Optimizing Testosterone to Avoid or Improve PTSD: Getting Proactive for PTSD Awareness Month

Optimizing Testosterone to Avoid or Improve PTSD: Getting Proactive for PTSD Awareness Month 
by Bryan Stephanenko

PTSD is not a one-size-fits-all condition. The single label is misleading for healthcare teams as it seems to discount the unique genetic, lifestyle, and environmental factors that contributed to each patient’s symptoms once they meet diagnostic criteria. The diagnosis is often disempowering as well – telling the person it’s not their fault, they are broken, and they require medications or specialists to fix what is wrong with them. A colleague of mine (Geoff Dardia, Founder of the Special Operations Forces Health Initiative at Task Force Dagger Foundation) refers to this model of care as the “name it – blame it – tame it – bill it – refill it” approach… and it’s a problem. 

As a Functional Medicine-trained physician treating the soldier and veteran population, I am taught to look closely at the genetic-lifestyle-environment interaction over time and to continuously ask why. I look for what might have set this person up for the condition (antecedents), what might have triggered it (triggers), and what continues to drive the disease process (mediators). For military and first responder community members, I specifically look for things like head injuries, repeat blast-wave exposures, chronic stress, sleep deprivation, and exposure to the heavy metals or toxins associated with munitions or their job. 

These factors contribute to the total brain and body burden that leads to root cause dysfunction. On the battlefield, root cause dysfunction leads to loss of lethality, loss of combat effectiveness, and, ultimately, loss of life. On the home front, root cause dysfunction leads to relationship strain (between family, peers, and command); a loss of trust and support; isolation and separation from the military community; and, ultimately, loss of mission, purpose, and focus – which can be a death sentence for some (suicide).

In honor of June as PTSD Awareness Month, I focus below on how to address root cause dysfunction by optimizing the hormone Testosterone. Testosterone is specifically related to the risk of developing PTSD (antecedent) and can be a driver (mediator) of the disease process. Testosterone is more generally related to energy levels, muscle mass, mental clarity, cognitive function, sexual performance, and sense of well-being – which everyone wants. Being low in Testosterone can also lead to symptoms that may get incorrectly diagnosed as PTSD, depression, anxiety, or metabolic syndrome – which nobody wants. 

In explaining ways to optimize your Testosterone to lower your risk of PTSD or improve your quality of life despite a PTSD diagnosis, I will use the mnemonic “P-T-S-D” which stands for the steps in hormone metabolism: Production, Transformation, Transportation, Sensitivity, and Degradation.  

Each term is defined below in the context of Testosterone metabolism and then paired with a few simple take-away points and actionable items. These actionable items can be safe and easy to implement today to begin optimizing your Testosterone activity tomorrow.

Production: how the body converts raw materials – digested and absorbed through your gut – into testosterone. 

• Takeaway #1: High-quality healthy fats and dietary cholesterol are key.

  • Action: Buy grass-fed, organic, free-range, wild-caught animal products (meats, eggs, real butter, and dairy products) when possible. If not, eat plenty of vegetables with your protein. The fat of the animal holds most of the pesticides, toxins, and hormones that animal was exposed to and can contribute to inflammation and metabolic disruption when you eat it. Eating plenty of vegetables (like broccoli, cauliflower, asparagus, onions, and garlic) can buffer some of the impact of conventional animal products. 

• Takeaway #2: Your body makes testosterone while you sleep.

  • Action: Track your sleep with activity trackers (wearable technology) and get at least six hours of restful sleep. You should wake up feeling refreshed with minimal interruptions.If not, get more information or a medical evaluation.
    
  • Action: Avoid alcohol or sleep medications as much as possible as they interfere with sleep quality and prevent your brain and body from getting to the stage of sleep where you make hormones (deep stages 3 & 4; delta-wave sleep).
  • Action: Maintain Routine & Rhythm – your body relies on biorhythms to make and manage the right hormones at the right time. Have a similar “wind-down ritual” and start it around the same time each night.
    

• Takeaway #3: Production relies on Vitamin D, Zinc, Selenium, and Magnesium.
  

  • Action:  Eat your veggies, 5 – 8 servings daily, various colors, especially ones containing the nutrients listed.
  • Action: Consider supplements in the form of a high-quality multivitamin and 2000 – 4000 IU of Vitamin D3 daily. For higher quality supplements, avoid purchasing online (like Amazon) and look for USP or NSF seals of approval on the bottle. 

Transformation: How the body makes the right version of the hormone that the body knows how to use.

• Takeaway #1: Stress diverts resources the wrong way.

  • Action: Use wearable technology (like Oura Ring), apps (like HRV4Training), or biofeedback devices (like HeartMath) to track Heart Rate Variability (HRV). HRV is an indirect marker of how stressed the body is. Be mindful it represents the total stress on the body, including psychological stressors, over-training, poor sleep, substance use, heat stress, and worry/anxiety. Consistently low HRV scores (low ‘coherence’) mean your body is stressed and stuck in a fight-or-flight mode. 

