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?
There does seem to be some potential issues with vasectomies and T-levels
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.
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.