In this episode of Functional Medicine Research, I interview Dr. Deb Matthew about her new book on male sexual health "Why Can't I Keep Up Anymore?: A Guide to Regaining Energy, Focus, and Peak Physical & Sexual Performance for Men Over 40". We discussed the causes of male sexual dysfunction, lab testing, causes of low testosterone, stress and cortisol levels, sex hormone binding globulin, testosterone replacement methods, how sleep affects hormones and much more.
This book isn't just for men. If your male partner is showing signs of low testosterone then this book is a must-read with resources on how to find the right kind of doctor to get well.
Male Sexual Performance with Dr. Deb Matthew Interview Transcript
Dr. Hedberg: Well, welcome, everyone, to "Functional Medicine Research." I'm Dr. Hedberg, and I'm really excited today to have Dr. Deb Matthew on the show. Dr. Matthew is a medical doctor, and she's also known as the happy hormones doctor. She's a best-selling author, international speaker, educator, wife, and mother of four. And after suffering for years with fatigue and irritability, her quest to resolve her personal health led her to change everything about her practice of medicine. She has been featured on national podcasts, radio, and broadcast shows, including NBC, ABC, CBS, and Fox. Dr. Matthew, welcome to the show.
Dr. Matthew: Thank you so much. It's great to be here.
Dr. Hedberg: So, we're going to be talking about your new book, "Why Can't I Keep Up Anymore?: A Guide to Regaining Energy, Focus, and Peak Physical & Sexual Performance for Men Over 40," which I read recently. It's an excellent book. Wanted to have you on and talk about something that is...well, I would say most male issues are overlooked, but testosterone is really a big one and so is sexual performance and male hormones. So, why don't we begin by talking about why testosterone is so important for men?
Dr. Matthew: Yeah. You know, hormones, in general, play a big role in how we feel on the inside, how we relate to the world around us, how we react to other people. And so, testosterone drives a lot of how men feel and even behavior, and it really plays a role in men feeling like a man. So, it's important for drive and for motivation so that when you wake up in the morning and your boots hit the floor, you're ready to take on the world. And when testosterone levels are not quite right, men just don't quite feel right. And for women, when we go through our hormonal changes, it's pretty obvious. We either get menstrual problems or, you know, we get hot flashes. And so, there's some pretty obvious things that happen at some pretty obvious times in our life in order to notify us that our hormones may be changing. But for men, it's much more subtle.
So, it is something that often happens gradually over time. And so, what I hear men say a lot is, you know, "I just don't quite feel like myself anymore. I'm just not quite keeping up the same way that I used to. But you know, maybe it's just my age." I hear that all the time, "It must just be my age. I'm not 18 anymore." And so, you know, maybe it's not fair to compare to an 18-year-old, but if you're 40 or 50, like let's not blame it on age. If you're 95, okay, fine. We'll blame it on your age. But when you're younger, even though things change, they don't have to feel that way. And so, one of the things that could be contributing to not quite feeling like yourself anymore is low testosterone.
Dr. Hedberg: One of the things I see in practice is men who, you know, they're diagnosed with low testosterone or they have the symptoms and they see their conventional medical physician and they try a testosterone, but it doesn't work at all. Sometimes they get a little bit worse. Sometimes there's really no change. What do you think the conventional medical approach is missing when something like that happens to a man?
Dr. Matthew: Oh, am I ever glad that you asked this question because this is what we deal with all day every day. So, if all we do is replace testosterone with topical gels or whatever it is, some men do feel better, like you said, some don't really feel better because there's a whole lot of factors that affect why the testosterone was low in the first place and how that new testosterone is going to react in your body. So, it's, first of all, important for us to have some basic understanding of why the testosterone was low in the first place. So, again, like if you're 95, we're going to blame it on your age. But we see low testosterone in younger and younger men. We have men in their 20s in the practice that have low testosterone.
