Male Sexual Performance with Dr. Deb Matthew

In this episode of Functional Medicine Research, I interview Dr. Deb Matthew about her new book on male sexual health “Why Can’t I Keep Up Anymore?: A Guide to Regaining Energy, Focus, and Peak Physical & Sexual Performance for Men Over 40”. We discussed the causes of male sexual dysfunction, lab testing, causes of low testosterone, stress and cortisol levels, sex hormone binding globulin, testosterone replacement methods, how sleep affects hormones and much more.
This book isn’t just for men. If your male partner is showing signs of low testosterone then this book is a must-read with resources on how to find the right kind of doctor to get well.

Why Can't I Keep Up Anymore Deborah Matthew

Male Sexual Performance with Dr. Deb Matthew Interview Transcript

Dr. Hedberg: Well, welcome, everyone, to “Functional Medicine Research.” I’m Dr. Hedberg, and I’m really excited today to have Dr. Deb Matthew on the show. Dr. Matthew is a medical doctor, and she’s also known as the happy hormones doctor. She’s a best-selling author, international speaker, educator, wife, and mother of four. And after suffering for years with fatigue and irritability, her quest to resolve her personal health led her to change everything about her practice of medicine. She has been featured on national podcasts, radio, and broadcast shows, including NBC, ABC, CBS, and Fox. Dr. Matthew, welcome to the show.

Dr. Matthew: Thank you so much. It’s great to be here.

Dr. Hedberg: So, we’re going to be talking about your new book, “Why Can’t I Keep Up Anymore?: A Guide to Regaining Energy, Focus, and Peak Physical & Sexual Performance for Men Over 40,” which I read recently. It’s an excellent book. Wanted to have you on and talk about something that is…well, I would say most male issues are overlooked, but testosterone is really a big one and so is sexual performance and male hormones. So, why don’t we begin by talking about why testosterone is so important for men?

Dr. Matthew: Yeah. You know, hormones, in general, play a big role in how we feel on the inside, how we relate to the world around us, how we react to other people. And so, testosterone drives a lot of how men feel and even behavior, and it really plays a role in men feeling like a man. So, it’s important for drive and for motivation so that when you wake up in the morning and your boots hit the floor, you’re ready to take on the world. And when testosterone levels are not quite right, men just don’t quite feel right. And for women, when we go through our hormonal changes, it’s pretty obvious. We either get menstrual problems or, you know, we get hot flashes. And so, there’s some pretty obvious things that happen at some pretty obvious times in our life in order to notify us that our hormones may be changing. But for men, it’s much more subtle.

So, it is something that often happens gradually over time. And so, what I hear men say a lot is, you know, “I just don’t quite feel like myself anymore. I’m just not quite keeping up the same way that I used to. But you know, maybe it’s just my age.” I hear that all the time, “It must just be my age. I’m not 18 anymore.” And so, you know, maybe it’s not fair to compare to an 18-year-old, but if you’re 40 or 50, like let’s not blame it on age. If you’re 95, okay, fine. We’ll blame it on your age. But when you’re younger, even though things change, they don’t have to feel that way. And so, one of the things that could be contributing to not quite feeling like yourself anymore is low testosterone.

Dr. Hedberg: One of the things I see in practice is men who, you know, they’re diagnosed with low testosterone or they have the symptoms and they see their conventional medical physician and they try a testosterone, but it doesn’t work at all. Sometimes they get a little bit worse. Sometimes there’s really no change. What do you think the conventional medical approach is missing when something like that happens to a man?

Dr. Matthew: Oh, am I ever glad that you asked this question because this is what we deal with all day every day. So, if all we do is replace testosterone with topical gels or whatever it is, some men do feel better, like you said, some don’t really feel better because there’s a whole lot of factors that affect why the testosterone was low in the first place and how that new testosterone is going to react in your body. So, it’s, first of all, important for us to have some basic understanding of why the testosterone was low in the first place. So, again, like if you’re 95, we’re going to blame it on your age. But we see low testosterone in younger and younger men. We have men in their 20s in the practice that have low testosterone.

