testosterone

Can Zinc Reverse Low Testosterone? A Case Study

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Zinc is an essential mineral required for numerous biochemical processes such as DNA and immune system regulation, structure formation that includes collagen synthesis, and regulation of steroid hormone synthesis. The mechanisms for these zinc-dependent processes are in-part shown within the DNA whereby zinc acts as a factor for gene transcription. In addition, zinc regulates how proteins are made, and acts as a co-factor for proteins/enzymes such as angiotensin converting enzyme (ACE).

Testosterone is a steroid hormone that controls cell signals important for both males and females. It is synthesized at a much higher rate in males and is well known for its positive effects on muscle protein synthesis and mass. Testosterone is of particular importance for development of male secondary sexual characteristics, and promotes maturation and release of sperm. This hormone is made within Leydig cells of the testis in males. Because of this, zinc is considered to be an essential mineral for fertility and fertilization. The reduction of this mineral causes Leydig cells to become morphologically smaller with apparent abnormal cellular structures that include the endoplasmic reticulum.

Like other steroid hormones, testosterone is synthesized from cholesterol followed by circulation in plasma. These hormones are mostly bound to specific transport proteins (e.g., sex hormone-binding globulin) leaving a small fraction as “free” hormones. Free steroid hormones are able to produce physiological effects by binding steroid nuclear receptors found in the cytoplasm or the nucleus of cells. Interestingly, binding of nuclear receptors to DNA requires zinc-finger motifs (small regions of a protein structure). In addition, testosterone is converted to the more biologically active form, dihydrotestosterone, by the zinc-dependent enzyme 5-alpha-reductase.

Zinc Deficiency and Low Testosterone

Multiple clinical and animal studies have strongly demonstrated the connection between levels of zinc and its relation to circulating testosterone levels. For example, one meta-analysis study included 38 manuscripts (8 clinical and 30 animal) concluded that zinc deficiency reduces levels of testosterone. In addition, they found that zinc supplementation improves testosterone levels. Another study showed that serum testosterone levels were much higher in men who supplemented with zinc for 3-6 months (3.7 fold increase) Therefore, zinc is required for three important factors regarding levels of testosterone:

  1. Functionality of nuclear steroid receptors by zinc finger motifs.
  2. Conversion of testosterone to its more biologically active form, dihydrotestosterone, by action of zinc-dependent enzymes.
  3. Biosynthesis of testosterone.

How does zinc control testosterone biosynthesis? Testosterone is secreted by Leydig cells which produce 0.17-0.35 mmol/24hrs after stimulation with luteinizing hormone (LH). LH is stimulated by a hypothalamus hormone (GnRH) in both males and females. In females, this same hormone (LH) stimulates ovulation at mid-menstrual cycle. At the biochemical levels, the synthesis begins with cholesterol which undergoes a convoluted cascade of steroid hormone chemical “adjustments” thereby producing a variety of steroids. These are mediated by cytochrome P450 enzymes and lead to production of steroid hormones including: pregnenolone, progesterone, cortisol, and DHEA. In a zinc deficiency, some of these cytochrome enzymes that lead to testosterone production, such as P450scc, become downregulated.

In addition, zinc controls storage and secretion of multiple enzymes, including enzymes that depend on zinc for function. These enzymes are involved in cell signaling and for the activity of certain proteins that bind to DNA. An example would be the ACE enzyme, which contains zinc in its structure and is therefore zinc dependent. Zinc deficiency impairs ACE’s activity which leads to reduction of testosterone levels, followed by reduced sperm production. Zinc also plays a role in how LH receptors signal, and a chronic deficiency will induce oxidative stress within Leydig cells. Because of this, with zinc deficiency, Leydig cells are able to uptake cholesterol but cannot convert it properly to testosterone.

Case Study: Pyroluria With Zinc Deficiency and Low Testosterone

This is a follow up from the previously presented case of a young man who was diagnosed with pyroluria (or Hemopyrrollactamuria “HPU”). This individual presented with multiple zinc-deficiency related symptoms that also matched with symptoms of low testosterone. Zinc RBC levels showed marked reduction of intracellular zinc, while other mineral levels were in range (copper, selenium, magnesium). The patient was deficient in zinc even after initiating lower doses of zinc (daily 7-15 mg) for 8 months prior to these results. The patient began a treatment of 60-80 mg of daily zinc glycinate taken at nighttime. He experienced significant bodily changes within one week. These included deepening of his voice, new hair growth on arms, and substantial increase in libido. After one month of continued positive changes, it was shown that his total testosterone levels increased by 135, while the free testosterone increased by 29 which is significant and correlates with positive bodily changes.

Increase in Total and Free Testosterone With Zinc Supplementation

The patient continued to take zinc supplements. He is still experiencing the positive changes, and there was no reduction in any of the positive changes previously reported. The patient was asked to measure total/free testosterone levels, now about 2.5 months into treatment. Due to circadian variation, blood levels of testosterone were evaluated from a morning draw. Testosterone, like zinc, is affected by circadian variation with a peak around 09.00 hr and trough at 18.00 hr. Studies show a variation of testosterone levels as much as 30% between 08.00 and 16.00 hr.

