The conversation around men’s hormones tends to begin and end with testosterone. A man feels tired, gains weight, loses muscle, struggles with libido, or develops erectile dysfunction, and the immediate question becomes: “What’s his testosterone level?” What often gets overlooked, however, is that men experience a cascade of physiological changes that testosterone on its own can’t fix.

While testosterone certainly matters, focusing on testosterone alone is much like focusing on estrogen alone in women. Hormones do not operate in isolation. They are influenced by gut health, blood sugar regulation, inflammation, liver function, nutrient status, stress, sleep, and environmental exposures. If those fundamentals are compromised, simply changing a hormone level rarely produces the transformation people are hoping for.

One reason male hormone issues often go unrecognized is that they lack the obvious hormonal milestones women experience. Many women have a monthly cycle that provides feedback when something is shifting. Men don’t have a comparable monthly signal. Instead, hormonal changes tend to show up gradually as weight gain, fatigue, declining motivation, worsening metabolic health, reduced libido, fertility challenges, or erectile dysfunction. These symptoms are often considered to be separate issues rather than recognized as pieces of the same puzzle.

That puzzle frequently involves andropause, which is the gradual age-related decline in androgen-dominant hormones. Increasingly, however, younger men are facing functional andropause where testosterone levels, overall hormone balance, and metabolic health begin to decline long before age alone would explain it.

The good news is that low testosterone is not always the primary problem. Sometimes, it is the messenger. When we identify and address the underlying factors suppressing hormone production and balance, we can frequently improve a man’s health, vitality, and hormone status without starting with testosterone replacement therapy.

That’s exactly what happened with Peter.

The Real-Life Impacts of Andropause

Peter came to work with me at age 40. He had about 30 pounds he wanted to lose and no motivation to actually do it. He’d recently remarried. He and his wife were hoping to conceive, but he was struggling. On top of the weight and flat energy, he was also dealing with erectile dysfunction and a stubbornly high LDL.

At first glance, this could look like four different issues (and is often addressed as such), but to help Peter reclaim his life and build a future with his new wife, we had to tackle his symptoms from a root-cause perspective.

Testosterone Is Not the Whole Picture

Here’s the trap I watch men fall into: they get a testosterone test done, see a low number, start supplementing, and wait to feel better. They may see a bump in their libido, but frequently their other symptoms remain the same or worsen. Why is this?

Testosterone is not made or cleared in a vacuum, and topping up the end product does nothing for the system that produces and metabolizes it. With a root-cause approach, we often find one or more of the following factors contributing to hormone imbalance:

• Aromatization. Aromatase converts testosterone into estrogen, and it lives most densely in fat cells, especially around the belly. The more visceral fat a person has, the more aromatase there is, and the more testosterone is converted to estrogen. Belly fat essentially becomes its own estrogen factory. And don’t assume your lean clients are off the hook because blood sugar issues and chronic stress drive this process too.
• Estrogen that won’t leave. Estrogens get conjugated in the liver and ideally are discarded through bile and urine. But when gut beta-glucuronidase runs high, it deconjugates estrogen on its way out, causing it to be reabsorbed. In turn, this pushes the total estrogen load back up (Baker et al., 2017).
• A whole system that’s suppressing production. Subclinical hypothyroidism, chronic inflammation, dysglycemia, and a stressed HPA axis each have the potential to impair testosterone production and overall hormone balance.

When these underlying issues are left unaddressed, adding testosterone often becomes little more than a temporary patch. What’s worse is that without addressing the fundamentals, testosterone may aromatize into estrogen and natural testosterone production can continue to lag.

1. Fuel for Hormone Production

This is the fundamental that sounds too simple to matter, and it’s often the one holding everything back.

The entire hormone pathway is built from cholesterol, and the downstream hormones are made from fatty acids, so chronically low-fat or low-protein eating starves the body of the raw materials it needs for hormone production. I see this a lot in current and former vegetarians and vegans, and in men who’ve simply lost their taste for protein.

Minerals matter just as much. For example, zinc is required for testosterone synthesis, and when zinc is deficient, the Leydig cell can’t properly convert precursors into active hormones (Te et al., 2023). Magnesium is a cofactor for hundreds of reactions, including the phase II detoxification pathways that help clear excess hormones.