And so, you know, if a man is in his 40s or in his 50s and testosterone is low, we still want to think about the why behind it. And there’s a whole bunch of reasons you know, that I’d be happy to talk about because I think that’s important. But there is lab testing that we can do to get a better understanding of the why’s behind it. And then what we’d love to be able to do is address some of those factors, because if we can correct the factors causing the testosterone to be low, then there’s an opportunity for the testosterone to get better even maybe without the testosterone replacement. So, that’s one thing is we want to know the why behind it.

And then the next is when we’re giving a man testosterone replacement, we need to make sure that it’s going to work properly in their body. So, one of the things that I see, not that uncommonly is testosterone naturally, it gets converted into estrogen to some degree in all men and that’s normal, but for some men, the problem is that the testosterone gets converted too much into estrogen. And there’s a list of reasons why that may be, diabetes, obesity, especially like that belly fat, or inflammation in the body.

So, if a man is making testosterone into estrogen at a greater rate than they should, then the testosterone will be low and the estrogen will be higher than it should. So, now, if their doctor measures their testosterone level, finds it low, gives them more testosterone in the form of a gel or shot or whatever, then as the testosterone level goes higher, the estrogen level just goes higher too. And so, the relationship or the ratio between testosterone and estrogen is important because too much estrogen doesn’t feel good for a man. So, the testosterone level might look better on their test, but they don’t feel better because estrogen is getting in the way. So, that’s another reason why they may not feel better even if they’re on testosterone and even if their lab value goes up.

Another thing that I see that’s a problem is that it’s actually difficult to get an accurate testosterone blood level for men who are on topical testosterone gel, which is the most common way of giving testosterone. So, it matters how many hours it’s been from when you applied the gel to when you get your lab done. So, if you get up in the morning and if a man puts the gel on, say at, you know, 8:00 a.m. and then goes to the lab and gets the lab tests done at 10:00 a.m. their level’s expected to be quite a bit higher than if they went on the way home from work at 4:00 p.m. Or if they put the testosterone on their arm and then somebody sticks a needle in their arm right through the spot where they rubbed the gel, then the level could be quite high.

So, it makes it difficult to really accurately dose it based on a blood test, and you know, a lot of doctors have recognized it’s not quite so perfect and it’s not quite so accurate. So, they let men sit with relatively lowish levels of testosterone so that even though they’re taking the testosterone, as long as their lab test isn’t ridiculously low, they’re told that it’s fine, even if it’s not that great. So, there’s a bunch of reasons why just because you’ve been handed a prescription for testosterone and just because you’ve been applying it properly that it’s not really doing all the things that it’s supposed to be doing.

Dr. Hedberg: Right. And that’s kind of the issue sometimes with conventional medicine is just looking at a single hormone and then taking a single approach when obviously everything is connected. So, one of the other things that I’ll see sometimes is I might actually see elevated testosterone. It could be elevated total and elevated free testosterone, but they’re not on testosterone and they have all the symptoms of low testosterone. And I might also see the sex hormone binding globulin is actually elevated. Can you talk a little bit about what might be some of the issues with that particular picture?

Dr. Matthew: So, sex hormone binding globulin that you mentioned is a protein in the bloodstream that attaches to testosterone and kind of carries it through the bloodstream. So, sometimes I describe it it’s like a bus and that loads up all the testosterone molecules onto the bus so that it can’t be used, and the only testosterone that your cells can use and feel is the testosterone that’s free or you know, the stuff that’s walking, no room for it on the bus. So, when men have a high amount of sex hormone binding globulin, a whole fleet of buses, then they can bind up most of the testosterone and there’s not much left for their cells to use. So, the vast majority of the testosterone gets loaded up on the buses there’s hardly any left for when they’re walking.

And with age, sometimes SHBG or sex hormone binding globulin levels go high. So, for whatever given amount of testosterone a man has, like the total amount, like you said, it could even be, you know, nice and generous, but if it’s all bound, if it’s all on the bus, then they can’t use it. So, they don’t feel better. They have all the symptoms of low testosterone, but they’re told that everything is normal, and that can be really frustrating. And one of the things actually that makes that sex hormone binding level go high is when men have a higher estrogen level. So, men with diabetes, with more belly fat, with more inflammation who are flipping more testosterone over into estrogen could be specifically at risk for having too much of this sex hormone binding globulin.

