Dr. Eugene Shippen is a board-certified family practice doctor who for ten years delivered babies and today has a big following of women and men he delivered in his early practice. As their needs changed, so did he. He realized that so many of the babies he delivered are now of menopausal age and that their requirements to feel good in this day and age needed to be understood. As a result, he has written the book The Testosterone Syndrome to help men and women through the difficult passage of declining hormones. He is a big proponent of bioidentical hormone replacement and continues to grow, learn, and keep up with cutting-edge ways of keeping the aging process at bay. You will learn about forward-thinking approaches to health and wellness in his interview. Dr. Shippen practices in Reading, Pennsylvania.
SS: Nice to talk to you again, Dr. Shippen. People are so interested in what you have to say. What are you thinking about these days?
ES: Well, selenium is on my mind … Selenium supplementation is definitely part of the framework of anticancer and so simple to supplement safely. Selenium supplementation should not be missing from anybody’s program. Additionally, vitamin D (especially vitamin D3 is absolutely critical as a strong anticancer, antiaging supplement. It’s a health hormone for every part of the body, not just for your bones and calcium. Then there’s iodine replacement. These are nutrients that I feel are absolutely essential for everyone’s health routine, not just women but men as well.
SS: Speaking of nutrient supplementation, every time I hear RDA [Recommended Dietary Allowance], they never seem to be sufficient. Who is setting these guidelines? And why are they so underestimated?
ES: Well, the nutritional community is very conservative and has been for many years. Initially, the minimum daily requirement was established to prevent deficiency in the overt form. How do we prevent rickets? How do we prevent scurvy? How do we prevent thiamine deficiency? So the government developed the minimum amount that would relieve the overt vitamin deficiency diseases.
Later, the minimal daily requirement became transformed into the recommended dietary allowances. The government figured if you get more than that, you’re okay. They never really paid much attention to the huge individual variation that’s genetically determined in people’s requirements for vitamins. The scientific way would be to actually measure vitamin levels in people with or without supplementation and adjust their vitamins individually; but, of course, that’s expensive and time-consuming. Nobody wants to go through that tedious process. So we supplement with levels above the RDAs, and sometimes these megadoses are too much for many people.
It’s a very crude science when you start to talk about supplementing vitamins, where one individual might need ten times the amount of vitamin than the next person to achieve optimal levels. And, of course, just taking a blanket megadose of vitamins is not healthy.
SS: Why?
ES: Overloading vitamins downregulates certain enzymes. For example, an overload of vitamin B6, which is very important in many functions, can actually cause neuropathy, and a deficiency can also cause neuropathy. There’s a range for many of the vitamins, where optimal levels are healthy but excessive levels may actually do some damage.
SS: What’s neuropathy?
ES: Neuropathy is a nerve impairment that causes symptoms such as numbness, tingling, or lack of sensation or weakness. Carpal tunnel symptoms in which the hands get numb are frequently a sign of a vitamin B6 deficiency. Excessive vitamin D can cause carpal tunnel–like symptoms, too.
Most people might need 10 mg or 25 or 50 mg of vitamin B6 in some cases; and some individuals might require 100 or more because of genetic defects. But if everybody took 500 mg, then many people, over time, would start to get numbness and tingling. So just taking a load of vitamins, although the body excretes it, may have some negative effects.
I’m cautious when it comes to supplementation. I think we should all take a basic multivitamin. Your doctor then should be looking at specific things that might require larger doses of certain vitamins like niacin, if you have problems with high cholesterol levels. We have found that megadoses of niacin actually have reversed arterial plaque. None of the statins that lower cholesterol will reverse plaque, but niacin will in large doses.
SS: That’s interesting. Do you think calcium supplementation is important?
ES: If you get adequate vitamin D, you absorb calcium at a much higher rate. Vitamin D regulates the absorption of calcium. So if you’re low in vitamin D, you may actually be downregulating the calcium you’re taking.
SS: A lot of calcium supplements have vitamin D in them. The problem with calcium supplements for most women, as doctors have been telling me, is the side effects—namely, bloating and gas. And then that report came out a few months ago in the media about the uselessness of calcium, so you don’t know what to believe.
ES: The amount of vitamin D that’s in calcium supplements is not sufficient; 400 IU (international units, the typical amount in supplements) of vitamin D is minuscule. Neither calcium nor vitamin D is absorbed well in supplement form.
