The Functional Medicine Approach to Testosterone Replacement

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Low testosterone, or “Low T,” has become an increasingly common problem among men of all ages. It can tank energy levels, cause concentration problems, weight gain, and a decreased libido. Too often, conventional treatments for low testosterone simply involve hormone supplementation—a solution that is often ineffective on its own and carries both short-term and long-term risks. Fortunately, the functional medicine approach to treating low testosterone offers a more holistic solution.

Let’s delve into healthy testosterone levels in men, possible reasons behind declining testosterone levels, as well as the potential risks associated with replacement therapy.

Explore more about Functional Medicine for Men

Declining testosterone levels in men

Today, average testosterone levels in men are significantly lower than they were just a few decades ago (1). This is due, in part, to lifestyle changes, diet, stress, and environmental toxin exposure over time. But the cause of declining testosterone levels is complex and multifactorial. 

It’s normal for testosterone to decrease with age, and some men may not experience negative symptoms. Though low testosterone affects as many as 1 in 4 men, only about 1 in 20 men experience noticeable symptoms (2).

For some men, abnormally low testosterone levels are due to an underlying condition or a pituitary disorder. Medications can also play a role, including those used for cholesterol management, and to treat depression or anxiety (3).

Read: Must-Have Medical Checkups for Men: 6 Appointments You Shouldn’t Skip

Who should consider low testosterone therapy

You may need testosterone replacement therapy if you have low testosterone levels. Normal testosterone levels are considered anywhere between 300 and 1,000 ng/dl. A testosterone level below 300 ng/dl is considered the threshold for low testosterone.

Testosterone therapy is recommended for conditions you’re born with, such as Klinefelter syndrome, as well as low T levels due to acquired conditions, like an injury or cancer treatment.

You should also ask your doctor about doing a blood test to check your testosterone level if you’re experiencing:

  • Low libido
  • Weight gain or difficulty losing weight
  • Low energy or fatigue
  • Trouble concentrating
  • Loss of lean muscle (including strength loss)
  • Changes in mood or behavior
  • Sleep disturbances

Because there’s such a wide range of what’s considered “normal” for testosterone levels, your doctor will also rely on symptoms to help diagnose low testosterone. Your doctor can help you decide if TRT is right for you, and discuss with you the benefits and risks of treatment.

Related: Is TRT Right for Me?

Root causes of low testosterone

Low testosterone is often caused by imbalances in certain other hormones, including cortisol and estrogen.

Cortisol is a stress hormone produced by the adrenal glands that can cause inflammation and downregulate or suppress testosterone production (4). Too much cortisol can be caused by lifestyle factors such as poor diet, lack of sleep, and chronic stress (5).

Estrogen can also suppress testosterone production. This can be caused by too much body fat, as well as other lifestyle factors such as diet and exposure to environmental toxins.

Other causes of testosterone deficiency include (6,7):

  • Nutrient deficiencies, such as zinc, magnesium, & vitamin D
  • Certain medications such as statins and antidepressants
  • Chronic inflammation
  • Excessive alcohol consumption
  • Liver disease

By addressing the root cause of low testosterone levels—or even preventing them from occurring in the first place—functional medicine practitioners can help men achieve optimal health without relying on synthetic hormone supplementation alone.

Learn more: 6 Evidence-Based Ways to Increase Testosterone Naturally

Testosterone therapy may not be appropriate for men with obesity

In males with obesity there is increased aromatase activity, which converts testosterone to estradiol resulting in decreased testosterone and elevated estrogen levels (8). 

This suggests that overweight men with low testosterone should work with a functional medicine practitioner to first reduce body fat before introducing testosterone therapy to avoid unhealthy levels of estrogen in the body.

Read: Muscle Loss, Hormone Imbalance Among Top Factors Sabotaging Weight Loss

The functional medicine approach for low testosterone

At its core, the functional medicine approach aims to identify and treat the underlying cause of low testosterone. This means that synthetic testosterone therapy may not be the right option to treat a low testosterone level in all men. A functional approach to restoring optimal testosterone levels may involve dietary, lifestyle, and the proper use of certain dietary supplements in addition to or before exploring testosterone therapy.

First, saliva and/or blood tests are necessary to measure both free testosterone & bound testosterone. Another test measures bioavailable testosterone, which can be used more readily by the body.

For men with low circulating testosterone levels, treatment options may include:

  • Diet changes and lifestyle modifications to reduce stress and improve overall health.
  • Dietary supplements such as magnesium, zinc, ashwagandha, vitamin D3, and adaptogenic herbs like Rhodiola rosea.
  • Testosterone gel or topical creams for those with low testosterone levels.
  • Testosterone injections, if necessary.

It’s important to note that testosterone replacement therapy is not without risk and hormone therapy should always be monitored by a qualified medical provider. 

Learn more: Men, Here’s How to Handle Your 6 Most Common Health Problems

Testing, treatment, & optimal levels

In general, optimal testosterone levels in men should be between 300-1,000 ng/dl—although individual levels are highly variable.

A functional doctor may suggest other hormone testing in addition to testosterone, such as:

  • Testosterone (free & bound)
  • Sex Hormone Binding Globulin
  • Prolactin
  • Estradiol
  • Cortisol

Testing male hormones gives a functional doctor a more complete picture of a man’s overall health & hormone function so more personalized treatment recommendations can be made.

Testosterone therapy involves the use of synthetic hormones to supplement natural levels. If you and your functional medicine provider at CentreSpringMD determine that testosterone replacement therapy is right for you, treatment is usually delivered in one of several ways:

  • Intramuscular injections (into the muscle)
  • Gels or creams are applied to specific areas of the body (with care taken to ensure any hormone isn’t transferred to a family member or partner).
  • Patches that transfer testosterone transdermally
  • Pellets implanted beneath the skin

Our doctors at CentreSpringMD often choose bioidentical hormone replacement to treat low testosterone as part of a functional and integrative approach due to their more natural interaction with the body, and fewer side effects.

Benefits of TRT

It is important to get the right level of TRT, as too much testosterone can be just as problematic as too little. Healthy testosterone function provides several major benefits, including (9):

  • Improved cognition and focus
  • Improved sexual desire & function
  • Muscle strength and physical stamina
  • Improved bone density
  • Improved body composition (Loss of belly fat/easier weight loss)

If you’ve been putting off addressing unwanted symptoms, setting up an appointment to discuss your concerns is easy—contact a functional men’s health provider at CentreSpringMD.

Testosterone replacement therapy risks & side effects

It’s important to understand the potential risks associated with TRT, which may include (9):

  • Gynecomastia (development of breast tissue)
  • Swelling or fluid retention
  • Prostate enlargement
  • Worsening sleep apnea

It is important to understand all aspects of testosterone replacement therapy before making a decision about whether it’s right for you.

Related: Tips to Increase Male Fertility | Diet, Lifestyle, & Supplements

What to remember

At CentreSpringMD, we believe in customizing each treatment plan for every individual. Our functional medicine doctors specialize in using natural and bioidentical hormones to help men restore their testosterone levels safely and effectively.

  • To learn more about testosterone replacement therapy and how CentreSpringMD can help, contact us today.

Low testosterone can be a debilitating problem for men—but it doesn’t have to be. With the help of a functional medicine practitioner, you can learn how to address the underlying causes of low testosterone with lifestyle changes and possibly supplementing hormones in an optimal manner. By understanding the factors that play into declining testosterone levels, you can work with your doctor to achieve an optimal balance and regain your male health.




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