Mens Health- Is it more than just testosterone?
Naturally, as men age, their testosterone declines. As human biology dictates, we expect this, and a natural decline in sex hormones occurs in both men and women. Younger men, however, are presenting with symptoms of low testosterone, even in their 20’s. The key word here is symptoms of low testosterone, but when we test their testosterone levels, we often see that they are within the range they should be for age and sex (in many young men.) So why are so many young men showing up with symptoms of low sexual desire, trouble with morning erections or less spontaneous erections, low mood, depression and fatigue?
I have definitely heard my fair share of gym bro talk, and some of this information is harmful and incorrect. Knowledge sharing is important, but when it comes to our health, I do not believe that a one size fits all approach is ideal. General health recommendations are the starting point for good health, but when there are concerns, identifying the cause should be the beginning. Hormones are powerful, which is why when they are out of balance, low, or even high, we often experience symptoms. Keeping that in mind, there are lots of things to consider before starting on testosterone replacement therapy that you should be discussing with your prescribing physician.
So, what are some other reasons you may be feeling symptoms of low testosterone, when in fact your testosterone levels are ok?
Estrogen
We live in a world where our exposure to household products, detergents, fillers in food, diet and plastics, promote an estrogenic state in our body. Often times, we supplement with so many things, but do not take time to address our gut microbiome or liver metabolism which play a strong role in the detoxification and elimination of our hormones. Testosterone has many pathways, and one of them is the formation of Estradiol. This is through a process called aromatization. Some men feel that they don’t have enough testosterone, but hormones behave relative to each other. A higher level of estrogen for a man can definitely make his testosterone feel like its low, when it isn’t.
Stress
The main producers of testosterone are the testes and the adrenal glands. During periods of stress, our pituitary gland sends out a hormone called adrenocorticotropic hormone (ACTH) that acts on our adrenal glands to produce cortisol. This helps us cope with stress, but the feedback is to inhibit another hormone called Gonadotropin releasing hormone (GnRH.) This is the relationship between the HPA (Hypothalamic-pituitary axis) and the HPG (Hypothalamic- pituitary gonad axis.) Recall that stress comes in different forms, and as individuals, our ability to cope is individual. As children we are programmed differently to deal with stress, and some people may have experienced stress earlier in life and now it is impacting them in the present day. Other forms of stress people often don’t think about are when we get sick. Our immune health can also be a cause of stress. Most people today experience stress due to work-life balance and the demands of society. I find many of my patients benefit from support here, particularly using nutrition and botanical medicine!
Body fat
We are all genetically different but depending on your personal baseline, body fat can be contributing to feelings of low testosterone. One reason is because the hormone androstenedione that is made in adipose, breast and axillary fat, can convert to either testosterone or estrogen. Studies show that peripheral aromatization is favored (in both men and women) which means that the favored conversion is to produce estrogen. This is often why people will say that fat is estrogenic. Extra adipose tissue also has an impact on other hormones such as insulin, adiponectin and leptin. Having a healthy body weight is important for so many reasons, not just your hormones!
Diet
The focus here really is on diversity. Our gut and liver really are so important for us to process and eliminate effectively. Most people are not getting enough vegetables, particularly cruciferous and leafy greens. A lack of diversity in our diet also has implications on the beneficial bacteria that support our mental health, hormonal health, immune health, digestive health, skin health and more! Eating late at night influences our growth hormone as well, which affects our ability to build, regenerate and repair. I always tell my patients that it is what we do 80% of the time that shows up in our life- this includes our exercise routine, the food we consume (and I am talking about realfood,) the time of day we are eating, the diversity in our diet and so much more!
Nutrients
There are a plethora of reasons that people are low in different micronutrients. There are micronutrient tests which I will sometimes use to understand exactly what the concern is, especially in the patient that seems like they are doing a lot of things right. However, there are common vitamins and minerals that most people are low in, and this can be for a variety of reasons such as: poor diet, gut health, chronic stress, medications they are taking, age, genetically being predisposed to certain deficiencies, other comorbidities, a lack of dietary diversity and more. Re-building requires the right building blocks, and nutrients play a significant role in our ability to produce hormones.
This article is meant to be educational, and to provide a perspective that I feel is often missing when we approach men’s health. There are many different ways to treat symptoms, but treating symptoms is not always the right approach. Managing symptoms, starting with foundations in supporting the body and trying to understand where the problem is coming from, I believe should be the primary approach.
Written by: Dr. Mashael Mawji, ND
BSc. FNH (Hon)