Low Testosterone in Women: Why Your Total Testosterone Number Is Misleading

All right, guys. Well, thank you for all who joined us live. We're about to transition into the next segment. Um, if you are watching a recording of this and you want to become a patient, you can apply by going to medmatrixusa.com and clicking get started. And yeah, let's move on into the next segment, which is hormone deficiencies. So, why are hormone and first with the new segment just got to say it. Um, nothing you hear today is medical advice. It's really just education that's all. Um, so let's get into it. All right. So, um, Dr. Rose, for the people who are just joining us, for the people who are watching the recording, um, can you tell us a little bit about kind of your experience in hormone imbalances and, uh, hormones in general? Yeah, I mean, I it's it's just a huge part for all of us. um kind of really no matter what what sex, what stage of life, um I think we usually start to have that conversation with both women and men kind of, you know, once they're in their 30s, uh 40s, and definitely 50s. And so, um hormones in general is just part of it's just part of it should be part of the conversation really with almost any visit. um you know we we you hear about pmenopause in menopause and then in men there's kind of andropause when testosterone starts to drop. So um there's a lot I think in the media and social uh media right now about hormonal health um it can be tricky because these hormones are in the blood and again they affect everything. They can affect they can affect your mood. They can affect your sleep. They can affect um your libido. They can affect even your physical strength. And so it can be hard to say, well, is it is it my hormones? I don't know. You know, it's not it's not always so clear-cut. So that's kind of where we we dive deep and try to kind of sus that out for each individual. Gotcha. All right. So let's just kind of like for people who aren't aware, how do hormones play a role in the way we feel in our aging and our strength just everything because hormones pretty much regulate and control the way we feel, right? Yeah. So you know we do talk about that triangle um where there's when we sometimes when we say hormones we I think by default we are talking about the sex hormones. So the hormones like um estrogen, progesterone and testosterone which are secreted by the ovaries and the testes. But other I mean insulin is a hormone, right? There's a lot of other hormones. Um the ones that we usually talk about being kind of intimately connected would be the adrenal hormones. So people have heard of cortisol. Um another adrenal hormone is DHEA. And then there's thyroid. And so these are all really intimately related and impact each other. So yes, it um hormones, hormonal fluctuations, hormonal imbalance, those are going to affect everything. Mood, just how you feel for sure. Okay, gotcha. So um when do people normally start experiencing hormone deficiencies? Like average person, right? Yeah. So um what we find with I'll just use pmenopause as an example is that um par so perry menopause is going to be kind of when your sex hormones start to fluctuate right so normally before pmenopause in a woman who's cycling every month there's like a certain rhythm I won't go into the like really nerdy details but basically there's like you know there's certain hormones that have like FSH has a spike at a certain time and progesterone, we don't really have any the first two weeks, but we do have progesterone the second two weeks of the cycle. And it's ideally it's very regular. And then starting even as early as age 35, um those can start to fluctuate and it's not necessarily a deficiency at that point. It's just more of a kind of un erratic, I guess. And it's diff it can be different for every woman. Um but it can just be it can be a drop. It can be like a deficiency. There's not quite as much progesterone being um produced, not quite as much estrogen. But again, if for even for 10 15 years, there's just kind of this up and down. Every month might be a little bit different. Um, what's tricky is we obviously do really like to test for hormones, but clinically we're not necessarily going to see a deficiency in that pmenopausal window. We're not going to necessarily see that a woman's ovaries are not putting out enough progesterone or estrogen because it's just a snapshot. And it's the it's the fluctuations that are the issue, not necessarily like the overall amount of hormone that's the problem. It's really not until a woman is menopausal, post-menopausal, which is technically you do not have a cycle for 12 months is when you're technically in menopause. Um that she's kind of really not making any anymore. And that is obvious on blood work like that. I can I can look at the blood work without meeting the woman and I can just know I don't even need to know her age. I can just look at the the numbers and I can tell she's menopausal because