Ageless: The Naked Truth About Bioidentical Hormones (31 page)

But if the condition was high cholesterol, researchers found a lower incidence of Alzheimer’s disease. So people with higher cholesterol have a lower incidence of Alzheimer’s disease. Is it because they have more precursors to making their own neurosteroids? It’s an interesting question.

SS:
What do you think?

ES:
It makes sense to me that the good Lord put our cholesterol-forming enzymes in our brain for a reason. And if He wanted us to make cholesterol in the brain, cholesterol is a great antioxidant. You know, it’s not just a neutral molecule. It’s not a bad guy that needs to be eliminated. It’s there for a reason. Cholesterol forms the backbone of every single neurosteroid in the brain. Estrogen, testosterone, progesterone, allopregnenolone, plus pregnenolone that people are taking, are all based upon a cholesterol structure that the brain is able to make from cholesterol itself.

SS:
Let me play devil’s advocate for a minute. The standard treatment by cardiologists is to take heart patients and put them on statins
and then eliminate all fat from their body. In light of what you’re saying, zero fat intake to lower cholesterol …

ES:
Not fat. We’re talking about cholesterol now.

SS:
Right. But the cardiologist takes the patient off fat so that the body can’t produce the cholesterol, in order to keep the cholesterol at rock-bottom low.

ES:
Well, that’s true in a sense. Acetate comes from fat metabolism, and acetate is converted into cholesterol by enzymes that produce cholesterol, and that enzyme is inhibited by statins. So if we give a drug that causes that enzyme to be less active, less cholesterol is being produced by the liver and by other tissues in the body.

SS:
But my point is that most men of a certain age are on statins, and their heart doctors have taken them off all fats. They look terrible. Is that healthy?

ES:
No. There are good fats and bad fats. We are eating too many processed fats that are not similar to what the fats are in the normal diet.

SS:
So this is that specialization: We go to individual doctors who are looking only at their little area of specialty. A diabetes doctor, for example, is just looking at diabetes, not the whole picture.

ES:
That’s right. The cardiologist’s job is to ensure that you have a lower risk for either having a heart problem or attack or a recurring event. That’s his or her concern. Statins do that. Cardiovascular disease is primarily an endocrine disease, and cholesterol only adds to the abnormal decline of the hormones. If your hormones are intact, cholesterol doesn’t damage the arteries. So if you have adequate estrogen, your arteries are actually protected from plaque formation.

SS:
Well, I can proudly announce I have zero plaque in my heart and arteries.

ES:
And you’re a high-estrogen gal. When they did primate studies, the research showed that if you took perimenopausal monkeys and put them on estrogen from perimenopause until old age, and looked at their arteries, they had almost no plaque. If you waited till menopause and looked at the primates that had their ovaries taken out at menopause and then started on estrogen, they had about 10 percent plaquing. So even in perimenopause, plaquing is starting.

If you waited five years, took the ovaries out, made them estrogen-deficient for five years, there’s 40 percent plaquing in the arteries. So those doctors who tell women, “Well, let’s wait and see how you do for a year,” are telling women, “Let’s see how bad your arteries can get before we add estrogen back in.” It’s the worst advice they could possibly get!

SS:
Do you feel that men experience a type of perimenopause? Periandropause?

ES:
What happens is a man in his forties begins to have testosterone decline. His tests look normal, but decline has started, and now in most cases his estrogen is also declining. This is serious because men start to get plaquing when their testosterone is declining well before they become deficient. So if you wait for a guy to be totally deficient before you treat him with hormone replacement, the plaques will be so bad that they won’t reverse from HRT. Plaques don’t form when hormone balance is healthy, except for plaques due to stress or that which comes from infection. What’s more, there are many types of plaques that are unexplained.

SS:
Then the message to young men who are in their late thirties or early forties is to start doing hormone panels. But young men don’t think this way.

ES:
Actually, the way to keep your hormones elevated is all the things you tell your women to do in your Somersize books. Eat right, keep your weight in check, avoid sugar, stay active, and exercise.

