Why Testosterone Levels Are Falling And What You Can Do About It

Testosterone levels naturally decline as we age. There's a problem though...current data shows that the decline is actually happening much sooner and more acutely than normal.

In this article I'll discuss how the natural decline happens and why it's happening sooner and more drastically than times past.

In the last article we discussed what testosterone is, how it's made and what happens when it gets too low. Click here to read that article.

What Causes Low Testosterone

You can divide low T into two main categories. Primary hypogonadism and secondary hypogonadism.

Primary hypogonadism - The issues are in the balls.

Some examples of primary hypogonadism are gene mutations that affect the development and function of the testes. Other causes are:

1. Trauma

2. Toxicity

3. Tumors

4. Castration

of the testes.

Secondary hypogonadism - The issues aren’t in the balls, they’re in the brain…the hypothalamus and pituitary to be precise.

Some examples of secondary hypogonadism are gene mutations affecting the hypothalamus and pituitary gland, as well as trauma, tumors, and toxicity affecting the hypothalamus and pituitary.

There’s one last category of T deficiency that technically isn’t a deficiency at all. There are two main types of this.

The first is where a gene mutation either reduces the number of testosterone receptors throughout the body or changes their shape so testosterone can no longer bind as strongly to them. This makes testosterone levels almost irrelevant since they can’t do their business if they can’t insert their key into the biochemical locks.

The second is where you make too much of a specific type of protein called Sex Hormone Binding Globulin (SHBG) which binds up too much of your free (usable) testosterone (Tf). So, basically what happens is the testes are producing more than enough testosterone, but it’s just not able to be used properly.

Men who have been told by their doctors that they have "normal" total testosterone can actually have a functional deficiency if their Tf is too low. Unfortunately most primary care doctors and even urologists / male health doctors only order total testosterone (TT) and overlook the easy and inexpensive Tf test.

Too many men I work with tell me their doctors have said their testosterone levels are normal which isn't the case when we do a bit more digging. More about this later.

There! I literally summarized a 2-3 hour medical school lecture about hypogonadism in under 90 seconds.

I’m sure you noticed a pattern that for both primary and secondary hypogonadism the recurring themes are genes, trauma, toxicity, and tumors. One factor many medical texts leave out when describing the causes of hypogonadism is lifestyle, which, outside of a medical context, is the one thing we have the most control over.

So to make it easy let’s just group all causes of low testosterone into 5 categories:

1. Genes

2. Trauma

3. Toxicity

4. Tumors

5. Lifestyle

There are of course exceptions, but these are the most common, and for our purposes, the most actionable.

Genes

Genetics are very complicated and an in depth discussion is outside the scope of this guide but I’ll do my best to summarize. For most healthy men without major genetic androgen disorders there is going to be a natural difference in the genetic expression of testosterone between men. This will affect certain developmental characteristics and personality traits.

Men with larger frames and more natural lean muscle mass generally have more testosterone than those of us with smaller frames and who need to work out consistently in order to keep from looking like a stick-man Santa Claus….sometimes that’s just the breaks.

Genetic diseases, on the other hand, can affect your hormone balance through issues with production, or issues with binding.

What this looks like is:

1. Not producing enough testosterone because of dysfunctional Leydig (testicular) cells or abnormally low testicular volume.

2. Producing way too much testosterone (not very common).

3. Not producing enough healthy receptors for the testosterone to bind to.

4. Producing too many proteins like SHBG, which reduces the amount of free (usable) testosterone (Tf) in your blood even though your total T (Tt) can be normal or elevated.

There are also some gene-mediated autoimmune conditions where your body actually attacks your hypothalamus, pituitary, or testes. The 4 gene-mediated deficiencies above would normally be diagnosed in childhood or adolescence.

Autoimmune diseases, on the other hand, could show up later in life and can be diagnosed by a competent primary care doctor with training in internal medicine or immunology.

