Testosterone – it’s complicated

Of course it is! Everything about human physiology is full of layer and nuance.  Just when we think we have things figured out, new data emerges and we then have to figure out how to adjust what we think we know.  It’s fairly easy to believe that more testosterone equals more muscle and that’s that!! Numerous studies demonstrate that vegetarian, low fat or vegan diets often result in lower levels of free testosterone and also in general they tend to carry less muscle mass.

Now I’ve been on a high protein, high fat low carb all meat diet and have plenty of muscle, far above what my age group peers often have and yet when  I tested a early am testosterone back in January low and behold, it was shockingly low!! 227 ng/dL. This falls below the normal range of 270-1070.  How can this be as you are a big strong, lean guy who supposedly has excellent sexual function (I checked and I do).  So how is this possible?

Perhaps your total testosterone was low but I bet you’re free test must be good.  Nope free test was also below range at a wimpy 5.5ng/dL. What the heck is going on can this carnivorous diet be dooming you to a life of flab, depression and erectile dysfunction? 

Well as I said at the beginning, and have said all along laboratory values have to be put into context and we have to take into consideration a whole host of potential factors when considering them.  

Now we certainly know that levels can fluctuate from day to day and even on an hourly basis sometimes and indeed when I rechecked my testosterone levels a few days later they were higher to around 316/dL total and free of 58, still not spectacularly high but now into the lower end of the normal ranges.  So what can cause these day to day shifts?  

Despite speculation that I must be secretly taking drugs and I somehow must have tried to cycle off them when I took my test to not arouse suspicion, that is not the case. I was under no obligation to reveal any labs at all and if I were trying to hide drug usage I simply would not have bothered to take a testosterone test at all.  But as I did and the results were unexpected it serves as a good opportunity to talk about taking labs out of clinical context.  Why were they low that day in particular?  Could be the fact that I was training extremely hard the few days prior to getting my blood drawn as I was up over at Super Training gym with Mark Bell training and filming for a movie he and his brother Chris are shooting.  I could be I had a poor nights sleep. It could be a lot of things.  

But rather than going that route I think it is also important to understand the role of the receptor and hormone interaction and also the effects of diet on hormone function and overall clinical outcome.

A nice study done recently shows that diets high in protein but low in carbohydrates were associated with an overall lower resting concentration of testosterone levels but showed a normal post exercise concentration when compared to a higher carbohydrate diet.  So it could certainly be that my resting levels are a bit low but then are elevated when I need them during exercise.  Makes sense because I maintain excellent strength and have excellent training capacity.

Let’s talk a bit about the androgen receptor.  I like the analogy of using a key to represent the hormone and a lock to represent the receptor. We will call the act of opening doors clinical function.  If for example to lift 500lbs you need to open 500 doors and you have 800 keys(hormone)  but only 50 locks (receptor) it’s going to take you a long time to get 500 of those doors open.  Now if instead you have only 500 keys but you also have 500 locks you will open those 500 doors fairly quickly. Hopefully that analogy makes sense, if the receptor density is high then you may need less hormone for the same clinical effect.

Is there anything that has been shown to improve androgen receptor sensitivities.? Well in fact yes there are a number of things.  In fact testosterone can temporarily increase its own receptor, so during the post exercise period the receptor levels can potentially increase.  Carnitine is a supplement but it is also found copiously in red meat and it has also been demonstrated to up regulate the androgen receptor function and even was shown to be more effective than testosterone itself in improving male penile erections!! Yay for meat eaters!! Strength training also can upregulate the receptor as can time restricted feeding both are thing I do frequently as I train very hard and I generally only eat twice a day.

In fact there are fish that can change sex from male to female by changing the amount of sex hormone receptors.  The androgen receptor has also received attention in the treatment of several types of cancer including prostate and breast cancer by drugs called SARMs which can modulate the receptor and of course have made their way into athletics as agents of abuse!

Ok, this just scratches the surface about testosterone but it should serve as an example to folks about looking at an isolated lab value and trying to make a general conclusion.  Until next time enjoy a nice medium rare steak and put some weight on the bar!!