Chapter 5 E2 Management, DIM and Arimidex
Men convert a small amount of their testosterone (T) to estrogen (E) by the action of the aromatase enzyme. As men age, they experience both decreasing levels of T and increasing levels of E. When the T/E ratio begins to tip downwards, a number of negative health effects occur. This effect is sometimes called estrogen dominance.
Men who are on T replacement therapy (TRT) often experience elevated E as a side effect of boosting their T back to normal.
Whether you are on TRT or not, putting the T/E ratio back into proper balance generally restores a man's vigor including improved erectile function. The remainder of this chapter discusses two remedies that are used in estrogen management Diindolylmethane (DIM) and Arimidex.
Diindolylmethane (DIM) is a naturally occurring substance found primarily in cruciferous vegetables (e.g., cabbage, broccoli, cauliflower, Brussels sprouts, etc.) that helps the liver digest/metabolize Estradiol into more benign/healthy estrogens. When taken orally, DIM is not very bioavailable because it gets digested in the stomach and, therefore, doesnt make its way into the bloodstream. However, Indolplex is a proprietary formulation that increases DIM's oral bioavailability.
For more information about DIM see www.dimfaq.com. This website was written by Dr. Michael Zeligs of BioResponse who owns the patent on the proprietary DIM formulation.
I experienced a tremendous surge in erectile function during the first 2 or 3 months on a very low dosage of Indoplex (25 to 50 mg/day). The effect of Indoplex began after about 1 or 2 days and remains at about 80% of the initial surge effect level after about 3 years. Other men have reported similar results.
The recommended dosage for Indolplex is about 240 mg/day. This dosage is way too much for me, but I'm highly responsive to it. However, setting your DIM dosage is very tricky because the window of optimum E2 level is very narrow. See Chapter 7 for a discussion about setting your DIM dosage.
Many brands of DIM are available in vitamin stores and on the Internet. Some of these brands are manufactured under Zeligs patent and some arent. Unfortunately, supplements aren't well regulated like pharmaceuticals. As a result the quality of supplements varies greatly by brand.
Ive had excellent results using Indolplex with DIM by PhytoPharmica. (See www.ritecare.com/prodsheets/PHY-15336.html. ) About 20 blood test results as well as my clinical response (see Chapter 7) have confirmed that DIM works for me.
Arimidex is a prescription drug that is very effective in lowering blood levels of E by inhibiting the action of the aromatase enzyme. While some men report some clinical benefits from Arimidex, the results do not match what one would expect from the reduction in E2 that this treatment yields. The reason for this discrepancy is unknown.
DIM is a relatively benign supplement (no prescription required) with no side effects (unless you take too much). In contrast, Arimidex is a prescription drug with a long list of potential side effects.
I suspect that elevated E2 in men may result more from insufficient metabolization of E2 rather than excess aromatization. For a number of reasons/causes the P450 system in the liver declines in function as men age. Therefore, while we probably make more E2 as we get older, we also don't metabolize it as well as we did when we were younger.
In addition to being a food supplement rather than a drug, DIM supports a deficient system in our bodies to do what it was designed to do rather than blocking a functioning system from doing what it was meant to do.
Chapter 6 Amazing How Balancing T and E Improved My Health
In June 1999 at the age of 44, I was diagnosed with hypogonadism (low testosterone), microhematuria (microscopic blood in the urine), and prostatitis (frequent urination and an enlarged and painful prostate). Also, I had 2 positive cytology reports (indicating that I might have bladder cancer).
In February 2000, I started HCG shots. I had a kidney IVP to try to find the source of the microhematuria, but they found nothing.
I also discovered in early 2000 that I had Ulcerative Colitis (UC), which is an inflammation of the colon. I probably had this condition for years. When it flares up (about every month or 2), Cipro works very quickly (due to its anti-inflammatory properties rather than as an antibiotic, I suppose) to calm it down.
In May 2001, I started taking DIM which lowered my Estradiol (E2) from about 70 (<45) to about 40, putting my T and E2 in proper balance for the first time in years.
In August 2001, I visited my urologist. He told me that the microhematuria is gone and that my prostate is normal. Also, I've had consecutive 4 negative cytology reports in 2001. I saw my urologist last in 2003 and he said its no longer an issue.
I get a UC flare up about once a year now. It happens when my T and E2 get out of balance.
I should also mention that:
(1) I have more energy, particularly in the evenings.
(2) I have much stronger erections. I generally don't use V, but sometimes I'll take a half of a 25 mg, for a little extra boost.