On the flip side, too few carbohydrates can also backfire. Strip glycogen too far and you’ll push cortisol up, which can in turn raise blood sugar. We’re after whole-food complex carbohydrates, weighted toward fruits and vegetables, not carbohydrate zero. A CGM can be your best friend here so that you can identify how many carbohydrates, and what types, are best for each person.

Lastly, don’t forget water. Hydration supports circulation, liver function, and detoxification, all of which play an important role in healthy hormone metabolism.

2. Address Toxins and Heal Gut Function

I start with the gut in nearly every case because the gut is the foundation upon which the rest of the endocrine system is built. However, if a significant toxic burden is present, that must be addressed first. Environmental toxins can interfere with hormone signaling, detoxification pathways, immune regulation, and gut integrity. In particular, certain mold-derived mycotoxins have been shown to possess endocrine-disrupting properties and may influence reproductive hormones, thyroid function, fertility, and inflammatory signaling pathways (Kościelecka et al., 2023).

In some individuals, meaningful progress with gut and hormone restoration may be difficult until the source of ongoing toxin exposure has been identified and addressed. Once the toxic burden has been reduced and the body is no longer fighting an ongoing assault, the path is paved for deeper healing.

When addressing gut health through a hormone lens, two factors matter most.

First, the estrobolome.

The estrobolome is the collection of gut bacteria involved in estrogen metabolism. A dysbiotic microbiome often produces excess beta-glucuronidase, which is an enzyme that deconjugates estrogen and allows it to be reabsorbed rather than eliminated. The gut microbiome is now understood to be an important regulator of sex hormone balance (He et al., 2021), and recent research suggests that gut dysbiosis may contribute to lower testosterone levels through multiple pathways, including increased systemic inflammation, disruption of the HPG axis, impaired intestinal barrier function, and alterations in hormone metabolism (Pakpahan et al., 2025; Kaltsas et al., 2025).

Peter’s GI-MAP findings reflected this pattern precisely, showing both microbial dysbiosis and elevated beta-glucuronidase activity.

Second, the gut regulates inflammation and nutrient absorption, both of which directly impact hormone production.

Chronic intestinal inflammation can impair the absorption of key nutrients required for hormone production and metabolism, including zinc, magnesium, B vitamins, vitamin D, essential fatty acids, and protein. At the same time, inflammatory cytokines can negatively influence hormone signaling throughout the body. If the gut is inflamed and nutrients are not being absorbed efficiently, hormones cannot be produced or utilized optimally.

You have to fix the soil before you fuss over the plant.

For Peter, this meant addressing dysbiosis, supporting microbial diversity, improving digestion, and reducing the inflammatory burden coming from the gut. Before we tackled his hormones, we had to focus on creating an internal environment where healthy hormone production could occur naturally.

3. Blood Sugar Regulation Is Critical

If I had to name the single most common root stressor in the 40-something male (or, in many cases, younger than 40), it’s blood sugar. It interferes with nearly every metabolic function, and I’ve learned the hard way that the deeper hormonal corrections simply won’t hold until it’s addressed.

Here’s how it works: Glucose spikes, and then insulin spikes to clear it. Chronically high insulin keeps the body in fat-storage mode, which contributes to belly fat and, in turn, upregulates aromatase. As mentioned earlier, more aromatase means more testosterone is shunted to estrogen.

The relationship between blood sugar and testosterone is well documented in the research: men with diabetes consistently have lower testosterone levels than men without diabetes (Beatrice et al., 2014). In the NHANES III study, men with the lowest free T levels (the bottom third of the population) had approximately four times greater odds of having diabetes compared with men with the highest free testosterone levels (the top third), highlighting the strong relationship between testosterone levels and metabolic health (Selvin et al., 2007).

This is where a CGM earns its keep. With Peter, CGM data made his glucose roller coaster visible in a way no fasting lab ever had, and once he could see it, he could change it.

4. Hunt Down the Inflammation

Chronic, low-grade inflammation quietly degrades hormone production and places stress on not just the endocrine system, but the entire body.

