Recently I interviewed Dr. Deb Matthew, and we chatted about testosterone. If you would prefer to listen the interview you can access it by Clicking Here [1].
With me, I have Dr. Deb Matthew. We are going to chat about testosterone. I am really excited because I haven’t had an episode yet where I focused on just testosterone. Dr. Deb is an expert when it comes to this topic. I am going to dive into her bio, and then we will get into it.
Dr. Deb Matthew is known as the Happy Hormones doctor. She is a best-selling author, international speaker, educator, wife, and mom of four boys. After suffering for years from fatigue and irritability due to hormone imbalances, her quest to solve her personal health led her to change everything about the practice of medicine. She has been featured on national podcasts, radio, and broadcast shows, including NBC, ABC, CBS, and FOX. Thank you so much for joining us, Dr. Deb.
Dr. Deb Matthew:
I’m so glad to be back.
Dr. Eric:
I’m glad as well. This is the first time I have you on the podcast. We actually interviewed you before my podcast on the YouTube channel. The first interview Dr. Deb and I had on YouTube was more general, talking about sex hormones. I really wanted to have an episode that focuses on testosterone. For those who didn’t watch the first interview, can you give a little bit of your background, how you started focusing on hormones?
Dr. Deb:
I used to be tired all the time. Napping was my favorite hobby. I used to be cold all the time. Even in July in North Carolina, I would take a sweater with me everywhere I went because when I went into air-conditioned movie theaters and restaurants, I would shiver uncontrollably. The refrigeration section at the grocery store was the worst.
I was also really irritable. I would fly off the handle at my kids over the silliest little things, and then I felt so guilty for being such a horrible mom. My husband didn’t know what the heck to do with me. He started saying things like, “Why are you always in such a bad mood?” The reality is that I didn’t know what the heck was wrong with me. It was really confusing because nothing in my medical school training helped me understand what was happening to me.
When it finally changed was when my husband found a book that he thought I ought to read. It was a book about hormones written by Suzanne Somers. I remembered her as Chrissy Snow from Three’s Company, the ditzy blonde, and the Thigh Master. I looked at this book, and I looked at him and said, “You’ve got to be kidding me.” Medical doctors don’t want to get our advice from celebrities. He looked at me and said, “Well, honey, we have got to do something.” So I read the book.
Truthfully, that book changed my whole life. That was the first time I got introduced to this idea that our hormones impact how we feel, who we are on the inside, how we relate to other people and react to the world around us. I learned that there are actually places where practitioners can go to learn about this stuff. It’s not woo-woo medicine; there is real science behind it.
When I really learned what was going on and got my hormones in balance, I got my energy back. My kids got their mom back. My husband got his wife back. I got my life back. I couldn’t go back to just writing prescriptions all day long. That didn’t make any sense to me anymore. So I retired from my old practice. For the last 16 years, I have been helping men and women get their hormones back in balance, so they can get well, get off a lot of those prescription drugs, and love the way they feel.
Dr. Eric:
That’s awesome. Many listening to this know that I am in the Charlotte area in Mathews, North Carolina. Dr. Deb, that’s where your practice is, in the Charlotte area, too. She is not too far away. Thanks for getting deeper with your background.
The focus is going to be on testosterone. Before focusing on testosterone, can you give a brief breakdown of the different sex hormones?
Dr. Deb:
For women, for sex hormones especially, we think about estrogen, progesterone, and testosterone. Those are the ones that come from our ovaries. Estrogen and progesterone are the ones that go up and down over our menstrual cycle. All the changes that happen cyclically, like PMS, menstrual changes, menopause, those are all tied up with estrogen and progesterone. Birth control pills have synthetic forms of estrogen and progesterone in them.
Testosterone is another really important hormone for women. We usually think of it as the male hormone. Of course, it’s really important for men, too. Men even have some estrogen, but men have way more testosterone than women do. They have 10 times more testosterone than women. Women have 10 times more testosterone than estrogen. We think a lot about estrogen, but we can’t forget about testosterone, too.
Dr. Eric:
That’s good to know. You’re right. A lot of women focus more on progesterone and estrogen and don’t really think about testosterone.
Dr. Deb:
And their doctors, too. Their doctors are frequently not thinking about testosterone.
Dr. Eric:
That’s a good point. We’re going to focus on testosterone now. Why is it so important in both sexes?
Dr. Deb:
Testosterone has a lot of really important roles that it plays. Estrogen and progesterone also have a lot of important roles, but testosterone is very important for our physical body. Testosterone helps to keep our bones strong. Estrogen helps to prevent bone loss as we age. Progesterone actually stimulates new bone growth. Testosterone gives strength to our bones, so that if we trip and fall down, we won’t snap like a twig.
