To say that this paleo/ancestral life-way has saved and dramatically improved my life would be something between spot on and a complete understatement. I was really sick when I came on all this back in 1998 and for being almost 40 I feel like I’m doing pretty well. But I wonder at times if I’m doing as well as I could be? Relative to where I was when I was say 32 I am much less strong, muscular and creative. At 32 I was 175lbs and could clean and jerk 315lbs. I’d be hard pressed to get 245lbs at this point. Now, is this simple aging? Did I burn myself out doing CrossFit for too many years instead of following a periodized strength & conditioning program like CrossFit Football? Has my 5 years of traveling and time-zone changes fried my hypothalamus? Did I have high cortisol and create a pregnanalone steal that has dropped testosterone levels? Am I succumbing to the xenoestrogens from plastics in the environment? I’m really not sure, a definite “maybe” could be applied to all the above. Whatever the cause, what the heck should I do about this?
I have followed Art Devany’s work since 1998 and he has posted free testosterone levels in the 700’s. Pretty damn good, and I’d always assumed I would log similar numbers as I aged but alas…this does not seem to be the case. After wrapping up my book tour I was in the 200’s (ouch) and after being home for a month straight I crept up into the 500’s. Even for an average schlep my age these are worrisome numbers, and apparently I’m not alone. The following is an email/dialogue between myself and a guy a met a couple of years ago, I’ll call him Mr. X for a little anonymity. What we will see is a transition from non-paleo eating, to paleo, paleo + herbals and paleo + testosterone replacement (HRT). The literature is pretty clear on the idea that low testosterone in men is a bad thing for a variety of health issues including but not limited to cardiovascular disease, prostate health, cognition, immune function and silly stuff like libido and athletic performance. This will be the beginning of an ongoing exploration of this topic and hopefully folks will find it interesting, perhaps even helpful. Apologies to our XX chromosome readers as this may be a big yawn for y’all. To balance things out I will tackle the female side of hormones and aging in future posts. For now, let’s see what Mr. X has to say:
Robb I have heard you talk about testosterone quite a bit on the pod casts, and in a fairly recent one (maybe it was 86 or so) you said it would be interesting to hear from someone who had mixed T replacement with paleo, and what kind of results had they seen. I also get the impression you have some personal interests in the subject (you mentioned trying to get your own T levels up more than once in the show), and since I have had blood work both pre and post TRT, pre and post paleo, and even pre and post herbal T supplementation, I thought I would share. And though I am far from unique snowflake (seems like there is a low T epidemic amongst us late 30 guys), I wouldn’t mind a thumbs up or down from you on if I am on the right track. Can you spare a minute?
Just a few side notes: 39 yrs old, family man (9yr old daughter and wonderful, though non-paleo, wife), vasectomy (so sterility is no worry from TRT). So here is the run down:
May 11, 2010 (Pre-Paleo, Pre-TRT): I was tired constantly, barely exercising, doing deskwork all day (doing the slow sit of death as Kstar puts it!). Was 18-20% BF at 190lbs and 6’2”. Total T was crap (numbers tabulated below and in attached graphs). A friend of mine (powerlifter) recommended getting T checked, and also the Paleo-Diet (his ‘longevity doc’ had recommended it to him actually). Met with my endocrinologist, got numbers checked (details below), and he figured that insulin resistance was causing HPTA issues. He encouraged T replacement therapy and paleo. So I did it, went paleo, TRT, and Wendler’s 5/3/1 at the same time. Dropped lots of fat (from 18%->8% BF, dropped some weight (190->185), strength almost doubled within 6 months. Loving it! Paleo with TRT and high intensity weight lifting, it just works! Had bloodwork done 11/22, Total and Free-Direct T were right in mid-range. Doing good!
January 10, 2011 (Paleo, on TRT almost 8 mo’s): I started thinking more about how dropping so much fat, going paleo, and getting the epigenetic aspects of weightlifting should have fixed my insulin resistance. I went to my endo, and asked about quitting the TRT, and seeing where my numbers were. He was skeptical, but agreed it was certainly worth a shot (no harm either way). So I did, I stopped TRT, and to give myself as much advantage as I could, I did an herbal ‘post-cycle therapy’ regimen I found on anabolicminds.com, or t-Nation (one of those body builder sites with lots of steriod use!). So starting 1/11/2011, per day I took DIM 75mg, Tongkat-Ali 25-50 mg (SourceNaturals), Resveratrol 300mg (Resverage), Tribulus 450-850mg (Twinlab). Endo scheduled blood work 6 weeks out. Oh yeah – sleeping good, dark room, 9hrs/night, low stress, etc.
February 21, 2011 (Paleo, Herbal Post Cycle Therapy Only): Got my blood work done. Holy shit! The herbals worked – well kind of. My total T, after 8 months of HPTA shut down, was sitting great at 600 ng/dl. Perfect! But…..Free-Direct-T, pretty much bottom of the range at 10.3 (norm = 8.7-25.1 pg/ml). Interesting fact: cognitively I felt really good on the herbals, but energy was low. Kind of a mid-range point between the full benefits of TRT and just having crappy T levels all around. So not a bad place for someone who is just a little low. I would recommend this combination of herbs any time for a general guy just looking for a boost. But its not apparently going to solve the SHBG problem and raise the Free-T, SHBG just seems to be regulated in a completely different path. Also, as before, sleep was spot on, low stress, etc. I can’t figure at all why Free-T would be that low. My endo asked if I would go off the herbs (figured I would adapt eventually and lose the benefits anyways) and see where things stood. I agreed, and scheduled follow up for April.
Editors note: When we consider testosterone levels we have few important variables:
Total testosterone- As the name implies, it’s how much testosterone we have pumping through our pipes. It’s to sum of Free and Bound testosterone.
Free testosterone- Again, he name tells us what we have. Free testosterone is the most biologically active form of testosterone. Folks can have high total test, but low biologically active test and therefore still have signs/symptoms of overall low-T.
Bound testosterone-This is the fraction that is tied up with a protein called Sex Hormone Binding Protein (or Globulin) (SHBP/SHBG). If one has high SHBG one will tend to have low free testosterone, regardless of total testosterone.
April 11, 2011 (Paleo, Clean (no supplements, no TRT): Well, the herbs were definitely doing something, cause Total-T took a dive back down to 450 (from 600 on herbal PCT), and Free-T stayed low (10.1). At this point, I was feeling like crap, but still, my sleep was spot on (9+ hrs per night in a totally dark room), low stress, and my BF% wasn’t bad (had crept up slightly to 11.5%, and I tell you, after having been at 8%, 11.5% felt like fat!). My strength had dropped significantly (e.g. Bench went from 285 1RM to 245 1RM), and cognitive effects were setting in. So decided to go back on TRT.
August 11, 2011: Paleo, Back on TRT (100 mg test-cyp per week, IM): Well, BF sitting pretty nicely at 10% and 187 lbs, 6’2”. Strength is back (e.g. Bench 1RM back up to 290 – have a goal of 2x BW). Would like to gain more mass, but longevity is a more important factor, so sticking low carb paleo.
Conclusion: So, yeah, TRT and paleo is a kick ass gig. Heck, paleo alone is a kick ass gig! But TRT does have its upsides. I guess my question is, did I try enough to fix things, and just keep rolling with TRT?
Btw, one hypothesis I have is that vasectomies might result in lowered Free-T through some sort of positive feedback on SHBG production from sperm reabsorbtion. I noted in a pod cast you had yours reversed – presumably so you can have little ninos! Anyways, is this hypothesis legit or smoking crack?
Editors Note:
There does seem to be some potential issues with vasectomies and T-levels
My response:
Mr. X!!!
Great to hear from you man! And holy cats interesting timing. Tomorrow morning I’m going in to get the 2nd of my Tlevels checked, after using some standard tribulus productsand d-aspartic acid @3g per day.
I’m 39 and have suspected lowT for some time. I’ve followed guys like Art Devany who seems to have t levels in the 700’s at age 70…but alas…I do not think I won the genetic lottery in that regard. I did that discovery channel show back in july and lost 16lbs due to starvation (it was awesome!) and was a mess after the show. So, I had my levels checked and total was 560’s…forget free but it was low. So, started on some DHEA and the products listed above, titrated off the DHEA and will see how these things are affecting numbers.
I have noticed better body comp, better recovery, libido etc but nothing that would blow my sox off. I’ve upped my carbs from paleo sources (some potential of decreasing SHBP) and just tinkering with that
So…the D-aspartic acid works at the brian level producing more Luteinizing hormone (LH), which initiates the cascade of T production. That could be one thing to add to the mix. More carbs might affect free-T…but we also have seen very high fat levels do the same thing…so back and forth on that. I’d be interested to see the effects of HRT+D-aspartic acid as you get more of the cognitive/libido effects with the LH. And as to health…If the next 30-40 years (im 39) is just going to be a slow slide into the abyss, I’d rather take 5 off the top for more quality now. Although I suspect the opposite is true, we actually see a slowing of aging, decreased telomere damage and other goodies with high/normal T-levels.
I’d love to take this info and craft a blog post from it. i’d of course make it anonymous, but combining this with my info would be a really powerful post and would set a point for further investigations in this direction. Either way, let’s keep this dialogue going and I’ll let you know what my #’s are when I get them.
