Post on 26-Dec-2015
Stephen Gangemi, DC, DIBAKICAK USA - 2015
THE FEMINIZATION OF THE MALE SPECIES
The The OverviewOverview
• There is a growing number of males of all ages showing increased estrogen levels and/or decreased testosterone levels.
• Diet, lifestyle, and environment play a significant role.
Copyright Stephen Gangemi DC, DIBAK 2
GoalsGoals
• Learn the signs and symptoms of estrogen-testosterone imbalances
• Learn ways to evaluate and treat these hormonal imbalances naturally, to improve and vitalize health
Copyright Stephen Gangemi DC, DIBAK 3
Estrogen In UteroEstrogen In Utero
• 2D to 4D ratio• The smaller the 2D:4D ratio the
greater testosterone exposure in the first trimester
• Or, better said: The longer your ring finger compared to your index finger the more androgen exposure
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Estrogen During Estrogen During PubertyPuberty
• Tanner Stages or Sexual Maturity Stages (SMR)
• SMR 3 – typically ages 12-13• Acne• Perspiration increases• Growth spurt• Breast tissue – gynecomastia
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Estrogen During Estrogen During PubertyPuberty
• Gynecomastia: swelling of the breast tissue in boys or men, caused by an imbalance of the hormones estrogen and testosterone
• Tender lump under one or both nippleso Increase in the ratio of estrogen/testosteroneo Is it normal? – Obesity link
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Estrogen During Estrogen During PubertyPuberty
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Estrogen in AdultsEstrogen in Adults
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Elevated Estrogen/Low Elevated Estrogen/Low Testosterone RisksTestosterone Risks
• Stroke• Heart disease• Prostate cancer• Dementia/Alzheimer’s disease• Obesity/Metabolic syndrome
• Diabetes
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Signs and Symptoms Signs and Symptoms of High Estrogenof High Estrogen
• Increased body fat• Loss of muscle tone• Fatigue• Enlarged prostate• Erectile Dysfunction/low libido• Emotional issues (e.g. depression,
anxiety)
• Poor sports performanceCopyright Stephen Gangemi DC, DIBAK
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Pitching a Tent: SREPitching a Tent: SRE• Are you waking up with an
erection?• Sleep-related erection (SRE)• SREs start as we enter the REM phase of our
sleep cycle and last until the next cycle of non-REM sleep
• SREs are linked to levels of testosterone• Erectile function is a good predictor of
current cardiovascular problems as well as future risk of heart attacks and strokes
Copyright Stephen Gangemi DC, DIBAK
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Emotional Issues: Emotional Issues: DopamineDopamine
• Dopamine: motivation , learning, stress management, addictions
• Testosterone impacts dopamine receptors in men
• Dopamine LH Testosterone
Copyright Stephen Gangemi DC, DIBAK
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Emotional Issues: Emotional Issues: SerotoninSerotonin
• Serotonin (low): loss of pleasure, “depressed”
• Testosterone increases serotonin sensitivity in men
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Causes of Low T:ECauses of Low T:E• Stress• Overtraining (under resting)• Insulin resistance• Xenoestrogens• Phytoestrogens• Genetics• Protective mechanism (male prenatal care
drops testosterone levels)Copyright Stephen Gangemi DC, DIBAK
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StressStress
• Adrenal gland depletion• High cortisol, low or depleted DHEA• DHEA Androstenedione
Testosterone
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OvertrainingOvertraining
• Aerobic/Anaerobic imbalances• Thyroid and adrenal gland dysfunctions• Inadequate rest
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Insulin ResistanceInsulin Resistance• Cells no longer respond properly to insulin• Fatigue, especially after meals• Weight gain or can’t lose• Cravings for sweets• Aches and pains (inflammation)
High estrogen in men (and high testosterone in women)
Copyright Stephen Gangemi DC, DIBAK
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XenoestrogensXenoestrogensChemical estrogen mimicker / hormone
disruptors imitate estrogen in the body
•PCBs (polychlorinated biphenyl) – plastics, sealants, adhesives, fire retardants •BPA (Bisphenol A) – plastics; (resin identification code 7)
•Phthalates – plastics, stabilizers, sealants (everything from toys to cleaners to hair spray)•Parabens•Insecticides/Herbicides
