The human body is a highly sophisticated organism, it has the capacity for change, yet has complex physiological mechanisms in place that are dedicated to maintaining a constant internal environment, despite external change. This process is called Homeostasis. It is important to appreciate that contrast is necessary to maintain this state of equilibrium.
Anabolic processes predominate at night, when we are resting, and catabolic processes predominate during the day, when we are active. Whilst testosterone has long been considered the primary male sex-hormone responsible for growth and repair, it’s bi-products, oestrogen and dihydrotestosterone, are also integral to anabolism. All hormones are dependent, whether that be a direct or indirect relationship, they are not independent. The ratio of these hormones to one another is as important as their absolute quantitative levels.
The autonomic nervous system has two contrasting elements, the sympathetic nervous system which is involved in the ‘fight or flight’ response, whereas the parasympathetic nervous system conserves energy and helps facilitate digestion. It does not take a rocket scientist to work out that the parasympathetic nervous system has more of a symbiotic relationship with anabolism, and conversely the sympathetic nervous system works synergistically with catabolism.
The wonder of the human body never fails to amaze me, despite its apparent complexity, simplicity is the key to achieving balance. Humans have a higher state of consciousness compared to most species on this planet. (When I use that phrase my thoughts immediately skyrocket back to an embarrassing, yet amusing story of a group of us dancing in the queue at Club UK, to what we thought was ‘Higher State of Consciousness’ by Josh Wink, only to be tapped on the shoulder by someone say “it’s the generator mate”). I firmly believe that the further we travel away from nature; the worse our physical and psychological health becomes.
The fundamentals of health are lifestyle, nutrition, and exercise. We have since added ‘challenging ourselves’ to earn that dopamine reward. Humans are pre-programmed to seek the path of least resistance. It is a survival instinct that has become distorted over time, now fuelling and misdirecting choices, often bad choices. The average person in the modern civilised world does not need to struggle to survive because we live in a time of abundance and plenty compared to Hunter-Gatherer. However, we still have primary directives:
- To find shelter
- To find food
- To procreate
(Forgive me the occasional film reference or parody. Can you guess the reference?!)
We’ve discussed before how our testosterone levels follow a diurnal pattern. To summarise, anabolic processes predominate at night when we are resting. The primary purpose of testosterone, oestrogen and dihydrotestosterone is to help facilitate growth and repair. Your male androgens help you recover from the day and prepare you for tomorrow and this adaptation response means that you can become more efficient. We therefore measure testosterone levels in the morning when your levels are at their highest, which makes entire sense as it is a marker of how effective the anabolic processes have been overnight. During the day, numerous physiological processes utilise male androgens. Variation in activity and utilisation differs from both person to person and from day to day.
If we consider our primary directives, most of us live in concrete jungles. If we look back at Hunter-Gatherer, we should be outside during the day, weather permitting, foraging and hunting for food and exposing our skin to sunlight, which helps produce vitamin D. Vitamin D has numerous functions within the body, including an important role in testosterone production and immunity. We should be breathing fresh air, taking in oxygen and expelling carbon dioxide, not breathing in recycled air. If we are fortunate enough to be outside, the industrial revolution and our continued obsession with technological advancements has created a level of pollution that is sometimes visible to the naked eye.
Upon waking, one of our instinctive drives should be to find food. Cortisol, the primary catabolic hormone, surges and we leave the safety of our shelters to forage and/or hunt. Humans live in relative safety compared to other species, even predators at the top of their respective trees struggle to survive. There is a natural order within the Animal Kingdom and this order appears to necessitate a level of struggle. In nature you do not see obesity, why? Because if a predator were obese, it would not be fast or agile enough to catch its prey. If prey is obese, guess who is being picked off first by the predator? Its literally survival of the fittest. The predator wants to expend the least amount of energy to achieve its goal, which is to attain food. It would follow the path of least resistance. What do humans do? We walk from the bedroom to the fridge where food is already plentiful. This is why I am a massive advocate of time restricted eating. How peculiar is it that we believed for many years the adage that “breakfast is the most important meal of the day” and that “eggs are bad”. How can eggs be bad? They evolve into a chicken, a complete organism, it makes no sense! Cholesterol.. how many times have you heard that cholesterol is bad for you? Cholesterol is the precursor to Pregnenolone, the ‘Father Hormone’, which then cascades down to Cortisol, Testosterone and Aldosterone. Cholesterol is responsible for your steroid hormone production. Let cortisol serve its function, channel your hormones down the path that was intended. Work with nature, not against it.
Let us now consider testosterone. Men with Testosterone Deficiency present with the symptoms associated with having low testosterone. These include varying degrees of fatigue, low mood, anxiety and/or depersonalisation, brain fog and low libido. The aim of Testosterone Replacement Therapy (TRT) should be to attempt to reverse those negative symptoms. This should be done with an understanding that supraphysiological levels of testosterone can have a negative impact on other physiological parameters such as blood pressure, haematocrit, SHBG, HDL and LDL. It is understandable that men seek high levels, with the understanding that low levels mean mental unrest. So conversely, high levels must mean mental wellness, right? Wrong.
