Welcome to Episode #3 of Inspiration.Education.
Far fewer men seek Integrative/Functional Medicine than women. This week on my social media I have been sharing lots of information about men's health. In the video above I have discussed in detail the following :
1. Subtypes of Testosterone deficiency
2. Physiologic age-related changes in Testosterone
3. Impact of low Testosterone on overall health.
ROLE OF TESTOSTERONE IN MALE HEALTH
Testosterone is well known for its role in tissue growth and repair as well as male reproduction. What many folks are unaware of is Testosterone's broader role as a major biomarker for co-morbid conditions.
Testosterone serves as an immune modulator, particularly in autoimmune conditions.
Testosterone is an adipocyte growth inhibitor.
Testosterone is connected with energy metabolism via its connection to other hormones such as insulin and Leptin.
Low Testosterone is common in young males, as young as 30 years old.
Low Testosterone is connected to cardiovascular health.
The relationship between stress and the immune system is complex. Some things to consider:
TYPES OF HORMONAL DEFICIENCIES
When I examine older male patients with late-onset hypogonadism (LOH) I typically break down the hypogonadism into three main groups as per the European Male Aging Study. Breaking them down helps with the treatment plan.
Secondary Hypogonadism is statistically correlated with obesity and elevated BMI than age.
Primary Hypogonadism is associated with age.
Compensated Hypogonadism is called compensated because the Testosterone levels are normal, however, the gonadotropins are elevated. This type can mimick primary hypogonadism.
The diagnosis of hypogonadism is not simple. It is not just low laboratory testosterone. Patients must have clinical signs and symptoms of low T along with the labs.
WHAT I TREAT MOST FREQUENTLY
What I treat in my clinic is secondary testosterone deficiency. I am not sure if it is just me or I find these numbers to be astonishingly grave.
89% of all Testosterone deficiency is secondary means it is related to obesity and visceral fat.
Out of this 89%, 70% has known metabolic dysfunction such as metabolic syndrome, diabetes, high blood pressure, or high cholesterol.
In my professional opinion, any male with metabolic issues should seek holistic/Integrated care.
LEPTIN - TESTOSTERONE - INSULIN
Leptin is a small hormone secreted by the fat cells. It is secreted predominantly by the visceral fat. Visceral fat also is known as ectopic fat. Ectopic fat is the fat that accumulates outside of the adipose tissues. Just like an ectopic pregnancy, which implants at a wrong anatomical location. Leptin can also be present in other fat cells; however, we will focus on ectopic fat cells. These fat deposits are present in the many organs such as liver, aka fatty liver, pancreas, muscle. Most of the issues with leptin resistance we encounter these days are due to these ectopic fats.
What is Leptin Resistance?
Leptin resistance is a condition akin to insulin resistance. In leptin resistance, it takes more leptin for the bain to feel like you have "enough fat storage."
In obese patients, there is a new energy regulation mode that l is adopted by the body. Since the hypothalamus is unresponsive to the peripheral leptin levels, obese individuals tend to have high leptin, high body fat, and high food intake.
Elevated Leptin inhibits androgen synthesis. This concept has extensive animal model support; if you like to read more about it, especially the human studies, please see Leibel et al.
Leptin resistance, like insulin resistance, leads to GnRH deficiency. A particular type of hypogonadism called hypogonadotropic hypogonadism emerges. Relationship with this type of low testosterone and metabolic disorder is bidirectional and eventually leads to a vicious cycle of inflammation in the body.
THIS IS WHAT YOU CAN START DOING TODAY
Lifestyle factors that cause Leptin Resistance:
-Sleep Disorders - fragmented sleep leads to leptin resistance. FIX YOUR SLEEP.
-Elevated triglycerides (high triglycerides block the leptin from entering the brain)
How can we treat it??
Here are some Integrative/Functional therapies for both Insulin Resistance and Leptin Resistance. These are the same tools I use for PCOS, metabolic syndrome, type 2 diabetes.
Ketogenic Diet - Avacado, olive oil, nuts, coconut oil
Add clean, lean protein
Insulin sensitizing foods that are high in fiber - Arablinogalactan is the supplement I could not think of in the video presentation
Alpha Lipoic Acid
Herbs such as berberine.
Vitamins and supplements - Chromium, selenium, Vitamin b, Vitamin D, Vitamin C, Magnesium
"My goal is to share my knowledge with the world. I believe in delivering valuable and ethical content that changes the lives of my patients." -Kiran Grewal MD
To Your Health,
Kiran Grewal MD