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PhytoestrogensPhytoestrogens
Plant based estrogen mimicker
•Phytoestrogens (soy primarily)•Molds (Mycoestrogens) mycotoxins
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SoySoy• Soy isoflavones bind to the body's
estrogen receptors and display estrogen-like effects
• Controversy over decreasing the T:E• Fermented tempeh, miso, natto, and
soy sauce okay• Unfermented not – especially soy
protein isolates
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Conventional TreatmentConventional Treatment• Drugs
o Testosterone Cypionate- shoto Androgel - gelo Striant – patcho Natesto – nasal spray
• Problemso Doesn’t address the causeo Pituitary suppression (FSH & LH)o Conversion to estrogen
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The BiochemistryThe Biochemistry
• Low T:E or high E:T • Inability to make testosterone or
over conversion to estrogen via the aromatase enzyme
• Conversion to DHT via 5α-reductase enzyme
Copyright Stephen Gangemi DC, DIBAK
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Inability to Make Inability to Make TestosteroneTestosterone
• The substrateso Vitamin Eo Selenium, Zinc, Irono Vitamin A – not beta carotene o Vitamins B3 and B5o Saturated fatso BCAAso Pituitary FSH/LH
• FSH – Sertoli cells in testes initiate spermatogenesis• LH – Leydig cells in testes make testosterone
o Adrenal glands (DHEA)
Copyright Stephen Gangemi DC, DIBAK
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Aromatase EnzymeAromatase Enzyme• Aromatase converts testosterone to
estradiol• Most activated by insulin resistance due to
a high carbohydrate diet• Higher estrogen, in turn, increases insulin
resistance• And the insulin resistance increases
estrogen• Aromatase inhibitor medications
• Arimidex and FemaraCopyright Stephen Gangemi DC, DIBAK 24
Estrogen Detox: LiverEstrogen Detox: Liver
• Phase 1 liver detox Hydroxylation: CYT P450 enzymes
• Vitamins B2 (FADH) and B3 (NADPH) activate the CYT P450 enzymes
• Antioxidants due to free radicals (ROS – reactive oxygen species) generated during process
Copyright Stephen Gangemi DC, DIBAK
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Estrogen Detox: LiverEstrogen Detox: Liver
• Phase 2 hormone detox in the liver primarily via:
Glucuronidation and Sulfation
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GlucuronidationGlucuronidation• Artichoke• Magnesium• Investigate insulin issues
Copyright Stephen Gangemi DC, DIBAK
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SulfationSulfation• Cysteine• Vitamin B6 (P-5-P)• Vitamin B12 (Methyl B12)• Folic acid (5MTHF)
Copyright Stephen Gangemi DC, DIBAK
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Extrahepatic Estrogen Extrahepatic Estrogen DetoxDetox
• Breast, prostate, fat tissue• METHLYATION• GLUTATHIONE• ACETYLATION• DIINDOLYLMETHANE• INDOLE-3-CARBINOL• ROSEMARY
Copyright Stephen Gangemi DC, DIBAK
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METHLYATIONMETHLYATION
• Cycle between methionine and homocysteine
• Methyl B12• 5MTHF• P-5-P• Magnesium• Betaine & Choline
Copyright Stephen Gangemi DC, DIBAK
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GLUTATHIONEGLUTATHIONE
• Cysteine• Glycine• Glutamic Acid• Magnesium & Potassium • Selenium
o Parathyroid
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ACETYLATIONACETYLATION
• Pantothenic acid – vitamin B5• Pantethine is activated pantothenic
acid
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The Others…The Others…• INDOLE-3-CARBINOL
o Brassica vegetables: cabbage, cauliflower, broccoli, Brussels sprouts, kale, collard greens
• DIINDOLYMETHANE (derived from digestion of I3C)
• ROSEMARY
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Evaluation & Evaluation & TreatmentTreatment
• Laboratory testing• Applied kinesiology assessment• Signs & symptoms
• Office treatment/therapy• Lifestyle changes• Dietary changes and/or supplements
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Laboratory TestingLaboratory Testing
• Free and total testosterone by LC/MS (Liquid chromatography/ Mass spectrometry)o LabCorp #070038o NOT the direct method by analogue radioimmunoassay
• Free estrogens (E2 – estradiol)• FSH and LH
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Laboratory TestingLaboratory Testing
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6.0 High % 4.8 − 5.6 01
LabCorp
Laboratory Corporation of America
LabCorp Burlington 1447 York Court
Burlington, NC 27215−3361
Phone: 800−762−4344
Specimen Number
Patient ID
Control Number
Account Number