Testosterone also helps to maintain our muscle mass. Naturally, with age, our muscle mass declines. Our skin and hair and muscles get thinner, and testosterone helps to keep all of those things more robust. Technically, what testosterone is doing is helping to prevent frailty as we get older. It’s really important for our physical body and our strength and stamina.
It’s also really important for everything to do with sex. It’s important for us to think about it and care about it in the first place, to become aroused. It’s important for vaginal lubrication, arousal and orgasm. For men, it’s important for all those same things, for erections. When women don’t have the right amount of testosterone, it can impact our sexual function.
Testosterone also is really important for how we feel on the inside. All these hormones are important for that. Estrogen is like a natural antidepressant. Progesterone is a calming hormone, so it’s like a natural anti-anxiety hormone. It’s good for sleep. Testosterone is what gives us our motivation, our confidence, self-esteem, decisiveness, get up and go and get things accomplished.
When testosterone levels go down, sex drive goes out the window. We start to age at an accelerated rate. We just feel more blah. How women describe feeling is they are just putting one foot in front of the other, making their way through the day. If things really have to happen today, we’ll make it happen. If it doesn’t really have to happen today, we’ll just push it to the side because we’re not really feeling it.
When I say that to women who come in to see me, when they are sitting across the table from me, and I talk about feeling flat, kind of blah, putting one foot in front of the other, I can just see their eyes nodding. A lot of women really resonate with that. Testosterone is a really important hormone for our physical health, and it’s really important for our mood and how we feel.
All this is true for men, too: confidence, motivation, stamina, muscle strength, sexual health. If a person were to walk into their doctor’s office and try to put this into words, “I just don’t feel like myself. I don’t really get excited about things anymore. I’ve lost my motivation. I just feel kind of tired.” What’s their doctor going to do? Prozac, sleeping pills. That’s really what we are trained to do at medical school, to prescribe medicines to fix whatever things you’re complaining about. In this case, antidepressants don’t really work well because they’re not fixing the right problem.
Dr. Eric:
The next question I was going to ask you are common symptoms of a testosterone deficiency, but you just answered it. There might be others. If someone is having low libido, low mood, low stamina, those are some of the signs and symptoms of a possible testosterone deficiency.
Dr. Deb:
Because you talk a lot about thyroid, one of the things we should mention is there is a lot of overlap between thyroid symptoms and testosterone symptoms. More so with the low thyroid, but the fatigue, the low libido, the mood changes, etc., there is a lot of overlap there. Testosterone symptoms can sometimes make women go to their doctor thinking, “Gosh, it’s got to be a thyroid problem.” Their thyroid gets measured, and they are told, “No, everything’s fine.” Nobody thought to look at their testosterone.
Dr. Eric:
Good to know. If they go to a conventional medical doctor, sometimes they won’t even look at the thyroid. If they do, they will often just look at TSH. As you mentioned, they will neglect looking at the sex hormones, including testosterone.
Dr. Deb:
Just like you can have low thyroid, or you can have hyperthyroidism and too much thyroid, the same thing is true with testosterone. You can have low testosterone, which is very common in women probably over 35. Testosterone levels start to go down as our ovaries are inching their way toward menopause. We can talk about some of the things that cause low testosterone.
Women can also have high testosterone. There is a very common condition called PCOS (polycystic ovarian syndrome), which results in high levels of testosterone. There are some other hormones that act like testosterone; we call this group of hormones androgens. They are the male hormones. Women can have too much of these.
These symptoms are totally different. If you have too much of these hormones, you can have acne, especially along the chin and jawline; hair growing in the places where you don’t want it; thinning hair on your head; irregular periods, either no periods at all or periods come randomly or heavy periods that never want to go away. A lot of women who have this problem struggle with their weight. Often, they end up having blood sugar problems and prediabetes. Cysts on the ovaries, which is where the name comes from.
If somebody has all of those symptoms, and they are pretty notable, then probably what will happen is at some point along the way, they will be diagnosed with PCOS. This is a very common problem. We find it in 1/10 women; 10% of women have PCOS. The majority of them have not been diagnosed. Often, what happens is when they’re teenagers, they never really get regular periods, so they just get put on birth control pills.
Now they are on birth control pills, which shut down our natural hormones and replace them with the synthetic chemicals in the birth control pills that mimic our hormones, but they are not the same thing. That regulates periods. It does help with some of the symptoms, but it’s not really fixing the underlying problem. Then at some point, this woman is going to want to start a family. She is going to come off birth control pills but not have regular periods and have problems with fertility because one of the things that this testosterone does is it interferes with fertility.
