The Dr. Hyman Show - Testosterone 101: What Every Man (And Woman) Needs To Know

Episode Date: July 29, 2024

Testosterone levels in men have dropped significantly over the past few decades and in this episode of "The Doctor’s Farmacy," we’ll uncover some of the reasons why. Dr. George Papanicolaou joins me to discuss the critical role testosterone plays in metabolic health and overall well-being. We dive into how low testosterone levels can impact everything from muscle mass to blood sugar control, and discuss the best methods for measuring and optimizing hormone levels.  View Show Notes From This Episode Get Free Weekly Health Tips from Dr. Hyman Sign Up for Dr. Hyman’s Weekly Longevity Journal Full-length episodes of these interviews can be found here: Are Your Hormones Out Of Balance? | Know Your Numbers Male Menopause, Low Libido and Testosterone Replacement Fertility in Crisis: Exploring the Toxic Threats to Fertility and the Rise in Infertility This episode is brought to you by Mitopure, Butcher Box, Purity Coffee, and Armra. Support essential mitochondrial health and save 10% on Mitopure. Visit TimelineNutrition.com/Drhyman and use code DRHYMAN10. ButcherBox is giving new members two pounds of wild-caught salmon for FREE plus $30 off. Visit ButcherBox.com/Farmacy and use code FARMACY30. Visit PurityCoffee.com and use the code DOCTORSFARMACY at checkout to get 30% off your first order. Save 15% on your first order of ARMRA Colostrum and unlock the power of 400+ functional nutrients. Just visit TryARMRA.com/Mark or use code MARK.

Coming up on this episode of The Doctor's Pharmacy. When you look at heart disease, particularly in relationship to metabolic syndrome and even diabetes, if you have low testosterone, which you probably will have in those cases, actually, there are studies that show replacing testosterone will improve your metabolic syndrome, will actually improve your glycemic control.

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Now, before we jump into today's episode, I'd like to note that while I wish I could help everyone by my personal practice, there's simply not enough time for me to do this at scale. And that's why I've been busy building several passion projects to help you better understand, well, you. If you're looking for data about your biology, check out Function Health for real-time lab insights.

And if you're in need of deepening your knowledge around your health journey, well, check out my membership community, Dr. Hyman Plus. And if you're looking for curated, trusted supplements and health products for your health journey, well, check out my membership community, Dr. Hyman Plus. And if you're looking for curated, trusted supplements and health products for your health journey, visit my website, drhyman.com, for my website store and a summary of my favorite and thoroughly tested products. Hi, I'm Dr. Mark Hyman, a practicing physician and proponent of systems medicine, a framework to help you understand the why or the root cause of your symptoms. Welcome to The Doctor's Pharmacy. Every week, I bring on interesting guests to discuss the latest topics in the field of functional medicine and do a deep dive on how these

topics pertain to your health. In today's episode, I have some interesting discussions with other experts in the field. So let's just trump right in. The first thing you should know is your testosterone. And your testosterone is something that's not just good to look at if you're 90 years old and, you know, are having trouble or if you're 70 or 60. These are hormones that are things that you should know about your health all through your life spectrum. You know, I've seen 30-year-olds with the hormone levels of a 90-year-old, right? They go, well, you know, and by the way, what's normal, right? If you look at a normal range of hormones, depending on which lab you look at, the reference range is like 200 to 1,000. So is having a level of 250 the same as having a level

of 950? Obviously not. And how do they come to those ranges? Well, they come to those ranges by looking at the average in a population, which is if you have an unhealthy population, the average is bad, right? So you want to be optimal. Now, we typically say for a male, you should have a testosterone level over 500, but probably it should be more like six, seven, eight, even 900. And hormone levels are really important because they determine so much about your health. Hormones, particularly testosterone, is important for building muscle, for motivation, for cognitive function, for energy, for focus. And if you don't have adequate levels of testosterone, by the way, also for sexual function, for libido, for erections,

for all things that are important in life. And if you don't have adequate levels of testosterone, you will find your health diminished. You'll have low energy, low motivation, low concentration, low cognitive function, low libido, low sexual function, and erectile dysfunction. Not so great. So how do you measure hormones? We look at both the total testosterone and also the free testosterone. And we also look at estrogen levels, and we look at also brain hormone levels like FSH and LH. And we look at something called sex hormone binding globulin. So we don't just look at one thing. We look at the whole pattern of what's going on with your hormonal health. And we can tell a lot, for example, some guys, you know, this is really common in America where you see guys with big bellies,