Mr. X’s response:
Sweet! Good luck tomorrow – and Robb, thanks for responding! Yes, definitely would not mind at all if you blogged on my info (just call me Mr. X or something). Hmm, I forgot to add that very recently I had added in 25mg of DHEA daily and tinkered with 10-20 mg of Pregnenolone (both oral capsules), about 6 weeks ago, just before my latest test.
I think the DHEA->T conversion may have resulted in my more recent really high Free-T number (TT of 874 and FreeT of 23.5, which feels fracking great by the way!). If not from conversion, perhaps I had some DHEA->androsteine->aromatase->E that bound up some of the aromatase and left more T unconverted? Not sure…
I will say, DHEA and Preg definite have some potent cognitive improvements for me – but I am titrating it down to more like 10mg DHEA in divided 5mg doses (am and pm), and ordered some sublingual Preg 10mg (to avoid the first pass through the liver) – I felt like my E2 levels were getting a bit too high (purely subjective, no numbers, lets just say I noticed my emotions a bit more than normal).
Interesting article! Yes, I will echo the DAMNIT! Grrr…
I will pick up some D-Aspartic right now on the way home from work if I can find it – thanks for the tip! I will let you know how it works for me.
Definitely let me know if I can give you any more info – and I would certainly like to hear how your own efforts go. GOOD LUCK!
My follow-up to Mr. X:
So, I’ve been rattling this around and does it seem like one would want to go the herbal/dhea route as long as possible, then switch to HRT? If so why? I think we get “better” signaling, and a profile that looks more complete but that’s just a gut sense…if we are just looking at performance markers I’m not sure I can support that. HRT seems to consistently produce the “best” results if we are looking at strength, performance etc.
Mr. X’s response:
I always have this rattling through my mind! Again, just an N=1 for me, but I can say that on the herbals I ‘felt’ more…well, normal might be the right word. In a nutshell, I agree completely – herbal does seem to promote a more complete range of steriodogenesis, if less ‘punch’ for Free/DirectT. I am curious about some recent work I read about ‘loosely bound’ serum T (technically not included the Free/Direct assay) that still seems to have some bioavailable activity? I need to do more research on that front. But to give you more from my personal experiments to try to capture it subjectively, and some thoughts on perhaps why, here is where I am at the moment:
[Scenario 1 – Low T, No Mitigation] As a baseline scenario, I think any of us who have been at a Free/Direct T in the lowest quartile, regardless of the causal factors (be they behavioral such as lack of sleep, physiological – poor diet or inhibitory feedback loop of some sort, or pharmacological – result of prior steroid use etc.), this is a bad place to be. Lack of energy, poor mood, and a growing body of evidence related to adverse physiological outcomes (cardiovascular, cognitive, body composition, etc.) suggest some form of corrective action is desired – no where to go but up!
[Scenario 2 – Herbal Support] Ok, so while we don’t know exactly what the initiating point of entry is for herbal/OTC products such as Tongkat Ali/Longjack, while for others we have a better idea (Tribbulus, Resveratrol, DIM, d-aspartic acid) we do know that they have a measurable and quantifiable effect, either direct or indirect. They are definitely capable of raising Total Serum T to normal/high normal (albeit not supraphysiological) levels. In doing so, and I think this is probably what you and I are both thinking is beneficial to this route, it is probable that all of the upstream steriodogenesis pathways are being stimulated, leading to increased T production. So chol->pregnenolone->DHEA->androsteien-dione->T (and the other various side routes as well such as the mineralo- and gluco- corticoid processes). This would present a more ‘normal’ and complete pathway. And these precursors are all bio-active in their own way, not just androgenicly (is that a word?!). Again, after total HPTA shut down following 8 months of TRT, herbals got my total to full normal levels. That has to be a good start for many folks! And it felt pretty darn good.
[Scenario 3 – Exogenous T replacement] This from an N=1 has the most impact on Total as well as Free/Direct T, but is also short cutting the biochemical pathways. Not only are we not using the chol->pregnenolone->DHEA->etc. pathways, we are actually suppressing the endocrine tissues in the testicles that do the majority of those conversions in men (ok ok, so the adrenals do some, and almost every cell in the body can make preg, but the leydig cells seem to play the largest role in this from what I have read in the publications). So we are jumping into the pathway full bore right at the T stage, with only 3 ways out for the material: aromatization, binding to SHBG, or indeed being used as Free T at various receptor sites. Definitely most androgenic bang for the buck so to speak, but really requires some other mechanism to address the ‘back filling’ of all the other suppressed steps in the process (e.g. hCG shots, herbals, or DHEA and preg supplementation), not to mention ‘shrinkage!’ hCG shots are just too expensive to do legitimately, and long term use hasn’t been studied. Tribulus from some accounts I have read can help, but won’t prevent testicular atrophy (though it does seem to offer increased DHEA production support). I haven’t found anything on Tongkat/Longjack or resveratrol (in men) in concert with HRT. But again, N=1, backfilling with DHEA daily does work significantly well, and occasional preg does too (though I am pulling back on my preg usage – seems to be to feminizing in my opinion).
I am this week going to start trib/tongkat supp with my HRT, and see if I can titrate off of the DHEA…I hate that DHEA has to be taken 2x per day (its pulsatile in serum). On the D-aspartic acid front – I looked into it, but found some indications that it has some similar actions in some folks as MSG/aspartame regarding brain activity – mostly anecdotal – but I am a little shy on trying it just yet.
Bottom Line?
I think Mr. X provided a fantastic recap looking at the various scenarios. If you know/suspect low testosterone levels, it behooves you to look into treatment, but don’t forget to clean up lifestyle issues such as sleep and nutrition. I think as a first-line intervention there are a number of herbal/nutraceutical options that improve all or most aspects of androgen signaling. That seems smart. All of these hormones and intermediates flip various genetic switches on and off, so I think it’s smart to start conservatively and work to get a full picture going. If at some point however it becomes necessary to hit the HRT path, I think that is also smart and appropriate, especially if herbal/nutraceutical support provides a more “natural” profile. This is all very black box stuff and as always I reserve the right to change my mind as additional information is made available, but this is what makes sense to me at this point. To find help in this area I’d seek out a reputable anti-aging doctor, Functional medicine doc or similar individual. Keep good notes and if you are game please share your experiences so we can help refine this message and see what does and does not work.
With the DAA you always see a recommendation of 3g/ day. Wan we get some recommended dosages for the tribulus, resveratrol, and DIM. Thanks
Robb,
This article’s timing is great in my situation. I’m 40, married with a two year old, have been eating paleo for close to two years, and exercise regularly(primarily lifting with very little to no cardio).
That’s where the good part ends. I’m stressed, don’t sleep very well, have recurring dermatitis on my face, and probably get into the wine too often.
I recently moved and that seems to have really caused more stress issues for me. I find myslef falling asleep at work especially in the afternoon.
I’m going to see a functional medicine doctor tomorrow for the first time and am anxious to discuss T level tests with him. As of now, he wants to perform some adrenal fatigue tests.
If you have the time, could you suggest anything else I should discuss with my Dr. Thanks, William
I did herbs for 6 months with before and after blood work,I just turned 37,always been lean and cant grow a beard BTW.
First test numbers were 308 total and 6.9(8.7-25) free,after winter recovery from knee surgery, ouch! After 6 months Tongat/pine pollen/tribulus it was 436 and free was still low at 8.0 with DHEAS at 275(88.9-427)and SHBG at 38.9(16.5-55.9)all thyroid #s were good and D3 is low at 37.Herbs help with sexy time but that’s it.Motivation is in the gutter and I cant gain muscle unless I eat to sickness for weeks on end,Paleo for 5 years stress,sleep ect is good.
These numbers have had me seriously thinking about TRT.
Robb,
I’m 41, and can’t lose fat for anything, even on strict Paleo (not even fruit) – and I’m over 300 pounds. I also suspected it was a hormonal issue, so I had T tested. Yep, it was 190. The awesome part was that my doctor considered that a ‘normal’ range, and suggested that my T would increase as I lost weight. (yep, the old ‘you got your peanut butter in my chocolate!’ ‘well you got your chocolate in my peanut butter!’ argument).
After gently beating his head on the desk for a while, he relented and suggested I take 100 units of DHEA every day for a month and then get retested, which is next week. I will keep you posted, but I certainly don’t feel any different.
Kevin
Twitter: imadness
Good stuff man.
your doctor needs to be fired!!! my t levels at 330 for age 48 where considered low
Great Article Robb.
Question(s);
At what point should a guy get his T levels tested? When does low-T become a clinical diagnosis instead of just “I’m tired and can’t think straight”? Is there any value in going out, getting those supps you mentioned, just to see if there’s any improvement in the subjective markers, i.e. mental acuity, sex drive, mood, etc? How long until an improvement might be noticed?
Thanks Robb.
Spank_McMcMc
My advice is google low testosterone symtoms and see how many you really stack up to. Then google low testosterone+causes and see if you are doing any of those. If so, make adjustments and then re-google (new word??) low testosterone and reevaluate. Your tricep is an indication of how male you are, that and if you wake up “rock solid.”
