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Question for Dr. Phil - I received my testosterone testing

back and I wanted a...
Question for Dr. Phil - I received my testosterone testing back and I wanted a second opinion. My total is 304 and my free is 4.07, pretty low. Wanted to figure out the best way to increase my free testosterone - are there any effective drug-free options, i.e. thru diet. Or what treatments are the most effective. PSA completely normal.
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Answered in 37 minutes by:
9/29/2017
Doctor John MD
Doctor John MD, Board Certified MD
Category: Medical
Satisfied Customers: 776
Experience: Medical Physician
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Hello and welcome to JustAnswer.com

This is Dr. John and I will be helping you today.

I will be reviewing your question and will respond shortly.

I may need to ask a few more questions in order to best serve you.

Thank you for your patience.

Answers here are for education and information only.

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I have a few more questions to ask, is that ok?

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Customer reply replied 3 months ago
For sure! Ask away

do you have the rest of the lab work as well?

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A few questions as well:

  1. are you on any medications or supplements currently?
  2. how much alcohol do you drink?
  3. what type of exercise do you do?
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Customer reply replied 3 months ago
I do have quite a bit of lab work. I ordered this specific test (Total, Free - testosterone) myself. Let me know what you're looking for.
Customer reply replied 3 months ago
1. No medications. Supplements - Occasional Sodium Naproxen (Aleve) for pain, Occasional melatonin (5-10mg) for sleeplessnness, plant-based protein (powder) to get to about 170 grams/day - my weight is 175, creatine, l-carnitine.2. Alcohol - 1 glass of red wine daily or every other day.3. I'm a boxing coach, I train between 2-4 hours per day. Running, resistance training, high-intensity interval training...

thanks for those answers.

How much sleep do you get each night?

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Customer reply replied 3 months ago
I work on getting 8 hours...and with melatonin I can get there. But recently I wake up in the middle of the night 3-4 then get up walk around and then fall back to sleep. Maybe 6-7 hours.I have a BMI of about 20-25, which is one of the reasons I took the testerone test. I eat between 1800-2000 calories a day. Chicken/fish/turkey...very little red meat.

So there are a couple issues and a few may sound a little counter-intuitive to you.

But, I'll let you know that I'm a sports medicine trained physician, so deal with a lot of athletes that end up with low testosterone.

Two issues I find for them are:

1) Amount and intensity of workouts.
2) Dietary intake

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Customer reply replied 3 months ago
How lucky I got that your a sports medicine! Since I run the training and monitor food logging, I can answer in detail whatever questions you may have.

So for someone like yourself its often a combination of overtraining/poor recovery/inadequate nutrition.

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So with 2-4 hours a day of moderate to high intensity exercise, the 1800-2000 calories is low. Thats what we recommend for an average, sedentary individual.

I deal with a lot of triathletes so their training can be similar (2-4 hours a day) and most of them need close to 3500-4000 calories a day during their heavy training

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If we look at Tour de France cyclists (usually around 130-140 lbs and 4-6 hours of exercise), their calorie requirements are 4000 to 6000 calories a day.

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Customer reply replied 3 months ago
I dunno man, I'm trying every which way to drop that BMI...and I just can't seem to do it. I don't train as hard as a TdF cyclist or a triathlete I don't think. My runs 3-4 miles at 10min miles so nice and easy. My sprint work is 3 minute type suicide drills. Then mitt work and sparring, abs, weights, home...on heavy days I might do that 3 or at most 4 times (not the running, that's a weekend thing). But I can't loose my belly fat. I've tried a lot of diets, I'm very frustrated. I eat tons of fresh fruit, salads, vegetables...minimal processed carbs, no sugars, no artificial sweeteners (stevia is the only thing), maybe molasses for the potassium. Gluten free pasta on occasion. Quest bars for protein, and Vega protein for recovery.

and that is the classic complaint of overtraining in guys that can't lose that last little bit of weight. Cortisol level go up and belly fat stay up as well.

Let me grab a couple websites for you to check out...

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oh, and whats your breakdown of carbs and fat as well for your diet?

