Full Podcast Transcript

The following is an edited transcript of Dr. Michael Duben’s interview with Dr. Diane Hayden on the Natural Nutmeg podcast.

What Is a Functional Endocrinologist?

Dr. Hayden: What is a functional endocrinologist? How is that different from traditional endocrinology, and how did you make that transition?

Dr. Duben: Functional medicine is a wider approach than traditional medicine. Traditional medicine is actually a part of functional medicine, but the difference is that functional medicine attempts to look at and address root causes of disease — not simply manage chronic symptoms.

One of the issues with traditional medicine is that chronic diseases like diabetes, hypertension, and hormonal deficiency are rarely reversed. Moreover, there’s usually not even an attempt to do so. The difference with functional medicine is that you look at a much broader and deeper picture of what’s going on with a patient. You address not only the symptoms at hand but the entire lifestyle.

For example, if you’re dealing with diabetes, you don’t only assess medications — you take a very detailed look at dietary history, various stressors and what can be done about them, and sleep, which is super important. Sleep is such a disruptor and such a cause for stress, which then downstream causes hormonal disruption. You also look at habits, exercise, relationships, even spiritual aspects of a person’s life, and you try to put it all together in a holistic approach.

You don’t simply tweak medicines — you try to go deeper. And often, not always, but often you’re able to either completely eliminate or reverse a disease, or at the very least substantially improve it.

Dr. Duben’s Journey from Traditional to Functional Medicine

Dr. Duben: My own personal journey was a slow evolution. I’m trained as a traditional Western medicine doctor, and I am very grateful for being trained at absolutely wonderful, esteemed institutions. A lot of people who trained me were people with national and international stature. I learned an incredible amount from them.

But very early on, I started noticing limitations in the traditional approach. The first one for me was a huge discrepancy between the recommended diet for diabetics — which at the time was the food pyramid that essentially encouraged people to eat all the wrong foods — and what the published medical literature actually showed.

During my training, we had to present major topics every six months in front of the entire department — professors, the chairman, the program director — people with combined experience literally measured in centuries. You had to be ready. My topic was low-carb versus low-fat diet. I delved into the published medical literature, and to my amazement, the lion’s share of studies clearly showed the benefit of a low-carbohydrate, high-protein diet versus a typical low-fat, high-carb diet — whether you looked at cholesterol, blood sugar, or weight loss outcomes.

That was the first interesting red flag: Why are all these esteemed societies recommending things that are not correct based on their own literature?

As years went by, this realization was confirmed again and again. I also remembered something from medical school — the chairman of surgery lectured us on how to examine a patient and said that 70 to 80 percent of diagnosis comes from talking to a patient. Throughout the years, that completely panned out. But the regular insurance model simply does not allow you the time to do that.

So I realized the deficiencies in both training and the insurance-based model. I started hearing about alternatives. My initial reaction was to dismiss it, but I kept hearing about functional medicine from people I respected. Eventually I decided to look into it, and what I saw looked very promising. I completed the full Institute for Functional Medicine course — seven modules — and what I learned was tremendous.

I also realized that many things I had considered probably useless — vitamins, supplements, botanicals — are actually very useful and scientifically proven to be so. That’s something they didn’t teach in medical school, residency, or fellowship.

The Hybrid Approach: Combining Traditional Endocrinology with Functional Medicine

Dr. Duben: What I’m offering patients is a hybrid — my training in endocrinology and laboratory science combined with an additional level of knowledge: probiotics, targeted vitamins, natural substances, specialized diets, and everything else that goes beyond traditional medications.

And time. My practice is not insurance-based. It’s strictly fee-for-service so that I can actually spend time with people, talk to them, and address all of their concerns. I encourage patients to bring questions they’ve read about online. I can offer a different perspective because most people don’t have the training or expertise to evaluate medical claims — but I do, and I can explain why something is correct or incorrect.

Men’s Health: Testosterone, Hormones, and the Root-Cause Approach

Dr. Hayden: Let’s talk about men’s health — a topic nobody’s really talking about. Typically, men are the last people to go to the doctor. How do you treat men’s health from the standpoint of hormone replacement and testosterone?

Dr. Duben: As always, it starts with a very long and detailed conversation — and that right off the bat is something that usually doesn’t happen. Most primary care doctors would just order a total testosterone, and not necessarily using the best available methodology.

I do a detailed dive into what’s going on: all the comorbidities involved, the nature of the symptoms. Sleep is overlooked so badly in men. Poor sleep and sleep deprivation are a huge killer of testosterone — it lowers testosterone like crazy, as does any stress.

I explore the symptoms in depth. With erectile dysfunction, for example: Are there spontaneous erections at night? Is there a lack of interest, or is libido okay but erections are not? In many men it’s both. I look at weight, eating habits, stress levels — everything in the human body affects everything else.

I’ve had fairly young men — business owners, general contractors running their own businesses — they barely sleep, they’re stressed through the roof. That alone, even if you’re otherwise healthy, can tank your testosterone. But this just goes entirely undiscussed at most doctors’ offices.

Why the Standard American Diet Destroys Hormone Health

Dr. Duben: What people eat — the Standard American Diet — creates constant ongoing inflammation. That’s a big topic in functional medicine. Inflammation often caused by food starts in the gut and spills elsewhere. It affects your brain, your gut microbiome, your mood, your hormones, and your hormone metabolism. Everything is interrelated.

Are you obese? Do you have obstructive sleep apnea? That affects sleep, which affects testosterone. All of these factors need to be evaluated together.

Testosterone Replacement vs. Testosterone Optimization: What’s the Difference?

