When normal isn't optimal
I met with a patient a few weeks ago. He felt like his hormones were “out of whack.” Over the years he struggled with weight gain, loss of muscle, fatigue and low mood. As a smart dude, he had already educated himself on men’s health, and started incorporating specific lifestyle changes like clean eating and a fitness routine tailored to his goals. He started taking supplements, focusing on sleep and stress reduction.
When his symptoms didn’t improve despite his hard work, he did what most normal people would do and sought medical advice. Over a year, he saw not one, but three different doctors including an endocrinologist (hormone specialist). They checked him out, ran some labs, including his hormone levels and they all told him the same thing.
Everything is normal.
Feeling defeated, he came to our clinic and indeed, while his hormones were in normal range, they were far from optimal. We started him on testosterone replacement and a simple supplement routine. As long as he continues to live his healthy lifestyle - he will do extremely well.
This patient’s story is common. In western medicine, lab results come with a normal range. These ranges are usually large and even if you are “in range,” you may be at the bottom of that range, yet you will be told you are normal.
There’s a big difference between normal and optimal.
I’m going to give you a breakdown on testosterone. If you prefer to listen to information rather than read, I created a 27 minute video on this topic. You can watch it here:
If you are like me and prefer to read, it’s in written form below.
A man’s testosterone peaks in his late teens and 20s, then gradually declines as he ages. Peak levels are between 700 and 1000 ng/dl. Every decade, testosterone levels drop by about 100 points, meaning it is common for a man in his 70s or 80s to have levels between 200-400 ng/dl, or even lower.
Many of my male patients who are 40-60 years old will have testosterone levels of a 70 or 80 year old. Many of them are told this is normal, as it is in normal range. While that is not an incorrect statement and they are in “normal range,” there is a problem with this mentality.
Let me explain why.
Testosterone is man’s most dominant hormone and plays a critical role in his physiology. It is important for male growth, maturation and masculine characteristics and vital for sex drive (libido), spermatogenesis (production of sperm), bone density, fat distribution, and muscle mass/strength. Not surprising, low levels of testosterone can lead to fatigue, mood changes/irritability, low libido/erectile dysfunction, a change in body composition (loss of muscle mass and increasing fat mass), lack of motivation/drive and even brain fog.
We are seeing a more rapid decline in men’s testosterone levels than ever before. The reasoning behind this is complex. It has to do with increasing obesity and less physical activity, the standard American diet, increased alcohol consumption, disrupted sleep patterns and environmental toxins like endocrine disruptors found in plastics and other products.
This is why lifestyle is so important. Regular exercise including strength training, a healthy diet, good sleep, stress reduction, resiliency training and reduction or elimination of toxic substances like excessive alcohol use or opioid use are critical for those wanting to optimize their hormones. I’m upfront with my male patients about this. If they aren’t willing to adopt a healthy lifestyle, it will be hard for them to maintain healthy testosterone levels.
But often, even when they are doing everything right, as was the case with my patient, their testosterone levels may be on the low end of the scale from things they can’t control.
This is when medical management is an option.
Testosterone optimization takes a skilled practitioner who understands the entire male hormone cascade. It can include things like human chorionic gonadotropin (HCG) injections, clomiphene pills or testosterone injections and creams. It depends on the person, their age, their financial means and their desired form of treatment. It’s also not a simple process. It takes a practitioner who understands the potential side effects of testosterone therapy like elevated estrogen levels, elevated blood count, acne and hair loss. And it takes a practitioner who knows the contraindications and risks to the therapy.
Knowledge is power. I believe all men should get their hormone levels checked, even younger men. If they have suboptimal levels, they can start with making lifestyle changes and using supplementation to support healthy hormone production. If this doesn’t get them to their goal, I recommend they work with a provider who understands male hormone management, not a provider who will tell them they are “normal” when they have the hormone levels of an 80 year old.
Onward
Dr. Lynn K Wagner (
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The content in my newsletters is for educational and informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or health concerns.
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