Beyond Testosterone: Men’s Health and Dietary Supplements

At least 38 million male Baby Boomers are currently facing andropause, often called “male menopause.” Although not all men experience difficulties at this stage in life, andropause is potentially associated with a host of vague and not-so-vague signs and symptoms, including decreased muscle strength, diminished energy, and lagging physical function. As if those problems weren’t enough, men of a certain age also experience reduced sexual performance, slower cognitive functioning, and depression.

“Just as women experience different psychological and physical changes as they go through hormonal changes, men do as well,” says David Foreman, RPh, ND, a retired pharmacist and naturopathic physician. “In most cases, men tend to ignore it or blame it on something else.”

A Better Approach

Conventional treatment for troubling andropause symptoms is almost always some form of testosterone. Foreman isn’t so keen on this approach. “The body is supposed to go through this decline in hormones. To me, it’s malpractice to focus on maintaining the testosterone levels of an 18-year-old in a person who’s 65. I don’t believe the body was designed for that.”

Foreman says it’s also a big mistake for manufacturers of finished products to focus just on enhancing sexual performance and testosterone levels. “Men also produce estrogen and progesterone, as well as metabolites of sex hormones,” he explains. Additionally, cortisol, a hormone that is increased in stress also tends to increase during aging, while DHEA, the precursor for testosterone, usually decreases, he says.

Rather than aim at increasing testosterone, Foreman recommends ingredients that help manage the individual symptoms of andropause.

One of Foreman’s favorite supplements for maintaining energy levels and cognitive function in aging men is pyrroloquinoline quinone, or PQQ. “PQQ helps the body increase the numbers of mitochondria and protects them from being damaged,” Foreman says. “It increases energy without giving you a buzz.”

Although the function of PQQ in human physiology remains controversial, PQQ appears to stimulate mitochondrial biogenesis and, by this mechanism, may have possible health benefits such as improved energy utilization, at least in animal studies. Mice and rats fed diets deficient in PQQ have reduced mitochondrial content, grow poorly, fail to reproduce, and have functional deficits in connective tissue, studies show.¹ Conversely, rats supplemented with PQQ demonstrate improved memory when subjected to oxidative stress compared to nonsupplemented rats or rats supplemented with COQ10.² Other animal studies suggest PQQ can help mitigate the effects of severe stroke, protect the brain against neurotoxins, and possibly protect against Parkinsonism and Alzheimer’s disease.³ Still, a rat is a rat and not a person, so until clinical trials in humans are undertaken, there’s no way to know the effects of PQQ in people and how useful it can be in enhancing health in andropause.

Bruce Abedon, director of scientific affairs at NutraGenesis LLC (Brattleboro, VT), agrees that the focus of andropause treatment shouldn’t be just sexual enhancement. To that purpose, his company developed ZTEN, a proprietary formulation composed of two multipatented ingredients-extracts of the herbs ashwagandha (Withania somnifera), sold under the trade name Sensoril, and Cissus quadrangularis.

“Sensoril has adaptogenic properties-meaning it helps bring about balance in the body, provides resistance to various stressors, and helps balance hormone levels,” he explains. Abedon says that Sensoril has been studied in eight randomized, double-blind, placebo-controlled clinical trials, which have found significant improvements in stress, concentration, memory, sleep quality, and energy. Moreover, Sensoril has been shown to reduce cortisol and improve DHEA levels. Significant improvements have also been seen in cardiovascular health in men, Abedon says.

The Cissus quadrangularis extract was included in the ZTEN formulation for its weight management and metabolic wellness properties, which have been proven in two clinical trials so far, Abedon says. “As men get older, they often gain weight around the abdomen, which increases the risk for cardiovascular disease, so reduction in waist size is particularly important for older people,” he says. “Also, they tend to have increased issues with blood sugar management. The Cissus extract helps support this area as well.”

Sexual-Enhancement Supplements: Hype or Help?

So, then, what about those sexual-enhancement supplements? Do they have a role in andropause?

