Testosterone Replacement, Natural & Unnatural Part 2
Shifting social paradigms
In addition to lower rates of smoking in men (smoking elevates testosterone levels), the Forbes article mentions the generational differences in how men work and live, then versus now. The article mentions the shift in work away from manual labor with the consequence of fewer strong laborers, as well as the inhibiting effect of the hormone oxytocin which is produced by the prevalence of more supportive relationships, such as with marriage, child-raising and more cooperative work environments. In recent surveys, Millennial men in the US, and to a greater extent the UK, are defining themselves as something other than “completely masculine”, with only 30% rating themselves as completely masculine, compared to 65% of men over the age of 65. Characteristics definitive of masculinity in this study included self-reliance, toughness and hypersexuality.
At the same time, jobs have shifted away from traditionally male sectors like manufacturing and labor and toward sectors traditionally dominated by women, while the need for men to go out and “bring home the bacon” as the primary bread-winner has significantly diminished. This leaves men with a “purpose void” as noted by popular men’s author Warren Farrell which contributes to lack of motivation and depression in young men. These then directly contribute to the difficulty in the younger generations finding the energy to live life and actively address life’s challenges, which now goes by the name of “adulting”. With men falling behind women in terms of academic achievement and demonstrating difficulty in consistently addressing life’s challenges, women are left wondering where the men went, because all they see are boys.
The article also mentions the problem of causality- does low T cause physical debility or does sedentary living cause low T, or is it both? Does depression contribute to low T or does low T cause depression? Probably all are true. Studies have shown that supplementing with testosterone increases muscle mass AND have shown that exercise increases natural testosterone (finally some actionable advice!). We also know that testosterone is proven to rise when men think they have bested another man in competition (even regardless of whether they actually did!). I think it prudent to assume as the authors did at the conclusion of the 2018 study in Scientific Reports: “causality cannot be traced, but declining levels could be contributing to a silent decline in overall health and increased risk for chronic disease.” This assumption would require men to take responsibility for their health and require action- but what action specifically? That depends on what you are treating.
The testicle is connected to the pituitary-bone (well, sorta…)
Testosterone levels decline naturally with aging after peaking around ages 18-19. The average rate of decline in bioavailable testosterone is 2-3% per year. Studies show that 20% of men over age 60 have total testosterone levels below normal, and 50% of those older than 80 are low. Testosterone is produced by the testes, which is regulated by the pituitary gland, which in turn is regulated by the hypothalamus. The function of all systems of our body decline as we age, and the endocrine system is no different. In the setting of low T, it is possible that the primary cause of deficiency could be at one of those three locations, but with late-onset hypogonadism (read advanced age), it’s likely a combination of all three slowly declining- because that’s what our body does over time, when left to itself.
It is beyond the scope of this article to discuss the specific workup and treatments for specific problems (for example erectile dysfunction). The focus is instead on prevention and treatment of low testosterone. Suffice it to say that all of the symptoms of low T mentioned above (sexual, physical and emotional) could be caused anywhere along the hypothalamus-pituitary-testicular axis. Additionally, any of those signs or symptoms could be caused by medications, obstructive sleep apnea, thyroid disease, diabetes or depression. These conditions can all cause low testosterone as well and treatment of these diseases would increase testosterone. So you can see the difficulties presented in the workup of one specific symptom. Instead, we will follow the KISS (keep it simple) principle and begin with the commonly accepted ways to increase testosterone naturally, including supplement use, and without prescription medication.
Natural Testosterone Elevation
Here are ways to successfully elevate testosterone which have been proven in at least one study.
