in Taiwan with improvements in sexual function”

4) Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, Aug 1999, 19(8):951 956, “Testosterone and Andropause: The Feasibility of Testosterone Replacement Therapy in Elderly Men”

5) https://www.peaktestosterone.com/forum/index.php?topic=6274.msg52417#msg52417

6) Clinical Endocrinology Volume 14, Issue 1, pages 49 61, Jan 1981, “ANDROGEN REPLACEMENT WITH ORAL TESTOSTERONE UNDECANOATE IN HYPOGONADAL MEN: A DOUBLE BLIND CONTROLLED STUDY”

7) Physiology & Behavior, Apr 2002 75(4):557 566, “Exogenous testosterone, aggression, and mood in eugonadal and hypogonadal men”

8) Clinical Genetics, Apr 1988, 33(4):262 269, April 1988, “Follow-up of 30 Klinefelter males treated with testosterone”

Arginine or Citrulline to Increase Salivary Nitrite / Nitric Oxide?

A poster on the Peak Testosterone Forum wrote in and asked if citrulline would increase the salivary nitrite levels that the new Berkeley Test Strips measure:

“Can someone tell me what is the appropiate dose of Citrulline and if I should see any change in my Berkley strips ? I’m not seeing any increase in my measurements.  I’m taking 2 (1.2 grams) tablets of L Citrulline from Now Foods each day divided in two servings . I’m not seeing any increase in my measurements. Thanks in advance.” [1]

Of course, this same question would also likely apply to arginine as well, because citrulline essentially is an alternate way to increase arginine levels.  For more information, see my link on The Benefits of Citrulline.  And I answered the poster that I knew citrulline and arginine can increase endothelial nitric oxide levels, but that that would not necessarily translate into increased salivary nitrite levels.

CAUTION:  Arginine should be used with care and I explain some of the risks in this page on Herpes and Arginine

To find out if I was right, I wrote the good people at Berkeley Test. There are so many scammers in the health business, but all my interactions with this company have been excellent: they are helpful, knowledgeable and emphasize whole plant foods to boost nitric oxide. You can read a very interesting interview that I had with them in my page on A Review of Berkeley Test Strips for more information, where they document how the Berkeley Test Strips actually measure salivary nitrite levels. This is a back door method that your body has to increase arterial nitric oxide levels and is VERY important for any man over about the age of 35 to place in his bedroom arsenal. Again, read the above link and you’ll understand how it works.

Berkeley’s response was very interesting and essentially verified what I said, i.e. that some key things can upgrade and downgrade the production of your regular, arterial nitric oxide levels:

1)  https://peaktestosterone.com/forum/index.php?topic=4925.0

“Keep in mind, arginine is a semi-essential amino acid, so a balanced diet provides a source. However, a supplemental Citrulline / Arginine blend can augment NO bioavailability. However, there are a number of factors that can influence the outcomes, such as:

1. Expression of NOS, which can be influenced by exercise (high intensity and daily routines can up regulate its expression) and age (as we age or become more sedentary, NOS expression is lower),

2. The presence of arginase (which breaks down arginine, thereby reducing the availability for NOS usage) and

In other words, citrulline and arginine may not improve nitite levels, but they can boost arterial NO levels of course along with exercise.  And, generously as always, they even went to give some ideas on ways to actually increase your salivary nitrite levels directly:

“We have been told products such as nitroxyl or arginext with B12 to be effective at enhancing saliva NO levels in individuals with healthy BMI and daily exercise.

The individuals also incorporate multiple leafy green salads into their diet and, on occasion when salads are not available, they will supplement with Peak Nitric Oxide or various beet juices, such as Red Ace, Red Rush, or Beet It — these 3 our the most potent and have been well characterized for contributing the the alternative or non-NOS pathway. And the supplement, Peak Nitric Oxide, is based on the NO3 concentration of a Beet It shot, which can be equally effective and its duration is longer in comparison to Neo40, which we have been told to be short-lived and too expensive.

So, a natural whole food diet with the incorporation of multiple leafy green salads per day with a beet shot and the additional of a citrulline source, when necessary of arginext (arginine/citrulline)/b12 or nitroxyl/B12 with daily exercise, and, if necessary, Peak Nitric Oxide as a supplement can be an effective way to sustain your NO levels as validated by Berkeley Test. Keep healthy and eat smart.”

The safey of nitroxyl and arginext I do not know:  you’ll have to do your own research.  But the bottom line is that citrulline (and arginine) can increase endothelial nitric oxide and can be used synergistically with a few supplements, higher nitrate foods and nitrate-food-based supplements.

REFERENCES:

The Adrenal Glands and Testosterone - Peak Testosterone

Testosterone is one of those ubiquitous molecules that affects just about everything in us men. One of the connections that few men realize is that testosterone even affects your adrenals, the “stress glands” of the body. The adrenals are the endocrine glands that sit next to the kidneys and produce such critical stress hormones as cortisol, ephinephrine (adrenaline) and norepinephrine (noradrenaline). In addition, the adrenals also make an important stress modulator, DHEA, that acts in a complimentary fashion to cortisol in particular. The adrenals even make a little testosterone, although you get the lion s share of your T from the testes of course.

So how does testosterone affect the adrenals?  Let’s look at a few of the comments from men who have gone on HRT (Hormone Replacement Therapy) in the Peak Testosterone Forum and see how their enthusiasm might relate to their adrenals and stress and cortisol levels:

Notice this man’s comments before HRT:

“I suffered from extreme fatigue, muscle pains and weakness. (which are not ‘common’ side effects of low T). The fatigue is remarkably better (so much better I no longer need prescription stimulants to make it through the day!…I suffered from extreme fatigue, muscle pains and weakness.” [1]

If you read through his post, he suffered from all the classic symptoms of what some call “adrenal fatigue”.  Adrenal fatigue is basically the controversial theory that a number of prominent many alternative practitioners subscribe to and posits that the adrenals can become “exhausted” from chronic overstimulation, leading to decreased output of key hormones such as cortisol.  The standard symptoms are very similar to what this man described:  fatigue, aches, mental fog, weakness.

Now notice his description as to how he felt after testosterone therapy in the same post:

REFERENCES:

1)  https://peaktestosterone.com/forum/index.php?topic=433.0

2)  https://peaktestosterone.com/forum/index.php?topic=513.120

3) Neuropsychopharmacology, 2005 October, 30(10):1906 1912, “Testosterone Suppression of CRH-stimulated Cortisol in Men”

4) Medicine and Science in Sports and Exercise, 1998, 30(7):1140-1145, “Autonomic imbalance hypothesis and overtraining syndrome”

5) Sports Medicine (Auckland, N.Z.), 1995, 20(4):251-276, “Blood hormones as markers of training stress and overtraining”

“After 4 weeks my sex drive is “through the roof”…The fatigue is remarkably better…I no longer need prescription stimulants…The weakness I felt is totally gone! I don’t ‘feel sick’ like I did for the past 5 years!”

Many men who go from low testosterone to higher testosterone on HRT (assuming their estradiol levels are managed properly as well) experience this same remarkable transformation from Mr. Seeming Adrenal Fatigue to, well, the complete opposite.

NOTE: Please see my link on Testosterone and Cortisol for additional information.

I could go on with posts like this, but I’m sure you get the idea.  HRT very often makes a huge difference in hypogonadal men and the reasons are many:  it lowers insulin; it lowers inflammation; it boosts neurotransmitters and so on.  But one question remains:  could it also be “boosting” the adrenals?

The answer is that the research shows that there is actually a testosterone-to-adrenal link and one that could possibly help the adrenals to “heal” and “recover”.  One study looked at young men and basically suppressed their testosterone pharmaceutically and then compared it when testosterone replacement was introduced.  So, basically, the researchers were comparing a hypogonadal state versus a high testosterone state.

Did you know you can inexpensively do your own testing for most hormones? The industry leader is Discounted Labs..

Now many people would probably expect the higher testosterone state to have higher cortisol levels.  The guys should be more “wired” and “restless”, right?  Wrong!  The hypogonadal state had significantly higher cortisol levels, indicating that the adrenals had to work harder without sufficient testosterone.  The authors summarized by stating “CRH-stimulated cortisol was significantly decreased during the testosterone-replaced condition compared with the induced hypogonadal (relatively testosterone deficient) condition created by leuprolide with placebo replacement .” [3]  (It is not just this study that shows this link between T and the adrenals:  many animal studies have as well.)

How does testosterone do this, i.e. inhibit the overreaction to stress?  It does it, actually, by acting on the adrenals themselves, i.e. acting at “ground zero” of cortisol production.  Cortisol is actually produced via trigger hormones:  CRH is released from the hypothalamus, which in turn triggers ACTH from the pituitary that then tells the adrenals to pump out cortisol.  Testosterone works by, according to the above study, inhibiting sensitivity of the adrenals to ACTH. This has many advantages, because under stress conditions, more ACTH may be produced but the adrenals are significantly protected.

There are some who are claiming that one should first fix any adrenal exhaustion.  However, I feel this is likely misguided IF the man is low testosterone in the first place.  The above study shows that a man likely needs ample testosterone in order to dampen his stress response.  Again, the authors pointed this out by saying “in contrast, our data demonstrate that the effect of testosterone in young men is to inhibit rather than augment the cortisol response to CRH stimulation.” [3]

NOTE:  For related information, see my Stress and Cortisol Links.

Many men with low or lowish testosterone begin experiencing anxiety and the same can be said with men who believe they have adrenal fatigue.  I cannot help but wonder how often the latter do not realize that their testosterone levels have fallen, leaving them vulnerable to overreacting to the stressors that life, especially modern life, seems to naturally bring.

So the bottom line is get tested and start monitoring if at all possible. Find and work with a good physician who will test your cortisol and testosterone levels.

CAUTION:  One last note: many men are competitive and high octane if you will.  It is very difficult for them to exercise in a relaxed and steady manner.  (I’m one of them.)  Are you attracted to HIIT, interval training, bodybuilding, triathlons, marathons, etc.?  If so, then you need to ask yourself if you are possibly overtraining.  It is very easy to do, especially if you are natural and have the right personality. Overtraining can easily lead to disturbed sleep, lowered immunity and – you guessed it – adrenal/cortisol issues as well.

Researchers have noted that a typical pattern is increased ACTH (to the stress of overtraining) which leads to decreased sensitivity to the same and so cortisol levels, initially increased, start to fall.  Eventually, ACTH levels actually start to decrease as well, exemplifying a kind of “fatigue” or “exhaustion” response. [4]  Remember:  our bodies were built to walk.  High octane men do not like to walk and often speak of it as a “waste of time” and in a derogatory manner.  But, like it or not, we weren’t meant to be Formula One or Indy every day.

So, based on what I’ve seen in Peak Testosterone Forum, probably 5-10% of the men reading this will have lowish testosterone and “adrenal fatigue-like” symptoms simply because there are one stage or another of overtraining.  See my link on How to Overcome Overtraining for some more information.

Low Fat Diet: What is It? - Peak Testosterone

Most men that show up at my site have a damaged endothelium and, after they read around my site a little bit, they realize that the best way to repair their endothelium is by eliminating most of the fat from their diet. Going on a Low Fat Diet can actually remove arterial plaque according to some studies and lowers blood pressure, increases blood flow, stabilizes plaque and in general lets the lining of the arteries heal. And, as I outline in my page on a Low Fat Diet and Erectile Dysfunction, this can be very good for your erections. Letting those penile arteries heal is absolutely critical for many of us who have grown up on a typical Western lifestyle.

Unfortunately, most men will not even consider a Low Fat Diet, because there is so much misinformation out there.  For one thing, a Low Fat Diet is equated to a No Fat Diet.  The truth is that the goal for a Low Fat Diet is to get the content of your diet down to around 10-15 percent of total calories.  The 10 percent level has been studied by the researchers Drs. Dean Ornish and Caldwell Esselstyn, who are the “Apostles of Low Fat”. They have had tremedous successes as I document in my link on What a Low Fat Diet Can Do For You for more details.

NOTE: Ironically, some researchers have called a diet of 20 percent or even 25 percent low fat. To add to the confusion, the actual research term for what the public calls a Low Fat Diet is actually a “Very Low Diet” and give it a threshold of 15 percent, something I am mentioning in case you do some research on your own.

REFERENCES:

1) Am J Clin Nutr, Sep 1990, 52(3):491-494, “Cholesterol-lowering effect of a low-fat diet containing lean beef is reversed by the addition of beef fat”

Before I go on, let me mention one of the big reasons that I love a Low Fat Diet:  it complements well someone who exercises for an extended period of time and/or lifts weights.  It is an ideally adaptable way of eating, because

1.  Weight Lifting.  When lifting weights, you simply add low fat protein sources.  These abound and include undenatured whey protein powders, undenatured rice protein, egg whites and even low fat milks.  Of course, Ornish and other researchers have not studied the higher levels of proteins that weight lifters and body builders consume, but results should still be excellent.  (See this link on Potential Protein Dangers however.)

2.  Endurance Training. One of the major theories of overtraining is “glycogen depletion.”  After extended training, one must regularly “reload” glycogen stores and there is no better way than with the clean, whole foods carbohydrates that a Low Fat Diet will supply. (Competitive athletes will likely have to supplement with some fat, though, simply because they burn so many calories and have a greater fatty acid burden.  But then they have little to worry about when it comes to heart disease!)

3.  Meat. Now this would probably make Ornish and Esselstyn cringe, but it is likely that one can even do a Low Fat Diet with very lean cuts of meat and possibly achieve good outcomes, assuming you couldn find them.  (Whatever you do, do NOT use processed meats as study after study has associated these with colon cancer risk.)  There are several studies that have actually looked at the effect of Low Fat diets with meat.  One of the most interesting found that low fat beef dramatically lowered cholesterol and adding beef drippings back in steadily raised cholesterol just as expected. [1] In other words, it’s the fat in meat that sends cholesterol through the roof.  NOTE:  One should also read, though, my pages on The Potential Risks of Protein and Significant Risks Associated with Meat Consumption.

So what exactly is a low fat diet?  Let’s start with some calculation based on that 10 percent of calories number. In fact, let’s say you are eating 2,700 calories per day.  10% of 2700 is 270 calories from fat, which translates to 30 grams of fat per day from all sources (since fat is 9 grams per calorie).

For those in the U.S. or eating a standard Western diet, this seem very low indeed.  In fact, many of us have eaten 30 grams of fat in one meal for decades!

Ornish has received some heat because he eliminates nuts, fish, olive oil and other items that many researchers consider heart healthy.  But the fact is this:  Ornish’s Diet works..

The Low Fat Diet will has been shown to reverse heart disease and cancer. Think about that:  there are not pills or drugs that can do that! If there was a compound that could actually reverse heart disease, for example, every drug company on planet earth would be fighting for it and spending billions advertising for it. (The statins will reduce arteriosclerosis, but only if taken in very massive doses.)

And, to his credit, Dr.Ornish is also an excellent, down-to-earth writer.  I would recommend either of his two books as an easy read that will probably save your life: Dr. Ornish’s Program for Reversing Heart Disease and Eat More, Weight Less.  Eat More, Weigh Less is particularly important if you want good, low fat recipes.  Dr. Ornish collaborated with a French chef for this book and close to two thirds of the book are delicious dishes and food preparation ideas for low fat cuisine.

What is better and easier in the long run is to just go completely on a Low Fat Diet.  You will probably have a week or two where you find your self craving meat, butter, oils, cheese – all those things – but then the desire will suddenly disappear.  I remember when I first started a Low Fat Diet, if I smelled a steak or something grilled, it would just about kill me – I really think I would have stolen a drumstick right out of a baby’s hand if no one was looking in those moments. However, it just took a little time and soon all of the stuff I grew up on actually sounded greasy and heavy.  So, again, give your palate time to adjust and be patient:  it’s well-worth the wait.

Another objection that you may have is:  will I get enough fat in my diet on a Low Fat Diet?  The answer, of course, is yes.  Remember that if you eat an Ornish, you will get about 10% of your calories from fat.  If, for example, you eat 2,700 calories in a day on an Low Fat Diet, that is 270 fat calories, which would be almost exactly 30 g of fat.  And that is more than enough for your body’s basic requirements.

I know some of you may be thinking that you could never live without fat in your diet.  Well, actually you will be surprised how your palate will change if you just give it a couple of weeks.  My experience, and Dr. Ornish echoes this, is that it’s best to go “cold turkey”.  In other words, if you try to go pretty-doggone-Low-Fat but still not-quite-Low-Fat, the desire for fatty foods does not go away, because you are still occasionally tasting and sampling your old Western Diet.

Your family and friends all love you, but they also have almost killed you with their love. Well, now it’s time to pull away from the crowd with the Low Fat Diet. Do you really want to live like them?  Isn’t it better to be a little lonely at times than to live a life full of angioplasties, stints, prostate cancer, strokes and limp sex?

Are you ready?  Here are the details for those of you willing to pay the price to get your youth back:

NOTE:  All the signs point to the Low Fat Diet being very good for erectile strength.  Read this link on How the Low Fat Diet is Good for your Sex Life.

Interval Training - The Many Advantages - Peak Testosterone

Want to boost your Growth Hormone response?  Want to build muscle and burn fat like never before?  Want to actually rebuild your brain?  Then Interval Training is just the thing for you.

NOTE:  You can also read more in my link about HIIT (High-Intensity Interval Training) as well.

The reason is that Interval Training is a proven, and natural of course, method to increase your body’s Growth Hormone output.  Growth Hormone was shown in a recent study to literally burn almost 10%body fat off middle aged male participants as well as reduce their baseline metabolic rate by about 200 calories. [6] These are incredible numbers.  So what doesn’t every doctor prescrible growth hormone for those middle aged and beyond?  Primarily cost.  The price of hormone has come down, but it is for the time being the stuff of Hollywood stars, ex-athletes and the rich and famous.

Well, that was until Interval Training came along:  now even the poorest of the poor can enjoy many nice bursts of Growth Hormone throughout the day by employing some very simple scientific exercise strategies that we will outline below.

Interval Training is nothing complex:  it’s basically exercising the way you did when you were a kid.  Watch kids play:  they don’t run at a slow, steady pace for an hour.  They sprint over somewhere, then rest, the sprint somewhere else and so on.  Going fast and hard followed by slow and relaxed is Interval Training at its core.ts core.

For example, classic Interval Training is doing some form of exercise at a very intense level for 30 to 60 seconds and then resting for a few minutes and repeating for several cycles.  The research studies have usually been done using sprinting, but the form of exercise really doesn’t matter much:  the key is to do something where you get out of breath and start sweating. Intensity in your Interval Training is what you are aiming for.

But it’s actually not as bad as it sounds:  you can do anything for 30-60 seconds, right?  A stationary bike, stair stepper or even weights [3] – anything can be used.  For example, with weight training, as long as you rachet up the resistance or weight significantly for a minute or two so that you’re wheezing and puffing, then that is Interval Training.  So it’s basically push yourself, then relax and repeat.  And I think most people will find this actually more enjoyable than just straight and steady endurance/aerobic exercising.  (Note:  Remember to build up slowly into this if you haven’t exercised in a while and consult your doctor.)

So what’s the advantage?  Many studies have shown that even one or two cycles of Interval Training churn out Growth Hormone into your system for several hours afterward.  And Growth Hormone is one of your truest friends:  it improves mental abilities – actually, it allows you to rebuild your brain even past youth – and burns fat and builds muscle while it’s at it.

So how much Growth Hormone can you churn out using Interval Training?  Well, one famous study [1] looked at nine males doing either one 6 second or one 30 second sprint.  The 30 second sprint gave a peak Growth Hormone response 450% higher than the 6 second sprint and elevated Growth Hormone levels for 90-120 minutes in total. That shows the magnitude of the Growth Hormone response from Interval Training exercise for only one cycle.  Even the 6 second sprint eleveated Growth Hormone for about 60 minutes afterward.  So even minimal time and cycles of Interval Training will still produce significant Growth Hormone output.

The bottom line is that you don’t have to train like an olympic athlete to get a powerful Growth Hormone response. In fact, you want to be careful, because if you do too many sprints during your Interval Training, you will have to take a break from training the next day due to muscle soreness, etc.  Plus, you’ll have to be careful not to overtrain which can decrease testosterone, raise cortisol and decrease immunity, all of these being Exercise-Session  Killers.

Therefore, you have to listen to your body.  One key study [2] found that “Total IGHC (Growth Hormone Response) increased linearly with increasing exercise intensity”.  In other words, the more intensity and the longer the intensity, the greater your body’s output of Growth Hormone.  So find that balance between intensity and being able to do Interval Training the next day.  Remember that even one or two cycles of Interval Training will get you a nice Growth Hormone response.

Also, don’t get too hung up on the exact times that you must do for each.  The basic idea behind interval training is this:  you go fast and then you go slow and then you repeat. Does it really matter whether you get a Growth Hormone response of 44% or 64%?  No, what really matters is that your workout is enjoyable enough that you’re back doing it the next day!  If you are a beginner, don’t try to sprint like a wild man for ten minutes straight. Just do what you can do and build up slowly and gradually.

Note:  Is there a way to boost Growth Hormone using much less weight during weight lifting?  Well, it turns out the answer may be yes.  Scientists recently found [4] that doing 40% of your one rep max at a slow pace – three seconds up and three seconds back – to exhaustion gave greater growth hormone response than traditional weight lifting techniques.  This has left the researchers scratching their heads.  These results should be considered preliminary, but maybe slowing down your reps is just what the Endocrinologist ordered.  Don’t forget to look at my Volume link to see a new way to put on muscle that is easier on the joints.

Most of the studies on Interval Training have been done on younger individuals (20-35 years).  Can the middle aged and beyond athlete expect a Growth Hormone (GH) benefit?  One study [3] examined just this question and here is their summary:  “The magnitude of GH release is greater in young women than in young men and is reduced by 4-7-fold in older individuals compared with younger individuals.”  At first, this sounds discouraging, but it’s not.  You can still get a significant Growth Hormone response even though it is not as large as a young person’s.  Imagine how much you would pay for a supplement that would increase your Growth Hormone response significantly for several hours.  Well, there is no such supplement:  instead you can just do a little exercise and achieve the same results!   .

By the way, one Hormone that goes hand in hand with Growth Hormone is IGF-1 and a 2008 study found that weight training increased IGF-1 levels in muscle tissue by 54%! [5] Adding creatine to weight training produced an even greater IGF-1 response.

I should also mention that one theory postulates that what you really want to aim for is brief Interval Training 2-3 times/day.  Of course, most of us have busy lives and so that is probably not possible.  But such a regimen of Interval Training would create a elevated Growth Hormone response throughout the day.  The study [3] cited above aimed to do just that and wrote “as a result, 24-hour integrated Growth Hormone concentrations are not usually elevated by a single bout of exercise. However, repeated bouts of aerobic exercise within a 24-hour period result in increased 24-hour integrated Growth Hormone concentrations”. This study, in young women, created a 24 hour Growth Hormone response twice the normal!  And, when coupled with long, quality Sleep in the night, Interval Training would dramatically elevate Growth Hormone for you night and day.

CAUTION: If you find your performance dropping off after a period of Interval Training, then you may need to take a week or two off.  You are probably experience a type of Overtraining which can lead to decreased testosterone output and immune function.

Remember:  exercise like a kid and have fun rebuilding your body and brain.

REFERENCES:

1) J Sports Sci, Jun 2002,20(6):487-94

2) J Appl Physiol,May 2002,92(5):2053-60:2053-60

3) Sports Med,2002,32(15):987-1004

4) J Physiological Sciences,2008,58(1):7-14

5) J Sports Nutr, 2008, 18:389-398

6) J Clin Endocrinology Metabolism, in press Sep. 4, 2007

SHBG: Causes and Natural Solutions for Low SHBG.

Many men have learned that SHBG binds to a little over half of their testosterone molecules and renders them “inactive”.  Because of this, as SHBG goes up, unbound testosterone goes down.  Many physicians like to focus on free testosterone, which is your T that is not bound to SHBG or another protein called albumin.  And the rule is simple:  as SHBG goes down, free testosterone goes up.  And free testosterone is considered the form of testosterone that is active and available to act on tissues.

NOTE: It is actually a little more complicated than that as testosterone bound to albumin can be easily unbound and used as well.  But the point remains the same.

So clearly a man wants low SHBG, since it indicates that his free testosterone would be improved, right?

Wrong! As it turns out, low SHBG is often a sign of many of the worst chronic diseases that we face in modern, civlized societies.

1.  Obesity and Being Overweight.  Low SHBG is associated with obesity. [1] The reason is probably due to a loss of insulin sensitivity as we’ll discuss below.

2.  Lower Insulin Levels. There is evidence that increasing insulin lowers SHBG. [2]  Studies have found this both in vitor and in vivo as well, i.e. on human subjects and male ones at that. [3] Therefore, SHBG is often a flag or warning signal of insulin and blood sugar issues. In other words, SHBG does not cause insulin resistance but does indicate it.

NOTE:  You may also want to read my link on The Causes of High SHBG.

3.  Cardiovascular Disease, Diabetes, Metabolic Syndrome and Decreased Longevity. Due to #1 and #2, mumerous studies have shown that low SHBG can actually indicate decreased longevity.  For example, one study found:

“Low SHBG and IGFBP-1 were both associated with an increased prevalence of abnormal glucose tolerance and the metabolic syndrome, but only SHBG was associated with diabetes mellitus. SHBG was less influenced by body mass index than IGFBP-1. Low SHBG indicated increased cardiovascular and coronary disease mortality; the association remained after adjustment for abnormal glucose tolerance, but not after adjustment for prevalent cardiovascular disease.” [1]

This is about as ugly as it gets.  Low SHBG is correlated with three of the biggest killers of  men:  heart disease, diabetes and Metabolic Syndrome.  A more recent and larger scale study verified the above results but did find that all mortality risk was due to its association with diabetes, lowered HDL and weight gain. So SHBG does not seem causative, but rather often a sign that something else is wrong.  By the way, it was “ischemic heart disease” risk that was associated with lowered SHBG in this case, which basically means accelerated arteriosclerosis and decreased blood supply to the heart.

4. Apnea. I document in my link on Apnea and Testosterone how apnea can affect your baseline testosterone levels by 30 percent or more. Other studies have shown that apnea significantly lowers SHBG as well. [7] So if you have low testosterone and low SHBG, this is something to consider.

5. Obesity.  Because weight gain can lead to loss of insulin sensitivity, low SHBG values are correlated to extra weight.

6. Inflammation. One study (in women) found that lowered SHBG was associated with elevated CRP (C-Reactive Protein), one of the “gold standard” markers of systemic inflammation that is linked to heart disease, dementia and autoimmune disorders. [8]

7. Hypothyroidism. One study found that low SHBG was associated with hypothyroidism and could even be reversed by correcting the underlying thyroid issue. [9]

8. Elevated Triglycerides. Several studies have found that elevated triglycerides, which are a risk factor for both heart disease and erectile dysfunction, are also tied in with low SHBG. [10] Of course, this should be no shock since elevated triglycerides usually come from eating meals with an overly high glycemic load and refined carbohydrates.

NOTE:  HRT will lower SHBG some and steroid usage even moreso.

So, as you can see, having low SHBG and the supposedly elevated free testosterone that accompanies it, is usually nothing to brag about. This means that, in general, if you have low SHBG, you should find the underlying cause and correct it.

This may not be as easy to do as you might think, because most doctors are very unlikely to do anything about a lowish value of SHBG, because the lab ranges are VERY wide.  On the Peak Testosterone Forum I have seen ranges such as 7-47 nmol/l, 10-50 nmol/l or even 10-80 nmol/l. In all cases the lower value for SHBG is extremely low and so will not even be on your doctor’s radar. However, values below about 20 can be indications of underlying issues and should not be ignored in my opinion.

Hopefully, one way or another you can get your doctor to consider doing the following:

1. Monitor. Test you for any of the (appropriate) conditions above.  Many of these you can get as part of a standard physical or well-being check, so you may want to ask your physicain about that possibility.

2. Correct Medical Conditions. Correct any issues found in #1.  Work with your doctor and do what you have to do:  treat your thyroid dysfunction; exercise; lower the glycemic load of your diet;  lose those extra pounds; get a CPAP machine.

3. Natural Cure #1. The root cause for low shbg is generally the beginnings of fatty liver and insulin resistance and, as mentioned above, low SHBG is good predictor of future diabetes.  One of our posters went after his low SHBG with a vengeance in this regard and exercised (heavily), took berberine and liver cleanses, lost weight and did other things to get rid of the fatty liver and insulin resistance.  He actually more than doubled his SHBG and is one of the very few men I know that have done so.  You can read his story here in my page on How to Cure Low SHBG.

4. Natural Cure #2 (For Men With High Estradiol)? I had a report from a long time poster who was suffering with low SHBG and high estradiol levels.  This man actually took an AI (aromatase inhibitor which lowers estradiol) and found that his SHBG increased significantly, an outcome that is counterintuitive in my mind.  This is a little scary, because I think the original poster did estradiol conversions incorrectly and the man did not have high estradiol.  Thus an AI could drive his estradiol too low and possibly lead to bone loss if done long enough.

In any event, it seem to have cured this man’s low SHBG.   The description and possible explanation is as follows:

“A young male presented with chronically elevated E2 [estradiol] and low SHBG. Physicians prescribed testosterone, which only exacerbated the SHBG/E2 imbalance. His problems persisted for years. His entire youth, in fact. I suggested that he try an AI-only mode of treatment.

This worked to bring his E2 within normal range, and … surprisingly, his SHBG increased to from the single digits and low teens to 30! SHBG has remained at 30, even though AI has been discontinued. He claims that he is “85% cured.” His FT is now a bit low (FAI of 0.65) and I have suggested that with T supplementation, he might actually bring himself to a completely normal hormonal profile.

It seems like he was able to wake up dormant SHBG expression by simply starving E2. I have no other explanation for this case. I have never, in 10+ years of reading about these kinds of cases, seen a liver completely correct itself with regard to SHBG expression. Perhaps, like insulin receptors, receptors in the liver can become increasingly desensitized to estrogen? In these cases, a course of AI over a 3 month period can completely resensitize them… or so it seems.” [17]

NOTE:  Be sure to measure your estradiol with the correct test (LC-MS/MS) for men.

There are also many natural ways to raise SHBG as well.  I have a few ideas below.  Of course, it is most important to correct underlying medical conditions, but here are some other methods that can help which perhaps could be combined synergistically to really raise SHBG:

5. Coffee.  Several studies on women showed that coffee raised SHBG.  Finally, this was verified in a study on men as well. [12]

6. Green Tea. A couple of studies, admittedly on women, have shown that green tea increases SHBG levels. [13]

7. Lower Fat Diets and Fiber. One study on men showed that low fat diets increased SHBG, probably due to the fact that they increase insulin sensitivity. [14] So one simply way to likely raise your SHBG a little is to eat a low glycemic, low fat diet.  I discuss in my link on Low Fat Diets and Diabetes that this way of eating will likely reverse any prediabetes or diabetes that you have and lower arterial plaque at the same time.  A smiliar study echoed the same result and suggested that fiber may play a role as well. [15]

8. T3 and T4 (If Hypothyroid). One study found that “Thyroid hormones (triiodothyronine (T3) and thyroxine (T4)) increase SHBG accumulation in HepG2 cell culture medium over 5 days, and increase cellular SHBG mRNA levels.” [16] A hypothyroid man that goes on thyroid medication will often see his low SHBG rise.

NOTE:  If you actually have high SHBG and not low, see my link on the Causes of High SHBG and Natural Solutions.

The concerns here are that 1) adding HRT may lower an already low SHBG even further, 2) may sidetrack a man from dealing with underlying medical issues and 3) will simply create an overabundance of free estradiol.

Now I definitely agree with 2.  All reasonable underlying issues should be tracked and investigatedby by or with your doctor.  Argument 1, however, may be weak.  To test this hypothesis, it would be best to look for research with participants that are likely to have low SHBG.  One such study was done on senior men with Metabolic Syndrome (prediabetes) and the researchers found that giving these men testosterone gel did indeed lower their SHBG a little.  However, this was for a very small net change in testosterone. [12]

The same study boosted men’s testosteorne much more significantly with testosterone undecanoate and actually found that the particpants’ SHBG rose.  Thus in this case, the testosterone actually helped.  Why did the undecanoate do the trick where the gel did not?  The reason is probably the fact that the undecanoate gave over a 100% increase in testosterone and testeosterone lowers insulin.

As far as #3, one has to realize that the difference in, say, free testosterone from low to midrange SHBG is not that great.  For example, let’s say you were a lowish testosteorne guy with total testosterone of 400 ng/dl and had SHBG of 32, which is a very “normal amount”.  That SHBG of 32 nmol/l would give you a free testosterone level of 8.31 ng/dl.  A man with SHBG of 20 and total T of 400 would have free testosterone of 10.5.

This is an increase of 26% in free T. Now this is a bump, admittedly, but it is not the kind of bump that is going to make that much difference. Thus SHBG does matter, but it is not the force of nature that many men think it is when it comes to elavating testosterone levels.  However, it does matter in the sense that it can foreshadown many medical conditions that need to be dealt with.

However, what I hear “on the streets” is that men who are low SHBG or just high converters to estrogen tend to do better with 3X weekly subQ injections. I believe the reason for this is that with smaller doses of testosterone cypionate more often, you get a smoother ride with lower estradiol peaks.  The reason this is probably important is that if you are low SHBG, then you are going to be higher free estradiol. And, of course, elevated free estradiol causes many issues for us men.

REFERENCES:

1)   The Journal of Clinical Endocrinology & Metabolism, Mar 1 2005, 90(3):1550-1556, “Sex Hormone-Binding Globulin and Insulin-Like Growth Factor-Binding Protein-1 as Indicators of Metabolic Syndrome, Cardiovascular Risk, and Mortality in Elderly Men”

2) The Journal of Steroid Biochemistry and Molecular Biology, Jun 1995, 53(1-6): “Interrelations between sex hormone-binding globulin (SHBG), plasma lipoproteins and cardiovascular risk”

3) The Journal of Clinical Endocrinology & Metabolism, Jul 1 1996, 81(7):2515-2519, “Acute and chronic regulation of serum sex hormone-binding globulin levels by plasma insulin concentrations in male noninsulin-dependent diabetes mellitus patients”

4) Diabetes Care, May 2004, 27(5):1036-1041, “Testosterone and Sex Hormone Binding Globulin Predict the Metabolic Syndrome and Diabetes in Middle-Aged Men”

5) Arch Intern Med. 2007; 167(12):1252-1260, “Sex Steroids and All-Cause and Cause-Specific Mortality in Men”

6) International Journal of Impotence Research, 2003, 15(Suppl 4):S14 S20, “Hypogonadism and diabetes”

7) J Clin Endocrinol Metab, 1989 Feb, 68(2):352-8, “Neuroendocrine dysfunction in sleep apnea: reversal by continuous positive airways pressure therapy”

8) Ann Epidemiol, 2006 Feb, 16(2):105-12, Epub 2005 Oct 10, “Sex hormone-binding globulin and serum testosterone are inversely associated with C-reactive protein levels in postmenopausal women at high risk for cardiovascular disease”

9) Horm Res, 1990,34:215 218, “Reproductive Endocrine Functions in Men with Primary Hypothyroidism: Effect of Thyroxine Replacement”

10) Am J Clin Nutr, l996, 63:22-3l, “Association of dietary factors and selected plasma variables with sex hormone-binding globulin in rural Chinese women”

11) Journal of Andrology, 29(1):102 105, January-February 2008″A Dose-Response Study of Testosterone on Sexual Dysfunction and Features of the Metabolic Syndrome Using Testosterone Gel and Parenteral Testosterone Undecanoate”

12) Eur J Endocrinol, Aug 1 2003, 149:145-152, “The associations of age, lifestyle factors and chronic disease with testosterone in men: the Tromso Study”

13) Reproductive Sciences, Jan 2006, 13(1):63-68, “Effects of Chinese Green Tea on Weight, and Hormonal and Biochemical Profiles in Obese Patients With Polycystic Ovary Syndrome A Randomized Placebo-Controlled Trial”

14) The Journal of Clinical Endocrinology & Metabolism, May 1 1987, 64(5):1083-1085, “DIETARY LIPIDS : AN ADDITIONAL REGULATOR OF PLASMA LEVELS OF SEX HORMONE BINDING GLOBULIN”

15) Am J Clin Nutr, Dec 1996 64(6):850-855, “Effects of dietary fat and fiber on plasma and urine androgens and estrogens in men: a controlled feeding study”

16) Journal of Molecular Endocrinology, 2009, 43, 19 27, “Thyroid hormones act indirectly to increase sex hormone-binding globulin production by liver via hepatocyte nuclear factor-4a”

17) https://www.peaktestosterone.com/forum/index.php?topic=5794.0

Low SHBG SolutionsWhat about HRT and Low SHBG?

Testosterone Cypionate Injections - Peak Testosterone

Cypionate injections actually had a very lackluster history in its early years and it is very important for any man interested in injections to understand why.  In fact, it’s not an overstatement to say that many men have had quite miserable experiences, but in the great majority of cases, you can’t blame cypionate!  Blame the docs who usually just did not know any better. Let me give you some examples from the Peak Testosterone Forum:

NOTE: For reasons unknown, in some countries testosterone enanthate is used almost exclusively over testosterone cypionate.  The two have similar half lives and virtually everything on this page that applies to cypionate also applies to enanthate as well.

1.  Time Between Injections. Ten or even five years ago, most doctors made the patient wait a ridiculous amount of time between injections – between two and four weeks in some cases!  Here are some examples of the suffering this can incur:

The problem is that testosterone cypionate has a half-life of 8-12 days!  So, after a couple of weeks, you have very little in your system.  Notice that this man said that he felt terrible for two-and-a-half weeks, which of course corresponds to the time period when he had very little testosterone left.  Basically, the doc gave him just enough testosterone to tease him!

Now most doctors do not do monthly schedules, but I get men all the time writing in via email or on the forum on two and three week regimens.  These are little better.  Even a two week regimen leaves a man hypogonadal for a few days at the end of the cycle.  Just when life seems good, the rug gets pulled out from under you.

2.  Roller Coster Rides.  Men on cypionate injections every two or three weeks usually have other issues.  The docs know that the patient is going to be low for the last week or two and so the tendency is to give more testosterone.  The thinking is basically to give a big initial dose knowing that the man will go close to zero so that the average is in a more “reasonable” zone.

Elevated estradiol can also lead to some of the symptoms that are associated with HRT, such as fluid retention and prostate enlargement.  For example, check out this poor guy whose doctor put him on a four week cycle:

“This progressed (after the first T injection) into heavier swelling, fatigue and bouts of shortness of breath along with several instances of dizziness leaving me in a position that I have now been out of work for nearly a month.” [2]

Again, it is likely his physician gave him a massive dose to try to compensate for the very long time between injections.

3.  Unmanaged Estradiol. Something related to #2 is the fact that some men are overweight and some are “high converters,” meaning that they will change a lot of their precious testosterone into estradiol and end up with overly high estradiol levels while on testosterone replacement.  Because of this, many HRT docs and anti-aging clinics try not to allow estradiol levels go too high or too low and generally keep men in the 20-30 pg/ml range for not only heart health but also to make sure that libido and mood do not crash as well.  (See my Estrogen (Estradiol) Links for Men for more information.)

Did you know you can inexpensively do your own testing for most hormones? The industry leader is Discounted Labs..

One more important point:  some men seem very sensitive to estradiol.  A matter of just 3-5 points can help or hurt erectile strength and morning erections according to many reports.  This may seem like a placebo effect, but keep in mind that a healthy male has a very high ratio of testosterone-to-estradiol and so a small amount of estrogen must be matches by a lot of testosterone to make up for it.

Besides erectile and libido issues, men going too high with estradiol can be at risk for “water retention”, i.e. swelling of the feet, etc.  This can be frightening but is generally from estradiol going too high.  In fact, look at the post above where the man experienced swelling from HRT.

High estrogen can also lead to mood swings, depression and other related brain-related issues.  And it can be downright dangerous to the ol’ bod long term:  one study showed that going over 37 pg/ml led to a 133% increase in mortality. [3] Some believe estrogens are the prime cause of prostate cancer.  More on this below.

NOTE:  There are three estrogens (estrone or E1, estradiol or E2 and estriol or E3).  E2 is known as the “bad estrogen”, although a man needs to have sufficient estradiol for bone, brain and arterial health.

Testosterone Cypionate Protocols

1.  Weekly or Twice per Week. One of the most important factors for success with this injectable is that it should be administered weekly or even twice per week.  Some men even do a Monday, Wednesday, Friday schedule or even every other day.  These options avoid the roller coaster ride that we spoke of above due to cypionate’s relatively short half life.  Again, savvy docs give the patient smaller amounts weekly rather than one “horse dose” every two or three weeks like the old school methodologies.  Essentially, this makes the peaks less high and and valleys less low a and smooths the range of testosterone levels experienced. As we age, put on weight and have increased stress levels, a bigger percentage of our testosterone is converted to the estrogens.  These larger dosages tend to ramp up these pathways and a man can end up with a disproportionately large estradiol spike.

2,  Arimidex.  Many men on the forum are on Arimidex (anastrozole) and it is fairly common in any testosterone cypionate protocol. The reasons are that usually men are going to 900 to even 1200 ng/dl peak generally with cypionate and have put on weight over the years. This means that most men will end up with high estradiol levels for about a week.

Of course, talk to your doctor, but cypionate usually peaks on the 3rd of 4th day after the injection and so the first dose of Armidex will be given then (on a weekly cycle) with a second dose three days later. Common dosages are 1/4 mg or a 1/2 mg two times per week. From what I have seen, most of the anti-aging physicians and HRT clinics try to keep a man between about 20-30 pg/ml. Most men can get off of Armidex by losing weight, decreasing their dosage a little and going to more frequent injections. Arimidex is considered pretty safe and side effects seem to be low, especially in the lower dosages given for HRT. However, there is potentially the danger of knocking your estradiol too low and ending up with long term bone loss. I recommend scanning through these concerns on my site as well: Arimidex Problems.

NOTE: Although not very common, Arimidex can be given by itself to (most low T) men to raise testosterone levels as I document in my link on Testosterone and Arimidex . This is called by some Arimidex Monotherapy. Many men like the idea of simultaneously raising testosterone and lowering estrogen. See also my link on the Testosterone-to-Estrogen Ratio.  I don’t think I have seen a case of Armidex Monotherapy on the Peak Testosterone Forum, although some men have asked about it.

3.  Injection Options. There are several basic options here:  you can go to the physicians office for injections; you can self-inject; or you can get a family member to give you the injections.  Now not all doctors will allow injections outside of their office.  The argument is that testosterone is a controlled substance. I think the real reason is to get you in for an additional office visit reimbursement or payment.  However, on the forum, many men are self-injecting and I expect this percentage to increase over time.

The amount of fluid injected is relatively small and usually feels like a little ant bite.  It is possible to “hit a nerve” which stings a little more and can leave a small sore bump for a day.  But cypionate injections rarely cause issues if reasonable hygiene and procedures are followed.

NOTE:  Yet another option out there is called “SubQ”.  Standard injections are intramuscular, but for details on this other methodology, you can watch this training video by Dr. John Crisler, one of the most well-known online HRT docs that has been doing these sorts of things forever. According to Dr. Crisler, this has the advantages of 1) not poking so many holes in the muscle, 2) even more smoothing of testosterone and estradiol and 3) often reducing the need for Arimidex.

4.  Needle Size, Length and Gauge. Your doctor should have very specific instructions for you on how to self-inject if that is route and you and he/she decide to take.  But here are a few things to discuss and/or be informed of: [4]

a) The smaller the gauge number, the wider the needle.  Thus a 20 gauge needle is bigger than a 21.

b) You will typically be given two needles, one to draw and one to inject.  The larger is usually to draw.

c) Needle size can vary considerably.  18-22 is common for drawing and 21-27 for injecting from what I have seen.

d) You can inject with a 27 gauge needle, but it is much slower.

e) You also have varying needle lengths.  1.5 inch is very common, but your doctor may provide a slightly different length based on your body fat levels.

f)  You may be able to use a 25 gauge needle (for intramuscular quad injections) if you can use a 1 inch needle. If you’ve got some extra fat and need a 1 1/2 inch needle that may be too challenging. [5]

The above applies to intramuscular injections. SubQ injections use a much smaller needle and it is a one step process.

5. To HCG or not to HCG. One very common protocol with the HRT clinics and anti-aging doctors is called “The Trifecta” and includes testosterone cypionate, Armidex and HCG.  Short term results are pretty good but in my opinion you should avoid if at all possible the use of Arimidex. It is better to lose weight and lower your cypionate dose instead.  HCG is added primarily to reduce testicular shrinkage and, in some men, provide a modest boost in libido and/or mood.  See my link on Testosterone and HCG for additional details.

CAUTION: This page is NOT intended to be a guide for self-treatment.  Always work with a physician, who can give you proper dosing/procedures as well as careful monitoring of estradiol, red blood cell counts, liver function and PSA.  Also, realize that testosterone cypionate, and standard HRT in general, will lower fertility.  If you want to have kids, discuss possible alternative with your doctor, such as Clomid and HCG Monotherapy .

1)   https://peaktestosterone.com/forum/index.php?topic=121.0

2) https://peaktestosterone.com/forum/index.php?topic=620.msg5717#msg5717

3) https://www.lef.org/magazine/mag2010/may2010_Why-Estrogen-Balance-is-Critical-to-Aging-Men_01.htm

4) https://peaktestosterone.com/forum/index.php?topic=1178.0

5) https://peaktestosterone.com/forum/index.php?topic=1624.0

Unbelievable Stories Illustrating Why You Should Self-Test - PT

REFERENCES:

1)   https://www.peaktestosterone.com/forum/index.php?topic=4286.0

2) https://www.peaktestosterone.com/forum/index.php?topic=7592.0

Think I’m being dramatic?  I actually believe that I am understating the situation, and I’m going to show you just a few examples from my own life and some of the men on The Peak Testosterone Forum that will help you understand why I believe this is so important:

1.  Homocysteine.  I have never had homocysteine pulled in my life as far as I know. This is simply incredible:  elevated homocysteine lowers nitric oxide and can accelerate heart disease, which is mostly related to arterial plaque, something I cover in my page on Erectile Dysfunction and High Homocysteine. High homocysteine can also indicate one of the debilitating and fairly common SNP’s (gene issues) that many men struggle with:  dual homozygous MTHFR.  High homocysteine is also associated with cancer, Alzheimers and many other conditions.  So why would you not pull homocysteine?  This is a $50 test that could save you a lot of needless suffering and potentially keep you around for a few more holidays.

2. C Reactive Protein (CRP).  This is another big gun.  High CRP is associated with heart disease, erectile dysfunction and many cancers and autoimmune diseases.  Yet I have had this pulled one time in my entire adult life!  I would guess that there are 200 studies clearly showing the importance of CRP, and yet it is usually not part of a physical.  This is just nonsensical and should be pulled fairly regularly, especially since it is about $35.

3. Thyroid Panels. Did you know that low thyroid function causes symptoms very similar to low testosterone?  And hypothyroidism is just about as common as hypogonadism, and I see it all the time on The Peak Testosterone Forum.  To evaluate if you are hypothyroid, along with your symptoms of course, one would need (at a minimum) TSH, free T3, free T4, rT3 and antibodies.  Yet what do the great majority of docs pull still?  TSH and maybe T4 if you’re lucky.  This makes absolutely no sense because a) a large percentage of hypothyroid men have a conversion problem from T4 into T3 and b) Hashimoto’s is the most common form of hypothyroidism and you need antibodies to properly diagnose it.  Again, I never had a full thyroid panel in spite of having some hypothyroid symptoms off and on.  I have had TSH pulled a few times, which is miserable test by itself, and T4 I think once.  Again, if you don’t pull these numbers, ain’t no one gonna probably do it!  (You can get a 20-30% boost often in your testosterone if you correct hypothyroidism.  See my page on Testosterone and Thyroid Function.)

4. Low Estradiol Doesn’t Matter?  Here is what one of our forum members wrote:

“Hi All – went to a famous endo today and the visit was very disappointing. He felt my T was low but normal and it should not be the cause of my symptoms. He said extradiol is a female hormone and its good that its low.” [1]

This is dangerous advice as best.  The poster’s signature reveals that his estradiol was tested at below 10 pg/ml!  NOTE:  13.9 pg/ml is the theshhold that I have read where bone loss typically occurs.  This man, if he had taken this endocrinologists advice, would probably have ended up with osteopenia in a couple of years.  By the way to add insult to injury, or injury to insult, this doctor prescribed a bunch of relaxants to him!

The point of this story is the great majority of physicians simply do not realize that estradiol is VERY important to men – just as important as testosterone in terms of sexual function per recent research. You don’t want it too high nor too low – just like with all the other hormones!  So the great majority of you out there will have to pull this number yourself if you want it monitored.  (Be sure to use the appropriate LC-MS/MS test if you do.)

5. LH and FSH Are Females Hormones??  This one made me laugh:  one of our forum member relayed the following story:

“So here’s a story about my friend. Ever since I got diagnosed with high prolactin then I had low T he wanted to check his level’s out as well. So he finds a random doctor through his insurance. He goes in and tells the doc he wants to do a checkup. He tells the doc my story about having low t and my symptoms and the doctor tells him ” You are not your friend.” My friend then asks the doc to check his testosterone levels and the doctor says he “doesn’t do illegal practices”. Since when is getting your testosterone checked an ilegal practice? lol.”

So the doctor only runs my friends basic blood work like thyroid and checks for cholesterol. My friend gets his results and he found out he has high triglycerides. So my friend goes back to the doc and finally convinces him to get his testosterone checked out. The doc finally says yes. My friend asks him what about lh and fsh. The doc tells him to not worry about it as those are female hormones. lol True story. ” [2]

Rest assured, LH and FSH are NOT female hormones.  In us men LH triggers testosterone production and FSH sperm.  Furthermore, men with low testosterone should have their LH and FSH pulled, because these values can provide clues as to whether the problem is with the testes or in the brain (pituitary or hypothalamus).  Again, great and potentially helpful information is provided at a very reasonable cost.

To this day, I have never had my LH or FSH pulled as far as I know.  I have no idea whether I am primary or secondary. If I had it to over again, I would have pulled those numbers myself, but I just didn’t understand things at that time.

CAUTION: I always recommend men take their numbers to a knowledgeable doc or naturopath.  Take the extra time and maybe pay cash for someone who will be thorough and who understands the latest research. Some men have tremendous knowledge about health and hormones and want to self-treat.  I don’t think that’s a good itdea:  it’s very easy to miss something important or critical and so get someone (good) who does this for a living.

CONCLUSION:  There are many other hormones that have a solid record in helping some men out:  DHEA and cortisol come to mind.  Think of the horrendous irony that these are not examined when you consider the following facts:

1. Laboratory testing costs for your doctor (and for you) have dramatically dropped in the last 10 years.  You can pull many critical labs now without a doctor’s order for less than $25, something I cover in my page on Testosterone Labs.

2. Research is just pouring out of the research labs and universities and we now know much, much more about anti-aging, healthy lifestyles and the health markers that go along with them.

I discussed hormones above, but you also have blood sugar / insulin tests, genetic testing, cardiovascular testing, all of which can literally save your neck if your physician does not pull it.  Remember:  physicians feel that they are only responsible for acute care.  The system simply does not have the money for monitoring and prevention.  That leaves one person to step in:  YOU!

Vegetarianism, Longevity and Mortality - Peak Testosterone

REFERENCES:

1)  Bratisl Lek Listy, 2008, 109(10):463-6, “Vegetarian diets, chronic diseases and longevity”

2) Am J Clin Nutr, 1999 Sep, 70(3 Suppl):516S-524S, “Mortality in vegetarians and nonvegetarians: detailed findings from a collaborative analysis of 5 prospective studies”

3) Am J Clin Nutr, 1999 Sep, 70(3 Suppl):532S-538S, “Associations between diet and cancer, ischemic heart disease, and all-cause mortality in non-Hispanic white California Seventh-day Adventists”

4) Ann Nutr Metab, 2012, 60:233-240, “Cardiovascular Disease Mortality and Cancer Incidence in Vegetarians: A Meta-Analysis and Systematic Review”

Right now Paleo and Low Carb diets are BY FAR the most popular here in the U.S. among men from all that I have seen. They simply dominate the health and fitness landscape and vegetarianism is now associated with weakness and ill health. This is the ultimate irony, however:  vegetarians actually enjoy superior longevity and significantly increased mortality rates.

Now why would the health and fitness community not promote the dietary regimen that produces the greatest longevity?  Well, I don’t know either, but I want to start by pointing out a common theme:  vegetarians have improved longevity almost entirely due to reduced cardiovascular mortality rates. In other words, vegetarians generally live longer simply because heart disease is the number one killer and vegetarianism greatly reduces the risk of dying from heart disease.  There are many reasons for this, but here is something that I want to point out immediately:  anything that improves your cardiovascular system is VERY likely to improve your sexual health and erectile strength.

The reason is that the cardiovascular and penile/erectile systems are joined at the hip so to speak.  Erections are very dependent on blood flow and clean arteries and so is heart health as well.  This is one of the reasons I am largely vegetarian:  it’s G-O-O-D for the bedroom.

Anyway, here are just some of the studies that show improved mortality and longevity rates from a vegetarian lifestyle:

1.  Meta-Analysis. One journal article pooled five studies and found that vegetarians had significantly reduced cardiovascular mortality rates, i.e. the risk of dying from heart-related issues. [2] Those who ate fish but not meat or were lactoovovegetarians enjoyed a particularly large benefit and decreased their death rates by a little over a third.

The abstract shows has one and only one sentence in it: “Vegetarians have a lower risk of dying from ischaemic heart disease than non-vegetarians.”

NOTE: I consider myself a “Plant-Based Eater”.  In my mind, this has a less dogmatic connotation that avoids a lot of the unnecessary rhetoric that sometimes goes along with being a vegetarian. For example, I do eat occasionally eat meat and consume eggs almost daily.  I also am willing to admit some of the advantages that eating meat confers. But, overall, in my mind vegetarianism is the clear winner overall.

2. Large Adventist Health Study.  This very large study of over 34,000 Seventh Day Adventists (SDAs) shows very similar results to #1:  vegetarian men enjoy improved cardiovascular mortality rates by about one third or even a little over. [3] (fyi:  They also found that vegetaarian Adventists had lower risks of diabetes, arthritis and high blood pressure than meat-eating Adventists.

3. The Other China Study.  This study from China made a mishmash of the research by including some semi-vegetarian groups in it.  Due to not making careful distinctions between vegetarians and non-vegetarians, conclusions were hard to come by.  Still the researchers will willing to state clearly: “The mortality from ischemic heart disease was significantly lower in vegetarians than in nonvegetarians (RR = 0.71; 95% CI, 0.56 0.87).” [4]

4.  European Vegetarians. [1] This research summary out of Slovakia was clearly vege-skeptic. For example, the authors noted that vegetarianism conferred little benefit in the cancer arena, but admitted that “in vegetarians, a decrease of ischemic heart disease mortality was observed probably due to lower total serum cholesterol levels, lower prevalence of obesity and higher consumption of antioxidants. Very probably, an ample consumption of fruits and vegetables and not the exclusion of meat make vegetarians healthful.” This is the ultimate irony:  the researchers try to defend meat eating and yet admit that fruits and vegetables and high antioxidants (obviously from plants) are keys to cardiovascular improvements that beat meat out every time. So what’s not to like??

The summary of all this research data can be summarized as follows:

1.  Several studies show big benefits in longevity to vegetarians.  These mortality benefits are largely cardiovascular.

2.  No studies (that I know of) show any significant advantage to eating meat in terms of extending life span or reducing death rates.

3.  A couple of studies show relatively neutral benefits in terms of all cause mortality and cancer.

4.  All studies show vegetarians experience an improvement in ischemic heart disease mortality rates.  We will discuss this more below.

Now a quick side comment:  in light of this data, the evidence points to vegetarianism as being the likely winner.  Admittedly, the data is not as consistent as one would like.  But meat never wins and has often lost.

In light of this, one cannot help but ask, “Why do herbivores (meat-eaters) so aggressive attack vegetarian diets?” It simply does not make sense based on the data. Again, just go to the Paleo and Low Carb sites and you will constant charges that a) vegetarian diets will increase heart disease (in spite of the evidence), b) are packed with “anti-nutrients” and c) will hammer your testosterone.  Yet the evidence actually shows that Vegetarians Are Equal or Better in Testosterone Than Meat Eaters.

But now let’s go back to what is probably the most important point about vegetarian diets and longevity:  the improvement in ischemic heart disease. This is should be of interest to men everywhere, because ischemic means a “lack of blood supply” or “insufficient supply of blood” to a tissue or organ.  In other words, vegetarianism improves blood flow. (Yes, that is what my book, The Peak Erectile Strength Diet is all about.)  And, if you’re interested in sex, it’s all about blood flow.  So, again, a vegetarian diet is one of the keys, in my opinion, of becoming a true Orgasmatarian and this is shown clearly in virtually all of these mortality studies.

In addition, I have to point out that I think it is remarkable, actually, that vegetarian diets do so well considering there are so many vegetarains that eat a lot of wheat and other refined carbs. I am particularly afraid of wheat, because it is heavily GMO’d, has a high glycemic index and produces an immune response in many people, a fact that I cover in my link on A Review of Wheat Belly.

It is quite easy to supercharge a vegetarian diet, by limiting things like wheat and refined carbs, and make it even much more healthy and likely to produce superior longevity.  This is shown by the fact that the most elite cultures on planet earth with no heart disease, hypertension, cancer, etc. are all almost entirely vegetarian.  For more information, see my link on A Review of Healthy at 100.

Arginine May Really Help Some Guys - Peak Testosterone

I recently received an interesting email from a middle-aged reader.  Basically, he felt strongly that even small amounts of Arginine, or more correctly L-Arginine, made dramatic improvements in his erectile strength.  A preliminary look at the studies might lead one to believe that this was a placebo effect, which can be significant with erectile and hormonal issues.  This is especially true since the amount that he was taking was relatively small as well – less than 3 grams daily for sure.

L-Arginine has simply not proven so far to be a heavy hitter in the nitric oxide/erectile dysfunction world:  studies have been lackluster at best.  The one exception to this is the study where a little Arginine was coupled with Pycnogenol and provided an excellent and relatively safe supplement solution for guys with erectile dysfunction.

However, in spite of Arginine’s checkered past, the research definitely leaves room for it to be a significant erection-booster for some guys.  For example, one study [1] of patients with Type II diabetes found that just 3 grams daily of L-Arginine dropped blood pressure very significantly, from an average of  135/87 to 123/81.  This is impressive and resulted from a substantial increase in the “erection chemical” nitric oxide.  (L-Arginine is the precursor of nitric oxide.)

