The Cause of Your Low Testosterone Symptoms
Back in late 2018, a young man in his early 20s contacted me because he felt stressed, depressed, anxious, lacked motivation and suffered regular panic attacks. His libido was low, and he had to take cialis to feel any sexual desire at all.
In short, he was not in a good place. And he was convinced this was due to low testosterone:
He was desperate in a desperate state, so we did a consultation to see how best I could help him.
Before the consultation I asked him to send me any previous blood tests along with detailed breakdown of his current lifestyle.
Context is everything. You can’t truly help someone until you can see the full picture.
A Verdict of Low Testosterone?
His prior blood tests revealed that he had low testosterone. I don’t put a lot of stock in the total testosterone number alone. This is because symptoms are the most important factor when it comes to hormonal balance.
However, his total testosterone ranged from 400-500 ng/dL (13.9 nmol/L – 17.3 nmol/L). This is very low for a man in his early 20s.
He also had low gonadotropin levels – luteinizing hormone (LH) and follicle stimulating hormone (FSH). Gonadotropins are hormones sent by the pituitary gland to the testes to produce testosterone.
This indicated that he likely had secondary hypogonadism. In secondary hypogonadism, the signal sent from the brain to the testes (via gonadotropin hormones) is weak. So because the testes don’t receive a strong signal, they fail to produce sufficient levels of testosterone.
In addition, he had low estradiol (a form of estrogen), which you would expect because his testosterone was so low. In men, estradiol is made predominantly from the conversion of testosterone. This process is known as aromatization. Essentially, the less testosterone you have, the less estrogen you produce.
Contrary to what many believe, estrogen is not a “female hormone.” Estrogen is crucial to male health and contributes to memory, mood, and libido among other things.
But that wasn’t all.
He also had elevated prolactin > 20 ng/mL (450 miu/L). Prolactin is another hormone produced in the pituitary gland. Elevated levels of prolactin can indicate a tumor in the pituitary gland, leads to the hypersecretion of prolactin.
High prolactin levels in men can also lead to erectile dysfunction, mood swings, low libido and even vision disturbances in some cases. However, his prolactin levels weren’t high enough to indicate a pituitary tumor (adenoma).
The Sickcare Solution
This young man was very exasperated. He had seen leading doctors, taken multiple blood tests, and even took an MRI scan.
His blood tests mostly “normal” (i.e. within range) and the MRI scans showed nothing wrong.
Yet he still felt like crap.
So due to his low testosterone symptoms and high prolactin levels, his doctor prescribed him clomid (a drug to elevate testosterone and maintain fertility) and cabergoline (a dopamine agonist) to bring prolactin down.
I’ve written extensively about clomid in my book Optimized Under 35. Research suggests clomid is a relatively safe and effective treatment option for hypogonadal men who want to elevate testosterone and maintain fertility.
One study looked at the effect of clomid treatment in young obese men with low testosterone aged 18-21. Eleven subjects were given 25mg of clomid every other day for three months.
Testosterone and gonadotropin hormones were measured before and after treatment. The average baseline testosterone levels were 233 ng/dL (8.1 nmol/L) and increased to 581 ng/dL (20.1 nmol/L) post treatment. Luteinizing hormone (LH) and follicle stimulating hormone levels (FSH) also increased.
Studies also show that cabergoline is effective at reducing high prolactin levels. One study gave a single dose of 300 mcg of cabergoline to 15 patients with hyperprolactinoma (i.e. a pituitary tumor). Prolactin levels were taken several hours before treatment and up to seven days after.
The authors of the study noted a significant reduction in serum prolactin levels; ranging from 49.2-55.2%. This occurred quickly – within two-five days of treatment.
These medications are clearly effective at treating low testosterone and high prolactin in men. Nevertheless, this young man wasn’t sure whether taking medication was the right thing for him.
Now, it’s not my place to advise on medications or give medical advise because I am not a doctor. However, I am a firm advocate of improving your health through diet and lifestyle changes.
The modern medical system is preoccupied with treating symptoms. I call this the Sickcare Solution. I believe we should aim to fix root causes instead.
