Men’s Health: Understanding Testosterone and Boosting Libido
Your total testosterone is normal, but you still can’t get it up?
So, you’ve been to see the doctor about your libido issues, and he’s done some blood tests on your sex hormones including testosterone, and he tells you your total testosterone is fine. He tells your it’s all in your head and refers you to a psychologist. At which point you go ‘Arghhhh no way!’ Unfortunately for many men this is the frustrating and reoccurring issue which bugs them, especially from their thirties and forties.
What is testosterone and how important is it for libido?
Testosterone is classed a steroid hormone which is produced in the testes of men throughout their life from puberty onwards. However, it starts to decline with aging, about 1-2% per year, from the age of 30 onwards. This process can be sped up through poor lifestyle habits, like too much alcohol, poor sleep, little exercise, too much stress and a poor diet.
Testosterone is responsible for regulating not just the sex drive (libido), but also bone mass, body fat and muscle mass as well as the production of red blood cells. When testosterone levels fall below normal levels this can result in reduced muscle mass, low libido, irritability, depression, poor concentration, loss of body hair, fatigue, and an increased risk of brittle bones.
It’s important to remember that libido is not just driven by hormones. If your lifestyle habits are out of balance, like doing too much or too little exercise, drinking too much alcohol or having psychological issues like depression / anxiety, they can all influence your libido too. So finding the root cause is important, rather than just thinking it’s a testosterone deficiency.
Why you should check Sex hormone binding globulin (SHBG)
All hormones are carried around in the body by carrier proteins. Testosterone is carried through the body by SHBG predominantly and by albumin.1 SHBG binds more to testosterone than to the estrogens.2 The main role of SHBG is to control the availability of sex hormones to cells and to transport them through the body. In order to determine how much testosterone is getting into the cells, aka the ‘free testosterone’ we need to know your SHBG and your total testosterone levels and calculate the difference. Laboratories now do this calculation on your behalf to gauge the free testosterone. Measuring the free testosterone levels is a more accurate measure of testosterone status than the total testosterone.3, 4
The normal range for SHBG is 10-57mmol/L. An all too common situation as men get older is that is the SHBG begins to rise to high levels thereby block the availability of free testosterone to cells. The symptoms of high SHBG are similar to those of low testosterone as indicated previously.5
Therefore, we need to identify what causes high SHBG, in order to reduce it. For men it could be related to high thyroid levels (hyperthyroidism),6 or low growth hormone7. Other issues could be related to the liver, as SHBG is produced in the liver if one has diseases of the liver like NAFLD, hepatitis infections or cirrhosis, then SHBG can be high8,9.
Lifestyle factors can also play a role like drinking too much alcohol10, smoking11, and too much stress12. This stress can also come from over exertion as in too much training.
Long term implications of too much SHBG
There are potential long-term disease risks with too much SHBG. It is linked to bone loss and reduced bone density in a number of studies13,14. Also there’s an increased risk of Alzheimer’s disease15 and prostate cancer16
What can be done to reduce it?
There are some dietary changes which can help. High protein diets are associated with reduced SHBG17. How much protein? As long as you’re getting your baseline 1.2 g/kg of bodyweight protein you should be fine, some people may need more based upon their training regimes. A liver function test can help determine your total protein levels as a first line blood check.
Getting the body fat levels down to healthy levels also helps to reduce SHBG.18 For women that’s below 22% body fat and for men that’s below 20%.
Additionally, some supplemental minerals and vitamins can lower SHBG. Boron tops the list with researchers recommending an intake of up to 10mg / day lowering SHBG19. The best forms of boron are Boron Glycinate or citrate. Boron is especially powerful in lowering your SHBG and if your total testosterone is already high, you’re naturally going to have higher than normal SHBG, so it would be safer to start on a lower dosage of 3mg or 6mg/day of boron then follow up with a ‘free’ testosterone test 2-4 weeks later and see where your levels are at. Having your free testosterone levels between 2-4% is ideal.
Vitamin D3 lowers the SHBG and raises testosterone and optimal levels to aim for are around 50ng/dL. There is an additional synergy between boron and Vitamin D3 in that boron extends the half life of vitamin D3 in the blood, providing even more time for vitamin D3 to exert its long ranging effects. Fish oil also reduced SHBG20 and the safest way to get your omegas is with eating the fish. Having 4 portions a week of either sardine, mackerel, wild salmon, herring or anchovy should be sufficient. The tinned versions have comparable if not more levels of omega-3’s.
So depending on your circumstances, you may need to look at your lifestyle, your diet and your training regime in helping you lower your SHBG and working with a functional medicine specialist will help you find your sweet spot to feel great and get your Va Va Voom back!