Dr. Hedberg: Yeah. Some of the strategies I’ve seen that can lower sex binding globulin is actually building up the glutes in the thighs, increasing muscle mass there through squats can be effective. And then also if patients are on T3, have also found some connections there increasing sex hormone binding globulin. Anything else that you’re aware of? I mean, I know what happens with age, any other causes of high SHBG, and any other advice on lowering that?

Dr. Matthew: You know, it is tricky, in my experience, to lower it or raise it because some men, you know, have a very low amount too. So, it’s kind of hard to budget, to budget meaning to move it. We can sometimes try stinging nettle as a nutritional supplement that can help to lower it when it’s too high. We want to make sure that blood sugar levels are normal because blood sugar imbalances are one of the things that can make it go up. If there is an excessive amount of fibroid, that’s another thing that seems to make SHBG go up or an excessive amount of estrogen. So, trying to normalize as many of those things as possible can help.

Dr. Hedberg: Excellent. So, let’s talk a little bit more about testing. So, practitioners have the choice of blood, urine, and saliva, and then, of course, there’s different testosterone markers that can be run. What is your approach to testing and what are you testing for?

Dr. Matthew: Yeah. So, for men, I usually start off actually just by doing a blood test, and I’ll talk about what I think about the saliva testing and the urine testing too. But, you know, for the most part, blood testing is quick. It’s easy. We can get it covered under health insurance. At least we can know if there’s a problem or not. And really, I believe that even still today, while we can get different and more information, even from a urine test that for men for testosterone, the blood test is still the gold standard, but we need to get a full panel. So, we want to know not only the total testosterone level, but we need the free testosterone level, which is the part of testosterone that actually works.

And we need that sex hormone binding globulin so that we can look at the relationship. How well can that testosterone actually work in your body? We also need to look at an estrogen level, and I typically look at estradiol, which is the strong form of estrogen, and also, I think really importantly, LH level, which stands for luteinizing hormone. And this is the hormone that’s released from your pituitary gland in your brain and it goes through the body and tells the body to make more testosterone. So, for men who have a lot of stress, if they have a cortisol problem, if they’ve got too much inflammation, there’s a whole list of reasons why the brain may not send out enough luteinizing hormone or L H and then the body doesn’t know that it’s supposed to make more testosterone, so the testosterone level is low.

So, if we know that the LH level is low, then we have a whole series of things that we can do to try to boost testosterone naturally. On the other hand, if the testes are simply not working, whether it’s because of an autoimmune problem or whatever it is, the LH level often is quite high because the brain is spitting out lots of this luteinizing hormone to try to yell at the body to get more testosterone. So, that’s a really important lab to know in the beginning so that we can know that we’re trying to correct the right problem. Once a man is already on testosterone replacement, then the brain senses that there’s already testosterone in the system, stops spitting out a lot of this luteinizing hormone. And so, the luteinizing hormone or LH, we would expect it to be kind of low in a man who’s already on testosterone, and then it’s not meaningful.

So, it has to be done before we start treatment. Another one that we look at frequently is called dihydrotestosterone or DHT. This is made out of testosterone. So, testosterone can be flipped over into estrogen or converted over into dihydrotestosterone. It’s three times as strong as testosterone, but a lot of the benefits that men feel from testosterone, in fact, come from this metabolite, the DHT. So, sexual function and mood and energy, a lot of that comes from the DHT. So, some men don’t flip very much over, some men flip over too much, which is a problem because too much DHT can be associated with prostate growth. And then if the prostate grows too big, then you can’t pee. You got to go see a urologist. So, we don’t want that to happen. And DHT is also the hormone associated with male pattern baldness.

So, if you have the gene for male pattern baldness, it doesn’t really matter what your DHT level is. You know, you’re still going to struggle with the baldness, but if we were to give testosterone replacement and boost DHT levels, then we can just accelerate the rate of hair loss. So, knowing ahead of time if there’s an issue there can, again, sort of help us make the right kind of decisions. So, I would typically start with blood work for the testosterone, but I pretty much always also been from thinking about testosterone in a man, look at cortisol levels. And the reason for that is cortisol is our stress hormone, and so, it goes up to help us cope with stress.

