Dr. med. Peter Niemann in an expert interview – Testosterone: A fascinating hormone for health and well-being

The hormone testosterone is often exclusively associated with potency. However, this naturally occurring substance plays a role in numerous bodily functions, including those of the nervous system and the heart. It is often overlooked that the so-called "male hormone" also significantly impacts women's health and well-being. In cases of low testosterone levels, substitution therapy is often the preferred clinical approach. From an integrative medicine perspective, however, maintaining a healthy lifestyle—including a balanced, nutrient-rich diet, healthy body weight, and effective stress management—is especially essential for regulating testosterone levels.

serotalin®: Prof. Dr. Niemann, could you please briefly explain what testosterone is and what role it plays in the human body?

Dr. Niemann: Testosterone is a hormone, or messenger substance, that influences organs far from its production site. As the name suggests, testosterone is primarily produced in the male testes. Despite its origin, its effects extend across the body. The hormone impacts the testicles, sperm production, and sexual function, but also influences the brain, muscles, heart, and even lungs. Testosterone receptors are found throughout the body.

serotalin®: How do testosterone levels differ between men and women, and what impact do these differences have on health?

Dr. Niemann: It's fantastic you mention that women also have testosterone—it’s often forgotten. Testosterone is vital for women, too, and is produced in smaller amounts in the adrenal cortex and ovaries. Some colleagues even prescribe it to women for conditions like libido dysfunction or chronic pain. In men, production is significantly higher due to the testes, especially after puberty. Male testosterone levels are about 10 times higher than female levels. This ratio remains consistent, though it varies slightly between pre- and postmenopausal women.

serotalin®: Testosterone influences various health aspects, such as muscle mass, fertility, mood, and energy. Could you elaborate on how these processes are regulated by testosterone?

Dr. Niemann: Another very interesting question. As I said at the beginning, in principle all organs of the human body are influenced by testosterone. There are numerous testosterone receptors that occur in varying densities, which partly depend on age and genes. These receptors work according to the key-lock principle: a hormone or messenger substance - i.e. a protein - docks onto these receptors, which triggers a biochemical reaction in the target cell. These receptors are distributed throughout the body, with some areas having a higher concentration.

For example, men's muscles have a relatively high density of testosterone receptors. These lead to an increase in muscle efficiency and metabolism, which means that muscle mass increases without much effort. If a man then trains additionally, he experiences a disproportionate increase in muscle mass. In the case of bones, testosterone causes bone mass to become stronger and more robust, which means that men suffer less from bone loss or osteoporosis. This happens through increased activity of the osteoblasts, which build bone mass, and reduced activity of the osteoclasts, which break down bone.

There are certain areas of the brain with high concentrations of testosterone, such as the limbic system, which is responsible for energy and emotional balance. Higher testosterone levels lead to less anxiety, more self-confidence, and greater attractiveness to women. In addition, men with more testosterone are more resistant to stress. Testosterone can influence the processing and release of pain signals in the spinal cord, which means that people with higher testosterone levels are more resistant to pain. It is also believed that testosterone reduces inflammatory processes in nerve cells, which can lead to lower rates of depression and more energy. Finally, testosterone also influences the heart by increasing its efficiency and muscle mass , which contributes to physical fitness.

serotalin®: What symptoms and health effects are associated with testosterone deficiency (hypogonadism), and how is it diagnosed?

Dr. Niemann: Symptoms range from sexual dysfunction and infertility to muscle weakness, depression, and cognitive issues. Diagnoses can involve questionnaires or direct testosterone level measurement. Integrative medicine emphasizes a comprehensive approach, considering symptoms and related factors like vitamin deficiencies or thyroid dysfunctions. Testosterone levels can fluctuate, so repeated tests are often necessary.

Regarding the diagnostic options: There are many ways to diagnose testosterone deficiency - for example, simply by using certain questionnaires or by asking about certain symptoms of testosterone deficiency such as tiredness, lethargy and erectile dysfunction. For a 50-year-old man, the clinical approach would be to try therapy with testosterone. However, this approach is not my preferred approach. The other option - which is also not my preferred approach - is to simply determine the testosterone level. This is then compared with certain values, although there are different threshold values ​​that are associated with testosterone deficiency. If this value is not met, testosterone substitution is recommended.

As an integrative medicine practitioner, I am naturally a fan of a more complex approach: I first ask my patient to describe their symptoms in detail. If I suspect that testosterone could play a role, I not only determine the testosterone level, but also numerous other parameters such as various vitamins, etc. If the testosterone level is low, I check it again after two weeks, as it can vary. If the level is also low in the second test, I would show my patient a variety of treatment options.

serotalin®: Could you outline the options for testosterone therapy? Who could benefit, and what types are available?

Dr. Niemann: There are many ways to treat a testosterone deficiency. First of all, men with low testosterone levels and the associated symptoms should think about increasing their testosterone levels. According to my colleagues, one third of all men over the age of 45 in Western countries suffer from a testosterone deficiency.

The two simplest and most effective therapeutic measures are direct testosterone intake:

1. Testosterone gel : This gel is applied daily to the lower abdomen or thigh, where it is quickly absorbed and leads to an immediate increase in testosterone levels. It is easy to use, but care must be taken to ensure that it is not accidentally absorbed by children or partners immediately after application.
2. Testosterone injections : These depot injections are given every few weeks. Some men prefer this method because they ensure a constant testosterone level and do not require daily applications.

