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It’s not just for men: The sex hormone testosterone plays a role in both men’s and women’s health by supporting metabolism, libido, and bone density. Dr. Jennifer Greer, ND, returns to the podcast to discuss the best ways to balance healthy testosterone levels at every age.
During this episode you’ll learn about:
Resources to topics mentioned in this episode:
Products related to this episode: Advanced Testosterone Support, Zinc, Men's Multi 50+, Hormone Advantage
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Subscribe to the show wherever you listen to podcasts so you never miss an episode. You can also learn more about the topics in the episode by checking out the latest news, videos, and stories on Thorne’s Take 5 Daily blog.
During this episode you’ll learn about:
Resources to topics mentioned in this episode:
Products related to this episode: Advanced Testosterone Support, Zinc, Men's Multi 50+, Hormone Advantage
Subscribe to More Content
Subscribe to the show wherever you listen to podcasts so you never miss an episode. You can also learn more about the topics in the episode by checking out the latest news, videos, and stories on Thorne’s Take 5 Daily blog.
Dr. Robert Rountree:
This is The Thorne Podcast, the show that navigates the complex world of wellness and explores the latest science behind diet, supplements and lifestyle approaches to good health. I'm Dr. Robert Rountree, Chief Medical Advisor at Thorne and functional medicine doctor. As a reminder, the recommendations made in this podcast are the recommendations of the individuals who express them and not the recommendations of Thorne. Statements in this podcast have not been evaluated by the Food and Drug Administration. Any products mentioned are not intended to diagnose, treat, cure, or prevent any disease.
Hi everyone, and welcome to The Thorne Podcast. Thanks for giving us a listen. I'm really looking forward to today's discussion. My guest this week is Dr. Jennifer Greer. She's a naturopathic doctor and she's director of medical education in Thorne's Department of Medical Affairs. Welcome back to the show, Jenny.
Dr. Jennifer Greer:
Thank you. Excited to be here today.
Dr. Robert Rountree:
Great. One thing I was curious about before we dive in is I'd love to hear a little bit more about what led you on your personal health journey. Why did you want to go into medicine and wellness? What was your original inspiration for that?
Dr. Jennifer Greer:
Well, if you want to go way back…
Dr. Robert Rountree:
Way back.
Dr. Jennifer Greer:
Way back, my original inspiration as a little girl, my mom, who is retired now, was a registered nurse, and her nursing school textbooks were on a shelf in my dad's office. And I would frequently get her nursing textbooks and look and read through them, even as a very little kid.
Dr. Robert Rountree:
Just for fun?
Dr. Jennifer Greer:
Just for fun. I was so interested in them, especially the one that was pediatrics nursing and my pediatrician when I was very young was a woman. Her name was Dr. Keithley, and she was amazing. And I would tell everyone, "I want to be Dr. Keithley when I grow up, I'm going to be a pediatrician." But that's not exactly as life goes, what you say you're going to be when you're 3 and what you end up doing with life is a little different. But in college, I started on that journey. I was a pre-med student and science major, but I started having some health challenges in college, particularly around chronic fatigue. I had had chronic migraines my whole life and I had some other challenges around IBS, and it turns out later on that I also have an autoimmune thyroid condition. So for me, that made college really hard just as far as I was exhausted all the time. I didn't feel great. I had trouble focusing, and I was on an academic scholarship that had very harsh standards to keep it.
Dr. Robert Rountree:
Oh, boy.
Dr. Jennifer Greer:
So I was also under a lot of stress, and that ended up leading me down a different path. I ended up studying exercise, physiology, kinesiology, and some of those other things. Went on to get a master's degree in higher education. I worked in higher ed and college athletics for several years, but in the back of my head, I always had this childhood dream, and I had this interest in health and wellness because of all of the health challenges that I had faced personally and the things I was just struggling with on a daily basis. I ended up starting a PhD program in nutrition, exercise, and wellness at Arizona State University actually. So I moved to Arizona and I started seeing a naturopathic physician as my personal doctor, and within three months of working with her, it changed my life completely.
Dr. Robert Rountree:
Bingo.
Dr. Jennifer Greer:
That did it. And I went from not feeling great most of the time to feeling great almost every single day in a way I had not since I was a teenager. So after I would say about six to eight months of working with her, I went in for a follow-up appointment one day and I said, "You know what? I think it's time for me to go to med school now." And she said, "I think it is, too."
Dr. Robert Rountree:
"You got it."
Dr. Jennifer Greer:
So I did. And that's basically how it happened.
Dr. Robert Rountree:
Wow. Well, I think the world is better off for your journey.
Dr. Jennifer Greer:
Well, thank you. It was an around the world journey, but I think that's life, right? You never know what's going to happen, and it's all valuable and all of those things I learned and experienced and did have brought me to where I am now. And I use everything every day at Thorne.
Dr. Robert Rountree:
Everything every day. Great. So let's get into the main topic for this week, which is testosterone. Now everybody's heard of testosterone, right? But we're going to break down exactly what it does, why maintaining a balance level is crucial and how it impacts everything from energy and mood to muscle mass and overall vitality. So we'll also talk about some of the natural ingredients and supplements, maybe diet, that can help support healthy testosterone levels. So we'll make it clear that it's not just a matter of you being low and you need that shot, right?
Dr. Jennifer Greer:
Right.
Dr. Robert Rountree:
We're going to look at the latest research in that regard, discuss what it would mean for health in the long run. Jenny, why don't you start us off by telling us what testosterone is exactly and what it does in the body.
Dr. Jennifer Greer:
Yeah. Oh, gosh. Testosterone is an amazing hormone. So testosterone is what we think of as one of the sex hormones. So we will put that in the category with testosterone, estrogen, and progesterone. And what we mean by that as calling them sex hormones is they are the main hormones that drive the factors that have to do with reproduction in the body. The thing that a lot of people I think maybe don't understand is that both men and women have and need all three of those hormones.
Dr. Robert Rountree:
Men and women?
Dr. Jennifer Greer:
Yes, men and women. So testosterone, while it's primarily thought of as a men's hormone, and it is very important for men's health and has many, many roles in men's health, it's important for women too. It just has a much smaller, a little bit more minor of a role than some of the other hormones for women. And so testosterone does incredible things in the body. One of the interesting things that a lot of people don't know about testosterone is you need testosterone in order for your body to produce red blood cells. And for someone who is low in testosterone, which could be an aging male, that actually could lead to an increased risk for something like anemia, because if you don't have enough testosterone, you can't stimulate that red blood cell production. And so it's really involved in a lot of things.
And then beyond that, testosterone plays a role in our muscle mass and how much muscle we have on our body. It plays a role in fat metabolism, how we break down fats and use them for energy. It plays a role in our bone density. So how healthy are our bones? It plays a role in libido, which is a huge one for a lot of people as well.
Dr. Robert Rountree:
Sex drive.
Dr. Jennifer Greer:
That's sex drive.
Dr. Robert Rountree:
Let's just be honest.
Dr. Jennifer Greer:
Yeah, absolutely. And low testosterone could mean “no sex drive,” and then too high of testosterone could as well. And so it's again, one of those things where happy medium is really important.
Dr. Robert Rountree:
So at what age should a person start thinking about testosterone and why do we even consider age as an issue? What happens with age and testosterone?
Dr. Jennifer Greer:
So as we age, our bodies become less efficient at producing hormones and they don't do it as well. There are a couple of factors that play into that. Of course, there's a feedback loop between our brain and our adrenal glands and our other organs that controls how much of these hormones that we produce. Also, as we age, our bodies change. And so the interplay between say testosterone and estrogen can be affected by our overall body composition. And also just the functionality of the body in producing hormones starts to decrease with age. And so testosterone-wise, a lot of men, I think it's great for men to have an idea, at least in their 30s, of a baseline of what their testosterone is looking like.
That can be a time where some men may start to show signs of low testosterone, which can happen, and that can definitely happen in your 30s. And so I think that's a good time to first start thinking about it. What does it look like? Am I in a healthy range for me at this age? That way as you're getting older, if you start to have symptoms of low testosterone, you want to compare back and know what it looks like. You at least know what your baseline was, and then you can compare better over time.
Dr. Robert Rountree:
So when you say “know what your baseline is,” are you suggesting that people do self-testing or are you saying that everyone should go to a doctor? Everyone should see an endocrinologist at 30? I mean, I'm being a little facetious here, but where's the spectrum there of how to find out about your testosterone?
