Transcript ICAK-USA-2015-Gangemi

THE FEMINIZATION OF THE
MALE SPECIES
Stephen Gangemi, DC, DIBAK
ICAK USA - 2015
The Overview
• There is a growing number of males of
all ages showing increased estrogen
levels and/or decreased testosterone
levels.
• Diet, lifestyle, and environment play a
significant role.
Copyright Stephen Gangemi DC, DIBAK
2
Goals
• Learn the signs and symptoms of
estrogen-testosterone imbalances
• Learn ways to evaluate and treat
these hormonal imbalances naturally,
to improve and vitalize health
Copyright Stephen Gangemi DC,
DIBAK
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Estrogen In Utero
• 2D to 4D ratio
• The smaller the 2D:4D ratio the greater
testosterone exposure in the first
trimester
• Or, better said: The longer your ring
finger compared to your index finger
the more androgen exposure
Copyright Stephen Gangemi DC,
DIBAK
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Estrogen During Puberty
• Tanner Stages or Sexual Maturity
Stages (SMR)
• SMR 3 – typically ages 12-13
• Acne
• Perspiration increases
• Growth spurt
• Breast tissue – gynecomastia
Copyright Stephen Gangemi DC,
DIBAK
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Estrogen During Puberty
• Gynecomastia: swelling of the breast
tissue in boys or men, caused by an
imbalance of the hormones estrogen
and testosterone
• Tender lump under one or both nipples
o Increase in the ratio of estrogen/testosterone
o Is it normal? – Obesity link
Copyright Stephen Gangemi DC,
DIBAK
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Estrogen During Puberty
Copyright Stephen Gangemi DC,
DIBAK
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Estrogen in Adults
Copyright Stephen Gangemi DC,
DIBAK
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Elevated Estrogen/Low
Testosterone Risks
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•
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Stroke
Heart disease
Prostate cancer
Dementia/Alzheimer’s disease
Obesity/Metabolic syndrome
• Diabetes
Copyright Stephen Gangemi DC,
DIBAK
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Signs and Symptoms of
High Estrogen
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•
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Increased body fat
Loss of muscle tone
Fatigue
Enlarged prostate
Erectile Dysfunction/low libido
Emotional issues (e.g. depression, anxiety)
Poor sports performance
Copyright Stephen Gangemi DC,
DIBAK
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Pitching a Tent: SRE
• Are you waking up with an erection?
• Sleep-related erection (SRE)
• SREs start as we enter the REM phase of our
sleep cycle and last until the next cycle of
non-REM sleep
• SREs are linked to levels of testosterone
• Erectile function is a good predictor of
current cardiovascular problems as well as
future risk of heart attacks and strokes
Copyright Stephen Gangemi DC,
DIBAK
11
Emotional Issues:
Dopamine
• Dopamine: motivation , learning, stress
management, addictions
• Testosterone impacts dopamine
receptors in men
• Dopamine  LH  Testosterone
Copyright Stephen Gangemi DC,
DIBAK
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Emotional Issues:
Serotonin
• Serotonin (low): loss of pleasure,
“depressed”
• Testosterone increases serotonin
sensitivity in men
Copyright Stephen Gangemi DC,
DIBAK
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Causes of Low T:E
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Stress
Overtraining (under resting)
Insulin resistance
Xenoestrogens
Phytoestrogens
Genetics
Protective mechanism (male prenatal care
drops testosterone levels)
Copyright Stephen Gangemi DC,
DIBAK
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Stress
• Adrenal gland depletion
• High cortisol, low or depleted DHEA
• DHEA  Androstenedione  Testosterone
Copyright Stephen Gangemi DC,
DIBAK
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Overtraining
• Aerobic/Anaerobic imbalances
• Thyroid and adrenal gland dysfunctions
• Inadequate rest
Copyright Stephen Gangemi DC,
DIBAK
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Insulin Resistance
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•
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•
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Cells no longer respond properly to insulin
Fatigue, especially after meals
Weight gain or can’t lose
Cravings for sweets
Aches and pains (inflammation)
High estrogen in men
(and high testosterone in women)
Copyright Stephen Gangemi DC,
DIBAK
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Xenoestrogens
Chemical estrogen mimicker / hormone disruptors
imitate estrogen in the body
•PCBs (polychlorinated biphenyl) – plastics, sealants,
adhesives, fire retardants
•BPA (Bisphenol A) – plastics; (resin identification code 7)