The study authors were not looking at erectile issues, but the extra nitric oxide would have undoubtedly helped the male participants noticeably.  So a key point here is that for those with type II diabetes and/or hypertension, Arginine may produce much more powerful results than for healthy individuals.  Of course, a huge percentage of guys in a Western society that are middle aged and beyond are diabetic, prediabetic and/or have some hypertension or Metabolic Syndrome.  So L-Arginine may give a nice increase in erectile strength for such individuals.

REFERENCES:

1) Journal of the American College of Nutrition, 2002, 21(5):422-427, “”Oral Arginine Reduces Systemic Blood Pressure in Type 2 Diabetes: Its Potential Role in Nitric Oxide Generation”

2) DIABETES, NOV 2005, 54:3282-3287, “Reduced Nitric Oxide Concentration in the Renal Cortex of Streptozotocin-Induced Diabetic Rats”

CAUTION:  Talk with your doctor first and read my link about Arginine and some of the reservations and cautions that one should consider first.

The reason that L-Arginine helps diabetic men so much?  Animal studies have shown that L-Arginine raises nitric oxide levels much more in diabetic animals. [2] In other words, “a little goes a long way” for those losing their blood sugar control.

Research has shown that Arginine actually helps with ADMA-related issues very significantly.  Again, this may be yet another reason that some guys get solid results from L-Arginine.

Sex and Erectile Dysfunction - Peak Testosterone

What lifestyle change makes a fivefold difference in your odds of having erectile dysfunction?  Eating brocolli?  Jogging?  The answer is probably not the first thing that comes to your mind:  it’s having regular sexual intercourse.

I hate to keep repeating myself, but males need to have sex! A life of asceticism and denial is hard on the male body. Once again, a major study showed that for guys to be healthy, they need to have sex.  Finnish researchers found that the risk of erectile dysfunction was inversely related to the number of times of intercourse per week. [1] In other words, the more sex you have, the less likely you are to have erectile dysfunction.  Or as they say on the streets – use it or lose it!

1)   The Amer J of Med, 2008, 121(7):592, “Regular Intercourse Protects Against Erectile Dysfunction: Tampere Aging Male Urologic Study”

2) J of Andrology, Mar/Apr 2007, 28(2):223-228  ,”Penile Oxygen Saturation in the Flaccid and Erect Penis in Men with and without Erectile Dysfunction”

Notice the drastic reduction in erectile dysfunction between men who had sex and men who did not: the rate is almost five times different! The lead researcher wrote “Regular intercourse has an important role in preserving erectile function among elderly men, whereas morning erection does not exert a similar effect. Continued sexual activity decreases the incidence of erectile dysfunction in direct proportion to coital frequency.”

There are probably a great meany reason that sex actually improves erectile dysfunction.  One of the minor reasons is that sex exercises, perhaps as nothing else can, those penile muscles. Another minor reason is that the penis needs “oxygenation”.  One study states that “oxygenation of the cavernous tissue is important in regulation of local mechanisms of erection.  Blood flow aterialization during erections is felt to be crucial in providing the free oxygen necessary for formations of NO by neuronal and endothelial nitric oxide synthase.”  [2]  These same researchers documented that males with erectile dysfunction demonstated “severe hypoxia” in the arterial penile chambers, where hypoxia simply means “lack of oxygen”.  They then point out that “chronic hypoxia leads to less NPT [nocturnal erections] with eventual corporal fibrosis and progressive and irreversible ED [erectile dysfunction]”.  In other words, the penile tissues can actually deteriorate without this oxygenation to where the erectile dysfunction can be irreversible.

The researchers in the first study I cited alluded to something much more mysterious and powerful than simple penile oxygenation. Yes, sex will help oxygenate the penis, but the it’s erection-curing powers seem to go far beyond that.  Again, this study highlighted the fact that sexual activity helped significantly with erectile dysfunction even though morning erections could not do the same thing.

The reason undoubtedly that sexual intercourse is very different from morning erections on many fronts.  An orgasm leads to the release of a flood of hormones and neurotransmitters that simply do not occur from a simple morning erection.  Somehow these differences make all the difference in the world and can actually heal and protect.

NOTE: A lot of middle aged guys will find that sexual intercourse will actually give them morning erections when they had none before. Sex can help with “maintenance” if you will.

So get out the To Do list and cross off everything except you know what tonight…

NOTE:  I know that some of you need some practical ideas for how to get more sex from the woman in your life.  Well, it’s not as hard as you might think in most cases.  Here are a few ideas that will definitely help:  Oxytocin, Massage, Pelvic Angle, Tease Her and Increase Her Libido.  Treating her right isn’t a bad idea either!

REFERENCES:

Miraforte- Testosterone Booster for Middle-aged Males?

What is interesting is that Super Miraforte is very often sold to bodybuilders, because of its powers to decrease estrogen and likely slightly increase testosterone.  Chrysin has a questionable history of decreasing estrogen.  However, Life Extension seems to have supercharged it with the addition of piperine for increased absorption.  This is likely the reason that Super Miraforte has been very well-received and reviewed and is used by bodybuilders in many cases.  (I have even read that some doctors are recommending it.)

Could Super Miraforte possibly increase testosterone?  One of the key things that most older men need is Estrogen Control and Miraforte does just that.  The reason that this is so critical is that, not only will estrogen “crowd out” testosterone, but it also can directly put the brakes on the testosterone output from your Leydig cells. [1][2]  This means that Super Miraforte , by decreasing estrogen, could lead to a T increase for middle-aged and beyond males that are struggling with inflated levels of the female hormones.

ARE YOU LOW SHBG? Miroforte contains Nettle and Nettle lowers SHBG. This is usually a good thing, unless you are a Low SHBG guy. Low SHBG is a fairly common condition, linked to insulin resistance, that makes HRT tough for example. Low SHBG should be cautious about using Nettle products in my opinion. I am talking about SHBG below about 18 by the way.

CAUTION: If you have any medical conditions or are on any medications, please consult with your doctor before taking any supplement.  Also, some men have such low T and E that their levels of estradiol are dangerously low.  See my link on Why Men Need Estrogen for more information.

Below I outline how Super Miraforte can benefit your sex life, including possibly increasing testosterone and libido and decreasing testosterone libido.

1. Chrysin. Chrysin is a known estrogen lowerer and it works by inhibiting the aromatization of testosterone to estrogen. As males age (and gain weight), an increasing percentage of their precious T is converted to E and chrysin can help.

CAUTION: Supermiraforte has been around quite awhile. However, it should be noted that one study showed Chrysin inhibiting the conversion of T4 to T3 and thus negatively impacting thyroid function. [3] This could potentially lead to weight gain, which would sabotage estrogen control.

2. Nettle. Nettle is a well-known liver protector. What is not so well known is that it also fights aromatization of testosterone to estrogen as well.

4. Muira Puima. This herb is an aphrodisiac with a long history and some of its effects have even been documented in a few small studies. [1] Another study reported improved morning erections as well.

5. Maca.  This plant is another libido booster that I cover extensively in my link on The Superpowers of Maca.  Maca has actually been used as a food for centuries with an admirable safety profile.

6. Piperine. This compound from pepper, as in black, boosts the absorption of many supplements and compounds. Life Extension Foundation, by including, some piperine is essentially “supercharging” their supplement for better efficacy.

NOTE:  Increasing testosterone in men can also lead to increases in nitric oxide as well as testosterone works positively on NOS (Nitric Oxide Synthase).

REFERENCES:

1. Presented at the First International Congress on Ethnopharmacology, Strasbourg, France, Jun 5-9, 1990, Contributions to the clinical validation of the traditional use of Ptychopetalum guyanna.

2) J Clin Endocrinol Metab, 1978 Dec, 47(6):1368-73, “Direct inhibition of Leydig cell function by estradiol”

3) Prog Clin Biol Res, 1986, 213:359-71, “Iodothyronine deiodinase is inhibited by plant flavonoids”

The Benefits of Dark Chocolate - Peak Testosterone

We all know that anything that tastes or feels good is bad for you, right?  Wrong!  We’ve already covered how Sex Is Good For Males. Well, dark chocolate is yet another example.

Dark chocolate is relatively low on calories and high on flavanoid-rich cocoa.  Dove is the gold standard, but almost any true dark chocolate will do.

The merits of dark chocolate are coming out in the studies almost every month, but here’s a few of the most important:

REFERENCES:

1) J Nutr, 2008;138:1939-1945, “Regular consumption of dark chocolate is associated with low serum concentrations of C-reactive protein in a healthy italian population”

2) J of Alzheimer s Disease, 18(4), in-press, A Diet Enriched in Polyphenols and Polyunsaturated Fatty Acids, LMN Diet, Induces Neurogenesis in the Subventricular Zone and Hippocampus of Adult Mouse Brain.

3) J of Proteome Res, 2009, Published online ahead of print Oct 2009, “Metabolic Effects of Dark Chocolate Consumption on Energy, Gut Microbiota, and Stress-Related Metabolism in Free-Living Subjects”

4) J Nutr, Jun 2006, 136(6):1565-9, “Long-term ingestion of high flavanol cocoa provides photoprotection against UV-induced erythema and improves skin condition in women”

5) University of Copenhagen. “Dark Chocolate Is More Filling Than Milk Chocolate And Lessens Cravings.” ScienceDaily 23 December 2008. 22 March 2010

6) Journal Agric Food Chem, 2008, 56 (18):8527 8533, “Impact of Alkalization on the Antioxidant and Flavanol Content of Commercial Cocoa Powders”

7) Circulation: Heart Failure, 2010; 3:612-616, “Chocolate Intake and Incidence of Heart Failure: A Population-Based Prospective Study of Middle-Aged and Elderly Women”

8) Physiol Behav. 2011 Feb 12;103(3-4):255-260, “Consumption of cocoa flavanols results in an acute improvement in visual and cognitive functions”

9) BMJ, 2012, 344: e3657, Published online 2012 May 31, “The effectiveness and cost effectiveness of dark chocolate consumption as prevention therapy in people at high risk of cardiovascular disease: best case scenario analysis using a Markov model”

10) https://esciencenews.com/articles/2012/05/31/ dark.chocolate.could.prevent.heart.problems.high.risk.people

11) HYPERTENSION, AHA, Published online before print August 14, 2012, “Benefits in Cognitive Function, Blood Pressure, and Insulin Resistance Through Cocoa Flavanol Consumption in Elderly Subjects With Mild Cognitive Impairment”

12) Am J Clin Nutr, 2005 Mar, 81(3):611-4, Short-term administration of dark chocolate is followed by a significant increase in insulin sensitivity and a decrease in blood pressure in healthy persons”

13) https://www.eurekalert.org/pub_releases/2014-02/foas-wdc022714.php, “Why dark chocolate is good for your heart New research in the FASEB Journal suggests that consumption of dark chocolate lowers the augmentation index, a key vascular health predictor, and reduces adhesion of white blood cells to the vessel wall”

1)  Heart Health. Cocoa, the main ingredient in dark chocolate, is very good for the heart.  It lowers blood pressure among other things. See #4 here.

2)  Kuna.  Imagine a world with no heart disease.  Well, the Kuna live in such a world and cocoa is one of their secret weapons. Read here to find out about the Kuna and the unique lessons we can live from this third world people.

3)  Nitric Oxide. Dark chocolate increases Nitric Oxide, the stuff of erections.  Yes, it increases blood flow into the penis and that’s just what you need for a healthy sex life.  For other examples of foods that do the same, consider the Peak Testosterone Erectile Strength Diet.

4)  Inflammation. A 2008 study showed that small amounts, one or two squares, of dark chocolate reduced inflammation, which is implicated in heart disease and a host of other ailments. [1]  See my link on Inflammation for more details.

5) Delay In Dementia and Alzheimers. The polyphenols in dark chocolate will very likely delay and prevent Alzheimers and dementia according to one recent study. [2]

6) Appetite Suppression.  Dark chocolate is highly satisfying to the appetite and can actually help you to lose weight. Researchers in Copenhagen showed that men who first consumed dark chocolate later consumed 15% less pizza, which adds up to a lot of calories. [5]  In other words, dark chocolate can actually prevent you from overstuffing the ol’ pie hole.

7) Stearic Acid.  The primary fat in chocolate is a saturated fat, but has much less negative effects on your blood lipids than most other kinds of saturated fat.

8) Stress Reduction. Well, this is still more good news for chocolate lovers.  All you type A’s out there, listen to this:  Nestle’s lab found that in high anxiety subjects, a small bar of dark chocolate significantly reduced stress hormones. [3]

9) Skin. Consumption of 2 tablespoons of high-flavanoid cacao for 12 weeks resulted in skin that was smoother and more moist, which is important for a more youthful look. [4]

10) Heart Failure Protection. One 2010 study (of women) showed substantial protection against heart failure hospitalization or death in those who ate just an ounce of chocolate – not necessarily dark in this case – once or twice per week. [7] Note that eating over one serving per day was associated in a loss of all protective benefits.

11) Brain and Vision.  High flavanol dark chocolate was found to significantly increase short term cognitive and visual brain functions. [8]  For example, it improved choice reaction time, spatial memory, visual contrast sensitivity and motion detection for starters. In other words, chocolate is not just a sex booster – it’s a brain booster.

12) Medicine. Yes, researchers have actually suggested that dark chocolate could be used as medicine!  As I always say, “Food is clinical” and dark chocolate is a perfect example of this.  Researchers studied people with high blood pressure (hypertension) and Metabolic Syndrome and found that  dark chocolate actually saved lives and decreased mortality. [9] The researchers emphasized that it needs to be 1) dark chocolate with 2) at least 60-70% cocoa. [10]

13) Brain Booster. The studies keep rolling in showing that cocoa is a brain builder.  For example, a 2012 study in the journal Hypertension, shows that older people with mild cognitive impairment were significantly helped by consuming high-flavonol cocao. [11] It is important to note that this study showed the benefit ONLY occurring with the higher flanonol cocoas, so your dark chocolate must be of high quality and low processing.

14) Insulin Sensitivity. One of the huge battles for most men (over the age of about 40) is managing their blood glucose and insulin levels. Of course,  prediabetes and often Metabolic Syndrome occur when men lose their insulin sensitivity.  (This can be triggered by Inflammation.) Again, high quality cocoa can come to the rescue as one study found that it increased insulin sensitivity. [12] Is there anything this wonder plant can’t do???

“What are you waiting for?”  That’s my only question for those of you who don’t eat dark chocolate. It is simply one of those things in life that is too good to be true but really is.

15) Serotonin. Chocolate also contains significant amounts of both serotonin and tryptophan, which are important in the production of serotonin. They believe this explains the calming effect of chocolate on many people. (Magnesium actually helps tryptophan into serotonin.)

16) De-Stiffens Arteries. A recent study found that dark chocolate de-hardened arteries in overweight, middle-aged men.  And they also found that it kept white blood cells from sticking to arterial walls, which should help with arteriosclerosis prevention. [13]

CAUTION:  You may want to read my link on Does Chocolate Have An Ideal Dosage?  There are some strong indications that there is such a thing as too much chocolate.

CAUTION 2:  You may want to read my link on TNF Inhibitors as well. Cocoa may stimulate TNF-alpha production in some cases and this inflammatory cytokine is a root cause for diabetes, arthritis, arteriosclerosis and many other ills. However, it should be pointed out that The Kuna, who are heavy consumers of cocoa, show no ill effects.

CAUTION 3: The only “side effect” that I know related to dark chocolate is that it can relax the valve between stomach and esophagus in some sensitive people, leading to heart burn.  Also, if you happen to be the type that actually knows what to do in the kitchen and are using cocoa in your recipes, you will generally want to avoid Dutch-processed cocoa or cocoa “processed with alkali”.  Alkali processing is used to lower the naturally acidic pH of raw cocoa but, unfortunately, strips out most of the flavanol content.  One study, for example, showed that alkali processing lowered the flavanol content from an average of 34.6 to 13.8 and 7.8, respectively, for lightly and heavily processed cocoas. [6]  My understanding is that the standard Hershey’s and Nestle’s cocoa that you buy in the supermarkets (in the U.S.) use a processing called Broma that leaves the flavanol content largely untouched.

Best HRT: My Vote is For SubQ Cypionate - Peak Testosterone

I’ve been on HRT now for over six years and it has been quite the uphill battle at times.  Initially, I tried Androgel, compounded creams, Testopel pellets and intramuscular testosterone cypionate injections in that order. Androgel did nothing for me, but all of the other options brought improvements to my life and health.  However, it was unquestionably subQ testosterone cypionate that seemed to solve all of my problems, i.e. provide nice, steady levels of testosterone and estradiol with no side effects or the necessity of taking an aromatase inhibitor such as Arimidex (anastrazole).

For those who don’t know, subQ means subcutaneous, i.e. injecting into the subcutanteous fat layer.  It is commonly used for a number of medicines including insulin and so docs are generally well familiar and even comfortable with it. My current protocol is 50 mg twice weekly into the abdominals.  Of course, if you try this protocol, your doctor will give you instructions as to how he or she wants you to do it.  Here is some starter info in this thread  How to Do Different Kinds of Testosterone Cypionate Injections if you want more information.

But, before I to into more detail as to why I think subQ is so the best protocol out there for most guys, let me cover the significant disadvantages that I see with the other delivery systems.  Please keep in mind that these are just my opinion and what works for me:  you and your doc have to decide what is best for you.

1.  Topicals. First of all, I have kids and a wife and I was always concerned they might be getting some exposure.  I always washed myself and covered the area, so I doubt it was ever an issue.  But it was just a nagging doubt that seemed to linger.  However, a more realistic concern is one uncovered by ZRT Labs – thanks Sam for the rec!  – that showed that the topical testosterones create a non-physiological and unnatrual distribution of testosterone within the body – something I cover in link on Potential Risks Associated with Testosterone Therapy – where very high testosterone and estradiol levels exist in the capillaries.  Assuming this is true, I figured it cannot be a good thing.  (Besides, Androgel never boosted my T a ng!)

In addition, topicals tend to jack up DHT levels to supraphysiological levels.  I have seen many time on the Peak Testosterone Forum, men with 2, 3 or even 4 times the upper value of the lab range for DHT in men that are on topical (transdermal) testosterone. This is essentially a “steroid” level of DHT, and I cannot see any good coming out of that long term. Time will tell I guess.

2.  Longer Term Solutions (Pellets and Undecanoate). Both testosterone pellets (implants) and testosterone undecanoate (Nebido / Aveed) are solutions that do not need to be done weekly or daily but rather every 2-3 months (roughly).  As such, they are very convenient for some men.  However, the problem is that these delivery systems give a fairly slow ride up to peaking levels and then a slow ramp down.  Some men are not going to feel as good during the pretty quick ramp up and down.  I basically had a few good weeks out of 3 months and that was about it.  It gave me a taste as to what HRT could do for me, but did not give me reliable results.  Plus, some men will find that, when the pellets or undecanoate hits peaking levels that they are too high in estradiol..  And it will be difficult for a doctor to prescribe Arimidex or maybe DIM / chrysin, because the levels change significantly from week-to-week.  There are other issues, but I’ll let you read my page on Testosterone Pellets for more information if you are interested.

3.  Intramuscular Cypionate. I am very thankful that I was put on intramuscular cypionate by my former HRT clinic:  it restored my morning erections for the first time in my life and got rid of three decades of mild depression virtually overnight.  That said, even weekly cypionate give you a pretty wild ride with your testosterone and estradiol.  I ended up with a little gyno because of it and, for awhile I was on Arimidex as well.

While each of the above provided improvement over the former, I did not like the battle with even mild gynecomastia, nor swings that I felt weekly.  And this is where subQ stepped in.  Look at what subQ testosterone cypionate injections did for me:

For all these reasons, I think that I can make a compelling case for subQ testosterone cypionate being the best overall choice out there.  Men who are Low SHBG may feel better using a shorter ester such as propionate. However, we have had at least one low SHBG man who has successfully used cypionate.

I also like the fact that I seem to feel better with each passing month that goes by.  This might just be coincidence, but I feel that, as time has gone on, morning erections are coming more steadily and more strongly and the body is almost “healing” itself from the years of either low or unsteady testosterone levels.

The Best HRT? I Say SubQ Cypionate

Natural Arterial Plaque Reduction - Peak Testosterone

This leads to an important question:

Can arterial plaque be reduced without losing weight, i.e. when the person is in maintenance mode?

This is critical for any person wanting to have and maintain clean and clear arteries as the decades roll by.  We all can only lose weight for so long after all.  The winning diet will be the one that can regress plaque under ANY circumstance.

As some of you know, the most famous plaque reduction studies were done by low fat apostle Dr. Dean Ornish.  However, in his studies the particpants lost weight on average, so this actually proved little other than plaque reversal was indeed possible.  For example, his study noted that “patients in the experimental group lost 10.9 kg (23.9 lbs) at 1 year and sustained a weight loss of 5.8 kg (12.8 lbs) at 5 years, whereas weight in the control group changed little from baseline.” [2] Initially, it appeared that the low fat diet regressed the plaque, but, in fact, it was most likely simply the weight loss. Again, the acid test comes during maintenance mode, ie when he is neither gaining or losing weight.

1. Bantus. The first example comes from one of Nathan Pritikins low fat diet classics.[3] Pritikin points out an interesting study that compared an arterial autopsy examination of 42 Bantus to 22 Europeans.  The comparison was shocking:  only one Bantu had atherosclerosis, compared to all of the Europeans who had significant atherosclerosis.  What was the Bantu’s secret?  You guessed it:  they ate a low fat with about 15-20% of calories from fat with their staple being a type of corn. [5]

A similar study noted that “the severe degrees of atherosclerosis observed in the majority of these European aortas have not been seen by us in the Bantu subjects…These observations are in accordance with the observance that populations with low serum cholesterol tend to have lower incidence of severe atheoslcerosis.” [4] There is also a humorous paper that only reluctantly admits the dramatic reduction in heart disease among the Bantus:

“A proportion of urban Bantu, admittedly small, is exposed to all the influences that, among white populations, are believed to favor coronary heart disease; yet in Johannesburg, with approaching two thirds of a million Bantu, at least 10,000 being over 65 years, it is doubted whether more than 10 die annually from coronary heart disease.”  And no wonder – considering they have no arterial plaque! [5]

NOTE: On this page I cover evidence that low fat diets, when properly done, can lower or control arterial plaque.  However, I give more complete coverage and other methodologies on this page: How to Clear the Plaque Out of Your Arteries.

2.  Tarahumara. These native peoples from northern Mexico consume a low fat diet and have cholesterol in the 120’s.  The are one of the longest lived peoples on planet earth and have NO hypertension.  Again, think how incredible that is the men and women living past 80, 90 and 100 have no rise in blood pressure.  The reason most likely lies in the fact that their low cholesterol levels protect them from atherosclerosis.  Nathan Pritikin cites example from other low fat cultures as well.  I give very detailed coverage on this page:  The Tarahumara Diet. (The Tarahumara are my personal fitness heroes:  they are famed ultramarathoners on top of everything else.)

4. Statin Studies. The researchers reversing plaque in patients have noted that plaque reversal seems to occur (generally speaking) with LDL at about 80.  (Dr. Davis goes even lower.)  Dr. Esselstyn notes that you cannot get plaque in your arteries if your cholesterol is below 80, something I cover in my page, A Review of Prevent and Reverse Heart Disease. He also insists on plant-based nutrition to limit inflammation and increase nitric oxide boosting phytochemicals. Regardless as to the exact level, the point is that these plaque reducers believes that there is a point an LDL theshold at which atherosclerosis greatly slows down and/or halts altogether. One way to test that theory is to look at the studies on statins.

Now I am no fan of statin drugs for a variety of reasons, but they do lower cholesterol and if lowering cholesterol is actually important in regressing plaque, we should be able to see some results in the literature.  And this is indeed the case:  multiple studies on statins show that plaque is reversed with these drugs.  I will quote just one which used Mevacor:

“In men and women with moderately elevated LDL cholesterol, lovastatin reverses progression of IMT in the carotid arteries and appears to reduce the risk of major cardiovascular events and mortality.” [7]  (Cholesterol was reduced from 159 to 113.)

Statins can have side effects and their long term safety is unknown.  That said, they definitely can regress plaque and this is further evidence that low cholesterol does usually help keep those arteries free of plaque.

CAUTION:  A poorly done low fat diet is just as bad as a Western Diet.  Many men load up on white rice and wheat and dried fruit and call that “low fat.”  These high glycemic foods do little except spike blood sugar and pour triglycerides into the blood stream.  They can also switch lipids to a deadly “pattern B” mode, where the LDL particles grow smaler and more atherosclerotic.  Remember;  a low fat diet, even though it is fairly high in carbs, can actually regress diabetes.  But it has to be low glycemic.  I discuss this in my page on Regressing Diabetes with a Low Fat Diet.

NOTE: One very confusing point is that a low fat diet acoeding to fbe popular meaning of the word is total fat calories less than about 15% of total. However, researchers use very low fat diet as less than 15%. To researchers anlow fat diet is about at Mediiterrnean Diet levels, which is about 35%! Usually, when I see a Low Carb blogger criticizing low fat, they are citing a study that does not apply for this reason.

1)  Circulation, 2010 Mar 16, 121(10):1200-8, “Dietary intervention to reverse carotid atherosclerosis”

2) https://jama.jamanetwork.com/article?articleid=188274, JAMA, Dec 16 1998, 280(23), “Intensive Lifestyle Changes for Reversal of Coronary Heart Disease”

3) The Pritkin Program for Diet and Exercise, by Nathan Pritikin with Patrick M. McGrady, Bantam, 1990, p. 375-376.

4) J Clin Invest, Oct 1954, 33(10): 1366 1371, “Fat Intake, Serum Cholesterol Concentration, and Atherosclerosis in the South African Bantu. Part II. Atherosclerosis and Coronary Artery Disease”

5) Circulation, Jan 1964, 29(1), “Coronary Heart Disease. Limitations to the Application to White Populations of Lessons Learned from the Underprivileged ”

6) N Engl J Med, 1985, 313:52, “Nathan Pritikin’s Heart”, https://www.pritikin.com/eperspective/specialissues/pritikinatkins/

7) Circulation, 1994 Oct, 90(4):1679-87, “Effect of lovastatin on early carotid atherosclerosis and cardiovascular events. Asymptomatic Carotid Artery Progression Study (ACAPS) Research Group”

My Personal HRT Story - Peak Testosterone

I’ve had a number of men on the Peak Testosterone Forum (and in emails) ask why I started this site.  And they’ve asked what has worked for me and what hasn’t.  And they’ve asked how I boosted my testosterone.  Those are all fair questions of course.

When asked a question like this, I scarcely know where to start.  It has been a very long road and I’ve been through about five distinct stages. I’m not trying to bore anyone into a coma, but I think most of the men coming to the site are very much going to relate to one of these and so I am going to do a thumbnail sketch of each:

NEWS FLASH: I was pretty excited to have an interview with Men’s Health Magazine, which was published in a recent 2015 issue, regarding TRT. You can read about it here: My Men’s Health Magazine Interview.

Well, it all started for me in about 2007.  This is when I really hit “the Wall”.  As I’ve described elsewhere, I was absolutely miserable.  Here were some of my symptoms:

Basically, I was just barely able to function at work and in my personal life. Survival was just about my only goal. Work, relationships – everything was a chore.

Of course, I searched for answers.  I began reading on the internet and tried to find what would cause my symptoms.  To my surprise, I found many syndromes that could supposedly cause these symptoms.  This included adrenal fatigue, yeast overgrowth/candididas, celiac’s disease, Lyme Disease, Epstein-Barr, fibromyalgia, Chronic Fatigue Syndrome and several others.  The doctors ran all the standard tests and found nothing.  I even had my colon checked for celiac disease and nothing turned up.  Everything was a dead end.

My doctor at the time was an excellent diagnostician if you had the flu or a stomach ulcer or a rash or broken leg.  But he absolutely did not know what to do with me. When I explained to him that I was beginning to experience a little erectile dysfunction, his solution was simple:  20 mg Cialis horse tabs.  And wow did those bad boys work!  It was like being back in high school!

I should also mention that during this time I tried everything I could think of to try to boost my testosterone naturally.  But nothing worked.  Changes in diet, sleep, etc. just gave me no significant increase in testosterone that I could see what so very.  And so my testosterone story seemed to have deadended.

Fortunately, we did another testosterone blood draw and it dipped into the 280’s.  Suddenly, my doctor was willing to designate me as hypogonadal!  I could not wait to start testosterone therapy but, at the time, knew absolutely nothing about it.  My physician’s solution – and I think this was the only HRT method he knew anything about whatsoever – was to give me Androgel.

Androgel, for those who do not know, is the blockbuster bioidentical testosterone that really brought HRT into the mainstream.  Suddenly, PCPs everywhere had a Big Pharma-backed method of giving a man testosterone that was easy and convenient.  This made testosterone therapy less “steroid like” and more palatable to those in primary care.

Androgel came in bottles with a pump on the top and applying was similar to lotion.  You just rub on the upper body and – voila! – the testosterone absorbs through the skin and you’re cured.

If it was only that easy!  I found out the hard way that Androgel is often poorly absorbed and some men get no boost in testosterone whatsoever.  (See my link on Testosterone and Androgel for more information.) I was one of “those men” and my next reading showed no significant increase in testosterone.  I I knew that I did not feel any better – that was for sure.  My doctor then – reluctantly! – allowed me to increase the number of pumps on my Androgel.  Soon I found I was slathering Androgel all over my upper body.  It was getting ridiculous as my upper body was just covered with the stuff in thick goopy layers.

I thought, “This ought to take care of the problem!” Well, it didn’t.  Strangely, I found that no matter how much Androgel I put on myself, my testosterone did not increase.  Androgel never got me out of the lower 300’s and with all that gel all over my upper body, I was worried about transferrence to my wife and kids.  (On the Forum, this is by far the most common complaint that we get about HRT, i.e. what one might call Androgel Failure.)

This was very disappointing as I felt I may have finally found the root cause of many of my problems. I assumed that HRT was just not going to work for me.  I did not know that there were actually many different forms of HRT that were much more effective than Androgel and just assumed that I was out of luck.  I did, however, ask my doctor if he knew of another physician that dealt with this kind of thing, i.e. “men’s issues”.  I think he couldn’t wait to get rid of me and so he referred me to a urologist that he had heard knew something about testosterone.  I made an appointment as fast as I could!

My urologist read my case and, fortunately, recognized that Androgel just was not going to work with me.  He did not know a lot about HRT, actually, but did know of a good compounding pharmacy.  He said that a compounded testosterone was cheaper and could be made with a stronger strength and absorption than Androgel.

And this turned out to be true.  The compounded testosterone did what I thought could never happen:  it brought up testosterone levels up into the 400’s.  I even had a reading around 550 one time.  But, in general, my testosterone readings during this period were less than 500.  My urologist was very comfortable with me at this level, because he had undoubtedly seen many men struggle and in many cases die from prostate cancer.  I told him how I had read a number of studies showing prostate cancer risk was not increased by giving men HRT.  His response, “Sure until they come up with a study that shows the opposite.”  This just showed his caution and who can blame him?

What I found was that I felt better but certainly not great. However, it was during this time that I had another big breakthrough:  I tried a Low Fat diet.  I had picked up a copy of Dean Ornish’s book and, being experimental, I tried it.  I was shocked at the results.  Within just a few days, it had greatly improved my fatigue and erectile dysfunction. This, coupled with the slight increase in testosterone, finally gave me hope:  I was actually feeling better for the first time in years!

NOTE: I actually follow mostly closely a Low Fat Diet build on the guidelines of another researcher named Neal Bernard, at least to a large part. Dr. Bernard shows how to reverse disabetes and slow down or even reduce your arterial plaque, something I cover in this link on Low Fat Diets and Diabetes and The Best Health Books. I also avoid the heavily GMO’d grains (wheat, corn, soy).

Inside I was anxious to try to raise my testosterone more and was convinced that this would help me considerably.  I had been reading much more about testosterone and realized at this point that the 400’s was still quite low compare to normal youthful levels.  However, my urologist was clearly uncomfortable with the idea and I was very thankful to have found him in the first place, since finally I was at least moving in the right direction.

After being on the compounded testosterone for a couple of years, my doctor actually came to me and asked if I wanted to try pellets.  He had a change of heart and told me that he could probably get me into the mid 600’s with pellets if I was willing to try it.

Of course, I was all over that and, after making sure that my insurance covered it, I scheduled the procedure.  For those who don’t know how pellets work, it’s an interesting procedure where little mini-tubes are inserted into your hip tissue quite close to the surface.  These tubes have the pellets and basically the tube is withdrawn leaving the pellets under your skin.  You can actually feel the pellets after the procedure as a small bump.

The procedure wasn’t too bad.  Sure, you’re partially naked with the nurse and doc staring at your hemorrohoids for about 20 minutes while you lay on your side, but I would have done just about anything to get my testosterone levels up.  Of course, you have a good amount of anasthesia and cannot really feel anything except the pressure of your urologist wiggling the mini-tube (trocar) to get into place.

Now I had read somewhere that getting pellets was no more painful “than drawing blood.”  And that is true if you are just talking about the procedure itself.  However, afterward, I found it to be quite painful.  Basically, I could not exercise or lift weights for about five days afterward, which for me was a fate worse than death, and the area felt semi-infected.  (It was not actually infected – it was just painful and felt inflamed.)

However, after I recoved from the procedure itself, I was one happy guy.  We never measured my testosterone at the peak, but I would guess I went up to close to upper 600’s and so, finally, I had doubled my testosterone levels! The biggest change was “in my head”.  I FELT fantastic.  Testosterone has a big effect on a man’s brain and I definitely felt it right between the ears.  What I noticed in particular was that the anxiety and sense of melancholy that I had experienced for years and years subsided.  Testosterone was simply a fantastic “brain tonic” if you will.

I also noticed that I started to get some morning erections and my erectile strength became even more consistent.  I was sold on the power of testosterone!  Of course, anything to do with erections is always front and center for a guy, but I was particularly struck with the mental aspect.  I noticed feelings – and I don’t know quite how to describe this – that I had not felt since I was much, much younger.  I was always into music growing up and I found that music once again profoundly affected me the way it used to. And there were feelings of elation and joy in the everyday things of life that I just had not experienced for a very, very long time.

I can remember thinking:  “you’re just not really alive if you are low testosterone.”

One other thing I noticed was that my gains in the gym seemed to acclerate.  I had been able to put on muscle even when I was in the 300’s, but it was slow going.  However, during this relatively short time period, I picked up some nice increases in strength and leg and arm size.

But there was a gnawing thought in the back of my head:  could I go through that procedure again?  I’m a very thin guy – a card-carrying Skinny Bastard by any standards – and I had precious little fat tissue as buffer against those trocars.  Plus, my doc wanted me to take antibiotics for a few days before the procedure to insure that I did not get an infection.  This went against my tightly held health beliefs that antibiotics very often attack your all-important good gut flora.  So the whole thing seemed a messy, painful business.  And yet, I had to admit, it was literally a fountain of youth for me.

Another problem that arose was that after a couple of months my testosterone levels began to fall somewhat.  That’s the way the pellets work.  Everyman is a little different, but, depending on the number of pellets and other factors, your testosterone levels will gradually begin to fall and then you need another procedure.  I also found that my urologist seemed to be trying to spread out the time between procedures quite a bit and so I was concerned about having a month+ of lowish testosterone where I felt about like I did with the compounding.

All of my hesitation about pellets finally came to a head one day at work and I did a quick search for HRT clinics.  I noticed one just a couple of miles from my house and went in for an appointment.  By this time, I had become quite knowledge on HRT matters and had been wanting to get on HRT.  This particular clinic was great because 1) they were national and thus should be fairly stable/reliable, 2) they worked with my insurance companies and 3) they used cypionate with Arimidex, which was my preferred delivery system based on the research that I had seen.

NOTE: Injections must be well-managed to avoid most side effects and to be effective. I discuss that here in my link on Testosterone Cypionate .

I was really looking forward to my first shot as my libido was really slipping from being so long on the pellets. I believe that by the time I got into the clinic, it had been almost four months since my pellet procedure.

When I got my injection, the reaction I got was spectacular.  No, I didn’t start getting spontaneous erections like I was 14 again.  What I did get that evening was, as best I can describe it, “fireworks in my brain“.  I felt a little Jim Carrey in The Mask:  the feeling was really powerful between the ears. Not painful.  Not scary.  But I definitely had the sesnsation that there was some “rewiring” going on.

Jumping ahead a little, the injections did something huge for me:  they completely vaporized my dysthymia. I had had mild depression pretty much all of my adult life.  A Low Fat Diet got rid of some of it and exercise still another part of it.  But I could never really defeat it completely. What I noticed a couple of weeks after my injection was that I had absolutely no sense of melancholy about me.

Also, I have always been high anxiety.  I will sometimes call myself Captain Anxiety in front of my family and they always laugh, because they know it is true.  The injections greatly helped with this issue.  It was strikingly noticeable to my boss and he has commented several times to me about just this.  This goes along with a lot of research that shows that, counterintuitively to some, low testosterone animals are actually the ones most likely to fight.

And then I got the best gift of all. In fact, it was like Christmas:  I got my morning erections back.  I got occasional morning erections with a Low Fat Diet and compounding and even a few more with pellets.  But there was no comparison with the injections:  morning erections occurred almost every night.

The return of the morning erections also was a “Aha!” moment for me.  I suddely realized the obvious:  I had not had morning erections probably my entire adult life.  This coupled with the lifelong dysthymia makes me wonder if I was low testosterone my entire adult life.  (I have had zero dysthymia, a.k.a. mild depression, since going on testosterone cypionate.)

When I started cypioante at the HRT clinic, my protocol was the following:

–Testosterone Cypionate (130 mg weekly intramuscular)

–Arimidex (1/2 mg 2 X per week)

It took abou 9-12 months, but I was finally able to get completely off of Arimidex by doing the following:

1.  Dropping my dosage to 100 mg per week.

2.  Doing my cypionate injections subQ (subcutaneous) two times per week.  (50 mg each injection)

3.  Losing weight and getting down to about 12-13%% bodyfat.  (The more bodyfat, the more estradiol is produced.)

And I also faced another realization:  I probably had pretty bad venous leakage and my newfound testosterone levels finally helped me overcome that.  My HRT clinic has me at a trough of about 670 ng/dl and a peak of about 850 ng/dl.  And, because my last estradiol read was 21 pg/ml, I backed off my dosage of Armidex to the 1/4 mg.  One of my goals is to take as few pharmaceutical as possible.

So you can see why I am such a huge fan of HRT:  it literally gave me back the youth back that I never had.  I feel fanstic and have put on some extra muscle by the way.  I am now significantly stronger than I was in college and my physique is better too.

That said, I want to point out that not everyone has such a rosy experience with testosterone therapy and, like everything, there are certain risks and rewards.  I highly encourage every man interested in TRT to read my link on Weird Testosterone Risks for more information:  it has all the things that my doctor should have told me before I went on testosterone.

In the meantime, I am very much enjoying feeling about half of my age!  I seriously feel MUCH better than I did in my 20’s or 30’s and I feel that I owe it all to a Low Fat Diet, exercise, my HRT program and a good woman.

At the end of the year in 2013 I had to go off of HRT briefly due to a high PSA reading and even had a prostate biopsy. However, they found that there was no cancer (or even precancer) but did find inflammation. I was able to resume HRT. For details of my whole experience, see this page: My Prostate Scare (High PSA but No Cancer).

I got a PSA at my clinic about a month afterwards and already my PSA had dropped from a peak of 6.3 to 3.9.   This is a very good sign that my new “prostate program” was working, because the urologist said my prostate would be inflamed for several months afterward.  (They take 12 chunks out of the prostate when they do the biopsy.)

One interesting comment is that I implemented a bunch of natural anti-inflammatories (turmeric, quercetin, bromelain and IP6) and flaxseed along with a vegan diet in order to protect my prostate.  To be honest, as much as I love whole grains, vegetables and fruits, I don’t really want to be vegan but am doing it to make sure my IGF-1 levels stay in line.  And it seemed to work:  over about 6 to 9 monts my PSA dropped down to a low of 1.9, which is close to my early HRT levels.

In mid 2015 my PSA bumped jumped back up a bit to 2.9.  My urologist suggested that I try the new 4kScore test, which is able to tell with solid accuracy whether or not you have the aggressive form of prostate cancer.  I took this test and it found that I have a very low probability of having the aggressive form of prostate cancer, something I cover in more detail here:  My 4kScore to Test for Aggressive Prostate Cancer

Stage I.  Pain and Suffering

There was one problem though:  Cialis gave me tremendous heartburn.  I knew that this was not going to be a good long term solution.  At the time I did not understand that Cialis and the other PDE5 inhibitors have issues with other similar enzymes in the ear, eyes and stomach and can cause very severe side effects.  I would occasionally get mild ringing in my ears as well and cut back on the dose. Plus, I found that Cialis was somewhat ingermittent (The PDE5 Inhbititors are notorious for decreasing in efficacy, something I discuss in this link on Viagra Failure.)

Stage II.  Diagnosis and Non-Treatment (Androgel)

I can’t remember for sure, but I am almost positive that I asked my doctor for a testosterone test.  I had run across an article that stated low testosterone symptoms and I had a lot of them.  Nothing else had worked, so maybe, just maybe it could be hormonal.  My testosterone reading came back in the low 300’s – I don’t remember the exact number – and my doctor told me I was fine.

In those days all the labs had the lower range at about 260 or maybe 280 ng/dl.  And I was around 320, so my doctor concluded I was okay.  Well, I’m a numbers guy and I was thinking things to myself like, “That’s only a little over 10% above this magic threshold.  So maybe I’ve got about 90% of the symptomology and not 100%, but that’s still bad!”

My reasoning was not bad if you think about it.  No man hits a magic number and then all of his low testosterone symptoms appear, right?  Obviously, as his testosterone lowers more and more symptoms appear at a greater and greater degree.  However, I really didn’t know any better and so I just let it lie, although I did bug him for another test or two and they were always in the 300-350 ng/dl range.  Unfortunately, he would not budge and I probably suffered for a year like this, going back and forth with him.

Stage III.  A Change in Diet and an Almost Effective Treatment (Compounding)Stage IV.  Painful But Effective Treatment (Testopel Pellets)Stage V.  Finally!  Testosterone Injections and ArimidexElevated PSA

Lose Weight Gradually - Peaktestosterone

Many of us guys have a simple philosophy in life:  “More is always better”. And we apply it even to weight loss. Let’s face it:  dieting can be literally painful and so we just want to “get it over with”.  That’s when many of  push the pedal to the floor and try to lose weight rapidly.

I want to give you a few reasons why this is a bad idea – a very bad idea.  Losing weight is a grand and noble endeavor and I spend a lot of time on this site showing you just how hard those extra pounds are on your body and sex life.

If you are extremely overweight – it happens! – then you may need to lose weight fairly rapidly for health reasons.  Discuss with your doctor.  He can examine your physical results and let you know how urgent the situation is.  But, all of that said, keep in mind that losing weight rapidly can be every bit as hard on you as the pounds were in the first place and below I explain just why:

Need to boost your Nitric Oxide naturally through food, drink and supplements? Check out Lee Myer’s book here: The Peak Erectile Strength Diet

Or do you need the most comprehensive testosterone book in Amazon? Here it is: Natural Versus Testosterone Therapy

1) Testosterone. Rapid weight loss will annhiliate your testosterone and any reduction in testosterone will make weight loss that much harder since testosterone will help maintain your muscle mass.

2) Muscle. If you lose weight too rapidly, you can very easily lose muscle as well, which again makes it harder for you to maintain your weight.

3) Uric Acid.  Rapid weight loss can lead to increased uric acid levels, a known risk factor for heart disease, and even kidney stones. [1]

4) Appetite. The more you cut back on calories, the more gherlin is stimulated and gherlin is the appetite-stimulating hormone.  This is one of the reasons that dieters seldom keep the weight off after a year or two:  they are fighting against their body’s own appetite safety mechanisms.  And Mother Nature usually wins…

REFERENCES:

1) https://www.nlm.nih.gov/MEDLINEPLUS/ency/article/000422.htm

tryptophan is in many of the high protein foods we eat

Many of us guys pride ourselves on being logical and rational and look down on emotions and feelings.  It is critical to recognize, though, the importance of this aspect of your life:  any of us can become irritable and inefficient when our emotions peak or wane to an extreme.  After all, there’s no such thing as a true Stoic (or Vulcan).

This is all important because our neurotransmitter levels, and therefore emotions, can be strongly effected by what we eat.  And let’s face it:  even Yoda would have trouble mastering his neurotransmitters.  We ask the question, “Why not optimize your transmitter levels and be in a good mood instead of crappy one?”  We think that’s a good question.

I. Seratonin:Let’s start with our good friend and confidant, seratonin.  Seratonin is what most anti-depressants stimulate and for good reason:  seratonin puts you in a good mood with a positive outlook.  You just can’t help yourself with an abundant supply of this neurotransitter.  It helps you sleep and night and be at peace during the day and just as important:  it suppresses your appetite!

So how can you boost this little wonder worker?  If you guessed “by eating right”, you would be spot on.  Seratonin is actually made from the amino acid tryptophan and the more tryptophan that you get in your brain, the more seratonin you brain produces.  Furthermore, tryptophan is in many of the high protein foods we eat and so it would seem that the more protein one eats, the more seratonin, right?  Wrong!  Unfortunately, Mother Nature is often counterintuitive.

As it turns out, tryptophan competes with many other amino acids to make it past the blood brain barrier and thus seratonin is actually decreased after a high protein meal. All those other aminos from a high protein meal basically crowd out tryptophan and says, “Wait your turn!”  In other words, after a medium or high protein meal, tryptophan stays high in the blood but decreases in the brain where it is needed the most.

And here’s another even more counterintuitive twist:  if you eat a low protein/medium (or high) carb meal, the rise in insulin pulls all the aminos except tryptophan into muscle and other body tissues leaving tryptophan at high levels in the blood.  And because there are no competing amino acids, it is ushered directly into the brain and raises seratonin.

Therefore, a low protein, medium carb meal raises seratonin levels, boosting your emotions and producing a sense of peace and relaxation. All is well with the world. Yes, this is yet another reason to consider a Low Fat (or Ornish) Diet.

This has been verified by multiple studies which show that a low fat diet and high carbs boosts mood. For example, one study of obese women found that simple carbs were the prime mood booster. Subsequent work on healthy subjects revealed that “over 1 year, there was a favorable effect of an energy-restricted LF diet compared with an isocaloric LC diet on mood state and affect in overweight and obese individuals”.  [1] Another study that we have mentioned elsewhere showed the Mediterranean Diet to be a depression healer. [2] And yet another study found that a low carb diet was much more worse for mood and outlook.  Australian scientists placed participants on a low fat or low carb diet and, not surprisingly, found that both groups lost an equal amount of weight.  However, the low carb group “felt more angry, depressed and confused” than the Low Fat. [4] The bottom line is that a Low Fat Diet has been found repeatedly to boost mood and improve outlook.

Ever wondered why some of the guys in the gym that can outlift you by a magnitude of ten are so overweight?  During the bulking phase, they are eating tons of protein at every meal.  This will trigger their appetite and encourage hunger.  Unless they are very disciplined, they will very likely overeat.  For example, one study found that “Protein…was found to suppress subsequent intake independent of its contribution to total calories. Fat was found to be the least effective of the macronutrients in suppressing future food intake”. [3]

So should you avoid protein like the plague?  Not necessarily and that leads to the discussion of dopamine and diet below:

II. Dopamine:Dopamine levels are also dependent on an amino acid, tirosine.  But, unlike tryptophan, tirosine does not get crowded out and so, in general, a higher protein meal will lead to increased dopamine levels.  Furthermore, too many carbs will wash out some of the effects of the tirosine because insulin will ferry all amino acids out of the blood and into muscle and other tissue.

So who cares about dopamine?  All guys should!  Dopamine (and its cousin norepinephrine) are the feel good chemicals of sex and those rushes and highs that us guys experience are a direct result of increasing dopamine.  In fact, dopamine is what is boosted by crack and other narcotics.

So to maximize mood throughout the day, try the Low Fat (or Ornish) Diet but supplementing with egg whites every other meal.  This will alternate you between seratonin and dopamine throughout the day and preserve your arteries while you’re at it.

By the way, David Kessler, former head of the FDA, has recently documented in his book The End of Overeating how the food industry uses salt, sugar and fat to literally make you addicted to processed foods.  This trinity – salt, sugar and fat – literally alter your brain chemistry, particularly by modifying dopamine levels, to make you pant and paw like one of Pavlov’s dogs.

If you eat anything out of a box, can or package, you are going to have a very tough time controlling your appetite.  Food executives and engineers are not stuipd:  they now how to keep you coming back for more. Again, stay out of the middle of grocery store – it’s the Tire Inflation Zone for us guys!

REFERENCES:

1) Arch Intern Med, 2009, 169(20):1873-1880, “Long-term Effects of a Very Low-Carbohydrate Diet and a Low-Fat Diet on Mood and Cognitive Function”

2) Br J Nutr, 2009, 101(12):1821-1827, “Adherence to the Mediterranean diet is associated with better mental and physical health”

3) Physiol Behav, 1987, 39(5):561-569, “Macronutrient relationships with meal patterns and mood in the spontaneous feeding behavior of humans”

4) Prevention, Apr 2010, p. 45.

Salt (Too Much) Can Be Deadly - Peak Testosterone

Most health-conscious people have grown up with the idea that salt is only bad for those who are “salt-sensitive.”  What is meant by this is that there is research that shows that the blood pressure in a certain minority of people will increase with salt.

However, what has emerged in the last ten years is a much more ugly picture of salt.  Salt is not just a problem for the “sensitive” but for the population at large and, furthermore, it does not just elevate blood pressure but results in increased risk for a host of medical conditions.

NOTE: Read my link on How to Defeat Inflammation for more details

Consider what that all that extra salt in your diet, primarily from added salt and processed foods, will do to you according to the latest research:

1) Adiponectin.  Many people have heard of the inflammatory markers TNF-alpha and C-Reactive protein.  However, one lesser known inflammation-controlling protein is Adiponectin:  the less you have, the higher your inflammation.  Adiponectin can be whacked by being overweight and – you guessed it! – by salt intake. [1]  Adiponectin levels likely play a role “in type 2 diabetes, obesity, atherosclerosis, non-alcoholic fatty liver disease (NAFLD) and an independent risk factor for metabolic syndrome”. [2]

Perhaps more scary is adiponectin’s correlation to stomach (gastric), prostate, and colon cancers as well as leukemia.  In women, it has also been tied to endometrial and breast cancers  [5]

REFERENCES:

1) Journal of Hypertension, Jun 2010, 28:36, “Salt Intake and Inflammation in Essential Hypertension: 1B.05”

2) https://en.wikipedia.org/wiki/Adiponectin

3) European Journal of Cancer Prevention, Mar 2011, 20(2):132-139, “Salt, processed meat and the risk of cancer”

4) British Journal of Cancer, 2004, 90:128 134, “Salt and salted food intake and subsequent risk of gastric cancer among middle-aged Japanese men and women”

5) British Journal of Cancer, 2006, “Adiponectin and cancer: a systematic review”

6) BMJ, 2009; 339:b4567, “Salt intake, stroke, and cardiovascular disease: meta-analysis of prospective studies”

What makes adiponectin so toxic and an apparent precursor to so many deadly conditions?  The likely root cause is its role in increasing insulin resistance, a key factor in type II diabetes and Metabolic Syndrome.

2. Stomach, Colon, Testicular and Bladder Cancer. Higher salt intakes are now correlated with all four of these nasty cancers.  [3]  This likely also explains the previously mysterious link between GI cancers and processed meats, which are high in salt. [4]

4. Stroke and Cardiovascular Disease.  A large, recent meta-analysis found that salt significantly increased the risk for both stroke and cardiovascular disease. [6] The authors pointed out that the risk was likely actually underestimated by the their study results as well.

Nitric Oxide Replacement Therapy - Peak Testosterone

But how do you measure the above strategy? How do you know if those nitrates you are eating are actually creating nitric oxide? Well, one way we can fairly accurately measure this is through the new nitric oxide test strips that have hit Amazon – see Berkeley Nitric Oxide Test Strips (50 Count) for example – and the market in general. These strips measure nitric oxide indirectly, however, saliva is an obligatory step in the bioconversion for the body to form nitric oxide and nitrite is a well established biomarker or surrogate for nitric oxide; nitrite serves as both a precursor for nitric oxide through the chemical reduction and a byproduct of nitric oxide via oxidation, which, in turn, can be recycled to form nitric oxide.

I was fortunate to have a recent interview with Berkeley Test’s representatives and they explained the real power of these strips, which I have included below.

NOTE: For other ways to boost NO through food and also my Review of the Berkeley Nitric Oxide Test Strips

Q. Why should a man buy your current test strips when it’s not truly measuring endothelial NO?

A. The reality is that you can’t necessarily control the degree of endothelial NO gene expression or endothelial NO production, especially as you age, but you are able to compensate with a diet rich in vegetables with high nitric oxide potency. Hence, the strips are “enabling” — they provoke you to change your dietary lifestyle to ensure your nitric oxide levels are elevated.

From a practical standpoint, the strips empower you to identify, which foods are rich in nitric oxide potency, but they also help in the timing to achieve optimal levels with a nitric oxide potent diet. For example, optimal nitric oxide levels to enhance performance are typically found 2-3 hrs after eating nitric oxide potent natural beet juice derived from winter beets resulting in an elevation to Target-Threshold levels shown with Berkeley s saliva nitric oxide test strips.

To achieve Threshold levels with Berkeley Test strips through natural whole foods diets, such as DASH, reinforce the recommended multi-servings of leafy greens that exhibit the benefits of these diets.

Hence, the strips are helpful in screening what foods are producing the greatest NO response. And for those foods which exhibit nitric oxide potency, Berkeley Test strips provides insight as to when levels are optimal. A number of clinical studies have reported on the effects of nitric oxide foods and diets elevating saliva levels in context of lowering blood pressure (see Scientific Articles, The Science Behind Nitric Oxide and Nitric Oxide potent foods at Berkeley Test).

Q. So these test strips are not really measuring arterial nitric oxide levels? Thus, a young man with good endothelial nitric oxide production may be misrepresented by the strips, i.e. his arterial nitric oxide may be good even though he has not eaten much in the way of nitrates?

A. The strips are reflective of nitric oxide bioavailability and bioactivity that is reflective of both nitric oxide produced by the endothelial cells and dietary sources, i.e., nitrate-rich vegetables.

Regarding the dietary source, ie, nitric oxide-potent beets and spinach, the bio-conversion of nitrate to nitrite in saliva to make nitric oxide is an obligatory and necessary step for arterial pressure changes: in brief, if saliva is interrupted, blood pressure is elevated.

For example, Webb s work (Hypertension 51:784, 2008) elegantly reinforced the obligatory role of saliva in humans. They showed that ingestion of beet juice by healthy volunteers markedly reduced blood pressure (BP) and by disrupting saliva, either by spitting or interrupting the conversion of dietary nitrate to nitrite in the mouth, the reduction of blood pressure was abated; by blocking the saliva from recirculating, it prevented a rise in plasma levels, and blocked a decrease in blood pressure and abolished the inhibitor effects on platelets aggregation confirming both arterial pressure changes and cardio-protective effects were attributable to the conversion in the mouth. So, our mothers were right: eat your vegetables and do not spit. (Wink et al, Hypertension 51:617, 2008.) Sobko et al (Nitric Oxide 22:136, 2010 ) shows that Japanese traditional diets abundant in leafy greens elevated both plasma and saliva levels with a corresponding BP decrease, or the recent clinical correlate between saliva and blood pressure lowering with nitric oxide-potent spinach. Here, the consumption of spinach lowered systolic blood pressure and increased large artery compliance acutely in healthy men and women with a corresponding 8-fold increase in salivary levels (Liua et al, Nitric Oxide 35: 123, 2013 ).

Ahluwalia s reports in 2012 and 2013 re-enforces the concept among pre-hypertensives (Nitric Oxide 26:197, 2012). They showed in a cross over protocol of 14 volunteers who ingested inorganic nitrates, plasma and saliva level increased 3 hrs post ingestion with a significant reduction of BP. A follow on study (Kapil et al, Biology Medicine 55:93, 2013), showed that nitrite/nitrate is extracted from blood by the salivary gland, accumulates in saliva, and it is then reduced to nitric oxide to have a direct BP lowering effect. And when interrupting saliva levels in volunteers that already had elevated levels, a rise in systolic and diastolic BP resulted. In their most recent paper (Ghosh et al, Hypertension 61, 2013), they found that pre-hypertensives may be more sensitive to the BP lowering effects of the dietary nitrate-nitrite-nitric oxide pathway; it is a fascinating paper that sets the stage for an inexpensive antihypertensive strategy with beet juice.

As you well know this field is rapidly evolving. If we look to how other biomarkers evolved, such as serum cholesterol or blood pressure, new clinical correlates causes the scientific community to reassess how to interpret the information. For example, just this past year, new guidance was provided regarding BP measurements.

In like fashion, we envision saliva testing for nitric oxide status will evolve; eventually, we would like to see descriptive terms, i.e., low or depleted, move to quantitative ranges that provides guidance as to a physiological outcome, i.e. arterial pressure or endothelial dysfunction. This is something we are interested in providing some day, however, that will be driven by more clinical evaluations and correlates. So, this discussion will continue to evolve and will be on going.

Today, Berkeley Test strips are reflective of nitric oxide bioavailability and bioactivity that is reflective of both nitric oxide produced by the endothelial cells and dietary sources, i.e., nitrate-rich vegetables.

Neo40: An Interview with Dr. Nathan Bryan - Peak Testosterone

If you’ve been on the internet lately, at least here in the U.S., you’ve likely seen an add for a new supplement called Neo40 Daily – Nitric Oxide Supplement. Noe40 is one of the hotter supplements right now and holds tremendous promise for cardiovascular and endothelial health. Neo40 was designed from start to finish to boost nitric oxide in a healthy and natural manner.

It’s co-founder and co-designer, Dr. Nathan Bryan, is one of the foremost nitric oxide gurus on planet earth. In the last three years alone, his name can be found on over a dozen nitric oxide-related studies and he is front and center in developing natural solutions to the age-related decline in this precious compound.

Many men have now used it as a complementary treatment for help with high blood pressure and erectile dysfunction – talk to your doctor first of course since it is only billed as nitric oxide booster – and the consensus seems to be that it provides some relief.  Dr. Bryan graciously granted an interview with Peak Testosterone about Neo40 Daily and other related issues that should be of interest to every middle-aged and beyond male.  Here are his responses to my questions about Neo40, nitric oxide and future treatment of erectile dysfunction:

A. The medical community now recognizes and appreciates that erectile dysfunction (ED) is really the first sign of vascular problems and conditions of NO insufficiency. Years ago when it was still taboo to discuss sexual dysfunction, typically the first signs of cardiovascular disease came in the form of a heart attack or stroke. Really at that point, it is too late to change the course of events. Now that ED is considered a medical condition, it is openly discussed between doctors and their patients.