I told him to be truly healthy and avoid long-term medication, he needed to find out what led to the low testosterone, high prolactin, and other symptoms.
So to investigate further, I needed to understand more about his lifestyle:
Sleep, diet, exercise, supplements – the whole shebang.
Living a Clean Lifestyle?
His symptoms of anxiety, depression, low motivation, low libido and lethargy are all linked with low testosterone. And his blood work showed that his testosterone was on the low end.
Nonetheless, that doesn’t necessarily mean he needed to undergo testosterone replacement therapy.
As a mentor of mine once told me:
“When you’re a hammer everything looks like a nail.”
This man was under a lot of stress running his business. He was under extreme pressure every day, and this was clearly taking its toll on his health.
That’s not really extraordinary, because who among us doesn’t deal with stress?
Now apart from this, he lifted weights 2-3 times a week, meditated daily, drank minimal alcohol, and slept at least eight hours a night. Although in spite of sleeping a lot, he never felt well rested and frequently woke up in the night to urinate.
I also asked him to record everything he ate. It looked something like this:
Breakfast: Eggs, fresh green juice, and an espresso.
Snacks: Nuts, fruit, or a fresh juice.
Lunch: Vegetables, a form of protein such as chicken, and some cheese.
Mid-afternoon: Same as before or a protein shake.
Dinner: Salmon and salad or a healthy takeaway
He also typically drank a breakfast smoothie consisting of spinach, kale, MCT oil, protein powder, greek yoghurt, and coconut water.
On the surface, it appears as though he led a healthy lifestyle. His diet was low-carb, and included good protein sources and green vegetables.
But something was not adding up. And as we’ll see in a moment, his diet isn’t as great as it appears.
After he filled me in on his lifestyle, I asked him to get a comprehensive blood panel done. At first, he was reluctant, as he’d done so many tests already.
I understood his reticence. However, here’s what I told him:
The tests I do for my 1on1 coaching clients are NOTHING like a normal doctor’s test. Let’s take a closer look…
A Normal Range For Normal Health
Taking a blood test is great for one main reason:
It gives you a clear and objective assessment of your current state of health.
A typical blood test will have a reference range for each marker of health. So if you’re within that range, then as far as modern medicine is concerned you’re normal!
However nowadays, “normal” is a byword for mediocre or failing health. And for the most part, blood tests in this format are deeply flawed.
Reference ranges are often arbitrary, or conjured up based on population averages. They’re rarely, if ever age-adjusted, so everyone gets lumped into the same range.
For example, the reference range for total testosterone is taken from the entire population. That means a 25 year old man is comparing his testosterone levels to an 80 year old man.
Subsequently, if a 25 year old man has 300 ng/dL (10.4 nmol/L) of total testosterone (comparable to an 80 year old); he is considered normal. This is simply because his testosterone is within the “normal” reference range.
Furthermore, no distinction is made between normal and optimal levels of testosterone. Yet surely, we should all be striving for optimal when it comes to health? Nope!
When it comes to hormones, and health in general, average doesn’t come into it. We are all biochemically unique, and this requires a more tailored approach.
Sadly, it appears modern medicine is utterly obsessed with averages.
Optimal is the Only Option
The blood tests my clients take have multiple reference ranges. This includes:
- Below standard
- Below optimal
- Above optimal
- Above standard
The aim for my clients is to get the majority of their markers into the “optimal” range.
For context, the doctor’s range is from below standard to above standard. So, he’ll only be concerned if your result comes back outside of those.
That leaves a whole lot in between!
Moreover, many lab tests don’t test enough markers. As a result, they fail to give you a comprehensive and accurate picture of your overall health.
Seldom do I see tests for folic acid (vitamin B9), zinc, free T3 (a thyroid hormone), progesterone (a precursor to testosterone), or even inflammatory markers like homocysteine.
These markers such as these are critical to your health, yet they’re completely overlooked.
Finally, even though blood tests have reference ranges, the data is only useful when interpreted properly. Typical lab tests offer no interpretation of the data, i.e. the trends and what it could mean in the future if you don’t address them.
For example, if your blood tests show a trend toward cardiovascular disease, you can take preemptive action to prevent it. Modern medicine is extremely reactive and has no interest in preventative care.
