I was trained that low testosterone was solely an issue for a minority of males in middle age who were going through “male menopause.” Wrong.
I have found low or suboptimal testosterone levels in men, women and even in the pediatric population.
The initial approach, as with any chronic health issue, is a full history with an initial emphasis that focuses on diet, exercise, weight management and other relevant factors.
A man in his 60s came in a number of years ago complaining of a depressed mood. His family said he was disinterested in life and kept to himself. He was tired and had given up golf. For those of you that think golf is a total waste of time, he was exhibiting wisdom, but the patient was giving up something he enjoyed. A psychiatrist had him on two antidepressants, Wellbutrin and Lexapro at what should have been effective doses.
His total and free testosterone levels were at the low end of normal, so we discussed the various options to raise testosterone: creams, gels, roll-on, oral clomiphene and intramuscular (IM) injections. We initially started the injections every two weeks but found, as with many males, that the benefits dropped off between seven and ten days. Switching to a weekly IM shot in the office smoothed out those troughs and he gradually started to feel better. His mood and energy improved and over 3-4 months we were able to wean him off the antidepressants.
Fast forward a year or two and I had just finished reading a book by David Brownstein, MD, called Iodine: Why You Need It, Why You Can’t Live Without It. A bit wordy for a title, but the book was intriguing. Brownstein and his associates had done a study of over 5,000 men and women in America and found that 95% of people were iodine deficient and 100% were bromine toxic.
I have repeatedly referred to this as a “double whammy” on the endocrine system. The hormonal and glandular tissues of the body require iodine (and other minerals) for normal cellular functioning and the iodine receptors can be blocked by a variety of toxins including halides like bromine. This effect was most important when it came to activity of the thyroid gland, but was potentially relevant to the entire endocrine system. I wondered if iodine replacement could improve testosterone production by giving the body what it needed (iodine) and displacing toxins that it didn’t need (bromine, chlorine and possibly fluoride to a lesser degree).
I saw a 55-year-old around that time with low libido and erectile dysfunction. His total testosterone level was 230 with normal above 450. Many, including me, argue that a higher number in the 600-800s can be more optimal for brain health, cardiovascular health, bone density, mental health and sexual function. We discussed options and he was willing to be the index case for iodine replacement. A 24-hour urine iodine loading test confirmed chronic profound iodine deficiency and we started supplementation with 12.5mg once a week. (Being too aggressive can displace too many toxins like bromine into the system and people feel horribly.)
We worked up slowly to three times a week. The good news is that his testosterone level went from 230 to 350 and then close to 400 and ultimately over 550. The downside is it took almost a year-and-a-half to have that effect. With higher levels of testosterone, he lived a more vigorous life.
A few years ago, I saw a 15-year-old for an urgent visit during lunch. He was depressed and tired. He also commented that, in contrast to his male friends, he didn’t seem to have much of an interest in sex. His total testosterone came back extremely low at 108. He started oral iodine supplementation and the testosterone level normalized within 3-4 months presumably because at 15, he had less of a toxic load than the 55-year-old.
So maybe everyone should go on testosterone replacement or iodine? It’s not so easy. There are potential risks of treatment that need to be discussed with a qualified practitioner. There are many other factors that should be considered for each individual. If you have chronic fatigue, low libido, sexual dysfunction, depression or other signs of low testosterone, talk with your practitioner about getting some initial labs tests.
Andrew Lenhardt, MD