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Can you go anywhere anymore without seeing an ad or reading some journal article about 'Low T'?
I hope not - and thank God.
It's normal for testosterone levels in men to decrease as they age but 'normal' doesn't mean 'good'. It's normal for your kids to come home from school with all Cs on their report card, but that doesn't mean you're high-fiving them for their good performance. Thesaurus the word "normal" - you'll find 'average', 'run-of-the-mill', 'mediocre', or my personal favorite - 'unexceptional'. Seriously - look it up. If you're cool with your health being 'normal', you can stop reading here.
Up until 200 years ago, no one lived this long. The average life expectancy in 1817 was 35 years. To survive, men evolved over the centuries to produce the optimal levels of necessary anabolic hormones like testosterone, DHEA, and growth hormone until about the age of 35 - perhaps 40. But now we live way longer than that - sometimes up to 85 or 90. That's a lot of years without hormones. Maybe in another few hundred million centuries human physiology will upgrade, but for now, that's all the T you get.
On top of living past the age of 35, you live here in the United States - still the most amazingly fortunate, but quite possibly the most toxic country on the planet. It's an environment overrun with neuroendocrine disrupters - i.e. pollutants that disrupt endocrine function, causing all sorts of hormonal problems. Pesticides, herbicides, plastics, phthalates, BCPs, bisphenols, hormones in food, ultra processed food, soy (which is in everything), anything with a red dye, anything with a fragrance, all aluminum based antiperspirants... The list is endless.
These endocrine disruptors are 100% poison - and sadly they are everywhere. They don't just cause low T, they lead to alterations in sperm quality, fertility, abnormalities in sex organs, endometriosis, early puberty, altered nervous system function, immune system dysregulation, cancer, respiratory illness, metabolic issues, diabetes, obesity, cardiovascular disease, growth/neurological and learning disabilities, and more unnecessary misery. Because of these environmental toxins, we are seeing clinically significant testosterone deficiency show up in men in their 40s, 30s and even in their 20s. According to recent studies, average adult male testosterone levels have been declining every year for decades - about 1% per year since the 1980s - a staggering 25% decline in the past two decades alone.
Now, reference ranges for total testosterone in men not only reflect physiologic decline, but they account for the environmental theft as well. We used to see ranges of 600-1400. Today, it's pretty common to see ranges all the way down to 180-750. Are you still ok with 'normal'?
SIGNS OF LOW T
There are many symptoms suggestive of low T. As a healthcare provider for men, I can tell you that unlike women, 'low libido' is rarely on the Top 5 list. It can be, but low T symptoms are often more insidious than difficulties with erections or low libido, making it tricky to catch for men. As T levels decline, men experience many of the following symptoms:
- Loss of muscle mass
- Poor concentration
- Decreased motivation
- Increased body fat
- Hot flashes
- Sleep disruption
- Longer recovery times from work outs
- Longer recovery times from injuries
Testosterone loss equals quality of life loss. Physiologic testosterone replacement is life changing. Men often tell me they didn't realize how bad things had become until they were healthy again. Optimized men report a decrease in joint pain, an increase in lean muscle mass, restored mental clarity, better motivation and mood, sleep and sexual performance. Most of my testosterone optimized men define their adult lives by 'before' and 'after' starting testosterone therapy.
A FEW CAVEATS
Testosterone optimization is life changing, but it is extremely important that you go about this carefully. I can't stress this enough. A lot has changed - even in the past 10 years - in how we deliver and manage testosterone replacement therapy. Many providers are still using outdated practices now known to cause serious long term damage. In spite of this, I still see men EVERYDAY following these outdated TRT protocols. It's important to work with someone specifically trained in testosterone replacement and who is up to date on the risks, benefits, and best TRT practices.
HOW DO I KNOW IF I HAVE LOW T?
Do you live in an environment saturated with endocrine disrupting chemicals? Are you 40 years of age or older? Do you feel like you've been run over by a train? Have unexplained excess body fat? No energy? Crappy sleep? Grumpy Old Man Syndrome? Less than fully erect erections?
Relax - The best way to determine if you have low testosterone is easy: Have your blood tested.
This is simple - any lab can do it. Ask to have your total, free, and bioavailable testosterone measured. (If your physician doesn't know why you're asking for all three, you'll want to find a physician who does). While you're bleeding, ask for a complete blood count, basic metabolic panel and a few other two dollar labs to give you a good idea of how everything in your body is operating. Testosterone doesn't work in a vacuum - it needs to be well balanced with everything else.