In addition to these direct measures, there are also indirect approaches that I also find important. These include:

1. Dietary supplements : In my experience, certain dietary supplements such as zinc and selenium can moderately increase testosterone levels. They are not as effective as direct testosterone supplements, but in my opinion can be helpful in supporting them.
2. Holistic approaches : A comprehensive examination can reveal other causes of testosterone deficiency. These include thyroid problems, vitamin deficiencies (vitamin B12 or folic acid) or heavy metal poisoning. Correcting these problems can not only improve testosterone levels but also increase general well-being. In my book, I have described a little more than a dozen therapeutic approaches. My holistic approaches go beyond conventional medicine and often include integrative or holistic medicine.

serotalin®: What risks and side effects are associated with testosterone therapy and how can these be minimized? Can you also discuss the risks of anabolic steroids?

Dr. Niemann: The most common and most discussed side effect of testosterone preparations is the increase in cardiovascular risk - that is, the risk of a heart attack or stroke. This topic has been studied for decades and is complex and controversial. The latest studies suggest that testosterone either does not increase cardiovascular risk at all or only increases it minimally. Nevertheless, you should be aware of the possible risk and have your heart function checked before starting testosterone therapy - ideally by a cardiologist.

Other risks and side effects include the usual risks of an injection such as pain, infection and redness. The specific side effects of testosterone include irritation, increased aggressiveness and occasionally headaches, dizziness and eating disorders, especially at the beginning. Overall, however, testosterone is well tolerated. In order to minimize these risks, in addition to the cardiological examination before testosterone therapy, you should remain in close contact with the prescribing doctor during treatment. If necessary, the dosage must be adjusted or the application form changed. Overall, I consider testosterone to be a valuable treatment option for many men - but this should be done with caution and under medical supervision.

However, the unregulated abuse of anabolic steroids is risky and dangerous. These substances may also be contaminated. Such preparations can significantly increase cardiovascular risk and lead to testicular atrophy, which can affect fertility. They can also cause skin problems such as acne and hypertrophied heart muscle, which negatively affects blood circulation.

serotalin®: How do lifestyle factors such as diet, exercise, stress and sleep affect testosterone levels? Are there any natural methods to increase testosterone levels that you can recommend?

Dr. Niemann: I think the least used area, but also the most difficult to implement, is lifestyle. In my opinion, lifestyle is responsible for at least two thirds of testosterone deficiencies. In many Western countries, we have been observing declining testosterone levels for decades. This is an undeniable fact. If you look more closely at the causes, it is usually the lifestyle factors that cause problems: an unhealthy diet, poor environmental conditions, psychological problems and sleep disorders - to name just a few.

When it comes to diet, it seems that highly processed foods, also known as ultra-processed foods, have a negative impact on overall health and testosterone levels. If young people eat frozen pizza, cookies and chips every day - all highly processed products - this leads to lower testosterone levels in the medium term (three to five years). A better diet includes fruit, vegetables and - fortunately for many men - meat, ideally in the form of organic meat. There is evidence that a diet rich in meat can improve testosterone levels. It is also important to drink high-quality water, as water quality is not optimal everywhere.

Being overweight is also another major factor that reduces testosterone levels, as fat tissue produces estrogens that counteract testosterone, so try to stay fit. Stress is another factor that can lower testosterone levels, as it leads to increased cortisol production. Long-term stress reduction and avoiding lack of sleep can be difficult, but in my opinion it is necessary. Excessive screen time should also be avoided, as this is often associated with unhealthy diet, lack of exercise, and little sunlight. There is also evidence that electromagnetic radiation, such as from cell phones, can lower testosterone levels, so men should not carry their phone in their pockets, and women should not keep it near their abdomen because of the ovaries. Marijuana has also been shown to be harmful to the testicles and brain, and lowers testosterone levels.

I recommend zinc and selenium as two important nutrients because I have found that they can support testosterone levels. I am a fan of making positive life changes to improve long-term health. This is the harder route but the more effective in the long term. However, if that is not feasible, testosterone can also help and I think it is generally good that this option is available.

serotalin®: You have had an impressive international career with a wide range of medical training and experience. How has your diverse medical training, including your studies in acupuncture and integrative medicine, influenced your view on the treatment of testosterone deficiency and other chronic conditions?

Dr. Niemann: It has definitely changed my perspective: Since I saw conventional medicine as the ultimate solution during my training and early career, 12 years ago I would have spoken almost exclusively about testosterone and second-line therapies in this conversation - and hardly mentioned anything about other approaches. I have now gained a more global understanding and realized how massively testosterone levels have declined in the Western world. Men and women suffer equally from this and I realized that the problem is much more complex than a simple deficiency that can be remedied with one or two preparations.

Today I see people as much more complex, which has made my work more difficult but also more fulfilling. I used to think that an antibiotic or a daily testosterone gel would be enough to solve health problems. But I have now learned that holistic approaches such as acupuncture, hypnosis, nutritional supplements, lifestyle changes and manual therapy combine numerous benefits. These holistic methods have also proven to be more effective in my own life.

Conclusion:

In short: I am grateful that we have had so much space and time to talk about testosterone levels. There are many effective strategies for treating testosterone deficiency. Testosterone replacement is a useful therapy, but we should not forget that there are many other options that are also very effective. I have only touched on a few of the many in this interview.

About the author:

Dr. Peter Niemann, a specialist in internal and integrative medicine and a specialist in geriatrics, advises his patients in his practice on the basis of comprehensive expertise and empathy - in the sense of holistic treatment. As an expert on the subject of testosterone, Niemann has written the book "Power hormone testosterone: Why it is so important for men and how you can increase it naturally - for more health, fitness and endurance". Dr. Peter Niemann's expertise is rounded off with anti-inflammatory therapy approaches, acupuncture and holistic anti-aging management.