SS: What’s a good calcium supplement?
ES: There are different forms. Liquid forms or calcium tablets dissolve and liquefy well. The best thing a patient can do is stick a couple of calcium tablets in a glass of water and see what happens. If the tablets are still sitting there the next morning undissolved, they’re probably going out through evacuation the next day. We even see calcium supplements on X-rays.
SS: The whole supplement?
ES: Yes, right there in the colon—and they haven’t broken down at all. The chewable calcium citrate seems to be the least irritating to the gastrointestinal tract and seems to break down better. The tablet forms compress the calcium too much, making it hard to break down.
SS: One of my neighbors here is Dick Van Dyke, you know, the comedian. He’s around eighty, looks amazing, and is in great physical shape. He grinds all his supplements up every morning and takes them down in some awful, gaggy two to three gulps of some drink. But he told me that when coroners do autopsies on people, they find all these undissolved vitamins.
ES: He’s right. If you get adequate vitamin D, your calcium absorption from food increases so much, you may not need very much calcium supplementation, unless you’re really eating a poor diet. There is lots of calcium in all the foods that you recommend in your Somersize program, Suzanne. So if you add it up, you get between 700 and 1,000 mg a day of calcium in a good diet.
SS: Now let’s talk about the brain.
ES: I did some research for a talk recently, and I spent four months researching the literature on the connections between the brain, the brain cells, the aging brain, Alzheimer’s disease, and all of the different functions in the brain that are required to keep the brain healthy during your lifetime.
Only one in every ten cells in the brain is a neuron. The neurons do the work of the brain. They store memory, make memory, move our arms and legs, and so on. So it means nine-tenths of the cells are supportive cells. These little supportive cells repair tissue, repair the neurons, supply nutrients to the neurons, and generate their own hormones. They’re called neurosteroids.
Most people don’t realize it, but the brain can make all of the hormones that are present in the body. It can make its own cortisone, estrogen, testosterone, DHEA, and progesterone. These little supportive cells have the capacity to generate hormones within the brain structure itself.
These hormones regulate every major function of the brain, from brain repair, growth of new neurons, to the structural maintenance of the long axons, which connect different areas of the brain from one brain cell to another in different areas. In fact, the long axons go from the brain out to your fingertips. And these are myelinated, meaning they’re coated with myelin. Myelin is the sheath around the neuron cells that protects it. And myelin requires progesterone.
SS: And the brain requires a template that it recognizes as reproductive, in the right proportions of the minor and major hormones, to operate optimally.
ES: Yes, and in the peripheral nervous system, the cells that coat and make myelin are called Schwann cells. In the brain they’re called oligodendrocytes, and these require progesterone. What’s fascinating is that synthetic progesterone does not help these cells make myelin.
SS: But bioidentical—
ES: But bioidentical does, and of course, regular progesterone that’s either produced by the ovary or in males (we men don’t have ovaries) is generated by the cells. Progesterone has a lot to do with maintenance of these long axons and the repair of the axons and the coating. Progesterone in both men and women can help in regenerating spinal nerves, because those are myelinated fibers that go up and down the spine. Some research is going on to show that progesterone is neuroprotective and neuroregenerative to repair myelin to make these connections.
SS: Let me understand—for male hormonal decline, it’s not just a matter of throwing in testosterone. It’s looking at the ratio of all of them together, and that men need to look at their progesterone and estrogen levels?
ES: Yes, those cells that make their own progesterone need to be healthy to keep making their own progesterone. So it’s really a balance between maintaining circulating levels of systemic hormones and replacing those that are no longer being produced.
Looking at all the hormones requires a balancing act among all of them. As we age, the synchronous production of hormones becomes dissynchronous. The rise and fall during the day gets dysregulated and upset, so part of the skill of replacing hormones is trying to bring some synchronous side to hormones. DHEA, for example, is probably best given at bedtime.
SS: That’s interesting, because I take mine in the morning.
ES: That’s fine for your morning, but your brain regenerates at night. The night is not a sleeping, quiet period. The night is your regenerative period. The night is the most active regenerative time in your whole body for the entire twenty-four-hour period. Your body tears down during the day and rebuilds at night. There’s a surge of hormones at night that helps to direct the replacement. So people with sleep disorders, who are not treating their sleep apnea, are having dysregulated production of hormones during this dysregulated sleep cycle.
