Low Testosterone - Guest Expert, Douglas Sutherland, MD.

"Doc, can we check my testosterone levels today?"

I hear this question multiple times every day in my urology clinic, regardless of the reason the gentleman was sent my way in the first place. I have had men ask me this very question while literally sweating from the pain of passing a kidney stone! It shows just how impactful TV, radio and social media advertisements have become in our lives - just about every patient goes on to explain, "...well, I heard about this on the radio and I think I have some symptoms of low T."

The Testosterone Paradox

What is so interesting about the topic of testosterone is the great paradox I see in my practice. I am certain close to 100% of the men I see in clinic would be interested in getting a free blood test to measure their testosterone levels if I offered it. I am equally certain most of them would be reluctant to start testosterone hormone replacement if I found that their testosterone level was actually low. To be sure, nearly every man who asks me about checking his testosterone level also knows there is some downside risk to taking testosterone supplements. 

The contrasting opinions amongst patients I see in my clinic are in tune with the known medical science about measuring testosterone levels and starting hormonal replacement. The truth is, testosterone measurement and replacement is hardly scientific at all - yet. There are few clinical guidelines for doctors and patients to follow, and those that do exist are dated, vague, and provide little assurance that there is a "best way" to manage low testosterone. It will be years before testosterone hormone replacement therapy is standardized and perfected.

It should come as no surprise that I rarely "push" a man to start taking testosterone hormone replacement even if I think it is the right thing to do. The reason? There is an alternative option to testosterone injections and creams. 

Obesity Kills Your Manhood

I can make this statement unequivocally without one more shred of scientific evidence. 70% of men with low testosterone are obese. In every study I have reviewed on the topic, there is a clear and direct link between weight loss and improved testosterone production. Even better, the more weight is lost, the more the testosterone levels improve. It does not matter how you lose the weight - diet or surgery - if the weight comes off, the body responds by improving testosterone levels without a testosterone shot or single day of applying testosterone cream.

Weight loss is a true win-win for most of us men. 

Unfortunately there are exceptions to every rule and weight loss alone is not always enough to improve testosterone levels. There are many other areas to consider improving* before hormone replacement:

- Medication modification (stopping pain meds, changing hypertension meds)
- Sleep habits
- Stress reduction
- Glycemic control/diet modification
- Exercise modification: more resistance training, less cardiovascular 
- Unique urological conditions (e.g. varicocele repair)

Some men will simply not respond to these natural methods of boosting testosterone levels. Others will have testosterone levels so low that it is unlikely these natural options will fix the problem.

Don't Avoid The Testosterone Conversation

While it is true that there are downside risks to starting testosterone hormone replacement therapy (TRT), there is simply no question that TRT plays an important role for some men. There is an immense volume of scientific data showing that an abnormally low testosterone level is bad for you. Very bad. Low testosterone is associated with heart disease, prostate cancer, depression, diabetes, and many other medical conditions. 

In subsequent blog posts I will highlight some of the controversies surrounding TRT. But my posts are no replacement for the conversations you could be having with Dr. Valerie Sutherland and her exceptional team. Given that you have already taken the first step of studying her program, do not hesitate to ask her about how to improve your testosterone profile.

Douglas E. Sutherland, M.D.

*You will note that I do not list "herbal/naturopathic" remedies above, though a quick Google search will find thousands of websites selling products guaranteed to boost your testosterone.  My general statement on these things when asked is, "I have no idea if they work". Most natural supplements that promise to boost testosterone are not harmful, but even the safety profile for most of these products is unknown or untestable. There is no concrete evidence to make recommendations on this topic - so unfortunately, you are on your own. If you do decide to try them, do so safely (follow the instructions) and do it like a scientist would: use the product for a set period of time (4-6 weeks) and if you do not see any improvement, dump it. 

Further Reading Recommendations
1. American Urological Association:
2. Endocrine Society:
3. JAMA 2017 Editorial:
4. NY Times March 2017:
5. NY Times Oct 2010:
6. New England J of Medicine 2016 Editorial:
7. Scientific American 2016:

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