Ask the expert: boys have hormones too which are getting pushed off balance. Here’s what you can do:
This article and podcast (!) with Dr Anand Patel is a look at the modern day issues that are hurting men’s hormones. We consider the major trends (whether or not issues are getting worse with our modern lives), what the factors are that are causing this and more importantly what we can do about it.
Men have hormones too - and modern life is pushing them off…
Male infertility, dropping sperm counts, low testosterone and even ‘moobs’ are all things that seem to be on the rise these days. We discuss all with Dr Anand Patel: Harley Street doctor at the Centre for Men’s Health, expert in male and sexual health and committee member of the British Society of Sexual Medicine. We talk about the causes, how to identify if you are affected and most importantly what you can do about it. We cover everything from the effects of skipping leg day, to soy, to waist circumference to sleepless nights and everything in between!
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Hormones are often seen as a ‘woman’s issue’, which is obviously not the case - hormones are fundamental to men’s health and they too are being pushed off balance. The good news however is that awareness is slowly changing. People are more aware of their bodies, are increasingly health conscious and health checks are becoming more ‘in Vogue’. There is still a long way to go but it is starting….
The bad news is that when it comes to men’s health there is an increasing life expectancy gap between men and women. Why? Men tend to deal with illness later than women, they still tend to ignore issues and seek out care later. Being proactive, not being afraid to speak to your doctor is key and something we need to do more of.
Personal awareness is key: being honest and aware when it comes to your own body as a man is important, it is happening slowly which is perhaps why we are seeing more data on hormonal/sperm count issues and more diagnoses - which are certainly on the rise. However, according to data testosterone imbalance impacts from 6 - 40% of men aged 30-70 yrs old so more diagnosis and awareness is unlikely to explain the full picture. Environmental and lifestyle issues are likely to play a contributing role.
Symptoms to watch for that indicate you may have a hormonal imbalance (specifically low testosterone):
The way and combination of symptoms that you may experience obviously varies from person to person (and confusingly they can also be signs of other issues) but, here are some things to watch out for:
Loss of concentration/lack of ability to focus
Sleepiness during the day
Erectile dysfunction (ED)
Loss of body muscle mass
Struggling to put muscle mass on in the gym
Easy fractures (impacts bone strength and density)
Mood issues: feeling down/anxious and resistant to antidepressant treatment
Harder to lose weight
Type 2 Diabetes is another major hormonal issue that is rampantly on the rise in our modern society and is likely to cost the UK £30bn this year alone. Diet and lifestyle play a major role here with too much sugar and sedentary lives playing a huge role.
Some of the contributing factors to hormonal imbalance/testosterone issues:
Waist circumference: as much as there is an increasing section of society more dedicated to wellness, our modern lifestyles can easily lead us to put on weight and if you have a testosterone imbalance it is even harder to lose weight. If you have a waist circumference above a certain point it is a significant indicator that you may be prone to conditions like this (plus heart conditions/stroke risk). When it comes to hormones and specifically testosterone more fat = testosterone being turned into estrogen (which is why we are seeing more Man Boobs - or ‘Moobs). Click here for more.
How does this work? There is an enzyme within fat cells that actually converts testosterone to estrogen. Viscous cycle.
Consequences: Men do need some estrogen, but when the ratio of testosterone to estrogen gets knocked off libido falls and sperm count and production can be affected.
Levels to watch out for:
Caucasian men: you need a waist circumference below 94cm
Asian men: you need a waist circumference below 90 cm
Upper limits 102 cm - above that you are at risk.
Phytoestrogens: These are plant derived compounds which can mimic hormones ie. Estrogen. Soy being one of the more obvious examples (Dr Anand did a special with the BBC on this subject). Data shows that it can have an impact if you have too much, however it is not cut and dry with some people (depending on genetics/ethnicity/existing fertility and even gut bacteria!) affected more than others. If in doubt, keep it to a minimum.
Exercise: doing none at all/being very sedentary, doing too much or the wrong sort can be equally problematic: too much fat from no exercise = testosterone conversion to estrogen and potentially higher stress levels. Too much exercise and very high levels of cardio exercise can also throw your hormones off balance. Ideally you want 20-30 minutes per day of moderate exercise (moderate = you increase your heart and breathing rate until you cannot sing is a good test!) this will improve your sugar control for 16hrs after. Resistance training is particularly powerful for keeping you healthy and balancing hormones. This is body weight/light weights ideally.
