Surprising new federal research suggests low testosterone isn't the only thing men need to worry about as they age. The female hormone estrogen also plays a role in the same issues tied to "low T" — such as increased body fat and diminished libido, strength, and energy.
But wellness expert Erika Schwartz, M.D., tells Newsmax Health the findings shouldn't prompt the millions of men who take testosterone to suddenly drop it and start loading up on estrogen.
The take-home message, she says: Male and female hormones are both critical to men's health in midlife and beyond. Making sure all men have adequate levels tailored to their individual needs — by supplementing them with natural bioidentical hormones — can stave off obesity-related conditions and boost their overall health.
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"I think the big picture is the NIH [National Institutes of Health], as usual, is wasting everybody's money by doing studies on things we've known for 20 years," says Dr. Schwartz. "Men do need testosterone, but what I think the study is showing is that men need both estrogen and testosterone."
She added that the new findings go beyond the question of "low T" therapy, and confirm that some widely prescribed anti-cancer drugs that reduce levels of estrogen in the body — known as selective estrogen-receptor modulators (SERMS), such as Arimidex (anastrozole) — can have serious negative health effects.
"Taking these drugs that block the production of hormones has really created a lot of health problems," she explains. "The study is very clearly showing if you're giving these guys these hormone blockers, these SERMS … that stop their bodies from making these hormones, that's a big problem."
Millions of men are prescribed testosterone gel, patches, or shots. Many others take natural supplements or bioidentical hormones to boost libido, energy, and strength. Doctors rarely prescribe estrogen to men, because some testosterone converts to estrogen in the body (levels of both hormones fall as men age).
The new study, funded by the NIH and published in the New England Journal of Medicine this week, raises questions about just how much men need but didn’t conclude that hormone replacement therapy is good or bad.
Lead researcher Joel Finkelstein, M.D., of Massachusetts General Hospital, said investigators didn't seek to determine whether testosterone and estrogen therapy is beneficial, but instead analyzed which hormones produce which particular effects.
For the study, about 400 healthy men, ages 20 to 50, were given monthly shots of Arimidex to reduce their estrogen production. They were then given various doses of testosterone gel or an in active dummy gel to use. About half of the men were also given a drug to prevent testosterone's conversion into estrogen.
After 16 weeks, the results showed both estrogen and testosterone were needed to maintain sex drive and performance, while strength and muscle size were tied to testosterone and body-fat mass depended on estrogen.
While critical of the study for being so short and involving so few men, Dr. Schwartz notes the researchers did conclude low hormone levels do contribute to less muscle and bone strength and mobility, impaired thinking skills, heart disease, and other problems.
"Men, just like women, need hormones as they get older, as long as the testosterone you're giving them is bioidentical," she adds, referring to hormones derived from plant products that have the exact same chemical structure of human hormones, unlike synthetic drugs.
"This study proves that if you stop the production of in estrogen in men, you create problems for men, so you don’t want to treat low testosterone with drugs that stop estrogen production."
She also notes that the findings support the idea that there is no one-size-fits-all prescription for hormone replacement therapy for men. Some may benefit from a small dose; others may need more.
"There is such variation in levels of testosterone that men need, so they are gradually coming to idea that we are not all the same — what a shocking idea!" she says. "As men get over the age of 40, they start to have symptoms of weight gain, loss of muscle, loss of libido. Now some men with those complaints will have higher levels of testosterone and some will have lower levels."
"Low T" is typically diagnosed in men with hormone levels under 200 or 300 nanograms per deciliter of blood. But Dr. Schwartz says treatment needs to also take into account a patient's symptoms and particular physiology. Current medical practices don't call for testing hormone levels in men when they are younger to establish a baseline for comparison — something she advocates doing for men's health — so doctors can't say whether a man with a level of 200 or 300 is necessarily deficient.
"Because everybody is different and we don’t have baseline testosterone levels when men are 18, you should treat people based on clinical symptoms, in addition to [considering] blood test levels," she says. "You have to tailor a treatment program to individuals, and it always has to use bioidentical hormones — not synthetic hormones or drugs like Arimidex."
She also notes diet, activity levels, and lifestyle can all affect hormone levels.
"People who exercise will have higher levels of testosterone because they'll have higher levels of all hormones … and will need less [supplementation]," she notes. "And a diet low in alcohol, cafffeine, sugar substitutes, and soda — a healthy diet — is also important."
But even healthy individuals experience declines in hormones as they get older.
"With aging, you will still need hormones," she adds. "So rather than waiting for a disease and then treating a disease with a drug, if we actually treat people with hormones that they're losing as they age, and change their diet, exercise, and lifestyles, then we'll have a population of healthy people — and we won't be spending our money on developing on new ways of treating disease with drugs."
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