You never know what you are going to find until you look.
Too so many, the definition of health and wellness is a projection of outward appearance. A person looks the part of health and therefore de facto they must be healthy. However, outward appearances of health often have little to do with internal health. In fact, I would tell you that some of my most unhealthy clients fit this outward definition of health.
Such was a man that presented to my office. This 43 year old client looked the part. He was 6.2′ weighed 190 lbs (previously had weighed 285), current body fat was 12%, he ran 15-20 miles weekly, he lifted weights weekly, he ate what most would consider a healthy diet: high raw vegetable/fruit intake, high healthy fat intake, balanced animal/non-animal protein intake, gluten free, and dairy free. He even took several targeted supplements that were based on prior functional testing. This client looked the part of health and lived the part of health. But, as healthy as his physical appearance presented, his symptoms suggested otherwise.
The client reported his stress levels had been very high for the past 2 years. This left him in a constant state of brain fog. He had noticed a decrease in motivation, decrease in drive, slowed decision making ability, decreased endurance, increased anxiety, increase in sleep disruption, fatigue, decreased exercise recovery, light-headedness…The noticeably absent symptoms were ED and libido problems. The client knew he looked and played the part of health, but he knew that his symptoms didn’t match.
You never know what you are going to find until you look.
The shock on his face was evident when he was presented with his test results. Despite making so many “healthy” lifestyle choices, despite no symptoms of ED and low libido, hormone testing revealed his Testosterone was low. His symptoms didn’t follow the marketing presented on low T. His physiology didn’t care what marketing said, his physiologic dysfunction existed.
Evaluation is the key to discovery. It is amazing that 25% of men on Testosterone today have not had levels evaluated prior to initiation of therapy. This amounts to simply blind doping. This is no surprise as that is exactly what most have come to expect through experience in many other traditional therapies i.e. anti-depressant and anti-anxiety therapies. Think about it–when was the last time someone had their neurotransmitters evaluated prior to starting anti-depressant therapy?
I chose to evaluate his hormone levels in capillary blood. Capillaries are the small blood vessels that connect veins to arteries. Another great option is saliva. These 2 test mediums both look at free hormone levels and correlate well with each other. Saliva and capillary tests give us the best look at hormone levels inside the cell. Inside the cell is where the majority of hormone receptors are and where the majority of the hormone activity is. Watch our youtube video Hormone Testing 101 for more discussion on hormone testing.
The cause of his low T? According to his test results—stress. The 3 most common causes of low Testosterone are high estrogen, obesity, and stress (not necessarily in that order). I discuss and highlight 8 causes of low T in great detail in my new book “Man Boob Nation”. Obesity was obviously not a factor in this client. Despite a BMI of 25.1, his fat content was 12%—definitely not overweight as the BMI suggested. Body Mass Index (BMI) doesn’t do a good job of differentiating the different components that go into an individual’s weight–high muscle content as in this case. Test results revealed normal estrogen levels indicating low aromatase activity. Aromatase is the enzyme that will convert Testosterone to Estrogen in men. Upwards of 80% of estrogen production in men occurs this way. This matches his low body fat as aromatase activity is concentrated in abdominal fat in men. Stress was the cause of this clients low Testosterone. This was evident via his significantly elevated am cortisol. High stress, as in this client, will shut down Testosterone production at all levels of production: hypothalamus, pituitary, and testicle.
In case you haven’t figured it out, this patient is me. Despite living the part of health, exercising the part of health, eating the part of health, and looking the part of health, I developed low Testosterone. My cause was not testicular failure. This was evident in my normal Leutenizing hormone (LH). Leutenizing hormone is the hormone that stimulates testicular Testosterone production. Testicular failure will result in an elevated LH in most. Neither were my symptoms as marketing presents—ED and low libido. My cause was simple—stress. The focus of treatment should therefore be on stimulating endogenous Testosterone production and most importantly—managing the overactive stress response. Why treat anything other than the cause(s)? No band-aid medicine here, only solution-based therapies.
If you follow the marketing, almost every man has low T. In fact, this is not the case. As a percentage, the numbers are actually quite low. According to the science, 5-10% of men have low Testosterone. Some studies suggest a higher incidence (up to 40%) in men. The number of men with low Testosterone increases with age, weight, metabolic syndrome, and type II diabetes. The problem with these numbers is that there is no uniform definition of what constitutes low Testosterone, the symptoms are different from man to man, and studies have historically only defined ED and low libido as symptoms of low T. This post clearly shows how a definition of low T that only involves ED and low libido is woefully inadequate. If ED and low libido were the only symptoms required to direct Testosterone testing, my levels would have never been checked.
The majority of studies just look at low libido and erectile dysfunction (ED) to define low T. In this example (me), there were no symptoms of sexual dysfunction. So, maybe the numbers are much higher? I believe so. Most patients and physicians don’t realize this potential because they are just looking at men as marketing presents them—men are simply Testosterone fueled erections. If a man has normal libido and no ED, yet every other symptom presented above, there is no way he has low T. Physicians, medical providers, and patients are guilty of following this logic. It is the result of clever direct to consumer marketing (don’t forget that doctors are consumers too) and frank laziness on the part of the medical community. However, the science does not support this tunnel vision logic.
So, what to do?
As I stated previously, I like to treat the cause(s) of each individuals problems. To treat my cause, I need to better manage my stress and control my stress response. How to do that? First, there is no better reliever of stress than exercise. I have to continue regular exercise, but be very careful to not overdue it as excessive exercise can lead to stress. If I could remove myself from stressors I could, but such is life. Another important component for me in stress relief is prayer. Studies have shown the benefits of prayer in healing therapies. To actually manage the overzealous stress response, I am using high dose rhodiola. Rhodiola is an herb commonly referred to as an adaptogen. Adaptogens have been used by ancient cultures for thousands of years. Other adaptogens include MACA, ashwagandha, and ginseng. These adaptogens won’t take my stress away, but they will help my body to better handle the stress–thus the term adaptogen.
The paragraph above describes my treatment of the primary cause—stress. However, I want to increase my endogenous Testosterone production as well. To support Testosterone production, I turned to my favorite herbal therapy for men—Tribulus. Tribulus has been shown to increase endogenous free Testosterone production. I also like the herb Long Jack and Horny Goat Weed. Who comes up with these names? Additional therapies I employ that have been shown to help Testosterone production include Zinc and Quercetin. These therapies must be approached therapeutically and followed by a physician knowledgeable in Integrative medicine to see good physiologic results. Many OTC products come woefully short in this endeavor.
This is what an integrative approach to the treatment of low Testosterone looks like. Think outside the box when evaluating an individuals symptoms. Treat the source of the problems and focus therapy on working with the body to provide healing. If this doesn’t work, then I can start a physiologic dose of Testosterone.
Why is low Testosterone so important to men? Contrary to the message presented by lawyers on TV, low T has consistently been shown to be associated with increased cardiovascular disease, increased cardiovascular mortality, and an increase in all-cause mortality. Essentially, low T is a biomarker for poor health in men. I looked the part, but my physiology didn’t match the part. Now, I am on a journey to match the two and improve my health.