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Male Aging - Hormone Basics

Hormones are the chemical messengers of the body. They are produced primarily in glands and organs that are part of the body's endocrine system. However, other organs, such as the heart, can produce certain hormones as needed.

Throughout the body, there are receptors matched to specific hormones. Hormones and their receptors can be thought of as analogous to keys and locks. When the appropriate hormone (key) binds to a matching receptor (lock), it enables (unlocks) the receptor allowing the chemical message carried by the hormone to be transmitted to the internal mechanism of a cell.

The body produces many hormones. Some act directly on receptors, and some exist solely to control other hormones. Glands that contain many hormone receptors are said to be hormonally active. The prostate certainly fits this description. Virtually all of the sex steroid hormones have receptors on the prostate.

Much medical writing, particularly older studies and books,  support the theory that high testosterone levels are the cause of prostate problems. If this were so, young men whose testosterone levels are high compared to older men, would be the primary group affected by prostate disease. In recent studies, high testosterone levels were not correlated to prostate disease. In fact, many studies seem to suggest that men with low free testosterone levels have higher risk of developing prostate problems, including prostate cancer.

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The latest research appears to indicate that the increase in conversion of testosterone to estradiol, and also conversion to its more active component, DHT, rather than the overall testosterone level, is a primary factor initiating many prostate problems. This contradicts some widely held beliefs.

Both DHT and estradiol are necessary for proper functioning of the prostate, but their levels can become skewed due to nutritional deficiencies or lifestyle/environmental issues. When they become unbalanced with respect to the other  hormones, the problems start. The imbalance increases sensitivity of the prostate to the estrogens.  The increase in conversion of testosterone to DHT, and increased sensitivity to the estrogens, particularly estradiol, appear to be significant in the development of prostate disease.

Virtually all hormones exist in the body in two forms, free and bound. Only free hormones are active. Bound hormones are paired with a protein called "Sex Hormone Binding Globulin (SHBG) and cannot bind with receptors. SHBG also rises with advancing age. The net effect is that the age-related decrease in total testosterone is magnified by this increased binding to SHBG, resulting in a lessened amount of free testosterone.

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When testosterone becomes bound to SHBG, its ability to attach to receptors is inhibited. Since only free testosterone can deliver its hormonal message to prostatic receptors, a rise in SHBG is significant. It results in symptoms of low testosterone, even though total testosterone levels may appear normal. This is a very common condition in older men and the reason why free and total (not just total) testosterone should always be measured.

Low levels of free testosterone and increased levels of SHBG tend to magnify the effects of estradiol. Aging also causes a slight rise in estradiol, which compounds the problem. Some research suggests that increased levels of estradiol activate the liver to make more estradiol. Thus, the ratio of most of the androgens to estrogens is altered significantly, setting the scene for prostate dysfunction. These combined effects of elevated estradiol and SHBG, along with corresponding lowered levels of free testosterone have a profound effect and are significant contributors to the development of BPH and other prostate conditions as a man ages.

Normal levels of testosterone can vary significantly between men. The numbers are derived from a sampling of presumed healthy men of various ages separated into age groups and averaged for each group. Older men are generally at the lower end of the range. Based on this, it is considered normal for older men to have lower levels of testosterone. However, in many studies, it appears that prostate problems occur more frequently in men with relatively low testosterone levels. Thus, normal may be quite different from optimal.

The previous accepted belief that the prostate was responsive only to testosterone is now known to be incorrect. The prostate is also rich in receptors for progesterone and estrogen. While both estrogen and progesterone were previously thought to be specifically female, with little effect on the prostate, quite the opposite is true.

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Progesterone, in addition to its own properties, has profound effects on the availability of all the other sex hormones. A deficiency in progesterone inherently results in deficiency of some of the others. As a man ages, his progesterone production also decreases, resulting in a corresponding decrease in his levels of testosterone. At the same time more of his available testosterone is converted to DHT and estradiol. The end result is that the relative ratios of estrogen to progesterone, and estrogen to testosterone increase. This allows more estrogen (particularly estradiol) to reach receptors on the prostate, thereby increasing its overall effect. Some studies have found that estradiol reduces the body’s clearance of DHT from the prostate, thereby compounding the problem.

As we age, the level of another hormone, DHEA, also drops, resulting in an additional decrease in testosterone levels, again compounding the problem. Many recent studies have found that both low levels of DHEA and testosterone correspond directly to prostate problems. Thus, the age-related drop in progesterone, DHEA, and testosterone, and the relative rise in estrogen and SHBG levels, results in increased risk for prostate problems. Coincidentally, excess estradiol is also known to be a key player in abnormal breast tissue proliferation. This is one reason older men frequently have enlarged breasts.

Testosterone deficiency contributes to low libido, reduced muscle mass, reduced bone mass, erectile dysfunction, atherosclerosis, depression, and other problems. Adequate testosterone levels are essential for a man to have normal libido, orgasms, and spontaneous erections.  Unfortunately, there is no specific value to determine what an adequate or normal level is.  What is normal for one man may be woefully insufficient for another.  If your testosterone levels fall on the low side of the normal range and you are having symptoms of low testosterone, herbal testosterone boosters, or over-the-counter progesterone or DHEA creams may help.

You can find various herbal boosters and some hormone creams in the Supplements section.

A more detailed explanation of hormone basics and a diagram is in my book, Your Prostate, Your Libido, Your Life

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