“In all honesty, I am not a big fan of sexual-enhancement herbs like tongkat ali and horny goatweed,” Foreman says. “The issue of erectile dysfunction is not normally testosterone-related. If you talk to experts in that area, they will tell you that it is more related to the cardiovascular system, or between the ears, meaning there is some anxiety or stressor that keeps the man from performing. Rarely does it link back to hormone levels.”

Mark Blumenthal, executive director of the American Botanical Council (Austin, TX), is also not impressed with supplements claiming to increase sexual performance and testosterone levels. Take, for instance, horny goat weed (Epimedium grandiflorum). “I think the name pulls the demand for horny goat weed more than the science supports it,” Blumenthal says. Maca powder, frequently marketed for its effects on sexual performance and sex hormones, is another herb with equivocal science behind the claims, he says. If testosterone is indeed low, “most of the men that I know, frankly, are using some type of testosterone application. It’s very challenging to identify herbs that actually have proven, reliable ability to increase testosterone,” he says.

Not everyone in the industry agrees with that conclusion. Annie Eng, CEO at HP Ingredients (Bradenton, FL), says that tongkat ali, the root of the Malaysian plant Eurycoma longifolia, has been used for centuries by the aboriginal people of Southeast Asia for vitality, energy, antiaging, and, yes, sexual enhancement. HP Ingredients manufactures LJ100, a standardized extract of tongkat ali that is patented for the treatment of sexual dysfunction and male fertility. LJ100 contains 28% eurypeptides, which have been shown to have androgenic properties and are believed to be the active ingredient of tongkat ali.

Eng has the scientific data to back up her claims. “We have published 12 human clinical trials on LJ100 and have four human clinical trials that are ongoing.” Some of the studies were conducted in the United States in collaboration with the Massachusetts Institute of Technology, but most have been conducted in Malaysia. In vitro studies have shown that LJ100 inhibits sex hormone binding globulin (SHBG), a protein that binds testosterone and other sex steroids, making them inactive in the body, Eng says.

“LJ100 works by inhibiting SHBG, thereby releasing bound testosterone and increasing free testosterone naturally,” Eng explains.

LJ100 also catalyzes the conversion of cholesterol to pregnenolone, which then is converted to DHEA and other sex steroids. Human clinical studies have shown that LJ100 can reduce body fat, lower cortisol, increase testosterone, and improve sexual performance and satisfaction, according to Eng.⁴

Jennifer Gu, director of R&D at AIDP Inc. (City of Industry, CA), whose company manufactures the tongkat ali extract LongJaX, also agrees that tongkat ali has a place for enhancing men’s health in andropause and has some effects on hormone levels. But, she notes, traditionally tongkat ali was used as an energy tonic, not just for sexual enhancement. “While certain individual peptides may be responsible for the effect on testosterone levels, there are probably multiple components in tongkat ali that are effective, and it’s possible they have a synergistic effect,” she says.

Another ingredient Gu says supports the aging process in men (and also in women) is cordyceps, a fungus that grows on the larvae of insects. Cordyceps sp. are used extensively in traditional Chinese medicine, where they are considered a mild adaptogen and enhance not only hormone function but also lung function.

“There are tissue culture studies that show it can stimulate testosterone production in male cells and female hormones in female cells. It has some aphrodisiac properties, but it is not as specific as Eurycoma longifolia for this application,” Gu says. Cordyceps also demonstrates a wide range of other activities that have been demonstrated primarily in animal and tissue culture studies, including immune-enhancing properties, anticancer properties, antihyperglycemic effects, kidney protection, and energy enhancement.

The herb fenugreek (Trigonella foenum graecum) has testosterone-like properties, says Gencor Pacific’s (Irvine, CA) president Jith Veeravalli, which may be useful in andropause. Gencor Pacific manufactures the fenugreek extract Testofen. “Fenugreek contains over 100 phytochemical constituents, including furostanol saponins and steroidal saponins,” says Veeravalli, which possibly work by displacing SHBG-bound testosterone. As with LJ100, this makes testosterone more available in the body without actually raising testosterone levels.

