Top 5 Myths of Hormone Imbalance in Men - Why Hormone Optimization Matters

Dr. Joseph Pazona, Board Certified Urologist

When a man is performing at his best, his body and mind are like a finely tuned machine. The machine requires optimal fuel (food, nutritional supplements), well-functioning components (organ systems) and rest (sleep, mindfulness). When any of these elements are imbalanced, problems arise.


Hormones play a vital role in all of these elements. Every organ in our body is regulated by hormones. When hormone imbalance in men exists, peak performance is next to impossible.


The key hormone for men is testosterone. Low testosterone can cause:

  • Decreased energy
  • Weight gain
  • Sexual dysfunction
  • Brain fog
  • Weakened bones and muscles


Hormone imbalance in men is also seen with excess testosterone levels. Many men end up in “low T” clinics and are placed on super high, unnatural doses of testosterone. More is not always better. 


Instead, let’s focus on hormone optimization. The understanding that there are safe ways to replace testosterone and treat hormone imbalance in men. Let’s review the top myth of hormone imbalance in men because . . .


You want to feel better . . .  don’t you?


Hormone Imbalance in Men - Myth #1 

Testosterone should only be replaced if total levels are <250 ng/dl

Wrong. Have you ever looked at the “reference range” for total testosterone. Labs and insurance companies (don’t get me started on them) define a “normal” total testosterone as:

250 - 827 ng/dl.


You’ve got to be kidding me. I call BS. If you ever looked at and surveyed a man with a total testosterone level of 300 ng/dl and compared him to a man with a level of 800 ng/dl, you wouldn’t believe your eyes.


The first man would be overweight, look depressed, and report feeling terrible. The second man, assuming he didn’t have any other medical issues, would likely be a healthy appearing, youthful chap with a big smile on his face.


Unfortunately, insurance companies and the medical community have defined “low T” as levels <250 ng/dl. As a result, many men with a hormone imbalance have been dismissed by the medical community with “normal levels” and told “you’re fine.”


Most men feel optimal when their testosterone levels are in the 700 - 1100 nd/dl range. A single blood test at a particular age ignores what your hormone levels might have been 5, 10 or 20 years ago when you felt better!


So don’t let some healthcare professional dismiss your low T symptoms because your level was 314 ng/dl. 


As I alluded to at the beginning, too much testosterone is not good either. Some healthcare professionals “jack” men up with enough testosterone to turn them into the Hulk. Acne, aggression, and hair loss are just some of the signs of excess testosterone.


Total testosterone levels >1500 ng/dl have unknown long-term health risks as well.


Hormone imbalance in men is poorly managed by the medical community and you should make certain you find someone with expertise.


Hormone Imbalance in Men - Myth #2: 

Testosterone replacement therapy causes heart attacks.

There is a bias in the medical community that doing something is always inherently more dangerous than not doing something. This bias is strong regarding hormone replacement therapy. As a result, men (and women) suffer with symptoms of hormone imbalance.


The truth is that NOT optimizing testosterone levels may be associated with heart disease.


Wait a minute? I thought testosterone causes heart attacks because it makes the blood too thick? Wrong.


Heart attacks are caused by atherosclerosis or inflammation of the coronary blood vessels. Clots and plaques composed of platelets and cholesterol cause a complete blockage of the arteries. A high red blood cell count does not cause clots.


There’s evidence to the contrary that LOW testosterone is associated with heart disease. The American College of Cardiology released an expert analysis in 2019 regarding men with very low testosterone levels on prostate cancer treatment. They concluded that lowering testosterone levels, “does increase cardiovascular risk, particularly among individuals with prior cardiovascular disease or cardiac risk factors.”


Additionally, low testosterone is linked to obesity, insulin resistance, and diabetes. All major risk factors for heart disease. So what should you believe?


A review of the literature by one set of authors concluded, “The relationship of testosterone levels with cardiovascular (CV) outcomes is challenging and has shown conflicting results.”


Most results suggesting any risk were in older, sicker men. In other words, unless you have known heart disease or several risk factors, there is no evidence that fixing a hormone imbalance will cause a heart attack.

