The Epidemic of Testosterone Deficiency in Boys and Men of All Ages
Testosterone is the hormone that is responsible for normal growth and development of male sex characteristics. Testosterone is made in the Leydig cells in the testes as the result of stimulation via leutenizing hormone (LH) from the anterior portion of the pituitary gland. The LH is stimulated via gonadotropin releasing hormone (GnRH) from the hypothalamus which initiates the entire cascade. Optimal testosterone levels then provide a message via a negative feedback loop to the brain (hypothalamus) and production is halted. Therefore, this works in a pulsatile (intermittent) fashion and typically ebbs and flows throughout the day with levels at their highest in the early morning. Testosterone is then released into the bloodstream where it is bound to albumin and sex hormone binding globulin (which renders it inert and/or limits its effectiveness) or remains free. The free testosterone is then available to attach to receptors on the cell membrane and ultimately the nucleus to exhibit its effects and create its magic. (3,4) The testosterone is then metabolized to dihydrotestosterone (DHT) via 5 alpha reductase and estradiol via aromatase. These hormones also induce positive effects on optimal male function and physiology. Testosterone levels for men typically peak between the ages of 18-25. Levels will typically begin to slowly decrease after the age of 30 to the tune of a 1% loss per year. Thus, the negative effects of testosterone deficiency such as weight gain, low libido, reduced muscle mass, insulin resistance, chronic inflammation, and depression to name a few commonly occur in men aged 35 or older (ie. the typical testosterone client).
At this time in the world, multiple factors, however, are negatively affecting testosterone levels in men and boys of all ages. Testosterone levels have been on a steady decline over the last 40-50 years looking at population statistics. (1,2) Therefore, optimal levels of testosterone as reported by the major laboratory companies Quest and LabCorp have also plummeted. These changes have created even more limitations on the treatment of men with low testosterone due to arbitrary insurance mandates and fear by the medical community to proactively resolve a chronic health issue with multiple comorbidities. The reason for this continued decrement is multifactorial and includes insulin resistance/Type II diabetes mellitus, poor diet including processed foods/vegetable oils ,endocrine disrupting environmental pollutants such as glyphosate, phytoestrogens such as soy protein by products, and xenoestrogens such as phthalates from plastics. (5,6) Poor sleep habits, excessive stress, chronic inflammation, limited exercise and weight training, and increasing body fat percentages/obesity also play significant roles in this epidemic. These issues also affect sperm production and increases the risk of infertility challenges (7).
Therefore, the initial treatment of all health issues, including low testosterone levels, resides in addressing the foundational pillars of health. These principles include optimal sleep and sleep hygiene (which may include an evaluation for sleep apnea), nutritional intake including protein and reductions in processed carbohydrates and inflammatory vegetable oils (adding fasting/intermittent fasting), stress reduction, sunlight and nature exposure, exercise including bouts of heavy resistance training, hot and cold exposure, breathwork, mindset training, finding your life purpose, reducing clutter including toxic relationships, and focusing on passion and things that light your fire. These areas are not the fun or glamour topics in health optimization, but they are an absolute necessity to provide the basis for transformation recovery, restoration, transformation, and evolution. It is akin to building a house. If the ground and the foundation is poorly built, the place will crumble into oblivion no matter what nice furniture and gadgets are present on the upper floors. Understand that these pillars take months to years to master and will not instantly improve after a week or two. Accountability thus becomes the focus no matter your age or current status.
Once these foundational pieces are in place, then we are able to address a comprehensive laboratory panel, epigenetic evaluation, urine and saliva studies, and wearable data to address hormone deficiencies as well as vitamin and micronutrient deficiencies. These treatments would include bio-identical hormone replacement (such as testosterone and thyroid), peptides (such as growth hormone analogs), supplements (such as Vitamin D and Omega 3 Fatty Acids), biohacking tools ( such as infrared sauna, cryotherapy, and hyperbaric oxygen), and IV therapies (such as high dose Vitamin C and NAD+). These treatments are typically incorporated into a comprehensive program and done concomitantly with the foundational pillars, but you cannot have the latter without the former.
The problems of systems dysfunction including low testosterone do not discriminate in relation to age as has been discussed in the aforementioned paragraphs. Similar to the beginning lines of the book A Tale of Two Cities, we live in an era where “it is the best of times and the worst of times.” The best because our knowledge base and technology is progressing at warp speed and we have limitless potential due to regenerative longevity. It is the worst of times due to the poor nutritional value of our food supply, environmental chemicals and pollution, and endocrine disruptors that are wreaking havoc on our health span. Therefore, if symptoms are present at any age, they must be evaluated by an enlightened physician that understands the complexity and has an open mind to both the evaluation and treatment process. A physician who treats on a systems basis as opposed to a disease basis that pervades our current healthcare practices. A physician, group, and company that treats with a precision medicine and health optimization approach to meet your goals.
Thus the take home message is that men of all ages are under siege and attack from the ravages of our personal decisions and our environment. Nobody is immune from these attacks and burying our head in the sand provides no benefit and is actually a detriment to our society. Brining these issues to light reduces useless treatments like antidepressants and anxiolytics and focuses on fixing the root cause of the problem. The paradigm shift in health care treatment to resolve problems is both the present and the future. Take the steps and you too will be part of the solution as opposed to being part of the problem.
1. A population-level decline in serum testosterone levels in American me. J Clin Endcrinol Metab. 2007 Jan:92(1):196-202.
2. Testosterone levels show a steady decrease in young US men. Urology Times Journal. 2020. July: Vol. 8. Issue 7.
3. Testosterone supplementation upregulates androgen receptor expression and translational capacity during severe energy deficit. American Journal of Physiology-Endocrinology and Metabolism. Howard et al. Vol. 319, No. 4.
4. Biological actions of androgens. Mooradian et al. Endocr. Rev. 8 (1): 1-28. 5. How dangerous are phthalate plasticizers? Integrated approach to toxicity based on metabolism, electron transfer, reactive oxygen species and cell signaling. Kovacic, Peter. Medical Hypotheses, Vol. 74, Issue 4, 626-628.
6. Urinary phthalate metabolites are associated with decreased serum testosterone in men, women, and children from Nhanes 2011-2012. J Clin Endocinol. Metab. 2014 Nov: 99(11): 4346-52.
7. Are oestrogens involved in falling sperm counts and disorders of the male reproductive tract?” Lancet 341(8857): 1392-5.
Dr. Michael J. Meighen, MD/PhD