Androgens

If you scored high in the ‘Androgens’ section of the Health Score Quiz, please read this article as it contains some useful information and resources to help you.

This page is designed to help you understand why you might be experiencing symptoms relating to low androgen levels, with a particular focus on low testosterone. In this section we look at the prevalence, symptoms, contributing factors, where the dysfunction might arise, testing and some considerations to help improve androgen levels, in particular testosterone levels.

Are low androgens common?

It has been known for some time that elderly men have declines in blood levels of testosterone and that testosterone tends to gradually decline with age. What is less clear is if this is a natural occurrence, a product of our environment or related to specific dysfunctions that may have developed.

Low testosterone prevalence is said to be around the 30% mark from the age of 40 and this slowly progresses as we age to around the 50% mark in our 80’s. Low testosterone is also becoming very common in males under forty as well and it has been shown that testosterone drops between 0.3 – 1.4% every year from the age of 25.

It is also said that a lot of the stats are largely under-reported as well, in part due to a lack of investigation, this area not being considered or fobbed off as another diagnosis entirely and also the fact that males tend not to reach out to their Doctor or healthcare provider to discuss this as a possibility.

The truth is that the testes are fragile and the system that allows for optimal levels of testosterone being produced can be negatively impacted by a number of things.

What are the symptoms of low androgen levels?

The reason that low testosterone is often overlooked as a diagnosis and not tested is the fact that we often present with a number of symptoms, that might not always be associated with low testosterone, these include:

• Mental & physical fatigue
• Low mood, anxiety
• Insomnia
• Difficulties with short term memory
• Excessive muscle soreness and poor recovery from training
• Reduced stamina
• Gaining body fat, especially around the belly
• Anaemia
• Decreased bone density/osteopenia or osteoporosis
• Losing muscle mass and strength or more frequent injury
• General loss of vitality

Then you have the symptoms one might consider to be more related to low testosterone, such as:


• Reduced sex drive
• Inability to get or maintain an erection

What contributes to low testosterone?

In this section I am going to outline some external influencers and also explain a little of the areas of defect that can occur in the body leading to low testosterone levels.

Broadly, there are a number of external factors that can lead to lower levels of testosterone, some of these include:

• Exposure to high levels of stress, both acute and chronic
• Impaired sleep
• Poor diet and nutrient insufficiencies
• Environmental chemicals, especially plasticizers, specific toxic metals etc
• Inflammation and oxidative stress in the body
• Misuse of drugs and alcohol
• Trauma
• Genetic abnormalities and tumours (rare)
• Past use of anabolic steroids
• Excessive body fat

Mechanistically there are then a number of areas in the testosterone production and action system that can go wrong, let me explain as simply as possible.

1. Stimulation

Are your testes getting the stimulation that they need to make testosterone? Sure, some testosterone can be produced in the adrenals and peripheral tissue, however the large majority is in the testes themselves. If for one reason of another the brain is not telling the testes to make testosterone effectively, this can lead to a low testosterone state.

This process is influenced by the hypothalamus and the pituitary glands. The hypothalamus makes gonadotrophin releasing hormone, which tells the pituitary to make luteinising hormone, which tells specific cells in the testes to make testosterone.

What if these glands are not functioning properly or are being suppressed by inflammation and oxidative stress or by the excessive production of prolactin? What if the receptors that sit on the surface of the testes are not functioning properly and the luteinising hormone is unable to adequately stimulate the testes? End result can be less testosterone being produced with all of these factors.

2. Production

Next, if we assume that the testes are getting the stimulation they need, yet the production of testosterone is still low. This suggests that there is some dysfunction within the testes themselves. These very sensitive glands and the cells within them that help to make testosterone can be influenced by changes in nutrient status, environmental chemicals, inflammation or oxidative stress, excess insulin, all potentially leading to less testosterone being produced.

3. Binding

What if you are stimulating and making adequate testosterone, yet you still have low testosterone symptoms and when looking at your blood test results you have low levels of free testosterone (the available testosterone able to act upon your cells)?

A binding issue typically results from excessive levels of Sex Hormone Binding Globulin (SHBG). Excessive amounts of it means that too much testosterone gets bound up and this results in low free testosterone. This is a massive issue that I have seen which tends to correlate strongly with high levels of stress, aging and estrogen levels.

4. Conversion

This relates to what the body does with testosterone. Hormones can be converted into other hormones via different enzymatic reactions. As a result, in some people they can be converting excessive levels of testosterone into hormones such as estrogen and DHT.

This can result in not only low testosterone symptoms and low free testosterone levels; it can result in excessive levels of estrogen and/or DHT leading to other symptoms such as hair fall, excessive breast tissue growth, inability to lower fat as efficiently as expected, water retention, acne and more. Obesity, zinc issues, alcohol consumption, stress and inflammation and insulin resistance are all factors in the excessive conversion of testosterone into estrogen in males.

5. Action

Similar to how luteinising hormone needs to bind to the hormone receptors on the surface of the testes, testosterone also needs to bind to other cells in our body to stimulate its action. This can be a harder one to pick up because everything on testing can look pretty normal, yet someone is suffering with low testosterone symptoms.

From this, I hope you can see that there any many potential areas that can influence testosterone production and eventual action. Testing helps to define where the imbalance might be coming from and will therefore guide the therapeutic approach or any further investigation that may need to take place.

What should I test when I suspect low testosterone?

Based upon the above, you need to consider a broad testing approach to determine the probable area of dysfunction and then you can get on with either treating the cause or investigating further to establish that.

Here are some blood tests that I would look at if I suspected low testosterone based upon symptoms initially, with those in bold as a primary requirement for initial testing:

• Testosterone
• Sex Hormone Binding Globulin (SHBG)
• Prolactin
• Luteinising Hormone (LH)
• Follicle stimulating hormone (FSH)
• Free testosterone or just work out the testosterone to SHBG ratio
• Estradiol (E2)
• DHEA-S
• Complete Blood Count
• Biochemistry Panel covering kidney function, liver function, cholesterol, glucose, insulin and more
• Body composition assessment to review body fat levels, visceral fat, skeletal muscle mass etc

Bonus tests:

• Zinc
• Magnesium
• Vitamin D
• Urine hormone metabolite testing inclusive of adrenal, DHT, DHEA and sex hormones
• Toxicity assessments

What can you do about low androgen levels, especially testosterone?

Here is the good news, there is plenty you can do to help improve testosterone levels and reduce the symptoms of low testosterone.

Below is a list of areas that I would consider as a priority. Of course, these are easier said than done, but that is where we come in to support you with behaviour change and guiding the most appropriate changes required:

1. Optimise your diet – less processed foods, reduced alcohol, more anti-inflammatory foods, more nutrient dense foods
2. Reduce your body fat levels
3. Address any blood glucose/insulin issues
4. Reduce your stress levels, get support to help you with stress or past traumas
5. Introduce exercise and work towards a graduated program including some forms of strength training
6. Optimise sleep health and the sleep/wake cycle
7. Get some sunshine or address any vitamin D deficiencies
8. Address other nutrient insufficiencies, especially zinc and magnesium

After these basics there are other more intricate approaches that can help break the cycle of low testosterone. This is sometimes needed, because making the changes above can be really challenging when you are suffering with the symptoms of low testosterone. In some cases, you have to both treat symptoms while trying to address underlying causes.

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