Tests

Andropause, also known as male menopause, manopause, testosterone deficiency, androgen deficiency in the aging male (ADAM) and a few other names refers to reduced testosterone and accompanying symptoms.

Whilst testosterone is a steroid hormone, made using cholesterol, sex hormone binding globulin is a transport protein. SHBG plays a huge role in how much of your total testosterone is available as free testosterone for actual use.

SHBG binds to testosterone. Imagine testosterone is the red strands within the image and SHBG is the rest of the structure. SHBG very tightly binds the testosterone, rendering it unavailable for use.


It is entirely possible for a man to have “normal” levels of total testosterone whilst also suffering from the symptoms of low testosterone. Symptoms such as:

🍆Sexual Symptoms: Reduced libido, erectile dysfunction, fewer spontaneous erections
💪 Other Physical Symptoms: Reduced energy, disrupted sleep, more fat, less muscle
🧠Mental Symptoms: Brain fog, difficulty concentrating & focusing, poor memory
💞Emotional Symptoms: Reduced passion, interest, drive and motivation, variable mood

Hence it is extremely important to consider your SHBG alongside your total testosterone and any symptoms. Knowing only your total testosterone does not tell you whether you have enough freely circulating testosterone and SHBG does typically increase with age.

If you have both your total testosterone and SHBG measured but your labs do not tell you free testosterone you can estimate it directly using an online calculator, and the estimation is clinically validated as a useful marker.

Enter your total T and SHBG here (both US and Rest of World Units accepted)

https://www.issam.ch/freetesto.htm

There *are* some diet, supplementation and lifestyle interventions which can reduce SHBG, and they are almost entirely things which lead to other good health outcomes, like resistance training, sleep optimisation and stress mitigation, but there are also some more surprising potentials, such as tactical carbohydrate intake and some minerals and herbs.

Link goes to the free testosterone calculator

When testing testosterone, “Total Testosterone” rather than “Free Testosterone” is the most commonly measured biomarker. Although Low T symptoms are more closely associated with lower Free Testosterone, Total T is simpler and lower cost to measure and correlates very well with Free T when Sex Hormone Binding Globulin (SHBG) is also measured since the Free T can be reliably estimated.

📊 Laboratory reference ranges for testosterone, and many other biomarkers, reflect what is statistically “normal” rather than necessarily healthy or desirable. The bottom 2.5% and top 2.5% are those considered abnormal.

📉If the population around you becomes on average more sick and unwell, and you do too, congratulations! You are normal!

🔬Ideally, we could use functional ranges based on clinical research into values that accompany healthy functioning, excluding from the data people with known metabolic dysfunction, including diabetes, obesity and metabolic syndrome.

These are the ranges used by a number of different institutions and studies around the world to define the normal range for total testosterone, expressed in their nmol/L and the US format of ng/dL.

🏋️‍♂️ More important than comparing against these ranges is knowing your personal history and changes, since it is entirely possible to be symptom free and healthy whilst also being bottom quartile.

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Link goes to a full size image on Instagram. Message me there, or here via WhatsApp to ask me anything or connect if you want to work with me as a client.

Andropause, also known as male menopause, manopause, testosterone deficiency, androgen deficiency in the aging male (ADAM) and a few other names is all about reduced testosterone and accompanying symptoms.

📉 Key any variation of the words testosterone males deficiency aging into a search engine or ChatGPT and you are likely to quickly read that after age 30-40, male testosterone declines by about 1-2% per year.

😵‍💫Even if this is true, and there is data to challenge it, it is *misleading*. It obscures the science-based evidence that many men maintain a similar level of testosterone from age 30-40 into their 70s and 80s.

🏋️‍♂️ The average fall is driven by men whose testosterone is significantly falling and this is *often* being caused by modifiable lifestyle and nutrition factors rather than as an inevitable consequence of natural aging.

📈 For a man seeking to retain, or regain, drive, confidence, motivation, passion, sexual desire and more, this can be empowering. It says that - in many cases - if low testosterone is remedied, then quality of life and physical, mental and emotional health can all be improved.

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Link goes to a full size image on Instagram. Message me there, or here via WhatsApp to ask me anything or connect if you want to work with me as a client.

For myself, before beginning practice as a nutritional therapist, I simply always wanted more data, more potential insights. Any test which gave me new information appealed. I was a dedicated n=1 quantified self enthusiast.

Now, for my clients, I am far more selective. If a client is not cost constrained I will happily recommend a basket of potentially useful tests, For most others when I recommend a test I do so with explicit rationale for what actionable insights it can bring us & what the alternative is, enabling the client to make a truly informed choice.

