Is It Really Hypogonadism?
Technically, hypogonadism is the failure of the testicles to produce sufficient testosterone to keep a man’s body healthy. Testosterone levels decrease in a man’s body as he ages, but a drastic loss of the hormone can create a wide variety of health problems. Unfortunately, hypogonadism is usually the diagnosis whenever a blood test returns a low testosterone score, even though the cause may not even originate in the testicles.
Some of the causes of low testosterone can be aromatase activity on the testosterone molecule, converting it into estridiol. Another cause could be too much sex hormone binding globulin (SHBG) which interacts with testosterone to render it inert. Another cause could simply be a low production of Luteinizing hormone (LH) which is the signal to the testicles to produce testosterone. Low blood flow into the genitals can also return a low testosterone score. Even a low intake of essential minerals such as zinc can lower your testosterone levels.
If your doctor has determined that you are suffering from hypogonadism based solely on a testosterone level, then your case was not given the attention that it deserves. Here are some things to consider:
Aromatase is an enzyme which increases in our bodies as we age. The unfortunate aspect of this enzyme is that it converts testosterone into estridiol, an estrogen (female hormone). If you are overweight and have “man boobs”, you should press your doctor to check your estridiol 17 levels. If your estridiol levels are high, then there is a very distinct probability that an aromatase inhibitor may help get you back on track.
Sex Hormone Binding Globulin (SHGB) is a molecule synthesized in the liver which “locks up” testosterone in such a way that it cannot be used by the body’s testosterone receptors. Your testicles may be pumping testosterone into the system in large quantities, but if SHBG gets to it before it can be utilized by the body, it will appear that you are not producing enough testosterone.
Luteinizing Hormone (LH) is a hormone that is produced in the pituitary gland and is a messenger to the testicles, telling them how much testosterone to produce. Even though your testicles may be quite capable of producing testosterone, they won’t do it until the LH has been received from the pituitary gland. There could be a problem with the gland such as a tumor or cyst. Low LH can often be reversed with inexpensive over the counter hormones such as Melatonin.
Because blood carries the LH from the pituitary gland into the genital region, it is only logical that proper blood flow to the genitals is essential. Poor exercise, improper diet, being overweight can all lead to poor circulation which can lower the amount of LH the testicles receive, thereby decreasing the amount of testosterone produced. Exercise and proper diet can dramatically improve your testosterone score. If you are in a job where you spend a majority of your time sitting then walking or jogging may improve your situation.
A diet high in minerals such as zinc is crucial to proper testosterone production. Eating a healthy amount of shellfish such as shrimp can only help. If you are allergic, don’t worry, most drug stores sell zinc tablets in the vitamin section (and they are a lot cheaper than shrimp).
A blood test for testosterone should look for Testosterone, Estridiol 17, LH, and SHBG.
Here are some scenarios where close attention could have been paid.
John has low testosterone levels, even after three months of replacement therapy with a testosterone cream, his testosterone levels are low. He is not responding to therapy well. He takes a blood test which shows that his estridiol levels are high. His problem: aromatase is converting testosterone into estrogen. He is given an estrogen blocker and he begins responding to the testosterone replacement therapy to the point that his testosterone levels are high. He eventually scales back his testosterone and continues taking the aromatase inhibitor.
Dave had a similar problem, but his doctor did test for estridiol 17 and everything came out normal, except for the testosterone. Dave’s doctor did not check for SHBG. Dave was producing testosterone and was responding poorly to testosterone replacement therapy. His SHGB level was high , locking up the testosterone before it could do any good.
Mark was tested with low testosterone. He ate well, tried to exercise, and still he showed low testosterone. What was unknown to Mark and his doctor was that he had a small growth that was putting pressure on the pituitary gland, limiting the amount of LH that could escape into the bloodstream. His testicles were only producing testosterone in quantities determined by the limited flow of LH.
Dan was an overweight truck driver who ate poorly and spent most of his time sitting behind the wheel of a tractor trailer. He was diagnosed with low testosterone. Many times low testosterone can cause weight gain, but in Dan’s case, the weight gain caused the low testosterone. Due to poor diet and lack of exercise, the blood flow into the gonads was enough to keep the cells alive, but not enough for them to receive and process the LH sent by the pituitary. A good diet and regular walks improved his situation without the use of drugs. An added bonus to him was that as his weight went down, his testosterone concentration rose because of his lowered body weight.
So, if you have been diagnosed with hypogonadism, make sure that your doctor has run all of the testing required to determine the nature of your particular case.