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Gidon Lieberman is our Medical Director at Fertifa. He’s a leading consultant gynaecologist and fertility specialist with over 25 years of experience. He’s accredited for laparoscopic and hysteroscopic surgery, gynaecological ultrasound and management of the menopause. He’s especially interested in the hormonal health of both men and women – and is very well known for his excellent analogies. In this article, he will talk about testosterone testing and the initial advice we give Fertifa patients.

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I always look closely at the adverts on my social media feeds, perhaps the algorithms know me better than I know myself.

Tired all the time (TATT)? Yes. Overweight? Yes. Depressed?Kinda. Lethargic? Yes. Low libido? Certainly not what it used to be. All these questions leading me to an undiagnosed medical problem that will unify these symptoms? Could a low testosterone really be the answer? I was really triggered.

It’s possibly a coincidence- but I am also hearing from an increasing number of men who have accessed home blood tests and been diagnosed with low(ish) testosterone levels.

To be clear, I am not talking about recognised medical conditions (such as male hypogonadisim). In such situations the levels are well below the normal range then further medical investigation and treatment is needed.

Many of the men I talk with have testosterone levels in the normal range but advised to have testosterone therapy for less robust reasons such as “those levels are for the average person and you are unique”, “you might have had high levels when younger” or may absolute favourite “what is normal?”

The following then happens - you start taking testosterone supplementation (exogenous testosterone) which boots your total level and you are likely to feel good as the total amount of hormone in your body goes up.

Then your own (endogenous) testosterone production starts to fall as your body ‘detects’ high levels in the bloodstream. Your testicles will shrink as endogenous testosterone productions switches off. This will decrease your total testosterone level resulting in more symptoms, requiring more exogenous testosterone to deal with those symptoms and on and on.

So, back to where you started with testosterone levels in the normal range, taking medication (that may be unnecessary) and with smaller testicles.

Hmmm. So those symptoms that I was experiencing: feeling tired all the time, weight issues, depression, loss of libido may be nothing to do with my testosterone level? The answer is probably not. The actual reasons are multifactorial and the solutions do not always lay in a tube or injection of testosterone.

So what advice do I give to our Fertifa patients when they ask about this?

1.       Start with the obvious: weight.

Most testosterone is carried around the body in a ‘biological suitcase’ making it inert, in fact only 4% of testosterone is free to wonder around the body having an effect. This carrier suitcase (SHBG) is higher in overweight men. So, more SHBG less active testosterone. Loose fat, increase your active testosterone levels.

Fat produces oestrogen. If you want to decrease your oestrogen levels, then fat loss can help. Small, regular interventions each day have well recognised benefits.

2.       Exercise is important, but regular exercise is even more important.

It does not need to be done in a gym.

20-30 minutes everyday is optimal, but 10 minutes is so much better than zero. Exercise will increase your testosterone level even if you are not overweight. If you forget to do it today, then just restart tomorrow. If you can incorporate a little bit of muscle maintenance, then even better. Remember exercise does not need to happen in the gym.

3.       Alcohol is the crutch we like to depend on. But people who long term drink will have lower testosterone levels.

It is a fact. Just drink a little less. It is certainly not helpful that alcohol and sport are so closely associated- maybe this will change.

I can remember when tobacco companies sponsored sport. Maybe society will realise that alcohol and sport need a little more distancing.

4.       Sleep! Poor sleep affects testosterone levels, mood and behaviour.

I like the idea that good sleep habits will improve testosterone levels.  Alcohol and weight gain, however, will negatively affect your sleep.  There is so much good advice available to help you sleep. If you are a Fertifa patient, you can read more about the value of sleep in our Library via the Fertifa Patient App.

5.       Incorporate quiet time into your day

When we were little kids and misbehaving, 10 minutes of quiet time normally sorted things out. So, incorporate 10 minutes quiet time into your day. Maybe even twice a day. Set an alarm on your phone for ten minutes, put it on airplane mode and just relax. Breathe and quieten the inner dialogue. Settling the mind will stabilise your mood, helping relieve the symptoms of anxiety and even depression.

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Like so much of modern medicine, we turn to pharma for the answers. But the correct medicine does not always need to be a doctor’s prescription.

Before having the blood test, let's first think about how we can take more responsibility for our own health by changing the things we can change and have control over.

If you are a Fertifa patient and you would like to speak to someone in our team about your testosterone health or men's health challenges generally, get in touch directly with your dedicated Patient Advisor via the Fertifa Patient App. We are here to support our patients through all men's health challenges, no matter what they look like 💜

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