Supporting Testosterone
From The Desk of Dr. Leisha
What is Testosterone? When most people think of testosterone, they typically think of being big and strong. Being aggressive. Being hairy. Or simply put, being a man! However, these preconceived notions do not account for the full range of effects testosterone has on the human body.
Testosterone is one of the most important hormones in the human body, regardless of sex. In fact, it’s the most abundant sex hormone found in both men and women. We already know that testosterone is important for anabolic processes, such as building bones and muscle, but there growing information about the ways testosterone can affect our mental health.
There’s been growing concern and research around the topic of declining testosterone levels not only in older men but also in younger men, and even among men who are in their prime years. This decline is being observed on a broader, global scale, and some studies suggest that testosterone levels in young men today are lower than those of previous generations. Here's a breakdown of the comparison and trends:
Normal Testosterone Levels for Young Men: In healthy young men (generally in their late teens to early 30s), testosterone levels are typically at their peak. The average total testosterone level for men in this age group usually ranges between 300 to 1,000 ng/dL.
This range can vary, but the highest levels are usually seen during adolescence and early adulthood.
A peak testosterone level in the early 20s is common, after which it gradually starts to decline, usually around the age of 30 or so.
Factors Influencing Testosterone in Young Men: Testosterone production is largely driven by the hypothalamus-pituitary-gonadal axis, and lifestyle factors, health conditions, and environmental influences play significant roles in determining how much testosterone young men produce.
Declining Testosterone Trends Worldwide:
In recent decades, several studies have shown that testosterone levels in men have been steadily declining worldwide. This is especially concerning for younger generations, who seem to be experiencing lower testosterone levels than their counterparts did in the past. For example:
A 2007 study published in The Journal of Clinical Endocrinology & Metabolism found that testosterone levels in American men had decreased by about 1% per year from the 1980s to the early 2000s.
A 2013 study from the Journal of Clinical Endocrinology & Metabolism reported that testosterone levels in men aged 45–79 were significantly lower in the 2000s compared to men of the same age in the 1980s.
These studies and others suggest that this decline isn’t just a result of aging, but may be a global trend affecting men of all age groups.
Potential Causes of Testosterone Decline in Young Men:
Environmental Factors:
Endocrine Disruptors: Chemicals such as phthalates, bisphenol A (BPA), and other substances found in plastics, pesticides, and everyday products can disrupt hormonal systems. These chemicals have been linked to reduced testosterone levels, especially in younger men.
Pollution and Toxins: Air pollution, exposure to heavy metals, and other environmental pollutants may also contribute to hormonal imbalances, leading to lower testosterone production.
Obesity and Lifestyle Factors:
Obesity: Increased body fat, especially abdominal fat, is strongly linked to lower testosterone levels. Fat cells produce estrogen (a female hormone), which can disrupt the balance of male hormones.
Poor Diet: Diets high in processed foods, sugars, and unhealthy fats have been associated with lower testosterone levels, while a healthy, balanced diet with adequate micronutrients and healthy fats supports normal testosterone production.
Lack of Physical Activity: Sedentary lifestyles and lack of regular physical activity can lead to a reduction in testosterone. Exercise, especially strength training and high-intensity interval training (HIIT), can boost testosterone production.
Stress and Mental Health:
Chronic Stress: High levels of the stress hormone cortisol can suppress testosterone production. Given the modern pressures on mental health, such as work stress, social media impact, and societal pressures, young men may be experiencing more chronic stress than previous generations.
Sleep Deprivation: Sleep is crucial for maintaining testosterone levels, with the majority of testosterone secretion occurring during deep sleep stages. The rise of sleep disorders and lifestyle choices that reduce sleep can have a significant impact.
Dietary and Lifestyle Changes:
The increase in the consumption of processed foods, the rise of sedentary lifestyles, and the prevalence of "screen time" (which often disrupts sleep) are all factors contributing to lower testosterone levels in younger men.
Additionally, the increasing trend of men delaying fatherhood or focusing on career goals earlier in life could potentially influence testosterone levels, as fertility and hormonal health tend to decline as men get older.
Global Impact:
The global trend of declining testosterone levels is still being studied, but it’s clear that it’s a multifactorial issue involving genetics, environment, lifestyle, and societal changes. Countries with higher levels of pollution, stress, poor diet, and lack of physical activity seem to see more significant drops in testosterone in young men.
The psychological effects of testosterone
Testosterone is essential for the development of neurotransmitters dopamine and serotonin. Emerging literature is demonstrating just how important testosterone is to a man’s psychological function. As men age testosterone levels decline, but with that decline comes possible deleterious outcomes not only to metabolic health, but also psychological health. Some of these problems include worsening insulin sensitivity and cardiovascular health, decreased bone density, increased visceral fat, and symptoms of anxiety and/or depression.
Parallels between low testosterone and depression
These changes can lead to fatigue, irritability, excessive sleeping, over or undereating, anxiety, brain fog, and lack of enjoyment of life (anhedonia). Many of these are common symptoms of depression, but there may be hormonal factors at play. This is why understanding the psychological influence of testosterone is crucial. Statistically-speaking, almost 50% of men with low testosterone report depressive symptoms. The degree of depressive symptoms reported in a patient is inversely related to the level of testosterone he may present with, especially his free testosterone levels. This means the lower his levels are, the worse his depression symptoms may be. The level of his testosterone is also inversely related to his functional capacity, which translates into more lost hours of productivity as well as his inability to perform in day-to-day life. This can negatively impact a person’s professional or personal life.