Dr. Jennifer Greer:
Yeah. Well, I think that there are definitely some self-tests on the market that you can get some information that way. A lot of practitioners will run a testosterone as part of a general health panel, maybe one time in your 30s just to check in where you're at. But particularly if you're having some unexplained symptoms, things that might be related to low libido or fatigue, or maybe you're working out all the time, but you're not seeing improvements in your muscle strength, your sleep could be affected. Metabolism. Blood sugar is affected by testosterone. And so I think it's important to have an idea of what your level is at some point in your 30s, and maybe you just have to ask your doctor for it when you're in for your annual checkup at some point in those years, because if your testosterone is low and you don't have a good amount of adequate muscle mass on your body, your metabolism starts to get out of whack. That could lead to blood sugar dysregulation, insulin sensitivity issues, maybe even type 2 diabetes development in the future.
Dr. Robert Rountree:
If a person goes to see their doctor for a general checkup and they have this concern about their testosterone, you're saying they shouldn't hesitate to ask the doctor, "Can I get tested for this?" If they want a fancier test?
Dr. Jennifer Greer:
Yeah, absolutely. And they might find out from their doctor, "Hey, your insurance is not going to cover this test unless you have a specific diagnosis or certain symptoms." And in that case, there may be a cash-pay price that's affordable, or there might be another way like a home test for you to look at it.
Dr. Robert Rountree:
So don't be hesitant to bring it up to your doctor.
Dr. Jennifer Greer:
Exactly.
Dr. Robert Rountree:
If you have a concern about it.
Dr. Jennifer Greer:
Yeah, knowledge is power. And if you don't know what's going on with your body, then how can you make sure that you're aging optimally and healthfully?
Dr. Robert Rountree:
Isn't there some emerging data that's suggesting that maybe testosterone levels are declining overall in our society, maybe because of environmental toxins or maybe because of metabolic syndrome? Is that a real thing?
Dr. Jennifer Greer:
Yeah, absolutely. That is a real thing. There are certain chemicals that we are being exposed to more and more, whether it's from plastics, even fragrances in some products that are what, they're called endocrine disruptors, and some of them are called estrogen mimickers, right? And so what they essentially do is they make our bodies think that they are estrogen and they stimulate those estrogen processes, which then lowers the amount of testosterone that's available in the bloodstream. And that's one of the interplays between hormones is having too high of estrogen can lead to too low testosterone, and that can then lead to symptoms and difficulty.
Dr. Robert Rountree:
So testosterone is made into estrogen, right?
Dr. Jennifer Greer:
It is.
Dr. Robert Rountree:
There's an enzyme called aromatase that does that, and isn't aromatase affected by things like your metabolism or your inflammation, etc.?
Dr. Jennifer Greer:
Absolutely. And also aromatase is very active in fat cells, so that can become sort of a self-driving situation. As your testosterone goes lower, maybe your body composition starts to change, you experience more exposure to some environmental things, and then your body composition becomes a little bit more fat-dominant vs. muscle-dominant, and those fat cells are then having high aromatase activity, which can lead to conversion of testosterone into estrogen.
Dr. Robert Rountree:
And that explains the connection between metabolic syndrome, Type 2 diabetes and low testosterone?
Dr. Jennifer Greer:
Absolutely. Yep. Well, all of those interplay together. There's also some other things that happen with our hormones around insulin and growth factors and those sorts of things, but the androgens and the insulins are very interwoven with one another, how they affect our bodies, and how our metabolism works. And so that can lead to those types of metabolic dysfunction issues.
Dr. Robert Rountree:
The implication here is that if a person starts getting low testosterone, whether that's male or female, it's not a simple issue of saying your testosterone is low and now you need to get [a] shot, or now you need to cream or a gel or something like that. Is that what you're saying?
Dr. Jennifer Greer:
Yeah, exactly. For some people, that's going to be the answer. For some people, they just do need some more testosterone, but for other people it might be a little more complicated than that. And if there is that increased conversion of testosterone to estrogen happening, then some other things might need to be considered like cleaning up your environmental exposure. So do you have a lot of fragrance heavy things around your house and a lot of plastics and other types of things that are introducing those potential chemicals into your life? I think you also have to think about your diet too. So are you eating enough fiber? Fiber plays a big role in how our body eliminates things like excess hormone that's been metabolized by our liver, and then it has to go out of our body. Well, you need fiber for that. So there are a lot of little things that you can do lifestyle wise to help as well. And that might be part of the bigger picture for someone besides just going straight to testosterone replacement.
Dr. Robert Rountree:
I would think, especially in a younger person, let's say in their 40s, once they start on testosterone replacement, they're actually at risk of decreasing their fertility, right?
Dr. Jennifer Greer:
Yes. Absolutely.
Dr. Robert Rountree:
Isn't that a concern that if you do testosterone injections, then you stop making as much sperm. I think that's my understanding of that.
Dr. Jennifer Greer:
Absolutely. Yeah.
Dr. Robert Rountree:
So maybe in a younger person that still wants to have kids, then you would have reasons for looking for other ways to get your testosterone levels up.
Dr. Jennifer Greer:
Absolutely.
Dr. Robert Rountree:
Besides that. And another situation might be an athlete, a professional athlete in particular, they got to be really careful about taking hormones because suddenly you're disqualified from the Tour de France, right?
Dr. Jennifer Greer:
Right. And definitely you don't want that. So you do have to think about what are the other things that might be playing a role in testosterone being lower in my body, and how can I optimize those?
Dr. Robert Rountree:
Well, let's talk about some of those. You already mentioned diet, eating less sugar, less processed food, not being exposed to fragrances in the household or other chemicals, etc. But beyond that, are there specific things that are evidence-based that a person can take?
Dr. Jennifer Greer:
Diet-wise, of course, we talked about fiber, which plays a big role in balance of hormones, and I think also omega-3 fatty acids. So a lot of people in the U.S. especially don't eat much in the way of fatty fish, at least not very often. And our diets tend to be very heavy in omega-6 fatty acids in the U.S., which come from things like seeds and seed oils and nuts and other plants. And they're not inherently bad. We do need some omega-6 fats in our diet, but when the balance gets out of whack where you have predominantly omega-6 at a much higher level than omega-3, that can drive inflammation in the body, and as you were saying before, inflammation and testosterone have a tight relationship with one another.
And so if you're having very high inflammation levels in the body, that could be affecting your testosterone negatively as well. And so I think thinking about getting some healthy fatty fish in your diet, or maybe even an omega-3 supplement to your diet can be beneficial for some people.
There are other things too, like herbs. So a lot of times people will be interested in botanicals, and so there's a really interesting botanical that is called shilajit, and it comes from decomposed plant matter, which-
Dr. Robert Rountree:
Oh, really?
Dr. Jennifer Greer:
... sounds kind of gross when you think about that.
Dr. Robert Rountree:
Yeah, I've heard of that herb, but I didn't know that's what it was. It's an Ayurvedic herb, right?
Dr. Jennifer Greer:
It is. It's an Ayurvedic herb. It comes from the Himalayas. It's basically as plants decompose, they are fermented by different organisms in the soil, and this shilajit starts to seep out through the cracks of the rocks in the Himalayas, and it's really high in things like antioxidants that are called urolithins. It's high in another substance called humic acids, particularly one that's called fulvic acid, and it's also very, very high in minerals. So shilajit is about 20 to 40% mineral, but really low in heavy metals. So it's a really nice clean source of minerals in the body, and that's been studied for its benefits towards healthy testosterone levels. It helps to support healthy testosterone levels. It can help to support your cardiovascular system, particularly endothelial function for blood flow, helps to support your sexual health by supporting testosterone levels and can help to even maintain healthy sperm number and function. So it's a really interesting kind of botanical medicine because it's not the traditional herb that you think of. It's this kind of over time, it turns into this really deeply rich nutritive substance that helps your body.
Dr. Robert Rountree:
So it sounds like it actually is extracting a lot of beneficial nutrients from the soil.
Dr. Jennifer Greer:
Definitely.
Dr. Robert Rountree:
That fermentation decomposition process, which I think you're saying has been well studied.
Dr. Jennifer Greer:
It has, yes. Yeah, there are quite a few studies on shilajit, it's something that's been used as you mentioned in Ayurvedic medicine for years. So it's not a new substance. It's just maybe a little bit newer to people in the U.S. where they haven't heard of it before.
Dr. Robert Rountree:
And because it's been in Ayurvedic medicine for a long time, we know that it's safe.
Dr. Jennifer Greer:
Yes, exactly.
Dr. Robert Rountree:
That's a pretty good assumption.
Dr. Jennifer Greer:
Yeah. And again, as with anything, right, the safety is in the dose. So if you're taking an herbal substance of any type, you want to stay within the recommended dosing for that because those dosing recommendations come from what studies show and what historical use show are safe for that particular herb.
