Tuesday, May 17, 2016

Real Deal #21: Why Controlling Our Stress Response Keeps Us Young

"The idea that you can reduce stress, increase your testosterone, and become a beast in bed is probably nonsense, but it is still good for you to reduce stress. My first advice for reducing stress is to stop worrying about your testosterone," says Daniel Shoskes, MD, a urologist at the Cleveland Clinic.

THE INTRODUCTION

Wise Geek:
Cortisol and testosterone are closely connected in both men and women, although testosterone tends to be associated more with men. When cortisol levels rise, testosterone levels tend to decrease. This can cause a number of health problems if the spike in cortisol levels is prolonged, and it is also a concern for athletes in training, as testosterone helps people build muscle, and cortisol actually breaks it down. Levels of these hormones can be measured in a doctor's office if there is a concern about a hormone imbalance.

Cortisol is secreted by the adrenal gland, while testosterone is made in small amounts in this gland and in larger amounts in the gonads. The body produces more cortisol in response to stress. At the same time, it reduces testosterone production, dedicating energy to the production of cortisol so that enough will be available. Cortisol and testosterone levels tend to change together, a reflection of the interconnected systems in the body.

In ordinary conditions, after a brief burst of stress, people return to a more normal state. Both cortisol levels and testosterone levels readjust because the stressor is gone, with cortisol dropping to a more normal level and testosterone rising. In cases where people cannot escape stress, as for example when people are on the battlefield or are struggling with a hostile work environment, cortisol levels remain elevated and the production of testosterone continues to be suppressed.

In the short term, this can cause symptoms like a decreased sex drive. Over the long term, mood disorders can develop and people may lose muscle mass and tone. In people who are still growing, a prolonged cortisol and testosterone imbalance can cause developmental delays, including a small size and delayed onset of puberty. Children growing up in stressful environments often have a number of medical problems related to chronic stress and can experience comorbidities like poor nutrition, making it even harder for them to develop normally.

Everyday Health:
"That may be true, but there is an old saw in research that you need to remember," says Dr. Shoskes. "Association does not equal causality. There is very little evidence that stress lowers testosterone and even less evidence that lowering stress will raise testosterone. That being said, we do know that acute and chronic stress have physiologic effects on the body. So, lowering stress could help with low testosterone symptoms like low libido, low energy, and depression."

THE EVIDENCE

"According to a few studies conducted by an endocronologist Matthew Hardy, our testicles produce this enzyme called 11ßHSD-1, which protects testosterone from the destructive effects of cortisol. However, when cortisol is too high, there simply isn’t enough of the enzyme 11ßHSD-1 to counteract the stress hormone, and as a result a lion’s share of your freshly produced testosterone molecules will be destroyed before they even leave the sack. Not only that, but cortisol and testosterone are both made from pregnenolone (which the body synthesizes from cholesterol). When cortisol is elevated, it basically “robs” the raw building material of testosterone into making a stress hormone, rather than male sex hormone."
Journal of Abnormal Psychology:
The hypothalamus -pituitary-adrenal (HPA) axis and the hypothalamus-pituitary-gonadal (HPG) axis are two hormonal axes that work together to maintain an appropriate balance between withdrawing in the presence of fearful or threatening stimuli, and approaching in the presence of rewarding stimuli. The HPA axis is involved in potentiating the state of fear, generating sensitivity to punishment, and inducing withdrawal behavior (Schulkin, Gold, & McEwen, 1998), leading to the hypothesis that this system may be hypoactive in psychopathic individuals. In antisocial groups more generally, low cortisol levels have been observed in aggressive children (McBurnett, Lahey, Rathouz, & Loeber, 2000), adolescents with conduct disorder (Pajer, Gardner, Rubin, Perel, & Neal, 2001) and violent adults (Virkkunen, 1985).

The HPG axis is hypothesized to be associated with psychopathy because its end product testosterone has been associated with approach-related behaviors including reward-seeking (Daitzman & Zuckerman, 1980), dominance (Archer, 2006), and aggression (Dabbs, Jurkovic, & Frady, 1991). Testosterone has been associated with a variety of antisocial behaviors including difficulties on the job, law breaking, marriage failures, drug use, alcohol abuse, and violent behavior (Mazur & Booth, 1998), which are commonly observed in psychopathy, but not with psychopathy as a whole.

The HPA and HPG axes are mutually inhibitory – testosterone inhibits functioning of the HPA axis at the level of the hypothalamus, while cortisol suppresses the activity of the HPG axis at all levels, diminishing the production of testosterone and inhibiting the action of testosterone at target tissues (Johnson, Kamilaris, Chrousos, & Gold, 1992; Tilbrook, Turner, & Clark, 2000). Animal studies have shown that one of the primary targets of testosterone and cortisol is the amygdala (Koolhass, Van den Brink, Roozendaal, & Boorsma, 1990), a brain region that is consistently implicated in psychopathy (Blair, 2007). In the amygdala, cortisol is hypothesized to promote fearfulness and withdrawal behavior (Schulkin, et al., 1998); testosterone has the opposite effect – it serves to promote reward-seeking and approach behavior (Daitzman & Zuckerman, 1980).

