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Do This Before You Take Testosterone Replacement Therapy (TRT)!

how can you naturally improve your testosterone or what can you do instead of taking testosterone replacement therapy if you truly have low testosterone I'm Dr Rea Malik urologist and pelvic surgeon low testosterone is extremely common up to 30% of men over the age of 45 have low levels of testosterone and low levels of testosterone and hypogonadism which is the clinical syndrome associated with low testosterone is extremely common in fact when you look at hypogonadism or the clinical symptom associated with low testosterone about 20% of men over the age of 60 30% of men over the age of 70 and nearly half of men over the age of 80 suffer from symptoms now what symptoms can you see so men who have a low level of testosterone can have symptoms including brain fog sexual dysfunction including low desire difficulty with erections uh mood changes difficulty in gaining muscle mass having increased weight due to increased fat fatigue and even just loss of Vitality or energy for the things that you used to do now while testosterone replacement therapy is very effective in improving these symptoms it can cause some unwanted side effects some of which include having your testicles uh shrink and size because your natural production of testosterone decreases or also having infertility because your body is no longer producing testosterone and subsequently not producing enough sperm so what can you do before you try testosterone replacement to to improve your testosterone levels now first off we know that men who have low testosterone and symptoms often have one of three conditions that are associated with metabolic syndrome this can include diabetes high blood pressure and high cholesterol now the first things first is you can work on improving those conditions you can try to lose weight if you're overweight you can work on improving your blood pressure improving your cholesterol and reducing your blood sugars if you're diabetic now first off let's talk about diet and exercise so there's been about four studies that have looked at diet and exercise specifically for increasing testosterone levels so when looking at randomized control trials mean they put people into either diet or Lifestyle Changes exercise changes and they put another group and did not and they looked at changes in testosterone levels so once they looked at a 12 week randomized control trial where people were randomized to do aerobic exercise three times a week and limit their diet to 1,800 60 calories per day for 12 weeks and at the end of the study they found that there was a significant difference in terms of testosterone levels however the difference in testosterone levels on average was about 25 nanog per deciliter so not a huge change I think the important part here is that they focus on aerobic exercise which is great for weight loss but if you're doing too much aerobic exercise that can increase stress so if you're an endurance athlete and you're doing tons of running ultramarathons marathons then that can increase your cortisol level which can then dampen your testosterone level I've talked all about what type of exercise is best for boosting testosterone in a video previously so make sure you check that one out another very small study looked at men and they put them through a 52 we intensive um monitored program with both dietitians and physiotherapists and again saw this small increase in testosterone that was statistically significant but the more interesting part of that is that these people recovered from their metabolic syndrome and what does that mean exactly they had decreased their waist circumference to less than 40 in they had decreased their blood pressure to less than 130 over 85 they had decreased their triglyceride level below 150 they had increased their HDL above 40 and decreased their LDL below 100 and as I mentioned before there's actually been multiple studies that have shown that there is a link between metabolic syndrome and having low testosterone so the more metabolic issues that you have which are any of these issues I've described or diabetes or high cholesterol or high blood pressure this raises the likelihood that you're going to have low testosterone and having low testosterone also makes it more likely that you will develop metabolic syndrome now the more interesting study was a randomized control trial of adult men between the ages of 40 and 79 who randomized to receive a diet in weight loss regimen and they found that those men who lost 10% of their body weight had an 85 point increase in testosterone levels now that is pretty impressive to me and really good indicator that if you are overweight losing weight will significantly improve your testosterone levels now there's also been um metaanalyses looking at men who've undergone bariatric surgery and they found that essentially weight loss even with bariatric surgery results in quite significant increases in testosterone levels so ultimately it's unequivocal that weight loss can help and diet can help and the most rigorously studied diet is the Mediterranean diet which essentially includes High intakes of vegetables poultry eggs lowfat dairy and essentially healthy fats so olive oil and nuts these are healthy fats you actually don't want to go on too much of a lowfat diet because that can actually reduce your testosterone level as well so if you have sleep apnea that has been found to be correlated with low testosterone so what is sleep apnea it's when you restrict your oxygen intake at night because you're having apneic episodes meaning you're breath holding in the middle of the night and um it's causing reduced oxygen levels so this reduced oxygen levels can actually cause blunting of LH which is the hormone that sends signals to the testicles to create testosterone and so what they found is that when they surgically correct sleep apnea there is a significant Improvement in testosterone levels however more commonly people are using things like CPAP or continuous positive airway pressure to improve sleep apnea there was a study done in 206 where they took uh 153 men who had obstructive sleep apnea and 60 men who didn't and they provided those men with sleep apnea with a nasal sleep app so a machine that goes on the nose that reduces sleep apneic episodes and what they found was that these men who used the nasal CPAP compared to the men who have obstructive sleep apnea and didn't get the nasal CPAP they saw a 222 nanogram per deil increase in testosterone levels so if you have sleep apnea it is extremely important