right? Pretty much the norm. If you have a big belly, what's going on there? You have visceral fat or visceral adipose tissue or VAT or belly fat, right? And it's not like normal fat. It's actually producing all sorts of bad things, including inflammation, including oxidative stress. It screws up your brain chemistry. It makes you hungry. It prevents you from burning fat. It makes you gain more weight. It makes you more insulin resistant. It creates a vicious cycle. But one of the things that happens is you actually tend to shift your hormone production to more estrogen. So when you see men, for example, who have big bellies, they often have loss of hair on their body or they have, you know, soft, more soft skin, right?

So what's going on there? Well, they're having high estrogen and low testosterone. And so basically, the bigger your belly, the lower testosterone. It's an easy task. You can just look in the mirror, but it's better to know your numbers and check your blood. Now, when you have low testosterone, what can you do about it? If you have low total, low free testosterone, if you have high estrogen levels, what can you do? Well, it's important to understand that these things can be managed through lifestyle, right? Cutting out the sugar and starch, increasing fat. Where does cholesterol, I mean, where did your testosterone come from? It comes from fat.

Cholesterol is the building block of all your steroid hormones. Steroid hormones are not just, you know, obviously cortisone or anabolic hormones, but all your sex hormones are made from cholesterol. So if you have low fat in your diet and low saturated fat, you actually tend to have lower sex hormones. And so you can boost the quality of fat in your diet. You can cut out the starch and sugar and other things that also help. Alcohol is not good. So alcohol also increases estrogen levels. It poisons your liver, so you can't metabolize it. And by the yes, men have estrogen. They just have lower levels than women. And yes, women have testosterone, just lower levels than men. So the testosterone levels go down, estrogen levels go up with alcohol. And so there's a lot of things you can do like changing your diet and stopping drinking or reducing drinking. But you also can exercise

large muscle groups, like the large muscles, like your glute muscles or hamstrings, your quads, heavy weight lifting with lower body muscles is a great way to boost your testosterone and also your growth hormone. We'll talk about that in a minute. So having a proper exercise routine is really important. Also, environmental chemicals can affect your hormones. So reducing your exposure to environmental chemicals, really important. It's important to understand, you know, again, looking at the numbers, you've got to understand not what's the normal level, but what is the optimal level for where you are? Like, you know, I am 63 years old, but I don't want the hormone levels of a 95-year-old who's unhealthy. I want the hormone levels of a young 40 or 50 or even

30-year-old. So I want my hormones around of a young 40 or 50 or even 30 year old. So I want my hormones around 800, 700. And that's where I get them by using a comprehensive approach. You just have to know what to do because everything we do influences our hormones. So getting your testosterone straight is really important for men for all the reasons I just mentioned. We also look at other hormones, including DHEA sulfate. This is a hormone that looks at your adrenal function. Adrenal function is connected to at other hormones, including DHEA sulfate. This is a hormone that looks at your adrenal function. Adrenal function is connected to your sex hormones, but often as we're under stress, as we age,

our DHEA levels go down and we tend to age faster. We tend to have more fatigue. We tend to have less libido. We tend to have other issues. So checking your DHEA level is really important because that tells you where you are in the stress response and also what you can do about it. Now you can boost your DHEA by lifestyle factors we talked about. You can actually take DHEA. It's a supplement. It's a hormone. It's held as a

supplement. And we also look at, in addition to that, we look at IGF-1, which is an add-on test of function health panel. IGF-1 measures your basic level of something called insulin-like growth factor one. And that is important because it's an indirect reflection of your growth hormone. As we age, our growth hormone goes down. We tend to repair things less well. We tend to rebuild tissues less well. So you want to make sure we have adequate growth hormone. Now, you don't want it too high because too high can mean insulin resistance. It can mean more inflammation. It can be a sign of, you know, more issues, you know, potentially that cause cancer. So we want to keep our growth hormone

