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low T symptoms

Low T Symptoms and Fertility; Barking up the Wrong Tree?

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pesticides and fertility
vladimirfloyd / Adobe Stock

I could not be more against testosterone supplementation. Sure, patients feel better and have more energy, but people on cocaine have more energy, too. Doesn’t mean it’s a good idea.

Several years ago, very aggressive marketing by the manufacturers of testosterone supplementation put “low T” on the map, leading to a huge uptake of lab testing for testosterone levels. And guess what? Just like the vitamin D phenomenon, it seems like everyone (males and females alike) came back low.

And low testosterone became linked to everything from fatigue, low libido, belly fat and erectile dysfunction. And you can’t talk about testosterone without talking about fertility.

This is because male fertility is the ultimate expression of testosterone (it’s not, but that’s how society would have us view it). For this reason, you can bet your right testicle on the fact that any fertility consult with a “fertility specialist” will include a testosterone check.

But there are many other factors that play a role in fertility that are indirectly related to testosterone. Environmental chemical exposure to BPA and phthalates are well known to affect fertility rates in both men and women.

Low testosterone, much like low cholesterol or high blood sugar or high blood pressure, is merely the symptom of a bigger problem. Fixing high cholesterol with statins, lowering blood sugar with insulin or lowering blood pressure with medications does not, in any way, shape or form. None of those medications fix the actual underlying “broken thing” that is causing the cholesterol, blood sugar or blood pressure.

Testosterone replacement therapy is absolutely no different.

So, while you feel better in your own little plastic bubble of T replacement therapy, there is something very wrong with your physiology that is absolutely increasing your risk of all kinds of really nasty things like Alzheimer’s, cancer, heart disease and stroke.

I have certainly written on this topic before, but just in case you think I’m really off base on this one, I’d like to present this particular study.

In it, researchers looked at the levels of pesticide exposure from fruits and vegetables and how this related to sperm quality in a group of 189 men age 18-22. The fruits and veggies were categorized as having high [Pesticide Residue Burden Score (PRBS) ≥4] or low-to-moderate (PRBS <4) pesticide residues on the basis of data from the USDA Pesticide Data Program.

Here’s what they found:

  • Higher intakes of fruits and veggies, in general, did not affect sperm quality.
  • However, men eating fruits and vegetable intake with the lowest pesticides (≥2.8 servings/d) had a 169% sperm count and a 173% higher sperm concentration.
  • The intake of fruit and vegetables, regardless of pesticide-residue status, was not associated with reproductive hormone concentrations.

So what does this mean? It means that, while eating more fruits and veggies is important for your health, but it is really important to pay attention to whether or not you are eating organic foods that are well-known to be higher in pesticide levels.

The Environmental Working Group’s Guide to Pesticide Exposure in Produce is the best guide you can find to get this information.

Low T Symptoms – Is This the REAL Answer for a Cure?

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low T symptoms heart disease
Irina Karlova/Dollar Photo Club

Low T syndrome. Low testosterone. Male sexual dysfunction. Doesn’t matter what you call it, I couldn’t be more against the use of testosterone replacement.

Much to my chagrin, I hear a local clinic advertising on the radio station we have playing at the office several times per day. What I find interesting about this clinic’s advertising is that, as of about 6 months ago, they have been pushing the idea that low testosterone and male sexual dysfunction are two different diagnosis, but I’d pretty much bet treatment for both of these “unique” conditions is the same.

And much like every other clinic that treats “low T syndrome” I’m confident that these clinics don’t know enough about physiology to be treating functional problems.

And that’s what low testosterone levels indicate. While testosterone levels will decline with age, the lab ranges indicate normal for the age and gender of the person being tested. If your values come back abnormally low, it’s because something is WRONG.

And it’s not low testosterone.

Low testosterone is just the marker, not the problem. I picture the scene of a dramatically abdominally overweight man sitting on the couch, watching football, drinking beer and eating a bag of chips. When the “low T syndrome” commercial comes on, he nods knowingly, confident that low T is the reason he is overweight, has fatigue and no sexual drive.

