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Men's Health

Low Testosterone in Men: The 6 Root Causes TRT Doesn't Fix

Dr. Nick Carruthers·May 6, 2026·8 min read

The short answer

Low Testosterone in Men: The 6 Root Causes TRT Doesn't Fix

Testosterone replacement is a downstream fix for an upstream problem. Here's what actually crashed your levels — and how to rebuild them.

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The TRT Trap

Average male testosterone has dropped ~1% per year for the last 30 years. That's not genetic. That's environmental, metabolic, and behavioral — and TRT doesn't fix any of it. It just adds exogenous hormone on top of a broken system, suppresses your own production, and locks you into the protocol forever.

If you want testosterone you actually make, you have to address the six root causes.

1. Insulin Resistance

Insulin resistance directly suppresses LH (luteinizing hormone), the brain signal that tells the testes to make testosterone. It also elevates aromatase — converting what little T you make into estrogen.

Fix the metabolism. Watch T climb.

2. Poor Sleep / Sleep Apnea

70% of testosterone is made between 11 PM and 3 AM in deep sleep. Six hours of sleep cuts T production by ~15%. Untreated sleep apnea destroys it. Get a sleep study before you get a script.

3. Gut Dysfunction

Your gut runs the inflammation that suppresses the HPG axis. Endotoxin (LPS) leaking through a permeable gut wall directly suppresses Leydig cell testosterone production. This is upstream of everything.

4. Endocrine-Disrupting Chemicals

Plastics (BPA, phthalates), pesticides (atrazine, glyphosate), parabens, and flame retardants are estrogenic. They down-regulate testosterone receptors and elevate SHBG, locking up the testosterone you do make. Audit your water, food storage, personal care.

5. Chronic Stress + Low Vagal Tone

Cortisol is the natural antagonist to testosterone. Chronically elevated cortisol pulls the pregnenolone precursor toward stress hormones (pregnenolone steal). HRV training, breathwork, and recovery aren't soft — they're testosterone protocol.

6. Nutrient & Building-Block Deficits

  • Zinc — aromatase inhibitor, T cofactor
  • Magnesium — frees up bound testosterone
  • Vitamin D — direct T precursor signaling
  • Boron — increases free T
  • Cholesterol — yes, you need it; sub-160 total cholesterol = T problem

What To Test (Beyond Total T)

  • Total + Free Testosterone
  • SHBG
  • LH, FSH (tells you brain vs testes problem)
  • Estradiol (sensitive assay)
  • Fasting insulin, HOMA-IR
  • DHEA-S, cortisol rhythm

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Dr. Nicole Rivera

Medically reviewed by

Dr. Nicole Rivera

Last updated May 6, 2026

Dr. Nicole Rivera is the co-founder of Integrative You and host of the Integrative You podcast. She has spent 15+ years in root-cause clinical practice, working with hormonal collapse, Lyme, mold, gut and autoimmune patterns.

  • Doctor of Chiropractic (DC)
  • IFMC certified
  • Training with IFM, Klinghardt, Kresser and Shoemaker
  • Member of the clinical medical board for Applied Functional Medicine
  • Clinical focus: epigenetic and DNA precision medicine
  • Clinical focus: hormonal health and women's medicine

Topics she covers

Mold illness & CIRSLyme diseaseHeavy metalsAnxiety & the nervous systemGut healthHormones & thyroidAutoimmune & skin

Sources

  • Generalized anxiety disorder: what you need to know — National Institute of Mental Health
  • Psychological and pharmacological treatments for generalized anxiety disorder — Cognitive Behaviour Therapy
  • Small intestinal bacterial overgrowth and irritable bowel syndrome — Frontiers in Psychiatry
  • Leaky Gut Syndrome: myths and management — Mayo Clinic Proceedings
  • Thyroid function tests — American Thyroid Association
  • Hormone testing before hormone therapy — American College of Obstetricians and Gynecologists
  • Entrepreneurship and mental health — NIH/PMC
  • Occupational stress and health — CDC/NIOSH
Full bio and credentials Hear her on the podcast

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