It’s important to appreciate that hormonal health is integral to physical and psychological well-being. Hormones are chemical messengers that effect multiple organs, their role is to keep these organs working and any changes in hormone levels have a physiological impact on the body as a whole. The emphasis is on stability, the emphasis is on maintaining function.
The fundamentals of health are lifestyle, nutrition and exercise. These elements are dependent, not independent, you must address, and continue to address, all of these aspects to maintain a healthy body. The same statement applies to hormones, they are dependent. Testosterone is the forgotten hormone, it can be the missing link. Testosterone is necessary for the development of the male sexual organs and fertility, but it’s association with muscular development has warped its perception due to it’s flagrant use as a Performance Enhancing Drug. This is not restricted to bodybuilding and sports, you will also find the use of Androgenic Anabolic Steroids in your local gym. There is a silent epidemic.
All patients present to our clinic with an element of either depression, anxiety or depersonalisation. This can be mild, moderate or severe. The second commonest symptom is ‘brain fog’, a decline in cognitive function. Men often notice a decline in libido and, whilst not diagnostic, loss of daily morning erections is also a common sign. Most men have already presented to their GP and been offered the concoction of anti-depressants and Viagra, some have accepted, but many have resisted in favour of finding a root cause.
I would concentrate on these three symptoms; mental well-being, cognitive function and libido. If they are lacking, I would look to finding out why. Taking control and responsibility for your own health will bring you more satisfaction than handing over responsibility to someone else at the earliest opportunity. The journey is yours, you are in the driving seat and it can be as fast or as slow as you like. It can be a straight road or full of twists and turns, this does not matter. What matters is your perspective and your attitude to the road ahead. The destination is ultimately death, so you must appreciate every moment, seize opportunities with both hands and be determined to continue forwards.
As already mentioned, there are three fundamentals, all have to be addressed, none can be ignored. I will start with lifestyle, then nutrition and finally exercise. This is a very basic blueprint, we need a semblance of simplicity in a civilised world that encourages complexity. Paradoxically, over-intellectualisation and a distortion of truth leads to confusion. A drowning man in this sea of misinformation is treading water to keep his head above the surface, not swimming to shore.
Reduce Stress – Stress is catabolic, an abnormal amount of stress causes too much cortisol production and lowers testosterone. Identify and then address. If said stressor is unchangeable, understand, rationalise and find a coping strategy.
Sleep – Basic sleep hygiene is a must as your anabolic processes predominate at night. You should wake up refreshed, ready to tackle the day head on. I wish there were ‘sleep prescriptions’ because the importance of sleep cannot be over-emphasised. You can download snoring apps (the wonder of technology!) and, if you are concerned, request a sleep study through your GP or through us.
Mindfulness – Mindfulness is a mental state achieved by focusing one’s awareness on the present moment. How do you achieve it? Be more dog! It’s important to take some time out every single day to clear the mind of the machinations of this modern world. The model is distorted, the prize is materialism. It should be community, only the individual can affect a change to the community. If the goal is too great, the game ends before it has begun. Self is community, community is self.
As a principle, I’m a big fan of low carb, high fat and ‘Time Restricted Eating’. Let’s go back to hunter-gatherer days, let’s be highly evolved hunter-gatherers. What should your primary drive be when you wake up from your comfortable bed? Eat a healthy nutritious breakfast, kick start your digestive system by activating the parasympathetic nervous system which is designed for resting and recovering? Or activating your sympathetic, fight or flight nervous system so that you can be productive, alert and reactive to your environment? The answer should be obvious. If this healthy hunter-gatherer finds food straight away, he has already fulfilled one of his drives. Food, check, what’s left? Sex? Ok, no arguments there! I hope you get what I mean? In the day, you want cortisol to predominate to help you hunt and be able to evade that sabre tooth tiger.
Some fats are good. Remember, cholesterol is converted to Pregnenolone, the father hormone, which eventually cascades down to Aldosterone, Cortisol and guess what? Testosterone. Much like Testosterone Replacement Therapy, you cannot have a one-size-fits-all approach to nutrition. Your physiology, genetics and requirements will be different to mine. Low carb does not mean scarce/no carb, it’s just that in our society we have the tendency to fill ourselves up with carbs, instead of vegetables and healthy meat and fish. I’m talking about ‘carb overeating’, not AVOIDING carbs. Modern farming trends are focused towards carbs because they can be mass produced in order to feed the masses. Your brain needs glucose, your muscles store and utilise glycogen. You need to eat a diet appropriate to your physiology and NEEDS! Furthermore, different energy systems, aerobic and anaerobic, and muscle fibres, type 1, 2a and 2b, prefer different fuel sources.
I’m not going to bang on about exercise, primarily because this field is too broad-ranging and there are no right or wrong answers. Resistance exercise and cardio are a must for a healthy heart and body. I will just say, we are designed to move, our skeletons are tall and slender, which suggests that we are more adept at endurance than power. Our highly sophisticated big brains and fine motor control outweighs the need for big muscles in a civilised society. The most successful men on earth are not the most muscle-bound monsters you often see at the gym. Arnold Schwarzenegger is perhaps the exception and what he has achieved in his lifetime is truly inspiring. I will take this opportunity to recite his six ‘Rules For Success’:
Rules For Success
1. Trust yourself
2. Break the Rules
3. Don’t Be Afraid to Fail
4. Don’t Listen to the Naysayers
5. Work Your Butt Off
6. Give Back
Let’s talk about giving back as this is important. I went to the Masai Mara on safari in the summer. It had me thinking about a lot of things, but I want to share one musing I had on the coach back to Nairobi. The African lion has a harmonious relationship with its environment. It’s apparent that life on the plains is not easy; fast agile prey, searing heat, lack of water etc. However, despite the hardships it endures on a daily basis, it will always remain King of the Jungle. I believe its struggle to survive is fundamental to its continued evolutionary success and position in the animal kingdom. Undoubtedly, a lazy, overfed lion will eventually lose its physical and psychological characteristics that once made it the formidable apex predator that it currently is. Competition, both internal and external, breeds success. Times of plenty are not guaranteed in nature and so it cannot afford to be lazy.
