Stephen Gangemi, DC, DIBAK ICAK USA - 2015 THE FEMINIZATION OF THE MALE SPECIES.

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

Copyright Stephen Gangemi DC, DIBAK

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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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• 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 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


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Emotional Issues: Emotional Issues: DopamineDopamine

• Dopamine: motivation , learning, stress management, addictions

• Testosterone impacts dopamine receptors in men

• Dopamine LH Testosterone


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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)


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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


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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)


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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


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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


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SulfationSulfation• Cysteine• Vitamin B6 (P-5-P)• Vitamin B12 (Methyl B12)• Folic acid (5MTHF)


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Extrahepatic Estrogen Extrahepatic Estrogen DetoxDetox

• Breast, prostate, fat tissue• METHLYATION• GLUTATHIONE• ACETYLATION• DIINDOLYLMETHANE• INDOLE-3-CARBINOL• ROSEMARY


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METHLYATIONMETHLYATION

• Cycle between methionine and homocysteine

• Methyl B12• 5MTHF• P-5-P• Magnesium• Betaine & Choline


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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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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



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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


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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)


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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


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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: [email protected]: drgangemi.com

sock-doc.com


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Stephen Gangemi, DC, DIBAK ICAK USA - 2015 THE FEMINIZATION OF THE MALE SPECIES.

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Transcript of Stephen Gangemi, DC, DIBAK ICAK USA - 2015 THE FEMINIZATION OF THE MALE SPECIES.