The results show continued increase of total and free testosterone levels (see figure). Specifically, total testosterone increased to 786 ng/dL, and free testosterone increased to 93.1 pg/mL. This accounts for an overall 49% and 85% increase for total and free testosterone over baseline, respectively. It is important to mention here that the patient did not have any major changes to his diet, supplement, or exercise regimen other than addition of high doses of zinc (initially 80 mg, and currently at 90 mg zinc glycinate). It is worth noting here that this patient likely had much lower testosterone levels 8 months prior to this treatment. This is because he had already commenced on 15 mg of zinc for 8 months prior to the 04/11/2023 blood draw. However, he clearly needed more zinc which was being selectively depleted due to HPU.

low testosterone and zinc
Figure 1. Total testosterone with zinc supplementation.
Testosterone and zinc
Figure 2. Free testosterone with zinc supplementation.

Conclusion

Zinc is an essential mineral and has been clearly demonstrated in clinical, animal, and biochemical studies to be involved in the synthesis of testosterone. Testosterone levels can be affected by various dysfunctions, including genetic factors and mineral deficiencies. The case presented here demonstrates that reduced levels of testosterone in adult males should include zinc deficiency analysis in the differential diagnosis. Zinc RBC assessment is preferable over plasma/serum levels for reasons previously detailed. Because of the risk (minor in this case) for zinc-induced copper depletion, future tests for this patient will include zinc and copper assessment to monitor sufficiency status and confirm that his copper levels have not been significantly altered.

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More people than ever are reading Hormones Matter, a testament to the need for independent voices in health and medicine. We are not funded and accept limited advertising. Unlike many health sites, we don’t force you to purchase a subscription. We believe health information should be open to all. If you read Hormones Matter, and like it, please help support it. Contribute now.

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Hormone Treatment During Pregnancy and Gender Variance in Later Life

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For as long as I can remember, I’ve always had an unusual partially feminine gender identity, but until recently I never consciously acknowledged it. Then, a couple of years ago I realised that, although at a conscious level I identify as male, my body language, my pattern of arousal and orgasm, and my instinctive social behaviour are all very much more like what you’d typically see in a woman rather than a man. In addition, I appear to be suffering from secondary hypogonadism (i.e. my brain regions that control hormones aren’t working correctly), and I have a “eunuchoid” body structure, which indicates that my testosterone production has been below normal all my life.

Is Being Transgendered Just One of Those Things?

Although it never became my career, as a student I excelled at both chemistry and biology, and I’ve retained an amateur interest in the sciences ever since. Most people seem to assume that being transgendered is “just one of those things”, but I resolved to use that background in science to try and figure out whether there was an actual physical explanation for it. Accordingly, I tried to discover as much as I could about sexual development in the unborn child, and the kinds of things that can go wrong with that process.

Sexual Blueprints

Our sex-determining chromosome, the Y chromosome, is far smaller than any of our other chromosome and only has a few dozen functional genes on it. Basically all the Y chromosome does is to tell your undifferentiated gonads to turn into testicles (without it they’ll turn into ovaries instead). All of the genetic blueprints for actually building a male or female body are located elsewhere in your genome, so everyone has the full set of instructions for both sexes.

By default the “female” instructions are what get followed during fetal development, but if there’s testosterone present, the “male” instructions will be followed instead. Ordinarily this system works quite well, and you’ll develop as one sex throughout the pregnancy (which one depending on whether you have testicles churning out testosterone or not).

An Endocrine Disruptor

What appears to have happened in my case is that the pregnancy was no different from that of any other male baby, except that partway through the second trimester, something catastrophic happened that severely disrupted my endocrine system, so that for a few weeks I wasn’t producing any testosterone. Following that, my endocrine system recovered and everything went back to normal for the remainder of the pregnancy. The result is that I was built using the instructions for male development for most of the pregnancy, but during the time I wasn’t producing any testosterone, the instructions for female development were followed instead. That seems to have happened after all my physical development had completed, but very early in the process of wiring up my brain’s permanent structure (all the things that are affected seem to be associated with evolutionarily ancient parts of the brain, which points to the period of female development having happened early on in the process of wiring up my brain).

Based on when genital development takes place and when the process of building the permanent structure of the brain begins, I was able to work out that whatever it was must have happened somewhere around 16 or 17 weeks after conception, at or very soon after the time my mother would have first felt me moving inside her. Knowing what she was like when I was younger, my immediate thought was that she must have had a depressive episode, decided that she couldn’t cope with another child so soon after the first, and taken an overdose of something in an attempt to bring on a miscarriage.

A DIY Abortion That Didn’t Take

A bit of snooping on maternity forums soon revealed that the first thing most unhappily pregnant women contemplating a DIY abortion seem to think of is an overdose of contraceptive pills. I was able to subsequently confirm that my parents were using birth control pills for contraception at the time – the high dosage first generation ones. There was also something otherwise completely inexplicable that happened later in my childhood, which makes me think she must have been hiding a guilty secret along those lines.

My mother passed away in 2010, and in a way I’m glad that happened before I discovered any of this, because I would have been angry with her and she didn’t deserve that. She did her best to be a good mother to me and to all her other children, and I don’t hold her responsible in any way for what happened. I can’t blame my father either. He lost 3 brothers during his childhood and then his first wife died on their honeymoon, so I can understand why he became so obsessed with the idea of having a large family.

Brain Sexual Identity and DES

One further thing that made me think an exposure to artificial female hormones is the cause of my conditions was reading in the book “Brain Sex” about a pattern of behaviour commonly shown by teenage boys whose mothers were given treatment with a drug called diethylstilbestrol or DES in an attempt to prevent miscarriage . The boys in the study were typically very shy, socially withdrawn, had low self esteem, were regarded as sissies, bullied, ostracised by their peers, with no ability to fight back when attacked and no interest in sport. The authors of the book described it as “feminized behaviour”, and my teenage years matched it so closely it could have come straight out of my school report!