Dr. Robert Rountree:
And is this, I guess we don't really call it an herb. We call it a substance? What do you call it?
Dr. Jennifer Greer:
Yeah. I think that, I keep saying herb. You're right, it's not really an herb.
Dr. Robert Rountree:
It's a substance.
Dr. Jennifer Greer:
It's a substance that comes from plant matter. So in that way, I think it's a botanical, but it's not what you would think of as fresh dried herb or something like that.
Dr. Robert Rountree:
And is this something that women and men can do it, too, they shouldn't be concerned?
Dr. Jennifer Greer:
It is. I think a lot of the studies have been in men, but it can be beneficial to women as well. Again, you would want to think about the dose that you're using and is it appropriate for a woman vs. a man? Those are probably a little bit different within that, but yes, it's something that can benefit both.
Dr. Robert Rountree:
Both sexes. Any other herbs that are your favorites in this regard?
Dr. Jennifer Greer:
Yeah, I also really like ashwagandha, which another Ayurvedic herb.
Dr. Robert Rountree:
“Sweat of a horse” or something like that.
Dr. Jennifer Greer:
Something like that.
Dr. Robert Rountree:
It means something like that? Yeah.
Dr. Jennifer Greer:
Yep. Yeah, it's such a great herb. Withania somnifera is the Latin name for it. It's a beautiful herb that really helps to balance our body's stress response, but also helps to balance our sex hormones, too. There are a lot of different extracts of ashwagandha on the market, and so some of them have different amounts of the active constituent in them based on the way that they're produced. And so that's called withanolide glycosides. So that's kind of the active constituent that you would be looking for in ashwagandha. And a higher potency extract is one that is going to be in the range of around 35% of those withanolide glycosides. And that range of that plant has been steady. They use both the root and the leaf because that's where the withanolides are present, and that allows this more concentrated extract to be produced.
And in men, it's been shown to support healthy testosterone levels and help to maintain healthy DHEA-S levels. So DHEA is kind of a precursor hormone that your body produces. It's another androgen that can be converted into testosterone. Ashwagandha is also safe in women. And the interesting thing is when you look studies and you look at how it might affect testosterone, it does affect testosterone differently in men and women. So while it may help to support healthy levels in men who might need a little extra support, it doesn't quite do the same thing in women. It's not adding that extra push, so to speak, or adding that to their testosterone. So it is a safe herb for both men and women to take because it kind of acts a little bit differently. And that's why I think that it's important to think about herbs often as modulators vs. just drivers in one direction or the other.
Dr. Robert Rountree:
They're not stimulants. It's not a stimulant.
Dr. Jennifer Greer:
It's not a stimulant. Right, exactly. It helps your body do what it needs to do.
Dr. Robert Rountree:
I think the word is adaptogen.
Dr. Jennifer Greer:
Yes.
Dr. Robert Rountree:
Yeah, adapt. It's a great concept that Western medicine doesn't really quite understand, conventional Western medicine. Naturopathic medicine is all over it, but the idea that if something is low and adaptogen can help bring it back up to normal without stimulating it, but if something is high, maybe a little too much testosterone, it can actually regulate it.
Dr. Jennifer Greer:
Yeah, absolutely. That's great about an adaptogen, because they're all about balance and they're all about supporting your body into returning to its place of balance.
Dr. Robert Rountree:
And then are there any particular minerals that are helpful before we end this discussion? I have some ideas, but I'm curious about what you think.
Dr. Jennifer Greer:
Zinc is the first one that I think of particularly with supporting testosterone levels and men's health. So zinc has been studied actually quite a lot around men's health, and it's one that's often recommended to support sperm production and reproductive health in men because it does help to support overall healthy testosterone levels, but has some benefit for sperm production as well.
Dr. Robert Rountree:
And it's good for the prostate, too, right?
Dr. Jennifer Greer:
Yes, absolutely.
Dr. Robert Rountree:
Yeah. And it's good for leaky gut. I should throw in that concept as well.
Dr. Jennifer Greer:
Yes, yes. Zinc has a multitude of benefits for the body. I do also like to just talk about zinc as a, it's not a mineral that you want to go out and take as much as you can of it every single day, right? It's again, you have to be smart about what you're taking and stay within recommended dosing ranges. Zinc and copper are complementary-slash-opposing minerals in the body. And so if your zinc levels are too high, if you're taking in too much zinc, that could potentially lead to a copper deficiency and vice versa. So it's important to stay within recommended dosing for zinc just because you don't want to accidentally cause something else to be out of align.
Dr. Robert Rountree:
OK. What's a ballpark upper limit for zinc in case people are thinking, “Oh my gosh, am I in that range?” So where would you say you definitely don't want to exceed that amount?
Dr. Jennifer Greer:
Yeah. Well, there've been some actual studies around this, which are pretty interesting, where they looked at a combination of supplemental zinc and dietary zinc over time. And so when the combination of those two is – both your dietary and your supplemental zinc – is in that 40 to 60 milligram range per day, that for no more than 10 weeks, you're probably fine. If you're taking more than say 50 milligrams of zinc even supplementally, you have to think about what's in your diet, too. So over time, two, three months, six months, eight months, you've been taking it every day for three years now and you didn't even realize it. That could lead to a problem over time. I think people should stick if you're taking it supplementally, stick in the range of 15 to 30 milligrams a day, and that's what you're going to see most supplements set at.
Dr. Robert Rountree:
Yeah. OK. That's great advice. OK, well now we got to take a short break and when we get back, we'll take some specific questions from our audience.
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And we're back. So now it's time to answer some questions from the community. Our first question this week comes from a listener who asked, "I'm trying to have a child soon, and I heard testosterone can affect fertility. How does testosterone relate to sperm health? And is there anything I should be doing, I assume, to improve fertility or maybe to not make fertility worse?"
Dr. Jennifer Greer:
Yeah, that's a great question. So especially if it's someone who has low testosterone or they're experiencing low testosterone and they're concerned about how that's going to affect their fertility, when you give testosterone as a hormone replacement therapy, all of the research shows that actually leads to low sperm counts, which can cause even more problems with fertility. So there are other strategies that reproductive endocrinologists use for men around supporting sperm health and testosterone without giving testosterone directly. And so those are good considerations. I think that also anytime you're thinking about trying to have a child, thinking about how you can support your health in general, so are you eating a nutritious diet? Are you getting enough of the nutrients you need? Maybe we talk about women taking prenatal vitamins. We don't often talk about men taking prenatal vitamins, and they may have nutrient gaps in their diets that need to be supported. So a men's prenatal is not a crazy idea at all.
Dr. Robert Rountree:
Men's prenatal, I love it.
Dr. Jennifer Greer:
Yeah, I think it might not be called that, but-
Dr. Robert Rountree:
Yeah. But that's what you're thinking.
Dr. Jennifer Greer:
Yeah, you can think of it in that way. “How can I best support my health before I have a child?” And then thinking about other things that affect testosterone levels too. We spoke earlier about endocrine disruptors in the environment and certain things around your home. Stress management is another one. So if you've got a lot of stress in your life that might be causing your testosterone levels to be suboptimal, then thinking about how you can manage and balance that stress is going to be beneficial, too.
Dr. Robert Rountree:
I have to confess that I have checked my testosterone several times over the years and that there's been times when my level was really low, and lo and behold, it was during a very stressful period and instead of immediately thinking, “Well, I need to get some pellets or a shot,” I thought, well, what activities can I engage in that might bring this back up? And lo and behold, it did come back up. So once it's down, it doesn't always have to stay down.
Dr. Jennifer Greer:
Right, exactly. And sometimes it's just a matter of optimizing our lifestyle and balancing the things that are out of balance. And once you do that, testosterone can start coming back up on its own.
Dr. Robert Rountree:
Comes back on its own. That takes us to the next question. The person says, "I've heard a lot of talk about testosterone therapy, right? There's low T clinics everywhere these days. What's the difference between a supplement and actual testosterone therapy and when would you use one vs. the other?"
Dr. Jennifer Greer:
Oh, this is a fantastic question because they are two completely different things. When you are using testosterone therapy, you are being given actual testosterone, so your body's not having to do any extra work to produce it. And in fact, by giving you this testosterone from outside of your body, that can then lead to your body's own production of it being even lower. So you're thinking about testosterone therapy as “I am actually replacing this hormone with something else from outside of my body.” When you think about supplements, supplements are going to be substances we talked about earlier, like botanicals, minerals, things that are supporting your body's balance and its own production of testosterone. So they're a very different experience. One is hitting a tree with a sledgehammer, and the other one is kind of like a regular hammer. So it's two very-
Dr. Robert Rountree:
A tap. It's more of a tap.
