Dr. Goodyear is author of the popular book, Manboob Nation: An integrative model to low testosterone. In this episode we dismiss the idea about natural testosterone decline in men, how belly fat increases estrogen receptor signaling leading to cancer and other health challenges.
• Aromatase activity, toxins and inflammation
• Estrogen (in men) as a driver of inflammation
• Environmental influence on estrogen receptor expression
• And much, much more!
02:06 Dr. Goodyear’s Journey: Dr. Goodyear had a lot of training in women’s hormones, being a board certified OB/GYN. What he was taught did not bear out in day to day practice. He took a close looked at the science. It got him into the integrative medical movement. The functional medicine approach gave him to tools to help his patients. His woman patients would ask him to see their husbands. He looked at the science and discovered that medicine was approaching low testosterone differently than the science said. This was the impetus for his book.
05:37 Do Doctors do Their Homework? In the traditional medical business model, seeing 25 to 40 patients per day, you don’t have time to read. A study in 2001 showed that the time it takes from a randomized controlled study to clinical practice is on average 17 years. That means that your average practitioner is practicing medicine that is 17 years behind the science. Functional medicine is beginning to fall into the same cookie cutter methodology as traditional medicine.
09:35 Causes of Low Testosterone: There is a natural decline in testosterone, however what is being seen today is not natural. There are environmental and health issues effecting it. There are about 1.6% annual decline in testosterone following peak production in the mid 20s. Over the lifespan of a man, there is about a 47% decline. From 1940 to 1992 there was a 100% drop in sperm count.
11:06 Stress and Low T: Stress shuts down the HPA axis. We don’t procreate while being chased by the figurative lion.
13:21 Testosterone Decline in Younger Men: The effect of our environment is showing in the younger generations. We are seeing hormone production issues before birth. Environmental toxins, unfortunately, has become a political ideology on both sides.
16:37 Start with Diet: Dr. Goodyear recommends diet changes. Include vegetables, fruits, spirulina, chlorella, alpha lipoic acid, herbs and supplements. Limit protein from animal sources. This augments our detoxification pathways.
18:29 Low T Assessment: Total testosterone is the classic area of diagnostic criteria. Total testosterone is analogues to a Fed Ex truck. It can drive by and deliver nothing. With an assessment of free testosterone, you can see that you have one truck stop at your house and drop off the entire contents. Free testosterone is functional. It is a different window into the same process. Most hormone receptors are inside the cell, so we want to look inside the cell. Metabolites are the leftover material from testosterone. Measuring them also provides a view into the process.
21:20 Metabolites: Dr. Goodyear likes how they interact with the receptors. DHT is short acting. The conversion of testosterone to DHT occurs near the receptor site. Assessing testosterone, DHT and 5 alpha DHT levels gives you a good view of the potency of the androgens and the potency of your therapy. If someone has a 5 alpha reductase dominance, you will see a more androgenic response than you would if it was 5 beta.
22:23 Cancer: There is great controversy over testosterone and prostate cancer. Cancer researched found that in a man with prostate cancer, metabolites of DHT do not interact with the androgen receptors. They interact with the alpha estrogen receptors, promoting a pro-inflammatory pro-growth signal. Some environmental toxins upregulate ER alpha receptor expression. This predisposition to cancer starts before birth.
25:04 Bioidentical Therapies: In most men, low testosterone is a biomarker of poor health. By treating the causes, testosterone levels can rebound. If an overweight man loses weight, his testosterone levels rise. If a man with systemic inflammation reduces his inflammation, studies say that his hypothalamus will start to produce more GnRH.
27:01 Obesity and Hormones: The ability to aromatize testosterone to estrogen is heavily concentrated within abdominal fat. Along with abdominal fat, there is often an insulin resistance issue and an increase in adipose cytokine production, thus an increase in inflammation. The increase in estrogen and inflammation increase the aromatase activity. The resulting estrogen production can shut down the HPA axis, leading to a decrease in LH and FSH production. There is also a decrease in testosterone estradiol ratio. This promotes inflammation and weight gain. High leptin levels have been shown to inhibit 17-hydroxyprogesterone to testosterone production, showing a direct inhibitory effect in the testicles for testosterone production. Leptin drives aromatase.
29:59 Chicken/Egg Fat/Low T Which Came First? In most cases, low T is an effect, not the cause.
33:25 Testosterone Replacement Therapy: Dr. Goodyear tries to mimic what the body does. Peak testosterone production is in the morning. Topical testosterone is his preference. The half-life of bioidentical testosterone is a little short, so Dr. Goodyear recommends twice daily dosing. Not only do you want better hormone levels, you want to feel better. Application of topical testosterone for rapid absorption is near the anal sphincter, but Dr. Goodyear recommends using the inner arms. Stay away from heavy fatty tissues and hairy areas.
38:27 Reducing 5-Alpha Reductase Activity: She saw palmetto works on BPH and slows it in the prostate. Progesterone competes for 5-alpha reductase activity. Some men are low in progesterone and can benefit from supplementation.
39:46 Dr. Goodyear’s Favorite Nutrient: Adaptogens is his answer. Rhodiola, ashwaganda, maca, and panax ginseng are powerful for dealing with adrenal issues.
40:45 Dr. Goodyear’s Elevator Speech: Exercise, but don’t overdo it. Limit cardio to 3 days a week. Do resistance training. Resistance training increases endogenous hormone production.