there's just not much there. Um so that's a huge range that some women are going to start experiencing that at age 35 and other women I mean I have some patients who don't you know really start to feel anything. Their cycles don't change until they're like 54. It's like a 20 year span, right? Um, so and then yeah, and then men, I mean, testosterone, there's different reasons for kind of a drop in testosterone. There's, you know, age related testosterone usually drop is really usually we see that starting mid4s, I would say, is when at least on the blood work when you start to see it. There's plenty of men that have kind of suboptimal levels of testosterone earlier, but when it's like age related, I would say mid-4s. Okay. Gotcha. Do you feel like balancing, let's talk about sex hormones specifically. Do you feel like balancing sex hormones is the greatest lever you can pull against anti-aging? Well, there's a question. Um, yeah, it might be. If I had to pick one lever, yeah, I mean, it's it's it can be such a shock to the system to have those fluctuations, to have those drops um that um and it can be such a safe therapeutic tool when done right and when kind of tailored to that individual's needs that it um I mean, you've heard me say this, like you know, people's lives are changed Not everybody, but a number people are just they're not sleeping. They have brain fog. They're irritable. So, right there, that's going to affect every aspect of life, right? That's going to affect family life, work life, energy, your intimate relationship with your partner, your relationship with yourself. Um, and then there's like weight gain that goes along with it. And so pretty soon it's like you just you know as people say like I just don't feel like myself and um and it's confusing because it just feels like it came out of nowhere. So um yes I think when you can kind of like and all of those things are going to age you essentially right chronic sleep deprivation right there that's going to age you. Um, so I think when done right, yeah, I think it is probably one of the strongest tools in longevity medicine. Okay, gotcha. So when some I mean we hear all the time people go to their normal doctors and they're told they patients go to the doctor and they say, "Hey, I want to test my sex hormones." And then they're told, "Oh, we don't do that." or oh it it doesn't matter or blood testing for sex hormones is relevant. What is your kind of take on that? So I think it's this is still current like the American Association of Gynecologists their general recommendation is like they don't it's not part of standard of care to test hormone levels. Um and we do it for a couple of reasons. One is to get a baseline. Um and the other and yeah to get a baseline and to you know because we get really specific on estradile which is the strongest form of estrogen. There's like a whole pan there's a whole number of biioarkers um around testosterone not just total testosterone and progesterone and you know it's a very complete list. So we get really like at first glance we get like a really comprehensive baseline picture. So good to have for anybody and then if we do start um some kind of bio identical hormone plan we can it can help us monitor moving forward. Now, most important where I guess I do agree with kind of that more conventional medicine model of we don't of not testing somebody's symptoms and their response to the hormone replacement therapy. That's more important to me than chasing lab values. I like both. I find that putting them together is like the most valuable. But I do agree that um you know if somebody um I guess I'll just use progesterone as an example. If somebody tells me that you know now that they're taking their oral progesterone before bed, they're suddenly not suddenly they're now not um waking up between 2 a.m. every morning like they used to. And they feel better when they wake up and they feel better throughout the day. But their progesterone levels, you know, on blood work, their progesterone just went up a little bit. Like it changed, but it wasn't like drastic. That's great. I don't need to pump them. I don't need to give them a much higher dose of progesterone. They've already they're already responding really well. So, that's kind of how I use the blood work. I do think it's really helpful. Um, and I also don't really understand the mentality of like I don't see why not like if if somebody goes to their physician and they ask for it, you know, it's basically dictated by the insurance like unless there's like a reason why the insurance for the insurance to cover that testing, it's not going to be ordered. But being free of that those restrictions, like why not? If somebody's curious and you know how to interpret them, I don't see what the harm is. What about let's talk about the gut connection and hormones? I mean, all the time in kind of like social media, especially around health, you hear, "Oh, gut health, right? Gut health