Dr. Jennifer Greer:
... more a tap. So you're either coming in heavy and hard or you're coming in gentle. And that's kind of the difference between the two.
Dr. Robert Rountree:
I have to say that I have had more than one man come in who was in say his late 40s that said, "Hey, I'm not getting the muscle mass I need after I work out and can't you just give me some testosterone?" Because they saw an ad, they read an ad somewhere. And the one thing I tell them is once you start down that path, it's kind of hard to reverse it. And if you're 40 and you're thinking I'm going to start doing the injections or the pellets or something, you got to ask yourself, is this something I really want to do for a long term?
Dr. Jennifer Greer:
Yeah, absolutely. Because it is a commitment. Like we said, when you start taking that testosterone from somewhere else, your body's going to start to rely on that and it's going to need that outside source. So it's for a lot of people, it's worthwhile to try some other things first, some lifestyle changes and that sort of thing. There are going to be some people who the answer is that they need the testosterone replacement therapy, and sometimes that's because there is something else going on in their body that's limiting their ability to produce it, and so they absolutely need to replace it. But that's a great discussion to have with your doctor on that.
Dr. Robert Rountree:
And what I hear you saying again is that the supplements are not doing that. They're not having that effect. So the supplements don't have testosterone in them, and we will get to that in a minute, but a good supplement doesn't actually contain testosterone. It provides support for the body making the appropriate amount of testosterone. Did I say that right?
Dr. Jennifer Greer:
Yeah, absolutely. That is correct.
Dr. Robert Rountree:
That takes us to the next question. “What are the ingredients in testosterone supplements, and then are they natural compounds?” That's kind of a loaded question, right?
Dr. Jennifer Greer:
It is. It definitely is. Well, we talked earlier a little bit about shilajit and ashwagandha. There are some other herbs that you may see, things like Tribulus, an herb called pygeum that sometimes shows up. Fenugreek is another one. Some of the minerals like zinc. But the thing you have to be careful about with supplements is making sure that you are purchasing supplements from a reputable company who is doing regular testing. They use third-party certifications, they have all of their regulatory cGMP, it's all in order. Because there are a lot of supplements on the market that do cut corners. And I see articles all the time where products have been tested and they have testosterone in them or thyroid hormone in them.
Dr. Robert Rountree:
They have the real hormone?
Dr. Jennifer Greer:
Yeah, real hormone. And that can be dangerous if you don't know what you're getting. And so knowing what you're getting, making sure you understand that you're getting a high-quality product, that's one of the most important things you can do if you're going to use supplements.
Dr. Robert Rountree:
Beware of ads that make strong claims.
Dr. Jennifer Greer:
Yes.
Dr. Robert Rountree:
"If you take this supplement, you'll have amazing increases in your libido and your muscle mass and your stamina and all kinds of things." I think those are all red flags.
Dr. Jennifer Greer:
Agreed. Yeah, agreed.
Dr. Robert Rountree:
In fact, I would say probably the categories of dietary supplements out there that most frequently reported as being, can we say, “contaminated” or maybe intentionally added things that shouldn't be in there are weight loss and testosterone formula. So those are the two areas that I'd say people should be the most concerned about. And that's the area where you really want to go with a company that's proven to be legitimate.
Dr. Jennifer Greer:
Absolutely. It's incredibly important. And I think having those two categories in mind when you're looking for supplements, because honestly those are two of the top categories that people are looking for supplements for. And so you really need to be thinking about, “Who is this company? What are they doing?” Check their website, see what they're putting out there, look to see if there are any articles available, what they're testing is, and what you can find out about what they're doing.
Dr. Robert Rountree:
The next question is, "I've recently heard that average testosterone levels in men are dropping over time." We talked about that. "What is causing this, if we do know? And is there anything I can do to prevent that from happening in me, a decline in my own levels?"
Dr. Jennifer Greer:
Super great question. And we talked about this a little bit before, and it's a complex subject. We only know so much about what's causing this right now. There's some strong indications that there are environmental factors at play in this. We talked about endocrine disrupting chemicals, estrogen mimickers, those things can be contributing. We also just live a busier, more stressful lifestyle. People are not as physically active these days as they used to be. And people in general take a lot more medications for a variety of illnesses, and those can play a role in hormonal health as well. So I think there's a lot of factors to consider about what might be leading to dropping levels of testosterone in men and that it's a pretty complex thing.
Dr. Robert Rountree:
If a person is having a drop in their testosterone level, then they probably need a pretty good workup is what you're saying, that you don't just say it's low and we're going to replace that.
Dr. Jennifer Greer:
Right.
Dr. Robert Rountree:
You're saying a whole lifestyle evaluation, metabolic evaluation, physical exam.
Dr. Jennifer Greer:
Yes.
Dr. Robert Rountree:
All those things.
Dr. Jennifer Greer:
Absolutely. And part of that even is if you're going to start someone on testosterone, you do need to make sure that their body is in the space to be healthy, to give them testosterone because it could lead to problems down the road if they're not healthy. Not everyone is a candidate for hormone replacement therapy, both men and women. And so that's a consideration as well. And while I think it's great that there are home tests on the market and you can get an idea of what your testosterone level is, working with your health-care practitioner who can evaluate everything about your health history. Maybe you had a parent who had a similar change in their testosterone levels around the same age, which could indicate that there might be something deeper going on within your endocrine system. Maybe you just have a really stressful lifestyle or I mentioned medications before. Having someone who can work through all of those parts and help you to figure out where you can optimize your health and whether or not testosterone is a good fit for you is really important.
Dr. Robert Rountree:
This next question kind of follows that the person says, "I'm in my 50s, and I felt like I'm slowing down. How much of this is because of testosterone? And are there safe ways... " Safe ways, this is interesting. The person says, "Are there safe ways to support healthy levels at my age?" So we've kind of touched on this maybe as a final question, you could sort of summarize what the general practices a person should engage in to do that.
Dr. Jennifer Greer:
Yeah, absolutely. So the first thing I would say is testosterone could be one factor. It is not the only factor. Of course, as we age, all of our metabolic processes do become less efficient for a variety of reasons. Thyroid function starts to decline with age. Our production of all of our hormones declines with age. We start to lose muscle mass as we age. And again, we're experiencing different things in life as we age. So we are less recreation time, more time to be stressed out. And so there are a lot of factors that play into that feeling of slowing down as you age. And it's really important, again, to work with your health-care practitioner if you're feeling that way, so that all of those things can be assessed because it might not be testosterone at all. You could have a perfectly healthy testosterone level, but maybe your thyroid function is suboptimal or maybe there's something else going on that needs to be further evaluated.
But even within that, there are things that you can do safely to help support healthy testosterone levels. One of those we talked about is stress management. And a great stress management tool for a lot of people is exercise. And exercise is also going to support muscle mass. And then again, muscle mass and testosterone are hand in hand. So that's one thing you can do, making sure that you are eating a nutritious diet. So I think that the word healthy around diet can be a little bit charged for some people. I like nutritious diet.
Dr. Robert Rountree:
Yeah, yeah, nutritious diet.
Dr. Jennifer Greer:
Yeah. What you're looking for is all of those nutrients that your body needs, everything that you get from food, both the macronutrients, so that's your protein, your fats, your carbohydrates, and the micronutrients, which are vitamins, minerals, antioxidants, all of those little things. Those are the building blocks that your body then uses to make hormones, to make and repair tissues for everything to work correctly, you need nutrition. And so thinking about your diet from a perspective of nutritious fuel for a healthy lifestyle, that can be really beneficial too.
Dr. Robert Rountree:
Your body will slow down with age. It is inevitable.
Dr. Jennifer Greer:
Absolutely.
Dr. Robert Rountree:
It will happen for everyone, but there are things you can do about it that don't have to be super aggressive, like you said, exercise and eating a more nutritious diet. So I think those are really good concepts to end on. And then if you've done all those things and it's not quite enough and perhaps you've measured your testosterone levels and you find that they're dropping, then maybe the first step is not necessarily to go to a hormone replacement, that there are a lot of other things out there that are evidence-based that you can use.
Dr. Jennifer Greer:
Absolutely, absolutely. And you can also have further discussions with your doctor and figure out if there is something else going on, making sure you're targeting that too.
Dr. Robert Rountree:
Wonderful. All right, folks, that's all the time we have this week. Be sure to leave a comment and subscribe the show. If you do, we'd really appreciate that. Thanks for listening, and thank you Dr. Greer for podcasting with me again.
Dr. Jennifer Greer:
Thank you so much. It was great to be here.
