No, I am not talking about how you zone out during that conversation, lecture, class, work meeting, seminar, or Charlie Brown’s teacher talking. Bla Bla Bla is what I generally think of the average low testosterone male patient. Men with low testosterone say things like: I just don’t feel like doing (insert hobby) anymore, I have lost drive in life, I don’t feel like working out anymore, I feel so weak, or I feel just bla. Testosterone is a hormone produced in the testicles, ovaries (yes both men and women produce testosterone), and adrenal glands, and helps maintain bone density, fat distribution, muscle strength and mass, facial and body hair, red blood cell production, sex drive, and sperm production. Testosterone generally peaks during adolescence and steadily declines every year from about 30 years old. Americans, mostly men, currently spend about $2Billion on testosterone therapy per year, which is estimated to raise to about $4Billion; partially thanks to drug marketing campaigns urging older men to “boost your T” or “do you have low T?”. People are looking to testosterone hormonal therapy for anti-aging, to mask symptoms, make up for unhealthy lifestyle choices, build muscle, promote athletic performance, sexual function, and more.
However, we must appreciate that hormones, like melatonin, DHEA, progesterone, estrogen, testosterone, and human growth hormone, are not nutrients, yet they are being treated like they are just another supplement by growing numbers of people. Hormones are powerful, they set in motion, speed up, control or regulate cells, tissues, or organs. Hormones are secreted by the endocrine glands (Hypothalamus, Pineal Gland, Pituitary Gland, Thyroid, Parathyroid, Thymus, Adrenal, Pancreas, Ovaries, and Testes) directly into the circulating blood and ultimately landing in binding receptor sites in, or on, their target cells. The complexity of the hormonal system is great and the inter-connectivity between the hormonal system, immune system, and nervous system take this complexity to a higher level. There is constant communication back and forth amongst the endocrine glands and the nervous system almost like a conversation goes back and forth. There are countless known factors and unknown factors at play; all of which no one yet fully understands. The amazing thing is how the body, when functioning optimally, self regulates to balance hormone levels.
This self regulation is where things begin to get tricky in today’s society. Recently we have discovered that many things can act like hormones, such as soy products, toxins found in make-up, bug spray, weed killer, abdominal belly fat and much more. Particularly with testosterone regulation, understand that testosterone and estrogen are in balance with each other and compete for receptor sites on cells. We now understand that many of these soy products and toxins act like estrogen and bind to the testosterone/estrogen receptor site on the cells. This creates a competition for the receptor sites and it seems these toxins are quite determined to not let go of the receptor site; this is where a good purification program can help clear the receptor sites and the extra cellular matrix. Another challenge to balancing testosterone in older men is we are not sure is lower testosterone normal aging or is it due to a medical condition. An additional challenge is that there is significant symptom overlap from other issues such as medication side effects, sleep apnea, thyroid problems, diabetes, and depression, and treating these issues may cause testosterone to rise. When it comes to hormones we don’t even have a consensus on which method of testing is the best, blood, saliva, or urine and what levels are medically relevant at what age and time (some hormones cycle up and down at different times); generally the blood seems to be the least accurate method of testing but yet the most common testing done. Additionally the quantity of testosterone required to produce different effects in the body varies widely from person to person.
Did you know that the body can turn testosterone into estrogen? One of the most important factors that affect testosterone levels and the ratio between testosterone and estrogen is the aromatase enzyme. Ever hear of someone taking an aromatase inhibitor? Aromatase converts testosterone to estrogen, further depleting free testosterone levels and increasing estrogen levels; and appreciate that estrogen is associated with some cancers.
Signs of low testosterone: low sex drive, erectile dysfunction, low sperm count, unexplained hair loss, hot flashes, low bone density, testicular atrophy, decrease in lean muscle mass, increased body fat, elevated HbA1c, Osteopenia, insomnia, fatigue, low concentration, lack of motivation, depression, low self-confidence, swollen or tender breasts, difficulty concentration or remembering, low energy, and high blood pressure.
Common Causes of low testosterone: obesity, toxins, parabens, BPA, abdominal belly fat, low tissue calcium, low vitamin D, lack of exercise, testicle injury or cancer, hormonal disorders, infection, liver or kidney disease, low cholesterol, poor sleep, and diabetes.
Risks of taking prescription testosterone include: sleep apnea, acne, skin reactions, prostate growth, promotes the growth of some prostate cancers, enlarged breasts, testicle shrinkage, blood clot or DVT, increased risk for cardiovascular disease, and contact with other people may spread the hormone to those not prescribed.
In summary, the topic of testosterone is a tricky one and it seems we don’t have everything figured out at this point. Clinically, I have had multiple patients who were taking hormones only to find out later they got cancer and their oncologist tells them that taking the hormones played a significant role in what caused their cancer, and proliferated their cancer growth. In my opinion, I am not a big fan of taking testosterone for most people, and I find that when we clean up many of the lifestyle factors, most people will return to a self regulating state and the symptoms subside. Like many health problems there are things to avoid and things to do to help us return to normal regulation.
Things to avoid include: bad fats such as refined oils and trans fats as these tend to negatively effect glands and their hormone output, sugar, high fructose corn syrup, diabetes, high percentage body fat, toxins, soy based products, parabens, alcohol, drugs, estrogen or other hormone transfer from contact with others taking hormones, processed foods, and plastics.
Things to do: live a healthy lifestyle with adequate sleep, eat real whole foods, exercise, lift weights, reduce stress/worry/anxiety/etc, deep breathing, make sure your vitamin D levels are good, make sure you are not too low cholesterol as hormones are made from cholesterol, encourage optimal liver and kidney function, reduce belly fat, and eat cruciferous vegetables .
It is my preference to give these lifestyle modifications, and occasionally supplements, adequate time to encourage and support the body to both produce testosterone and self regulate the endocrine system and hormonal balance before considering taking prescription testosterone. Until next time, yours in good health Dr. B.
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