ED is a symptom of endothelial dysfunction. Endothelial dysfunction is defined as the inability to produce NO in response to normal stimuli. Endothelial cells line every single blood vessel in our body, whether that is the blood vessel supplying the penis or clitoris or the heart. Therefore, the same endothelial dysfunction that occurs in the penis for ED is also occurring in the heart which may be a sign of poor coronary circulation and the onset and progression of cardiovascular disease. Since endothelial or erectile dysfunction is really an early stage for cardiovascular dysfunction, this gives doctors and scientists an opportunity to recognize at risk patients and take pro-active steps to address endothelial dysfunction and hopefully prevent the progression of cardiovascular disease.

Drugs such as Viagra, Cialis and Levitra were first developed and tested as heart medications. I think that if you can correct endothelial dysfunction by assisting the body to restore normal vascular function and NO production, one can reverse ED. So rather than treating ED, if you take the approach of treating the underlying vascular problem, which occurs in every organ system, then the ED will correct itself.

Q. Would consuming higher nitrate and other nitric-oxide boosting foods possibly accelerate Neo40 s effectiveness?

A. Yes. It is well recognized for many years that green leafy vegetables in particular are cardioprotective and beneficial for you. These effects are now recognized to be due to their nitrate content which can be reduced to nitric oxide by a series of metabolic steps that require bacteria in your mouth and gut and in part, cellular systems in mammals. Eating foods rich in nitrate and antioxidants can provide a source of nitric oxide in the body and will certainly enhance the effects of a dietary supplement like Neo40.

Q. If someone takes Neo40 to improve their erectile strength or hardness factor, what should their expectations be?

A. One should have realistic expectations. Neo40 is a dietary supplement and not an erectile dysfunction drug so it will not be as effective as taking a Viagra or Cialis. However, supplying a source of nitric oxide when and where it is needed will certainly improve erectile strength and hardness due to the enhanced blood flow and the ability of those blood vessels to accommodate for blood, which is the physiological basis for an erection. One should also appreciate that the underlying vascular dysfunction that caused the ED did not occur overnight but months or years to develop. A simple, quick fix is not possible and should not be expected.

Q. For example, how long does Neo40 take to work? Is it a matter of hours, days weeks? And how much potency does it seem to have compared to a Viagra or Cialis?

A. We see peak blood concentrations of NO and NO metabolites at 20 minutes after taking the lozenge. There are two phases to the Neo40 assistance of the body s underlying physiology, an acute phase that generates NO immediately upon dissolution in the mouth and a slower onset phase that acts to restore and replete NO within the vasculature. This second phase takes hours.

Neo40 and drugs like Viagra and Cialis are working at different stages of the cell signaling pathway. For example, Viagra and Cialis are drugs classified as phosphodiesterase inhibitors or PD5 inhibitors. Typically when NO is produced in the vasculature, it binds to and activates an enzyme called soluble guanylyl cyclase (sGC). sGC then converts GTP to cGMP. cGMP, through a calcium dependent mechanism causes blood vessels to relax to increase blood flow. PD5 enzymes then degrade cGMP and turn the signal off. Therefore, by inhibiting the enzyme that degrades the cGMP signal that NO turns on, you get a better and sustained erection. However, without production of NO, this pathway does not and cannot work. In fact, this is why Viagra and Cialis do not work in 100% of the population.

By providing a source of NO through a dietary supplement like Neo40, this pathway becomes primed and activated. Neo40 is not a ED drug and, therefore, is not as potent as Viagra or Cialis, but also does not have the adverse side effects as well.

Q. Where do you plan to go with Neo40? Where does its future lie?

A. I think we are at the very beginning of huge movement in NO based technologies, both pharmaceutical remedies and natural dietary supplements. We hope that the technology behind Neo40 will be a viable and safe solution to any condition related to NO insufficiency. This is very important since we recognize that NO insufficiency is really the earliest sign of a number of many contemporary diseases. Recognizing patient populations that may be NO insufficient and then implement strategies to restore NO, we hope to be able to reverse the course of disease and hopefully prevent the manifestation of a number of different diseases. We have our Neogenis test strips that can detect NO availability and Neo40 as a solution. We think the future is very bright for Neo40 and anticipate market acceptance as a daily regimen to support cardiovascular health.

Q. One of my readers asked me if Neo40 would work synergistically with some of the other standard erectile dysfunction herbs, such as Pycnogenol, Korean Ginseng and/or Horny Goat Weed (Icaarin). Do you have any recommendations in this regard?

A. Yes. We think Neo40 will work synergistically with these other herbs due to the fact that NO is what activates this pathway and these herbs have been shown to affect the downstream signaling, either affecting PD5 activity or other components of the pathway.

Q. There is some concern out there with nitrate consumption in processed foods. Should those taking Neo40 back off on consumption of amine-containing foods or have any other concerns?

A. We recommend a balanced diet with lots of fresh fruits and vegetables and limited processed foods. There is some evidence in the literature about nitrite and/or nitrate reacting with amines to form nitrosamines, some of which are considered carcinogens. The design and formulation of Neo40 as a dietary supplement is such that the chemistry is directed towards NO production and away from nitrosative chemistry. In fact, there are a number of nitrosation inhibitors in the Neo40. We do recommend taking Neo40 on an empty stomach to prevent any unwanted reactions or scavenging of NO by indigested stomach contents.

Q. Contaminants in supplements and herbs are a hot topic right now. How do you handle heavy metal and contaminant testing with your product?

A. All of our raw material is tested for heavy metals and microbiology before and after it is manufactured into the Neo40 lozenge. We have very strict quality control in place to ensure safety.

Q. From what I understand, there is a reductase enzyme present in Hawthorn that helps with the nitrate to nitrite conversion in saliva, correct? Does this enzyme affect any other processes or similar enzyme systems in the body that consumers should be aware of?

A. Mammals including humans do not have a functional nitrate reductase enzyme. We rely specifically on certain bacteria to perform this first metabolic activation step. The activity in the hawthorn is responsible for making sure the entire process leads to NO production.

Q. What side effects are you seeing with Neo40? Anything to watch out for?

A. No adverse side effects have been reported. We do hear the occasional complaint of mouth and tongue sensitivity but have found that drinking plenty of water before and after taking the lozenge will eliminate this slight discomfort. Some people also may experience an occasional burp. Since NO is a gas, the occasional burp is a sure sign the product is working.

Q. Your ingredients include a proprietary herbal blend ? Does this include only hawthorn and beetroot? Or are their other herbs as well?

A. The proprietary blend includes hawthorn and beets and several other cofactors and substrates that make the system for generating NO active.

Q. Taking Cialis with a nitrate (nitroglycerin) can lead to dangerous blood pressure dips. Do you know of any risks in taking your product along with nitrates or any other drug?

A. We recommend to always check with your physician before starting any new dietary supplement or pharmaceutical regimen. Neo40 is designed to restore physiological levels of NO whereas organic nitrates such as nitroglycerin are designed to release pharmacological levels of NO and therefore creates a problem with drugs like Viagra or Cialis.

A. The dietary supplement consumer and market response to Neo40 has been overwhelmingly positive. From our clinical trial, 80% of the patients getting the Neo40 responded as having more energy. This has been a consistent response from our customers as well. We also hear testimonies of better mental acuity and focus, better endurance and performance during workouts, reduction in blood pressure from people with high blood pressure and a surprising response indicating better sexual performance in both men and women.

Q. It seems clear that Neo40 has some strong triglyceride-lowering properties. Is this from the increased nitric oxide levels or some other mechanism?

A. It is not clear to us what is exactly responsible for the drop in triglycerides. There is some published literature showing that hawthorn berry leads to reduction in triglycerides so may simply be a dietary supplement effect of the hawthorn in the Neo40. There might however be a link to NO production since NO has been shown to affect PPAR-gamma signaling and lead to change in fat metabolism. Regardless, a reduction in triglycerides is very important in modifying cardiovascular risk.

Q. It would seem to me that the improvements to C-Reactive protein, triglycerides, blood pressure and nitric oxide make this a strong contender for cardiovascular patients. Do you plan on broadening clinical trials to examine heart-related outcomes?

A. The basis for my research over the past 10 years has been directed towards cardiovascular disease. The discoveries and design of the Neo40 is based on improving cardiovascular health. We have a number of trials in the planning phase that are designed to investigate the effects of Neo40 on coronary blood flow in patients with coronary artery disease and to determine the effects of Neo40 on endothelial function. In time, we will mobilize the resources to do a large scale study on heart attack and stroke, but typically these types of trials are very expensive and take many years to complete. However the data we have published to date on modifying cardiovascular risk in patients over 40 years of age is quite impressive, especially for a dietary supplement.

Estradiol: - High Levels Increase Arterial Plaque -

Do you have high estradiol? Consider the evidence that it can accelerate arterial plaque:

One of the very few subjects that I enjoy more than hormones is regressing arterial plaque.  So imagine how excited I got when I found a study that combined both subjects.  A 2006 study in the Journal of Clinical Endocrinology looked at a variety of hormones and lifestyle factors, such as testosterone, estradiol, SHBG, BMI, waist-to-hip ratio, blood pressure and lipids in relation to arterial plaque in men.  And they did not just study association but rather causation.  By that I mean that they measured the above hormonal and lifestyle factors and then watched the participants for three years afterward with the goal of finding which were most predictive of developing arterial plaque. [1] And the results were very interesting on many fronts.

NOTE: Arterial plaque was measured using an ultrasound IMT (intima medial thickness) of the carotid (neck) artery.  This is one the two common ways to check for plaque, the other being a Heart Scan (Calcium Score), the latter being something I discuss in my page called Heart Scan Results. An IMT has no radiation and, as of this writing, can be done without a doctor’s orders in almost all states through Lifeline for $70.

What did the researchers find?  Their results would probably surprise most men:

1.  The only hormone that predicted an increase in arterial plaque was estradiol (both total and free).

2. The only lifestyle factors that predicted an increase in arterial plaque were LDL and HDL.  (This is no surprise.  All the Plaque Regressers set low targets for LDL – see my page Your Target LDL Levels to Regress Plaque – and relatively high values for HDL, the “good” cholesterol.)

Basically, higher estradiol levels meant higher plaque levels three years later.  This is, for many scientists, a complete turnaround in expectations:  for years and years the estrogen in women was seen as heart protective. However, the thinking on that has done an about face. The authors wrote:

1)  J Clin Endocrinol Metab, 2006 Nov ,91(11):4433-7, “Circulating estradiol is an independent predictor of progression of carotid artery intima-media thickness in middle-aged men.”

2) J Mol Med (Berl), 2002 Mar, 80(3):176-80, “Coronary artery wall atherosclerosis in relation to the estrogen receptor 1 gene polymorphism: an autopsy study”

“Our findings of a positive association between serum E2 levels and intima-media thickening supports the notion that estrogens, besides possibly increasing the risk for thrombosis and thereby cardiovascular events, also have an important impact on atherogenesis in men. In the present study, we found a positive association between free E2 and the annual increase in intima-media thickness at higher, but not lower, free E2 levels. This might suggest that high doses of E2 (and possibly other estrogens) should be avoided in clinical trials. Indeed, high-dose parenteral administration of a slow-release preparation of E2 was recently shown to increase the risk of nonfatal ischemic heart disease events in men.”

Notice that in this study lower estradiol was NOT correlated with increased atherosclerosis – only high.  Low estradiol is dangerous for other reasons, such as osteoporosis, but in this study it did not seem to accelerate plaque.  The study also commented that

b)  Researchers have discovered that the estrogen receptors in arterial walls likely play a role in the buildup of arterial plaque directly. [2]

What this means is that researchers now have evidence of  and biological plausability (cause-and-effect) for, a link between higher estradiol levels and arterial calcification.

Estradiol Management and HRT

One key point in my mind is that this study seem to argue for an emphasis on weight loss and reasonable dosages of testosterone for men on HRT, Clomid, HCG Monotherapy or any therapy that increases testosterone levels in order to lower estradiol levels.  Some physicians now – and I have seen this on the  Peak Testosterone Forum – believe that there is no practical upper limit to estradiol for men on HRT. They will double or triple a man’s testosterone levels and, therefore,  roughly double or triple their estradiol levels at the same time. And, as this study shows, boosting those estradiol levels could actually carry a long term risk.

Furthermore, testosterone did not show an ability to improve IMT in this study, so one cannot count on it to protect one’s arteries from the buildup of plaque. Testosterone does some remarkable things for cardiovascular health, such as decrease hardening of the arteries, lower insulin levels, help prevent prediabetes and diabetes, decrease body fat (a little), help improve libido/erectile strength and lower key inflammatory markers.  Put all of these together and I would think that you should generally improve plaque levels.  However, according to this study, testosterone was neutral and estradiol must be monitored independently.

So how do you manage estradiol?  Well, one way HRT clinics and anti-aging physicians do it is with Arimidex (anastrozole).  Arimidex is an aromatase inhibitor and will drop your estradiol levels nicely.  The problem with Arimidex is that it can negatively impact the clotting cascade, and, therefore, may only improve half of the equation.  Now the rebuttal is that the amount of Arimidex usually given to men on HRT is usually quite low.  I was on Arimidex briefly and was given initially 0.5 mg twice per week.  That is a very small amount and I don’t believe there is any evidence that clotting has been an issue with doctors that use it.  You’ll have to discuss risks with your doctors or PA as there are no studies.

I would argue that there is a better way for most men and the following should be their goal:

a) Lower the testosterone dose as much as possible.  This will, in turn, lower estradiol levels.

b) Drop your body fat into the 10-12% range.  (This is easy using Clarence Bass’ approach documented in his book Challenge Yourself.

c) If you are injecting testosterone cypionate or enanthate, go to two or more times weekly (which usually will mean subQ).

This is the approach I took and I got completely off of Arimidex.  My last estradiol read was 27 pg/ml, which is a Youthful and Natural Level of Estradiol.

REFERENCES:

DHEA and IGF-1 (Cancer, Anti-Aging Hormone) - Peak Testosterone

I recently started a experiment with 25 mg oral DHEA daily to try to boost my low levels (108 mcg/dl DHEAS). As of this writing, I’ve only been taking DHEA for about three weeks to a month, but I would definitely call it a success.  It seemed to lower anxiety and produce a relaxing effect, which is fairly common with oral DHEA at reasonable dosages (in low DHEA men).  However, I was concerned, because I had read that DHEA can raise IGF-1 levels.  I had a high PSA read at one time and did not want to take any chances, since elevated IGF-1 levels are a known risk factor for certain types of cancer.  Furthermore, lowering IGF-1 is actually a strong anti-aging strategy that has considerable research behind it.  (Of course, you don’t want be too low in IGF-1 either.)  In other words, boosting IGF-1 was not something I was interested in doing, especially at age 55.

I decided to do a little digging, because I knew that often very large dosages of DHEA are given and studies on men are less common.  Basically, I was wondering how applicable the research was. And I was also only interested in the effect from physiological dosages of DHEA, i.e. dosages of DHEA that would not boost DHEA-S levels beyond normal youthful levels.  For the typical middle-aged or senior man, this will be in the 25-50 mg per day range, but it is important to do blood draws before and after.

What I found was that at these kind of lower DHEA dosages, the effect on IGF-1 was fairly small more than likely.  Below is a summary of the resarch that I came across:

CONCLUSION:  My conclusion is that 25 mg per day as I am doing is probably a fairly prudent and non-aggressive protocol.  Assuming linearity, then IGF-1 would increase on average by only 5%.  This seemis like an acceptable risk for me considering that oral DHEA lowers anxiety for me from what I can tell.

It should also be pointed out that DHEA has been found in many animal studies to be cancer protective.  An example of this, and one that is near and dear to my heart, is a study looking at DHEA levels in prostate cancer-free men with and found that “although mean levels of DHEA were 11% lower among cases than controls and DHEA-S levels were 12% lower than among controls, no dose-response association was noted for either DHEA or DHEA-S. It seems unlikely that serum levels of DHEA or DHEA-S are important risk factors for prostate cancer.” [5] If this is true, then the primary argument against raising IGF-1 levels with DHEA is anti-aging.

CAUTION:  Always talk to your doctor first before taking any supplement if you have any medical condition or are on any medications.

REFERENCES:

1) Metabolism Clinical and Experimental, 2006, 55:858-870, “Endocrine effects of oral dehydroepiandrosterone in men with HIV infection: a prospective, randomized, double-blind, placedbo-controlled trial”

2) https://www.diabetesincontrol.com/articles/53-/15766-how-do-estrone-levels-affect-men-and-their-risk-for-diabetes

3) J Clin Endocrinol Metab, 1994 Jun, 78(6):1360-7, “Effects of replacement dose of dehydroepiandrosterone in men and women of advancing age”

4) Clin Endocrinology, 1998, 49:421-432, “The effect of six months treatment with a 100 mg daily dose of dehydroepiandrosterone (DHEA) on circulating sex steroids, body composition and muscle strength in age advanced men and women”

5) Cancer Epidemiol Biomarkers Prev, 1993 May-Jun, 2(3):219-21, “The relationship of serum dehydroepiandrosterone and its sulfate to subsequent cancer of the prostate”

1. 50 mg Daily in Middle-Aged and Senior Men.  A study using a 50 mg dose in healthy men aged 40-70 for 3 months resulted in the following:

“Although 24-h GH pulse parameters and IGF binding protein-3 (IGFBP-3) levels were unchanged, serum IGF-1 levels increased by 10% and IGFBP-1 levels decreased by 20%, resulting in a significant increase in the IGF-1/IGFBP-1 ratio. These changes were accompanied by an improvement in perceived physical and psychological well-being for both men and women without discernible changes in serum lipid profiles, insulin sensitivity or percentage body fat.” [3]

The decreased IGFBP-1 levels basically mean that IGF-1 was more bioavailable.  Again, I was taking half of this amount.of DHEA, so I would expect the change to be even less for me.  And, if you read the next study, you’ll see the IGFBP-1 did not change with an even great dose of DHEA, calling into question that aspect of the chnage.

2. 100 mg Daily in Early Senior-Aged Men. A followup study with a 100 mg daily dose in men 55-70 resulted in a slightly greater change in IGF-1 (16%), but this time no significant change in IGFBP-1. [4] Of some concern is the fact that both of the studies had the same lead author.  Of course, the most important thing is to take your IGF-1 measurement before and after supplementaiton and verify your own personal results.  Studies just deal in averages and so it is good to confirm with your own labwork anyway.  Please note that I do would not take 100 mg daily anyway:  this is going to be a non-physiological dose for most men.

Nitric Oxide Test Strips - Interview with Dr. Bryan-

All us middle-aged and senior men owe Dr. Nathan Bryan of Neogenis a lunch or two.  Dr. Bryan came up with an inexpensive saliva test to measure my second most favorite molecule – nitric oxide.  (Yes, testosterone is #1.)

I’ve had a lot of fun, being a certified health geek, using the strips and have found them to be quite revealing and accurate. I get emails and forum posts quite often from men wondering if their erectile dysfunction problems are testosterone-related or nitric oxide-related. Of course, testing for testosterone is only a blood draw away and now, thanks to Dr. Bryan, you can easily check your NO levels as well. (Amazon now carries these as Nitric Oxide Diagnostic Test Strips for those interested.)

Of course, when you use the strips on a regular basis, a number of practical questions come to mind.  Dr. Bryan was gracious enough to answer some of these for me below:Q. These work by measuring the nitrate on the tongue, right?

More times than not, ED is a result of NO deficiency. However, there are also other causes of ED than just a vascular problem such as anxiety issues, hormonal problems etc that may be unrelated to NO.

Q. Nitric oxide is a fairly volatile molecule? Does this mean you need to test daily for a few days and take a rolling average?

NO has a very short half life but since we are measuring more stable endproducts of NO metabolism, we get a better sense of NO production/availabilty. We recommend testing 1-2 times weekly first thing in the morning for the most accurate readings.Q. I know that most modern toothpastes actually have a rather harsh chemical in them specifically designed to kill the bacteria on teeth. Does this mean that results on the test strips could be skewed after brushing? And do you think that these toothpastes could be somewhat lowering nitric oxide levels by killing the good bacteria in your mouth along with the bad?

Many bacteria on the teeth and tongue are responsible for converting nitrate to nitrite and NO so anything that removes or kills these good bacteria will affect the test strips and NO production. In fact we think this may be the link between oral health and cardiovascular disease.

Q. I know you can improve your nitric oxide during the day through exercise, certain foods and various supplements. But let s say you want to establish a baseline nitric oxide reading to find out your unassisted endothelial function. Would this potentially be a valuable measurement? If so, is first thing in the morning upon waking a good time to do this?

Great question and we are currently attempting to determine how endotheliail function correlates with the salivary test strip. We think this will be a very valuable measurement. The most accurate test is first thing in the morning before brushing, before drinking anything so that this reflects a fasted state and a period of rest and no exercise.

The strips measure nitrite and nitric oxide in the saliva, not nitrate.

Q. Are there any cases where this will not translate as well to your actual cardiovascular nitric oxide levels? In other words, are theire circumstances where a saliva test would not correspond to actual plasma levels?

Yes, we have found that in cases of severe periodontal disease and active infections in the mouth, the saliva test does not translate well into actual cardiovascular NO levels but is a result of the infection in the mouth. Interestingly, although salivary levels may be high in this particular case, we have evidence that this overproduction of NO iin the mouth may actually shut down NO production throughout the rest of the body, causing systemic problems from a local oral infection.

Q. What if your nitric oxide levels look good on the test strips and yet your blood pressure is hypertensive? What could this mean?

Hypertension is the result of insufficient NO production throughout the blood vessels in the body. This is referred to as endothelial dysfunction. What we are measuring in the salivary strips is the amount of NO bioactivity that is recycled through the salivary glands. This activity is a reflection of what is produced by the blood vessels and what is consumed through the diet from nitrate rich vegetables. Eating a high nitrate meal such as a spinach salad will cause a temporary increase in salivary nitrite and NO 3-4 hours after the meal. So in this case, although the test strip may indicate normal, this is a short term spike and does not really reflect true steady state levels. That is why we recommend testing after a 6-8 hour fast.

Q. What if someone eats spinach or takes Neo40 and shows up consistently as depleted or low on your test strips an hour or two later? Does this mean a heavily damaged endothelium or could there be other explanations?

This typically means their body is really depleted and deficient in total body NO availability. The conversion of spinach nitrate requires adequate digestion and absorption. People who take proton pump inhibitors, antibiotics and/or antiseptic mouthwash will not be able to properly digest, absorb and utilize the nitrate from spinach to make nitric oxide. What we are measuring in the saliva is what is recycled from what the body has not used. If your body is using all the NO that we provide through the Neo40, there is none to recycle to show up in the saliva. Consider filling up an empty barrel. It takes time to fill the barrel depending on how low the levels was. We only know the barrel is full, when it starts to run over. The runover we are measuring in the body is what shows up in the saliva.

Alpha Blocker #2: Phentolamine (Vasoviril) - Peak Testosterone

Oral Phentolamine is another alpha-blocker which, unlike doxazosin, is marketed specifically as a treatment for erectile dysfunction and is, like Viagra, taken on demand . The trade name is Vasoviril. It has not been granted a licence in Europe or North America, but is approved in Brazil and Mexico.

CAUTION:  All the alpha blockers should only be used under a doctor’s supervision, because they 1) interact very negatively with certain medications, 2) can have very serious side effects and 3) can cause priapism, an erection that does not go away and can damage the penis permanently.  See my link on Common Causes of Priapism for more information on the latter. If you ever have an erection that will no go away after an hour or two, go to the E.R. Your sex life is at stake.

Phentolamine is a non-selective alpha-adrenergic blocker and thus is in the same general class as the well-known herb herbal erectile dysfunction remedy yohimbine.  The alpha-adrenergic receptors are used by noradrenaline and noradrenaline to put the brakes on erections.

NOTE:  You can find out more information about another alpha blocker by going to my page on Doxazosin and Erectile Dysfunction.

An August 2002 report in the International Journal of Impotence Research stated that, averaging two American trials, the mean change scores in the EF domain from baseline to the end of treatment in the parallel-design study were -2.3, 5.7 and 6.7 for the placebo, 40 mg, and 80 mg groups, respectively. So a healthy increase of 8 or 9 over a placebo. (The two trials were 28 Goldstein I, Carson C, Rosen R, Islam A. Vasomax for the treatment of male erectile dysfunction ; and Goldstein I. Oral phentolamine: an Alpha-1, Alpha-2 adrenergic antagonist for the treatment of erectile dysfunction.)

Oral Phentolamine is faster acting and shorter lasting than Viagra, and should be taken on an empty stomach. Users suggest it takes effect in about half an hour and it lasts about two to four hours. They also suggest Phentolamine works very well in combination with PDE5i. The cost is about twice that of Viagra.

My experience on the Peak Testosterone Forum is that alpha blockers are rarely used to treat erectile dysfunction.  However, some of the study work indicates that they can be very effective in many men.  For example, a German trial in 1998 reported that phentolamine helped 50% of men. And there are other reports it works synergistically with PDE5i.

A paper in 2001 from the Boston School of Medicine reviewed data on Vasomax (now Vasoviril) and stated that two large scale trials have found that Vasomax was associated with significant increases in the IIEF-EF scale. However these trials were conducted when Viagra was being developed and many men on the trials left to join the Viagra testing. And Viagra is generally regarded as more successful.

A 2002 Californian study reported that

-Supplements - Industry Problems

As you know, I have little trust or faith in the food industry and on this site I put example after example of How the Food Industry Endangers Your Health Daily.  The problem is that they can make money – lots and lots of money – by putting your health at risk.

Most health-conscious people are, to one extent or the other, aware of this fact and try as best they can to “live naturally” by avoiding processed foods.  They try to eat whole foods instead and very often try to use herbal and other (seemingly more) natural supplements in order to improve and maintain their health.  By the same token, I find many guys that write into me have an inherent trust in supplements to improve their testosterone, erectile function and health in general and an inherent distrust of drugs and the pharmaceutical industry.

This often wholesale acceptance of supplement is potentially very dangerous.  The reason?  Greed.

The same motivator that has corrupted the food and pharmaceutical industries is little better in the supplement industry. Again, people can make money – and a lot of it – by selling you something that will hurt your health.  I have already covered How Many Everyday Supplements and Vitamins Can Be Dangerous. Imagine how dangerous some of the more exotic supplements that guys take for men’s health or bodybuilding are!  It’s not pretty.

The Men’s Journal recently did an excellent article on testosterone-related examples of this fact. [1] They gave many examples, but one of the most prominent was a “muscle activator” by Tren_Extreme. One innocent buyer took this product for several months and found that he itched, couldn’t sleep and lost 34 pounds inexplicably. These are all classic signs of liver damage and the FDA discovered that the manufacturers had been adding a powerful untested synthetic steroid.

As I cover in my link on Bioidentical Testosterone, steroids often have side effects and this one was no exception.  The individual involved was still struggling to recover from the damage that was done.  Why would Tren-Extreme put its purchaers at risk with an untested steroid?  Greed.

Guys have also gotten themselves in trouble with erectile dysfunction products as well. One poor guy took an erection-related supplement which produced a “super erection” from the Yohimbine ingredient. [2]  Of course, priapism, an erection that last over about four hours, will injure penile tissue and can cause permanent damage. The doctors actually had to operate on this individual and apply a shunt.

NOTE: Be very careful with yohimbe.  One 37 year old bodybuilder overingested it before a competition and lost consciousness, went into seizures and had about twice normal blood pressure levels. [3]

There was a drink supplement called Total Body Formula or Total Body Mega Formula that the FDA recalled in 2008 poisoned consumers with overdoses of chromium and selenium, leading to deformed nails, hair loss, diarrhea and a host of other nasty symptoms. [4] Again, this list could go on and on, but you are far more safe avoiding all such products all together unless it is from a manufactuer with a stellar, long term track record.

It’s simply not worth the risk.  Most of you can achieve incredible health results with just food and exercise alone.  You can Heal Your Erections with Food, Improve Your Testosterone Naturally and put on muscle without any additional chemical regardless of age.

You only get one life – don’t put it in the hands of some greedy fool that just wants to fatten his bank account…

REFERENCES:1) Men’s Journal, Nov. 2009, p. 63.

2) Journal of Medical Toxicology, “Refractory Priapism Associated with Ingestion of Yohimbe Extract”

3) Clinical Toxicology, Sep 2009, 47(8):827-829, “Acute neurotoxicity after yohimbine ingestion by a body builder”

4) https://www.fda.gov/safety/medwatch-fda-safety-information-and-adverse-event-reporting-program/medical-product-safety-information SafetyAlertsforHumanMedicalProducts/ucm070027.htm

Boron and Testosterone - Peak Testosterone

REFERENCES:

1) J Trace Elem Med Biol, 2011 Jan, 25(1):54-8. Epub 2010 Dec 3, “Comparative effects of daily and weekly boron supplementation on plasma steroid hormones and proinflammatory cytokines”

2) Reprod Toxicol, 1997 Jan-Feb, 11(1):123-60, “An assessment of boric acid and borax using the IEHR Evaluative Process for Assessing Human Developmental and Reproductive Toxicity of Agents. Expert Scientific Committee”

3) https://www.vrp.com/bone-and-joint/boron-higher-doses-necessary-for-cognitive-bone-and-joint-health

4) https://www.lef.org/magazine/mag2006/aug2006_aas_01.htm

5) https://robthoburn.wordpress.com/2011/02/02/boron-increases-testosterone-again/

6) https://www.traceminerals.com/ products/liquid-tablet-minerals/concentrace-ionic-minerals

6) https://www.bioimmersion.com/docs/fructoborate_monograph.pdf, “Vitamin D/ Steroid Hormone Homeostasis and Calcium Fructoborate Supplementation”

7) Biol Trace Elem Res, 1997 Mar, 56(3):273-86, “The effect of boron supplementation on its urinary excretion and selected cardiovascular risk factors in healthy male subjects”

It’s not very often I get excited about a trace mineral, but Boron is an exception. Boron ain’t boring – let me tell you. Below I am going to outline one thing after another that boron does that is going to help you in the bedroom, including boosting free testosterone.

First of all, boron is a trace mineral that your body needs and, like magnesium, is used by and positively influences many of your tissues and processes. There is no RDA for boron, but a significant percentage of the population is well below the 3 mg/day threshold that many experts would recommend. In fact, the average is considered to be about 1.5 mg/day. [2] Here is just a partial list of what boron is known to affect:  hormones, inflammation, blood plasma, vitamin D, bone maintenance and cognition/learning. [3] (NOTE:  Tell your woman that there is evidence that boron can help with osteoporosis. [4])

Boron can also be fickle to get in the diet.  Only certain plants contain boron and, unfortunately, things like soil and weather can affect boron content significantly. However, if you are eating one of the healthy, research-backed diets, then it is possible to get upwards of 10 mg/day. [2] Plant foods, such as lentils, nuts, peanuts, avocado and certain fruits and vegetables, all generally have significant boron content.

Researchers, in the above-mentioned study [1], decided to give participants boron levels near the upper end of what one can get through diet. They gave 8 healthy volunteers right around middle-age 10 mg of sodium tetraborate – Borax for you old-timers – on a daily basis.  The results were remarkable.

Looks at the sex life-boosting properties that Borax exhibited:

1.  Free Testosterone.  Increased 28%. [5] (See my link on Free Testosterone for more information.)

2. DHT. Increased (not statistically significantly however).

3. Vitamin D.  (not statistically significantly, but boron is a known increaser of Vitamin D)

4. C-Reactive Protein.  Statisically significant decrease.

5.  TNF-alpha.  Statisically significant decrease.

CAUTION:   Estradiol. One study in healthy men noted a significant increase in testosterone but also a jump in estradiol:  “Plasma estradiol concentrations increased significantly as a result of supplementation (51.9 to 73.9 pmol/L) and there was a trend for plasma testosterone levels to be increased. ” [7]

These five changes are a dream-come-true for us men. Notice the nice boost in free testosterone-to-estrogen ratio – this is going to do nothing but help the sex life of most men.  And that’s just the beginning of the good news.  Other studies have shown that Boron is a huge inflammation fighter.  (Some people even take it for arthritis.)  However, the one caution is the possible increase in estradiol.  If you decide to supplement with Boron, you may want to pull your testeosterone and estradiol before.  For more information, see my page on Inexpensive Self-Testing Testosterone Labs and Which Estradiol Test is the Best for Men?

So who cares?  Well, anything that fights inflammation, particular TNF-alpha and C-Reactive protein is very likely to improve your artery health, which will in turn improve blood flow, slow arteriosclerosis and do many other things to help you pump out more nitric oxide. Remember that C-Reactive protein is a broad measure of systemic inflammation that is strongly predictive of cardiovascular disease.  And TNF-alpha is strongly predictive not only of heart disease, but also erectile dysfunction, diabetes, arthritis and many other nasty conditions. See my link on TNF Inhibitors for more information.

NEWS FLASH:  We had a great forum thread on boron and the best form and one regular posted a study using calcium fructoborate to “increase Vitamin D 19.6%, DHEA 56%, and Free Testosterone 29.5%. One male participant had an increase of 50% in testosterone.” [6] Hard to argue with that, eh?

It’s hard for me to think of too many things that are worse for your sex life in the short term (and long term for that matter).  Sugar and corn syrup wreak immediate havoc on several key components of your sexual strength and function.  These nasty effects can last for hours and all for what?  Sugar and corn syrup add little to no nutritional benefits – in fact, quite the opposite.

CAUTION:  Boron is very powerful and little study work has been done to determine the proper dosage, side effects, etc. I personally am waiting a few years before taking this mineral, although I do get a little in my Concentrace Mineral Drops of which I take about 20-40 drops per day at the time of this writing, which is about 0.5-1.0 mg/day, a relatively small amount compared to the studies, which have been generally been on supplementation in the 10 mg/day range. [5][6] So my approach is cautious and may have little effect, but my goal is primarily to avoid a deficiency.

Lose Weight to Decrease Estradiol - Peak Testosterone

Are you overweight? If so, realize that you can very significantly lower your estradiol through weight loss (and boost testosterone while you are at it):

In my page Testosterone and Weight Loss, I discuss how men can profoundly increase their testosterone – sometimes double or even triple it – through weight loss if they have ~ 75+ pounds to lose. And considering that one third of the U.S. population is obese and another third is overweight, many men fall into this category or darn close. Of course, the tragedy is that few men understand what a powerful and positive impact weight loss can have on their hormone levels.

Below are a couple of studies from the research showing this effect:

1. Study: Healthy Versus Thin Controls.  Lets start with a study of obese men versus thin healthy controls.  The researchers found that “serum estrone (E,) and 17 -estradiol (E2) were noted to be 2-fold elevated in a group of morbidly obese men.” [1] There are actually three primary estrogens in men and the most powerful of the three is estradiol.  The same study also found that the obese men had average testosterone of 348 ng/dl versus the 519 ng/dl of normal men, which is about a 33% reduction in testosterone.  Furthermore, some of you may recognize that 348 number:  it is the exact threshold at which LabCorp defines hypogonadism in adult males.  Basically, these men, by putting on all those extra pounds, drove themselves into a hypogonadal state.

The tragedy is that very few doctors will explain just what all those extra pounds do to a guy and will just give the man Cialis if testosterone is high enough or put him on HRT (TRT or testosterone therapy) if it is low enough.

2. Study: Effect of Weight Loss on Estradiol, T and T/E2. A more recent study took moderately obese men and had them lose about 60 pounds of weight.  Most obese men have significantly more to lose than just 60 pounds, but this shows a nice snapshot of the change that can occur.  Look at what happened to their hormones levels:

—Testosterone increased 34% from 400 to 536 ng/dl

—Estradiol dropped 22% from 36 to 28 pg/ml

—The testosterone-to-estradiol ratio increased by 72% from 11.1 to 19.1.

The authors basically noted that weight loss restored these men to normal hormone levels:

“In conclusion, increased circulating estrogens and reduced androgen binding were found in moderately obese men, which were completely corrected with weight loss..”

Of course, I would guess many of them could have lost a bit more weight and improved things even furthermore.

Some of you may be thinking, “22% is not that great.  Why not just take Arimidex?”  First of all, I have seen even greater drops on the Peak Testosterone Forum. In fact, the way that I would word it is that, if you drop your body fat percentage down to around 15% – yes, what you were (hopefully) in high school or college – your estradiol levels will fall right back to youthful levels.  In other words, skewed estradiol levels are not so much a function of aging but just the weight gain that occurs so often with those in Western societies.

But even if you “only” got a 22% drop in estradiol, remember that you would boost your testosterone-to-estradiol ratio by 72% according to the above study, which is very likely to make you feel a lot better.  Plus, you’ll like feel much, much better for many other reasons as well.  I outline those in my page on 20+  Reasons to Lose That Extra Body Fat.  Here is just a partial list:

Also, my favorite way to lose weight is with the approach of Clarence Bass. Clarence was a Muscle and Fitness columnist for almost two decades and has done well in Over 40 Mr. USA competitions as well.  He is most famous for maintaining low body fat percentages (2-6%) year around, decade after decade.  What I like about his approach is that he emphasizes losing weight slowly, never being hungry, using a bioimpedance scale and a program comprised of the following:

a) weights and cardio

b) a primarily plant-based diet with some meat

And the other thing about Clarence is that he has proven his program works well into his senior years.  He is still has a great physique, energy and respiratory fitness in his late 70’s!  If you are interested, see my pages  Clarence Bass: Challenge Yourself, Clarence Bass, Senior Bodybuilding and Clarence Bass: Ripped for more information.

REFERENCES:

1) J Clin Endocrinol Metab. 1979 Apr, 48(4):633f , “Increased Estrogen Production in Obese Men”

2) The Journal of Clinical Endocrinology & Metabolism, Published Online: July 01, 2013, 53(4), “The Effect of Weight Loss on Reproductive Hormones in Obese Men”

Natural ACE Inhibitors - Peak Testosterone

ACE Inhibitors are a widely prescribed class of medications for hypertension (high blood pressure). They have been around so long that doctors rarely explain the side effects, some of which are surprsingly serious and/or common as I will discuss below.  (Insurance companies love this class of medication, because, generally, there are cheap.)

If you read about how an ACE Inhibitor works, it is VERY complex and involves multiple systems in the body. Basically, the kidneys release a protein called renin. Renin acts like a filter and plays a role in angiotensen I. The ACE (angiothensin converting) enzyme converts some of angiotensin I to angiotensis II and the latter increases blood pressure and constricts vessels, etc. So someone got the idea of slowing down or inhibiting the ACE enzyme in order to lower blood pressure.  Seems easy enough, eh? However, as you will see below, disturbing this extremely complex set of interrelated systems is fraught with risk, some of which could affect your bedroom performance in one way or the other.

There are many research-backed ways to attack hypertension and I outline some of them in my link on 30+ Natural Ways to Lower Blood Pressure. Using natural methods can in many cases lower your need for antihypertensive medications or eliminated it altogether.  In fact, I discuss below some natural ACE inhibitors that can be of asistance. (High blood pressure is very serious, so do not do anything without discussing with your physician first.)

Are ACE Inhibitors popular? Yes, because they are cheap and synergistically combined with other antihypertensives for additive effects in some cases. Look at the sheer number of ACE Inhibitors out on the market as well: Altace, Lotensin, Accupril, Capoten, Prinivil, Zestril, Univasc, Vasotec, Monopril and Mavik.

CAUTION: Not everything about ACE Inhibitors is bad. They have some extremely beneficial properties and one must weigh the pros and cons with your doctor. Do NOT quit any medication without first consulting your physician.

1)   Journal of Hypertension. Supplement : Official Journal of the International Society of Hypertension, 1988, 6(4):S649-51], “Effects of first-line antihypertensive agents on sexual function and sex hormones”

2) Eur J Heart Fail (2006) 8 (5): 451-459, “Correlation of flow mediated dilation with inflammatory markers in patients with impaired cardiac function. Beneficial effects of inhibition of ACE”

3) https://seniorjournal.com/NEWS/Alzheimers/2007/7-05-08-ChooseAnACE.htm

4) Clinical Cardiology, Jan 2003, 26(1):25-30, “Prevalence and risk factors for erectile dysfunction in men with diabetes, hypertension, or both diseases: A community survey among 1,412 Israeli men”

5) https://www.dynamicchiropractic.ca/mpacms/dc_ca/article.php?id=53661

6)

7) https://www.rxlist.com/script/main/notfoundstatic.asp

8)

That said, “eyes wide open” as I always say. As a patient, you have the right to know how a medication works, what it will do to your body and potential side effects that could be an issue for you down the road. First of all, let’s start with a couple of the not-so-well-known benefits of going with synthetic ACE Inhibitors:

1. Improved Sexual Function (in SOME cases). ACE Inhibitors have a spotty record when it comes to bedroom performance for reasons we will discuss below. However, ACE Inhibitors do generally improve endothelial function and blood flow at least.  In some men, this helps their sex lives. For example, one study looked at the result of a variety of standard antihypertensive medication, including an ACE Inhibitor (captopril), a calcium channel blocker and a beta blocker. [1] Which drug was the only one that did not cause sexual dysfunction? You got it: the ACE Inhibitor. Well, actually this study did not say there was an average improvement, but, anecdotally, some men report a benefit.

2. Decrease Inflammation. One of the Holy Grails in the health world is lowering inflammation, especially markers such as C-Reactive Protein and TNF alpha.  Furthermore, decreasing inflammation as a principle is usually excellent for erections. One study found that one of the ACE Inhibitors greatly increased blood flow by lowering the above inflammatory cyokines (TNF alpha and CRP). [2] (CAUTION: One of the ACE Inhibitors in the study did not do much of anything however.)

And an example of the benefits of this are that some ACE Inhibitors (but not all) have been found to significantly lower the risk of developing dementia, a condition that is now thought to be substantially caused by elevated inflammation.

So are ACE Inhibitors then nothing but Goodness and Light?  Again, there are a few studies that show improvements in function for men with hypertension. [4] However, as mentioned above, this is spotty and certainly not what one would expect from something that can so dramatically increase blood flow.

So now let’s look at some of the many very common side effects associated with pharmaceutical ACE Inhibitors:

1. Lowered DHEA. DHEA is critical to cortisol control and libido. ACE Inhibitors are known to often lower DHEA levels and this is likely one of the big reasons that ACE Inhibitors do not score as well as they should in the erectile strength department. Yes, Erectile Dysfunction is a Risk for High Blood Pressure , but an erection is complex and lowering DHEA is likely to be a net negative. The evidence is surprisingly strong that DHEA deficiences, for example, can play a role in depression, adrenal insufficiency and possibly chronic fatigue syndrome. [6] None of these is going to help your sex life!

2. Persistent Cough. This one will seem just a tad bizarre. Imagine a medication where a VERY common side effect is that you will develop a chronic, nagging cough. Welcome to the world of ACE Inhibitors. Approximately 5 to 25% of patients will develop this kind of cough and it can take a couple of weeks for the cough to stop even after the medicaiton is halted. [7]

3. Erectile Dysfunction. Sexual dysfunction, although not nearly as prevalent as the cough side effect, is widely reported nonetheless. What is worse is that I have never seen a good explanation as to why. This is a good example that they simply do not know or care to know how these pharmaceuticals work.

4. Gynocomastia. Here’s one your doctor is unlikely to mention: gynocomastia is a well-known and fairly side effect of the ACE Inhibitors. Again, I have never seen a plausible explanation as to why, showing these drugs are poorly understood.

ACE inhibitors lower blood pressure by preventing the breakdown of bradykinin, a molecule that causes blood vessels to widen. The swelling is believed to be caused by too much bradykinin, which makes blood vessels widen until they leak, letting fluid seep into tissues.

5. Angioderma. ACE inhibitors lower blood pressure by preventing the breakdown of bradykinin, a molecule that causes blood vessels to widen. The swelling is believed to be caused by too much bradykinin, which makes blood vessels widen until they leak, letting fluid seep into tissues. A not-too-uncommon scenario is for an ACE Inhibitor user to experience swelling of the face and neck – sometimes leading to hospitalization or death! – from this type of tissue enlargement.  [8]

Natural ACE Inhibitors

One question that may cross your mind: “Are there any natural ACE Inhibitors?” The answer is yes and no. There are not ACE Inhibitors with necessarily the same power as one of the pharmaceuticals. That said, it is curious that the medical community has ignored the natural alternatives that seem to be virtually devoid of side effects:

NOTE: Do not take these if you are on medications without first consulting your doctor.  Pomegranate juice is so powerful, for example, that it can alter absorption rates of certain pharmaceuticals.

1.  Pomegranate Juice. Pomegrantate Juice has a natural ACE Inhibitor (among other powerful phytochemicals) that can lower blood pressure.  I call pomegranate juice my Best Bedroom Buddy, because it also increases nitric oxide and improves lipid profiles and on and on.  For more information, read my link on The Many Benefits of Pomegranate Juice.

2. Hawthorne Berry.  This fruit is an ACE Inhibitor and, remarkably, its’ also a Calcium Channel Blocker and nitric oxide booster. [5] You can buy it by itself or as NEO 40 (Neogenis Labs) , which has additional ingredients in it including L-Citrulline.  You can read more about in my links about  The Good and Bad of L-Citrlline and An Interview with Nathan Bryan.

REFERENCES:

Flaxseed: Solid Reductions in Cancer and PSA diseases.

I am always on the hunt for prostate cancer cures and methods of prevention. I consider it to be just as interesting a topic as testosterone itself. The reason is simple: if my PSA rises, then it’s game over: I may have to go off of HRT. (Morgentaler’s study calls this into question, but I am giving here the prevailing medical sentiment.) Plus, it may be game over as in permanently! I knew someone who had metastatic prostate cancer and this very nice guy was here one day and almost literally gone the next.

As you’ll see below, there is a new way that will likely significantly reduce your PSA and provide substantial prostate cancer as well.  And I have seen very little coverage on the subject and feel that this deserves mention to say the least.  This is especially true since prostate cancer is incredibly common, especially in Western societies. As I discuss elsewhere on the site, HCA’s from cooked red meat were a huge part of my early diet and experts feel these are likely culprits in prostate cancer development. One prospective study found that there was a 20% risk increase of prostate cancer (and even greater risk of other diseases) from certain HCA’s and concluded:

“Very well done meat was positively associated with prostate cancer risk. In addition, this study lends epidemiologic support to the animal studies, which have implicated PhIP as a prostate carcinogen.” [1]

And one study showed that about 1 in 6 men with a PSA < 4.0 developed prostate cancer in seven years. [2] In other words, this is a very common cancer and, in fact, is only exceeded by lung cancer and heart disease as a killer of men. [3]

NOTE: It should be noted that one of the leading researchers believes that testosterone has nothing to do with prostate cancer and has built a strong case to support that assertion. He tells his side of the argument here in this must-read article. In addition, it should be pointed out that the PSA exam is far from perfect and can fluctuate considerably due to exercise, sexual activity, infections and so on. That said, PSA is certainly not always wrong.

What they found was the removed prostates of the men on the Low Fat Diet with flaxseed and “matched by age, race, prostate-specific antigen level at diagnosis, and biopsy Gleason sum” had a much greater rate of cancer cell death and a much lower rate of cancer cell proliferation.  Furthermore, those with lower a Gleason score less than 6.0 had lower PSA’s. [5] Suddenly, it dawned on everyone that not all sources of alpha linolenic acid are created equal.

CAUTION: This study showed a drop in testosterone from the diet of about 15% from 420 ng/dl to 360 ng/dl. As you’ll see below, this may be an anomaly as men on an identical diet experienced no change in testosterone in the study mentioned in #3 below. [6] In my case, it is of no concern anyway, because I am on HRT.  If you are a low testosterone man, you may want to do some testosterone testing before and after just to make sure.  See my link on Testosterone Labs for additional information.

3.  2004 Study of a Low Fat Diet + Flaxseed. A followup study to #2 was conducted on men scheduled for a prostate biopsy.  These were men with potential prostate issue (and high PSA’s). The men were put on the same kind of diet (less than 20% of total calories from fat) and 30 grams of flaxseed per day.  The results were remarkable: [6]

4. 2008: Flax Seed More Powerful Than Low Fat Diet. A 2008 paper answered the next logical question:  was it the flax seed or the Low Fat Diet that was responsible for the prostate cancer protection?  All of the above studies used both simultaneously, so it is difficult to know which was the more powerful solution.  To answer that questions, the same researcher (Wendy Demark-Wahnefried) at Duke University created four study groups:  a) the control, b) men with flax seed, c) men on a Low Fat Diet and d) men on both flax seed and a Low Fat Diet. [7]

Now I am a big Low Fat Diet fan and I list the reasons here in my link on The Incredible Benefits of a Low Fat Diet. And one of those reasons is that a study by Dean Ornish indicated that a Low Fat Diet would more than likely provide substantial reductions in prostate cancer rates. However, the Ornish Study looked primarily at markers whereas this 2008 study actually examined the prostates. Like study #2, the men went on the various combinations of flaxseed and/or a Low Fat Diet for 30 days before a prostatectomy and then their prostates were examined. So this study provided the “acid test!”

The results were clear: flax seed provided the greatest protection:

Basically, it was flaxseed that provided the most prostate cancer protection, although the 20% reduction of the Low Fat Diet is pretty impressive just on its own. Remember that the classic definition of a Low Fat Diet is more around 10% of calories from fat and so this allowed double that amount. In other words, what I would call a “true” Low Fat Diet may have provided additiona protection.

However, the bottom line is that flaxseed was clearly the superstar and clearly reduced prostate cancer rates dramatically all by itself.  Notice that combining it with a Low Fat Diet did not seem to provide that many synergies, only reducing prostate cancer proliferation rates by an additional 5%.  However, there are other reasons to go on a Low Fat Diet as metnioned above.  For additional ways, see my page on How to Lower Your Prostate Cancer Risk Naturally according to the latest research.

OMEGA-3’s: One huge potential benefit of using flaxseed with a Low Fat Diet is that you may be able to reduce or eliminate your dependence on fish oil. Fish oil is an excellent source of omega-3’s, but many of the world’s supercultures do not consume fish yet enjoy almost perfect health with regards to the chronic diseases that plague Westerners. They get ample omega-3’s through their non-fish diet, which is mostly plants and live to be 90+ in almost perfect health with no dementia or Alzheimer’s.

Now why would anyone want to lower their consumption of fish oil?  Well, it appears that in some cases it may increase the risk of prostate cancer according to one recent study. [8] And, furthermore, the problem is that more than one study has indicated this may be the case.  The researchers in charge of the study actually recommended eating fish once or twice per week instead.

I hope to write a page soon on how to get (some or possibly all) of your omega-3’s from flaxseed and thus reduce your dependence on fish oil.  It does require a good nutritional base to do it properly as I will discuss.

DOSAGE: How much flaxseed is the 30 grams used in the above studies?  I am sitting here looking at my package of ground flaxseed and it says that 2 tablespoons provide 13 grams.  If you do the calculations this works out to basically 4.5 tablespoons of ground flaxseed.

For anyone following a Low Fat Diet, this would add about 10.4 grams of additional fat into your diet and would take someone from the traditional 10% fat level to 13.4% fat.  If you reduce your carbs to make up for the increase in calories, it would take you up to 13.7% fat.

CAUTION: The only caution that I have about flaxseed is that I wish they would study the effect on the male brain.  As I document in my link on Soy and Men, there are a couple of studies linking soy consumption to shrinkage of some brain tissues. This is a controvesial find by the way, but flaxseed also has a sizeable propopertion of phytoestrogen and so I think this would be an important study to conduct.

REFERENCES:

1)  Cancer Res, Dec 15 2005, 65(24):11779-84, “A Prospective Study of Meat and Meat Mutagens and Prostate Cancer Risk”

2) N Engl J Med, 2004, 350:2239-46, “Prevalence of Prostate Cancer among Men with a Prostate-Specific Antigen Level ≤4.0 ng per Milliliter”

3) https://www.cancer.org/cancer/prostatecancer/detailedguide/prostate-cancer-key-statistics

4) , “A MIRACLE SEED COMES DOWN TO EARTH”, by David Schardt

5) Urology, Jul 2001, 58(1):47:52, “Pilot study of dietary fat restriction and flaxseed supplementation in men with prostate cancer before surgery: exploring the effects on hormonal levels, prostate-specific antigen, and histopathologic features”

6) Urology, May 2004, 63(5):900-904, “Pilot study to explore effects of low-fat, flaxseed-supplemented diet on proliferation of benign prostatic epithelium and prostate-specific antigen”

7) Cancer Epidemiol Biomarkers Prev, 2008 Dec, 17(12):3577–3587., “Flaxseed Supplementation (not Dietary Fat Restriction) Reduces Prostate Cancer Proliferation Rates in Men Presurgery”

8) https://www.dailymail.co.uk/health/article-2359466/Taking-omega-3-fish-oil-supplements-increase-risk-aggressive-prostate-cancer-70.html

So is there any way for someone like myself, who ate a ton of fast food hamburger cooked at near blast furnace temperatures to put the odds back in his favor?  Yes, that appears to be the case and researchers have been lasering in on flaxseed for the last decade, because it seems to have anti-prostate cancer superpowers. Let’s look at the interesting history of flax seeds on this subject:

1.  Pre-2001.  Interestingly enough, prior to about 2005, researchers seemed to generally consider flaxseed a risk factor for prostate cancer based on several epidemiological studies.  It turns out that the reasoning behind this conclusion was entirely circumstantial:  it was actually ALA (alpha-linolenic acid, NOT alpha lipoic acid) in the diet that was linked in these studies to prostate cancer. [4] Experts assumed that since flaxseed was high in ALA that this meant it was linked to prostate cancer risk.

My guess is that there is a logical explanation for the above: one of the big sources of ALA in the diet are some of the standard cooking oils such as safflower, sunflower, canola, etc.  These oils, being high in omega-6’s, can increase inflammation if over consumed and animal studies show they accelerate prostate cancer.

2. 2001 Study of Low Fat + Flaxseed. The concern about flaxseed really turned around in 2001 with a study lead by Wendy Demark-Wahnefried that looked at men with actual prostate cancer. These men were put on a low fat diet – less than 20% fat by their definition – and 30 grams of flax seed per day. The way they conducted the study was particularly impressive, because all the particpants were waiting for a prostatectomy, i.e. the researchers were able to examine the prostate tissue of the men and examine the actual spread of the prostate cancer.

Progesterone Lowers Estradiol - Peak Testosterone

Many men know that progesterone lowers DHT (dihydrotestosterone), which could be good or bad depending on your situation.  What is not as well known is that progesterone can also lower estradiol levels in us guys.  Many men, especially as they age, end up with high estradiol levels – usually due to weight gain – and are wondering how to control it naturally.  Of course, the first order of business should be to drop those extra pounds through diet and exercise.  But one also might want to pull one’s progeseterone levels as this could be a partial explanation as well.

Here is a summary of the research-based evidence that progesterone lowers estradiol by modifying aromatase activity. Aromatase is the enzyme in fat tissue that converts some of your testosterone into estradiol.  This is why overweight men tend to have higher estradiol and lower testosterone:  the more fat tissue, the more aromatase.

I will mention that all of the studies below are in women.  Furthermore, it is not really that common for men to take progesterone and then monitor their estradiol, and so it is difficult to even find confirmation out on the forums.  However, we had man on the The Peak Testosterone Forum who, when asked if progesterone lowers estradiol, wrote, “Yes it does. I proved it on myself.” [3]

Here are some of the studies that state the same thing:

1. Fat Cells. An in vitro study shows that progesterone inhibits aromatase in a dose dependent manner, i.e. the more progesterone, the greater the inhibition:

Regardless, it seems clear that a solid amount of evidence indicates that progesterone inhibits aromatase.  (Of course, it would be nice to have a study or two in men confirming this fact.)

Also, I am not encouraging anyone to necessarily try progesterone.  It does have some risks, which I list here:  The Potential Dangers of Progesterone. And there is a potential backdoor route:  supplemental pregnenalone can raise progesterone in some men.

REFERENCES:

1)  Anticancer Res, 2008 Jul-Aug, 28(4B):2129-33, “The anti-aromatase effect of progesterone and of its natural metabolites 20alpha- and 5alpha-dihydroprogesterone in the MCF-7aro breast cancer cell line

2) Biochem Pharmacol, 2008 Jul 15, 76(2):208-15, “MCF-7aro/ERE, a novel cell line for rapid screening of aromatase inhibitors, ERalpha ligands and ERRalpha”

3) https://www.peaktestosterone.com/forum/index.php?topic=7927.0

3) Acta Endocrinol (Copenh), 1975 Nov, 80(3):569-76, “Progesterone, 20 alpha-dihydroprogesterone and 20 beta-dihydroprogesterone in mother and child at birth”

4) Journal of Endocrinology, 1998, 158:401 407, “Progesterone inhibits glucocorticoid-dependent aromatase induction in human adipose fibroblasts”

5) J Steroid Biochem, 1986 May, 24(5):1033-9, “Aromatase activity and concentrations of cortisol, progesterone and testosterone in breast and abdominal adipose tissue”

“In fibroblasts derived from human adipose tissue, aromatase induction is observed after exposure to 1 M cortisol in the presence of serum or platelet-derived growth factor (PDGF). Progesterone suppresses this induction in a dose-dependent manner, 10 M resulting in complete inhibition. A reduced cortisol concentration (0 1 M) concomitantly reduces the progesterone concentration required for effective inhibition (10 100 nM). This effect of progesterone is specific, as neither the release of cellular enzymes nor aromatase induction by dibutyrylcAMP, which acts independently from cortisol, are affected.” [4]

NOTE:  Progesterone seems like the most controversial of the big gun, common hormones for men.  It has some stellar results as you can read about in my page on Progesterone and Erectile Dysfunction and The Benefits of Progesterone in Men. However, it also has some decided risks, which I discuss in my page The Potential Dangers of Progesterone.

2. Aromatase Activity. One study took pre and post menopausal women, in order to get a wide range of hormonal values, and basically evaluated all their hormonal data points beside aromatase activity.  What they found was that aromatase activity was not correlated with testosterone or cortisol, but was inversely related with progesterone.  This means that the more the progesterone, the less the aromatase activity. [5]

3. Cancer Breast Cell Line.  One study looked at a breast cancer cell line that produces high levels of aromatase and found that a metabolite of progesterone (20alphaDHP) is an aromatase inhibitor. It did not find progesterone itself to be one however. [1] And don’t get hung up on the fact that this is a breast cancer line – they use it for rapid screening of AIs (aromatase inhibitors). [2]

Do males have significant amounts of 20alphaDHP?  I had trouble finding confirmation of that fact but did find this:

DHEA: How to Increase It (Naturally and Otherwise) - Peak Testosterone

On this page, I will be talking about the standard DHEA dosages that I see out there. However, even discussing the subject makes some assumptions in my mind. First of all, I don’t think anyone should supplement that is not actually low in DHEA-S. Furthermore, I believe that this kind of “protocol” should be followed:

a) Talk to a doc or LEF, naturopath or Life Extension Foundation and find out if you have any contraindications.  (High PSA, arrhythmia, etc.)  Read my page on DHEA Dangers.

b) Get a DHEA-S blood draw and, if low, proceed to b.

c) Discuss with  a doc or LEF, naturopath or Life Extension Foundation an appropriate dosage.  Of course, I recommend reading below

c)  Find your target DHEA-S levels.  I have seen docs and the LEF generally target a range of 350-500 ug/dl approximately.

d) Re-measure after a few weeks and verify you have hit your target levels.