Dr. Robert Rountree:
Thanks for listening to The Thorne Podcast. Make sure to never miss an episode by subscribing to the show on your podcast app of choice. If you've got a health or wellness question you'd like answered, simply follow our Instagram and shoot a message to @ThorneHealth. You can also learn more about the topics we discussed by visiting thorne.com and checking out the latest news videos and stories on Thorne's Take 5 Daily blog. Once again, thanks for tuning in and don't forget to join us next time for another episode of The Thorne Podcast.
Dr. Robert Rountree:
This is The Thorne Podcast, the show that navigates the complex world of wellness and explores the latest science behind diet, supplements and lifestyle approaches to good health. I'm Dr. Robert Rountree, Chief Medical Advisor at Thorne and functional medicine doctor. As a reminder, the recommendations made in this podcast are the recommendations of the individuals who express them and not the recommendations of Thorne. Statements in this podcast have not been evaluated by the Food and Drug Administration. Any products mentioned are not intended to diagnose, treat, cure, or prevent any disease.
Hi everyone, and welcome to The Thorne Podcast. Thanks for giving us a listen. I'm really looking forward to today's discussion. My guest this week is Dr. Jennifer Greer. She's a naturopathic doctor and she's director of medical education in Thorne's Department of Medical Affairs. Welcome back to the show, Jenny.
Dr. Jennifer Greer:
Thank you. Excited to be here today.
Dr. Robert Rountree:
Great. One thing I was curious about before we dive in is I'd love to hear a little bit more about what led you on your personal health journey. Why did you want to go into medicine and wellness? What was your original inspiration for that?
Dr. Jennifer Greer:
Well, if you want to go way back…
Dr. Robert Rountree:
Way back.
Dr. Jennifer Greer:
Way back, my original inspiration as a little girl, my mom, who is retired now, was a registered nurse, and her nursing school textbooks were on a shelf in my dad's office. And I would frequently get her nursing textbooks and look and read through them, even as a very little kid.
Dr. Robert Rountree:
Just for fun?
Dr. Jennifer Greer:
Just for fun. I was so interested in them, especially the one that was pediatrics nursing and my pediatrician when I was very young was a woman. Her name was Dr. Keithley, and she was amazing. And I would tell everyone, "I want to be Dr. Keithley when I grow up, I'm going to be a pediatrician." But that's not exactly as life goes, what you say you're going to be when you're 3 and what you end up doing with life is a little different. But in college, I started on that journey. I was a pre-med student and science major, but I started having some health challenges in college, particularly around chronic fatigue. I had had chronic migraines my whole life and I had some other challenges around IBS, and it turns out later on that I also have an autoimmune thyroid condition. So for me, that made college really hard just as far as I was exhausted all the time. I didn't feel great. I had trouble focusing, and I was on an academic scholarship that had very harsh standards to keep it.
Dr. Robert Rountree:
Oh, boy.
Dr. Jennifer Greer:
So I was also under a lot of stress, and that ended up leading me down a different path. I ended up studying exercise, physiology, kinesiology, and some of those other things. Went on to get a master's degree in higher education. I worked in higher ed and college athletics for several years, but in the back of my head, I always had this childhood dream, and I had this interest in health and wellness because of all of the health challenges that I had faced personally and the things I was just struggling with on a daily basis. I ended up starting a PhD program in nutrition, exercise, and wellness at Arizona State University actually. So I moved to Arizona and I started seeing a naturopathic physician as my personal doctor, and within three months of working with her, it changed my life completely.
Dr. Robert Rountree:
Bingo.
Dr. Jennifer Greer:
That did it. And I went from not feeling great most of the time to feeling great almost every single day in a way I had not since I was a teenager. So after I would say about six to eight months of working with her, I went in for a follow-up appointment one day and I said, "You know what? I think it's time for me to go to med school now." And she said, "I think it is, too."
Dr. Robert Rountree:
"You got it."
Dr. Jennifer Greer:
So I did. And that's basically how it happened.
Dr. Robert Rountree:
Wow. Well, I think the world is better off for your journey.
Dr. Jennifer Greer:
Well, thank you. It was an around the world journey, but I think that's life, right? You never know what's going to happen, and it's all valuable and all of those things I learned and experienced and did have brought me to where I am now. And I use everything every day at Thorne.
Dr. Robert Rountree:
Everything every day. Great. So let's get into the main topic for this week, which is testosterone. Now everybody's heard of testosterone, right? But we're going to break down exactly what it does, why maintaining a balance level is crucial and how it impacts everything from energy and mood to muscle mass and overall vitality. So we'll also talk about some of the natural ingredients and supplements, maybe diet, that can help support healthy testosterone levels. So we'll make it clear that it's not just a matter of you being low and you need that shot, right?
Dr. Jennifer Greer:
Right.
Dr. Robert Rountree:
We're going to look at the latest research in that regard, discuss what it would mean for health in the long run. Jenny, why don't you start us off by telling us what testosterone is exactly and what it does in the body.
Dr. Jennifer Greer:
Yeah. Oh, gosh. Testosterone is an amazing hormone. So testosterone is what we think of as one of the sex hormones. So we will put that in the category with testosterone, estrogen, and progesterone. And what we mean by that as calling them sex hormones is they are the main hormones that drive the factors that have to do with reproduction in the body. The thing that a lot of people I think maybe don't understand is that both men and women have and need all three of those hormones.
Dr. Robert Rountree:
Men and women?
Dr. Jennifer Greer:
Yes, men and women. So testosterone, while it's primarily thought of as a men's hormone, and it is very important for men's health and has many, many roles in men's health, it's important for women too. It just has a much smaller, a little bit more minor of a role than some of the other hormones for women. And so testosterone does incredible things in the body. One of the interesting things that a lot of people don't know about testosterone is you need testosterone in order for your body to produce red blood cells. And for someone who is low in testosterone, which could be an aging male, that actually could lead to an increased risk for something like anemia, because if you don't have enough testosterone, you can't stimulate that red blood cell production. And so it's really involved in a lot of things.
And then beyond that, testosterone plays a role in our muscle mass and how much muscle we have on our body. It plays a role in fat metabolism, how we break down fats and use them for energy. It plays a role in our bone density. So how healthy are our bones? It plays a role in libido, which is a huge one for a lot of people as well.
Dr. Robert Rountree:
Sex drive.
Dr. Jennifer Greer:
That's sex drive.
Dr. Robert Rountree:
Let's just be honest.
Dr. Jennifer Greer:
Yeah, absolutely. And low testosterone could mean “no sex drive,” and then too high of testosterone could as well. And so it's again, one of those things where happy medium is really important.
Dr. Robert Rountree:
So at what age should a person start thinking about testosterone and why do we even consider age as an issue? What happens with age and testosterone?
Dr. Jennifer Greer:
So as we age, our bodies become less efficient at producing hormones and they don't do it as well. There are a couple of factors that play into that. Of course, there's a feedback loop between our brain and our adrenal glands and our other organs that controls how much of these hormones that we produce. Also, as we age, our bodies change. And so the interplay between say testosterone and estrogen can be affected by our overall body composition. And also just the functionality of the body in producing hormones starts to decrease with age. And so testosterone-wise, a lot of men, I think it's great for men to have an idea, at least in their 30s, of a baseline of what their testosterone is looking like.
That can be a time where some men may start to show signs of low testosterone, which can happen, and that can definitely happen in your 30s. And so I think that's a good time to first start thinking about it. What does it look like? Am I in a healthy range for me at this age? That way as you're getting older, if you start to have symptoms of low testosterone, you want to compare back and know what it looks like. You at least know what your baseline was, and then you can compare better over time.
Dr. Robert Rountree:
So when you say “know what your baseline is,” are you suggesting that people do self-testing or are you saying that everyone should go to a doctor? Everyone should see an endocrinologist at 30? I mean, I'm being a little facetious here, but where's the spectrum there of how to find out about your testosterone?
Dr. Jennifer Greer:
Yeah. Well, I think that there are definitely some self-tests on the market that you can get some information that way. A lot of practitioners will run a testosterone as part of a general health panel, maybe one time in your 30s just to check in where you're at. But particularly if you're having some unexplained symptoms, things that might be related to low libido or fatigue, or maybe you're working out all the time, but you're not seeing improvements in your muscle strength, your sleep could be affected. Metabolism. Blood sugar is affected by testosterone. And so I think it's important to have an idea of what your level is at some point in your 30s, and maybe you just have to ask your doctor for it when you're in for your annual checkup at some point in those years, because if your testosterone is low and you don't have a good amount of adequate muscle mass on your body, your metabolism starts to get out of whack. That could lead to blood sugar dysregulation, insulin sensitivity issues, maybe even type 2 diabetes development in the future.