Hey Robb,
What would you suggest for a “primer” on this topic? And when you did your T-testing, did you also get Cortisol numbers?
I ordered a full hormone panel in July from ZRT laboratory- and here were a few of my data points:
– Cortisol at wakeup = 12.9 ng/ml
– Cortisol at noon = 2.2 ng/ml
– Cortisol in evening = 1.6 ng/ml
– Cortisol at bedtime = .9 ng/ml
Total Testosterone = 713 ng/dL, and T/SHBG ratio was 0.7
…Tim
Looks good man! I’ll get an info-graphic on this put together.
Yeah, I’d like to echo Tim’s point about a primer. As a 45 YO, I’m very interested. Gotta confess, though, that much of this post went over my head.
Please confirm “free testosterone levels in the 700s” in the second paragraph. That would imply that total testosterone would be 50 times that if you are talking about free testosterone. Even “free and loosely bound” would unlikely be that high. I suspect the 700 value is total serum testosterone.
BTW Robb, I emailed you a while back with some blood test results from my TRT. ( I am the one that said he was more Weston A. Price than Paleo : ) )
A link on treating TRT can be found here
http://www.allthingsmale.com/word_docs/TRT.doc
This is not written by my doctor and opinions will of course vary, but I am mostly following this with my own doctor.
I would encourage any male to get his Total T tested every few years to establish a baseline.
And stay away from hair-loss medications or you may end up like me sticking needles in yourself for the past 5 years.
What about the old TimFerriss Brazil nut selenium and testosterone
“FOUR HOURS PRIOR TO SEX
4 Brazil nuts
20 raw almonds
2 capsules of the aforementioned cod/butter combination
Brazil Nut Explanation: I began consuming Brazil nuts for selenium, as I tested de
Looks like my comment got snipped “Going in and out of ketosis had created a selenium deficiency. Unbeknownst to me, longterm
ketogenic dieting has been associated with selenium deficiency. This was a real lightbulb
moment.” http://paste2.org/p/1762113
You lost me at “Tim Ferris”…..
Is there a particular age or demographic that you would suggest have T-levels checked?
35-40 is likely a good time to start tracking things.
Actually Rob any male no matter their age should consider testing if they have low energy, low libido, bad body comp, poor sleep, low Vitamin D levels or an increase waist line. I have seen low T in males below 25 yrs old who I operate on and routinely find them to have metabolic bone disease and subsequently find they have hypogonadism. The work up usually reveals the real cause……bad 06/3 ratios and elevated HS CRP. Its all tied to the diet and a lof of baseline inflammation. Another cause is hyper-cortisolism from a variety of causes but this is decidely more rare a cause in younger males. I am finding an epidemic of low T in young men below 30 who I operate on and find them to have terrible bone.
I think most men over the age of 25 years old should be getting their blood/androgen levels checked every 6 months. It is great to get a snap shot of how your training/diet and life is treating your body.
Most people don’t get their levels checked until they start to feel tired and off their game. If they had checked it earlier they might be able to avoid some of the common pitfalls.
John
That post was all over my head so I’ll wait for the post for the ladies, but the topic reminded me of this wonderful episode of This American Life on testosterone. It was really interesting and educational on the effects of this important hormone even for women.
http://www.thisamericanlife.org/radio-archives/episode/220/testosterone
I love that episode and think it can be really helpful for women to hear the trans man talk about his experiences with testosterone.
Would love the female equivalent to this post. Really struggling as of late with fatigue, muscle loss, muscle weakness, amenorrhea, low dhea etc.
I had the same thing! Including sleepless nights, focusing issues, memory issues that I never had before, stressed out, bordering on depression. Interviewed & reviewed several Doctors-got tested. Initially: high estrogen, barely any progesterone, almost no testosterone, low DHEA, low Vitamin D, high cholesterol & triglycerides. What a mess! No wonder I felt old at 45. 4 months later: muscle mass increased, body fat decreased,cholesterol down, triglycerides normal, estrogen testosterone progesterone DHEA all normal for a late 20s early 30s. Dr prescribed Testosterone cream 0.2%, progesterone caps 75mg, DHEA SR 10mg, pregnenolone 25mg, vitamin D 10,000IU. Now- WOW!! Energy up, mind is back to sharp & quick, memory is dangerously accurate, body shape headed to athletic, not stressed out all the time & sleeping better! DO YOUR RESEARCH BEFORE YOU GO TO A DR!!! Usually not covered by insurance.
I had bottom of the foot surgery and was off my feet-no weight bearing at all for 6 weeks. My husband is a strict paleo eater & that is the food I was given. I lost 10 pounds LAYING IN BED!!! 10 POUNDS!
I would urge you to seek a good Aging Doctor with HRT skills. Also, call the compounding pharmacies in your area or better yet go in & talk to the pharmacist-he/she will give you a wealth of information on HRT (if you get the right one). Sometimes they will even give you the names of some they like in the area.
Good Luck!!
AC from what I have been told recently it takes about 44hours to teach everything there is to know about male hormones and about +200hrs to teach female hormones. This may take a while….
Yea, the female story is far more complex. Shocker!!
Another great post Robb — this topic deserves more discussion. I recently wrote about T levels in response to the recent study that becoming a father and taking care of young children can lower T.
http://jdmoyer.com/2011/09/14/modulating-testosterone-levels-for-men/
Vitamin A is important for T, and doesn’t get much discussion. Here’s Masterjohn’s article on vitamin A and T levels:
http://www.westonaprice.org/mens-health/vitamin-a-forgotten-bodybuilding-nutrient
Lots of guys are suppressing T–>DHT conversion by inhibiting 5AR, via too much supplemental zinc, B6, resveratrol, etc. Adequate DHT is needed for sex drive and performance (some hair loss is the trade-off, for men who are genetically susceptible). Here’s a good article that gets into the details:
http://meridianvalleylab.com/5-alpha-reductase-over-inhibition/
Good stuff. It’s a tough one with zinc as it also acts as an aromatase inhib which can help reduce estrogen and improve SHBP profile…but then the 5-alpha red is impacted. It’s like biology wants this stuff tightly controlled!
omg ‘androgenic BANG.’ I *heart* this post…LOVE TESTOSTERONE!!
It’s indeedy very complicated and BIG BLACK BOX… everyone’s got different deficiencies and biochemistry… Ridiculously excellent biohacking on this post!!
Consider the value of addressing in this modern toxified world:
(1) estrogen dominance (from prior exposures to plastics, soy, non-organic produce/meat, etc — Ori Hefmekler has great book on this — 3 lines of defense including boosting liver enzyme functions (to eliminate endocrine disruptors), herbs like off of Robb’s Paleo Solns food matrix turmeric, thyme, oregano, sage, rosemary, ginger, etc)
(2) if excess E from pregnenolone, then consider estrogen inhibitors: flaxseed lignans, citrus, passionflower/chrysin, chamomile, cruciferous indoles, DIM, indole-3-carbinol etc.
(3) impaired adrenals — I think for a ton of athletes this is a huge obstacle. Pretty in Primal is awesome…
http://prettyinprimal.blogspot.com/2011/10/adrenal-fatigue.html
Birth control (and adrenal fatigue) made me into a eunuch for 1-2 yrs so I feel your pain… Hope you guys get your BONERS back pronto!
G
P.S. Testing as Robb is aware is available for PCBs, BPA and other endocrine disrupting chemicals (EDCs) if all else does not respond.
http://www.metametrix.com/toxins
http://www.metametrix.com/test-menu/profiles/toxicants-and-detoxification/bisphenol-a
http://www.metametrix.com/test-menu/profiles/toxicants-and-detoxification/polychlorinated-biphenyl-testing
Hey Robb,
Very timely post, this is something I have been thinking about lately.
When I was 29, I had one testicle removed because of testicular cancer. I was fortunate to catch it before it spread and did not require any chemo. There was no suggestion at that time that I needed any hormone treatment or supplementation. I was told that my remaining testicle would make up for the missing one and everything would be fine.
After reading your book over a year ago, I know better than to just blindly listen to standard medical advice like that.
Today I turn 42 and I’ve definitely been having low energy, low libido and feeling fuzzy headed for a while now. My diet hasn’t been that great over the past few months but I’m getting that cleaned up now. Once my eating has been clean (with good sleep, low stress) for a month or so I want to get my T levels tested.
I will be keenly following this post and any follow ups. When I get my tests done I’ll report what my results are and what actions I’ll be taking if necessary.
Thanks for all your hard work and the great information you provide.
Shane
Robb,
Yes please, please, please “tackle the female side of hormones and aging”. I am a 40 year old, over stressed, over worked, fatigued Mom & Wife. I just got your book and am in the process of changing over to the paleo lifestyle for me & my family. I have noticed body changes i.e low thyroid, fatigue, high triglycerides (genetic disorder I’ve had for the last 5 yrs),acid reflux, dysphagia, abnormal hair growth, some hair, eyelash loss, 30lb weight gain over a span of 5 yrs. I realize that some is aging related but I also realize that it is my diet and lack of exercise. I also have a daughter whose diet has to be modified due to whey intolerance, severe acne, eye sty’s & danruff from hormone imbalance & A.D.D. There are a lot of women facing these issues & trying to make the best decisions on what to feed their families so they are healthy as well. Most women do the grocery shopping and the cooking so it’s important for us Gal’s to know what’s best.