SS:
Eat real food.

ES:
Yes, eat real food, and your hormones will stay much higher longer in most cases. And positive stress helps, too. Being a winner will raise your testosterone levels. With the losing football team, for instance, all the testosterone levels are low after the game. The winners get a buoyant surge of testosterone from being on top, winning the battle, so to speak. So positive stress—from those things that drive us in our business pursuits or our lifetime pursuits that feed us positive feelings, those things we’re happy about, such as having a job that you’re happy with—all drive your hormones up. By contrast, having a job that beats you down every day will lower your testosterone and increase your cortisol levels. Cortisol, of course, is damaging to the system.

SS:
So here’s where the craft of the doctor comes in: being able to assess that a man who is happy in his life, happy in his marriage, happy in what he’s chosen to do, or to understand that this is a guy who is just beaten down by all of it. That assessment allows the doctor to understand what needs to be done, right?

ES:
That should be part of the assessment. Plus, the doctor should understand the effects of the environment, toxicity, stress, and all those factors that figure into it. It’s much more complex than a simple weight reduction exercise program or a change in lifestyle. It’s all of it combined; no single study is ever going to come out that finds one factor to be the primary cause anymore.

SS:
That is what this book is about.

ES:
All these factors are part of health and antiaging. The more you can be aware of lifestyle and hormonal factors, and how they change individually, is part of the picture. Studies that assess total hormone replacement will never be done, because hormone replacement will be different for every single person. You can’t do a double-blind study on a test group that are all getting different amounts.

SS:
So what do you do, personally? Everyone wants to know what his or her doctor is taking.

ES:
I don’t like to say because then everyone will want to do what I am doing, and it’s individualized. But I do take vitamin D, and I take my hormones in a certain pattern now.

SS:
In a rhythm?

ES:
Yes. Taking hormones in a steady day-in-day-out pattern doesn’t make sense. You must try to replace them with some pulsatility that reflects the natural pulsatility or rhythm that is there.

SS:
By creating a peak?

ES:
Yes, peaks and valleys. A resting phase. Just as you need it in your menstrual cycle.

SS:
I so agree.

ES:
There’s a surge, and it needs to relax. Is that healthier than steady (static) hormones? Probably, but we don’t have the studies to really show that it is a lot better. For most men, if they just take a very high dose of testosterone, they’ll feel good for a while, and then it
kind of wears off. The testosterone receptors should be fired up, but they aren’t. When you ignite a receptor over and over and over again, it downregulates.

SS:
I take my hormones in a rhythm to create a peak. What is the process for men? Do men reach a testosterone peak each month?

ES:
No, thank God we don’t have a monthly …

SS:
There’s nothing that simulates it?

ES:
I believe there should be resting periods and surges. In other words, peaks. It’s very much similar to how we treat diabetics. With diabetics, you need insulin replacement. We give them a baseline level of insulin, long-acting insulin, and they take that. It lasts all day long. Then every time they eat, they take a dose of insulin to rise and fall with the meals. So with testosterone, there are a number of ways that you can take testosterone that will give you a peak-and-valley effect. When we’re young, in our teens and twenties, there’s a peak of testosterone every ninety minutes. It’s a rapid cycle up and down. So testosterone’s bouncing off the ceiling and off the floor. While on the ceiling, it’s activating the receptors and firing us off and making every coed look wonderful. And then it relaxes a little, thank God, and recharges, then it surges again. So all day long, we’re distracted every ninety minutes.

SS:
I always say to my husband, “All men think about is sex, isn’t it?” And he always goes, “Yep.”

ES:
He’s got that right. Those receptors in men and women are made to activate and deactivate. So treatment should be aimed at trying to have some activation and deactivation. That’s why the typical injections really don’t work very well.

SS:
It’s a big bang, and then it peters out? (Excuse the pun!)

