Every man who lives long enough will face prostate symptoms. All men will also see a decrease in testosterone levels as they age and many men will have difficulty controlling their blood sugar levels as the mechanisms that regulate it fail over time. These three contributors to accelerated aging are intertwined and routinely related. Luckily, with a little attention, a man can maintain health despite the physiologic challenges of being a guy.
Prostate symptoms can include hesitancy of urination or trouble going, increased frequency of urination, sexual dysfunction, and other symptoms that can mimic back pain or digestive concerns. Benign prostatic hypertrophy (BPH) or enlarged prostate is very common especially in men over 55 years old. However, younger men may experience symptoms of BPH as well and BPH isn’t the only pathology of the prostate.
Prostatitis can be infectious or non-infectious and prostate cancer can be confused with BPH. It makes sense to be screened for prostate health, yet even this has come under fire recently. The PSA or prostate-specific antigen blood test has been used routinely to screen for prostate cancer, often along with a physical examination. However, the value of this test is hotly debated, with no real alternative screening procedure.
To add complication to a man’s vigilance to his prostate health is that symptoms of blood sugar regulation can mimic symptoms of an enlarged prostate. For example, diabetes or even a prediabetic state can cause increased frequency and volume of urination known as polyuria. Polyuria as well as BPH may result in nocturnal urination or waking up to go at night. Polyuria in diabetes or prediabetes often accompany excessive thirst (polydipsia) and increased appetite (polyphagia). However, increased thirst and appetite may simply be caused by mild to moderate dehydration, stress, or even changes in one’s schedule.
As if that were not hard enough, the constant decreased production of testosterone can cause depression, sexual performance challenges, blood sugar dysregulation, and can contribute to the increased size of prostate tissue. The effect of testosterone in prostate health is also a debated topic among medical circles. Quite often, improvements to testosterone can alleviate prostate symptoms yet testosterone may feed an existing prostate cancer.
So, when motivated to improve the health of an aging male body, it is important to take a full look at all of these aspects to catch dysfunction as early as possible to improve quality of life. Here are the biomarker players of the aging male.
Free and total Testosterone- Free testosterone is the bioavailable testosterone that fuels the male hormone system. Its level is what matters when men are diagnosed with “low T” or low testosterone levels. About one to four percent of testosterone is found as free testosterone as another marker known as Sex Hormone Binding Globulin wraps up the bioavailable testosterone.
Sex Hormone Binding Globulin (SHBG)-Because of the value of free testosterone and the known association with SHBG, attempts have been made to decrease SHBG through dietary manipulation, supplements and medications. As a man ages, his SHBG levels increase.
DHT (Dihydrotestosterone)- Male-pattern baldness is due to this highly potent metabolite of testosterone. DHT is three to four times stronger than free testosterone and once made does not get further metabolized. The important enzyme that converts testosterone to DHT is 5-alpha-reductase. For both prostate symptoms as well as male-pattern baldness, medications can inhibit this enzyme but these medicines are not without risk.
Estrogen-While commonly thought of as a female hormone, and it is, estrogen is important in moderate levels in men as well. However, where there is estrogen, there is growth. Excess estrogen can exacerbate prostate symptoms. An important enzyme known as aromatase converts testosterone to estrogen. This enzyme is found in high supply in fat (adipose) tissue.
Insulin-When being screened and even diagnosed for diabetes, fasting glucose is often measured. However, insulin controls SHBG and testosterone levels possibly by altering enzyme activity and is now being measured routinely as well. It is possible to catch early signs of blood sugar dysregulation by measuring fasting insulin as well as fasting glucose. High levels of insulin cause 5-alpha reductase and aromatase to be more active, raising DHT and estrogen levels.
The pattern that we should be concerned with is the following: Low Free Testosterone, high SHBG, high DHT, high Estrogen, and high Insulin.
It is possible to “aim and fire” at each of these biomarkers to manipulate and control physiology. Rather, if we think of hormone health as a complex symphony, this approach often fails. So, now instead of treating blood sugar dysregulation, low testosterone, depression, sexual performance challenges, prostate enlargement, and each of the biomarkers above with separate medicines, a single clinical entity of accelerated male aging can be treated.
Nutrients that support aging male physiology include zinc, essential fatty acids, selenium, vitamins E and D. Interestingly, zinc is known to inhibit 5-alpha reductase as well as perform other essential functions throughout the body. Fatty acids and vitamin D can reduce inflammation and selenium and vitamin E are important antioxidants for the hormone system. These nutrients are routinely tested for in any integrative practitioner’s practice.
Saw palmetto and stinging nettle are commonly used herbs in dietary supplements for prostate health. Saw palmetto is known, like zinc, to inhibit the action of 5-alpha reductase. Stinging nettle binds to SHBG instead of testosterone being bound to SHBG. This creates more available free testosterone. Progesterone, often used as a cream topically, can counteract the effects of estrogen. Natural progesterone is often synthesized from wild yam (I would strongly encourage using a paraben-free product). Chrysin is an aromatase inhibitor which is an active constituent of blue passion flower.
So, while all of these natural products have their place, men do not age prematurely because of stinging nettle deficiency syndrome. Supporting aging male physiology consists of foundational health. This includes hydration which is directly implicated in several contributors of accelerated aging, minimal red meat consumption, periodic sexual contact, and stress management. Three liters of water per day is recommended for most men with most of it consumed early in the day as to not contribute to nocturnal urination. Red meat should be limited to four servings per week and I strongly recommend grass-fed meats whenever possible as these have less inflammatory fatty acid content.
Weekly ejaculation supports the health of the prostate as well as overall healthy aging. Chronic stress can cause trouble with the hypothalamus-pituitary-adrenal axis which in turn can cause hormone dysregulation. Certain adaptogenic herbs can be helpful. One such herb is Lepidium peruvianum when appropriate phenotypes or colors are used and the proper preparation is used to improve bioavailability. This type of herbal supplement is for proper tone of the interplay between the nervous system and the endocrine system, and as such, should be thought of differently than those herbs that have a singular mechanism of action.
However, as mentioned earlier, the conversion of testosterone to estrogen is done by the enzyme aromatase which is found in fat. The very best way to reduce the activity of aromatase is to reduce the mass of metabolically activity fat tissue. Even for seemingly slender individuals, excess fat tissue is a problem for the aging male. This is where body mass index calculations do not help guide therapy. As men age muscle loss, known as sarcopenia, is combined with an accumulation of fat. This change in body composition is collectively known as sarcopenic obesity, which should be the primary target for men as they age. A combination of adequate protein intake, resistance training, and copious amounts of plant nutrients is the key recipe for this pattern.
The aging male, which described typically as those 55+, may apply to any man who has accelerated the aging process with poor dietary habits, high or chronic stress, or a sedentary lifestyle. Even without prostate enlargement, depression, sexual dysfunction, or known blood sugar dysregulation, accelerated aging can be addressed to support well-being and vitality.
Dr. Schuler is the National Medical Educator for Natural Health International, an education-driven natural products company with an emphasis on foundational health and hormone balance.