• Takeaway #2: Inflammation is a metabolic stressor.

  • Action: Avoid smoking, alcohol, fried foods, added sugar, sodas, processed foods, and pesticides as much as possible.
  • Action: Include Protein, Fiber (I mean vegetables and beans), and healthy fats in each meal to stabilize blood sugar. Blood sugar spikes lead to insulin spikes which create inflammation and increase the loss of testosterone to estrogen.
  • Action: Eat the protein and vegetables on your plate first before you eat the starches and carbs. This minimizes insulin spikes from your food, which spark inflammation. 

Transportation: How the body shuttles the hormone around the body and gets the active version to organs that need it. 

• Takeaway #1: Testosterone is typically bound to a protein called Sex Hormone Binding Globulin (SHBG) and released when ready to use.
  
  
  • Action: Do all of the other things listed in this article and you’ll likely maintain a healthy balance of SHBG – especially maintaining an optimal body fat amount and distribution; sleeping 6 – 8 hours nightly; and eating 5 – 8 servings of vegetables daily. 

Sensitivity: How well the organs and tissues of the body respond to the active hormone – yes, you can have good numbers and still have low testosterone activity!

• Takeaway #1: The right type of exercise increases sensitivity.
  

  • Action: Perform heavy resistance exercise at least every 48 – 72 hours, try to keep lifting sessions less than 1 hour (androgens and adrenaline start to drain), keep short rest intervals between sets (60 – 90 seconds), and don’t skip leg days (biggest metabolic impact – besides… friends don’t let friends skip leg day).
    

• Takeaway #2: Testosterone receptors rely on zinc, selenium, and thyroid hormone.

  • Action: Eat foods that contain zinc and selenium; consider a high-quality multivitamin as stated above in “Production – Takeaway #3.”
  • Action: If you’re doing everything right and still not feeling right, request bloodwork to evaluate thyroid and other hormones to rule out a bigger problem. Otherwise, most of the lifestyle and nutrition things that maximize testosterone will also balance thyroid hormone metabolism.
    

• Takeaway #3: Consider a short trial of Maca (Peruvian Ginseng) for 1 – 2 weeks.
  

  It comes in a powder form and can easily be added to shakes, drinks, and foods. Do this with professional supervision, find a high-quality supplement (see “Production – Takeaway #3 above”), start low, and communicate any unwanted side-effects. Specifically, maca may increase testosterone activity – without increasing measurable testosterone levels – by increasing the sensitivity of testosterone receptors around the body. Generally, maca is an “adaptogen” which helps the body deal with metabolic stressors and maintain metabolic balance (resilience) in the body. 

Degradation: How the body breaks testosterone down into other hormones (like Estrogen or Dihydrotestosterone [DHT]) and metabolic waste. 

• Takeaway #1: Decrease “aromatase” enzyme activity – which converts androgens (testosterone and its close cousins) to estrogens.

  • Action: Get a body fat or body composition assessment, then maintain a healthy amount and distribution of body fat. Aromatase activity goes up with high body fat. High aromatase activity means your testosterone is being converted to estrogen.
  • Action: Stabilize blood sugar to avoid insulin spikes which increases aromatase activity in addition to sparking inflammation. See “Transformation – Takeaway #2” above.

• Takeaway #2: Optimize “5-alpha reductase” enzyme activity – which converts testosterone to DHT (a double-edged sword; more potent androgen but leads to prostate enlargement and male-pattern balding).

  • Action: Eat foods and vegetables containing Zinc and Selenium.
  • Action: Consider herbs (like saw palmetto) and other nutrients that balance this enzyme’s activity.

• Takeaway #3: High Fiber + Enough Water = Good waste removal

  • Action: Have at least one bowel movement daily.
  • Action: Drink at least 64 oz of water, more on training days, and much more (with electrolytes) when training in the heat.

The intent of providing this information is to give you a good place to start – time now – on something that can address root-cause dysfunction, unravel complex health conditions, and improve quality of life. While the actions above are generally safe, raising testosterone activity and taking certain supplements can come with risks that should be discussed with your primary care provider before getting started.

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Bryan Stepanenko, MD MPH IFMCP is an Army Family Physician that plans to serve a full career bringing Personalized Lifestyle & Integrative Medicine that addresses root cause dysfunction to military service members and their families. He lectures internationally on the role of Functional Medicine and Shared Medical Appointments in caring for our warfighter community, as well as the Military Operational Environment and Root Cause Dysfunction. He serves as teaching faculty for the DoD’s only Functional Medicine training pathway through the National Capital Region Pain Initiative, which is based out of Walter Reed. He accepted a military scholarship to attend medical school in Florida at the University of Miami where he completed a dual degree program (Medical Doctorate & Masters in Public Health). He completed residency training at Martin Army Community Hospital in Fort Benning, Georgia, and is currently licensed and practicing in the Military Health System. 

DISCLAIMER: The information and perspectives in this article are solely the opinions and perspectives of the author and do not represent the Army, Military Health System, or Defense Health Agency more generally. 

© 2020 The Havok Journal

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