Today’s women are busy taking care of everyone else, giving 110% to their jobs & forgetting about taking care of themselves. I want to change my current lifestyle and take better care of myself before My health is compromised further. I am extremely interested in what you have to say about female aging and hormones so that I am armed with the tools I need to a healthier me & healthier lifestyle that I can also share with my family. I know there are other women out there that are interested in this subject as well. Your changing lives, keep on & thanks for all you do.
Sincerely,
Brittney W.
I had the same thing! Including sleepless nights, focusing issues, memory issues that I never had before, stressed out, bordering on depression. Interviewed & reviewed several Doctors-got tested. Initially: high estrogen, barely any progesterone, almost no testosterone, low DHEA, low Vitamin D, high cholesterol & triglycerides. What a mess! No wonder I felt old at 45. 4 months later: muscle mass increased, body fat decreased,cholesterol down, triglycerides normal, estrogen testosterone progesterone DHEA all normal for a late 20s early 30s. Dr prescribed Testosterone cream 0.2%, progesterone caps 75mg, DHEA SR 10mg, pregnenolone 25mg, vitamin D 10,000IU. Now- WOW!! Energy up, mind is back to sharp & quick, memory is dangerously accurate, body shape headed to athletic, not stressed out all the time & sleeping better! DO YOUR RESEARCH BEFORE YOU GO TO A DR!!! Usually not covered by insurance.
Further, started no-low carb and WOW more improvement!! More muscle mass. More brain power. Couple these together & feel better. It does take a few months before you can look back & recognize the improvement. It is a little subtle on some things.
GOOD LUCK!!
Robb,
Great post!
Curious out of all the herbals “Mr X” was using, do you have reservations with any of them?
Thanks
Resveratrol is a grey area item for me. Dhea can obviously be a problem but less concerned.
Robb, Thanks for all the info you put out there! Dr. Janet Lang is a restorative endocrinologist who would be an excellent guest for probably several podcasts. I would urge both men and women to check out her website and order the CDs she sell of her lectures-really inexpensive. She helps you to understand the wacky world of hormones. I am a 57 yo female who has been eating paleo for about 3 yrs. but wasn’t getting as lean as I wanted. Am now working with one of her practitioners to heal my gut and tackle insulin, adrenal and hormone issues. So far so good! Hope this helps someone as it seems many men and women have hormone/adrenal problems. Thanks and keep up the good work! Elaine
Awesome! Will check her out.
I’ve read in a few places how testosterone drops in men that live in long term relationships and have kids. Does anyone know if there are studies about what level of impact this has on testosterone? I’m not necessarily advocating bachelorhood though. That comes with it’s own set of health risks….
I’ve read stuff along that line…but what’s a married cave-man to do?!
After reading this I started some research because in the last 6-9 months I have noticed a dramatic change in body composition and sex drive. I just turned 39 and I know things change as I age but I also “know” they shouldn’t change markedly in such a short period of time when most lifestyle components (sleep, diet, stress, etc.) stay the same.
I found this regarding D-Aspartic acid and MSG/aspartame. I am not a research biochemist but it does seem plausible.
“The aspartic acid in aspartame is some sort of modified dipeptide of aspartic acid and phenyalanine. D-aspartic acid is l-aspartic acid that has been converted by racemase or something similar to that. Completely different.”
Kevin
Hey Robb,
This is a pet area of mine (no pun intended.) I’m a practicing acupuncturist/herbalist/nutritionist, and I spent a number of years working as an herbalist/nutritionist for a slew of LA/Beverly Hills/Santa Monica based endocrinologists & functional med docs, including several that offered a niche practice in TRT. I’ve seen this issue for years and have done a ton of research on it for clients and myself.
Your article overall is excellent. A couple of clinical notes for yourself and your readers:
1. everybody with low T should get an ultrasound for testicular varicocele. For the unfamiliar, these are veinous abnormalities in the blood supply return from the testes–this is the vein where T flows into circulation. Due to genetic factors and/or injury, the veins can develop valve problems and poor flow, decreasing T levels. Some varicocele are palapable, or even visible in the scrotum, but many are not. (mine looks like an extra nut. I call it my “third brain.)
About 35% of men have some kind of varicocele, and about 15% develop issues with them, usually pain, but also low T is high on the list of bad effects from the varicocele.
Men who get the varicocele repaired surgically (it’s minimally invasive microsurgery these days) have an average increase of total T of about 170 ng/dl post-surgicaly, which is HUGE. Men in their late 30’s and beyond often develop varicocele that aren’t palbable but can still be suppressing T. It’s worth getting it checked out. The surgery can be expensive, but may be covered under insurance if there is also pain present. It’s worth noting that a small but significant portion of low back pain in men who also have low T is referred pain due to the varicocele, and this is completely ameliorated by the surgery.
2. Herbally, you listed some good ones. There is some question as to tribulus’s action and reliability, since it appears that there’s a wide range in quality of product, and the active compounds vary greatly from batch to batch based on climate, soil conditions, and most importantly, time of harvest. I’ve certainly seen a wide variation in my clinic.
There are two more botanicals worth consideration:
Chaste tree berry helps regulate and balance the hypothalamic-pituitary interaction, as well as blocking prolactin production. This is good, because prolactin has antagonistic effects on T levels and function.
Also, mucuna pruriens, an ayurvedic herb, is a rich source of l-dopa, which crosses the blood-brain barrier and is converted to dopamine. There is a synergistic interaction between dopamine, and a lesser extent, serotonin, as control hormones to stimulate T production. When dopamine & serotonin are low, it suppress both T and HGH. Increasing dopamine, and to a lesser extent, serotonin, and both T and HGH rise.
Finally, green tea, and to a lesser extent, black tea, have been shown to increase SHBG, but it appears it does so by blocking it! The blocking effect then causes a rise in SHBG via negative feedback. Under supplementation with green tea extract, we often see some paradoxical increases in SHBG simulatenous with increases in free T, which you’d not expect unless there is some SHBG blocking going on. The jury’s still out on this one, YMMV, but it may be worth some experimentation for those who are wrestling with SHBG-related free T issues.
I could write more here on T’s role as a mood hormone in men, but my little screed is long enough for now, as it’s time to get some training, but I wanted to drop you a note before the comment thread reaches its usual epic proportions.
Cheers,
LT
so is it the kitchen sink approach then? in your years of practice, besides the varicocele issue, what causes the low t if a person is eating well? is it “random”, unique to each individual, or can you track it?
In my experience, stress is the number one cause of low T. Be it from poor sleep, disrupted hypothalamic function from adrenal dysregulation, or from flat-out theft, a.k.a the pregnenolone steal, wherein the stress pathways hog all the raw materials to make T.
In every instance that I can remember, it’s been some form of long-term chronic stress that has in some way whacked out the kidney adrenals.
The solution is to a. lower stress, and b. to assist the adrenals in healing. There are many protocols for dealing with adrenal dysfunction. Once the adrenals are doing well, then attention is paid to the thyroid, hypothalamus, and pituitary. But until the adrenals are fixed, there’s not much good in addressing those other organs’ functioning. The adrenals are the rate-limiting step.
In my humble-ish opinion, stress has an evolutionary adaptation to downregulating all of metabolism. And that is because our ancient ancestors routinely had to deal with the stress of doing without; the stress of not enough food. THose who had evolved mechanisms to preserve resources would survive, those who continued to burn resources at the ‘normal’ rate would run through their reserves quicker, and die more easily. Thus, even if you’re eating well, all stress looks like potential starvation to the body, and the body adjusts accordingly.
Or, in programmerspeak: “it’s not a bug, it’s a feature.”
thats fantastic, thanks for replying. and it leads me to the question, what are some of the best protocols to heal the adrenals?
Are there any “natural” cures or helpful things to supplement for varicoceles? Like better vein health in that area? Anything to help a spermatocele? Ive been told I have enough T but its not circulating properly (got this info sometime ago).
THank you
You guys just blew my mind, great stuff.
Is there any truth in higher protein diets (>15% of total calories) lowering testosterone? Whether it’s through gluconeogenesis > cortisol > lower T or some other mechanism?
Hi Robb! Im 27, low non existing libido, and mental fog since 3 years. I also plateaued in all my lifts. I consider myself very skinny (185cm/75kg) for the shitloads of weigths Im lifting.
Finally got my T tested =normal. Free T=very low for my age.
things I tried, but did not work for me:
-no more metcons, heavy sort lifting sessions
-tribulis
-going strict paleo (still am)
-increasing calories
-increase paleo carbs
-increasing sleep
-avoid plastics
what I just started doing :
I follow a bulgarian weightlifitng training template that is said to get the T flowing.
looks kind of like this: (http://www.endlesshumanpotential.com/bulgarian-weightlifting.html)
3-4 very short and intense weightlifitng sessions per day to stimulate T production. Working as a coach I got the time to do this, so it may be worth a desperate try.
I’ll keep you updated.
hey tristan i know its been a few years but wondering if you ever figured your stuff out because i have found myself in a similar situation.