The main hormonal component of the contraceptive pills my parents were using is norethisterone acetate, a progestin, whereas DES is an estrogen. What estrogens and progestins both have in common is that they are female hormone derivatives, and are basically completely incompatible with masculinity. Both types of hormone have the ability to disrupt testicular hormone production at quite modest doses, well below those commonly used for medical treatment for women.

DES was for many years used to chemically castrate men suffering from hormone-sensitive prostate cancer, while progestins are commonly used for chemical castration of sex offenders and transsexuals. If they also suppress testosterone in a male fetus, then any use of them during a pregnancy of a male child carries a risk of creating a baby who developed as the wrong sex for part of the pregnancy. This is what I think happened to me, and to the DES sons.

For nearly two years I’ve been trying to find out as much as I can about DES sons, reading their personal accounts of how they’ve been affected and chatting with them online. Among the ones I’ve had contact with or whose life stories I’ve read, there seems to be a very high incidence of both intersex-related genital abnormalities and gender dysphoria. As a group they seem to commonly experience many of the same problems I have (a genital abnormality, feminized behaviour as a teenager, low testosterone and problems with hormones, gender variance). The key difference is that on the whole they seem to be far more psychologically female than I am (which is exactly what you’d expect, considering that their exposure was for a much larger part of the pregnancy than mine). I think it’s quite likely that for most of them, their testosterone production was completely suppressed and they were developing as female throughout the time their mothers were on the drug!

DES and all other estrogens were withdrawn from use in pregnancy 30 years ago, however, treatments for prevention of miscarriage, based on progestins rather than estrogens, continue to be used to the present day. One of these involves a progestin called hydroxyprogesterone caproate, given as a weekly intramuscular injection of either 250mg or 500mg, starting 16 weeks into the pregnancy – just around the time I think my hormone exposure occurred. The difference is that this treatment continues to be administered for the remainder of the pregnancy. If this drug does suppress testosterone production in a male fetus, then it’s hard to imagine a treatment better suited to creating as baby with a male body but a female brain! I’m fairly sure that if you gave an adult man 250mg per week of this drug, his testosterone production would be seriously impaired. Why wouldn’t the same happen to a male fetus?

Females Affected Too

In this article, I’ve only been looking at the effects of artificial sex hormones on a male fetus, however it’s likely that, under the right circumstances, a female fetus could be affected too. This could happen if the external hormone mimics the action of testosterone (e.g.progestin induced virilization), or if it disrupts endogenous hormone production in a way that causes excessive androgens to be produced (hyperandrogenism).

Postscript: This article was published previously September 2013. 

Improving Male and Female Fertility with Vitamin D

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Vitamin D is essential to a healthy life, at any stage, yet its effectiveness is often overlooked by practitioners treating parents who are trying to conceive. The overwhelming majority of infertility cases are treated with drugs or surgical procedures, and are successful less than 50 percent.

Supplementation presents a simple, safe, inexpensive, and potentially effective approach to preparing for fruitful conception. In this article, I address vitamin D’s role in reproduction, evidence supporting the positive effect of this nutrient on fertility, and how to become vitamin D healthy parents.

Vitamin D’s Role in Reproduction

The human reproductive system comprises billions of cells. Every cell in the female and male reproductive systems contains genetic codes as well as a receptor to receive vitamin D.
Vitamin D is actually a steroid hormone produced by our body. We manufacture vitamin D when we take a quality vitamin D3 supplement, expose our skin to optimal sun light, or consume lots of fatty fish or vitamin D3-fortified foods.

Cells in the female reproductive system (including the ovaries, fallopian tubes, uterus, placenta, and decidua) are replete with vitamin D receptors. The male reproductive system cells (including the testes, prostate, and urethra) also are abundant with vitamin D receptors.

When we have ample amounts of activated vitamin D, it binds with its receptor to regulate genes in our reproductive system. For example, activated vitamin D in the female reproductive system controls the genes involved in estrogen production. Vitamin D also regulates several genes during the process of embryo implantation.

Conversely, when the reproductive system lacks activated vitamin D, genes essential to conception are not expressed. Hence, the chances of achieving successful conception are diminished.

Both Mom and Dad Need Vitamin D for Fertility

For many couples, getting pregnant and carrying a pregnancy to term present daunting challenges. But few understand how vitamin D plays a role in fertility of both biological parents. Scientific research indicates that the significant prevalence of vitamin D deficiency correlates to the incidences of infertility cases in women and men:

  • Researchers in Milan, Italy conducted a study of 335 women who were candidates for in vitro fertilization (IVF). Published in the August 14, 2014 issue of The Journal of Clinical Endocrinology & Metabolism, the study demonstrated that the women with vitamin D levels of more than 30 ng/mL (75 nmol/L) enjoyed the highest chance of pregnancy. The researchers concluded vitamin D is an emerging factor influencing female fertility and IVF outcome.
  • Greek researchers recently examined 30 years of scientific literature on the role of vitamin D in human reproduction. The accumulated evidence suggests that vitamin D is significantly involved in the reproductive system of both genders. Regarding fertility, the researchers noted that vitamin D status is associated with semen quality and sperm count, motility, and morphology. Moreover, they concluded that there also is a positive effect of vitamin D supplementation on testosterone concentrations and fertility outcomes. The review was published in a 2013 issue of the International Journal of Clinical Practice.
  • An Australian fertility specialist, Anne Clark, M.D., presented findings to the 2008 Fertility Society of Australia Conference that demonstrated the role of low vitamin D in men. More than one-third of the 794 men who underwent a vitamin D blood serum test were determined to be deficient in vitamin D (as well as folate). Among the couples where the male completed supplementation treatment for nutritional deficiencies, more than one-half conceived naturally or with minimal treatment.