Account Phone Number 866−999−4041
Route 09
Patient Last Name
Account Address PROFESSIONAL CO−OP SERVICE INC
850 West Dania Beach Blvd Dania Beach FL 33004
Patient First Name
Patient Middle Name
Patient SS# Patient Phone Total Volume
Age (Y/M/D) 63/00/08
Date of Birth 06/17/52
Sex M
Fasting No
Patient Address Additional Information
Date and Time Collected 06/25/15 16:00
Date Entered 06/25/15
Date and Time Reported 06/28/15 01:35ET
Physician Name NPI Physician ID GANGEMI
Tests Ordered Testosterone, F Eqlib+T LC/MS; Hemoglobin A1c; Ferritin, Serum
TESTS
Testosterone, F Eqlib+T LC/MS
RESULT
FLAG
UNITS
REFERENCE INTERVAL
LAB
Testosterone, Total, LC/MS 851.4 ng/dL 348.0 − 1197.0 01 Testosterone, Free 8.26 ng/dL 5.00 − 21.00 % Free Testosterone 0.97 Low % 1.50 − 4.20 01
Hemoglobin A1c
Increased risk for diabetes: 5.7 − 6.4 Diabetes: >6.4 Glycemic control for adults with diabetes: <7.0
Ferritin, Serum 85 ng/mL 30 − 400 01
01 BN LabCorp Burlington Dir: William F Hancock, MD1447 York Court, Burlington, NC 27215−3361
For inquiries, the physician may contact Branch: 800−762−4344 Lab: 800−762−4344
Laboratory TestingLaboratory Testing
Copyright Stephen Gangemi DC, DIBAK
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LabCorp
Laboratory Corporation of America
LabCorp Burlington 1447 York Court
Burlington, NC 27215−3361
Phone: 800−762−4344
Specimen Number
Patient ID Control Number
Account Number
Account Phone Number
Route 09
Patient Last Name
Account Address PROFESSIONAL CO−OP SERVICE INC
850 West Dania Beach Blvd Dania Beach FL 33004
Patient First Name
Patient Middle Name
Patient SS# Patient Phone
Total Volume
Age (Y/M/D) 20/03/03
Date of Birth 03/06/95
Sex M
Fasting No
Patient Address
Additional Information
UPIN: U83560
Date and Time Collected 06/09/15 09:11
Date Entered 06/09/15
Date and Time Reported 06/15/15 13:57ET
Physician Name GANGEMI , S
NPI
Physician ID
Tests Ordered Estradiol, Free Serum; Testosterone, F Eqlib+T LC/MS; FSH and LH; Drawing Fee
General Comments
A duplicate report has been generated due to demographic updates.
TESTS Estradiol, Free Serum Estradiol, Serum, MS
Reference Range: Adult Males: 8.0 − 35
Free Estradiol, Percent Reference Range: Adult Males: 1.7 − 5.4
RESULT 22
2.4
FLAG
UNITS pg/mL %
REFERENCE INTERVAL
LAB 01 01
Free Estradiol, Serum Reference Range: Adult Males: 0.2 − 1.5
Testosterone, F Eqlib+T LC/MS
0.53 pg/mL 01
Testosterone, Total, LC/MS 230.3 Low ng/dL 348.0 − 1197.0 02 Testosterone, Free 4.65 Low ng/dL 5.00 − 21.00 % Free Testosterone 2.02 % 1.50 − 4.20 02
FSH and LH LH
<0.2
Low
mIU/mL
1.7 − 8.6
02
FSH <0.2 Low mIU/mL 1.5 − 12.4 02
01 ES Esoterix Endocrinology Dir: Samuel Pepkowitz, MD4301 Lost Hills Road, Calabasas Hills, CA 91301−5358
02 BN LabCorp Burlington Dir: William F Hancock, MD1447 York Court, Burlington, NC 27215−3361
For inquiries, the physician may contact Branch: 800−762−4344 Lab: 800−762−4344
LSASS with EstrogenLSASS with Estrogen
• Ligament Stretch Adrenal Stress Syndrome
• Estrogen affects fibroblasts that make up collagen which is the main component of connective tissue
• Challenge the ligament stretch with estrogen
Copyright Stephen Gangemi DC, DIBAK
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Insulin and Sugar Insulin and Sugar ChallengesChallenges
• Aerobic testing with sugar• Hyperinsulinemia testing (Dr.
Schmitt)• Dysglycemia testing (Left TMJ –
drgangemi.com)• “Fatty Rub” with insulin (Dr. Lebowitz)
Copyright Stephen Gangemi DC, DIBAK
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Estrogen ChallengesEstrogen Challenges• Estrogen with Heart Rate Variability
(WS HearthMath technique)• “Fatty Rub” with estrogen
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Lifestyle Changes Lifestyle Changes Dietary Dietary
• High saturated fat diet• High quality protein• Low carbs, eliminate refined carbs• Chemical-free products• Organic foods
Copyright Stephen Gangemi DC, DIBAK
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Lifestyle Changes Lifestyle Changes Exercise Exercise
• True aerobic – not “chronic cardio”• Anaerobic/HIIT: in moderation• Strength
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Lifestyle ChangesLifestyle Changes• Stress reduction• Sleep quality• Cosmetics, body products - anything
in contact with the body• Cleaning products• Stop watching Oprah
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Questions, Information Questions, Information & Research & Research
Email: drgangemi@gmail.comWebsites: drgangemi.com
sock-doc.com
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