 Hello everyone, welcome to Sugar MD channel. Today we are talking about Testosterone. Now we are going to talk about why would your testosterone go low to begin with or we'll start with actually what's normal testosterone level. Everybody is curious about that. What would be normal for you and we're going to talk about why does testosterone level go low. We're gonna talk about how to naturally raise testosterone levels. We're gonna talk about would testosterone therapy help or not and we will talk about potential side effects if you go on testosterone treatment. I am Dr. Ahmet Ergin. I'm an endocrinologist and endocrinologist means a hormone specialist. We also deal with diabetes all the time that's why you're in this channel and we will get to the bottom of this today. Let's get started. So number one, what is testosterone level that is normal for you? Well most people look at the reference ranges right. Reference range as you can imagine it says reference range. You refer to it but it doesn't mean that your level is should be in certain part of the reference range. Reference range simply means that 95% of the population normal population lives in that range. So when you look at your lab results you will see anywhere from 250 at the bottom end up to maybe a thousand. I'm talking about the United States measurements in Europe could be different. Regardless you will see a bottom end and upper end and most men naturally wants to be on the upper end. Hey you know oh my god I want to have high testosterone levels dude but believe it or not high testosterone levels has been associated with infidelity, criminal activity, aggression and all sorts of crazy behavior. So maybe if you don't have very high testosterone level maybe it's good for you. So anyways but majority of the men healthy men normal men just like me would be around 400 to 600 testosterone levels. Now you're wondering like what is your testosterone level? Well actually last time I checked it was like around 580 which puts me right in the ball part of healthy adult male. Now of course you know most everybody wonders hey you know what if my testosterone was 800, 900, 1000 would I be like much more muscular and da da da da we'll talk about that but that's the normal range that you're looking for and if you are between 400 and 600 you are in a good range be happy don't dig any further. Now you're gonna be asking hey what if I have symptoms what if I have if I'm tired what if I have no stamina I can't lift weights I get tired easily I have no sex drive my erection is dead you know what do we do about that? Well I'll tell you right now the symptoms of low testosterone can be many and the most clear symptoms are low sex drive. So if you for example have erectile dysfunction but your sex drive is okay testosterone is not going to help you if that's the case that is what it is. So if your testosterone level let's say is 200 or 150 and you have erectile dysfunction and you're wondering if you take testosterone would your erection improve probably not gonna happen and I can tell you by first hand because I treat these people I treat guys who come to me with low testosterone and I bring them back in six weeks and three months and I ask them how their symptoms are improving none very rarely somebody's erectile dysfunction will improve and that's been shown in studies as well. Now in terms of low sex drive this could be low testosterone but it could be also many other factors if you're stressed out if there's too many things going on in your brain if you're not if you do not have a good relationship with your partner or your wife then that may not be that may be the exact reason actually for the low sex drive but your testosterone may be completely normal. So and and tiredness and tiredness is a very common symptom it could be from lack of sleep it could be from sleep apnea it could be from obesity insulin resistance diabetes you name it there's so many things that can cause tiredness inflammation chronic disorders chronic kidney disease you name it so it doesn't have to be testosterone just because you're tired now should you check your levels why not if you're diabetic you should get your levels checked especially if you feel like you're having symptoms but if you're diabetic you have a good sex life you have no erection problems everything looks fine there is really no need to check it either. So we'll talk about why testosterone levels go low now so well I'll tell you right now there's so many reasons of course but this is a diabetes channel so I'm going to talk to you from your perspective what could be the reason now we talk about insulin resistance we talk about diabetes all the time and type 2 diabetes has been most commonly associated with low testosterone like if you have a type 1 diabetes for example you are not overweight your your waist circumference is not large more than likely you're not going to have testosterone problems and these people never come to me and complain about their testosterone or low sex drive etc unless they're really very old etc but normally type 2 diabetes associated with low testosterone way more than type 1 diabetes and when type 1 diabetics get that problem it's typically related to obesity or increased waist circumference as well so measure your waist circumference if you are 40 inches as a man or more than 102 centimeter from you can measure from your you know belly button all around if it is more than that you're definitely a candidate for insulin resistance metabolic syndrome if you're diabetic you already have that not every type 2 diabetic necessarily have that problem like increased abdominal circumference but sometimes they have insulin resistance