Minimize stress and cortisol levels. High cortisol, secreted by the adrenal glands in times of stress, directly lowers testosterone. Stress can also lead to eating as a means of coping, which leads to weight gain and increased body fat which leads directly to low testosterone (another reason to have only healthy food available and to exercise regularly). A consistent mindfulness practice, healthy amounts of sleep, plenty of laughter and a balanced and intentional lifestyle are essential. If you feel overwhelmed, start here. Without the right mindset, you will have difficulty with the consistent motivation required for lifestyle change. A good coach can work wonders here. Several studies have proven that mindset, health and wellness coaching leads to better health outcomes. These are due to increased self-knowledge, internal motivation and confidence. Laughter and a balanced lifestyle are key indicators for any definition of personal success.
Exercise and weight-lifting. Helps keep you from getting fat. Specifically, weight-lifting and HIIT classes are best. However, as an aging athlete and certified personal trainer, I would not recommend HIIT for most people over 40 (most of who low T affects), and very few over 50, unless they have a several-year history of consistent training, including HIIT training. Plyometrics are high-risk for those of us over 40, and there are much safer, effective and activity-specific modalities for us. You could probably tolerate it for a while, but your ligaments and cartilage would start complaining after a few weeks, if not sooner, and you would lose your gains and more if you are significantly injured. If you’re already overweight, ease in. A personal trainer is very efficient here as they can get you on a solid plan with meaningful action within a day.
Balanced diet with whole foods and minimal processed foods. You need the right nutrients, fiber and limited fat. The Mediterranean diet is easy, common-sensical and effective. Don’t buy anything that comes in a box, bag, can or bottle. Be sure to eat a large meal before you go grocery shopping. If you need a lot of words to convince you of the importance of eating healthy, you have a lot more problems than low testosterone.
Sleep is crucial for memory formation, stress reduction and testosterone formation apart from stress mitigation. As an adult, you need 7-10 hours every night. 5 hours of sleep has been shown to cause 15% reduction in testosterone, 4 hours leads to borderline deficiency. Your testosterone will improve 15% for every additional hour of sleep you achieve.
Zinc supplements have been shown to increase testosterone. You can’t absorb this nutrient without the right amount of stomach acid and if you’re on an acid lowering medication like omeprazole or others, then you should probably stop taking it. Before you do that, however, read the remainder of this article and discuss it with your doctor.
Plenty of sun. Too much time indoors is unnatural and unhealthy, and you need vitamin D to increase testosterone. Supplements can be necessary if you’re home bound and unable to get outside- in which case you should be supplementing with calcium as well.
Natural supplements. Ashuaghanda and ginger extract are potential elevators of testosterone but more research is needed.
Healthy lifestyle. Or at least avoiding an unhealthy lifestyle. Excess alcohol and drugs are associated with diminished testosterone. Probably some kind of couch effect and/or increased stress levels, depending on the drug. Again, there are links between low T, obesity, chronic disease and premature death.
Avoidance of hormone-like chemicals (parabens, plastics). More on this below.
Increased curiosity. I made this one up, and I doubt there are studies demonstrating its efficacy, but only because it hasn’t been studied. But when I look back on all of the obese patients I’ve seen, of all ages, one thing most had in common was what seemed like at least a mild depression. Like life was something they were more or less enduring, and had lost its spark. I was often left with the impression that they didn’t find life to be joyous or amazing, let alone a gift to be cherished. There is so much in life that is joyous and amazing that I often wondered how they didn’t see it, or why they stopped looking. If you don’t see life as a beautiful gift, you are missing something very important and need to go find it! A coach is someone who can help you dig within, and find without, the joy you’re missing. It is NEVER too late, and you will ALWAYS be worthy of it!
These are the standard steps that can be taken by everyone to treat, or avoid getting, low testosterone. They, especially the mindset, diet and exercise steps, are often capable of solving or preventing low T by themselves, and are certainly necessary to developing a thriving and fulfilling life. Sometimes, however, and for various reasons including aging and our environment, they aren’t enough to normalize testosterone, and more steps need to be taken. The discussion that follows is sometimes necessary now that we live in a post-modern world being filled at an alarming rate with plastics and other chemicals, while at the same time our soils are being depleted of essential nutrients.