With that in mind, I’ve been trying to rationalise a moving scene in the recent David Attenborough ‘Serengeti’ series. An old male elephant went to its resting place to die. What happened next was, for want of a better word, humbling. The lions shared their spoils with other predators that would normally be their fierce adversaries. Isn’t that amazing?! Why would such enemies share their bounty? We can take a lot of things from this, but one may be that this also highlights an unconscious awareness that to survive, whilst there is an inherent need to ‘struggle’, there is no need for greed. Competition for food isn’t necessary in a time of plenty, even between lions and hyenas! In social communities, structure is necessary to maintain order and harmony, but there is no place for greed. As cruel as nature can be, there is no maleficence, it’s purely about continued survival and harmony. Yet in modern Western society, plenty abounds and there is no need to struggle. Why are we worse off? One reason may be that life is easy. We have disrupted our internal survival mechanisms through living in continued times of plenty. As a consequence, testosterone levels are dropping. There are other reasons obviously but this is an important one.
Western society has ‘Dopamine For Sale’, you can expect it without needing to apply the necessary amount of effort to earn that reward. There is a subsequent frustration and lack of satisfaction from attaining the perceived reward. There is a physical and psychological disruption and feedback mechanisms have been disrupted. We are ‘sicker’ in a time of wealth and prosperity. Again, this is only one element in a catalogue of errors.
Lower testosterone reference ranges reflect this, our genetic code hasn’t lowered our testosterone levels, our civilised, lazy, energy-saving, more is better society has! It is clear that excess has ultimately had a negative health consequence, whether this is short-term or long-term our future generations will no doubt find out. Man’s supposed higher state of consciousness has allowed and encouraged reward without effort. The further we move away from nature, the sicker we are.
Testosterone is integral for drive and determination. Step away from the modern civilised model of ‘more is better’ and earn your Dopamine reward, struggle because your health depends upon it. We have the ability to save the world but that collective shift needs to start with the individual. I said be more dog earlier, perhaps it should be ‘Be More Lion!’?
So, what’s the premise behind normalisation? What does long term physical and psychological health look like? The funny thing is, life is full of highs and lows, and twists and turns. Optimising your male androgen levels at least gives you the foundations to perceive threats as opportunities. It’s simply a matter of perspective, the rest is up to you.
One of my patients received some earth-shattering news a few months back, news that would knock even the strongest person on their butt. What did he do? He took stock, assessed the situation, looked at his options and critically analysed the pros and cons of each option. He kept an open mind and made a judgement call that was both unconventional and courageous. It turns out that it was in his best interests. There were twists and turns along the way and I’m sure there were moments of darkness and doubt.
Normalising testosterone levels, whether it be through addressing the aforementioned subjects or Testosterone Replacement Therapy, is primarily about mental well-being, not about muscles and sex. Muscles and sex are obviously great, but state of mind supersedes having big muscles and a stonker.
How should you feel with normal testosterone levels? The answer is ‘normal’! It’s not about manipulating your levels to help facilitate something that is beyond your genetics. Remember, your genetics need you to be strong and have the ability to procreate. Your DNA depends on it.
Normal, what is normal? What should you feel? It’s a bizarre question really. My life experiences will be different to yours; and it’s those experiences that have helped mould me into the man writing this blog. I’ve made mistakes, a lot of them, but it’s helped me understand life, or at least my perception of life. It’s allowed me to empathise with men who have also made bad choices. We are all walking wounded, but in adversity we find our true nature. Only then can you fully appreciate the light.
If you cannot normalise your male androgen levels naturally and you need my support, your New Patient TRT Consultation is your chance to tell your story. It’s a safe place, there is no judgement, there is no need for shame, because today is day one. I cannot do any more than guide you and support you on the path to hormone optimisation. Handing over some control is not a bad thing when you are struggling.
There is a silent epidemic of men suffering with a degree of depression, anxiety and depersonalisation. Let’s talk about mental health, let’s all change our Facebook profiles and see how many ‘Dopamine for Sale’ likes we get for being such altruistic wonderful people. Deeper and deeper down the rabbit hole we fall. A sensible, perhaps progressive, but surely logical, approach would be to look to find a physical cause for a psychological problem. You cannot separate the physical from the psychological, but you can separate the psychological from the physical. We do have the power to see light even immersed in darkness.
We are so far removed from nature, we’ve forgotten how to survive. Having to survive can be life-affirming, my patient mentioned earlier knows this. I wouldn’t have wished what he went through on anyone, but he’s stronger now than he’s ever been.
The further we travel away from nature, the worse our physical and psychological health. Testosterone reference ranges are lowering, our DNA has not changed, it reflects a sick society. This must change or we will perish. Maybe this is what we need? If we hit rock bottom, maybe someone will stop and think.
What you do from this day forwards is up to you. Back to basics, lifestyle, nutrition, exercise… and challenging yourself.
Dr Robert Stevens MBChB MRCGP Dip.FIPT