by Dr. Karl Nadolsky
In my last article “Replace Testosterone = Leaner” I talked about men who had low testosterone and got replaced with testosterone ended up losing a lot of fat and getting lean and mean. This is a quick follow up article to address the fact that the increased body fat itself is what causes the low testosterone. The question for me and my brother (Dr. Karl Nadolsky) was would these men increase their testosterone by losing weight?
So the logic is that gaining excess fat is causing the low testosterone by way of increasing estrogen (major female hormone) and other inflammatory adipokines (basically hormones that the fat actually produces and sends out in the body). The last article talked about just adding back the testosterone, which helped the men lose significant amounts of fat. We wanted to know if just losing the fat that is causing the low testosterone in the first place would fix the problem. Well there was just a study released that says this is the case!
The study had 3 different groups of men all of whom had low testosterone (less than 300 ng/dL) :
- Diet and exercise group
- Metformin group (metformin is an insulin sensitizer like berberine)
- Placebo group
What they found is that only the diet and exercise group (who each lost an average of 17 pounds in one year) increased their testosterone. The average boost in testosterone was about 15% which doesn’t seem like a lot but close to HALF of the group completely resolved their low testosterone problems (they resolved their hypogonadism).
What was also interesting is that they measured LH (luteinizing hormone). This is the signal the brain tells the testicles to make testosterone. What they found is that it DID NOT increase which means that the group that increased their testosterone somehow increased their LH sensitivity. This goes in line with what I said earlier about the fat producing inflammatory adipokines. This is the same thing that happens with insulin sensitivity and leptin sensitivity. You can read more about that here.
So what is the take home from this as a patient? If you have low testosterone as found on a morning serum total testosterone test (less than 300 ng/dL) and you have some excess body fat (over 25 BMI, waist circumference greater than 38-40 inches, body fat percentage over 20%) you have a few options:
- You could try a good diet and exercise program (such as our Lean Doc Consulting) which will help you solve the underlying problem.
- You could just say screw it and ask your doctor for testosterone replacement and not solve the underlying problem and remain on testosterone for the rest of your life which will basically ruin your chances of ever making any good sperm (no more kids)
- You could try both! You could go on the exercise and diet program and ask your doc for a low dose of testosterone and then slowly wean yourself off as you lose the fat.
The hope of the last option would be that you would intially boost your fat loss efforts and not be reliant on testosterone for the rest of your life (while on testosterone you need regular prostate and blood count checks).
Reference –
ENDO 2012: The Endocrine Society 94th Annual Meeting: Abstract OR28-3. Presented June 25, 2012.
Any thoughts can be commented here for discussion
Jason says
Great article Doc!
Dr. Spencer Nadolsky says
Thanks!!!
chuck says
What about men who have struggled with an eating disorder and over exercise and have low testosterone from low body weight and body fat percentage? I’d love to here any suggestions you may have!
Dr. Karl Nadolsky says
Hey Chuck, that is a very interesting and important question. I think that the obvious answer to the absolute problem is to increase the amounts of Leaner Living foods, especially a variety of natural fat sources like nuts (pistachios, almonds, walnuts, etc), and decreasing the aerobic exercising substituting for more intense resistance training. But getting to the root of the emotional/psychological issue is going to be the roadblock. Seeing a psychiatrist at least once would be what I recommend for any patient in that situation, and then continue to carry out the plan and recommendations while I help that patient improve their diet and exercise regimen. Hope that helps! -Dr. K
chuck says
Dr. K,
Thanks so much for your answer. That’s exactly what I am planning to do- I began seeing someone for the psychological side of it today as well as cleaning healthy fats and more natural saturated fats as well like coconut oil and grass fed meat.
Thanks again for responding- that’s really cool and I am really enjoying your blog!
Dr. Spencer Nadolsky says
Chuck,
I definitely agree with my brother. There is a lot of good data on females with eating disorders who really down regulate their HPA/HPG Axis (the connection between the brain and the gonads/adrenals). There have been a few studies with males as well with eating disorders. What happens is basically your brain stops telling your testes to produce testosterone. It will be very important to work with a psychologist/psychiatrist to completely overcome the eating issues.
As for low body fat / body weight, it is more so the actual nutrition that is affecting your testosterone (but the body fat levels can play a role as well).
We would be interested in hearing more of your story if you wish. You can shoot us an email through our contact us link at the top.
Thanks!
Dr. S
Dr. Karl says
Great Chuck,
I’m glad we can be of some help and let us know your progress!
-Dr. K
chuck says
Dr Karl and Dr Spencer,
For the past 6 weeks I have actually been at an inpatient eating disorder clinic in Denver working to beat my eating disorder once and for all. When I entered the clinic, I was severely underweight, however still able to function, but had very low body fat. That being said, I had my Testosterone tested in the first few days and found out that it was at 108. After 4 weeks, I had the testosterone tested again and, with a healthier diet and progressing weight restoration, I have more than doubled my testosterone levels and am up to 221! Talk about motivating to continue my battle right?
Thanks again for your responses!
Dr. Spencer Nadolsky says
That’s great Chuck! Keep up the good work!!
Lizabeth says
Yeah, that’s the tiktce, sir or ma’am