anyways due to visceral fat and there are other indicators that your doctors can check for insulin resistance scores but definitely insulin resistance is the ultimate factor when you're an insulin resistant your fat cells may make inflammatory cytokines and they basically go to your pituitary and give the signals that you know you're sick you know you don't want to really you don't really need to make testosterone right now your body has more important things to worry about for example if you go to a hospital and go check all the young people's testosterone levels if they are sick testosterone levels will go down it's like in a balloon when the balloon is dying and you're in the air you gotta throw all the unnecessary things and try to keep it light right so that's what body does since testosterone is not a vital hormone that's the first thing that goes down when your body's inflamed when you're sick and if you're not sleeping well and if you are under stress and you're constantly working you don't have a balanced life you're not eating right you're eating all this inflammatory foods fast food the stuff that we talk not to do not to eat all the time and if you are constantly doing that then definitely your testosterone will naturally go down and when you are obese or overweight there's something called sex hormone binding globulin that goes down because liver doesn't make enough of that and when that goes down your total testosterone levels go down and free testosterone levels become relatively higher and that gives the full sense to the pituitary gland which is the master gland to make less testosterone because pituitary gland is the manager so if you make give the impression to your pituitary gland that there's a bunch of testosterone around here in the body because your your pituitary gland operates by the levels of free testosterone levels and since in obese individuals that levels go artificially high your pituitary gives even less signal to make testosterone because your pituitary thinks that there's a lot of testosterone but there is really not so as a result guys there is a strong correlation between waist circumference and testosterone and to prove that there are actually a lot of studies out there that shows that if you lose 10% of your body weight your testosterone will go 100 points up so that's pretty good I mean if if you are let's say 320 pounds and you're supposed to be like 200 pounds you're almost like you need to lose almost 50% of your body weight now that's difficult to do but if your testosterone is 200 right now and you lose 30% of your body weight your testosterone can go up to 500 naturally so that brings us to the next topic of how to improve your testosterone naturally well if you eliminate the causes of you know the low testosterone you can definitely achieve that and you can do a few other things in addition to that now what are the causes like we discussed well is sleep better especially if you are a night shift worker that's a disaster so change your job if you can make sure you get seven to eight hours of sleep make sure you eat good food you eat salmon you get enough vitamin d that's that's in salmon you get a lot of zinc in your diet that is in salmon nuts although omega 3 containing foods they all have zinc and vitamin d if you have to take vitamin d from outside that's okay over the counter very easy to do you can take 2000 to 5000 units of vitamin d that's not going to hurt zinc supplements is really not necessary as long as you're eating well but if you're like a carnivore type of guy you may want to take some zinc maybe or vitamin d but make sure you are incorporating fatty fish in your diet that is very fundamental if you are having good omega 3 fatty acids in your diet that's how your testosterone is built you need to make sure that you have enough nutrients for that testosterone to be able to produce in your testicles so the next thing is training so you're gonna be like hey if i go to gym can i do better yes the only problem is when people have low testosterone they psychologically think that you know they are too tired to go to gym well sometimes you're gonna kick your own ass i'm sorry you gotta do that and that's what i do i sometimes wake up i'm like oh well i'm too tired but guess what i'm gonna move on get up and go and if you do that you're gonna eventually realize oh well that that really worked out i feel better now it may not be the case in the first couple weeks but eventually that that energy will come to you the resistance training number one okay so resistance training will boost your testosterone if you can do high intensity training there's also going to boost your testosterone now if you're on a keto type of diet or a carnivore type of diet you may not be able to do resistance training as much as you want to or you may not be able to do high intensity exercise because those type of exercises require carbohydrate in your muscles because you need this rapid energy source that needs to be like an explosive energy source and and that's why you know if you're gonna eat your carbs your healthy carbs of course your fruits etc do that right before the resistance training or right before your high intensity training now you don't want to jump into high intensity training immediately especially if you're not a fit guy to begin with so you need to improve your fitness slowly so if you're like a 45 50 year old guy who potentially have a heart disease already i don't recommend you go out for a sprint because you may drop dead that wouldn't be nice but we want to make sure that you're building your skill you're building your fitness and eventually you're starting to do small amounts