First, the important part: I’m not against testosterone replacement/hormone replacement (TRT/HRT) in the least, and was writing about the importance of testosterone before the internet existed and decades before the current “low T” trend seen all over the TV via the commercials these days. Readers can find various articles and vids on BrinkZone covering the topic as well as my recent teaming up with AMC to be able to directly work with people on their TRT/HRT needs. If anyone concludes I’m some how anti TRT/HRT from this article, they’d be wrong…
Having said all that, some people and medical professionals will jump quickly to TRT/HRT in individuals who may not require it, or worse, refuse to treat those that do. Each person’s situation is unique as to why they may have disturbances in their hormonal milieu, some times the reason can be ascertained via proper testing and evaluation, some times it can’t. There’s no doubt whatsoever in my view that those who need TRT/HRT will benefit if properly treated, and there’s many out there not being properly treated. Again, there’s also individuals who may show very low testosterone (T) levels but do not require TRT. That’s why it’s essential to fully evaluate each person vs. treating them as a lab number.
This is a case study I have put together of a young man who had a total testosterone level of 92ng/dl that went to 775ng/dl with no TRT or any medications used, such as Clomiphene (Clomid). Yes, it’s an extreme case but also one that demonstrates how resilient the human body and mind can be if given the proper tools to heal itself.
Note, it didn’t happen quickly nor easily but it did happen, and today he’s a much happier and healthier person. His was a perfect storm of both physical – and all too often ignored – psychological factors that lead to his extremely low T levels and what he did to reverse it. Anyone looking for a quick fix or magic pill here will be disappointed. Those who identify with him and perhaps have similar issues, hopefully this is the wake up call that leads you to address it and realize you’re not alone. The interesting thing is, he was exactly that guy who people would ask how he stayed so lean all the time. Always lean, strong, and constantly in the gym, he was the paragon of what many wanted to achieve, not knowing that under that shell was a person who felt both physically and emotionally terrible.
When I’d speak with him, I became more and more convinced his issues (as he’d mentioned depression, lack of sleep, no libido etc.) were not a matter of a change of diet or training per se, but stemmed from psychological aspects he needed to address first if long term, recovery was to take place. I also recommended getting his testosterone and other hormones checked, and suspected his excessive training, dieting, and stress levels would show his T and or other hormones far from where they should be for his age and seemingly impressive conditioning. Even I was shocked to see it came back at 92ng/dl!
What I have done is taken some key issues in bullet point form regarding his background that lead to some of the psychological components and behaviors that followed, what he was doing during the worst of it, and quoting him as needed. Finally, leaving his approach to recovery in his own words.
•Struggled with weight and body image issues growing up which worsened over time
•Struggled with disordered eating while growing up, often binge eating compulsively eat to soothe anxiety, stress and for pleasure.
•Reinforced by family environment
•Vicious cycle established where as comments by family, coaches etc regarding weight gain resulted in cycles of sadness, anxiety, and remorse followed by eating binges everyday after school and more weight gain, which re started the cycle.
• Started dieting, which resulted in “a lot of attention for losing substantial amounts of weight but wasn’t weightlifting so I became weak, frail and undernourished.”
• Started researching weightlifting and how to eat for muscle gain and started bulking via nutrition/weightlifting routines from popular web site.
• Gained muscle, received attention from peers, women, coaches, started succeeding in football, increased self confidence leading to a black and white and thinking and obsession with body image, lifting, dieting etc. and lead to dichotomous (black-and-white) approach with no balance in approach.
• By college, obsessed with bulking, cutting, weightlifting etc., and intensifies body dysmorphia and disordered eating patterns now under the guise of “counting macros/bodybuilding diets etc” which fed the behavior. Become obsessed with intermittent fasting (IF) as a means to maintain BW but start bingeing 1x/week using IF as justification
• Extremely stressful life events follow: death of brother, death of friend, school related stress, breakup with girlfriend, multiple jobs to pay for school, study for GRE’s. Back injury follows and prevents heavy lifting.
•Without heavy regular lifting as an outlet for the stress due to back injury, strict dieting returns as coping mechanism.
• Reduces BF down to 8% percent but then back injury gets worse and after reaching goals of 8 percent, bingeing returns. Regain back to 15% BF now with less muscle “feeling horribly defeated depressed sad but trying to focus more on grad school and rehabbing back”
• Go one rapid fat loss bodybuilding diet that cycles carbs and calories while full time grad school, working and “getting as ripped as possible while rehabbing back.”
Bad To Worse:
• New diet drops BF from 15% to approximately 8-9% rapidly.
• Lifting 4x/week cardio 2x/week at the start towards the end upping cardio, yohimbine hcl, and caffeine to “mobilize and lose remaining fat around abs,” but start getting injured from fatigue and feeling over-stressed.
