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Friday, October 31, 2014

Low Testosterone in Men

Low Testosterone (hypogonadism)
Dr. Christopher Bray MD PhD

Low levels of testosterone cause symptoms of decreased energy / libido, decreased strength / endurance / muscle mass, depressed mood, and erectile difficulties. Sometimes slower hair growth and hot flashes are noticed. Muscle mass is lost and increased fat accumulation is common. Symptoms are often very subtle and develop gradually.
To establish a diagnosis, the testosterone needs to be checked on more than one occasion. The testosterone should be checked between 8 to 10am. A bioavailable testosterone (or free testosterone) should be used for confirmation, which is more accurate the screening total testosterone test. Normal free testosterone is 9 to 30 ng/dL. Normal bioavailable testosterone is approximately 50 to 200 ng/dL, but does vary some based on age (and the exact lab test don). LH and FSH should be checked at the confirmation test. High levels of these LH/FSH usually indicates a less common form of low testosterone – a problem with the testes (primary). Low or normal levels of LH/FSH indicate that the problem is not a problem with the testes (secondary). Iron (iron excess), prolactin (pituitary disease), PSA (prostate cancer), and thyroid function are also often tested in blood work.

The most common type of low testosterone in men is secondary hypogonadism. Causes include pre-diabetes or diabetes, obstructive sleep apnea, obesity, long-term narcotic use, long-term corticosteroid use, excess alcohol, aging, malnutrition (anorexia), and other chronic medical conditions (chronic infections, chronic kidney disease, autoimmune disease, cancer). Toxin exposure, like from bisphenol A, and phthalates, can cause low levels as well. Phthalates are common in plastics, shampoos, colognes, detergents, chemical cleaners, paints, and food packaging. Bisphenol A is common in plastic bottles, dental sealants, sports equipment (mouth guards), eyeglasses, CD/DVDs, and lining of aluminum cans. Pesticides also affect male fertility.

Testosterone replacement is done to achieve normal levels of testosterone and requires blood level monitoring. Replacement to normal levels can reduce osteoporosis, depression, dementia, heart disease, and obesity. Replacement can be achieved by injections or topical gels / patches. Testosterone replacement can be associated with an increased risk of prostate cancer, excess red blood cell concentration and blood clots, gynecomastia (enlarged breasts, which can occur with alcohol too), decreased sperm count, and liver damage. This is the reason that regular monitoring by a physician is required. Blood labs and a digital rectal exam should be done at least every 6 months.

Universal Recommendations:

-       Correct any dietary problems by avoiding sugar and unhealthy carbohydrates

-       Eat multiple meals a day with sufficient proteins, vegetables, high-fiber fruits, and healthy fats (organic and free-range / wild as much as possible)

-       Get adequate sleep every night (at least 7 hours per night)

-       Fix any sleep apnea problems first

-       Maintain an ideal body weight

-       Reduce stress

-       Do regular strength and interval training exercises

-       Reduce alcohol (which causes testosterone to be converted to estrogen)

-       Avoid environmental estrogens: pesticides, plastic containers, plastic bottles, canned goods, aluminum cans, microwavable meals, Styrofoam

-       Increase foods high in: Quercetin, Chrysin, Naringenin, Apigenin, Genistein, Diadzein, Oleuropein, Resveratrol, Linoleic Acid, Progesterone, Zinc

Natural Aromatase Options:

There are many natural aromatase options which inhibit estrogen to testosterone conversion. These are good for both men and women. Zinc is one option. Others are listed in the article referenced by the link.

"Zinc: The best sources are wheat germ, oysters and liver, Less zinc-rich sources include meat, sesame, sunflower and pumpkin seeds, nuts like pecans and brazils, spinach, mushrooms etc."

Pharmaceutical and Supplement Recommendations:

-       There are many prescription options for testosterone replacement as well as medication that affect the testosterone levels without hormonal intervention. Similarly, there are supplements that have effect on testosterone. This is the subject of another discussion.
Raising your free testosterone and decreasing SHBG
1.       Lower your estrogen levels
a.       Aim for a healthy weight (ideally body mass index 20 to 25; or at a minimum less than 30)
b.      Eat cruciferous veggies (broccoli, kale, brussels sprouts, cauliflower, maca - rich in zinc which slows down aromatase which converts testosterone to estrogen; also rich in Indole-3-Carbinol which converts to 3,3-Diindolylmethane (DIM) in the stomach - which helps flush out estrogen)
c.       Avoid exposures to toxic chemicals (phthalates, lead, mercury, pesticides, parabens, bisphenol-A, ecxitotoxins – like aspartame, MSG, hydrolysed vegetable proteins and oils, acesulfame K, sweeteners, and diet products). Statins can interfere with hormone production as well.
d.      Don’t use plastic products (phthalates and xeno-estrogens)
e.      Avoid parabens in personal care products (butylparaben, ethylparaben, heptylparaben, methylparaben, propylparaben)
f.        Eat organic foods
g.       Avoid bisphenol-A (linked to cancer, reproductive harm, obesity, ADHD, immune system harm) – contained in canned goods, plastics, food/drink cartons, microwave meal containers, and even grocery receipts.
h.      Increase calcium-D-glucarate present in the skin of berries like blueberries and juniper berries
i.         Eat methylaters like betaine from beets which helps chelate and remove excess estrogens
j.        Remove processed meats from your diet (hormone and antibiotic exposure)
k.       Eat more citrus (anti-estrogenic properties)
l.         Eat fermented foods or take probiotics (good gut health to help detoxify)
m.    Wild nettle root supplement (decreases SHBG and decreases aromatase activity)
n.      Maca root supplement (removes estrogen and is high in DIM)
o.      Avoid soy (has estrogenic activity)
p.      Excess alcohol  (slows the liver’s ability to remove estrogen AND upregulates aromatase)
q.      If you drink, don’t drink beer (high in phytoestrogens)
r.        Filter your water (unfiltered water has many hormones and pharmaceuticals – even birth control)
s.       More strength training
t.        Improve your sleep quality (enhances hypothalamic and pituitary function)
2.       Green tea increases SHBG (so reduce consumption)
3.       Decrease sugar, carbohydrates, and high fructose corn syrup
4.       Nettle root can lower SHBG (so is a helpful supplement)
5.       Boron can lower SHBG (so is a helpful supplement)
6.       Vitamin D can lower SHBG (so is a helpful supplement)
7.       Certain medications – statins, beta-blockers, sedatives, sleep medications can cause high SHBG
8.       Reduce alcohol
9.       Increase magnesium (so is a helpful supplement)
10.   Identify and fix any problems with insufficient sleep or with sleep apnea

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