Testosterone 101: What Every Man (And Woman) Needs To Know

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.

Because it improves muscle mass and blood sugar, yeah.

Exactly.

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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 jump 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 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. They go, well, you know, and what, 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 1000. 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 6, 7, 8, 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 your 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. hormones 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, and it's not like normal fat. It's actually producing all sorts of bad things, including inflammation, including you know, oxidative stress, it screws up your, your brain chemistry, it makes you hungry, it, it, it prevents you from burning fat, it, it makes you gain more weight, it makes you more insulin resistance, 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, no, no 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 your testosterone. It's easy to test. You 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're, 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 obviously cortisol 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 can 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 way, 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, your 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 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, I, 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 800, 700, and that's where I get them by, by using a comprehensive approach. You just have to know what to do because everything we do influences our hormones. So getting, getting your testosterone straight is really important for men, for, 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 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 sold 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 the DHE low, there's lots of things you can do. We've talked about a lot on the podcast, but, you know, all sorts of ways to regulate your stress response from meditation to yoga, to breath work, to, you know, 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. They're not just, you're not just a passive recipient of whatever numbers you 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, and 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, but it can be elevated if you have a large 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 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. 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 men 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.

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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 diet, stress, all these factors we look at comprehensively in functional medicine. That's what we do at the UltraWellness Center. That's why you have so much success We're not just a knee jerk, oh, you have low testosterone, give testosterone.

It's a comprehensive approach to all these variables. Right. So, this gentleman came in, he was experiencing fatigue. 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 he was not getting the clinical benefits that he wanted. So when a patient like that comes in, we 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 identify 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 free testosterone was really low.

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's- check the normals, let's say 300 doing 500.

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. And if you don't check these other tests, you're going to talk about you don't really know what's going on. So tell us about how that works.

Yeah, so the way, so when you see that, you're like, well, that's interesting. So the tests that I do included something called a Dutch profile. Dutch profile that just doesn't tell me about the total amount of testosterone. It also tells us how 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.

You came in with testosterone.

He was taking testosterone when he came in and he'd actually gained more gain more visceral fat while he was taking this.

It sort of backfired.

He like, yeah, testosterone was supposed to build muscle.

This is very interesting.

This is very, it's why I brought up this case. This is a great case. And, you know, if you just go to regular traditional doctor, even if you get testosterone, they'll just give you testosterone. They won't look at all these other.

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, 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 aromatizer.

So this Dutch profile is a test we do here at the Ultra Wellness Center.

It's quite different.

It looks at how all these hormones interact, how they're metabolized, what's getting converted to what, where the imbalances are.

This is not something you get with just a traditional hormone test that you go to the lab and get. It's a saliva test. It's a saliva test. And so, and it's a very effective test and it made sense when I saw that picture. So that's the difference. Now he had some other things going on and that included his sleep apnea, but 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. He was gonna. Now that was going to block his body's natural ability to so readily turn testosterone into estrogen. And I. Because of his age and the, the, 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 Ipamorelin, 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 his the man boobs went away and he was feeling great, gained muscle mass and was extraordinarily pleased with the outcome.

Amazing.

So, you know, you talk about these.

Anastrozole, which is a medication, it's used often in cancer treatment for women, for breast cancer because it blocks estrogen production by the body. 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. It's called diindolmethane or DIM. 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 along with the hormone replacement to help mitigate.

And I will, and I will commonly use DIM and calcium D-glucarate because they both increase the metabolism of estrogen. I use them in women, but I also use them in men, particularly a gentleman like this. That would have been an option. I chose to do something that would be more aggressive.

Yeah, this is a, you know, this is definitely gonna 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 said before, is we balance out everything else. We do lifestyle factors and we make sure 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 did that work?

How do you do an injectable?

So injectables can be given IM, but recently in the muscle, which is in the muscle. And, the research has shown that the sub-Q injection, meaning you just pinch the little fat around your waist, you inject right into 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 simple procedure. Oh, it's very simple.

And, you use compounded hormones, you just get them 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 wrong ingredient of testosterone is going to be very similar. It's the carrier molecule that might be different. So some pharmacies use grapeseed oil. I mean some compounding pharmacies use grapeseed 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 sub-Q injections.

And what about the topicals? Can you talk about when you would decide to use topicals or why or...

I don't use topicals. tropicals that often. And the reason being is that they're just sloppy. I'll just say they're, 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 or what other location you may have placed it or if he 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 the sub-Q injectable form of testosterone.

And, there's other forms, right?

Pellets.

Can you talk about that?

Oh, you can do pellets. So, now again, Pellets.

What is that? How do you do it?

So they have to be placed under 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 there, you know, it is a hormone and it can have adverse effects and there's concern about risks of prostate cancer, high cholesterol, heart disease. How do you address that?

Well, I think the data on all of those are mixed. When you look at heart disease, particularly in 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.

It improves muscle mass, 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 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. The, the issue that may, that.

No, I've talked to some urologists at Harvard and your specialist 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, they're beginning to understand it's safer and they know it's an 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, and really improve their overall experience of life in a very, in a fairly safe way. There's, there's no reason. I, 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 secarogogs for hormones that can actually increase muscle mass and decrease body fat as they're aging.

Yeah, I think it's 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 terrible disease. But we are seeing people living longer lives and sometimes in order to live vital lives 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 where I use topical testosterone for women on the clitoris here at the Ultra Wellness Center. I mean, you 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 bodybuilders. They use super physiologic doses. They use 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 make sure you're checking everything. So, I always check the sex hormone binding globulin. I always check the estrogen levels just to find a gentleman like this that really needed an adjustment, needed to be on a aromatase inhibitor. There are some docs that just put you on an aromatase inhibitor right with this testosterone.

Yeah, I usually do the natural version.

Right.

DIM, which is a supplement. And I'll use biotin. 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 DHT in particular, 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 in your, and, and that can lead to hair loss.

And that's why men get hair loss and some of the drugs like propicia are actually blocking DHT.

They're five alpha reductase inhibitors.

Yeah, to prevent the hair loss.

Right. 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 Propitia. Now Propitia has some concerns in regards to some side effects that can be permanent. So we're careful with using that.

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. So, I'm a little, you know, I'm not, I use testosterone in women both clitorally and and it is part of their overall gel or that I'll create for them with their cream. But I'm somewhat careful about it because of the hair loss. Because the women that are coming in that need it are also going through menopause and 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% a year, and that's more than doubled since the 1970s. A man today has nearly 60% 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 sperm counts could reach 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're on somewhere in the spectrum from insulin resistance to pre-diabetes 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 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 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 clotted 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 is 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, 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, worse 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, 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. That leads to leaky gut. Also, our sea of environmental toxins is not good for our hormones. The sea of industrial chemicals and pollutants, sometimes light 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 Leydig cells, which contain 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? different things causing different problems. It's all the same stuff. It's our diet, nutrition, lack of exercise, and some 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 talking 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 eggs. It causes poor egg quality. 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 different 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. You know, and they give you like, you know, 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 know, you look at, at, at farmers. They're testing the soil. They want to know what nutrients are in there, what the levels of nitrogen, potassium, phosphorus, that they're so deep into 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.

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