Furthermore, cortisol and testosterone affect the amount of communication between subcortical regions, such as the amygdala, and cortical regions, such as the orbitofrontal cortex. Cortisol has been found to strengthen the communication between these regions, whereas testosterone has been found to reduce it (Schutter & van Honk, 2005; van Wingen, Mattern, Verkes, Buitelaar, & Fernandez, 2010). Increased testosterone relative to cortisol may reduce the communication between the amygdala and orbitofrontal cortex, meaning that there is less emotional input from the amygdala to guide decision-making in the orbitofrontal cortex. Conversely, the cortical regions that are important in emotion regulation and inhibition are less able to regulate input from sub-cortical regions, including impulsive, reward-seeking, and aggressive urges. In sum, a high testosterone/cortisol ratio may enhance sensitivity to reward relative to punishment, promote approach rather than avoidance reactions, and reduce the emotional input from the amygdala to the orbitofrontal cortex that is critical for empathy and recognizing cues that a decision may be risky or harmful. It may also impair the ability to regulate emotion and aggression.

* * *

A study published in the journal Hormones and Behavior provides new evidence for what's called the cortisol testosterone hormonal axis. Researchers measured hormone levels in 57 men who were pitted against each other in one-on-one competition. Their cortisol and testosterone levels were measured after competing. The men who lost were asked if they wanted to compete again. All the men who declined had high cortisol levels and had a significant drop in their testosterone. The researchers believe this is a hormonal response that prepares the body to respond to stress by escaping danger.

As Dr. Shoskes says, it is hard to find any hard evidence that raising your testosterone will reduce stress, but it does seem to work for male guinea pigs. A study published in The Journal of Physiology found that high levels of stress in the guinea pigs results in high cortisol, low testosterone, and increased anxiety behavior. When they were given testosterone replacement therapy, their anxiety behaviors went away.

* * *

When women were in the fertile phase of their menstrual cycle — that is, when they were more likely to get pregnant — those men with low cortisol levels (so were likely more chill) were seen as more attractive than men with high cortisol levels. Past research suggests that when women are most fertile, they tend to judge men on traits that might best benefit any potential offspring in the long-term, and the scientists noted that a person's general cortisol levels are heritable

"We speculate, then, that males with low cortisol possess something desirable that women seek to secure for their offspring," Moore said. "This could be, for example, good health or a healthy response to stress."



Britta K. Hölzel,1,2 James Carmody,3 Karleyton C. Evans,1 Elizabeth A. Hoge,4 Jeffery A. Dusek,5,6 Lucas Morgan,1 Roger K. Pitman,1 and Sara W. Lazar1. "Stress reduction correlates with structural changes in the amygdala." Social Cognitive and Affective Neuroscience. 2010 Mar; 5(1): 11–17. doi: 10.1093/scan/nsp034.

David R. Rubinow, M.D.,1 Catherine A. Roca, M.D.,1 Peter J. Schmidt, M.D.,1 Merry A. Danaceau, R.N.,2 Karen Putnam, B.S.,3 Giovanni Cizza, M.D.,4 George Chrousos, M.D.,5 and Lynnette Nieman, M.D.5 "Testosterone Suppression of CRH-stimulated Cortisol in Men." Neuropsychopharmacology. 2005 Oct; 30(10): 1906–1912. doi: 10.1038/sj.npp.1300742.

Bruce S McEwen. "Allostasis and Allostatic Load: Implications for Neuropsychopharmacology." Neuropsychopharmacology (2000) 22, 108–124. doi:10.1016/S0893-133X(99)00129-3.

Swaab DF1, Bao AM, Lucassen PJ. "The stress system in the human brain in depression and neurodegeneration." Ageing Research Reviews. 2005 May;4(2):141-94. PubMed.

THE VERDICT

"The findings of the national survey mentioned earlier support what mental health clinicians experience in their own practices — many people are unable to find a way to put the brakes on stress. Chronic low-level stress keeps the HPA axis activated, much like a motor that is idling too high for too long. After a while, this has an effect on the body that contributes to the health problems associated with chronic stress.

Persistent epinephrine surges can damage blood vessels and arteries, increasing blood pressure and raising risk of heart attacks or strokes. Elevated cortisol levels create physiological changes that help to replenish the body’s energy stores that are depleted during the stress response. But they inadvertently contribute to the buildup of fat tissue and to weight gain. For example, cortisol increases appetite, so that people will want to eat more to obtain extra energy. It also increases storage of unused nutrients as fat."
Harvard Health:
Fortunately, people can learn techniques to counter the stress response. There are several other simple techniques that can also help, including getting enough sleep, staying physically active, maintaining adequate hydration, and learning to perceive stressful events in the proper context.

Relaxation response. Dr. Herbert Benson, director emeritus of the Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital, has devoted much of his career to learning how people can counter the stress response by using a combination of approaches that elicit the relaxation response. These include deep abdominal breathing, focus on a soothing word (such as peace or calm), visualization of tranquil scenes, repetitive prayer, yoga, and tai chi.

Physical activity. People can use exercise to stifle the buildup of stress in several ways. Exercise, such as taking a brisk walk shortly after feeling stressed, not only deepens breathing but also helps relieve muscle tension. Movement therapies such as yoga, tai chi, and qi gong combine fluid movements with deep breathing and mental focus, all of which can induce calm.

Social support. Confidants, friends, acquaintances, co-workers, relatives, spouses, and companions all provide a life-enhancing social net — and may increase longevity. It’s not clear why, but the buffering theory holds that people who enjoy close relationships with family and friends receive emotional support that indirectly helps to sustain them at times of stress and crisis.

More information:
» Forbes: "Do Your Testosterone And Cortisol Levels Dictate Your Leadership Ability?"
» Coaching Positive Performance: "How to deal with worry"
» Anabolic Men: "3 Weird but Still Effective Tricks to Raise Natural Testosterone Levels"
» Anabolic Men: "8 Ways to Lower Stress Hormone Levels Naturally" (strength training, laughing, sleeping, relaxation, high-power posture, Vitamin C, Rhodiola rosea)
» Anabolic Men: "One Week Sample Testosterone Boosting Workout Routine"

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