SS: I understand the importance of sleep and the healing hormone work that happens during the night. We are sleep-deprived as a society.
ES: There’s a lot of science that needs to be done by looking at the synchrony of hormones with aging in men. For example, testosterone normally rises at night, and then in the early morning hours, it peaks and then declines during the day.
SS: That is not a surprise to me. I have a husband who is on full hormone replacement.
ES: Yes, you’re right. Other things rise in the early morning with men, and that’s a sign of health. That early morning rise actually reflects testosterone. It’s a very good biomarker for when testosterone is inadequate in men, because they lose that early morning erectile capacity, but when you replace hormones, you see that rise return. That indicates health, and it’s not a sexual thing. Those morning rises actually aren’t very useful. They’re reflex erections that relate to the sensitivity of the vascular tissue and neural tissue in the pelvis.
When those tissues are healthy, nerve and vascularwise, they’re much more responsive. The rise and fall has been documented, and it goes on all night long. Men just don’t pay much attention to it until they wake up in the morning. But if testosterone is low, this rise disappears or is significantly reduced, and that is a good way to have some assessment of whether their testosterone levels are low and whether their treatment is adequate.
At any rate, going back to the brain and the importance of hormone replacement for regenerating cells, you need to understand that the immune cells in the brain are little cells that actually migrate. These little cells in the brain are called microglia, and they monitor for infection and help suppress excessive inflammation after injury. These cells are very sensitive to estrogen. When levels of hormones go down, these microglia can’t do their job, and then brain inflammation goes up.
After a stroke, if adequate estrogen is present, it suppresses excessive damage—and the area of the stroke is much smaller and heals much greater. When estrogen is not present after a stroke, there’s a greater widespread inflammation that causes cellular destruction.
So if women and men are on hormone replacement, including estrogen, and have a stroke, they will have much smaller areas of stroke and much greater healing of the area of tissue around the stroke.
SS: That’s fantastic information.
ES: The studies are very clear. The damaging effects of stroke are controlled by hormones.
SS: This is a great argument for those women who are toughing it out and going natural. I don’t really believe they are doing themselves a service.
ES: Everything I say about estrogen is true for men, but we men get our estrogen from our testosterone and from our DHEA.
SS: But at some point, in testosterone decline, estrogen production exceeds testosterone, right?
ES: Yes, because if you look at the estrogen levels in aging men, the estrogen levels go down very slowly, but the testosterone levels go down much faster. Some men are very estrogen-deficient, and some men, because they became obese, have estrogen production that is still quite high, but no testosterone.
SS: And this has got to be at epidemic proportions because of the obesity problem in this country.
ES: Yes, it is. There are two kinds of testosterone deficiency. One is overt deficiency, in which the testicles aren’t working and you don’t have enough estrogen or testosterone. This can occur at any age from the forties on. If it’s below age forty, it’s probably related to other endocrine problems. But if you become completely deficient in testosterone, you don’t generate enough testosterone to make estrogen. Add to that, if you get syndrome X and become centrally obese and/or obese late in life, then you generate these estrogens in the fat cells. And estrogen suppresses testosterone.
SS: So what’s the prognosis for these men?
ES: We find that the men with higher estrogen have an increase in problems with heart attacks.
SS: Well, as I look around America, there are many men who fall into that category.
ES: This is why estrogen and testosterone have to be measured in men. I measure estradiol as a primary powerful estrogen in men. Some of the men are high in estrogen and low in testosterone, and some are low in both. So it really needs to be done on an individual basis. And those men who have middle-age spread are the high-estrogen guys. They have more risk factors for stroke and heart attack.
SS: When a patient walks into your office, in that first thirty seconds, do you pretty much know what’s going on with them?
ES: You have to look at their life history to get a clear picture. Were they thin when they were young and now they are obese? Or were they obese all their life? Now, strangely, I’ve seen men who were obese all their life who have low testosterone, and some with high estrogen, and they are healthy as a horse. They have no sexual dysfunction, either. Their bodies have adapted to that balance.
SS: I didn’t realize that the body can adapt to this condition.
ES: Yes, this condition is normal for this man. If a man goes from having a low estrogen/high testosterone ratio—in other words, muscular and athletically built—to becoming dumpy, fat, and centrally obese in his forties and fifties, he will have real trouble. His estrogen goes up and becomes a serious problem. A lot of men are being given aromatase inhibitors, which block the fat cell conversion of testosterone into estrogen to help control the problem. The problem with this is, yes, it may downregulate the estrogen, but what does it do to the brain?