levels in a good level, not too high, not too low. So, but, but again, things like strength training and exercise and certain supplements like arginine can actually help naturally build growth hormone. There's peptides we can use. There's all sorts of things that can be used to optimize your hormone levels and your growth hormone levels to fix your adrenals. And if your adrenals are shot like with a DHEA low, there's lots of things you can do. We've talked about a lot in the podcast, but all sorts of ways to regulate your stress response from meditation to yoga, to breath work, to hanging out with friends, to being in nature, the list goes on. But it's important to understand that you have power over these numbers. You're not just a passive recipient of whatever numbers

you've got. They're highly modifiable because your entire biology is the result, we call your phenotype, is the result of your lifestyle washing over every cell in your body every minute. So every thought you have, every bite of food you take, every exercise you do or don't do, how much sleep you get, it all influences everything all the time. So we have tremendous power at any moment. What else should we be paying attention to as a man? Well, PSA tests are important, and they're not perfect, and it can be elevated if you have an enlarged prostate, but it can also be a sign of cancer.

So it's important to see what's going on with your PSA. And it's something we screen as part of the panel. And we also look at not just the total PSA, but the free PSA, which gives us a better indicator of whether or not you are having a higher likelihood of having early prostate cancer. And it's something you can track over time. And often with PSA, people can have normal PSA and still have prostate cancer. But what we see often is a change in the number over time. And often with PSA, people can have normal PSA and still have prostate cancer. But what we see often is a change in the number over time. So it's the rate of increase. So let's

say your number is one, but it goes to, let's say four is considered abnormal. Let's say it goes to two. Well, one to two is a big jump, right? That means something may be going on. Or if it goes two to four. So it doesn't have to be abnormal, but it can still be an indicator over time of how to pick up early signs of prostate cancer. And it's one of the major cancers in man that kills so many people. So I think that's important to know. So you get a big comprehensive view of what's going on with your hormones, and then you can intervene with various lifestyle factors and you can actually see changes over time. And then we can recheck and see how you're doing. Are you tired of sleeping hotter than you'd like?

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temperature changes to trigger deep sleep. Visit www.sleep.me slash drhyman to get your chili pad and save up to $315 with the code drhyman. That's S-L-E-E-P dot me, M-E slash Dr. Hyman, D-R-H-Y-M-A-N. This offer is available exclusively for Doctors Pharmacy listeners and only for a limited time. So tell us about this patient you had who came in with fatigue and he was overweight. What was the story with this patient and how did you approach him? Because functional medicine is a very different approach. Like you said, it's not just here take the testosterone, it's looking at all the variables that could be impacting a patient and affecting their hormones, whether it's toxins, whether

it's their gut, whether it's nutritional deficiencies, whether it's their gut whether it's nutritional deficiencies whether it's their diet stress all these factors we look at comprehensively in functional medicine that's what we do at the ultra wellness center that's why you have so much success because we're not just a knee jerk oh you have low testosterone give testosterone it's a comprehensive approach to these all these variables right so this gentleman came in he was experiencing fatigue he as you described already he was having adiposity around his waist and also in his breast tissue and he had been working out and he'd already been to a physician who had given him testosterone and it wasn't he was not getting the clinical benefit that he wanted so when they when a patient like that comes in we begin to go

through everything we go through the begin to go through everything. We go through the lifestyle, we go through previous treatments, and we go around our matrix, which is that tool that we use that identifies the way we think about overall health in a patient. And we don't treat the symptoms, we treat the systems. So in this particular patient, i immediately identified that he was a busy executive 52 years old he was under stress he was a little bit overweight and he had been on testosterone and he brought me some lab values and his testosterone had gone up but his his free testosterone was really low that's the active test that's the active testosterone. That's the active testosterone.

So I started to think. So in other words, what you're saying is a guy could have a normal level, if the doctor says, let's see your check, the normal is let's say 300 to 1,000. And he was about 550. So it's 550, which seems pretty good, but if you don't check the level of active free hormone,

you're not really knowing what's going on. Right. And if you don't check these other tests you're gonna talk about, you don't really know what's going on right and if you don't check these other tests you're going to talk about right you don't really know what's going on so tell us about so that works yeah so the way so when you see that you're like well that's interesting so the tests that i do um included a agent a something called a dutch profile uh a dutch profile that just doesn't tell me about the total amount of testosterone it also tells us how your meta you metabolize your testosterone and as you mentioned earlier mark that you convert your