Don't forget leg day: seriously! There is a trend of guys focusing to much on arms and upper body, however, research shows that particularly are we get older maintaining mass in legs (something that slips with sedentary lifestyle and into later life) can increase your risks and reduces testosterone. Make sure you’re doing a full body workout and maximise lower body strength.
Environmental issues: pesticides, plastics, non stick coatings on pan, BPA are all factors that have been shown to impact our hormones. Being aware is key. Unfortunately some companies are much more environmental and body friendly than others so you have to be vigilant and take matters into your own hands to avoid where you can. Click here for more.
Stress: a common function of our modern lives. The reality is that if you’re highly stressed (a lot of Adrenaline/Cortisol) your brain is telling your body that the risks are too high to reproduce. Physically it makes a difference as these hormones actually make your testicles and penis get sucked in towards the body! It also can impact sexual desire and function. Something that is becoming increasingly common. The same thing happens with more extreme exercise and hormonal imbalance can be seen quite often in athletes.
Sleep: linked of course to our stressful lives is another thing that can really impacted our hormones, particularly if we have a deficiency over a long period of time. 7-8hrs is ideal but the reality is people need to prioritise it and ‘sleep hygiene’. We spend ⅓ of our time asleep (ideally) so investing in things like a proper mattress is smart. Click here for much more.
Meditation is very powerful to combat anxiety: exposure to modern news cycles/social media is toxic. Other things to watch for are stress eating/detox teas/quick fix ‘health products’ which are actually worse for you and can further exacerbate imbalance.
What are the next steps if you think you have a hormonal imbalance/low testosterone?
One thing to be aware of is that the medical community actually needs to be better educated on the whole around these issues with the focus mainly on life saving and prostate issues so sometimes you need to push a bit if you think you may have an issue. Ask for a blood test and be persistent - you can always ask for another doctor.
How does it get tested?
Testosterone has its own circadian rhythm (highest in the morning) so ideally you get a blood test three hours after waking (ideally avoid alcohol/sex three days ahead of a test). Another hormone to test for is Sex Hormone Binding Globulin - or SHBG - the reason this is important is that if that is present at a high level it ‘grabs’ the testosterone in your blood and means it cannot be used. If you consider this level as well as testosterone that will give you a picture of the ‘free testosterone’ available for use in the body - which is what you want to really check out. It is also worth repeating the test four weeks later as hormone levels can sometimes throw off strange levels in isolation and if you are going to be on treatment it can be lifelong so is worth asking for a repeat.
How do I interpret my results?
If you have a test that comes back as ‘low’ check this against the definition of ‘low’ according to the British Society of Sexual Medicine’s guidance (click here for more) as there can be a bit of variance around what is defined as ‘low’ so just worth double checking.
What happens if I have a low reading? What is the right treatment?
Well first and foremost it depends on the stage of life you’re in as testosterone treatment ironically can impact fertility with as many as ⅔ of men treated becoming infertile.
Why? The body is a finely tuned machine and is dedicated to keeping hormones in fine balance so if you are getting high levels of external testosterone administered then your brain detects it and switches off production of two key hormones LH and FSH (which makes you produce sperm). Therefore there are two ways of dealing with it if you are looking to preserve your fertility:
Clomiphene: this is actually a drug also used for egg harvest around IVF - it stimulates at the brain level in order to produce more FSH and LH. The intention is to kick start production that way.
HCG: which is given alongside testosterone treatment, which is designed to keep up the testosterone level within the testicles which keeps fertility/keeps stimulating sperm production.
The downside? The problem with these options is that we dont have long term data vs traditional testosterone thereapy where there is much more long term evidence. If you are put off by that then one alternative is to freeze sperm before starting the traditional treatment which is of course another option.
Traditional treatment is direct administration of testosterone: that can come as a gel applied every day and it dries very quickly (just avoid close skin contact with particularly young people immediately following and swimming/showering). This is very effective and you should start to notice the effects around two months after starting treatment (should impact mood first). The alternative is an injection which can last up to three months.
Dr Anand’s tips to keep hormones balanced as possible:
20 to 30 mins of resistance exercise every day - moderate is key and dont forget leg day!
Keep your waist circumference under 100cm if you can
Drink and smoke as little as possible
Eat a broad range of whole foods - avoid BPA/Pesticides/excess phytoestrogen.
Work/life and stress balance: meditation helps.
For more from Dr Anand please check out The Centre for Men’s Health here or drop us an email: sarah@betterbabies and we will be happy to connect you.
This article is for informational purposes only. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment and should never be relied upon for specific medical advice. The information on this website has been developed following years of personal research and from referenced and sourced medical research. Before making any changes we strongly recommend you consult a healthcare professional before you begin.