• Increased training volume follows. Lifting 4x/week cardio 4-6x/week, start bingeing over set refeeds the diet recommends. Waking up in the middle of the night “…starving and bingeing more until going back to sleep. Can barely sleep, or function, relying on a lot of stimulants and nootropics all day everyday to keep going, can’t fall asleep or stay asleep at night. Realize that sex drive is no longer existent and haven’t desired a woman in a long time. This is terrifying and no matter what I try sex drive is gone, sleep is wrecked, anxious and stressed all the time and so I decide to stop dieting and go to the doctor”
• Stopped dieting and start going to maintenance calories
• Lab results come back finding 92ng/dl of testosterone. Follow up lab (shown) only slightly higher at just over 100ng/dl
• Pituitary tumor suspected due to such low T levels. MRIs and additional tests do not find a pituitary tumor
• Reduces cardio and maintain lifting, rehabbing injuries, but “feeling horribly about reduced lifting losing strength and everything is now getting worse and terrified to eat more. After r/o comes back negative for pituitary realize that I’ve just been dieting for too long and need to focus on recovery. This was the wake up call moment for me and I knew I had to take steps to recover fully.
Unfortunately during this time period, struggling a lot with bingeing, night time eating, seemingly insatiable hunger, insomnia, sexual dysfunction, ridiculous fatigue, GI problems, constipation, anxiety, depression, and OCD ruminations. It was a very dark difficult time period of my life before I was finally able to break free of it”
Road To Recovery:
• Started eating sufficient calories, raising them each week
• Little to no cardio
• Slowly very slowly raising training volume “as opposed to the over-training of the past”
• Correcting sleep and reducing stimulants until sleeping 7-8 hrs nightly
• Stopped fasting
• Regular meals and snacks
• lots of varied fruits and vegetables
•Raised fats to at least .45-5g/lb
• Primarily obtaining most fats from monounsaturated sources and a good amount from nutritious saturated sources i.e., lean red meat 1-2x/week (e.g., steak, liver, high quality ground beef)
•Worked on cultivating skills/mindset to reduce stress
• Regular social activities not related to food and exercise
• More sexual activity and intimacy, dating despite sexual dysfunction
• “The mental and psychological components were as critical as the physical components in my opinion as I consider them very much interrelated and I knew if I didn’t address the psychological component I wouldn’t get better.”
• “Most of all …patience. Lots and lots of patience, trust, faith, self acceptance, love, stoicism etc.”
Today: In His Own Words:
“I’m actually glad this happened because it caused me to change how I operated and approached life. It forced me to challenge my perfectionism, OCD/anxiety/depressive tendencies, my coping skills, my struggles with body image and overachieving and a variety of insecurities. I embraced CBT and mindfulness meditation and worked hard to face my fears, both on my own and with a professional, to help cope appropriately as opposed to reverting back to old cognitive distortions, fallacies and maladaptive coping skills.
My training is actually high frequency high volume now and I consume around 3300-3500+ cals on training days 4x/week at a bw of 190-195 and approx bf of 12-15% so things are working better than ever. Recently squatted 450, benched 315 and deadlifted 555 injury free and with testosterone between 670-800. Sex, anxiety, depression symptoms all resolved and feeling better than ever.
When I was diagnosed with hypogonadism, I had a test of 92ng/dl following a series of tragedies, bouts with eating disorders and severe over taxing of my body and mind.
I was devastated and felt that my life was falling apart at that time. The doctors I had met with in New York were horrendous and made me feel horrible. They were the epitome of unprofessional and shamed me at every appointment for my eating and exercising habits and dismissed me as an ‘overstressed depressed mentally unstable person who needed help,’ (their exact words). Although I was struggling with stress and depression, it was not their place to berate me with judgments and condensing comments that only made me feel worse. I needed help badly and didn’t know where to turn. Luckily I was able to connect with Will Brink who also recommended I connect with Michael Scally. These two individuals were able to guide me in the right direction and with their advice, I was able to restore my health and T levels without TRT.
I just wanted to thank these two amazing individuals for everything they have taught me as well as their support. They are the epitome of professionals and I recommend them to everyone. I hope that in time more professionals can help dismiss the lies and misconceptions so men everywhere can receive the help they need if my story sounds at all familiar.
Will Brink’s articles and consults were a great resource and helped a lot during the aforementioned dark times. He helped guide me in the right direction to healing my body and getting back on track and constantly honed in on what the real issues were, and never wavered in his advice on what I truly needed to address. He never did so with any judgment or condescension, just a steady firm push in the right direction.
If you are having trouble troubleshooting your situation I would highly recommend being honest with yourself and analyzing all of your psychosocial factors, seeing a therapist, and read as much as possible from Will Brink, especially if you require TRT. Don’t just chalk it up to stress or depression. There could be a lot more lurking under the surface.”
The fitness/bodybuilding life style can be a path to improved health, well-being and performance, or for some, it can turn into a nightmare under the right conditions. Chronic and extreme stress, extended dieting, and over training can and will crash T levels in men, and will ultimately damage your health, be you male or female. Underlying those behaviors often lurks psychological phenomena that must also be addressed to see long term changes versus simply exchanging one maladaptive behavior for another. This case study is a perfect example of that reality.
For some, TRT/HRT is a viable and highly beneficial option, but in other cases, it’s a Band-Aid to the underlying causes, and thus, again, exposing the fact each person is unique and their case/situation must be viewed as such. I hope this case study leads those readers who identify with it taking the steps to change it.
See you in the gym….