A 58-year-old male Naturopathic Doctor (myself) presented at my clinic complaining of unexplained low energy, feeling uncharacteristically emotional with a decreased of motivation to do any physical or mental beyond that required for his job. Power naps during the day did return some energy but at the end of the day he has little left to do anything other than watch television. The diagnosis could be anything from depression, to low thyroid, so blood work was requested (14 vials to be exact) In addition, a blood spot test was completed – a relatively new way to measure to measure hormones like testosterone.
The preliminary results of the blood tests have returned. Iron metabolism (Ferritin, Hemoglobin, Serum Iron and Iron Saturation) were normal. Thyroid parameters were normal – although the Free T4 was at the lower end of the range. No thyroid antibodies and the ANA was negative (which reduces the possibility of autoimmunity). In other words, low thyroid and anemia were ruled out. The Fasting Blood Glucose was normal as was the HBA1c. His waist-to-hip ratio, however, is 1.0 (and should be less than 0.9) and a previous blood insulin reading was at the top of the range, so he may have some Insulin Resistance.
The most revealing parameters have to do with cholesterol, heart and hormones. Total Cholesterol was 5.32 (which is slightly above the upper range of normal). His total cholesterol had been around 5.4 for 20 years. Cholesterol usually is released by the liver when the body has a need to make more testosterone or when there is a low thyroid state (Both conditions are on the rise in aging males). When the cholesterol is high there is also a suspicion that plaque may be forming on the arteries. Of the blood parameters tested, the HDL was low (1.03 versus the optimal 1.5 or more) and the Apolipoprotein B was 1.13 (any value above 0.8 is associated with an increased risk of heart disease). The Total testosterone, although in the normal range was in the lower third and the Free Testosterone was so low that it was almost out of range. Testosterone in males is heart protective and anti-plaque as estrogen is in women.
From the first round of blood work, the working diagnosis is Low Testosterone – especially low Free Testosterone (some of the symptoms include fatigue, tiredness, depression and lack of motivation).
The first line of defense is to attempt to increase the testosterone naturally. In this case, moderate exercise – both interval training and strength training was prescribed which will increase the testosterone and the HDL and reduce the insulin resistance. To protect the heart by decreasing the Apo B and increasing the HDL, Niacin, Pantethine (B5), Resveratrol and Green Tea were also prescribed.
The answer to the question from the last blog is Homocysteine. Homocysteine is an indirect measure of methylation. “More than any other single test, homocysteine correctly identifies the risk of such conditions as heart attack, stroke, and dementia years before the onset of any symptoms.” (Dr. Hyman, M.D.)
In the next blog, we will track the progress of the patient, discuss the results of the blood spot analysis (if available) and investigate certain herbs that are reputed to raise testosterone naturally.