The biggest complaints men have that often lead them to consider testosterone therapy are weight gain, lack of energy, low libido, depression, and lack of muscle tone. They have been convinced that taking testosterone therapy will solve their problems. | Craig Cooper
The makers and marketers of testosterone therapy hope you believe this myth. But the other side of the coin is more likely the truth: men have low T and/or these classic symptoms because they are overweight, don’t get enough sleep, eat a poor diet, consume too much alcohol, are sedentary, and don’t manage chronic stress.
In other words:
These classic symptoms that drive men to think they need testosterone therapy are the result of lifestyle choices, not low testosterone.
While it is true that testosterone levels decline somewhat with age, lifestyle changes and not testosterone therapy is the way to tackle the classic symptoms.
6 reasons you should avoid testosterone therapy
Here are the six types of men who should definitely not take testosterone therapy unless they have eliminated and/or addressed all the lifestyle factors that could be causing their symptoms. These are the men upon whom all the internet, magazine, and TV ads are focused. Are you one of them?
Low T and symptoms: All you need to do is to make lifestyle changes that are relevant to you.
Low T and no symptoms: Same thing here… even with no symptoms as yet, you can alleviate them by making lifestyle changes that are relevant to you.
Low T, symptoms, and overweight. Make lifestyle changes that are relevant to you, with special attention to becoming lean again. Men who are overweight and who drop their excess pounds can experience a significant rise in their testosterone levels. A study of nearly 900 men with pre-diabetes showed that weight loss reduced the prevalence of low T by nearly 50 percent. Without doubt, this is the #1 foundation of L-therapy.
Normal T and symptoms. Normal T isn’t the be-all end-all … Make lifestyle changes that are relevant to you and you will probably boost testosterone into the optimal range while you reverse the symptoms.
Normal T, symptoms, and sleep deprived. Make lifestyle changes that are relevant to you, with special attention to stress, relaxation and sleep. A study in theJournal of the American Medical Association reported on the impact on testosterone levels when men were sleep deprived. The authors found that T levels declined by 10 percent to 15 percent among men who were sleep deprived for one week. Adequate sleep (7-8 hours nightly) is absolutely necessary for healthy production of testosterone.
Cosmetic/vanity reasons: Do you really think testosterone therapy will make you look like the guy in the Cenegenics ads (he’s a doctor, by the way) at 65? Even if such therapy did marginally help, are you willing to risk the serious side effects associated with its use? My friend who takes T for cosmetic reasons is a newly single Newport Beach guy on the dating hunt. He was already 11% body fat before he started T therapy – and he wanted to get to 9%. And you know what – he looks no different! And he is potentially setting himself up for a lifetime of health challenges and side effects.
Using L-Therapy instead of T-Therapy
The following lifestyle factors can have a hugely positive effect on your testosterone levels. Take a look to see which ones you can change to help improve your testosterone levels and eliminate your symptoms?
Healthy diet. This term has been co-opted by the mainstream to mean “low fat, whole grains and cardio training.” Don’t believe that load of bull. It’s what’s been making men unhealthy for more than 50 years. Instead, focus on a diet that is based on whole, natural foods (grains aren’t a natural human food) and is low in sugar and unhealthy fats. A good example is the Mediterranean diet. In addition, some foods naturally help boost testosterone levels. Two of my friends consistently feed themselves on a diet of highly refined and processed foods. Recently, one of them also got prostate cancer. Clean up your diet and you will feel the natural energy and sexual boost that follows.
Regular specific exercise. A combination of intense exercise and strength training (lifting heavy weights) can help boost T levels. Research shows that high intensity interval training (HIIT) can also boost T levels. One of my T-taking friends was constantly exhausted because he was doing a lot of “cardio,” or endurance exercise that has been shown to increase the adrenal load and decrease T. He was exhausted because he was training to hard and too long without adequate rest and sleep. Since cutting back on the long runs and rides he has seen his energy increase and he’s sleeping better as well.
Maintain a healthy weight. Men who carry excess fat also can have too much estrogen, since this hormone is produced in fat cells. An imbalance in estrogen and testosterone levels is a recipe for classic low-T symptoms. Lose the excess weight (diet and exercise will definitely help) and then maintain your new, healthy weight.
Stress management. Stress can cause low T because the stress hormone, cortisol, blocks production of testosterone. Daily management of stress using meditation, yoga, tai chi, progressive relaxation, or whatever works for you, is highly recommended.
Adequate sleep. Do you get at least 7 hours of sleep each night? If not, then your T levels can decline. Seven to 8 hours of sleep nightly is recommended to help maintain healthy testosterone levels.
Limit alcohol. Drinking alcohol has two main effects on sex hormones: it lowers testosterone and raises estrogen. That’s a double whammy no guy wants! And alcohol also impairs the liver that is critical for processing estrogen and managing the amount of free testosterone that is made available in our body. Limit alcohol consumption to two drinks or less per day to help keep your liver healthy and your T levels up.
