Part 1
About five months ago I was diagnosed with a somewhat common but frequently undiagnosed medical issue that is not even on the radar of most primary care physicians. Fixing that medical issue has had massive benefits to my productivity, business, and general well-being.
I feel extremely fortunate to have discovered and fixed this issue and hope that I can help others discover and fix this issue if they have it. In this post, I will share some of my own experience and provide a bit of an orientation to the issue in case it can help others. I really want to “raise awareness” (although I hate that phrase).
This post won’t have any relevance to most of you. But for the few who find it relevant, it just might change your life . . .
Intro
Around the time of my 40th birthday last spring, I noticed that I had become really unproductive. I just couldn’t focus. I felt physically exhausted for no apparent reason. I felt depressed and had serious trouble getting stuck in negative mental states. I was very indecisive.
What was wrong with me? I had no clue. I just didn’t feel like myself. It took enormous mental energy for me to focus enough to compose a short and inconsequential email. Why couldn’t I get my act together?
I was relatively healthy and should have felt great. Paleo diet. Regular heavy lifting. No alcohol. 20% body fat, which is certainly not ideal, but not “fat” either. I did a ton of work on my mindset and was doing Tony Robbins’ Hour of Power every morning. While I’d feel better while doing the Hour of Power, the conditioning was not sticking at all and I would be in an extremely low mental state for most of the day.
At the end of a day of accomplishing not too much, I was exhausted and all I could do was lay on the couch and read my phone while I yelled at my young kids to stay in bed and be quiet. What had happened to me?
Awareness
Luckily, around that time I had to see to see a doctor for a minor issue unrelated to this post. I saw a naturopath. I don’t really like seeing doctors and the visit seemed to take forever. She asked lots and lots of questions. I’d think “Why is she even asking me this? That’s not why I’m here. Where is this going?”
Eventually, she looked up from her notes and said “I think I know what’s going on with you, but I’m going to have to do a blood draw to be sure . . . “
5 Months Later . . .
About 5 months after starting treatment for this issue, my productivity is through the roof. I can focus intensely and for long periods of time. I’ve put on 7 pounds of muscle. My cholesterol is down. My blood sugar is optimal.
But by far the the biggest benefits from fixing this issue have been mental and emotional. I am always optimistic. I am calmly confident. Setbacks don’t really phase me, even serious ones. Truth be told, things in my business are not going well yet, but the challenges don’t throw me off. Six months ago I would often feel devastated in the face of even a minor setback.
Everything isn’t sunshine and rainbows and I still have down days where I need to more intentionally manage my emotionally state. The difference is that now I am able to manage my emotional state effectively, whereas six months ago I wasn’t. (@Kung Fu Steve’s coaching has also helped a lot, but that doesn’t fit cleanly into this narrative, so I won’t mention it.)
The Issue
If you haven’t guessed it yet, my medical issue was low testosterone.
When my naturopath mentioned that she suspected low testosterone was my problem, I was more than a little skeptical.
So, as I waited for my lab results, I fired up the Google. As I read through the lists of clinical symptoms for low testosterone (one is included below), I realized, to my surprise, that I had many of them.
I never really had low testosterone on my radar, even though I was decently well read in the health and fitness area. Sure, I had heard awkward radio commercials for testosterone replacement therapy (TRT) clinics, but I had thought of low testosterone as an issue for 70 year old dudes who didn’t want to accept the fact that they were 70, but wanted to feel like they were 30 again. I learned that TRT is also, at least sometimes, for 30 year olds who don’t want to feel like 70 year olds anymore.
I also learned that while our testosterone levels naturally do decline as we age, there has also been a much more precipitous drop off in testosterone levels in recent years that is most likely due to environmental factors (plastics, pollution, pesticides, etc.) that disrupt our endocrine systems.
Our grandfathers generally had much higher testosterone levels than we do. One of the two big U.S. blood-testing labs recently dropped its “normal” ranges for total testosterone by about 100 ng/dl as the blood samples they have been testing have been dropping so much.
Testosterone affects virtually every system in the body, so if your testosterone level is too low, you will not be doing well.
When I got my labs back, I found out that my total testosterone was below “normal,” my free testosterone was below “normal,” and my estrogen (also essential for male health) was so low it didn’t even register. While this is a terrible hormonal profile, I was overjoyed. I finally knew what was wrong with me and I knew that it was fixable.