It’s important for women to have a proper diagnosis. If you don’t have all the symptoms, or if you just have some of the symptoms, sometimes it slides through the cracks. Too much testosterone is not a good thing either.
Dr. Eric:
What I’ve learned, what I’ve researched, is when someone has elevated testosterone, especially in the presence of PCOS, a lot of times it’s insulin resistance related. Is that true?
Dr. Deb:
Exactly. The underlying problem is an insulin problem. There is too much insulin, so that’s what’s going on with type 2 diabetes. You don’t have to have type 2 diabetes; it doesn’t have to be that severe. There is a problem with insulin that affects the ovaries to trigger more testosterone production. This testosterone causes symptoms, and the testosterone interferes with the regular ovulation and ovarian function, which messes up periods and causes problems with fertility. We can cover it up with birth control pills. If we can go backwards and get down to working on the insulin resistance and some of the other factors here, we can actually get the hormones much better balanced.
Dr. Eric:
If someone has elevated testosterone, so PCOS, would you still suspect insulin resistance?
Dr. Deb:
When somebody has insulin resistance, whether they have a diagnosis of PCOS or not, it can trigger more testosterone production. Even if a woman doesn’t have the label of PCOS, we would still want to think about working on insulin levels.
Dr. Eric:
I’m just saying, because you mentioned a lot of women with PCOS are not diagnosed. Even if they were evaluated, and they don’t have cysts, and their cycle is fine, is it possible that it hasn’t reached that point yet, where they are at the beginning stages? If nothing was taken care of, if it wasn’t addressed, eventually, they might have developed PCOS?
Dr. Deb:
Exactly. While we are talking about this, let me talk about another hormone that causes testosterone levels. 50% of a woman’s testosterone comes from her ovaries, and the other 50% comes from the adrenal glands. The adrenal glands make adrenaline, cortisol, and one called DHEA (dehydroepiandrosterone). You can understand why we call it DHEA. It can be used to make testosterone. 50% of the testosterone comes from here.
When you are stressed, your adrenal glands will start getting stimulated to deal with the stress. They will make more cortisol, and they can make more DHEA. That can result in more testosterone. Sometimes, it can be from stress, but usually, there is a limit to how high the testosterone will go.
For some women who have PCOS, their testosterone levels aren’t that bad, but their DHEA levels are quite elevated. If their doctor only measured their testosterone, they might miss it. They can still have acne or hair growing or whatever the symptoms are. We would also want to make sure to look at the DHEA. We can talk about lab testing in a minute, but that’s another important one to think about. Addressing stress is an important way to try to help get testosterone levels normalized.
Dr. Eric:
A follow-up question for men: I don’t know if you ever see elevated testosterone in men. Obviously, men can’t have PCOS. Would you say it’s in most cases stress-related if they have that elevated testosterone?
Dr. Deb:
I have never had a man walk in my door and say, “Somebody help me. I have too much testosterone in my system.” Those guys aren’t coming in complaining. They’re out taking over companies and driving sports cars. I don’t know what they’re doing, but I’ve never seen them.
Dr. Eric:
Good to know. Makes sense. Most of the men probably are on the lower side.
Dr. Deb:
Most of the men who come in have low testosterone, yeah.
Dr. Eric:
Before we get into testing, what causes the decrease in testosterone?
Dr. Deb:
Low testosterone, there are a few really important things that women need to know. One of them is birth control pills. When you are on birth control pills, it’s not hormones; it’s synthetic, man-made chemicals that are never found in your body but are made to try to mimic the hormones. What happens is they shut off your natural hormones, which get replaced with the synthetic chemicals, but your brain feels like it’s got the hormones in the system, so the message to your ovaries gets turned off. Okay, we don’t want you to ovulate and get pregnant, so that part is okay. But the message to make testosterone also gets turned down.
Plus when you take birth control pills, your liver reacts by making more of a hormone called sex hormone binding globulin (SHBG). When you have more SHBG, it binds to testosterone and inactivates it. First of all, your testosterone level goes down a bit. What you’ve got gets inactivated. Now you feel like you have low testosterone, and your body could be making it. It’s just a side effect of the birth control pill. That’s one really important thing that women need to know.
When they go on birth control pills, libido may go down. They could have vaginal dryness. They may just not feel as good. There is a bajillion birth control pills that all have different types of these chemicals in them that all act a little bit differently. Birth control pills is one that’s important to know.
Another thing that can lower testosterone is stress. We talked about how stress can cause more of this DHEA that can make more testosterone. What often happens is your adrenal glands pump out a lot of cortisol to help you cope with stress. They can only maintain that for a while, and then your system starts to shut down inappropriately. Now you don’t make enough DHEA. If you don’t have enough DHEA, then you don’t make as much testosterone. Stress is an important cause of low testosterone for women and for men. Coping with stress in healthy ways is one of the ways to help normalize testosterone levels when it’s low.