SS: What does it do to the brain?
ES: We men get our estrogen in our brain from aromatase conversion of testosterone and DHEA. So when you give an aromatase inhibitor, you are downregulating one of the key hormones that causes the brain to be self-repairing and self-protecting.
Another factor is the use of Proscar to block DHT [dihydrotestosterone] conversion from testosterone to shrink the prostate. But there’s DHT in the brain. And this medicine that blocks DHT formation is also affecting the conversion of progesterone into something called allopregnenolone, which is different from pregnenolone. Pregnenolone is a potent neurosteroid that’s important in brain repair. So these men are being given DHT to shrink the prostate, and the prostate shrinks because you make it deficient in DHT, but you’re shrinking the brain at the same time. I think more studies need to be done to see if this really makes sense. The drug companies that give us systemic-acting hormone blockers should be aware that these medications are going to have pervasive effects in other tissues that might show up in two, three years, five years, ten years.
SS: What do you think about statins?
ES: Statins inhibit the ability of your body to generate its own cholesterol. So if we lower cholesterol, there’s a clear reduction in events with the studies on statins. There are reductions of stroke, and there is a reduction of heart attack of 20, 25, 30 percent, depending upon the study.
SS: Significant.
ES: However, long-term studies have failed to show any improvement in overall mortality rate. It’s interesting that if you lower the major cause of death by 25 or 30 percent, you don’t see an upside on longevity of an equivalent amount. So what’s happening? We’re becoming unhealthy in other ways. But they don’t seem to report on what is causing these other people to die.
The brain itself makes its own little neurosteroids by manufacturing its own cholesterol in the brain. So if we inhibit the body’s ability to make its own cholesterol, are we also inhibiting the ability of the body to make its own neurosteroids?
SS: So are you saying that ultimately statins could actually be working against us?
ES: Exactly. And those studies are yet to be done. Statins have some important positive effects on inflammation. So now drug companies are talking about maybe using them to treat Alzheimer’s. Remember I said when hormones decline, the inflammation of the brain goes up? Well, they’re touting the anti-inflammatory effects of statins to cut down the brain inflammation of Alzheimer’s. That’s the theory. Drug companies would love to have a drug that would go in and stop Alzheimer’s.
The problem is, if you inhibit the brain from making its own cholesterol, you’re inhibiting the brain from making its own neuroprotective hormones that control the Alzheimer’s process. But if your cholesterol is very low, you have an increased risk of Alzheimer’s disease.
There’s a study called the Cache Study that showed that if you had lower cholesterol, you had a lower incidence of vascular dementia. Those are the strokes and heart attacks that come from ministrokes, or brain degeneration that comes from ministrokes.
But if the condition was high cholesterol, researchers found a lower incidence of Alzheimer’s disease. So people with higher cholesterol have a lower incidence of Alzheimer’s disease. Is it because they have more precursors to making their own neurosteroids? It’s an interesting question.
SS: What do you think?
ES: It makes sense to me that the good Lord put our cholesterol-forming enzymes in our brain for a reason. And if He wanted us to make cholesterol in the brain, cholesterol is a great antioxidant. You know, it’s not just a neutral molecule. It’s not a bad guy that needs to be eliminated. It’s there for a reason. Cholesterol forms the backbone of every single neurosteroid in the brain. Estrogen, testosterone, progesterone, allopregnenolone, plus pregnenolone that people are taking, are all based upon a cholesterol structure that the brain is able to make from cholesterol itself.
SS: Let me play devil’s advocate for a minute. The standard treatment by cardiologists is to take heart patients and put them on statins and then eliminate all fat from their body. In light of what you’re saying, zero fat intake to lower cholesterol …
ES: Not fat. We’re talking about cholesterol now.
SS: Right. But the cardiologist takes the patient off fat so that the body can’t produce the cholesterol, in order to keep the cholesterol at rock-bottom low.
ES: Well, that’s true in a sense. Acetate comes from fat metabolism, and acetate is converted into cholesterol by enzymes that produce cholesterol, and that enzyme is inhibited by statins. So if we give a drug that causes that enzyme to be less active, less cholesterol is being produced by the liver and by other tissues in the body.
SS: But my point is that most men of a certain age are on statins, and their heart doctors have taken them off all fats. They look terrible. Is that healthy?
