← The Dr. Gabrielle Lyon Show
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We've been told for decades that giving men testosterone drives prostate cancer and that blocking it is perfectly safe for the rest of the body. Most of the mainstream advice is completely, yes, completely backwards. We have 30 year old men walking into clinics, losing their drive, losing their muscle mass, and being told by their doctors that because their labs are in normal range, everything is fine. Endocrine disrupting chemicals, also known as EDCs, can directly contribute to low testosterone. These environmental toxins interfere with the body's natural hormone systems by mimicking, blocking or altering hormonal signals. Even if you are eating right and training hard, your environment could be sabotaging your hormone production. When men experience severe erectile dysfunction or cognitive decline, the medical establishment almost never looks at the one organ system that may play a major role in fixing it. And you guessed it, it's skeletal muscle. Let's dive into the physiology and the latest research. Hey guys, welcome back to the show. And today we are tackling something I get asked constantly about in my clinic. And you guessed it, it's the hormone that is simultaneously the most demonized and the most misunderstood in modern medicine. And that friends, is testosterone. There is so much dogma and misinformation out there regarding this hormone, especially the outdated fears surrounding testosterone treatment and prostate cancer. Most of the mainstream advice is completely, yes, completely backwards. And for women, testosterone is often entirely ignored, may be used off label for hypoactive sexual desire disorder or perimenopausal symptoms, or are brushed off. Just as the normal part of aging. Major guidelines don't provide any formal parameters for women and for men, we're still relying on old, outdated population based reference ranges. We have 30 year old men walking into clinics, feeling like garbage, losing their drive, losing their muscle mass, thinking that the dad bod is in and being told by their doctors that because their labs are in, quote, normal range, everything is fine. Worse, our environment is actively waging a chemical war on our endocrine systems. We're going to be hearing more about this. And when things go wrong, when men experience severe erectile dysfunction or cognitive decline, the medical establishment almost never looks at the one organ system that may play a major role in fixing it. And you guessed it, it's skeletal muscle. By the end of this episode, you are going to understand exactly what the latest science says about testosterone. We're going to dismantle the 80 year old myth about prostate cancer. We are going to talk about the invisible chemicals in your home that are unfortunately chemically castrating you. And I'm going to give you the exact clinical protocols and the what medical guidelines say so you can walk into your doctor's office armed with the facts. If you are new here, I'm Dr. Gabrielle Lyon and I want to shift the paradigm of medicine to muscle centric medicine. Skeletal muscle is not just about looking good. It's your metabolic sync, your body's armor and the organ of longevity and robust optimized hormone levels, specifically testosterone, are non negotiable for maintaining that skeletal muscle as we age. If you find value in today's solo cast, please hit subscribe, leave a review and share this with someone who needs to hear it. Let's address the elephant in the room. We've been told for decades that giving men testosterone drives prostate cancer and that blocking it is perfectly safe for the rest of the body. We've also been told that a single static reference range is acceptable for diagnosing testosterone deficiency. Here's the reality when we look at the literature, the exact opposite is true. We base our foundational knowledge strictly on the medical guidelines, which can be quite variable depending on the medical society, from urology to endocrine or others. The American Urological Guidelines define a normal testosterone range of 300 to 1,000 nanograms per deciliter. But treating everyone with a single broad stroke misses the nuance of biological aging and metabolic health. And where are we getting these reference ranges from? And who is the ideal patient we are basing it off of? Is it a 50 year old male with multiple comorbidities like hypertension, diabetes, hyperlipidemia, et cetera? Or a 20 year old athlete? Or an average 45 year old who doesn't work out and is at home eating TV dinners every single night, a plethora of processed foods or endocrine disruptors? Does anyone know the science, the clinical evidence? Let's dive into the physiology and the latest research. First, does one size fit all? A new massive systematic review and pooled analysis from Baylor College of Medicine and Shane et al. Looking at over 200,000 men, showed that serum testosterone progressively declines across adulthood at a rate of approximately 3.5 nanograms per decade per year. The estimated median concentration decreased from 560 nanograms per deciliter at age 20 down to 425 nanograms per deciliter at Age 75. The authors concluded that these declines support the concept of age specific reference intervals. But some top experts in the field, like