Low testosterone caused by an autoimmune-mediated inflammatory disease is not a common thing that most doctors look for when addressing low testosterone. This can be simply ruled out using a combination of your medical history and two routine blood assessments:

1. History - Personal history of an autoimmune disease.

2. History - History of maternal or paternal autoimmune disease

3. Labs - C-Reactive Protein (HSCRP)

4. Labs - Antinuclear Antibody (ANA)

Trauma / Injury

Direct trauma to the testicles, and conditions like orchitis (infection / inflammation of the testes), can hurt the testes’ ability to produce testosterone.

This can and should be diagnosed by a urologist. A common sign that damage to the testes is affecting testosterone production is that you would see:

1. Very low levels of total and free testosterone.

2. Normal to high levels of LH and FSH (the brain hormones that stimulate testosterone production by the testes) on a blood test.

3. History of injury to the testes.

Head injuries can also affect hormone balance. Head trauma from impact, concussion and percussion can damage the hypothalamus and pituitary gland.

Men suffer head injuries about twice as often as women do and it’s estimated that 30% of male athletes have had an undiagnosed concussion or traumatic brain injury (TBI).

While it may seem unlikely that your frequent head knocks from high school football or other high-impact, high-velocity sports is causing you to have low T, it shouldn’t be lightly dismissed. This is especially true if you have other symptoms of long-term TBI, a history of frequent concussions, or any time spent in a combat zone near explosives and artillery.

A recent study looked at the effects of concussions on testosterone levels in men and while the study size was small, it showed some compelling evidences that head trauma can lead to a reduction in testosterone production.

Side note: Aggression in men has been popularly associated with high testosterone. Not only is this patently false (more on this in later articles), but unprovoked aggression can be more common in men with low testosterone levels.

We also know from the many high-profile incidents of unprovoked aggression in men with Chronic Traumatic Encephalopathies (CTEs) that head injury can predispose men to violence.

If we take into consideration the findings in the study correlating head trauma with lower testosterone levels, it might be a stretch, but it could be the case that low testosterone could be one of the driving factors for overaggressive behavior post-concussion...just some food for thought.

Tumors

Tumors of the testicles can affect sperm and testosterone production, and while testicular cancer in middle-aged men is rare (10,000 new diagnoses in the US each year), it’s still something we should pay attention to.

Testicular cancer is easy to detect early by feeling for any irregular lumps or bumps each time you’re in the shower. This might seem overly cautious, but it’s a small investment of time to prevent a major health concern in the future.

Brain tumors on the other hand aren’t so easily identified or treated but can also be a reason for testosterone to be low….or even too high.

In adults, some clues that a hormone imbalance is being caused by a brain tumor are:

1. Frequent and intense headaches

2. Unexplained changes to mood

3. Sudden visual changes

4. Gradual loss of sensation or movement of the extremities

5. Loss of balance

6. Unexplained nausea and vomiting

7. Blood tests will often be far out of range in either direction meaning your LH, FSH, and Total Testosterone levels could be very high or very low.

While brain tumors are admittedly one of the rarer causes of low testosterone in men, it does support my rule that low testosterone is a "canary in the coal mine."

What this means is that:

1. Men should have normal testosterone levels for their age.

2. When they don't it should be a cause for concern and make the patient and the doctor pause and figure out exactly why.

3. Sometimes it can be simply explained by something like stress, poor sleep, diet, sedentary lifestyle, or another common cause, but sometimes it can point to a bigger problem that may have gone undiagnosed for a long time.

This is one of the reasons that simply "fixing" testosterone using hormone replacement therapy isn't my first approach.

In my opinion, It's better to figure out why the testosterone is low in the first place, address those factors, and then use exogenous testosterone if necessary or to assist the process of healing.

Am I being a little overly cautious? Probably. But, when it comes to my health and that of my clients I'd rather be proactive than reactive, especially when it comes to things like head injuries, autoimmune diseases, cancer and toxicity.

Toxicity

Our brain and our testicles are highly susceptible to damage from chemical, microbial, and environmental toxins.

The brain has a strongly inbuilt protective system called the blood-brain barrier which filters out many microbes and harmful substances such as heavy metals, plastics, pesticides, some drugs, and many other chemicals. Our testes, on the other hand, don’t have this robust filtration system so are even more susceptible to damage from microbial infections and toxicants.