testosterone to estrogen and there are some men that naturally convert their testosterone very efficiently too efficiently into estrogen and so they're over aromatizing and you can see that on the Dutch profile you can see that the results show you that pattern he was an over aromatizer and so when he was being given testosterone he was converting a lot of it into estrogen so he was actually taking testosterone yeah at the time came in with his news he was he was taking testosterone when he came in and he actually gained more gain more visceral fat while he was taking sort of backfire he had muscle is very interesting it's my brother's case is a great case you know if you just go to regular

traditional doctor and you get testosterone they'll just give you testosterone they won't look at all these right variables and like well I don't know why you're losing muscle and gaining fat and growing boobs and losing hair in your body right so it was an interesting case because what hadn't been tested was his sex you know uh hormone binding globulin hadn't been tested and his estrogen had not been tested and he had been on the testosterone for almost nine months. And he saw these differences. So on the basic labs that anybody can get, I checked his estradiol level. I checked his sex hormone binding globulin.

And his estradiol level relative to his testosterone was elevated. His sex hormone binding globulin was also elevated. And that's what was binding the free testosterone. And then when I looked at his Dutch profile, it all made sense. He was an over an over aromatizer so this Dutch profile is a test we do at the ultra wellness center it's quite different it looks at how all these hormones interact correct how they're metabolized what's getting converted to what where the imbalances are this is not something you get whether it's a traditional hormone test that you go to the lab and get right it's a saliva test it's a saliva test and so uh and and it's very it's a very

effective test and uh it made sense when i saw that picture so so that's the that's the difference now he had some other things going on um and that included the sleep apnea but the the main thing was is that all we needed to do was address this hormone imbalance. And to do that, we needed to account for the fact that he didn't aromatize really well. So you add in something, an aromatase inhibitor called anastrozole. So I added anastrozole to his treatment plan. And that, you know, was going to make a difference. Now that was going to block his body's natural ability to so readily turn testosterone into estrogen. And because of his age and the urgency, because he was getting

a lot of emotional stress over this, I added in a peptide. So I added in something called CJC 1297, and that actually helps you, along with Ipramoralin, that combination will help you lose fat and gain muscle. So we added that in for a three month cycle, and he did extraordinarily well. He lost all that visceral adiposity around his waist, also the man boobs went away away and he was feeling great gained muscle mass and did it was extraordinarily pleased with the outcome amazing so you know you talk about these this anastrozole which is a medication

it's used often in cancer treatment for women for breast cancer as it blocks estrogen production by the body there There are also natural ways to inhibit aromatase and to help with the excess estrogen. One of the ways that we deal with hormone imbalances is using foods and using even ingredients that are in foods that are powerful regulators of hormones. One of the most important things is a compound found in the broccoli family, the brassica family. Right. It's called diendylmethane or DIM.

Right. And that can be used in patients who are taking testosterone to help affect the hormone metabolism into estrogen and limit that. Absolutely. You can also use biotin. Right. And so there's a lot of other things that can be taken. Yeah. Along with the hormone replacement to help mitigate.

And I will. And I will commonly use DIM and calcium deglucurate because they both increase the metabolism of estrogen. I use them in women, but I also use them in men, particularly gentlemen like this. That would have been an option. I chose to do something that would be a more aggressive approach. Yeah, this is definitely going to work faster. And then what about the method of testosterone replacement?

Can you talk about the options for men about what kinds of available? Testosterone replacements there are and what is the point at which you would initiate that? What's your decision on these patients of okay? This is now the time to start right? So the first thing I do is as I I said before, is we balance out everything else. We do lifestyle factors and we make sure that that's all in place. If after six months or so of lifestyle factor intervention, they're not improving, that's when we'll start talking about testosterone replacement. And testosterone replacement, you can do topicals you can do

injectables and I tend to use the injectables because they're very effective and very efficient so how does that work how do you do it in so injectables can be given I am but recently muscle and which is in the muscle and their research research has shown that the sub-q injection meaning you just pinch the you know the little fat around your waist you inject right into that little that little piece of tissue that you have there that's called a sub-q injection you can get absorption and elevation of testosterone just as effectively as i am so it's a very very simple and that's an easier procedure oh it's very simple and use compounded hormones you just get them at the regular pharmacy where do you get them so they can, you just get them at the regular pharmacy. Where do you get them? So they can be, you can get them in a regular pharmacy and you can get them compounded.