The reason that the aforementioned clinic that I hear advertising on the radio is trying to separate low T levels from male sexual dysfunction is that the clinical studies on this topic has found no consistent relationship between the two. Which makes complete sense (unless, of course, you believe the prior advertising).

In addition to not actually fixing the problem (more on this in a minute), there are grave concerns with testosterone supplementation, especially in males. Mainly the increased risk of developing prostate cancer in a person who has health concerns already (hence the low T in the first place), although recent research puts increased clotting and heart attacks on the list as well.

This particular article is one of the best overviews on the topic of where low T levels come from. In it, the authors give an overview of how lifestyle damages the Leydig cells of the testes, where a chunk of the male production of testosterone comes from.

And maybe I’m just giving this article such raves reviews because the authors note that it all stems from my favorite topic, mitochondrial dysfunction. It takes a large amount of energy to produce testosterone and this energy comes from ATP formation in the mitochondria.

When that process of generating energy is compromised, the Leydig cells production of testosterone suffers. This situation can occur in a variety of ways:

  • Environmental chemicals like PCBs, BPA (and most other plastics) and phthalates.
  • Low nutritional quality diet devoid of protective antioxidants.
  • A sedentary lifestyle with little physical activity.

This list should come as no surprise. But hopefully it will serve as a reminder the next time your doctor checks your testosterone and recommends T replacement therapy, either by injection, creams or pellets under the skin.

Evaluation of lifestyle and addressing problems with your lifestyle is the ONLY way to manage low T symptoms—anything else is missing the real problem and increasing your risk of certain cancers.  Luckily, this article raises the suggestion that antioxidant supplements like CoQ10, alpha lipoic acid, vitamin E (the mixed tocopherol variety–NOT straight up alpha tocopherol) and vitamin C can be strong players in protecting your body’s ability to produce testosterone.

Incidentally, if you’re a female and feeling a little slighted by this article (considering that you don’t have Leydig cells and testicles …), I have addressed the adrenal component of testosterone production in a prior article that can be read by clicking here.

The adrenals are a major contributing factor to testosterone production (via DHEA) in both males and females and also need to be fully addressed and treated if someone has low T levels.

 

Diabetes and the Secret of Erectile Dysfunction – The Answer Lies Here

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low T symptoms heart disease
Irina Karlova/Dollar Photo Club

Let’s face it, erectile dysfunction, or ED as it is known in the radio commercials, is not a good thing.

For us men, back in the late teens, twenties or thirties there could be few things less desirable.  For some reason, though, as we age it becomes almost acceptable for erectile dysfunction.  Maybe it’s because, along with the ED comes a lack of sexual desire, making the ED really a secondary problem.

If you listen to the commercials (which I can no longer do since I threw the radio out the window in frustration) about erectile dysfunction you will be convinced that testosterone deficiency, or low T syndrome, is the cause of ED.

Here’s the real truth.

Erectile dysfunction is cardiovascular disease.  Period.  An erection is all about controlling blood flow.  If blood flow is poor an erection is not going to happen.

This can be due to poor vascular reactivity (aka endothelial dysfunction) where the blood vessels cannot open and close when needed or it can be more advanced where the blood vessels that are supposed to fill the penis with blood are full of plaque (atherosclerosis).

This means that both the short and long term answer for ED needs to focus on the health of your blood vessels (aka vascular health).

Considering that diabetes is so incredibly bad for your blood vessels, the findings of this particular study looking at the relationship between ED and diabetes should come as no surprise.  In it, researchers looked at 220 Type 2 diabetic to see how common erectile dysfunction was and whether depression or anxiety played any additional role.

The questionnaires used were the IIEF (International Index of Erectile Function), SAS (self-rating anxiety scale) and SDS (self-rating depression scale) to assess whether and how much these situations were present.  Here’s what they found:

  • 52.9% of the patients were affected by erectile dysfunction.
  • In those diabetics who spent less time with their HbA1c levels below 7% (indicating that they were better controlled) over a two year period had a lower likelihood of ED. The reverse was also true.
  • Patients with ED had higher levels of triglycerides and fasting insulin.
  • Resistin (a hormone released by the abdominal fat that has been linked to prediabetes and diabetes) levels were higher in patients with ED.
  • Free testosterone was lower in patients affected by ED (remember that this is just ONE other problem and NOT the cause of the ED).
  • Depression and anxiety were not related to the risk of ED.

