Bombshell: Explosive Medical Secrets That Will Redefine Aging (20 page)

AM:
Estrogen in men comes from the conversion of testosterone to estrogen. As men age, their testosterone goes down but so does their estrogen. Higher estrogen is often found in men who are obese. If you have more fat tissue, you have more aromatase, which is an enzyme that converts testosterone to estradiol. If you have more aromatase as a man, you are going to end up with more estradiol. If those levels are excessive, you are at a higher risk of getting breast tissue (you’ve seen those man boobs on guys who are heavy). Actually, some studies show that when estrogen levels are too high or too low in men, there is a higher risk of atherosclerosis and stroke, and when estrogen levels are too low, a greater risk of osteoporosis.

SS:
Is there danger in those scenarios?

AM:
Well, if he has boobs, he’s in danger of somebody thinking he’s a woman.

SS:
There’s always somebody for everybody! [Laughs.]

AM:
There may also be some rare instances when a man has extremely high estradiol levels and it interferes with his response to testosterone therapy. However, those cases are rare. It is not unusual to see a mild or modest increase in estradiol in men who are receiving T therapy, or in overweight individuals, and by and large, the elevated estradiol is unlikely to cause any trouble at all. Men with more abundant fatty tissue may have more aromatase, but I’m not aware of any problems that arise from too much aromatase. Specifically, there is no reason to think that aromatase itself is a risk for cancer.

SS:
Is it true that the prostate is akin to a woman’s breast?

AM:
In what way?

SS:
My understanding is that a woman’s breast has ducts where
we make the milk. Similarly, the prostate has ducts where testosterone makes food for the sperm. In connecting the dots, it seems to me that when a man stops producing or is not making very much testosterone anymore, the prostate enlarges, looking for its key ingredient, testosterone, which was always there and now is not. And that the remedy (it seems to me) is to replace the missing or deficient testosterone; it would calm the prostate down because now it has what it needs and will, therefore, return to its original size.

AM:
Well, that’s a brilliant conclusion, Suzanne! Of course I say so because I’ve wondered the same thing! Enlarged prostates happen to older men and do not happen to twenty-year-olds. When I lecture, I usually find somebody in the audience who is under thirty and I point him out and ask if he realizes that he is at his peak of production of testosterone? They are always very proud, and then I ask, “Do you feel your prostate growing right now?” People laugh because it’s absurd.

But then why has the thinking been that enlargement of the prostate comes from high testosterone? If that were true, every young man would have prostate cancer or enlarged prostates and it just doesn’t happen. That model for T and enlarged prostate growth, and prostate cancer, has been wrong. It makes more sense, logically, that testosterone (or DHT) may actually prevent prostate growth, since enlarged prostates occur when we age and T has declined.

SS:
So the prostate is looking for testosterone? I ask because men have been given testosterone as a cancer preventative in Europe for over fifty years.

AM:
What exactly causes cancer is open for debate. Could be a lot of things, particularly in this environment of toxicity and stress; but I think yours is as good a hypothesis as any that happens in the normal environment for the prostate where the hormonal environment has been disrupted. I wrote an editorial this past year for the journal
Cancer
about how low testosterone is now being seen in many studies as a risk for bad cancers. I’m talking about
low
testosterone, not
high
! I enjoyed writing that article about how the original thinking has been turned upside down.

Suzanne, perhaps I think overly simplistically about some of these things, but I believe one can make a reasonable argument that testosterone therapy may reduce the impetus for prostate cancer to grow or metastasize. It’s like a bear in the woods that has lots of berries and fish around. He’s happy, he has lots of food, and he doesn’t have
to travel very far. Suddenly you take that same bear and take away the food; no fish, no berries. That bear now has to go far afield to find food and survive. He might even need to start changing its habits to find other sources of nourishment. Similarly, think about a prostate cancer that likes testosterone; if there’s not much around it’s going to find other “food sources” or might find ways to travel far afield to get what it needs. There are multiple studies that show that men with low testosterone are at risk for getting not only prostate cancer but also higher-grade and more aggressive cancers. A number of studies performed in the laboratory have shown that prostate cancer cells appear to behave less aggressively when exposed to abundant levels of testosterone, and more aggressively when deprived of testosterone.

SS:
It makes sense.

AM:
I believe before too long the data will be strong enough so that it will be possible to say that having normal amounts of testosterone is protective from developing prostate cancer. It may well be the
key factor
to keeping those cancers well behaved.

SS:
Well, it has been my belief for the last six or seven of my books that it is an environment of balanced hormones for men and women that can prevent cancer. The theories you have just stated apply to women as well as men; if high estrogen caused women to get breast cancer, then all young women, who make tons of estrogen, would have breast cancer. The environment in a young woman is of balanced hormones; it’s not until menopause when the balance is “off” that the cancers and problems begin. You know, connect the dots.

AM:
Having normal testosterone doesn’t necessarily mean somebody’s going to live forever, but I do think it’s a key component for general health.

SS:
You are speaking of quality of life, and for a man, maintaining his mojo?

AM:
Yes, it’s impossible for a man without testosterone to keep (your word) his mojo. Aging is complicated, and there are many factors that determine why one will age well and the other doesn’t.

SS:
So what we’ve said in this interview, if I may paraphrase, is: Testosterone does not cause prostate cancer, and if a man has had prostate cancer he can and should take testosterone replacement. And now the new big news from your research; if a man has active cancer, he can and should take testosterone replacement?