Dr. Mohakara have challenged this dogma, stating that healthy individuals at all ages can and have been shown to have healthy Testosterone levels. And it's not aging itself. It is the acquisition of comorbidities like diabetes, hypertension, atherosclerosis. In addition, I believe it's important to acknowledge environmental exposures like endocrine disruptors, chemical exposures, I.e. burn pits, and occupational exposures like traumatic brain injuries, concussions, blast exposures, military exposures. The list goes on. I think we could probably do a whole episode on just the environmental exposures, but we should dive deeper into these endocrine disruptors, which have gotten a lot of attention lately. Endocrine disrupting chemicals, also known as EDCs, can directly contribute to low testosterone. These environmental toxins interfere with the body's natural hormone systems by mimicking, blocking, or altering hormonal signals. Guys, this is major. The environmental attack and endocrine disruptors. Even if you are eating right and training hard, your environment could be sabotaging your hormone production. We have to talk about endocrine disrupting chemicals, or EDCs. Think of your hormone receptors like locks and your hormones as the keys. EDCs are like someone breaking off a fish fake key. Inside the lock, your body produces the testosterone, but it can't actually bind and do its job. Furthermore, xenoestrogens, chemicals that mimic estrogen, cross the blood brain barrier. They bind to estrogen receptors in your hypothalamus. Your brain registers this chemical imposter and thinks, well, we have too many sex hormones. And it prematurely shuts down the signaling cascade to. To your testes or ovaries. But it gets worse. EDCs, like phalites, induce severe oxidative stress right inside the Leydig cells, the actual factories in the testes that make testosterone. They damage the mitochondrial membranes and halt the enzymes that convert cholesterol into hormones. How EDCs lower testosterone. Endocrine disruptors reduce testosterone levels through sex. Several biological pathways. They block production. EDCs can interfere with the enzymes required for your body to synthesize testosterone. They also have receptor blocking potential. Some chemicals act as antiandrogens, binding to testosterone receptors. So the hormone cannot function properly even if the lab shows adequate levels. Kind of puts us in a terrible position. It can also increase breakdown. Disruptors can cause the liver to accelerate the breakdown and clearance of testosterone from your bloodstream. What about the brain Disrupting the brain? They can mess, like I'd mentioned, with the hypothalamus and the pituitary gland, which are the control centers that tell your body to produce testosterone. Common offenders and where they hide. Endocrine disruptors are pervasive in everyday consumer goods and the environment when we've all heard about bpa. BPA is found in hard plastics and the lining of metal food cans. And I bet you they're in energy drinks, which I drink way too much of. Phthalates used to make plastic flexible and found in personal care products like lotions, fragrances and shampoos. What about pesticides and herbicides? Chemicals like atrazine, organophosphates and ddt. Pfas, the forever chemicals used in nonstick cookware, which is one of the reasons we never use that water resistant clothing and food packaging. Parabens. These are preservatives widely used in cosmetics and skincare products. There are also some theories that there are everyday items that may also be dysregulating your testosterone. This goes for men and women and other bodily hormones. Hormones. Thermal receipts. I definitely laughed when I heard this. I just thought, is the world getting more paranoid? But the glossy receipts you get from the grocery store are coated in unbound BPAs. If you use alcohol based hand sanitizer and then grab a receipt, which you all know that is right at the checkout, you increase your skin's absorption of that endocrine disruptor by up to 100 folds. You guys, this is a major problem. Atrazine. This is one of the most widely used agricultural herbicides in the world. It violently upgrades the aromatase enzyme, which means it actively converts the testosterone you have into estrogen. And it runs right off the crops into the municipal tap water. Now, this one was a little rough. Performance apparel. Synthetic water resistant athletic wear often contains pfas or forever chemicals. When you train, your body temperature rises. I mean, my husband sweats buckets. Your pores open and you leach these chemicals directly into your bloodstream. Now, a lot of what we see online, you think, oh man, they're just really paranoid about everything. But the more we begin to learn about our environment and the more that we learn about our body's interaction, then we understand the necessity of high output sweating to excrete water solubles like EDCs, those are phalates. And the importance of clean protein sourcing to avoid these lipid soluble toxins, which can potentially, I hate to say this, be stored in animal fat. So minimizing exposure. While it's virtually impossible to avoid any environmental disrupting chemicals, it's nearly impossible. You can significantly reduce your exposure by making a few lifestyle tweaks. Filter