(3) My workouts are more intense and less strenuous.
(4) My skin color went form pale to dark. It's embarrassing when people ask me if I've been somewhere warm on vacation lately. I just say no, rather going into detail about how I rebalanced my hormones.
(5) I sleep better. Shorter duration, but more restful.
(6) I don't get sick as often.
(7) My insulin sensitivity has improved dramatically (I'm T2 diabetic w/o meds and my HbA1c went from 7.1% to 6.0%).
(8) I can only imagine the various positive effects that rebalancing my hormones has had on my cardiovascular/lipid profile, bone health, immune system, etc.
I don't want to leave the impression that rebalancing my hormones was easy. No way. And the fact that the vast majority of doctors, including endocrinologists and urologists, are vastly undereducated about the benefits and methods of TRT makes the job extra difficult. It took me two years and a lot of study and experimentation to achieve the above.
Chapter 7 Adjusting DIM Dosage
I am amazed at the power that DIM has on me and with the effect that extremely small adjustments to my daily dosage have on my health.
When I first tried DIM in early 2000 (using the manufacturer's recommended dosage of two 120 mg tablets per day), I felt pretty good for a few days or so and then I crashed big time. So, I stopped taking it and returned to normal (or at least to my previous status). I was very confused and didn't know what to conclude other than this stuff was not for me. It wasn't until a year and a half later that I suspected that the reason for the negative response was that I was overdosing and, thereby, reducing my E2 too low. So, I started taking half a tablet a day. I felt great for about 2 weeks including more energy and much stronger erections. But after a while I felt down again. So, I dropped my dosage to a quarter of a tablet. That worked very well. I've been fine-tuning the dosage ever since.
A lot of posters say that they tried DIM and it improved their erections, but after a week they were as bad or worse off than before they started. What happened was that they dropped their E2 down to the optimum level and then went beyond it. The window of optimum E2 level is very small. Too little E2 is not a good thing. E2 is needed for libido as well as heart, muscle and bone health. That's why I suggest starting low (e.g., one tablet per day at dinner) and then see how it goes. If your erections get strong for a few days and then go away, that means that the dosage is too high for you. Stop for 2 or 3 days and start up again at half a tablet per day. If the same thing happens again, go to one quarter of a tablet per day. Once youre in the right range and you want to adjust from there, make the adjustment small and keep it at that level for a week, or better yet, 2 weeks. Observe your body's response and adjust accordingly.
Getting the dosage right is extremely tricky and extremely critical. The thing that makes adjusting the DIM dosage so difficult is that the clinical response you get (i.e., how you feel) when you take too much (i.e., drop your E2 too low) feels a lot like the response you get when you take too little (i.e., when your E2 is too high). As a result, when you feel down, you don't know whether to increase or decrease the dosage. That's why I learned to listen very carefully to my body and rely on certain indicators. These indicators include erectile response, nipple sensitivity, the quality and restfulness of my sleep, my tendency to maintain or gain weight, and the presence or absence of a burning sensation in my lips and tongue. Eventually, using these indicators, I developed the ability to regulate my daily DIM complex intake.
To fine-tune my dosage, I use a jeweler's scale (cost about $200) that measures to an accuracy of 2 mg (0.002 g) to parcel out my dosage. (See the Tanita 1210-50 at http://balanc.temp.veriohosting.com/paypal/diamond.html ) Since one 120 mg DIM tablet weighs a little over a gram, that translates to an accuracy of about 0.1 mg of DIM complex in adjusting my dosage.
Before starting DIM, my T to E2 ratio was about 10 to 1 (T average of about 700 and E2 average of about 70). Now my T to E2 ratio is about 20 to 1 (T average of about 800 and E2 average of about 40).
Please note that I'm not suggesting that your E2 level indicators will be the same ones as mine. I'm only suggesting that by listening to your body, and finding YOUR indicators, you might be able to find your "right" dosage as well.
It is very likely that I am more in tune with my body's signals than most men. As a result, this approach would not be for everyone. I follow a very disciplined and intense program of diet and exercise. I know very quickly when my energy is waning.
I wish I could tell you that it was easier than this. Until we have better ways of measuring E2, this is the best I can offer. Of course, whatever you do, it's best to verify your clinical observations with before and after blood tests.
For a discussion on how DIM improved my health in many ways, see Chapter 6 Amazing How Rebalancing T and E Improved My Health."
**********************************************************
I hope that this primer makes it a little easier for the next guy to take his life back.