How to Become Vitamin D Healthy Parents

In today’s modern indoor living, the most effective source of vitamin D3 (cholecalciferol) is an oil-based soft gel or liquid supplement. Vitamin D3 supplements are available over the counter in retail and online stores. Beware of vitamin D prescriptions as most contain vitamin D2 (ergocalciferol) that is much less effective than vitamin D3.

The amount of vitamin D3 depends upon your vitamin D level, derived from a simple blood test called 25(OH)D. Assume you are vitamin D deficient (most people are) and get your blood tested by your healthcare practitioner.

Based on the results of your test, supplement daily with vitamin D3 to safely increase your blood levels. A number of vitamin D experts believe a healthy vitamin D range is at least 50 to 80 ng/mL (125 to 200 nmol/L).

Repeat the test in three to six months. Increase or maintain your daily D3 dose in response to your current level. Getting within range will take time (at least months) but rest assured that you will be gaining vitamin D wellness that should increase your chances of getting pregnant.

Vitamin D’s benefits do not end with fertility! Stay tuned for my next Hormones Matter article “Maternal Vitamin D: Pregnancy and Beyond.”

Editor’s Note: Susan Rex Ryan is an award-winning author who is dedicated to vitamin D awareness. Her extensive collection of health articles can be found on Hormones Matter as well as on her vitamin D blog at smilinsuepubs.com. Follow Sue on FB “Susan Rex Ryan” and Twitter @vitD3sue.

Hormones Matter does not provide medical advice, diagnosis or treatment.

Copyright © 2014 by Smilin Sue Publishing, LLC
All rights reserved.

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Uterus and Ovaries: Fountain of Youth

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Numerous studies have shown a strong correlation between removal of both ovaries / bilateral oophorectomy (castration) and accelerated aging as measured by an increased risk of chronic health conditions. Hysterectomy / uterus removal with preservation of both ovaries is also associated with some of these chronic conditions. These include heart disease, stroke, metabolic syndrome, osteoporosis, hip fracture, lung cancer, colorectal cancer, dementia, Parkinsonism, impaired cognition and memory, mood disorders, sleep disorders, adverse skin and body composition changes, adverse ocular changes including glaucoma, impaired sexual function, more severe hot flushes and urogenital atrophy. Wow, that’s quite a list!

Ovaries: Health Powerhouses

This 2016 article titled “Study: Remove ovaries, age faster” sums up the findings of Mayo Clinic researchers proving yet again the harmful and unethical practice of ovary removal. The study found that ovary removal (oophorectomy) is associated with a higher incidence of 18 chronic conditions and should be discontinued in women who are not at high risk for ovarian cancer. Although this study cites the increase in chronic conditions in women who undergo oophorectomy before age 46, other studies have shown that oophorectomy even after menopause does more harm than good. Here is one that showed that to be true up to age 75.

The ovaries have both reproductive and endocrine functions as detailed in this International Menopause Society article. After menopause, the ovaries produce mostly androgens, some of which are converted into estrogen. Testosterone levels are more than 40% lower in women without ovaries compared to intact women. Women without their uterus likewise have lower levels but not as low as women without ovaries per this article. Estrogen therapy mitigates some but not all of the increased health risks of oophorectomy. But estrogen further reduces androgen levels increasing risk of osteoporosis and fracture. Nothing can replace the lifelong functions of the ovaries (and uterus).

The Uterus / Ovaries / Tubes Connection

The harms of ovary removal would also apply to ovarian failure that commonly occurs after hysterectomy and some other medical treatments. As previously cited, women who have had a hysterectomy have lower levels of testosterone. According to this 1986 publication, 39% of these women showed signs of ovarian failure. This study showed a nearly 2-fold increased risk of ovarian failure when both ovaries were preserved and nearly 3-fold when one was preserved. This likely explains the increased risk of heart disease and metabolic conditions as shown by multiple studies including this recent Mayo Clinic one. However, per this 1982 study, the uterus itself protects women from heart disease via the uterine substance prostacyclin. Loss of bone density is another harm of hysterectomy as shown by multiple studies such as this one.

Removal of even one ovary (unilateral oophorectomy) without hysterectomy is also harmful. Studies out of the Mayo Clinic showed increased risks of cognitive impairment or dementia and parkinsonism. Colorectal cancer is another increased risk according to this Chinese study and this Swedish one.

The Fallopian tubes appear to impair ovarian function to some degree as evidenced by Post Tubal Ligation / Sterilization Syndrome. This study shows an increase in Follicle Stimulating Hormone (FSH) after tube removal (salpingectomy).

Ovarian impairment after hysterectomy or salpingectomy is thought to be the mechanism of the reduced risk of ovarian cancer which is already rare.

The Uterus: Anatomy, Sex, Cancer Prevention

Hysterectomy is associated with other harms besides impaired ovarian / endocrine function. The uterus and its ligaments / pelvic support structures are essential for pelvic organ integrity as well as skeletal integrity. The effects on these structures and functions are detailed here and here. This article shows the many hysterectomized women lamenting their “broken bodies” – changes to their figures, back, hip and midsection pain, pelvic pain, bladder and bowel issues, and effects of severed nerves and blood vessels.

The uterus and associated nerves and blood vessels play a key role in sexuality and vibrancy. You can hear the desperation in women’s comments about the devastating sexual losses and feelings of emotional emptiness.