And in the short-term, that’s a good thing, but a lot of people have chronic stress and chronic, either elevations of cortisol or other problems with their cortisol production. And that is one of the factors that can interfere with the luteinizing hormone production and cause low testosterone. And also if there’s a problem with cortisol, the testosterone receptors don’t work as well. So, for any given amount of testosterone in the blood, you don’t feel it as much. And if we can correct the cortisol problem, a lot of times, first of all, a lot of the symptoms that guys were blaming on their low T can start to feel better, and also we will end up getting either naturally improving testosterone levels or at least getting much better results from our treatment. So, I would typically look at cortisol.

And for cortisol testing, that is not okay in a blood test. I mean, we can do a screening test, but that’s really not the best way to test for cortisol. So, for cortisol, I would definitely do a saliva test or a urine test. If we’re going to do urine test, I typically use DUTCH tests. We can get cortisol levels at different times over the day because you can collect the urine at home in the morning, in the afternoon, in the evening, etc. And we can also, as you were mentioning, we can do estrogen and testosterone in the urine test, and it gives us good information because we can not just see what’s the testosterone level, but we can also see the metabolites or how the body is breaking down testosterone.

We can see how the body is using estrogen because for some men, and this is really important for women too, if we’re not breaking down estrogen into the healthy metabolites, if they’re breaking down into metabolites that can cause problems like promote cancer, whether it’s breast cancer or prostate cancer, then we would really want to know that because there are things that we can do in order to optimize that in order to potentially reduce risks. So, I like doing cortisol in a DUTCH test almost all the time. And sometimes we do do testosterone in the DUTCH test as well because we can get that specific information, but it’s not always the first place that I start.

And for saliva testing, saliva testing is fine to do the cortisol better than a blood test. Definitely. I don’t love saliva testing for testosterone because what I have found, and I’ve been doing saliva testing since 2006, but what I have found is that in a saliva test, it seems to under-represent…let me say that backwards, it tends to over-represent how much testosterone is present. So, sometimes I’ll do a saliva test and the testosterone level looks okay but if I do a blood test, I can see that the testosterone level is lower or in urine test, I can see the testosterone level is lower. So, if the testosterone is super-duper low, it’ll be super-duper low in the saliva test and we’ll pick it up. But for those men who, you know, it’s kind of more borderline, I find that the saliva test sometimes doesn’t call it out as being low. So, it’s not my first choice. It’s okay but that’s why I prefer the blood test or the urine test.

Dr. Hedberg: Yeah. That’s a nice overview. And so, let’s say, you know, you’ve established that a man has low testosterone, nothing too out of the ordinary and it looks fairly straightforward. You want to do testosterone replacement therapy. So, there’s a lot of choices out there. There’s creams, gels, pellets, injections, things like that. Can you talk a little bit about your favorite approaches and what you’re using in your practice?

Dr. Matthew: Yeah. I don’t do a lot of topicals. There are some practitioners who really love the topicals the best, and that’s what they do almost all the time. In my experience though, first of all, it’s just more difficult for me to measure hormone levels in a saliva test. It’s more variable, like it matters like we said, what time of day you get the blood test’s done. We can do saliva testing to measure it, but I don’t feel that it’s the most accurate way to do it. And really the bottom line is my patients who we’ve put on topical creams or topical gels haven’t really loved it, haven’t had great changes in how they feel and you know, just not really finding the results that we had hoped for.

So, what we do a lot more of is either the injections or the pellets. Injections are done at home. Typically, they’re done once a week. Sometimes we make the dose smaller and do it a little bit more often. It depends on the response. If we do an injection once a week, there’s a boost in testosterone levels over a few days, and then it starts to come down again and some men are more rapid metabolizers and they feel that more. So, they feel really good really fast, and then it goes downhill and they don’t feel good the second half of the week. So, then we can split the dose in half and do a shot twice a week, or you could do a seventh of the dose every day but there’s not very many people that sign up for that.

