The Diagnosis and Treatment of Male Andropause in Your Practice – Part II
by Dr. Greg Fors, DC – Board Certified Neurologist DIBCN Posted On: 08/12/2011
In my previous article, ‘The Diagnosis and Treatment of Male Andropause in Your Practice – Part One’ I laid the foundation for the understanding and diagnosis of male Andropause. Please refer to part one for any clarification on symptomatology and diagnostic criteria in the treatment of this very common disorder. The primary symptoms of Male Andropause include increased abdominal fat, decreased muscle mass, irritability, depression, anxiety, difficulty concentrating, and decreased facial and leg hair. Recall that the underlying metabolic cause of this disorder in aging male patients is too little free testosterone and too much estrogen. Please refer to my first article for optimal laboratory levels when diagnosing and following appropriate treatment protocols.
Raising Testosterone Levels Naturally The best botanical agent known to raise testosterone levels in aging males is the plant known as Tribulus Terrestris, a flowering plant that grows throughout India, Pakistan and Sri Lanka. Indian Ayurvedic practice utilizes this plant as a primary male tonic. The key compounds found in Tribulus Terrestris are extracted from the aerial parts of the plant. The subsequent extract contains a whole host of phytoactive and phytodynamic ingredients, the most important being protodioscin and its related steroidal saponins.
Independent studies have shown that Tribulus Terrestris steroidal saponin extracts increase hormone levels, but not outside the normal range. These steroidal saponins increase testosterone levels by increasing Gonadotropin-Releasing Hormone (GnRH) production within the hypothalamus. This in turn stimulates the production of Luteinizing Hormone (LH) and Follicle-Stimulating hormone (FSH) in the anterior pituitary gland. In males, LH stimulates Leydig cell production of testosterone and FSH stimulates spermatogenesis in the testes. This regulatory system controlling testosterone is often referred to as the hypothalamic-pituitary-testicular axis.
Research has now established that the primary steroidal saponin in Tribulus Terrestris that creates these physiological effects is protodioscin. Protodioscin has been shown to directly elevate testosterone by increasing the production of LH(1) and by increasing testosterone precursors such as dehydroepiandrosterone(2) and dehydroepiandrosterone sulphate.(3) Unfortunately, most Tribulus based supplements contain none or only negligible amounts of this protodioscin, therefore, benefits to your patient are questionable. This is not the case if your Tribulus formula is standardized to contain a specific content of protodioscin of at least 10%. However, this is only half the problem; once testosterone has been elevated you must make certain that at least 2% consists of the free unbound form and isn’t converted to estrogen.