ES: No. There are good fats and bad fats. We are eating too many processed fats that are not similar to what the fats are in the normal diet.
SS: So this is that specialization: We go to individual doctors who are looking only at their little area of specialty. A diabetes doctor, for example, is just looking at diabetes, not the whole picture.
ES: That’s right. The cardiologist’s job is to ensure that you have a lower risk for either having a heart problem or attack or a recurring event. That’s his or her concern. Statins do that. Cardiovascular disease is primarily an endocrine disease, and cholesterol only adds to the abnormal decline of the hormones. If your hormones are intact, cholesterol doesn’t damage the arteries. So if you have adequate estrogen, your arteries are actually protected from plaque formation.
SS: Well, I can proudly announce I have zero plaque in my heart and arteries.
ES: And you’re a high-estrogen gal. When they did primate studies, the research showed that if you took perimenopausal monkeys and put them on estrogen from perimenopause until old age, and looked at their arteries, they had almost no plaque. If you waited till menopause and looked at the primates that had their ovaries taken out at menopause and then started on estrogen, they had about 10 percent plaquing. So even in perimenopause, plaquing is starting.
If you waited five years, took the ovaries out, made them estrogen-deficient for five years, there’s 40 percent plaquing in the arteries. So those doctors who tell women, “Well, let’s wait and see how you do for a year,” are telling women, “Let’s see how bad your arteries can get before we add estrogen back in.” It’s the worst advice they could possibly get!
SS: Do you feel that men experience a type of perimenopause? Periandropause?
ES: What happens is a man in his forties begins to have testosterone decline. His tests look normal, but decline has started, and now in most cases his estrogen is also declining. This is serious because men start to get plaquing when their testosterone is declining well before they become deficient. So if you wait for a guy to be totally deficient before you treat him with hormone replacement, the plaques will be so bad that they won’t reverse from HRT. Plaques don’t form when hormone balance is healthy, except for plaques due to stress or that which comes from infection. What’s more, there are many types of plaques that are unexplained.
SS: Then the message to young men who are in their late thirties or early forties is to start doing hormone panels. But young men don’t think this way.
ES: Actually, the way to keep your hormones elevated is all the things you tell your women to do in your Somersize books. Eat right, keep your weight in check, avoid sugar, stay active, and exercise.
SS: Eat real food.
ES: Yes, eat real food, and your hormones will stay much higher longer in most cases. And positive stress helps, too. Being a winner will raise your testosterone levels. With the losing football team, for instance, all the testosterone levels are low after the game. The winners get a buoyant surge of testosterone from being on top, winning the battle, so to speak. So positive stress—from those things that drive us in our business pursuits or our lifetime pursuits that feed us positive feelings, those things we’re happy about, such as having a job that you’re happy with—all drive your hormones up. By contrast, having a job that beats you down every day will lower your testosterone and increase your cortisol levels. Cortisol, of course, is damaging to the system.
SS: So here’s where the craft of the doctor comes in: being able to assess that a man who is happy in his life, happy in his marriage, happy in what he’s chosen to do, or to understand that this is a guy who is just beaten down by all of it. That assessment allows the doctor to understand what needs to be done, right?
ES: That should be part of the assessment. Plus, the doctor should understand the effects of the environment, toxicity, stress, and all those factors that figure into it. It’s much more complex than a simple weight reduction exercise program or a change in lifestyle. It’s all of it combined; no single study is ever going to come out that finds one factor to be the primary cause anymore.
SS: That is what this book is about.
ES: All these factors are part of health and antiaging. The more you can be aware of lifestyle and hormonal factors, and how they change individually, is part of the picture. Studies that assess total hormone replacement will never be done, because hormone replacement will be different for every single person. You can’t do a double-blind study on a test group that are all getting different amounts.
SS: So what do you do, personally? Everyone wants to know what his or her doctor is taking.
ES: I don’t like to say because then everyone will want to do what I am doing, and it’s individualized. But I do take vitamin D, and I take my hormones in a certain pattern now.
SS: In a rhythm?
ES: Yes. Taking hormones in a steady day-in-day-out pattern doesn’t make sense. You must try to replace them with some pulsatility that reflects the natural pulsatility or rhythm that is there.
SS: By creating a peak?
ES: Yes, peaks and valleys. A resting phase. Just as you need it in your menstrual cycle.
SS: I so agree.