your water. Use a certified water filter to remove potential contaminants. Choose safer packaging. Swap plastic water bottles and food containers for glass or stainless steel. And never microwave food in plastic. Take it out of the container and put it in a glass. Review your products. Opt for fragrance free and paraben free personal care cleaning products whenever possible. I have a list that I use. Eat fresh. Okay. So since pesticides can disrupt hormones, wash your produce thoroughly or opt for organic. And of course there's, you know, questions about organic. But again, if we can minimize the contamination, that is best. Okay, so we've covered environmental endocrine disruptors. Now we're going to move to prostate cancer and the prostate cancer paradigm shift. And nothing blew my mind more than this. The biggest fear surrounding testosterone has been prostate cancer for decades. The dogma was that giving a man testosterone was like pouring gasoline on a fire. That you would surely give him prostate cancer. And that is what we have been taught. And it didn't even matter if he had prostate cancer or not. Where did this come from? It originated from a single study in 1941 by Huggins and Hodges. By the way, we're phenomenal physician scientists. The theory that high testosterone inherently leads to enhanced prostate cancer growth owes its origins to equivocal results from a relatively limited study on just a few men, and really only one of them using alkaline phosphatase, an erratic marker that we no longer use today. But I digress. The science has evolved into what we call the androgen saturation model. The androgen receptors in the prostate become maximally saturated at a relatively low level of testosterone, thought to be. Are you ready? 250 nanograms per deciliter. So anything above that level should not have any significant effect on the prostate since the levels are saturated. This is hugely important to understand. Think of your prostate like a houseplant. If the plant is dying of thirst, giving it water will make it grow rapidly. But once the soil is completely saturated, pouring more water on it doesn't make the plant grow any more faster. The prostate is the same way. We now have incredible data proving this. A recent retrospective analysis by the Baylor College of Medicine team, AKA my husband et al. He made me put this in, as I like to call it. Looking at 43 men who were on active surveillance for prostate cancer. These men initiated testosterone replacement therapy. Their median testosterone levels increased from 272 nanograms per deciliter all the way to 578.5 nanograms per deciliter. Did their cancer explode? No. There was actually no significant variation in their mean PSA levels. The available data showed no apparent increase in prostate cancer progression or disease. Worsening do you understand what this means? Prostate cancer and testosterone. There was a mistake made in the understanding. In fact, there's actually no data proving that testosterone causes or worsens prostate cancer. You can look at my earlier episode with Abe Morgenthaler, a prominent urologist who lectures, publishes and speaks a lot on this topic. And I encourage you to look into this area more, especially his work. So finally, what happens when you strip away androgens? So these guys that were on treatment. A meta analysis in nature of over 2.5 million patients evaluated the effects of androgen deprivation therapy, or adt, on men getting treated for prostate cancer. The results were staggering. They found that ADT significantly increases the risk of dementia, Alzheimer's disease, Parkinson's disease and depression. What this means on a cellular level is that androgens are highly protective of your neurocognitive environment. And living without the healthy levels your body needs can be detrimental. Androgens are not just sex hormones. They are fundamental to sustaining the neuronal microenvironment in your brain, maintaining synaptic density, degrading beta amyloid and promoting neuroplasticity. Thinking better. Furthermore, treating everyone with a single static reference range is flawed. Like I mentioned before, that massive systematic review by Baylor of over 261,000 men showed that serum testosterone varied by age. But that's not all. Other research by them showed there are genetic variability person to person with something called CAG repeats. So your testosterone may be more like your, I don't know, sleep number, meaning that everyone may need a different level to achieve that appropriate dose response effect. What are CAG repeats? Deep inside your cells, you have a gene that builds something called an androgen receptor. Think of this receptor as a lock and testosterone as the key. When testosterone, the key, fits into the receptor, AKA the lock, it tells your body to do something like build muscle, grow body hair, maintain bone strength. Within this gene, there is a small section of DNA that repeats itself, hence tag, repeat. Most people have somewhere between 10 and 35 of these repeats. The number you have is something you're born with and it doesn't change over your lifetime. What does that number mean? Fewer CAG repeats. Shorter. Each receptor works more efficiently. Your body responds more strongly to testosterone. More CAG repeats means longer. Each receptor works less