CAUTION:   My labs were 108 ug/dl, which is very low, and this is the sole reason that I tried it. Again, you do not want to even consider taking DHEA in my opinion unless you are low in DHEA-S and you do not want to go too high in DHEA-S after you begin taking DHEA either. Set a target with your physician or naturopath. From what I have seen, usually the upper mid range of DHEA-S is what is targeted and where men often feel best.

1. Ray Peat (~4 mg daily).  Ray Peat, a respected blogger with a Ph. D. in Biology wrote:

“Young people produce about 12 to 15 milligrams of DHEA per day, and that amount decreases by about 2 mg. per day for every decade after the age of 30. This is one of the reasons that young people eat more without getting fat, and tolerate cold weather better: DHEA, like the thyroid hormone, increases our heat production and ability to burn calories. At the age of 50, about 4 mg of DHEA per day will usually restore the level of DHEA in the blood to a youthful level. It is important to avoid taking more than needed, since some people (especially if they are deficient in progesterone, pregnenolone, or thyroid) can turn the excess into estrogen or testosterone, and large amounts of those sex hormones can disturb the function of the thymus gland and the liver.” [1]

His comment about 4 mg restoring youthful levels does not mesh with that of LEF, where around 25 mg is used to get men back to youthful levels.  Studies that I have seen also mention a higher dosage to get to youthful levels. As I always say:  measure yourself and see if you are hitting your target levels.  You can do that with these cheap Self-Testing Testosterone Labs.

2. Dr Shames (5-10 mg daily). Dr. Shames is one of the pioneering thyroid and adrenal fatigue physicians.  He writes in his book that it is a “potent medication” that should be limited in his opinion to 5-10 mg daily. [4]

CAUTION: I always recommend, when it comes to hormones, working with a knowledgeable physician, naturopath or organization such as Life Extenson Foundation.  Also, some countries do not allow over the counter purchases of DHEA.

3. LEF (15-50 mg daily). To find the dosage appropriate for me, I called Life Extension Foundation and they recommended 25 mg for a man on testosterone therapy like myself.  However, their page says that one may need between 15 and 50 mg in order to achieve target levels of DHEA-S.  What are these target levels?   According to their web site as of this writing, the stated goal for adult men is to keep DHEAS levels between 350 and 500 ug/dl. [2] This is what I call a “replacement philosophy,” where the goal is simply to restore a give hormone to youthful levels. The contrast to this is going “supraphysiological,” i.e. raising hormones past what is normal and natural.  This often leads to problems in my opinion whether you are talking about testosterone, estradiol, DHEA, melatonin, etc.

One of the moderators on the Peak Testosterone Forum provided an example of this when he took 25 mg of DHEA and yet it only boosted his levels of DHEA-S to ~220 ug/dl. []

4. IGF-1 (25 mg).  On my page DHEA and IGF-1, I make a case that 25 mg should probably be your upper limit on DHEA, in order to avoid raising your IGF-1 levels too much.  (Not everyone reacts the same to a given dosage, so the best thing is to measure your IGF-1 before and after using on of these Hormone Labs in my opinion.)

5. Well Known TRT Doctors (25 mg daily). Dr. Shippen is one of the early pioneers of testosterone therapy and seems to be well-respected by his patients.  (I have no affiliation.)  He wrote the TRT classic The Testosterone Syndrome years ago that was clearly ahead of its day. According to one of our senior posters on testosterone therapy, Dr. Shippen prescribed 25 mg of oral DHEA per day.  Dr. Shippen prefers this brand.  Like me, this man is on HRT (testosterone therapy) that includes a combination of testosterone cypionate and daily HCG.  Does this mean that Dr. Shippen always recommends 25 mg?  Of course not.  I am sure he tailors based on your preexisting DHEA-S levels, whether you are on TRT and a number of other factors, i.e. you’d have to set up an appointment to verify. [3]

In addition, you can read in my post on How DHEA and Pregnenalone Cured My Anxiety how Dr. Justin Saya put me on a similar dosage of 25 mg of DHEA per day (oral before bed). Again, you would have to call Dr. Saya and make an appt to find his dosage for you inidividually.

6.Diabetes and Prediabetes (25-50 mg daily). This is an involved subject as the studies are mixed.  In my opinion, the data overall suggests that  men struggling with blood sugar issues and high cholesterol can improve insulin sensitivity and normalize blood sugar levels with reasonable dosages of DHEA.  Of course, if you are diabetic in particular, it is critical to talk to your doctor first before making any changes.

7. Mood, Depression, Anxiety and Cognition (50 mg). Dosages in the successful studies for these conditions tend to be 50 mg from what I have seen.  For example, one study of middle-aged and senior men and women 40-70 years found that 50 mg “was associated with a remarkable increase in perceived physical and psychological well-being for both men (67%) and women (84%) .” [5]

REFERENCES:

1) https://raypeat.com/articles/articles/three-hormones.shtml

2) https://www.lef.org/Protocols/Metabolic-Health/Dhea-Restoration/Page-les

3) https://www.peaktestosterone.com/forum/index.php?topic=7610.0

4) Feeling Fat, Fuzzy or Frazzled, by Dr. Shames, p. 163

5) J Clin Endocrinol Metab, 1994 Jun, 78(6):1360-7, “Effects of replacement dose of dehydroepiandrosterone in men and women of advancing age”

6) https://www.peaktestosterone.com/forum/index.php?topic=7610.0

Testosterone and Migraines: Low Levels Appear to Be a Cause

Migraine headaches are excruciatingly painful.  Pre-migraine symptoms create fear and dread in victims.  Medications are very potent and often have limited success, which is why I have many natural, research-backed ideas on my Migraine Prevention page for those interested. There is also another interesting root cause theory out there: migraines have a strong hormonal component testosterone probably the key player. Below are some of the interesting lines of research evidence that this is indeed the case:

1. Dzugan’s Hormonal Migraine Cure. For anyone interested in anti-aging and hormones, Sergey Dzugan is one of the more fascinating researchers in my opinion.  His general methodology is to carefully restore testosterone, estradiol, progesterone, DHEA and pregnenalone to youthful levels. This strategy has allowed him to document some amazing clinical successes, which he has published in various medical journals.  Dr. Dzugan tackled migraine headaches, using this hormone-restoring technique and his results have apparently been very good.  He has even published a book on the subject:  The Migraine Cure: How to Forever Banish the Curse of Migraines.

In my opinion, it is no wonder that restoring these hormones to youthful levels help so much:  they all have a profound and positive effect on the brain and migraine is, after all, a brain-centered medical issue. How many young men suffer from migraines?  Not many and so one can’t help but wonder if part of that can be explained by their (generally) ample hormones levels.

Of course, one potential issue with Dzugan’s approach is that we cannot tell which hormone or hormones is most responsible for improving migraines, since he modifies so many of them.  However, I believe the biggest gun is probably testosterone for reasons I describe below:

NOTE:  Cluster headaches, which are the only headaches considered by some experts to be often more painful than migraines, are also related according to significant research to hormones.  See my page Low Testosterone and Cluster Headaches for more information.

a) Adiponectin Controls the Severity of Migraines.  One recent study (in women) found that “found that in all 20 participants when levels of LMW [Low Molecular Weight Adiponectin] increased, the severity of pain decreased. When the ratio of HMW [Heavy Molecular Weight Adiponectin] to LMW molecules increased, the pain severity increased..” [3] Although this is a small study, they hit 100% accuracy using adiponectin-based markers to predict whether or not particpants would respond to migraine treatment.

Although this was a study in women, the adiponectin pathways work very similarly in men and this is, undoubtedly, one of the reasons that Dr. Dzugan’s method above is so successful.  In fact, researchers have even noted that adiponectin has a powerful inflence on a) inflammation, b) immunity andc) insulin sensitivity, all of which have been implicated in migraine. And researchers have even verified that adiponectin directly plays a role in pain pathways as well. [3][5]

That said, it is worth noting that a number of studies have shown that testosterone decreases adiponectin levels in low T men. This has been verified in both animal and human studies.  Castrated animals, for example, immediately see their adiponectin levels rise.  And one study looked at normal and low testosterone men. As expected, they found adiponectin was significantly higher in the low T cohort. So they looked at what would happen if they put these men on testosterone therapy and the results were impressive:  the adiponectin levels of they hypogonadal men dropped to the levels of the normal testosterone men.

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CONCLUSION: In men that are significantly overweight, losing the extra pounds will greatly lower adiponectin levels and increase testosterone levels.  This is, of course, the most natural method to use..  In men that are not overweight or for men with particularly severe migraines, testosterone and perhaps other hormonal therapies can drop adiponectin levels and improve and sometimes permanently cure migraine headaches.  Discuss with your doctor and read these pages for some background on HRT in men:  Risks, Rewards, Testing for Testosterone Therapy.

NOTE: Spread the word to your wife or girlfriend suffering from migraines: there is now a study showing that restoring testosterone in women (using pellets) can dramatically help.  The researchers concluded that “improvement in headache severity was noted by 92% of patients and the mean level of improvement was statistically significant (3.3 on a 5 point scale)…Continuous testosterone was effective therapy in reducing the severity of migraine headaches in both pre- and post-menopausal women.”

1) Clin Endocrinol (Oxf), 2004 Apr, 60(4):500-7, “Serum adiponectin levels in hypogonadal males: influence of testosterone replacement therapy”

2) J Androl, 2005 Jan-Feb;26(1):85-92, “Testosterone administration suppresses adiponectin levels in men”

3) https://www.sciencedaily.com/releases/2013/03/130318131205.htm

4) Maturitas,  2012 Apr, 71(4):385-8, “Testosterone pellet implants and migraine headaches: a pilot study”

5) Cephalalgia, 27(5):435 446, May 2007, “Migraine and adiponectin: is there a connection?”

Exercise Can Greatly Increase/ Lower Inflammation - Peak Testosterone

You ever feel like you live in Opposite World?  Well, I do sometimes as I read about the world of health, medicine and longevity.  I’ll explain what I mean below, but first consider this proposition:

Not only is the above true, but I will show below that moderate exercise is nearly as powerful as any anti-inflammatory drug.  The effects are both profound and long-lasting. The best example of this from the research is probably from a study that put the participants in two groups doing 30 minute bike rides.  One group did “regular” bike riding and the other the same but with a lot of braking.  What was the purpose of the braking?  Basically, to inflict greater muscle damage.

As you may have guessed, the partipants doing just normal cardio on the bike without all the braking achieved the powerful anti-inflammatory effects:  their IL-6 levels rose a little bit post-exercise – maybe 50% – and then dropped 50% below baseline values on days 2-7! [8] (IL-6 is your body’s Inflammation Increaser.) Yes, it looks like you can cut your IL-6 levels in half by simply sticking with moderate exercise rather long duration or intense exercise protocols that do significant muscle damage even though they are relatively equal as to how hard they push your cardiovascular system.

The title of this study was “Exercise-induced increase in serum interleukin-6 in humans is related to muscle damage”  and I highly recommend that you pull up the full study online and read through it here.

Keep in mind that this study is not the only one to show that moderate exercise, i.e. exercise such as a brisk walk, swimming or easier cardio style biking like the above, dramatically decreases inflammatory levels in the body.  There are also studies that show that moderate exercise decreases TNF alpha for days after, and TNF is your body’s other big Inflammation Increaser.

Again, why have I never read an article in any fitness or health magazine or blog on this subject?!  I believe this is underplayed by the health press because moderate exercise does not sell.  Nobody wants to hear about moderate exercise, because it is considered boring and time consuming.  But the fact is that there is no pill that can do what moderate exercise can do for you. Don’t forget that it also boost baseline nitric oxide levels and is a powerful anti-depressant.  But to get these benefits, you have to be willing to let your body rest and forego all the muscle (and I sure tendon/ligament) damage.  Don’t believe me?  Check out this:

DOES INTENSE AND/OR LONG EXERCISE RAISE INFLAMMATION? Let me answer that question with a question:  do you know what Overtraining Syndrome (OTS) is?  If so, you know you know that OTS is a nasty condition that afflicts men that have trained too intensely for too long.  Not surprisingly, recent evidence shows that inflammation is the root cause of Overtraining Sydnrome (OTS).  Check out this summary:

“A number of hypotheses have been proposed to explain various symptoms associated with OTS, yet none have sufficiently accounted for all the manifestations of the syndrome. A recent article in Medicine and Science in Sport and Exercise presents an all-encompassing hypothesis focused on the role of cytokines in initiating and perpetuating OTS. The Cytokine Hypothesis suggests that exercise-induced muscle and connective tissue microtrauma triggers the release of pro-inflammatory cytokines (e.g. IL-1 beta, IL-6 and TNF-alpha), which when sufficient rest is allowed, can aid in the healing process. The acute inflammation that results from excessive exercise with inadequate rest, however, evolves into a chronic response resulting in a systemic immune response involving the central nervous system (CNS), liver, and immune system (see Figure 1).” [11]

In other words, overexercising can do the polar opposite of all that you want to do as a guy.  Instead of de-aging yourself, you can actually put your foot on the accelerator to the grave.  Instead of avoiding all the chronic disease that you see all around you, you are actually embracing it.

SO WHEN DOES INTENSE AND/OR LONG EXERCISE RAISE INFLAMMATION?  To understand the discussion, I need to explain that there are two primary inflammatory “messengers” in the body:  IL-6 and TNF alpha. These messengers are called “cytokines” in the research, and, if you read health stuff, you will see them crop up all the time, because they are so fundamentally associated with the chronic disease that you see in modern societies – more on that below.

So at what point does exercise increase inflammation rather than lower it?  Here are a few key principles:

a) If you are overweight or obese, this will increase TNF alpha levels and TNF alpha is arguably the prime player in inflammation.  Exercise, by increasing metabolism and burning calories, can help with weight loss.

b) Exercise increases transiently IL-6  and IL-6, in turn, dampens TNF alpha.  This is one of the ways that exercise can lower inflammation in a positive way. [12] That said, exercise, if overdone, can actually lead to runaway inflammation.

c) Exercise (if done right) can lower both baseline TNF alpha and IL-6 levels.  However, if done for too long or with too much intensity or volume can increase inflammation.

Here are some example from the research of “over-exercising” and how it can dramatically raise inflammation for days afterward:

1. Equivalent to Trauma. Participants were put on a 2.5 hour treadmill run at 75% VO2max- pretty serious exercise indeed.  Researchers observed the following:

“The plasma concentration of IL-6 increased after 30 min of running, and peaked at the end of running with a 25-fold increase compared with the pre-exercise value. IL-1ra increased only after running, and peaked after 2 h of rest with an 18-fold increase compared with the pre-exercise value…The results suggest that very early events in exercise trigger the release of IL-6, and that the cytokine response to exercise has similarities to that observed after trauma.” [1]

2. IL-6 @ 2 Hours Post-Exercise. Another earlier study put particpants on a mere 30 minute bike ride but added in a lot of braking, which of course would tend to really work the muscles.  What they found was that two hours after exercis IL-6 levels were 4.75 X baseline values.  Again, just 30 minutes of exercise spiked IL-6 for hours after exercise. [8]

3. IL-6 Elevated for At Least 3 Days. This same study found that IL-6 was elevated between 2.0 and 2.5 X baseline IL-6 before the study.  In other words, just 30 minutes of exercise doubled inflammation for days afterward.

4. IL-6 Levels Increase a 100 Fold Post-Marathon. This astonishing increase is hard to argue as being good from the longevity and anti-aging perspective if you ask me much as I admire anyone who does a marathon.  It’s fun and impressive, but it is hard to believe these levels of inflammation are going to play out well in the long term if done regularly. [10]

REBUTTAL:  Anti-Inflammatory Molecules May Save the Day? Some may argue that a trained individual will secrete a barrage of anti-inflammatories that compensate for the astronomical increases in IL-6.

“Thus, the increase in TNF-alpha and IL-1beta levels is accompanied by a dramatic increase in IL-6. This release is balanced by the release of cytokine inhibitors (IL-1ra and TNF receptors (TNF-R)) and the anti-inflammatory cytokine IL-10. In addition, the concentrations of the chemokines IL-8, macrophage inflammatory protein (MIP)-1alpha and MIP-1beta are elevated after a marathon (K Ostrowski and BK Pedersen, unpubl. data, 2000). These findings suggest that cytokine inhibitors and anti-inflammatory cytokines restrict the magnitude and duration of the inflammatory response to exercise.” [10]

SO WHO CARES ABOUT IL-6 and TNF ALPHA? Let’s look at just IL-6. Elevated levels of IL-6 has been associated with just about every nasty chronic disease you can think of:

a. Atherosclerosis (Arterial Plaque). “…the interleukin-6 (IL-6) cytokines and their signalling events have been shown to contribute to both, atherosclerotic plaque development and plaque destabilisation via a variety of mechanisms.” [3]

b.  Alzheimer’s. “We investigated whether interleukin-6 could be detected in plaques of Alzheimer’s disease patients prior to the onset of neuritic degeneration. We found interleukin-6 mostly in plaques where neuritic pathology has not yet developed. This indicates that the appearance of interleukin-6 may precede neuritic changes and is not just a consequence of neuritic degeneration.” [4]

c. Crohn’s. “Increased levels of IL-6 and sIL-6R have been demonstrated in both serum and intestinal tissues of the patients with active Crohn’s disease. In animal model studies, anti-IL-6R monoclonal antibody (mAb) successfully prevented intestinal inflammation and systemic wasting disease by suppressing adhesion molecule expression by vascular endothelium.” [5]

d.  Irritable Bowel Syndrome. “IBS patients showed significantly (P < .017) higher baseline TNF-alpha, IL-1beta, IL-6, and LPS-induced IL-6 levels compared with HCs.” [6]

e. Rheumatoid Arthritis. “Interleukin 6 (IL-6) is a pleiotropic cytokine with a pivotal role in the pathophysiology of rheumatoid arthritis (RA). It is found in abundance in the synovial fluid and serum of patients with RA and the level correlates with the disease activity and joint destruction.” [7]

So bottom line for you guys 40+:  be careful.  If you can afford it, pull some of these values and see how you are doing.  You generally don’t want elevated IL-6 or TNF alpha.

REFERENCES:

1)  J of Physiology, Dec 1998, 513(3):889 894, “A trauma-like elevation of plasma cytokines in humans in response to treadmill running”

2) International Journal of Obesity, 2000, 24:1207-1211, “Moderate-intensity regular exercise decreases serum tumor necrosis factor-a and HbA1c levels in healthy women”

3) Thromb Haemost, 2009 Aug, 102(2):215-22, “How much is too much? Interleukin-6 and its signalling in atherosclerosis”

4) Neurobiol Aging, 1996 Sep-Oct, 17(5):795-800, “Interleukin-6-associated inflammatory processes in Alzheimer’s disease: new therapeutic options”

5) Curr Drug Targets Inflamm Allergy, 2003 Jun;2(2):125-30, “IL-6 and Crohn’s disease”

6) Gastroenterology, 2007 Mar, 132(3):913-20, “Immune activation in patients with irritable bowel syndrome”

7) Ther Adv Musculoskelet Dis, 2010 Oct, 2(5):247 256, “The Role of Interleukin 6 in the Pathophysiology of Rheumatoid Arthritis”

8) Journal of Physiology, 1997, 499(3):833-841, “Exercise-induced increase in serum interleukin-6 in humans is related to muscle damage”

9) J Am Coll Cardiol, Dec 2004, 44(12), “Effects of prior moderate exercise on postprandial metabolism and vascular function in lean and centrally obese men”

10) Immunology and Cell Biology, 2000, 78:532 535;, “Special Feature for the Olympics: Effects of Excercise on the Immune System”

11) https://www.rndsystems.com/resources/articles/cytokines-and-overtraining

12) Journal of Applied Physiology, Apr 1 2005, 8(4):1154-1162, “The anti-inflammatory effect of exercise”

How One Meal Can Significantly Lower Your Testosterone?

What many men do not realize is that the size of their meals, especially certain macronutriet components, can strongly influence their testosterone levels for hours afterward.  What the research shows is that you can turn your meals into an “anti-androgen” pretty easily.  Here are just a few ways to do it:

1.  Too Much Fat. One thing that has intrigued researchers is how and why a high fat meal lower testosterone levels for hours afterward.  One study wrote that “postprandial [post-meal] testosterone concentrations have been shown to significantly decrease after a fat-rich meal, which may be due to inhibition of testosterone production by chylomicrons.” [1] Chylomicrons are simply lipoproteins that include things like cholesterol and triglycerides. These same researchers looked at high fat meals in the 65-85% range and found that total and free testosterone were reduced by 22% and 23%, respectively.  And, even more significantly, they remained lowered for 8 hours afterward!

The researchers already knew the results, because about 10 years earlier researchers found that a high fat meal very significantly lowered testosterone but a “mixed meal” had a negligible effect on testosterone. [2] The mixed meal was “mixed carbohydrate and protein with minimal fat.” Therefore, carbs are kept to a reasonable quantity and fat is minimized.  One interesting thing is that one study showed that when participants were given just fat, their testosterone did not change appreciably. [3]

LOW FAT DIET: Notice what diet is unlikely to decrease your testosterone post meal: the kind of diet that I eat on a regular basis. I eat a kind of hybrid Low Fat Diet that is based on supplemental protein, for muscle building purposes, coupled with a low glycemic load diet. The extra protein that I consume should put this in the category of the “Mixed Diet” above that preserved testosterone post-meal. This is because carbs are reasonable and low glycemic and fat is low. And remember: a low glycemic, Low Fat Diet has a good chance of regressing both your prediabetes/diabetes AND arterial plaque, something I cover in my page on Low Fat Diets and Diabetes. However, some studies show that an increase the protein/carbohydrate ratio leads to a significant decrease in testosterone levels. For example, one small study of normal, healthy men showed a 21% in testosterone levels as the protein-to-carbohydrate ratio was increased. [5]

SELF-TEST BEFORE AND AFTER: The bottom line is it seems clear that the extremes in meal macronutrient selection will often lower your testosterone significantly.  However, these changes are poorly understood and probably have considerable individual variation.  For this reason, it is probably wise to monitor your testosterone before and after any major changes. For information on labs that have been brought up on the forum, see my page on Testosterone Testing Labs.  (I have no affiliation with or personal knowledge of these labs, so do your own due diligence.)

REFERENCES:

1)  Metabolism, 2001 Nov, 50(11):1351-5, “Effects of a high-fat diet on postabsorptive and postprandial testosterone responses to a fat-rich meal”

2) Metabolism, 1990 Sep, 39(9):943-6, “Effects of a fat-containing meal on sex hormones in men”

3) https://www.jissn.com/content/pdf/1550-2783-8-19.pdf

4) Aging Cell, 2010 April, 9(2):236 242, “Long-term effects of calorie restriction on serum sex hormone concentrations in men”

5) Life Sciences, May 4 1987, 40(18):1761 1768, “Diet-hormone interactions: Protein/carbohydrate ratio alters reciprocally the plasma levels of testosterone and cortisol and their respective binding globulins in man”

6) Karila, TA., et al. Rapid Weight Loss Decreases Serum Testosterone. (2008) Int. Journal of Sports Medicine. May 30

2.  High Glycemic Load Foods. There are a couple of studies now that show that consuming glucose significantly lowers testosterone post-meal.  In fact, the above study that showed that straight fats do not lower testosterone also showed that dextrose, which is essentially glucose, lowers testosterone. [3] I cover another study on my Testosterone and Glucose page, where participants were actually given glucose and saw their testosterone drop by about 25%. From these studies, we can conclude that high glycemic foods likely have the potential to lower your T significantly.

3.  Rapid Weight Loss.  Lost of fat or high glycemic foods can really lower your testosterone, but the king is probably the exact opposite:  food deprivation.  One study on wrestlers who were attempting to drop weight rapidly before a match showed a testosterone drop of over 60%! [6] Ouch! These were healthy, fit young men and yet their testosterone was drastically dropped by dieting.  One study suggests that a reduction of more than15% of your baseline calories will begin to lower your testosterone levels.

4.  Caloric Restriction. And what happens when you lower calories significantly for long periods of time?  Does the body recalibrate and testosterone levels readjust.  The answer appears to be ‘no’.  Caloric restricion is an anti-aging method that has had rather lackluster results in primates.  Basically, the idea is that you eat a lowered amount of calories such that you reduce your body weight and reset your body’s basal metabolic rate.  Researchers decide that his could be instructive in determining just what  reducing calories in the long term can do to one’s testosterone levels.  One study looked at men who had been practicing CR an average of 7.5 years and matched them with controls eating a typical Western Diet. [4] The study showed that long termcaloric restriction resulted in a 32% drop in testosterone levels.  (There could be other factors involved, since CR practitioners tend to eat more fiber, less fat, etc. than the typical Western Diet.)

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Glutathione:Protection Against Testosterone-Killing Mercury

Remember also that mercury attacks your precious testosterone, so glutathione is one of your body’s natural testosterone protectors. Glutathione is involved in dozens of other critical systems and even protects your body’s Vitamin C.  And we know Vitamin C provides critical collagen protection, including that in your skin.

So how do we raise glutathione levels naturally?

2. Maca. This Peruvian aphrodisiac was found to increase the all-important natural super-antioxidants SOD and glutathione. [3]

3. Avoid Alcohol.  Alcohol consumption decreases glutathione.  Why?  Because alcohol creates a toxin that glutathione must detoxify. [1]

5. Exercise. Exercise increases the important form of glutathione. [6]  However, it should be kept in mind that this is the body’s natural response to the increased oxidative load that exercise places upon it.

6. Glucose/Sugars/High Glycemic Foods. A number of in vitro study of human epithelial cells showed that increased glucose led to decreased glutathione levels. [7][9]

7. Resveratrol. Resveratrol increased glutathione in lung epithelial cells that were “smoke depleted”. [8]  Good sources of resveratrol are red wine, peanuts and cocoa. nuts and cocoa.

8. Grape Seed Extract. This potent and relatively cheap supplement can help improve blood flow – always good for erections – and arterial clotting and inflammation. And, just as important, one study found that it raised plasma glutathione levels by 52%! [10] Admittedly, this was in type II diabetics, but it should help virtually any middle-aged or senior male.

9. Nanodelivery Glutathione. Again, glutathione, if taken by itself, is very poorly absorbed. LEF (Life Extension Foundation) has a product with a nonodelivery system that supposedly greatly improves absorption. The product is called “Lipoceutical Glutathione” if you are interested.

10. Magnesium (Deficiency). There is some evidence that correcting a magneisum deficiency could boost glutathione levels. [12] And there is also evidence that increasing glutathione can increase magnesium in some tissues as well. [11]

1) Alcohol and Alcoholism, 21(1):81-84, “ALCOHOL ENHANCES VITAMIN C EXCRETION IN THE URINE”

2) Arzneimittel-Forschung, 1992, 42:829-831

3) Journal Plant Foods for Human Nutrition (Formerly Qualitas Plantarum), Jun 2007, 62(2), “The Influence of Maca ( Lepidium meyenii ) on Antioxidant Status, Lipid and Glucose Metabolism in Rat”

4) Eur J Clin Invest, 2001 Feb, 31(2):171-8, “Oral supplementation with whey proteins increases plasma glutathione levels of HIV-infected patients’

5) Toxicol Ind Health, May 2009, 25(4-5):325-328, “Whey proteins influence hepatic glutathione after CCl4 intoxication”

6) J Appl Physiol, 1993 Feb, 74(2): 788-92, “Blood glutathione status during exercise: effect of carbohydrate supplementation”

7) Journal of Molecular Endocrinology, 2004, 33:797-803, “High glucose decreases intracellular glutathione concentrations and upregulates inducible nitric oxide synthase gene expression in intestinal epithelial cells”

8) American Journal of Physiology, Lung Cellular and Molecular Physiology, 294(3):L478 88, “Resveratrol induces glutathione synthesis by activation of Nrf2 and protects against cigarette smoke-mediated oxidative stress in human lung epithelial cells”.9) FEBS, 2 Jan 2 1998, 421(1):19-22 “High concentration of glucose causes impairment of the function of the glutathione redox cycle in human vascular smooth muscle cells”

10) Diabetic Medicine, May 2009, 26(5):526 531, “Effects of grape seed extract in Type 2 diabetic subjects at high cardiovascular risk: a double blind randomized placebo controlled trial examining metabolic markers, vascular tone, inflammation, oxidative stress and insulin sensitivity”

11) Hypertension, 1999, 34:76-82, “Effects of Glutathione on Red Blood Cell Intracellular Magnesium”

12) Inflammation Research, Jun 2008, 57(6):279-286, “Effects of magnesium supplementation on the glutathione redox system in atopic asthmatic children”

The Natural Cause of Low Testosterone-II - Peak Testosterone

So you found out you are low testosterone or hypogonadal, eh? A natural question for many men is:

“What in the world caused this?  What happened to me??”

Sometimes wives and girlfriends are wondering the same thing!

It turns out that is not as easy to answer these kind of questions as you might think.  For example, it is rare for someone to come to the Peak Testosterone Forum and have any idea what caused their low testosterone. Occasionally, someone has taken steroids or a “prohormone” that has left them without testosterone and the answer is obvious.  Or perhaps a man has a brain injury and suddenly develops low testosterone symptoms, indicating a damaged pituitary or other CNS issues.  These situations are fairly obvious and are not what I am going to discuss here.

What is very important to look at are the cases that might escape a physician’s eye, because he/she 1) is not looking or 2) is ignorant.  And this is case (much) more often that not on forum  and, as I will show below, this can in some cases have detrimental outcomes.  When one develops hypogonadism, there are many things that should be checked:

1. Empty Sella Syndrome. This is a fairly common problem with the pituitary where the size of the pituitary is greatly decreased due to injury, a tumor, anatomical injury, etc.  One study looked at men with erectile dysfunction and low testosterone levels and found that 6.7% of them likely had empty sella syndrome. [1] Yet another study looked at men with low testosterone and found a still higher percentage:  17.6%. [2] Of course, empty sella will lead to secondary hypogonadism because of improper signalling from the pituitary, since it is the pituitary that actually signals the testes to produce testosterone.

It should be noted that sometimes it can be better termed “partially empty sella,” because some of the gland still remains.  However, still other times the pituitary is not even visible on the MRI.

2. Micro and Macroadenomas of the Pituitary. Related to #1 are pituitary tumors that can cause empty sella syndrome.  In fact, if you read the first study above, you will see that most of the empty sella syndrome cases were related to tumor growth. [1] Microadenomas were identified in 7.8% of the cases in the second study as well.

3. Prolactinoma.  Another reason that larger pituitary tumors can cause hypogonadism is that they frequently raise prolactin levels.  A prolactinoma can stay within the sella, the little “pouch” area where the pituitary sits, or can extend out and cause headaches, visual issues and other medical problems.  Only about 10% of macroadenomas fall into this category. [3] If you do have a prolactinoma, it is usually treated with a dopamine agonist which shrinks the tumor substantially and lowers prolactin levels.  Sometimes surgery is required however.

By the way, the second study indicates that serum prolactin levels are a good predictor of a macroadenoma.  There were actually four men with macroadenomas and 3 of them had prolactin levels > twice the upper limit, which was probably around 30.  So, if your prolactin is high, you’ll want to discuss it immediately with your doctor.

4. The Two O’s: Overweight and Obese. Fat cells contain aromatase and, as you gain weight, those fat cells enlarge and build up extra aromatase, the enzyme that converts testosterone to estradiol.  Yes, that means that an overweight or obese man will tend to have more estradiol, the “bad” estrogen, and less of his precious testosterone. [4][6]

And if the free estrogen to free testosterone ratio gets high enough, obesity can actually create a form of secondary hypogonadism and very significantly turn off your testosterone production.  Research shows that testosterone may be as much as 2.5 times lower in obese men. [7] Ouch!  Verifying this is the fact that one study found that massive weight loss (57+ pounds) resulted in an average 58% increase in testosterone levels. [8] If you lose enough weight, it is possible to even double your testosterone.

Even relatively thin guys like myself can benefit:  I had accumulated about 10 pounds of visceral fat and dropped most of it off and found that my estradiol levels plummeted.  This gave me a much nicer testosterone-to-estradiol ratio, which is very important.  (See my link on The Testosterone-to-Estrogen Ratio for other ideas as well.

5.  Hemochromatosis. This common genetic disorder affects about 1 in 200 of people of European ancestry. [9] You have to have two copies to have the potential to develop the disease but 1 out of every 8-10 people are carriers!  Persons with hemochromatosis are much more likely to build up iron, which is very hard on the body.  The brain, cardiovascular system and liver can all be negatively impacted.

One other thing that can be affected is testosterone.  One study found that 6.4% of men with hemochromatosis were hypogonadal. [10] This may sound like a fairly low percentage, but keep in mind that they set their definition of hypogonadal at the incredibly low of about 4.1 nmol/l.  This translates to about 120 ng/dl in our units here in the U.S., which is about a third of LabCorp’s current threshold!  So the reality is that a very significant percentage of men with heriditary hemochromatosis likely have low testosterone.

Other common symptoms include:

If you have low testosterone symptoms and some of these other standard symptoms, talk to your doctor.

6) Stress. There have been reports that very high levels of stress can induce a type of hypogonadism. One study looked at this by giving men high doses of hydrocortisone (cortisol) and, sure enough, testosterone came crashing down. [11] Animals studies have shown that one way this occurs is through an enzyme called 11 HSD-1 that, under normal circumstances, keeps your cortisol from hammering your testosterone levels.  Extreme stress, however, can overwhelm 11 HSD-1 with too much cortisol and result in a kind of hypogonadism. [12]

7) Zinc Deficiency. One study took young men (average age 27.5) and then artificially created a zinc deficiency in them by putting them on a zinc-restricted diet.  Serum testosterone fell like a rock after 20 weeks from 1173 ng/dl to 311 ng/dl!  The same study showed testosterone doubling in those who were only mildly zinc deficient.  See my link on Zinc Deficiencies and Low Testosterone for additional information.

8) Weight Loss and Intense Exercise.  My page A Protocol to Lose Weight Rapidly and Maintain Muscle discusses a study where the male participants were able to do something remarkable: they combined a wide variety of intense exercises with a 40% reduction in calories and lost 11 pounds and either maintained or even gained some muscle. This is not an easy thing to do and so I did a page covering the subject for men that are interested in short term, accelerated weight loss.

However, one of the guys on the Peak Testosterone Forum noticed that the testosterone levels of the men in the study dropped from 507 to 126 ng/dl! That is a severe fall in testosterone and left those men deep in hypogonadal territory.  Of course, the moral of the story is that you can powerfully suppress your body’s testosterone production with such a stressful weight loss and thus it may not be appropriate for anyone except men on testosterone therapy, whose levels are held fixed through the administration of exogenous T.

9) Kallmann Syndrome. Kallmann Syndrome is basically hypogonadism that usually affects puberty with an accompanying lack of sense of smell.  It is fairly rare, but when you aggregate it with other similar conditions that result in low LH/testosterone going through puberty, it is probably around 1 in every 5,000 males.  Delayed puberty and small testes/penis are common accompanying symptoms as well.  HH (hypergonadotropic hypogonadism) is the broader term and we had one man who was diagnosed with the same.  He wrote:

“I like probably many people on this forum had unusually low sex drive for several years, and kept getting told my T was “normal” consistently testing in the 320-330 range. i finally did research and discovered that is not at all normal for someone in their 30s who is otherwise very healthy and who lifts heavy weights 3-4x/week. so i went to an endo and got complete tests w/pituitary MRI done and he agreed my T was low. he asked what treatment options i was interested in, and i said HCG looked interesting to me because i still wanted to have children. he said there is also low dose Clomid to consider. when i went back for results he said i had “abnormally normal” LH levels, in other words that i should have a natural pituitary response to produce more LH given my testosterone levels and that was not occurring. otherwise my system was functioning fine. he even diagnosed me with HH as a result. (i also have a weak but not nonexistent sense of smell, and my belief is that i have a milder form of Kallmann Syndrome, as although i went through puberty on time, i never grew much bodily hair and was a very scrawny kid until i hit the weights hard in my 20s. i think it doesn’t get called Kallmann by the medical profession because it is rare and doesn’t get diagnosed since puberty occurs)”. [16]

10) Klinefelter’s Syndrome. This surprisingly common genetic condition, where a male ends up with an extra X (female) chromosome, affects up to 1 in 500 males. [14] (Concerning is the fact that one 2007 study found that one type of Klinefelter’s seemed to be dramatically increasing in prevalence, so this may be an issue for an ever increasing number of young men.)   Sometimes it is “obvious” that there is an underlying condition due to symptoms such as undescended testicles. However, that is not always the case with Klinefelter’s and symptoms are less severe.  In these cases, many boys are never diagnosed with the condition and limp into early adulthood. There are many common symptoms that often affect someone with Klinefelter’s, including a characteristic pear-like body shape, gynecomastia, slow motor development, social awkwardness and so on. In addition, a man with Klinefelter’s is frequently hypogonadal. The good news is that hypogonadal Klinefelter’s males respond well to HRT treatment, at least according to a couple of studies. [16]

11) Sickle Cell Disease. Studies show that this disease can lead to low testosterone.  One small study of men with sickle cell found that 24% of them had low LH and FSH and, therefore, were likely secondary hypogonadal.  The authors concluded that it was not due to ferritin (tissue iron) levels. [13]

12) The Perfect Storm. Now this model, that I call the “Perfect Storm”, is, admittedly, speculation on my part.  First of all there are several quite common underlying issues with men that can lower testosterone in the 30% range, which I cover in various place on my site.  This is not an exhaustive list, but here are a few:

a) Vitamin D Deficiency. (See my link on Testosterone and Vitamin D for more details.)

b) Varicocele. (See #11 in my link on Improving Male Fertility.)

c) Apnea. (See my link on Apnea and Testosterone for details.)

d) Depression. (See my link on Testosterone and Depression for additional details.)

e) Mercury.  (We have had a few men write into the Peak Testosterone Forum who have been eating fish every day or nearly every day, not realizing that, depending on the type of fish, they could be poisoning themselves with methylmercury.  See my link on Fish Safety.)

In addition, we already mentioned above other T-related factors, including stress and being overweight. Simple lack of sleep could do it as well. Basically, I cannot help but wonder that if a man has 2 or 3 of these issues, which would not be terribly uncommon, that he could get a combined effect and perhaps drop his testosterone 50% or more?  As far as I know, no study has looked at the combined effects of one or more of these testosterone-lowering issues, but it certainly could happen.  In this case, it is prudent to troubleshoot each individual issue and get to the root cause.

13) Concussions and Head Injuries. It is very likely that head injuries can lead to hypogonadism and complete dysregulation of the HPA axis.  We had an ex-athlete discuss his battle with just this phenomenon, and you can read the interview I had with him on this page called https://www.peaktestosterone.com/.

14) GI (Gut) Issues. This is one I cannot prove, but is just common sense:  GI or gut issues likely lower testosterone significantly.  The reason I say this is that certain nutrients (Vitamin E, Vitamin C, magnesium, zinc, etc.) all play a role in the body’s production of testosterone.  Therefore, anything that significantly affects your absorption of these same nutrients can likely lower testosterone levels.  And this is important, because there are a host of GI issues that affect men in modern societies:  atrophic gastritis, IBS, ulcerative colitis, Crohn’s, diverticulitis, etc.

15) Parasites. We had one low testosterone man on the Forum of who found that he had a parasite (a tapeworm) and then eradicated it only to find that he felt much better and his testosterone climbed significantly. See my page on Testosterone and Parasites for his story.

16. Overtraining. This ties in with #6 and #8 above.  If you overtrain long enough, it is a HUGE stressor for the body and brain.  Your immunity is suppressed, your adrenal hormones end up fried, your libido and erections are negatively impacted and testosterone can be lowered as well.  See my pages on Testosterone and Overtraining and The Best Signs of Overtraining for some information.

REFERENCES:

1)  The Journal of Urology, Feb 1996, 155(2):529-533, “Prevalence of Hypothalamic-Pituitary Imaging Abnormalities in Impotent Men with Secondary Hypogonadism”

2) The Journal of Urology, Sep 2003, 170(3):795-798, “The Value Of Pituitary Magnetic Resonance Imaging In Men With Hypogonadism”

3) The Journal of Clinical Endocrinology & Metabolism, Aug 1 2007, 92(8):2861-2865, “Long-Term Management of Prolactinomas”

4) Medical Hypotheses, April 1998, 50(4):331-333, “The role of estradiol in the maintenance of secondary hypogonadism in males in erectile dysfunction”

5) International Journal of Impotence Research, 2003, 15:38 43, “Oestrogen-mediated hormonal imbalance precipitates erectile dysfunction”

6) Med Hypotheses, 1998 Apr, 50(4):331-3, “The role of estradiol in the maintenance of secondary hypogonadism in males in erectile dysfunction”

7) The Journal of Clinical Endocrinology & Metabolism, Dec 1 1977, 45(6):1211-1219, “Low Serum Testosterone and Sex-Hormone-Binding-Globulin in Massively Obese Men”

8) The Journal of Clinical Endocrinology & Metabolism, May 1 1988, 66(5):1019-1023, “Effect of Massive Weight Loss on Hypothalamic Pituitary-Gonadal Function in Obese Men”

9) https://www.clinicalkey.com/topics/hematology/hemochromatosis.html

10) The Journal of Clinical Endocrinology & Metabolism, Apr 1 2005, 90(4):2451-2455, “Hypogonadism in Hereditary Hemochromatosis”

11) Clin Endocrinol Metab, 1983 Sep, 57(3):671-3, “Acute suppression of circulating testosterone levels by cortisol in men”

12) J Androl, 1997, 18:475-4791997, 18:475-479

13) Acta Haematol, 2012;128(2):65-8, “Hypogonadism in patients with sickle cell disease: central or peripheral?”

14) European Journal of Human Genetics, 2008, 16:163 170, “Is the prevalence of Klinefelter syndrome increasing?”

15) Clinical Genetics, April 1988, 33(4):262 269, “Follow-up of 30 Klinefelter males treated with testosterone”

16) https://www.peaktestosterone.com/forum/index.php?topic=223.msg1764#msg1764

Causes of Low TestosteroneSTEP 5A. Find if you have one of the less well-known causes of low testosterone:

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Inflammation and Acupuncture - Peaktestosterone

One of my relatives, who shall remain nameless, had horrendous knee pain and could barely walk.  His mom recommended that he go see her doctor.  He went in and the doc asked him to lay down and the next thing he knew he felt some “nail-like” pains in his knee as the doc shoved in acupuncture needles like a martial artist.

Of course, his mom had neglected to tell him the doc was an acupuncturist, because she knew he wouldn’t go otherwise.  His comment to all of us:  “I’m glad I wasn’t having pain in my testicles.” Most importantly, the pain in his knee mysteriously disappeared.

This is the mystery of acupuncture:  until recently no one could quite figure out how it worked.  Scientists, though, in the last decade have made numerous discoveries about acupuncture and its effects on the body.  One of the most powerful seems to be acupuncture’s effects on inflammation.  (Acupuncture also seems to affect certain cerebral and circulatory centers as well.)

NOTE: One key in the above-mentioned asthma study were many treatments over several weeks.  There have been some studies of acupuncture with less-than-stellar results and experts speculate that it may be that treatment was simply too infrequent.

REFERENCES:

1) J Tradit Chin Med, 1998 Mar, 18(1):27-30, “Clinical observation on 25 cases of hormone dependent bronchial asthma treated by acupuncture”

2) Zhong Xi Yi Jie He Za Zhi, 1991 Dec, 11(12):721-3, “Desensitive treatment with positive allergens in acupoints of the head for allergic rhinitis and its mechanism”

One sign of this is that acupuncture has shown some remarkable study results when it comes to inflammation-related diseases.  For example, one study of patients on steroid inhalers for asthma achieved a 96% success rate. [1] Some critics like to point out that there is likely a very powerful placebo effect with acupuncture.  However, can you really argue that a 96% success is because of placebo?  A better word for that is “miraculous”.

Acupuncture also has a long history of treating seasonal allergies (rhinitis). Several studies have born this out, including one where three fourths of patients were permanently cured  from treatment and another fifth improved significantly. [2] Again, this success rate is too high to be explained by a placebo effect.

Other examples abound:  acupuncture has helped patients with other inflammatory conditions such as arthritis and Crohn’s, etc.  And, if you stop and think about it, these are amazing benefits considering, in general, the effect cannot be local.  For example, in the case of asthma, the needles are not not anywhere in the vicinity of lung tissue.  The same can be said for treatment of intestinal disorders such as Crohn’s.  Clearly, something much more sytemic is going on.

The answer may like in the fact that acupuncture has been found to reduce some of the major inflammatory markers, such IL-10 and TNF-alpha.  In addition, certain neuropeptides are affected in a positive manner as well.  So, while acupuncture may seem counterintuitve, i.e. why would insertion of hair like needles into the skin produce such significant and profound effects? – its healing powers actually begin to make some sense.  So the bottom line is that you may want to consider acupuncture as a possible treatment option for conditions that are tied to inflammation and pain.

Pomegranate Juice and Erectile Dysfunction - Peak Testosterone

Pomegranate juice has amassed a significant body of research showing that it can improve many health markers, particularly cardiovascular, that are linked to improved erections.  And Peak Testosterone readers know the maxim:  “if it’s good for the heart, it’s good for the penis.”  (Thanks to Dr. Lamm for that concept.) And it is true, because if you lower blood pressure, increase nitric oxide, reverse plaque and improve lipids – all of these things will almost always help any erectile dysfunction you may be struggling with.  Verifying this is a showing pomegrantate juice improved erectile function in 42 men with ED. [2]

This is something that I have seen confirmed on the Peak Testosterone Forum. Look at the comments of this man:

“Back to the individual labs that we call our own bodies, I have to say the POM juice has had a very noticeable positive effect for me over the last three months. In reading further on these few threads, I have added more nitrate friendly veggies multiple times per day when possible. I can’t eat a whole bag of arugula like PeakT, but I try. Lately I have added 1.5g of Citrulline and grape seed extract pill (subbing in for Pycnogenol). I would agree with the one comment that if your anxiety/stress levels shoot up, or sleep is disturbed, this protocol can’t overcome it with immediacy of Viagra/Cialis. However, on a regular basis, I have noticed a big difference, especially overnight and in the mornings. FYI, I drink 4-6 oz of POM brand with my breakfast.” [11]

Pomegranate juice certainly does not work that well for everyone, but we have an ongoing poll that shows that 17% of men who tried it feel it has improved libido and erections and another 17% that feel it has helped erections but not necessarily libido. [12] That’s about a third of the guys out there and is not a bad percentage for one juice. The research clearly backs up pomegranate’s excellent erectile and arterial properties.

You do have to watch for a fading effect with pomegranate juice, i.e. it works very well for a week or two or a month or two and then fades in efficacy.  Of course, one should not be relying on any one juice, food, supplement, etc. for their erectile strength:  it needs to a holistic, comprehenisve program based on what I have seen.  But pomegranate juice can be a nice tool in your arsensal.

Anyway, below are 7 Signs That Pomegranate Juice Will Improve Your Erectile Dysfunction:

1. Plaque Reversal (Sometimes).  You put all these properties together and Pomegranate Juice becomes a near magic elixir that actually partially reversed artheriosclerosis in one study!  You read that right – pomegranate juice can actually clear off some of the plaque in your arteries assuming you take it faithfully for three, six or even twelve months. [1] Here is a quote from Lef.org’s site about this study: “Remarkably, patients drinking 1.7 oz of pomegranate juice experienced a whopping 35% reduction in the IMT score and a 44% improvement in carotid artery blood flow”. IMT is the thickness between inner and middle layers of the artery.

REFERENCES:

1) Clin Nutr. 2004 Jun;23(3):423-33, “”Pomegranate juice consumption for 3 years by patients with carotid artery stenosis reduces common carotid intima-media thickness, blood pressure and LDL oxidation””

2) International Journal of Impotence Research, Nov/Dec 2007,19(6):564 567

3) Nitric Oxide, 2006 Sep, 15(2):93-102

4) Intl J for Vitamin and Nutrition Res, May 2006, 76(3):147-151

5) The J of Nutritional Biochem, 16(9):570-576, Sep 2005, B. Fuhrman, et. al., “Pomegranate juice inhibits oxidized LDL uptake and cholesterol biosynthesis in macrophages”

6) Clin Nutr 2004;23(3):423-33

7) Amer J of Cardiology, 98(5):705-706, Sep 1 2006, “Rhabdomyolysis Associated With Pomegranate Juice Consumption”, Alexey V. Sorokin, et. al.

8) The American Journal of Cardiology, Oct2009, 104(7):936-942, “Effects of Consumption of Pomegranate Juice on Carotid Intima Media Thickness in Men and Women at Moderate Risk for Coronary Heart Disease”

9) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3355694/

10) Am J Clin Nutr, 2000, 71:1062 76., “Pomegranate juice consumption reduces oxidative stress, atherogenic modifications to LDL, and platelet aggregation: studies in humans and in atherosclerotic apolipoprotein E deficient mice”

11) https://www.peaktestosterone.com/forum/index.php?topic=3693.0

12) https://www.peaktestosterone.com/forum/index.php?topic=3317.0

13) https://center4research.org/i-saw-it-on-the-internet/pomegranate-prostate/

The participants in this study were men with narrowing of the arteries (stenosis) due to arterial plaque buildup. This seems to be pomegranate juice’s “sweet spot”:  improving arterial health in men under oxidative stress and narrowing of the arteries.

One subsequent study studied giving 8 oz of pomegranate juice to middle and senior-aged men (and women) without significant narrowing of the arteries but at moderate risk for heart disease. [8] It found that pomegranate juice did not actually reverse arteriosclerosis in this case but would likely slow progression in those under oxidative stress, HDL or triglyceride issues.  Of course, this describes a huge subset of the population in any modern industrialized society.

So pomegranate juice may or may not reverse your arterial plaque, depending on the status of your health.

2. Increase Nitric Oxide. Are there other reasons to take pomegranate?  Yes!  One of the studies mentioned above [1] showed an average 20% drop in blood pressure. The reason for this is simple:  it will significantly increase Nitric Oxide output!  Yes, the same stuff that Viagra increases, pomegranate will do the same and one study showed as much as 50% in heart cells!

Of course, many supplements, fruits, vegetables and even a few grains will increase your Nitric Oxide levels. Researchers in one study looked at many of the heavy hitters in this category and concluded that Pomegranate Juice was “much more potent than Concord grape juice, blueberry juice, red wine, ascorbic acid [Vitamin C], and DL-alpha-tocopherol [Vitamin D]”. [3] See my book The Peak Erectile Strength Diet for more information.

3. Lowers Total Cholesterol and LDL. Arterial plaque can narrow and age your arteries and the penile arteries are always affected simultaneously. One of the ways that we can help protect the lining of our arteries is by lowering our LDL and pomegrante will do this for you. [4] One study found little change in lipids in health individuals, so this may vary as well based on your health status.

4. Inhibits Oxidized LDL. Oxidized LDL is what does the actual damage and pomegranate juice has been shown to limit this a variety of ways. [5] One set of authors wrote that “most importantly, PJ treatment significantly and substantially inhibited the progression of atherosclerotic lesions. PJ inhibited atherogenic modifications of LDL, including its retention, oxidation, and aggregation.” [10]

5. Lowers Blood Pressure. Probably the biggest and most consistent cause of erectile dysfunction is elevated blood pressure.  dramatically lowers blood pressure. [6]

6. Fertility.  There is an animal study showing that pomegranate improves sperm quality.  See my page on Natural Ways to Improve Fertility for details.

7. Prostate. There is some evidence that pomegranate juice may help fight against prostate cancer.  However, the primary study was funded by POM (as are some of the above studies), so many commentators feel that the more research is needed. [13]

CAUTION:  Pomegranate Juice can potentially interfere with certain medications including statins, calcium channel blockers, immunosuppressants,  antiarrhythmics and others.  The issue is that Pomegranate Juice (and Grapefruit Juice) affect the P450 3A4 enzyme system within the liver, i.e. absorption of certain drugs can be affected.  One journal documented a serious muscle tissue breakdown case that occurred from Pomegranate Juice interacting with a statin. [7]  Please consult with your doctor or pharmacist for possible interactions. In addition, please read my link on The Potential Side Effects of Pomegranate Juice : there was an animal study showing it increase the risk of Parkinson’s.

CAUTION: #2  Again, talk to your doctor if you are on any medications:   there are three reported cases of priapism occurring in men simultaneously taking Viagra. [8] Again, pomegranate juice is very powerful.

LDL-P: Important Number for Arterial Plaque Reversal

Of course, the million dollar question is how you do all of this? (Actually, it’s probably a 10 billion dollar question as hospitals would be empty if we got heart disease under control.)  The key to managing heart disease is to manage arterial plaque (atherosclerosis).  No plaque – no (or very little) heart disease.  It’s that simple.  And to do that you actually have to monitor a wide variety of lipid and inflammatory markers.

The most common metrics are HDL, LDL and triglycerides and I give a lot of coverage to these on my site because of it.  These are very affordable and are part of almost every man’s annual physical exam, so it just makes sense to be well-versed in this “Lipid Trifecta.”. The men who have shown us the way in my opinion with these markers are  three physicians and researchers that I call The Plaque Regressers: Dr. Gould, Dr. Esselstyn and Dr. Davis. All three of them have strict guidelines on LDL and two of them on LDL, HDL and triglycerides. You can see the kind of numbers that they talk about in my page on LDL Levels and HDL, LDL and Triglycerides.

However, on this page, I want to discuss a less well-known, but every more powerful marker to monitor your lipids and make sure that you regress or maintain the calcification in your arteries:  LDL-P (the LDL Particle Count). As important as LDL, HDL and triglycerides are, the big gun according to the latest research is LDL-P and I’ll discuss just why below.

1.  Low LDL-C Can Backfire.  All the Plaque Regressers want you to have low LDL (< 80). There are a hundred gurus out there who will tell you that LDL-C does not matter, but they are risking their arterial health in my opinion.  Their assumptions are based largely on studies comparing atherosclerosis in the general population.  But we don’t want to be just be a little better than the general public, who on average have very diseased cardiovascular systems.  We want NO plaque.

And, according to the Framington Offspring Study data, about 9% of all individuals will have low LDL-C and high LDL-P. [1] Those who fall into this category actually have high heart disease risk.  The clear message of this study was that low LDL-C is NOT a guarantee against heart disease – quite the opposite.  To truly proect yourself, you have to have low LDL-C and low LDL-P.

Another way to look at this is that, according to that same data, 18.4% of those with no known heart disease will have low LDL-C also have high LDL-P.  So, if you have low LDL-C, you cannot just assume you are out of the woods and, to play it safe, you should also pull LDL-P.

Low Fat Diets: Does this mean that the low fat diet gurus were all wrong?  No, of course not.  First of all, 82% of those with low LDL-C also have low LDL-P, so, generally speaking, going for low LDL is a great starting point.  Furthermore, the low fat gurus almost all emphasize a lifestyle that will try to keep a man out of prediabetes and prediabetes is what usually causes high LDL-P is individuals with low LDL-C.  However, a poorly implemented low fat diet based on wheat and higher glycemic carbs in a man that is overweight and/or sedentary could cause problems without a doubt.  Again, pulling that LDL-P number to play it safe is the way to go.

By the way, I really admire the original low fat guru Nathan Pritikin for his stance on this issue in the pre-LDL-P days.  He not only consumed a low fat diet but jogged an hour every day.  And it worked for him fantastically as he died, per a coroner’s report, with perfectly clear arteries (and very likely had significant arterial plaque early in life). The coroner examined him after his death and declared that “Nathan Pritikin’s arteries were free of any signs of heart disease, and were as “soft and pliable” as a teenager’s. “In a man 69 years old,” wrote pathologist Jeffrey Hubbard, “the near absence of atherosclerosis and the complete absence of its effects are remarkable.”” [4] No, it’s never too late to clear out arterial plaque.

According to the Framington Data, he is both high LDL-C and LDL-P, placing him in the worst category.  Of course, I hope that he is an exception somehow, but my point is that this is the big question with regard to Low Carb and some Paleo Diets that are higher fat.  (NOTE:  There is a study out there that says if you lose weight on Low Carb, you can regress plaque.  But what happens when you stop losing weight and you are in “maintenance mode?”)

NOTE:  I believe a Low Fat Paleo Diet is the safest way to go and the best implementation of true Paleo, since wild game is almost always low fat.

2. LDL-P Best Predicts Heart Attack Risk.  The above study found that the LDL Particle Count was the single best predictor or future cardiovascular disease risk. The study basically looked at individuals without known heart disease and then followed them until their first cardiac event and, again, LDL-P was the superstar.

NOTE:  I cover this in even greater detail and more studies in this page:  LDL-P, the Best Predictor of Heart Disease.

3.  LDL-P Is Very Correlated to Arterial Plaque Levels (IMT).  Many of you know that I push getting a Heart Scan or IMT score to track your plaque levels. Of course, this isn’t my idea:  all the Plaque Regressers do it.  One of the ways you can monitor your plaque is through an IMT, which is a non-invasive ultrasound of your carotid (neck) artery.  One study found that IMT scores were correlated with LDL-P, i.e. the higher the Particle Count, the thicker the neck artery with plaque. [4]

CONCLUSION: Having Low LDL-P gives a good probability that you will have a much lower risk of heart disease. To improve these odds still further, you should also strive to have low LDL-C as well as low LDL-P. Generally speaking, men without prediabetes, which usually means a decent triglcyerides-to-HDL ratio, and low LDL-C will be in good shape and have a low LDL Particle Count.  But it is better to pull this number to make sure.  If you want to feel young and stay young, you have to keep those arteries plaque free.  This will also maximize your nitric oxide levels and improve your sex life as well.

What should you target for LDL-P?  I make a case for values between 700 and 850 nmol/l in this page on LDL-P Particle Count Target Levels for Plaque Reversal. Read this page and you will see some of the research data on this subject.