So, we really liked the testosterone injections because it’s easier for us to measure the levels. Although I still have to say, we need to be very consistent because the level will be a little different if you give yourself a shot on Monday, if we do the blood test on Tuesday or Wednesday or Thursday or Friday, the level is going to change.

So, we consistently do it midweek all the time, and what we’re looking for is we want the testosterone level to be in the upper half of the normal range midweek. The other one that we do like though is pellets. And the pellets, they look like little tic tacs and we just numb the skin on the back of the hip, kind of like right above where your back pocket would be. We make a tiny incision, it’s like a little paper cut and then we just slide these little pellets in under the skin and put a little band-aid over it. And then they slowly dissolve over the next four, five, six months, and they get a really nice stable testosterone level.

So, the pellets are the one that gives the most stable testosterone release over time. It’s nice because you come and you get a little procedure done, it takes just a couple of minutes, and then you can forget about it for a whole bunch of months and you just feel fine in the meantime. The downside of the pellets is it’s a procedure. So, you got to get a shot of numbing, the lidocaine [SP] and there’s, you know, a little incision site kind of, you know, it’s not something where people need pain medicines or Motrin or Tylenol or anything after that, but it can be uncomfortable. And a lot of times you’ll get a bruise there and we ask you to not exercise for a couple of days and stay at a swimming pools and hot tubs for a couple of days. So, you know, it’s a little bit of a thing.

The other thing about pellets is that they are more expensive. Testosterone by injection, even if you have to pay full price out of pocket and it’s not covered at all by your health insurance is really not that expensive. You know, if you had to pay full price out of pocket for a vial, you can get it for, you know, $100 or less and it’ll last you for sometimes up to four months. So, you know, $25, $30 bucks a month, whereas the pellets, you know, depending on the practitioner, it varies widely. But the pellets are significantly more expensive. So, you’re paying for convenience because you don’t have to give yourself a shot all the time and you get a more stable level, but you know, there’s trade-offs for all of them.

The other thing that I would like to mention is that all of these testosterone treatments are what we call bioidentical, meaning that the testosterone is an exact match for the testosterone that a man’s body is supposed to be making. Which is different from women’s hormones, where we have a whole bunch of hormone replacement options that are synthetic chemicals, and they’re not an exact match for what would normally be in a woman’s body so that we get some of the same effects, but not all of them, and we get some of the same potential side effects or downsides, but sometimes we get extra ones that we hadn’t counted on. But for men, these treatments are all bioidentical, so we can measure the levels, we can monitor properly. So, that’s a good thing.

Dr. Hedberg: That’s excellent. And once you have them on testosterone replacement therapy, you mentioned a few things earlier. Lifestyle is obviously a real key. Can you talk a little bit about sleep because I know that’s something that I see as a major issue with low T? Can you talk about sleep and how we should think about that?

Dr. Matthew: Testosterone is released at night when you are in a nice deep state of sleep. For men who don’t sleep well, that’s another one of the potential causes for not making enough testosterone. So, sleep apnea is a common…right, that’s a common thing. A lot of men have sleep apnea and if they’re not sleeping well at night, that could cause testosterone levels to go low and so, that’s a really good reason. If you snore, if you kind of hold your breath at night, or at least if your significant other tells you that you snore and you hold your breath at night, getting a sleep study is important and treating that appropriately because that potentially could help, first of all, boost your testosterone levels. But again, some of the symptoms that we might be blaming on low T like being more tired and memory issues and mood issues could actually be from not getting a good night’s sleep and not getting enough oxygen to your brain at night.

But also, interestingly, if you do have sleep apnea and you, you know, get your testosterone measured and it’s low and you get started on testosterone replacement, testosterone replacement could theoretically make the sleep apnea worse. So, it’s kind of a two-way street and we need to take both of those into account. But poor quality sleep is one of the more common symptoms that men complain about when their testosterone is low. And if we can correct testosterone, whether it means giving testosterone replacement or correcting the underlying problems that caused it, often sleep can get a lot better.

Dr. Hedberg: Yeah. So, I see that quite a bit, and I’m glad you brought up sleep apnea because that’s often overlooked.

