Bowel: definition

What Is Unexplained Adult Male Hypogonadism?

[dropcap]H ypogonadism in males is a distressing reproductive disorder characterized by inadequate production of male andogen hormones and/or spermatozoa by the testes.

Q: How do andogens affect reproductive health?

A: Male androgen hormones control the development and maintenance of male sex organs and masculine secondary sex characteristics and are required for health, especially bone health. 

Testosterone is the major andogen hormone. While most of this steroid is produced by the testes, some is also produced by the adrenal glands. In hypogonadism, the testosterone level in blood is 300 ng/dl or below. 

Hypogonadism in men 45 years or older is significantly higher in men with hypertension, hyperlipidaemia, diabetes, obesity, prostate disease, and asthma or chronic obstructive pulmonary disease.¹

Interestingly, a 2014 study by Shortridge et al. on experiences and treatment of men with hypogonadism seeking care found that some symptoms continued despite treatment, and therapy was discontinued at a high rate, which men generally attributed to cost and perceptions of efficacy.² Compare this to the reversal seen in celiac men on gluten free diet.

Who is Affected in the General Population? Prevalence rate of hypogonadism was 38.7% in a study of 2162 primary care patients; 836 were hypogonadal, with 80 receiving testosterone.¹

What Is Unexplained Adult Male Hypogonadism In Celiac Disease and/or Gluten Sensitivity?

• Hypogonadism in males is associated with celiac disease and may be a presenting feature of untreated celiac disease.
• Affected males show a picture of tissue resistance to androgens which responds to a gluten free diet. Androgens are the male hormones  produced by the gonads (testicles) that are responsible for masculine features.
• Androgen resistance and hypothalmic-pituitary dysfunction appear to be relatively specific to celiac disease and cannot be explained merely in terms of malnutrition or chronic ill-health.³

Q: What is the relationship between androgen resistance and hypothalmic-pituitary dysfunction?

A: The hypothalmus, located in the brain, is constantly monitoring male hormone levels in the bloodstream that are released by the testes. Normally, when levels are inadequate, the hypothalmus sends gonatotropin releasing hormone (LHRH) to cause the pituitary gland nearby to release FSH and LH stimulating hormones. These hormones travel by blood to the male gonads to regulate their function. 

Follicle stimulating hormone (FSH) stimulates the development of sperm in the Sertoli cells. Luteinizing hormone (LH) stimulates the production of testosterone. Testosterone secreted from the Leydig cells produces mature male characteristics and is responsible for proper sperm production.

• Exaggerated responses of FSH (89%) and LH (49%) to LHRH were found in celiacs with sub-total villous atrophy and were commonly found when basal gonadotropin concentrations were normal. LH response was closely linked to villous atrophy of the jejunum.⁴
• Hormone alterations are reversible upon the start of a gluten free diet, emphasizing the importance of early diagnosis.
• As regards the nutritional aspects, the folic acid deficiency of celiac disease can affect rapidly proliferating tissues such as the seminiferous epithelium. Seminiferous epithelium refers to the cells (epithelia) that line the seminal vesicles, located in the testicles.
• More attention should be paid to deficiencies of fat-soluble vitamins, such as A and D, observed in celiac disease because vitamin A is important for Sertoli cell function, as well as, for early spermatogenetic phases.
• Vitamin E supports the correct differentiation and function of epidydimal epithelium, spermatid maturation and secretion of proteins by the prostate. The detection of early biomarkers of andrological or endocrinological dysfunctions should trigger timely strategies for prevention and treatment.⁵

How Prevalent Is Unexplained Adult Male Hypogonadism In Celiac Disease and/or Gluten Sensitivity?

Hypogonadism in males has increased frequency in males with untreated celiac disease.⁵

What Are The Symptoms Of Unexplained Adult Male Hypogonadism?

Hypogonadism in males is marked by these symptoms:

• Immature secondary sex characteristics, that is, deepening of the voice, growth and development of genitals, arm pit and pubic hair, and development of male sweat glands.
• Low or no sex drive.
• Decreased muscle mass.
• Reduced semen quality.
• Possible loss of height due to osteoporosis because low testosterone cause bones to thin, increasing the risk of fractures.