1)  J Clin Lipidol. 2007 Dec 1; 1(6): 583 592, “LDL Particle Number and Risk of Future Cardiovascular Disease in the Framingham Offspring Study Implications for LDL Management”

2) https://www.peaktestosterone.com/forum/index.php?topic=6105.msg51267#msg51267

3) https://www.athero.org/commentaries/comm564.pdf

4) N Engl J Med, 1985, 313:52, “Nathan Pritikin’s Heart”, https://www.pritikin.com/eperspective/specialissues/pritikinatkins/

5) May 2007Volume 192, Atherosclerosis, May 2007, 192(1):211 217, “LDL particle subclasses, LDL particle size, and carotid atherosclerosis in the Multi-Ethnic Study of Atherosclerosis (MESA)”

Acne from Testosterone Therapy (DHT) - Peak Testosterone

Remember those post-puberty glory days and the change in facial terrain that followed?  Well, some guys find themselves observing the same phenomenon after boosting their testosterone via Hormone Replacement Therapy!  Yes, that’s always fun to explain to the wife and kids, eh?  Actually, sometimes it is not as visible to the general public.  I have noticed on The Peak Testosterone Forum that many guys get acne on their neck, back and shoulders.

How does testosterone do it?  Many studies have shown that increasing testosterone levels increases DHT (dihydrotestosterone) levels, which in turn fires up the sebaceous glands. [8]

However, one thing most guys don’t realize is that diet alone can help very significantly with acne and I’ll cover that below and some of the key dietary scientific findings, mostly from the last four years (as of this writing) that can help or even cure this issue.  I even through in a standard cosmetic treatment that may help as well.

1. Low Glycemic Diet.  A couple of studies have shown significant decreases in acne through a diet based on low-glycemic carbohydrates, such as most whole grains, fruits and veges. [1] One of these studies was based on fairly high protein (25%), medium carbohydrate (45%) and medium-high fat (30%). [2] Care should be taken to avoid too much saturated fat in order to avoid erectile issues, which means the protein would need to come probably mostly from egg whites. See my page on The Potential Dangers of Saturated Fat In Men (particularly in men over 40) for more information.

2.  Fish Oil. Multiple studies have indicated that increased consumption of fish and sea food, and thus most likely fish oil, is associated with decreased acne. [3]

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3.  Red Light Therapy. A recent study showed that red light therapy appears to be an excellent solution for acne.  Acne is primarily caused by bacteria that live within skin pores where red light therapy specializes in penetrating. [4] You may recall from my page on Skin and Eye Treatments that red light therapy is also very effective aginst the wrinkling that occurs around the eye, a difficult are to treat in general.

4.  Dairy. Some people reports good results with acne simply by giving up dairy. [5] This is anecdotal but is easy and worth a try. I would recommend taking some supplemental calcium to make sure that you get enough.

5. Stress. Watch your stress levels:  cortisol accelerates acne by altering hormone levels that jump start sebaceous gland oil production.  Read my link on How to Reduce Stress for research-backed ways to decrease cortisol levels.

6. Diary and Milk Products. Finally!  Dermatologists have for yours denied a link between diet and acne.  However, a recent review recently overturned this assumption and found a consistent link between dairy consumption and acne. [6]

7. High Glycemic Meals. The same study mentioned in #6 above also found a link between high glycemic eating and acne. [6] The key concept to understand is “glycemic load”.  Some foods are high glycemic foods, such as carrots, but you would have to eat so much of them that it they never spike insulin or blood sugar significantly. For the sake of your skin, watch your glycemic load.  Yes, we need carbs, but they need to be whole food, high fiber.

8. Clearasil.  Although not exactly natural, some of the over the counter treatments pretty low in side effects.  (Discuss with your doc or pharmacist of course.)  And I’m not really advocating one brand, but the point is that sometimes you can use the standard “high school” over the counter treatments to get things under control.  One poster on the The Peak Testosterone Forum wrote: “I started using Clearasil Stayclear twice a day and it is already noticeably clearer.” [7] In addition, there are a lot of over-the-counter preparations that help with acne and they usually contain various combinations of salicylic acid and benzoyl peroxide. Clearasil’s most potent formulation is 10% behzoyl peroxide: Clearasil Acne Control Vanishing Cream, 1 oz is an example.  Other Clearasil products contain salicylic acid, generally 2% in strength.  (I have not seen greater than that.)  Both of these ingredients are proven acne fighters, but sometimes you need with proven wrinkle-fighter Retin-A. (If you put it on your face, you have to be very careful with sun exposure.  Discuss with the doc that writes the prescription.)

1) J Am Acad Dermatol, 2007 Aug, 57(2):247-56, “The effect of a high-protein, low glycemic-load diet versus a conventional, high glycemic-load diet on biochemical parameters associated with acne vulgaris: a randomized, investigator-masked, controlled trial”

2) Am J Clin Nutr, 2007 Jul, 86(1):107-15, “A low-glycemic-load diet improves symptoms in acne vulgaris patients: a randomized controlled trial”

3)  Arch Dermatol, 1961 Dec, 84:898-911, “Adolescent acne and dietary iodine”

4) Photodermatology, Photoimmunology & Photomedicine, Published Online: 11 Sep 2008, 24(5):244-248, “Non-invasive diagnostic evaluation of phototherapeutic effects of red light phototherapy of acne vulgaris”

5) Prevention., April 2010, p.4.

6) Journal of the Academy of Nutrition and Dietetics, 2013, 113(3):416-430, “Acne: The Role of Medical Nutrition Therapy”

7)  https://www.peaktestosterone.com/forum/index.php?topic=1060.0

8) Journal of Investigative Dermatology, 1992, 99:509 511; “Control of Human Sebocyte Proliferation In Vitro by Testosterone and 5-Alpha-Dihydrotestosterone Is Dependent on the Localization of the Sebaceous Glands”

Large Particle LDL Can Take Out Your Heart & Erections

Before I go into the research that shows that all LDL can cause arteriosclerosis, let me give you a little history.  The argument that only small particle LDL particles cause arterial issues almost always comes from those who want to justify having high LDL numbers.  Western societies have notoriously high LDL numbers and we all want to feel good about the way we eat.  So it’s very convenient to ignore LDL.  However, below I will show you many reasons from the research why this is very naive thinking.

CAUTION:  Some researchers have noted that it is the LDL-P that really counts and not the the LDL-C.  LDL-C is the traditional LDL number that you and I are used to and that physicians commonly pull for our annual physical.  LDL-P is known as the “particle count” and it is this nummber that correlates most powerfully with heart disease and atherosclerosis.  So why do we use LDL-C?  Well, the reason, at least in my mind is simple:  most people who have hgih LDL-C problem usually have an LDL-P problem as problem.  Now that is certainly not always true, especially for men who are on lower fat diets like myself, and who can sometimes have low LDL-C but higher LDL-P.

Also, many readers do not understand why I repeatedly emphasize arterial health.  Again, as Dr. Steven Lamm emphasized: what’s good for the heart is good for the penis. Common sense tells you that you have to keep those penile arteries plaque-free if you want to maintain your erectile strength.  Remember:  that plaque will harden the arteries and limit nitric oxide – both of which are bad for erections.

1. Unoxidized LDL. Another apologetic argument of LDL disbelievers:  “inflammation and oxidation are the causes of arteriosclerosis, not LDL!”  Unfortunately, this simply does not hold in real life.  One study noted that “native, unoxidized LDL has direct atherogenic effects, for example to enhance activated monocytes to produce the inflammatory mediators TNF-α and IL-8.” [2] Of course, TNF-alpha is the inflammatory cytokine playing a role in heart disease and dozens of other nasty chronic conditions.

2.  Large, “Fluffy” LDL.  Not only is large LDL plaque-building, but it is also a major player.  The same study above stated:

“Finally, large cholesterol-rich LDL is the predominant type of LDL in familial hypercholesterolemia (44), and it is firmly established that this LDL is responsible for their premature atherosclerosis. Thus, large and small LDL are atherogenic, and it is not possible to judge which if any is more harmful, overall.” [2]

3.  Intermediate LDL. Yes, there are all different sizes of LDL and even ones in the middle. Researchers call this kind IDL.  And some kinds of IDL can be artherogenic: “These data suggest that IDL CE content may be a determinant of progression of coronary lesions and may be influenced by compliance with or metabolic response to lipid-lowering dietary advice in patients with coronary artery disease during simvastatin treatment.” [5]

[2]And the research does indeed show that this kind of LDL is particularly viscious. [4] A number of studies have shown this clearly:  “Particularly atherogenic forms of LDL include small, dense LDL particles and oxidized LDL. All lipoproteins that contain apolipoprotein B, such as LDL, very-low-density lipoprotein, and intermediate-density lipoprotein, tend to promote atherosclerosis.” [3]

5.  All Arterial Plaque Reversers. There are a number of well-known doctors out there who are actually reversing arteriosclerosis.  This is a remarkable accomplishment if you think about it, because heart disease is the number one killer of men.  Every one of these clinicians includes in their practice a strong LDL-lowering in strategy.  This includes the famous physicians Drs. Davis, Esselstyn and Gould for example.  Each of them has their own protocol for lowering LDL, but all of them have a proven track record of reducing arteriosclerosis by starting with LDL as their base technique.

And what LDL levels do they want?  Is LDL of 120+ like the typical American okay?  Each of them wants LDL to be in the 60-85 range, something I document in my link on LDL Thresholds for Arterial Health. By the way, the books of these authors are a fascinating read and not all of them are traditional Low Fat. One rule that I really like Dr. Davis’ “Rule of 60” for plaque reversal: LDL < 60; HDL > 60; Triglycerides < 60.

6. Primal Cultures.  Loren Cordain documented, in one of his early papers, how every modern primal culture with no heart disease had cholesterol below 150. [2] Of course, Loren Cordain is the founder and cheif apostle of the Paleo Diet, and many Paleo followers will be shocked to learn that Loren Cordain originally advocated LDL in the 50-70 range, because of the overwhelming eviden’ce of good health from these supposedly “primitive” peoples that were so heart healthy. [2]

Now cholesterol is not that relevant of a number, but cholesterol of 150 will almost always mean low LDL. If your cholesterol is low, then your LDL is very likely to be low as well and this is why Loren Cordain came to his original conclusions.  Even the Masai, who ate boatloads of saturated fat had cholesterol right at 150.  Some people say the Eskimo/Intuits had cholesterol greater than 150, but they also ate mountains of fish and suffered with severe osteoporosis-related issues because of their diet.

Large Particle LDL: What Can You Do?

Again, do not fall for the idea that your LDL number does not matter and that it is only inflammation and triclycerides that count. Consider what these authors wrote: “Thus, large and small LDL are atherogenic, and it is not possible to judge which if any is more harmful, overall.” [2] Does this mean that all men with medium or high levels of LDL will develop arteriosclerosis?  None of us can say always of course.  But it does mean that you are taking your life into your own hands.

So what can you do? It is simple. I have a link with good starter information called How to Clear Your Arteries and I also highly recommend that you read the books of the above doctors. Particularly relevant is Prevent and Reverse Heart Disease by Dr. Esselstyn, both of whom generally advocate a drug-free approach.

1)  https://thepaleodiet.com/wp-content/uploads/2012/11/JACC-LDL-Final.pdf, JACC, June 2, 2004:2142–62004, 43(11), “Optimal Low-Density Lipoprotein Is 50 to 70 mg/dl: Lower Is Better and Physiologically Normal”

2) The Journal of Clinical Endocrinology & Metabolism, Oct 1 2003, 88(10), “Low-Density Lipoprotein Size and Cardiovascular Disease: A Reappraisal”

3) Circulation, 2004, 109:III-2-III-7, “Atherosclerosis: Evolving Vascular Biology and Clinical Implications: Atherogenic Lipoprotein Particles in Atherosclerosis”

4) Can J Cardiol, 2001 Aug, 17(8):859-65, “A prospective, population-based study of low density lipoprotein particle size as a risk factor for ischemic heart disease in men”

5) Arteriosclerosis, Thrombosis, and Vascular Biology, 1998, 18:577-583, “IDL Composition and Angiographically Determined Progression of Atherosclerotic Lesions During Simvastatin Therapy”

A Zinc Deficiencies and Low Testosterone - Peak Testosterone

A Zinc Deficiency and Low TestosteroneOne of our posters on the Peak Testosterone Forum listed a thread from a bodybuilding forum where a man took 25 mg of zinc for a couple of months and almost quadrupled his testosterone from 170 to 635 ng/dl. [1] Now I’ll be the first to tell you that you can’t rely on a semi-random story on the internet for health and fitness advice.  But, as I’ll show below, this story is not only not far-fetched but actually backed by the findings of a couple of studies.

In fact, let’s look at one study that took four young men and gave them a zinc deficient diet.  Their testosterone dropped from a pre-study level of 1176 ng/dl to a zinc deficient level of 311 ng/dl in just 20 weeks. [1] This is a drop to almost one fourth of starting levels!  This seems to match well with the almost four times increase that the above man reportedly experienced from zinc supplementation.  However, one might be thinking that this is an artificially created scenario and my not work as well in real life.  Well, the researchers read our minds and examined a more practical “real life” scenario:

They took a group of “mildly zinc deficient” seniors and found that their average testosterone levels were very low:  244 ng/dl, which is hypogonadal by any lab standards that I know of.  So what happened when they gave them zinc?   Their testosterone almost doubled to 470 ng/dl. Notice that this did not magically give them youthful levels.  However, the key is that it did boost their testosterone back up to more normal levels for their age group.  Not bad for an inexpensive supplement, eh?

The takeaways from this study seem clear and are:

–Zinc deficiency can lead to very low testosterone levels.

–Correcting a zinc deficiency can lead to dramatic increases in testosterone.

–Correcting a zinc deficiency can restore testosterone to “normal” levels

NOTE: You can test for a zinc deficiency using what is called a “taste test.”  For example, check out the Designs for Health Zinc Challenge

There are other signs that zinc may improve your testosterone levels besides just a straight deficiency.  For example, one study took men with long term infertility and testosterone less than 480 ng/dl and put them on zinc.  Their testosterone, dihydrotestosterone (DHT) and sperm counts rose significantly. [3] Of course, it’s probably prudent to just get a zinc test done, but this study shows just how widespread zinc deficiencies may be and how other male-related symptoms may be a sign that one is low on zinc.

NOTE:  You may also be interested in my page on the https://www.peaktestosterone.com/.

Why does zinc boost testosterone?  I have never been able to find a solid explanation for it.  Of course, zinc is known for inhibiting the aromatase enzyme, which will tend to lower estradiol and raise testosterone.  My HRT clinic, for example, will even give a man zinc as “Arimidex Light” just for that purpose.  But it’s aromatase-limiting powers are quite limited and so this would have a minimal impact on testosterone.  Adding to the mystery is that neither the enzyme that converts pregnenolone to progesterone, DHEA to androstenedione or androstenedione to testosterone actually contains zinc, so zinc’s testosterone-raising role is clearly secondary.  However, since zinc is actually in 100+ human enzymes, its role in human health is critical and it is, therefore, no surprise that it can so dramatically alter one’s testosterone.

So will zinc always raise testosterone levels in men?  Well, some supplement manufacturers would like us to believe so, but that is probably not the case.  I discuss this in more detail on my page on Zinc, ZMA and Testosterone, but the zinc / magnesium combo in ZMA supposedly significantly increased testosterone according to the first study (funded by someone with a financial interest). However, follow up studies have not shown this to be the case and the consensus seems to be that zinc will only boost testosterone significantly in those that are truly zinc depleted.

CAUTION:  More is not better when it comes to zinc.  Zinc can be neurotoxic and competes with copper.  There is evidence that even small amounts of zinc supplements can lead to some rather nasty issues, something I show in my page on The Potential Dangers of Zinc Supplementation.

REFERENCES:

1) https://www.peaktestosterone.com/forum/index.php?topic=3369.0

2) Nutrition, 1996 May;12(5):344-8, “Zinc status and serum testosterone levels of healthy adults”

3) Systems Biology in Reproductive Medicine, 1981, 7(1):69-73, “Effect of Zinc Administration on Plasma Testosterone, Dihydrotestosterone, and Sperm Count”

4) Am J Clin Nutr, Jul 1992, 56(1):1 148-157, “Effects of dietary zinc depletion on seminal volume and zinc loss, serum testosterone concentrations, and sperm morphology in young men”

Testosterone and DHEA - Peak Testosterone

On the Peak Testosterone Forum I see certain men’s health solutions that have a pretty solid track record. HRT (TRT) does pretty well with a good protocol and on the erectile side, things like pomegranate juice and Citrulline have a decent batting average. DHEA is brand new, but we now have several men who have recently experimented with it with some short term successes at least. For example, look at what this man wrote:

“Before that i was experimenting with 50mgs of DHEA, after a week or two, I noticed morning erections, that were rock hard, the last time i had this was when i was a teenager.” [1]

And it also helped out this guy who was on HCG Monotherapy in several ways:

“I started on 50mg DHEA daily about a week ago and I think it’s helped my mood and libido considerably. I am on HCG mono and my T levels look great, but I needed some additional help. My DHEA was in the low 200s so I thought I’d give it a try and I can say I’m actually thinking it’s working.” [2]

Just how does DHEA work its magic in some men?  Well, one thing that we can say is that it is NOT from increasing total testosterone.  Multiple studies in men – it definitely can raise T and DHT in women! – have shown no effect in total testosterone and this is what we will cover below.  We will also look at what DHEA does to free testosterone.

1)  https://www.peaktestosterone.com/forum/index.php?topic=6099.0

2) https://www.peaktestosterone.com/forum/index.php?topic=6182.0

3) The Journal of Clinical Endocrinology & Metabolism, Published Online: July 01, 2013, 78(6), “Effects of replacement dose of dehydroepiandrosterone in men and women of advancing age.”

4) Urology, Mar 1999, 53(3):590 594, “Dehydroepiandrosterone in the treatment of erectile dysfunction: a prospective, double-blind, randomized, placebo-controlled study”

5) https://www.peaktestosterone.com/forum/index.php?topic=6186.0

6) American Journal of Physiology – Endocrinology and Metabolism, 1 Jan 1995, 268(1): “DHEA administration increases rapid eye movement sleep and EEG power in the sigma frequency range”

7) ) Metabolism Clinical and Experimental, 2006, 55:858-870, “Endocrine effects of oral dehydroepiandrosterone in men with HIV infection: a prospective, randomized, double-blind, placedbo-controlled trial”

8) Clin Endocrinology, 1998, 49:421-432, “The effect of six months treatment with a 100 mg daily dose of dehydroepiandrosterone (DHEA) on circulating sex steroids, body composition and muscle strength in age advanced men and women”

9) Journal of Andrology, Nov-Dec 2008, 29(6):610 617, “Reference Ranges for Serum Dehydroepiandrosterone Sulfate and Testosterone in Adult Men”

NOTE:  If you are interested in whether or not testosterone therapy (HTR / TRT) impacts DHEA, skip to the bottom of this page.

a) 50 mg in Men Aged 40-70. According to this study, some change in IGF-1 occurred, but none in testosterone. [3] This dosage is kind of the standard dosage that I see most men taking on The Peak Testosterone Forum with 25-100 mg being the range.

b) 100 mg in Men Aged 55-70.  This small study had a six month study period and found that there was difference in either testosterone or DHT in the men. [8]

c) ~600 mg in HIV Positive Men.  Probably the ultimate verification that supplemental DHEA does not change total testosterone came from a study of HIV positive men where a very large dosage (600 ng/dl) was administered on a daily basis. [7]

1.  Boosting Free Testosterone When Combined With Intense Exercise. Now some of you may know that DHEA can be a precursor to testosterone. So you may be thinking, “Aha!  I know why DHEA sometimes does these things:  it’s boosting testosterone!”  However,that typically is not the case, at least in terms of total testosterone.  Many studies in men have shown no significant change in total testosterone.  Plus, if DHEA routinely increased total testosterone, every bodybuilder on the planet would be taking it.

While it does not appear to consistently boost total testosterone, it may actually boost free testosterone quite significantly if combined with HIIT in some men.  See my page How to Increase Testosterone Naturally for the study.  As a verification, this same study showed no significant difference in total testosterone levels – only free.

2.  Raising Levels Decreased by HRT (Testosterone Therapy). I have not seen proof of this, but one of the well-known online HRT physicians, has stated that HRT generally lowers DHEA levels.  We saw this in one of our own guys whose DHEA levels on HRT were about 500 and then rose to 600 when he quit. [2][5] For this reason, some HRT docs and clinics recommend supplemental DHEA.

4.  Brain Booster. In my opinion, HRT works not because it can (sometimes) improve erectile function or restore morning erections, but instead because it is such a brain booster for hypogonadal men.  For a man who has low testosterone, Testosterone Can Restore Brain Dopamine and increase brain-benefitting estradiol and DHT levels as well. Therefore, libido and mood usually increase on a well-done HRT program. Depression scores improve. And even mental performance can improve – working and verbal memory for example. Basically, this is not always the case, but usually in my opinion testosterone is a great “brain tonic” for a man that is deficient.

Now let’s go back to DHEA.  Does it exert similar brain-boosting characteristics?  The answer is that it probably does not for most men, simply because there are quite a few studies who found that in men no increased libido, mood or memory.  (Women do a little better in the studies.)  However, there was one study that found that it “was associated with a remarkable increase in perceived physical and psychological well-being for both men (67%) and women (84%).” [3] Unfortunately, there was no increase in libido. Like most of the studies, the participants were give 50 mg per day.  The bottom line is that some men, for reasons unknown, may get a boost in well-being, mood and the like, but don’t expect it.  This brain boost may be responsible for some of the good reports I am getting.

5. Sleep Aid. DHEA can lower cortisol and is considered a “stress tonic” by some.  Perhaps for this reason, DHEA seems to help with sleep in the sense that it increases REM sleep. [6] Interestingly enough, morning erections generally occur during the REM sleep phase, so perhaps this explains why the man above enjoyed improved morning erections? (A very large dose, 500 mg, was given in this study and it was on healthy young men.  So more study work needs to be done in this area.)

6. Cortisol Reduction. DHEA can lower cortisol as well in some men.  Generally, this is not the case though according to a number of studies

Did you know you can inexpensively do your own testing for most hormones? The industry leader is Discounted Labs..

CAUTION: DHEA should not be given in my opinion if you are not low in DHEA.  It should also not be given in higher dosages. See my page Potential DHEA Dangers for more information.  While DHEA levels plummet with aging, it is important to get a DHEA read before.  You can pull your DHEA inexpensively here:  Testosterone Labs.

Testosterone Therapy (HRT / TRT) and DHEA

Above I documented the studies that show that DHEA does not significantly increase total testosterone on average but likely does increase free testosterone in many men. But what about the other way around? What if a man significantly boosts his testosterone through HRT (TRT)? Will that raise or lower his DHEA?

Unfortunately, my answer to that question is anecdotal:  there are several knowledgeable HRT physicians who have stated that decreased DHEA is a common side effect in the medium and long term testosterone therapy.  The reason given for this is that testosterone tends to shut down the body’s HPA (hypothalamus-pituitary-adrenal) axis, and the theory is that this “shutdown” can leave some men with lower DHEA.

Can I prove this or back it with some references from the medical journals?  No, I cannot.  However, I can tell you that my DHEA was every low after being on testosterone cypionate for a couple of years.  My DHEA-S was right around 100 ug/dl last year (2014) and a typical range for a man my age would be about 109-208 (25th, 75th percentile). [9]

On a practical level, it would be prudent for men on TRT to measure their DHEA-S before and after TRT.  For more information on DHEA, see my Index Page on DHEA.

REFERENCES:

Visceral (Belly) Fat, Insulin and Testosterone - Peak Testosterone

Call it anything you want, but it’s ugly and it’s hard on your health.  The subject recently came up in The Peak Testosterone Forum. A poster asked this question:

“So I’ve read in several articles how visceral fat (yes, the nasty deadly one) is harder to get rid of from diet and exercise than subcutaneous fat. I have not seen anything that compares these two as a result of HRT. With that said, here is a fairly obvious observation I’ve made from my TRT over the last 2-1/2 months:”

“…4) My waste has shrunk almost 2 belt notches after gaining this 5 to 6 pounds!…So from all of this it seems the only explanation for the belt reduction is visceral fat removal. Does picking up your T levels significantly cause visceral fat to fall away faster than subcutaneous? Is this fully understood?” [1]

As you can see, this man went on HRT and is asking if the increased testosterone could have improved his visceral (belly) fat levels?  The answer is “Yes!”

REFERENCES:

1) https://peaktestosterone.com/forum/index.php?topic=1347.0

2) International Journal of Obesity and Related Metabolic Disorders : Journal of the International Association for the Study of Obesity, 1992, 16(12):991-997, “The effects of testosterone treatment on body composition and metabolism in middle-aged obese men.”

3) J Clin Endocrinol Metab, 2008, 93(1):139-146, “Testosterone therapy prevents gain in visceral adipose tissue and loss of skeletal muscle in nonobese aging men”

4) International Journal of Obesity and Related Metabolic Disorders : Journal of the International Association for the Study of Obesity, 2000, 24(4):485-491, “Low serum testosterone level as a predictor of increased visceral fat in Japanese-American men”

5) J Clin Endocrinol Metab, 1998, 83:1886, “Testosterone deficiency in young men: marked alterations in whole body protein kinetics, strength and adiposity”

6) American Journal of Physiology – Cell Physiology, Aug 1 2013, 305:C355-C359, “Testosterone induces cell proliferation and cell cycle gene overexpression in human visceral preadipocytes”

Below, I will show some studies that show powerfully testosterone can lower visceral fat. But this should be a sobering reminder to most men out there: if a man overeats, his high testosterone levels end up creating deadly fat in the belly area, i.e. visceral fat through signaling of preadipocytes. [6] Yes, you are predisposed to deadly visceral fat!

1.  Obese Men.  In one study of obese men, they made no lifestyle changes but simply gave the men testosterone therapy.  The participants experienced many positive changes, but one of them was a significant decrease in visceral fat.[2] As I mention in my link on Testosterone and Insulin, testosterone has a powerful insulin lowering effect.

2. Non-obese Seniors. One study put men on patches and only modestly increased their testosterone levels by about 30% from their starting point.  Even with such relatively small changes, visceral fat decreased significantly in these senior men. [3]

So it’s literally no exagerration to say that if you are low or lowish T, adding testosterone will probably melt off your visceral fat.  Of course, deciding whether or not to go on HRT is a personal decision between you and your doctor that involves many variables, but it’s always good to know the truth and the truth is that testosterone is strongly related to your “gut”.

This fact has been verified in many other ways as well.  First of all, a study on Japanese American men found that testosterone levels were inversely associated with visceral fat. [4]  In other words, the more testosterone, the less the visceral fat and vice versa.  Another interesting study gave a little more understanding by essentially blocking testosterone signaling in healthy young men. [5]  What they found was that all fat increased, but especially visceral fat.  In other words, if you are low testosterone, you will very much be at risk for general weight gain as well.

NOTE:  See my link on How to Lower Fasting Insulin Levels for more information of interest as well.

BPH (Enlarged Prostate) and Testosterone - Peak Testosterone

Most men know that DHT (dihydrotestosterone) can cause, or at least play a huge role, in two problems that men usually experience as they age: male pattern baldness and BPH (enlarged prostate). Neither one will kill you, but they sure can make me miserable. Men who produce low levels of DHT simply do not develop BPH. Furthermore, in puberty, it is well-accepted that DHT is the primary engine of prostate growth.  So why not later in life as well?  And why not when a man goes on HRT (TRT) due to the fact that some of his new testosterone will get converted into DHT.

One way to test out if DHT is really responsibel for the growth of the prostate later in life would be to simply give men DHT and see what happens.  Or at least this would verify biological plauability.  Surely, if DHT is the root cause of BPH, then some of the men would develop the condition, right?  Researchers actually tested this situation and gave 70 mg of DHT per day to senior men and watched what happened.  Interestingly, enough, their prostates did grow a little, but they could find no relationship with DHT:

“With time on study, there was an increase during 24 months in total prostate volume (29%; 95% confidence interval [CI], 23% – 34%), central prostate volume (75%; 95% CI, 64% – 86%; P < .01), and serum prostate specific antigen level (PSA; 15%; 95% CI, 6% – 24%). However, DHT had no effect on these changes (P > .2).” [1]

So, surprisingly, this study provided inconclusive results.  Researchers, undoubtedly, had further doubts of the DHT-is-the-sole-cause of BPH by observing that only middle-age and senior men get BPH.  Yet often they have lower testosterone and DHT levels.  Furthermore, men on HRT (TRT) seem to seldom get BPH.  It does happen, of course, but with much less frequency than what one might expect.

1)  https://www.medscape.com/viewarticle/732585, “Dihydrotestosterone May Not Affect Prostate Growth But May Reduce BMD,” Laurie Barclay, MD, Nov 16 2010

2) https://www.health.harvard.edu/family_health_guide/testosterone-prostate-cancer-and-balding-is-there-a-link-thefamilyhealth-guide

3) The Journal of Clinical Endocrinology & Metabolism, 85(8), Received: February 15 2000, Accepted: May 12 2000, “Transdermal Testosterone Gel Improves Sexual Function, Mood, Muscle Strength, and Body Composition Parameters in Hypogonadal Men”

4) Amer J of Psychiatry, Jan 2003, 160(1):105-111, “Testosterone Gel Supplementation for Men With Refractory Depression: A Randomized, Placebo-Controlled Trial”

5) The Journal of Clinical Endocrinology & Metabolism, 88(6), “AA2500 Testosterone Gel Normalizes Androgen Levels in Aging Males with Improvements in Body Composition and Sexual Function”

6) https://www.usrf.org/news/BPH_Prevention/DHT_Rev.pdf

7) https://kidney.niddk.nih.gov/KUDiseases/pubs/prostateenlargement/

For example, we have had literally hundreds of men on HRT on the The Peak Testosterone Forum, and I do not remember one of them complaining of BPH. There probably has been someone, but my point is that it is quite rare. And this is really remarkable on our forum, because so many men are on testosterone cypionate in one form or the other and tend to have beefy testosterone levels.  In fact, most of the guys on our forum using cypionate have doubled or tripled their testosterone levels from their hypogonadal state. So why aren’t more of them miserable with an enlarged prostate?

Perhaps the answer is that cypionate does not raise DHT as much as the transdermal (topical) testosterones?  This is generally true and something I discuss in my link on DHT Levels. Some of the transdermals can put a man over twice the top of the lab’s physiological DHT range for example.  So what happens when we look at the HRT (TRT) studies of transdermals on men? Do they show a higher-than-expected rate of BPH and prostate growth?  Surprisingly, a number of studies actually show the opposite:

EXAMPLE 1: One stud of 1.0% testosterone gel produced very few case of BPH.  This study looked at 56 (depressed) men and resulted in only one man with an enlarged prostate. [1]

EXAMPLE 2: Yet another study of 99 men and 106 men on 50 and 100 mg of Testim, respectively, yielded almost no cases of enlarged prostate.  In fact, no men using 50 mg had BPH and only one using 100 mg.  And, in the case of the latter, it was considered a mild case. [5]

Both of these two studies involve only 1 or 2% of the study population – that is not a very high incidence and matches what I have seen on the forum.  These are simply not the kind of results one would expect if DHT was the sole factor in BPH.

CAUTION: Of course, talk to your doctor about his or her experience using HRT:  the studies simply deal with averages.  In addition, one study using stronger topicals did show a fairly significant rate of enlarged prostates. [3]

WHAT ABOUT DRUGS TO REDUCE DHT?  Propecia (finasteride) has been shown “in clinical studies of men with BPH, 5-alpha reductase inhibitors reduce prostate volume by approximately 20% to 30%.” [6] So one can rebut with the question, “If DHT has nothing to do with prostate volume, then why can you strink the prostate with DHT reducers.  These drugs are risky in my opinion, because about 10% of men will have permanent side effects called “post finasteride syndrome.”  Essentially, a man develops low testosterone symptoms regardless of DHT or T levels – a mysterious situation indeed. But the incidence is high enough that many doctors have no doubt that it occurs and will not prescribe them to their patients.

NEWS FLASH: A recent study noted a link between male pattern baldness and prostate cancer. [2] Again, DHT has been implicated as playing a role in both, so this is not too surprising.   See my page on Natural Prostate Cancer Prevention.

REFERENCES:

Prolactin In Men And Why You Should Monitor It - Peak Testosterone

There is a common suite of symptoms that bring men over to Peak Testosterone or to the Peak Testosterone Forum, such as fatigue, low libido, erectile dysfunction, mental fog, loss of morning erections and depression – been there myself! One thing that is problematic is that there are many conditions and underlying root issues that can produce these symptoms. And trying to discover the cause of these kind of more vague symptoms is not something doctors usually want or, frankly, are often equipped to handle.  And a perfect example is prolactin.

Prolactin is something that should be pulled much, much more frequently by physicians in my opinion.  It’s a cheap test and high and low values are surprisingly common.  And, as I will show below, high and low values can show the underlying cause of many common chronic conditions.  However, with health care costs spiraling out of control, most docs rarely pull it.  For example, I was low testosterone for probably five years before anyone pulled my prolactin.  This is really troubling, because I had almost every symptoms above.

For those of you who may be struggling unnecessarily, I have made pulling prolactin part of my “Peak Testosterone Program,” and below is STEP 6:  Six Great Reasons to Monitor and Test Prolactin in Men:

1. High Prolactin Can Lower Testosterone and Libido. One study used testosterone less than 400 ng/dl and/or low libido as a sign of a man with possible high prolactin. [1]  Of course, the reason is that, as prolactin rises, it generally tends to lower testosterone.  Dopamine and prolactin have a yin and yang relationship.  Thus, as prolactin rises, dopamine will probably be lower and, of course, that is never good for one’s sex life (or career).  Low dopamine is associated with many psychological conditions, including some forms of depression, OCD, ADHD, neuroticism, etc.  (Low dopamine and RLS (Restless Leg Syndrome also often occur together.)

Many young men, who should have a raging libido, show up at the doctor’s office not knowing why they have little to no desire for sex.  Most doctors will hand them a Cialis or recommend counseling.  Why not pull prolactin instead of just making huge assumptions?

NOTE:  Another common problem that I see on the Peak Testosterone Forum is men in the upper part of the lab range for prolactin.  Of course, their prolactin is not high enough to warrant one of the powerful medications such as cabergonine, since it is often full of side effects.  Yet my experience is that even moderately high levels like this can cause some men issues.  Again, isn’t it better to know the root cause?

CAUTION:  Macuna pruriens, according to one study anyway, can lower prolactin and raise testosterone by about 30% and will likely provide some relief to these men.  You can read about it on my page on How to Lower Prolactin Naturally. As a caution, though, a couple of men on our forum got arrhythmias (heart palpiations) from taking macuna, so please discuss with your doctor first.

2. High Prolactin May Be a Sign of Zinc Deficiency. Some men may have high prolactin, because they just need some zinc.  Again, pulling prolactin might be a way to discover this hidden issue.  Zinc is an expensive supplement and low levels can negiatively impact literally dozens of metabolic pathways in the body.

3. High Prolactin Can Cause Gynecomastic, a.k.a. “Man Boobs.”  The same study mentioned above also used gynecomastia as a possible sign of high prolactin levels. [1] Many men are struggling with gyno and so why not pull this number if that is the case?  The good news is that, even if the doctor does not pull a man’s prolactin, it is fairly common to prescribe tamoxifen for gyno and one study showed that this lowered prolactin.  See my page on Tamoxifen and Prolactin for additional information.

4. High Prolactin Can Be a Sign of a Prolactinoma. Prolactinomas seem to be a fairly common kind of tumor.  They are usually benign but can cause visual issues and headaches if they get large enough.  Again, we have had quite a few posters who have had some kind of pituitary tumor.

5. Low Prolactin May Signal Metabolic Syndrome: It might seem low prolactin would be a good thing – a sign of high dopamine and high testosterone.  Unfortunately, that is usually not the case.  In fact, low prolactin is actually strongly associated with Metabolic Syndrome according to one recent Journal of Sexual Medicine study. [2] It is also linked with arterial plaque!  So, in actuality, low prolactin is not only something non-desireable, but is usually dangerous.  If you do have low prolactin, then you may want to look for other signs of fatty liver, prediabetes and insulin resistance here:  Blood Glucose and Insulin Pages.

6. Low Prolactin May Cause Premature Ejaculation.  Low dopamine and high prolactin can cause anorgasmia in some men or delayed orgasm in still others.  See my page on Men That Cannot Orgasm for more information.

7. High Prolactin Can Be Caused By Hypothyroidism. Check your thyroid hormones as low thyroid function can mildly elevate prolactin levels.  Obviously, there can be synergies in symptoms, since high prolactin and hypothyroidism can lower testosterone, dopamine and libido and also increase fatigue.  One of our forum members wrote the following story his personal experience with exactly this issue:

“I got 4 tests with prolactine at 32-48 and tsh 1.2-4, then i have 4 tests with prolactine in the middle of range with tsh 0.07-0.53, i also noticed this winter i got swollen breasts when i didnt use levothyroxine and the breasts returned to normal in a few days when i started with levothyroxine. Not sure if my memory works but i think range for prolactin is 4-20 g/L” [3]

REFERENCES:

1)  The Journal of Urology, 1997, 158(5):1764-1767, “Endocrine screening in 1,022 men with erectile dysfunction: clinical significance and cost-effective strategy.”

2) 4) J Sex Med, 2009 May, 6(5):1457-66, “Hypoprolactinemia: a new clinical syndrome in patients with sexual dysfunction”

3) https://www.peaktestosterone.com/forum/index.php?topic=7194.0

How I Do a Low Fat Diet - Peak Testosterone

I get asked every so often how I implement a low fat diet.  This isn’t something I really discuss often, because my diet is so spartan and countercultural.  Besides, there are many great low fat books out there with great recipes.  Cooking is deifnitely my forte and,I basically, I eat to minimize prep time.   I enjoy what I eat, but for me it’s much more chemistry than culinary. Notably missing from my standard diet are little things like a) cooking and b) foods that are socially acceptable.  The latter simply does not matter me to any more. For all these reasons, you may not find my diet very practical.  But for those not faint of heart, you can check out how I eat below and it may give you some ideas at least.

Let me mention some strong points of my diet that may not be readily apparent:

a) Low Fat Paleo. I consider my diet very Paleo  and would term it “Low Fat Paleo”.  I rarely consume wheat, for example, and the primary “grain” that I eat is quinoa, which is not really a true grain. I also eat fish (BPA-free, low mercury sardines) almost every day and rarely have dairy or soy.

b) Good Fats. One of the big problems that plant-based folks often have is horrendous omega-6 to omega-3 ratios. Mine is stellar and right around 1:1.

c) Just Pretty Low Fat. I do not go super low with the fat levels and am in the 15-20% range (as a percentage of total fat).  I believe this is important to displace some carbohydrates and increase nutrient absorption.  It is the recommendation in the Pritikin Edge as well.

d) 90% Plant. I believe that the sweet spot for diets is 90% Plant / 10% Animal.  The ultraelite supercultures (Hunza, Abkhasians, Tarahumara, Vilcabambans) eat roughly this way and they enjoy not only incredible longevity but a life without heart disease, cancer or autoimmune disorders.

SUCCESSES:  Here are some goals that I have achieved while consuming a low fat diet that I think are noteworthy:

a) Heart Scan of Zero. About a year ago, I had a heart scan and they found zero cardiac artery plaque.  That’s pretty good for a guy in low mid 50’s in a Western Culture.  This is good for erections and should greatly improve my chances of traditional heart disease, assuming I can maintain it.

b) A1C. My latest A1C was 5.2.  While not stellar, this is a pretty respectable number for a guy eating a solid amount of carbohydrates.

c) Hypertrophy. I am a skinny bastard, but I have 20+ more pounds of muscle than I did in college with almost exactly the same amount of body fat.

d) Excellent Triglycerides, LDL-C and apoB. For example, in 9/4/2014 I pulled the standard lipids and had cholesterol of 121, triglycerides of 98 and LDL of 76.  My apoB was 68 mg/dl, which is a very respectable number.  I’d like to get the triglycerides and apoB down about 10% more, but the point is that diet alone can get you very close to plaque regression levels.

CONCERNS:  Here are a few things that I need to work on:

a) Occasional Prehypertension. When I go to a doctor’s appointment, I will at time get a reading that is about 128/86.  This could be a side effect from TRT or from overwork.  I can only say, “Working on it.”

b) High PSA. I had a high PSA read and actually had to have a biopsy.  They found (in a biopsy) no cancer and inflammation, so so far so good.

RDA’s: Although not perfect, my RDA totals are very good.  I eat pumpkin seeds, which are high in zinc and magnesium, and consume nutritional yeast, which is high in the B vitamins, areas where plant-based men can come out a little low:

Yes, selenium is a little low, but I actually take it in supplement form to make sure I get enough. Iron is a little high, but I am consuming almost entirely non-heme, so I believe I will be okay there. Niacin is also a little low, but I haven’t worked on that yet. Note that sodium is not actually low, as I get ample amounts from my pumpkin seeds which have salt.

FOODS:  I guess I should also include the actual foods that I eat!  Here they are:

HOW I EAT – THE MECHANICS:  As I mentioned, my diet is designed around minimum prep time and fast but nutritious meals.  Basically, I do the following:

Note that for sauces I will use low fat ones that I find at Trader Joe’s.  This includes various salsas, salad dressings,  etc.  This adds some “spice” to eating the same thing virtually every meal.  I will sometimes substitute brown rice or millet in place of the quinoa.

MACRONUTRIENT LEVELS: I exercise about an hour a day and, therefore, need a good supply of carbs in my opinion.  My goal is a carb-to-protein ratio less than 2:1, which this diet achieves.  In addition, as mentioned above, I was targetting fat levels at 15-20% of total calories.  You’ll also notice that I consume a fair amount of protein for hypertrophy (muscle building) purposes:

Everyone is obsessed with saturated fat for reasons that escape me. I consume about 4 grams per day. Saturated fat servers no useful purpose and lowers nitric oxide levels. So I avoid it.

TOTAL CALORIES: All the above numbers are based on a diet of 2,000 calories.. However, I have some buffer, where I can eat some additional calories – around 300 – from fruit, etc.. Therefore, my actual calories levels are around 2,300 per day.  This is probably low for some of you men out there that are very athletic, doing endurance sports or just young with a high metabolism.

OTHER PAGES OF INTEREST:

My Heart Scan Results

A Review of the Pritikin Edge

HDL, LDL and Triglcyeride Targets to Regress Arterial Plaque

ApoB Levels to Regress Plaque

Why (Non-Wheat) Grains are Perfectly Paleo

How To Lose Weight The Easy and Healthy Way - Peaktestosterone

Most of the men who write me wanting to improve their erectile dysfunction or low testosterone are significantly overweight. The truth is that they don’t need to be told that their spare tire is an issue – they’re experiencing the symptoms first hand!

Many of them have struggled all their lives with weight issues and many of you reading this are in the same situation.  Rest assured, though, that losing weight does not have to be the laborious, painful experience that so many make it to be.  The key is to understand your body, your hormones and a few tips and tricks that the research has uncovered.  For example, did you know that one study showed that if you lose weight by diet along you will lose muscle? [25] However, if you add exercise to your diet, you will lose primarily fat and maintain your muscle. Again, many people, even in the health community, are unaware of this fact.

Now, before I move on and discuss the best way to lose weight, I want to mention that more than anything else it is perhaps most critical that you not lose weight too rapidly.  You will have trainers, your conscience and maybe a few friends and family pushing you to drop those pounds quickly.  Well, don’t listen!  Losing weight rapidly destroys your testosterone (and leutinizing hormone) like nothing else.  A recent Finnish study found that wrestlers who dropped weight very quickly decreased testosterone levels by over 60%! [14] Ouch! (See the bottom for more details.)

So my advice is relax and lose weight slowly, steadily and peacefully with dignity and grace.  No need for television theatrics.  No need for family and friends or even yourself to suffer immeasurably.  Losing weight is not a monumental decision – it’s just a part of life for all of us.

If you need motivation, read here about the Many Dangers of Being Overweight.  And here’s some scientific findings that will really help:

1)  Muscle. If you have lost a lot of muscle over the years, you will find it easy to put on weight.  Remember that “Muscle Burns Fat”.  If you can trade five pounds of fat for five pounds of muscle, you will burn 200 more calories per day!  This translates to at least 21 pounds per year.  A lot of people wonder why they gain weight so easily and it’s because they’ve let their muscle mass slowly decline, which leads to a nasty metabolic downward spiral.

2)  Fructose.  Watch the fructose!  Read here about How Fructose Sabotages Weight Loss.

3) Green Tea Extract. One supplement will help you lose weight is Green Tea Extract.  Animal experiments have shown that mice (with an obesity gene) experienced less weight gain with Green Tea Extract and had lower cholesterol and triglyceride levels as well. [7]  Another 2008 study showed that rats had less weight gain while on Green Tea Extract. [8] Previous studies had shown that Green Tea does this through thermogenesis [9], basically increasing one’s metabolism and fat burning, but these animal studies showed additional mechanisms.  But additional research has shown that Green Tea inhibits fat-digesting enzymes [10] and helps you eliminate (poop) a higher percentage of fat after ingesting a high fat meal. [11]

4) Exercise. I don’t need to tell you that exercise burns calories. [1] I have known a number of people who could not lose weight until they started exercising and exercise makes you less insulin resistant.  Regardless of the reason, you may need to couple exercise with your weight loss program.

5) Insulin Resistance.  Read my link on Metabolic Syndrome.  One of the hallmarks of Metabolic Syndrome is insulin resistance and scientists have just discovered that high insulin levels keep your body from breaking down fat.  An insulin resitant individual will have high insulin levels and high glucose concentrations, a toxic combination that causes damage in different ways.  The high insulin levels are deadly because the block the breakdown of fats by adrenaline and lipase. [15] In other words, insulin resistance makes it MUCH easier for to retain fat, so it is critical that you put in your gym or road time.

6) Low Glycemic Index. One recent 12-week study found that eating a low glycemic diet produced greater weight loss than those on a high glycemic diet. [16] Low glycemic foods are those that do not spike your blood sugar as much, such as whole grains and most fruits and vegetables.  NOTE:  It should be noted, though, that not all studies have found these results.  Glycemic Load is, by the way, a much more important concept actually than the Glycemic Index.

7) Exercise to Increase Basal Metabolism. As we age our metabolism slows down, largely due to the loss of lean muscle mass.  “Muscle burns fat” is a saying that is largely true.  Exercise is one of the best ways to ramp up your metabolism and burn off calories.  Plus, most forms of exercise will also build some muscle for you as well.  The book, The GI Mediterranean Diet – an excellent read by the way – talks about how if you exercise in the morning for even 20 minutes, you increase your metabolism for the next 10-12 hours! [18] Yet another study found that weight training (8 exercises, 8 sets, and 6 repetitions) increased baseline energy expenditure for at least 72 hours afterward! [20]  If you exercise in the evening, you only get this boost in metabolism for four or five hours until you go to bed.  Of course, the best thing to do is exercise for a half hour in the morning and then a half hour in the evening and you’ll be burning calories every waking hour.

8) Squats.  Do strength and weight training on your large muscle groups, especially the quads (thighs) and gluts (butt). Researchers at Syracuse University found that the body takes more energy afterwards to repair and rebuild and so more calories are burned off. [19]

9) Avoid Late Night Snacks. You still here “calories in, calories out” is all that matters in weight gain and weight loss.  That belief is slowly getting shattered of lateResearchers recently found that late night snacks affect metabolism negatively and lead to greater weight gain. [21]  Mice fed late at night gained over twice as much weight as mice fed during regular feeding hours.

10) Sitting and Lipase. Scientists have found that sitting does something particularly nasty: it shuts off the activity of an all-important weight loss enzyme called lipase. It does this by severely limiting the circulation of lipase and lipase is critical because it allows the body to process fat and cholesterol.  Just the simple act of standing allows for a much, much better dispersion of lipase throughout your tissues.  If you are sedentary and haven’t been able to lose weight, now you know one of the reasons why.  It’s not just that you have been burning enough calories, it’s that you have been limiting your body’s natural chemical processing factories.  So, the old expression “Get off your a#$%!” might actually save one’s life!

11) High-Intensity Training.  If you can take the pain, High-Intensity Training, a close relative of Interval Training, has also been shown to help you lose weight the fastest. Intensity is a technical term that basically refers to the amount of effort in a certain amount of time or the amount of “sweat and burn” the exercise induces.  High-Intensity Training actually boosts your metabolism so that you “burn fat” for more hours than other training methods. [22] Researchers put (female) participants on a repeated cyle of “sprinting” on a stationary bike for 12 seconds and then pedaling much more slowly for 12 seconds and so on for twenty minutes three times per week. [23]  This very minimal amount of exercise significantly reduced body fat and controlled blood sugar metabolism.

12) GoWear/Sensewear/Bodybugg. This is the device used on Biggest Loser and with good reason:  many guys may benefit from the use of this armband which uses a complex set of readings on acceleration, skin temperature/response and heat to determine how many calories you have burned. It is supposedly much more accurate than standard heart monitors and considering that a lot of us are motivated by numbers, myself included, this offers a considerable level of detail.  You get numbers and charts galore as it is used in conjunction with a web site that lets you analyze your progress.

13) Sleep.  Sleep is a key to keeping off the pounds.  It is so important that I have created a separate link How Lack of Sleep Sabotages Weight Loss.

14) Low Fat Diet.  The beauty of a Low Fat (or Ornish) Diet is that it solves your hunger problem during dieting, because you can eat as much as you want.  Think how much you can eat if you are eating nothing but (whole) grains, beans, legumes, vegetables, fruit and egg whites?  You can fill your stomach up many times per day and still lose weight because there is no high-calorie fat in your gut.  Fat is 9 calories per gram, whereas carbohydrates and protein are only 4 calories per gram.  The typical American eats a diet around 35-40% fat and so the typical American end up eating too many calories.

In fact, the astonishing thing is that you will get full before you actually get all the calories.  In other words, you’ll actually lose weight on a Low Fat (or Ornish) Diet.  Dr. Ornish performed a study and found that people who followed his diet lost an average of 22 pounds in their first year. [5] Imagine almost effortlessly losing weight while you walk around full and satisfied.  In other words, forget dieting -just eat the right way!

15) Vinegar: Vinegar has just been found in an extremely promising animal study to lower visceral fat.  Visceral fat is that annoying and dangerous fat that most guys get around their abdomen, i.e. a paunch/spare tire/gut.  Lab animals who consumed vinegar had 10% lower fat. Please about How Vinegar Can Help You Maintain (or Lower) Your Weight.

16) Appetite. One of keys to weight control is controlling your appetite. Packaged and processed food, in particular, is packed with sugar, salt and fat and compel you to eat more than you need.  On the other side, there are actually many healthy foods that are particularly satisfying.  Read this link about Foods that Help Control Appetite.

17) Stress. Watch your stress levels.  Researchers recently found that on average chronic stress led to weight gain, due to “eating in the absence of hunger”. [26]

18) Whey.  Research, some of it quite recent, has shown that whey will very likely help you lose weight.  Whey, a common bodybuilding protein supplement, does this through satiety of the appetite [27], control of glucose and insulin post-meal [28] and muscle building (and muscle burns more calories).  Even more interesting is the fact that whey appears to actually raise the body’s Resting Energy Expenditure, thus making your system a fat-burning inferno. [29]  In other words, whey seems to help you burn off those calories in almost every way possible. CAUTION:  Almost all store bought wheys that I have seen are loaded with dangerous excitotoxins and I document that here in my link called No Whey!.  However, there is an alternative, undenatured or biologically active whey, which I document in my link called Yes Whey if you want more information.

NOTE 1: Chromium, in spite of what your health food store may have told you, has been shown to be ineffective for weight loss.  However, it does seem to help your body manage blood sugar.  So there is some justification for taking chromium but not as miracle weight loss supplement.

NOTE 2:  For those of you who are Mediterranean Diet aficionados, you’ll be glad to know that a recent meta-analysis found that most studies showed a decreased risk for becoming obese for those who followed a Mediterranean Diet. [6] Again, the Mediterranean Diet is relatively high fat (~30%), making it easier to put on weight. However, it does convey a low glycemic load, which may contribute to its ability to keep off weight gain.  And one could also speculate that perhaps because it is fulfilling and satisfying, it leaves its practioners eating somewhat less.

NOTE 3:  You can’t trust the calorie labelling on food items. [17] The problem is that our bodies digest food and don’t burn it, which is where the whole calorie calculations are based on.  This is important because protein and fiber actually take significant energy to digest whereas cheap carbs do not.  So if one consumes a meal with a lot of protein and fiber, the amount of calories actually stored by the body may be as much as 25% less than that with sugars and other less healthy foods.  Yes, this is yet another reason to avoid the bad stuff.

REFERENCES:

1) Metabolism, 2001, 50(7):795 – 800

3) Amer J of Clin Nutrition,Jun 1984,39(6):930-6

6) Obesity Reviews, Nov 2008, 9(6):582-593

7) Amer Soc for Nutrition J Nutr, Feb 2008, 138:323-331

8) Amer Soc for Nutrition J. Nutr, Nov 2008, 138:2156-2163

9) Int J Obes Relat Metab Disord, 2000 Feb, 24(2):252-8; J Med Food, 2006, 9(4):451-8

10) J Nutr Biochem, 2000 Jan, 11(1):45-51

11) Eur J Clin Nutr, Nov 2006, 60(11):1330-1336

12) Nutr J, 2008, submitted

13) West Afr J Med, Apr-Jun 1990, 9(2):108-115

14) Karila, TA., et al. Rapid Weight Loss Decreases Serum Testosterone. (2008) Int. Journal of Sports Medicine. May 30

16) Eur J of Clin Nutr, 2008, 62:145-149

17) Brit J of Nutr, 2001, 85:271-287, A perspective on food energy standards for nutrition labelling, Geoffrey Livesey

18) The GI Mediterranean Diet, Dr. Fedon Alexander Lindberg, p. 89-90.

19) Men’s Health, Sep 2009, p. 38.

20) J of Strength and Conditioning Res, Sep 2008, 22(5):1602-1609, “Resting Energy Expenditure and Delayed-Onset Muscle Soreness After Full-Body Resistance Training With an Eccentric Concentration”, Hackney, Kyle J

21) Obesity, “Circadian Timing of Food Intake Contributes to Weight Gain”, Arble, et. al.

22) Intl J of Obesity, 2008, 32:684-691, “The effects of high-intensity intermittent exercise training on fat loss and fasting insulin levels of young women”

23) International Journal of Obesity, 2001, 25:332-339, “Impact of high-intensity exercise on energy expenditure, lipid oxidation and body fatness”

25) The Amer J of Med, 95(2):131-140, “Effect of an energy-restrictive diet, with or without exercise, on lean tissue mass, resting metabolic rate, cardiovascular risk factors, and bone in overweight postmenopausal women”

26) Obesity, 2008, 17(1):72 77, “Acute Stress-related Changes in Eating in the Absence of Hunger”

27) British Journal of Nutrition, 2003 Feb, 89(2):239-48, “Casein and whey exert different effects on plasma amino acid profiles, gastrointestinal hormone secretion and appetite”

28) FASEB Journal, “The Effect of Whey Protein on Post-Meal Blood Glucose and Insulin”

29) Med Sci Sports Exercise, 2009 Dec 4, [Epub ahead of print], “Timing Protein Intake Increases Energy Expenditure 24 Hours Post-Resistance Training”

Review of the Berkeley Nitric Oxide Test Strips

A. The underlying science for both strips is relatively the same. We touch upon it in detail in our FAQ section and provide scientific papers on clinical studies (see FAQ and Scientific Articles at Berkeley Test).

The patent pending strips by Berkeley Test is different in the following ways from that of Neogenis’:

* First, Berkeley Test is very affordable. This is relevant for those monitoring their own levels on a frequent basis, i.e., multi-daily testing, in order to make dietary adjustments. At present, the Amazon retail pricing is less than 70-cents compared to Neogenis , which is about three times as much, presently $2.10. In working with corporate wellness programs and educational organizations, Berkeley Test provide significant discount to encourage heart healthy meals enriched with leafy greens, vegetables, and fruits.

* Second, Berkeley Test is much easier to use. We have an absorption pad and test pad on the opposite sides for the strip; the absorption pad allows you to easily collect the saliva from your mouth and then you simply fold it over to make contact with the test pad. Feedback from elite athletes (see our   Berkeley Test All-stars) and senior residences at an independent living facility find the absorption pad was very important to them; they did not like using Neogenis because you have to use your finger to apply the saliva.

* Third, Berkeley Test provides packets of 50 and 10 strips per packets as well as individually sealed for corporate wellness and educational programs and other partners interested in validating nitric oxide potent foods. Surprisingly, we found it made a significant difference for different types of individuals. For example, some of the power users love the 50 packet because they use it 2-3 times a day, hence, the 50 packet per month makes economic sense. Whereas other simply want to check once to every other day, therefore, they like the 5-day packet of 10 strips. And now we are finding some of our partners want large orders of the individually sealed strips to give out to their employees to encourage health healthy lunches.

NOTE: For additional information, see my pages on Nitric Oxide Replacement Therapy.

Q. Can you please share what you were going to say about the sensitivity of the strips? I have gotten many questions about Neogenis products on the Forum and so it will be very helpful if I can explain some details about your strips?

A. The current sensitivity of both strips is relatively the same; in short, the underlying test is functionally the same. The Berkeley Test strip is reflective of total body status of nitric oxide derived from both endothelial nitric oxide synthesis and the bioconversion from dietary sources, ie, nitric oxide-potent beets, spinach, among other leafy greens.

Q. Can the Test Strips be used to test the effectiveness of dietary and supplement modifications that one has made in order to improve his nitric oxide status?

A. Philosophically, we are advocates of natural whole food approaches in elevating nitric oxide levels. We receive a lot of email of appreciation ranging from: Berkeley is an effective compliance tool to keep me on my DASH diet to Berkeley strips remind me to incorporate multiple leafy green servings into my meals to Berkeley strips are a great Game to get my kids to eat their salads and so on.

More recently, we are finding users are finding that Berkeley Test is effective at screening for nitric oxide supplements. We are not against nitric oxide supplements, but we receive a lot more emails from folks who tell us about nitric oxide supplements that are bogus or don’t come close to raising my levels compared to spinach and so on. We recommend that if you are unclear about the effectiveness of your nitric oxide supplements compare them to Mediterranean salad rich in arugula, beets, and spinach or an all-natural beet root juice from a reliable source 2 hrs afterwards. We continue to search for a high quality all-natural ingredient alternatives.

A. As a follow up to our previous response, in our opinion, which is reinforced by the current biomedical literature and scientific clinical correlates, a natural source delivered through vegetables and fruits is a very effective and safe way to elevate nitric oxide via the non-nitric oxide synthase pathway. Natural whole foods is both an effective and safe way to elevate nitric oxide as reviewed by Lundberg at the Karolinski Institute.