And so, you know, if a man is in his 40s or in his 50s and testosterone is low, we still want to think about the why behind it. And there's a whole bunch of reasons you know, that I'd be happy to talk about because I think that's important. But there is lab testing that we can do to get a better understanding of the why's behind it. And then what we'd love to be able to do is address some of those factors, because if we can correct the factors causing the testosterone to be low, then there's an opportunity for the testosterone to get better even maybe without the testosterone replacement. So, that's one thing is we want to know the why behind it.
And then the next is when we're giving a man testosterone replacement, we need to make sure that it's going to work properly in their body. So, one of the things that I see, not that uncommonly is testosterone naturally, it gets converted into estrogen to some degree in all men and that's normal, but for some men, the problem is that the testosterone gets converted too much into estrogen. And there's a list of reasons why that may be, diabetes, obesity, especially like that belly fat, or inflammation in the body.
So, if a man is making testosterone into estrogen at a greater rate than they should, then the testosterone will be low and the estrogen will be higher than it should. So, now, if their doctor measures their testosterone level, finds it low, gives them more testosterone in the form of a gel or shot or whatever, then as the testosterone level goes higher, the estrogen level just goes higher too. And so, the relationship or the ratio between testosterone and estrogen is important because too much estrogen doesn't feel good for a man. So, the testosterone level might look better on their test, but they don't feel better because estrogen is getting in the way. So, that's another reason why they may not feel better even if they're on testosterone and even if their lab value goes up.
Another thing that I see that's a problem is that it's actually difficult to get an accurate testosterone blood level for men who are on topical testosterone gel, which is the most common way of giving testosterone. So, it matters how many hours it's been from when you applied the gel to when you get your lab done. So, if you get up in the morning and if a man puts the gel on, say at, you know, 8:00 a.m. and then goes to the lab and gets the lab tests done at 10:00 a.m. their level's expected to be quite a bit higher than if they went on the way home from work at 4:00 p.m. Or if they put the testosterone on their arm and then somebody sticks a needle in their arm right through the spot where they rubbed the gel, then the level could be quite high.
So, it makes it difficult to really accurately dose it based on a blood test, and you know, a lot of doctors have recognized it's not quite so perfect and it's not quite so accurate. So, they let men sit with relatively lowish levels of testosterone so that even though they're taking the testosterone, as long as their lab test isn't ridiculously low, they're told that it's fine, even if it's not that great. So, there's a bunch of reasons why just because you've been handed a prescription for testosterone and just because you've been applying it properly that it's not really doing all the things that it's supposed to be doing.
Dr. Hedberg: Right. And that's kind of the issue sometimes with conventional medicine is just looking at a single hormone and then taking a single approach when obviously everything is connected. So, one of the other things that I'll see sometimes is I might actually see elevated testosterone. It could be elevated total and elevated free testosterone, but they're not on testosterone and they have all the symptoms of low testosterone. And I might also see the sex hormone binding globulin is actually elevated. Can you talk a little bit about what might be some of the issues with that particular picture?
Dr. Matthew: So, sex hormone binding globulin that you mentioned is a protein in the bloodstream that attaches to testosterone and kind of carries it through the bloodstream. So, sometimes I describe it it's like a bus and that loads up all the testosterone molecules onto the bus so that it can't be used, and the only testosterone that your cells can use and feel is the testosterone that's free or you know, the stuff that's walking, no room for it on the bus. So, when men have a high amount of sex hormone binding globulin, a whole fleet of buses, then they can bind up most of the testosterone and there's not much left for their cells to use. So, the vast majority of the testosterone gets loaded up on the buses there's hardly any left for when they're walking.
And with age, sometimes SHBG or sex hormone binding globulin levels go high. So, for whatever given amount of testosterone a man has, like the total amount, like you said, it could even be, you know, nice and generous, but if it's all bound, if it's all on the bus, then they can't use it. So, they don't feel better. They have all the symptoms of low testosterone, but they're told that everything is normal, and that can be really frustrating.
