A couple of weeks ago, a successful and fairly health-conscious 62-year-old man walked into my office with a problem I hear a lot: he couldn’t build any muscle or strength.
He wasn’t fatigued – far from it. He had a busy job and exercised like a demon every day. But he always ended up feeling physically weak, like he hadn’t been exercising at all.
On top of that, here are some of the other symptoms he was experiencing:
- loss of sexual desire
- an inability to maintain erections like he did a few years ago
- extra breast tissue
- skin tags on his neck
- excess weight in his gut, but not his hips (so, a high ‘waist-to-hip ratio’).
When I asked him whether his doctors had measured his hormones, he gave the answer I’d come to expect: ‘Yes, and they said my testosterone level was normal for my age.’
Unfortunately, lots of guys are hearing from their doctors that their testosterone levels are OK – and, in many cases, that information is dead wrong. That’s because many doctors aren’t doing much more than some superficial lab tests and a whole lot of guesswork.
But if you want to restore your testosterone levels – and get your energy, strength, and sex life back – you need to know what’s really going on in your body with this critical hormone. And I’ve developed a four-test protocol that can help you do just that.
It’s not about how much you’ve got – but how much of it you can use
The first test I conduct is for free testosterone. Testosterone in the body is largely bound to a protein called ‘sex hormone binding globulin’(SHBG). While testosterone is bound, it’s not active in the body. However, when the testosterone is unbound – or, ‘free’ – it’s able to be active.
As we age, our SHBG levels increase, which binds up more testosterone. And that leads to a decrease in free testosterone for our bodies to use. Without ample free testosterone, we don’t get the full effect of this hormone on our metabolism, energy, circulation, and sexual function.
When we only measure total testosterone, as was done in my patient, we’re looking at both the free and bound testosterone together, and not getting the full picture of what the problem is.
Too much of the wrong hormone could be stifling your manhood
The second test that I do for patients is for oestradiol, a form of oestrogen. Now we normally think of that as a female hormone – but both men and women have it, and this delicate balance between testosterone and oestrogen has a lot to do with human sexuality.
We know, for instance, that testosterone is critical in women for libido, sexual sensitivity, and response. Less well-known is that oestrogen, particularly oestradiol, is necessary for male sexual response.
This stands to reason, since we know that oestrogen receptors are abundant in the male brain, testes, and penis – and receptors mean that the body is expecting them to be stimulated.
Receptors for oestrogen in the penis are predominantly in the neurovascular bundles of the erectile tissue, and so oestrogen affects erectile function regardless of how much testosterone is in the body.
Oestrogen is produced in the male brain in areas most important for sexual desire, and oestrogen can make guys more fertile by playing a critical role in sperm production.
But its role in regulating the male reproductive system doesn’t mean that oestradiol necessarily stimulates it. In fact, it can frequently suppress male sexuality.
In general, the higher the oestradiol in the body of a man, the less active the free testosterone is. And the body has pathways to actually convert testosterone into oestradiol, so measuring testosterone without measuring oestradiol is foolish. Men with the same testosterone levels but with varying levels of oestradiol will experience very different health issues from each other.
I can’t tell you how many patients on testosterone creams come to me with adequate levels of blood testosterone but without having experienced the benefits of testosterone therapy. When I examine them, they exhibit subtle signs of increased oestrogen, like extra breast tissue and diminished size of the testicles. When I measure their oestradiol levels, they are through the roof – because the testosterone is just converting into oestradiol and negating itself.
The final puzzle pieces are in your blood…and your brain!
The last two tests I performed on my patient may surprise you.
The third is called the glycohaemoglobin test, also known as HbA1c, and it tests the amount of sugar that’s bound to the haemoglobin in your red blood cells over the course of three months (which is exactly the lifespan of a red blood cell).
You see, high blood sugar is associated with high blood pressure, high blood lipids, and a number of physical findings including skin tags around the neck and a big belly. And increasing belly fat raises the level of the enzyme that helps break testosterone down into oestradiol… resulting in high oestrogen levels… and low testosterone.
This association of belly fat with low testosterone has been demonstrated multiple times. In a study published in the European Journal of Epidemiology, researchers took over 1,500 men in a Norwegian town and measured their hormone levels, waist-to-hip ratio, and lifestyle factors. The most predictive factor for low testosterone, amazingly, was the circumference of the man’s waist.
And the final test measures a hormone secreted by the pituitary gland, which tells the testes to make more testosterone. Much like other pituitary hormones (like TSH or ACTH), the luteinizing hormone or LH goes up in response to a low testosterone, in an effort to stimulate the production of more of it. If the testosterone is low and the LH is ALSO low, we know that the pituitary is exhausted, or isn’t being stimulated by the hypothalamus, or is missing a key nutrient such as zinc or manganese. That’s what makes testing LH so important.
When you need more than one test, you need more than one remedy
Now, my patient’s total testosterone level was technically in the normal range, but it was at the low end of normal. His free testosterone, on the other hand, was clearly below normal, even for a man his age.
To make matters worse, his oestradiol level was above the laboratory upper limit of 39 picograms per millilitre (pg/mL) – and in my office, we consider any oestradiol level above 25 pg/mL to be suspect.
While his blood sugar wasn’t in the diabetic range at 5.8 per cent, it certainly could be considered high enough for an increased risk of diabetes and well above the range associated with good health.
Finally, his LH was at the upper range of normal, which would be appropriate for someone who had a functionally low testosterone level.
As a result of my findings from these four tests, I put my patient on a custom-made compounded cream including a bioidentical form of testosterone as well as a herb called chrysin, which naturally inhibits the conversion of testosterone into oestradiol.
I also put him on a boron supplement, which helps boost the production of testosterone, and the herb berberine to help control blood sugar. In addition, I used a medical food designed to enhance insulin sensitivity and weight loss.
Finally, I put him on a Paleo-style diet, which does wonders in terms of both weight loss and insulin/glucose management.
And you know what? Just two months later, my patient was thinner, more powerful than ever, and ready to take on the world!
Sometimes their ‘normal ‘isn’t right for you
Gentlemen, if you’ve already come up ‘normal’ on a traditional testosterone test… but still feel like something is not quite right… ask your doctor to do a little more digging. He should be able to run a full hormone panel blood test that includes free testosterone, oestradiol, and LH – or, at least, send you to a specialist in endocrinology who can do it.
The HbA1c test, although widely available, is usually only run on diabetes patients in conventional medical practices, so your mainstream doctor may be puzzled why you’d ask for it. Even if he orders one for you, he may not know how to properly interpret the results, especially in relation to the findings from the other three tests.
So whether or not you’ve had your testosterone tested, your best bet is to find a holistic doctor who can look at the ‘big picture’ of your hormonal imbalances and prescribe a whole body approach to getting everything back where it should be.
You can find a well-qualified practitioner of holistic medicine through the Institute for Complementary Medicine (ICNM) www.icnm.org.uk
Dr. Glenn S. Rothfeld
Nutrition & Healing
Vol. 10, Issue 4 • April 2016
Full references and citations for this article are available in the downloadable PDF version of the monthly Nutrition and Healing issue in which this article appears.