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Bill is a 48-year-old male with symptoms of increasing fatigue for the past few years, muscle aches after exercise, and worsening mental fog.  He feels his mind is not as sharp as it used to be and it takes considerable effort to stay organized.

Mike is a 58-year-old male who has noticed a decrease in muscle tone over the past year  Despite working out and lifting weights on a regular basis, his muscles look out of shape.  He has also noticed a decrease in his exercise capacity and feels tired and unmotivated.  As an architect, who relies on his creativity, he is not able to focus on his job and his self-confidence has suffered in the past year.

Marty is an 80-year-old male who has developed an unstable gait and random and increasing urinary leakage.  He finds it difficult to remember names and suffers from mood swings and depression. 

What is the condition that explains all of the symptoms in the men described above? 

They all had low levels of testosterone in their blood.  These men are patients I saw in my medical practice, a small sampling of what has become only too common in the US  over the past two decades.  Despite this, most primary care physicians do not check testosterone levels routinely in men. When they do, they do not know how to treat them.  All three of my patients mentioned above had seen their traditional doctors for their symptoms and were prescribed medications merely for symptom management. Low testosterone was not even considered in their differential diagnosis.  Bill has prescribed Adderall, Mike an anti-depressant, and Marty, a neurology consult. All three men were referred to me for consultation by their wives. All three had low levels of free and total T.  Free testosterone is the bio-available testosterone that functions to maintain cognitive function, muscle and sphincter tone, mood, sex drive, and endurance in men.  

After prescribing an adequate dose of bio-identical testosterone gel, the quality of life and health of all three improved significantly, and most of their symptoms resolved within a few weeks.  All three noticed a significant improvement in their physical, mental, and emotional well-being, quality of life, self-confidence, and mood.

Testosterone is the primary gonadal hormone in men, produced by the testicles in high concentrations during adolescence with a gradual decrease during midlife and beyond.  In the US, men run low testosterone levels which have decreased significantly since 2010. In addition, lifestyle plays a significant role in testosterone production and maintenance of a normal level.  The Standard American Diet (SAD), high in processed foods, animal protein, sugar, alcohol, and additives disrupts the endocrine system resulting in low testosterone production and impaired receptor binding.  A plant-based diet and regular aerobic exercise with moderate weight lifting can maintain normal testosterone levels. In fact, men who transition from a Standard American Diet to a plant-based diet with regular exercise can often raise their testosterone levels without pharmaceutical replacement.  

Low testosterone impacts physical, mental, and emotional health in men, so checking the free and total testosterone level needs to become a routine part of yearly blood testing for men, age forty and older.  Any male patients who complain of fatigue, reduced muscle tone, or depression should especially have their testosterone level tested.  In older men, many neurological symptoms like those described by Marty, are often misdiagnosed as neurologic disorders, as testosterone levels are not checked.  Testosterone is a biomarker for the diagnosis of dementia and low levels have been shown to be associated with memory loss and cognitive decline.  

I remember when I first began practicing medicine after my residency nearly 30 years ago, there were concerns about rising numbers of men with low sperm counts and infertility.  This coincided with the introduction of genetically modified (corrupted) food.  We now know that hormone production is directly impacted by the quality of food we eat as the building blocks of our cells’ molecular structure are derived from the breakdown products of food.  Pesticides, used prolifically in US farming, also act as hormone disruptors and run interference with hormonal production and binding.  This impacts the normal functioning of hormones in our body.  The explosive use of chemicals in farming and processed food has resulted in an epidemic of hormonal conditions such as estrogen dominance, PCOS, hypogonadism, low testosterone, infertility, and obesity.  It is vital to incorporate an awareness of how what we eat affects our health.  

Alcohol is another significant offender for hormone disruption, autoimmune disease, and cancer, in the US, and worldwide. Not only is it the #1 cause of leaky gut by creating disruption of the biodiversity of gut flora, but it also interferes with the liver’s ability to process and deactivate hormones once they have completed their role in the body. An increase in alcohol intake in the US along with an animal-based diet over the past two decades has caused an exponential increase in estrogen levels, resulting in an explosion of diseases of estrogen dominance. In fact, alcohol alone or along with a diet high in animal protein (including dairy) is now considered to be the primary cause for an increase in breast and prostate cancer rates in both women and men.  Alcohol is a neurotoxin, which is the most common cause of erectile dysfunction in men. The tiny nerves that cause an erection to die off as a result of the neurotoxic effects of alcohol.  We have years of evidence that emphasizes the importance of lifestyle modification as the most effective way to correct hormonal and sexual dysfunction, in addition to preventing and reversing the myriad of co-morbidities that plague our country.

Testosterone is available in both synthetic and natural or bio-identical forms.  Synthetic testosterone is not bio-identical in molecular structure to human testosterone, and as a result, can cause more side effects.  Bio-identical testosterone is synthesized from plant sources to identically match the molecular structure of human testosterone, making this a more natural approach to hormone therapy. It has a gentler effect on the body with fewer side effects and is also easier and less messy to apply.    After prescribing bio-identical testosterone for my patients, I check free and total testosterone levels in their blood every 3 months to maintain therapeutic levels of testosterone by adjusting their dose as indicated.

Every primary care physician has the responsibility to learn about the effects of low testosterone in men, and the benefits of bio-identical hormone balancing and replacement.  This can be a life-changing intervention for men, contributing to a significant improvement in the physical and emotional quality of their life and health.  Aging does not have to be the degenerative condition we have normalized it to be.  There is enough scientific evidence available for us to be able to help our patients reclaim their health and vitality as they age.  

Our patients truly deserve this.

©April2021 Kalpana (Rose) M. Kumar M.D., CEO and Medical Director, The Ommani Center for Integrative Medicine, Pewaukee, WI.   Author of 2nd Edition – Becoming Real: Reclaiming Your Health in Midlife 2014, Medial Press. Dr. Kumar is currently accepting new patients. Call 262.695.5311 for an appointment, either virtual or in-person for those free of symptoms. 

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Evidence Based Integrative Medicine