Male Hormone Treatment

Male hormones are steroids.  As such, they affect more than just sperm count and sperm quality to enhance fertility.  Recall that the fetal development is driven by the primal gonads that ultimately differentiate into testes and ovaries.  These dictate a baby’s cerebral growth, muscle fibers, nervous system, and hormonal chemistry (Schoenwolf, Bleyl, Brauer, & Francis-West, 2008).   

To think that the brain controls all of this development is an exercise in naivete.  Male hormones are powerful substances.  They can perform admirably when a couple is struggling with infertility.  Still, male hormones cannot remain compartmentalized when taken as therapy.  They affect all parts of the body and brain.  Thus, consideration must be made to the side and long-term effects.

Taylor Hooton, a 17-year-old high school baseball pitcher from Plano, Texas was 6-feet-2-inches, or 1.88-meters, and 180-pounds, or 82 kilograms (Grossfeld, 2008).  He wanted to use steroids for bulking his body, but a very common effect of steroids… emotional instability… destabilized him to the point that he hung himself from depression. This emotional instability effect is a frequent denominator. 

Pro wrestler Chris Benoit, “The Canadian Crippler,” portrayed it when he first strangled his wife, suffocated his 7-year-old son, placed a Bible next to their bodies, and then took the pulley of a weight machine and hung himself (ESPN, 2007).   Misapplication of male hormonal substances has been a popular item in the news media and Congress.  The topic appears to have taken root in the 1980’s when Denver Bronco’s defensive lineman Lyle Alzado developed a brain tumor and then admitted his violent moods were attributed to two decades of incessant male steroid use (Airoso, et al., 2014).

The sports industries and children’s sports arenas appear to be more regulated in recent years, but the infertility arena remains open for unmonitored use of these powerful agents.  Approximately 6% of men who are involved with infertility in some way admit to taking male hormone therapy (Zini, Fischer, Nam, & Jarvi 2004). 

These are not the vitamins to enhance spermatogenesis or new sperm growth under natural processes (vitamins and antioxidants C, D, E, B12, Folic Acid (B9), Selenium, and Zinc) or the popular herb, Saw palmetto that has received research support (Bennett & Hicklin, 1998; Jodai, et al., 1988; Lowe & Patel, 2008).  These are the very steroid structures that can cross all human membranes without any inhibition, influencing the nuclear “mind” of every cell in its path.  These are the anabolic substances that, upon entrance in the male human, become testosterone. 

Morales & Lunenfeld (2002), have given a more positive view to this risky business by considering that the benefits may outweigh the risks in some scenarios.  Take the elderly, who are not trying to conceive, but are trying to promote bone strength and a modicum of energy at the risk of emotional instability.  These elderly men with “andropause” struggle with very small testes, excessive fat around the belly organs, and decreased bone density. 

Testosterone patches, gel, or implants are prescribed if oral prescriptions are not selected such as fluoxymesterone, methyltestosterone, testosterone undecanoate, or mesterolone (Morales & Lunenfeld, 2002).  Vermeulen (2001), cautioned against this practice stating the risks exceed benefits, endanger the prostate especially, and hasten cellular mortality in an effort of gaining bone strength and vitality.  This sounds reminiscent of the risks and outcomes known to professional sports players and celebrated youth in the news media.

Still, sufficient levels of dehydroepiandrosterone (DHEA) are needed in the scrotal epididymis to ensure the maturation process in spermatozoa to sperm (Adimoelja  & Adaikan, 1997). Tribulus terrestris L (TTL), an herbal plant from Bulgaria and China, has been found to be high in DHEA.  Many use the active ingredient, Protodioscin, to enhance sexual vitality.  In special cases where a unique illness causes the adrenal glands to over secrete hormones, application of steroid “suppression” therapy can restore fertility to these men (Augarten, Weissenberg, Pariente, & Sack, 1991). 

What does this mean for the informed man, desiring to have virility, stamina, and fertility?  In a word, caution.  There are many substances well-suited for enhancing the body’s inherent capacity to heal, correct flaws, and restore deficiencies.  These include the vitamins and antioxidants, also called co-enzymes (vitamins C, D, E, B12, Folic Acid (B9), Selenium, and Zinc), which assist biochemical reactions throughout the human systems, especially reproductive.  Introduction of exogenous or externally-resourced steroids may need to be kept to extremely short-term use (as in days) to limit dangerous side and long-term effects.  There once was an old motto that has not been used of late: “everything in moderation.”

Male hormone treatment remains a hot topic.  The masculinization hormone therapies are much-sought after to combat the feminization influences of environmental effects and other chronic illnesses that sap virility.  Meanwhile, intermittent therapies (such as sildenafil/Viagra) are purchased with fervor to help “secondary” sex organ function, specifically penile performance.  Therapies exist in both the prescriptive and non-prescriptive arena.  The former is highly regulated and the latter is not. 