Most of the time, the raw ingredient of testosterone is going to be very similar. It's the carrier molecule that might be different. So some pharmacies use grape seed oil. I mean, some compounding pharmacies use grape seedeseed oil because there's some theoretic advantage of absorption. So when they compound it, it's going to be the same raw material. It's going to be the carrier that might be different. And so I use compounded when that's appropriate. Sometimes patients don't want compounded. It's a little more expensive. So we'll go with a pharmaceutical grade from the local pharmacy, and then we'll do with a pharmaceutical grade from the local pharmacy.

And then we'll do sub-Q injections. And what about the topicals? Can you talk about when you would decide to use topicals or why? I don't use topicals that often. And the reason being is that they're just sloppy. I'll just say you need to use large quantities of them to get the concentration that you need. You need to be sure to wash your hands after you've used it because you can actually,

by touching your child or touching your wife, they can actually absorb some of that testosterone. And I've had situations where women are beginning to have the effects of elevated testosterone because they're coming in contact with their husband's testosterone on their shoulder on you know or other what other location you may have placed it or if you didn't wash his hands appropriately and they're in intimate contact so i don't use gels that often because you can do sub-q injections i primarily will use

uh the sub-q injectable form of testosterone. And there's other forms, right? Pellets. Can you talk about that? You can do pellets. So now, again, pellets. What is that? How do you do it? So they have to be placed on your skin,

and they're usually placed for up to six months. They get replaced. The issue, well, there's no issue with pellets. They work fine, but you don't have the ability to make any alterations in the testosterone concentrations. So if it's not enough, they're not experiencing it, you have to remove them. You have to put new pellets in. I find that using testosterone injectable is just, it's very flexible and it's very,

very simple and easy. And it doesn't involve the placing of pellets in the skin. Yeah. And in terms of the side effects of testosterone placement, because it is a hormone and it can have adverse effects, and there's concern about risk of prostate cancer, high cholesterol, heart disease. how do you address that well i think the the data on all of those are mixed when you look at you look at heart disease particularly relationship to metabolic syndrome and even diabetes actually taking if you have low testosterone which you probably will have in those cases. Actually, there are studies that show replacing testosterone

will improve your metabolic syndrome, will actually improve your glycemic control. Because it improves muscle mass and blood sugar, yeah. Exactly. So in that regard... But it can spike people's cholesterol. Oh, you can. You can spike people's cholesterol.

Does that mean they need a statin? No, it does not mean they need a statin. It's not something, you know, you can also, I've seen some studies where it also lowers cholesterol. So, it's something I watch closely. It's not something I see that often. And the other concern about prostate cancer is it's pretty clear in the data that testosterone does not cause prostate cancer if you have prostate cancer it can it's not something you want to be taking because it can accelerate the growth of the cancer uh the the issue that may that no i've talked to some urologists at harvard and your specialists in prostate cancer and you know a lot of times after

prostate cancer treatment men have low sexual function and that they're actually using testosterone replacement in some of these men when they're carefully monitoring them. Yes. Yeah, that's absolutely. Yeah. I've read that in the literature as well. And so there's, there's a lot of safety behind testosterone. And that's why I think men are beginning to understand it's safer and they know it's an option and they want it. And particularly when you start to combine it with the lifestyle changes, and you combine it with the use of peptides, which I mentioned. You know, men can regain a huge amount of vitality and really improve their overall experience of life in a fairly safe way. There's no reason. I believe that as we age, things happen to our bodies that we should and can account

for. And I think it's a pretty low-hanging fruit for men to address these hormone issues and use things like peptides that are sacchargogs for hormones that can actually increase muscle mass and decrease body fat as they're aging. Yeah, I think this is a really important point, George. We are living longer, although our life expectancy is going down as a country because of all the obesity and herbal disease. But we are seeing people living longer lives and sometimes in order to live vital lives

there there needs to be a little bit of extra support because we do decline as we age but there are ways to mitigate that through the lifestyle interventions exercise is so important building muscle is so important and that's why testosterone is so critical even for women testosterone is very important and i think that affects their sexual function, it affects their muscle mass, energy, motivation, mood. And it's really an ignored aspect of hormone therapy in women. I think it's just estrogen and progesterone. But women also need this. And I have many patients who use topical testosterone for women on the clitoris here at the Ultraluna Center.