Dr. Robert Rountree:
If a person goes to see their doctor for a general checkup and they have this concern about their testosterone, you're saying they shouldn't hesitate to ask the doctor, "Can I get tested for this?" If they want a fancier test?
Dr. Jennifer Greer:
Yeah, absolutely. And they might find out from their doctor, "Hey, your insurance is not going to cover this test unless you have a specific diagnosis or certain symptoms." And in that case, there may be a cash-pay price that's affordable, or there might be another way like a home test for you to look at it.
Dr. Robert Rountree:
So don't be hesitant to bring it up to your doctor.
Dr. Jennifer Greer:
Exactly.
Dr. Robert Rountree:
If you have a concern about it.
Dr. Jennifer Greer:
Yeah, knowledge is power. And if you don't know what's going on with your body, then how can you make sure that you're aging optimally and healthfully?
Dr. Robert Rountree:
Isn't there some emerging data that's suggesting that maybe testosterone levels are declining overall in our society, maybe because of environmental toxins or maybe because of metabolic syndrome? Is that a real thing?
Dr. Jennifer Greer:
Yeah, absolutely. That is a real thing. There are certain chemicals that we are being exposed to more and more, whether it's from plastics, even fragrances in some products that are what, they're called endocrine disruptors, and some of them are called estrogen mimickers, right? And so what they essentially do is they make our bodies think that they are estrogen and they stimulate those estrogen processes, which then lowers the amount of testosterone that's available in the bloodstream. And that's one of the interplays between hormones is having too high of estrogen can lead to too low testosterone, and that can then lead to symptoms and difficulty.
Dr. Robert Rountree:
So testosterone is made into estrogen, right?
Dr. Jennifer Greer:
It is.
Dr. Robert Rountree:
There's an enzyme called aromatase that does that, and isn't aromatase affected by things like your metabolism or your inflammation, etc.?
Dr. Jennifer Greer:
Absolutely. And also aromatase is very active in fat cells, so that can become sort of a self-driving situation. As your testosterone goes lower, maybe your body composition starts to change, you experience more exposure to some environmental things, and then your body composition becomes a little bit more fat-dominant vs. muscle-dominant, and those fat cells are then having high aromatase activity, which can lead to conversion of testosterone into estrogen.
Dr. Robert Rountree:
And that explains the connection between metabolic syndrome, Type 2 diabetes and low testosterone?
Dr. Jennifer Greer:
Absolutely. Yep. Well, all of those interplay together. There's also some other things that happen with our hormones around insulin and growth factors and those sorts of things, but the androgens and the insulins are very interwoven with one another, how they affect our bodies, and how our metabolism works. And so that can lead to those types of metabolic dysfunction issues.
Dr. Robert Rountree:
The implication here is that if a person starts getting low testosterone, whether that's male or female, it's not a simple issue of saying your testosterone is low and now you need to get [a] shot, or now you need to cream or a gel or something like that. Is that what you're saying?
Dr. Jennifer Greer:
Yeah, exactly. For some people, that's going to be the answer. For some people, they just do need some more testosterone, but for other people it might be a little more complicated than that. And if there is that increased conversion of testosterone to estrogen happening, then some other things might need to be considered like cleaning up your environmental exposure. So do you have a lot of fragrance heavy things around your house and a lot of plastics and other types of things that are introducing those potential chemicals into your life? I think you also have to think about your diet too. So are you eating enough fiber? Fiber plays a big role in how our body eliminates things like excess hormone that's been metabolized by our liver, and then it has to go out of our body. Well, you need fiber for that. So there are a lot of little things that you can do lifestyle wise to help as well. And that might be part of the bigger picture for someone besides just going straight to testosterone replacement.
Dr. Robert Rountree:
I would think, especially in a younger person, let's say in their 40s, once they start on testosterone replacement, they're actually at risk of decreasing their fertility, right?
Dr. Jennifer Greer:
Yes. Absolutely.
Dr. Robert Rountree:
Isn't that a concern that if you do testosterone injections, then you stop making as much sperm. I think that's my understanding of that.
Dr. Jennifer Greer:
Absolutely. Yeah.
Dr. Robert Rountree:
So maybe in a younger person that still wants to have kids, then you would have reasons for looking for other ways to get your testosterone levels up.
Dr. Jennifer Greer:
Absolutely.
Dr. Robert Rountree:
Besides that. And another situation might be an athlete, a professional athlete in particular, they got to be really careful about taking hormones because suddenly you're disqualified from the Tour de France, right?
Dr. Jennifer Greer:
Right. And definitely you don't want that. So you do have to think about what are the other things that might be playing a role in testosterone being lower in my body, and how can I optimize those?
Dr. Robert Rountree:
Well, let's talk about some of those. You already mentioned diet, eating less sugar, less processed food, not being exposed to fragrances in the household or other chemicals, etc. But beyond that, are there specific things that are evidence-based that a person can take?
Dr. Jennifer Greer:
Diet-wise, of course, we talked about fiber, which plays a big role in balance of hormones, and I think also omega-3 fatty acids. So a lot of people in the U.S. especially don't eat much in the way of fatty fish, at least not very often. And our diets tend to be very heavy in omega-6 fatty acids in the U.S., which come from things like seeds and seed oils and nuts and other plants. And they're not inherently bad. We do need some omega-6 fats in our diet, but when the balance gets out of whack where you have predominantly omega-6 at a much higher level than omega-3, that can drive inflammation in the body, and as you were saying before, inflammation and testosterone have a tight relationship with one another.
And so if you're having very high inflammation levels in the body, that could be affecting your testosterone negatively as well. And so I think thinking about getting some healthy fatty fish in your diet, or maybe even an omega-3 supplement to your diet can be beneficial for some people.
There are other things too, like herbs. So a lot of times people will be interested in botanicals, and so there's a really interesting botanical that is called shilajit, and it comes from decomposed plant matter, which-
Dr. Robert Rountree:
Oh, really?
Dr. Jennifer Greer:
... sounds kind of gross when you think about that.
Dr. Robert Rountree:
Yeah, I've heard of that herb, but I didn't know that's what it was. It's an Ayurvedic herb, right?
Dr. Jennifer Greer:
It is. It's an Ayurvedic herb. It comes from the Himalayas. It's basically as plants decompose, they are fermented by different organisms in the soil, and this shilajit starts to seep out through the cracks of the rocks in the Himalayas, and it's really high in things like antioxidants that are called urolithins. It's high in another substance called humic acids, particularly one that's called fulvic acid, and it's also very, very high in minerals. So shilajit is about 20 to 40% mineral, but really low in heavy metals. So it's a really nice clean source of minerals in the body, and that's been studied for its benefits towards healthy testosterone levels. It helps to support healthy testosterone levels. It can help to support your cardiovascular system, particularly endothelial function for blood flow, helps to support your sexual health by supporting testosterone levels and can help to even maintain healthy sperm number and function. So it's a really interesting kind of botanical medicine because it's not the traditional herb that you think of. It's this kind of over time, it turns into this really deeply rich nutritive substance that helps your body.
Dr. Robert Rountree:
So it sounds like it actually is extracting a lot of beneficial nutrients from the soil.
Dr. Jennifer Greer:
Definitely.
Dr. Robert Rountree:
That fermentation decomposition process, which I think you're saying has been well studied.
Dr. Jennifer Greer:
It has, yes. Yeah, there are quite a few studies on shilajit, it's something that's been used as you mentioned in Ayurvedic medicine for years. So it's not a new substance. It's just maybe a little bit newer to people in the U.S. where they haven't heard of it before.
Dr. Robert Rountree:
And because it's been in Ayurvedic medicine for a long time, we know that it's safe.
Dr. Jennifer Greer:
Yes, exactly.
Dr. Robert Rountree:
That's a pretty good assumption.
Dr. Jennifer Greer:
Yeah. And again, as with anything, right, the safety is in the dose. So if you're taking an herbal substance of any type, you want to stay within the recommended dosing for that because those dosing recommendations come from what studies show and what historical use show are safe for that particular herb.
Dr. Robert Rountree:
And is this, I guess we don't really call it an herb. We call it a substance? What do you call it?
Dr. Jennifer Greer:
Yeah. I think that, I keep saying herb. You're right, it's not really an herb.
Dr. Robert Rountree:
It's a substance.
Dr. Jennifer Greer:
It's a substance that comes from plant matter. So in that way, I think it's a botanical, but it's not what you would think of as fresh dried herb or something like that.