to get that corrected before you try any sort of testosterone replacement one because testosterone replacement can exacerbate sleep apnea and if you have sleep apnea you may find that you're more likely to have side effects with the testosterone replacement including Arroyos or increase in blood cell count which can put you at higher risk for things like stroke or blood clot however ever there have been data about the quality of your sleep so essentially they found that sleeping less than 5 hours a night compared to those who sleep 8 hours or more had a 10 to 15% reduction in their testosterone levels also they've looked at when you sleep and they found that sleeping in the earlier part of the night so that first stretch of sleep is significantly more important for testosterone preservation than the late night so if you wake up between 4: and 8:00 a.m. they've not found as much much of a problem in terms of testosterone levels so getting to bed at a reasonable time every single night and getting good high quality sleep can be seriously important for improving your testosterone levels the next thing is stress so stress is so ubiquitous in today's society but certainly more stress is never good and in terms of testosterone stress increases cortisol and cortisol may actually inhibit the production of testosterone by inhibiting certain enzymatic Pathways that lead to testosterone production and so ultimately what do we know about how stress affects people's testosterone levels so in one study they looked at what things correlated with having hypogonadism or having low testosterone and symptoms and what they found was that having high work rated stress was significantly associated with having lower levels of testosterone and symptoms associated with hypog and that was common in people who worked more than one job who had a longer than 1 hour commun to work who had often had sales quotas or deadlines and had a often fears of layoffs or mergers and so work stress can be significantly detrimental to your testosterone levels another example is where they looked at Medical residen so medical residents are often stressed all the time because they're put into new situations where they're taking care of patients and often life or death situations also they're on call so they're often sleep deprived because they're up every 4 nights to take care of patients and so their sleep cycles are often off and this was a small study but they compared men who were residents so who were Q4 call high stress job compared to other hospital employees who were also men who may have some stress in their job obviously because they work in a health care setting but certainly not quite as significant as those residents and what they found was that there was essentially a 250 nanogram per deciliter difference in testosterone levels for those residents compared to those other hospital employees that's really significant so ultimately finding ways if it's within your power to reduce your stress live closer to work um find if if stress and deadlines are really affecting you negatively then looking for alternative options that you can still work for but not maybe have that stress pressure at work realizing that this is affecting your quality of life and a whole host of other issues can be important if it's available to you and I realize that it's not available to everybody some people really have to work more than one job or need to commute that far because there are no jobs closer to them and ultimately if that is in your if that if that is your circumstance then you need to work a little bit in terms of reducing stress when you're home or on that commute so that you can sort of um leave work at work and try not to bring that stress home with you and lastly Vera seals so veric seals are when there is a dilation of the veins that are around the cord that leads to the testicle and this dilation of veins then causes a increase in temperature in that area that can then affect testicular cell function including L cell function which then produces testosterone now verical treatment is typically done for men who are infertile or they're having testicular shrinking due to the verical so not everyone needs a surgical impr treatment for a verical but they have looked at men who've undergone verical and looked at their change in testosterone levels now there have been a host of studies looking at these infertile men's testosterones before and after varicus sectomy what they've seen is that it's about a 90 nanogram per deer increase in testosterone levels after verical repair now this is encouraging in terms of seeing that yes there is a testosterone Improvement after surgery however all of these Studies have been done on infertile men not men who are necessarily have had their children and are subsequently presenting for low testosterone so it still remains to be seen if a person who has had children and has had normal fertility is actually having an impact on their testosterone from varicoses because varicoses are very very common in fact 15 to 20% of men who are normally fertile will have a veric casil whereas when you're looking at men who have infertility 40% of them will have some presence of a verical so is doing surgery on all of these veric casals going to improve testosterone enough to make the risks of a verical repair worth it it is remains unclear at this point bottom line what can you do to improve your testosterone levels naturally one is improve your diet increase your exercise and reduce your weight also do increase your resistance training of your high uh of your large muscle groups which I've talked about previously in a video a couple videos about how that improves testosterone levels reduce your stress improve your sleep and if you have sleep apnea treat it with A continuous positive airway pressure or sleep machine as that will improve your testosterone as well consider getting a verical repair if you are infertile and you are having issues with testosterone as well improving or treating the verical May improve your testosterone as well and lastly which I talked about in my video last week is reduce your exposure to endocrine disrupting chemicals as this can negatively impact your testosterone levels and if these things are not working we have a whole host of medical and um onlab treatments for tesin replacement as well as off Lael treatments that can help preserve fertility in those who want to and if you want to learn more about that please comment below and let me know and as always remember to take care of yourself because you're worth it

Dr.

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