Moreover, phthalates (“thal-8’s”) or “endocrine disruptors,” used to soften typically hard poly-vinyl-chloride (PVC) plastic into plastic wrap, food containers, creams and lotions, have found their way into the food chain and now the herbal supplement supply (Schettler, 2006).   These substances are a major contributor to the feminization of the male reproductive system, globally.  The concept of “safe” is an elusive one.  Are there safe, non-prescription options available?  A short review of the concept of “safe” as well as some of the male hormone treatment options is in order.

What is “safe?”  In the technical sense, it does not exist.  To toxicologists, the concept is best-described using a standardized measurement tool, called a “lethal dose.”  The term “LD50” is the dose of a toxin or substance that would kill 50% of specified population after a specified duration such as a year (Lethal Dosage (LD50) Values, 2014).  Material Safety Data Sheets (MSDS) are created for those substances considered dangerous and thus require special handling instructions. 

You are probably familiar with MSDS sheets in all workplace settings.  Still, every substance from liquids to solids to radiation to pure water has an LD50.  Yes, physicians sometimes treat people for something referred to as “hyponatremia” when individuals imbibe too much pure water in too short a time and dilute their salt ratio!  So, nothing is “safe.” Vinegar (acetic acid) has an LD50 of 3.5-5.2 g/kg, table salt (sodium chloride) has an LD50 of 4.5 g/kg, and drinking alcohol (ethanol, that’s not denatured) has an LD50 of 11.3-21.3 g/kg (Krauskopf, 1973).

Halden (2010), declared bisphenol A and di-(2-ethylhexyl) phthalate (DEHP) was the most dangerous of the phthalates molecules.  DEHP has a high-molecular weight structure, which makes it attach to fatty food items easily that, in turn, becomes trapped in the body. 

DEHP has an LD50 of 26.3 g/kg in a guinea pig, 34.0 ml/kg in a mouse, 33.9 g/kg in a rabbit, and 30.6 g/kg in a rat (Krauskopf, 1973). Clearly, LD50 levels are extrapolated from tested animals rather than humans to create those MSDS sheets!  That said, Krauskopf (1973) reported a 70 kg.

man inadvertently ate 10 grams of dibutyl phthalate, then appeared at the hospital with nausea and vertigo where he then experienced near failure of his kidneys with a significant rash before eventually recovering with time. 

With this wonderful news, let’s consider the options for male hormone treatment. 

After all, many herbal remedies, specifically if the supplied using an emulsifier, emollient, or plasticized coating are known to be contaminated with phthalates.  Research questionnaires have revealed approximately a third of men who are involved with infertility activities take some form of alternative therapy (Zini, Fischer, Nam, & Jarvi 2004). These are men who use mostly antioxidants and vitamins, since research has supported these for improving spermatogenesis or growing new and stronger sperm. 

Saw palmetto and vitamins C, D, E, B12, Folic Acid (B9), Selenium, and Zinc have received support.  There are a small number of men who partake in male hormones, which is approximately 6% of this group.  Testosterone as dehydroepiandrosterone (DHEA), and Clomiphene citrate (Clomid) are the most-cited hormones for male hormone enhancement.  Testosterone, in more “pure” forms, are only available by prescription. 

The chief concern is many men do not sufficiently monitor their prostate and prostate levels when taking male hormone therapy, which can put them at significant risk for prostate cancer (De La Taille, et al., 2000; DiPaola, et al., 1998).  This increased frequency over normal is paramount given the steroid effects of the hormones.

DHEA is usually available in 25 mg and 100 capsules, plasticized. The starting dose of DHEA is often suggested between 15–75 mg, as a daily dose, but 50 mg is the average dose.  Clomiphene citrate can improve sperm counts but is usually used to assist women with irregular ovulation such as those with polycystic ovary syndrome (PCOS) (Fritz & Speroff, 2011).

By law, it requires a prescription and is usually dosed at 50 mg daily (1 tablet) for five days.  As such, clomiphene citrate is technically not an “herbal” remedy.  Using it for this secondary purpose, however, makes it an alternative therapy.

Just when you thought your male gonads were safe, the fear of sperm count reductions has taken a front seat… again.  It was 2008 when the U.S. Congress tried to put phthalates (“thal-8’s”) out of harm’s way by banning the toxin from children’s toys (Bernstein, 2014).  The idea was to limit oral ingestion of the “endocrine disruptors” so they would not infuse huge quantities of estrogen in little boys.  Sadly, the estrogen-structured phthalates chemicals continue to find their way in everything these days to soften poly-vinyl-chloride or PVC plastics from plastic wrap, to lunch bags, to creams and lotions.  These low-molecular weight phthalates are newer than the high-molecular weight structures Congress originally addressed.  Specifically, dimethyl phthalate (DMP), diethyl phthalate (DEP) and dibutyl phthalate (DBP) are the culprits used for these applications (Meeker, Sathyanarayana, & Swan, 2009).  According to Halden (2010), the most dangerous of phthalates molecules is considered to be bisphenol A and di-(2-ethylhexyl) phthalate (DEHP) because it is a high-molecular weight structure and thus more lipophilic, attaching to fatty items in food… and remaining trapped in the body.  It leaches from things seemly as innocent as bottled water and soft drinks.  Given the prevalence of softened and pliable plastics in our everyday world, it seems prudent to limit undue use, especially storing foods.

