He came to me looking worried. “I’m not that old, as fit as a fiddle, got lots of irons in the fire at work, happy to be married with kids all grown… but my sex life is in the toilet.” Indeed, he looked as stated: good muscle mass, no dad belly to speak of, graying nicely, nimble in movement and agile in thought. But his sex drive was low, and his erections weren’t what they used to be a couple of years back. “My doc checked my T- level and said it was really low but everything else was fine. What’s happening to me?” He wondered whether his hormones had ”checked out for good or what.”

Check the Oil

Testosterone is a pretty important molecule for men’s health. Think of it as oil in the car. When low or absent, many parts are affected, and things don’t run as smoothly. Normal testosterone balance is critical in life. In the womb, it determines anatomic maleness. At puberty, I don’t have to tell you what it does: feeds the growth spurt, cracks the voice, encourages hair growth, acne, stronger muscles and is the ultimate governor of teenage thought and action. In men, it is essential for normal growth, reproductive and sexual function. Although most known for being a “sex steroid,” testosterone affects many body functions. In the brain, it influences mood, memory and intellect as well as sex drive. “Vitamin T” maintains muscle strength and growth and helps keep blood counts up and bone strength normal. It may also be good for cholesterol and insulin balance. Testosterone keeps erections strong and supports normal fertility and prostate function. In summary, as has been said about vitamins, testosterone is about as “essential” a hormone there is for a healthy body.

Origin Analysis

So, I went to work on this gentleman. When T levels are low, one of the key questions to answer is: Why? This root cause analysis is crucial for several reasons. It can uncover medical issues like diabetes, thyroid disorders, or prolactin problems that may be treatable and reverse the problem. It can also tell us whether “manopause” or andropause has arrived. This age-related condition occurs when testosterone levels fall hard and for good. Typically transpiring in the seventh or eighth decade of life, it portends the time when the testicles are spent and finished making hormones and sperm. It is the basis for men having a true “biological clock,” as has been said of women with menopause. Lastly, low T may simply reflect the effects of a stressful life, whether due to worry, anxiety, poor sleep, overwork, or too much travelling. Figuring out which of these causes exists is simply a matter of checking the hormones that control testosterone balance, such as luteinizing hormone, estradiol, cortisol and prolactin. Easy-peasy.

Cro-Magnon Clues

Our fast-moving gentleman was a great example of the modern, stressed-out man. Otherwise healthy, he was burning the candle at both ends, working long days and weekends, getting poor sleep and lots of travel. You might think that testosterone would increase with stress, but alas, that is not true. To understand this hormonal paradox, let’s roll back to our caveman days. For Neanderthals or Cro-Magnon men, what kinds of stress did they have? How about freezing, starvation, or being chased by woolly mammoths. Nice to have that “fight or flight” nervous system around, all juiced up with adrenaline (cortisol), to help them survive. In such times, testosterone takes the backburner, as mind and body need peaky awareness and quick, explosive energy to respond to threats. Once the stress passes and relaxation ensue, that’s when testosterone rises, recovering and rebuilding muscle, bone, and blood. A “rest and restore” hormone at its best. So, our antiquated, “fight or flight” nervous system, perfectly suited for us as cavemen 50,000 years ago, is now simply an overused reflex. Although we needed it to live longer then, we need to turn it off to live longer now.

Luckily his treatment was simple, but I did make a deal with him. I would push his “lazy” (from stress) pituitary harder to make more testosterone by giving him a daily pill called clomiphene citrate (or enclomiphene, both off-label use) and restore his testosterone balance. And he would examine his life, figure out what’s chasing (stressing) him the most, and try to reduce its impact. And, this deal, I reminded him, will likely lead him to a longer, healthier life.