I also consider the potential downside effects of tests. The experience of extracting the various bodily excretions can be unpleasant. For some, having knowledge of unfavourable metrics is anxiety inducing rather than empowering, even with an expert practitioner ready to support them.

Generically, purposeful functional testing offers the following benefits

1, Establish *your* personal norms

Comparison against statistical norms can be useful, sometimes, but can also be misleading if and when *your* natural norms are naturally lower or higher than others with no negative impact.

Sometimes the statistical norms are just not helpful. If the population you are being plotted against has a high incidence of metabolic dysfunction, being average is not a great sign.

Building up your own history with regular testing enables you to be informed of change over time and connect this with your health and vitality and context at the time, giving the result meaning. For example, if you see a low or high anomaly in contrast to your personal history, it suggests there has been a significant change, prompting further investigation and action.

2. Highlight root causes and opportunities

Functional testing can reveal or suggest the root causes of problems and in doing so, inform focused action.

Some tests, such as Hormone panels, Organic Acid Tests and 24-Hour Cortisol Tests, deliver information which cannot be intuited or inferred from subjective experience and experimentation, thus adding a lot of value within a health optimisation plan.

3. Create baselines for test-retest comparison

To complement your own sense of wellbeing you may find it very powerful to be able to quantify the impact of changes you make to your diet, lifestyle and supplements. This is exactly what a test-retest approach can do.

4. Provide validation and motivation

Seeing positive changes within test results can offer objective validation that interventions are working.

Receiving this clear signal can reinforce commitment and help you stay consistent with the choices that progress you towards your health goals.

5. Novel Personalised Insights

Using the examples of Continuous Glucose-Monitoring (CGM) and Heart Rate Variability (HRV) some tests can make available real-time biofeedback on metrics which could otherwise be entirely unknowable to you. These novel insights can enable you to grow your awareness of problems and opportunities and even support your natural sense of interoception.

6. Trade off between cost and speed

If a food intolerance or sensitivity is suspected then an elimination and managed reintroduction diet is a fantastic tool to identify the problems and has no direct cost. It does however take weeks of thorough planning and effort to provide clarity and certainty.

Using something like an IgG food sensitivity test cannot give you certainty but can highlight potentially problematic foods, enabling a simpler and shorter elimination and reintroduction approach.

Link goes to a full size image, on Instagram, where you are welcome to connect and ask me anything.

Why test at all? I have a separate post dedicated to that, and in brief, the value includes establishing your own personalised norms, highlighting potential root causes, creating baselines for test-change-retest protocols, validating intervention outcomes, and offering novel personalised insights.

These are the tests and biomarkers I would often consider for a client seeking to improve their natural testosterone:

1. Total and Free Testosterone

The ‘free’ testosterone is critical, since only this is actually available for active use, and knowing both provides two signals. One on testosterone production, and the other on testosterone availability.

2. Sex Hormone-Binding Globulin

If total testosterone is okay but free testosterone is low, this is often a root cause. SHBG binds to testosterone, making it unavailable for active use. If this is true, interventions to reduce SHBG may be high value.

3. Luteinizing Hormone (LH) & Follicle-Stimulating Hormone (FSH)

These hormones regulate testosterone production within the male testes, so if their levels are exceptionally lower or higher in the presence of low testosterone they are suggestive of a root cause, and a target for intervention.

4. Estrogen

Males and females both produce and need estrogen(s) and testosterone, whilst the levels of course are very different. Testosterone may be converted to estrogen via aromatisation, and if the fraction being converted is excessive it can result in too little of the former and too much of the latter.

5. DHEA-Sulfate

DHEA-S is a precursor building block for both testosterone and estrogen. Just as with testosterone, normal levels decline with age and low levels can indicate issues, and opportunities, with diet, lifestyle and body composition.

6. 24-Hour Cortisol

Used to inform whether the daily oscillating pattern of cortisol has peaks and troughs at the appropriate times, and whether its activity may be suppressing testosterone production

7. Vitamin D3, Magnesium & Zinc

By no means the only essential micronutrients, but those for which insufficiency may be common, and with strong links to testosterone production.

8. Omega-3 Index

Omega-3 fatty acids are essential (hence essential fatty acids) for cellular activity including hormone production. If this is below optimal, it is very easily addressed via diet and supplementation.

9. Inflammatory Markers

Chronic inflammation, regardless of source, can impair endocrine organ function, including and not limited to testosterone production. If present, identifying and addressing the root cause is a high priority.

10. HbA1C Blood Glucose

Poor blood glucose regulation, leading toward prediabetes and diabetes, can impair testosterone production, with the good news being that insulin sensitivity is highly manageable, for most people, via diet and lifestyle practices.

Link goes to a full size image, on Instagram, where you are welcome to ask me anything

Working on it, coming soon :-)