Not Just Low Testosterone…
When this young man’s blood test came back, it was immediately clear there was more to it than just low testosterone.
This is why I always want to know about a client’s lifestyle factors, such as sleep, diet, exercise, and stress levels. They can have a dramatic impact, not only on your testosterone levels, but the rest of your health.
The trends on his blood test showed not only sex hormone dysfunction (which we knew), but also immune, cardiovascular, and blood sugar issues.
Today, there is a lot on the internet about low testosterone. More and more men are starting to understand its critical role to their health. Indeed, part of what I do is to educate and bring awareness to this topic.
However, there is also a tendency to compartmentalize things. As a result, people jump to the conclusion that low testosterone automatically means you need to undergo testosterone replacement therapy.
The body does not compartmentalize though. Everything in your body is linked. So if one area of your health isn’t optimal, this has a knock on effect elsewhere.
In this man’s case, there’s no doubt his low testosterone was partly explained by his blood sugar regulation, thyroid and immune system issues.
The Hormone Panel
First, let’s take a look at his hormone panel. As with previous tests, his testosterone was on the low side. Most doctors would likely say his testosterone was “OK,” simply because he was within the reference range.
However, if you’re in your early 20s then you are in the prime of life. You should not have 542 ng/dL (18.8 nmol/L) of total testosterone. Even for an older man, this is still pretty average.
His progesterone was very low. Low progesterone is often a sign of underlying inflammation. We’ll see more of this trend shortly.
In addition, his DHEA-S levels were slightly low – suggesting adrenal stress. He didn’t drink that much coffee, but his day to day life business work was highly stressful. Decreased DHEA-S levels are associated with low sex drive and low mood.
All Roads Lead to Insulin Resistance
One major thing that stood on his test was his elevated glucose (blood sugar) and fasted insulin levels.
His levels are high given the test was done fasted first thing in the morning. This indicates he has poor blood sugar regulation. And for some reason, he’s not metabolizing carbohydrates effectively.
These are the first signs of insulin resistance and the road to type 2 diabetes. Indeed, studies indicate that low testosterone is associated with insulin resistance and an adverse lipid profile.
We’ll see later that his lipid profile (i.e. cholesterol markers) is not great. Therefore, it comes as no surprise that he had low testosterone, as cholesterol is a necessary precursor for testosterone production.
High blood sugar and insulin resistance is the genesis of many disease states. In addition to low testosterone and diabetes; it’s also associated with obesity and heart disease. Evidence even suggests that high blood glucose levels correlate with tumor malignancy in cancer patients.
Dehydration and Low Stomach Acid
The blood test also indicated his kidneys were under stress. Specifically, he had elevated urea levels.
When the body breaks down proteins, they turn into carbon dioxide, water, and ammonia. Ammonia is toxic to the body, so the body converts it into urea. This urea is then transported to the kidneys and excreted through urine.
This young man’s urea was on the high side. Urea can be elevated in the presence of high dietary protein intake. However, his protein intake was not dramatically high.
High urea can also be due to dehydration and low stomach acid. And given he had immune system issues; low stomach could have been a possibility
Stomach acid is vital to kill pathogens in foods. This stops you from getting bacterial infections and viruses. So if you have low stomach acid, this can compromise your immune system. Evidence suggests that up to 70% of our immune system is found in our gut – so this makes total sense.
He also had elevated hemoglobin, further demonstrating that he was likely dehydrated.
I also had reason to believe that he had digestive tract issues due to decreased globulin levels. Globulin are proteins in the blood that serve as the body’s antibody system.
Decreased globulin levels are associated with digestive system inflammation and immune deficiency.
As part of his diet, he mentioned that he was taking protein shakes every day. Protein shakes can work well – but they aren’t for everyone. In some individuals it can lead to inflammation in the digestive tract. This is especially true if you’re lactose intolerant. This can cause bloating, stomach cramps, and diarrhea.
The report indicated he had low alkaline phosphatase (ALP). ALP is a group of enzymes found in bone, liver and the intestines. Decreased levels are associate with zinc deficiency.
Zinc contributes to numerous vital functions in the body. Zinc deficiency is associated with low testosterone, low sperm count and immune system dysfunction.