STDs

Sexually Transmitted Infections like chlamydia and gonorrhea can cause swelling of the testicles which can, if left untreated, result in chronically low testosterone and sperm count. I often advise my clients to request an STD screening from their doctor at part of their annual or semiannual physical examine, even if they've been with the same sexual partner and/or regularly use condoms.

Viral, bacterial and other microbial infections of the genitourinary tract can be asymptomatic for years while causing damage to the testes or prostate without the person knowing it.

Now for the scary stuff....

Environmental Toxins

Chronic or high-acute exposure to environmental toxins and other chemicals can damage the testicles, causing low sperm count and low testosterone.

Toxic metals like arsenic, lead, and cadmium aerosolize on heavily trafficked roads which get into the air we breathe. Those same metals, plus petrochemicals, are washed from highways and into our soil and groundwater every time it rains.

The chemicals from pharmaceutical drugs make their way from our toilets and back into the circulation of our municipal fresh water systems. Yes, you are literally getting exposed to very small amounts of women’s birth control medication, antidepressants, and hundreds of other drugs, whenever you drink unfiltered city water…and every little bit adds up.

Synthetic pesticides, herbicides and other industrial chemicals regularly enter our food supply, and get absorbed through our skin through industrially-produced skin-care products. Even the receipts you get from the grocery store are coated in a chemical called bisphenol-A (BPA) which can absorb through your skin and into your bloodstream. Plastics get into our food and water through the widespread use of plastic water bottles and plastic lining for food storage containers. As a side note for plastics, most plastic products release estrogenic chemicals which could be another factor affecting testosterone levels.

Then there’s our microbiome…Our gut houses trillions of microbial cells that keep us healthy. Up until recently it was believed that gut microbes just help with digestion. This, it turns out, is actually one of the less important functions of our gut microbe colonies. They communicate with our brain and other organs through complex chemical pathways that affect our mood, regulate our growth, increase or decrease our energy, and regulate the production of our brain and sex hormones including dopamine, serotonin, and you guessed it, testosterone.

The three classes of chemicals I mentioned above (metals, industrial petrochemicals, and pharmaceuticals) are just a handful of toxins called endocrine disruptors ED, so called because they damage the endocrine (hormonal) systems in our body. Exposure to these endocrine disruptors have been linked to reduced testosterone levels in men.

In a recent statement by the American Urological Association (AUA) there is a concerning trend that baseline levels of testosterone are declining precipitously, not only in older men, but also adolescents and young men. This is definitely a cause for concern!

Of all the potential suggested reasons for this troubling statistic, endocrine disruption has been set forward as major cause for concern. Fortunately with knowledge and insight come power and there are some things you can do to protect yourself and your children.

When it comes to preventing testosterone deficiency from toxicity there are a few things you can do including:

1. Getting regularly tested for STIs if you're having unprotected sex with more than one partner or with someone who is having sex with multiple people.

2. Limiting direct exposure to industrial pesticides, herbicides and other chemicals.

3. Filtering your water.

4. Safeguarding your gut microbiome through your diet by eating a high-fiber diet.

5. Sweat regularly and heavily through vigorous exercise or regular sauna use.

6. Take supplements like N-Acetyl-Cysteine, Glutathione, or Broccoli Seed Extract to boost your internal detox systems.

Lifestyle

While we don't have much control over our genetics, trauma, tumors, or toxicity, the one place we have the most control over is our lifestyle. In fact, for the majority of men with lower than average testosterone levels, simple changes to sleep, stress, nutrition, exercise, alcohol use, and sexual habits can have major influences on your testosterone levels which in turn influence all the reasons a man would want to boost his testosterone in the first place:

1. Increased energy

2. Fat loss

3. Muscle gain

4. Improved cognitive function

5. Increased libido and strength of erection

6. Etc

Ok, I've made a command decision to stop this article here at 5000+ words. We'll continue our discussion about how lifestyle factors affect testosterone levels in the next article

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