ED or “Erectile Dysfunction” is the persistent inability to achieve and or maintain erection for satisfactory sufficient sexual performance. This can be can by problems associated with physical, phycological or both.
Male infertility is the reduce inability to conceive due to poor sperm function, low hormone levels and other factors.
Andropause is an absolute or relative deficiency of testosterone or its metabolite often accompanied by ED, fatigue and mood changes.
These problems are not rare, having 1 in 5 men who experience these problem at any age. Risks also increase with age and other health problems such as diabetes.
Functions Of Testosterone
- Sex hormone
- Needed for normal sperm development
- Involved in the making of protein’s and muscle formation
- Help build bone
Physiological & Cognitive Functions of Testosterone
- There are many receptor sites across the male body
- Help to regulate acute HPA responses (Hypothalamic-Pituitary-Adrenal (HPA) axis) when under pressure
- Helps regulate cholesterol
- Helps maintain powerful immune system
- Improves mood and mental focus
- improves oxygen uptake throughout the body
- Helps control blood sugar
Low testosterone affects
- Fatigue / tiredness / loss of energy
- Weight gain
- Increase cholesterol
- Insulin resistance
- Diabetes
- Metabolic syndrome
- Mood (Depression, anxiety, anger, bad temper, nervousness, poor stress repsonse)
- Cognitive function (Loss of memory or concentration)
- Sexual health (loss of sex drive or libido, loss of erections or problem during sex, decreased intensity of orgasms)
- Physical changes (General pain, aches, stiffness, weakness, loss of fitness for unknow reasons, bone loss)
- Metabolic changes
Erectile Dysfunction – The Important Early Warning Sign of Bigger Problems
Erectile dysfunction “ED” is an early indicator of other serious health problems that should not be ignored due to ED being an early waring sign of cardiovascular health problems such as cardiovascular disease, coronary artery disease and or metabolic health problems. Men who experience ED have a 40-50% higher risk of cardiovascular events, this is why its important to take an advanced cardio test if you have experienced ED.
ED’s Link to Brain Circulation
Testosterones is crucial in protecting brain health by delaying neural brain cell death. Reduced circulation can cause both ED and lead to increased impairment of the brain such as reduced memory, impaired learning ability and cognitive decline, so its important to recognize that ED can be that perfect early warning sign to diagnose circulation problems and factor in any cognitive decline that may stem from reduced testosterone levels.
Think of ED as less of a stand alone problem and more of a symptoms of more systemic health imbalances. Therefore we need to understand more about vascular health and advanced hormones markers.
Causes of Low Testosterone
The functional causes of low testosterone are associated with primary hypogonadism, this is the testicals themselves. Hypogonadism occurs when the testicals fails to produce enough testosterone due to a functional problem such as:
- An autoimmune disorder
- Testicalar infection
- Undescended testicals
- Testicular injury
- Reproductive surgery
- Heamochromatosis
- Poor temperature control
- Genetic conditions
- Poor health (toxic load that influences the endocrine system)
The functional causes of low testosterone are associated with secondary hypogonadism, this is a problem where the brain has problem communicating with the testicals themselves via the pituitary gland or hypothalamus such as in head trauma or a related tumor.
There organs cause the production of Luteinizing hormone LH and or follicle stimulating hormone FSH that signals the testicals to produce testosterone. In addition if there is overproduction of prolactinoma this can reduce testosterone production.
Chronic opioid & or anabolic steroid use also reduces testosterone production by shutting down natural testosterone production. Signs of secondary hypogonadism include:
- Decreased libido
- Erectile dysfunction
- Infertility
- Reduced muscle mass
- Fatigue
The functional causes of low testosterone are associated with late onset hypogonadism, this is an age related decline in testosterone levels primary related to the hypothalamic/pituitary dysregulation due to aging, chronic illness and or inflammation.
- Low libido
- Depression
- Mood changes
- bone loss
- Decreases in strength, agility
- Loss of memory
Metabolic Causes of Low Testosterone
There are a number of metabolic causes for low testosterone, lets explore these. Metabolic causes are a significant contributor to loss of testosterone and hypogonadism.
Obesity, particularly visceral adiposity plays a key role by increasing aromatase activity, aromatase is the key enzyme that catalyzes testosterone into estradiol, this also suppresses testosterone production and lead to estrogen dominance in men.
Elevated insulin also stimulates aromatase activity making more estrogen out of your valuable testosterone. Elevated insulin also suppresses sex binding globulin and then binds to testosterone limiting it ability to work.
Insulin resistance also causes low grade chronic inflammation, it also increases IL6 and TNF alpha which are immune and inflammation markers that inhibit methylation, increases cortisol (stress) and cortisol then inhibits testosterone.
Systemic Causes of Low Testosterone
Cardiovascular disease and low testosterone are a double bind, meaning both these problems can cause each other.
So its important to remember the depth of the problem, that low testosterone can be cause by:
- Visceral adiposity
- Insulin resistance
- Elevated inflammatory markers
- Endotherial dysfunction (A lack of vasodilation/poor circulation)
- Hemochromatosis (excess iron can inhibit the pituitary and testicals)
- Hypothyroidism (Via suppression of hypothalamic secretion of gonadropin releasing hormone GnRH increasing prolactin
- Metabolic effects (weight gain, type 2 diabetes, insulin resistance)
Chronic Hypothalamic – Pituitary-Gonadal Axis Stress
- Chronic stress & high cortisol
- Depression & anxiety
- Exhaustion & overtraining
All can lead to low testosterone production.
Medications that cause low testosterone
There are many medication know to disrupt testosterone production, these include:
- Steroids (Glucocorticoids – Prednisolone)
- Opioids (Codeine & Morphine)
- Antifungal medications
- Some anti acids medications
- Spironolactone
- Chemotherapy
- Alcohol (Especially beer which has high levels of estrogen due to the hops plant used to make beer)
Life Style Factors for Low Testosterone
- High sugar intake and processed foods
- Excessive alcohol consumption
- Calorie restriction
- Zinc and vitamin D deficiency
- Low protein and low healthy fat intake
- Sleep quality and quantity and lack of deep sleep (including sleep apnea)
- 70% of testosterone production is made while you are asleep which peaks toward the early morning.
Environmental & Chemical Exposure That Cause Low testosterone
The following are considered to be testosterone inhibitors by interfering with the hpg access (Hypothalamic-Pituitary-Gonadal (HPG) axis (a system in the body regulating reproduction) and androgen activity, these are therefore linked to male infertility:
- Bisphenol A (BPA)
- Phthalates
- Pesticides / Herbicides
- Heavy metals
Key Recommended Tests for Low Testosterone
Male hormone profile is a Saliva hormone test that measures free bioavailable hormone levels in their active form, this is useful when total testosterones looks normal but symptoms suggest testosterone deficiency.
Dried urine hormone test measures metabolized hormones, also metabolites which shows how the body processes testosterone and establishing if there is over converting of testosterone to estrogen or aromatizing into estrogen.