Preclinical research shows that inflammatory cytokines directly interfere with testosterone production in the testes, reducing the ability of Leydig cells to manufacture hormones (Mauduit et al., 1998; Leisegang & Henkel, 2018). Inflammation can also alter hormone transport and signaling throughout the body, creating a situation where hormone levels may look acceptable on paper while symptoms persist.

Gut dysfunction and diet are two of the most common drivers of chronic inflammation. A highly processed, high-glycemic diet can contribute to intestinal permeability and systemic inflammation, while food sensitivities can keep the immune system on high alert. This is why I often pair food-sensitivity testing with a comprehensive gut-healing strategy.

Beyond the gut, I also look for other hidden sources of inflammation, including chronic infections, unresolved injuries, overtraining, poor sleep, ongoing psychological stress, toxin exposure, and impaired detoxification pathways.

For Peter, reducing inflammation wasn’t a separate goal from improving testosterone. It was one of the primary ways we helped him to holistically heal, which, in turn, rebalanced his hormones overall.

5. Give the Liver Some Love

Hormone balance isn’t just about producing hormones. It’s also about clearing them. We can’t effectively rebalance hormones on top of a liver and gut that aren’t equipped to process and eliminate them.

The liver is one of the body’s primary hormone-processing organs. Once hormones have done their job, they must be broken down, packaged, and eliminated. When liver function becomes overwhelmed or sluggish, hormones and other compounds may not be cleared efficiently, creating a backlog that can contribute to hormonal imbalances.

The good news is that liver detoxification pathways rely heavily on nutrients that we can support through optimizing gut function, a nutrient-dense diet, and targeted supplementation. B vitamins, sulfur-containing foods, amino acids, antioxidants, and vitamin C, to name just a few, all play important roles in helping the liver process and eliminate hormones efficiently.

6. The Hidden Jewel – The Adrenals

Stress management and sleep optimization aren’t optional extras. They are foundational approaches that create the conditions for hormone healing to occur.

This is the fundamental men love to wave off, and in male physiology it’s one of the most important, partly because of a detail that surprises people: in men, the adrenals are a primary producer of progesterone. Progesterone plays a critical role in male hormone balance by helping regulate testosterone, estrogen, and DHT levels while also supporting prostate, brain, bone, and thyroid health. Because men produce progesterone through the adrenal glands, chronic stress and HPA-axis dysfunction can significantly disrupt hormonal balance. In addition to progesterone, the adrenal glands produce several hormones that influence testosterone balance, including DHEA and cortisol. When adrenal function becomes compromised, the effects can ripple throughout the entire endocrine system.

Chronic stress is particularly disruptive. When the body remains in a prolonged state of stress, cortisol production can become dysregulated, creating downstream effects on blood sugar, thyroid function, immune health, recovery, and hormone production. Research shows that the HPA axis directly suppresses the HPG axis, making stress a true upstream driver of low testosterone rather than simply a consequence of it (Nargund, 2015).

Sleep belongs in this conversation as well because the endocrine system cannot regulate without adequate recovery. Much of the body’s repair, regeneration, and hormone production depends on restorative sleep.

7. Hormone-Specific Supports

For Peter, I ran a DUTCH panel. His cortisol, DHEA, and progesterone levels were all low, while his androgen levels were suppressed and his estrogen levels were trending high-normal.

We were already in the process of addressing the fundamentals to support hormone production and balance. By the time we layered on hormone supports, we had already empowered his body to make the best use of them.

Based on the results from his DUTCH test, we brought in supplements to address DHEA and cortisol alongside estrogen-clearance and testosterone-boosting supports. One important thing we did not do—we didn’t bring in a testosterone prescription. It’s not that this would have been wrong. Instead, we decided to address the fundamentals first, remove the roadblocks, provide Peter with the building blocks he needed for hormone balance and production, and most importantly, allow time for his body to go to work through these interventions.

Healing Takes Time, but It’s Worth It

Peter worked through all seven of the fundamentals: food and hydration, toxins, gut health, blood sugar, inflammation, liver, the adrenals, and finally hormone support.

After six months of work, Peter’s DHEA had normalized, and his progesterone, estrogen, and testosterone were making considerable strides toward normal. His testosterone still wasn’t where I ultimately wanted it, but it was heading in the right direction because we’d rebuilt the system that makes and balances it instead of just topping off the tank.