The annual production of plastics averages over 300 million tons, globally (Schettler, 2006).  The prevalence of plastics has shifted phthalates into the food chain.  Foods that have high-fat content have much greater contamination with phthalates usually such as DEHP (Cao, 2010).  Phthalates have now infiltrated almost everyone and can be detected in urinary metabolite biomarkers in 89% to 98% of the American population (Zota, Calafat, & Woodruff, 2014).  The increase in phthalates levels has demonstrated an association with depolarized mitochondria in sperm and is a contributing factor in the deterioration in overall semen quality (Pant, et al., 2008).  Phthalates has been also associated with penile volume reductions and higher numbers of boys with incomplete testicular decent (Swan, et al., 2005).

The diet is the primary point of entry for phthalates (Schettler, 2006).  Exercising caution in storing foods can reduce the risk of promoting additional exposure.  Selecting foods that are low in fat can ensure the concentration of phthalates entering your body each day is kept to a minimum.  High fiber diets can absorb phthalates in foods.  It is impossible to remove plastics, entirely.  However, using glass products and other non-plastic storage containers can be one way to combat this global love-affair with plastic and protect the male reproductive system.

 

References:

Adimoelja, A., & Adaikan, P. G. (1997). Protodioscin from herbal plant Tribulus terrestris L improves the male sexual functions, probably via DHEA. Int J Impot Res, 9(supp 1), S1-S70. Retrieved June 6, 2014 from https://www.andromedical.com/pdf/en/protodioscin.pdf

Augarten, A., Weissenberg, R., Pariente, C., & Sack, J. (1991). Reversible male infertility in late onset congenital adrenal hyperplasia. Journal of endocrinological investigation, 14(3), 237-240. doi:10.1007/BF03346799.

Bennett, B. C., & Hicklin, J. R. (1998). Uses of saw palmetto (Serenoa repens, Arecaceae) in Florida. Economic Botany, 52(4), 381-393. Retrieved August 4, 2014 from http://link.springer.com/article/10.1007/BF02862068#page-1

Grossfeld, S. (2008). A sad and revealing tale of teen steroid use. The New York Times. Retrieved August 4, 2014 from http://www.nytimes.com/2008/02/20/sports/20iht-doping20.10225773.html?pagewanted=all&_r=0

Jodai, A., Maruta, N., Shimomae, E., Sakuragi, T., Shindo, K., & Saito, Y. (1988). A long-term therapeutic experience with Cernilton in chronic prostatitis. Hinyokika Kiyo, 34(3), 561-568. Retrieved August 4, 2014 from http://www.researchgate.net/publication/12057682_Phytotherapy_for_benign_prostatic_hyperplasia/file/d912f506aef0431da3.pdf#page=174

Justin Airoso, Reham Al Ahmad, Jerome Azarewicz, Christopher Balogh, Michael Barbieri, Hasan Bashir, & Andrew Berdahl. (2014). Steroids In Professional Sports. Retrieved August 4, 2014 from http://www.personal.psu.edu/cjb5120/seventhassignment.html

Kamel, R. M. (2010). Management of the infertile couple: an evidence-based protocol. Reproductive Biology and Endocrinology, 8(1), 21. Retrieved August 4, 2014 from http://www.rbej.com/content/8/1/21/

Lowe, F. C., & Patel, T. (2008). Complementary and alternative medicine in urology: what we need to know in 2008. BJU international, 102(4), 422-424. doi: 10.1111/j.1464-410X.2008.07702.x.

Morales, A., & Lunenfeld, B. (2002). Investigation, treatment and monitoring of late-onset hypogonadism in males. Official recommendations of ISSAM. The aging male, 5(2), 74-86. Retrieved August 4, 2014 from http://centromedicoathenas.com.br/pdf/Investigation_treatment_and.pdf

Schoenwolf, G. C., Bleyl, S. B., Brauer, P. R., Francis-West, P. H. (2008). Larsen’s Human Embryology: With Student Consult Online Access, 4th ed. Churchill Livingstone. ISBN-13: 978-0443068119.

Steroids discovered in probe of slayings, suicide. (2007). ESPN.com news services. Retrieved August 4, 2014 from http://sports.espn.go.com/espn/news/story?id=2917133

Vermeulen, A. (2001). Androgen replacement therapy in the aging male—a critical evaluation. The Journal of Clinical Endocrinology & Metabolism, 86(6), 2380-2390. Retrieved August 4, 2014 from http://press.endocrine.org/doi/full/10.1210/jcem.86.6.7630

Zini, A., Fischer, M. A., Nam, R. K., & Jarvi, K. (2004). Use of alternative and hormonal therapies in male infertility. Urology, 63(1), 141-143. doi: http://dx.doi.org/10.1016/j.urology.2003.07.018.

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