For more information regarding men’s hormones and sexual health, please contact Functional Medicine Practioner, Miles Price at 2881 8131 or firstname.lastname@example.org
- Anderson DC. Sex-hormone-binding globulin. Clin Endocrinol (Oxf). 1974;3(1):69‐96.
- Dunn JF, Nisula BC, Rodbard D. Transport of steroid hormones: binding of 21 endogenous steroids to both testosterone-binding globulin and corticosteroid-binding globulin in human plasma. J Clin Endocrinol Metab. 1981;53(1):58‐68.
- Vermeulen A, Verdonck L, Kaufman JM. A critical evaluation of simple methods for the estimation of free testosterone in serum. J Clin Endocrinol Metab. 1999;84(10):3666‐3672
- Winters SJ, Kelley DE, Goodpaster B. The analog free testosterone assay: are the results in men clinically useful? [published correction appears in Clin Chem 1999 Mar;45(3):444]. Clin Chem. 1998;44(10):2178‐2182.
- Ring J, Welliver C, Parenteau M, Markwell S, Brannigan RE, Köhler TS. The Utility of Sex Hormone-Binding Globulin in Hypogonadism and Infertile Males. J Urol. 2017;197(5):1326‐1331.
- Vierhapper H, Bieglmayer C, Nowotny P, Waldhäusl W. Normal serum concentrations of sex hormone binding-globulin in patients with hyperthyroidism due to subacute thyroiditis. Thyroid. 1998;8(12):1107‐1111.
- Menezes M, Salvatori R, Melo LD, et al. Prolactin and sex steroids levels in congenital lifetime isolated GH deficiency. Endocrine. 2013;44(1):207‐211.
- Forbes A, Alexander GJ, Smith HM, Williams R. Elevation of serum sex hormone-binding globulin in females with fulminant hepatitis B virus infection. J Med Virol. 1988;26(1):93‐98. doi:10.1002/jmv.1890260113
- Maruyama Y, Adachi Y, Aoki N, Suzuki Y, Shinohara H, Yamamoto T. Mechanism of feminization in male patients with non-alcoholic liver cirrhosis: role of sex hormone-binding globulin. Gastroenterol Jpn. 1991;26(4):435‐439.
- Hirko KA, Spiegelman D, Willett WC, Hankinson SE, Eliassen AH. Alcohol consumption in relation to plasma sex hormones, prolactin, and sex hormone-binding globulin in premenopausal women. Cancer Epidemiol Biomarkers Prev. 2014;23(12):2943‐
- English KM, Pugh PJ, Parry H, Scutt NE, Channer KS, Jones TH. Effect of cigarette smoking on levels of bioavailable testosterone in healthy men. Clin Sci (Lond). 2001;100(6):661‐665.
- Lennartsson AK, Kushnir MM, Bergquist J, Billig H, Jonsdottir IH. Sex steroid levels temporarily increase in response to acute psychosocial stress in healthy men and women. Int J Psychophysiol. 2012;84(3):246‐253.
- Legrand E, Hedde C, Gallois Y, et al. Osteoporosis in men: a potential role for the sex hormone binding globulin. Bone. 2001;29(1):90‐95.
- Slemenda CW, Longcope C, Zhou L, Hui SL, Peacock M, Johnston CC. Sex steroids and bone mass in older men. Positive associations with serum estrogens and negative associations with androgens. J Clin Invest. 1997;100(7):1755‐
- Xu J, Xia LL, Song N, Chen SD, Wang G. Testosterone, Estradiol, and Sex Hormone-Binding Globulin in Alzheimer’s Disease: A Meta-Analysis. Curr Alzheimer Res. 2016;13(3):215‐222
- García-Cruz E, Carrión Puig A, García-Larrosa A, et al. Higher sex hormone-binding globulin and lower bioavailable testosterone are related to prostate cancer detection on prostate biopsy. Scand J Urol. 2013;47(4):282‐289.
- Longcope C, Feldman HA, McKinlay JB, Araujo AB. Diet and sex hormone-binding globulin. J Clin Endocrinol Metab. 2000;85(1):293‐296.
- Hautanen A. Synthesis and regulation of sex hormone-binding globulin in obesity. Int J Obes Relat Metab Disord. 2000;24 Suppl 2:S64‐S70.
- Naghii MR, Mofid M, Asgari AR, Hedayati M, Daneshpour MS. Comparative effects of daily and weekly boron supplementation on plasma steroid hormones and proinflammatory cytokines. J Trace Elem Med Biol. 2011;25(1):54‐58.
- Nagata C, Takatsuka N, Kawakami N, Shimizu H. Relationships between types of fat consumed and serum estrogen and androgen concentrations in Japanese men. Nutr Cancer. 2000;38(2):163‐167.