How Does Unexplained Adult Male Hypogonadism In Celiac Disease and/or Gluten Sensitivity Develop?

Hypogonadism in males results from unclear etiology involving gluten exposure and deficiencies including zinc and vitamin A, vitamin E, and vitamin D.⁵,³

Does Unexplained Adult Male Hypogonadism Respond To Gluten-Free Diet?

Yes. Celiac disease-related hypogonadism responds to gluten free diet.⁵

6 Steps To Improve Adult Male Hypogonadism In Celiac Disease and/or Gluten Sensitivity:

• [dropcap]1 Remove the Trigger. Maintain a Strict, Nutritious Gluten Free Diet:

[box type=”shadow” ]Treatment. This condition responds to the complete elimination of gluten, which is the required treatment that improves both male  hypogonadism and gut health.

• Gut health is the foundation to restore ALL health. Restored health will enable you to maintain a strict gluten free diet, just as other life tasks will be easier.
• A strict gluten free diet means removing 100% of wheat, barley, rye and oats from the diet.
• Cutting out bread and other obvious sources of gluten is not good enough for recovery. Even 1/8th teaspoon of flour or bread crumb is enough to sustain the inflammation that is damaging your small intestine, causing increased permeability (leaky gut) and allowing undigested gluten to enter your body where it can damage structures and function, and instigate immune inflammatory responses.

Correct Your Individual Nutritional Needs.

• Eat foods that can replenish missing nutrients. Find them under NUTRIENT DEFICIENCIES.
• Take nutritional supplements as needed. Find them under NUTRIENT DEFICIENCIES.

Recovery. You should begin to feel better within a week and notice more energy as inflammation subsides and the  absorbing cells that make up the surface lining of your small intestine are better able to function.

• Intestinal lining cells are replaced every 5 days. The healing process is like sunburn where the damaged surface layer of skin sloughs off and is replaced with new normal cells.
• Leaky gut normally resolves in two month after starting a gluten free diet and brings about a big improvement in health. Improvement in intestinal permeability precedes morphometric recovery (cell appearance and structure) of the small intestine in celiac disease.⁶
• The intestinal lining may take up to a year to heal.[/box]

• [dropcap]2  Reduce Inflammation. Foods to Eat and Foods Not to Eat:

Because gluten is inflammatory, eliminate OTHER inflammatory foods from your diet to reduce an additive effect to gluten. At the same time, try to eat foods that reduce inflammation (anti-inflammatory).

[box type=”shadow” ]Here Are Major Inflammatory Food Types That Reduce Healing:

• Damaging Foods. In susceptible persons, includes corn, dairy (cow), and soy. Lactose, the sugar in any animal milk disrupts intestinal permeability causing leaky gut.⁷
• Allergenic Foods. Includes foods that trigger the immune sytem to produce IgE antibodies. Allergy testing is the usual way to discover these offending foods.
• Shelf Stable Processed Foods. Includes any that contain additives and preservatives. Look for them on the nutrition label of the box or package. Additives and preservatives also disrupt intestinal permeability causing leaky gut.⁷
• Fats. Limit deep fried foods, trans-fats, saturated fats (animal fat/butter), and EXCESSIVE omega-6 fatty acid oils like corn oil. Rancid fats, sodium caprate (a medium chain fat), and sucrose monester fatty acid (a food grade surfactant) induce significant disruption of the intestinal barrier that causes leaky gut.⁷.
• Excessive Refined White Flours (bran layer removed). Includes products made from them such as cookies, bread, cakes, pies. Bran contains the vitamins and minerals that metabolize grains and slows the otherwise rapid entry of sugar from their digestion into the bloodstream. Also disrupt intestinal permeability causing leaky gut.⁷
• Refined Sugars.  Includes white sugar, corn fructose and high fructose corn syrup.
• Certain Spices. Includes paprika and cayenne pepper which disrupt intestinal permeability causing leaky gut.⁷
• Alcohol and Caffeine. Disrupt intestinal permeability causing leaky gut.⁷[/box]

[box type=”shadow” ]Here Are Important Anti-Inflammatory Food Types to Promote Health:

• Fruits. Contain ample amounts of vitamins, minerals and phytochemicals which are naturally occuring components in plants that detoxify toxins, carcinogens (reducing the risk by 50%) and mutagens.
• Non-Starchy Vegetables. Support intestinal integrity and provide ample amounts of vitamins, minerals and phytochemicals. Includes green leafy vegetables such as lettuce and kale, also onion, broccoli, garlic, and others.
• High Quality Complex Carbohydrates. Provide vitamins, minerals, and fiber while boosting serotonin levels to help you relax and feel calm. Includes whole grains, legumes, and root vegetables such as carrots, parsnips, sweet potatoes, turnips, red beets, and others.
• Antioxidants. Protect the body from inflammatory oxidant molecules that continually occur and help us handle stress and reduce irritability. Includes vitamin C-containing foods such as lemon, grapefruit, apricot, Brussels sprouts and strawberries, and others. Also, includes vitamin E-containing foods such as nuts, seeds, avocado, olive oil, and others. Cocoa is good, too.
• Omega-3 Fatty Acids. Balance opposing omega-6 fatty acids and bad fats. Fish sources includes tuna, salmon, cod, and others. Plants sources include flax, chia seeds, canola oil, and others.
• Probiotics. Supply normal microbes needed for colon health and health of the body such as these fermented foods: yogurt, kefir, and unpasteurized apple cider vinegar.
• Prebiotics/ High Fiber Foods.  Food with fiber keeps our population of colonic microbes healthy.
• Protective Herbs and Spices.  See below #6 below for examples.[/box]

• [dropcap]3  Information Sheet You Can Take to Your Doctor or Other Health Professional:

Click here.

• [dropcap]4  Manage Your Medications Safely:

[box type=”shadow” ]

Certain medications deplete zinc, vitamin A, vitamin E, and vitamin D which promotes adult male hypogonadism. Ask your doctor or pharmacist about this possible adverse effect if you are taking any of the drugs listed below. Do not stop prescribed medications without supervision.

This is not a complete listing.

ANTACIDS / ULCER MEDICATIONS

• Pepcid®, Tagamet®, Zantac® deplete Vitamin A, Vitamin D, Zinc.
• Magnesium and Aluminum Antacid preparations (Gaviscon®, Maalox®, Mylanta®) deplete Vitamin A, Vitamin D, Zinc.

ANTIBIOTICS disrupt intestinal permeability which complicates celiac disease.

•  Tetracyclines deplete Zinc.
• Cipro depletes Zinc.

ANTI-INFLAMMATORIES disrupt intestinal permeability which complicates celiac disease.

• Corticosteroids (Prednisone, Medrol®, Aristocort®, Decadron) deplete Vitamin D, Zinc.

ANTICONVULSANTS

• Phenobarbital and Barbituates; and Dilantin®, Tegretol®, Mysoline®, Depakane/Depacon® deplete Vitamin D, Zinc.

ANTIVIRAL AGENTS

• Zidovudine (Retrovir®, AZT and other related drugs) deplete Zinc.

CARDIOVASCULAR DRUGS

• Antihypertensives (Catapres®, Aldomet) deplete Zinc.
• ACE Inhibitors (Capoten®, Vasotec®, Monopril® and others) deplete Zinc.

CHOLESTEROL DRUGS

• Colestid® and Questran® deplete Vitamin A, Vitamin D, Vitamin E, Beta-carotene.

DIURETICS

• Thiazide Diuretics (Hydrochlorothiazide, Enduron®, Diuril®, Lozol®, Zaroxolyn®, Hygroton® and others) deplete Zinc.
• Loop Diuretics (Lasix®, Bumex®, Edecrin®) deplete Zinc.
• Potassium Sparing Diuretics (Midamor®, Aldactone®, Dyrenium® and others) deplete Zinc.

FEMALE HORMONES disrupt intestinal permeability which complicate celiac disease.

• Oral Contraceptives (Norinyl®, Ortho-Novum®, Triphasil®, and others) deplete Zinc.
• Oral Estrogen/Hormone Replacement (Evista®, Prempro®, Premarin®, Estratab® and others) deplete Zinc.