- David
Men convert a small amount of their testosterone (T) to estrogen (E) by the action of the aromatase enzyme. As men age, they experience both decreasing levels of T and increasing levels of E. When the T/E ratio begins to tip downwards, a number of negative health effects occur. This effect is sometimes called estrogen dominance.
Men who are on T replacement therapy (TRT) often experience elevated E as a side effect of boosting their T back to normal.
Whether you are on TRT or not, putting the T/E ratio back into proper balance generally restores a man's vigor including improved erectile function. The remainder of this chapter discusses two remedies that are used in estrogen management Diindolylmethane (DIM) and Arimidex.
Diindolylmethane (DIM) is a naturally occurring substance found primarily in cruciferous vegetables (e.g., cabbage, broccoli, cauliflower, Brussels sprouts, etc.) that helps the liver digest/metabolize Estradiol into more benign/healthy estrogens. When taken orally, DIM is not very bioavailable because it gets digested in the stomach and, therefore, doesnt make its way into the bloodstream. However, Indolplex is a proprietary formulation that increases DIM's oral bioavailability.
For more information about DIM see www.dimfaq.com. This website was written by Dr. Michael Zeligs of BioResponse who owns the patent on the proprietary DIM formulation.
I experienced a tremendous surge in erectile function during the first 2 or 3 months on a very low dosage of Indoplex (25 to 50 mg/day). The effect of Indoplex began after about 1 or 2 days and remains at about 80% of the initial surge effect level after about 3 years. Other men have reported similar results.
The recommended dosage for Indolplex is about 240 mg/day. This dosage is way too much for me, but I'm highly responsive to it. However, setting your DIM dosage is very tricky because the window of optimum E2 level is very narrow. See Chapter 7 for a discussion about setting your DIM dosage.
Many brands of DIM are available in vitamin stores and on the Internet. Some of these brands are manufactured under Zeligs patent and some arent. Unfortunately, supplements aren't well regulated like pharmaceuticals. As a result the quality of supplements varies greatly by brand.
Ive had excellent results using Indolplex with DIM by PhytoPharmica. (See www.ritecare.com/prodsheets/PHY-15336.html. ) About 20 blood test results as well as my clinical response (see Chapter 7) have confirmed that DIM works for me.
Arimidex is a prescription drug that is very effective in lowering blood levels of E by inhibiting the action of the aromatase enzyme. While some men report some clinical benefits from Arimidex, the results do not match what one would expect from the reduction in E2 that this treatment yields. The reason for this discrepancy is unknown.
DIM is a relatively benign supplement (no prescription required) with no side effects (unless you take too much). In contrast, Arimidex is a prescription drug with a long list of potential side effects.
I suspect that elevated E2 in men may result more from insufficient metabolization of E2 rather than excess aromatization. For a number of reasons/causes the P450 system in the liver declines in function as men age. Therefore, while we probably make more E2 as we get older, we also don't metabolize it as well as we did when we were younger.
In addition to being a food supplement rather than a drug, DIM supports a deficient system in our bodies to do what it was designed to do rather than blocking a functioning system from doing what it was meant to do.
Chapter 6 Amazing How Balancing T and E Improved My Health
In June 1999 at the age of 44, I was diagnosed with hypogonadism (low testosterone), microhematuria (microscopic blood in the urine), and prostatitis (frequent urination and an enlarged and painful prostate). Also, I had 2 positive cytology reports (indicating that I might have bladder cancer).
In February 2000, I started HCG shots. I had a kidney IVP to try to find the source of the microhematuria, but they found nothing.
I also discovered in early 2000 that I had Ulcerative Colitis (UC), which is an inflammation of the colon. I probably had this condition for years. When it flares up (about every month or 2), Cipro works very quickly (due to its anti-inflammatory properties rather than as an antibiotic, I suppose) to calm it down.
In May 2001, I started taking DIM which lowered my Estradiol (E2) from about 70 (<45) to about 40, putting my T and E2 in proper balance for the first time in years.
In August 2001, I visited my urologist. He told me that the microhematuria is gone and that my prostate is normal. Also, I've had consecutive 4 negative cytology reports in 2001. I saw my urologist last in 2003 and he said its no longer an issue.
I get a UC flare up about once a year now. It happens when my T and E2 get out of balance.
I should also mention that:
(1) I have more energy, particularly in the evenings.
(2) I have much stronger erections. I generally don't use V, but sometimes I'll take a half of a 25 mg, for a little extra boost.
