Hello VCMD family! Welcome to part 2 of our discussion on sex steroids and relevant information in the book Boundless. Let me give you a quick recap of why Boundless is such an extraordinary book when discussing such complex biological processes as the endocrine system. Unlike many traditional medical school textbooks, Boundless approaches the health and vitality of the human body from physical/morphological origins and our cognitive/evaluative organizations, as further detailed by the mysterious world of quantum mechanics.

Now let’s begin our discussion on testosterone. Testosterone (T) in the body is actually available in two forms; one is known as bioavailable free testosterone (Tf), and the other one known as total testosterone (Tt). Once T is produced by the testes (males) or the ovaries and/or adrenal glands (females), it enters the bloodstream as Tf, which is the bioavailable form of testosterone that our body utilizes. When it comes to low T (clinically known as hypogonadism), it is important to understand that having high Tt levels does not necessarily mean you have high levels of Tf. For example, the normal Ttrange for early morning in male adults is approximately 300 to 1000 ng/dL, but their Tf levels can be as low as 6.4 ng/mL. Thus, your healthcare provider must order a comprehensive hormone panel rather than testing for just Tt or Tf

So, what’s with the weird units of measurement?? Well, T is measured by weight in nanograms (1e-9 grams), diluted in a decaliter (101 liter) volume, or a milliliter (10-2 liter) volume. That brings us to normal T levels. I will provide you with the textbook ranges for men and women, which is only based on laboratory values and does not consider both forms of T. Remember, your Tf has more impact on your body than your total Tt (see above). For men, normal Tt parameters are:

For men, normal Tf parameters are:

For women, normal Tt parameters are:

For women, normal Tf parameters are:

Believe it or not, 25% of men over age 30 suffer from hypogonadism. Moreover, nearly 39% of men ages 45 years and older have low testosterone levels; that’s pretty profound! What’s alarming is that several studies have proven that low testosterone is associated with increased mortality. For example, in patients over 40-years-old, the mortality rate of those with low T was 40% higher! Levels of low T are without a doubt even more dangerous, with a greater risk of death than previously thought. Ok, let’s steer away from some of the [doom] studies; but the [gloom] evidence is too overwhelming, not to mention. 

Low T has been shown to drastically affect the quality of life in men and women. Thus, regardless of your sex, you may be at risk of low levels of testosterone. Generally, conditions that can lead to low levels are obesity, type II diabetes, liver/kidney disease, infection, and certain medications (e.g., chemotherapy). Additionally, comorbidities associated with causing low T, specifically in women are psychiatric trauma, birth control pills, childbirth, and adrenal stress. Common symptoms in women include sleep disturbances, increased body fat, infertility, low libido, depression, and worsening congestive heart failure. In men, symptoms include low libido, reduced erectile dysfunction, loss of lean muscle mass, fatigue, obesity, depression, and as mentioned above, increased risk of death. 

A testosterone deficiency caused by aging in men is commonly referred to as andropause. Andropause is associated with a higher incidence of diabetes, dementia and Alzheimer’s disease, heart attacks, frailty or sarcopenia (low lean muscle mass), and osteoporosis. Furthermore, low levels of T are associated with pro-inflammatory markers, such as oxidative stress. Such increased levels of oxidative stress may deteriorate your body’s overall vitality. But just what is oxidative stress? 