A really big cause of low testosterone is just the aging process. For men, testosterone levels very gradually go down over time. We’re seeing low testosterone in younger and younger and younger men.
For women, over the age of 35, as our ovaries are inching toward menopause, the testosterone levels start to go down. It’s super common for us to see low testosterone levels in perimenopausal women in their 40s and certainly in women who have gone through menopause.
Dr. Eric:
I’m glad you mentioned stress because stress can not only lead to low testosterone but also other sex hormones, like testosterone converts into estradiol. We can see that low. Definitely has a dramatic impact on all the sex hormones.
You mentioned SHBG, where birth control can increase that, and then the testosterone binds to it, so you have less free testosterone in the bloodstream, correct?
Dr. Deb:
That’s right. Also, hyperthyroidism-
Dr. Eric:
I was about to have a segue into the hyperthyroidism increasing SHBG.
Dr. Deb:
Hyperthyroidism can increase SHBG. When studies have looked at this, they have actually found that because hyperthyroidism increases your metabolism in many different ways, sometimes women end up with higher testosterone production because their system is just revved. Then they make more of this binding protein that inactivates it. At the end of the day, it comes out as a wash, which is interesting. We definitely see more SHBG, which definitely inactivates testosterone. You could be at risk for having low testosterone, and maybe the negative impact of the hyperthyroidism might boost the testosterone and negate that. You just need to test, and then you’ll know.
Dr. Eric:
That is interesting. You mentioned you’re seeing younger men with low testosterone. Would you say most of the time, if you have to guess, that’s more due to chronic stress compared to years ago?
Dr. Deb:
Part of it is due to stress. Part of it is due to lifestyle habits. If you’re not eating the right foods, if you become more inflamed, if you’re overweight, especially if guys are carrying weight on their belly, that causes a lot more testosterone to flip over into estrogen. Testosterone gets converted into estrogen. If that’s happening too much, then your estrogen goes up, and your testosterone goes down. That doesn’t feel good if you’re a guy.
Lifestyle habits. Alcohol causes more estrogen production. Too much marijuana isn’t good for testosterone levels. If you are not doing exercise, resistance exercise, like lifting weights, helps to boost testosterone.
Another thing that we really need to mention that is so important is the effect of toxins in our environment. I’m sure you talk about how toxins trigger autoimmunity. A lot of the toxins that we’re exposed to on a regular basis in our environment are hormone disruptors. They mess up how our hormones work. They mess up your thyroid, and they mess up testosterone. There are a lot of examples of toxins in the environment that lower testosterone in men. The problem is they are so hard to test.
For example, atrazine is an herbicide that gets sprayed on crops in order to kill the weeds. It rains, and the atrazine gets washed into rivers, lakes, and streams. Atrazine can turn a boy frog into a girl frog. Apparently, according to one study, there is enough atrazine in the urine of a typical American man to turn a boy frog into a girl frog. The real question is what does it do to a male human? We can’t really properly test that. What are we going to do? Get a bunch of men to drink a bunch of atrazine or roll in it? Who is signing up for that study? That would be completely unethical. We don’t really know. That is one example.
Another example is triclosan, which was an ingredient in antibacterial soap. They are no longer allowed to use it, but it was in our soap for a really long time. What we know from that one is when they took, I forget it was hamsters or gerbils, some type of cute fuzzy animal, and they exposed them to triclosan, it caused their testes to go from pink to blue. What does it do to male human testes? We don’t know. Thankfully, they have taken that one off the market now.
There are tens of thousands of these chemicals. Most of them have never been tested, so we have no idea. But we do know that is a really important factor in why we’re seeing a lot of hormone imbalances in women and men.
Dr. Eric:
That’s definitely important to know. That’s why we want to do everything you can to reduce your toxic load. Even though triclosan is not part of the hand sanitizers and soaps anymore, there are still other exposures.
Dr. Deb:
Your thyroid is one of those canaries in the coal mine, where your thyroid is one of the first things to be damaged when we’re exposed to a lot of these chemicals.
Dr. Eric:
I know in the research with thyroid, the xenoestrogens, like BPA, I don’t know if you’ve seen anything in the research that shows that could potentially affect testosterone.
Dr. Deb:
A lot of the chemicals do. A lot of what they do is because they act like estrogen, they throw off the estrogen/testosterone balance. Indirectly, they do definitely affect all of these. The way that these hormones work is a lot of times, they have equal and opposite actions. If one of the hormones is high/normal, and one of them is low/normal, even if technically the level of each hormone is in the normal range according to the lab, if they are out of balance, you still can have symptoms. If you actually could get your doctor to measure your hormone levels for you, which is sometimes difficult, sometimes they just look at it, and everything lands within the lab range. They say, “Everything’s normal, congratulations.” You’re sitting there, going, “I feel so crappy. How could it be normal?”
