Grumpy Old Man Syndrome: The Fix for Low Testosterone

by Ralph Esposito, ND, LAc

Grumpy old man syndrome, hypogonadism, low T, Andropause are the same name for a condition many men recognize as low testosterone (T). Certainly, most middle aged-men seek that fountain of youth, but testosterone replacement therapy is not always the answer.

The symptoms of low testosterone

  • Fatigue
  • Low libido
  • Gynecomastia (Man boobs)
  • Weakened erections
  • Muscle weakness
  • Decreased morning erections
  • High body fat, Low lean muscle
  • Infertility

The ranges for male total testosterone levels are very broad, ranging from 280ng/dL to 1,100 ng/dL. As you can see this is a very broad range. The goal is precision and personalization, therefore you need to identify where does your body function best. This involves a very thorough intake, with tailored questions but also specialized testing such as free and total testosterone, SHBG, DHEA-S, estrogens, and thyroid hormones.

Beyond testosterone levels

As a naturopath, it is expected that my patients present with clinically complex cases. Oftentimes men will present with low testosterone levels (free, total) and have no Low T symptoms and then other men present with normal levels with all the symptoms. This is when we need to start digging deeper, looking at the testosterone and androgen receptors. Androgen receptors and testosterone receptors send the message to your cell to grow, build, get strong, improve blood flow, produce sperm. If your receptors are not working, then your cells won’t respond and you don’t get the benefits of the testosterone. It’s like calling a disconnected phone line, you keep putting in the call but there’s no one to answer. Genomic testing using Opus23 gives us great insight as to whether your receptors are functioning or not. It’s a very elegant approach.

The Cause: Brain, Thyroid, Adrenals and Testosterone

Men often can’t pinpoint an exact time when they started feeling the symptoms of low T, maybe 30 years old, some say 50. That is because testosterone levels slowly decline as men age, but this doesn’t necessarily mean it should? No. So why does it happen? The hypothalamus and pituitary glands in the brain send signals to the thyroid, adrenals and gonads to produce certain hormones, including thyroid hormone and testosterone. We call this the HPA and HPG axis. Prolonged stress, poor sleep, poor food selection, alcohol, and even some drugs can impact the way these axes function. Over time the testicles and adrenal glands stop responding to the hypothalamus and pituitary, which have been pumping out FSH and LH which signal for DHEA, testosterone and androgen production. Further, the thyroid gets worn out too and thyroid levels begin to drop. The oft under looked thyroid hormone is essential for proper cell function, as thyroid hormone signals the Leydig cells (these are your testosterone powerhouses) to begin producing testosterone.

Now, if your thyroid and adrenal glands are worn out, your ability to produce adequate testosterone levels is diminished. This leads to the grumpy old man symptoms. It’s all connected. Other factors to rule out are trauma, varicoceles, heavy metal toxicity and other pharmaceutical induced causes.

The Fix

As a men’s health expert, the solution is never just one thing, but a combination of several causes. Men’s health is more than understanding how the male body works, but also how the male mind thinks.

The arsenal we have in improving testosterone and androgens is plentiful, but a select few are very targeted in their effects.

1. Nettle Root (Urtica dioica radix) – Uritca root works on reducing SHBG. SHBG is a hormone that binds to testosterone and makes it unavailable for use, which then lowers your active free testosterone. Oftentimes men will have normal total testosterone but have high levels of SHBG, meaning the actual amount of testosterone their cells are seeing is minimal.

2. Fenugreek (Trigonella foenum-graecum) – Fenugreek has been used for centuries but its testosterone enhancing benefits have gained attention quite recently. Excellent research has shown Fenugreek to improve free and total testosterone levels, improve lean body mass, control blood sugar and improve sex drive in men. It is suspected by inhibiting two enzymes aromatase and 5-alpha-reductase. Aromatase converts T into estrogens, not something you want as a man and often the cause of gynecomastia. 5-alpha-reductase converts T into DHT, the unwanted toxic byproduct of T. With Fenugreek, we selectively inhibit these pathways from multiple aspects, improving T production.

3. Ashwagandha root (Withania somnifera) – This adaptogen is excellent for the over-worked, over-stressed, sleep deprived Andropause man. As an adaptogen, it does what it sounds like, it helps the body to adapt to stress. Even more so, several studies have shown Ashwagandha root to improve testosterone levels in men.

4. DHEA – Produced by the adrenal glands, DHEA, is a precursor to testosterone. This nutrient can have profound impacts on improving T levels in men. Furthermore, DHEA has been associated with longevity and does not have any of the side effects of taking testosterone. However, it’s important to have your levels tested by your physician before you begin supplementing. DHEA, however can be converted into testosterone, it can also increase estrogen levels in some men.

I can’t emphasize the importance of understanding your unique biochemical individuality. There is a no one-size fits all. With addressing low testosterone levels, it’s important to have your hormones check, but also to understand the way your genes, enzymes, and hormones are functioning, which can be assessed via Opus 23. This allows for the most personalized solution to the body’s internal workings.

Dr. Ralph Esposito specializes in integrative urology and men’s health. He has been published and is a peer reviewer in well-respected medical journals. Further, Dr. Esposito has authored several medical textbook chapters and has designed education modules for health professionals specifically on male and female urological conditions, prostate disorders, hormonal issues, andropause, fertility, exercise, men’s health and sexual health.