I have a new client that came looking to optimize health. He’s a 30-year-old male living in Shanghai for the past few years. Very active CrossFit coach and CrossFitter, he is a former bodybuilder and during his competitive phase he did use steroids, though he stopped this over five years ago. Ran the DUTCH Complete Hormone profile, had total DHEA on the low side of normal, total estrogen and progesterone bottom of the reference range, testosterone very low, about 4.9, with 25 being the bottom of the reference range. Notified by DUTCH that there is a genetic mutation that can prevent the production of the metabolite they use to drive their testosterone measurement.” Yes, which is most common in patients of Asian descent; that is correct. And then Brandon says, “I do have a serum testosterone measurement he had done about a year ago that came back as 12.47. He is exhibiting some symptoms of low testosterone, including fatigue, weight gain, difficulty gaining muscle, but on a scale of one to five, he’s rating most of these symptoms as a one to two, with five being the highest. How would you approach this? Should I get another serum testosterone measurement? Should I be focusing on boosting conversion of DHEA to testosterone? Anything else to think of?

Dr. Amy Nett:  Yeah, so I mean I would still approach this like we do almost any other functional medicine patient the way we do because the question is, why are his hormones out of balance? And absolutely maybe it had something to do with the testosterone injections he was taking previously. That could have caused him negative feedback that his body still may be recovering from. But you need to think about, well, why isn’t his body producing a normal hormonal balance? Go back to the basics, do the gut testing, do HPA axis, and for somebody who’s very active, so you didn’t really mention the cortisol here, interestingly. So, I mean, my big question here is you’re mentioning fatigue, weight gain. So what does his cortisol look like? But I would definitely … and somebody who is very active, a CrossFit coach and CrossFit participant, what does his stress look like? What does his play and pleasure look like? But think about we always go back to those foundational pieces in the exposome, and I wouldn’t overlook those in somebody who’s been really competitive in terms of athletics, I would look at those. So go back, look at gut even though he may not be saying “I have gut issues” or this sort of thing to understand what’s causing the hormonal imbalance.

I would look at the other pieces as well. So that’s where I would actually focus, and you’re right. In Asian populations, some people do have a predisposition where I believe they have a deficiency in glucuronidation, and so you do want to rely potentially on the serum measurements. Again, we’re not really going into detail on the hormones, but I think that’s good and I would probably follow it with serum testosterone. But again, really look at the basics and see what’s causing. Is there something you can identify that’s really causing the body to have lower hormone production or sort of a hormone imbalance?