Hormone Blog Info Graphic

Hormone Imbalance in Men - Myth #3:

Testosterone injections are your only option.

Many men first learn about low T by a radio ad or billboard for a low T center. Men are then led to believe that their only option for treating their low T is synthetic testosterone injections.


Wrong.


In fact, synthetic testosterone injections are the WORST option for treating hormone imbalance in men. Now, before you get your panties ruffled, allow me to explain some good aspects of testosterone injections.


First, any responsible testosterone replacement is better than no testosterone replacement. Second, injections do work well for many men. Lastly, testosterone replacement therapy can be quite expensive and injections tend to be the least expensive of the bunch.


The issue is not knowing that there are other options for hormone optimization. Many men don’t feel better on testosterone injections. Others hate the idea of sticking themselves with a needle 50-100 times per year.


Testosterone injections also can cause a roller coaster effect. You’ll feel really good with high levels for a few days, then the bottom drops out and you feel crummy waiting for the next injection.


Topical testosterone (gels, ointments) and testosterone pellets (BioTE pellet therapy) are more effective at treating a hormone imbalance in men by producing more consistent testosterone levels. Although they have downsides as well, you as the patient should have the option of choosing.


You shouldn’t feel like you have no options because a medical practice is more interested in their business model instead of effectively caring for patients.

Hormone Imbalance in Men - Myth #4:

Testosterone replacement alone will make you feel better.

Treating hormone imbalances in men is a necessary but not sufficient component of peak performance. All the testosterone in the world won’t help if you’re chowing down chalupas on the couch and getting by on 5 hours of sleep a night. 


Think of hormone optimization as one leg of a three-legged stool. The other two components are:


If you remove one leg, the stool is imbalanced. Hormone imbalances in men require attention to these two important components. 


But don’t worry, you’re not alone. I’m not interested in handing out testosterone to patients and saying “good luck.” I’m happy to partner with you and provide guidance on what you should eat (not chalupas), how much sleep you need (7-9 hours and don’t argue with me on this one) and what supplements you should consider (DIM is a great place to start).


Anyone provider can prescribe testosterone. You deserve a partner on your healthcare team to maximize the results of your therapy.

Hormone Imbalance in Men - Myth #5:

Declining testosterone levels is a normal part of the aging process.

There is a stoicism that is passed down from our parents and grandparents. We were taught to accept “getting old” and all of the lovely changes that often occur:

  • Decreased energy
  • Lack of sleep
  • Brain fog
  • Loss of muscle mass
  • Excess fat


What if I told you the reason these things occur is a hormone imbalance in men? These symptoms of “aging” are related to declining hormone levels. Optimize hormones, symptoms improve.


Yes, hormone imbalances in men are more common as we age. Andropause or “the male menopause” is a real thing. But it doesn’t have to be left untreated. 

Closing Thoughts - Hormone Imbalance in Men

There’s a lack of clarity surrounding testosterone replacement therapy. I blame the medical community. We are sticking our heads in the sand while allowing businesses with ulterior motives (make money off men’s feelings of inadequacy) to enter the sandbox.


I suggest an alternative. Find a medical expert who’s not interested in simply replacing testosterone but is instead interested in hormone optimization. Someone who will look at all angles of treating hormone imbalances in men.


You need to address hormone imbalances by optimizing lifestyle choices, hormone levels, and nutritional supplementation.


Anything less is frankly . . . uncivilized.


Dr. Joseph Pazona is a board-certified urologist practicing in Nashville, TN. He is an expert at treating hormone imbalances in men. If you think you might be a good fit for joining Pazona MD, then give us a call (615) 527-4700 or email us hello@pazonamd.com

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About the Author

Doctor Joseph Pazona is the founder of Pazona MD, a specialty urology practice located in Nashville, TN. He has been published in medical journals on the topic of urology & authored several consumer ebooks on a variety of urologic conditions in addition to the topics of telemedicine, and continuing medical education (CME). When he’s not treating patients or writing he enjoys traveling, hiking, running, cooking, and spending time with his three children and fiancé, Catherine.


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