Testosterone levels predict a male’s muscle mass, power and strength but testosterone deficiency is in fact much more common that most men (and indeed women) realise. This is due to a variety of factors including exposure to environmental toxins, stress, nutritional deficiencies, poor gastrointestinal health and of course, advancing age.
Androgens (male hormones) are responsible for the development of the male characteristics and include testosterone, dihydrotestosterone, androstenedione, DHEA and androsterone.
Until recently, androgens were thought to have two principal effects:
1) Anabolic i.e. increases muscle and bone density
2) Androgenic i.e. responsible for growth, development and maintenance of the male sex organs as well as production of healthy sperm
Although there is much yet to be discovered about the role of androgens, it appears that they play a fundamental role in immune function, developing and maintaining muscle and bone mass as well as in the making of new red blood cells in the bone marrow. Similarly, testosterone can affect cardiovascular disease and emotional well-being. Though it is unclear as to whether the link is cause or effect, low testosterone levels correlate with depression and atherosclerosis.
Although cholesterol regularly receives a barrage of bad press, it is worth remembering that androgens (and other steroid hormones) are synthesized from cholesterol and in fact, the delivery of cholesterol into the mitochondria of cells is the rate-limiting step in the production of steroid hormones (regulated by the StAR protein).
95% of a man’s testosterone is manufactured in the testis. The adrenal gland perched atop the kidneys makes DHEA and androstenedione which can both potentially be converted into testosterone.
Testosterone levels are controlled primarily by negative feedback (see image) but a variety of other factors can affect this loop.
An estrogen derived from testosterone (by the action of an enzyme called aromatase) can act via receptors on Leydig cells of the testis to decrease testosterone. This is why assisted bodybuilders who inject anabolic steroids often need to take aromatase inhibitors to prevent the body’s natural control mechanisms from down-regulating testosterone levels.
It is a common clinical finding that men who are chronically stressed (physically or psychologically) and who display abnormal adrenal hormone rhythms have low testosterone levels and indeed are generally symptomatic in this regard.
The Leydig cells of the testis have been found to secrete Corticotrophin releasing hormone (involved in the pathway of stimulating cortisol, the body’s major stress hormone) which negatively affects testosterone secretion. This in part could explain the common finding of testosterone deficiency in stress.
At Invigorate Clinic, we frequently see men with low testosterone levels. Symptoms range from low sex drive and erectile dysfunction to an inability to grow or maintain muscle mass and reduce body fat despite appropriate stimuli.
Therapeutic strategies are initially aimed at conservative measures. For example, regulating blood sugars through diet, manipulation of timing and structure of training/exercise regimes, ensuring adequate intake of amino acids (in particular arginine), managing zinc/boron/vitamin D deficiencies and managing stress are some of the strategies used to naturally boost testosterone.
An underfunctioning thyroid gland is also associated with low testosterone. This is because T3 (the more active thyroid hormone) acts via receptors on the cells in the testes to increase testosterone secretion. Thus, a full thyroid work up is essential in patients who are symptomatic of reduced testosterone.
We will also look at your exposure to toxins such as xenoestrogens and, most importantly, your body’s ability to detoxify these harmful compounds.
It is also important to evaluate your gut health as the intestine plays an important role in regulating hormonal balance.
Testosterone replacement therapy is becoming increasingly popular for middle-aged men with testosterone deficiency. There are many methods of replacement. Oral replacement is not usually recommended due to low bioavailability and negative side effect profile, particularly at the level of the liver. Intramuscular injection on a bi-weekly basis is an option but topical application of testosterone creams or gels have become more popular. In some cases, a small dose of DHEA administered alongside testosterone proves more successful.
At Invigorate Clinic we like to test blood, urine and saliva markers when evaluating male hormones.
Most GP tests only look at blood levels of hormones. I like to use the analogy of a bank account to describe the differences in measuring markers in various body fluids. Measuring the blood hormone levels is the equivalent to counting up all your cash, stocks, bonds, property that you own. You can’t use your stocks or bonds to buy the weekly groceries because they are tied up at that time….they’re not not readily accessible. Testosterone, for example, is tied to a protein called Sex Hormone Binding Globulin as well as albumin.
Measuring markers in saliva is equivalent to looking at how much cash we have. Saliva markers give us an indication of how much hormone we have available to use at that moment in time. It is readily accessible.
A urinary hormone test may also be indicated. If we think of our bank account, urine markers are similar to our receipts. They are an indicator of what has been used up and how it was spent or used. This gives us more of an insight into the various pathways of hormone synthesis and degradation so that nutritional treatment can be targeted to a specific pathway that may be dysfunctional.
If you, or some one you know, is suffering from low testosterone, contact Invigorate Clinic today to arrange a comprehensive male hormone work up.