A 50-year-old man says to his doctor, “I’m just not feeling great.” Can you guess what his doctor tells him? “It’s normal, you’re just getting older.” Unfortunately, male medical issues, like low testosterone, are often overlooked and dismissed. Low testosterone is an important one because it affects a man’s overall sense of wellbeing.
Hormones, in general, play a big role in how we feel on the inside, how we relate to the world around us, and how we respond to other people. Testosterone governs a lot of how a man feels and behaves, playing a role in him “feeling like a man.” It’s important for drive and for motivation so that when a man wakes up in the morning and his boots hit the floor, he’s ready to take on the world. That’s what testosterone does for men.
When men go through hormonal changes (and they do), testosterone levels usually drop gradually and men kind of wake up one morning feeling not quite right. When women go through hormonal changes, it’s pretty obvious. We have menstrual problems and irregularities, we get hot flashes, and our moods and sleep are often all over the place–obvious events signaling that our hormones are changing. But for men, it’s much more subtle.
What I hear men say a lot is, “You know, I just don’t quite feel like myself anymore. I’m just not quite keeping up the same way that I used to. Maybe it’s just my age.” I hear this all the time, “It must just be my age. I’m not 18 anymore.” Maybe you’re not 18, but if you’re 40 or even 60, let’s not immediately blame it on age! If you’re 85, fine, maybe, but if you’re younger, you don’t have to accept feeling this way.
So let’s say a doctor is willing to explore a bit and test testosterone levels and they’re low. If all the doctor does is recommend replacement testosterone and nothing else, we’re missing a great opportunity to treat the whole man and pave a path to wonderful health all the way into golden years.
It’s important to have some basic understanding of WHY the testosterone may be low in the first place. So, again, if you’re 85, we’re going to blame it on your age. But I’m seeing low testosterone in young men. So what are underlying issues?
The first place to look for the ‘WHY’ is in a comprehensive set of labs–total and free testosterone levels, plus estradiol, sex hormone binding globulin (SHBG), cortisol, LH, and fasting insulin levels as well. I’ll explain what these are and why they’re important in a minute.
The second place to look for a ‘WHY’ is diet, sleep quality, excess weight (especially around the middle), diabetes, stress, genetics, physical movement/muscle mass, and alcohol consumption and prescription meds.
When we address some of these factors and treat the whole person, there’s an opportunity for testosterone levels to improve even without testosterone replacement.
If we look at all the possible ‘WHYS’ and whittle away at those, and still find a bit of low T either on labs or just symptomatically, then testosterone replacement may be the next step, but we then need to make sure it’s working properly.
One of the things that happens naturally with testosterone is that, some of it gets converted into estrogen. For some men, too much testosterone gets converted into excess estrogen, causing low T. Factors that cause this are diabetes, obesity (especially that belly fat), inflammation, or it may be that genetically they have more of the enzyme that makes this conversion.
If a man is converting testosterone into estrogen at a high rate, his testosterone will be low with elevated estrogen levels. So, if his doctor measures only testosterone and not estrogen levels, finds testosterone low, and then gives them more testosterone in the form of a gel or shot or whatever, the testosterone level will rise, but estrogen levels can increase as well. The relationship or the ratio between testosterone and estrogen is critical to monitor.Too much estrogen doesn’t feel good for a man, and can actually contribute to some types of cancers.
One of the other things I sometimes see, is elevated serum testosterone, even though the symptoms indicate low testosterone. I might also see elevated levels of sex hormone binding globulin (SHBG), which can explain a lot. SHBG, made by the liver in both men and women, binds sex hormones, including testosterone.
Our cells can use only free testosterone, not the testosterone bound in SHBG, so if you are a man with a high SHBG level (less testosterone available for cells use), you don’t feel good. You’ll still have all the symptoms of low testosterone, but you’re told that everything looks normal, and that can be really frustrating. That’s why it’s always good to test free testosterone as well as total testosterone.
LH levels, which stands for luteinizing hormone is another important marker to test. It’s affected and reduced by stress. The role of LH is to tell your body to make testosterone. If your LH levels are reduced, that’s a red flag that there’s probably an overload of stress going on, lowering T levels.
Here are the recommended blood markers to test when evaluating testosterone and hormonal health in men.
- Total testosterone
- Free Testosterone
- Thyroid panel (TSH, Free T4, Free T3)
A Source to order labs at cash prices yourself, without your doctor’s requisition, is here. It’s simple and easy and you get what you want without stepping into a doctor’s office.
Depression, anxiety, and sleep problems are things that both men and women can feel when testosterone levels are low. We go to the doctor and complain that we don’t feel good. We’re handed a prescription for antidepressants, anxiety pills, sleeping pills, when the underlying problem may be low testosterone
So let’s talk about sleep. Testosterone is released at night when you’re in a nice deep (REM) state of sleep. Men who don’t sleep well, who have symptoms of sleep apnea, may not be making enough testosterone. Some of the symptoms that we might be blaming on low T, like being more tired, memory and mood issues, may be tied to not getting a good night’s sleep and not getting enough oxygen to your brain at night. Low T can prevent good sleep, poor sleep can mean low T production–it’s a Catch-22.
Women, if your husband or partner is snoring or having other sleep issues plus hormone issues, encourage him to ask his doctor to book a sleep study. Sleep apnea affects hormone production and can also stress the heart.
What should women watch for in their male partners when it comes to low testosterone? Besides erectile dysfunction, testosterone levels really do affect mood and behavior; changes that may develop slowly over time. Remember, it can be subtle. Fatigue, especially, coming home from work and just wanting to sit on the couch, feeling low energy, flat mood, brain fogginess, kind of depressed, or not really excited about doing things that they used to really enjoy are all signs of low T.
Because testosterone and hormones are so far reaching, it’s important to find somebody who uses a functional medicine (root cause) approach (moi), meaning looking inside your body to see how things are working: diet, sleep, stress, blood sugar regulation; taking a holistic approach to keeping you feeling like The Man until you are 95!
Look at the person as a whole entity, understanding that diet, lifestyle, stress, sleep, genetics, thyroid, and inflammation are all factors in maintaining solid testosterone levels. Once addressed, there may be less need for testosterone replacement, especially below the age of 50.
Specific lab markers help to properly understand what’s going on under the hood. You can get these here.
Watch for the next post on hormone replacement for women coming soon!
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