I mean, we don't apply it directly. They do it themselves. But it's a very powerful treatment and it works i know it works because women are always calling back for refills and they're just happily referring all their friends for it so i think there's a lot of ways to use hormones judiciously to do the right amount it's different than we think of the anabolic steroids like testosterone and bodybuilder shoes they use super physiologic doses these doses far beyond what is ideal for a normal level you don't want to get super levels you want

optimal levels optimal levels right and you want to and you want to make sure you're checking you know everything so you i always check the sex uh hormone binding globulin i always check the estrogen levels just to find this a gentleman like this that really needed an adjustment needed to be on a aromatase inhibitor. There are some there are some docs that just put you on an aromatase inhibitor right with the testosterone. Yeah I usually do the natural versions. I use DIM which is a supplement. Right. And I use biotin. Yeah the other The other thing I think it's worth mentioning is that for some people, there's an increased conversion to something called DHT, which is a dihydrotestosterone that can happen when you use hormone replacement therapy.

And that increases the size of the prostate. So people are concerned about enlarged prostates with this, and it can also increase cancer risk in some patients. So it's really about looking at everybody's individual hormones and there are natural ways to affect the dihydrotestosterone too right so with yeah so with dht um in particular um so that's a you know that also and this is one of the concerns for women is hair loss you have you know increased dht which can affect the hair follicles, and that can lead to hair loss. And that's why men get hair loss,

and that's some of the drugs like Propecia are actually blocking DHT. They're 5-alpha reductase inhibitors. Yeah, to prevent the hair loss. Yeah, and so that's, you know, I'm generally, again, careful about that. And on the Dutch profile, it measures DHT. So we can actually see if a person, you know, is going to be making too much of that, and we can make adjustments. You know, and as you brought up before, there are things that we can use like Propecia. Now, Propecia, you know, has some concerns in regards to some side side effects that can be permanent so we're careful

with using that uh there's natural versions yeah there's natural palmetto which is basically an herb that you can take that helps to mitigate that conversion and you can use that topically as well as in an oil um so i'm a little i'm you know i'm not i use testosterone and women both clitorally and uh and it is part of their um their overall uh gel or um that i'll create for them with their cream but i'm somewhat careful about it because the hair loss yeah because the women the women that are coming in that need it are also going through menopause and they are they're naturally beginning to experience some of the natural aging that will thin out their hair and change their hair growth cycle. They'll have a shorter antigen phase. And so you have to be careful with the addition of testosterone.

Women tend to get all the blame for trouble conceiving, but it's not true. Men contribute to 50% of conception rates, miscarriages, and infertility cases. So sperm count is a problem. It's been declining at an accelerating rate, about 2.64 percent a year. And that's more than doubled since the 1970s. A man today has nearly 60 percent less sperm than his grandfather had. Think about that. Current projections suggest that sperm counts, if we see the current rates, which I don't think will go to zero, but that sperm counts could read zero by 2045 if nothing is done to improve the status of men's health. So that's a scary thought. What's causing this global decline in fertility? Let's get into it. First and foremost, it's our

diet. It's our poor diet and the metabolic dysfunction that's driving this infertility epidemic. 93.2% of Americans have some level of metabolic dysfunction, meaning they were on somewhere in the spectrum from insulin resistance to prediabetes to type 2 diabetes. And this is the thing that screws up both men and women's fertility. Now, sex hormones are regulated by our diet. You may not have known that, but sex hormones are directly regulated by what you eat. And pretty much everything is regulated by what you eat if you don't know by now listening to me.

Ultra processed foods and sugar and starch are causing massive shifts in our sex hormones. And that's driving the infertility crisis. Our SAD diet or standard American diet is 60% or more from ultra processed foods. The average American consumes, anywhere you look at it, from 113 to 150 pounds of sugar and about the same amount of flour every year per person. That's almost a pound

a day of sugar and flour per person. And that is not something we're used to eating. That's a pharmacologic dose of sugar that's causing dramatic hormonal shifts in our biology. The spiking sugar leads to high insulin levels. That leads to insulin resistance. And then we get blood sugar and hormone imbalances as a result. So what happens? What is the biology here for women? Let's talk about it. It's a little bit different for men and women. When women have high sugar and starch, it drives the insulin.