Dr. Duben: You have to differentiate. In some men, there’s nothing wrong with their testosterone — medications like Viagra or Cialis can do wonders and are much more effective specifically for erections than testosterone would be.

If there is testosterone deficiency, you have two categories. Testosterone replacement is for when testosterone is genuinely low and needs to be brought back to normal. Testosterone optimization is for when it’s not really low, but “low-ish,” and you want it higher. That’s a different situation, and you need to be clear about both the benefits and the potential downsides.

Very often, you don’t need testosterone at all — you need a medication that stimulates your pituitary gland. The pituitary is the master gland at the base of the brain that controls all other glands. It’s affected by stress and chronic disease. So often the root cause of low testosterone isn’t below the waist — it’s in the brain.

Whether it’s stress, sleep deprivation, chronic disease, or obesity — the pituitary suffers. The most elegant approach is not to just apply testosterone, but to wake up the pituitary while addressing all the lifestyle issues simultaneously.

Clomiphene: A Smarter Alternative to Testosterone Injections

Dr. Duben: There’s a very cheap, generic, widely available medication called clomiphene — women use it to stimulate ovulation. In men, it can wake up the pituitary. If the issue is there, testosterone normalizes, and then if you improve your lifestyle, you can wean someone off.

The disadvantage of starting testosterone directly is that once you start it, your own production goes down. If you take it for a long time, your own production may be diminished for a very long time — or forever. So one has to be careful.

I had a patient — about six feet tall, 260 pounds, fatigue, lethargy, testosterone around 190 (lower limit of normal is 250). His wife convinced him to eat well and take care of himself. He lost 70 pounds — almost bariatric-surgery-level achievement — went to the gym, and his testosterone almost normalized. It went up to 256. Then he slacked off, it dropped a little, and he went to a low-T center where they put him on $700-per-quarter testosterone injections. Now he’s over-replaced and not even much better off.

Instead, this man is a perfect candidate for clomiphene to stimulate his pituitary, coupled with continued diet and exercise. He’ll normalize his testosterone naturally.

Why Low-T Centers Don’t Address the Real Problem

Dr. Duben: The foundation is diet, exercise, sleep, and relationships. None of those things are addressed when you go to a low-T center. That’s not their business model. The business model is to sell you testosterone. So anybody who walks through the door will end up on testosterone, because that’s how money is made. There’s nothing wrong with making money — but the question is how.

Supplements for Sleep, Stress, and Hormone Health

Dr. Hayden: What about supplementation? Are there specific supplements you typically use?

Dr. Duben: It depends. There are magnesium-based supplements for sleep. Some help with falling asleep, some help people who fall asleep fine but wake up in the middle of the night. But you also need to discuss sleep hygiene — which no one does. We talk about the best strategies for winding down before bed. People are on their phones all the time and there’s no way to take care of your health like that.

There are also supplements like ashwagandha that help with stress and relaxation. But sometimes just talking about these issues — just having that conversation — a light bulb comes on. If you stress the importance several times, people get it. They’ll make changes if they want to help themselves. It’s just that this conversation doesn’t take place at a typical low-T center.

The Right Blood Tests for Testosterone: What Your Doctor Should Be Ordering

Dr. Hayden: What blood tests do you run? Most doctors just look at total testosterone, right?

Dr. Duben: The bare minimum is:

• Total testosterone by mass spectroscopy — the gold standard and most accurate method, drawn early in the morning around 8 AM
• Free testosterone — this is what actually does the biological work. Total testosterone is just the reserve, but it’s the free-floating, unattached testosterone that matters. The concentration is incredibly small — one in a trillion — so you need the best equipment and methodology
• Sex hormone-binding globulin (SHBG) — the protein that binds testosterone and makes it inactive
• LH and FSH — the pituitary hormones that tell you where the primary problem is. If pituitary hormones are elevated, the problem is in the testicles. If they’re normal or low, the problem is in the pituitary
• Prolactin — should not be elevated in men. If it is, it can be a cause of low testosterone. Sometimes a pituitary tumor (always benign) or certain medications are responsible

All of that has to be assessed. It’s both art and science — and it requires knowledge in laboratory science and endocrinology that most low-T centers simply don’t have.

The Bottom Line: Root-Cause Care Takes Time

Dr. Hayden: When someone comes to see you, they’re going to get time. You’re going to ask a lot of questions and cover a lot of lifestyle factors that a traditional doctor, by no fault of their own, just doesn’t have time to address.

Dr. Duben: That’s the bottom line. And a lot of doctors are simply not equipped. A big part of endocrinology training is understanding and interpreting labs. A lot of doctors take labs at face value — literally like it’s the word of God. But you need to know how the sausage is made. You need to know how to interpret labs before you issue advice. That’s a very important part of traditional endocrine training, and I’m very thankful for it.

Take the First Step Toward Optimal Hormone Health

You don’t have to settle for low energy, weight gain, and declining vitality. Hormone optimization with a board-certified endocrinologist can help you reclaim your strength, confidence, and quality of life — and you deserve a specialist who will find the root cause, not just hand you a prescription.

Call 203-760-5544 to schedule your comprehensive men’s hormone evaluation.

Restore Health LLC
501 Kings Highway East, Suite 103
Fairfield, CT 06825
restorehealthmd.com

Serving men throughout Fairfield County, including Westport, Southport, Darien, Greenwich, Norwalk, Stamford, Trumbull, Milford, Stratford, Bridgeport, and beyond.

Dr. Michael Duben, MD
Board-Certified Endocrinologist | Functional Medicine
Restore Health LLC | Fairfield, Connecticut