(3) My workouts are more intense and less strenuous.
(4) My skin color went form pale to dark. It's embarrassing when people ask me if I've been somewhere warm on vacation lately. I just say no, rather going into detail about how I rebalanced my hormones.
(5) I sleep better. Shorter duration, but more restful.
(6) I don't get sick as often.
(7) My insulin sensitivity has improved dramatically (I'm T2 diabetic w/o meds and my HbA1c went from 7.1% to 6.0%).
(8) I can only imagine the various positive effects that rebalancing my hormones has had on my cardiovascular/lipid profile, bone health, immune system, etc.
I don't want to leave the impression that rebalancing my hormones was easy. No way. And the fact that the vast majority of doctors, including endocrinologists and urologists, are vastly undereducated about the benefits and methods of TRT makes the job extra difficult. It took me two years and a lot of study and experimentation to achieve the above.
Chapter 7 Adjusting DIM Dosage
I am amazed at the power that DIM has on me and with the effect that extremely small adjustments to my daily dosage have on my health.
When I first tried DIM in early 2000 (using the manufacturer's recommended dosage of two 120 mg tablets per day), I felt pretty good for a few days or so and then I crashed big time. So, I stopped taking it and returned to normal (or at least to my previous status). I was very confused and didn't know what to conclude other than this stuff was not for me. It wasn't until a year and a half later that I suspected that the reason for the negative response was that I was overdosing and, thereby, reducing my E2 too low. So, I started taking half a tablet a day. I felt great for about 2 weeks including more energy and much stronger erections. But after a while I felt down again. So, I dropped my dosage to a quarter of a tablet. That worked very well. I've been fine-tuning the dosage ever since.
A lot of posters say that they tried DIM and it improved their erections, but after a week they were as bad or worse off than before they started. What happened was that they dropped their E2 down to the optimum level and then went beyond it. The window of optimum E2 level is very small. Too little E2 is not a good thing. E2 is needed for libido as well as heart, muscle and bone health. That's why I suggest starting low (e.g., one tablet per day at dinner) and then see how it goes. If your erections get strong for a few days and then go away, that means that the dosage is too high for you. Stop for 2 or 3 days and start up again at half a tablet per day. If the same thing happens again, go to one quarter of a tablet per day. Once youre in the right range and you want to adjust from there, make the adjustment small and keep it at that level for a week, or better yet, 2 weeks. Observe your body's response and adjust accordingly.
Getting the dosage right is extremely tricky and extremely critical. The thing that makes adjusting the DIM dosage so difficult is that the clinical response you get (i.e., how you feel) when you take too much (i.e., drop your E2 too low) feels a lot like the response you get when you take too little (i.e., when your E2 is too high). As a result, when you feel down, you don't know whether to increase or decrease the dosage. That's why I learned to listen very carefully to my body and rely on certain indicators. These indicators include erectile response, nipple sensitivity, the quality and restfulness of my sleep, my tendency to maintain or gain weight, and the presence or absence of a burning sensation in my lips and tongue. Eventually, using these indicators, I developed the ability to regulate my daily DIM complex intake.
To fine-tune my dosage, I use a jeweler's scale (cost about $200) that measures to an accuracy of 2 mg (0.002 g) to parcel out my dosage. (See the Tanita 1210-50 at http://balanc.temp.veriohosting.com/paypal/diamond.html ) Since one 120 mg DIM tablet weighs a little over a gram, that translates to an accuracy of about 0.1 mg of DIM complex in adjusting my dosage.
Before starting DIM, my T to E2 ratio was about 10 to 1 (T average of about 700 and E2 average of about 70). Now my T to E2 ratio is about 20 to 1 (T average of about 800 and E2 average of about 40).
Please note that I'm not suggesting that your E2 level indicators will be the same ones as mine. I'm only suggesting that by listening to your body, and finding YOUR indicators, you might be able to find your "right" dosage as well.
It is very likely that I am more in tune with my body's signals than most men. As a result, this approach would not be for everyone. I follow a very disciplined and intense program of diet and exercise. I know very quickly when my energy is waning.
I wish I could tell you that it was easier than this. Until we have better ways of measuring E2, this is the best I can offer. Of course, whatever you do, it's best to verify your clinical observations with before and after blood tests.
For a discussion on how DIM improved my health in many ways, see Chapter 6 Amazing How Rebalancing T and E Improved My Health."
**********************************************************
I hope that this primer makes it a little easier for the next guy to take his life back.
- David