WEIGHT LOSS DRUGS THAT BIND FAT 

• Zenicol (Orlistat®) depletes Vitamin A, Vitamin D, Vitamin E, Beta-carotene.

[/box]

• [dropcap]5 Nutritional Supplements To Help Correct Deficiencies:

[box type=”shadow” ]

The type and quantity of nutritional supplements that may be needed depend on which nutrients are deficient.

• Multivitamin/mineral combination once a day is useful to improve overall nutrient levels. This is a safe dose, but always check with your doctor to avoid interactions with medications.
• Vitamin A as prescribed following blood test for status.
• Vitamin D3 as prescribed following blood test for status.
• Vitamin E as prescribed following blood test for status.
• Chelated zinc as prescribed.

Storage Note: Store container tightly sealed, away from heat, moisture and direct light to avoid loss of potency. That is, in a safe kitchen cabinet – not in the bathroom or on the kitchen table.[/box]

• [dropcap]6 Manage Natural Remedies: 

[box type=”shadow” ]Hydration:

• Eight glasses of water are recommended per day unless there is a contraindication such as kidney or heart disease. The Institute of Medicine recommends approximately 2.7 liters (91 ounces) of total water, from all beverages and foods, each day for women and 3.7 liters (125 ounces) daily of total water for men.
• If you are thirsty, drink water. Add fresh, squeezed lemon to water. Lemon is anti-inflammatory, alkalizing and provides vitamin C.
• Hydration Test: Urine should be pale yellow. Fingertips should be plump, without pruning but this may not be reliable when fingers are swollen with edema. Lips should be plump, without puckering. The feeling of thirst can be unreliable.
• What is wrong with soda, coffee, tea, and alcohol? These drinks are dehydrating, increase acid, and deplete nutrients.[/box]

[box type=”shadow” ]Carminatives. The following  anti-inflammatory plant sources called carminitives help heal the digestive tract. They also tone the digestive muscles which improves peristalsis, thus aiding in the expulsion of gas from the stomach and intestine to relieve digestive colic and gastric discomfort.

Carminative Food Remedies:

• Raspberry.
• Carrot is also a cleansing digestive tonic.
• Grape is also bile stimulating and a cleansing remedy for sluggish digestion and laxative.
• Redbeets also stimulate and improve digestion and are easily digested.
• Cabbage also stimulates and improves digestion and is also a liver decongestant.
• Lettuce also stimulates and improves digestion and is also an alterative, meaning it improves the function of organs involved with the digestion and excretion of waste products to bring about a gradual change.
• Potatoes are antispasmodic (due to atropine like properties) and a liver remedy.

Carminative Herb Remedies:

• Sage is also a digestive, astringent, bile stimulant and energy tonic that heals the mucosa.  Drink as tea or use in cooking.
• Chamomile, lemon balm, and fennel, (as a tea) also help relieve nervous tension.
• Parsley also relieves indigestion.
• Rosemary as a tea and in cooking also is a nervous system tonic for stress and fatigue, bile stimulant, and can relieve headaches and indigestion.
• Thyme is also soothing remedy useful for stimulating digestion of rich, fatty foods.

Carminative Spice Remedies:

• Cloves are also antispasmodic.
• Nutmeg is also useful for indigestion.
• Ginger.[/box]

[box type=”shadow” ]Exercise Helps:

Exercise improves circulation and rids the body of toxins.

• Walking is aerobic exercise that reconditions the whole body to improve stamina. Read more about Exercise and Fitness.
• Weight training builds muscle. Read more about Exercise and Fitness.
• Stretching improves flexibilty. Read more about Exercise and Fitness.

Note: Exercise is important, but the amount and type of exercise undertaken depends on your health. Your first priority is to heal. [/box]

What Do Medical Research Studies Tell About Unexplained Adult Male Hypogonadism In Celiac Disease and/or Gluten Sensitivity?

RESEARCH STUDY SUMMARIES

“Vitamin and mineral deficiencies are highly prevalent in newly diagnosed celiac disease patients.” This study aiming to assess the nutritional and vitamin/mineral status of current “early diagnosed” untreated adult CD-patients in the Netherlands found that vitamin/mineral deficiencies are still common in newly “early diagnosed” CD-patients.