Over half of the diabetic patients had erectile dysfunction.  Half.

There are VERY few diabetic patients who cannot drastically improve their health with the right dietary choices, exercise program and attention to simple things like drinking out of plastic water bottles.  Many of the diabetics I come across knowingly and willingly make less-than-ideal choices.

If it was me, I would have to balance these lifestyle choices against the risk of developing ED.  Can’t say not exercising on a regular basis or eating that 2nd serving at dinner would win out.

If you’re really interested in learning about how you can make better choices, I would strongly suggest checking out my Diabetes eBook by clicking here.

Low T Symptoms: Should you Believe the Commercials?

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low T symptoms heart disease
Irina Karlova/Dollar Photo Club

Despite the complete lack of evidence about whether it has any benefit, a day does not go by that I don’t hear a commercial on the radio for male sexual dysfunction.

By the end of the commercial, you are led to believe that the only reason for male sexual dysfunction is low T.  Even worse, this low testosterone level seems to come out of nowhere and there is nothing you can do about it.  Except, of course, come in for an appointment for testosterone cream, pills or injections.

Regular readers of the Rantings of course know that low testosterone levels are merely a symptom of a poor quality lifestyle and not the problem itself.

To put it plainer, smoke (while not good for you to inhale) is not the problem—the house fire is.  The local fire department doesn’t rush to the scene of a house fire only to suck out the smoke and leave the fire raging.

And yet this is what the “testosterone movement” has led you to believe.  There really is no other way to describe it.  The past few years have seen a massive increase in the prescriptions for testosterone replacement therapy given to men (and women) based purely on low testosterone levels found on bloodwork.

Personally, it is incredibly rare for me to check testosterone levels in the blood, despite knowing a substantial amount about what contributes to low testosterone levels and how to fix low T problems.

Just because I don’t check for low testosterone does not mean that I don’t feel that low T is  a problem.  This particular study drives this point home.  In it, researchers looked at 115 male patients with type 2 diabetes and divided them up between normal (≥12.1 nmol/L) and low (≤12.1 nmol/L) testosterone levels.  They then compared levels of several markers of heart disease, including hsCRP, carotid artery carotid intima-media thickness (IMT) and atherosclerotic plaque by high-resolution B-mode ultrasound as well as assessing the health of the blood vessels (endothelial function) by brachial artery flow-mediated dilation.

Here’s what they found:

  • Lower testosterone was linked to poorer carotid IMT.
  • Those with low T had a 641% higher likelihood of a carotid IMT of 0.1 cm or greater (80% vs 39%).
  • Low T patients had a 260% higher risk of having plaques in the arteries (68.5% vs 44.8%).
  • Those with low T were 577% more likely to have endothelial dysfunction (80.5% vs 42.3%).
  • Low T patients had higher hsCRP levels (2.74 vs 0.89 mg/L).

While some of this may be a little technical, the bottom line is that low levels of testosterone is a marker of incredibly bad health, especially as it relates to heart disease.

But this does NOT mean that supplementing with testosterone is the answer.  Rather, the entire spectrum of lifestyle changes that include exercise, diet and stress management is the answer.  As a matter of fact, the most recent concerns over the use of testosterone replacement therapy had to do with actually increasing the risk of heart disease.  And this is on top of the well-accepted increased risk of developing prostate cancer.

This alone should YET again prove that we cannot find a single marker in the bloodstream and treat just that marker using artificial means (drugs, hormone therapy, surgery, etc…).

 

The Hip Bone is Connected to the…Testis??????

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Ok.  I KNOW that the body is wildly interconnected.  But some connections are too incredible to be believed at first glance.

I recently wrote a blog article about how weight gain is not one of the low T symptoms, but rather, weight gain leads to lower testosterone levels.  So you know that hormone levels are directly related to lifestyle choices.  Certainly the reverse can be true, where off-kilter hormone levels can create health problems.  But more often, poor lifestyle choices throw off the balance of your hormones.