A good analogy is to picture your cells as pieces of metal and oxidative stress being the rust on those metal pieces: the more oxidative stress you have, the more damage done to your cells. Fortunately, oxidative stress is reversible through the aid of antioxidants. What’s even more fortunate is that your diet is not the only way to improve your antioxidant levels. Testosterone therapy displays several antioxidant effects as well as enhancing vitality and function. One study found that men treated with bio-identical testosterone replacement therapy (BTRT) experienced a reduction in fat mass and an increased muscle mass and strength.2

Nonetheless, there have been some claims that are antithetical to the benefits of BTRT. For example, some studies raising concern in the past that testosterone therapy can A) increase the size of your prostate gland or B) potentially increase the risk of prostate cancer. Yet, evidence released since these initial claims show that claims A and B are false. Research has shown that BTRT is both safe and effective, not to mention it has a very positive effect on men’s health. The other potential risk that we are still required to speak to patients about is the association of testosterone therapy with cardiovascular disease. However, several studies have shown that men who restore testosterone to natural levels using BTRT have been shown to reduce their risk of heart attack and stroke.1 Additionally, other benefits of hormone therapy for men include:

How exciting is that?!

Did you know vitamin D is associated with testosterone levels? It is! One study found a link between vitamin D deficiency and low testosterone.8 Furthermore, a previous cross-sectional study found people found a link between vitamin D (more appropriately known as 25-hydroxyvitamin D) levels and testosterone levels in the blood.9 As of late, vitamin D is receiving a lot of attention, given that vitamin D supports our immune system in fighting infection and has implications as an adjunct therapy for COVID-19. 

I recently had a viral infection, like a cold, and I had such a strong intuition that my vitamin D levels were low. Nevertheless, it turns out my vitamin D levels were substantially low. It was down to 22 ng/mL when a normal range is between 30 ng/mL to 100 ng/mL. We generally try to bring those levels up to around 40 ng/mL or 50 ng/mL for the average patient. It is truly astounding just how many people suffer from low testosterone due to low vitamin D levels unbeknownst to them. 

Another study demonstrated that participants who spent more time in the sun slowly began to show increased testosterone levels. Researchers showed that “An hour of sunshine can boost a man’s testosterone level by up to [69%]. Men with more Vitamin D per milliliter of blood had much more of the main male sexual hormone circulating than those with less. Also, the average amount of testosterone over the course of the year was subject to the same fluctuations as the vitamin D level. Both decrease from October – at the beginning of the winter months and reach their lowest level in March because of the weaker solar radiation during this period.”10

The mechanism behind sunlight exposure influencing testosterone levels is accomplished by the vitamin D receptors found in the testicles. In other words, ultraviolet B (UVB) rays from the sun hit the cholesterol molecules in the skin cells, providing the energy for vitamin D synthesis, which acts on the receptors to support testosterone production. Therefore, increasing your vitamin D stores can boost your testosterone levels and other health-related measures, such as sperm quality, suggesting that this vitamin plays a significant role in testosterone production.11,12 Thus, it is very important that if you’re working on normalizing your testosterone levels through BTRT, I recommend that you also work on improving your vitamin D levels. One way I recommend for patients undergoing BTRT is by including a healthy sunbathing routine. Overall, the benefits of raising vitamin D levels, subsequently raising testosterone levels through sunlight exposure are well documented. I implore you to seek out the evidence yourself! Please let me know if I can provide some insightful tips on how to research medical journals. 

Here is our first body bio-hack practice! Sunlight not only stimulates vitamin D synthesis but also provides several antioxidant benefits.13,14 The near-infrared (NIR) portion of natural sunlight stimulates an excess of antioxidants in each of our healthy cells. The antioxidant reservoir’s cumulative effect is to enhance the body’s ability to rapidly and locally deal with changing conditions throughout the day.7 This drastically reduces the oxidative stress, or the rust, throughout our cells. Believe it or not, one of the best ways to get the full benefit of sunlight is to avoid wearing sunglasses. Sunglasses may be contributing to SAD, affecting emotions deleteriously.6

This concludes our discussion on androgens and the profound effects BHRT has on your body’s testosterone/estrogen levels. The evidence is clear: hormone replacement therapy using bio-identical hormones is an effective and natural option for restoring and balancing your hormone levels. There is no reason for you to suffer when effective restorative treatments are available. It is very important for you to consider this advantageous therapy! Your questions/comments are greatly appreciated! Love you all.

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