AM:
Almost. I’m not prepared to say yet that a man
should
take testosterone if he has been diagnosed with prostate cancer. At this
point, I do feel that many men who are symptomatic from low levels of testosterone will benefit from it, and the evidence so far, which is still quite limited, is that most of these men with prostate cancer who do receive T will not have any problems with it. However, there are situations where I would
not
give testosterone. And although the evidence regarding aggressive prostate cancer and
low
testosterone is intriguing, I’m also not ready to say yet that T therapy is a good treatment for prostate cancer. Right now that is just an idea—an interesting one—that may or may not turn out to be true. Hopefully we’ll have a chance to explore that possibility over the next few years.

As for the use of testosterone therapy in men without prostate cancer, I do think there is more and more evidence that a normal T concentration is good for health and longevity.

However, there is a strong public and even medical sentiment that the decline in testosterone as men age is “natural,” and therefore “good.” It is as if God/Nature designed us this way, so why are we mucking around with the natural decline in hormones? It’s a struggle to convince those with that thinking that there may be important benefits to hormone treatment in men. Sometimes, nature isn’t wonderful!

Your books, Suzanne, with the message that there is a new way to age and that hormones are a key ingredient, have had a huge influence. Some of the men who come into my office tell me that their wife or girlfriend read “that Suzanne Somers book,” they’re now feeling great, and they want their man to feel as good as they do, so he can keep up!

SS:
[Laughs.] Glad to boost your business!

AM:
The present notion that whatever happens to us as we age is “supposed to happen” makes my brain hurt! There is this idea that we are supposed to age gracefully like Katharine Hepburn in
On Golden Pond
.

SS:
Yes. I don’t think that beautiful lady was aging gracefully. Her head was shaking; she had all sorts of problems.

AM:
Yes, but it is a very romantic notion. What most people don’t recognize is that aging sucks! Big time! This is how I respond when people ask, “Why can’t we age gracefully, naturally?” Aging is associated with all sorts of lousy things—bad eyes, bad hearing, bad brains, bad teeth, bad joints, bad blood vessels. And cancer! All these are “natural” events that occur with aging. We treat all these to improve the quality of our lives, and in many cases to live longer and better. The testosterone deficiency that accompanies aging in men is really
no different. I had perfect vision until I turned forty or so, and now I can’t read anything without glasses. Should I give up my glasses because the diminished vision of aging is “natural”? That would be ridiculous!

SS:
We have to help ourselves, and your work is redefining that paradigm. Hormones are the antidote for everything you just mentioned except for bad eyes and that will be taken care of by nanobots thirteen or so years from now. For instance, it was Dr. Jonathan Wright who told me in my book
Breakthrough
that loss of hearing was a result of low aldosterone [a hormone] and by replacing aldosterone, many of his patients’ hearing is coming back measurably. My own husband, who had lost 5 percent of hearing in the upper ranges, has had his hearing restored by replacing aldosterone daily.

AM:
It’s time science starts thinking about quality of life. We’ve been depriving men of testosterone for no good reason other than a fear based on a misunderstanding of a small study performed over seventy years ago. Since the time of Huggins we started depriving men with advanced prostate cancer first by castration and then with medicines like Lupron and Zoladex. Those medications can be enormously helpful in some men with very advanced prostate cancer, particularly if they have metastases and pain, and also if given for a short while prior to radiation therapy, where it seems to improve outcomes. However, these testosterone-lowering medications have been used far too frequently, and at a considerable cost to the health and lives of men. Lowering testosterone levels to zero, or close to it, causes osteoporosis, which puts men at risk for fractures; it also increases the risk of heart attacks.

When the PSA goes down with treatment, patients and their doctors tend to be pleased because that seems like a good thing. It may be good for prostate cancer, and bad for health. A huge study published last year found that “cancer-specific survival” was improved in a group of men treated with androgen deprivation, but the overall survival was the same.

SS:
What does that mean?

AM:
It means that fewer people who were deprived of androgen died of prostate cancer, but they still died at the same rate as men who were not androgen deprived. They died of other things, like heart attacks. And in all likelihood they were miserable—low or absent sex drive, chronic fatigue, depression and irritability, weight gain.

Lowering testosterone severely causes men to increase their fat and increases their risk of getting metabolic syndrome and diabetes. The risk of a fracture increases substantially. The medical establishment jumps for joy that we saved a man from prostate cancer, but in doing so we produced conditions that killed him anyway. That’s not much of a victory.

SS:
And along the way they look and feel like crap.

AM:
Right. The big issue is this. If men don’t live any longer with a treatment, and they have no quality of life due to the loss of testosterone, then what the heck are we doing? Is this good medicine? I don’t think so. But in medicine there has been too much emphasis on statistics and pieces of data that do not tell the whole story, such as “cancer-specific survival.” Not enough thought goes into the misery men experience when deprived of the very essence of what makes them a man.

SS:
I believe I am not alone in thinking that I am interested in being on the planet for a long time but only with a quality of life.

AM:
Same for me … but here’s the good news: Little by little it’s changing. More and more people, even within the medical community, are opening their eyes and paying attention to what makes us healthy and vital. So, with that, I am not only hopeful, but enthusiastic.

SS:
This is all good news. Thanks so much for your time, Dr. Morgentaler, and keep doing your good work.

AM:
Thank you, Suzanne. It’s been my pleasure.