When it comes to your bones, as little as 15 years ago the view of what your bones do was limited to an attachment site for muscles so you can move.  Pretty inert.  They basically just sit there doing nothing, until, of course, they fracture and create a problem and pain.

Then all hell broke loose.

We now have a drastically different view of bone.  It is a highly active tissue at the heart of some very important physiological processes.  Here’s what I’ve written about in the past:

  1. Serotonin from the gut (the body’s main source of this neurotransmitter) will actually stop bone cells called osteoblasts from building more bone.
  2. Osteoblasts secrete a hormone called osteocalcin.  More osteoblasts = more bone = more osteocalcin released.
  3. Osteocalcin has an effect on abdominal fat and lowers your risk of diabetes.

This is already a pretty impressive list.  And it’s about to get a little bit bigger.

In this particular study (which was a mouse study, so keep this in mind), researchers found that osteocalcin had an effect on the Leydig cells in the testis.  These cells produce testosterone.

Good bone health drives testosterone levels.  Go back in time to 1995 and mention this to any researcher looking into bone and they would think you’re crazy.  Heck–when I mention this to people today, they still think I’m crazy.

But look at what this means.  We already know that healthy behaviors, as well as the opposite behaviors, affect testosterone levels as was described in a recent blog article that can be read by clicking here.

But just how deep this link is what shocks me.  It’s not a matter of getting the right nutrients, vitamins and minerals so you can make testosterone.  Rather, a healthy lifestyle may produce optimal testosterone levels through the gut-bone-testis axis.

Further, this means that merely taking natural hormone treatments will do absolutely NOTHING to the problem at hand.  In other words, the poor bone health seems to drive low T levels, but the reverse is not true–giving testosterone will not miraculously improve bone health.

Which further reinforces the fact that, if you have symptoms of low T, lifestyle is your ONLY answer.  Supplementation  / replacement is a train wreck waiting to happen.

Symptoms of Low T; Is Weight Gain On the List?

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You’re sitting on the couch, eating chips, drinking beer and watching sports. The commercial comes on that suggests that your gut is one of the symptoms of low T.

That HAS to be the reason.

So you run to your doctor.  He or she, thinking they are doing the right thing (because he or she read it somewhere…), checks your testosterone levels and finds that they are low, confirming your theory (and the advertising commercial).

The answer now seems easy.  Testosterone therapy.  Take your pick: injections, creams, pellets or pills.  The choice of delivery of the low T treatments are plenty and the answer is easy.  No need to change your lifestyle, just rub some cream on every day and life will be great and you’ll be feeling 18 again in no time.

About 2 months later, as you notice that your testicles have shrunk, reality sets in.  No miraculous improvements in energy or your waistline.  Personally, I always ask patients who are on testosterone if they feel better.  Most often I get a fuzzy answer and very little definite improvements.

Big surprise.

Let’s get something straight here.  Your low testosterone is NOT the problem.  It is merely a symptom.  If your doctor thinks they are practicing “preventative” medicine, finds low testosterone in your blood work and puts you on some form of testosterone, he or she clearly does not understand the human body.

Here’s how it works.  In males (and females for that matter, but I’ve covered this in a previous blog article that can be read by clicking here) the adrenals glands produce a hormone called DHEA.  DHEA can then be converted to testosterone and actually supplies a large chunk of a man’s circulating testosterone.

Stress and poor lifestyle changes are going to affect your testosterone levels.  These same lifestyles are going to make you fat.  Period.  It’s not like low T comes from uncontrollable gamma radiation from deep past Pluto and the only answer comes in a cream.

Just in case you don’t believe me and think that the doctor who put you on testosterone injections is correct, let me direct you to this particular article.

Researchers tracked hormone levels (estradiol and testosterone) in a large group of men over the course of almost 5 years.  What they found was that, in the men that put on more fat, there was no change in the hormone levels that preceded the fat gain.

However, as participants gained fat weight, the testosterone levels dropped.

The bottom line?  Get off the couch, fire the doctor that put you on testosterone pellets (and neglected to inform you that this will drastically increase your risk of prostate cancer) and make some positive changes to your lifestyle (you can read all about the changes I recommend in my free eBook by clicking here).  There is no easy answer in a cream.