Low zinc levels can also lead to sugar cravings. This means more you’re more likely to binge on sugar and junk food. Therefore, zinc’s importance cannot be overstated.
As part of his metabolic panel, we also did a test known as the “anion gap.” Basically, the anion gap checks the level of acid in your blood. Elevated levels are associated with metabolic acidosis and thiamine (vitamin B1) deficiency.
Vitamin B1 is essential for glucose metabolism. Remember his glucose and fasting insulin levels? Among other things, thiamine deficiency may help explain why his glucose was high.
We also discovered he was low in folic acid (vitamin B9). Folic acid deficiency can lead to fatigue, lethargy, and irritability. And guess what? He suffered from all these symptoms.
Now that’s not to say folic acid deficiency was solely responsible for how he was feeling. Nonetheless, it’s important to note it’s not just low testosterone that could contribute to the way he was feeling.
Cholesterol and Inflammatory Markers
Chronic inflammation is the underpinning of all disease. Although not all inflammation is bad. Acute inflammation is key to muscle growth, because it helps them grow back bigger and stronger.
This man’s lipid panel (cholesterol markers) and inflammatory markers pointed once again to high inflammation. Low testosterone is associated with high levels of inflammation.
When you’re inflamed, the last thing your body wants to do is produce testosterone.
His inflammatory markers showed elevated levels of c-reactive protein (CRP). Increased levels of CRP are associated with heart disease, diabetes, and stroke.
In addition, he also had high homocysteine levels. Homocysteine is an amino acid found in the blood. Elevated levels can increase the risk of heart disease, as it can damage the endothelial lining of the arteries.
High homocysteine is associated with vitamin B deficiency. And as we know in this case, he has multiple vitamin B deficiencies. Therefore, it’s no surprise that homocysteine is elevated.
The blood test showed he had low cholesterol. Low cholesterol is a strong indicator of inflammation and oxidative stress.
Decreased levels of HDL cholesterol are considered to be atherogenic, leading to the accumulation of fatty deposits in the arteries. This is the prelude to heart attack and stroke.
For most people, the elevation of LDL cholesterol, also known as “bad” cholesterol, is the issue. In this case however, LDL cholesterol is on the low side.Low LDL cholesterol is associated with anxiety and depression; two symptoms he also struggled with.
Due to a high saturated fat western style diet, many people have high levels of triglycerides. Interestingly, his triglycerides were on the low side. Triglycerides are a storage molecule for fat.
This points to a few possibilities. It could be the result of liver dysfunction, however his liver markers were good. It may also be the result of not enough dietary fat.
it appears he gets adequate levels of fat through his diet. The remaining alternative is guess what? Excess inflammation.
Inflammation is a recurrent theme with this gentleman. And if he doesn’t get it under control, it will lead to serious health problems.
Arguably, you could say he already has serious problems. But I contend this is just the tip of the iceberg. Remember, this guy is only in his early 20s!
Immune System Issues
The blood test pointed to issues with his immune system function. His monocytes and eosinophil levels were both elevated.
Monocytes are a type of white blood cell. They act as the body’s second line of defense against infection. They also facilitate healing and repair. High levels of monocytes can point to the recovery phase of an infection.
For example, if you have the flu a few days prior to taking the blood test, then this may elevate monocytes. Alternatively, this could mean you have a chronic infection.
Eosinophils are another type of white blood cell. They fight disease and are typically elevated in the presence of a parasitic infection, allergies, or cancer.
It’s possible something in his diet is aggravating his gastrointestinal tract. He may have an allergy or sensitivity to the food he’s causing, which may require further testing.
But given he has elevated monocytes, eosinophils AND low white blood cells, it’s possible he has a parasitic infection.
Many people suffer from parasitic infections without knowing it. H.pylori is the most common type of bacterial infection, and can be tested for via a stool test.
In my book Optimized Under 35, I wrote about how parasites and infections can actually disrupt hormone production:
Research suggests that, in addition to fungal infections, parasites such as roundworm and tapeworm can cause endocrine disorders. Multiple animal studies have shown parasitic infection to affect sex hormone production (i.e., lower testosterone) and dramatically affect sexual behavior. Anecdotally, in humans it can cause fatigue, joint pain, and anxiety.
