John has recently been diagnosed with low testosterone levels and sends metabolism.com this inquiry:
Iâ€™m so glad I found this site! About a month ago I was diagnosed with low T â€“ mine is 140. Very, very low. Symptoms were NO libido, fatigue, massive weight gain (from 195 to 275 in 9 months), swelling below the knees. Not sure if the T is responsible for all of this, but would love your opinion (at the same time â€“ the same day, actually â€“ i was also told I had type 2 diabetes (blood sugar of 203). Is there a link here?
My endocrinologist put me on Enenthate shots, 1ml every 2 weeks (done 2 shots so far). Do you think this is a good dosage? Are the shots better than the cream? Iâ€™m concerned about see-sawing T levels â€“ will they go up after the shot but creep back down again before the next treatment?
Iâ€™d really appreciate any insight, my doc did not spend a lot of time going into these kinds of details with me, it was a bit disappointing. Iâ€™m a white male, a little over 6â€² and 42 years old. Naturally I understand you are only giving an opinion, not actual medical advice. Thanks so much.
Reply by Dr. Pepper:
Thanks for your inquiry John. My first thought about the situation you describe is why would a 42 year old man develop low testosterone? Personally, I never take it for granted that the cause of newly diagnosed low testosterone is “aging”. There are many significant medical conditions that need to be ruled out primarily disorders of the testicle, and pituitary gland. Additional blood tests such as LH, FSH and prolactin and possibly radiological tests are often needed to make that determination. I don’t want to go on a wild goose chase here but swelling of the legs, rapid weight gain, low testosterone and type 2 diabetes may all be caused by an excess of cortisol in the body, known as Cushing’s Syndrome. That could be one way to unify all the events you describe.
Testosterone is generally administered as an injection or rubbed on as a gel. In nature, testosterone levels are more or less constant from day to day, so applying testosterone gel every day mimics this environment pretty well. The injections given every two or three weeks cause a rapid increase of testosterone to unnaturally high levels followed by steady decline often to low levels again before the next shot. My opinion is that shots are much less desirable although they tend to be a lot cheaper and simpler than the daily gels.
You may want to seek a second opinion to find out if other problems exist to explain how you developed low testosterone in the first place.
Keep us posted and good luck.
These comments are for educational purposes only and are not intended to provide medical care or advise.
Gary Pepper, M.D., Editor in Chief, Metabolism.com
The adrenal glands sitting on top of the kidneys make several hormones critical to life. The central part of the adrenal makes the hormone we refer to as adrenalin, technically from the group known as catecholamines. This is the stress responsive hormone causing rapid heart rate, sweating, increased mental alertness, preparing the body for “fight or flight”. The outer portion of the adrenal makes the hormone cortisol, also known as cortisone. Cortisol maintains, among other things, the blood pressure, fluid and salt balance. Without sufficient cortisol production by the adrenals, life cannot be sustained. What is surprising is that excess cortisol can be as harmful to health as insufficient cortisol.
Deficient cortisol production is referred to as adrenal insufficiency (Addison’s disease is one form of this), while excess adrenal function is termed Cushing’s Syndrome. During certain types of stress such as severe infection the adrenal gland can produce up to 10 times the normal amount of cortisol. If cortisol levels remain elevated for prolonged periods of time the hormone’s destructive nature is revealed by the break down of soft tissue such as skin and muscle and weakening of the immune system with frequent and aggressive infections occurring sometimes with fatal outcome. Heart disease has not been associated with high cortisol levels until a recent study suggested this possibility.
Researchers from the U.K. examined morning cortisol levels in 1066 men and women with Type 2 diabetes participating in the Edinburgh Type 2 Diabetes Study. A positive relationship was discovered between cortisol levels and the occurrence of heart disease such as heart attack and angina. The higher the cortisol levels were the greater the risk of heart disease. Cortisol levels in diabetics were found to be higher than in non-diabetics, in general. The researchers could not explain why the cortisol levels caused heart disease or why levels were higher in diabetics. (From the April edition of the Journal of Clinical Endocrinology and Metabolism 95:1602-1608).
‘Adrenal fatigue’ is a recently proposed diagnosis used to explain a variety of general symptoms such as fatigue, moodiness, muscle aches, and diminished mental function. Supposedly, adrenal fatigue results from mild impairment of cortisol production. Practitioners who diagnose “adrenal fatigue” are prescribing synthetic versions of cortisol as treatment. The possibility of heart disease resulting from excess cortisol should be a factor that patients and medical professionals must consider before embarking on adrenal “supplementation” programs.