Two recent human studies offer some evidence for these claims. A randomized, double-blind, placebo-controlled study was conducted on 60 healthy men and resulted in statistically significant improvements in overall male sexual health.⁵ An eight-week, placebo-controlled, human clinical study showed an increase in free testosterone levels, plus an increase in muscle mass and a decrease in body fat.⁶ “We are continuing to do research on Testofen in the area of sexual health and expect to present further information on its benefits by next year,” Veeravalli says.

Don’t Overlook Minerals

Emphasis on sexual-performance enhancers tends to overshadow the importance of minerals in men’s reproductive health. Zinc, in particular, has been linked to male fertility.

Max Motyka, director of the human products division at Albion Minerals (Clearfield, UT), recommends Albion’s proprietary zinc arginate chelate as the best zinc chelate to include in men’s formulas because it offers a sort of a two-for-one benefit. “Both zinc and arginine play important roles in the prostate in the generation of seminal fluid,” says Motyka, “and they are also involved in the stimulation of testosterone synthesis.”

Boron also plays a role in the balance between testosterone and estrogen in the male, Motyka says, and some data suggest that inadequate selenium intake may be linked to prostate cancer. A recent systematic review showed that higher concentrations of selenium in the body were associated with a 70% reduction in prostate cancer risk; however, studies have not found that supplementation with selenium reduces risk.⁷

Muscle Health

As men age, maintaining muscle mass can become an uphill battle. “One of the manifestations of andropause is you’re working out just like before, but all of a sudden you can’t maintain weight and you have muscle wasting,” Foreman says.

Albion Minerals markets a proprietary, patented creatine and magnesium chelate product, Creatine MagnaPower, which has been shown to have a positive effect on intracellular protein synthesis. Although creatine products are most often used for building muscle mass, Motyka says findings in studies show that creatine/magnesium supplements may also be useful in enhancing cognitive function. One study randomized 32 elderly adults to receive either placebo or 5 g of creatine four times per day. After one week of creatine supplementation, participants scored significantly better on cognition tests than the placebo group.⁸

Looking to the Future

Considering the sheer number of men in the United States entering middle age, you’d think the men’s health supplements industry would be racing to keep up with the latest research on new ingredients and formulations for andropause. Not so, said most of the leaders interviewed for this article. “I think research in this area is pretty slow,” says Gu, “because FDA regulation is very sensitive to anything that claims to influence hormone levels. We have some good products that we think will help people, but we worry that if we invest in extensive research, one day the FDA will say they don’t want anything that will change hormone levels.”

Foreman says that another contributor to the comparatively slow market is that women’s health always gets a higher percentage of research dollars than men’s health, mainly because women tend to buy more supplements than men.

Abedon concurs. “There’s much more interest in menopause ingredients because andropause is kind of a hidden secret-men don’t want to admit their bodies are changing.” 

Sidebar: Ingredients for a Healthy Prostate

Although not really a symptom of andropause per se, benign prostatic hyperplasia (BPH) is high on the list of issues affecting older men. And the urinary symptoms of frequency and hesitancy-not to mention not being able to get a good night’s sleep-have a major impact on men’s well being. Conventional medical intervention often falls short of producing satisfactory results.⁹ A host of different phytotherapies are marketed for BPH, including saw palmetto, Pygeum africanum, pumpkin seed, rye pollen, quercetin, and nettle root.

Mark Blumenthal of the American Botanical Council says that saw palmetto remains the unequivocal leader in this category. “There have been a couple of recently published meta-analyses that actually found equivocal support for efficacy [of saw palmetto],” Blumenthal comments, but “based on clinical research and my own experience, I am a strong believer in the use of saw palmetto extract for BPH.” Saw palmetto is believed to have anti-androgenic effects and inhibit 5-alpha reductase, and to have anti-inflammatory effects.⁹

Blumenthal recommends a combination of saw palmetto and nettle root (not the flowering portion) to reduce the frequency of nocturia in men with BPH. This combination is manufactured in Europe by Schwabe Germany (Karlsruhe, Germany) and sold under the brand name Prostagutt Forte. In the United States, Nature’s Way (Lehi, UT) markets it as Prostol.