Elevated testosterone levels are associated with elevated dopamine levels, which is the reason that an increase in testosterone is often linked with an improvement in mood. Some men describe a ‘honeymoon period’, a period of elation, that disappears even with healthy male androgen levels. A ‘normal’ effect is achieved through recognition of the need for contrast. Speaking solely from a hormonal perspective, with normal levels, if something good happens, you should feel positive about this experience and you will be rewarded by a dopamine spike. If something negative happens, you should be able to understand why it happened and either accept it for what it is, or be able to rationalise the incident and hopefully put measures in place to prevent it from happening again. There should be an appropriate response.
It is my understanding that high testosterone and high dopamine levels do not mean a state of Nirvana, because the human brain needs contrast in order to appreciate life experiences, and whilst a persistently elevated testosterone level and dopamine level may appear advantageous, those people are often involved in extremes of behaviour in order to elicit a response. We all know men at the gym who are abusing Androgenic Anabolic Steroids, they are great fun in small doses, but their behaviour, attitudes and responses seem disproportionate, they often appear to lack insight into their behaviour as they ‘feel great!’. High testosterone does not mean mental well-being, I know many men who suffer terribly with anxiety with high testosterone levels.
Managing mental unrest is a large part of my job. We started the ‘Healthy Body, Healthy Mind #ChooseTRT’ campaign after two of my younger patients, within the space of two weeks, confided in me and said that they would not still be here without TRT. Many people do not appreciate the importance of hormonal health in mental well-being. High levels and hormonal fluctuations bring about their own problems, most men just want a semblance of normality. Often the desire to be ‘more than human’ is what has led them to be sat in front of me in the first place, seeking my help and guidance. Unlike the internet or gym locker room, I will never give you falsehoods and platitudes.
I would like to draw a parallel with the prescribing of Selective Serotonin Reuptake Inhibitors (SSRIs) in the management of depression. The premise behind their use is to increase the level of Serotonin available for your brain to use. Serotonin is considered the primary hormone responsible for ‘happiness’, but to give one hormone such responsibility demonstrates a short-sightedness if we consider the body and mind as a whole. Most hormones do not have one sole function, they often influence numerous tissues. Notably, Serotonin plays an important role in sexual function and gut health. Humans display an arrogance with their sledgehammer approach to medicine and fail to appreciate the need for careful titration to restore the equilibrium that exists within the body. So, to my point (I could go on for hours about the misuse and over-prescribing of SSRIs!), men with low testosterone have often presented to their doctors with an element of mood dysregulation. Most have been offered anti-depressants and the vast majority of doctors have not sought to look for causation. The use of SSRIs parallels the effect of high testosterone levels achieved with the use of TRT. Why? Simply put, it’s because of the blunting effect that high levels have on mood. If the human experience is about an appreciation of contrast, flooding the brain with Serotonin removes the ability for your consciousness to recognise change. As I explained previously, you should be responding appropriately to the highs and lows in life. Men on anti-depressants often recognise that their emotions are flattened and are therefore no longer responding appropriately. Antidepressants have their place in the management of depression and anxiety, however their over-use and the blunting affect that they can have on mood needs close monitoring.
I am a massive fan of Bill Hicks, he was a comedic prophet and had some hard-hitting views on life, the universe and everything else. This is one that has stuck with me..
“Today a young man on acid realised that all matter is merely energy condensed to a slow vibration, that we are all one consciousness experiencing itself subjectively, there is no such thing as death, life is only a dream, and we are the imagination of ourselves. Here’s Tom with the Weather.”
Ignoring the psychedelia reference and potential lengthy discussion about quantum physics, which would further solidify my belief that there is an equal and opposite reaction to everything in life, this comment tickles me. Uncertainty is inevitable and should therefore be appreciated. As painful as the lessons to be learnt from hardship are, they are in fact necessary, and merely part of the journey. My job is fascinating, as individuals, all of your stories are unique as you are experiencing them. However, they all share similarities. As your doctor, I can be objective. I sit, I listen, I try to empathise and relate with you. Having accepted some responsibility that you have entrusted me with, I then attempt to guide and support you on your journey to hormonal balance.
We manage a private Facebook group ‘TRT in the UK‘ which is dedicated to increasing understanding and awareness surrounding Testosterone Deficiency and Testosterone Replacement Therapy. It is a very active community, part of our mission is to remove the stigma attached to low testosterone, so that people can see it for what it is, simply a hormone deficiency. The fact that it is the male sex-hormone is irrelevant. Both Dorian Yates and Joe Rogan are very open about the fact that they need TRT, try telling them that they are less Alpha!
It is sometimes hard to gain a sense of perspective when our senses are over-stimulated, our focus is distorted by the machinations of the machine. We have become complicit in the game more through perceived necessity than volition. We have elected governments (govern-minds), supposedly making decisions based on the needs of the collective, not the elite. However, their influence is wide reaching and powerful. It is difficult to attain a semblance of normality when normality is predetermined and influenced by others.
If we can affect a positive change to the individual, we can affect a positive change to the collective. If we are to believe that harmony can only be established through contrast, we must make a choice, a conscious decision. Understanding duality, understanding the need for both the masculine Yang and the feminine Yin, that survival drive can be channeled into not only improving your own health, but it can also have a positive effect on both individual and collective consciousness. Primary directive #4 is ‘Belief’.
The Sine Wave Hypothesis – A balanced mind and body can only be achieved with the understanding and recognition of the need for contrast.
Dr Robert Stevens MBChB MRCGP Dip.FIPT