Dr. Matthew: Yeah. A lot of men have sleep apnea and they don’t know. And part of why they don’t know is because who really wants to go sleep in a sleep center and, you know, get the diagnosis and nobody wants to wear a sleep apnea machine. So, you know, there’s a lot of guys out there that kind of would just sort of rather not know, but if the results of the sleep apnea is gaining weight, feeling tired, having brain fog, you know, not feeling like your best, it really is worth getting it addressed.

Dr. Hedberg: Right. So, for the women listening, if your husband or your partner is snoring or having other sleep issues and having hormone issues, see if you can get him to have a sleep study and that could be a big factor in his issues. Any other lifestyle recommendations that you’re making to men who have low T?

Dr. Matthew: Yes. So, we sort of mentioned about we kind of like to understand the why behind the low T. So, one of the really big causes of low T in men is stress. And when we have a lot of stress, that affects cortisol levels, cortisol shuts down testosterone, and men and women end up feeling more tired, just kind of slapped, you know, like depression and anxiety are things that men feel and women when testosterone levels are low. And because we’re not thinking along those lines, you know, we end up going to the doctor and we complain and we don’t feel good, and we’re handed a prescription for antidepressants anxiety pills, sleeping pills, but really the underlying problem may be low testosterone and stress may be a factor.

So, finding healthy ways of coping with stress, whether it’s exercise, going out for a walk, or being open to trying things like breathing exercises or meditation or yoga, those things are such powerful medicine. And unfortunately, you know, I know that all of the listeners here know that you’re supposed to eat healthy and you’re supposed to exercise, but doing this kind of self-care is equally as important. It’s almost like a three-legged stool. But while everybody would applaud you for eating your broccoli and going to the gym, if you were to sit on a bench in the park and, you know, do some meditation or breathing exercises, you know, people might look at you a little funny about what are you doing or if we’re doing this kind of stuff, we feel guilty because we really feel like we should be, you know, cutting the grass or whatever other things that are out there that we ought to be doing.

But I would really encourage everyone should be open-minded and really look…we can’t control the stress in our lives. We can’t control pandemics and elections and, you know, economies and all this kind of stuff, but the one thing that we always can potentially have control over is what we choose to think about. And thinking positive thoughts, feeling gratitude, these are some really great ways of helping to balance the stress in your life. Even if you can’t make the stressors go away, counting your blessings goes a long way to decreasing the impact that the stress and the cortisol are having on your body, including on testosterone. So, coping with stress is really important for all of us, whether testosterone is low or not low, whether somebody is going to be on testosterone replacement or not, but for somebody who has low testosterone, definitely, it’s important. And if you’re going to be on testosterone replacement, it’s also important to make sure that you get the best results from the testosterone treatment.

Dr. Hedberg: And for the women listening, what should they really be looking for in their male partners when it comes to low testosterone? I mean, there are some things that are going to be very obvious, like erectile dysfunction, but are there any other clues or hints you can give them to look for?

Dr. Matthew: Yeah. So, testosterone really affects mood and behavior. So, those are places to start. And because this is the kind of thing that creeps up slowly over time, it’s subtle, but fatigue, especially, you know, coming home from work and just wanting to sit on the couch and not really feeling energetic, flat mood, so kind of depressed or, you know, just kind of not really excited about doing things that they used to really enjoy. Lack of motivation, you know, you got your honeydew list and you want them to get that list knocked off, but they’re sort of procrastinating. And, you know, whereas in the past they might’ve got the hammer and got stuff done, and now, you know, they’re not motivated to do that or to do their hobbies. The things that they actually enjoy and used to want to do for themselves.

So, it affects behavior, and because it is subtle, a lot of times it gets blamed on age and I would really encourage you if you, if your significant other is saying, “Well, you know, it’s just my age.” That’s sort of a red flag. They’re not feeling as good as they used to. They know that something has changed. They’re not quite sure what, and low T could be a part of it. But there’s more because testosterone is what maintains muscle mass. And so, when testosterone levels go down, muscle mass can go down. And even if they’re exercising, they don’t get the same results from exercise. So, muscles don’t build, they don’t feel as strong. They’re also more prone to either soreness after exercise or more injuries. So, if they’re always complaining that they’re achy and they’re sore, that can be another clue.