There is an increased risk of renal cell, thyroid, and colorectal cancers after hysterectomy. How ironic when cancer fear tactics are commonly used to market hysterectomy and/or oophorectomy.

Adhesions that commonly form after these surgeries can cause serious problems especially in the long term. Surgical complications – nerve injuries, bladder, bowel and ureter injuries, vaginal cuff dehiscence, a too short vagina, infections, hemorrhage – are more common than indicated by gynecologists.

Although “The Miraculous Uterus” article fails to mention the anatomical harms, it is otherwise “spot on.” It talks about the “ovarian conservation scam” and that “passion, love, ecstasy, the emotional essence that drives human achievement, forever after elude them.” This explains why “there’s no effective outrage against the barbarism of hysterectomy.”

Compelling Evidence of Harm

Clearly, there is compelling medical evidence that both hysterectomy and oophorectomy are destructive surgeries. Unfortunately, some hysterectomy forums censor negative posts giving a slanted view of the life shattering effects. Here is a sampling of women’s experiences on the Gyn Reform site.

The medical literature on the harms of these surgeries dates back over a century. Listed below are a small number of the numerous publications (minus the ovarian failure studies cited above). The Gyn Reform website has a fairly comprehensive list of resources on oophorectomy. Its Ovaries for Life sister site provides a good overview of the lifelong importance of our ovaries.

1912 – The Physiological Influence of Ovarian Secretion

1914 – Nervous and Mental Disturbances following Castration in Women

1958 – The controversial ovary

1973 – Osteoporosis after Oophorectomy for Non-malignant Disease in Premenopausal Women

“Oophorectomy before the age of 45 years was found to be associated with a significantly increased prevalence of osteoporosis within three to six years of operation.

1974 – Endocrine Function of the Postmenopausal Ovary: Concentration of Androgens and Estrogens in Ovarian and Peripheral Vein Blood

1978 – The emotional and psychosexual aspects of hysterectomy

1981 – Premenopausal hysterectomy and cardiovascular disease

1981 – Sexual response after hysterectomy-oophorectomy: Recent studies and reconsideration of psychogenesis

1981 – The role of estrogen and oophorectomy in immune synovitis

1982 – Prostacyclin from the uterus and woman’s cardiovascular advantage

1989 – The effects of simple hysterectomy on vesicourethral function

“The results show that simple hysterectomy is associated with a significant incidence of post-operative vesicourethral dysfunction and that there is an identifiable neurological abnormality incurred at operation which is pertinent to the subsequent disordered voiding.

1990 – Effects of bilateral oophorectomy on lipoprotein metabolism

1994 – The climacteric ovary as a functional gonadotropin-driven androgen-producing gland

1996 – Urinary incontinence in older women: who is at risk? Study of Osteoporotic Fractures Research Group

“Urinary incontinence is a common problem in older women, more common than most chronic medical conditions. Of the associated factors that are preventable or modifiable, obesity and hysterectomy may have the greatest impact on the prevalence of daily incontinence.

1997 – Bladder, bowel and sexual function after hysterectomy for benign conditions

1998 – Ovaries, androgens and the menopause: practical applications

1998 – Impairment of basal forebrain cholinergic neurons associated with aging and long-term loss of ovarian function

1998 – Influence of bilateral oophorectomy upon lipid metabolism

1999 – Estrogen and movement disorders

2000 – The hypothalamic-pituitary-adrenal and gonadal axes in rheumatoid arthritis

2000 – Risk of myocardial infarction after oophorectomy and hysterectomy

2000 – Hysterectomy, Oophorectomy, and Endogenous Sex Hormone Levels in Older Women: The Rancho Bernardo Study

2005 – Ovarian conservation at the time of hysterectomy for benign disease

Ovarian conservation until age 65 benefits long-term survival…. There is sustained, but decreasing, benefit until the age of 75, when excess mortality for oophorectomy is less than 1%.

2007 – Ovarian conservation at the time of hysterectomy for benign disease

Approximately 78% of women between the ages of 45 and 64 years have prophylactic oophorectomy when hysterectomy is performed for benign disease. Therefore, the decision to perform prophylactic oophorectomy should be approached with great caution for the majority of women who are at low risk of developing ovarian cancer.”

2009 – Ovarian conservation at the time of hysterectomy and long-term health outcomes in the nurses’ health study

In no analysis or age group was oophorectomy associated with increased survival.

2010 – Current indications and role of surgery in the management of sigmoid diverticulitis

A previous history of hysterectomy is a valuable clinical clue to the correct diagnosis as colovaginal and colovesical fistulas are rare in females with their uterus in place, as the uterus becomes a screen interposed between the inflamed colon and the bladder and vagina.”

2012 – Oophorectomy for whom and at what age? Primum non nocere

2016 – Study: Remove ovaries, age faster

2017 – Cardiovascular and metabolic morbidity after hysterectomy with ovarian conservation: a cohort study

A Harmful Practice That Won’t Die

Ovary removal / castration was introduced by Robert Battey in 1872 and “was practised widely for several decades….. Better insight into female physiology and ovarian function finally pushed the sinister operation of Robert Battey from the scene.” This publication refers to Battey’s operation as “barbaric.”

Despite the long-standing and compelling evidence of harm, these surgeries continue at alarming rates. Publications are misleading in that they report inpatient surgeries despite the large majority being outpatient (70% in 2014). This 2008 article reported that oophorectomies “more than doubled in frequency since the 1960’s.” According to results of a FOIA request by Ovaries for Life, there are over 700,000 oophorectomies every year despite there being only ~22,000 cases of ovarian cancer. Hysterectomy figures obtained by Ovaries for Life are also shocking at 830,000 in light of less than 70,000 cases of endometrial and cervical cancers.