Q. Why do you emphasize the DASH Diet out of curiosity? There are many great diets out there – why specifically the DASH?

A. Your point is very good and your observation that we tend to selectively push DASH is correct; actually, there are a number of well-characterized heart healthy plant-based diets that are very effective at elevating nitric oxide in the body.

With that said, the reason for emphasizing DASH is because of how well characterized the diet is as it relates to potentiating nitric oxide levels in context of the underlying nitric oxide benefit to reduce hypertension.

From a practical standpoint, we see how effective the strips have been at influencing dietary lifestyle changes for the better, ie, DASH compliance. Based on a very large number of emails, we see the strips bringing heart healthy foods, repeatedly, into one’s daily meals.

Q. You (and Dr. Bryan) have mentioned that the best time to test your NO is really in the morning right when you wake up to get a baseline reading. However, can you really measure this with the strips as they stand now since they’re not really measuring true endothelial NO, just a correlate? Plus, if you ate some nitrates at 8 pm, aren’t they completely out of your system by the time you wake up the morning?

A. Berkeley Test strips are reflective of the total nitric oxide bioactivity and bioavailability. For the vast majority of users, early morning readings provides a relative baseline and then measuring at various time points after eating foods presumably rich in nitric oxide potency will give you feedback as to when your levels have peaked. Depending on the food source and amount as well as the frequency of eating will influence your levels throughout the day. And for some elite athletes versus sedentary individual, we find levels will vary dramatically. However, it is not usual to see peak levels within 2-3 hrs after eating a spinach-beet salad.

Q. You mentioned that nitrites can “build up” in your system I believe? In other words, a man might have to eat nitrate-based foods for a few days. I thought nitrites were short-lived or is that just NO itself? Or did you mean that one’s responsiveness to nitrites has to build up?

A. Nitric oxide is measured in milliseconds, and nitrite is in constant flux with nitrate, which is relatively stable. But keep in mind, the flux for both nitrate and nitrite is influenced by a number of factors, i.e., high intensity training causing pH changes which influences nitrite reduction, the amount of XOR in RBC, i.e., pre-hypertensive are higher in XOR, therefore may be more effective in reducing nitrate, frequency of eating nitric oxide-potent foods as well as the amount and type of nitrate rich foods, and so on.

However, I think a reasonable rule of thumb is that the current strips provide a snapshot of one’s nitric oxide bioavailablity and bioactivity within the body. Based on clinical correlates, saliva levels serve as a meaningful biomarker of the nitric oxide benefits derived from natural whole foods diet rich with nitric oxide-potent leafy greens and beets.

Q. How well do your test strips measure arterial (endothelial) nitric oxide?

A. The strips are effective at providing a gauge of total body status. More to your point, the strips are reflective of nitric oxide bioactivity and bioavailability derived from both endogenous, ie, nitric oxide synthase, and exogenous, ie, bioconversion of a dietary source.

From a practical standpoint, we see the strips as an effective means to reinforce the importance of plant-based diets rich in nitric-potent foods. I sense you would agree, especially, for the US, we as a society fall far short of the recommended servings of ‘heart healthy’ vegetables.

Q. Let’s say someone eats a meal that includes a significant amount of beet root juice, spinach or arugula and yet does not register much if any increase on your test strips. What would your reaction be? What could cause this?

If the individual is depleted a few hours after eating a nitrate-rich meal, here are some thoughts: first, antibiotics and/or mouthwash disrupted the microflora in the mouth, second, drug interference, i.e. proton pump antagonist, third, a systemic concern, i.e., poor GI absorption if so, see your doctor, third, you are unusually depleted possibly because of a poor diet if so, please consider seeing a nutritionist and reassess your vegetable and fruit intake and it may take some time to replenish your pools per se. And there are other considerations depending on the individual.

If you encounter such a problem with our strip and simply have a question, please feel free to contact us at info@berkeleytest.com and we will be more than happy to work with you.

Please check Scientific Articles at Berkeley Test.

Brain Dopamine and Testosterone - Peak Testosterone

Testosterone and dopamine are intimately connected in a bidirectional relationship. Testosterone regulates dopamine and dopamine testosterone. Because many of the men that show up to my site are low testosterone, I want to start with the research that shows that testosterone profoundly affects brain dopamine levels. Testosterone profoundly affects many other neurotransmitters as well, which I over in my link on Testosterone and the Brain.

Here are three keys ways that testosterone and dopamine influence each other:

1. MPOA (Medial Preoptic Area). This region of the brain sits near the hippocampus and is critical for the bedroom. If this area is injured, animal studies show that no copulation will occur. And one study in rats showed this by microinjecting dopamine stimulators into the MPOA, which increased mountings, and dopamine suppressors, which did the opposite. [1] Therefore, it is obviously dopamine in this region that is one of the key gatekeepers.

What testosterone have to do with this?  Research, again in animals, has shown that testosterone controls dopamine release in the MPOA. In fact, castrated animals show no interest in mounting and had no dopamine release in the MPOA.  Castrated animals given testosterone, however, would do their duty with a female AND had the necessary dopamine release. [2] The clear takeaway:  testosterone governs dopamine release in key areas of the brain.

2.  Low Testosterone Can Destroy Dopamine. So testosterone can stimulate release of brain dopamine and low testosterone can inhibit it.  However, preliminary evidence shows that low testosterone can have a much more nefarious side and may play a role in Parkinson’s Disease.  Of course, Parkinson’s is the well-known condition that afflicts over a million people and is characterized by muscle rigidity and tremors due to loss of brain dopamine levels.

What researchers at Rush University Medical School found out is that mice who suddenly lost their testosterone had a rapid rise in iNOS levels.  Many of you are familiar with eNOS, which is the endothelial nitric oxide synthase that Viagra and Cialis act on and which dilates your arteries.  iNOS, inducible nitric oxide synthase, is its less well-known cousin and is involved in immune and inflammation response.

1)  Physiology and Behavior, 2005, 86:356-368, “Dopamine, the medial preoptic area, and male s_xual behavior”

2) Hormones and Behavior, May 2001, 39(3):216-224, “Testosterone Restoration of Copulatory Behavior Correlates with Medial Preoptic Dopamine Release in Castrated Male Rats”

3) J Neurol Neurosurg Psychiatry, 2004 Apr;75(4):637-9, “Are men at greater risk for Parkinson’s disease than women?”

4) https://www.rush.edu/webapps/MEDREL/servlet/NewsRelease?id=1712, Rush University Medical Center press release, July 26, 2013,  “Sudden Decline in Testosterone May Cause Parkinson s Disease Symptoms in Men”

5) Arch Neurol, 2002, 59(5):807-811, “Refractory Nonmotor Symptoms in Male Patients With Parkinson Disease Due to Testosterone Deficiency”

6) Journal of Clinical Neuroscience, Jan 2006, 13(1):133 136, “Testosterone improves motor function in Parkinson s disease”

7) Endocrinology, 1992 Jul, 131(1):395-9, “Role of dopamine in the regulation of gonadotropin-releasing hormone in the male rat brain as studied by in situ hybridization”

iNOS is known for releasing large amounts of nitric oxide as a defensive tactic.  Nitric oxide is a free radical that can be used as a weapon and, therefore, sudden low testosterone essentially puts a huge oxidative load on the brain and may actually do some damage that leads to Parkinson’s. [4] A further verification of this is the fact that, according to one study, men are 1.5 times more likely to contract Parkinson’s and that low testosterone levels have been associated with Parkinson’s. [3][6] In addition, giving male Parkinson’s patients testosterone can help with tremors. [5]

NOTE:  It is important to point out that there have been other key factors identified in the progression of Parkinson’s, including copper and pesticides.  I cover the latter in my link on Pesticides and Parkinson’s.

It is also VERY important to note that testosterone’s impact on the male brain is extraordinarily profound.  I know that when I got my first testosterone cypionate injections, I felt like “fireworks” were going off in my brain.  Low testosterone is linked with depression, mood disturbances, fatiuge, anxiety, decreased working memory, mental fog and on and on the list goes.

Yes, testosterone is the Bedroom Hormone.  Yes, testosterone is the Muscle Hormone.  But, more than that, testosterone is the Brain Hormone.

Here are a few links that may be of interest:  Testosterone and Depression, Testosterone and Mood and . Finally, you may also want to check out my link on Natural Dopamine Increasers as well.

REFERENCES:

Vegan Men Have Highest Testosterone Levels : Vegetarianism

REFERENCES:

1) British Journal of Cancer, 2000, 83(1):95-97, Hormones and diet: low insulin-like growth factor-1 but normal bioavailable androgens in vegan men

The corollary to this formula is that vegetarians (and vegans especially) must have lower testosterone levels than their carnivore counterparts. This kind of thinking permeates most popular health blogs and forums out there, especially on Paleo Diet and bodybuilding sites. In addition, almost every major men’s health magazine, at least here in the U.S., have recipes and recommendations with meat front and center stage.  The message that guys get is clear:  if you want to be healthy and hormonal – you must eat meat.

The reasoning behind such thinking is fairly straightforward and goes something like this:

1.  Meat is full of saturated fat and the research shows that saturated fat is pro-testosterone.

2.  Vegetarian and vegan diets are higher fiber which also has been linked to low testosterone.

3.  Bodybuilding, a sport obviously highly dependent on testosterone, is completely dominated by carnivores.

I myself have discussed some these issues at length in my links on The Two F’s: Fat and Fiber and Testosterone and Diet.

So what do the studies show?  Well, first of all, saturated fat is definitely pro-testosterone and it is true that higher fiber diets have some linkage to lower testosterone. I myself have discussed some these issues at length in my links on The Two F’s: Fat and Fiber and Testosterone and Diet.

CAUTION: Saturated fat slows down blood flow, something always less than desireable for sexually active males, and can destroys arterial health under most circumstances: read my link on The Potential Dangers of Saturated Fat for more details.

However, what I also bring up, and this is generally ignored by the bodybuilding and Paleo communities, is that vegetarian diets tend to have ample pro-testosterone monounsaturated fats. Even more importantly, vegetarian (and vegan) diets are also high in certain phytochemicals, which have some evidence for increasing testosterone, as I document in my link on Antioxidants and Testosterone. Whole grains, fruits, vegetables, beans, legumes, nuts, seeds are the bulk of what most vegetarians eat and they are all packed with antioxidants, anti-inflammatories and other constituents that will protect and in some cases even stimulate those all-important Leydig cells.

So who is the winner?  Well, to date there has only been one study that directly examined this question.  The researchers were primarily interested in comparing IGF-1 levels in vegans, vegetarians and meat-eaters, but also monitored a variety of other androgen-related hormones, including testosterone, as well. What they found was that vegetarians and vegans had average testosterone 6% and 16% higher than the carnivores, respectively. This, by the way, was after adjusting for important variables such as age and smoking status.[1]

The one variable that the researchers did not adjust for was BMI (body mass index) and when they did that, the vegetarians and meat-eaters had virtually equal testosterone and vegans were higher than everyone by about 6%.  Again, this flies in the face of almost everything you read on the web:  supposedly vegans and vegetarians do everything backwards and are loading up on toxic grains, fiber and all the things that will their slam manliness. In fact, though, the truth is that their testosterone levels are perfectly health and may even be higher on average than carnivores.  Either way, there is no evidence that vegetarians are suffering from a lack of androgens.

Did you know you can inexpensively do your own testing for most hormones? The industry leader is Discounted Labs.

And this really is common sense.  Vegetarian diets have been studies extensively and there have been no signs that vegetarians have low testosterone whatsoever.  Furthermore, vegetarian (or very close) diets have been adopted by hundreds of millions of people around the globe and there are simply no signs of mass symptoms of low testosterone in these populations. In fact, one could actually argue quite the opposite:  cultures and societies that eat low quanitites of meat are known for their active sex lives later in life.  (See my book, the https://www.peaktestosterone.com/, for other reasons that many plant foods boost erectile strength.)

It should also be noted that those in the study were in early middle age, which means that had lived long enough to accumulate damage to the Leydig cells, the hypothalamus and other key tissues that control and govern testosterone.  Therefore, it is possible that younger meat-eating males may have slightly higher testosterone but build up damage from some of the pro-inflammatory or other aspects of a meat-based diet.  We just don’t know the answer to those kind of questions yet.

One very revealing aspect of the above study was that vegetarians and vegans both had very robust levels of SHBG, again significantly higher than the meat-eaters.  SHBG, Sex Hormone-Binding Globulin, is the protein tthat does just what its name implies:  it chemically bonds to most of the testosterone in your body.  Now that sounds bad, but researchers have noted that generally as SHBG increases so does total testosterone.

The Okinawans are another example that plant-based diets outperform meat-based diets in the long run.  The traditional Okinawans were actually not strict vegetarians, as they did eat some pork and fish.  However, the great bulk of their diet was always vegetarian and they ate relatively little fat, including saturated fat. Interestingly enough, they also consumed significant soy, which has fairly high levels of various phytoestrogens.

Yet, as I document in my link on https://www.peaktestosterone.com/, the average 70-year-old Okinawan has testosterone of 439 ng/dl, a very respectable number, and a direct contrast to the 346 ng/dl average level of the typical 70-year old American. [62] Just as remarkable is the fact that the typical Okinawan 100-year old has testosterone of 298, which is above the level considered hypogonadal. By any standards, Okinawans have delayed andropause by a couple of decades and are a further sign that the carnivore lifestyle is anything but superior when it comes to preserving and protecting one’s testosterone levels..

What about the fact that bodybuilding is dominated by the carnivore lifestyle?  Bill Pearl says that after going vegetarian, he had the same amount of muscle that he did when he won his Mr. Universe titles.  Kenneth Williams, a vegan bodybuilder, placed third in the 2004 Natural Olympia bodybuilding competition.  And, of course, Mike Mahler is long time vegetarian and strength coach extraordinaire. The fact is that, if you desire, one can easily build a massive physique while on a vegetarian or vegan diet.

Metabolic Syndrome (Prediabetes) Solutions

Okay, so you’ve read my link on Metabolic Syndrome and think you may have it.  Or maybe you want to avoid dealing with it and its destructive force on your testosterone and erectile strength?  Either way, this is nasty stuff and below I give you many research-based solutions to prevent or even eliminate its hold on your life.  Science has come so far in its understanding of Metabolic Syndrome that there is simply no reason to let it take out your heart, brain and penis.

Below are 20 solutions to prevent and defeat Metabolic Syndrome.  Put these all together and you have handily defeated what is probably Pubic Enemy Number One.  (Yes, I meant Pubic.)

1)  Magnesium. Magnesium is one of the few supplements that I would recommend for most people and one of the reasons is the close relationship between Magnesium and Metabolic Syndrome.

2) Low Fat (or Ornish) Diet.  A Low Fat or (Ornish) Diet will lower blood pressure, dramatically decrease cholesterol and even clean out your arteries.  In short, it will reverse almost every negative aspect of Metabolic Syndrome.  Please read this link on a Low Fat or (Ornish) Diet for more details.

3) Exercise had done very well in defeating Metabolic Syndrome.  For example, one study of sedentary but healthy subjects with Metabolic Syndrome resulted in “30.5% (32 participants) [who] were no longer classified as having the metabolic syndrome after the exercise training. Among the 32 participants who improved their metabolic profile, 43% decreased triglycerides, 16% improved HDL cholesterol, 38% decreased blood pressure, 9% improved fasting plasma glucose, and 28% decreased their waist circumference.” [6] In other words, even without any dieting or even baseline dietary changes, exercise made very significant improvements in a large number of patients.

4)  Being Overweight is another huge risk factor for insulin resistance and Metabolic Syndrome. In fact, recent research shows that fat tissue is the number one cause of insulin resistance. [30]  The reason?  When you get fat enough, macrophages (white blood cells) actually move in and take residence in your fat and begin to pump out pro-inflammatory cytokines and this inflammation response leads to the nasty insulin resistance that causes so many problems.  The good news is that the same study [31] showed that participants that dropped the pounds sent the macrophages running out of their fatty tissues and reversed their insulin resistance (and diabetes) risk.  I advise reading my link on How to Lose Weight the Right Way, as you can easily depress your testosterone levels if you are not careful.

5) Vinegar and Cinnamon. Both vinegar and cinnamon [18] help with glucose and insulin metabolism.  Try to include a tablespoon or two of vinegar prior to any meal with a significant amount of carbs.  Read about How Vinegar Can Help Keep the Pounds and Decrease Insulin and Glucose. Remember:  Anything that blunts the glucose spike that occurs after a meal should also blunt the insulin spike as well. CAUTION: There is a certain type of “mock” cinnamon (Cassia) commonly sold in stores that has significant amounts a liver and kidney toxin called couramin. You only want to buy true cinnamon, which is Ceylon Cinnamon.

6) Whole Grains. Whole grains lower insulin resistance simply because they are broken down by our digestive systems more slowly and thus spike blood sugar much less.  Several studies have shown that Whole Grains lower insulin resistance. [4]  See this link on Grains for more details.

REFERENCES:

1)  Magnesium. Magnesium is one of the few supplements that I would recommend for most people and one of the reasons is the close relationship between Magnesium and Metabolic Syndrome.

2) Low Fat (or Ornish) Diet.  A Low Fat or (Ornish) Diet will lower blood pressure, dramatically decrease cholesterol and even clean out your arteries.  In short, it will reverse almost every negative aspect of Metabolic Syndrome.  Please read this link on a Low Fat or (Ornish) Diet for more details.

Need to boost your Nitric Oxide naturally through food, drink and supplements? Check out Lee Myer’s book here: The Peak Erectile Strength Diet

Or do you need the most comprehensive testosterone book in Amazon? Here it is: Natural Versus Testosterone Therapy

3) Exercise had done very well in defeating Metabolic Syndrome.  For example, one study of sedentary but healthy subjects with Metabolic Syndrome resulted in “30.5% (32 participants) [who] were no longer classified as having the metabolic syndrome after the exercise training. Among the 32 participants who improved their metabolic profile, 43% decreased triglycerides, 16% improved HDL cholesterol, 38% decreased blood pressure, 9% improved fasting plasma glucose, and 28% decreased their waist circumference.” [6] In other words, even without any dieting or even baseline dietary changes, exercise made very significant improvements in a large number of patients.

4)  Being Overweight is another huge risk factor for insulin resistance and Metabolic Syndrome. In fact, recent research shows that fat tissue is the number one cause of insulin resistance. [30]  The reason?  When you get fat enough, macrophages (white blood cells) actually move in and take residence in your fat and begin to pump out pro-inflammatory cytokines and this inflammation response leads to the nasty insulin resistance that causes so many problems.  The good news is that the same study [31] showed that participants that dropped the pounds sent the macrophages running out of their fatty tissues and reversed their insulin resistance (and diabetes) risk.  I advise reading my link on How to Lose Weight the Right Way, as you can easily depress your testosterone levels if you are not careful.

5) Vinegar and Cinnamon. Both vinegar and cinnamon [18] help with glucose and insulin metabolism.  Try to include a tablespoon or two of vinegar prior to any meal with a significant amount of carbs.  Read about How Vinegar Can Help Keep the Pounds and Decrease Insulin and Glucose. Remember:  Anything that blunts the glucose spike that occurs after a meal should also blunt the insulin spike as well. CAUTION: There is a certain type of “mock” cinnamon (Cassia) commonly sold in stores that has significant amounts a liver and kidney toxin called couramin. You only want to buy true cinnamon, which is Ceylon Cinnamon.

6) Whole Grains. Whole grains lower insulin resistance simply because they are broken down by our digestive systems more slowly and thus spike blood sugar much less.  Several studies have shown that Whole Grains lower insulin resistance. [4]  See this link on Grains for more details.

7) Saturated Fats and Total Fats. Researchers have used a high fat diet [20] and saturated fats [21] (on animals) to induce insulin resistance!  That’s how potent these are at generating Metabolic Disorder symptoms.  You definitely want to keep saturated fats and total fat to a minimum unless you are going to be extremely careful.

8) Fish Oil.  Many studies have shown that fish oil protects against insulin resistance.

9) Blood Pressure. High blood pressure is one of the hallmarks of Metabolic Syndrome and there are excellent strategies to lower your blood pressure.  See this link on How to Lower Your Blood Pressure for details.

10) Mediterranean Diet with Nuts.  The Mediterranean Diet probably help with erectile dysfunction is that a recent study [11] found to improve Metabolic Syndrome . Metabolic Syndrome is a set of conditions (high blood pressure, insulin resistance, poor lipids, etc.) that plague Western societies.  There are several interesting things about this study.  First of all, the participants were seniors, all of whom were at risk for heart disease including about two thirds who already had developed Metabolic Syndrome . The study found that the Metabolic Syndrome was actually reversed for 14% of the participants. (NOTE:  Nuts were also a part of the most succesful cohort in this study.)

11) Juvenon.  This is a supplement that is basically a combination of Acetyl-L-Carnitine, the mitochondria booster, and ALA (Alpha Lipoic Acid), the powerful antioxidant. One study showed a nice reduction in blood pressure in those with Metabolic Syndrome of 139 to 130. [14]

12) Alpha-lipoic Acid.  Alpha-lipoic acid, one of the components of Juvenon, has been shown in a study to improve insulin resistance.  [17]

13) Testosterone. Researchers castrated rats which made them much more insulin resistant. [19] They then administered supplemental testosterone which helped reverse the insulin sensitivity resulting from castration. This, of course, implies that testosterone plays a strong role in both insulin resistance and sensitivity.  Again, see my link on How to Improve Testosterone Naturally or Testosterone Therapy for ways to boost your testosterone. Also, one well-known HRT clinic has actually reversed ALL of their Type II diabetics.  In other words, all of their patients with Type II diabetes have been able to get off of insulin by simply raising their testosterone into the 800-1000 ng/dl range!

14) Stress.  Stress has been associated with Metabolic Syndrome.  Stress negatively affects hormones (cortisol and testosterone) and leads to behaviors such as increased smoking and drinking and decreased exercise. [22]

15) Black Tea.  Tea, like cinnamon and vinegar, seems to dampen the post-meal glucose and insulin responses according to one study. [23] The research is new but looks very promising: tea was actually found to mimic the Diabetes drugs Precose and Glyset. Again, this is a rather conusing result to many, because the the school of thought has always been that caffeine causes significant sugar spikes not amerliorations of the same.

16) Dark Chocolate (Cacao).  A recent study found that dark chocolate improved insulin sensitivity. [26]  Of course, the secret is not the sugar or milk – it’s the cacao, which is one of the staples of the ultra heart healthy Kuna peoples. Eating a small bar per day (dark only) is a heart healthy idea.

17) Sleep. Studies have shown that lack of sleep leads to greatly reduced glucose clearance, i.e. you become much more insulin resistant, and your immunity is whacked. [24] In one recent study scientists placed 11 participants in a closed environment where  sleep, calories and physical activity could be carefully controlled.  The researchers found that as those in the study went from 8.5 hours of sleep to 5.5 hours, their blood sugar was significantly higher and their insulin resistance significantly worse. [25]

18) Fructose.  One 2009 study found that men put on a high-fructose (200 g/day) diet significantly increased the number of men with metabolic syndrome (and their blood pressure).  In addition, putting them on a uric acid blocker almost eliminated the increase. [27] You don’t need to worry about the small amount of fructose in fruit:  200 g is a LOT of fructose.  But you should definitely limit sweets and cokes and anything with a substantial amount of sugar or corn syrup.

19) High-Intensity Training.  If you can take the pain, High-Intensity Training, a close relative of Interval Training, has also been shown to do a nice job of lowering insulin levels. Intensity is a technical term that basically refers to the amount of effort in a certain amount of time or the amount of “sweat and burn” the exercise induces.  Researchers put (female) participants on a repeated cyle of “sprinting” on a stationary bike for 12 seconds and then pedaling much more slowly for 12 seconds and so on for twenty minutes three times per week. [29]  This very minimal amount of exercise significantly reduced insulin levels.

20) Leucine / Branched Amino Acids (BCAA’s). Leucine is the heavy-hitter amino in Brached Chain Amino Acid supplements and is responsible for many of the muscle-building effects of whey.  And it turns out that leucine may be one of your potent weapons for fighting insulin resistance and prediabetes.  See my link on Branched Chain Amino Acids for more details.

21) Sugary and Sweet Drinks. It will probably come as no surprise that these have been found to accelerate Metabolic Syndrome (and type II diabetes). [32]  Of course, it could’t have anything to do with the extra fructose and empty calories…

22) Coffee.  Many men do not know that coffee has a strong “glucose-limiting” compound in it and supplement manufacturers have pulled out and put into an extract due to its potency. This is one of the reasons that coffee can so be so healthful for some men and several studies have shown its ability to put the brakes on Metabolic Syndrome. [33]

REFERENCES

1) Jour Urol, 2007 Feb,177(2):651-4; Jour Clin Endocrin Metab 1990 Oct,71(4):929-31

2) Hypertension,1998;31:780-786

3) Obesity Reviews,Jul 2008,9(4)340-354(15)

4) Am J Clin Nutr,2003 Nov,78(5):965-71

5) J of Mens Health, Sep 2008, 5(1):S40-S45

6) Med Sci Sports Exerc, Oct 2003, 35(10):1703-9

7) Tex Heart Inst J, 2005, 32(3): 387 389

8) Am J Cardiol, 2008 Feb 15,101(4):497-501

9) Diabetes Care, 2005, 28:1636-1642

10) Kobe J Med Sciences, 2007, 53:99-106

11) Diabetes, 2005, 54:1926-1933

12) J Clin Invest, 2007, 117(712) J Clin Invest, 2007, 117(7): 1995-2003

13) Yale University (2004, February 23). Young People Prone To Type 2 Diabetes Exhibit Alterations In Mitochondrial Activity

14) J of Clin Hypertension, May 9 2007, 9(4):249-255

15) Circulation, 2005, 111(11):1448-1454; Lupus, 2005, 14(9):760-764

17) Henriksen EJ, et al. Chronic thioctic acid treatment increases insulin stimulated glucose transport activity in skeletal muscle of obese zucker rats. Diabetes (Suppl.) (1994) 1:122A

18) Diabetes Res Clin Pract, 2003, 62:139-48

19) Physiologica Scandinavica, 1992, 146:505 510

20) Science, 1987, 237(4817):885-888

21) J. Nutr, Nov 2005, 135:2634-2638

22) European Heart Journal, Advance Access published online on January 23, 2008, “Work stress and coronary heart disease: what are the mechanisms?”, Received 1 August 2007; revised 14 November 2007; accepted 22 November 2007.

23) “Alpha-Glucosidase Inhibitors for Type 2 Diabetes.” Chen, H., Journal of Food Science, published online June 30, 2009.

24) Obesity Reviews,Jul 2008,9(4)340-354(15)

25) J of Clin Endocrin & Metab, Nedeltcheva, A.V. , published online ahead of print, June 30, 2009

26) Amer J of Clin Nutr, March 2005, 81(3):611-614, “Short-term administration of dark chocolate is followed by a significant increase in insulin sensitivity and a decrease in blood pressure in healthy persons”

27) Perez-Pozo S, et al “Excessive fructose intake raises blood pressure in humans” AHA BPRC 2009; Abstract P127

28) J Endocrin Invest, Jun 2007,30(6):451-8; Journal Andrology, 2009, 30:10-22

29) International Journal of Obesity, 2001, 25:332-339, “Impact of high-intensity exercise on energy expenditure, lipid oxidation and body fatness”

30) Diabetes, Published online before print March 31, 2010, “Pro-inflammatory CD11c+CD206+ adipose tissue macrophages are associated with insulin resistance in human obesity”

31)  Sciencealert.com, “Meddling Fat Causes Diabetes”, Aug. 16, 2010

32) Diabetes Care, Nov 2010, 33(11):2477-2483, “Sugar-Sweetened Beverages and Risk of Metabolic Syndrome and Type 2 Diabetes”

33) Diabetes Research and Clinical Practice, Jun 2007, 76(3):383 389, “Habitual coffee but not green tea consumption is inversely associated with metabolicsyndrome: An epidemiological study in a general Japanese population”

Maca, Testosterone and Libido - Peak Testosterone

Will Maca (Lepidium meyenii or L. peruvianum) improve erectile dysfunction? The answer is ‘yes, indirectly’.  This is one of the few herbs that has some decent evidence for being a good, old fashioned  and legitimate aphrodisiac. This is a plant that grows in the high altitudes of the Andes in Peru and has been eaten by the natives for centuries for both food and increasing sexual potency.  And, in this case, it looks like the natives knew what they were doing:  studies on rats and mice have shown it dramatically improves sexual behaviors.  [1]  In other words, at least in rodents, science has shown that Maca is a powerful aphrodisiac.

What about in humans?  Well, even though no studies have been done on Maca’s libido-enhancing powers to date on humans, Maca has been shown to also be something sent down by the fertility gods.  Researchers examining nine men, aged 24-44, found that “the semen volume, total sperm count, motile sperm count, and sperm motility (Grades a+b) were significantly increased after treatment with Maca”. [2] So Maca gives you more sperm, better sperm and more seminal fluid.  And it definitely makes you feel more “full” down there below the belt and ready to ejaculate!

It’s interesting that these men had no statistically significant changes in hormones such as follicle stimulating hormone, luetinizing hormone, testosterone, estrogen or prolactin.  Somehow, Maca does its thing without significantly altering hormone levels. However, the researchers did speculate that perhaps Maca changed levels of free testosterone, which is most critical for us males, without changing total testosterone.

REFERENCES:

1) Urology,2000,55:598-602;J Ethnopharmacol,2001,75:225-9

2) Asian J Androl,Dec 2001,3:301-303

3) Food and Chemical Toxicology, Mar 2008, 46(3):1006-1013, “Maca (Lepidium meyenii) and yacon (Smallanthus sonchifolius) in combination with silymarin as food supplements: In vivo safety assessment”

Maca has many other very desireable properties, including improved lipid profiles, lowering cortisol, aiding in muscle growth, boosting super-antioxidants and so on.  I document these in my link on the Powerful Effects of Maca.

One other item of interest is whether or not Maca affects androgens. No study to date has found a statistically significant increase or decrease in testosterone or other hormones and Maca’s actions appear to be in the aphrodisiac realm. One suspected compound is p-methoxybenzyl isothiocyanate, but this has not been thoroughly studied.

I take organic Maca from Navitas: Navitas Naturals Organic Raw Maca Powder and have had good results with it.   I always cook it, usually through throwing it in my oatmeal.

Some people have trouble digesting the starch of the maca root, which can lead to stomach upset, gas and/or diahrrea.  If this is an issue for you, you can order the gelatinized form, which is usually in the human studies by the way:  Maca Power – 100% Certified Organic “Gelatinized” Maca. My understanding is that simple cooking does not break down these starches sufficiently for those who have trouble, whereas the gelatinized version handles that for you.

I should also forewarn you that Maca has a strong taste that is completely quite different from anything else you have probably eaten.  I don’t find the flavor objectionable but many people do.  For many guys, though, the benefits far outweigh its strong aftertaste.

CAUTION: Maca is generally one of the most well-received supplements – although really it could be considered a food like fenugreek – on the forum and in emails. For example, this forum poster lists it as his favorite. However, I did get one forum poster who said that Maca gave him issues and actually lowered his libido and another that said it lowered his testosterone. You can read about that here. Maca reportedly can be stimulating for some and so some men cycle it, i.e. four or five days consuming Maca and a few days of rest afterwards.

Also, it is worth noting that some supplement manufacturers put Maca and Horny Goat Weed together in the same capsule taking advantage of their complementary effects on male physiology.  Horny Goat Weed directly boosts Nitric Oxide and boost libido.  Maca, through a complete different pathway, boosts semen volume and libido.  It is a good combination that does work well for many guys, but you want to get a formulation that has an extract of Icariin (for the Nitric Oxide) and 500 mg of the Maca.

Testosterone Levels - Peak Testosterone

I cover the benefits of DHT (dihydrotestosterone), such as increased libido and orgasm frequency, in my page on Testosterone and DHT. Many men with a low sex drive are searching for a root cause and often they need to look no farther than their DHT levels.  If your physician has never pulled your DHT levels, you can do it yourself here:  Inexpensive Testosterone Labs. (I have no affiliation with any of them.)

Once you have the number, then the question becomes “what do you do with it?”  Let’s look at how different experts choose target DHT levels.  As you’ll see, there is a considerable difference in opinion:

REFERENCES:

1)   https://ask.lef.org/7366%5C/Testosterone-Cream—too-high-dosage?Keywords=androgel%20bioidentical%20testosterone%252Breplacement

2) Neuro Endocrinol Lett, 2008 Apr, 29(2):201-4, “Dihydrotestosterone and testosterone throughout the life span of Czech men”

3) Clin Endocrinol (Oxf), 2012 Nov, 77(5):755-63, “Serum testosterone, dihydrotestosterone and estradiol concentrations in older men self-reporting very good health: the healthy man study”

4.  https://www.peaktestosterone.com/forum/index.php?topic=5712.0

5) https://www.peaktestosterone.com/forum/index.php?topic=4095.0

1.  WRONG WAY TO DO IT: Typical lab ranges for DHT are 16-79 or 30-85 ng/dl.  Most physicians that pull your DHT will simply look look to see if you fall within this range to decide if your DHT levels are “okay” or not.  My experience on the Peak Testosterone Forum is that often men experience libido problems when one gets into the low 30’s (or below) ng/dl range.  In other words, just like with testosterone, the lower end of the range can be problematic for a significant percentage of men

2. Life Extension Foundation. LEF is an organization that has tried to go a step beyond standard Western medicine and actually provide more natural longevity and anti-aging strategies.  They are very research-based and their articles are generally excellent, although definitely pro-supplement in orientation.  One nice service that they provide is a lot of lab testing and their recommended levels for DHT are between 30 and 50 ng/dl for adult males. (You should call them and confirm of course.) [1] Their reasoning for targeting the lower half of the physiological DHT range I am sure is avoidance of common DHT-related issues that some men could experience.  DHT is the hormone most responsible for BPH (enlarged prostate) and male pattern baldness.

3. Site Sponsors. A couple of our site sponsors officially target the same 30 to 50 ng/dl, and these clinics have worked with hundreds of patients of course.  One grey area is transdermal testosterone:  some men feel great on testosterone products applied to the skin.  These can be compounded or brand products such as Androgel, Fortesta or Axiron.  They key is that these will often boost DHT well above 100 ng/dl, i.e. to supraphysiological levels.  So we have an interesting situation where the large pharaceutical backed products often boost guys to very high levels of DHT. The theory is that gels like these have a higher DHT conversion rate because of the extra alpha reductase in hair follicles. More concentrated products that are rubbed over a smaller surface area will not, according to the theory, have as high of a rate of conversion into DHT.   Side effects from this are suprisingly rare, but in my opinion, it’s always good to stay physiological.

4. INTERESTING THEORY:. Some anti-aging clinics believe that all hormones should be restored to youthful levels.  I call this a “replacement philosophy” and it a very popular theory out there that many men feel comfortable with. One argument for a replacement philosophy of DHT are a couple of studies that show that healthy men have no decrease in DHT through the normal aging process. For example, one study examined over 10,000 men and concluded that “the data show that after a peak of DHT:T in infancy and a subsequent decrease in puberty, the ratio of both androgens remains practically without change from approx. 20 years of age till old age.” [2] Yet another study looked at 325 men over 40 that reported themselves in good or excellent health and found the following:

“Serum T, DHT and E(2) displayed no decrease associated with age among men over 40 years of age who self-report very good or excellent health although obesity and ex-smoking status were associated with decreased serum androgens (T and DHT) but not E(2). These findings support the interpretation that the age-related decline in blood T accompanying non-specific symptoms in older men may be due to accumulating age-related co-morbidities rather than a symptomatic androgen deficiency state.” [3]

Assuming these studies are correct and the T/DHT ratio and the absolute level of DHT remain constant in healthy middle-aged and senior men, one appears to have Mother Nature on his side if he wants beefy DHT numbers.  Yet another argument for this standpoint is the fact that so few men on HRT have issues with an enlarged prostate.  When a man goes on testosterone therapy, his testosterone will ramp up (if the physician knew what he/she was doing) and DHT will go up correspondingly.  This causes a small but measureable increase in prostate volume normally.  I can say that, of all the men that have gone on HRT on Peak Testosterone Forum, not one of them has complained of BPH that I remember. (It does happen from time to time though, so “eyes wide open.”)

COMMENT: As you can see, there is tremendous variance in philosophy as far as treatment and safety when it comes to DHT.  How can you decide, then, what ideal target DHT levels are?  Unfortunately, there are no DHT-mortality studies and very minimal research on DHT and cardiovascular / arterial health.  Your crystal ball is probably just as polished as anyone else’s at this point, and that means, at least at this time, you are going to have to do your own research and hopefully find a knowledgeable physician to provide their best guess.

Pulling DHT is not as common on the forum, because it is a fairly expensive test – closer to $100 than not. (In the U.S. you can now pull total testosterone for less than $30 for example.) However, a few guys have pulled it and DHT can help diagnose low libido in many cases – it’s definitely worth looking at.   However, it is not perfect of course as libido is complicated. We had a man on HRT who have boosted his DHT above midrange and yet his libido really struggled. [5] He believed it was due to unmanaged estradiol and that is certainly a possibility.  High prolactin can also lower libido, but that will generally drive down testosterone and, therefore, DHT simultaneously.  And anything that negatively impact the brain and neurotransmitters can do the same from recreational drugs to pharmaceuticals to poor lifestyle choices, sleep disorders, nutritional deficiencies, etc.

That said, DHT is one of the stronger predictors of libido, especially when it is low as this man described:

“The trick, of course, is to find a “normal” doc who’ll prescribe anything unless you have extremely low T levels. My last few blood tests had me between 335-375 ng/dl, my libido was seriously diminished, and I was suffering noticeable mental fog and lack of concentration..” [4]

What was his DHT at the time?  It was 27 ng/dl within a lab range of 16-79, i.e. near the bottom.

Thyroid: Natural Ways to Boost Your T3 - Peak Testosterone

Do you have low T3?  If so, then it is likely that you also have some of the standard hypothyroid symptoms:  lowered testosterone, decreased libido, mental fog, fatigue and perhaps decreased erectile strength.  Some physicians will immediately put you on thyroid medications.  The good news is that thyroid meds appear to be quite safe and pretty easy to quit, unlike many other pharmaceuticals. However, wouldn’t you like to know the root cause of your low T3 if at all possible?  Why spend the time and money on medications if you don’t have to, eh?  What has happened is that the research that has been pouring out of the laboratories has just not made it into the doctor’s offices yet.  It will happen, but natural solutions are just not considered yet.

Before I discuss those solutions, I want to answer a question that may have crossed your mind:  why am I only focusing on T3 in this article.  After all, low T3 men tend to fall in one of two categories:  a) medium high T4, low T3 or b) low T3 and low T4.  And the T4 level does provide valuable information actually.  For example, if you have low T4, it is possible that you have a damaged pituitary – the pituitary actually sends the signal to the thyroid to produce T3 and T4 -or that your thyroid is under autoimmune attack, etc.  (You can read about some of the other reasons for hypothyroidism and how it can affect testosterone on this page:  Testosterone and Your Thyroid.)

But, again, on this page I want to cover lifestyle and chronic disease-related issues that may help you to reverse, partially or otherwise your hypothyroidism. And this is important, because, if you have an underlying lifestyle issues, it is probably causing you other problems that you may not even be aware of.  That’s why I believe it is important to read some of these Less Well Known and Potentially Correctiale Reasons for Low T3:

1. Low Zinc. According to an animal study, low zinc levels could lead to decreased T4, which, in turn, could lead to decreased T3 levels. [1] Zinc deficiencies can also dramatically affect testosterone levels as I discuss in my page on Zinc Deficiencies and Low Testosterone. One way to test for a zinc deficiency is through a simple zinc taste test. CAUTION:  Be sure to ready my page on The Nasty Effects of Too Much Zinc.

2. Magnesium Deficiency. Zinc isn’t the only mineral that can sometimes lower testosterone:  there is evidence that magnesium deficiencies can do the same thing.  And so is it any wonder that low magnesium can also lower thyroid hormones as well?  An animal study shows that this is exactly what happens: magnesium deficient animals had decreased T4 output, increased TSH and their thyroid gland enlarged. [2] And studies have shown that many individuals are walking around with low levels of magnesium.  The reasons are many, but at the top of the list are probably the fact that magnesium-rich foods are avoided by some men andsoils are now often depleted

3. Dieting. A lot of men don’t realize that, if they significantly cut calories, it will lower testosterone and push them into a state of hypothyroidism.  Basically, the body slows down to conserve energy.  It’s hard to fight Mother Nature!

4. Stress. One study deliberately put men in a stressful combat training situation and found that T3 levels did not decrease significantly.  However, what did decrease was free T3, the bioactive T3 needed by your tissues. [3] Interestingly enough, the researchers did not find increased stress hormone levels in these men, but the fact reamins that their free T3 was somehow affected.

5. Selenium Deficiency. It’s not just magneisum – soils are often depleted of selenium now as well. [6] This can negatively impact thyroid function, because selenium is a key part of certain thyroid enzymes and is needed for the conversion of T4 into T3. [4] As expected, animals studies show decreased thyroid output from low selenium. [5] You can get a beefy does of selenium in brazil nuts, but be careful:  do not eat more than one per day and that may even be too much.  You can actually poison yourself with selenium as the typical brazil nut has an RDA or two in it.

6. Riboflavin (Vitamin B2) and Pryidoxine (Vitamin B6). One study showed that low levels of Vitamin B2 led to decreased conversion to T3. [8] And too little Vitamin B6 can rev up your immune system, such that it attacks the thyroid.

7.  Tyrosine Deficiency. Some people do not make enough tyrosine from phenylalanine due to an enzyme deficiency.  This is quite rare though.  However, there is a theory out there that, under stress, we need more tyrosine, perhaps even supplemental.  I have no studies to show tyrosine supplementation helped T3 levels but am just passing along information.

8.  Gut Issues. Many men walk around with diarrhea, constipation, intestinal cramping, etc. and do not realize that they are part of the epidemic of gut issues that includes Crohn’s, Irritable Bowel Syndrome, Diverticulitis, Celiac Disease and many more.  These gut issues have massive counterintuitive consequences and one of them is decreased nutrient absorption.  Yes, that means that it is quite common for men with these diseases to have low levels of all the nutrients and vitamins that you see above.

Stomach issues are quite prevalent and can cause similar nutrient-absoprtion issues as well.  Atrophic gastritis is prime example:  you have to give good stomach acid to aid those chemical reactions in your stomach.  So, if you have any doubts about the health of your GI tract, get checked asap.

9. Inflammation and Infection. Many lines of evidence have pointed to inflammation lowering thyroid hormones.  To test this theory out, researchers built an elaborate animal model and discoverd that both T3 and T4 were lowered by inflammation. [7]

REFERENCES:

1) Biological Trace Element Research, Jan 1998, 61(1):89-96, “Zinc supplementation on serum levels and hepatic conversion of thyroid hormones in obese (ob/ob) mice

2) The Journal of Nutrition, 1984, 114(8):1510-1517, “The effect of magnesium depletion on thyroid function in rats”

3) Life Sciences, 1994, 55(17):PL327 PL332, “Impact of stress and triiodothyronine on plasma magnesium fractions”

4) Endocrinology, 2000 Jul, 141(7):2490-500, “Effects of selenium deficiency on tissue selenium content, deiodinase activity, and thyroid hormone economy in the rat during development.

5) Am J Clin Nutr, 1993 Feb, 57(2 Suppl):236S-239S, “Selenium deficiency, thyroid hormone metabolism, and thyroid hormone deiodinases”

6) https://californiaagriculture.ucanr.edu/landingpage.cfm?article=ca.v054n02p49&fulltext=yes

7) J Endocrinol, Dec 1 2006, 191:707-714, “Chronic local inflammation in mice results in decreased TRH and type 3 deiodinase mRNA expression in the hypothalamic paraventricular nucleus independently of diminished food intake”

8) Endocrinology, Published Online: July 01, 2013, “Effects of Vitamin Deficiency on the in Vitro and in Vivo Deiodination of Thyroxine in the Rat”

Body Fat and Testosterone - Peak Testosterone

Testosterone and body fat are intimately related for us guys.  Either one can strongly affect the other and even lead to a viscious cycle of increased weight gain and lowered testosterone.

Let’s start with what happens when you put on extra body fat:  you slowly begin to increase cortisol, lower testosterone and decrease human growth hormone.  If you reach medical obesity, all three of these hormones are negatively impacted very significantly. [1]

Why does increased body weight lead to a reduction in testosterone levels?  The reasons are many, but one of the most important is increased aromatization. Fat cells contain aromatase and as you increase weight your levels of this enzyme increase.  Unfortunately, aromatase converts testosterone to estrogen (estradiol) and so the all important testosterone/estradiol ratio is shifted downward.

In fact, cortisol will also create a similar viscious cycle, especially for those with an “apple shape”, which most guys are. Studies show that abdominal fat, or visceral fat as it is called in the medical world, has much higher levels of cortisol. [2] Therefore, as you inflate that spare tire around your middle, more cortisol is created and cortisol will definitely reduce testosterone.  Again, you can see the viscious cycle here:  lowered testosterone will lead to an increase in overall body fat including abdominal and you have a very negative downward spiral going on.

Put this all together and it explains the reason that visceral fat and low testosterone are intimately and negatively related in the studies. [3]  Either one can contribute to the other.  And both are associated with increased risk of diabetes, cardiovascular disease and insulin resistance. [4] (See my link on Low Testosterone Symptoms as well.)

So it is critical to get your testosterone tested regularly and keep your weight down.  Read my links on How to Improve Your Testosterone Naturally for ideas as well.

1) Metabolism, Sep 1995, 44(Supplement 3):Pages 21-23 “Endocrine abnormalities of obesity”

2) Science, Dec 7 2001, 294(5549):2166-2170, “A Transgenic Model of Visceral Obesity and the Metabolic Syndrome”

3) Metabolism, Sep 1990, 39(9):897-901, “Visceral fat accumulation in men is positively associated with insulin, glucose, and C-peptide levels, but negatively with testosterone levels”

4) Obesity, 2006, 14:16S 19S, “Why Visceral Fat is Bad: Mechanisms of the Metabolic Syndrome”

Broccoli - Peak Testosterone

REFERENCES:

1) JAMA, 1999, 282:1233-1239

2) J. Nutr, 2002, 132:307-309

3) Carcinogenesis, May 2003, 24(5):891-897

4) Cancer Res, 1994, 54:1976s-1981s; J Nutr, 2001, 131(suppl):3027s-3033s;

5) Cancer Res, 1998, 58:4102-4106

6) “Broccoli: A Unique Vegetable That Protects Mammalian Hearts through the Redox Cycling of the Thioredoxin Superfamily”, Jan. 23 2008 issue of ACS’ Journal of Agricultural and Food Chemistry.

7) J Natl Canc Inst, 2000, 92:61-68; Cancer Epidem Biomarkers Prev, 2000, 9:795-804

8) Cancer Res, 2005 Sep 15, 65(18):8548-8557

9)  Cancer Prev Res, April 1 2009

11) Brit J of Cancer, 2006, 94:407 426, Published online 24 January 2006, “BRCA1 and BRCA2 as molecular targets for phytochemicals indole-3-carbinol and genistein in breast and prostate cancer cells”

12) Cancer Prevention Research, Apr 1 2009, “Dietary Sulforaphane-Rich Broccoli Sprouts Reduce Colonization and Attenuate Gastritis in Helicobacter pylori Infected Mice and Humans”

13) https://www.naturalnews.com/027876_broccoli_arteries.html

Vitamin D and Magnesium are impressive supplements.  They both combat a wide array of diseases and conditions that plague modern societies.  But I would have to say broccoli, especially in the anti-cancer arena, is king.  In fact, as you study the research on this vegetable, it is almost mystifying that one vegetable could do so well against so many conditions.  It is, simply put, Mother Nature’s Special Forces to try to protect you from the enemy.

I should mention that any cruciferous vegetable has the same superpowers.  Therefore, consider cauliflower and cabbage your special friends as well.  And don’t forget to tell the Little Woman that broccoli will 1) lower her levels of the “bad estrogen” and 2) offer substantail protection against breast cancer.  (Among other things, it causes breast cancer cells to self-destruct.)  You might save her life and score a few points while you’re at it.  And, if you’re like most of us, you really need to score a few points!

NOTE: Broccoli is easy to cook.  Simply grab a coffee cup/mug and put a third or half of an inch of water in the bottom.  Then pull out some fresh broccoli and pull off enough florets to fill up the cup.  Put it in the microwave for about 2.5 minutes and the steam will cook the broccoli nice and soft.  Add a little salt and you are good to go.  And if you’re one of those people who just can’t stand the smell or taste of broccoli, then you’ve still got no excuse:  just eat cauliflower and cabbage instead.  All of these are in the cruciferous vegetable category and share similar properties.

The bottom line, though, is that one way or another you need to be cooking and eating this at least four days a week.  Here’s just a few reasons why:

1.  Stroke.  Broccoli, in a Journal of the American Medical Association issue, lessened the risk of stroke more than any other vegetable or fruit studied! [1].

2. Cataracts.  Broccoli decreases your risk for cataracts.

3. Herpes and Shingles.  We have already covered that broccoli’s Indole-3-Carbinol (I3C) protects against herpes and shingles viruses.

4.  Colorectal Cancer.  Animal studies have shown broccoli to be protective against colon cancer. [2]

5.  Prostate Cancer. Broccoli’s allyl isothiocyanate causes prostate cancer cells to self-destruct. [3]

6. Anti-carcinogens. These same isothiocyanates (ITCs) are recognized in multiple studies as powerful anti-carcinogens. [4]

7. Another isothiocyanate (ITAC) called phenethyl isothiocyanate (PEITC) blocked tumor promoters. [5]

8) Apoptosis. Many studies show IECs induce apoptosis, i.e. cause cancer cells to self-destruct.

9) Cardiovascular Protection. Broccoli has several studies showing that it is heart protective as well. [6]  Scientists recently discovered that this may be because sulfuraphane increases the activity of a protein called NRf2 that is known to be inactive at sites of arterial plaque buildup. [13]

10) Prostate Cancer.  Broccoli has long been known as protecting the prostate from cancer. [7]

11) Lung Cancer.  Broccoli slows the progression of lung cancer [8] and improves COPD.

12) H. Pylori and Stomach Cancer.  One kind of ITC in broccoli has been found to be extremely damaging to H. Pylori, the bacteria that often causes ulcers and stomach cancer. [9]  One 2009 study verifies this and found that those who ate broccoli sprouts had significantly reduced levels of H. Pylori and this will undoubtedly greatly reduce one’s risk of stomach cancer. [12]

13) Tongue (and Prostate) Cancer.  Sulfurophane has been found in the laboratory to fight metastic tongue and prostate cancer cells. [10]0]

14) Bladder Cancer.  You got the idea by now:  broccoli protects from bladder cancer as well.

And, trust me, this is just scratching the surface of broccoli’s power! Broccoli (and other cruciferous vegetables) have also been found to aid in DNA repair.  In other words, even if your DNA does get damaged the I3C in broccoli has been found to activate proteins that repair DNA. [11] So broccoli isn’t just about defense – it’s about offense as well.

So whether you love the taste of broccoli or hate it, figure out some way to consume it – it will very likely save your life someday.

10) Intl J of Cancer, 2008, 123(6):1255-1261

Mood and Testosterone - Peak Testosterone

As we point out often on this site, testosterone effects everything for us guys and, especially, the male brain. One of the surpising things that testosterone alters rapidly is mood.  Yes, testosterone can make us guys “bitchy.”  In fact, believe it or not, researchers have a term for it:  Irritable Male Syndrome. [1]

Researchers first noticed the effects of low testosterone in animals and have since studied this effect in a wide variety of mammals. What is counterintuitive is that instead of becoming docile and quiet, males with decreased testosterone become much more prone to fighting. Researchers noted that it could likely be due to a drop in brain opiods that are necessary for mood elevation. Thus they become both fearful and irritable at the same time – a toxic combination by any standards.  (Think of that next time you make fun of a woman with PMS, eh?)

So just what do researchers mean by “mood?”  Generally, questionaires are used and monitor psychological items such as “positive mood responses (alert, friendly, full of energy, well/good feelings) and negative mood responses (angry, irritable, sad, tired, nervous).” [4]  Other studies have looked at similar attributes, such as “angry, alert, irritable, full of pep (energy), sad/blue, tired, friendly, nervous, and well/good.” [7]

However, changes in mood parameters such as this are generally only experienced by men with hypogonadal testosterone levels. Several studies have shown that men with normal or even low normal testosterone levels experience little to no benefit in this area from testosterone therapy for example. [2] Young, healthy males may be more resilient as well to low testosterone according to one study, although the researchers found that they had “hot flashes” and were “emotionally charged.” [3] Can you say PMS?

As a side note, you can, in fact, swing the pendulum too far the other way:  researchers have actually increased testosterone to supraphysiological (abnormally high) levels and some of the men displayed signs of hypomania, i.e. symptoms such as euphoria and hypersexuality. [6]  And I have heard this from an HRT clinic:  if they go too high with a man’s testosterone, he gets “amped” as the clinician put it and can lose their temper easily, etc.

Did you know you can inexpensively do your own testing for most hormones? The industry leader is Discounted Labs..

The main point, though, is that raising one’s testosterone, either naturally or through HRT, can be a definite mood-booster.  On The Peak Testosterone Forum I find this to be the one of the most common benefits of going on testosterone.  Men describe the incredible change to their mood and attitude from HRT (Hormone Replacement Therapy).  Look at just a few of the comments:

“I am on day 25 and have lost over 24 pounds and feel like I am living again.I feel better than I have in years. Having spontaneous erections again, more energy and a better emotional state.” [8]

“I’m also much “calmer” than before and mind seems better able to focus. You would think Raising T levels would make you prone to anger and violence? But it has had the opposite effect on me.” [9]

“I am still taking my 1cc of 200 ml of Testosterone Cypionate a week and .5mg-1mg daily dose of Armidex. My next follow up blood work is in February. Words cannot describe how I been but in one word it will have to be INCREDIBLE. I make love to my wife on an average 6-8 times a week. I am taking advantage of this feeling because I never had it before and I am 34 years old. I love it. I am finally at the point where my wife has had enough in the bedroom and I am asking for more. This is the first in my life I ever felt so good and confident.” [10]

(See this link on Hormone Replacement Therapy (HRT) for more information on testosterone therapy.)

The Depression Connection

Hopefully, the above quotes are a few real-life examples that show you just how important testosterone can be to mood.  No, it is not a silver bullet that always works, but it is very often a major player.  One of the sign that is a root cause of many mood disorders is the very recent recognition by the practicing medical community that correcting endocrine issues, especially testosterone, can greatly help with depression.

Physicians and those in the mental health fields suddenly noticed that a substantial percentage of depressed men were low T and giving them testosterone helped very often.  The subject of Testosterone and Depression is so important that I did a page on it and documented the many kind of depression and mood conditions that HRT can help with.  In my opinion, if a man is struggling with depression, one of the first numbers that should be pulled is testosterone.

1) Reprod Fertil Dev, 2001, 13(7-8):567-76, “The irritable male syndrome”

2) Maturitas, 2005 Feb 14, 50(2):124-33, “Effect of oral testosterone undecanoate on visuospatial cognition, mood and quality of life in elderly men with low-normal gonadal status”

3) Arch Gen Psychiatry, 2004 Oct, 61(10):997-1004, “The effects of pharmacologically induced hypogonadism on mood in healthy men”

4) The Journal of Clinical Endocrinology & Metabolism, Aug 1 2000, 85(8):2839-2853, “Transdermal Testosterone Gel Improves Sexual Function, Mood, Muscle Strength, and Body Composition Parameters in Hypogonadal Men”

5) The Journal of Clinical Endocrinology & Metabolism, May 1 2004, 89(5):2085-2098, “Long-Term Testosterone Gel (AndroGel) Treatment Maintains Beneficial Effects on Sexual Function and Mood, Lean and Fat Mass, and Bone Mineral Density in Hypogonadal Men”

6) Archives of General Psychiatry, Feb 2000, 57(2), “Effects of Supraphysiologic Doses of Testosterone on Mood and Aggression in Normal Men”

7) J Clin Endocrinol Metab, 1996 Oct, 81(10):3578-83, “Testosterone replacement therapy improves mood in hypogonadal men–a clinical research center study”

8) https://peaktestosterone.com/forum/index.php?topic=638.0

9)  https://peaktestosterone.com/forum/index.php?topic=433.0

10) https://peaktestosterone.com/forum/index.php?topic=513.105

Walking: Drop Your Blood Pressure the Easy Way .

Just walk.  Those two words can save your life.  They can also save your sex life, as I discuss in my link on Walking and Erectile Dysfunction. On this page I want to go into the study results that show how walking and walking alone can lower blood pressure and protect you from hypertension. In fact, I will show you that, particularly if you have high blood pressure or are a senior with normal blood pressure, walking is likely to lower that mercury as much as any medication.  (Of course, talk to your doctor if applicable.)

Of course, physicians do not usually mention the power of a simple, natural solutions such as walking to help with hypertension, so this is why I mention it here.  High blood pressure is a huge risk factor for erectile dysfunction, stroke and cardiovascular disease, so it is something to take very seriously.  Get that blood pressure below 120/80 and never give up.  It can take some effort and work, but I believe most men can do it naturally without pharmaceuticals as long as they are willing to put in the effort and time to see what works.  And walking can be a huge part of that plan as I will show below.

NOTE:  I have other great ideas to lower your blood pressure in these pages on Erectile Dysfunction and High Blood Presure and How I Lowered My Blood Pressure.

Here are some of the key studies that should encourage you to start walking and drop your blood pressure:

1.  10,000 Steps.  Some of you may have heard of the 10,000 Steps Program.  It’s a great concept where you basically strap on a pedometer and try to reach 10,000 steps from waking to sleeping.  (Pedometers can be tactully hidden under your shirt.) I know that when I walk a mile, I take about 1,850 steps and you are probably roughly the same.  This may make 10,000 steps may seem like a lot, but it’s really not.  The reason I say that is that the pedometer will record not just when you walk on a treadmill or in a park but also when you do yardwork or play with the kids.  10,000 steps comes more quickly than you might think in the course of a normal day and is a great measure of total physical activity.

1)  Hypertension Research : Official Journal of the Japanese Society of Hypertension, 2000, 23(6):573-580, “Walking 10,000 steps/day or more reduces blood pressure and sympathetic nerve activity in mild essential hypertension.”

