By Elizabeth Boham, MD, MS, RD and Mark Hyman, MD

Low T? You have seen the ad. Are you a man who wonders if you have low T or low testosterone levels? If so, do you wonder if medication is indicated? Steve* was one such patient, who came to see us with concerns about his testosterone and how he was feeling. He had heard the pharmaceutical ad on TV and wondered if his testosterone was too low and if he needed to take medication. Steve was in his late-40s and feeling tired. He was gaining weight around his mid-section, and he felt that his relationship with his wife was not what it used to be. He had lost some lean-muscle mass, and he also reported that he had less interest in his daily life activities. He wondered if all of these symptoms could be attributed to aging, or if there were a way he could he feel better.

Low levels of testosterone are common in men over the age of 45. Studies have shown that almost 40% of men over the age of 45 have low testosterone levels (less than 300 ng/dl). Do all of these men need hormone therapy or testosterone to feel better? At The UltraWellness Center in Lenox, Massachusetts, we practice Functional Medicine. When using the Functional Medicine approach, we are looking to get to the underlying cause for a patient’s symptoms. In many situations, and often in cases of low testosterone levels, we start with lifestyle modification. We do this because often lifestyle modification works better and it does not come with the side effects that medication can have. You may be amazed to realize how much you can improve your hormone levels and balance, by changing your lifestyle.

When a patient comes to see us, we first get a detailed history and do a physical exam. Steve, like many men, had gained 40 pounds over the last 15 or so years. Much of that weight gain was around his belly. We measured his waist and hip circumference and calculated his waist-to-hip ratio. This simple test is one of the best ways to figure out your overall level of health and risk for disease. This is because weight around your belly, or visceral adiposity, is associated with a higher risk of heart disease, cancer and diabetes as well as a lower level of testosterone in men.

Steve’s waist-to-hip ratio was 1.1. Ideally, men want to have a waist-to-hip ratio of less than 0.9. His testosterone level was officially in the normal range. But, it was on the lower end of normal. When we check testosterone in men, we also check their estrogen level. His estradiol level was at the higher end of normal for a man. Why does this occur? Both men and women have an enzyme, called aromatase, in their fat cells. Aromatase is an enzyme that converts hormones like testosterone into estrogen. When we gain more fat cells, we will have higher levels of aromatase. As a result, people with more fat cells in their bodies, have high levels of aromatase and higher levels of estrogen. The result of these horomone imbalances is that men like Steve do not feel like themselves.

What did we do for Steve and what can you do?

5 Steps to Fix Your Low T!

1. Get out your tape measure. Midway between you hip bone and bottom of your rib cage, measure your waist circumference. Keep the tape measure horizontal to the ground. Record you results. Then measure the circumference around your hip bones. Record your results.

Ideally your Waist / Hip should be Too much weight around your belly has been associated with low testosterone levels in men as well as heart disease, diabetes and cancer.

2. Change your diet. What you eat has a tremendous impact on your insulin levels and all of the hormone levels in your body. A diet high in refined and processed carbohydrates and sugars will result in insulin resistance. Insulin resistance means that your insulin is not working well and not doing its job of getting your food into your cells so it can be turned into energy. When you remove sugars, flours and refined carbohydrates from your diet, you can improve your insulin sensitivity. When your insulin sensitivity improves, you will lose weight from your belly. For men, their aromatase levels will decrease, and naturally their estrogen levels will decrease and their testosterone levels will increase. To learn more about how to change your diet and reverse insulin resistance, you can read The Blood Sugar Solution 10 Day Detox Diet.

3. Exercise is your best medicine. This is true. Exercise can be more effective than all of the medications we are able to prescribe for improving your health and your hormone balance. Work to get in exercise most days of the week. Strength training is very effective for raising a man’s testosterone level and should be a part of your exercise routine at least 2 days per week. We recommend that our patients try to do at least 40 minutes of exercise most days of the week and include a mixture of aerobic and strength-training exercises.

4. Boost-up your Omega-3 Levels. The Omega-3 fats found in fatty fish and flax seed have amazing anti-inflammatory properties. They can help decrease the activity of aromatase and therefore lower the production of estrogen in men. In addition, these healthy fats also improve insulin sensitivity. Reach for 1000mg of DHA + EPA every day.

5. Add in phytonutrients. Phytonutrients are components in plant foods that have a host of wonderful effects on your health. Phytonutrients have also been found to lower aromatase in your body and therefore improve a man’s testosterone levels naturally. Some phytonutrients for hormone balance include; curcumin, resveratrol, epigallocatechin and lignans. Add colorful plant foods such as the spice turmeric, red grapes, green tea and ground flax seed into your daily diet to get these phytonutrients. There are also some supplements that combine these phytonutrients for optimal hormone balance.

Our nutritionists at The UltraWellness Center helped Steve adjust his diet. We also helped him increase his exercise levels and adjust his supplement regimen to get the necessary nutrients for his hormones to get into better balance. Almost immediately, Steve was feeling better. And within a few months he noticed his energy improve, his belly fat start to melt away and his relationship with his wife strengthen. Steve got his hormones under better balance without needing to go on medication. Give it a try. You will be amazed at how well you feel.

* Patient’s name and identifying characteristics were changed to protect his privacy.