In the past 20 years, men’s testosterone has dropped significantly. Increasing percentages of men now suffer low testosterone thanks to stress, extra body fat and toxins in the environment. But you can boost your testosterone and reap the health benefits.In 2007, researchers reported in the Journal of Clinical Endocrinology and Metabolism [1] about the population-wide decline (17 percent) in men’s testosterone levels from 1987 to 2004.
To find the possible reasons for this decline in testosterone, look to metabolic and functional medicine models of hormone health to demonstrate how and why testosterone levels can drop.
Emotional Stresses
We know that stress, chronic worry, anxiety and depressed mood are emotional triggers that increase cortisol production. The production of this hormone slows the manufacture of testosterone from the testosterone precursors DHEA (dehydroepiandrosterone), androstenedione and androstenediol. Also, we know that having too much body fat produces inflammatory chemicals that further disrupt hormone function. The fatter you are, the more your testosterone is converted to estrogen because of an enzyme called aromatase.
Plus, there are other factors that boost cortisol production and reduce testosterone. Called the “cortisol steal” phenomenon, the condition is linked to chronic pain, low blood sugar, insulin problems, sleep deprivation, disrupted light cycles, infection and chronic inflammation.
Toxic Difficulties
We also know that toxic exposures seem to be increasing as our world of commercial personal-care products grows. Many cosmetics and other items contain chemicals called phthalates. Phthalates were introduced in the 1920s for industrial uses, but their use has expanded in recent years.
In 2008, the National Research Council[2] reported: “A variety of effects on the development of the reproductive system can be observed in males at much lower doses than previously observed after exposure to various phthalates.” The findings included increased rates of infertility, decreased sperm count and other characteristics of androgen hormone disturbance. Phthalates are not only used as plasticizers, food binders and lubricants, but are included in personal-care items (shampoos, moisturizers, liquid soaps, hair sprays and colognes), bathroom scents, sprays and detergents.
Moreover, bisphenol-A (BPA), a toxin frequently found in plastics, is a known endocrine disrupter and can mimic human hormones in your body. The average levels of bisphenol-A in people are above those that cause harm to animals in laboratory experiments, according to a 2007 consensus statement by 38 experts.[3] Bisphenol-A is often used in the plastics of water bottles, baby bottles, sports equipment, CDs/DVDs, dental sealants and more.[4]
Testosterone Supplementation
The treatment for testosterone deficiency is really quite simple. Your doctor will probably require a blood test before prescribing it to look for levels of the other related hormones DHT, DHEA, SHBG, LH/FSH and estradiol in your blood, urine or saliva. The bio-identical testosterone from compounding pharmacists offers fewer side effects and better efficacy over the long term; it is used in the form of a cream or gel applied daily to the soft skin areas, excluding genitalia. Alternatively, synthetic versions come in creams, gels and shots. I recommend you stay away from the pellets until you’ve proven testosterone therapy is working for six months without side effects.
You previously may have heard that that testosterone therapy worsened BPH (benign prostatic hypertrophy). This has clearly been disproven, and there are no worries about that.[5] Prostate cancer risk with testosterone supplementation, however, has been more controversial. In a search of the scientific literature on this, I found two earlier reports[6] [7] (2005, 2007) suggesting there is a risk and recommending “regular monitoring for prostate cancer” for those getting supplementation.
In 2008, researchers reported in Endocrinology Practice: [8] “Trials of up to 36 months in length and longitudinal studies consistently fail to demonstrate an increased prostate cancer risk associated with increased testosterone levels.” And in 2009, a review by German researchers showed there are no valid studies suggesting a risk of prostate cancer with testosterone supplementation.[9]
Furthermore, in men who have had prostate cancer and been treated, testosterone supplementation has been shown to be safe. Researchers in this area[10] [11] conclude: “Monitoring with PSA and digital rectal examination at regular intervals is recommended.”
Sperm Count
We also know that sperm count has been shown to decrease when testosterone therapy is continued beyond about six months.This happens because the body naturally slows endogenous testosterone production when it is detected that there is plenty in the blood circulation and tissues. Correspondingly, sperm count decreases, albeit not drastically. Shortly after discontinuation of testosterone therapy, sperm count begins to rise. Within a year, it can be back to pre-treatment levels.
I think this gives you a pretty good idea about testosterone supplementation. Next week, I’ll address the hormones estrogen and progesterone.
Feel good for your best health,
Michael Cutler, M.D.
Easy Health Options
[1] Travison, TG, AB Araujo, AB O’Donnell, V Kupelian, JB McKinlay. A population-level decline in serum testosterone levels in American men. 2007. Journal of Clinical Endocrinology and Metabolism 92:196-202.
[2] Committee on the Health Risks of Phthalates, National Research Council (2008). Phthalates and Cumulative Risk Assessment: The Task Ahead. National Academies Proc
[3] Vom Saal FS, Akingbemi BT, Belcher SM, et al (2007). “Chapel Hill bisphenol A expert panel consensus statement: integration of mechanism, effects in animals and potential to impact human health at current levels of exposure.” Reprod. Toxicol. 24 (2): 131-8.
[4] National Toxicology Program, U.S. Department of Health and Human Services (26 Nov 2007)
[5] Rhoden E et al. “Medical Progress: Risks of Testosterone Replacement Therapy and Recommendations for Monitoring.” N Engl J Med 2004; Jan 29; 350:482-492
[6] Parsons JK, Carter HB, Platz EA, Wright EJ, Landis P, Metter EJ. Serum testosterone and the risk of prostate cancer: potential implications for testosterone therapy. Cancer Epidemiol Biomarkers Prev 2005 Sep;14(9):2257-60.
[7] Brand TC, Canby-Hagino E, Thompson IM, Testosterone replacement therapy and prostate cancer: a word of caution. Curr Urol Rep. 2007 May;8(3):185-9.
[8] Dobs AS, Morgentaler A. Does testosterone therapy increase the risk of prostate cancer? Endocr Pract. 2008 Oct;14(7):904-11.
[9] Rinnab L, Gust K, Hautmann RE, Kufer R. [Testosterone replacement therapy and prostate cancer. The current position 67 years after the Huggins myth]. Urologe A. 2009 May;48(5):516-22. [Article in German]
[10] Morgentaler A. Testosterone therapy for men at risk for or with history of prostate cancer. Curr Treat Options Oncol. 2006 Sep;7(5):363-9.
[11] Rhoden EL, Averbeck MA. Testosterone therapy and prostate carcinoma. Curr Urol Rep. 2009 Nov;10(6):453-9
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