That leads to increased androgen production. Androgens are testosterone. That leads to free testosterone being increased. And that will lead to all sorts of problems like PCOS, for example, which causes irregular, painful, heavy periods, so clotting, heavy bleeding, for example, which causes irregular, painful, heavy periods or clotting, heavy bleeding, weight gain, hair loss on your head, hair growth on your face, acne, lack of ovulation, as we mentioned. And so this is really not a fun problem to have for women, but it's often solvable by addressing the root causes of diet and lifestyle. Endometriosis is another factor we talked about that can be driven,

but not necessarily by the high sugar diet. Although there's some evidence that this is an autoimmune disease, which can be caused by leaky gut and other drivers of inflammation caused by our diet. Now, what happens with men when they have too much starch and sugar? Well, they get insulin resistance and that leads to the opposite. It leads to low testosterone levels in men. That leads to damage to their blood vessels because of the insulin resistance that causes inflammation and blood vessels are needed to have good erections so they get erectile dysfunction and it also because of low testosterone

affects sperm quality and what's even worse when they gain body fat as a result of insulin resistance they make more estrogen because there's an enzyme in your fat tissue called aromatase that converts testosterone to estrogen. So that's really bad. They get higher body fat, they lose the hair on their bodies, and they have low sex drive, low sex function, low fertility, low sperm count, and the list goes on. So when you have this higher body fat, you get all these problems, and that leads to more inflammation.

And then more inflammation for men and women leads to more infertility, more endometriosis, more PCOS. Where's pregnancy outcomes? Even if you're using IVF or advanced fertility treatments. Ovulation problems, as I mentioned, you get poor quality of eggs and sperm. So the very seed of a new life is being damaged by your diet. And we're going to talk about that. This can also lead to miscarriages.

Inflammation can lead to that and also birth defects. So all around our toxic diet, lifestyle, and environmental toxins are driving so much of these problems. As I mentioned, inflammation is a big driver in fertility. So what's causing inflammation? Of course, inflammation, as you know, listening to me forever, driving almost every known chronic disease. Heart disease, diabetes, cancer, dementia, autoimmune diseases, the list goes on, depression.

And it's not just driving those things. It's driving fertility issues, right? So it's our processed SAD diet. It's excess sugar. It's the insulin resistance that results, the blood sugar imbalances, the chronic diseases that result, type 2 diabetes, obesity, and damage to our gut microbiome. We're going to talk about how the gut microbiome plays a big role in hormones and fertility, at least the leaky gut.

Also, our sea of environmental toxins is not good for our hormones. The sea of industrial chemicals and pollutants, sometimes latent infections can cause inflammation. But those are the main causes. And then we also see damage to our mitochondria because anything that causes inflammation will affect our energy production. And energy production is essential for every factor of life, including healthy sperm and eggs. So we need healthy mitochondria to have healthy sperm and eggs.

It's our energy factories. It's involved in ATP production. And ATP is the energy. It's the gas. So sperm have to swim, right? Eggs have to grow mature. That takes energy. And we lose energy.

And that leads to more fertility issues. After fertilization, if you're lucky enough to have a fertilized embryo, then the embryo has mitochondria from the mother. And that's good. If you don't have healthy mitochondria from our diet and from toxins and so forth, we can't have proper embryonic development. We can't have proper cell division and differentiation, which is necessary for the developing fetus to grow into a healthy baby. Also, sex hormone synthesis takes place in the mitochondria. So poor mitochondrial function is connected to hormone balance. The estrogen and progesterone are produced

in special cells inside the ovaries, and these cells require mitochondria functioning at a good level to do this. Testosterone is also produced in cells called the lytic cells, which contain a lot of mitochondria. Those are your testicles, and that is necessary for producing testosterone. So you can see the whole hormone production cycle requires energy, and we do a lot of things that cause mitochondrial dysfunction. Again, our poor diet. It's all the same stuff, right? It's not like different things causing different problems.