Diagnosing Low Testosterone
There are two components of properly diagnosing low testosterone: 1) low lab numbers and 2) clinical symptoms. You should have both to be diagnosed with low testosterone.
You figure out your lab numbers by having a blood draw. “Normal” range for total testosterone is something between about 300 and 1100 ng/dl. Different labs have different ranges for “normal.” What is important is that, most likely, if you are under 500 ng/dl, you will likely feel like crap, even if you are within “normal” range. This is a critical point that too many physicians do not understand. If you can convince your doctor to order a testosterone test (which is itself often a challenge), you will often simply be told “you’re fine” if you have total testosterone anywhere above 300 ng/dl. But you might not be fine.
Clinical symptoms of low testosterone include “irritability or increased sadness, reduced libido, low energy, fatigue, decreased ability to concentrate on tasks, lack of morning erections, and a change in body composition with more central body fat.” This is one list, but you can find other similar lists online.
Note that some of these symptoms are the same as symptoms of depression and erectile dysfunction. Many guys with low testosterone end up getting prescribed antidepressants (which lower their testosterone even more) and Viagra. Their symptoms are treated, but the underlying cause isn’t.
There are no bright lines as to when someone has low testosterone, so you really want to be working with an experienced physician who specializes in TRT. One patient might have 400 ng/dl total testosterone and feel great and the next patient might have 400 ng/dl and feel absolutely terrible. Both are within “normal” range, but one is very much not well.
Personal Responsibility and Knowledge
Of course, we want to take personal responsibility for all aspects of our life, including our health. But it is especially important to be knowledgeable about TRT if you are considering TRT.
You simply do not want to be messing with your hormones using a bad protocol as that can make things much, much worse. I wouldn’t be comfortable undergoing TRT if I didn’t feel reasonably knowledgeable myself.
You want to be able to use your doctor as a consultant who works for you and with you, not a white-coated all-knowing demigod. I’ve included some resources below that could help get you up to speed.
“If I do have low testosterone, can’t I just increase it naturally or with supplements?”
Not really, but there are lots of folks who will be happy to sell you a “testosterone booster” that will not help. Note that certain supplements WILL increase libido without actually increasing testosterone levels. And, yeah, there are certain things you can do to temporarily boost your testosterone (heavy squats, cold showers, etc.), but if you have seriously low levels, those temporary boosts won’t change anything for you.
On further thought, I guess I need to qualify the above statements. I am assuming that you are already living a healthy lifestyle; managed stress, decent sleep, healthy weight, good diet, weight training, no substance abuse issues, etc. If you are 100 pounds overweight, never exercise, abuse alcohol or sugar, start there. Guys with a crappy lifestyle can actually massively increase their testosterone by optimizing their lifestyle factors.
But if you have these lifestyle factors dialed and you still have low testosterone, you are going to need TRT if you want meaningful improvement in your testosterone levels.
Also, sometimes apparent testosterone issues are actually thyroid issues. A good TRT doc should be looking for thyroid issues and getting them resolved first.
What should you do if you suspect you have low testosterone?
If your lifestyle factors are already dialed in and if you read through the list of clinical low testosterone symptoms (from the list above or from another list you find through Google) and suspect that low testosterone may be an issue for you, the next step is to get a blood draw.
You can try to convince your primary care physician to order one. From what I’ve read in online forums, that can be a real challenge. Another option is to approach a TRT clinic in your area. However, initial intake appointments at TRT clinics can be really expensive. Mine wasn’t, but some are.
A third option is to just order your own blood test. There is a company called discountedlabs.com that allows you to order whatever blood test you want and you pay for it out of pocket. You want to get your total testosterone and free testosterone numbers. Here is a link to the test you want TESTOSTERONE Total and Free (Regular) | Discounted Labs . It is on sale for $30 now, but that could change by the time you read this. You basically pick the test and schedule a blood draw at one of their many locations. Then you go in for your blood draw and they’ll email your results a few days later. Testosterone levels vary throughout the day, but generally peak mid-morning, so try to have your draw between 8 and 11 a.m. for the most accurate results.
If your total testosterone is under 500 ng/dl or if your free testosterone is at the lower end of the “normal” range, I would consider purchasing the Testosterone Optimization Therapy Bible by Jay Campbell (best and most comprehensive TRT resource I’ve found), reading it cover to cover, and then starting to look for a reputable TRT clinic in your area.