Thyroid is the worst, right? I was on Synthroid for 10 years. It probably took me 10 years to get diagnosed with hypothyroidism. I was on Synthroid for10 years. I felt no better. It took me 20 years to learn this stuff and get my thyroid in balance. We are talking about testosterone today, and that’s important, too. When we are talking about these toxins and getting these labs, thyroid is just the worst.
Dr. Eric:
You make a good point. These hormones are all inter-related. Even if it’s not directly affecting testosterone by affecting estrogen or other hormones, it could indirectly affect testosterone.
Dr. Deb:
We still don’t feel good.
Dr. Eric:
Let’s talk a little bit about testing. I imagine blood is probably the most common method you use for testosterone.
Dr. Deb:
For hormones, we can do saliva testing, urine testing, but blood testing actually works really well for testosterone. We do want to do more than just a testosterone level because we have the total testosterone, and we also have free testosterone. You want to know both. Testosterone circulates around in your bloodstream, but you also have this SHBG. SHBG is going to grab hold of testosterone and inactivate it. Whatever is left over that hasn’t been inactivated, that’s your free testosterone. That’s what you feel. If you have more or less testosterone, or more or less SHBG, it’s going to impact how much free testosterone you have. I like to look at the total testosterone, free testosterone, and SHBG to understand really what’s going on.
We also want to look at DHEA because that is the precursor hormone. For men and women, if we are going to order the blood test, we want to order DHEAS, which stands for DHEA sulfate. That is how DHEA is carried through the bloodstream. If we just order straight DHEA, it fluctuates a lot. The level goes up and down over the day. The DHEAS is the one for us to order.
For men, DHEA is made into testosterone, but it’s not enough. It’s just a small amount. For women though, 50% comes from DHEA. If the DHEA level is not very good, if it’s kind of low, if we actually give women some DHEA, we can actually raise their testosterone level naturally. Knowing what the DHEA level is is important. If your DHEA level is kind of high to start with, we wouldn’t want to give you more; otherwise, we will cause you to have side effects. It’s important to measure DHEA.
I also think that we should be measuring cortisol levels. That one is not the best one to measure in a blood test. For cortisol, we prefer to measure in a saliva test or urine test because we can measure multiple times in a day. Cortisol has a Circadian rhythm, where it changes over the 24 hours. What we’re really looking for is is it going up when it’s supposed to go up, and is it going down when it’s supposed to go down? If the pattern is off, that’s a problem.
Testosterone and cortisol are opposites. Testosterone is a build and repair hormone. It makes you strong, and it’s an anti-aging hormone. Cortisol is a wear and tear hormone. It breaks things down, like your bones and muscle. It’s an aging hormone. They are kind of opposites. High cortisol can be a cause of low testosterone, so we would want to know that.
We are trying to look for as many potential underlying causes as we can, so we can fix them. All these things are often going on at the same time: too much stress, not enough DHEA, toxins in the environment, birth control pills. You get all of these all at once, and then you feel really bad. You go to your doctor and walk out with a Prozac prescription that kills your sex drive and makes you gain weight, and you still don’t feel good.
Dr. Eric:
Do you also test for estradiol to see if the testosterone is overconverting?
Dr. Deb:
Yes although it does depend. For men, absolutely, because that’s an important cause of the low testosterone, if too much is converting. For women, typically, I am measuring all the hormones. If somebody is on birth control pills, the birth control pills shut down estrogen, so the lab test won’t be valid. It is very important for women who are having menstrual cycles, we have to do the tests at the right time in the cycle. Otherwise, the estrogen and progesterone levels won’t be valid. We would expect completely different estrogen numbers when you are on your period versus when you are ovulating versus the week after you’ve ovulated. The timing matters a lot. You can’t just march into your doctor on any random Thursday afternoon and ask for an estrogen level on the spot and be able to properly interpret it.
Dr. Eric:
Glad you mentioned that. How about optimal levels? Can you talk about both free and total testosterone? I know it differs between men and women. What do you look for? What do you ideally want to see?
Dr. Deb:
That’s a really loaded question. It should be obvious. This is the lab range, and this is the optimal level. But nobody can decide. Every lab sets what they consider to be the normal range. It varies so much.
If we start with women and just talk about blood testing, for the longest time, LabCorp had 40 as the upper limit as normal and 4 as the lower. You could be 4-40; that was the normal range. Other labs said that the normal range went from 15-85. You could have twice as much testosterone at the other lab, and that was considered normal.
