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Testosterone – The Forgotten Hormone

Hormonal balance is integral to both physical and psychological well-being. All hormones are dependent, whether that be a direct relationship or indirect, they are not independent. You must adopt a holistic approach to hormonal health in order to achieve stability. The body likes stability, it has sophisticated mechanisms in place to help maintain homeostasis, which is the ability to maintain a constant internal environment in response to environmental changes. Hormones are chemical messengers that effect multiple target organs, their influence on these organs is integral to this process.

Testosterone has traditionally been thought of as the male sex-hormone, with its primary role being one of development of the male sex organs, sex-drive and muscles. In fact, its role in muscle development has led to widespread abuse, which is not only confined to bodybuilding and sports, but extends way further into the Instagram selfie generation who feel as if they must conform to a stereotype of needing the perfect sculpted body to be ‘someone’. In fact, the use of Androgenic Anabolic Steroids to achieve this optimal state often leads to Testosterone Deficiency Syndrome.

Other risk factors for low testosterone outside of normal pathologies include, recreational drug use, alcohol and opiate abuse, antidepressant use and traumatic brain injury, to name a few. Our environment is full of endocrine disruptors, cows pumped full of oestrogen to keep them producing milk pollutes our waterways. Modern civilised lifestyles are so far removed from nature, our diets rely too much on chemicals and carbohydrates, we don’t appreciate the importance of daily physical exercise.

Testosterone is integral to long term physical and psychological health. The cardinal symptoms of low testosterone are a degree of depression, anxiety and/or depersonalisation; then ‘brain fog’, a term that seems to accurately describe the cognitive decline associated with low testosterone; then low libido.As already mentioned, the commonest presenting symptoms of low testosterone are an element of mental illness, a decline in cognitive function, and a low libido. In essence, you no longer feel like your old self. Men often describe a lack of drive and determination that impacts on most areas of their lives. They are good at hiding these issues, especially when it comes to work, but in the bedroom, there are only so many times you can make the excuse of fatigue. In fact, fatigue is another very prominent concern most men have.

It’s no wonder men are tired; the stresses and strains of the modern world will undoubtedly have an impact on your well-being. As you age, your level of responsibility increases, not only with family and friends around you, employment carries an added burden and money becomes the most important commodity. It’s no wonder men get tired as they age, the weight of the civilised world will take it’s toll on your physical and psychological health.

Testosterone levels are supposed to decline with age. Why? Because you are supposed to make way for the next generation. Once you have found a mate, then procreated, then raised that child into adulthood, your time is done. I speak purely from a biological perspective. Of course, biology is more complex than this and there will be a perceived benefit to the next generation in keeping you around. There are lessons to be leaned, there is wisdom to be imparted.

The ultimate goal of maintaining healthy male androgen levels is to sustain both quantity and quality of life. We have become so far removed from nature, we are living longer, but are we living better. The emphasis should be on lifestyle, nutrition and exercise. Then hormonal health, then modern medicine.

We live in a sick society. The modern medical model is firefighting, it isn’t tackling the elements that have caused the fire. We must address the fundamentals of health; we must understand that in order to affect a positive change to the collective, we must address the individual. That individual needs to take responsibility for their own health and appreciate that the reward takes effort. The path of least resistance is a path well-trodden and we are distracted from the truth by the machinations of big business. No longer can you rely on altruism if there is a pound sign attached to it.

So, what can you do to help maintain healthy male androgen levels? You need to appreciate the importance of the journey and understand that this is life, the destination is death. You need to remember that you are a biological organism, your highly sophisticated body is designed to keep you alive and well. We seemed determined to abuse this gift. Our higher state of consciousness seems to want to take us to the edge, then push us over the edge of the cliff. Modern medicine is focused on a curative approach rather than a preventative one because there so many people already at the edge.

Avoid risk factors such as Androgenic Anabolic Steroids, recreational drugs, opiates and alcohol abuse. Avoid getting knocked in the head, this should be an obvious one! Avoid antidepressants if you can, there is a place for the use of anti-depressants in mental illness, but they are not smarties, in my opinion, they are over-prescribed. Most men have presented to their doctor with low mood, anxiety and depersonalisation and been offered antidepressants, only to find the root cause, low testosterone. You must help yourself.

Let’s address each as aspect of health, remembering that they are dependent, but for the sake of this exercise, we will separate them for simplicity. Our lives lack simplicity, we are deeply involved in the game. You must play the game, much like in poker, you can’t alter the cards you are given, just how you play your hand.

Lifestyle – Life is about balance. That isn’t an excuse to be complacent, more an understanding that for there to be light, there must be darkness, for there to be happiness, there must be sadness. We under-emphasise the importance of realism, we do our very best to alter how we conceptualise the living world by distorting both our external environment and internal biochemistry. We are determined to chase a different state of consciousness, not appreciate the beauty of our current state. We burden ourselves with undue stress. Too much cortisol and catabolism means inadequate testosterone and anabolism. Catabolic processes predominate during the day, anabolic processes predominate at night. Day night, catabolic anabolic, cortisol testosterone. If you live a life full of stress, you must practice mindfulness. To have balance, you paradoxically need opposites.