Dr. Robert Rountree:
And is this something that women and men can do it, too, they shouldn't be concerned?
Dr. Jennifer Greer:
It is. I think a lot of the studies have been in men, but it can be beneficial to women as well. Again, you would want to think about the dose that you're using and is it appropriate for a woman vs. a man? Those are probably a little bit different within that, but yes, it's something that can benefit both.
Dr. Robert Rountree:
Both sexes. Any other herbs that are your favorites in this regard?
Dr. Jennifer Greer:
Yeah, I also really like ashwagandha, which another Ayurvedic herb.
Dr. Robert Rountree:
“Sweat of a horse” or something like that.
Dr. Jennifer Greer:
Something like that.
Dr. Robert Rountree:
It means something like that? Yeah.
Dr. Jennifer Greer:
Yep. Yeah, it's such a great herb. Withania somnifera is the Latin name for it. It's a beautiful herb that really helps to balance our body's stress response, but also helps to balance our sex hormones, too. There are a lot of different extracts of ashwagandha on the market, and so some of them have different amounts of the active constituent in them based on the way that they're produced. And so that's called withanolide glycosides. So that's kind of the active constituent that you would be looking for in ashwagandha. And a higher potency extract is one that is going to be in the range of around 35% of those withanolide glycosides. And that range of that plant has been steady. They use both the root and the leaf because that's where the withanolides are present, and that allows this more concentrated extract to be produced.
And in men, it's been shown to support healthy testosterone levels and help to maintain healthy DHEA-S levels. So DHEA is kind of a precursor hormone that your body produces. It's another androgen that can be converted into testosterone. Ashwagandha is also safe in women. And the interesting thing is when you look studies and you look at how it might affect testosterone, it does affect testosterone differently in men and women. So while it may help to support healthy levels in men who might need a little extra support, it doesn't quite do the same thing in women. It's not adding that extra push, so to speak, or adding that to their testosterone. So it is a safe herb for both men and women to take because it kind of acts a little bit differently. And that's why I think that it's important to think about herbs often as modulators vs. just drivers in one direction or the other.
Dr. Robert Rountree:
They're not stimulants. It's not a stimulant.
Dr. Jennifer Greer:
It's not a stimulant. Right, exactly. It helps your body do what it needs to do.
Dr. Robert Rountree:
I think the word is adaptogen.
Dr. Jennifer Greer:
Yes.
Dr. Robert Rountree:
Yeah, adapt. It's a great concept that Western medicine doesn't really quite understand, conventional Western medicine. Naturopathic medicine is all over it, but the idea that if something is low and adaptogen can help bring it back up to normal without stimulating it, but if something is high, maybe a little too much testosterone, it can actually regulate it.
Dr. Jennifer Greer:
Yeah, absolutely. That's great about an adaptogen, because they're all about balance and they're all about supporting your body into returning to its place of balance.
Dr. Robert Rountree:
And then are there any particular minerals that are helpful before we end this discussion? I have some ideas, but I'm curious about what you think.
Dr. Jennifer Greer:
Zinc is the first one that I think of particularly with supporting testosterone levels and men's health. So zinc has been studied actually quite a lot around men's health, and it's one that's often recommended to support sperm production and reproductive health in men because it does help to support overall healthy testosterone levels, but has some benefit for sperm production as well.
Dr. Robert Rountree:
And it's good for the prostate, too, right?
Dr. Jennifer Greer:
Yes, absolutely.
Dr. Robert Rountree:
Yeah. And it's good for leaky gut. I should throw in that concept as well.
Dr. Jennifer Greer:
Yes, yes. Zinc has a multitude of benefits for the body. I do also like to just talk about zinc as a, it's not a mineral that you want to go out and take as much as you can of it every single day, right? It's again, you have to be smart about what you're taking and stay within recommended dosing ranges. Zinc and copper are complementary-slash-opposing minerals in the body. And so if your zinc levels are too high, if you're taking in too much zinc, that could potentially lead to a copper deficiency and vice versa. So it's important to stay within recommended dosing for zinc just because you don't want to accidentally cause something else to be out of align.
Dr. Robert Rountree:
OK. What's a ballpark upper limit for zinc in case people are thinking, “Oh my gosh, am I in that range?” So where would you say you definitely don't want to exceed that amount?
Dr. Jennifer Greer:
Yeah. Well, there've been some actual studies around this, which are pretty interesting, where they looked at a combination of supplemental zinc and dietary zinc over time. And so when the combination of those two is – both your dietary and your supplemental zinc – is in that 40 to 60 milligram range per day, that for no more than 10 weeks, you're probably fine. If you're taking more than say 50 milligrams of zinc even supplementally, you have to think about what's in your diet, too. So over time, two, three months, six months, eight months, you've been taking it every day for three years now and you didn't even realize it. That could lead to a problem over time. I think people should stick if you're taking it supplementally, stick in the range of 15 to 30 milligrams a day, and that's what you're going to see most supplements set at.
Dr. Robert Rountree:
Yeah. OK. That's great advice. OK, well now we got to take a short break and when we get back, we'll take some specific questions from our audience.
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And we're back. So now it's time to answer some questions from the community. Our first question this week comes from a listener who asked, "I'm trying to have a child soon, and I heard testosterone can affect fertility. How does testosterone relate to sperm health? And is there anything I should be doing, I assume, to improve fertility or maybe to not make fertility worse?"
Dr. Jennifer Greer:
Yeah, that's a great question. So especially if it's someone who has low testosterone or they're experiencing low testosterone and they're concerned about how that's going to affect their fertility, when you give testosterone as a hormone replacement therapy, all of the research shows that actually leads to low sperm counts, which can cause even more problems with fertility. So there are other strategies that reproductive endocrinologists use for men around supporting sperm health and testosterone without giving testosterone directly. And so those are good considerations. I think that also anytime you're thinking about trying to have a child, thinking about how you can support your health in general, so are you eating a nutritious diet? Are you getting enough of the nutrients you need? Maybe we talk about women taking prenatal vitamins. We don't often talk about men taking prenatal vitamins, and they may have nutrient gaps in their diets that need to be supported. So a men's prenatal is not a crazy idea at all.
Dr. Robert Rountree:
Men's prenatal, I love it.
Dr. Jennifer Greer:
Yeah, I think it might not be called that, but-
Dr. Robert Rountree:
Yeah. But that's what you're thinking.
Dr. Jennifer Greer:
Yeah, you can think of it in that way. “How can I best support my health before I have a child?” And then thinking about other things that affect testosterone levels too. We spoke earlier about endocrine disruptors in the environment and certain things around your home. Stress management is another one. So if you've got a lot of stress in your life that might be causing your testosterone levels to be suboptimal, then thinking about how you can manage and balance that stress is going to be beneficial, too.
Dr. Robert Rountree:
I have to confess that I have checked my testosterone several times over the years and that there's been times when my level was really low, and lo and behold, it was during a very stressful period and instead of immediately thinking, “Well, I need to get some pellets or a shot,” I thought, well, what activities can I engage in that might bring this back up? And lo and behold, it did come back up. So once it's down, it doesn't always have to stay down.
Dr. Jennifer Greer:
Right, exactly. And sometimes it's just a matter of optimizing our lifestyle and balancing the things that are out of balance. And once you do that, testosterone can start coming back up on its own.
Dr. Robert Rountree:
Comes back on its own. That takes us to the next question. The person says, "I've heard a lot of talk about testosterone therapy, right? There's low T clinics everywhere these days. What's the difference between a supplement and actual testosterone therapy and when would you use one vs. the other?"
Dr. Jennifer Greer:
Oh, this is a fantastic question because they are two completely different things. When you are using testosterone therapy, you are being given actual testosterone, so your body's not having to do any extra work to produce it. And in fact, by giving you this testosterone from outside of your body, that can then lead to your body's own production of it being even lower. So you're thinking about testosterone therapy as “I am actually replacing this hormone with something else from outside of my body.” When you think about supplements, supplements are going to be substances we talked about earlier, like botanicals, minerals, things that are supporting your body's balance and its own production of testosterone. So they're a very different experience. One is hitting a tree with a sledgehammer, and the other one is kind of like a regular hammer. So it's two very-
Dr. Robert Rountree:
A tap. It's more of a tap.
Dr. Jennifer Greer:
... more a tap. So you're either coming in heavy and hard or you're coming in gentle. And that's kind of the difference between the two.
Dr. Robert Rountree:
I have to say that I have had more than one man come in who was in say his late 40s that said, "Hey, I'm not getting the muscle mass I need after I work out and can't you just give me some testosterone?" Because they saw an ad, they read an ad somewhere. And the one thing I tell them is once you start down that path, it's kind of hard to reverse it. And if you're 40 and you're thinking I'm going to start doing the injections or the pellets or something, you got to ask yourself, is this something I really want to do for a long term?