ES: There’s a surge, and it needs to relax. Is that healthier than steady (static) hormones? Probably, but we don’t have the studies to really show that it is a lot better. For most men, if they just take a very high dose of testosterone, they’ll feel good for a while, and then it kind of wears off. The testosterone receptors should be fired up, but they aren’t. When you ignite a receptor over and over and over again, it downregulates.
SS: I take my hormones in a rhythm to create a peak. What is the process for men? Do men reach a testosterone peak each month?
ES: No, thank God we don’t have a monthly …
SS: There’s nothing that simulates it?
ES: I believe there should be resting periods and surges. In other words, peaks. It’s very much similar to how we treat diabetics. With diabetics, you need insulin replacement. We give them a baseline level of insulin, long-acting insulin, and they take that. It lasts all day long. Then every time they eat, they take a dose of insulin to rise and fall with the meals. So with testosterone, there are a number of ways that you can take testosterone that will give you a peak-and-valley effect. When we’re young, in our teens and twenties, there’s a peak of testosterone every ninety minutes. It’s a rapid cycle up and down. So testosterone’s bouncing off the ceiling and off the floor. While on the ceiling, it’s activating the receptors and firing us off and making every coed look wonderful. And then it relaxes a little, thank God, and recharges, then it surges again. So all day long, we’re distracted every ninety minutes.
SS: I always say to my husband, “All men think about is sex, isn’t it?” And he always goes, “Yep.”
ES: He’s got that right. Those receptors in men and women are made to activate and deactivate. So treatment should be aimed at trying to have some activation and deactivation. That’s why the typical injections really don’t work very well.
SS: It’s a big bang, and then it peters out? (Excuse the pun!)
ES: That’s right. So for a while, you have far too much testosterone, and then you don’t have enough. Then you have far too much. The testosterone receptors weren’t made to fire up over a two-week period and then decline. They were supposed to be pulsating all day long.
SS: I have male friends who tell me that their doctor has told them they “have more than enough testosterone” or “too much” and that they don’t need testosterone replacement. But at age sixty-five and seventy, they would have to be in decline, right? Does this mean that the ratio is off somewhere else?
ES: Well, I’ll tell you what is usually the problem: It’s sex hormone binding globulin, and they don’t measure it. Sex hormone binding globulin goes up as men get older, and in some men it skyrockets. Sex hormone binding globulin is a protein that binds testosterone and keeps it from being useful. So when you measure total circulating testosterone, you can have a very high level. But if you’re at a level that sex hormone binding globulin is high enough, it completely negates it. I had one seventy-five-year-old guy who came to see me. He had lost his wife, and he had a new girlfriend who was very voluptuous. And he just couldn’t rise to the occasion. I did his testosterone. He had read my book, and he said, “Oh, I’m jumping out of the pages of your book.” He had his testosterone done, and it was over 900.
SS: So what was the problem?
ES: I did his sex hormone binding globulin, and it was off the charts—very high. In other words, there’s a normal range, and he was 50 percent above the normal range, but he had very little free testosterone.
SS: And the free testosterone is the available active hormone, right?
ES: Right. So with this guy, his testicles were fine. He was pumping plenty of testosterone, but wasn’t going anywhere, so he started having problems in parts of his body that no one realized or attributed to sex hormone binding globulin. There are some natural products to lower sex hormone binding globulin, and there are also drugs that we know will lower it. What I did with this man was to treat his sex hormone binding globulin to lower it, and his overall testosterone levels dropped. His sex hormone binding globulin dropped to the middle of the normal range, and his free testosterone came back. Now it’s well in the normal range, and he is happy because he is firing bullets again.
SS: With the voluptuous babe.
ES: He is a happy camper. Yet he is now running a lower total testosterone. But his free testosterone is normal, whereas at a higher testosterone level he was deficient, but his numbers looked like they were off the charts. That was a revelation to me, because most doctors would have said, “You’re producing too much. There’s nothing wrong with you,” it’s organic or psychological or something, and written it off.
SS: And when testosterone is imbalanced like that, is that a dangerous place for a man to be?
ES: Well, in the sense that this man is symptomatic in that the blood vessels in his pelvis are not dilating. So if his free testosterone is low enough that he’s not able to get dilation of the blood vessels in the pelvis that give him a good erection, he’s two to three times more likely to have a stroke. Or a heart attack.
SS: Okay. So it is dangerous.
