Testosterone Concerns in Obese Men – Part 2

By: Michael Lam, MD, MPH; Justin Lam, ABAAHP, FMNM; Carrie Lam, MD


Read Part 1 | Part 3

Testosterone Concerns and the Endocrine System

Testosterone concerns and HRTThe endocrine system is made up of a number of glands that, to a large respect, play a role in just about every bodily function. Foremost among these glands is what is referred to as the HPA (hypothalamic-pituitary-adrenal) hormonal axis. The HPA axis is one of the mechanisms responsible for testosterone concerns and your body’s automatic stress response or as it is also referred to – the NeuroEndoMetabolic(NEM) stress response.

The hypothalamus, when stress is perceived, releases a corticotropin-releasing hormone (CRH) that binds to receptors which are on the pituitary gland. This results in the release of the adrenocorticotropic hormone (ACTH). ACTH, in turn, binds to receptors present on the adrenal cortex of the adrenal glands (which are each situated at the top of one of the two adrenal glands) and stimulates cortisol release. Once enough cortisol is released to enable you to handle the stressful situation, or when the stressful situation passes, feedback is sent to the hypothalamus and thus ACTH production is reduced, things are once more in balance, and a state of homeostasis is reached.

When stress is ongoing, however, the body keeps on producing cortisol, increasing the production levels if the stress is severe. The constant and possibly increased production of this hormone leads to a number of health conditions that could be debilitating in nature. These include constant fatigue, weight gain, hormonal imbalance, headaches, depression, mood swings, and anxiety… to name a few.

After a while, the adrenal glands can no longer keep up with the cortisol demand put on it by the body to handle stress, and cortisol supply is taken up by other parts of the body. Ultimately, the adrenal glands are unable to function as intended and your cortisol levels are too low. Once you reach this stage of adrenal gland fatigue your symptoms have gotten progressively worse and recovery is a long-term uphill battle.

In males, testosterone production is a concern as cortisol production directly affects a male’s testosterone production as well as the production of other essential hormones. Putting it simply, low cortisol is usually associated with low testosterone.

Stress and Hormone Function

Testosterone concerns and stressFrom an NEM perspective, multiple organs, systems, and pathways are involved when the body is subjected to constant stress. While the adrenals are initially the primary defense against mild or intermittent stress with its increase in cortisol production, the other systems are kicked into action when stress is severe or prolonged.

In response to stress, the NEM response is automatically activated, with your body deciding which organs to activate and which to allow to rest, as well as which hormone’s production to increase and which to decrease. In effect, when subjected to constant stress, those systems deemed not necessary for survival are decreased or even shut down in order for your body to address threats.

Hormone production is governed by the neuroendocrine system. The hormonal stress response is primarily governed by the adrenals, thyroid, and male testes (in males) with the HPA axis and hypothalamic-pituitary-gonadal (HPG) axis the key pathway regulators. When the adrenal glands become fatigued and are unable to function properly, fatigue is the result, which in turn, results in lower libido as reproduction is not deemed necessary for your immediate survival.

Besides a lower libido, heightened cortisol production during the initial stages of adrenal fatigue results in a lowered production of other hormones. As adrenal fatigue progresses, however, and the adrenals become unable to produce the cortisol needed, more systems may be shut down and other organs and pathways mobilized to produce this hormone. Resultantly, the testosterone production in the testes is affected, as is the hormone production in other body systems and organs, which will be discussed more below. If of a long-lasting nature, this state of affairs has a debilitating effect on the body as a whole, resulting in burnout as the body eventually runs out of ways to produce cortisol.

Among the symptoms associated with this ‘burnout stage’ are included:

  • Extreme tiredness
  • Weight loss or weight gain
  • Anxiety
  • Major depression
  • General apathy
  • Loss of interest in life and the world around you
  • A non-existent sex drive (and its related conditions)

Cortisol as a Testosterone Concerns

In men, testosterone is produced in the adrenals and the testes. There is, however, a link between cortisol and testosterone production.

Pregnenolone is a precursor hormone that is synthesized from cholesterol. This happens mainly in the adrenal glands, although it is also synthesized in other parts of the body, including the testicles, liver, brain, retinas, and by the skin. Pregnenolone is considered a master hormone as most hormones are synthesized from it. These include testosterone, DHEA, progesterone, estrogen, and cortisol.

Testosterone production becomes a concern when the body is under constant stress and more and more cortisol is produced. As the body demands more cortisol to deal with the problem, the pregnenolone reserves are used to synthesize the cortisol needed to deal with the stressful situation, leaving less of this hormone available for the synthesis of other hormones in the adrenal glands. If, however, adrenal fatigue sets in, and the adrenals are no longer able to cope with the demand, the pregnenolone manufactured by other parts of the body is reserved for cortisol production.

The increased cortisol production results in the decreased production of testosterone which has its own set of complications.
This implies testosterone production or lack thereof is directly linked to your body’s cortisol production and by implications is linked to adrenal fatigue, but there is more to this when obesity comes into play.

Obesity as a Testosterone Concern

Obesity as one of testosterone concernsStudies indicate that there is a strong correlation between obesity and lower cortisol levels in men. This lowered cortisol production is a concern, as it leads to a number of health issues.

