Men's Health with Dr. Ralph Esposito, ND, LAc
Q: What originally sparked your interest to pursue a medical career? And what drives your passion to work in the field of medicine?
A: At the age of 6 my pediatrician told my mother, “If your husband had 2 heart attacks at 48, your son is going to have one at 30.” Before I hit 2nd grade my triglycerides and cholesterol levels were astronomical, especially for a kid. As a kid, after experiencing the perils of chronic disease in my family, I found comfort in thinking that if anything were to happen to me I’d be okay because doctors had medicine, and there would be a pill to cure me. My trust in modern medicine was soon let down, by age 16 the doctors did nothing to address my hyperlipidemia, I was overweight and my father at this point had CAD, COPD, PAD, sarcopenia, was physically disabled, on 15+ medications and today added leukemia to that list.
You would then assume I got into medicine because I saw medicine fail my dad. Yes. But more so, I’m stubborn and I was determined to prove that perhaps modern medicine did not have all the answers. Mix that with drive and a reluctance to accept the status quo, you have what some would call passion.
Q: In your own words, can you explain to me what you do within the field of Naturopathic Medicine?
A: I currently work as a medical consultant and research analyst where I use my background in research, writing and clinical work to contribute to the clinical and research teams. My speciality is in urology, men’s health and hormones where I try to decipher a lot of the conflicting research and evidence on hormones (ie: Does testosterone cause prostate cancer, Is soy bad for male and female hormones, insulin resistance and chronic disease). A lot of my work involves analyzing labs as well, with a lot of focus on lipidology, inflammatory markers and I am a huge fan of the DUTCH test.
Q: What do you believe is the reason behind why men are less likely to engage in their health? And how do you see this shifting?
A: I really wish i had a simple answer for this, but a large part has to do with machismo. Men, societally, are expected to be tough, be strong, be the alpha and not show any weakness. Illness, in many men, is perceived as a weakness. It can even stem back evolutionarily, where the wounded and weak were considered inadequate and sub-optimal, the same goes in the 21st century. Stick 10 guys in a doctor’s waiting room and each one is trying to figure out what’s wrong with the other guy and if his issue is as bad or worse than his. Want to magnify this? Make it a urologist’s waiting room, now these men feel more vulnerable. Seeing the doctor is not the issue, it's the perception of showing illness which makes men feel less manly.
Now, more than ever, men are being more open about their health as it is trendy to eat well, live well, exercise. Now you will see men more concerned about preventive medicine, but this is more prominent in the younger men in their late 20's, 30's. The more we can promote wellness, and making men feel ‘optimal’ then the more likely they are to engage in their health because now you’re not discussing illness but instead optimal performance.
Q: What are the most common conditions you treat in men’s health? And how can Naturopathic Physicians offer them care that they aren't already receiving?
A: Low testosterone (low T) is the most common, with the runner up being sexual dysfunction interlaced with prostatitis. I also do see a significant amount of prostate cancer. Low testosterone is often a metabolic dysfunction and a hypothalamic-pituitary-adrenal/gonadal dysfunction rather than an inability of the testicles to produce T. Working on the basics of sleep, stress, lifestyle and supporting with supplements like Urtica, Maca, Withania. However, one thing naturopaths look at more deeply are the detoxification pathways and I pay a lot of attention to the estrogen metabolites: 2-OH-E1, 4-OH-E2 and 16-alpha-OH-E1 and testosterone, DHT and their respective metabolites, which then allows us to work on the whole body rather than a particular organ.
Most men will die with prostate cancer rather than from prostate cancer. But as a naturopath I would rephrase that and suggest that we help men live as if they don’t have prostate cancer. Improving quality of life is a key goal, and this can be done by supporting them on their journey with personalized food plans, supplements, exercise/fitness and as a coach to help them with the many tough decisions coming their way, such as deciding between active surveillance, radiation, chemo and androgen deprivation.
Q: Clinically, have you seen the long term effects of steroid use?
A: Typically there are two views on steroid use. One group shuns hormone use claiming it is cheating and isn’t necessary. The other group thinks they’re benign. I reside in neither, but I will say there is significant benefit to Testosterone Replacement Therapy (TRT), if it is done correctly and if all other factors and causes have been exhausted. The group that has the benign outlook, often is the group I see abusing these drugs and having downside effects later on. I have seen the detriments of steroids in some men just taking one cycle of testosterone but the issue here is they were not receiving the proper guidance and did not need it in the first place.
What needs to be clear is testosterone or any other hormone replacement, does not just impact the testicles and androgen system. It impacts every organ, every cell including adrenals, thyroid, liver, heart, brain etc. Most of the negative effects I have noticed in men after they come off T, is they then experience symptoms of hypothyroidism, depression, elevated estrogens, sexual dysfunction. This occurs most commonly because they thought they needed more T, but instead needed a rebalance of their Hypothalamic, Pituitary, Adrenal/Thyroid/Gonad axis.
Now, there are some men that need and would greatly benefit from testosterone and hormone replacement. But there are other ways to do this via more subtle medications like clomid, oxandrolone, arimidex, hCG, etc. All of course need to be monitored via proper lab testing and intake.
Q: When working closely with men to promote their health, what have you learned from your patients?
A: I have learned that often the key to a man’s health is his partner. When, and if, a man allows his significant other to help manage his health then the outcomes are much improved with increased compliance, more return visits and more motivation.
Also, men are creatures of habit and they are data driven. If I told my patient they had to abstain from starchy vegetables because their cause of male health issues are likely related to insulin resistance and blood sugar dysregulation, they may be resistant. Once I show them their numbers, that is when they get on board. I have noticed particularly lab testing has been a great motivational tool, especially when getting men to focus on sleep and stress management.
Q: Where do you see the future of men’s health?
A: Many male health issues are largely attributed to lifestyle factors. Prostate cancer is largely influenced by diet and lifestyle. Sexual dysfunction and male hormonal imbalances are often connected and corrected with diet, stress, lifestyle and exercise. Many conventional medical practitioners are now starting to recognize this, which is why I think men’s health is moving more towards integration where naturopaths, dietitians, medical doctors, physical therapists, acupuncturists all work together and contribute to putting all the puzzle pieces together. My vision has always been to bring integrative medicine to major institutions, where the greatest minds can converse and work towards parsing out all the nonsense in medicine and just practice good medicine.
Q: Is there something that you would like to share with our readers?
A: I want your male readers to not be so shy about their health. I know it may not seem so ‘alpha,’ but I want every man to feel like they are the best version of themselves, and to think that they don’t have to do it alone.
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