About five months ago I was diagnosed with a somewhat common but frequently undiagnosed medical issue that is not even on the radar of most primary care physicians. Fixing that medical issue has had massive benefits to my productivity, business, and general well-being.
I feel extremely fortunate to have discovered and fixed this issue and hope that I can help others discover and fix this issue if they have it. In this post, I will share some of my own experience and provide a bit of an orientation to the issue in case it can help others. I really want to “raise awareness” (although I hate that phrase).
This post won’t have any relevance to most of you. But for the few who find it relevant, it just might change your life . . .
Intro
Around the time of my 40th birthday last spring, I noticed that I had become really unproductive. I just couldn’t focus. I felt physically exhausted for no apparent reason. I felt depressed and had serious trouble getting stuck in negative mental states. I was very indecisive.
What was wrong with me? I had no clue. I just didn’t feel like myself. It took enormous mental energy for me to focus enough to compose a short and inconsequential email. Why couldn’t I get my act together?
I was relatively healthy and should have felt great. Paleo diet. Regular heavy lifting. No alcohol. 20% body fat, which is certainly not ideal, but not “fat” either. I did a ton of work on my mindset and was doing Tony Robbins’ Hour of Power every morning. While I’d feel better while doing the Hour of Power, the conditioning was not sticking at all and I would be in an extremely low mental state for most of the day.
At the end of a day of accomplishing not too much, I was exhausted and all I could do was lay on the couch and read my phone while I yelled at my young kids to stay in bed and be quiet. What had happened to me?
Awareness
Luckily, around that time I had to see to see a doctor for a minor issue unrelated to this post. I saw a naturopath. I don’t really like seeing doctors and the visit seemed to take forever. She asked lots and lots of questions. I’d think “Why is she even asking me this? That’s not why I’m here. Where is this going?”
Eventually, she looked up from her notes and said “I think I know what’s going on with you, but I’m going to have to do a blood draw to be sure . . . “
5 Months Later . . .
About 5 months after starting treatment for this issue, my productivity is through the roof. I can focus intensely and for long periods of time. I’ve put on 7 pounds of muscle. My cholesterol is down. My blood sugar is optimal.
But by far the the biggest benefits from fixing this issue have been mental and emotional. I am always optimistic. I am calmly confident. Setbacks don’t really phase me, even serious ones. Truth be told, things in my business are not going well yet, but the challenges don’t throw me off. Six months ago I would often feel devastated in the face of even a minor setback.
Everything isn’t sunshine and rainbows and I still have down days where I need to more intentionally manage my emotionally state. The difference is that now I am able to manage my emotional state effectively, whereas six months ago I wasn’t. (@Kung Fu Steve’s coaching has also helped a lot, but that doesn’t fit cleanly into this narrative, so I won’t mention it.)
The Issue
If you haven’t guessed it yet, my medical issue was low testosterone.
When my naturopath mentioned that she suspected low testosterone was my problem, I was more than a little skeptical.
So, as I waited for my lab results, I fired up the Google. As I read through the lists of clinical symptoms for low testosterone (one is included below), I realized, to my surprise, that I had many of them.
I never really had low testosterone on my radar, even though I was decently well read in the health and fitness area. Sure, I had heard awkward radio commercials for testosterone replacement therapy (TRT) clinics, but I had thought of low testosterone as an issue for 70 year old dudes who didn’t want to accept the fact that they were 70, but wanted to feel like they were 30 again. I learned that TRT is also, at least sometimes, for 30 year olds who don’t want to feel like 70 year olds anymore.
I also learned that while our testosterone levels naturally do decline as we age, there has also been a much more precipitous drop off in testosterone levels in recent years that is most likely due to environmental factors (plastics, pollution, pesticides, etc.) that disrupt our endocrine systems.
Our grandfathers generally had much higher testosterone levels than we do. One of the two big U.S. blood-testing labs recently dropped its “normal” ranges for total testosterone by about 100 ng/dl as the blood samples they have been testing have been dropping so much.
Testosterone affects virtually every system in the body, so if your testosterone level is too low, you will not be doing well.
When I got my labs back, I found out that my total testosterone was below “normal,” my free testosterone was below “normal,” and my estrogen (also essential for male health) was so low it didn’t even register. While this is a terrible hormonal profile, I was overjoyed. I finally knew what was wrong with me and I knew that it was fixable.