Take supplements that can help boost nitric oxide and promote better energy and sexual health. There are many herbs like Tribulus terrestris that have been shown in the studies to help promote strength, libido and peak performance. These ingredients can work together to promote natural free testosterone levels, and boost sexual health.
Bottom line
Whether your T is 200 or 1000 ng/dL is irrelevant – what matters is how you feel. I know guys with clinically low testosterone that are bouncing off the walls with energy; and others with high T that act depressed and lethargic. If you are experiencing any of the classic symptoms of low testosterone or you think you need to “treat” low T, the answer you are looking for is not T therapy; it’s L therapy—lifestyle changes. Take a look at what you can personally change that will have the greatest impact on your energy and sexual health – and commit to a program today.
To begin to understand them and how they work, you must first understand what factors contribute to testosterone decline. The primary factors are the American diet, insulin resistance, high stress levels (cortisol demand), lack of exercise, and toxin exposure. Allow me to explain each of these in more detail.
The main dietary contributors to low testosterone are refined carbohydrates and unhealthy fats/oils. Processed grains (bread, pasta, etc.) and refined sugars (sucrose, high fructose corn syrup or HFCS, etc.) cause insulin and cortisol to rise which steals from the production of testosterone in the testes and adrenal glands.
Unhealthy fats/oils that lower testosterone include animal sources (high in Arachidonic Acid which leads to high omega-6 fats), trans-fats (unnatural chemicals) and processed oils. What are processed oils? These are corn oil, sunflower oil, safflower oil, linseed oil, cottonseed oil, peanut oil, soybean oil and canola oil which go through pressing, heating and the addition of industrial chemicals and toxic solvents.
What are healthy oils that build testosterone? These are the naturally-derived saturated fats from avocados, raw nuts (almonds, walnuts, pecans), coconut and coconut oil, butter from grass-fed organic milk, and olive oil. A 1984 study showed that a diet with less than 40 percent of energy as fat from mostly natural saturated sources leads to a decrease in testosterone levels. [1] Also I recommend oils that increase your omega-3 (anti-inflammatory) to omega-6 (inflammatory) ratio which include flaxseeds (and oil), walnut oil, fish oil, EPA/HFA fish oils supplements, and leafy green vegetables. Additionally, zinc deficiency [2] has been associated with low testosterone.
Chronic stress from emotional or physical causes increases cortisol production, thus shunting away from the production of testosterone. These include fear, anxiety, worry, depression or despair, insomnia [3] and chronic pain/infection/inflammation.
Certain types of strength training will increase testosterone levels. A 2011 study showed that wrestlers who performed a series of intense 6-second sprints significantly boosted testosterone (and lowered cortisol levels) over four weeks. [4] Research also indicates increased testosterone levels result from full-body resistance training two to three times per week. [5] This should be done with very short rest periods [6] –including training for your legs [7] –and you should max out with repetitions. Even better is to do forced repetitions [8] (max out on your own, then complete one to five more with assistance). However, long endurance sports (cycling, running) seem to lower testosterone levels over time. [9]
Certain toxic chemicals prevalent in our environment are considered anti-androgens (and lower testosterone effectiveness). They are hormone disruptors which are thought to block hormone receptor sites on tissue cells and also interfere with its metabolism. These are pesticides, food preservatives and additives, heavy metals (i.e. mercury), phthalates [10][11] (in personal care products, paints, etc.), bisphenol A [12](plasticizers), and others. Medications can be anti-androgens too:
Natural libido boosters
There are herbs and nutrients that have been shown to boost testosterone naturally. Here is an important point about testosterone metabolism: approximately 7 percent of testosterone is metabolized to dihydrotestosterone (DHT) by the enzyme 5-alpha reductase. More importantly, DHT binds to the same testosterone cell receptors and does so much more strongly, making it about five times more potent than testosterone!
Fortunately, there are herbs you can consume that are known to blocks the enzyme 5-alpha reductase and therefore block DHT formation and increase testosterone. Fenugreek is one. Other natural 5-alpha reductase inhibitors [13] include phytosterols (e.g. Saw Palmetto), polyphenols (resveratrol, quercitin, flavonoids, red wine and dealcoholized red wine, dark chocolate, etc.), green tea, coconut oil and palm oil.
Approximately 0.3 percent of testosterone is converted into estradiol by the enzyme aromatase, which is increased by advancing age, obesity, hyperinsulinemia, steroid use (including testosterone) and alcohol. The prescription drug anastrozole (Arimidex) and others are used to block aromatase (and thus increase testosterone), and there are natural aromatase inhibitors you can buy at the health food store: flavones, resveratrol, chrysin, genistein and quercetin.
Herbs and nutrient supplements used specifically to boost libido, sexual function and well-being include Tribulus terrestris, D-Aspartic acid, Maca, Tongkat ali, Mucuna pruriens (increases dopamine which can improve libido), vitamin D3, Coleus forskohlii, Damiana, Horny goat weed, Ashwagandha, and others.