It affects memory. So, memory may not be so sharp. They may be feeling like, you know, those senior moments, even if they’re not quite a senior citizen yet. It affects weight. So, we’re more likely to gain weight, men and women, more likely to gain weight. And for men, especially on the belly. It affects risk factors for chronic disease. So, when testosterone goes down, there’s a correlation with blood sugar going up and men with diabetes have a higher risk for low testosterone. There’s a greater risk for high cholesterol and for heart disease, in general, because testosterone is important for heart health for men.

It also helps to keep our bones strong for both men and women. So, men with low T are more likely to end up with osteoporosis and we’re more likely to end up as frail men in their senior years. So, testosterone is one of the most important things to help prevent frailty. And we know that men who have low testosterone, and I’m going to say that differently, men whose testosterone levels are at the low end of the normal range, not even counting all the way low, men with testosterone levels at the low end of the range don’t live as long as men with testosterone levels at the upper end of the range because of its effect on so many different factors, including dementia, heart disease, diabetes, etc. Testosterone is actually anti-inflammatory and inflammation we know is one of the root causes of chronic disease.

Dr. Hedberg: This has been a really excellent overview. Now, you’re located in North Carolina. What part of North Carolina are you in?

Dr. Matthew: I’m in Charlotte.

Dr. Hedberg: Charlotte, right? And for people who, you know, might live on the other side of the country and places like that, what’s the best way to find an integrative doctor who works with testosterone the way that you do?

Dr. Matthew: You know, there’s a couple of websites that I would refer people to. One of them is Institute for Functional Medicine, and they are at And the other one is the American Academy of Anti-Aging Medicine or A4M, and they are at And the four is a number four, not the words written out. They both have like directories of practitioners that have been trained, not just in testosterone replacement because your primary care doctor can give you a testosterone prescription, but what they’re not going to do is they’re not going to do the whole person approach. They’re not going to consider the underlying factors. They’re not going to consider how testosterone interacts with estrogen or cortisol. They’re much less likely to talk to you about how food affects your hormone levels or how stress affects your hormone levels or what kind of exercise would be the best to do to boost your testosterone levels. So, if you can find somebody who uses a functional medicine approach, meaning that they’re looking inside your body to see how things are functioning and addressing the parts that they find that aren’t doing the right job, we just get so much better results because we really do want to put the testosterone in a healthy body so that we can get the best benefits.

Dr. Hedberg: Excellent. And one other thing, as far as finding you online, how would you like people to find you, what’s your website?

Dr. Matthew: The website is Signature Wellness and we’re .org instead of .com. So, And we have lots of information on the website, both for women’s health and for men’s health. And so, it’s a good resource.

Dr. Hedberg: Yeah. And you also work with women and women’s hormones.

Dr. Matthew: That’s right. And testosterone deficiencies for women have a lot of the similar symptoms. So, fatigue, lack of interest in intimacy, vaginal dryness, moodiness, not sleeping well, gaining weight, loss of muscle tone, and just feeling kind of saggy skin, aging. So, see this a lot. In fact, we treat low testosterone even more frequently than we treat on low estrogen. And it’s something that we start to see in women over 35. So, it’s not just for older women.

Dr. Hedberg: Excellent. And you mentioned the A4M and you’re actually I believe one of the testing proctors for A4M, is that correct?

Dr. Matthew: Right. I’m one of the oral board examiners. They offer a board certification exam.

Dr. Hedberg: Excellent. Okay. So, the book is “Why Can’t I Keep Up Anymore” by Dr. Deborah Matthew. Dr. Matthew, thanks for coming on the show.

Dr. Matthew: Thank you so much. This has been fun.

Dr. Hedberg: So there’ll be a full transcript posted on So, to everyone listening, you can just search for Dr. Matthew, if you want to read the transcript and I’ll have links to all of the resources that she mentioned today in the podcast. So, take care, everyone. This is Dr. Hedberg, and I will talk to you soon.

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