Men's Health Q&A with Leah Johansen, M.D.

A functional & integrative view on midlife male vitality
Leah Johansen, M.D.

Note: I have no financial interest to express. All recommendations are based on personal preference and experience I’ve had with patients.

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Unlocking the Body's Healing Capacity

Q) You refer to the body's "Inner Pharmacy", what does that mean in a clinical context & how can mean start to access it?

A) "Your body produces its own medicine, dressed as endogenous neurotransmitters—dopamine, oxytocin, testosterone, endorphins, cannabinoids, etc. That’s your inner pharmacy, which can be stimulated by the outside(external) or stimulated within (endogenous) to produce from within your body. Clinically, this could be called neurochemical or electrochemical self-regulation. You can stimulate production with breath, sound, nutrition, movement, touch, or your mind. The goal is to rely less on external substances—and more on activating your innate potential to be in its optimal, balanced state."

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Smarter Lab Work after 40

Q) What lab tests do you most often recommend for men over 40, and how do you interpret them beyond basic reference ranges?

A) Hormones: Total and Free Testosterone, SHBG (sex hormone binding globulin), Estradio Prostate specific antigen (PSA) (aim for <1)

Inflammatory / Cardiovascular markers / Metabolic Biomarkers (predictable of future heart attack and stroke, but modifiable with lifestyle): Hemoglobin A1c (three month markers for blood sugars), cardioIQ (an advanced cardiovascular panel) to include: LDL Particle size, triglycerides, HDL, Apolipo protein B, lipoprotein (a), high-sensitivity CRP, and homocysteine

Nutrients and General: Complete Blood Count (CBC), Comprehensive metabolic panel(CMP), Vitamin D (25-OH), Magnesium (RBC)

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READING BETWEEN THE LINES

Q) What are some early signs that a man’s hormones may be out of balance, even if lab results are technically “normal”?

A) "Hormonal imbalance often begins subtly—long before it appears on lab tests. Early signs may include low motivation, poor sleep, difficulty concentrating, reduced libido, or erectile challenges. When testosterone declines and estrogen increases—common with increased body fat—men may also experience irritability, breast tissue development, and diminished executive function."

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The Truth About Testosterone

Q) What’s one common misconception about testosterone you wish more men understood?

A) "The misconception is that testosterone itself is the problem—when really, low testosterone is a consequence of deeper imbalances. It reflects chronic patterns rooted in self-worth: Am I good enough? Do I belong?

If you’re chronically over working, drinking too much, not moving, or stuck in a toxic environment, it’s not just poor habits—it’s often because you don’t believe you’re worthy of care. That belief alone creates the pattern of desire for anything to give you pleasure (a dopamine hit). We are wired for pleasure.

Your nervous system encodes every thought, every belief. Shame, fear, or unprocessed trauma all leave imprints that affect hormone levels. That’s why even with “normal” testosterone, many men still feel depleted. Prescriptions can be useful tools, but when paired with the deeper work: healing your mindset, nurturing your spirit, and restoring connection to your body and purpose this is where true vitality begins."

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PROSTATE HEALTH IN PRACTICE

Q) What’s your approach to supporting prostate health in midlife men and how do you integrate functional and preventative strategies?

A) "I want to share that the answer to this question has evolved the more I study. As I have researched prostate enlargement (BPH) and prostate cancer, I initially discovered the need for prostate massage to release inflammation caused by a number of things including microplastics. The same environmental exposures that cause breast cancer in women cause prostate or testicular cancer in men. A good resource on this is the book ‘Healthy Prostate’ by Ronald Bazar. I still believe working the pelvic floor and prostate massage are important, especially if the enlargement is considerable and causing significant urinary symptoms (inability to urinate immediately or fully emptying the bladder causing disruption in your sleep). If your bladder is housing too much urine over time it can cause an infection that can also spread to the prostate. Be sure to obtain a rectal exam by a Urologist or experienced family medicine provider to check for suspicious nodules if your prostate specific antigen (PSA) is increasing. Ideally, your PSA should be below 1. If it is increasing expect inflammation or pressure upon your prostate causing elevation in the marker. Address food chemicals, environmental exposures, excess body fat, and lack of movement to start."

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Hormone support without prescriptions:

Q) Are there natural or lifestyle-based ways to support testosterone and longevity for men who want to avoid hormone therapy?