•Phthalates – plastics, stabilizers, sealants (everything
from toys to cleaners to hair spray)
•Parabens
•Insecticides/Herbicides
Copyright Stephen Gangemi DC,
DIBAK
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Phytoestrogens
Plant based estrogen mimicker
• Phytoestrogens (soy primarily)
• Molds (Mycoestrogens)  mycotoxins
Copyright Stephen Gangemi DC,
DIBAK
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Soy
• Soy isoflavones bind to the body's
estrogen receptors and display
estrogen-like effects
• Controversy over decreasing the T:E
• Fermented tempeh, miso, natto, and
soy sauce okay
• Unfermented not – especially soy
protein isolates
Copyright Stephen Gangemi DC,
DIBAK
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Conventional Treatment
• Drugs
o
o
o
o
Testosterone Cypionate- shot
Androgel - gel
Striant – patch
Natesto – nasal spray
• Problems
o Doesn’t address the cause
o Pituitary suppression (FSH & LH)
o Conversion to estrogen
Copyright Stephen Gangemi DC,
DIBAK
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The Biochemistry
• Low T:E or high E:T
• Inability to make testosterone or over
conversion to estrogen via the
aromatase enzyme
• Conversion to DHT via 5α-reductase
enzyme
Copyright Stephen Gangemi DC,
DIBAK
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Inability to Make
Testosterone
• The substrates
Vitamin E
Selenium, Zinc, Iron
Vitamin A – not beta carotene
Vitamins B3 and B5
Saturated fats
BCAAs
Pituitary FSH/LH
• FSH – Sertoli cells in testes initiate spermatogenesis
• LH – Leydig cells in testes make testosterone
o Adrenal glands (DHEA)
o
o
o
o
o
o
o
Copyright Stephen Gangemi DC,
DIBAK
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Aromatase Enzyme
• Aromatase converts testosterone to
estradiol
• Most activated by insulin resistance due to a
high carbohydrate diet
• Higher estrogen, in turn, increases insulin
resistance
• And the insulin resistance increases estrogen
• Aromatase inhibitor medications
• Arimidex and Femara
Copyright Stephen Gangemi DC, DIBAK
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Estrogen Detox: Liver
• Phase 1 liver detox  Hydroxylation: CYT P450
enzymes
• Vitamins B2 (FADH) and B3 (NADPH) activate the
CYT P450 enzymes
• Antioxidants due to free radicals (ROS – reactive
oxygen species) generated during process
Copyright Stephen Gangemi DC,
DIBAK
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Estrogen Detox: Liver
• Phase 2 hormone detox in the liver
primarily via:
Glucuronidation and Sulfation
Copyright Stephen Gangemi DC,
DIBAK
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Glucuronidation
• Artichoke
• Magnesium
• Investigate insulin issues
Copyright Stephen Gangemi DC,
DIBAK
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Sulfation
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Cysteine
Vitamin B6 (P-5-P)
Vitamin B12 (Methyl B12)
Folic acid (5MTHF)
Copyright Stephen Gangemi DC,
DIBAK
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Extrahepatic Estrogen
Detox
• Breast, prostate, fat tissue
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METHLYATION
GLUTATHIONE
ACETYLATION
DIINDOLYLMETHANE
INDOLE-3-CARBINOL
ROSEMARY
Copyright Stephen Gangemi DC,
DIBAK
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METHLYATION
• Cycle between methionine and
homocysteine
• Methyl B12
• 5MTHF
• P-5-P
• Magnesium
• Betaine & Choline
Copyright Stephen Gangemi DC,
DIBAK
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GLUTATHIONE
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Cysteine
Glycine
Glutamic Acid
Magnesium & Potassium
Selenium
o Parathyroid
Copyright Stephen Gangemi DC,
DIBAK
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ACETYLATION
• Pantothenic acid – vitamin B5
• Pantethine is activated pantothenic
acid
Copyright Stephen Gangemi DC,
DIBAK
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The Others…
• INDOLE-3-CARBINOL
o Brassica vegetables: cabbage, cauliflower,
broccoli, Brussels sprouts, kale, collard greens
• DIINDOLYMETHANE (derived from digestion of I3C)
• ROSEMARY
Copyright Stephen Gangemi DC,
DIBAK
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Evaluation & Treatment
• Laboratory testing
• Applied kinesiology assessment
• Signs & symptoms
• Office treatment/therapy
• Lifestyle changes
• Dietary changes and/or supplements
Copyright Stephen Gangemi DC,
DIBAK
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Laboratory Testing
• Free and total testosterone by LC/MS
(Liquid chromatography/ Mass spectrometry)
o LabCorp #070038
o NOT the direct method by analogue radioimmunoassay
• Free estrogens (E2 – estradiol)
• FSH and LH
Copyright Stephen Gangemi DC,
DIBAK
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Laboratory Testing
LabCorp Burlington
1447 York Court