Prescription testosterone
Testosterone replacement therapy is not only a prescription (in the USA) but also is a controlled substance by the Drug Enforcement Agency (DEA) because of its street value. I prefer to prescribe compounded testosterone because it is considered more bioidentical than synthetic (drug company-patented) methyltestosterone. Although bioidentical hormones have proven much safer than synthetic hormones, [14][15] less has been proven about the advantages of bioidentical testosterone over synthetic.
There are a few different routes of administration for testosterone. It can be injected every two weeks; implanted as pellets every four months; taken by mouth daily (don’t advise use of methyltestosterone by mouth—it can damage your liver); put under the tongue (50 to 200 mg divided two to three times daily) or applied as a gel or patch. For all these methods you’ll need to follow your blood levels with re-testing. The best method in my opinion is the compounded cream applied to your skin (recommended 10 to 300 mg daily). I prefer to prescribe transdermal compounded testosterone because it is easy to apply once daily and I can increase the dose and concentration to reach clinical results plus follow levels with saliva testing. Take caution to avoid applying it to hairy areas (hair contains 5-alpha reductase) so it does not get converted to DHT. Also, do not apply it to fat areas (contain aromatase) so it does not get converted to estradiol.
In previous articles on testosterone I exposed the latest controversy over safety of testosterone replacement therapy in my article, “Testosterone supplementation: Looking at controversial studies.” I also reviewed the risks of having low testosterone and the many reasons you could benefit from replacement therapy if your levels are low (with varying opinions on what is considered low) in my article “Know the disease risks of low testosterone.” Next week I’ll discuss the clinical tests you’ll want, optimal levels, precautions, and final decision-making tips for testosterone replacement therapy.
To feeling good for health,
Michael Cutler, M.D. Easy Health Options
[1] Hämäläinen E, Adlercreutz H, Puska P, Pietinen P. Diet and serum sex hormones in healthy men. J Steroid Biochem. 1984 Jan;20(1):459-64. [2] Prasad AS, Mantzoros CS, Beck FW, Hess JW, Brewer GJ (May 1996). “Zinc status and serum testosterone levels of healthy adults”. Nutrition 12 (5): 344–8. [3] Andersen ML, Tufik S (October 2008). “The effects of testosterone on sleep and sleep-disordered breathing in men: its bidirectional interaction with erectile function”. Sleep Med Rev 12 (5): 365–79. [4] Farzad B, Gharakhanlou R, Agha-Alinejad H, Curby DG, Bayati M, Bahraminejad M, Mäestu J. Physiological and performance changes from the addition of a sprint interval program to wrestling training. J Strength Cond Res. 2011 Sep;25(9):2392-9. [5] Vingren JL, Kraemer WJ, Ratamess NA, Anderson JM, Volek JS, Maresh CM. Testosterone physiology in resistance exercise and training: the up-stream regulatory elements. Sports Med. 2010 Dec 1;40(12):1037-53 [6] Rahimi R, Qaderi M, Faraji H, Boroujerdi SS. Effects of very short rest periods on hormonal responses to resistance exercise in men. J Strength Cond Res. 2010 Jul;24(7):1851-9. [7] Hansen S, Kvorning T, Kjaer M, Sjøgaard G. The effect of short-term strength training on human skeletal muscle: the importance of physiologically elevated hormone levels. Scand J Med Sci Sports. 2001 Dec;11(6):347-54. [8] Ahtiainen JP, Pakarinen A, Kraemer WJ, Häkkinen K. Acute hormonal responses to heavy resistance exercise in strength athletes versus nonathletes. Can J Appl Physiol. 2004 Oct;29(5):527-43. [9] Izquierdo M, Hakkinen K, Ibanez J, Anton A, Garrues M, Ruesta M, Gorostiaga EM. Effects of strength training on submaximal and maximal endurance performance capacity in middle-aged and older men. J Strength Cond Res. 2003 Feb;17(1):129-39. [10] Rudel R, Perovich L. Endocrine disrupting chemicals in indoor and outdoor air. Atmospheric Environment Jan 2008;43(1):170-181. [11] National Research Council (US) Committee on the Health Risks of Phthalates. Phthalates and Cumulative Risk Assessment: The Task Ahead. Washington (DC): National Academies Press (US); 2008. Access online Pubmed at: http://www.ncbi.nlm.nih.gov/pubmed/?term=Phthalates+and+Cumulative+Risk+Assessment%3A+The+Task+Ahead [12] Gore AC. Endocrine-Disrupting Chemicals: From Basic Research to Clinical Practice. Contemporary Endocrinology. June 8, 2007. Humana Press. [13] Rushton DH. Nutritional factors and hair loss. Clin Exp Dermatol. 2002 Jul;27(5):396-404. [14]Conaway E. Bioidentical hormones: an evidence-based review for primary care providers. J Am Osteopath Assoc. 2011 Mar;111(3):153-64. [15] Life Extension Foundation white paper on bioidentical hormones, Bioidentical Hormones: Why Is There Still a Controversy?” access online at: http://www.lef.org/Magazine/2009/10/Bioidentical-Hormones/Page-01