2) Arteriosclerosis, Thrombosis, and Vascular Biology. 2013; 33:1085-1091, “Walking Versus Running for Hypertension, Cholesterol, and Diabetes Mellitus Risk Reduction”

3) https://mx1.ishib.org/journal/17-2s4/ethn-17-03-503.pdf, Ethnicity & Disease, Summer 2007, 17, IMPACT OF EXERCISE (WALKING) ON BLOOD PRESSURE LEVELS IN AFRICAN AMERICAN ADULTS WITH NEWLY DIAGNOSED HYPERTENSION

4) Medicine and Science in Sports and Exercise, “Increased Daily Walking Lowers Blood Pressure in Postmenopausal Women”

5) Preventive Medicine, Aug 2001, 33(2):120-127, “Walking and resting blood pressure in adults: A Meta-analysis”

6) The American Journal of Cardiology, Jun 1 1994, 73(15):1124-1128, “Moderate- and high-intensity exercise lowers blood pressure in normotensive subjects 60 to 79 years of age”

2.  13-Point Drop in Middle-Aged Males.  One study looked at the effect of walking on newly diagnosed (with hypertension) African-American males.  Although the study design made it impossible to come to any direct conclusions [3], the results were impressive to say the least.  Average measurements dropped from 147.7 to 134.4 and 95.7 to 88.6 for systolic and diastolic blood pressures, respectively.  And this is even more remarkable when you consider that the only real difference from the control group was that the intervention group was encouraged to walk an extra 30 minutes beyond their normal daily activity.  Again, researchers noted that results were as good as the typical pharmaceutical solution.

NOTE: These big drops in blood pressure mean more blood flow and more nitric oxide.  And increases in blood flow and nitric oxide mean better erections.  Walking also avoid overtraining syndrome.  This is a big problem with guys – they overtrain and actually make their hormones and health worse in many cases.

3.  Protection from High Blood Pressure.  The power of walking was also shown in a recent study where researchers put participants in a walking group and a running group of equal energy expenditure.  In other words, they made the walkers walk longer to match the calories burned of an equivalent runner.  The authors concluded that “equivalent energy expenditures by moderate (walking) and vigorous (running) exercise produced similar risk reductions for hypertension, hypercholesterolemia, diabetes mellitus, and possibly CHD.” [2] In reality, the walking actually produced greater risk reductions in every category, but apparently not with statistical significance.  For example, running reduced the risk of developing hypertension by 4.2% but walking reduced it by 7.2%.

5.  Meta-analysis of Many Studies.  Results in this meta-analysis were not as dramatic – 3 and 2 mm decreases for systolic and diastolic – but this undoubtedly included normotensives, i.e those with normal blood pressure. [5] Obviously, walking lowers blood pressure much less dramatically (if at all) in healthy individuals with no blood pressure issues.

6.  Normotensive Elderly.  One study looked at seniors with normal blood pressure and found that 45 minutes of walking at 70% of Heart Rate Reserve, a measure of exercise intensity,  or 35 minutes at 85% of HRR yielded impressive drops in blood pressure:  8-9 mm in systolic and 4-8 in diastolic. [6] Again, these are in those with blood pressure lower than the standard 120/80.

REFERENCES:

Visceral Belly Fat and Testosterone - The Powerful Link -

Call it anything you want, but it’s ugly and it’s hard on your health.  The subject recently came up in The Peak Testosterone Forum. A poster asked this question:

“So I’ve read in several articles how visceral fat (yes, the nasty deadly one) is harder to get rid of from diet and exercise than subcutaneous fat. I have not seen anything that compares these two as a result of HRT. With that said, here is a fairly obvious observation I’ve made from my TRT over the last 2-1/2 months:”

“…4) My waste has shrunk almost 2 belt notches after gaining this 5 to 6 pounds!…So from all of this it seems the only explanation for the belt reduction is visceral fat removal. Does picking up your T levels significantly cause visceral fat to fall away faster than subcutaneous? Is this fully understood?” [1]

As you can see, this man went on HRT and is asking if the increased testosterone could have improved his visceral (belly) fat levels?  The answer is “Yes!”

REFERENCES:

1) https://peaktestosterone.com/forum/index.php?topic=1347.0

2) International Journal of Obesity and Related Metabolic Disorders : Journal of the International Association for the Study of Obesity, 1992, 16(12):991-997, “The effects of testosterone treatment on body composition and metabolism in middle-aged obese men.”

3) J Clin Endocrinol Metab, 2008, 93(1):139-146, “Testosterone therapy prevents gain in visceral adipose tissue and loss of skeletal muscle in nonobese aging men”

4) International Journal of Obesity and Related Metabolic Disorders : Journal of the International Association for the Study of Obesity, 2000, 24(4):485-491, “Low serum testosterone level as a predictor of increased visceral fat in Japanese-American men”

5) J Clin Endocrinol Metab, 1998, 83:1886, “Testosterone deficiency in young men: marked alterations in whole body protein kinetics, strength and adiposity”

6) American Journal of Physiology – Cell Physiology, Aug 1 2013, 305:C355-C359, “Testosterone induces cell proliferation and cell cycle gene overexpression in human visceral preadipocytes”

Below, I will show some studies that show powerfully testosterone can lower visceral fat. But this should be a sobering reminder to most men out there: if a man overeats, his high testosterone levels end up creating deadly fat in the belly area, i.e. visceral fat through signaling of preadipocytes. [6] Yes, you are predisposed to deadly visceral fat!

1.  Obese Men.  In one study of obese men, they made no lifestyle changes but simply gave the men testosterone therapy.  The participants experienced many positive changes, but one of them was a significant decrease in visceral fat.[2] As I mention in my link on Testosterone and Insulin, testosterone has a powerful insulin lowering effect.

2. Non-obese Seniors. One study put men on patches and only modestly increased their testosterone levels by about 30% from their starting point.  Even with such relatively small changes, visceral fat decreased significantly in these senior men. [3]

So it’s literally no exagerration to say that if you are low or lowish T, adding testosterone will probably melt off your visceral fat.  Of course, deciding whether or not to go on HRT is a personal decision between you and your doctor that involves many variables, but it’s always good to know the truth and the truth is that testosterone is strongly related to your “gut”.

This fact has been verified in many other ways as well.  First of all, a study on Japanese American men found that testosterone levels were inversely associated with visceral fat. [4]  In other words, the more testosterone, the less the visceral fat and vice versa.  Another interesting study gave a little more understanding by essentially blocking testosterone signaling in healthy young men. [5]  What they found was that all fat increased, but especially visceral fat.  In other words, if you are low testosterone, you will very much be at risk for general weight gain as well.

NOTE:  See my link on How to Lower Fasting Insulin Levels for more information of interest as well.

Maca: Libido Booster and Food of the Incan Love Gods

Will Maca (Lepidium meyenii or L. peruvianum) improve erectile dysfunction? The answer is ‘yes, indirectly’.  This is one of the few herbs that has some decent evidence for being a good, old fashioned  and legitimate aphrodisiac. This is a plant that grows in the high altitudes of the Andes in Peru and has been eaten by the natives for centuries for both food and increasing sexual potency.  And, in this case, it looks like the natives knew what they were doing:  studies on rats and mice have shown it dramatically improves sexual behaviors.  [1]  In other words, at least in rodents, science has shown that Maca is a powerful aphrodisiac.

What about in humans?  Well, even though no studies have been done on Maca’s libido-enhancing powers to date on humans, Maca has been shown to also be something sent down by the fertility gods.  Researchers examining nine men, aged 24-44, found that “the semen volume, total sperm count, motile sperm count, and sperm motility (Grades a+b) were significantly increased after treatment with Maca”. [2] So Maca gives you more sperm, better sperm and more seminal fluid.  And it definitely makes you feel more “full” down there below the belt and ready to ejaculate!

Maca has many other very desireable properties, including improved lipid profiles, lowering cortisol, aiding in muscle growth, boosting super-antioxidants and so on.  I document these in my link on the Powerful Effects of Maca.

One other item of interest is whether or not Maca affects androgens. No study to date has found a statistically significant increase or decrease in testosterone or other hormones and Maca’s actions appear to be in the aphrodisiac realm. One suspected compound is p-methoxybenzyl isothiocyanate, but this has not been thoroughly studied.

Maca has an excellent safety profile and we can take comfort in the fact that it has been eaten as a food for probably millennia by the Peruvians and Bolivians.  It has been placed fresh on foods by the natives as well as cooked in various dishes. Peruvians consider it a food, although they recognize its “medicinal powers” as well. The only caution that I know regarding Maca is that one study on Maca showed a moderate increase in blood pressure at the relatively low dose of just 600 mg/day. [3] (Of course, work with your doctor whenever trying a new program or supplement.)

I take organic Maca from Navitas: Navitas Naturals Organic Raw Maca Powder and have had good results with it.   I always cook it, usually through throwing it in my oatmeal.

Some people have trouble digesting the starch of the maca root, which can lead to stomach upset, gas and/or diahrrea.  If this is an issue for you, you can order the gelatinized form, which is usually in the human studies by the way:  Maca Power – 100% Certified Organic “Gelatinized” Maca. My understanding is that simple cooking does not break down these starches sufficiently for those who have trouble, whereas the gelatinized version handles that for you.

I should also forewarn you that Maca has a strong taste that is completely quite different from anything else you have probably eaten.  I don’t find the flavor objectionable but many people do.  For many guys, though, the benefits far outweigh its strong aftertaste.

CAUTION: Maca is generally one of the most well-received supplements – although really it could be considered a food like fenugreek – on the forum and in emails. For example, this forum poster lists it as his favorite. However, I did get one forum poster who said that Maca gave him issues and actually lowered his libido and another that said it lowered his testosterone. You can read about that here. Maca reportedly can be stimulating for some and so some men cycle it, i.e. four or five days consuming Maca and a few days of rest afterwards.

Also, it is worth noting that some supplement manufacturers put Maca and Horny Goat Weed together in the same capsule taking advantage of their complementary effects on male physiology.  Horny Goat Weed directly boosts Nitric Oxide and boost libido.  Maca, through a complete different pathway, boosts semen volume and libido.  It is a good combination that does work well for many guys, but you want to get a formulation that has an extract of Icariin (for the Nitric Oxide) and 500 mg of the Maca.

REFERENCES:

1) Urology,2000,55:598-602;J Ethnopharmacol,2001,75:225-9

2) Asian J Androl,Dec 2001,3:301-303

3) Food and Chemical Toxicology, Mar 2008, 46(3):1006-1013, “Maca (Lepidium meyenii) and yacon (Smallanthus sonchifolius) in combination with silymarin as food supplements: In vivo safety assessment”

Maca – Side Effects

Estradiol and HDL - Peak Testosterone

One interesting protocol change that I have observed on the Peak Testosterone Forum of late is that some of the guys on HRT are saying that their doctors want their estradiol quite high. “More is better” seems to be the philosophy with these physicians. Now I am very skeptical of that position for many reasons:

In spite of all these negatives, these doctors wanting higher estradiol levels do have an interesting point: estradiol is incredibly important according to recent research for arterial health. In fact, one study showed that IMT (intima media thickness) scores, i.e. arterial plaque levels, were tied to estradiol levels. The authors concluded:

“Circulating E2 is a predictor of progression of carotid artery intima-media thickness in middle-aged men. Further studies are needed to investigate the role of endogenous E2 for incident cardiovascular disease events.” [1]

1)  JCEM, 91(11), Received: May 02, 2006, Accepted: August 17, 2006, Published Online: July 02, 2013, “Circulating Estradiol Is an Independent Predictor of Progression of Carotid Artery Intima-Media Thickness in Middle-Aged

2) JCEM, Published Online: July 01, 2013, “Physiological levels of estradiol stimulate plasma high density lipoprotein2 cholesterol levels in normal men”

3) Arteriosclerosis, Thrombosis, and Vascular Biology, 2004, 24: 1741-1742, “Estrogen and HDL: All that Glitters Is not Gold”

4) JAMA, 2009 May 13, 301(18):1892-901, “Circulating estradiol and mortality in men with systolic chronic heart failure”

5) J CARDIOVASC PHARMACOL THER, May 2014, 19(3):256-268, “Regulation of Endothelial Nitric Oxide Synthase and High-Density Lipoprotein Quality by Estradiol in Cardiovascular Pathology”

Men have the idea that estradiol, being the chief estrogen is “bad,”  because it is the “female hormone.”  Well, the truth is that you desperately need a certain amount of estradiol in order for arteries to be healthy and on this page we are going to look at one reason why:  estradiol is a stimulator of HDL, the good cholesterol that shuttles cholesterol out of foam cells.  Researchers have long known that women, who have higher estradiol levels than men of course, enjoy improved and increased HDL levels.  So the question is whether or not the same effect would be seen in men as well.

NOTE:  Again, you do not want to be “deficient” in estradiol.  For the many reasons, see my page Do Men Really Need Estrogen, Especially Estradiol? for more information.

“Plasma HDL cholesterol, particularly, the HDL2 fraction, decreased significantly in response to the low serum E2 level…Only a small decrease in HDL2 cholesterol was seen in these men. There were no hormonal or lipid changes in the placebo group. We conclude that in men, physiological levels of E2 [estradiol] are important in maintaining plasma levels of HDL cholesterol, especially the HDL2 fraction. ” [2]

So this study directly confirmed the idea that estradiol increase HDL.  However, one concern that researchers have is that you don’t want to increase HDL unless the quality also increases.  It turns out that you can increase HDL and actually make it pro-oxidant to where it does not do it’s cholesterol transporting job.  One study showed that this was indeed the case: estradiol lead to the incorporation of serum amyloid A (SAA) into the HDL, which actually turns your good cholesterol from friend into foe. This ugly turn of events can create a “franken-HDL” that would increase plaque instead of decrease it. [3] Indications of these issues were shown in a study on men with chronic heart failure, where participants with estradiol greater than 37 pg/ml had more than double the risk of dying. [4]

There is yet another “cardiovascular dark side” to estradiol increases:  estradiol generally raises CRP (C-Reactive Protein) and other inflammatory markers. [3] This may negate any cardiovascular benefit when artificially elevated.  Many women, for example, are not allowed estradiol creams (for post-menopause, etc.) over clotting concerns.  Although men have much lower levels of estradiol, the concerns still remain.

All of this means that, while estradiol does increase HDL, it is highly debatable as to whether or not it is wise to just let estradiol go overly high.  This is a real issue for men on HRT, whose estradiol often goes very high due to the increase in testosterone coupled with being overweight.  (Fat contains aromatase, the enzyme that convert testosterone to estradiol.)

NOTE:  Does testosterone affect HDL?  Read my page on Testosterone and HDL for additional information.

REFERENCES:

Herbs, Testosterone - Peak Testosterone

Androstenedione – banned by the FDA in April 2004.  6-OXO – banned by the FDA in July 2006.  One over the counter testosterone booster after another banned by the FDA. A fella could quickly get the idea that there are no herbs that can increase testosterone according to the research.  After all, doesn’t the FDA just instantly shut them down?

Actually, the opposite is actually the case:  there are many studies using herbs that show an increase in testosterone under certain circumstances and I have listed them below.  Now it is true that the FDA tends to shut anything that boost testosterone in the 50-100% range.

However, below I outline some of the herbs that likely work (to a lesser extent) under certain circumstances.

CAUTION: If you think you have low testosterone, get checked out by a (good) doc.  Low testosterone is a serious medical condition that has long term consequences, including risks for diabetes, heart disease and erectile dyfunction. Also, if you are on any medications or have an existing medical condition, talk to your physician before making any change

1.  Fenugreek. One study on 30 young males found that 500 mg of Fenugreek increased total and free testosterone by 7% and 12%, respectively. [10] Now this isn’t a big increase, but it also seems to proportionately inhibit the normal conversion to estrogen and DHT. Furthermore, Fenugreek is dirt cheap – see for example Fenugreek Seed 610 mg 90 Caps – and so it may be worth a try. Fenugreek has many other excellent properties, including blood sugar/insulin control and libido and growth hormone augmentation.

NOTE: The brand that has gotten the best comments on the Peak Testosterone Forum is Testofen. I cover both the pros and cons in my page on https://www.peaktestosterone.com/.

Is Fenugreek safe?  Well, it should be as it is eaten as a common food and spice in many eastern cultures.  Now there is a fenugreek extract, Testofen, out there that is very effective in improving libido and has its own following. However, the extracts may boost prolactin, not something a guy necessarily wants to do. Here is an example of the extract on Amazon: Testofen Fenugreek Extract (300 mg 60 Caps).You can read more about here in my link on https://www.peaktestosterone.com/.

2) Korean Ginseng. Does Ginseng increase testosterone? Well, it may in certain circumstances, especially guys that are struggling in the androgen/fertility areas.  Several studies have noted that Ginseng boosts cAMP levels.  One follow-up study observed that boosting cAMP in turn increases testosterone, LH and DHT levels in men with low sperm counts. [3]  (And study on rats has also observed an increase in testosterone levels.) [4]

NOTE: One very small study of college age men showed that testosterone (and growth hormone) levels were not significantly raised by Ginseng. [5] My guess is that Ginseng produces a small boost in testosteorne for some men.  It has the added benefit, for men with erectile dysfunction, of generally increasing nitric oxide and hardness factor. For more information, see this link on How Ginseng Can Boost Erectile Dysfunction.

Some Ginseng manufacturers have been caught with lead in the their products. To get around this, one should probably play it safe and go with a brand that has been tested by an impartial testing company such as Consumer Lab. This brand, for example, was found to be lead free and to deliver the active ginsenocides specified on the label: Solgar – Korean Ginseng Root Extract, 60 veggie caps .

Did you know you can inexpensively do your own testing for most hormones? The industry leader is Discounted Labs..

DOSAGE: In one of the studies where the men experienced significant improvement in erectile dysfunction [13][14], the men took 900 mg of Korean Ginseng three times daily. Smaller amounts can be taken effectively by many men of course and several studies have used 600 mg 3 times daily.

3) Horny Goat Weed. Horny Goat Weed has a PDE5 inhibitor, a la Viagra and Cialis, called Icariin. Most Horny Goat Weed supplements on the market have an extract of Icariin to boost its power and efficacy. This may be good for testosterone in some circumstances as one study showed that Icariin increased testosterone levels in animals with damaged reproductive systems. [6]

Icariin has the added benefit of generally improving erectile function in men with erectile issues. For more information, see this link on The Benefits of Icariin and Horny Goat Weed. Also, for those interested: Source Naturals, a supplement manufacturer that seems to have a good reputation, has a Horny Goat Weed extract with 10% Icariin: Source Naturals Horny Goat Weed Extract (Epimedium) 1000mg, 60 Tablets .

4) Tribulis Terristris.  This herb is somewhat controversial because, although initial evidence showed that it did increase testosterone, one one recent and study showed the opposite. [12] What gives?  Well, one important thing to note is that the study showing that Tribulis did not significantly increase testosterone was on younger, healthy men.  These men already, generally, have abundant testosterone, so do we really expect Tribulis to help in this category?

Tribulis may very well affect men with low testosterone or with certain types of hypogonadism, which may explain the many anecdotal reports of it helping significantly.  Furthermore, Tribulis has some excellent properties, such as raising libido, that make it a very likely bedroom booster even in cases where it only marginally helps testosterone. For example, other studies show that it increases both libido and nitric oxide.  Some of these other qualities I have covered in some detail elsewhere in my links on Super Sexual Herbs, Aphrodisiacs (Male Libido Supplements) and the How to Increase Testosterone Naturally Guide.

Tribulis is typically packaged in very expensive formulations in health food and bodybuilding stores.  However, the herb itself is not expensive: Ultimate Bulgarian Tribulus (750 mg, 90-Count) or NOW’s brand NOW Tribulus (1000mg, 45% Extract, 180 Tablets)

DOSAGE: The dosage in the above study was 10-20 mg/kg daily.  For a 180 lb man, this works out to be between about 800-1600 mg daily. Many men take smaller amounts, more in the 400-800 mg per day range.

5) Tongkat Ali (Eurycoma Longfolia). One study on rats using Tongkat Ali showed a significant increase in testosterone. [1] This has not been verified in humans however.  One set of researchers in Brazil noted that Tonkat Ali’s true powers seem to lie in its ability to halt the “inhibitory effects of estrogen on testosterone production.”  [2] They further noted something very important for many guys: “where there is an excess of estrogen or deficiency in testosterone, EL may be able to act as a remedy for the condition.”  Of course, a low testosterone, high estrogen state is what a large percentage of males struggle with in modern, industrialized societies and so Tongkat Ali may be a significant help in these situations. NOTE:  Tongkat Ali is generally sold as an extract and probably the most reliable form is LJ100 as it is, at least, backed by certain agreed-upon concentration levels.  I am a little cautious about this product, though, because some of its components have shown toxicity. [11] However, the counterargument is that men have been using Tongkat Ali for years seemingly without issue.

6) Zinc (ZMA).  There is one supplement, ZMA, a form of zinc that has one study that shows a boost in testosterone.  Although, a follow-up study showed no significant benefit, it seems like that zinc deficient men may get some benefit in testosterone levels, if nothing else from improved sleep. For more information, see my link on Zinc and ZMA. ZMA also has an absorbable form of magnesium, which is worth its weight in gold.

CAUTIONS: Another supplement, high potency resveratrol, has also been shown to raise testosterone. [7]  However, it has also been reported as an estrogen agonist, i.e. estrogenic. [8] Forskolin is another supplement that has a study showing a modest increase in testosterone. [9] Unfortunately, little is known about its medium, or even short term effects.

1) Fundam Clin Pharmacol, 2002 Dec, 16(6):479-83, “Effect of Eurycoma longifolia Jack on orientation activities in middle-aged male rats”

2) Clinics (Sao Paulo). 2010 January; 65(1): 93 98, “The Effect of Eurycoma Longifolia Jack on Spermatogenesis in Estrogen-Treated Rats”

3)  Panminerva Med, 1996 Dec, 38(4):249-54, “Effects of Panax Ginseng C.A. Meyer saponins on male fertility”

4) 8)  Systems Biology in Reproductive Medicine, 1982, 8(4):261-263, “Effect of Panax Ginseng on Testosterone Level and Prostate in Male Rats”

5) J Strength Cond Res, 2002 May;16(2):179-83, “Effects of ginseng ingestion on growth hormone, testosterone, cortisol, and insulin-like growth factor 1 responses to acute resistance exercise”

6) Asian J Androl, 2006 Sep, 8(5):601-5, Epub 2006 Jun 5, “The testosterone mimetic properties of icariin”

7) Arch Pharm Res, 2008 Jan;31(1):83-7, “trans-Resveratrol relaxes the corpus cavernosum ex vivo and enhances testosterone levels and sperm quality in vivo”

8) Proc Natl Acad Sci U S A, 1997 Dec 9, 94(25):14138 14143, “Resveratrol, a polyphenolic compound found in grapes and wine, is an agonist for the estrogenreceptor”

9) Obesity Research, 2005, 13:1335 1343; “Body Composition and Hormonal Adaptations Associated with Forskolin Consumption in Overweight and Obese Men”

10) https://robthoburn.wordpress.com/2011/02/05/fenugreek-increases-testosterone-and-it-smells/

11) Planta Med, 2002 Jul, 68(7):662-4, “The toxicity of some quassinoids from Eurycoma longifolia”

12) J Ethnopharmacol, 2005 Oct 3, 101(1-3):319-23, “The aphrodisiac herb Tribulus terrestris does not influence the androgen production in young men”

13) The Journal of Urology, Nov 2002, 168(5):2070 2073, “A Double-Blind Crossover Study Evaluating the Efficacy of Korean Red Ginseng in Patients With Erectile Dysfunction: A Preliminary Report”

14) British Journal of Clinical Pharmacology, Oct 2008, 66(4):444-450, “Red ginseng for treating erectile dysfunction: a systematic review”

If You Low Cortisol, How Do You Increase It? - Peak Testosterone

One of the very common issues that I see on the The Peak Testosterone Forum is extreme fatigue.  Of course, there can be many reasons for this:  low testosterone, nutritional deficiencies, sleep disorders, gut issues, hypothyroidism, blood glucose / insulin issues, etc.  But one of the most overlooked and surprisingly common causes of fatigue is low cortisol, and this is because many men do not even realize that low cortisol is possible in our stressed out, fast-paced lives.  They assume that high cortisol is the norm and do not recognize some of the standard low cortisol symptoms such as dizziness, joint aches, heart palpitations, weakness, anxiety, etc.   As always, I recommend pulling your numbers and you can do that (if you are in the U.S. and in the U.K:) here:  Inexpensive Testosterone Labs.

Another group of men that can end up with low cortisol are men on testosterone therpay.  This can be a side effect for some men on HRT (TRT) due to a partial “shutdown” process. I don’t know of any studies out there providing evidence for that phenomenon, but it is definitely reported and may be one of the reasons for HRT failure in some men.  Therefore, it is probably prudent for men taking testosterone to regularly monitor their cortsiol, something they can do at the above link.

The big question is this:  if you find that you have low cortisol and standard low cortisol symptoms, how do you naturally raise your cortisol levels?  Below I list The Three Most Common Ways to Try to Increase Cortisol:

CAUTION: If you have low cortisol, I always recommend that you work with a knowledgeable physician.  In addition, all three of the methodologies below are best tested and implemented with a knowledgeable physician or naturopath:

1. Low Dose Hydrocortisone (Cortef usually). This is one of the most powerful, yet most controversial solutions  for raising cortisol levels.  First of all, the benefits can easily be as impressive as TRT for many men.  You can give hydrocortisone and see profoundly positive changes in some men.  They will feel better almost right away with fatigue vanishing and energy level returning, etc.  It can be a real life saver, at least in the short term, for many men out there.

I cover the classic, must read book on the subject here:  Low Dose Cortisol Replacement Therapy as covered in Safe Uses of Cortisol by Dr. Willaim Jeffries. This book will answer most of your questions about the use of small dosages of hydrocortisone to replace cortisol.  (Cortisol is actually converted to hydrocortisone in the body.)

Furthermore, proponents of this approach (when diagnosed appropriately of course) – and they include some big online names such as Drs. Crisler, Shames, Mariano, etc. – insist on only using low dose hydrocortisone.  Low dose is generally defined between 5 and 20 mg / day and is considered physiological and not supposed to result in much of a shutdown.  Some doctors will go up to about 40 mg/day  The duration of therapy is variable:  some of the doctors try to only use hydrocortisone for a few weeks, say 6-8, and others allow indefinite use.

NOTE: Dosages often start with 5 or 10 mg in the morning and then 5 mg is added after a week if no improvement is noted.  Common protocols I have seen are 10 mg in the morning and 10 in the evening or 10 – 5 – 2.5 – 2.5 mg at 6-8 hour intervals.  Again, discuss with your doctor and to read more about the subject, see Dr. Shames’ pioneering book on adrenal fatigue  Feeling Fat, Fuzzy, or Frazzled?.  (I’m not a big fan of adrenal fatigue theory, but this book is packed with helpful information.)

POTENTIAL LONG TERM ISSUES:  Dr. Scally has probably been the most vocal critic of this type of protocol and has outlined his concerns in a thread here. The thread is long – definitely worth the read sometime – and so I have summarized his concerns below::

a) Osteoporosis. One study looked at hydrocortisone given in the 20-30 mg/day range and found that “a high proportion of patients on conventional corticosteroid replacement therapy are over treated or on inappropriate replacement regimens. To reduce the long term risk of osteoporosis, corticosteroid replacement therapy should be individually assessed and over replacement avoided.” [1] Dr. Scally then quotes out of a study that is very clear that “”physicians gave a daily dose of 7.5 mg or more of prednisolone as the threshold at which one should be concerned about fracture risk, whereas more recent studies clearly indicate a substantial risk in individuals taking between 2.5 and 7.5 mg daily, a risk that was significantly higher than individuals taking a low dose (2.5 mg daily or less) for nonvertebral fracture, hip fracture or vertebral fracture.” [3]

This singificance of this is 2.5 mg and 7.5 mg of prednisolone is the equivalent of 10 and 30 mg of hydrocortisone daily and basically this review is saying, therefore, that anything over 10 mg/day puts you at an increased risk of fractures.  30 mg/day greatly (more than doubles) your risk of fracture.

b) Memory and Psychological Issues.

c) Diabetes

d) Hypertension

Again, there are studies to back up these very serious concerns.

REBUTTALS: In spite of the research that outlines very serious problems with hydrocortisone, there is literally an underground community, if you will, that have actively experimented with and implemented low dose therapies.  They feel that the concerns are grossly overstated:

a) Field Experience. The counterargument to the above is that Dr. Jeffries – the originator of the low dose hydrocortisone protocols –  developed his treatment plan for those with low cortisol and accompanying fibromyalgia, arthritis and certain other medical conditions. And, anecdotally, some in these communities have been taking low dose hydrocortisone for years supposedly without issues.  Furthermore, some doctors and big sites such as Stop the Thyroid Madness have backed this protocol.  And, if you want to read Dr. Jeffries original book that started it all, check it out here: Safe Uses of Cortisol.

Ray Peat argued forcefully, though, against some of the higher dosages in Dr. Jeffries “low dose” protocol:

“The doses they prescribe as “replacement” are much more than the adrenals would produce, so they in themselves are diabetogenic. William Jefferies told people that, since the adrenals produce 20 mg of cortisol per day, they should take 30 or 40 mg, as a replacement dose, because only half of it is absorbed. They got fat faces quickly. Using pregnenolone, they were able to taper off the cortisol in a month or two.” [11]

b) Restart.  Some men seem to be able to restart their cortisol production, ironically, with low dose hydrocortisone.  Of course, what this means is that, in this case, hydrocortisone can be used successfully only on a short term basis.  Still other men may be able to get by the regular cycling?

The bottom line is that there is little data and one probably has to rely on the input from a physician as to a proper protocol and application in order to make sure you don’t have long term issues.

NOTE: Some thyroid patients state that low cortisol patients often need a little hydrocortisone to “push” the thyroid hormones intracellularly.  From a functional medicine perspective, this is correct and appears to be backed by many anecdotal reports.  Of course, this means that some thyroid patients are likely not experiencing good success due to their low cortsiol.

2. Licorice Extract. This is another controversial solution to boost cortisol.  One reads reports of men taking licorice extract with dramatic improvements in things like fatigue and mental fog probably due to a boost in cortisol. It works by “the active metabolites in licorice extract which are glycyrrhizic acid and glycyrrhetic acid can lead to a syndrome known as apparent mineralocorticoid excess. These side effects arise from the inhibition of the enzyme 11- -HSD and subsequent increase in the activity of cortisol.” [8] Because licorice is consumed as a food and and has been used nutraceutically for peptic ulcers and Addison patients, considerable research has gone into safe levels.  There are differing views on the subject as you can see from this excerpt below:

“The main difficulty with licorice dosing lies in its availability in various forms such as candies, beverages, supplements and extracts that contain different amounts of the active components of licorice. In the United States, the manufacture of some dietary supplements, including licorice, is not closely regulated. In 1991, the European Union proposed a provisional figure of 100 mg/day as the upper limit for ingestion of glycyrrhizin (approximately the amount found in 60 70 g licorice). In April 2003, the Scientific Committee on Food confirmed an upper limit of 100 mg/day. This was based on data from human volunteer studies.” [8]

Why are researchers so concerned?  There are two primary side effects observed:  hypertension and muscle weakness.  I would add a third as well:  potentially lowered testosterone levels. [6][7] Consider the serious drop in testosterone that occurred by giving men 7 g daily of a of licorice containing 0.5 g of glycyrrhizic acid :  participants went from 740 ng/dl (day 0) to 414 ng/dl (day 4) and 484 (day 7).  Those are drops of 44% and 35%, respectively!

So, while one could argue “any port in a storm,” keep in mnd that some would label licorice an actual “endocrine disruptor” and that’s not a bad term considering the drop in T mentioned above.  This would be especially true if you are already hypogonadal.

REBUTTAL: Proponents of licorice argure that this is a widely used food, has relatively low side effects and can make a night and day difference for some people. Let me just relate one story out there that I came across on the web from a man who complained of anheonia, i.e. an inability to feel pleasure.

“Also I knew it wasn’t just the sex drive, I never got excited, I never got thrilled, I never got scared, goosebumps or heavy sweating. I used to be quite nervous and sweat alot, all this had gone. As we both know norepinephrine plays a massive part, its just about how do we get the adrenal glands working again. LICORICE ROOT ITS THE NEXT BEST THING TO A MIRACLE!!!!!!!!!! I am being 100% serious, thank God, I really thought I was stuck in a life of anhedonia, with no hope. just lay there with no feelings, no enjoyment. Just feeling very flat and cold. But now its back, sorry to be graphic but i feel like my testicles are alive again, i feel very sexual, its like when you are full of adrenaline the testes are filled with life and so is the brain. I think it has to do with adrenaline and noradrenaline. When I am nervous my heart now races once again, I can sleep easily through the night and love my sleep, I also enjoy exercising and being active. This is a gift a gift of the highest order. It is adrenaline and noradrenaline that drives our brains and our bodies.” [10]

Licorice also has some other nice properties:  it can suppress appetite and fights H. Pylori as well.  And, as with hydrocortisone, some practitioners urge tapering off one’s licorice dose in order to completely get off of it.

3.  Pregnenalone or Progesterone.  Many men want to raise cortisol more “naturally” by using one of these two hormones. The theory is this:

a) Some men have a dysfunctional cortisol production pathway due to aging, etc.

b) By taking a hormone that is farther upstream, the body can then backfill the appropriate downstream hormones based on the need

c) If the body is low in cortisol and you provide more upstream “hormonal substrate,” the body will then make sure that cortisol is replenished via a “trickle down effect

Does it really work this smoothly?  Not on your life!  Yes, it does happen, but not with any consistency or reliability from what I have seen.  As you know, theory and practice are often widely divergent.  And what few studies there are out there show the same thing.  For example, one set of authors noted that “we have previously found that pregnenolone is preferentially metabolized to allopregnanolone, rather than other compounds such as cortisol or DHEA.” [4] Counterintuivitely, allopregnenalone oftenactually lowers cortisol. [5] (Allopregnenalone is anti-anxiety, so that makes some sense.)

CONCLUSION:   You can try supplementing with pregnenalone or progesterone, and you may be one of the fortunate ones. Furthermore, both of these have other excellent properties that can really help some men in and of themselves.  See my Summary Page on Pregnenalone and Progesterone for more information. I would add, though, that I always recommend when it comes to hormones to a) test yourself first and b) work with a physician, naturopath or perhaps Life Extension Foundation.

REFERENCES:

1) Clin Endocrinol (Oxf). 1997 Mar;46(3):255-61. Glucocorticoid replacement therapy: are patients over treated and does it matter?

2) Eur J Endocrinol, 2011 Nov;165(5):761-9, “Grapefruit juice and licorice increase cortisol availability in patients with Addison’s disease”, https://www.ncbi.nlm.nih.gov/pubmed/21896619

3) Health Technol Assess, 2007 Mar, 11(7), “Glucocorticoid-induced osteoporosis: a systematic review and cost-utility analysis”

4) Biol Psychiatry, 2013 Jun 1, 73(11): 1045 1053, “Allopregnanolone Elevations Following Pregnenolone Administration are Associated with Enhanced Activation of Emotion Regulation Neurocircuits”

5) Exp Clin Psychopharmacol, 2010 Feb, 18(1): 78 86, “Effects of acute progesterone administration upon responses to acute psychosocial stress in men”

6) Endocrinologia Japonica, 1988, 35(2):333-342, “Inhibitory effect of glycyrrhetinic acid on testosterone production in rat gonads.”

7) Steroids. 2004 Oct-Nov, 69(11-12):763-6, “Licorice reduces serum testosterone in healthy women”

8) Ther Adv Endocrinol Metab, 2012 Aug, 3(4): 125 138, “Licorice abuse: time to send a warning message”

9) N Engl J Med, Oct 7 1999; 341:1158, “Reduction of Serum Testosterone in Men by Licorice”

10) https://www.dr-bob.org/babble/20101203/msgs/972934.html

11) https://www.raypeatforum.com/forum/search.php?keywords=Cortisol&t=1035&sf=msgonly

Brain Diet - Peak Testosterone

Let me start with a question:  what is more important than that grey matter between your ears?  We all know the answer to that question and that is why I am going to show you a Brain Diet that will dramatically improve your ability to learn, your memory and your congition in general. What you eat and drink (and a few lifestyle changes) can actually rebuild your brain no matter what your age.

Remember:  your brain and memory are what determines your personality, your intelligence, your ability to function in your career and relationships and even your sexuality.  And how many of you reading this want to end up like Uncle Harold, talking to himself in some home where he can’t remember what happened 30 seconds ago?  You need your brain.  You need your memory.

Here’s the good news:  cience has proven that you can actually jump start your memory, cognition and mental faculties in middle age and beyond.  In other words, even if your brain has started to go through the normal process of atrophy associated with aging, you can actually begin a program that will actually rewire your brain and even develop new synapses.  Scientists call this neurogenesis. You can even put a halt to what scientists thought, until a few years ago, was the inevitable shrinking of the brain and atrophy of your brain.

Let me put it another way:  forget all the stupid memory books and memory tricks and get on the Brain Diet.  You can improve your memory without trying to do any unnatural acts.  When you were younger, did you do weird associations or tricks to remember something?  No!  While it was not always effortless, you certainly did not have stress and strain.  You just remembered it.  Well, you can do same thing now if you will take the time to rebuild your brain. Researchers even have a name for this rebuilding of brain cells and connections: neurogenesis.  (Please read this link on Brain Killers as well.  You need to protect your precious grey matter from many dietary, environmental and life style dangers that you might not have ever thought about!)

This is incredibly important because “according to the U.S. Census Bureau, in 2020 almost 20 percent of the U.S. population will be over 65; over 12 million people will be over 85; more than 500,000 Americans will be over 100 – the fastest growing age group of all”. [37] The entire population is aging and there is no need for this to be a demographic disaster.  Peak Testosterone is all about showing you how to maintain your youthful memory, cognition, energy and fitness throughout your life – using science of course.

The important thing is to start now.  It is a fact that you can rebuild your brain through a proper Brain Diet no matter what age you are.  Please don’t wait until the plaques and tangles of Alzheimers have slowly destroyed your grey matter, especially in the memory areas of the brain, and it is too late. It is time to boost both your memory and mental abilities by following these research-proven principles:

NEWS FLASH:  There’s an old saying, “The worse it tastes, the better it is for you.”  Well, that sort of earthy cynicism just does not always play out in the health world.  A 2009 study exemplifies this best by declaring my three favorite (or darn close) foods and drinks “dementia busters.”  For me there is no better news than to hear that red wine, dark chocolate and tea are all associated with better cognitive performance. [41]

Another study of older rats that were exhibiting signs of brain aging issues showed that giving blueberry extract restored cognitive abilities and spatial memory. [35] Again, this shows actual healing being accomplished, not just protection.  Blueberries have also been shown to protect against the brain damage caused by ischemic events (loss of blood flow to the brain), stroke and free radical damage.  This is incredibly important as we age, because there are so many stressors that can damage the brain – lack of sleep, poor glucose regulation, etc. – that blueberries are an excellent insurance policy as well.

REFERENCES:

3) Jour Biol Chem, Feb18 2005,280(7):5892-901;Jour Alzheimers Dis, Sep. 10 2006,10(1)1-7;Neurobiol Aging. 2005 Dec;26 Suppl 1:133-6

4) Arch Intern Med,Nov 12 2007,167(20):2184-90

7) Amer J of Clin Nutr,Feb 2006,83(2):355-361

8) J of Nutr,Apr 2006,136:1043-1047

9) J Neurochem,Jun 2005,93(5):1157-67

10) Ann NY Acad Sci,Apr 2007,1100:470-85

11) “Mediterranean Diet and risk of Alzheimer’s disease.” Scarmeas, Nikolaos; Stern, Yaakov; Tang, Ming-Xin; Mayeux, Richard; Luchsinger, Jose.” Annals of Neurology. April 2006; Published online April 18, 2006

12) Public Health Nutrition,Oct 2005,7(7):959-963

13) Public Health Nutr,2004,7(7),959-963

15) Am J Epidem, 1997,145:498-506

19) Epidemiology,1997,145(1):33-41

21) J Am Geriatr Soc,Jun 1997,45(6):718-24

22)  Saving Your Brain, Jeff Victoroff, p. 135

23) Amer J of Clin Nutr,Sep 2005,82(3):627-635

25) JAMA,2003,289:1405-1413

29) Arch of Neurology,July 2003,60:7

30) Arch Neurol,2003;60:194-200

31) Neurology,2004,62:1573-1579

33) Drugs Aging,2003,20(10):711-721;Redox Rep,2002,7(3):171-177

35) Free Radic Biol Med, 2008 Aug 1, 45(3):295-305

37) https://www.scienceblog.com/cms/blog/7253-promise-brain-fitness-23835.html

38) J Alzheimers Dis, Dec 2005, 8(3):283-7, “Apple juice concentrate prevents oxidative damage and impaired maze performance in aged mice”

39) J Nutr Health Aging, 2004;8(2):92-7, “Apple juice prevents oxidative stress and impaired cognitive performance caused by genetic and dietary deficiencies in mice”

40) J Alzheimers Dis. 2006 Aug;9(3):287-91, “Apple juice concentrate maintains acetylcholine levels following dietary compromise”

41) Journal of Nutrition, Jan 2009, 139(1):120-127, “Intake of Flavonoid-Rich Wine, Tea, and Chocolate by Elderly Men and Women Is Associated with Better Cognitive Test Performance”

42) Am J Med, 2006 Sep, 119(9):751-9, “Fruit and vegetable juices and Alzheimer’s disease: the Kame Project”

Do You Lose Your Erection Much Too Fast? - Peak Testosterone

Most of us would define erectile dysfunction as the inability to get an erection. Nothing is more embarrassing than not being able to “rise to the occasion.”  However, the real problem for many males is actually not so much getting an erection but rather keeping it.  Consider this definition from the Cleveland Clinic for erectile dysfunction:

“The inability to develop and maintain an erection for satisfactory sexual intercourse or activity in the absence of an ejaculatory disorder such as premature ejaculation.” [1]

Many men with erection problems find that they can achieve an erection (one way or the other) but lose it rapidly.  This causes every bit the level of panic as not being able to get an erection in the first place.  It also causes complete confusion.  “How can I get an erection and then lose it so fast?”

Look at these desperate forum posts where the men involved express complete bewilderment and despair at the situation:

“I began noticing, in the last couple of years, that even with Cialis I couldn’t always maintain an erection. In the beginning I noticed that fast, vigorous sex with my 20-something wife, would sometimes have a desensitizing effect on my penis.” [2]

“For the past few years I have had difficulty maintaining Erections. It has gotten worse over the past year. I was taking mild doses of Viagra with some success and after time it did nothing. I would get hard, and then lose it.” [3]

“Every morning I get up I can get an erection no problem and actually feel horny after the certain herbs I have been taking..I do think the standing up thing helps now I can maintain the erection with no limit on time with very light stimulation. But if I leave him he will lose partially fairly quickly..not immediate tho ” [4]

“Then the next thing I noticed was ED. I was having some ‘special time’ with my lady, and I lost my erection. It was really crushing, but still I tried to forget it.” [5]

1)   https://www.clevelandclinicmeded.com/medicalpubs/ diseasemanagement/endocrinology/erectile-dysfunction/

2) https://peaktestosterone.com/forum/index.php?topic=122.0

3) https://peaktestosterone.com/forum/index.php?topic=57.0

4) https://peaktestosterone.com/forum/index.php?topic=64.0

5) https://peaktestosterone.com/forum/index.php?topic=148.0

6) https://www.webmd.com/erectile-dysfunction/guide/vascular-disease-ed

7) https://www.gyneflex.com/kegel_article.html (A reproduction of the original article by Kegel).

I could list other examples from the forum, but you get the idea:  this is a very common men’s issue.  So what causes a rapid loss of erection? Of course, there can be more than one reason, but we list some of the most common reasons below:

1. Venous Leakage. This refers to any vascular (blood vessel-related) condition that accelerates the loss of of blood from the penis during an erection. This creates a state where blood flows out of the penis as fast as it flows into the penis and is the equivalent of a boat taking on water more quickly it can be pumped out.  Venous leakage can occur due to many causes, a subject we will discuss a bit more below.  You can also read about it in my link on Venous Leakage.

NOTE: Always get check out by a doctor if you have erectile dyfunction as there are often medical conditions that underlie the condition.

2. Low Testosterone. So what is the leading cause of #1?  It is something you might not guess: low testosterone.  It turns out that testosterone is absolutely critical for the internal tissues of the penis.  When the penis loses proper testosterone levels, nerves and connective tissue literally begin to “wither” and “atrophy”. It is similar to a garden that loses its water supply.  For details on what testosterone levels typically lead to venous leakage, see my book Low Testosterone by the Numbers.

3. Loss of Morning Erections. Anything that negatively affects morning erections can the chances for venous leak.  As I outline in my link on The Basics of Morning Erections, this has to do with oxygenation.  Morning erections give a proper oxygen and nutrient supply to the internals of the penis and, without them, the penis literally begins to die off internally.

4. Smooth Muscle Issues. Smooth muscle relaxation and tone is critical for for erectile maintenance and anything effecting this musculature can potentially lead to venous leakage. [6]

5. Low Nitric Oxide Levels. Now I don’t have a study to prove this one, but anecdotally many men have noted that they lose erections quickly and, once they went on Viagra or Cialis (the classic PDE5 Inhibitors), the problem of losing their erections seemed to disappear.  This definitely does not really fit in with definition of venous leakage or classic erection loss issues, but it does seem to work in some cases.  In this case, efforts to improve endothelial function and restore more youthful nitric levels, something I dissuss at length on this site – see here – should help greatly.

Loss of Erection Solutions

1.  Increasing Baseline Testosterone Levels.  As mentioned above, the inside of your penis literally “rots” without enough testosterone.  And so one strategy that may help many men that lose their erections too quickly is to simply raise baseline testosterone levels up to allow for self-healing. There are many lifestyle factors that I outline on my site, such as Sleep, Losing Weight Too Fast, Being Overweight, Depression, that, if corrected, can potentially lead to significant increases in baseline testosterone.  Still other men will likely end up on Hormone Replacement Therapy or Clomid to raise their testosterone.  (Talk to your doctor for advice on the latter of course.)

But the important thing to note is that a number of studies have shown that increasing testosterone (significantly) will lead to greatly improved venous leakage.  Increasing testosterone will also boost nitric oxide levels and help with many other male health-related issues.

2.  Increasing Morning Erections. There are many things that you can do to increase the number and hardness factor of your morning erections. Many great examples of things that can increase your morning erection counts are give on the Peak Testosterone Forum, including HRT of course.

3. Kegels. One thing that can really help some men are “doing Kegels.” These exercises, often associated with female urinary incontinence, can actually really help men by restoring smooth muscle tone to the all-important pelvic floor muscles. [7]See my link on Kegel Exercise for Men for more details.

4.  Urological Visit for Venous Leakage.  Venous leakage is the realm of urologists and is usually diagnosed by the same.  There can be somewhat uncommon causes of venous leakage, such as Peyronie’s Disease, that a urologist can help identify.  Peyronie’s Disease is scar tissue, or a kind of plaque, along the spongy “storage containers” (corpus cavernosum) within the penis. This scarring can make it where the penis can no longer traps blood as efficiently.  But the important point is that one should get checked out by a doctor if you are experiencing an unusually rapid loss of erections.

Again, I would highly recomment discussing your situation with your urologist, as this is their “bread and butter”. Again, there can be a variety of reasons that one can lose an erection quickly and a urologist can do the real testing that needs to occur.  Furthermore, he can directly test for venous leakage using certain standard procedures, which were outline rather humorously by one of the Peak Testosterone Forum posters here.

REFERENCES:

Testosterone and HDL: Does HRT Raise or Lower It?

Well, one concern with HRT (or TRT as some prefer) is that it could lower HDL levels.  HDL is the “good cholesterol” that is responsible for cleaning up the “bad cholesterol” in your arteries.  It does this via a mechanism called RCT, or Reverse Cholesterol Transport.  RCT is a process – and HDL is the main player – that removes cholesterol from “foam cells” and then transports it to the liver for elimination.  Most of the plaque reversing gurus like to see respectable HDL levels and you can see my link on HDL, LDL and Triglyceride Levels To Reverse Atherosclerosis for their actual thresholds.  (Low HDL levels are also associated with a “pattern B,” pro-atherosclerotic lipid patterns.)

Although a surprisingly complex subject, clearly HDL is an important facet of arterial protection, including your penile ones.  So let’s start with a older study on Seventh Day Adventists and Mormons, who were chosen because of their avoidance of alcohol and cigarettes, that found that “testosterone has a strong negative association with HDL-C in men.” [1] In other words, the higher the testosterone levels in these men, the lower their HDL levels.

Other observations and research have shown similar results, i.e. cases where increased testosterone has led to lower HDL:

a) Men on steroids have significantly lowered HDL.  Yet another reason not to do steroids, eh?

b) Men taking the “old school” oral testosterones lead to lower HDL per one study. [6]

1. Oral Testosterone Undecanoate (Used in Andriol).  This type of oral testosterone is different that the one mentioned above, because it effectively bypasses the liver.  And one study showed that 120 mg/day led to no signficant decrease in HDL. Furthermore, the authors concluded, since the testosterone also lowered LDL and triglycerides, that “we conclude that TU [testosterone undecanoate] may be an effective drug for protecting coronary heart disease in healthy elderly men with lowered TT [total testosterone] and FT [free testosterone] levels.” [7]

2. Injected Testosterone Undecanoate (Used in Nebido / Aveed). One study noted that this resulted in a significantly improved total cholesterol/HDL ratio, which should, the authors noted, improve CVD risk.

3. HCG Monotherapy or HRT. Researchers gave hypogonadal men – non-Klinefelter (HCG), Klinefelter (HRT) – testosterone-raising treatments based on their underlying status concluded that “triglyceride, LpA-I:A-II, Lp(a), HDL cholesterol, HDL3 cholesterol, and apolipoprotein (apo) A-I concentrations did not change significantly after treatment.” [9]

4. Androgel. A study using 1% Androgel likewise showed no increases in HDL nor HDL’s “efflux capacity,” i.e. it’s ability to help macrophages get rid of their cholesterol. [10]

Just as important, I would argue that most men will have to self-monitor.  Get an HDL (and other basic lipids) read before HRT and then afterwards and see if your HDL has changed.  The studies deal with averages and you may be one of the unlucky ones that has their HDL lowered by HRT – who knows?  For example, keep in mind the relationship of blood pressure to testosterone.  Most studies that I have seen show a drop in blood pressure with HRT.  However, some men have the side effect of elevated blood pressure and even have to go off of testosterone because of it.  So there is no one-size-fits-all when it comes to HRT.

You may be thinking that your doctor is very unlikely to test this before or after unless you are covered via a physical or annual wellness check.  I would agree with you.

The good news is that, at least here in the U.S., you can pull your lipid numbers very easily without a doctors orders in most states.  (Thank God for freedom, eh?)  I have a list of labs that Peak Testosterone Forum members have used. See my page Testosterone Labs for more information.

1)  Metabolism, 1983 May, 32(5):428-32, “Relationship of plasma HDL-cholesterol to testosterone, estradiol, and sex-hormone-binding globulin levels in men and women”

2) JCEM, Published Online: July 01, 2013, “Physiological levels of estradiol stimulate plasma high density lipoprotein2 cholesterol levels in normal men”

3)  Arteriosclerosis, Thrombosis, and Vascular Biology, 2004, 24: 1741-1742, “Estrogen and HDL: All that Glitters Is not Gold”

4) JAMA, 2009 May 13, 301(18):1892-901, “Circulating estradiol and mortality in men with systolic chronic heart failure”

5) J Clin Invest, May 15 2003, 111(10):1579 1587, “HDL-associated estradiol stimulates endothelial NO synthase and vasodilation in an SR-BI dependent manner”

6) Medscape, Clin Lipidology, 2012;7(4):363-365, Katya B Rubinow, Stephanie T Page, “Testosterone, HDL and Cardiovascular Risk in Men: The Jury Is Still Out”

7) Jpn Heart J, 1997 Jan, 38(1):73-82, “Beneficial effects of testosterone undecanoate on the lipoprotein profiles in healthy elderly men. A placebo controlled study.”

8) International Journal of Endocrinology, 2014, “Effects of Five-Year Treatment with Testosterone Undecanoate on Metabolic and Hormonal Parameters in Ageing Men with Metabolic Syndrome”

9)  J Clin Endocrinol Metab, 1996 Sep, 81(9):3372-8, “Effects of gonadotropin and testosterone treatments on Lipoprotein(a), high density lipoprotein particles, and other lipoprotein levels in male hypogonadism”

10) J Lipid Res, Jul 2012; 53(7): 1376 1383, “Testosterone replacement in hypogonadal men alters the HDL proteome but not HDL cholesterol efflux capacity”

Erectile Dysfunction and Inflammation - Peaktestosterone

What does inflammation have to do with erectile dysfunction?  Possibly everything according to some experts. Probably the most foundational aspect of an erection is endothelial health and, it turns out, endothelial health has everything to do with inflammation (or the lack thereof).  In fact, one study found that ALL of the following inflammmatory markers were associated with erectile dysfunction: [1]

This list could continue, but the important point is that inflammation hammers the endothelium, the lining of your afteries and blood vessels, which then hammers your erections. This has caused some researcher to believe that inflammation is the true root of most erectile dysfunction. [2]

There are other indictions that this could be the case.  infections with Chlamydia pneumoniae or cytomegalovirus have been associated with erectile dysfunction as indicated by increased inflammatory markers. [3] The same has held true for gum disease as well. [4]

So how does chronic inflammation affect the endothelium in such a negative manner? First of all, it lowers nitric oxide availablity.  This has been observed in several populations, one of the most notable being apnea sufferers, who have elevated inflammation for chronic sleep interruptions. [5]  One of the ways inflammation controls nitric oxide is by affecting eNOS, the stuff of Viagra. [6] Yes, inflammation is the ultimate anti-Viagra in this sense.

Affecting NOS negatively is potentially dangerous in the long term as well, because nitric oxide decreases the damage done to arterial walls.  So as chronic inflammation turns off your nitric oxide, additional damage occurs to the endothelium, which in turn leads to decreased nitric oxide and so on.

The bottom line:  to avoid erectile dysfunction, you have to get this Enemy #1 in control.  Remember, this will also decrease your cancer and cardiovascular risks as well. Read my links on How to Decrease Inflammation and Juicing and Inflammation for starters.

REFERENCES:

1) European Heart Journal (2006) 27, 2640–2648, “Unfavourable endothelial and in?ammatory state in erectile dysfunction patients with or without coronary artery disease”

2) Eur Heart J, 2007, “Is erectile dysfunction a low-grade systemic inflammatory condition?”

3) Eur J Clin Invest, 2006 Jul, 36(7):497-502, “Infection induced inflammation is associated with erectile dysfunction in men with diabetes”

4) https://www.foxnews.com/health/2011/06/28/bad-gums-linked-to-erectile-dysfunction/

5) Circulation, 2008, 117: 2270-2278, “Inflammation, Oxidative Stress, and Repair Capacity of the Vascular Endothelium in Obstructive Sleep Apnea”

6) ENDOTHELIAL DYSFUNCTION AND INFLAMMATION, Progress in Inflammation Research, 2010, 65-80, “Post-translational regulation of eNOS activity in inflammation”

Dairy and Calcium: Overconsumption Dangers.

Calcium is an incredibly important element in the human body.  Virtually everyone knows that our bone composition and health is dependent on calcium, but few realize that calcium acts as an “electronic switch” for our neurons and is critically important to the brain.

Furthermore, Vitamin D and calcium (and therefore dairy) have been shown (at least in women) to help the body shed fat metabolically and the protein helps build and maintain muscle as well. [1] The females in this study lost about 4 pounds of fat and simultaneously gained 4 pounds of muscle, a nice exchange to say the least.

4.  Inflammation. Casein is also a known promoter of inflammation in many cases and it is even used in animal studies to do the same. [2]  Another interesting example is how small amounts of dark chocolate have been found to lower inflammation levels but additional amounts yield no net benefit.  The reason?  It is likely the casein in the chocolate overcoming cacao’s excellent benefits.  (See my link on The Benefits of Dark Chocolate for more information.)

So, again, moderation is the key when it comes to calcium.  I personally try not to consume more than 1-2 times the RDA for calcium.  As far as milk and dairy, I avoid them.  I will occasionally consume nonfat milk for a protein boost, but keep it to one serving only.

REFERENCES:

1) Medicine & Science in Sports & Exercise, Jun 2010, 42(6):1122-1130, “Body Composition and Strength Changes in Women with Milk and Resistance Exercise”

2)  Mediators Inflamm, 2004 Feb, 13(1): 33 37, “Analysis of leukocyte rolling and migration–using inhibitors in the undisturbed microcirculation of the rat mesentery–on inflammatory stimulation”

3) Journal of Periodontology, Jul 2000, 71(7):1057-1066, “Calcium and the Risk For Periodontal Disease”

4) Journal of the National Cancer Institute, 1987, 78(2):365-369, “Relative contribution of dietary protein level and aflatoxin B1 dose in generation of presumptive preneoplastic foci in rat liver”

5) J Nutr, 1987 Jul, 117(7):1298-302, “Dietary protein level and aflatoxin B1-induced preneoplastic hepatic lesions in the rat”

Calcium is used in so many chemical processes in the body that it would impossible to go into them all, but it does, for example, help with periodontal (gum) disease [3] and I have mentioned elsewhere, in my link on High Blood Pressure and Erections, how it forms a trinity of elements with sodium and potassium to help avoid hypertension.

All of that said, it is definitely possible for men to have “too much of a good thing” and calcium is no exception.  Both calcium and dairy can easily lead to very dangerous situations for males, including cancers, and so a few cautions are in order:

1.  Prostate Cancer and Calcium.  My Prostate Cancer link covers the study that shows that overly high calcium intakes can put males at greater risk for prostate cancer.

2.  Generalized Cancer Promotion.  Casein, the chief protein in milk and dairy is a known increaser of IGF-1. Many bodybuilders are IGF-1 enthusiasts, because it can add in hypertrophy (muscle building). However, IGF-1 is controversial at best because much research shows that in the right conditions it can promote cancer, especially as we age.  I cover this in detail in my link on IGF-1.

3.  Liver Cancer.  Many people have heard about the bestselling book The China Study and the work of T. Colin Campbell. What is not as well known is that his initial claim to fame in the research labs was examining the remarkable ability of casein to promote liver cancer under certain conditions in laboratory animals. If casein was high enough in the diet, liver cancer rates were dramatically increased. [4][5] Again, if you get enough dairy in your diet, there is good evidence it could make you vulnerable to this nasty cancer.

Protein Dangers - Peak Testosterone

Most guys are suprised there are very negative aspects of animal protein.  How could this be when you have so many diets such as Atkins, South Beach, Low Carb and so on that are based on an abundance of meat and dairy?  Furthermore, haven’t humans been eating meat since the dawn of antiquity?