Great article Robb!
I recently tested my Testosterone levels for the first time in my life.
They were in the 200’s !!
I am only 30 years old!! This explains why I have such low energy levels, horrible sleep and stubborn fat last 4 or 5 years.
I am going to research more into this but this gives me more ideas:) I hope it won’t be too expensive adding supplements and/or THT.
~Zorik
At 48, and just recently changing to full on Paleo, I felt the same symptoms as many writers here. I found a natural supplement called 2TX by Max Muscle Sports Nutrition. All natural. See http://www.maxmuscle.com/t2x as an overview. Can’t say enough good about what the relatively instant effects of this natural supplement does as, within a few days, I was noticeably feeiling and acting more like I thought I should. Your post has motivated me to do bloodwork as benchmarks for these things and not just feel the subjective self. For a firt time blood work series what does one ask for?
I’ve heard about these Estrogen blockers. Are you still taking this supplement?
Did you have your free testosterone level checked? What were the results?
Hey Robb,
You mentioned you were going to titrate off the DHEA – did it affect your numbers at all?
Regards,
Alex
I did titrate down the DHEA from 25mg 2x/day to DHEA 5mg 1x/day, and completely stopped taking the pregnenolone. Haven’t had numbers rechecked though. I will say, the switch was ROUGH! Wow – I think it was more the pregnenolone going cold turkey – but major mood swings and general iritability. The transition took about a week and a half, and then was feeling pretty good again. I have read about going off of preg/DHEA on other sites, and they all recommended a down stepping of the dose across a 2-3 week period, but I compressed it into 1 week. Apparently not so smart! In the end though, doing great on DHEA only, 5mg 1x/day. I have read a few publications recommending these far lower mg dosages than you generally find in the vitamin stores, but KAL makes DHEA in 5 and 10mg doses.
Paleo Urologist here. Not kidding.
I see a lot of patients with low testosterone, or symptoms of hypogonadism with “normal” levels. I have patients in their 20’s, 80’s, and in between. The drift of this thread is what I experience clinically: it is complicated, nuanced, multifactorial, and very individual. It is also a moving target.
If someone has the subjective symptoms of a low testosterone, I check T, Free T, SHBG, and estradiol. Herbals can help some and they won’t shut your endocrine system down, but the best bang for your buck is injectable testosterone cypionate. For guys who are truly low, it is a real life changer. For guys on the fence, less so. There are high and low testosterone men, and this factors into the equation as well.
On physiologic doses ( 100mg/week, which can be dosed differently) side effects do happen, but they they are usually tolerable if the patient is getting benefit. Your nuts will shrink. You may break out and your skin may get a little oily, but this isn’t very common. I haven’t seen any hair loss. It is not a good idea to take it if you want to have kids because it will slow down spermatogenesis.
I prefer the injecable T over the branded topical gels. If you can find a compounder who will mix it in sesame oil as opposed to cottonseed oil, my clinical observation is that your body will like this better.
I have seen zinc cut an obese patient’s estradiol in half, and I think it may help guys last a little longer who are already getting a shot. Some docs use it as a first line, but I do not. 50mg may cause some nausea on an empty stomach. I don’t do much with Vitamin A, but I do recall a study in 2009 that showed a higher death rate in people taking it. I know there were some issue with that study, but in the larger context of one’s health, I’d avoid too much of it.
Even though I do this stuff everyday, I still consider myself a student and I keep my mind flexible to individual patient scenarios and stories because in the face of a mountain of confusing data, N=1 may be the most important thing.
Oh, and by the way, in addition to fatherod dropping your testosterone, a woman’s tears can cut your levels by 13%. So don’t be surprised if while you are “manning up” and changing the diaper and she is irrationally bawling in a post-pregnancy funk, you grow some hooters. It’s not your fault.
Ted,
What’s your thought on the use of anastrozole as a way to reduce/eliminate nut shrinkage for those using exogenous T?
That is controversial. Some practicioners do it, but it is my understanding that the results are not that good. Also, there is some concern regarding the potential side effects of Danazol. I do not use it for testicular atrophy. Nobody else in my practice does either, but you do hear about it at meetings. I have had guys cycle off of testosterone for a month or longer just to keep their hormonal axis awake and they do get some size back pretty quickly.
Hi Dr. Ted, are you really a Paleo Urologist?! Can you please send me over your information by any chance? website? number? I am specifically looking for a doc or functional medicine doc that specializes in Urology/infertility.
Anastrozole is a competitive aromatase inhibitor used to lower estradiol. I think you mean Human Chorionic Gonadatropic (HCG) which is used to mimic lutenizing hormone to the testes and help keep them from shrinking. I take both of these though the HCG has had some supply issues as of late. Many believe HCG should only be used in small quantities such as 250 IU/twice per week.
HCG does work to preserve testicular volume as well as fertility. It is also an injection (sub Q). It can get a little expensive.
Hi doc, thanks for the tips! And thank you to all the folks who have commented as well – nice to know I am not alone in this issue!
As someone who has been on TRT for 5 years, I mostly agree with the above (not commenting on the vitamin A at this time)
Is it possible that all of this androgen signaling occurs downstream of thyroid production? Would be interested to see what Mr. X’s thyroid output looks like for comparison. I suspect that like the leptin –> insulin relationship, what we are seeing here with test production, shbg and estrogen might be occurring as an effect of low T3. If so, fixing this issue might correct the hormonal cascade downstream of it.
The Ray Peat, Matt Stone, Danny Roddy contingent has been putting forward this idea for some time, and in tinkering with it myself I have definitely seen some positive results. Would be interested to see if the numbers backed it up.
My endo was thinking along the same lines, but my thyroid levels were mid-range normal… go figure! So were LH and FSH by the way. In the end, the endo suspected that the insulin resistance was downregulating the HPTA in some way, but he wasn’t sure exactly how. Once I did get my BF% down and was doing the VLC paleo, my levels came up a bit (numbers above), but still in the lower quartile.
Robb… I know you have mentioned that you are a melatonin user as well
Personally, melatonin lowered my T significantly. When I got off it after a while I began to have morning wood again (TMI!). I’m only 22 as well and had used melatonin for 2 years! My T was 371!
Another thing to look at is thyroid as Geoff just mentioned. Higher t3 correlates with higher T almost always. Of course cortisol is a main factor here… but it makes a good stance of for a higher carb diet.
Also, cannabis will signifigantly reduce T levels. Most men who use the ganja don’t get consistent morning wood. Morning wood = good T production. The harder the wood, the better.
I have to second this. Lack of sleep has a pretty severe impact on my libido. Melatonin makes me fall asleep faster and earlier. But not taking it and sleeping less I am hornier than taking it and sleeping more. I’m only 22.
Also check ferrtin and iron!
yes but WHY is the T low? it seems to me that low free T/high E is a symptom, not a cause… is it moldy carpets, a hidden infection, too much xenoestrogen uptake? i have low free T and i think it’s caused by pathogenic gut issues still undefined, i’ve taken all the herbals, dhea, preg. and DAA and besides making me more aggressive, they havent made me ENJOY it or increase libido. plus theres the lack of strength, energy, and creativity, so there’s more to the puzzle than this.
Thank you!!
I was going to comment on this if no one else had.
For me what I see isnt the problem of producing test its the problem of encountering too much E. For how ever the funk you do that (SOO many ways.)
I delt with similar issues of “low t” when it really turned out to be High E. Robb, Mr. X did you get E levels checked and if so what were the numbers.
I also, at a recent BioSig cert, noted with another gent that “crossfitters have fat hamstrings.” Robb if you remember this is dictated by environmental estrogens. What I have noticed since doing biosig on clients is this is 100% true. Most are coming back with fat hammies. Im starting to wonder if working out in an industrial complex is part of the problem. We have machine shops nextdoor that use special chemicals and the ventilation between buildings sucks. There is something going on. Also if training Xfit then we could be overtraining blunting T levels (if training improper.)
If anyone goes in to get T levels checked get E levels. There are 3 kinds E2, E4, E16. Basically the ugly the bad and the good. They can all cause problems if one is out of whack. All of a sudden people like keeping there IWhatevers (Iphone, Ipad, Idont care) Right by their nuts. Im not saying they cause cancer but…….
Most of the problems I see with T is E. People should look into how to lower E levels (especially with their environment) first before trying an herb or taking a shot in the ass. I had a horrible experience just by changing my deodorant (It blocked my T and increased me E within days of using it). That is just one product, imagine what else could be going on in your system.
Room deodarants? These are endocrine disruptors and i can’t stand them!!
Nope. Speed stick. But yeah freeze will give you moobs too
Sorry *fabreze
Sorry, correction:
E2: The good
E4: The bad
E16: The ugly
I’m a 41 year old male that has been TRT for about 3 years (100 mg Test Cyp). When I started, my levels were borderline low and I weighted 250 lbs. Over the next year, I lost 60 lbs doing the HCG Diet (Original Simeons Protocol) and have successfully kept it off.
As pert of my HRT, I have also used HCG (which perfectly mimics Leutinizing Hormone) to keep things ‘plump’ and to continue to produce some of the other hormones produced in conjunction with testosterone.