ES:
That’s right. So for a while, you have far too much testosterone, and then you don’t have enough. Then you have far too much. The testosterone receptors weren’t made to fire up over a two-week period and then decline. They were supposed to be pulsating all day long.

SS:
I have male friends who tell me that their doctor has told them they “have more than enough testosterone” or “too much” and that
they don’t need testosterone replacement. But at age sixty-five and seventy, they would have to be in decline, right? Does this mean that the ratio is off somewhere else?

ES:
Well, I’ll tell you what is usually the problem: It’s sex hormone binding globulin, and they don’t measure it. Sex hormone binding globulin goes up as men get older, and in some men it skyrockets. Sex hormone binding globulin is a protein that binds testosterone and keeps it from being useful. So when you measure total circulating testosterone, you can have a very high level. But if you’re at a level that sex hormone binding globulin is high enough, it completely negates it. I had one seventy-five-year-old guy who came to see me. He had lost his wife, and he had a new girlfriend who was very voluptuous. And he just couldn’t rise to the occasion. I did his testosterone. He had read my book, and he said, “Oh, I’m jumping out of the pages of your book.” He had his testosterone done, and it was over 900.

SS:
So what was the problem?

ES:
I did his sex hormone binding globulin, and it was off the charts—very high. In other words, there’s a normal range, and he was 50 percent above the normal range, but he had very little free testosterone.

SS:
And the free testosterone is the available active hormone, right?

ES:
Right. So with this guy, his testicles were fine. He was pumping plenty of testosterone, but wasn’t going anywhere, so he started having problems in parts of his body that no one realized or attributed to sex hormone binding globulin. There are some natural products to lower sex hormone binding globulin, and there are also drugs that we know will lower it. What I did with this man was to treat his sex hormone binding globulin to lower it, and his overall testosterone levels dropped. His sex hormone binding globulin dropped to the middle of the normal range, and his free testosterone came back. Now it’s well in the normal range, and he is happy because he is firing bullets again.

SS:
With the voluptuous babe.

ES:
He is a happy camper. Yet he is now running a lower total
testosterone. But his free testosterone is normal, whereas at a higher testosterone level he was deficient, but his numbers looked like they were off the charts. That was a revelation to me, because most doctors would have said, “You’re producing too much. There’s nothing wrong with you,” it’s organic or psychological or something, and written it off.

SS:
And when testosterone is imbalanced like that, is that a dangerous place for a man to be?

ES:
Well, in the sense that this man is symptomatic in that the blood vessels in his pelvis are not dilating. So if his free testosterone is low enough that he’s not able to get dilation of the blood vessels in the pelvis that give him a good erection, he’s two to three times more likely to have a stroke. Or a heart attack.

SS:
Okay. So it is dangerous.

ES:
That means the arteries in his brain and the heart are not dilating. You see that on the Viagra ads or the Levitra ads that say that if you have erectile dysfunction, you have a two- to threefold increased chance of having a stroke or a heart attack, and this has been well documented. But what’s the connection? Well, testosterone is a major vasodilator for the heart, brain, and pelvic vasculature. Not the peripheral, not the arms and legs, but the central critical arteries that are very hormone-sensitive.

SS:
Let’s talk about ministrokes. Men and women don’t seem to realize that they are having them. It is just attributed to aging, momentary confusion, or forgetfulness. I know what ministrokes look like. I remember my father, before he had the big one, was having these little ministrokes. Could it be caught in time and reversed through hormone replacement?

ES:
Well, we know that men with lower testosterone have more severe strokes with more damage, just like the model I told you about estrogen. And all I can say is, if you take testosterone, you’ll immediately improve the circulation of the heart. We know that because you can put a man on a treadmill who has heart disease, give him a shot intravenously of testosterone, and he’ll last a minute longer before any of the vascular changes occur. So it does work quickly to restore nitric
oxide, which is the basic vasodilator in the arteries of the heart and the brain. So whatever you say about circulation of the heart and the pelvis, you can also relate to circulation for the brain.