is so important." But how like how is gut health connected to your sex hormones? Yeah. So, this I find really fascinating. There's something called um the estrobolome. It's not the estrobiome, it's the estrabolome. And this is like a subsection of the microbiome. So it's it's gut microbes which are responsible for basically um what we say um uh conjugating or kind of metabolizing breaking down estrogen. So ideally estrogen like again ovaries produce estrogen circulates through the whole you know all the estrogen receptors the body kind of gets what it needs and then the liver and that gut microbiome kind of bind that estrogen up and then you eliminate you poop out the rest. You don't need it. If somebody's estrobolome or that part of the gut microbiome is out of balance, then it that doesn't happen. That process doesn't happen and the estrogen gets recirculated a second time, a third time, it kind of stays in the system longer than it should and therefore estrogen locks into estrogen receptors more often than it should. And so you start to get it's like more exposure than what is optimal, right? More estrogen exposure. So then potentially a woman is going to have what we call estrogen dominant symptoms. And that can be um for a woman who's cycling um PMS and that can either be like emotional signs and symptoms of emot the emotional premenstrual syndrome or it could be physical. It could be really uh tender breasts. It could be really bad cramping. It could be really heavy periods. Um and so it's that again that's like you would not think that that was like a gut issue, right? But it essentially it is interesting. You that's so interesting. So how do you fix that? Just curious like what's your when that's happening what's your approach to fix that? Um, so there's certain supplements that you, well, I again, you know me, I like to test. So I like to test to see what's going on at that gut level. And there's certain um kind of biomarkers like something called betaglucaronidase is one enzyme that we can test for which can kind of tell us how what's happening with that estrogen metabolism. Um, and there's certain supplements that we can take. Um, actually kind of bumping up one's fiber intake. um whether that's dietary um like through your food, even taking an insoluble fiber, that's going to help. Um and uh for some women, while you're doing that, while you're kind of like optimizing that part of the gut microbiome, um bumping up progesterone, which estrogen and progesterone kind of balance each other out. So sometimes taking um oral progesterone especially during that second two weeks the uh um second two weeks of the cycle then the ludial phase that can really alleviate symptoms. So you're yes you have to figure out the estrogen metabolism piece but um you can also kind of just feel better and find more balance when you're optimizing progesterone at the same time. Okay. So let's keep going with this subject. How do um microtoxins or like things like mold and other toxins, you know, things like arsenic um play a role in affecting your sex hormones? Well, those are going to affect the liver and the liver is kind of detoxification pathways. And so if those are compromised and there's it's kind of um you're not processing anything optimally whether it's micotoxin that you've you know mold spores that you've been exposed to heavy metals that you've been exposed to through your occupation or other sources. Um then that's already compromised. it's going to be make it that much harder to kind of metabolize um conjugate estrogen as well. Okay, gotcha. So, can you uh break that down for people who might not know what that means? So, the I mean, we all kind of know in general that the liver is like a really important organ. Um and it's important for a lot of reasons, but one big reason is that it's our primary detoxification um organ. So everything that we put into our bodies um food, medications, supplements, uh and then unintentional things maybe like miccotoxins or heavy metals that all has to go through the liver. And so the liver has to kind of process um process all of those, break that down again, get it into the digestive tract so that it can be eliminated. if the liver is has a level of inflammation, if it's kind of um overt taxed, right? So, there's a lot of medications, there's a lot of alcohol use, there's um uh even even sometimes like a little fatty liver is going to partially impair detoxification. It's like that load. If that toxic load is just kind of gets higher and higher, things aren't going to process effectively as efficiently. Now, I do have to make a point that genetically we have differences too. Some people are like fast processors and some people are slow processors. So, it's why some people handle alcohol differently than other people. why people some people have a certain response to caffeine, you know, like they can they feel caffeine much more strongly than somebody else. A lot of that is just genetic. It's