Burlington, NC 27215−3361
LabCorp
Laboratory Corporation of America
Specimen Number
Patient ID
Patient Last Name
Patient First Name
Account Phone Number
866−999−4041
Route
09
Account Address
PROFESSIONAL CO−OP SERVICE INC
Patient Phone
Age (Y/M/D)
Account Number
Patient Middle Name
Patient SS#
Date of Birth
63/00/08
Phone: 800−762−4344
Control Number
06/17/52
850 West Dania Beach Blvd
Dania Beach FL 33004
Total Volume
Sex
M
Fasting
No
Patient Address
Date and Time Collected
06/25/15 16:00
Date Entered
06/25/15
Additional Information
Date and Time Reported
06/28/15 01:35ET
Physician Name
NPI
Physician ID
GANGEMI
Tests Ordered
Testosterone, F Eqlib+T LC/MS; Hemoglobin A1c; Ferritin, Serum
TESTS
Testosterone, F Eqlib+T LC/MS
Testosterone, Total, LC/MS
Testosterone, Free
% Free Testosterone
Hemoglobin A1c
RESULT
851.4
8.26
0.97
6.0
FLAG
UNITS
REFERENCE INTERVAL
348.0 − 1197.0
5.00 − 21.00
1.50 − 4.20
01
Low
ng/dL
ng/dL
%
High
%
4.8 − 5.6
01
30 − 400
01
Increased risk for diabetes: 5.7 − 6.4
Diabetes: >6.4
Glycemic control for adults with diabetes: <7.0
Ferritin, Serum
85
ng/mL
LAB
01
01
BN
LabCorp Burlington
Dir: William F Hancock, MD
1447 York Court, Burlington, NC 27215−3361
For inquiries, the physician may contact Branch: 800−762−4344 Lab: 800−762−4344
Copyright Stephen Gangemi DC,
DIBAK
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Laboratory Testing
LabCorp Burlington
1447 York Court
Burlington, NC 27215−3361
LabCorp
Phone: 800−762−4344
Laboratory Corporation of America
Specimen Number
Patient ID
Control Number
Patient Last Name
Patient First Name
Age (Y/M/D)
Account Phone Number
Route
09
Account Address
PROFESSIONAL CO−OP SERVICE INC
Patient Middle Name
Patient Phone
Patient SS#
Date of Birth
20/03/03
Account Number
03/06/95
Total Volume
Sex
M
Fasting
850 West Dania Beach Blvd
Dania Beach FL 33004
No
Patient Address
Date and Time Collected
06/09/15 09:11
Date Entered
06/09/15
Additional Information
UPIN: U83560
Date and Time Reported
06/15/15 13:57ET
Physician Name
GANGEMI
NPI
, S
Physician ID
Tests Ordered
Estradiol, Free Serum; Testosterone, F Eqlib+T LC/MS; FSH and LH; Drawing Fee
General Comments
A duplicate report has been generated due to demographic updates.
TESTS
Estradiol, Free Serum
Estradiol, Serum, MS
Reference Range:
Adult Males: 8.0 − 35
Free Estradiol, Percent
Reference Range:
Adult Males: 1.7 − 5.4
Free Estradiol, Serum
Reference Range:
Adult Males: 0.2 − 1.5
Testosterone, F Eqlib+T LC/MS
Testosterone, Total, LC/MS
Testosterone, Free
% Free Testosterone
FSH and LH
LH
FSH
01
ES
02
BN
RESULT
FLAG
UNITS
REFERENCE INTERVAL
LAB
22
pg/mL
01
2.4
%
01
0.53
pg/mL
01
230.3
4.65
2.02
Low
Low
<0.2
<0.2
Low
Low
ng/dL
ng/dL
%
348.0 − 1197.0
5.00 − 21.00
1.50 − 4.20
02
mIU/mL
mIU/mL
1.7 − 8.6
1.5 − 12.4
02
02
02
Esoterix Endocrinology
Dir: Samuel Pepkowitz, MD
4301 Lost Hills Road, Calabasas Hills, CA 91301−5358
LabCorp Burlington
Dir: William F Hancock, MD
1447 York Court, Burlington, NC 27215−3361
For inquiries, the physician may contact Branch: 800−762−4344 Lab: 800−762−4344
Copyright Stephen Gangemi DC,
DIBAK
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LSASS with Estrogen
• Ligament Stretch Adrenal Stress
Syndrome
• Estrogen affects fibroblasts that make
up collagen which is the main
component of connective tissue
• Challenge the ligament stretch with
estrogen
Copyright Stephen Gangemi DC,
DIBAK
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Insulin and Sugar
Challenges
• Aerobic testing with sugar
• Hyperinsulinemia testing (Dr. Schmitt)
• Dysglycemia testing (Left TMJ –
drgangemi.com)
• “Fatty Rub” with insulin (Dr. Lebowitz)
Copyright Stephen Gangemi DC,
DIBAK
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Estrogen Challenges
• Estrogen with Heart Rate Variability
(WS HearthMath technique)
• “Fatty Rub” with estrogen
Copyright Stephen Gangemi DC,
DIBAK
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Lifestyle Changes
Dietary
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High saturated fat diet
High quality protein
Low carbs, eliminate refined carbs
Chemical-free products
Organic foods
Copyright Stephen Gangemi DC,
DIBAK
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Lifestyle Changes
Exercise
• True aerobic – not “chronic cardio”
• Anaerobic/HIIT: in moderation
• Strength
Copyright Stephen Gangemi DC,
DIBAK
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Lifestyle Changes
• Stress reduction
• Sleep quality
• Cosmetics, body products - anything in
contact with the body
• Cleaning products
• Stop watching Oprah
Copyright Stephen Gangemi DC,
DIBAK
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Questions, Information
& Research
Email: [email protected]
Websites: drgangemi.com
sock-doc.com
Copyright Stephen Gangemi DC,
DIBAK
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