The bark of the African plum tree, Pygeum africanum, has anti-inflammatory and phytoestrogenic effects in BPH. A meta-analysis of 18 trials on Pygeum africanum for the treatment of BPH showed moderate improvement in nocturia, flow rate, and other symptoms.¹⁰ Blumenthal says that despite clinical research to support its use in BPH, sustainability issues have caused many companies to move away from pygeum. “It’s problematic, because if you gird the tree, you kill it,” he explains.

Rye pollen extract, marketed as Cernilton by Graminex LLC (Saginaw, MI), has been well researched as a therapy for BPH. A Cochrane Review meta-analysis found it to be well tolerated and to modestly improve urinary symptoms in BPH.¹¹ Foreman is a fan of Cernilton not only for BPH but for prostatitis and bladder inflammation that occurs without bacterial infection. “Cernilton has phenomenal anti-inflammatory properties and is an antispasmodic,” he says.

Pumpkin seed is a traditional remedy for bladder ailments, and some research supports this use. A large, 2010 German study-which was conducted by GlaxoSmithKline, interestingly-found that men with BPH who took pumpkin seed extract GranuFink Prosta Forte (Deutsche Chefaro Pharma GmbH; Dusseldorf, Germany) had significant improvements in lower urinary tract symptoms and also improved their quality of life.¹² Although not as widely researched as saw palmetto, “there’s a good basis for its use,” Blumenthal says. “I recommend it because it’s a food, so safety is well established, and the literature is highly suggestive that it’s effective.”

References

1. Killgore Jet al., “Nutritional importance of pyrroloquinoline quinone,” Science, vol. 245, no. 4920 (August 25, 1989).

2. Ohwada Ket al., “Pyrroloquinoline quinone (PQQ) prevents cognitive deficit caused by oxidative stress in rats,” Journal of Clinical Biochemistry and Nutrition, vol. 42 (January 2008).

3. Rucker Ret al., “Potential physiological importance of pyrroloquinoline quinone,” Alternative Medicine Review, vol. 14, no. 3 (September 2009).

3. www.hpingredients.com/index.php?page=LJ100

4. Steels, E et al., “Physiological aspects of male libido enhanced by standardized Trigonella foenum graecum extract and mineral formulation,”Phytotherapy Rsch, vol. 25, no. 9 (2011).

5. Wankhede et al., “Effect of Testofen on safety, anabolic activity and factors affecting exercise physiology,” in press.

6. Hurst Ret al., “Selenium and prostate cancer: systematic review and meta-analysis.” American Journal of Clinical Nutrition, vol. 96, no. 1 (July 2012).

7. McMorris Tet al., “Creatine supplementation and cognitive performance in elderly individuals,” Aging, Neuropsychology, and Cognition: A Journal on Normal and Dysfunctional Development, vol. 14, no. 5 (September 2007).

8. Nickel JC et al., “Nutraceuticals in prostate disease: the urologist’s role,” Reviews in Urology, vol. 10, no. 3 (2008).

9. Ishani A, et al., “Pygeum africanum for the treatment of patients with benign prostatic hyperplasia: a systematic review and quantitative meta-analysis,” American Journal of Medicine, vol. 109, no. 8, (December 2000).

10. Wilt Tet al., “Cernilton for benign prostatic hyperplasia,” Cochrane Database of Systematic Reviews, no 2, (2000).

11. Harkenthal M et al., “Large scale multi-centre randomized placebo controlled clinical study proves the efficacy of pumpkin seed in symptomatic benign prostatic hyperplasia (BPH) – G.R.A.N.U. study,” Planta Medica, vol. 76 (2010).

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