Dr. Jennifer Greer:
Yeah, absolutely. Because it is a commitment. Like we said, when you start taking that testosterone from somewhere else, your body's going to start to rely on that and it's going to need that outside source. So it's for a lot of people, it's worthwhile to try some other things first, some lifestyle changes and that sort of thing. There are going to be some people who the answer is that they need the testosterone replacement therapy, and sometimes that's because there is something else going on in their body that's limiting their ability to produce it, and so they absolutely need to replace it. But that's a great discussion to have with your doctor on that.
Dr. Robert Rountree:
And what I hear you saying again is that the supplements are not doing that. They're not having that effect. So the supplements don't have testosterone in them, and we will get to that in a minute, but a good supplement doesn't actually contain testosterone. It provides support for the body making the appropriate amount of testosterone. Did I say that right?
Dr. Jennifer Greer:
Yeah, absolutely. That is correct.
Dr. Robert Rountree:
That takes us to the next question. “What are the ingredients in testosterone supplements, and then are they natural compounds?” That's kind of a loaded question, right?
Dr. Jennifer Greer:
It is. It definitely is. Well, we talked earlier a little bit about shilajit and ashwagandha. There are some other herbs that you may see, things like Tribulus, an herb called pygeum that sometimes shows up. Fenugreek is another one. Some of the minerals like zinc. But the thing you have to be careful about with supplements is making sure that you are purchasing supplements from a reputable company who is doing regular testing. They use third-party certifications, they have all of their regulatory cGMP, it's all in order. Because there are a lot of supplements on the market that do cut corners. And I see articles all the time where products have been tested and they have testosterone in them or thyroid hormone in them.
Dr. Robert Rountree:
They have the real hormone?
Dr. Jennifer Greer:
Yeah, real hormone. And that can be dangerous if you don't know what you're getting. And so knowing what you're getting, making sure you understand that you're getting a high-quality product, that's one of the most important things you can do if you're going to use supplements.
Dr. Robert Rountree:
Beware of ads that make strong claims.
Dr. Jennifer Greer:
Yes.
Dr. Robert Rountree:
"If you take this supplement, you'll have amazing increases in your libido and your muscle mass and your stamina and all kinds of things." I think those are all red flags.
Dr. Jennifer Greer:
Agreed. Yeah, agreed.
Dr. Robert Rountree:
In fact, I would say probably the categories of dietary supplements out there that most frequently reported as being, can we say, “contaminated” or maybe intentionally added things that shouldn't be in there are weight loss and testosterone formula. So those are the two areas that I'd say people should be the most concerned about. And that's the area where you really want to go with a company that's proven to be legitimate.
Dr. Jennifer Greer:
Absolutely. It's incredibly important. And I think having those two categories in mind when you're looking for supplements, because honestly those are two of the top categories that people are looking for supplements for. And so you really need to be thinking about, “Who is this company? What are they doing?” Check their website, see what they're putting out there, look to see if there are any articles available, what they're testing is, and what you can find out about what they're doing.
Dr. Robert Rountree:
The next question is, "I've recently heard that average testosterone levels in men are dropping over time." We talked about that. "What is causing this, if we do know? And is there anything I can do to prevent that from happening in me, a decline in my own levels?"
Dr. Jennifer Greer:
Super great question. And we talked about this a little bit before, and it's a complex subject. We only know so much about what's causing this right now. There's some strong indications that there are environmental factors at play in this. We talked about endocrine disrupting chemicals, estrogen mimickers, those things can be contributing. We also just live a busier, more stressful lifestyle. People are not as physically active these days as they used to be. And people in general take a lot more medications for a variety of illnesses, and those can play a role in hormonal health as well. So I think there's a lot of factors to consider about what might be leading to dropping levels of testosterone in men and that it's a pretty complex thing.
Dr. Robert Rountree:
If a person is having a drop in their testosterone level, then they probably need a pretty good workup is what you're saying, that you don't just say it's low and we're going to replace that.
Dr. Jennifer Greer:
Right.
Dr. Robert Rountree:
You're saying a whole lifestyle evaluation, metabolic evaluation, physical exam.
Dr. Jennifer Greer:
Yes.
Dr. Robert Rountree:
All those things.
Dr. Jennifer Greer:
Absolutely. And part of that even is if you're going to start someone on testosterone, you do need to make sure that their body is in the space to be healthy, to give them testosterone because it could lead to problems down the road if they're not healthy. Not everyone is a candidate for hormone replacement therapy, both men and women. And so that's a consideration as well. And while I think it's great that there are home tests on the market and you can get an idea of what your testosterone level is, working with your health-care practitioner who can evaluate everything about your health history. Maybe you had a parent who had a similar change in their testosterone levels around the same age, which could indicate that there might be something deeper going on within your endocrine system. Maybe you just have a really stressful lifestyle or I mentioned medications before. Having someone who can work through all of those parts and help you to figure out where you can optimize your health and whether or not testosterone is a good fit for you is really important.
Dr. Robert Rountree:
This next question kind of follows that the person says, "I'm in my 50s, and I felt like I'm slowing down. How much of this is because of testosterone? And are there safe ways... " Safe ways, this is interesting. The person says, "Are there safe ways to support healthy levels at my age?" So we've kind of touched on this maybe as a final question, you could sort of summarize what the general practices a person should engage in to do that.
Dr. Jennifer Greer:
Yeah, absolutely. So the first thing I would say is testosterone could be one factor. It is not the only factor. Of course, as we age, all of our metabolic processes do become less efficient for a variety of reasons. Thyroid function starts to decline with age. Our production of all of our hormones declines with age. We start to lose muscle mass as we age. And again, we're experiencing different things in life as we age. So we are less recreation time, more time to be stressed out. And so there are a lot of factors that play into that feeling of slowing down as you age. And it's really important, again, to work with your health-care practitioner if you're feeling that way, so that all of those things can be assessed because it might not be testosterone at all. You could have a perfectly healthy testosterone level, but maybe your thyroid function is suboptimal or maybe there's something else going on that needs to be further evaluated.
But even within that, there are things that you can do safely to help support healthy testosterone levels. One of those we talked about is stress management. And a great stress management tool for a lot of people is exercise. And exercise is also going to support muscle mass. And then again, muscle mass and testosterone are hand in hand. So that's one thing you can do, making sure that you are eating a nutritious diet. So I think that the word healthy around diet can be a little bit charged for some people. I like nutritious diet.
Dr. Robert Rountree:
Yeah, yeah, nutritious diet.
Dr. Jennifer Greer:
Yeah. What you're looking for is all of those nutrients that your body needs, everything that you get from food, both the macronutrients, so that's your protein, your fats, your carbohydrates, and the micronutrients, which are vitamins, minerals, antioxidants, all of those little things. Those are the building blocks that your body then uses to make hormones, to make and repair tissues for everything to work correctly, you need nutrition. And so thinking about your diet from a perspective of nutritious fuel for a healthy lifestyle, that can be really beneficial too.
Dr. Robert Rountree:
Your body will slow down with age. It is inevitable.
Dr. Jennifer Greer:
Absolutely.
Dr. Robert Rountree:
It will happen for everyone, but there are things you can do about it that don't have to be super aggressive, like you said, exercise and eating a more nutritious diet. So I think those are really good concepts to end on. And then if you've done all those things and it's not quite enough and perhaps you've measured your testosterone levels and you find that they're dropping, then maybe the first step is not necessarily to go to a hormone replacement, that there are a lot of other things out there that are evidence-based that you can use.
Dr. Jennifer Greer:
Absolutely, absolutely. And you can also have further discussions with your doctor and figure out if there is something else going on, making sure you're targeting that too.
Dr. Robert Rountree:
Wonderful. All right, folks, that's all the time we have this week. Be sure to leave a comment and subscribe the show. If you do, we'd really appreciate that. Thanks for listening, and thank you Dr. Greer for podcasting with me again.
Dr. Jennifer Greer:
Thank you so much. It was great to be here.
Dr. Robert Rountree:
Thanks for listening to The Thorne Podcast. Make sure to never miss an episode by subscribing to the show on your podcast app of choice. If you've got a health or wellness question you'd like answered, simply follow our Instagram and shoot a message to @ThorneHealth. You can also learn more about the topics we discussed by visiting thorne.com and checking out the latest news videos and stories on Thorne's Take 5 Daily blog. Once again, thanks for tuning in and don't forget to join us next time for another episode of The Thorne Podcast.
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