Testosterone replacement therapy can help men (with low testosterone) build muscle mass, lose weight and feel better overall.
Does that mean that every man should use testosterone?
But it does mean that because of the potential benefits, it's worth looking into if you are suffering from any of the symptoms that may be associated with low testosterone.
In this case study, I'm going to walk you through the treatment of a 61-year-old patient of minewho was able to lose 20 pounds of fat mass while gaining 20 pounds of muscle mass through proper testosterone replacement therapy.
You will also find out how to determine if testosterone replacement therapy is worth considering in your case, the symptoms of low testosterone and how to properly and safely replace testosterone if indicated.
You can see his 3 months before and after pictures of this patient below:
To start with we need to talk about weight loss and testosterone.
One of the questions I frequently get asked is this:
Does testosterone help with weight loss?
The answer to this question is yes, it absolutely can help with weight loss.
Studies have shown that testosterone replacement therapy can help men not only lose weight but keep the weight off (1).
Testosterone in men is important for the maintenance and development of skeletal muscle mass.
It also plays a role in cardiovascular health, mood, energy levels, and even libido.
Testosterone, as it relates to thequality of life in men(2), is of utmost importance.
I have countless stories of men who start testosterone and have improved weight loss, more energy, better sex lives and an improvement in overall quality of life(3).
So why isn't testosterone discussed at your primary care office visit?
Why does testosterone replacement therapy get a bad name?
Why do most people equate testosterone with bodybuilders?
It turns out there is a general lack of knowledge as it relates to testosterone replacement among many physicians (and even patients).
The truth is that the testosterone replacement therapy I am referring to in this case study is the replacement of testosterone to normal and physiologic levels that a 20-30-year-old young man would experience in his life.
It is not the supraphysiologic levels that result in testicular atrophy or other negative side effects.
When you replace testosterone in physiologic and normal doses there are many benefits and hardly any negative side effects (aside from maybe some acne on occasion).
The doses that bodybuilders use are often 2-5x higher than normal physiologic levels and may cause negative side effects like infertility later in life.
We are not talking about this kind of testosterone dosing here.
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So now that that is out of the way, how does testosterone impact weight?
Through several mechanisms...
Testosterone helps men to build and maintain muscle mass(4).
Increasing muscle mass in the male body results in a baseline increase in resting energy expenditure or resting metabolic rate.
You probably know this as your "metabolism".
The higher your metabolism, the more calories you burn, the more weight you lose.
Testosterone replacement helps to lower leptin levels(5).
Leptin is the hormone secreted by fat cells (leptin resistance is a consequence of weight gain) and impacts both metabolism and body composition.
The higher leptin levels get the more difficult it is to lose weight and the easier it is to gain weight.
As leptin levels increase testosterone decreases and men experience many of the symptoms of low testosterone.
As testosterone levels are replaced leptin levels fall, men lose the excess weight they were carrying and their symptoms subside.
The inverse correlation between leptin and testosterone may explain why men have such a robust reaction to testosterone replacement therapy.
Testosterone plays a role in insulin signaling and insulin sensitivity(6).
Insulin is another hormone that directly leads to weight gain (7) in both men and women.
Insulin resistance is a very common cause of weight gain and testosterone and insulin have an inverse relationship with one another.
As insulin levels increase testosterone levels decrease.
Men who are overweight with large abdomens tend to have high insulin levels.
Testosterone plays a role in insulin signaling and as testosterone levels fall it creates an environment which allows for insulin resistance to develop.
As testosterone levels are replaced and weight is lost, insulin signaling improves.
So now that we know how testosterone helps with weight loss, how do you know if it will help you?
Men with low testosterone typically present with one or more of the following symptoms:
It's important to realize that many of these symptoms are non-specific and there is a crossover between other hormone imbalances.
Having said that, most men do know when something is "off".
If you fall into any of the above categories or have just been experiencing new symptoms for your body it would be reasonable to assess your hormones via blood testing.
It's also worth mentioning that nowadays men as young as 30 can have low testosterone levels.
While it is certainly more common for men in their 40-50's to have low testosterone it is now much more common in younger men as well.
The benefits of replacing testosterone vary from person to person and largely depend on your presenting symptoms.
In this particular patient he experienced the following improvements:
In my experience, most men (around 80%+) will experience positive side effects throughout treatment.
If a comprehensive approach is taken to balance hormones then that number increases dramatically.
It's important to realize that these are the subjective improvements in symptoms and don't represent changes to biomedical markers such as improvement in cholesterol, reduced blood sugar, and reduced insulin levels.
These symptoms were also accompanied by many positive changes in his lab work.
In order to get proper testosterone replacement, you will likely need to seek help from a knowledgeable physician or another provider.
Many primary care providers and general practitioners may not have the knowledge necessary to replace and/or monitor testosterone replacement therapy.
Part of your workup should include a comprehensive hormone and basic blood panel to evaluate hormone levels and other biomedical markers.
If you are interested in optimizing your testosterone levels (and other hormones) for weight loss then I would recommend starting with this panel:
As you can see from above each hormone must be evaluated in the setting of the other hormones and put into the context of your symptoms.
It's not as straightforward as "this is high, this is low so take this".
Having said that, if you are a male looking to optimize your testosterone levels you will want to focus on both estradiol and total testosterone.
Estradiol should be low (less than 30) and total testosterone should be 700+ (with standard reference ranges of 300-900).
Focusing on these values won't give you the best results possible but it makes the interpretation manageable for physicians who don't focus on hormone replacement therapy.
Just realize that this approach will not focus on optimal results.
To get the kind of results you see in this case study you will want to take a more comprehensive approach.
Below I will dissect the pertinent labs of this patient...
Let's go over the labs of this particular patient to give you an idea of what it takes (we will also go over his treatment below as well).
Let's start with testosterone:
As mentioned previously optimal testosterone levels are generally 700+.
This patients total testosterone is 797 with a range of 250-1100.
Because this patient is using weekly injections of testosterone cypionate we checked this value on day 6 prior to his next schedule testosterone injection.
Injectable testosterone reaches a peak on day 2-3 so this value is likely higher if we were to check it earlier in the week, but he was doing quite well on these levels.
As a reference, his starting total testosterone was 217 (labs not shown), so this represents a significant improvement from baseline.
As I mentioned previously this patient was also suffering from fatigue, low energy, mood changes and especially depression.
Further analysis of his labs showed some interesting findings...
His thyroid studies were sub-optimal.
His TSH was > 2.5 (optimal levels are less than 2.0), and both free T3 and T4 were in the low end of the optimal reference range.
This was probably a minor problem caused by poor nutrition, nutrient deficiencies, and other lifestyle factors - but will still certainly play a role in his overall energy levels and metabolism.
His iron studies were low...
While he wasn't outright anemic, low iron can absolutely contribute to low energy and sub-optimal thyroid function.
In addition to low iron, he also showed positive markers to both tissue transglutaminase and gliadin peptide antibody.
These markers together with the malabsorption of iron (and vitamin B12 though not shown) do indicate intestinal damage from a likely autoimmune source of Celiac's disease.
What's interesting is that these markers were never checked previously and this patient didn't necessarily complain of gastrointestinal issues.
Data has shown that many patients with Celiac's disease actually present with extraintestinal symptoms(8) including iron deficiency and mood-related changes.
Because of the resolution of this patient's depressive symptoms and mood changes, it's hard to say for sure what was causing them (as both testosterone and gluten was removed from his diet), but it is an interesting connection.
Here is the original post:
Testosterone Weight Loss Case Study: 20 # Lost with ...
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