Uncovering Potential Roots: Fatigue & Depression in Men
This is our third installment of the uncovering potential roots series! This time we’re taking a deep dive into men’s mental health. Men also suffer - often in silence - from hormone imbalances, fatigue and depression, and there are many roots at play. Let’s start by looking at a case study:
Hank is a 41-year-old male who presents with complaints of fatigue, inability to lose weight, loss of libido, and depression.
Hank returns months later with worsening symptoms and is offered a pill for his mental health. What potential roots are at play?
Looking at Hank’s case a bit deeper reveals that he has struggled with his weight since childhood. He was made fun of in school for having “big breasts” for a man. Growing up, he tried eating a low-calorie diet and increasing exercise. However, he hit a plateau and couldn’t eat less without feeling completely exhausted.
When we look at Hank’s life from childhood, we see early signs of metabolic dysfunction. For example, men with excessive breast tissue exhibit a process called gynecomastia. It is caused by an imbalance of the hormones estrogen and testosterone, and is driven by excessive aromatase.
Aromatase
Aromatase is an enzyme responsible for converting testosterone into estrogen (estradiol). An increase in fat tissue leads to an increase in this enzyme, which leads to lower testosterone levels.
As a child, Hank was raised on a standard American diet, and his parents thought it was normal that he was a little overweight. However, as he aged and his total body fat mass continued to increase, his hormones were thrown out of whack because his excessive body fat caused his insulin levels to rise and his blood sugars to dysregulate.
When his insulin levels increases, this further impacted his aromatase levels (which were already off since childhood), which further impacted his testosterone levels and created more estrogen in his body. Estrogen acts in the nervous system and influences our neurotransmitters. It modulates our cortisol levels and the action of this hormone. An excess leads to worsening depression and anxiety.
A Closer Look
In addition, Hank was not taught how to regulate his stress response when he was younger, so he struggled with anxiety in silence. Now he works a high-stress job, and when he comes home he is exhausted and has little to give for his family. This has created even more stress on his marriage, and he feels stuck.
This also makes sense in light of Hank’s symptoms because when the body is stressed, it results in high cortisol, which eventually results in low cortisol as it burns out. High cortisol decreases a man’s production of testosterone via the “cortisol steal” as the body prioritizes managing stress over the possibility of reproduction.
Chronic stress also increases a body’s level of sex hormone binding globulin (SHBG), which binds to available hormones and keeps them from being available to fit in cellular receptors.
Bringing It Together
When a man is dealing with testosterone and stress, cortisol can be another key factor in contributing to low testosterone levels. And, when a God-designed man’s testosterone levels are low, his entire mood, bone structure and physical wellbeing could be at stake.
Cortisol also impacts blood sugar and insulin, which as we covered, creates a downstream impact on aromatase.
A high-stress state also leads to disruption of the gut lining and decreased stomach acid, which makes it difficult for Hank’s body to absorb nutrients from food and breakdown and use those nutrients. It also leads to an overgrowth of bad bacteria in his gut, which worsens fatigue, depression and low libido.
Another Look
What else could be at play?
Well, when a man has higher estrogenic activity in the body, it also increases the level of a binding protein called ceruloplasmin, which binds copper, in the blood. As a result, that man often ends up with copper-zinc imbalance issues.
Since Hank was raised on the standard American diet and not taught about food sources with bio-available copper and zinc, the lack of these nutrients combined with his estrogenic body further contributed to his symptoms as he got older.
This results in a cascade of symptoms that often end up covered with pills and diagnoses later in life that turns into a fatty liver, depression, diabetes, etc.
Healing the Roots
Getting the roots of Hank’s problems and reversing symptoms will not happen overnight and will not be fixed by taking testosterone. Testosterone might be helpful for relief, but lifestyle medicine needs to be considered. Working with someone one-on-one might be necessary. Other helpful lifestyle interventions include:
eating to balance blood sugar (avoid highly-processed foods and beverages)
avoid cooking with highly processed oils, such as canola, sunflower, vegetable and soybean (opt for olive oil, ghee, or grass-fed butter)
assessing gut status (a GI map is helpful for this)
weight lifting (this helps the body regulate hormones and blood sugar)
nutrient replacement (beef liver is nature’s multivitamin; consider increasing zinc, selenium and magnesium intake; also increase the intake of foods containing natural aromatase inhibitors, like mushrooms, celery, carrots, grapes, etc.)
consume cod liver oil
honoring the body’s stress response and learning how to support it
Recommended Testing
These are some recommended tests to request from your functionally-trained provider:
total testosterone, free testosterone, and SHBG
copper, ceruloplasmin, retinol, zinc, RBC mag (ideally drawn by someone who is competent to look at ratios)
a four-sample adrenal saliva test, in order to validate elevated cortisol
GI map to begin to reverse any overgrowth
liver panel (your hormones need to be detoxed to be regulated, otherwise they recirculate; trouble in the liver leads to worsening imbalances)
Hgb A1c, fasting glucose, fasting insulin
iron, ferritin, TIBC, transferrin
All of these should be assessed in light of your yearly bloodwork and an in-depth history.
The world is beginning to normalize obesity, working high-stress jobs, and mental health disorders, but it is incredibly important that we begin to honor the fact that our bodies are interconnected.
There are always roots at play. This is just one example of many that occur on a daily basis. I am sharing to help spread awareness and hopefully encourage you to fight to determine the root cause of your symptoms.
**As always, the above information is not medical advice. This - and all other information I share - is for educational purposes only. For medical advice, please seek out the assistance of your own primary healthcare provider.