Nutrition – from a hormonal perspective, your body wants a low carbohydrate, high fat diet. Refined sugar lowers testosterone. Don’t be fooled by Coca Cola telling you to move more. Diet is king in hormonal health and weight management. It’s a massive simplification, but I believe our over-reliance on carbohydrates not only contributes to our ever-increasing waistlines, it is having a detrimental effect on our hormone profiles. A chicken and egg situation ensues, fat causes excess aromatisation and oestrogen production which negatively feeds back to the brain. Cholesterol is the precursor to Pregnenolone, the ‘Father Hormone’ which cascades down to Aldosterone, Cortisol and Testosterone. It’s about eating the right fats.

Testosterone is anabolic, its primary role is help facilitate growth and repair. Testosterone has long been abused as a Performance Enhancing Drug. If you do require Testosterone Replacement Therapy, the aim is normalisation, not enhancement. Your DNA wants you to be strong, it needs you to have the capability to procreate, it needs you to fulfil your biological imperative, pass on your DNA to the next generation.

Exercise can increase your natural testosterone production. You need to engage in both resistance and cardiovascular training to enhance your male androgen levels. If you treat the day and night as one cycle, you will appreciate the need for daily exercise. Let’s consider the Hunter-Gatherer, let’s be healthy Hunter-Gatherers, or at least reignite some lost biological imperatives. On waking we should try and find food, rather than open the fridge or cupboard and instantly fulfil one of our daily drives. We’ve spoken before about the need for opposites when it comes to establishing balance and stability. Food activates the parasympathetic nervous system, part of the involuntary autonomic nervous system that is associated with digestion and rest. This leads to confusion, a distortion in the mechanisms that attempt to maintain well-being.

You want to be alert and active in the day, every day. Treat each morning as the start of the next cycle. Exercise every day, your health, your hormones depend on it. Over-training is real, but most people do not reach anywhere near their physical limitations. It isn’t simply lack of effort, it’s also not adequately addressing the other aspects of health, lifestyle and nutrition. Remember, they are dependent, not independent. We are full of excuses; we are fed excuses and their acceptance is assumed due to the passivity of modern culture.

Accepting responsibility for your own health will ultimately improve your health. The power of your mind is immense, you can be physically unwell but psychologically well. To unlock that potential, you not only need to accept responsibility, you need to act on it. Low testosterone can rob you of that ability. Taking that all-important step forwards can seem like walking with lead boots on, each determined step is followed by a more determined step until the mind accepts the fragility of the body.

Ultimately, you need to accept some help. That’s not necessarily a bad thing, in fact it’s sometimes a good thing. Recognising you are fallible and need another human being is reflective of our recognition that there is a survival benefit in living in communities. Obviously, our communities have become sum what distorted, and the machine is dictating outcomes and our survival instincts have been lost. Preventable diseases are on the rise in our civilised society, is it the machine, or is it our inherent weakness? Surely, we should fight back and that should start with yourself.

If you’ve tried and failed, don’t be despondent, often through adversity, we find our true character and whilst the recovery process may seem like a long, windy undulating road at times, the journey is to be appreciated. We are all walking wounded, it’s simply a matter of perspective. The important message is don’t ever give up, there is always light in darkness.

If you have symptoms of low testosterone, be proactive, be your own best friend, you can’t help others if you can’t help yourself. I’m a big believer in the Chaos Theory, but you can’t spread happiness without having some happiness within, only you can affect that. Help yourself, get blood work done, either through your GP or an online pathology service. Take control.

You need the following blood tests to accurately diagnose Testosterone Deficiency Syndrome:

  • Total Testosterone
  • Free Testosterone
  • Follicle Stimulating Hormone
  • Lutenising Hormone
  • Sex Hormone Binding Globulin
  • Prolactin
  • Oestradiol
  • DHT
  • Full Blood Count
  • Prostate Specific Antigen
  • Urea & Electrolytes
  • Liver Function Tests
  • HbA1C
  • Lipids – including Cholesterol
  • Thyroid Function Tests

Herein lies your next challenge, understanding and interpreting the results. You then need an affirmative action plan to tackle this quagmire of misinformation and bias that abounds not only the medical community, but also the internet. Testosterone Deficiency Syndrome is a medical condition, there are British Society for Sexual Medicine guidelines that your doctor should be adhering to. There are complexities outside of the scope of these guidelines, that will further hamper your chances of receiving Testosterone Replacement Therapy even if you qualify. In providing you with a prescription, your doctor is ultimately taking responsibility for prescribing that medication. If they do not possess the level of expertise necessary to safely and effectively prescribe it, that places them in a position of weakness if anything was to go wrong.

Referral to an Endocrinologist would seem the most logical solution, an expert in the field of hormones. Testosterone Deficiency Syndrome is under-recognised, and the health complications of low testosterone are underappreciated, even within the field of Endocrinology. You need to educate yourself, go armed with the guidelines and research. You need to fight your own battle, after all, it is your health at the end of the day. The NHS was founded on the principle of need, in an entitled society, everyone’s perception of need is just as important. There is an unrealistic demand and the NHS has finite resources. You need to take control, understand that we are in this situation where need and entitlement are blurred and only you can affect a positive change.

We have created this guide to help you on your journey –
How to Get TRT in the UK – Update 

Dr Robert Stevens MBChB MRCGP Dip.FIPT