**INSIDER TIP** REFERENCE RANGE VS HEALTHY RANGE
You'll hear physicians mistakingly refer to laboratory reference ranges as 'normal ranges'. We've already established the shortcomings of the word 'normal', but it's important to understand where these laboratory reference ranges come from. Sometimes laboratory ranges are standardized for diagnostic (i.e. billing) purposes. For example, an HgbA1c of 6.5 buys you the diagnosis of diabetes, regardless of which lab you go to. More often than not, however, the 'reference range' is determined by the individual lab. They essentially throw the results they obtained from the people that went there into a statistical analysis to give them a mean (average) and two standard deviations on either side. 2.5% are on the 'too low' end, and 2.5% are on the 'too high end' - everyone else is 'normal'.
In real talk, normal is 95% of the results they obtained from the people who went to that lab. Did they screen these people to make sure they were healthy? That's what you want, right? You want to see how you stack up against other healthy people - not barely alive hospitalized people. Of course, both data sets represent 'living people', but we all want to be the best people we can be. The only certainty for beating the hospitalized patient reference range is 'still breathing'.
CAN'T I JUST TAKE SUPPLEMENTS
No. The market for testosterone enhancing products has exploded over the past decade, but these products are largely untested and completely unregulated. There is a lot of noise, but no actual data that these supplements increase testosterone in human males.
Int J Impot Res. 2021 Apr;33(3):311-317. doi: 10.1038/s41443-020-0285-x. Epub 2020 May 1.
The objective was to study available evidence for ingredients of popular over-the-counter testosterone and erectile dysfunction (ED) supplements. The top 16 male testosterone and 16 ED supplements in the USA were identified from the most popular online retailers: A1 Supplements, Amazon, Vitamin Shoppe, and Walmart. In total, 37 ingredients were identified and PUBMED online database was reviewed for randomized-controlled trials (RCT) studying their efficacy. Ingredients were categorized based on evidence quantity using an adapted version of the American Heart Association scoring system. In total, 16 ingredients from testosterone supplements and 21 from ED supplements were identified. Tribulus, Eurycoma longifolia, Zinc, L-arginine, Aspartate, Horny goat weed, and Yohimbine were most common. In all, 105 RCTs studying the identified ingredients were found. No whole supplement products have published RCT evidence. 19% of ingredients received an A grade for strong positive evidence with net positive evidence in two or more RCTs. In total, 68% received C or D grades for contradicting, negative, or lacking evidence. Overall, 69% of ingredients in testosterone supplements and 52% of ingredients in ED supplements have published RCT evidence. Many male supplements claim to improve testosterone or ED parameters; however, there is limited evidence, which should be considered when counseling patients.
HOW DO YOU TREAT LOW TESTOSTERONE?
In some men, testosterone can be increased by increasing the signal to the testicles to make testosterone. hCG, clomiphene, and enclomiphene are all analogs of the human hormone (LH) directing testosterone production. This is effective in some men and not in others. If a man wants to preserve fertility, these are options that need to be considered.
Testosterone can be reliability and safely replaced in men with injections, creams, or pellets.
There are pros and cons to each of these routes. Physicians and patients often swear by one and swear at the others, but by all currently available data, they are all safe. The choice is yours.
DID YOU KNOW?
THINGS YOU CAN DO TO IMPROVE YOUR TESTOSTERONE
Diet and lifestyle have a direct effect on your natural testosterone levels. And even when choosing testosterone replacement therapy, it's a good idea to make some simple lifestyle adjustments to help maximize the effect of the treatment. Remember, you are trying to build a good foundation for testosterone production - so try to avoid or eliminate destructive things, like smoking, recreational drug use, and excessive drinking.
LOSE EXCESS WEIGHT
If you have low testosterone levels, you may also have increased body fat. Even losing just a few pounds can help to increase natural testosterone production, and you will look and feel better too.
GET MOVING. GET CUT
High intensity interval training workouts (HIIT) naturally stimulate production of testosterone. Combine this with strength training to help build and keep that lean muscle.
FEED THE T
You have to give the body the right nutrients. Ensure you are getting the right amount of zinc, vitamin D, lean protein and essential fatty acids. Also try to limit or remove sugar and excessive alcohol consumption.
LOSE THE STRESS
When you are stressed, another hormone called cortisol kicks in. And when it's present for long periods of time due to constant stress, it can cause learning and memory problems, put a drain on your immune system, lead to bone density loss, cause you to gain weight, raise your blood pressure, cholesterol, and increase your risk of heart disease.
Dr. Kristen Lindgren has helped hundreds of men rebalance their testosterone and improve their quality of life.
Don't accept that you have to live with Low T
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