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my starting website for most men over 40 is MarksDailyApple.com

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Mark is a former marathoner and triathlete that dealt with a lot of overtraining issues. He's been a proponent of Paleo diet for a while and is starting to move more towards Ketogenic diet.

He does a great job at looking at the research out there, breaking it down and explaining it to everyone.

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and again, if you're spending 2 hours a day at moderate exercise, that still requires a decent caloric replacement and plenty of rest.

I can tell you that the athletes I've worked with usually get 10+ hours of sleep a night as well as a nap during the day.

Recovery is the key to making athletic improvements since that is where your body rebuilds and gets stronger, faster, leaner.

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Diet is important, because if you don't have enough protein then muscle doesn't get rebuilt.

Fat is also important, because guess what the precursor is for testosterone?

Cholesterol.

And if you are cutting fat intake, most likely you're also cutting down you cholesterol intake as well. Less cholesterol then less to convert to testosterone.

Does that make sense?

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Customer reply replied 3 months ago
Fat Carbs Prot Cals
60.27 158.94###-##-####

so total calories are too low for your 2 hours of exercise. so total calories need to go up.

You need to increase healthy fats and drop the carbs a little.

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Customer reply replied 3 months ago
My total cholesterol 156 mg/DL

and whats your HDL?

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Customer reply replied 3 months ago
HDL-C 48

we want to see both HDL and TC go up a little and as they do, your TT and free T will also go up.

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Is it starting to make sense?

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Customer reply replied 3 months ago
Yeah...that's so wild...not in a million years...Ok...raise total intake, the HDL, reduce the carbs, and get the cholesterol up. Probably would have to switch to from sprouted toaste and oatmeal in the morning to a yogurt in the morning, more avocados, more nuts...and a shit ton of margarine :) The more transfat the better hahaha

.healthy fats obviously. avoid margarine, butter and ghee (clarified butter) are actually better.

I told you up front it would be counter-intuitive from what we've all been taught

Cholesterol itself is not a bad thing. every cell in our body has cholesterol. The real problem is inflammation that happens in artery walls, and then cholesterol goes in to help repair (and then gets blamed)

Doctor John MD
Doctor John MD, Board Certified MD
Category: Medical
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Chris Masterjohn is another website I would start digging through as well

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And thank you for the positive rating!

Let me know how things work out for you.

-Doc John

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Customer reply replied 3 months ago
Not everyone on board with Paleo...Sisson seems a bit suspect with his franchises and $1000 and you too can become a coach. My huckster flag is up.https://www.scientificamerican.com/article/why-paleo-diet-half-baked-how-hunter-gatherer-really-eat/
Customer reply replied 3 months ago
Scientific American did a review ....

I'm not suggesting you do his coaching. I'm asking you to read through his information about overtraining (I think he calls it chronic cardio) and his recommendation for nutrition in athletes.

Obviously we can agree that you're doing is not giving you the results you want.
Your nutritional deficit (Calories out vs Calories in) is too high and thats why weight loss is stalling and also impacting hormonal response (testosterone)

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Customer reply replied 3 months ago
Oh for sure...was not suggesting that you were telling me to be a coach...just that Sisson and the entire paleo approach is somewhat suspect given that man has evolved over the last 10,000 years and the bacteria in our gut has definitely evolved impacting what we can digest. But to your point on calorie deficit, I will definitely try and correct and hope for a positive hormonal response. It was interesting on the earlier report you cited that they did find some positive correlation between HDL and testosterone but with their modeling could not confirm a causal relationship. Seems odd if we truly believe that cholesterol is a precursor of some sort to testosterone, or it could be the modeling is incomplete.

No worries, but wanted to make sure that you didnt think I was trying to push a coaching program on you.

There's more and more research starting to come out on gut biome and its impact on weight loss as well, which may also tie into diet. Whats interesting is 20+ ago in medical school, there was no talk about gut biome/probiotics etc. Now I even see GI docs telling patients to go on probiotics. Theres a lot more to it than that, but at least its a start.

At least from a physiology standpoint, its widely accepted that cholesterol is a precursor for a lot of different hormones including testosterone, estrogens and aldosterone.

Here's a chart that shows cholesterol to sterol hormone pathway. We had to know and draw out the entire pathways back in medical school

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