This individual would require further testing to determine whether he had a parasitic infection.
Most stool tests check for h.pylori only. However, there are a whole host of parasitic infections out there. So it’s better to spend money on getting a thorough test done to rule out other possibilities.
Oxalates Are No Bueno
Remember how I said earlier that his diet looked great but it really wasn’t? Well, he was taking in raw spinach every day from a green smoothie. Most people think this is a great idea, because green veggies right?
Actually, eating raw spinach is a bad idea because it’s full of oxalates. These are natural pesticides produced by plants to ward off pests. However, research suggests that oxalates can have a very negative effect on your health, which include:
- Neurological issues, leading to sleep disruption and memory loss
- Increased calcium excretion
To find out more on the hidden dangers of oxalates, I recommend you read this excellent article: Health Dangers of Oxalates.
According to nutrition and functional health expert Paul Burgess, eating spinach every day with its oxalate content could do considerable systemic damage. This is potentially what’s happening here.
Research suggests oxalates can also impair mitochondrial and monocyte function. As we saw above, he had elevated monocyte levels. It could be a parasitic infection, or it could be due to his oxalate intake.
We didn’t cover every single blood test marker here. Many of this man’s results were very good. However, he had multiple underlying issues.
He had low testosterone, but as you an see, low testosterone was the least of his problems. And it was likely a result of everything else going on in his body.
Taking a medication like clomid or testosterone replacement therapy (TRT) would not have fixed things for him. It would have only masked the underlying problems he had.
This is why I say TRT is only for those who need it.
Time and again, I’ve seen guys go on TRT, only to still struggle with fatigue and other symptoms that they had before it.
Instead of worrying about TRT, this man needed to spend time on reducing the inflammation in his body. His stress levels need to be managed better, because that’s clearly having a profound impact on his health.
Similarly, we would have to look into what causing his immune system issues.
He would also need to address his probable low stomach acid, which would lead to malabsorption of nutrients. Even if your diet is immaculate – ultimately you aren’t what you eat, but you are what you absorb.
Getting this man into a good place could take anywhere from 6-12 months – possibly more. We’d have to overhaul many aspects of his lifestyle, including his nutrition, exercise regime, and improve his sleep.
But 6-12 months of getting this right is far better than the alternative:
Taking medication isn’t going to fix you if you don’t address what got you into that state in the first place.
In the end, he chose not to work together with me. I understand he was very busy at work – and that’s fine. Although I dread to think how his health is going to be in the near future unless he changes something.
If you can relate to this story and recognize many of the symptoms, get in contact with me about my 1on1 coaching. We can take you through a comprehensive blood test and find out what’s really going on inside your body.
Ferrari C, Barbieri C, Caldara R, Mucci M, Codecasa F, Paracchi A, Romano C, Boghen M, Dubini A.”Long-lasting prolactin-lowering effect of cabergoline, a new dopamine agonist, in hyperprolactinemic patients.” J Clin Endocrinol Metab. 1986 Oct;63(4):941-5.
Vakkat Muraleedharan and T. Hugh Jones. “Testosterone and the metabolic syndrome.” Ther Adv Endocrinol Metab. 2010 Oct; 1(5): 207–223. doi: 10.1177/2042018810390258.
Ge Cui, Ting Zhang, Fan Ren, Wen-Ming Feng, Yunliang Yao, Jie Cui,Guo-Liang Zhu, and Qi-Lin Shi. “High Blood Glucose Levels Correlate with Tumor Malignancy in Colorectal Cancer Patients.” Med Sci Monit. 2015; 21: 3825–3833. Published online 2015 Dec 8. doi: 10.12659/MSM.894783.
Patel M, Yarlagadda V, Adedoyin O, Saini V, Assimos DG, Holmes RP, Mitchell T. “Oxalate induces mitochondrial dysfunction and disrupts redox homeostasis in a human monocyte derived cell line.” Redox Biol. 2018 May;15:207-215. doi: 10.1016/j.redox.2017.12.003. Epub 2017 Dec 15.