November is men’s health month and it’s more important than ever to talk about how guys can be proactive in their health. Over the last few years our nation has become sicker, increasingly hesitant to see doctors, and as a consequence we’re experiencing the sharpest decline in life expectancy in nearly 100 years. Among many heard lessons the pandemic has shown we can’t take our health for granted.
The majority of men coming into our practice have procrastinated seeing a doctor for years. The hesitancy is commonly from a past negative experience, not wanting to become drug-dependent, or simply not perceiving the need to make a change.
Unfortunately, these barriers are often not overcome until a medical emergency like a heart attack or other health scare occurs. For others more fortunate, a persistent spouse may be what prompts them to seek support for their health. By waiting until a health disaster occurs we miss out on the opportunity to make early preventive changes. Remember the adage “an ounce of prevention is worth a pound of cure”. In light of this, I hope this series can answer the “why it matters” and “how to start” questions to help men take control of their health trajectory.
In this post we’re going to look at a functional medicine approach of how the hormones testosterone and estrogen relate to heart disease, which tests to look at, and some of the common causes of imbalances.
Heart Disease and Testosterone
Heart disease has been the #1 cause of death in the U.S. since 1921 despite considerable effort towards prevention. Men are on average twice more likely to develop heart disease than women. Most of the focus is on cholesterol, blood pressure, and exercise, which all are proven and significant contributors. However, hormonal imbalances in men are an often overlooked contributor to heart disease risk. In men a healthy “balanced” hormonal state is a high level of testosterone and lower levels of estrogen. Imbalances can occur where either testosterone is reduced, estrogen is elevated, or both testosterone is low and estrogen elevates. We’ll discuss the implications of this through the rest of the article.
A little-known key function of testosterone is to protect arteries and veins (blood vessels) from buildup of cholesterol plaques. Testosterone in this setting works similar to an antioxidant, like those from vitamin C or green tea, by protecting blood vessels from gradual buildup of cholesterol plaques. Accumulation of plaques leads to blood vessel thickening which, if it happens in arteries that feed the heart, causes heart disease. It’s not surprising, then, that low testosterone has also been shown as a significant contributor to heart disease. Correcting low testosterone makes sense as part of a preventive strategy for heart disease in men but it can commonly go wrong.
Testosterone Replacement Concerns and Aromatase
Testosterone replacement therapy is the standard treatment for low testosterone in conventional medicine. Regardless of the cause of low testosterone, the wisdom of the day is to fix it with testosterone replacement. This one-size fits all approach can be a concern because of an enzyme in our body called aromatase. Aromatase, like other enzymes, works by converting substance “A” into substance “B” – in this case it converts testosterone into estrogen. Aromatase is part of normal hormone regulation and isn’t an issue unless it becomes excessively activated. When activation occurs for reasons we will discuss later, men can experience low testosterone and elevated levels of estrogen. High estrogen in men is a cause for concern because it increases the risk for mood disorders, heart disease, stroke risk, clotting abnormalities, and cancer.
So what’s the problem with testosterone replacement? When men have an activated aromatase enzyme, the testosterone that they receive from a shot, gel, or pill, can convert into estrogen within hours to days. Men can still be left with low testosterone but with the added burden of high estrogen. This goes to show why approaching the issue of low testosterone with a root-cause mindset rather than a simplified one size fits all is critical.
The most common root-causes of low testosterone and aromatase activation that I see are insulin resistance, an unsupported stress response, and inflammation. Very often these three patterns occur in pairs or all three together. These patterns can drive low testosterone and activate aromatase increasing estrogen. As we discussed earlier, these hormonal imbalances elevate men’s risk for cholesterol plaques to build up in their blood vessels leading to a higher risk for cardiovascular disease later in life. By addressing the root cause of the imbalances (inflammation, insulin resistance, stress, or other causes) we can normalize hormonal imbalances and give the body an opportunity to heal.
The first step is to understand if your hormones are in an unbalanced state. Lab tests that can help determine this are those that check your total + free testosterone and estradiol (a type of estrogen). Additional tests assessing vitamin D, levels of inflammation, and blood sugar can clarify what other factors are involved. I typically recommend a comprehensive panel of bloodwork tailored to the individual to get the best overall picture of processes at play and how to address them.
The second step is to start making simple diet and lifestyle adjustments. Reducing the amount of carbohydrates you consume is a critical step. Carbohydrates (aka sugar) are especially prone to causing insulin resistance when consumed in the forms of processed sugars/high fructose corn syrup. Even natural sugars, like cane sugar or maple syrup, are technically processed and can be harmful when not consumed in moderation.
Another opportunity is to reduce inflammatory foods, the worst offenders being gluten and dairy. Other common offenders for some (but not all) are corn, eggs, and soy.
The third step is to consider what lifestyle factors are at play. Lack of exercise, alcohol consumption, and poor sleep are all big players. One of the most important habits to consider changing is late night snacking. This might be one of the worst offenders on the list and also the most challenging to change.
There are a lot of ways for men to be proactive in their health and understanding levels of testosterone/estrogen should be at the top of the list. There is always a root cause for dysfunction in the body and dietary/lifestyle changes should be frontline treatments in our arsenal to be living proactively. If you need more direction, support, or a different perspective we at Turnpaugh Health & Wellness are here to help take the next step towards better health.
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