This information is for educational purposes only and is not intended as medical advice or treatment.
Gary Pepper, M.D.
5 steps, 5 simple steps can help us reduce dis-ease and induce ease.
1) Â EAT WHAT GROWS OUT OF THE GROUND. Â A pretty simple concept, yet the best way to have a healthy diet high in fiber, antioxidants, phytonutrients, good fats and good carbs. Â Eating 5 or more servings of fruits and vegetables combined can reduce your risk of cancer, heart disease, Â high blood pressure and even osteoporosis. Â Ideally eat 9 or more servings per day for optimal health. Â Add whole grains, legumes, Â nuts, seeds, herbs and spices and you are on your way to a truly health promoting diet. Â Of course it is important to minimize exposure to pesticides and toxins that can end up in our produce and we’ll cover that in a future post.
2) Â HYDRATE. Â Drinking adequate amounts of fluids is extremely important to our metabolism. Â Our bodies are at least 60% water and even mild dehydration can lead to headaches, fatigue and impaired athletic performance. Â Preferably our fluid intake will mostly come from purified water (I recommend Reverse Osmosis for several reasons we will cover in a future post). Â You can use RO water to make tea, coffee, lemonade and fruit seltzers. Â Most of us need at least 1 ounce per kilogram of body weight to start. Â We need to take in additional fluid in case of hot weather, losses during exertion, fever and other specific conditions.
3) Â BE ACTIVE. Â We all know that a sedentary lifestyle can increase our risk of heart disease and even cancer! Â Moderate activity that lasts at least 60 minutes should be done daily , or at least 5 days per week. Â To improve our fitness level, aerobic activity can be added a minimum of 3 times per week along with some weight training to build and maintain lean body mass.
4) Â RELAX. Â Stress can be as detrimental as a poor diet. Â The “fight or flight” response is great if you have to wrestle a foe or escape from one. Â A chronic “fight or flight” response is not great as the hormones coursing through our bloodstream can actually wreak havoc on our systems over time. Â A constant barrage of cortisol can even negatively affect parts of the brain. Â Deep breathing can reverse the stress response and begin to restore balance and harmony. Â Plan play time and get adequate sleep in order to keep that balance.
5) Â SMILE! Â Just the thought of a smile can make us feel really good. Â Imagine what the real thing can do!
Cortisol is a hormone (chemical) produced by the adrenal glands which is essential for life. Without cortisol the blood pressure would drop and shock followed by death would occur. Cortisol is also thought to play a role in general maintenance of the bodyâ€™s tissues and functions. Conditions of excessive adrenal cortisol production known as Cushingâ€™s syndrome cause high blood pressure, thinning of the skin, storage of fat in the abdomen, defective immune function, and mood disorders such as depression. People who take steroids such as Prednisone, Dexamethasone, and Hydrocortisone in high doses over long periods of time can also develop the complications of Cushingâ€™s Syndrome.
Several products now on the market claim to help regulate cortisol levels to assist in weight loss. The theory is that stress due to our environment or to dieting itself leads to excessive cortisol production which then leads to fat (and weight) accumulation in the body. These products then claim to reduce these harmful cortisol effects on the body.
As a practicing endocrinologist and author of a textbook chapter on the effects of cortisol on the body, I think I understand this problem fairly well. Over the last 25 years I have treated a number of individuals with excessive cortisol levels due to Cushingâ€™s Syndrome. The treatments must be monitored very carefully to avoid dropping the cortisol levels too low, as well as to prevent serious side-effects of the medications themselves. Since cortisol is essential for life, too much lowering of this hormone can be as bad as too much cortisol.
I was fascinated when I first heard about supposed over-the-counter cortisol regulators. From a medical point of view it would be a great advance if these products could do what they claim. I was skeptical however, because if a product could decrease cortisol levels it could also kill you by dropping levels too low. If these products really worked as well as the advertisements stated wouldnâ€™t there be people dying from overdoses?
Since then I have reviewed the claims of adrenal gland regulation by over-the-counter products. I have reviewed their lists of ingredients. These products seem more appropriate as hair gel then cortisol regulators. I found nothing to indicate they have any beneficial effects on cortisol levels what-so-ever. What is amazing to me is that with nothing to substantiate their claims, no regulatory agency has stepped in to stop their sales. I suggest you ask you own doctor their opinion of these supposed cortisol regulators before spending your hard earned money on them.