ES: That means the arteries in his brain and the heart are not dilating. You see that on the Viagra ads or the Levitra ads that say that if you have erectile dysfunction, you have a two- to threefold increased chance of having a stroke or a heart attack, and this has been well documented. But what’s the connection? Well, testosterone is a major vasodilator for the heart, brain, and pelvic vasculature. Not the peripheral, not the arms and legs, but the central critical arteries that are very hormone-sensitive.
SS: Let’s talk about ministrokes. Men and women don’t seem to realize that they are having them. It is just attributed to aging, momentary confusion, or forgetfulness. I know what ministrokes look like. I remember my father, before he had the big one, was having these little ministrokes. Could it be caught in time and reversed through hormone replacement?
ES: Well, we know that men with lower testosterone have more severe strokes with more damage, just like the model I told you about estrogen. And all I can say is, if you take testosterone, you’ll immediately improve the circulation of the heart. We know that because you can put a man on a treadmill who has heart disease, give him a shot intravenously of testosterone, and he’ll last a minute longer before any of the vascular changes occur. So it does work quickly to restore nitric oxide, which is the basic vasodilator in the arteries of the heart and the brain. So whatever you say about circulation of the heart and the pelvis, you can also relate to circulation for the brain.
SS: That’s important for men to know. Now, let’s talk about iodine.
ES: The linkage between hormones and iodine is fascinating. Iodine is trapped and concentrated in the thyroid, so most doctors are focused only on the iodine relationship to the thyroid gland. But the second and third most concentrated areas are in the breasts and in the ovaries. Our glands concentrate iodine, and the breast tissue is very, very sensitive to iodine. You can mimic the model for fibrocystic disease in animals by making them iodine-deficient. They’ll get fibrocystic changes in breast tissue just like the women today with fibrocystic disease. Dense breast tissue will go away with iodine, and so will cystic tissue.
SS: Is iodine something you would supplement daily?
ES: Yes. The Japanese, who have one-eighth the prostate cancer and nearly as little breast cancer and bowel cancer, have iodine levels about eight to ten times the American levels.
SS: I remember when we were kids, our mothers bought iodized salt. Did they know the importance of iodine replacement back then?
ES: Yes. Iodine deficiency was associated with goiter, so at that time they thought that putting a little iodine in the salt would be the end of it. And again, they set the RDA level …
SS: Let me guess, very low?
ES: Way low. But the daily intake of iodine of the Japanese is eight to ten times higher than ours from eating a lot of miso, kelp, seafood, and other foods very high in iodine. In our country, we get less than 1 mg a day.
SS: So do you think iodine, as we age, is a must?
ES: Yes, it’s absolutely critical to get more iodine. We are depleted of iodine in many ways. For instance, our water contains fluoride, and our swimming pools contain chlorine, so we are surrounded by “iodinelike molecules” that get brought into the body by these chemicals. If you don’t have enough iodine, these iodinelike molecules build up in the various tissues, causing a buildup of larger levels of bromine, fluorine, and chlorine where there should be iodine. These chemicals won’t activate the cellular functions the way iodine does. In fact, they lock it. Every single hormone receptor in the body has iodine residue in it.
SS: Naturally?
ES: Yes. There is an amino acid in every hormone receptor, insulin receptor, androgen and estrogen receptors. All of these hormone receptors have tyrosine residue with amino acid. Tyrosine is the building block for thyroid hormone. Tyrosine becomes iodinated very easily, and tyrosine residue is in every receptor researchers have ever studied. So we really need trace amounts of iodine in all of our hormone receptors for our hormones to work right.
SS: So when you supplement iodine, how much do you give to a person on a daily basis?
ES: You take a 50 mg dose. If your body needs it, you will latch on to that iodine, and it’s not going to come out in your urine. You can get an accurate reading from a iodine-loading test that will tell you if you are deficient and by how much. This test also measures the excretion of bromine, which is clogging up the iodine residue. You’ve got to get rid of the bromine and put iodine in. It takes a long time. It takes six months to a year to get rid of the buildup of all these other compounds and to get iodine back in your system. But people will start feeling better within days, weeks, or months of going on iodine supplementation.
SS: Why are we feeling so bad? Why do we need to do all this?
ES: It’s from our poor diets and the chemicals in the environment.
SS: Are we living too long?
ES: No, it’s not that we are living too long. We are living past our hormonal health. Hormones are the cornerstone to preserving age-related decline. I don’t think they reverse aging. They just make the landing a lot softer with more working parts.