just it's not that you're doing anything right or wrong. It's just kind of how you were designed. Um but you have to but you factor all of that in and that's going to affect that's partially going to impact also how you metabolize the sex hormones. Okay. Okay. So, if you're someone who's more affected, it's kind of off topic, but So, if you're someone uh who's more affected by caffeine, like you're more sensitive to coffee, you're probably a slow, you're slow because it stays in your system longer. Okay. So, are you more prone or less prone to um you know, being more affected by alcohol or are they not connected? Uh you're probably probably more you'll be more sensitive more affected. Okay, gotcha. So, if you're more sensitive to coffee, then you'd be more sensitive to usually. Yeah. Well, I think I think so. Yeah. Yeah. Okay. Because you because it stays in your you're you're not as efficient of a detoxer. Exactly. Yep. Okay. Cool. All right. Fun little fact for everyone. Um All right. So, let's talk about this saying that everyone knows stress kills. Like how does like scientifically how does stress actually kill you? Um I think in relation to like you know talking about cortisol um yeah tell me more. So people um people think of cortisol as like a stress as the stress hormone. Um so it is produced in the adrenal glands and it is produced um well I'll just back up a little bit. Um the normal what we call dal rhythm of cortisol um like in a healthy individual is that your cortisol has a spike in the morning when you wake up um and then it kind of drops between 8:00 a.m. and noon and then it continues to drop between noon and midnight. So in an ideal world your cortisol is really at its lowest while you're sleeping which should be at night and at its highest in the morning. Um, and what happens is usually early in life, uh, I'll say this, the this has impacts, trauma, stress has impacts for any age, but if somebody is living in a home or living with a level of trauma where they just don't feel safe like for years and years, that cortisol is not going to drop, right? So they're going to be in this like excuse me like hypervigilant state most of the time and that over time the adrenals they can't put that out anymore. Right? So that's kind of like this person's default is to have elevated cortisol all the time. They're in fight orflight mode. They're like, you know, they're not coming down. After decades of this, the adrenals aren't able to really continue to put uh put that have that same output. And so you start to get dysregulation where they're not getting that morning spike anymore. And it's high at night, but it's low in the morning and it's kind of all over. And then the third stage of what we call like adrenal fatigue is no, there's really not much cortisol at all. The adrenals are kind of shot. It's like an empty gas tank. So, and that's um I mean that level of fatigue is pretty significant and there's you know you're really just not able to I mean really really low cortisol you're like barely barely functioning. So I guess that would be kind of your definition of um stress kills, but it's it's a chronic thing and it um it's it's just running on empty is one way to put it. Did that answer the question? It did. Yeah. And I just wanted to thank everyone who's live with us right now. If you have any questions, we're kind of coming to an end on the hormone deficiency segment. So, feel free to drop some comments. And if um you are interested in becoming a patient, you can apply at medmatrixusa.com. So, kind of bringing us into the final stretch here. What is um what is sex hormone binding globulin? Globulin. Yeah. Why is it important? Um because I think this is one that's pretty overlooked. Yeah, it definitely is. Yeah. So, it's one it is it's a part of our standard panel that I really appreciate that we have. Um so, again, usually if you go to a provider and you and they test your testosterone, this is male men or women, although usually it's men who are asking, um they're going to get you're going to get a total testosterone level. Sex hormone binding globulin is a protein. It's globbulin. Um, it's a type of globulin, which is a type of protein. And the way that I talk about it is that it's floating around in the blood. All of this is in the blood. Remember, all the hormones are in the bloods. Um, so you've got this protein and then you've got your testosterone molecules and they're all floating around together. A glob when a globulin molecule connects to a testosterone molecule, it renders it inactive. That testosterone molecule can no longer lock into a receptor. it and cannot kind of do its job. So a high level of sex hormone binding globbulin is going to basically detract from total testosterone. So we also include um tests like free testosterone and bioavailable testosterone which take that into account. So those are actually more telling than the total um because it it's kind of the calculation after taking