Jan 13, 2016

Interview Transcript

Interviewer: You've been diagnosed with low testosterone. You don't want to do the creams and pills. Are there other things you can do? We'll talk about that next with Dr. Hotaling on The Scope.

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Interviewer: Dr. James Hotaling is a urologist and also an expert in men's health here at University of Utah Health Care. And guys that have been diagnosed with low testosterone, what else can you do, other than the creams and the pills?

Dr. Hotaling: There's really only three things that have been proven to naturally raise testosterone levels, the first of which is just weight loss. A lot of men are overweight and don't take great care of themselves. So trying to have a normal weight can help a lot, even losing as little as 15 to 20 pounds can make a huge difference. So that's one thing.

Interviewer: And for guys, that's a challenge because, as we get older, we tend to put on about a pound of fat a year, I hear.

Dr. Hotaling: That's absolutely correct. We have a Men's Health Center that's based South Jordan, and we actually have a nutritionist who a lot of our patients see because it's not that men don't want to take care of themselves. It's just that I think a lot of men view going to the doctor as a sign of weakness. So they need some help to learn how to take care of themselves. So that's the first thing. The second thing is exercise, particularly weight lifting. That's very clearly been shown to boost testosterone and human growth hormone. It's actually the only thing that can boost human growth hormone, which can then also drive testosterone.

Interviewer: Are we talking about Olympic strength-type training, or just going in and building up a sweat?

Dr. Hotaling: Yeah, just building up a sweat. Even lifting weights as infrequently as twice a week for 30 or 40 minutes can make a significant difference and it can also boost your metabolism for one to two days after you do that. So it can help with weight loss. And then the third thing is just trying to eat a healthy diet, avoiding a lot of excess sugar and that kind of thing, which, again, ties into weight loss. So those are really the three . . . and then, I guess, the fourth thing would be getting adequate sleep.

We know that when men are sleep-deprived, that can make a big difference in their testosterone production. We particularly see problems in people who have shift work, where they work at night and their circadian rhythm gets all flipped around. Typically, testosterone peaks at about 4:00 a.m. along with cortisol. So that's all tied to your body's rhythms. And the amount of testosterone you have varies minute-to-minute and hour-to-hour. So those things are all things that can help. I think it's also really important to outline the things that don't help, or haven't been proven to help, if that makes sense.

Interviewer: I bet you alcohol is on that list, isn't it?

Dr. Hotaling: Yeah, it is. Again, that goes . . . that's what the biggest thing is. No supplement has ever been shown to make any difference. There are all kinds of natural testosterone boosters, DHEA. And Utah actually is the national, and perhaps the international, hub of supplements. I mean, there are companies like Essential Oils, which are billion-dollar companies and there is no data that any of that makes any sort of difference. And some of it may even be harmful for men. So that's one thing.

I think the other thing that men should watch out for, we also see a lot of men who take Propecia, or finasteride for hair loss. And that can actually have effects on your testosterone, your sex drive, and even your fertility. So that's another good thing to avoid if you're concerned with that.

Interviewer: So avoid the bad, do the good, and about how long until men start seeing maybe some changes?

Dr. Hotaling: Unfortunately, weight loss, for most people, is a slow process, especially if you're going to have sustained weight loss. I mean, you could lose at most one to two pounds a week. But I think if men stick to a healthy diet and lift weights, they should see a difference in four to six weeks and start feeling better. And there has been data that that's essentially something that's been proven over and over again in the literature. Those are really the key things for men.

And I think the other really important thing men can do is just regularly see a primary care physician. Most men don't. Men seek health care at a rate that's about 30 or 40% lower than women. And part of the reason I'm in here talking to you today is that most of the things that bring men to see a doctor are urologic conditions because they disproportionally impact quality of life, and, we might say, men functions, if you will. So I think it's just really important to get in and see a doctor regularly.

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