Preserving age-related decline is not for everyone. It takes commitment. There are so many experts and so much misinformation that only a few people will ever really find their way to the doctors who are thinking this way. This is an evolving area of specialty. People ask me what I specialize in. I’m not an endocrinologist. I’m not an internist. I’m a doctor interested in the endocrine changes of aging. That’s a separate health specialty that has never been designated.
How do you best take care of aging people with different drug demands and different physical and nutritional demands? Not to denigrate the specialty of geriatrics—it’s very important—but the geriatricians are really just modifying and helping people who have degenerative disease.
Those of us in the antiaging movement—the doctors who are coming to the surface and studying aging—will really have a chance at intervening at early enough stages to prevent many of the age-related declines and diseases.
SS: What I love about you and the other doctors in this book is that you are excited about what you are doing.
ES: I’m more excited now about what I do than ever before, and I am doing my best work because I have more tools at hand. But there is a learning curve. I find it fascinating that in the next seven years, the total knowledge that we have from the beginning of time to now will be doubled. That means that there is no specialist who can keep up with his or her own specialty.
There is no multispecialty doctor who can possibly keep up with all of the interactions that are going on in different parts of the body. The problem with traditional medicine as we know it is that the specialists are getting more specialized and focused and less integrated in their thinking. They are dealing only with the kidney or the heart or the brain, or they are neurologists or renal specialists or cardiologists. They do a great job focusing on their one organ, but they are missing the forest by focusing on the trees.
SS: I agree.
ES: The specialty of the antiaging community says that if we really do integrative medicine and start looking at all the systems of the unit, it becomes a total endocrine system integrated with the immune system, integrated with the cardiac system, circulatory system, and neurological system. They are all one system, but with different instruments in the symphony that all have to be tuned together to play the music properly.
SS: Well put. And if people embrace this new medicine and take steps in their lives to replace declining hormones—focus on iodine, vitamin D, and functioning of the brain, eat right, avoid chemicals, and exercise—can they expect to live and die healthy?
ES: I’ll tell you this: They’ll know in their heart of hearts that they are healthier. They will not want to go back to where they were. Would you want to go back to where you were?
SS: Never. Wouldn’t consider it.
ES: It’s a pervasive sense of health that you know intuitively. Unfortunately, so many sit and listen to the lady next to them at the hair salon who says estrogen causes cancer and all these horrible things, so she throws her hormones away. Or somebody else who says testosterone causes prostate cancer so that person immediately stops hormone replacement. These messages can come from a specialist or layperson, but one comment can destroy the confidence a person has towards moving in this area.
But once you experience the positive effects of this new medicine, when you get really fine-tuned on your hormones, you won’t ever give it up, because you’ll know intuitively that you are healthier. It’s not as though you are going to be healthy for a short time and then pay a horrible price with things exploding at the other end of the line.
The vast majority of studies show that with balanced hormone replacement, there is improvement in overall mortality. When those hormones are in their best balanced levels, you are your healthiest. Will you live longer? I think so, but I know for sure that you will certainly feel better while you are alive.
SS: Well, let’s end it there. That’s fantastic. Thank you so much.
DR. SHIPPEN’S TOP FIVE ANTIAGING RECOMMENDATIONS
1. Four important antiaging supplements to include in your regimen are selenium, vitamin D3, iodine, and a multivitamin/mineral supplement. Speak with your doctor about exact dosages for your situation.
2. Certain structures of the brain require adequate hormones, particularly progesterone and testosterone. Bioidentical hormone replacement can keep the brain young and healthy.
3. In men, estrogen and testosterone have to be measured. Some men are high in estrogen and low in testosterone, and some are low in both. High-estrogen men are at greater risk for stroke and heart attack.
4. Sex hormone binding globulin increases with age, resulting in a decreased concentration of free testosterone. Testosterone deficiency is likely to be a primary contributor to erectile dysfunction. Talk to your doctor about the connection, as there are some natural products to lower sex hormone binding globulin, and there are also drugs that will lower it.
5. In addition to bioidentical hormone replacement, the way to keep your hormones elevated is to eat real food, keep your weight in check, avoid sugar, stay active, and exercise. Being a winner will raise your testosterone levels. Winners, whether in sports, business, or personal life, get a buoyant surge of testosterone from being victorious.