A) "Yes—start by removing what’s draining testosterone: excess body fat, poor sleep, chronic stress, and lack of movement. Prioritize strength training, pelvic floor mobility, and deep sleep(bed by 10 PM, no eating at least 3-4 hours bed). Address financial and emotional stress—tension in the lower body can suppress drive and create tension on the pelvic floor, reducing blood flow and nerve innervation to your vital testosterone producing organs.  Daily stillness, breath work, sunlight, and cold exposure help reset your hormones naturally. Supplement basics: DHEA (best if between ages 30-40s), methylene blue (with labs), Tonkat Ali, Fadogia, vitamin D, zinc, magnesium, ashwagandha, and fenugreek."

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The Cost to Chronic Stress

Q) How does long-term stress impact men’s health physiologically and what’s one accessible way to support the nervous system?

A) "Chronic stress drains testosterone, disrupts sleep, lowers libido, and disconnects men from their life force. When you're not living your truth, your body stays in survival mode—shutting down the systems that fuel vitality, sexual energy, and joy. One simple way to support your nervous system moment-to-moment: breathe deeply.Feel the breath move through your body. Allow any sensation that wants to come up, come up. Observe it but don’t become it. Let the frustration, anger, or happiness come up and move through you. I know this sounds simple but if you set a timer for 1 minute and do this you will turn on your vagus nerve and instantly put your body in a calmer state (invoking the parasympathetic system)and have more clarity in your mind."

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EMOTION & ILLNESS

Q) From your perspective, how does suppressed emotion relate to physical symptoms or chronic conditions in men?

A) "Suppressed emotion—especially unprocessed grief, trauma, or shame—can manifest as chronic tension, hormonal imbalances, autoimmune conditions, or nervous system dysregulation. Many men carry generational or childhood trauma (including sexual trauma, emotional or physical trauma) silently, and over time, this emotional weight shows up in the body as illness. Whether through addiction, over working, or isolation, the body eventually speaks what the heart has been forced to silence. Healing begins with awareness—acknowledging what’s been buried and creating safe ways to express it. Allowing the emotion to come through you and not become you. Emotions aren’t weakness; they are signals.Ignored, they become symptoms. Honored, they become healing."

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The Gut-brain-energy

Q) How is gut health connected to men’s mental clarity and energy levels?

A) "Your gut is your second brain—and when it’s inflamed, everything suffers. Gut imbalances (likeIBS, constipation, or dysbiosis) can create neuroinflammation, brain fog, low energy, and even poor libido. Inflammation blocks nutrient absorption, messes with your mitochondria (your energy powerhouse), and disrupts the delicate hormone balance needed for drive, clarity, and vitality. Start by slowing down when you eat. Eat in calm, grounded environments. Try not to eat when you are stressed or have challenging conversations while eating as inflammation, a stressed nervous system can cross react with the food, and create insulin resistance with high cortisol levels."

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STARTING FROM STUCK

Q) For a man who feels depleted, disconnected, or overwhelmed—what’s one helpful place to begin?

A) "Start by knowing this: you are not alone. Even if you feel isolated, there are people—seen and unseen—sending love, prayers, and energy your way. You are cared for. From that place, begin simply. Start with the body: clean up your food, prioritize deep sleep, reduce alcohol, and move your body. Then, sit in stillness. Begin by observing your mind, thoughts, emotions. Watch but don’t become them. Can you become unwavering? If still completely depleted, then check your hormone levels and see if you need to address this with pharmaceuticals or nutraceuticals."

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DAILY MOMENTUM

Q) What are two or three simple habits you recommend for supporting healthy aging and long-term vitality?

A) "Daily - Stack your habits. Make every breath count. Start with sleep. A meditation or deep hypnosis while sleeping creates deeper delta waves. Examples Here. Tape your mouth. Think ‘Breathe’ by James Nestor. Increased oxygenation overnight means more energy in the AM. Deep rest restores testosterone, energy, and your nervous system.

Next: stack your habits with movement–light yoga, a few sun salutations, deep breathing, set your intention, set your field, what do you want to create for the day.

Third: Evolve. Keep an open mind.Practice non-judgment. Make every thought count and by that I mean being very aware about judgment about anything and everything. We are far more judgmental about ourselves and others that negatively impact our vitality and keep us in a state of “not-enoughness”."

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QUICK WIN

Q) What’s one thing a man can do this week to regulate his nervous system or boost resilience?

A) "Awareness. What is throwing you off balance? It’s important to know your triggers. If you are triggered by something or someone, go into it. Allow it. See it. Witness it.It’s all neutral energy. Our perception is what navigates good or bad. Anxiety could be excitement if we perceive it in a healthy light. We exhaust energy by being excessively anxious, worried, angry, etc. Can you be unwavering? Be neutral as all things come through you. The fastest way to shift is to be aware and step back. Become the observer and decide then how to respond."

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