T Nation

Need Help Lowering Test Levels


#1

I have been reading the site learning a lot about TRT. I had all the symptons of low test so I had my doc do some bloodwork. My Test came back at 284 with a reference range of 250-900. Because it wasn't below the range he wouldn't help me out. I am going to a new doc in a couple of days to have more bloodwork done, and I don't want to have the same problem again.

I was wanting to try and lower my Test enough to put it out of range so the doc and my insurance will be more cooperative. Does anyone know what I can do to drive it down besides alcohol and lack of sleep?


#2

Not sure if you've already ready it or not, but this article by Cy Willson should offer some ideas.

http://www.T-Nation.com/readArticle.do?id=459887


#3

Damn, I was having a great day until I read Cy Willson's article. I am an "evolved" doctor, on HRT myself, but the few open minded doctors there are out there will burn out if they get an onslaught of drug seekers well trained in presentation. I burned out in psychiatry due to amphetamine-seeking young woman who manufactured classic ADHD, opiate seeking adults with MRI's showing herniated discs which didn't hurt, benzo junkies with DSM-IV textbook panic disorder, and on and on.

Look, the guy at 284 is LOW, and needs treatment, so I don't have a problem with his quest. But are you twenty-somethings out there with no low T symptoms thinking about trying the Cy Wilson protein fasting, alcohol binging routine to get your gear? If so, stay on the black market, please.

#4

Or you could do the very opposite of that program for pretty much free:

Reduce carbs (thereby increasing insulin sensitivity), increase good fats, don't drink alcohol in large quantities, sleep enough, get enough magnesium and essential oils in your diet and make sure you get enough vitamin D, which aids in pituitary and hence hormone regulation.


#5

I suspect that taking some birth control pills would down reg the HPTA. But if the doc tests for E2 progesterone or total estrogens, the game may be up. I have not seen anything written about doing something like that. But as many men age, E2 tends to increase and that does lower TT.


#6

I always cringe when I see people turn to hormone therapy, as we just don't have a full understanding of the complex ways in which hormones interact and their impacts on all the body's systems.

It may be necessary for some people, but given that there are potential risks (and based on recent medical history, there are are almost certainly risks we don't know), I'd want to start with more benign, modest approaches first.

First, like someone with borderline cholesterol concerns (setting aside, for the moment the debate about whether or not cholesterol is really the problem in cardiac health), I'd want to make sure that I had taken appropriate dietary and fitness steps, and then after giving these a fair chance, see how things are going. Do the symptoms you think indicate a problem persist or ease? Do your blood levels improve or not? Et cetera.

On diet, making sure I was eating clean, getting good fats, and cutting down on processed foods and foods that might contain hormone disrupting substances.

On the latter, I'm not thinking so much of individual foods, but on foods that may be coming with residual pesticides and accumulated environmental toxins, some of which can have important impacts on the body's hormones and hormone regulating processes.

Eating a lot of animal fats that have been fed hormones, and God knows what other garbage, on top of the normal bio-accumulation of a number of fat-soluble, hormone disrupting toxins that comes from eating a lot of fat up the food chain, could be having an effect on your body's hormones. Like a lot of other health matters, you may be more sensitive to some of these than others.

The point is to try to limit your exposures by reaching for organic foods, especially fatty foods and pre-processed foods where there may have been no attempt to really wash pesticide/herbacide/fungicide residues off crops before throwing them into the industrial-sized mixing bowl. This may or may not have an impact on you, but it seems a prudent step before you go messing with your hormonal balance.

Are you overfat or relatively lean? Low testosterone can contribute to difficulty gaining muscle and staying lean, but you also may find that with some hard dietary and exercise work that getting leaner has a positive impact on your testosterone levels.

I haven't seen enough literature on this subject to make anything approaching a strong claim, but we know that body fat can influence hormonal levels and hormonal balances, and that lower body fat likely shifts some balances in a positive direction, e.g., estrogen to testosterone levels.

Again, this isn't an area of done a lot of investigation into, but more based on my recollection of literature I've come across in looking into other issues, but at a minimum it might be worth a perusal through the medical literature, and Dr.PowerClean can probably add his more-informed two cents on the subject.

Obviously, there is a chicken and egg problem in that trying to get fit and healthy can be a problem if you have low energy from an underlying hormone/metabolic problem. You don't say if you've been exercising regularly, what you are doing exercise and diet wise, and for how long you've been doing them. If you see no improvement from changing diet and struggling to get your exercise, then consider further intervention.