Testosterone Replacement Therapy
Testosterone replacement therapy (TRT) is commonly prescribed to address low testosterone levels in both men and women. However, it is important to weigh the potential benefits and risks before starting treatment. Below are some of the pros and cons of testosterone replacement for both genders:
Pros of Testosterone Replacement Therapy (TRT)
For Men:
1. Improved Energy Levels:
TRT can help combat fatigue and increase overall energy, which is especially helpful for men experiencing low testosterone levels as they age.
2. Enhanced Muscle Mass and Strength:
Testosterone plays a crucial role in muscle development. TRT can increase muscle mass, strength, and endurance, which may be beneficial for those who experience muscle loss due to low testosterone.
3. Increased Libido:
TRT can improve sexual desire, arousal, and performance, which may be reduced in men with low testosterone levels.
4. Better Mood and Cognitive Function:
Testosterone replacement may help alleviate symptoms of depression, anxiety, and irritability, and improve overall cognitive function, focus, and memory.
5. Bone Density Improvement:
Testosterone helps maintain bone density, so TRT can reduce the risk of osteoporosis and fractures in men with low testosterone levels.
For Women:
1. Improved Sexual Desire:
Testosterone plays a role in sexual drive, and replacement therapy can increase libido, arousal, and sexual satisfaction in women, especially those experiencing low testosterone due to age or medical conditions like menopause.
2. Enhanced Mood and Energy Levels:
Women may experience improvements in mood, energy, and general well-being, especially if low testosterone is contributing to symptoms of fatigue, irritability, or depression.
3. Increased Muscle Mass and Strength:
Similar to men, women may notice a slight increase in muscle mass and strength, which can improve fitness and physical appearance.
4. Better Bone Health:
Testosterone helps with bone health, and some studies suggest that it may improve bone density and reduce the risk of osteoporosis in women.
5. Improved Cognitive Function:
Some women report enhanced memory, focus, and cognitive clarity when using testosterone replacement therapy.
Cons of Testosterone Replacement Therapy (TRT)
For Men:
1. Potential for Increased Red Blood Cell Count:
TRT can lead to an increase in red blood cell production, which can increase the risk of blood clots, stroke, or heart attack, especially in older men or those with pre-existing conditions.
2. Prostate Issues:
Testosterone can stimulate prostate growth. In men with an existing prostate condition, such as benign prostatic hyperplasia (BPH), TRT may worsen symptoms or increase the risk of developing prostate cancer.
3. Infertility:
TRT can suppress natural testosterone production and sperm production, potentially leading to infertility. This can be problematic for men who are trying to conceive.
4. Sleep Apnea:
Testosterone therapy can exacerbate or contribute to the development of sleep apnea, a condition where breathing stops and starts during sleep.
5. Mood Swings and Aggression:
High levels of testosterone or improper dosing can sometimes lead to irritability, mood swings, or aggressive behavior, often referred to as “roid rage”
6. Skin Issues:
Some men may experience acne, oily skin, or other dermatological issues as a side effect of testosterone therapy.
For Women:
1. Facial Hair and Acne:
High testosterone levels can cause unwanted side effects such as increased facial hair (hirsutism) and acne, which are often more pronounced with long-term therapy or high doses.
2. Voice Deepening:
A potential side effect of testosterone therapy in women is the deepening of the voice, which can be permanent in some cases.
3. Clitoral Enlargement:
Prolonged testosterone use may cause the clitoris to enlarge, which can be irreversible and cause discomfort.
4. Mood Swings and Irritability:
Some women may experience mood changes, irritability, or anxiety, particularly if the testosterone dosage is too high.
5. Increased Risk of Cardiovascular Issues:
While the research is still ongoing, there is concern that testosterone therapy may increase the risk of heart disease or worsen existing cardiovascular conditions in women, particularly if it’s not properly monitored.
6. Breast Cancer Risk:
There is some evidence that long-term testosterone use in women could influence the risk of breast cancer, though this is still a subject of ongoing research.
Considerations for Both Men and Women:
Monitoring and Adjusting Dosage: Testosterone therapy requires careful monitoring by a healthcare professional, as hormone levels must be adjusted over time to avoid complications like over- or under-dosing.
Individual Responses: The benefits and risks of TRT can vary widely between individuals. A person’s age, health status, and the underlying cause of low testosterone will affect how they respond to therapy.
Not a One-Size-Fits-All Solution: While testosterone therapy can be beneficial for many, it may not be the right choice for everyone. Non-hormonal options or lifestyle changes (such as exercise, diet, and stress management) should be explored as well.
What Can You Do
Talk with your provider about doing blood work to check your testosterone levels especially if symptomatic or prior to starting on medication for depression.
When it comes to obtaining blood work for possible hypogonadism, a complete blood cell (CBC), complete metabolic panel (CMP), follicle-stimulating hormone (FSH) (FSH/LH), total and free testosterone, and sex hormone binding globulin are recommended to start.
You can easily schedule an appointment with Dr. Leisha to order labs in our 15 minute concierge medicine appointment. From there we can run the necessary panels to determine what the best solutions might be for you.
We have developed a comprehensive package and membership for men who are looking to support their testosterone levels and improve their testosterone to homeostasis.
References:
https://pmc.ncbi.nlm.nih.gov/articles/PMC4330791/
https://pubmed.ncbi.nlm.nih.gov/32657051/
https://pmc.ncbi.nlm.nih.gov/articles/PMC9216439/#:~:text=Testosterone%20is%20one%20poss
ible%20biomarker,explain%20inconsistencies%20in%20previous%20results.
https://pmc.ncbi.nlm.nih.gov/articles/PMC7999217/
https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2712976
https://link.springer.com/article/10.1007/s00737-024-01513-6