One year after Peter and I concluded our work together, he and his wife had a baby girl. He sent me a message shortly after her birth saying, “That was some hard stuff I went through working with you, but I’m so grateful because I have my girl AND I have the energy to show up for her the way I want to.”

Don’t settle for temporary fixes. Learn more about our systems-based approach to male hormone health and start your journey toward lasting vitality. Start your training here.

References

• Baker, J. M., Al-Nakkash, L., & Herbst-Kralovetz, M. M. (2017). Estrogen–gut microbiome axis: Physiological and clinical implications. Maturitas, 103, 45–53. https://doi.org/10.1016/j.maturitas.2017.06.025
• Beatrice, A. M., Dutta, D., Kumar, M., Kumbenahalli Siddegowda, S., Sinha, A., Ray, S., & Chowdhury, S. (2014). Testosterone levels and type 2 diabetes in men: Current knowledge and clinical implications. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 7, 481–486. https://doi.org/10.2147/DMSO.S50777
• He, S., Li, H., Yu, Z., Zhang, F., Liang, S., Liu, H., Chen, H., & Lü, M. (2021). The gut microbiome and sex hormone-related diseases. Frontiers in Microbiology, 12, Article 711137. https://doi.org/10.3389/fmicb.2021.711137
• Kaltsas, A., Giannakodimos, I., Vasilopoulos, G., et al. (2025). The androbactome and the gut microbiota–testis axis: Emerging insights into male reproductive health. International Journal of Molecular Sciences, 26(13), 6211.
• Kościelecka, K., Kuczyńska, B., Wiśniewska, A., et al. (2023). Endocrine effect of some mycotoxins on humans. International Journal of Molecular Sciences, 24(19), 14744.
• Leisegang, K., & Henkel, R. (2018). The in vitro modulation of steroidogenesis by inflammatory cytokines and insulin in TM3 Leydig cells. Reproductive Biology and Endocrinology, 16(1), Article 26. https://doi.org/10.1186/s12958-018-0341-2
• Mauduit, C., Gasnier, F., Rey, C., Chauvin, M.-A., Stocco, D. M., Louisot, P., & Benahmed, M. (1998). Tumor necrosis factor-α inhibits Leydig cell steroidogenesis through a decrease in steroidogenic acute regulatory protein expression. Endocrinology, 139(6), 2863–2868. https://doi.org/10.1210/endo.139.6.6077
• Nargund, V. H. (2015). Effects of psychological stress on male fertility. Nature Reviews Urology, 12(7), 373–382. https://doi.org/10.1038/nrurol.2015.112
• Pakpahan, C., Laurus, G., Hartanto, M. C., Singh, R., Saharan, A., Darmadi, D., Rezano, A., & Wasian, G. (2025). Potential relationship of the gut microbiome with testosterone level in men: A systematic review. PeerJ, 13, Article e19289. https://doi.org/10.7717/peerj.19289
• Selvin, E., Feinleib, M., Zhang, L., Rohrmann, S., Rifai, N., Nelson, W. G., Dobs, A., Basaria, S., Golden, S. H., & Platz, E. A. (2007). Androgens and diabetes in men: Results from the Third National Health and Nutrition Examination Survey (NHANES III). Diabetes Care, 30(2), 234–238. https://doi.org/10.2337/dc06-1579
• Te, L., Liu, J., Ma, J., & Wang, S. (2023). Correlation between serum zinc and testosterone: A systematic review. Journal of Trace Elements in Medicine and Biology, 76, Article 127124. https://doi.org/10.1016/j.jtemb.2022.127124

Ishbel Cavaleri

FNTP, MRHP

Ishbel is the founder of The Gutsy Hormone, where she specializes in a gut-first approach to hormonal health. She is a Certified Life Coach, Master Restorative Wellness Practitioner, Functional Nutritional Therapy Practitioner (FNTP), and ReCODE 2.0 Practitioner.

In addition to her private practice, Ishbel serves as the Integrative Clinician within a functional medicine practice specializing in Chronic Inflammatory Response Syndrome (CIRS) and cognitive decline. Her work bridges functional nutrition, advanced lab interpretation, and mindset-based behavior change to help clients address complex, chronic health concerns at their root.

Read more about Ishbel