efficiently. Your body responds less strongly to testosterone, even if your testosterone levels are low normal. Let me give you a simple analogy. Imagine testosterone is like rain and your androgen receptors are like buckets catching that rain. If you have fewer CAG repeats, your buckets have Wide openings, they catch a lot of rain. If you have more CAG repeats, they have narrow openings. They have the same amount of rain falling, but less of it gets caught. The number of buckets essentially stays the same no matter what. It's the size of the opening of on each bucket that changes. So even if there's plenty of rain, AKA testosterone, in your body, your cells might not be catching it as much of it as someone else's cells would. To make up for this, your brain notices the buckets aren't filling up fast enough and tells your body to make it rain harder, no pun intended. Meaning it produces even more testosterone to try to compensate. What symptoms might someone with high CAG repeats notice? Even with normal or high testosterone blood levels, someone with a high number of CAG repeats might experience the following Low energy or fatigue, Reduced muscle mass, Less body or facial hair, Changes in mood or sexual function. These symptoms happen because the testosterone is there, but the body's receptors aren't catching enough of it. What should you do with this information? If you've ever had your CAG repeat length tested, share the results with your doctor. It can help them better understand how your body uses testosterone and may influence treatment decisions. If you are experiencing symptoms, so your testosterone may be more like your sleep number, meaning that everyone may need a different level to achieve the appropriate dose response effect. Due to receptor density variability, you may need 400 to feel great, whereas others may need 600 or 800 to achieve the same result. So due to genetic variations in receptor density called CAG repeats, there is essentially which is really important. Guys. No one size fits all. We should be practicing medicine and treating symptoms and patients, not numbers. Or at least that's what I think real clinicians should be doing. What about actionable protocols? The how to? So what do we actually do about this? Step one, the diagnosis cutoff. According to AUA guideline statement, clinicians should use a total testosterone level below 300 nanograms per deciliter as a reasonable cutoff in support of diagnosis of low testosterone. Now mind you, this varies per association, so specialty and country. Depending on the country you live in, your testosterone might be considered low at 250 versus 300. Step number two testing protocol. You cannot just test this once in the afternoon. AUA guidelines statement two mandates the diagnosis of low testosterone should be made only after two total testosterone measurements are taken on separate occasions, with both of them being conducted in the early morning, also being fasted. Step three Symptoms matter. Yes, they do. You are treating the patient, not just the blood test A way guideline statement 3 states the clinical diagnosis of testosterone deficiency is only made when patients have low total testosterone levels combined with symptoms or signs. Where should we get them to? What is the reasonable number? They quote 450 to 600. But I argue we should responsibly be getting patients to a place where their symptoms resolve. All while of course monitoring blood work to treat your patients safely, for example donating blood when appropriate, monitoring lipids as the individual taking care of your health safely. It is a better idea to be monitored and under the care of a physician or advanced practice provider with experience in this area. There are many great clinicians out there. We have them in our medical practice at Strong Medical shout out to Dr. Lisa Hunt, my doctor. Please avoid the pitfalls of some clinics just trying to take your money. Nothing is more important than your health and wellness. Step 4 My favorite muscle centric application Optimize your training and protein intake. Resistance training is non negotiable to sensitize the androgen receptors and maximize minimize muscle protein synthesis, especially as your age specific testosterone naturally shifts. More on this in a future episode. So to recap, testosterone normal ranges are highly dependent on age and probably more important, genetics. Initiating therapy in men on active surveillance for prostate cancer did not. Let me repeat that. Did not show significant changes in PSA progression or disease. Worsening and depriving the body of androgens comes with severe neurocognitive risks. You have the control to change your trajectory. You don't have to be a victim of your genetics or your age. You just have to know the right data and the tools. If you want to dive deeper into building metabolic Armor and the science behind it, pick up a copy of the New York Times bestseller Forever Strong and the Forever Strong Playbook. And please again take a moment to rate and review the podcast on Apple or Spotify. It's how we get the message out there to the world and we greatly appreciate it. And as my husband and David Goggins both say, stay hard, but I think they may have different meanings. Until next time, I'm Dr. Gabrielle Lyon. Stay Forever strong Sam.