Many media reports have questioned the high rate of these surgeries since gynecologic cancers are rare. The oldest one I could find was dated 1969. I found about three articles per decade in the mainstream media since then. According to the Athena Institute, half of U.S. medical schools in 1986 “had changed their suggestions and were now recommending a reconsideration of the common practice of ovariectomy.” Evidently, that never took hold.

Congress held two hearings on hysterectomy, one in 1976 and one in 1993. The 1993 transcripts state that the hysterectomy rate increased 250% in women ages 15 to 24 and 186% in ages 25 to 34 from 1965 to 1984! Despite these shocking statistics, it appears that no action was taken after either hearing.

According to this “Reassessing Hysterectomy” article, the Agency for Healthcare Research and Quality sponsored research and conferences on the overuse of hysterectomy in the 1990’s. This article is packed with information on the prevalence and harms of hysterectomy and oophorectomy as well as alternative treatment options. Yet, the high rate of hysterectomy has continued such that 45% of women will end up having one. Citing 2006 data, the oophorectomy rate was 73% of the hysterectomy rate.

How to End the Harm?

I’ve been researching this subject for over 10 years and sharing my experience and knowledge on various websites. It’s shocking how many women are misled and deceived into these surgeries. Age doesn’t seem to matter; younger and younger women are undergoing these surgeries. This appears to be the biggest surgical racket and women’s healthcare con as discussed here.

There are a number of issues that perpetuate the gross overuse of these harmful surgeries. These include:

  1. These surgeries and “forever after” care are very lucrative.
  2. The public has been led to believe that the female organs are disposable after childbearing is complete.
  3. Medical education and decades of practice have made these surgeries “a standard of care.”
  4. Informed consent is seriously lacking.
  5. Gynecology consent forms are open ended giving surgeons “carte blanche” to remove organs unnecessarily.
  6. We still live in a climate of gender disparity / male dominance.

As you can see from the list of publications above, some study authors have called out the practice of ovary removal as unethical. Numerous professional societies have issued guidelines discouraging its use in most women. But most have been silent on the overuse of hysterectomy despite its many harms.

Why has our government not stepped in to address this egregious harm? Women who have contacted their legislators have been met with indifference. Gyn Reform reported on their experiences with legislators and other authorities who can effect change. The non-profit HERS Foundation has been educating women and advocating for informed consent legislation since the 1980’s.

Why do insurance companies approve so many of these surgeries that are rarely necessary? Not only are the surgeries themselves expensive, treatments for the chronic after effects are costly. Reining in unnecessary treatments especially those that cause lifelong harm would go a long way towards making healthcare more affordable.

Why has Graduate Medical Education (GME) not changed their surgical requirements to favor organ preservation? Each resident must do at least 70 hysterectomies but there is no requirement for myomectomy (fibroid removal). Residents don’t need to do any cystectomies (cyst removals) either which is partly why so many women lose ovaries for benign ovarian cysts. Here are the GME ob/gyn requirements.

A popular mantra at Tufts in the 1970’s – “There’s no room in the tomb for the womb” – reflects this culture of the disposable uterus and gynecologists’ obsession with its removal. Insurance reimbursement rates are also to blame as they incentivize hysterectomy and oophorectomy over myomectomy and cystectomy. In many cases, medical management versus surgery is the appropriate course. The “Reassessing Hysterectomy” article cited above lists a number of treatment options for gynecologic problems. Revamping reimbursement rates to strongly favor organ preservation should eventually force GME to change their requirements. But how do we make that happen?

We Need Your Help

More people than ever are reading Hormones Matter, a testament to the need for independent voices in health and medicine. We are not funded and accept limited advertising. Unlike many health sites, we don’t force you to purchase a subscription. We believe health information should be open to all. If you read Hormones Matter, like it, please help support it. Contribute now.

Yes, I would like to support Hormones Matter. 

Lucas Cranach the Elder, Public domain, via Wikimedia Commons

Testosterone and Breast Cancer: Quick News

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Estrogen receptor positive (ER+) cancers account for approximately 75% of all breast cancers. In ER+ the cancers respond to the presence or absence of estrogens (estrone, estradiol). Almost 65% of ER+ cancers are also progesterone receptor positive (PR+) meaning the cancer also responds to presence or absence of progesterone. In contrast, the HER2 strain of cancers involves an over production of the protein epidermal growth factor. HER2+ cancers are not amenable to hormone treatments and have not been linked to hormone levels, until recently.

A study published in Cancer Epidemiology Biomarkers and Prevention (Sieri et al. 2009) found that high circulating levels of testosterone were associated with an increased risk of breast cancer in menopausal women. The association was strongest for ER+ cancers, but was also present ER- cancers such as the HER2 strain.  Though the association between testosterone and HER2+ cancers was not as strong as observed in the ER+ cancers, it was significant and merits additional research.

The role of androgens in breast cancer is controversial and there are differences between the hormone levels locally in the breast tissue versus those in circulation. Nevertheless, this study suggests that broader research, diagnostic and potentially treatment approach may be warranted.
To read this study go to: (Cancer Epidemiol Biomarkers Prev 2009;18 (1):169–76).

Wide Awake: A Hysterectomy Story

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I’ve always considered myself to be someone who takes charge of her life and health. After all, we only get one body, one heart, one set of eyes, one uterus, one pair of ovaries and so on. I never smoked and always exercised. I went in for my yearly pap smears. I never took my good health for granted.