the sex hormone binding globulin number into account. So here's an example. somebody a man has a level of um uh 400 450 um on his total testosterone and you're like you know in conventional medicine you're like you're fine but his sex hormone binding globulin is over a 100 now we really for we really want that number to be between for men I think we want it to be between like 20 and 40 um for sex hormone binding so say that for whatever reason uh there's different theories of why that might be elevated, but say his sex hormone binloabulin is really high. Really essentially the the the bioavailable testosterone, what his body can actually tap into is not even close to 400 or 450. It's probably closer to 200 or something. So, this is a guy who's probably pretty tired, um, low libido, low motivation, you know, maybe goes to the gym, but really has a hard time seeing results. like the skeletal muscle mass development is not what he wants. Um, so that's just an example of where how sex hormone binding globbulin plays a role. And if you're just testing total testosterone, you're really not going to have that full picture. H okay, gotcha. So pretty important to know, right? And I think on the So what about Yeah. And then what about like bioavailable testosterone too? Well, that's Yeah. So, so what we see is we get a re we get all of that. We get total testosterone, we get sex hormone binding globbulin, we get free testosterone, and then we get bioavailable. And so, um, yes, I'm looking at total, but I'm, you know, more interested probably in the free and the bioavailable because again, that's what the that's what his body can actually utilize. Okay, gotcha. Um, let's talk about two more kind of more specific hormones. Let's talk about um DHEA. What is DHEA and why is it also very important in just well-being? Yeah. So, people kind of in the longevity medicine space talk about DHEA. Um it is also made by the adrenal glands. It's kind of like there's a whole there's all these pathways, right, with sex hormone kind of how you you end up with the final metabolites of sex hormones. DHEA is like one step along the way. I think of it sometimes as a precursor hormone. So, it's made by the adrenal glands and then it gets converted um to both testosterone and then estrogen. Um so, if you're starting your raw ingredient, your DHEA is low, it's going to be harder for you to have optimal levels of estrogen and testosterone. It can be one reason why potentially you're you're suboptimal with those hormones because that that starting raw ingredient isn't um as optimal or as high as we'd like it. Um DHEA does decrease. It's supposed to decrease with each decade of life. So a younger person inherently is going to have a higher level than an older person. Um what so the goal for most of us as we get older is to maintain you know a certain level of DHEA and um we we specifically measure kind of a a metabolite of DHEA. It's DHEA sulfate or DHEAS. Um that one's just like easier to measure in the blood. So um coming back to stress, you know, again, this is made in the adrenal glands. Chronic stress is usually kind of the the culprit, I would say, if somebody has suboptimal levels of DHEA. It's not that they had, you know, a stressful week the week before they did the blood draw. This is like chronic stress, right? like a history of trauma, history of um you know a a really bad relation, long-term bad relationship, other whatever other um types of stress and trauma the person has dealt with have taken a toll on the adrenal glands and this just not making that raw ingredient of DHEA anymore. So in addition to you know the kind of more well-known types of hormone replacement therapy um sometimes we will prescribe DHEA um to kind of support the adrenals help with that raw ingredient and then um test monitor to see if that's getting you know if that's helping to boost things like serum levels of testosterone and estrogen. Okay. All right. So, um, why not just take a DHA supplement, um, as you get older? You don't know what your level is. You might not be low. It's not, if it's not low, you don't need to supplement. Um, and um, you can't, you know, it's just good to have that baseline before you then just randomly start supplement. There's also different dosages, right? Like sometimes we just start with 5 milligrams and then we build up to 25. Um but unless we kind of know what the level is, what your what your goals are, it's like hard to tweak that. Um there's also some providers that um you know, you can get DHEA in kind of over-the-counter supplement form or you can get that compounded through a compounding pharmacy. And there are some providers um and I have seen this with some people that the person actually feels better like you actually just get better results when you when it's compounded through a pharmacy. Um that's more of kind of like a clinical anecdote that I've seen a couple times and in conferences I have heard other providers say that. So