As Medical Director of Parsley Health LA, I see patients with significant hormone imbalances, like low testosterone, every single day. The first thing I do is determine the cause of the deficiency. Then we craft a highly personalized plan to rectify it.
There is one case that really sticks out in my mind. Jared was in his early 40s and had finally met the woman of his dreams. He was hoping to have a family. The problem is that Jared, trying to maintain a competitive edge as an athlete, started using testosterone in his mid-30s when he started to feel as though his performance was decreasing. It worked. He remained at the top of the heap for another few years. But what Jared did not anticipate (or perhaps he just didn’t value at that time) was that the testosterone supplementation reduced his sperm production. How significantly did it affect his sperm production? Very significantly. Zero. He has zero sperm. He should have millions.
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Low testosterone is a common problem. Testosterone levels in most men start to decline in the early to mid-30s. Symptoms of testosterone deficiency may often be attributed to “just getting older”. But the effects of aging aren’t just something that happen. We age for many reasons, but one of them is the continuous decline and imbalance of our hormones. Symptoms and signs of low testosterone include decreasing lean body mass or skeletal muscle with increased body fat; fatigue, decreased energy, motivation and drive; decreased sex drive (libido) and erectile dysfunction; brain fog or reduced concentration or mental focus; mood changes including depression, anxiety or irritability; decreased bone density; and hair loss.
Many conventional medical doctors will ignore low testosterone levels suggesting that they are in the normal range. They are. But that doesn’t mean the deficiency is not significant or that it doesn’t cause symptoms. Normal only means that the majority of the population falls into that range. (The majority of this population also demonstrate at least some symptoms.) It certainly does not mean “optimal” and may not even be normal for the individual. This is the difference between population and personalized medicine. At Parsley Health, we take into consideration both, but distinguish ourselves by specializing in the latter.
On the other side of the spectrum, however, too many physicians are too quick to prescribe (and too many young patients are too quick to request) testosterone supplementation or replacement too soon.
They don’t identify the root cause of the matter and so the underlying problem continues. The person may feel better initially due to replenished testosterone, but now the patient is dependent upon getting it externally. When we take in hormones in either pill, injection or cream form, we override our body’s natural ability to create the hormone. We basically trick the body into thinking it doesn’t need to produce it anymore because there is already plenty of it.
Almost everything in our bodies, just like almost everything in nature, is cyclic. Our hormones are cyclic. That means our brains tell our bodies to make hormones, then the hormones tell our bodies we have enough. When levels fall, low hormone levels are detected by the brain and the cycle repeats. If we are injecting testosterone, for example, the brain detects that we have plenty of that hormone and it stops the signals to produce more. Decreased levels of these signals, luteinizing hormone (LH) and follicle stimulating hormone (FSH), lead to decreased stimulation of the testicles resulting in decreased testosterone and sperm production respectively. The longer and higher the doses, the more likely the testicles are to become suppressed and less likely to be able to regain their function.
There is hope for Jared to still father children with his wife. I have had considerable success with “rescuing” sperm production by stimulating the testicles with either clomiphene or hCG (human chorionic gonadotropin) or both. Clomiphene blocks hormone receptors in the hypothalamus of the brain. This stimulates the brain to produce more GnRH (gonadal releasing hormone) which leads to more LH and FSH production which can stimulate the testicles.
Casey, a patient with a very similar story, was able to conceive last year with his wife. I’m very hopeful for Jared. The process can be very effective, but not enough to rely upon when your fertility depends upon it. That’s why I work with my younger members to boost their testosterone in other ways (discussed in the second part of this low testosterone series). Guidance regarding proper nutrition, adequate and appropriately restful sleep, stress reduction and exercise are all also essential components of a successful comprehensive program that is necessary to replenish low testosterone or low sperm production.