Diagnosing Low Testosterone
There are two components of properly diagnosing low testosterone: 1) low lab numbers and 2) clinical symptoms. You should have both to be diagnosed with low testosterone.
You figure out your lab numbers by having a blood draw. “Normal” range for total testosterone is something between about 300 and 1100 ng/dl. Different labs have different ranges for “normal.” What is important is that, most likely, if you are under 500 ng/dl, you will likely feel like crap, even if you are within “normal” range. This is a critical point that too many physicians do not understand. If you can convince your doctor to order a testosterone test (which is itself often a challenge), you will often simply be told “you’re fine” if you have total testosterone anywhere above 300 ng/dl. But you might not be fine.
Clinical symptoms of low testosterone include “irritability or increased sadness, reduced libido, low energy, fatigue, decreased ability to concentrate on tasks, lack of morning erections, and a change in body composition with more central body fat.” This is one list, but you can find other similar lists online.
Note that some of these symptoms are the same as symptoms of depression and erectile dysfunction. Many guys with low testosterone end up getting prescribed antidepressants (which lower their testosterone even more) and Viagra. Their symptoms are treated, but the underlying cause isn’t.
There are no bright lines as to when someone has low testosterone, so you really want to be working with an experienced physician who specializes in TRT. One patient might have 400 ng/dl total testosterone and feel great and the next patient might have 400 ng/dl and feel absolutely terrible. Both are within “normal” range, but one is very much not well.
Personal Responsibility and Knowledge
Of course, we want to take personal responsibility for all aspects of our life, including our health. But it is especially important to be knowledgeable about TRT if you are considering TRT.
You simply do not want to be messing with your hormones using a bad protocol as that can make things much, much worse. I wouldn’t be comfortable undergoing TRT if I didn’t feel reasonably knowledgeable myself.
You want to be able to use your doctor as a consultant who works for you and with you, not a white-coated all-knowing demigod. I’ve included some resources below that could help get you up to speed.
“If I do have low testosterone, can’t I just increase it naturally or with supplements?”
Not really, but there are lots of folks who will be happy to sell you a “testosterone booster” that will not help. Note that certain supplements WILL increase libido without actually increasing testosterone levels. And, yeah, there are certain things you can do to temporarily boost your testosterone (heavy squats, cold showers, etc.), but if you have seriously low levels, those temporary boosts won’t change anything for you.
On further thought, I guess I need to qualify the above statements. I am assuming that you are already living a healthy lifestyle; managed stress, decent sleep, healthy weight, good diet, weight training, no substance abuse issues, etc. If you are 100 pounds overweight, never exercise, abuse alcohol or sugar, start there. Guys with a crappy lifestyle can actually massively increase their testosterone by optimizing their lifestyle factors.
But if you have these lifestyle factors dialed and you still have low testosterone, you are going to need TRT if you want meaningful improvement in your testosterone levels.
Also, sometimes apparent testosterone issues are actually thyroid issues. A good TRT doc should be looking for thyroid issues and getting them resolved first.
What should you do if you suspect you have low testosterone?
If your lifestyle factors are already dialed in and if you read through the list of clinical low testosterone symptoms (from the list above or from another list you find through Google) and suspect that low testosterone may be an issue for you, the next step is to get a blood draw.
You can try to convince your primary care physician to order one. From what I’ve read in online forums, that can be a real challenge. Another option is to approach a TRT clinic in your area. However, initial intake appointments at TRT clinics can be really expensive. Mine wasn’t, but some are.
A third option is to just order your own blood test. There is a company called discountedlabs.com that allows you to order whatever blood test you want and you pay for it out of pocket. You want to get your total testosterone and free testosterone numbers. Here is a link to the test you want TESTOSTERONE Total and Free (Regular) | Discounted Labs . It is on sale for $30 now, but that could change by the time you read this. You basically pick the test and schedule a blood draw at one of their many locations. Then you go in for your blood draw and they’ll email your results a few days later. Testosterone levels vary throughout the day, but generally peak mid-morning, so try to have your draw between 8 and 11 a.m. for the most accurate results.
If your total testosterone is under 500 ng/dl or if your free testosterone is at the lower end of the “normal” range, I would consider purchasing the Testosterone Optimization Therapy Bible by Jay Campbell (best and most comprehensive TRT resource I’ve found), reading it cover to cover, and then starting to look for a reputable TRT clinic in your area.
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