At that stage, I wouldn't want to trust my general practitioner to give me a good treatment plan. I'd seek out a specialist whose practice is metabolic medicine, who is keeping up with the latest relevant literature, and who would be best suited to work with you to figure out just what is going on and how to treat it.

They are more likely to see the big picture and look for conflating or aggravating conditions, develop an effective treatment plan to address your particular situation, and understand the limits, side effects, and management issues in such a plan.

Regardless, if it were me, I'd want to sit down with whatever doctor you work with and ask about any long-term health risks a treatment may have, how you might be supplementing (not in the sense of taking more pills but in the adjuvant sense of the word) any treatment with diet and/or exercise, what contraindications there are to a therapy (as doctors don't always know everything about you, so it is good to have them run through these to make sure that there isn't something relevant that you overlooked telling them), and what side effects there might be.

I've just had too many experiences with doctors willing to prescribe lots of pills without fully disclosing what the potential risks are, or admitting levels of uncertainty about our understanding of a certain area of human physiology or a lack of understanding about how the particular mix of medications you would be taking affect us.

If nothing else, a doctor that isn't willing to give you the time to talk about these issues or dismisses your request for the information that allows you to participate in the decisions about your health, might have you considering a second opinion or seeking out a different doctor for your care.


#7

Lots of good advice.

"Obviously, there is a chicken and egg problem in that trying to get fit and healthy can be a problem if you have low energy from an underlying hormone/metabolic problem. You don't say if you've been exercising regularly, what you are doing exercise and diet wise, and for how long you've been doing them. If you see no improvement from changing diet and struggling to get your exercise, then consider further intervention."

This is where mind over matter comes in. You must force your body to correct. In order to do this you must work it, and work it hard. If you clean everything else up it will respond. If not, then HRT is only a last resort, and even then does not resolve you from doing what you should be doing anyway.

DJ


#8

You want lower test? Watch Dr. Phil.


#9

The issue here is that doctors, quite rightly, focus on getting poor health back up to around the average, or even below average provided it isnt poor!

Its not aiming very high, doctors arent the right people to ask about optimising health, theyre going to be too busy with real ill people, the whole system is set to up catch folks on the way down in health not average people trying to go up - as a general rule.

The reference levels are probably too low in this case. Sure you can carry on through life, even with lower T levels, without being in "poor health" and so not really hitting the doctors radar but that isnt good to hear, and in many ways i tend to agree with people who refuse to accept their lot and want more.

Bending the rules to get onto TRT is a sly move and the doctor isnt to blame at all, there's no deliberate barrier. Having said all that what i'd like to know is if a person has low T is that the new homestasis or would the body make more if it could, i.e. is something holding it back? That's where the overall benefit would come - improving all systems to allow more optimal hormone levels naturally.

What actually causes T to drop with age - and i mean from 20's to 60's rather than from 20 to 97. From a lower level of understanding of physiology there doesnt seem a really good reason for the body to lower hormones that significantly if an otherwise healthy life is lead.


#10

FWIW the original poster's test level is LOW -- there is something wrong here that can't be solved by more "benign approaches."

What you say makes sense perhaps for a man in his 50s with a test level of 500.

But OP needs to see an endo and get figured out what is going on here.

I have primary testicular failure. My testicles don't work any more.

My first indication was when I got a test level back that was more or less exactly like the original poster. A year later it was down even more and that was a year wasted that I could have been in treatment. "Benign approaches" did nothing for me.

==


#11

The body's sex hormone control system is imperfect. T levels are not controlled. The feedback loop uses the negative feedback pressures of the combined T, E2, estrogen metabolites, DHT and progesterone. The mix of those can change and the feedback mechanism does not care.

So some gain weight and get fat, fat leads to more E2, more E2 leads to more fat, the E2 reduces LH and T output. Meanwhile as one ages, SHBG increases, DHEA and GH reduce. Increased SHBG reduces the percent of FT against falling total T. And there are some aging effects going on as well.

Falling DHEA also has many [not well understood] effects and dropping HG and IGF-1 levels slow down all of the cells/organs in the body, and cells are not replaced as they should be.

So less %FT of less TT, from the effects of E reducing LH and SHBG increased SHBG bound T. Increased E competes with T at receptors, reducing the effects of what FT exists.

Even with guys who remain lean and otherwise healthy, T drops and relative amounts of E2 can be harmful even if absolute E levels are not abnormal.

There is some kind of link to cholesterol. What is the feedback mechanism for cholesterol? That is not known, but with age as T drops, cholesterol increases. That alone does not imply any cause and effect relationship. But when guys with low T and elevated cholesterol levels are put on TRT, cholesterol levels can be greatly improved.