For free testosterone, typically, the upper level for women goes up to about 2.5 or something like that. But the lower end is 0. You can have 0 free testosterone as a woman and be considered completely normal, which is just stupid. The problem is we can’t decide what’s too high, and we can’t decide what’s too low. We just let it go all the way down to the bottom without really caring about it.
For me, one of the most important things that I look for is do you have symptoms? Do you have symptoms of low testosterone or high testosterone? What I see in practice is for example, the women who have PCOS, etc., where they are having symptoms of acne, hair growing, etc., they very frequently have testosterone levels above 35. In the high 30s, 40s, 50s, 60s. They are not on any kind of testosterone replacement therapy. That’s a whole different ballpark of what number we look for.
When we see women with symptoms of low testosterone, I very commonly see the total testosterone is below 20.
For the high testosterone, often, those women have free testosterone at the upper end of what the lab says is normal, or a little bit over. For low testosterone, what I see women is under 20 typically have symptoms, even though the lab says that normal goes all the way down to 4. Sometimes, even in the mid-20s, etc., women will still have symptoms and not feel good.
The challenge that we have is for free testosterone, when we are measuring low levels, the lab tests become inaccurate. The machines that they use at the lab can’t properly count the number of molecules of testosterone when it gets really low, so it’s hard to put a number on what would be too low because it’s inaccurate, and it’s allowed to go down to 0.
For me personally, assuming somebody has symptoms, I would say that something below 20 would be where I would look at somebody and say, “I think your testosterone is too low. Maybe we need to help you naturally make more, or whatever we need to do to get your testosterone better.”
For men, they have much more testosterone than women, but we still have the same problem. Nobody can decide what’s normal. Nobody worries too much about where the upper limit is. I gotta tell you, LabCorp used to say 900 for men was the top. Then they pushed it and said you can go all the way up to 1,200. That’s normal. After a few years, they came back to 900.
For lower, there is even more disagreement. Some labs will say anything below 200 is low. Some labs will say anything below 300. Some labs, they have to be below 350 to be counted as low. Even the free testosterone, we have the same problem. The labsare different.
For me, I am starting by looking for symptoms again. If a man has symptoms of low testosterone, and his total testosterone level is below 400, or if the free testosterone is low, even if the total testosterone is normal, those are men where I would look at them and say, “Your testosterone is too low, and we need to do something about it.” Even if it’s a little bit above that, it depends on the symptoms and all their circumstances, they could still use a little more sometimes.
If you were a man who lived your whole life with a testosterone level at 850, and now, over time, because of all those various things, now you have gone down to 450. That still might be considered normal, but that’s a big change from where you used to be. You probably won’t feel as good as how you used to. It’s not like we want to make you 18 again, but it’s not healthy to have low testosterone.
Dr. Eric:
One question I had based on a patient I saw recently, and you might have already kind of answered this. I had a female patient who had free testosterone levels, but her total testosterone was out of range. I was going to ask you how would you approach that? It sounds like the first thing you would do is evaluate the symptoms.
Dr. Deb:
Are you talking out of range high or low?
Dr. Eric:
I think it was high. I think it was a little bit on the higher end, the total testosterone. Free was normal.
Dr. Deb:
Even so, if the total testosterone was high, I would still be looking for what’s driving it high, and what we could do to calm it down. Look at the insulin resistance. I would be looking for symptoms especially. A woman whose testosterone level is a little bit high is probably stronger. She is probably an athlete. She is probably competitive. She might be the vice president at the bank or running her own company or a doctor or lawyer. Testosterone gives us drive and motivation and confidence and assertiveness and self-esteem. Women who naturally have had a pretty decent amount of testosterone their whole life tend to be confident. They are in corporate America or are competitive athletes, whether they are amateur competitive athletes or professionals.
Women who have always had low testosterone are more likely to choose a different life path. Maybe they are a florist or kindergarten teacher, something that requires, I was going to say less assertiveness, but goodness knows if you’re a teacher, you need assertiveness to get all of those kids to sit down and behave. I am not trying to stereotype. But these hormones affect who we are. They affect our behavior and a lot of things about us. Sometimes, a little bit of extra testosterone can actually be an advantage in certain circumstances. It’s not always bad.
Dr. Eric:
That’s good to know. One last question I had with the testing: What are your thoughts on saliva testing for testosterone? Earlier, you mentioned urine testing for adrenals, Dutch testing for testosterone.
Dr. Deb:
When I am picking which test I am going to order for somebody, because I do all of these (saliva, urine, blood), usually the decision of which test I’m going to make depends on the other hormones. If for whatever reason the only thing I’m going to measure today, which doesn’t happen very often, is testosterone, I will just do it in a blood test. I think it’s perfectly fine.