This protocol has worked well for me, I’m maintaining total T-levels in the mid-800’s and Free T-levels around 25.
My current protocol is 100 mg T-cypionate on Saturday, plus a couple injections of about 150-200 iu of HCG on Thurs and Friday.
Now, as I transition into a Paleo lifestyle, I feel like I am getting the best of all worlds…no hunger, fitness, and all the other benefits of a good testosterone profile.
Is this something you follow 12 months of the year or cycle off Test Cyp & HCG a few times?
Im a 29 Year old with a total T of 200(ouch). Just about to start T treatments. I like this post…A lot!. I think i will attempt to do the same. Since i am so young i don’t think being on T treatments for the rest of my life will be a good idea. But Damn I need to get my T levels up, I feel like crap. I think i will go through the treatments for a few months and see how i feel. Possibly come off and try the Herbals. Ive messed around with Tribulus and im not sure I felt any effects. Actually I took this blood test after being on Trib for an entire month. But I did not try any of the other Supps. I have plenty of time to toy with this and I like this article as a starting point. Thanks.
Great dialogue! Thanks for sharing.
I’m wondering what people’s thoughts are on Royal Jelly as a natural test booster. Seem to be a couple studies on it. http://www.google.com/custom?domains=ergo-log.com&q=royal+jelly+&sa=+search+&sitesearch=ergo-log.com&client=pub-7117181179885591&forid=1&ie=ISO-8859-1&oe=ISO-8859-1&cof=LH%3A36%3BLW%3A92%3BL%3Ahttp%3A%2F%2Fwww.ergo-log.com%2Fplaatjes%2Flogo.gif%3B%3BS%3Ahttp%3A%2F%2F%3BFORID%3A1%3B&hl=en
I will echo previous questions:
1)What specific test/s should we be asking for? (Total and Free-T only? Look at Thyroid too? Plus Cortisol?)
2)What are the actual acceptable ranges? (>500 and 8.7-25?)
3)What would be a smart herbal way to improve function with specific doses?
Any specific lab you would recommend or would any lab work?
his style is a bit crude but:
http://www.chaosandpain.com/content/you-can-never-have-too-much-testosterone-seriously
For those who are interested here is a pretty well rounded lists of tests you can do for hormone panels and What can be SOME of the causes for hormone issues. I stripped this from another site:
FT is T that is not bound to SHBG or other proteins.
SHBG: http://en.wikipedia.org/…inding_globulin
Note that SHBG does not transport and release T, SHBG bound [SHBG-T] is not bioavailable. You will find many incorrect references to the contrary.
SHBG-T is tightly bound. Estrogens bind weakly to SHBG and SHBG can transport estrogens and release the estrogens throughout the body. Note that SHBG occurs in blood, but does not exist in tissues. So all T in tissues is considered FT. Secretions, such as saliva, can be used for hormone lab work and the results are considered FT, thus there is no TT in saliva testing. Many feel that saliva testing is quite useless.
Weakly bound T: T can be bound to other proteins [not SHBG] such as albumin in the blood. Those are weakly bound and the albumin bound T can be release T to tissues and this is considered hormone transport. There are other proteins to which T can be weakly bound. Note that some males loose serum albumin levels as they age. This is thought to also reduce bio-T:TT to some extent. In reality, these guys have low T, and lower albumin is one of the catabolic effects of low T. TRT would be expected to improve albumin levels.
With age, we see E2 and SHBG increase. This tends to increase TT, as FT/bio-T are falling and that can be misleading.
Bio-T is FT plus weakly bound T. Both measures are technically useful. Bio-T and FT are roughly proportional. So you typically do not have any need to do both of these types of labs.
TT is FT + weakly bound + SHBG-T. Note that for a given production rate of T, or a given TRT dose of T, the more SHBG you have, the more TT you will have. In this regard, TT can be the wrong therapeutic target and can be a simplistic and inappropriate concern if one does not understand the larger picture.
From a practical point of view, lab results should be useful. So the results need to be something that others are sufficiently familiar with to interpret. Most here are familiar with FT and not with bio-T. So FT will be better from that point of view.
To put the whole picture together, you also need estradiol numbers. With FT, TT and E2, there is very little need for SHBG lab numbers.
Note that some labs produce high FT ranges and results compared to other labs. FT lab numbers always need the lab ranges for interpretation. In this regard, I expect that bio-T has the same problem and bio-T results will always needs the lab’s ranges for interpretation.
In HPTA intact males, LH is released in pulses and diurnal patterns. This leads to changing FT levels. FT has a short half life. When you test FT in these males, the absolute number is not very important as the result is partly a factor of when the lab work was done. With TRT using transdermals, the swings in FT are more extreme and lab timing greatly determines the lab values. With frequently injected T, TT, FT and E2 levels can be very steady and FT lab results thus are more valuable in that case.
————–
Labs to be done before you start TRT
-LH and FSH [LH/FSH]
-TT
-FT or bio-T
-E2
-Prolactin [optional in most cases]
-DHT [sort of a waist of time and blood if your testosterone levels are low]
-PSA
-DRE: the dreaded digital rectal exam, doc gives you the finger.
Labs to be done when on TRT
-TT
-FT or bio-T
-Implications of injections VS transdermals [and injection frequency]
-E2
-Prolactin [optional and almost never on-going]
-DHT [should be checked, but perhaps not on-going]
-LH/FSH [optional and one last time -do I have cancer?]
-PSA
-DRE: the dreaded digital rectal exam [Your doc does not enjoy this either!]
Labs to never do and timing issues:
-DO NOT test E2 ultra sensitive
-DO NOT do saliva testing for T or E2 and expect any help here
-DO NOT test for free E2
-DO NOT test total estrogens
-DO NOT test PSA within 48 hours after a DRE [digital rectal (prostate) exam] or ejaculation
-DO NOT test prolactin with 48 hours of orgasm, avoid hugging puppies and babies
-DO NOT do lab work when muscles are sore from training or injury as your “liver markers” will show high levels. Those “liver tests” are really not liver specific.
-DO NOT waist time and money on tests that you cannot take any action on. Example, testing IGF-1 for growth hormone status if there is no way you could every pay for GH or actually legally qualify for GH.
-DO NOT routinely test for LH/FSH when on TRT, perhaps once to rule out certain testicular cancers and never again
-DO NOT test for serum DHEA, must test DHEA-S
-DO NOT do saliva testing for T, DHT, DHEA, pregnenolone if taking sublingual/buccal T, pregnenolone OR DHEA OR other steroid. The tests will be wrong and you do not want cross reactivity unknowns
-Testing E2&TT&FT makes also testing SHBG sort of useless.
Labs that are stupid after you start TRT
-LH/FSH
Thyroid labs [basic first line]
-TSH
-T3 no see fT3
-T4 no see fT4
-are you getting enough iodine? probably not! http://tnation.T-Nation.com/…thryoid_problem
-? stuff that Hardasnails will suggest to me via PM
Adrenal labs
-Cortisol four sample saliva testing [the gold standard]
-Pregnenolone [the foundation of the adrenal hormones and all steroid hormones *]
-DHEA [can’t make T without it] no see DHEA-S
-DHEA-S [DHEA Sulphate]
* Vit-D is multi-step derived from cholesterol directly, not via pregnenolone. Pregnenolone is also direct from cholesterol. Cholesterol is really the root of all steroid hormones. [Because cholesterol can be considered a precursor of testosterone, and testosterone a metabolite of cholesterol under Federal Statute [http://www.justice.gov/dea/pubs/csa/802.htm], cholesterol is technically a schedule III controlled substance and is subject to criminal penalties as an illegal anabolic steroid. Attempts by John McCain and others to explicitly classify DHEA as a schedule III anabolic steroid have nonetheless failed. See http://frwebgate.access.gpo.go… ]
General health labs
-CBC: Complete Blood Counts
-Hematocrit: Part of CBC but needs its own discussion
-Lipids: Fasting Cholesterol and related
-Vit_D25 hormone -yes vitamin D becomes an essential steroid hormone
-Glucose: Fasting levels indicate insulin function
-Liver markers -are they really liver specific? [Hint: not]
Things that you can determine without lab work
Symptoms: Why are you here
-Brain fog, no one knows what that means but everyone knows if they have it!
-Social withdrawal – “I would rather not go out”
-Why do I have boobs? This really is depressing if prolactin is the cause!
-Why do I carry fat like a woman?
-Why am I a moody bitch?
-Can’t get it up?
-It is up, now it’s gone.
-My penis is numb -your nerves love T too. Things to do with testosterone cream.
-My testes are softer and smaller
-My testes ache 24×7
-My scrotum is up-tight, gives “how are they hanging” a whole new meaning.
-Nocturnal erections -necessary but not sufficient
-“morning wood” -things are working
-Why do really hot looking women and girls now look like art instead of lust?
-I felt great when I started TRT, where did that go? Neural transmitters rule your life.
-My TRT seems ineffective or never was. Things that crash in the night.
-On TRT and still do not feel right, something else is wrong.
-Loss of hair on lower legs, skin below the knees is smooth and shiny.
-Why do I feel cold easily or all of the time?
-Why do really stressful situations leave me feeling physically beat up. Adrenal fatigue.
