In the year 2020, we have what is a substantially different environment to that of 200 years ago. While our ancestors have been around for about six million years, the modern form of humans evolved about 200,000 years ago. Civilization as we know it is only about 6,000 years old, and industrialisation started in the in the 1800s. This industrialisation era, as productive as it may be for civilisation and information technology today, was accompanied by some health risks to the human being. Never before had we been exposed to environmental and psychological stressors like the one’s that would emerge around that time. Sure, 200 years ago sounds like a lot to us, but in evolutionary time, that is merely a heartbeat. We are relatively unchanged, from a biological point of view, than humans who walked the earth 10,000 years + ago. One of these potential health risks was how our new environment could interfere with our testosterone levels. We do not know all of the potential causes of low testosterone, all we know for sure is that there is a strong correlation with the modern world and declining testosterone levels.
The causes of low testosterone or hypogonadism could be (and are not limited to) chronic liver disease, COPD, sleep apnea, renal disease, use of different recreational drugs, glucocorticoids, opiates, ketoconazole, anabolic steroids, HIV, hypertension, irregular lipids, infertility, obesity, sleep apnea, arthritis, diabetes, genetic mutations, metabolic syndrome, illnesses, aging, other hormone deficiencies, nutrient deficiencies, lifestyle issues and certain medications. As you can see, just about anything modern may play a role in the cause of low testosterone. For this reason, it is often very hard to pin point a patient’s true cause of low testosterone, because there may be a composite cause; which means several causes. General advice on correcting diet and lifestyle is given by some physicians to their patients before prescribing testosterone, which is actually good advice. However, the conundrum; of what exactly defines a healthy diet and lifestyle? The definition is different from physician to physician and neither of them have the empirical evidence to prove the other wrong. Less is known about the human body than many may assume, which is why exogenous testosterone as a medication has been such a life saver for many men (and women) around the globe. We may not be able to correct all of the root causes of low testosterone, but we can at least resolve the symptoms and achieve the clinical endpoint of correcting the hormone deficiency. Next time you are sure that XY is the cause of your low testosterone, ask yourself, could it be several causes? And some of those causes, are they even in your control? It may then be time to consider testosterone replacement therapy. Oh, and you young guns. It is never too early to check your testosterone levels. I have seen low testosterone in many men under 25. It is always good insurance to check your testosterone levels at least once per year.