When we are looking at the other hormones though, there is more information we can get. In the saliva test, we can do the cortisol four different times, and you’re not going to the lab to get your blood drawn four different times, especially not at midnight.
In the urine test, we can look more at how the different hormones, including testosterone, are broken down and how your body processes them. Depending on how you process them, that has implications for how they work and how you feel and what kind of health conditions you could be at risk for. If I’m interested in those pathways, if a woman has fibroids or fibrocystic breasts or ovarian cysts or problems like that, I might be really interested to know how she is processing her estrogen, so I would pick that test.
Testosterone can be measured in any of these tests. The gold standard at this point is still in a blood test. What I would say for women is first of all, you have to find the right practitioner to even order the test in the first place. Not all doctors are going to be able to do that. You’re probably best letting the practitioner choose the test that they are the most confident and comfortable with interpreting. Any of these tests would be okay.
Dr. Eric:
I will add that I don’t do Dutch testing on everybody, but when I have done Dutch testing, it’s common to see testosterone really low. Oftentimes, the report will red flag that and say, “Test it in the blood.” It will admit that it’s not completely accurate.
Dr. Deb:
The blood test is the gold standard for testosterone definitely. It’s important to know that in the urine test, you’re measuring the testosterone that your body used and you peed out. In the blood test, you are measuring how much is going around and around. It’s not quite apples to apples. You’re getting different information. Sometimes, one piece of information is really helpful.
Dr. Eric:
The final topic is increasing testosterone. I think you mentioned earlier weightlifting, resistance exercise. Let’s get into that. Bioidentical hormones, you don’t have to go into great detail with that. I’ll let you talk.
Dr. Deb:
Resistance exercise, lifting weights with heavier weights, is one of the things that boosts testosterone in men more so than in women. Women still need to do that resistance exercise. Men get a bigger boost in testosterone than women do.
Sometimes, you can’t avoid all the stress. Doing things to help balance the stress in your life, whether that’s yoga, breathing exercises, writing in a gratitude journal, doing what you can to manage stress in a healthy way is so important for hormones.
There are other things we can do. If your adrenal glands aren’t making the right amount of cortisol and DHEA, there are certain herbs we can use, adaptogenic herbs, things like ashwagandha, holy basil, ginseng, etc. Those can be helpful, too.
For women who have low testosterone and low DHEA on the test, we can give a nutritional supplement of DHEA to help naturally raise the levels. That doesn’t have to be permanent either. If you’re all stressed out, burned out, overwhelmed, sometimes we can give you some of these herbs and DHEA, and then you get better. Things can go back to normal. The younger you are, the more often things can just go back to normal. You won’t have to keep taking them.
There are other herbs that specifically help to boost testosterone levels. There is one called tongkatali. There is a number of herbs that can be used. The younger you are, the more likely it is that it would be helpful.
When men and women get to a certain age, and testosterone production is just low and not really coming back because of age- These days, age is not 96 anymore. For women, it means you have gone through menopause. In men, it’s somewhere in mid-life or lower if you have a lot of toxins in your system. We can give testosterone replacement. Almost all of testosterone is bioidentical, meaning it’s the natural form of testosterone. It’s exactly what your body used to make, which is so important.
There is still one pill on the market called Estratest, which is a synthetic drug form of estrogen and a synthetic drug form of testosterone. I don’t recommend it. It’s not the same thing as testosterone. It’s not good for your liver. You wouldn’t eat a drug version of a tomato, so I don’t know why you would want a synthetic version of testosterone.
But we can give testosterone. It’s important to have your level measured first to see if you even need it. We don’t want to give it to you if that’s not the appropriate thing. You want to be monitored for side effects. You want to have your level rechecked to make sure you are on the right amount.
You want to make sure you are working with a practitioner who is taking the whole person into account. It’s important to put any type of hormone replacement therapy into a healthy body because we want the benefits of the hormones, not the risks and side effects. Fortunately, the risks and side effects of testosterone are more nuisances. They can cause oily skin, oily hair, acne, hair growing where you don’t want it. All of these things are annoying, but they are not like heart attacks, strokes, breast cancer, or things like that.
But there are some practitioners out there who are so confident in the idea that testosterone makes people feel better that they have the mindset that more is better. Sometimes, they are giving pretty hefty doses of testosterone. Or they are not looking at the whole person and dealing with inflammation, nutritional levels, stress, and other things. If someone is not feeling good still, they just keep trying to go up and up and up on the testosterone to try to fix all of their symptoms. That’s not really the best approach either.