-Dry skin, brittle hair and nails
-Skin on the back of hand is thin, crinkly. Pinched skin does not recover
-Gum disease, the ugly killer
-Why do I have a chronic cough [when taking a statin drug]
-I have visual field disturbances such as reduced peripheral vision
-My joints have started to ache
-TRT and now leg cramps
-TRT and wife says I am snoring more
-I am not depressed, I just don’t care about anything, no joy, no motivation, no reward
-I want sex twice a day and my wife/GF is freaking out. What do do about her.
-We fixed my wife’s hormones and I can’t keep up with her needs. [Give me her phone number!]
-I want sex twice a day and my wife/GF loves it. Why are you still here?
Related:
-pituitary MRI for younger cases of hypothyroidism “what is in there”
-testicular ultrasound exam, detects cancer [please help with other uses]
—————————————
Serum E2 testing:
E2 is estradiol – in case you were wondering [E1=estrONE, E2=estraDIol, E3=esTRIol]. There are different lab tests to choose from and docs often get this wrong. Some testes have limited reporting ranges and will not report actual values below a certain level and might report <17 pg/ml instead of the actual value. The reason for this is that these tests were developed for work on women's hormones. Women who are fertile have very high levels of estrogen and some tests are appropriate for those levels. Women who are post menopausal have low levels of estrogens and the need tests that are sensitive for those low levels. For post menopausal women with breast cancer, SERM drugs are used to push there already low estrogen levels even lower. Ultra sensitive tests are used to detect these very low levels to determine the effectiveness of the treatment.
For TRT, use the basic LabCorp serum E2 test or Quest Sensitive 4021x. DO NOT USE Quest ULTRASENTIVE! There are some similar issues with other testing labs as well.
DO NOT test for free estradiol
DO NOT test for total estrogens
DO NOT do Saliva testing, simply because very few people know what to do with that data.
https://www.labcorp.com/…/?testId=408010
Note that many older men, getting fat with low testosterone, can have more estrogen than their post menopausal wives! And old men and women can end up having similar body shapes.
E2 levels are modulated with low doses of aromatase inhibitors such as Arimidex/anastrozole. Optimal level is near serum E2=22pg/ml. Some doctors will prescribe 1mg/day which is a TOTAL disaster unless you are female and have estrogen positive breast cancer. Another idiot doctor mistake.
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Note that Labquest can also report FT ranges that are about 5 times higher than reality. So you cannot compare Labquest results to Labcorp and others. FT lab results must be reported with lab ranges.
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Things that Damange your hormones:
Pituitary damage: ref http://en.wikipedia.org/…Pituitary_gland
-blows to the head or whiplash http://en.wikipedia.org/…_%28medicine%29
-adinomas http://en.wikipedia.org/…tuitary_adenoma
Drugs and chemicals:
-Rx drugs
-OTC drugs
-hair loss drugs
-alcohol
-other chemicals, toxins, pollution
-heavy metals
-fire retardants in furniture or fire fighter’s fire retardant clothes
-smoking
Effects of other reproductive and related hormones:
-Estradiol http://en.wikipedia.org/…/wiki/Estradiol
-Prolactin http://en.wikipedia.org/…/wiki/Prolactin
-Xeno estrogens http://en.wikipedia.org/…ki/Xenoestrogen
–lavender
-Xeno testosterone: http://tnation.T-Nation.com/…tase_inhibitors
–hair loss drugs 5-alpha reductase inhibitors -extremely dangerous for a few – see above
-Prohormones [PH] http://en.wikipedia.org/…wiki/Prohormone -extremely dangerous for a few
-Deca http://en.wikipedia.org/…wiki/Nandrolone – see xeno-testosterone above
Damage to the testicles [testes] ref http://en.wikipedia.org/…/wiki/Testicles
-cancer http://en.wikipedia.org/…sticular_cancer
-Varicocele [blood supply] http://en.wikipedia.org/…wiki/Varicocele
-Torsion [Physical damage] http://en.wikipedia.org/…ticular_torsion
-Trauma http://en.wikipedia.org/…sticular_trauma
-Fever: If you have a fever and your testes hurt, they may be damaged
Damage to the pituitary gland:
-head trauma, blow to the head or whip lash can scar the pituitary gland
-a pituitary adenoma http://en.wikipedia.org/…tuitary_adenoma
–can decrease LH and/or increase prolactin
–may press in optic nerves, reducing peripheral vision in one or both eyes
—could create other visual field disturbances [not vision correction issue]
–can results in other hormone problems
-watch for multiple pituitary hormone problems
Comorbidies: http://en.wikipedia.org/…iki/Comorbidity
-hypothyroidism http://en.wikipedia.org/…/Hypothyroidism
-adrenal fatigue http://en.wikipedia.org/…Adrenal_fatigue
–watch DHEA-S levels
-syndrome X aka metabolic disorder http://en.wikipedia.org/…abolic_syndrome
-insulin resistance [and diabetes] http://en.wikipedia.org/…ulin_resistance
-influences of the digestive system
-arterial disease and high blood pressure [BP]
-poor cell wall permeability
Deficiencies:
-low cholesterol, natural, diet induced, result of statin drugs
-low CoQ10, age related, induced by statin drugs
-low dietary EFA’s [essential fatty acids]
-low iodine = thryoid_problem
-other low trace minerals
-sub optimal vitamin D/zinc/magnesium levels
-anti oxidants
Some good info. Thanks!
I’m a 47 year old man who had really high Estradiol (E2) levels. Saliva tested 7 with a normal range of 1-3. Yikes!!!
For the past 5 weeks I’ve taken .25mg anastrozole (an aromatase inhibitor) every other day (.75mg per week total) and my E2 just came back at <10pg/ml, (blood test, range 12-56) which is too low. I will now lower the dose to .5mg per week and re-test.
My strength and energy levels have increased and am feeling like an animal in the gym again!
I am also going to start taking (after reading this article) 25mg DHEA and 3g D-Aspartic Acid to give T a little bump, which may lead to an increase in E2 also, in which case I will go back to .25 every other day.
I will get T, Free T and E2 re-tested in 4-6 weeks and hopefully all three will be within normal range (fingers crossed) and I will continue this protocol until my T levels drop too low (due to age) and then will look into TRT. No need to jump into TRT this early in the game.
I've also started melatonin 3-5 mg a night to assure proper sleep and also notice less morning (or even nightly) wood, but I don't think it has to do with lower testosterone levels while taking it. Perhaps just a different, deeper sleep pattern…
Careful with a protocol like that. Arimidex can shred your cholesterol profile.
Robb,
Great to see you talking about this stuff. I deal with something similar, but from the female perspective. I have polycystic ovarian syndrome, plus low estrodial and progesterone levels on top of that, which is strange because this disease is normally accompanied with high androgen levels and elevated estrodial. I have been paleo for over a year, and did near everything in my power to avoid estrogen supplementation from general feelings of anxiety towards taking any chemicals, and frustration at the medical community for wanting to just throw synthetic hormones such as birth control at the problem. However, earlier this year I bit the bullet and started on bio-identical estrodial and am going in to have levels re tested soon. It is really comforting to see someone that I respect as much as you supporting the use of hormone therapy in addition to the paleo diet- I feel like there is usually a strong push towards the belief that the diet can just “fix everything” and I have felt really discouraged since that wasn’t the case in my situation.
I’d love to see a similar analysis on this issue for women, or about women dealing with PCOS. It is a very common disease(1 in 10 American women have it) but I feel as though it is not regularly addressed on your site.
Best wishes,
M
Most
How many hormone profile tests did you run in a month? If its one then that can explain why your E levels came back normal.
PCOS is best treated with insulin management as it is tied in to insulin related issues.
Do you suffer from fatigue?
Chris
My E levels have been tested a variety of times over a number of years and have ranged from the lowest of 18 estrodial (when I was a nearly anorexic vegan) to 28 now (3 years and thirty pounds heavier, eating low carb moderate protein strict paleo for over a year). Normal E range for women is something 27-300, with the low end being for post menopausal women in late age. I am getting them tested again this week to see if the E levels have increased since introducing a daily 3mg of bio identical Estrodial a few months ago- which is a pretty high dosage, but which I think is actually not high enough yet since I still suffer many of the side effects of low E. My endocrinologist is wanting me to be in the 70 range, so we will see where they are coming in these days.
I suffer from fatigue but not as badly as I used to. My energy levels are pretty stable most of the time but can dip down if I start to go super super low carb on accident. I’m fit, strong and healthy with the exception of being less lean that most of CF women I know, which is most likely related to the PCOS. Controlling my insulin has basically been my MO, and I do not tolerate glucophage so I am doing it entirely with paleo+CF+lifting.
This is one of your most amazing posts ever, Robb. As a 57 year old Crossfitter and Personal Trainer, on HRT for the past decade or so, I’ve wrestled with these issues, and with doctors who know little about testosterone or HRT or all of the accompanying issues, for a long time. Great resource material for my annual T test and physical coming up soon. I’ll have to read this ten times to try to understand it all, but thank you!
Hey Robb-
One thing not discussed was tracking Estradiol while on HRT. I can tell you from personal experience that n=1 this measure will be all over the place.