again, that's going to need kind of uh professional expertise in figuring out the right dose and getting that prescription done correctly. Gotcha. Okay. And then last specific hormone we're going to talk about is prolactin. What is prolactin? And um I think that's ref referred to as your like motivation hormone, right? Can't Yeah. Tell me. Um talk more about that. I don't think of it like that. Um, I'm I'm it's I mean I'm usually looking at it kind of um as part of the overall like reproductive sex hormone picture. Um we it's definitely plays a role kind of when a woman's lactating. um it's made by the anterior pituitary. And one reason why we test for it is that if it's really high, we need to rule out a pituitary tumor. Um benign or malignant, but um pituitary tumors are not not exceptionally rare, like they do happen. Um, and so pro like testing prolactin is kind of one easy way to just make sure that there's not any kind of tumor. Um, but it can also if the prolactin levels are off or if the pituitary is kind of not functioning as well, you may see like a woman might have um irregular menes. She might have um she actually I have had I have had a couple patients over the years. I had a woman who you know did not had not just had a child was not breastfeeding and she started lactating. Um and that it was and then down you know after kind of all the workup there was a pituitary tumor. Um so irregular higher than desired levels of prolactin can um be detected when somebody is dealing with infertility again menstrual irregularities um and low libido all of that can kind of play a role. So maybe it's the maybe it's kind of when you what did you what did you say that you that you'd heard about it? Yeah, I I was talking to another provider, but we uh Okay, I'll have to get back on that. Okay, so let's do one more question here. Um let's see. Let's pick a good one. We got a lot of them that we didn't get through. We'll have to do another episode. Uh let let's talk a little let's just do one little bit on um hormone replacement therapy because I know it's something we do a lot here at Med Matrix. like what's the difference between um bio identical hormone replacement therapy, something that we do a lot of, versus kind of like the synthetic hormone replacement therapy that most women would get by, you know, they go to their OB or um just what you would normally experience. So um the quick answer to that is that bioididentical hormone replacement is um they are molecularly identical to our own hormones. Um whereas synthetic are molecularly similar but not identical. Um and so for example like conjugated ecoin estrogen was the hormone which is synthetic was done was the hormone that was used in the kind of famous now famous women's health initiative which is what caused like the medical community to tell you know to tell everybody to go off of HRT in 2002 just like overnight. So bioididentical um hormones are generally considered safer because they kind of mimic more much more closely mimic our own hormones. Um the hormones that are in uh birth control are um synthetic. Um the hormones that we prescribe um are bio identical. So that includes like oral progesterone. We almost exclusively use transermal estrogen which means like a cream or a patch and that is also bioididentical. Um, so it's really an issue of safety and that most people prefer to put more natural substances in or on their bodies than synthetic. Um uh I will say this like if you go and you get an estradiol patch anywhere that is bio identical like it's not excl like you can you know a gynecologist can or a primary care can prescribe an estradile patch and that is bio identical. They're just not all they're first of all a lot of them are refusing to do it and it's a skill in knowing how to prescribe it and knowing how and when and what level because there's varying differences in dosage and concentration etc. Um so it's like a whole we call it like menopause medicine and it's a whole it's a whole another level of training. Um, so it's not that like, you know, you can't get it elsewhere. It's just that it's not most people aren't really well trained in it and or aren't really willing to to do it. All right, good answer. Good explanation. Thank you. So, all right, guys. That will do it for today's uh segment on vitamin deficiencies and hormone deficiencies. We talked a ton about both men and women there. Um, so yeah, if you're listening, you're live now with us and you're not yet a patient, you want to become a patient, you go to medmatrixusa.com and you can apply there to become a patient. Um, don't forget to like, share, uh, you know, subscribe to the channel if you want to hear more. We're going to be we go live pretty much every Tuesdays, um, some Wednesdays, some Fridays around 4:30, uh, if you like joining in. And that is everything. Dr. Anything else you want to say? No, it's great. Great topics. Awesome. All right, everyone. Thank you so much for joining live.