That implies some kind of cause and effect. The mechanism is not known. I suspect that it may be internal the the liver.

The testes also age. Healthy men with low T often have elevated LH as the system tries to get more T out of testes that are not doing the job. With age, LH production can simply not be there or not elevated when the testes are weak. Time plus low hormones can make all of the body less responsive and leads to faster aging.

Part of this and aging processes in general involves the damage of proteins reacting with glucose to produce advanced glycation end products... abnormal. This and cholesterol contribute to endothelial dysfunction. That affects the circulatory system and impairs the exchange of nutrients and toxins which degrades organ function.

The hypothalamus, pituitary and testes can be affected. The liver ages too and it then does not metabolize and remove E2 in a youthful manner.

Aged cells are not renewed and cell walls often have too many omega-6 fatty acids and cell wall permeability suffers. Reduced nutrient and toxin exchange at the cellular levels leads to more free radical damage to the cells and to the mitochondrial. Mitochondria age and cellular vitality suffers.

Your health cannot be any better that the functions at the cellular level. This is a major factor in aging and it affects many things such as the systems that produce and control hormones.

The above is quick and dirty and would need a few good books to be covered in detail. All of these degradation mechanisms impair systems that lead to faster rates of damage... a downward spiral.


#12

Thanks KSman, interesting and depressing at once! I'd read about the increase of SHBG with age but wasnt fully apprised of some of those other factors. Aging is really out to get us!

the sad thing is that there are three options. 1) Accept the downward spiral and 'make do',

2) attempt a healthy lifestyle and slow the spiral down, at least up to a point.

3) Take TRT and compensate your own system, even if it may involve some health risks.

i don't like #1 at all. #2 sounds great except that in reality no amount of supplements and exercise will undo damaged systems - it's good but marginal. That leaves #3 for any man getting into 'old man' T levels and wanting some kind of physical vitality in older age.

My guess is that (stupid old!) feedback would still supress what little is left of the natural system in many cases even with modest TRT.

Any studies confirming recovery in natural T levels in older men, e.g. from exercise or dietary changes?

Of course some may be lucky and maintain genuinely adequate T levels all their life, well into 70's and beyond.


#13

The OP now has borderline low T levels but still within the normal range. He did not tell us any other information other than saying that he had unspecified symptoms that might be the result of low T levels. He then asked for how to trick a doctor into giving him TRT. You statement assumes that he has exactly what you had and therefore will not benefit from less risky strategies.

He did not say whether he drank or had made sure that he was not taking any medications, or whether he drinks, or is over fat. All these can contribute to low T levels. He hasn't specified whether he is already exercising regularly or has cleaned up his diet, including cutting animal fats (as there are extensive studies about contamination with hormone disrupting chemicals in these). Stress is another supressor of T levels. Taking care of any combination of these might make more than a marginal difference.

There are, of course, many other possible causes or contributing factors in low T levels other than hypogonadism (what you have) that will need to be eliminated. There are other possible illnesses which could contribute to a lower T level. The pituitary and thyroid can impact T production. All will need to be explored (as our shared advice on seeking out a specialist will do, hopefully).

Even if he none of these produce markedly higher T levels, there is also not necessarily a causal relationship between this and any of his symptoms, which could be the result of so many other possibilities, and which TRT would not necessarily address.

Are you suggesting this hypothetical person has low T levels and would benefit from raising it? If so, I'm not aware of any medical evidence to support your belief, and that trying to raise this person's T levels might produce an increase risk of several health problems?

We definitely agree on this, although in looking back at my post, I did not make this view clear (only that the OP should not be going to their general practitioner for this), so I'm really glad you said this. Besides endocrinologists (the most likely specialist), there may be a gerontologist in the area who specializes in metabolic aspects of aging that might be a good doctor for this.

Sorry to hear this, but I'm glad you've found the problem and something that helps. I lost a nut to Testicular cancer about 11 years ago and have had to keep an eye on my T levels. Being somewhat of an obsessive-compulsive on knowing what is going on with me and having learned just how little most doctors know about the latest studies on a condition (let alone studies on nutrition and lifestyle influences on health and illnesses), I've done a lot of reading on the subject. It is amazing how much we don't understand about the interactions of our glands and hormones and what the full impacts of tinkering with just one are. Fortunately for us, with so many men going on TRT in the last several years we are going to learn quite a bit about the long term effects of this therapy. Hopefully, it will be mostly good news, and no seriously bad news like women learned after a number of years of the mass experiment of so many woment being put on estrogen replacement therapy.