I can only tell you this:  animal protein has some very positive AND some very negative qualities. It is almost always a mistake to ignore or hide the research and such is the case with animal protein.  I eat between a half dozen and a dozen egg whites every day, but I know there are potential issues there.

Consider these problems with animal protein that the research has uncovered:

1.  Lower Testosterone. There are a couple of studies that show higher protein levels mean lower testosterone.  For example, one study of seven healthy men found that those with higher protein levels had 26% lower testosterone levels. [1]  The key according to this study was the protein to carbohydrate ratio.  (Fat and calories were held constant.)  For more information, read my link on Testosterone and Diet.

REFERENCES:

1) Life Sci, 1987 May 4, 40(18):1761-8, “Diet-hormone interactions: protein/carbohydrate ratio alters reciprocally the plasma levels of testosterone and cortisol and their respective binding globulins in man”

2) Am J Clin Nutr, 2003, 78:584S-592, “Bone mineral content of North Alaskan Eskimos”

3) Acta Medica Scandinavica, Jan/Dec 1983, 214(2):99 101, “Serum Calcium in Greenland Eskimos”

4) J Gerontol A Biol Sci Med Sci, 2010, “Protein Intake, Weight Loss, and Bone Mineral Density in Postmenopausal Women”

5) J Amer Dietetic Assoc, 2007, 107:1404-1408

6) American Journal of Clinical Nutrition, Sep 2005, 82(3):%53-558, “A high-protein diet increases postprandial but not fasting plasma total homocysteine concentrations: a dietary controlled, crossover trial in healthy volunteers”

7) N Engl J Med 2004; 350:1093-1103, “Purine-Rich Foods, Dairy and Protein Intake, and the Risk of Gout in Men”

8) Angiology, 2000 Oct, 51(10):817-26, “The effect of high-protein diets on coronary blood flow”

2. Cortisol. This same study found that high protein meant higher cortisol as well. [1]  Of course, this is a very undesireable situation – lower testosterone and higher cortisol – since lower testosterone is assiated with diabetes and heart disease and higher cortisol with neuron damage, muscle loss, visceral fat deposition (“beer gut”) and many other nasty anti-male qualities.  Read my link on Cortisol and Stress for more details.

3.  Bone Loss. There is some evidence that higher protein diets can lead to bone thinning and eventually osteoporosis (in some cases).  For example, in many of the supercultures that eat little dairy and almost no meat, osteoporosis is much less common.  According to conventional medical wisdom, these third world cultures should be rife with osteoporosis and hip fractures due to low calcium levels, but, in fact, the opposite is true.  Furthermore, several studies on the Eskimos have shown that they have accelerated bone loss and one of the key features of their diet is high animal protein. [2] One reason that experts speculate may be behind this phenomenon is that protein adds a tiny acidic load on the blood stream and the body, to compensate, pulls calcium from the bones to neutralize it. However, in fairness, the Eskimos have a low calcium diet and so that could play a role as well. [3]  NOTE: This has also been shown to be an issue for post-menopausal women, so you might want to tell your woman if it applies. [4]  Interestingly enough, significant bone loss was experienced for women consuming high levels of beef, chicken and vegetarian protein.

4.  IGF-1.  Many studies have shown that casein, the primary milk protein, increases IGF-1 and inflammation.  This is something I discuss in more detail in my link on The Pros and Cons of IGF-1, but suffice it to say this likely increases your risk of cancer and other problems.

5.  Homocysteine. Protein has been shown in several studes to raise homocysteine levels, a significant risk factor for heart disease.  For example, one study of healthy pre-middle-aged males found that a higher protein diet (21% of calories) lead to elevated homocysteine levels when compared to a lower protein diet. [6] There is some evidence that exercise can lower homocysteine levels, but clearly this is a potential risk.

6.  Decreased Immunity. Amino acids have powerful effects on the body, including our immune systems. One surprising property of protein, that most bodybuilders and athletes do not realize, is that the research shows that in many cases it can negatively effect our ability to fend off infections, parasites and autoimmune disorders. This is a big subject, which I cover in my link on Protein and Immunity.

7.  Gout and Urate Kidney Stones. Increased uric acid levels are an outgrowth of eating purine-rich foods such as red meat and sea food. One 12-year study of men found a 50% increase in gout from eating these high-protein foods. [7] High protein diets are also associated with an increased risk of the less common urate kidney stones.  However, high uric levels may increase formation of the much more common oxalate kidney stones.  Both gout and kidney stones are very painful conditions. Keep in mind that the erection-killing Metabolic Syndrome and insulin resistance are also associated strongly with elevated uric acid levels putting many modern, urban dwellers at risk for these issues.

8. Increased Systemic Inflammation. Researchers found that a high protein diet increased the inflammatory markers of “fibrinogen, Lp (a), and C-RP increased by an average of 14%, 106%, and 61% respectively.” [8] And we all know that elevated inflammation is the root of all evil, a root cause of heart disease, erectile dysfunction, autoimmune disease and cancer.

9. Lower DHT. DHT is important to libido and other functions of male health, so it is of some concern that researchers found that increasing the protein/carbohydrate ratio lowered DHT levels.  For more information, see my page on How To Increase DHT Naturally.

MYTH:  Higher protein diets have not been shown to affect kidney function. [5]

So why do I consume a lot of animal protein in the form of egg whites? Well, egg whites have no Saturated Fat, so I avoid all the problems associated with saturated fat consumption.  (See my page on The Potential Dangers of Saturated Fat for more information. Furthermore, egg whites are part of the Ornish Diet, which has a strong research track record.  (Well, maybe not as many as I consume!)

Finally, I lift weights and megadose on Vitamin C. These two things can potentially – and I emphasize potentially – protect me from 1-3 above.  Lifting weight has been shown in several studies to raise baseline testosterone and, of course, any weight bearing exercise is strongly protective of bone tissue.  Finally, megadosing on Vitamin C has been shown to lower cortisol and so I am counting on this to compensate.

Death (Mortality) Rates and Testosterone - Peak Testosterone

Eat your broccoli? Exercise like a wildman? Well, those are good, but one of the less obvious ways is the most important: avoid low testosterone like the plague. Yes, low testosterone can, quite literally, be the kiss of death for many men.

Think I’m exaggerating?  Well, one clear fact from the research about low testosterone is this: what you don t know could kill you. Several studies are clear that if your T gets low enough, you are taking your chances. Let’s look at some of research that demonstrates this by looking at what are called mortality, or death rates:

1.  Hypogonadal Seniors. One study found that hypogonadal senior men with total testosterone less than 250 ng/dl (8.5 nmol/l) were 33% more likely to die from all causes regardless of body weight and other traditional risk factors. [1] The reason for this? Most of the increased mortality comes from heart-related deaths. Low testosterone is a cardiovascular disaster, something that will be outlined below in more detail.

3.  Low Testosterone AND Low Estradiol. It should be pointed that other research has pointed to even more dire results. One 2009 study found that when men with low testosterone also had low estradiol, they were twice as likely to die from all causes, a very steep risk factor by any standards. [3] The reason for this all-cause drop in mortality is primarily due to an increase in cardiovascular deaths. As you ll see below, low T raises almost every major cardiovascular and arterial risk.

Now with the above studies one can’t help but ask the question, “Why are so many doctors reluctant to prescribe HRT to men with low testosterone?  As you can see from #2 above, men appear to have greatly increased mortality rates at even 354 ng/dl.  How can a physician feel good about leaving a man hypogonadal when he knows it may put him at risk?

Well, that’s a big subject and one I’m not sure I still understand.  I guess the fear is that there is some inherent risk that will be discovered with testosterone therapy.  Perhaps it will affect some risk factor negatively that we have not yet noticed. Or may, for example, some of the testosterone methodologies raise estradiol levels too much.  Who knows?

But consider the alternative:  leaving a man in a state of low testosterone makes him 2.7 times as likely to develop type II diabetes.  What be worse than this?  The elevated insulin levels and increase insulin resistance from being low testosterone are scary to say the least.

So let’s ask another question:  “Why are testosterone and death so strongly associated?”  So far researchers have not found a big link between low testosterone and cancer, although it is possible something will be found in the future.  However, a big connection has been found between cardiovascular disease and researchers have little doubt as to causality.  The reason is that low testosterone has been shown to be so clearly linked with many heart disease-promoting conditions:

1.  Diabetes.  See my link on Testosterone and Diabetes.

2.  Elevated Insulin and Insulin Resistance.  See my link on Testosterone and Insulin.

4.  Osteoporosis. Low testosterone men surprisingly often suffer from bone-related issues, bone loss, osteopenia and osteoporosis.  See my link on Testosterone, Bone Loss and Osteoporosis.

5.  Depression.  Low testosterone men are at a greater risk for depression and anxiety.  See my link on Testosterone and Depression.

Did you know you can inexpensively do your own testing for most hormones? The industry leader is Discounted Labs..

6.  Arteriosclerosis and Hardening of the Arteries. This is just one of the many reasons that low testosterone is so hard on the cardiovascular system:  it stiffens the ol’ arteries.

7.  Nitric Oxide and Blood Pressure. Testosterone improves the activity of NOS, the very enzyme that Viagra and Cialis work on, and can exert (along with #2 and #6) a small but significant drop in blood pressure. See my link on Testosterone and Blood Pressure.

Testosterone Therapy (TRT) versus Anti-Androgen Therapy and Mortality

Some of you may be thinking that the only missing piece at this point are studies that show that testosterone therapy (TRT) decreases actual death rates.  If low testosterone is really as bad as the above indicates, then one should be able to give hypogonadal men testosterone and see their longevity increase and death rates decrease, right?  It turns out that this has been done just recently and the best study to date is quite optimistic:

8. 40+ Year Old Veterans. Middle-aged and senior veterans on TRT were compared with those who are not and the researchers found that those on testosterone had lowered mortality rates.  Of course, the authors cautioned that larger sample sizes and followup studies were needed.  While that is always true, the results were so overwhelming that I am sure everyone took notice.  The authors wrote that “a mortality rate of 3.4 deaths per 100 person-years for testosterone-treated men” as compared with 5.7 deaths per 100 person-years in men not treated with testosterone.” [4]  This is approaching double the mortality rate! [4]

9. Prostate Cancer Patients. So, if giving low T men testosterone improves mortality rates, then wouldn’t we expect the opposite to happen in men that were given anti-androgen therapy?  (Testosterone is sometimes lowered via GnRH therapy or orchiectomy, but the effect is the same.)  This is exactly what is (usually) seen in men with prostate cancer and a number of studies show an increase in cardiovascular mortality of 15-20%. [5]

1) [Endocrine Society 2007 Annual Meeting, Abstract 55-2, “Androgen Deficiency and All-Cause Mortality in Older Men: The Rancho Bernardo Study”, https://www.medpagetoday.com/sso-token.php?redirecturl=%2fendocrinology%2fgeneralendocrinology%2f5861&rfr=https%3a%2f%2fwww.peaktestosterone.com

2) Circulation. 2007; 116:2694-2701, “Endogenous Testosterone and Mortality Due to All Causes, Cardiovascular Disease, and Cancer in Men”

3) J Clin Endocrinol Metab. 2009 Jul;94(7):2482-8. Epub 2009 Apr 28, “Low Serum Testosterone and Estradiol Predict Mortality in Elderly Men”

4) J Clin Endocrinol Metab, 2012 Jun, 97(6):2050-8, “Testosterone treatment and mortality in men with low testosterone levels”

5) Circulation, 2010 Feb 16, “Androgen-Deprivation Therapy in Prostate Cancer and Cardiovascular Risk”

- Peak Testosteronehttps://www.peaktestosterone.com/

Could sugar in your diet lead to erectile dysfunction?  That hasn’t been proven yet, but it’s inevitable and here’s why:

Scientists have discovered a new risk factor for heart disease:  sugar consumption. We’re all familiar with other cardiovascular risk factors that include saturated fat/cholesterol, low HDL, triglycerides and so on and, as I have shown, the Penis and the Heart are intimately linked. If you injure the lining of your arteries and coat it with calcifying plaque, you can expect your erectile strength to go down accordingly.  The arteries that supply blood to the penis and the veins within the penis are some of the first to be noticably affected.

This means that, for the sake of your sex life (and life in general), you need to be working on all cardiovascular risk factors and that now includes sugar consumption.  One recent study of Americans found that sugar was correlated with higher triglycerides and lower HDL levels.  Researchers grouped participants into five groups based on the amount of sugar consumed and found that, for men, the more the sugar, the worse the lipid profile. [1]  And researchers almost always find out that anything that negatively impacts your lipid profile will lead to erectile dysfunction and impotence.

The researchers found that the average person takes in 16% of their calories in the form of simple sugars.  For the typical guy, this means around 400 of his calories come from sugar, i.e. 100 grams.  This is enough, according to the study, to elevate our lipid profiles negatively and increase risk of heart disease.

1) JAMA. 2010, 303(15):1490-1497., “Caloric Sweetener Consumption and Dyslipidemia Among US Adults”

2) The Journal of Biological Chemistry, May 23, 2003 , 278:18791-18797, “High Glucose Inhibits Insulin-stimulated Nitric Oxide Production without Reducing Endothelial Nitric-oxide Synthase Ser1177 Phosphorylation in Human Aortic Endothelial Cells”

3) Nephron Exp Nephrol, 2003, 95(2):e62-8, “Effect of high glucose on nitric oxide production and endothelial nitric oxide synthase protein expression in human glomerular endothelial cells”

4) Am J Physiol Endocrinol Metab, 2001, 280: E171-E178, “Impairment of endothelial nitric oxide production by acute glucose overload”

Of course, part of the reason sugar is so hard on the heart is that half of standard table sugar is fructose and you can read more about the Negative Effects of Fructose on Heart and Erections elsewhere on my site. However, glucose, the other half of table sugar, is nearly as evil.  Glucose will, of course, raise blood glucose levels and, if high enough, elevated blood glucose levels will lower endothelial nitric oxide in various tissues throughout the body, including your blood vessels. [2] [3] And decreased nitric oxide means higher blood pressure and less blood flow for your erections.

Sugar also has long term effects as well:  it gives you a nearly instant high from endorphin production and thus stimulates you to eat more and more often than you should.  That and the extra calories will help you to put on weight and those extra pounds are correlated with lower testosterone and increased erectile dysfunction.

So long term or short term, sugar is going to be bad for your sex life.

REFERENCES:

NSAIDs, Advil, Motrin: Causes of Erectile Dysfunction - Peak Testosterone

NSAIDs, such as Advil, Motrin, Naprosyn, Aleve and ibuprofen, are taken like candy in America and much of the rest of the world as well.  Yet few people realize how incredibly dangerous these drugs can be.  It is no exaggeration to say that they are dangerous and can kill both you and your sex life.

What is particularly tragic about NSAIDs is that they are so universally accepted in our (American at least) society.  Every supermarket and drugstore has almost an entire shelf filled with different preparations of these drugs.  How could something be bad that is common, right?

Furthermore, it is well-known that many athletes take NSAIDs as if they were vitamins to supposedly help with healing, soreness and recovery.  In fact, NBA players Alonzo Mourning and Sean Eliot, are even mentioned in one Medscape article [1], because they suffered the beginnings of renal failure due to their significant NSAID consumption during the season. The damage was so severe that they required a kidney replacement.  (NOTE:  Athletes should also read the above Medscape article for information regarding how NSAIDs are known for actually slowing recovery and other athletes that have suffered damage.)

REFERENCES:1) https://www.medscape.com/viewarticle/553966_3, “Natural Antiinflammatory Agents for Pain Relief in Athletes: Lesser-Known Side Effects of NSAIDs”

2) The Journal of Urology, May 2006, 175(5):1812-1816, “Effect of Non steroidal Anti-Inflammatory Drug Use on the incidence of Erectile Dysfunction”

3) Stroke, Submitted on March 29, 2010, Accepted on May 8, 2010, “Increased Risk of Stroke Associated With Nonsteroidal Anti-Inflammatory Drugs. A Nationwide Case Crossover Study”

4) Clinical Gastroenterology, Feb 2000, 14(1):147-159, “How do NSAIDs cause ulcer disease?”

5) https://well.blogs.nytimes.com/2013/06/17/the-heart-perils-of-pain-relievers/

6) https://umm.edu/health/medical/altmed/supplement/vitamin-c-ascorbic-acid

7) https://www.uptodate.com/contents/nsaids-acute-kidney-injury-acute-renal-failure

8) https://blog.itriagehealth.com/nsaids-daily-affect-kidneys-2/

9) https://www.nursingtimes.net/mhra-warns-that-nsaids-can-cause-severe-renal-damage-in-patients-at-increased-risk/5002657.article

1.  Erectile Dysfunction. One 2006 study found that men using NSAIDs had almost double the rate of erectile dysfunction compared to those who were not. [2] Erectile dysfunction is a common side effect of these drugs and you should warn your woman as well:  they can affect her libido and sexual function just as much.

2.  Stroke.  Stroke has long been suspected as a possible side effect of NSAID use and a recent Taiwanese study verified this forcefully.  They studied all the common NSAIDs and found that almost all of them increased the risk of stroke by 20-90 percent. [3]  One NSAID was even found to more than double the risk!  And, by the way, NSAIDs increased the risk both for the common kind of stroke, ischemic, that destroys a part of the brain and can leave one partially paralyzed, and the less common kind, hemmorhagic, which results in nasty bleeding on the brain.  The latter can even result in an excruciating aneurysm.

4. Heart Attack. One recent study found that NSAIDs increased the risk of heart attack by 33%! This comes, by the way, from a monstrous analysis of many studies.  Commentators have noted that there really are not safe long term pain medications.  (Naproxen may actually be heart attack helpful, but it is the one exception.  Discuss with your doctor.)

5. Reduction in Vitamin C Levels. If #1-4 aren’t enough, then keep in mind that NSAIDs also lower Vitamin C levels and taking Vitamin C can casue the levels of the NSAID to increase. This University of Maryland Medical Center discussion explains why:

“Both aspirin and NSAIDs can lower the amount of vitamin C in the body because they cause more of the vitamin to be lost in urine. In addition, high doses of vitamin C can cause more of these drugs to stay in the body, raising the levels in your blood…If you regularly take aspirin or NSAIDs, talk to your doctor before taking more than the recommended daily allowance of vitamin C.” [6]

6. Kidney Damage and Failure. Originally, it was thought that NSAIDs were only hard on patients with existing kidney disease.  However, some subsequent research has cast doubts on the original optimism.  For example, some of the older esimates were that it would take a very large amount of NSAID usage over many years to cause overt kidney damage.  For example, check out this calculation:

“It is estimated that ingesting 10 kilograms of NSAIDs over a lifetime can cause direct kidney damage. Hence, if you take five Advil per day (5 x 200 milligram = 1 gram), for 10,000 days (about 27 years), then you have enough in your system to do kidney damage.” [8]

However, the above seem like a wildly optimistic assessment when you consider that between 1% and 5% of all NSAID users are estimated to have a renal event! [7] Why are these so nasty and hard on the kidneys? After all, isn’t limiting inflammation always good? The answer is that NSAIDs produce a very unnatural combination:  they simultaneously lower inflammation AND vasodilation.  The capillaries in the kidneys are very sensitive to anything that limits their ability to relax and allow more blood flow. NSAIDs sabotage that process.

And I will put a shameless plug in here for plant foods, so many of which have BOTH anti-inflammatories and vasodilators.

CONCLUSIONS: a) The cure can be worse that the disease.  b) It is very, very, very difficult to make a synthetic drug that does not cause more problems than it solves

Testosterone: A Powerful Anti-Inflammatory - Peaktestosterone

As it turns out, one of the key ways that testosterone protects us men is by “modulating inflammation”, i.e. keeping inflammation in check. Runaway inflammation is the curse of modern living (from poor diet and excess calories and body fat primarily) and is a root cause for heart disease, cancer and autoimmune diseases.  So low testosterone is a big deal as inflammation ages and damages tissues in many ways as the decades roll by and we will show examples of this below.

In addition, it should be noted that excessive inflammation can also affect Leydig cell function and reduce testosterone. One study states that “There is evidence from many experimental studies that IL-6, TNF-alpha and IL-1beta inhibit T secretion by their influence on the central (hypothalamic-pituitary) and peripheral (testicular) components of the gonadal axis.”  IL-6, TNF-alpha and IL-1 are molecules called cytokines that control inflammation levels in your body and they are all-important.

1. Adiponectin. Adiponectin is not an inflammatory cytokine like all the other markers I will discuss on this page.  However, I put it first, because it affects inflammation and is SO important, although the relationship is complex. But here is the key takeaway:  as a man loses insulin sensitivity (usually through weight gain and other aspects of a modern lifestyle), adiponectin levels will begin to drop and testosterone administration raises adiponectin levels. [2][3]

2.  Phospholipase D.  In 2011, scientists discovered one of the major reasons that testosterone may keep inflammation at bay.  It turns out that your T actually slows down the activity of an enzyme related to inflammation called Phospholipase D. [4]

4. TNF Alpha.  The most infamous of the inflammatory cytokines is undoubtedly TNF alpha as it has been singled out to be the root cause for so many nasty medical conditions including cardiovascular disease. See my page on Natural TNF Alpha Inhibitors for some additional information. And testosterone therapy has been found to lower TNF alpha levels in an animal study on rats following heart failure. [9]

Did you know you can inexpensively do your own testing for most hormones? The industry leader is Discounted Labs..

5. IL-6. Although this is not uniform, some studies show that testosterone administration will actually decrease IL-6. [7] IL-6 is associated with many conditions, including diabetes, certain cancers, Alzheimer’s and arterial plaque, etc.

6.  CRP (C-Reactive Protein). Most middle-aged and senior men reading this page will have prediabetes, Metabolic Syndrome or full-fledge type II diabetes.  For men suffering from these maladies relating to loss of insulin and blood sugar control, low testosterone had been found to correlate with higher CRP levels. [1] If testosterone actually causes this state of affairs, this is very bad indeed.  C-Reactive protein is now a common test given by doctors to measure systemic inflammation and it is very correlated to the risk for heart disease, Alzheimer’s, and many other medical conditions.

NOTE: The above study found that testosterone therapy did not actually lower CRP values, so low testosterone may not cause low CRP. When you see all the other ways below that testosterone negatively impacta inflammation, one cannot help but be skeptical however.

Now the short term data, which I outlined above, clearly shows that low testosterone affects some of the pro-inflammatory molecules in the body negatively and that testosterone therapy can help significantly.  However, keep in mind that the long term picture is much more negative.  The reason?  Low testosterone promotes several medical conditions that are known to be pro-inflammatory.

For example, one research summary wrote:

“We suggest that androgen deficiency is associated with IR [insulin resistance], T2D [type II diabetes], Met-S [Metabolic Syndrome], and with increased deposition of visceral fat, which serves as an endocrine organ, producing inflammatory cytokines and thus promoting endothelial dysfunction and vascular disease.” [8] Basically, low testosterone generally ages a man and puts his body in a pro-inflammatory state that is very difficult to escape from.[9]

Other researchers have made the same observation, nothing that testosterone seems to have a protective effect on your Beta cells (that make insulin) through controlling these inflammatory messengers. [10]

1)   Eur J Endocrinol, 2007 May, 156(5):595-602, “The effect of testosterone replacement therapy on adipocytokines and C-reactive protein in hypogonadal men with type 2 diabetes”

2) Obes Rev, 2005 Feb, 6(1):13-21, “Adiponectin: action, regulation and association to insulin sensitivity”

3) Journal of Andrology, January/February 2005, 26(1), “Testosterone Administration Suppresses Adiponectin Levels in Men”

4) https://www.fasebj.org/content/early/2011/06/20/fj.11-182758.full.pdf

5) Clinical and Experimental Rheumatology, 1993, 11(2):157-162, “Effect of gonadal steroids on the production of IL-1 and IL-6 by blood mononuclear cells in vitro”

6) Endocrinology September 1, 1991 vol. 129 no. 3 1305-1311, “Interleukin-1 Inhibits Cholesterol Side-Chain Cleavage Cytochrome P450 Expression in Primary Cultures of Leydig Cells*”

7) Journal of Endocrinological Investigation, 2005, 28(11 Suppl Proceedings):116-119, “The relationship between testosterone and molecular markers of inflammation in older men”

8) Journal of Andrology, Jan/Feb 2009, 30(1), “The Dark Side of Testosterone Deficiency: II. Type 2 Diabetes and Insulin Resistance”

9) Cellular Physiology and Biochemistry, 2007, 20:847-852, “Effects of Testosterone on Cytokines and Left Ventricular Remodeling Following Heart Failure”

10) Nature Reviews Endocrinology 5, December 2009, “Testosterone deficiency, insulin resistance and the metabolic syndrome”

Decrease Wrinkles in Two Minutes per Night - Peak Testosterone

Is there a miracle skin chemical out there?  Well, no, but we can come close with Retin-A. Imagine rubbing some lotion into your face each night and watching the years roll right off your appearance.  Well, Retin-A can do that for a lot of you.

I mean let s assume you ve gotten your libido back, your testosterone is up, your erections are hard and life is perfect and good. But is it really? You may have had the same thought cross your mind that crossed mine at one point: what good is it to FEEL 15 years younger on the inside if you don t LOOK 15 years younger on the outside?!?

Well, this is where Retin-A can come to the rescue.  Retin-A is actually most famous as a treatment for acne, so a lot of people don’t realize that it is a great wrinkle reducer and even wrinkle remover in some cases.

Now there are a lot of guys out there that feel that trying to make your face and appearance is girly stuff.  We picture a bunch of women talking and giggling about some weird mud pack they put on their face.  Well, that’s not what I am talking about here – there is nothing girly about Retin-A.  In fact, I would argue that using Retin-A is man’s work, pure and simple.

Why do I say that?  Because Retin-A is easy, straightforward and backed by science. Most of the expensive wrinkle reducing creams that your wife or girlfriend buys in the mall has little to no research behind it and is a huge waste of money.  Retin-A, on the hand, has many studies under its belt and years of use by dermatologists and physicians.

And, most importantly, Retin-A use is low key so no one ever has to know.  Applying Retin-A each night takes all of two minutes – it’s really that simple.  There is no weird grape leaf mudback from the swamps of Brazil and two hours of sitting under a hot towel watching Oprah.  You just put a little lotion on each night and – voila! – you are done.

There is nothing girly about taking two minutes each night and there’s nothing girly about looking ten years younger either.  How does Retin-A work its magic?  It does so by actually “killing” the outer layers of the skin on your face so that your body replaces it with new, “baby-like” skin. In fact, it can actually create a little redness and, in some cases make you literally peel when you first start using it.  That’s why it is important when you are first starting out with Retin-A to slowly build up your tolerance.

If Retin-A is working for you, then you will notice the following as the weeks and months go by:  your skin will become softer and smoother – almost polished – all the while your wrinkles are reducing as well.  And all of that from 2 minutes of work each night.  Now I do have to give a warning here:  if you are eating the typical Western diet or smoking or overweight, Retin-A isn’t going to stem the tide of free radical and glycemic damage that you are doing to your skin.  Yes, Retin-A is a solid performer, but it’s not going to work miracles!

So is Retin-A natural?  Well, yes and no.  It is naturally occurring and is just an acid form of Vitamin A.  Is it safe?  It has an excellent track record with very few side effects if used correctly.  In fact, you are really not supposed to put on much Retin-A – just a very thin layer, i.e. this isn’t a lotion to slather on your face like an after shave lotion.  Furthermore, the typical solution is either .1% or .05%, so when all is said and done you absorb very little of it.  Plus, it may help to know certain leukemia patients actually take large amounts of a medication called Vesanoid, which is basically tretinoin (Retin-A). However, you should discuss this with your doctor after reading my link on Just How Safe is Retin-A?.

So let me give you a few guidelines for how to actually use and get the stuff:

A great body of research shows that Retin-A decreases wrinkles and improves the general appearance of skin.  It comes in .1% and .05% lotions or creaams and  (It can actually make you peel.) Of course, I realize that the vast majority of guys know next-to-nothing about such things, so let me explain a little more:

A thin layer of Retin-A is usually applied at night.  Strong sunscreen must be applied over any areas where the Retin-A was used because topically applied A Vitamins, such as that in Retin-A, can make your skin absorb sunlight much more rapidly.  Again, sunscreen is critical unless you live north of the Yukon.

In addition, you have to be careful not to get Retin-A in your eyes.  If fact, you have to be extremely cautious about using Retin-A on the eye socket area where the skin is much more thin and delicate that the rest of your face:  you can do more damage than good around the eyes if you are not careful. Some people use a .025% solution around the eyes a few days per week with success, but every person is different. Go easy and slowly because if you damage the skin around your eyes, you’ll look much older instead of younger. Remember:  do no harm!

So how do you get Retin-A?  It’s prescription only in the US and other Western countries.  It is actually a very cheap drug to make, so you can get it at a very reasonable price from Mexico or other overseas pharmacies. However, I would advise getting it from a doctor rather than self-treating.  The reason is simple:  you really need to have someone overseeing your results to make sure you are using the right concentration and frequency and not causing too much inflammation.

NOTE: They key is to get tretinoin, which is retinoic acid, as that is substance that actually reduces wrinkles.  Tretinoin is actually sold under other brand names such as Renova.  However, you should remember that Retinol, which comes in many over-the-counter skin preparations is NOT tretinoin or Retin-A.  Do not get the two confused as Retinol does not have nearly the strength as Retin-A for most individuals.  The reason is the Retinol has to first be converted by the body to retinoic acid and that is generally an inefficient and highly variable process. Go for what works and that is tretinoin, a.k.a Retin-A.  There is also Retin-A Micro to consider as well. Some say that Renova has the best moisturizer in it, but that is unlikely to make a substantial difference.  Remember:  you are trying to build new skin and reduce wrinkles.

Retin-A can cause irritation if you use too high of a concentration too quickly.  Both .10% and .05% can achieve clinical results, but for example .10% may be too harsh for you skin:  every person is different.  You really don’t want significant redness or too much flaking for a significant period of time.  A doctor can help you get started on the right foot so that the inflammation/healing process is at a reasonable pace so that you get the kind of results you want without potentially damaging your skin.

Remember also that Retin-A will decay.  I recommend that once you open it, you refrigerate it to keep its potency for as long as possible.  If you are trying to be more secretive for some reason, be sure to keep it in a cool dry place at as low of a temperature as possible.  Anecdotally, it will last for four months or more if you are careful and still work.

NOTE: One other benefit of Retin-A is with hair loss when coupled with Rogaine (minoxidil).  It works by “exfoliating” you skin, which means it removes much of the hard, dry outer layer of your skin.  And this allows other chemicals to be absorbed more easily such as Rogaine. In other words, you may get improved hair re-growth results using the combination of Rogaine + Retin-A! Don’t self-treat with this but talk to your doctor as there are a number of studies showing good results using this technique. [4] In fact, some studies have shown just Retin-A by itself can result in hair growth.  Get yourself a good doctor and find out what can be done if this is an issue for you.

NOTE: There are some OTC products that are reasonably priced that have a study showing (apparently) wrinkle reduction benefits. [6] One of these products is called Boots No7 Protect & Perfect SerumNow, admittedly, the study was funded by the manufacturer.  However, the results were so remarkable that it is doubtful that it could be fabricated in my opinion, but one always has to keep in mind conflicts of interest.  What was remarkable was that not only did this product reduce wrinkles, but it also increased fibrillin-1 in the skin.  Key components of skin are elastin, collagen and fibrillin.  Fibrillin is particularly vulnerable to photoaging, i.e. sun damage, and this product, Boots No7 Protect & Perfect Serum, appears to actually reverse some of this damage.  

It is critical with Retin-A that you protect yourself from the sun, since treated skin will tan/color differently.  However, modern sunscreens can be quite toxic and dangerous.  See this discussion on The Safety of Modern Sunscreens for more details.

Clinically what works best is a combination of topical (applied to the skin) antioxidants coupled with a strong antioxidant-laden diet.  In my case, however, I have not found topical creams necessary.

If you want to try topical preparations of various antioxidants, then you are certainly in good company:  study after study has shown the benefits even, in some case, to the point of reducing sun damage and reducing wrinkles.  For example, topical Vitamin C is a proven wrinkle remover.  Furthermore, Vitamin C strengthens and even stimulates collagen regrowth. (Note:  I have read that about 15% of oral Vitamin C gets to the skin which means that if you take 1+ g, a significant amount will actually be there to protect your skin.)

How do you make your own Vitamin C?  Well, it’s surprisingly easy and it’s in the Infopacks that Smart Skin Care sells for a very reasonable price.  (I am in no way associated with this site.)  Doing this yourself will save you a lot of money – trust me!

NEWS FLASH: There is a supplement, Evelle, with clinically proven results to improve skin elasticity and roughness. [8] And it is no wonder, they put many known antioxidants and skin-improvers into one pill including Vit E, Vit C, Pycnogenol and Biotin among others.

That’s another thing that separates most of us guys from most of the females in this category:  rationality about money.  The Journal of Cosmetic Dermatology found that dry patches on eczema patients experienced as much relief with a 12$ over the counter moiturizer as with a $100 prescription cream called Mimyx.  If you go with a woman to one of the mall shops with a cosmetic department, almost every skin care product she grabs will be in the $50-$100 price range.  By making it yourself, you can do most everything in the $5-$10 price range.  Again, the goal in my opinion for us guys is fast, affordable and very discreet.  If you make it yourself, after all, no one has to know.

Another thing you can find in the same Smart Skin Care Info Packs is how to prepare topical CoQ10 preparations for you skin.  Studies have shown that CoQ10 both reduces wrinkle depth and protects against UVA radiation. [5] CoQ10 is a powerful antioxidant that is involved in the most primordial processes of the cell:  making ATP for energy.  This cellular energy-production process can produce an abundance of free radicals and CoQ10 is one of your first lines of defense.

CONCLUSION:

It’s not as hard as you might think to turn back the clock.  A little Retin-A and sun screen and you will be shocked at the results in 3 months.  Now if you’ve been smoking or a heavy sun-worshipper for decades, then you may have to resort to Cosmetic Surgery for Males.  But, either way, the practical steps on this page will make a significant difference.  Try it!

REFERENCES:

4) J Am Acad Dermatol, 1986, 15:880-883;Clin Pharmacol Ther, 1990m 47:439-46

5) Biofactors 1999;9(2-4):371-8

6) Br J Dermatol, 2009 Apr 28, [Epub ahead of print], “A cosmetic ‘anti-ageing’ product improves photoaged skin: a double-blind, randomized controlled trial”

8) J of Dermatological Treatment, Jul 2004, 15: 222-226, “Supplementation with Evelle improves smoothness and elasticity in a double blind, placebo-controlled study with 62 women”

Retin-A UsageRetin-A Do-It-Yourself Substitutes

Testosterone and Food - Peak Testosterone

I have extensive coverage on my site as to just how much food affects medium and long term baseline testosterone levels from many standpoints. In this link, I want to cover just how rapidly the food in one meal can affect your immediate testosterone levels. This is very important, because it can affect how we feel during the night, which is, for most of us anyway, the primary time for love making.  If the food we eat can lower testosterone the same night, that is obviously something to take into consideration.

Now, before I got into post-meal testosterone, it is important to briefly review some of the research that correlates certain foods and dietary regimens with testosterone levels:

1.  Fat and Fiber. Some research shows that total fat can raise medium term testosterone levels and fiber does the opposite.  These studies are oft-cited around bodybuilding and steroid sites in particular.

The bottom line is that much of the research on medium term food and testosterone is inconclusive:  there are clearly many questions remaining.  For example, one of the most important questions is what diet will best preserve testosterone into one’s senior years?  Most men’s forums would unswervingly prescribe a standard Paleo Diet along the lines of #1 above.  However, this is debatable advise, because the Okinawans, who do not really follow any of the above rules, have very high testosterone levels well into their senior years compared to Westerners. For more information, see my link on How to Avoid Andropause.

All of these type of questions are difficult to answer definitively. Furthermore, some of the above research is contradictory and confusing. For all of these reasons, on this page I want to focus on a different aspect of testosterone and food:  post-prandial (post-meal) testosterone.

This subject is extemely important, especially for men who are middle-aged and beyond. As you may know from my page on The Daily Cycle of Testosterone, testosterone levels dip between 15-35% for men on average from early morning to evening, depending on age and a few other factors

Many of the younger guys have lots of buffer built in and can afford decreased nightime testosterone.  Such is not necessarily the case once you hit about 40.  First of all you get a decrease from a natural diurnal cycle and the last thing you need is for the food you eat at dinner to push down your testosterone even further.

NOTE: Men also need to watch how they eat at dinner, because it can so severely limit blood flow, which is never helpful in the bedroom.  This is why I warn men so much regarding high total and saturated fat meals. I cannot tell you how many men’s sex lives have been helped simply by limiting How and Why Saturated Fat Can Be Bad For Men.

So is there any similar advice for men with regards to testosterone?  Can a meal actually affect our testosterone levels significantly?  Yes, indeed, and it might not be what you think:

1.  High Glycemic Load Meals. As I always say, “Food is clinical.”  Doctors don’t like to admit, but how we eat has a profound effect on the body, sometimes in ways that cannot be anticipated.  One of the these ways was recently discovered by researchers who found that men who consumed a significant quantity of glucose dipped their testosterone levels by an average of 25% post-meal. Any high glycemic load meal will likely do something similar and I cover this in my link on Testosterone, Glucose and Sugars. Remember that refined carbs – can you say white bread and white rice – spike your blood sugar and insulin levels about as much as table sugar.

2. Higher Fat Meals. Conventional wisdom says that eating a meal full of fat boosts testosterone and turns you into a gorilla-man.  However, what high fat meals actually do is just the opposite:  slow down blood flow, leading to “limpification” And, even worse according to one study, eating this way can also lead to significantly reduced post-prandial testosterone levels. [2] Ouch is right!

Basically the authors in this study compared a lower fat meal with mixed protein and carbs to a high fat meal and found that “the fat-containing meal, but not the nonnutritive or mixed carbohydrate and protein meal, resulted in a significant reduction in total and free testosterone.”

As I point out often on The Peak Testosterone Forum, wild game is very lean and almost always low fat.  And almost everything edible in nature is low fat with the exception of nuts, seeds and fish. So what?? Well, this means that man has generally not been able to eat the incredible amounts of fat that we find in modern diets from modern oils, butters and high fat livestock. Our bodies are just not tuned for high fat meals and it looks like we pay for it with decreased blood flow and testosterone.

NOTE: In fairness, one study did not show a loss of testosterone after a higher fat meal and instead showed one with a lower fat meal. [5]

3. Big Meals. An interesting study looked at the effects on cortisol of both a high protein and a high carbohydrate meal on healthy males (avg age = 26).  They way they did this was to give a pretty big shake to the participants:

–The high-protein meal was “a salad (iceberg lettuce, cucumber, mushroom, and sunflower oil), Gouda cheese, salami, and a strawberry protein shake.”

–The high-carbohydrate meal was “a salad (iceberg lettuce, cucumber, green pepper, and sunflower oil), savory cheese biscuits and TUC bacon biscuits, and a strawberry carbohydrate shake.”

Both of these meals were pretty big and were designed to be 30% of daily requirements.  That’s a pretty big meal and here is the interesting thing:  in men both of these meals caused huge rises in cortisol. (Women experienced a much smaller increase in any and all conditions.) As men we appear to be vulnerable to post-mail increases in cortisol for almost any conditions. And it may be these increases that lead to the decreases in testosterone?

4.  Soy. One study showed a meal with soy significantly lowered testosterone after a meal.  [5] I caution against soy for other reasons as well in this link on Soy and Men.

Regardless, this points to the fact that the only protection a man may have is to “graze”, i.e. do not consume overly high caloric and eat many meals throughout the day.  This also is critical for many men for their long term health due to blood glucose and insulin issues.  One study showed that type II diabetic men who ate this way, i.e. smaller meals spaced throughout the day, had much smaller insulin and blood glucose responses. And this will be critical not just for men with diabetes, but also men with prediabetes/Metabolic Syndrome as well, i.e. probably half the middle-aged and beyond population in Western societies.  Unless you are exercising heavily, odds are that you can protect your beta cells and your testosterone by smaller, more frequent (and low glycemic load) meals.

In my opinion, all roads seem to lead back to Low Fat or Mediterranean Diets that emphasize low glycemic foods.

REFERENCES:

1)  Life Sciences, May 1987, 40(18):1761 1768, “Diet-hormone interactions: Protein/carbohydrate ratio alters reciprocally the plasma levels of testosterone and cortisol and their respective binding globulins in man”

2) Metabolism, Sep 1990, 39(9):943 946, “Effects of a fat-containing meal on sex hormones in men”

3) PLOS One, Received: September 3, 2010; Accepted: January 9, 2011; Published: February 3, 2011, “Influence of Consumption of a High-Protein vs. High-Carbohydrate Meal on the Physiological Cortisol and Psychological Mood Response in Men and Women”

4) Diabetes Care, Jan 1993, 16(1):4-7, “Effect of Meal Frequency on Blood Glucose, Insulin, and Free Fatty Acids in NIDDM Subjects”

5) Metabolism, May 2001, 50(5):505 511, “Postprandial changes in sex hormones after meals of different composition”

2.  Mono and Saturated Fats. Some of the same research in #1 showed that monounsaturated fats and saturated fats were testosterone-boosting in the medium term as well.  And I actually give an example of some third world peoples that follow an interesting diet along these principles in my link on A Testosterone Diet?

3.  Decreased Protein. Again, some studies from the pool of research in #1 showed that lower protein levels were associated with increased testosterone. This flies in the face of almost all the standard bodybuilding advice and popular diets such as the Zone Diet and Body for Life. I do have to mention, though, that one study showed that, while a high carbohydrate diet did raise testosterone levels significantly, it also raised SHBG levels, thus likely washing out any benefits. [1]

4.  A Low Fat Diet. In direct contraction of #1, a Low Fat Diet was found in one study to keep testosterone levels the same yet and yet greatly decrease estrogen levels. (This may be due to #3.) For many men, this could have a profoundly positive effect, because it would boost their testosteorne-to-estrogen ratio.  In fact, the study is listed in my link on the Testosterone-to-Estrogen Ratio.

Did you know you can inexpensively do your own testing for most hormones? The industry leader is Discounted Labs..

Pesticides, Endocrine Disruptors and Testosterone - Peak Testosterone

1) Epidemiology,2006,17(1):61-68

2) Food Chem Toxicology, 2008, 46:270-279

3) 4) J Environmental Health, Jan 2009, 8:2″Mercury from chlor-alkali plants: measured concentrations in food product sugar”, Renee Dufault, et al;  Institute for Agriculture and Trade Policy, Jan 26 2009, “Much High Fructose Corn Syrup Contaminated with Mercury New Study Finds:  Brand Name Food Products Also Discovered to Contain Mercury”.

4) National Acad of Sciences, July 24 2009, “LIMITED DATA SUGGEST POSSIBLE ASSOCIATION BETWEEN AGENT ORANGE EXPOSURE AND ISCHEMIC HEART DISEASE AND PARKINSON’S DISEASE IN VIETNAM VETERANS”,

5) National Academy of Sciences, July 27 2007, , “Data Suggest a Possible Association Between Agent Orange Exposure and Hypertension, But the Evidence Is Limited”

6) https://www.nrdc.org/media/2009/090824.asp

7) Brian Halweil, Nov 2002, Worldwatch Institute on November 1, 2002, “Worldwatch Paper #163: Home Grown: The Case For Local Food In A Global Market”

8) Exp Neurol, Apr 2007, 204(2): 619 630, “Dieldrin exposure induces oxidative damage in the mouse nigrostriatal dopamine system”

9) Hayes WJ jr. and Laws ET jr. eds. (1991) Handbook of Pesticide Toxicology, Academic Press Inc., San Diego, 732-735, 741, 828, 832, 836-840

10) American Journal of Epidemiology, 2010, 171(4):455-464, “Pesticide Use and Thyroid Disease Among Women in the Agricultural Health Study”

Is organic food just for girly men? Actually, it might be just the opposite: recent studies are showing strong evidence that some pesticides may make a guy a little too light in the loafers. A recent issue of Epidemiology found a correlation between exposure to the pesticide chlorpyrifos and a decline in testosterone. [1] The researchers examined males undergoing fertility treatment and found “multiple linear regression models showed an inverse association between TCPY [a metabolite of chlorpyrifos] and testosterone concentration“.  Simply put, that means the more the chlorpyrifos, the less the testosterone.

The Tour De France is a little over 2,000 miles and your food typically has to travel about that on average to get to your local supermarket.  Your fruits, vegetables and grains travel an average of between 1,500 and 2,500 miles  and increasingly from foreign countries including China. [7]  This means – you guessed it – more pesticides and chemicals have to go on your food to get it to survive the typical megatrek to your plate.

What does that mean to all of you concentrating on your fitness and health?  It means that as you do the right thing and eat your fruits and green stuff, Old MacDonald is trying to shrink your nuts to the size of a fruit fly!  Am I exagerrating?  Well, a little bit.  But the study found that men with the most pesticide byproducts in their systems typically had 10% less testosterone than men with the least pesticide by products. That s quite a hit for just one pesticide, especially for those on the low testosterone side in the first place. I should also mention that previous research has found this pesticide widely present in the general population:  in other words, you’ll be extremely unlikely to escape ingesting it under normal circumstances.  (Before I go on, please, please read this section on Excitotoxins:  these have the potential to be much more deadly to your testosterone than even pesticides.)

The researchers also found that two additional pesticides, carbaryl and naphthalene, were also correlated with lower testosterone in subjects. Imagine what the other forty pesticides you re eating are doing to your precious testosterone. The concern over pesticides actually came over decades of observations as to what they (and other chemicals such as those used in plastics) are doing to the animal kingdom. Florida gators next to pesticide manufacturing plants have a drastically increased mortality and many of the adult males have ovaries instead of testes. Not good.

Atrazine is another example. In America 60 million pounds of this are sprayed on annually on sugar cane, corn and other crops where, of course, it washes into rivers, streams and various water supplies. Unfortunately, researchers found that it caused sexual abnormalities in frogs! In Europe it is banned but not in the good ol U.S. of A!  NOTE: The National Resources Defense Council just found Much Higher Levels of Atrazine than previously estimated by the EPA.[6]

Why do these chemicals cause so many problems? The trouble is that many of them are endocrine disruptors. Some of them, for example, mimic estrogen or testosterone and take over receptor sites. Others interfere with the chemical pathways responsible for formation or delivery of testosterone or estrogen. In the case of chlorpyrifos, researchers believe it effects luetinizing hormone, which signals production of testosterone in males.

I should mention that pesticides and herbicides don’t just do their damage by modifying hormone levels.  Pesticides and herbicides can do damage throughout the body without ever touching your hormones!  See this link on How Pesticides and Herbicides Can Lead to ADHD and Parkinson’s.

One example of this is dieldrin, a DDT alternative, which has proven to be more toxic to vertebrates than insects.  One study showed it increases oxidative stress, lowers dopamine levels and is likely a cause of Parkinson’s Disease. [8]  Furthermore, it has induced liver and hepatocellular cancers. [9]  Even worse, it is not biodegradable. It has been banned for decades yet still persists in our food supply like radioactive waste.  How could they use a non-biodegradable pesticide in our food supply?  Is it possible to be more irresponsible?

Previous data from the National Academy of Sciences has shown that Agent Orange and other herbicides do not just damage the brain but can induce hypertension, as shown by examination of Vietnam Vets with significant exposure. [5] Dioxins and other chemicals cause proteins to accumlate in and around the organs which can cause significant issues including lymphomas and cancers as well.  They stated that “the committee based its conclusion on the fact that AL amyloidosis shares many biological and pathological similarities with multiple myeloma and certain B-cell lymphomas, which have been found to be associated with exposure to herbicides”.  Nasty!

NOTE:  Dioxins are so deadly that they were used in 2005 to poison Victor Yushchenko, a well-known opposition Ukranian leader.

So how do you avoid these T-killing compounds?  If you want to shop at a regular supermarket, it will be tough. About the only thing that researchers can tell us at this point is which fruits and vegetables have the greatest incidence and total amount of pesticides.  Here’s a link that gives such a list: https://www.ewg.org/news/story.php?id=2076.

This EWG states that among the worst offenders, which they call the Dirty Dozen, are “apples, bell peppers, celery, cherries, imported grapes, nectarines, peaches, pears, potatoes, red raspberries, spinach and strawberries”.

The Latex Glove Award: Apples are particularly known for being the “most sprayed”. The problem is that apples are usually grafted and therefore not very pest resistant. Farmers spray more to compensate and that’s why organic is probably a good idea in this case.

The Latex Glove Runner Up: Probably the second most chemical-ridden item out of a farm is the potato.  Because they’re a root vegetable, they get treated with fungicides and then are sprayed with an herbicide to get rid of the “little string roots” that come out of potatoes.  After they are harvested, they get another dose making for one scary vegetable.

The least contaminated produce found was “asparagus, avocados, bananas, broccoli, cauliflower, corn, kiwi, mangoes, onions, papayas, pineapples and sweet peas”.

At least science has provided us with a way that you can try to avoid pesticides:  by limiting yourself to those on the least contaminated list.  Realistically, though, the only real way to avoid pesticdes is to buy organic.  Studies have shown that children who eat organic vegetables and fruit only dramatically lose pesticide residues in their body tissues and then regain them upon returning to regular produce.

Keep in mind that the knowledge about the effects of pesticides on humans is still in its infancy.  Making the task even more difficult is the fact that there are about 87,000 different chemicals currently in use making it impossible to test even a small percentage of the total. My opinion, though, is “better safe than sorry”.

News Flash #1: Pesticides and fungicides are increasingly being correlated with thyroid disease as well.  One 2009 study based in Nebraska found that women exposed to the most of organochlorine pesticides and fungicides were much (40%) more likely to develop hypothyroidism, which results often in weight gain, loss of libido and other serious medical conditions. [10]

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News Flash #2:  Recent research has found that Triclocarban, a chemical that is widespread in our water supply and various home care products such as antibacterial soaps, can actually increase testosterone. But before you try to transform yourself into Barry Bonds by washing your hands twenty times a day, I only relayed this story to show that we are not researching the products we put onto and into our bodies nearly enough.  Who knows what else triclocarban does to you?  Messing with your testosterone may be just the beginning.

Mercury:  Although not really a pesticide, I want to mention that Methyl Mercury will definitely lower testosterone. [2] Sadly, one of nature’s most healthy foods, fish, is often contaminated with Mercury and so extreme care is warranted.  Most recommend fish only once or twice per week because of it. Researchers just announced that mercury contamination is extremely common in high fructose corn syrup:  50% of products tested by researchers were contaminated! [3] The issue apparently is that there are no standards for mercury residue in hydrochloric acid and hydrochloric acid is used to make high fructose corn syrup.

REFERENCES:

Free Testosterone Levels STEP 2B. Free Testosterone Level

REFERENCES:

1) British Journal of Cancer, 2000, 83(1):95-97, Hormones and diet: low insulin-like growth factor-1 but normal bioavailable androgens in vegan men

2) The Journal of Urology, Sep 2003, 170(3):795-798, “The Value Of Pituitary Magnetic Resonance Imaging In Men With Hypogonadism”

3) https://www.questdiagnostics.com/testcenter/testguide.action?dc=TS_Testosterone_LCMSMS , Test Summary, Testosterone, LC/MS/MS, Clinical Use, Diagnose and monitor disorders associated with testosterone abnormalities (Table 1).

4) Testosterone, Free and Weakly Bound, Free and Albumin-Bound Testosterone, Test Number: 143255 CPT Code: 84402; 84403

5) Cleveland Clinic Journal of Medicine, November 2012, 79:11:797-806, “Androgen deficiency in older men: Indications, advantages, and pitfalls of testosterone replacement therapy”

6) ARCH GEN PSYCHIATRY, MAR 2008, 65(3):283-289, “Low Free Testosterone Concentration as a Potentially Treatable Cause of Depressive Symptoms in Older Men”]

7) https://www.priory.com/psych/sexdys.htm, “Antidepressant-Induced Sexual Dysfunction Associated With Low Serum Free Testosterone”

Free Testosterone Levels STEP 2B. Consider your Free Testosterone Levels if Needed:

There are two reasons that I know of to pull your free testosterone:

a) If you have medium or low medium total testosterone, it is possible to have proportionately lower free testosterone if you have high SHBG.  The low free testosterone, from what I have seen produces just as many symptoms as low total testosterone, and this is because it is the free testosterone that really acts on the tissues anyway.

b) Many studies use both total and free testosterone as independent markers of hypogonadism.

Also, another reason to understand free testosterone levels deals with a question that I get quite often on the Peak Testosterone Forum:

“My doctor says my free testosterone levels are fine, but I still feel lousy.  Are my levels really okay?”

That’s a tough question to answer and the reason is simply that there is such a wide variety of answers out there.  I’m going to cover some of the free testosterone hypogonadal ranges that I have seen out there and you’ll see that this is not easy to get your arms around.  And it is, by the way, one the reason that I use total testosterone in my discussions with men about the subject.  Doctors, labs and researchers seem very divided on free testosterone, which is not nearly as much of the case as with total.  For example, the unspoken rule of thumb that I now see out there with urologists and PCPs is that, while upper 200’s (in ng/dl) for total testosterone is considered hypogonadal, a man can get HRT if he is the 300’s.  So the variation between hypogonadal and treatable is maybe 30%.

Again, this is not the case with free T and let me give you some examples below.  I do want to say one thing about the units involved first.  All my numbers below are in ng/dl and often free testosterone is given in pg/ml.  The conversion is simple:  you simply take the free T number in ng/dl and multiply it by 10 to get the equivalent in pg/ml.

1.  1.5 ng/dl (Journal of Urology).  This is the lowest threshold that I have ever seen for defining hypogonadism:

“Low levels of TT and FT were defined as less than 300 and 1.5 ng/dl, respectively. Markedly low levels of TT were defined as less than 200 ng/dl.” [2]

We’ll go into this a bit later, but 1.5 ng/dl is VERY low free testosterone.

NOTE:

2. 3.5 ng/dl (Quest Diagnostics). One of the biggest labs in the United States is Quest and they list, for their top tier LCMSMS test a range of 35-155 pg/ml for an adult male aged 18 to 69. [3] As mentioned above, this translates to 3.5 ng/dl.

3. 4.0 ng/dl (LabCorp). The biggest lab in the U.S. is LabCorp and they weigh in with a hypogonadal free testosterone threshold of 4.0 for an adult male. [4]

4. 6.5 ng/dl (Cleveland Clinic Journal).  This journal weighs in with a significantly different number:

“Free testosterone levels can be diagnostic when total testosterone levels do not correspond with clinical presentation. However, the clinical utility of free testosterone is difficult to assess due to the variability among laboratory assays and a lack of consensus on threshold parameters. A threshold free testosterone level of more than 225 pmol/L (65 pg/mL) is generally considered normal.”

5. 10 ng/dl (For Depression). Free testosterone levels may play even more of a role in the case of depression. One group of scientists found that the lowest quintiles of total (300 ng/dl (10.2 nmol/l)) and free testosterone (10 ng/dl) were the  threshold for greatly increased risks of depression, 1.5 and 3.0 times, respectively. The bottom line is that if either free or total testosterone is low enough, get ready for a bumpy emotional and mental ride. [6]

NOTE:   13.5 pg/ml. Another study on men being treated with antidepressants found that levels of 13.5 pg/dl, which are very low levels, may be associated with sexual dysfunction. [7] The authors wrote that “free testosterone levels were found to be subnormal in 15 of 20 patients. No other consistent laboratory value nor physical examination finding could account for this observation…The male ASECS mean score was 20 with a mean free Testosterone of 13.5 pg/ml.” The bottom line:  watch your free testosterone levels as very low and even modestly low levels can worsen mood.

Another Way to Think of Your Free Testosterone Levels

As you can see from the above discussion, the problem with free testosterone is that there is no consensus as to what is hypogonadal, or clinically low testosterone.  In fact, not only is there no consensus, there is a huge range in the values that are used by researchers and labs.  This makes it all but useless for your doctor and my guess is that that is why they seldom use it.  (Another reason is that bioavailable testosterone is conceptually a much better number but is grossly understudied.)

So we should throw out free testosterone?  Well, I certainly don’t think so and I will give you an example where I believe it to be incredibly useful and, furthermore, a practical discussion point for some men with their physician.  In fact, let me go on record by saying that I think a fairly reasonable hypogonadal number is probably around 8 ng/dl.  The reason is simple.  As you’ll see in my book, the risk of all the medical conditions (diabetes, venous leakage, depression, prediabetes, osteoporosis, hardening of the arteries, etc.) all occur in the total testosterone range of 300-400 ng/dl range.  (For you it could be a little higher or lower:  the studies just deal in averages.)  This is something I document in my book Natural Versus Testosterone Therapy.

Did you know you can inexpensively do your own testing for most hormones? The industry leader is Discounted Labs..

To calculate how that 300-400 ng/dl of total testosterone translates to free testosterone, one just has to remember that the average free testosterone percentage for a healthy male (not on HRT) is about 2.0%. Thus, 300-400 ng/dl total testosterone is roughly equivalent to 6-8 ng/dl.  I would choose 8 ng/dl to play it safe, i.e. give the benefit of the doubt.  Again, symptoms are just as important as the number and we are all different, so your hypogonadal free testosterone number could be a little higher or a little lower.

PRACTICAL APPLICATION:   As mentioned above, I have seen a few guys on Peak Testosterone Forum who have had classic low testosterone symptoms with total testosterone around 500 ng/dl.  Normally, men do not have too many issues in the 500’s, but, upon further questioning, we usually discover that their free testosterone percentage was quite low – near 1.5%. And, if you look at the lab ranges for free testosterone percentage, you’ll see that it generally says 1.5-2.5%.   Therefore, men with a low free testosterone are simply at the lower end of this range.

But let’s do the math.  Again, let’s take a guy with total testosterone of 500 ng/dl and a free testosterone percentage of 1.5%:  he will have a free testosterone level of .015*500 = 7.5 ng/dl.  And, again, notice that this 7.5 ng/dl corresponds very closely to the 8 ng/dl that I calculated above.

And this is an argument that many doctors will listen to.  You can explain, assuming you have a low free T percentage, how your total testosterone in the low 500’s really corresponds to total testosterone in the 300’s.  And he (or she) may just listen.

THE EASY AND MORE ACCURATE METHOD: In my opinion, free testosterone is often an unreliable test.  What I see the more savvy (by my definition) doctors doing is pulling SHBG and total testosterone and plugging that into and online free testosterone calculator. This is what most often produces meaningful results that make sense.  You can play around with the numbers yourself.  For example, I ran the numbers with an SHBG of 50 and total testosterone of 500 and the calculator spit out a free T of 1.6% and 8.02 ng/dl.  So 50 and above is about when you’ll start getting these lower free testosterone percentages.  See my link on High SHBG for more information.