Testosterone deficiency (TD)
Testosterone is the most important androgen hormone. In males, most of the testosterone is produced by the testes, and a small amount is produced by the adrenals. Testosterone is regulated by luteinizing hormone (LH) from the anterior lobe of the pituitary gland (Rakel, 2018). LH stimulates the release of testosterone from the Leydig cells in the testes, while sperm production is under the influence of FSH (Rakel, 2018). Interestingly, testosterone follows a circadian rhythm similar to cortisol: with its highest peak at 7am and another peak around 4pm (Rakel, 2018). Testosterone is generally found in the body bound to a protein called sex hormone binding globulin (SHBG). In fact, the total testosterone that is measured is a measure of the testosterone that is bound to SHBG. Interestingly, various pathologies can increase or decrease SHBG. Liver disease, estrogen, and thyroid hormones can increase SHBG, as does age. Diabetes, metabolic syndrome, insulin resistance, obesity and hypothyroidism can decrease SHBG, which can also lead to a falsely low total testosterone. This is why checking free testosterone is a more accurate measure of testosterone levels in these individuals. Total serum testosterone levels also decrease with age, due to rising SHBG levels with aging, which explains the disproportion between total and bioavailable testosterone levels (McBride et al., 2016).
Most experts agree that a healthy range for total testosterone is 300-1050 ng/dl. “Data suggests that levels less than 440 ng/dL are associated with elevated 10 year cardiovascular risk in middle aged and elderly men” (Rakel, 2018). In addition, there is general agreement that free testosterone or bioavailable T (free T plus albumin bound T) would provide a better estimation of T status. The Dutch Complete test for measuring testosterone, since the test uses dry urine to measure testosterone metabolites as well as progesterone metabolites, androgen metabolites, free and metabolized cortisol.
Symptoms of low testosterone include low libido, decreased muscle mass and strength, wrinkled skin, aches and pains, drying and thinning hair, depression, anxiety, brain fog, fatigue and weight gain (FDN, 2017). Other symptoms include erectile dysfunction, difficulty achieving orgasm, decreased morning erection, and decreased sexual performance (Rakel, 2018).
Possible Causes of TD
There are several “general” causes of low testosterone. These include things such as chronic stress, HPA axis dysfunction, low fat/ cholesterol diet, lack of exercise and nutritional deficiencies (such as zinc, folate, B6, Vitamin D and K, Vitamin E and C, Mg and Carnitine). Dysfunctions in the HPA axis dysfunction can demonstrate as an inverted cortisol to testosterone ratio. As cortisol levels go up, testosterone levels go down. In fact, cortisol directly inhibits testosterone in the testes by inhibiting a protein called STAR (FDN, 2017). (Note-STAR is a transport protein that regulates cholesterol transfer into the mitochondria. It is a rate limiting step in the production of steroid hormones. Basically, cells cannot make the hormones if the cholesterol cannot get transported from the outer to inner mitochondrial membrane if STAR isn’t working properly). Exposure to glyphosate and GMO’s can also block the STAR protein.Other things that cause TD include overuse of opioids, perhaps due to DHEA suppression that occurs with the use of opioids (Rakel, 2018). And finally, endocrine disruptors such as phthalates and BPA are also implicated in TD. These are found in plastics and in personal care products. “Human studies on phthalates have demonstrated decreased free T levels in infants exposed to phthalates in breast milk and abnormal sperm morphology and sperm DNA damage in adult males” (Rakel, 2018). Human studies also indicate that exposure to significant amounts of BPA can increase the risk for precancerous cells in animal prostate tissue (Rakel, 2018). To make matters worse, BPA also acts as a weak estrogen in mammals, which can contribute even more to TD. This may be due to upregulation of aromatase enzymes, which can cause androgens to be converted to estrogen, which by default will lower testosterone.
What can you do?
Here are some suggestions I gathered in research:
- Avoid exposure to chemicals when possible! Avoid heating or microwaving food in plastic or plastic wraps. Do not store hot food in plastic containers. Use only BPA free containers when buying canned foods. Consider using glass and stainless steel to replace plastic containers. Avoid plastics with symbol 3 (PVC/phthalates), 6 (polystyrene foam) and 7 (BPA) at the bottom of the container. Recycling symbols 2,4,5, and 7 are safer options (Rakel, 2018).
It may be a good idea to run a toxic burden test such as GPL-Tox to identify where the sources of chemical exposures. The GPL-Tox also tests for Tiglycine (TG), one of the most specific markers for mitochondrial disorders resulting from mutations of mitochondrial DNA. These mutations can result from exposure to toxic chemicals, infections, inflammation, and nutritional deficiencies.
There are many methods of detoxification available online. One person I follow is a fellow FDN colleague, Wendy Myers. She talks about the Myers cocktail here
There is another interesting protocol using Biosil, Pectasol-C, and an infrared sauna. Other supplements to explore include NAC, cilantro extract, glutathione, alpha-lipoic acid (which can chelate mercury), curcumin and garlic.
Dr. Klinghardt also has extensive information in detoxification, and here is a link I often refer to that includes some of his clinical perils.
– Zinc, which has demonstrated a positive correlation with testosterone levels. 25-50mg in the form of zinc citrate, zinc acetate, or zinc picolinate (Rakel, 2018).
–Quercetin may reduce aromatase activity, and thus increase available testosterone. 400mg 1-2x per day is recommended (Rakel, 2018).
–Saw palmetto– is a weak inhibitor of 5-alpha reductase, which can play a role in reducing estrogen and DHT receptors. The dose is 160mg per day 2x per day.
–Maca– has been shown to increase testosterone in some studies, and can also improve sexual function. The dose is 500-1000mg up to 3x per day.
Unfortunately, some foods that we think of as “healthy” can increase SHBG such as flaxseeds, green tea, EGCG and mint tea. It may be a good idea to avoid these in excess and to rotate them.
McBride, J. A., Carson, C. C., 3rd, & Coward, R. M. (2016). Testosterone deficiency in the aging male. Ther Adv Urol, 8(1), 47-60. doi:10.1177/1756287215612961
Pomeroy, Lisa. Stress and Hormones Training. Retrieved December 19, 2017
Rakel, D. (2018). Integrative Mecidine (Vol. 4): Elsevier Inc.
Vann, Madeline. (2017, March 23) 1 in 4 men over 30 has Low Testosterone. Retrieved from http://abcnews.go.com/Health/Healthday/story?id=4508669&page=1