Houston we have a problem. Literally, Houston, you have a problem.

“Male Reproductive Disorders and Fertility Trends: Influences of Environment and Genetic Susceptibility. It is predicted that Japan and European Union will soon experience appreciable decreases in their populations due to persistently low total fertility rates (TFR) below replacement level (and the US is getting there)… we conclude that environmental exposures arising from modern lifestyle, rather than genetics, are the most important factors in the observed trends….there is an urgent need to prioritize research in reproductive physiology and pathophysiology, particularly in highly industrialized countries facing decreasing populations (Skakkebaek et al.)”

I am 8 chapters deep into the book on Testosterone and Male Health. We are going to have to lock me in a garage in Costa Rica for a month to get this thing done. It will be above all two things – entertaining and informative. I really don’t like health-ish books for the general public. There is too much boring background info that anyone could get on Wikipedia and then there is generally not enough meat and potatoes or the meat and potatoes are suspect and presented as fact. There are exceptions to every rule.

I do much better in short and medium form content. People read it. It’s generally free. I enjoy producing it. Everyone wins.

Helping dudes in an educated manor is my passion. I get to do that on a daily basis. It’s a blast and like anything I think there is a lot of science that still needs doing. I also think there are a lot of functional medicine practitioners who are making some fairly bold jumps in the purported efficacy of their protocols. Just like anything this too comes back to dollars. And the wave that plows through both the functional and conventional flaws is unbiased science, education, and questioning. Start paddling.

When I think of male hormonal health I think of these five basic aspects.

1) Lifestyle (Sleep, stress management/mindset) – Want to tank your testosterone? Pile on the stress and don’t sleep. Simple. We don’t fix anything without these two on board.

2) Estrogen – Endogenous or Exogenous, too much estrogen shuts down testosterone production at the level of the brain. We are all swimming in estrogenic endocrine disrupting compounds. Sorry. Write a letter to Obama or better yet go back in time and write it to Truman or Eisenhower.

3) Blood Sugar, Insulin, and Body fat – If you have diabetes you have endocrine dysfunction. Conversely, hypogonadal males are at three times greater risk of metabolic syndrome (Kaplan and Crawford). If you are a fat diabetic man you are also very likely going to be estrogen dominant and testosterone deficient. As Charles Poliquin put’s it to give fat guys exogenous testosterone is a crime against humanity because they will just aromatize it into estrogen. Enter the second drug on your conventional treatment model – estrogen blockers or aromatase inhibitors – Armidex. Solution. I think not.

4) Inflammatory or Immune Challenges (Foods, Heavy Metals, Infections, and/or Toxins) – The average American adult eats two tons of food a year. That food can either break you down, stress you out, and cause inflammation or it can nourish you, support you, and build you up. Your choice. Spend the rest of your life figuring out what that “food” is for you. Bugs – you live on this planet long enough and you are going to catch things that piss off your immune system. How big a deal this is comes down to how resilient we are genetically and physiologically. For some, these bugs become a constant internal stressor. Also, when the immune system ramps up it eats up Zinc faster than normal. We also have 1000x the lead of preindustrial humans. Heavy metals wreak havoc on our system and our susceptibility to symptoms is again genetic, but nevertheless getting rid of heavy metals also eats up Zinc. Fixing these issues involves science, individualization, support, and having all the fundamentals dialed in.

5) Nutrient Deficiency or Inadequacy – adequate amounts of Vitamin A,B,C,D,E, Selenium, Magnesium, and Zinc are needed for protecting the testicles and for testosterone production. I always go back to simple – if the body is malnourished or stressed it isn’t going to grow or reproduce AKA testosterone. For example, proton pump inhibitors are a 14+ billion dollar market and are not supposed to be used longer than 8 weeks. PPIs are directly related to lowered testosterone production. Hmmm, you can’t absorb zinc, iron, and B vitamins without stomach acid, go figure.

Are you starting to see the complexity of this issue?

We did a study and we gave 27 fat, sedentary, sleep deprived, toxic subjects Peruvian Maca for 6 weeks but their testosterone didn’t go up. NO shit. You think any one supplement is going to fix that poop sandwich of a problem.

…and exogenous testosterone doesn’t even begin to fix that problem either.

What we need is unbiased efficacy trials with all the above factors used in a systematic fashion.

You take the Functional Medicine approach, see if it works, how well, and for who. And then you take the deep dive into why.

We are getting there and if anyone wants to help me write an R01 grant or crowd source a few million dollars I will very happily run this experiment.

In all honestly the way Dr. Mark Hyman is pushing things forward this may not be outside the realm of possibility and may be closer than we think.

In the heart of the storm the future is still bright, and even The Journal of Clinical Endocrinology recently made the statement that we need to look to lifestyle changes before moving to hormone replacement therapy (Travison et al.). This is huge and not good for the pocket books of the Low T Clinics. Who are likely undereducated, not reading this, taking hormones themselves, and highly motivated to attach men to a lifelong EFT delivery of exogenous hormones to not fix an environmental/social/lifestyle issue.

and I’m done…for now.

Oh and Happy Saint Patrick’s Day. Binge drinking lowers testosterone and alcoholics have lower testosterone. So maybe you have 3 drinks instead of 20.

1. Kaplan SA, Crawford ED. Relationship between testosterone levels, insulin sensitivity, and mitochondrial function in men. Diabetes Care. Mar 2006;29(3):749; author reply 749-750.
2. Travison TG, Araujo AB, Kupelian V, O’Donnell AB, McKinlay JB. The relative contributions of aging, health, and lifestyle factors to serum testosterone decline in men. J Clin Endocrinol Metab. Feb 2007;92(2):549-555.
3. Skakkebaek NE, Rajpert-De Meyts E, Buck Louis GM, et al. Male Reproductive Disorders and Fertility Trends: Influences of Environment and Genetic Susceptibility. Physiological reviews. Jan 2016;96(1):55-97.