By Svetlana Kogan, M.D.
The topic of sexual health and low testosterone often causes patients to lower their eyes, shy away from the questions, feel demoralized, and too embarrassed to verbalize their concerns. I see this much more commonly in older men, especially those with hypertension, diabetes, or obesity. There is a lot of evidence in the research literature too, which prompts a close preventive look at the testosterone levels in men. For example, a European male aging study found that a Body Mass Index (BMI) of over 30 kg/meter squared, triples the risk of developing low testosterone with sexual symptoms. Here is the mechanism of obesity driving the decrease in the testosterone: An enzyme called aromatase, which is located within adipose (fat) tissue -increases conversion of testosterone into estrogen. This creates a negative feedback loop to a person’s pituitary gland, which starts producing less of the Luteinizing Hormone (LH) -which in turn leads to a decreased production of testosterone hormone by the Leydig cells in the patient’s testes.
A large VA study of men over the age of 40, who were monitored over a 5-year period, revealed that mortality in men with normal testosterone was 20.1%, while mortality in men with low testosterone was 34.9%. Other studies have found that men with normal testosterone levels generally have less cardiovascular disease, metabolic syndrome, diabetes, and osteoporosis. Testosterone levels were also found to be lower in men with Alzheimer’s disease compared with controls, and some studies suggest that low free testosterone levels may precede AD onset. Lastly, low testosterone is associated with increased all-cause mortality in men > 50 years old compared to controls in observational studies.
In patients with decreased sexual libido and weak or absent erections, a thorough functional physical exam can help pick up on the signs of low testosterone. Some of these signs are:
• Decreased body hair
• Central obesity
• Severe loss of muscle mass
• Breast enlargement or tenderness
• Decreased size and consistency of the testicles
• Anosmia (lack of normal sense of smell)
• Loss of temporal visual fields
• Increased skin pigmentation (possibly consistent with hemochromatosis), or dark patches in axillary folds, called Acanthosis Nigricans
Another opportunity for a functional primary care doctor to pick up on the underlying root causes of the low testosterone level is a through history. Here are some of the common predisposing scenarios I get from the history:
• Patient does not sleep well or has sleep apnea.
• Leads a very sedentary lifestyle and does not exercise adequately.
• Is exposed to chronic ongoing stress levels.
• Uses too much alcohol, opiates, or marijuana.
• Eats SAD (Standard American Diet) low in essential vitamins and minerals.
• Suffers from chronic inflammation.
If the physical exam and a history sound suggestive, I would be prompted to check the following markers in the blood to help in the diagnosis of inadequate testosterone: total and free testosterone, DHEA, pregnenolone, sex hormone binding globulin, Thyroid function hormones, PSA, liver enzymes, estrogen, LH, FSH, inflammatory markers, and insulin sensitivity with HbA1C. In addition to these basic tests, some patients require additional functional tests to address the genetic, gastro-intestinal, environmental, or stress-related root causes of their testosterone imbalance.
And here is what I love about functional medicine: It does not treat people as something broken that needs to be fixed with an additional prescription medication. Instead, functional medicine philosophy believes in the body’s innate and infinite wisdom. The job of the functional doctor is to remove the obstacles which are compromising the body’s ability to heal itself. So, the approach to low testosterone involves guiding the patient towards profound improvements in their nutrition, lifestyle, and emotional balance, as well as using the temporary vitamins and supplements, targeted to support the pathways involved in body’s achieving its optimal testosterone levels.
Svetlana Kogan, M.D.
The author of ‘Diet Slave No More!’, Svetlana Kogan, MD is a Board-Certified Internal Medicine, Holistic & Functional Medical Doctor with 25 years of experience. She has appeared as a health expert on prime-time TV and radio stations and has authored hundreds of holistic health articles for internet and print. She moved her Concierge Practice from Manhattan NYC to Naples in 2019. Her Functional Medicine Primary Care Practice is focused on prevention and holistic approach to illness, and longevity.
720 Fifth Ave S, Unit 209, Naples , FL 34102
Phone: (239) 676-6883
www.customlongevity.com