A Guide to Natural Hormone Balancing for Men
   by James Occhiogrosso, N.D.

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When an aging man first encounters a problem with his sexuality, it is almost inevitable that his thoughts turn to testosterone.  In many men, low testosterone levels cause significant problems, not only with sexuality, but also by setting the stage for some serious health issues. (For more information about testosterone, read Testosterone Supplementation for Older Men.

But testosterone is only one player in this complicated orchestra.  And, as I have mentioned many times in my articles, lectures, and my book, the body is all about balance.  It is most important for all the body’s hormones to be in balance with each other.

In the past, it was thought that the male andropause was caused primarily by a drop in the level of the man’s most potent sex hormone, testosterone.  While testosterone is extremely important, it is now known that the accompanying drops in other hormones, namely DHEA and progesterone, as well as increases in estradiol add to the problem.  The age-related changes in relative ratios of these hormones have a direct effect on the prostate, the libido, and a host of physical characteristics.

Progesterone and DHEA are precursors of testosterone, which means they can be used by the body to produce testosterone.   The previous accepted belief that the prostate was responsive only to androgens like testosterone is now known to be incorrect.  Both estrogen and progesterone were once thought to be specifically female, with little effect on the prostate, but quite the opposite is true. The prostate is rich in receptors for progesterone and estrogen, in addition to its androgen receptors. [1] [2]

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 decreases, resulting in a corresponding decrease in his level of free testosterone.  At the same time, more of his available testosterone is converted to DHT and estradiol. [3] [4] 

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 detrimental effects.  Aging also causes DHEA levels to drop, 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 and high estrogen levels correspond directly to prostate problems.  A large number of studies have linked imbalances in androgen to estrogen ratios to the development of both breast and prostate cancer.  Thus, the age-related drop in progesterone, DHEA, and testosterone, and the relative rise in estrogen, sets the stage for an increased risk of 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. 

Aside from normal aging, which is beyond our control, there are many lifestyle and nutritional issues that can cause additional estrogen production or initiate a reduction in androgens. For example, excess fat tissue produces estrogens.  An overweight or obese man can have significantly higher estrogen levels than a man of normal weight.  Alcohol consumption, smoking, and many other environmental factors can exacerbate age-related hormone imbalances.

The significance of the drop in progesterone and increase in the ratio of estrogen to progesterone cannot be ignored.  Studies indicate that progesterone increases the effects of the p53 gene that inhibits cancer growth and decreases the effects of the bcl-2 gene that accelerates it.  [5] [6]  The same studies (and others) also found that estradiol has the opposite effect on these genes.  Thus, the observed drop in progesterone, combined with the increased effect of estrogen, can be a prescription for disaster.

Note that I am referring only to natural or bio-identical progesterone in this article.  Compounds called progesterone produced by the pharmaceutical industry, and generally known as  “progestins,” are similar in structure to natural progesterone, but differ profoundly in their effects on the body.  Most researchers are well aware of the significantly different effects of natural progesterone and synthetic progestins.  However, the pharmaceutical industry often links the terms “progestins” and “progesterone.”  Printed literature typically makes no distinction between the two.  As a result, many medical practitioners—and the general public—believe they are the same.  They are not!  They are structurally different and have profoundly different effects on the human body. [7]

Rather than the exact levels of each hormone, the overall decrease in the androgen to estrogen ratio is the primary source of the symptoms many aging males experience.  As the ratio of androgens to estrogens decreases, so do the incidence of prostate disorders and symptoms of andropause.  Its symptoms include: reduction of sex drive, erectile dysfunction, uncomfortable or painful ejaculation, reduced ejaculate, difficulty achieving orgasm, blood in the urine or semen, loss of muscle mass, lowered energy levels, decreased exercise tolerance, depression, increased urinary urgency or frequency (particularly at night), weakened urinary stream, hot flashes, night sweats, breast enlargement, and an increased risk of many other chronic conditions.  While some of symptoms above can be the result of minor problems, they may also accompany serious problems and should be evaluated.  

Men over the age of fifty — and sometimes even younger — often start to experience some of the symptoms described above.  A simple salivary hormone test can clearly show which hormones are out of balance.  Subsequent supplementation with herbs and nutrients or natural bio-identical hormones can help realign the hormonal imbalances, resulting in a reduction of symptoms and a restoration of youthful vigor.