Steve was a man who spent a lot of time in the gym. He looked like he could take an iron bar and bend it with his arms. He was in his thirties and wondered why he was indifferent to women. He had nothing against women. He was close to his mother and other female relatives. Steve had a female boss and liked her quite a bit. Indeed it was a great mystery to him why he could be so casual about the opposite sex. And Steve did not have any homosexual orientation. He enjoyed friendships with women, but despite meeting many lovely and fine women, he had no interest in a romantic relationship.
"Unless we put medical freedom into the Constitution, the time will come when medicine will organize into an underground dictatorship ... To restrict the art of healing to one class of men and deny equal privileges to others will constitute the Bastille of medical science. All such laws are un-American and despotic and have no place in a republic ... The Constitution of this republic should make special privilege for medical freedom as well as religious freedom."
Dr. Benjamin Rush, signer of the Declaration of Independence
During this time I read an excellent book by Eugene Shippen called, The Testosterone Syndrome. Eugene is a funny yet mellow genius serving in rural Pennsylvania. Basically, he is a local treasure. Like most geniuses, his neighbors likely do not realize the magnitude of his contribution to medicine. I sure do, and many around the world also are thankful for his labor.
In any event, Eugene describes men who have no estrogen -- they have no libido. They can be very athletic and viral, but are very casual about sex. He explained it is not merely testosterone that causes men to be passionate, but also estrogen.
So with this in mind, I tested Steve's estrogen. It was very low. Since his testosterone was in the middle range I decide to give a little bit of testosterone in a lozenge. The fast release of the lozenge would hopefully cause him to have his testosterone become estrogen. Sort of the same thing that happens with shots of testosterone -- too much becomes estrogen because it is too much testosterone at once.
Yet when I reviewed his blood testing, I was not convinced his estrogen improved at all. Therefore, I gave him some very low dose estrogen. On retests, his estrogen was in the fully normal range for a man his age.
After some time, Steve mentioned that he was dating. Eventually he married.
It seems he had a problem with an enzyme called aromatase. Aromatase converts testosterone to estrogen, and some men have troubles with his enzyme. Steve had normal testosterone but he had trivial estrogen. I suspect the problem was that his aromatase enzyme was not functioning properly.
The take a message is the following: men need estrogen for libido. And by the way, women need a number of hormones to have maximal libido, including testosterone at low levels.
Wishing You Much Health!
Dr James S.