small durations of high intensity training and resistance training the same way you don't want to go lift like 50 pounds for your biceps at first you start with 5 10 pounds and then you build slowly and the way to do that is simple you know if you are able to comfortably do eight reps then you should be able to move on to a little bit higher rep and you can gradually increase it it requires time and patience but you can do it the next question is what if you took testosterone to make everything suddenly better well i can tell you it can help but you have to take testosterone and you have to go work out if you take testosterone don't work out you're going to gain weight so if you're taking testosterone you can i'm not against it as long as you don't have any contraindications which is a discussion between you and your doctor but if you're taking testosterone you have to make sure you're doing your resistance training and cardio every day that's how you get the most benefit from testosterone treatment then then you can yes help you but as i said most people just take testosterone and they expect miraculously turn into an iron man or something which is not going to happen now what are the side effects so of course a lot of you also have concerns about testosterone treatment causing problems it can't it can't so if you have a high blood pressure to begin with you have to control that first and the best way to do that is controlling your weight and your overall health but if you cannot do that at least you have to take some blood pressure medication natural medications or herbal medications or natural medications whatever you prefer but at the end of the day you have to get your blood pressure control if your testosterone raises your blood pressure then you are looking for a hard problem so we don't want that you want to control the blood pressure as good as your blood sugar because people ignore their blood pressure problems but this is as important or sometimes even more important than blood sugar levels if you already have high hematocrit levels or high red blood cells in your blood work a testosterone can drive that even higher and if in you when you have high red blood cells that increases your viscosity but the blood viscosity and that is a problem too because that also increases the risk of heart attacks and strokes so you definitely don't want to raise your hematocrit levels it's like in short it's like HCT or hematocrit levels so you need to keep that level less than 50 if possible but if it is 55 or more you definitely should not be taking testosterone some people do phylobotomies but most of the time you have to get to the bottom of this most of the time people with high red blood cells are the people who are smokers which are already high risk for cardiovascular disease which puts them even higher risk when they take testosterone and keep their habits and people with sleep apnea also have high hematocrit levels which is a relative contraindication to testosterone treatment especially if you're not treated there's a total contraindication so if you have sleep apnea for example and you're not using your CPAP machine you're not getting testosterone I'm not here to kill you even if you bag kneel down doesn't matter you're not gonna get that testosterone because that can kill you that can stop your breathing and that's one thing you don't want to do now increase in PSA which is prostate specific antigen can happen so as we get older the guys we all get a bigger prostate when the prostate enlarges it can cause some urinary problems like urination problems but also sometimes we develop prostate cancer believe it or not prostate cancer is one of the biggest killer of all men so if you live long enough you'll probably end up with prostate cancer at some point in your life now most prostate cancers you know will grow some of them will glow slowly some of them are faster it's very unpredictable but when you have testosterone on board things are gonna be really messy so if you have a little testosterone cancer that's really growing very slowly that may not kill you right away but you put testosterone on board it's going to get everywhere in your body my testosterone is like nothing else so you have to make sure you're getting monetization for prostate specific antigen as well and if the levels are the velocity we call that if the levels are going up fast you need to get a prostate biopsy and guess what that's not a pleasant biopsy if you have ever done it it hurts but regardless the bottom line is you have to monitor your PSA and that can go up and the lastly the aggression well sometimes the guys comment they just want more on more testosterone or they just cheat and they take more testosterone than prescribed don't do that I mean look aggression is not good if you're aggressive you know you may hurt somebody somebody may hurt you sometimes people come to my office I can clearly tell that they're on testosterone they're very aggressive they're like not nice to my staff sometimes and and nine out of ten they're on testosterone if there's a problem in their prescription or something like that they're enraged man they're like wow you know they're ready to beat somebody don't be that guy be nice but as I said if your testosterone levels are too high then can be a side effect so watch that out as well and guess what your relationship is at stake if you end up with too much aggression too so anyways guys I hope that video was helpful and please give a thumbs up share and we'll see you in the next video all right thank you for watching and I want you to be more informed and more educated so to do that go ahead and watch this next video right here