When the hormones are in balance and you exercise, more cortisol is released during this time. The cortisol, under these conditions, allows fat stores to be freed so that it can be used as an energy source. Insulin is usually lower and lipase, a fat burning enzyme, is released, thereby blocking lipoprotein lipase, a fat storing enzyme.

However, when your diet is incorrect and you eat many carbohydrates or foods high in sugar, insulin levels are spiked. This inhibits your body’s fat burning ability. In effect, raised insulin levels lead to the storage of fat.

In the long term, when stress (whether psychological or physical, e.g. stress put on the body due to diet) is prolonged, cortisol production is increased and may be continuous in nature. This occurs in early stages of adrenal fatigue. The result is that your pancreas works harder to keep up insulin production due to higher blood sugar levels.

In those instances where someone is obese, it follows that their cortisol levels are higher than they should be, indicating a body that is in a state of hormonal imbalance. As the adrenal glands become worn out, finding it increasingly difficult to constantly? produce elevated levels of cortisol, other parts of the body also help with the production of this hormone, including the testes.

Obesity is thus a testosterone concern, as it results in increased cortisol production over time which in turn results in a decrease in testosterone production and thus lower testosterone levels when the body is under unrelenting stress.

Symptoms Relating Directly to Men’s Testosterone Concerns

A hormonal imbalance in men, where their testosterone levels are particularly low, results in a number of related symptoms. These include the following:

A lowered sex drive

Although lower testosterone levels may not necessarily be the cause of a lowered sex drive, it may be one of the causes. As libido is different for all men, what one man may consider a low sex drive is not necessarily the same for another. What constitutes a ‘normal’ sex drive is thus difficult to define, so determining sex drive is an individual affair.

If, however, your libido shows a downward spiral for what is normal for you, testosterone as a factor bears looking into.

Problems gaining or sustaining an erection

Erectile dysfunction is a symptom related to testosterone concernsBesides possibly stimulating your sex drive, testosterone helps a man both achieve and maintain an erection. Although testosterone is not the sole cause of an erection, it does stimulate certain receptors present in the brain to produce a molecule called nitric oxide. Nitric oxide triggers chemical reactions in the body that result in an erection. Lower testosterone levels, however, results in difficulty with achieving as well as maintaining an erection.

Testosterone concerns, however, are not the sole reason a man does not attain or sustain an erection, as a number of health issues could contribute towards the problem. These issues include thyroid problems, high cholesterol, high blood pressure, diabetes, stress, anxiety, and depression. These problems are common in those who are obese and may be contributing factors that help lower testosterone levels.

A lowered semen production

Testosterone plays a role in semen production. It, therefore, follows that lower levels of this hormone result in smaller semen volume.

Although a lower testosterone count most certainly influences semen production, it does not necessarily follow that you have a lowered semen production due to lower levels of testosterone. Other factors contributing to a lowered semen production include:

  • The frequency of sex – frequent ejaculation reduces semen volume.
  • Drugs – certain medications such as antidepressants or even antibiotics reduce semen volume.
  • Age – As men get older, their semen volume decreases.
  • An obstruction – An obstruction in the ejaculatory duct or scar tissue may result in a reduced semen volume upon ejaculation.
  • Retrograde ejaculation – This is where semen goes back up into the bladder instead of out of the penis during ejaculation. The phenomenon is often the result of certain medications.

A loss in muscle mass and strength

Testosterone plays a role in building muscle. Loss of muscle mass and strength has been linked to lowered testosterone levels in men, especially during the aging process.

A lowered bone mass

Osteopenia or lower bone mass (bone density) is quite common in men with lower levels of testosterone. It is also one of the risk factors for osteoporosis. Lower testosterone levels may thus increase your chances of fractures.

Decreased energy levels

Lower testosterone levels are one of the symptoms of adrenal fatigue. One of the main symptoms of this condition is extreme fatigue and hormonal imbalance, i.e. lower testosterone, for example. Although fatigue is not necessarily the result of lower levels of this hormone, those with this condition do tend to experience fatigue.

Premature balding

Premature balding is a symptom related to testosterone concernsMany older men, as they age, start going bald. This may be due to a steady, natural decline in testosterone or due to their genes. Younger and obese men who experience hair loss, however, may ascribe this to lower testosterone levels.

Changes in mood

Studies suggest that men that have lower testosterone levels may experience irritability, mood swings, and depression. This may be ascribed to the hormonal imbalance experienced due to lower testosterone levels. Accompanying the lower testosterone levels is a higher occurrence of cortisol. The result is that the production of the ‘feel good’ hormones in the brain is compromised, giving rise to diverse symptoms, including anxiety, mood swings, frustration, lack of focus, depression, and so on.

Hot flashes and breast tenderness

When your testosterone levels are too low, estrogen, the female sex hormone level, can be high on relative or absolute basis is usually higher. This does not necessarily mean estrogen levels in males with a low testosterone count are higher than what is considered normal, however. Estrogen levels may be normal, while the testosterone levels are abnormally low, resulting in a relative state of estrogen dominance. The result is symptoms much like those experienced by menopausal women, i.e. breast tenderness, breast enlargement, and hot flashes.

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© Copyright 2018 Michael Lam, M.D. All Rights Reserved.


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