However, as it turns out, I had no idea how my body functioned or how I remained healthy. Not really. I didn’t understand how my female organs and hormones contributed to who I was. That is, I didn’t understand until my life fell completely apart after hysterectomy and ovary removal five years ago. Now, I’m wide awake.

On September 27, 2007, I woke up in recovery after undergoing a complete hysterectomy I didn’t need or consent to. I was coerced into agreeing to removal of my uterus after experiencing a distended abdomen. I looked six or seven months pregnant and was wearing maternity clothes. Only after surgery did I learn that my distended abdomen had nothing to do with my uterus. At no time did I agree to removal of my cervix, tubes or ovaries. Even my doctor agreed that I should keep my healthy ovaries.

When I arrived at the hospital the morning of my surgery, I was presented with a consent form which listed the wrong surgical procedure. According to the new consent, all of my healthy female organs were to be removed. I explained to the nurse that this was not the surgery I agreed to and I refused to sign the consent. As I waited to speak with my doctor about this, another nurse came into my room and said he was going to give me something to relax me. I explained that I didn’t want to be given any medication since I had not signed the consent and was waiting to speak with my doctor.  As I was protesting, he injected my IV with Versed.

That was my last waking memory.

My next memory was that of seeing a nurse I didn’t recognize. I asked her if my doctor was on his way to talk with me and she told me that I had already had surgery. In disbelief, I began to sob and asked what type of surgery. I wanted to know what organs had been removed. She matter-of-factly said “You have nothing left.” I cried out that I wanted to die, a curious fact that is noted in my medical record. Everything seemed to be happening in slow motion. Although I lost a lot of blood and had to be taken back to surgery, I was released the next morning with a prescription for hormones and iron pills.  I had no idea just how much my life was about to change.

I went back to my apartment but everything seemed different. It wasn’t that the apartment had changed. It was me. I felt like a different person. I also felt an emptiness I’ve never known. I assumed this was only temporary and would pass as I healed. I remembered researching hysterectomy and reading about how some women feel emptiness afterward because they can no longer have children. Eventually, I healed from the outward surgical wounds, but the emptiness remained. It was an emptiness that transcended far beyond not being able to have any more children.  I suddenly found myself in a body that didn’t feel like mine. Every bone, muscle and joint cried out in pain. I felt as if I had aged twenty years. My abdomen never did return to normal size. My sexuality vanished. My emotions were blunted. I didn’t know what was happening to me but I was afraid – very afraid. I cried for no reason and for every reason.  I did not want to live in the body I’d been left with.

Not knowing what else to do, I went out to a local bookstore and bought every book I could find on the topic of hysterectomy and hormones. One of the first books I read was “Hysterectomy Hoax” by Stanley West M.D. By the time I finished reading Dr. West’s book, I was finally wide awake. I had been castrated and there was no turning back. Finally, I realized I did not feel like the same woman because I wasn’t the same woman.  I felt a deep sense of betrayal. I became desperate to find a way to “fix” myself.

The truth is that there are over 400 estrogen receptor sites in a woman’s body. Every organ depends on an estrogen type hormone to function properly (there are three main estrogens: estrone, estradiol and estriol along with many more we’re only now beginning to understand) . Estrogens protect the heart, brain, lungs, bladder and more. The thyroid gland has estrogen receptors. When the ovaries are removed, the body often attacks the thyroid. Many women who’ve undergone hysterectomy go on to develop thyroid anti-bodies and/or thyroid disease. I developed thyroid problems almost immediately after surgery. I was first diagnosed with Hashimoto’s disease and then Hypothryroidism. I’ll have to take thyroid medication for the rest of my life. A woman’s brain has estrogen receptors too. Without estrogens, the brain develops diseases such as Dementia and Parkinson’s Disease. Memory and concentration are very real problems I face almost daily. Heart disease is a much greater risk for woman once their female organs are removed due to the loss of heart protection via the loss of estrogens.

The hormone replacement therapy (HRT) my doctor prescribed was not helping and was, in fact, making me feel much worse.  I was taking Premarin – an estrogen made from pregnant mare’s urine. The chemical structure of Premarin is nothing like a woman’s own natural estrogens. Because my body wasn’t tolerating Premarin, I began to research hormones — especially, bioidentical hormones. After I met with a hormone doctor, blood tests confirmed that all of my hormone levels were nearly non-existent. I was prescribed bioidentical estradiol and testosterone crèmes and compounded oral progesterone. Additionally, I was prescribed supplements such as DHEA, Calcium, Vitamin D, etc.  The creams were very messy and didn’t seem to help. I tried wearing a bioidentical estrogen patch (Vivelle Dot) but the adhesive made my skin break out with a blistery rash. Nothing was working.

Finally, I found a hormone doctor who uses bioidentical hormone pellets.  I decided to give the pellets a try even though they are quite expensive. They seem to work better for me than anything else I’ve tried.  My doctor inserts estrogen and testosterone pellets about every three months and I still take a compounded oral progesterone by mouth each night. Many doctors don’t prescribe progesterone for women who have undergone hysterectomy, but I learned through my own research that progesterone is critical for proper hormone balance. Nothing works like a woman’s own natural hormones but for a woman who has undergone hysterectomy and ovary removal, hormone “replacement” is a must.