Eighty (80) consecutively newly diagnosed adult CD-patients were included and a comparable sample of 24 healthy Dutch subjects was added to compare vitamin concentrations. Some of the CD patients reported to have used vitamin and mineral supplements before diagnosis of CD was made: 18 (22.5%) a multivitamin, folic acid or vitamin B-complex, 7 (8.8%) iron supplements and 14 (17.5%) a calcium supplement.

Nutritional status and serum concentrations of select mineral and vitamins were made before prescribing gluten free diet. Almost all CD-patients (87%) had at least one value below the lower limit of reference. Specifically, for vitamin A, 7.5% of patients showed deficient levels. Vitamin/mineral deficiencies were counter-intuitively not associated with a (higher) grade of histological intestinal damage or (impaired) nutritional status. Extensive nutritional assessments seem warranted to guide nutritional advices and follow-up in celiac disease treatment.⁸

“LH response was closely linked to jejunal morphology.“ This study investigating pituitary regulation of gonadal function in treated and untreated male patients with Celiac Disease demonstrated a derangement of pituitary regulation of gonadal function. Exaggerated responses of FSH (89%) and LH (49%) to LHRH were found in celiacs with sub-total villous atrophy and were commonly found when basal gonadotropin concentrations were normal. LH response was closely linked to jejunal morphology.⁹

“Male gonadal function in coeliac disease: 2. Sex hormones.” This study investigating levels of plasma testosterone, dihydrotestosterone, sex-hormone binding globulin, estradiol, and luteinising hormone in men with Celiac Disease and relating these findings to jejunal morphology, fertility, semen quality, and sexual function demonstrated androgen resistance and hypothalmic-pituitary dysfunction that appear to be relatively specific to Celiac Disease and cannot be explained merely in terms of malnutrition or chronic ill-health. Endocrine disturbance may be related to sexual dysfunction in Celiac Disease, but its relationship to disordered spermatogenesis in Celiac Disease has not been clearly established.³

Sources:

1. Mulligan T, Frick MF, Zuraw QC, Stemhagen A, McWhirter C. Prevalence of hypogonadism in males aged at least 45 years: the HIM study. Int J Clin Pract. 2006 Jul;60(7):762-9. [↩] [↩]
2. Shortridge EF, Polzer P, Donga P, Blanchette CM, Fang Y, Burudpakdee C, Carswell B. Experiences and treatment patterns of hypogonadal men in a U.S. health system. Int J Clin Pract. 2014 Mar 28. doi: 10.1111/ijcp.12418. [↩]
3. Farthing MJ, Rees LH, Edwards CR, Dawson AM. Male gonadal function in coeliac disease: 2. Sex hormones. Gut. Feb 1983;24(2):127-35. [↩] [↩] [↩]
4. Farthing MJ, Rees LH, Edwards CR, Dawson AM. Male gonadal function in coeliac disease: III. Pituitary regulation. Clinical Endocrinology. Dec 1983;19(6):661-71. [↩]
5. Stazi AV, Mantovani A. Celiac disease and its endocrine and nutritional implications on male reproduction. Minerva Medica. Jun 2004;95(3):243-54. [↩] [↩] [↩] [↩]
6. Cummins AG, Thompson FM, Butler RN, et al. Improvement in intestinal permeability precedes morphometric recovery of the small intestine in coeliac disease. Clinical Science. Apr 2001;100(4):379-86. [↩]
7. Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease. Journal of Gastroenterology and Hepatology. 2003;18:479-91. [↩] [↩] [↩] [↩] [↩] [↩]
8. Wierdsma NJ, van Bokhorst-de van der Schueren MA, Berkenpas M, Mulder CJ, van Bodegraven AA. Vitamin and mineral deficiencies are highly prevalent in newly diagnosed celiac disease patients. Nutrients. 2013 Sep 30;5(10):3975-92. doi: 10.3390/nu5103975. [↩]
9. Farthing MJ, Rees LH, Edwards CR, Dawson AM. Male gonadal function in coeliac disease: III. Pituitary regulation. Clinical Endocrinology. Dec 1983;19(6):661-71. [↩]