If we can get the person healthier, you don’t need such a big dose of testosterone because your body just works better. It is important to make sure that whomever you’re working with, if you end up to the point of talking about hormone replacement therapy, is using a functional medicine approach, where they are looking at you in a holistic way.
Dr. Eric:
How typically is testosterone administered in both women and men? Is it orally or cream?
Dr. Deb:
Typically, not orally. We can do it as a topical cream. We can do it as a lozenge that dissolves under your tongue. We can do it as injections. We can do it as pellets, which look like little Tic-Tacs that get inserted under your skin.
Dr. Eric:
That’s for both men and women?
Dr. Deb:
For both men and women, yes. We have lots of options.
Dr. Eric:
One other question when it comes to overconverting testosterone to estradiol: Do you ever recommend either natural or prescription aromatase inhibitors?
Dr. Deb:
Yes. We don’t usually need that for women. We can work with women without needing aromatase inhibitors.
For men though, if the main problem is that a man is able to make testosterone, but he is converting too much to estrogen, first of all, we want to work on the underlying causes. Insulin resistance, inflammation, belly fat, these are some of the primary drivers. We want to improve lifestyle habits and help lose weight. There are lots of toxins that act like estrogen, so we want to clear those out.
If we just gave more testosterone, they are just going to flip it into more estrogen, and they won’t feel better or get the results. I see that all the time. Men go into their primary care doctor. Sometimes, they have to ask for it. If somebody measures their testosterone level eventually, then they get a prescription for a testosterone gel. They put this gel on, and it just flips over into estrogen. They don’t feel better. Either they just give up on it, or they keep taking this gel because it was prescribed to them. But they don’t get that much progress because regular doctors are only looking at testosterone, not estrogen.
If a man came to me with these risk factors, and I could see the estrogen is relatively high compared with the testosterone, I would definitely give aromatase inhibitors, which prevent this conversion. We can use an herb called chrysin, which works a little bit. Sometimes, we have to use a medicine; a common one is called anastrozole. We don’t like to use medicines, but we can use half a pill twice a week. Sometimes, that’s enough to stop that conversion. The testosterone comes up. Then a man feels like himself again. He is much more likely to have the motivation to go to the gym and eat healthy and do the right things to lose the weight and get the inflammation down. Sometimes, things can reset themselves, and he doesn’t need to take it anymore.
Dr. Eric:
Thanks for sharing that. I think we covered a lot, but is there anything I didn’t ask you that I should have asked you? Anything else you’d like to talk about?
Dr. Deb:
One thing I’d like to say is that hormones are really important in how we feel. It’s something that you can’t see and touch. If your right elbow is swollen up double its size, when you walk into your doctor’s office, everybody will scramble around to figure out what to do to help you. When you walk in and say, “I don’t feel like myself. My career is stalling because I can’t get myself going to get stuff done,” they don’t have anything for that. You’re left to feel like you lack self-discipline; it’s like a personality flaw.
Please know that hormones are really important. It’s so common for women and men to have hormone imbalances. You can’t wait for your doctor to fix you. Your doctor doesn’t have a pill that’s going to fix you. We all need to take charge of our own health. I really believe that living well is the best medicine.
Dr. Eric:
Well said. Where can people find out more about you, Dr. Deb?
Dr. Deb:
The website for my practice is SignatureWellness.org. You can follow me on Facebook or Instagram @DrDebMatthew.
Dr. Eric:
Did you want to mention your book as well?
Dr. Deb:
Sure. I wrote a book. When people come in to see me, women will often say, “I’m feeling like this, this, and this. I wonder if it could be my hormones.” When men see me, “I’m feeling this, this, and this. Maybe it’s just my age.” That’s what I hear. Women think it’s their hormones, and men just think it’s their age.
I wrote this book to help women understand whether their symptoms could be from a hormone problem. It’s called This is Not Normal: A Busy Woman’s Guide to Symptoms of a Hormone Imbalance. It has a bunch of quizzes, so you could check the list of symptoms to see if it could be your testosterone, estrogen, cortisol, or anything else. It’s got tips for how to naturally start getting your hormones back in balance. It has some tips on how to talk to your doctor to try to get the right help. If your doctor is not the right person to get you help, there are some tips on resources for where you can go to find the right kind of doctor to help you. You can get a free copy at IsItYourHormones.com.
I have a book for men, too. It’s called Why Can’t I Keep Up Anymore? It’s a guide to regaining peak mental, physical performance over the age of 40. That one is available on our website and on Amazon.
Dr. Eric:
Thank you so much, Dr. Deb for your time and for sharing your knowledge about testosterone. I’m sure the listeners learned a lot, and I did as well.
Dr. Deb:
Thanks so much for having me.