As the days turned into weeks and the weeks turned into months, I realized that I was not getting back to my old self. In fact, I was getting further and further away from myself. Within the first year of surgery, I was diagnosed with severe vaginal atrophy and third degree bladder prolapse. The pelvic organs I had left, drifted down into the open space left from removal of my uterus. Chronic constipation became a huge problem. I experienced nerve damage that often prevented me from standing or walking. I developed problems with my eyes and was eventually diagnosed with severe dry eye disease. Due to corneal ulcers, I’m now legally blind in my left eye and can no longer see to drive.

Sadly, the aftermath of hysterectomy is filled with a lot of losses. There’s no turning back. Hysterectomy is final. For the woman who undergoes hysterectomy, life is forever changed. I lost my health, my career and then my home. I was engaged to be married at the time of surgery but never did marry. Unfortunately, it’s not uncommon for women to end up divorced and alone after hysterectomy. There have been more times than I’d like to admit that I felt all alone in my devastation. I felt as if I had stepped into some alternate world where I could no longer communicate. Hysterectomy impacts every facet of a woman’s life.  Every single cell is impacted.  And yet, nobody is talking about it.

For this reason, I decided to create a blog site and web site. I knew there must be other women who felt as alone and devastated as I did. Since creating my sites, I’ve heard from women all over the country, and sadly, their stories are all pretty much the same.  The names are different but the stories are the same. Many of their stories are posted on my web site. Most women share the feeling of betrayal. Once they awaken to the many adverse consequences of hysterectomy, they feel deeply betrayed by their doctor for not telling them about the true impact of the removal of their female organs. The trauma can’t be overstated. Women deserve better than this. They deserve to be told the consequences of hysterectomy and informed about the alternatives to hysterectomy. My goal is to make this a reality. I testified in both Indiana and Kentucky regarding hysterectomy informed consent laws and I created a petition on Change.org insisting ACOG (American Congress of Obstetricians and Gynecologists) inform women of the many consequences of hysterectomy and ovary removal (castration).  I support Hormones Matter and their research on hysterectomy. If you have had a hysterectomy, take The Hysterectomy Survey. Your data could save the life of another woman.

My Websites and Social Media

Website: Hysterectomy Consequences

Blog: Hysterectomylies

Twitter: www.twitter.com/jiggaz31

Facebook: www.facebook.com/hysterectomyconsequences

change.org petition: Help Stop Unnecessary Hysterectomy and Castration

 

 

 

Opioids, Chronic Pain and Low Testosterone in Men

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Does your guy suffer from chronic pain? Does he use opioid based pain-killers on a regular basis? Then he may also have low testosterone. Low testosterone or as the advertisers call it, Low T, is associated with a range of health issues beyond just reduced libido or sex drive. His low testosterone could be an important factor in his health and recovery.

Testosterone influences, muscle mass, bone density, cognition and memory, depression, and even insulin production. Many men with low testosterone are at risk of osteopenia and osteoporosis. Lower testosterone or hypogonadism has even been associated with an increased risk of heart attack. That means, in addition to worrying about managing chronic pain, the risks associated with long term opioid use, you and your guy now also should be aware of the critical hormone changes taking place. It is possible these hormone changes are compounding an already difficult recovery.

The study, published in the Clinical Journal of Pain, found that 53% of the men tested who were using daily opioids had low testosterone. Moreover, 74% of men using long-acting or time-released opioid pain killers had low testosterone compared to only 34% of those using short acting opioid pain-killers. Interestingly, the morphine-standardized equivalent dose (MSE),  a measure of how much pain-killer is circulating in the bloodstream, was not associated with the testosterone levels. This means that higher dose pain killers were not tied to lower testosterone, only the duration of the medication action was associated with the hormone change.  Long-acting (time release) pain-killers were linked to lower testosterone while short-acting pills were not.

 Long-acting Opioids

  • Buprenorphine
  • Fentanyl
  • Methadone
  • Morphine CR
  • Oxycodone

Short-acting Opioids

  • Oxycodone IR
  • Hydrocodone

If your guy is using is opioid pain-killers to manage a chronic pain from injury, have his doctor check his testosterone levels too.

Medical Disclaimer: All material on this web site is provided for your information only and may not be construed as, nor should it be a substitute for, professional medical advice. To read more about our health policy see Terms of Use.

Should your Guy be Taking Testosterone

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Testosterone prescriptions for men have increased almost 4-fold over the last decade. It’s marketed to treat everything from low libido, depression and middle-aged weight gain to improved cardiovascular health. Is it safe? Does it work? Should your guy be taking testosterone?  Here is the research.

Testosterone Treatment

Trials in older men with low testosterone levels have shown beneficial effects, such as increased strength, muscle mass, bone mineral density, insulin sensitivity, and libido. However, in elderly men, the treatment effects were short-lived (<6 months).

An observational study of over a 1000 male veterans aged >40 years compared mortality rates between those treated with testosterone and a group of controls with low testosterone. The treatment group showed almost half the rate of mortality, all causes, and lived longer compared to the control group.  Other research shows that testosterone replacement lowers HDL levels but only in younger men taking supra-physiological doses (anabolic steroids).

In contrast, a recent research trial with frail, elderly men (>65 years of age) was stopped early due to a greater occurrence of cardiovascular-related events in testosterone treated men.

Conclusion: The Jury is Still Out

Although some testosterone treatment trials report positive results, there is ongoing concern about the risk of incident prostate cancer or prostate cancer mortality because studies have not been large enough or long enough to address this. The report of adverse cardiovascular events associated with treatment highlights the need for further data on the risks and benefits of testosterone treatment in older men, particularly given the large numbers of older men who are prescribed testosterone. And data supporting the libido boost is still out with only some studies reporting benefits.  Should your guy be taking testosterone- the jury is still out.