My T levels on HRT were 1000+ w/ 100ml Test IM weekly but had to make some adjustments to proactively work my Estradiol down from 50+ level (as measured in August).
I would think that this should be added/mentioned as its such an inhibitor to Test having positive effects.
Keep up the awesome work.
I have patients take 50mg of zinc and it seems to help. The other non-prescriptive recommendation I have heard from Eugene Shippen, is to have patients take soy protien becuase it will give the aromatase something else to work on other than testosterone. I don’t like soy for a lot of reasons, so I have not had patients do this.
What measures did you take to drop your estradiol?
Tribulus terrestris grows here like a weed. Maybe I should start a testosterone herb garden, hah!
Does K2 deficiency play a part? Would it help to supplement K2. I don’t really know – just asking if anyone has experience. Low K2 linked to low testosterone, and osteocalcin enhances testosterone production by Leydig cells (Vit K2 needed for osteocalcin)These are mice and rat studies.
http://www.ncbi.nlm.nih.gov/pubmed/16844298
http://www.ncbi.nlm.nih.gov/pubmed/21914161
http://www.cell.com/abstract/S0092-8674%2811%2900118-8
I think, that Vitamin A, D and K2 work synergistically and one needs to keep them in balance. IIRC vitamin A and D protect against the negative effects of the other and K2 is helpful in getting calcium out of the places where it should not be and into the places it should. Vitamin D without K2 is just going to deposit calcium where you don’t want it.
Mr X, is the testosterone your taking bio-identical?
Intramuscular Testosterone Cypionate is not bioidentical. The testosterone molecule has an ester added to it for extra oil solubility leading to a slower release.
http://www.nejm.org/doi/full/10.1056/NEJMoa1000485
Robb what do you think of this study? i am not very good at reading this
Wow. Thanks for posting this. This post made me ask my doc for a T test on my regular bloodwork, and my T level was 79 (Crikey!! Not a typo!!). I’ve been in a funk for quite a while. Paleo has helped, but I still am not feeling great for a 35 y/o male with no major health problems. I’ve got an appt tomorrow to go over the bloodwork (had another draw to recheck the numbers.)
Not sure how this is going to pan out, but I’m going to start a thread on the forum to document the journey. Have read a lot since getting the news. It seems like low T is more and more common in guys these days, perhaps due to all the xenoestrogens in the environment. I know I jumped on the soy bandwagon years ago when playing around with vegetarianism..
Again, thanks for sharing, Mr X!
Good post…but I got lost in a lot of technical jargon that I don’t understand. How much T are you talking about taking if prescribed per day? 5mg? What is the best transport…patch, jell, injection? And the herbs can you break it down as far as brands and amounts per day per # for some one trying to increase T levels. I’m 64 and T level was 465…currently prescribed 5mg patch….just interested in others experience that is maybe in more layman terms or at least a sticky as to what the abbreviations mean…thanks for all everyones input…
rr
Great job,thanks for the info.
Outstanding information, I really can’t thank you enough,I feel I can go out and take on the problems in my life. Much apperication for taking the time to write this blog.
I am 49 and have been doing CF for three years. Prior to switching to CF, I did the typical globogym weights/cardio program for over 20 years. As I close in on my sixth decade, I’ve begun to scale my CF WODs so that I’m putting more emphasis on strength and scaling the metcons so that I’m not constantly broken down. When I was much younger and into bodybuilding, I took steroids prescribed by a doctor in Los Angeles (50 mg Anadrol p/day, 200 mg. Deca Durabolin p/wk IM). At that dose, I was a monster. The biggest side effect (other than anger and temper control) was that it completely shut down my own testosterone. Once the dose becomes large enough to shut down natural production, it leaves you dependent on other drugs (HCG) to recover. My opinion is that the use of exogenous testosterone should be limited to severe cases of low T, and only when other potential causes have been ruled out, and in the smallest effective dosage.
Wow, awesome weblog format! How lengthy have you been blogging for? you made running a blog glance easy. The entire glance of your website is wonderful, as neatly as the content!
I am 51 years old and have been eating Paleo for about 4 years. Up to about year and half ago, I have been at a low body fat that I have sported a 6pack for most of my life. I have begun to put on extra bodyfat around the middle and my sleep has begun to suffer. I have slept in a pitch black room for over 30 years. I started my career working shift work and found out out at an early the benefits of sleeping this way. I recently had my testosterone tested and it was found out it was low, I will begin injections next week. I will keep you posted on the results.
Here’s some heretical concepts to consider: fructose is only essential in humans for sperm mobility (presumably it suits their swim fast, die young lifestyle). And I suspect Inuit birthrates were relatively low on an all-meat diet. What if carbs are a fertility trigger?
Further, what if fertility is (has to be) a microadaptation to the environment and diet, one that introduces more variation faster in otherwise genetically similar bloodlines, probably by epigenetics (as seems to be the case?
So that adaptation (and maladaptation) to high-carb diets may have progressed further and faster in areas related to fertility: think – breast cancer, prostate cancer, puberty, multiple births.
So that occasional carbs (probably not that much or often) may be needed by some men trying to concieve, and by women for conception and more (a safe bet) for pregancy.
P.S. at 53 I’ve take tribulus 20,000mg every other month for a few years. I’ve recently found that the testosterone boost lasts longer on an almost all-meat diet than on a mixed low-carb regime. I’m also taking magnesium aspartate, vit D3, ascorbate 500-1,000daily, and 500mg niacin (inositol form).
I read the book “Testosterone for Life” two years ago, got tested for free T levels, was low and have been getting injections of Nebido since then every 10-12 weeks. Effect is excellent. Does not make me feel like I am 25 again (I am 46) but it is a big change from pre Nebido in terms of muscle mass, energy levels and libido. I live in Germany and anti aging Drs here will prescribe it for you and test you for this on your health insurance. The injection is painful but hey what is one day of butt pain for 3 months of excellent health! If you live in Deutschland, here is the anti aging Drs society http://www.gsaam.de/
Has anyone dealt with a Varicocele? Did you notice an increase in T levels? How did the whole process work out?
Robb – Can you update us on what if anything you are doing with T replacement and anything new on this front. How do you identify the best doctor that understands how to test and balance hormone level?
thanks Wyatt
Hey guys, the testosterone comments were interesting. I can relate my own experience. I’m 58 & got my levels checked July 2012-500 total/8.5free. At the time I was 163 lbs (5’10”) very little body fat. I ride a road bike about 550mi per month 90% of which is above 83%max HR. (this is ‘pre paleo’) My HRT doctor put me on 300mg test cyp per week. Pretty aggressive, but hey, he’s the doctor…I noticed 2 things(besides good overall testosterone effects-libido etc): 1. gained wgt-up to170-some fat, some muscle 2. Bike performance increased. I ride w HR monitor & a power meter so I have excellent tracking capabilities. The upshot? My average HR went down 8-10bpm while maintaining same power output. I could also ride harder longer. So the stuff works. Meanwhile, I’m not real happy with the slight belly fat wgt gain(up a belt notch) w no change in diet or workout..my wife’s personal trainer turned me on to paleo, I read your book plus everything else I could and decided paleo/primal would be a huge benefit. 6 weeks in, grass fed-the whole deal…belt notch back where it was. Bike energy Way off-I was a carb consuming machine before-the previous energy is not there. But no worries, my paleo research has shown me I was working out Way Wrong- chronic hard cardio-hurting myself, etc. So i’ve changed my whole fitness program in line with a paleo/primal model(makes way more sense)&plan to keep up w testosterone injections. for what its worth, my doctor also has me on daily DHEA/pregnenalone compounded pills(100/50) plus 1/2mg arimidex 3x per wk. oh, lets not forget the once a week self injected HCG…i hope this is relevant. Thanks & best regards, Dave
Does anyone know anything about high FSH levels in men, but all other hormones normal? Looking for someone specializing in infertility, urology, Paleo minded! And advice or suggestions would help! Thank you!
High FSH could indicate a varicocele
Thanks Joe, but would high fsh and one varicoele lead to a sperm count under a million? Or do you suppose something else has to be at play here? Urologist has no clue says there is no hope and finds all other test unnecessary as the is no cure. Trying Chinese herbs and 100% paleo to see if that helps! Any advice is much appreciated!
I was diagnosed with abnormally low T levels and a friend recommended I try Ageless Male. I also realized I need to improve my eating habits and follow an exercise pattern. This potent combination of diet, exercise, and a nutritional supplement has worked exceptionally well for me. Anyone with low T levels must read a few Ageless Male testimonials to see how it has helped plenty of men fight testosterone deficiency and regain masculinity an good health.
http://myagelessmale.wordpress.com/
WOW just what I was looking for. Came here by searching for low
t levels
Is D-Aspartic acid available as a food source? Best I can tell Aspartic acid shows up as 3g doses in nearly every meat one can name, and this makes me question why supplementation is necessary.
Ref: http://nutritiondata.self.com/foods-000092000000000000000-7.html
Please tell me why I am wrong so I can move forward with my life. Thanks.
Hi, I made the switch to pale 4 months ago, and have noticed increased libido etc, but I just read something which suggested that a high protein diet can lower testosterone levels by causing an overproduction of cortisol. Any comments? Data etc?