It's all the same stuff. It's our diet, nutrition, lack of exercise, insulin resistance, inflammation from all the causes, oxidative stress, chronic diseases, environmental toxins. All these things, aging, will affect the quality of sperm and egg. Microbiome, another big factor in causing infertility. Again, these things are not addressed. Think about it. Who's addressing mitochondria? Who's addressing inflammation? Who's addressing the issues around microbiome when it comes to fertility? These are not things you're going to hear about when you go to your fertility specialist, but they're critically important in providing the right environment

for having a healthy baby. So what is problems in your microbiome cause? Dysbiosis, that's imbalances in the flora, that's bad bugs. Symbiosis is good bug, good balance, right? Dysbiosis is bad, bad influences. And this influences inflammation and causes inflammation throughout the body, including your reproductive organs. It can cause even other things like obesity,

even having bad bugs in your gut can make you gain weight. And this negatively impacts the microbiome. It causes ovarian inflammation. It affects the gene expression in your gut can make you gain weight. And this negatively impacts the microbiome. It causes ovarian inflammation. It affects the gene expression in your eggs. It causes poor egg quality. The dysbiosis also affects estrogen levels. One of the things we see, and this is really important, is that your gut microbiome plays a role in regulating estrogen levels.

And often when you have high estrogen levels, it causes something called estrogen imbalance or estrogen dominance, where you have too much estrogen, not enough progesterone. And that is often found in PCOS. And when you have certain bad bugs in your gut that produce an enzyme called beta-glucuronidase, a little technical here, but I'll explain it. What happens is that enzyme takes the estrogen that you excrete from your liver that's already packaged and ready to be pooped out and unpacks it. That enzyme cleaves the estrogen from its basically carrier molecule. Then estrogen becomes free in your gut and you reabsorb it into the body, into the

intestinal circulation. And then it goes into your body, creating higher levels of estrogen, leading to more estrogen dominance and hormone imbalances. And then other problems like estrogen-related cancers, breast cancer, ovarian cancer, uterine cancer, endometriosis, worsens PMS, worsens pregnancy complications. When you look at the data, actually probiotics can be very helpful in improving pregnancy outcomes and even IVF outcomes. So giving probiotics when you're getting your fertility treatments can be a good thing. It also affects not only women, but men too. So having bad bugs in your gut affects your testosterone levels. Antibiotics and hormonal contraceptions will affect the gut microbiome. So a lot of things will mess up your gut microbiome. Taking the pill, antibiotics, stress, certain

acid blocking drugs, which you take all the time, obviously alcohol and other things are not good for fertility too. Obviously you should probably not smoke. You shouldn't have too much pot. All those things are bad for you. Certain medications can be problematic, obviously. Birth control pills, antidepressants, antipsychotics, obviously anabolic steroids. If you're taking testosterone as a guy, it's going to decrease your sperm production. Calcium channel blockers, because we need various pathways in our biochemistry to make things work. So these are blood pressure pills, but they can affect sperm motility.

Antibiotics can interfere with menstrual cycles. All this stuff is just to say that there's a lot of factors that we have control over that affect our fertility that are not being addressed from inflammation to metabolic health to mitochondrial function to dysbiosis to the medications we're taking. And all those things can be addressed. So let's talk a little bit more about where conventional medicine just misses the mark. No pun intended. Why does it miss the mark? Well, it doesn't get to the root causes of the hormone imbalances and other factors that cause this decline in fertility. It doesn't address diet, inflammation, mitochondrial health, dysbiosis, environmental toxins, stress, autoimmunity. And they give you general advice. Okay, lose weight,

eat more veggies. It's not quite personalized. It doesn't really measure what needs to be measured to understand what's going on in your biology. You look at farmers, they're testing the soil. They want to know what nutrients are in there, what the levels of nitrogen, potassium, phosphorus. They're so deep in understanding soil health as a way to predict what's going to be happening to the plants that they're growing in there. How do we not test for what's going on in a woman or a man to find out whether or not the sperm and egg are going to be healthy or whether the baby's going to be healthy, right? They don't check inflammation levels. They don't check nutrient levels. They don't check toxin levels. So we really need to do proper testing for fertility,

looking at all sorts of things from metabolic health to hormonal health, to nutrient status, to toxin levels. Thanks for listening today. If you love this podcast, please share it with your friends and family. Leave a comment on your own best practices on how you upgrade your health and subscribe wherever you get your podcasts.

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