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 and how can men 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) "The easiest and most comprehensive lab testing in the US right now is Mark Hymen's Function Health. I highly recommend his panel. Below are the basic labs to consider asking your primary care provider.

Hormones: Total and Free Testosterone, SHBG (sex hormone binding globulin), Estradiol, Prostate specific antigen (PSA) (aim for <1), Dihydrotestosterone (DHT, if concerned about hair loss)

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, Apolipoprotein B, lipoprotein (a), high-sensitivity CRP, and homocysteine

Nutrients and General Markers: 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. Get tested early. Address burnout and emotional fatigue as normally stress is a precursor to physical decline."

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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 overworking, 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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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 stuck out of trust—out of alignment with your parasympathetic nervous system—your body stays in survival mode, shutting down the systems that fuel vitality, sexual energy, and joy.

One accessible way to support your nervous system moment-to-moment awareness of your breath. Practice deepening your breath. Feel the breath move through your body. Allow any sensation, emotion, or thought that arises to come up—observe it without becoming it. Let frustration, anger, or happiness flow through you and then pass.

It may sound simple, but if you set a timer for just one minute and do this, you’ll activate your vagus nerve, instantly calming your body by engaging the parasympathetic system—and gaining greater mental clarity and whole body calm."

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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, overworking, 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 (like IBS, 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) "Begin with gratitude. Find one small thing—big or small—to be grateful for right now. From this place of appreciation, remember we are all fumbling through life. There is no manual (though I am creating one). We’re still discovering who we are in this world. The most important thing is to remember: you are not the fear matrix we’ve been taught to believe in. We are all in this together—one global family. Trust yourself. Remember your resilience.

From that foundation, start simply and focus on your body: clean up your food, prioritize deep, restorative sleep, reduce alcohol intake, and move your body regularly. Then, create space for stillness. Observe your mind—your thoughts and emotions—without becoming them. Can you cultivate unwavering presence despite the storms around you? Remember, it takes energy to be depressed, angry, upset, or isolated. Begin to do the opposite when your mind starts spinning negatively. Witness your mind but don’t follow it. Notice your emotions but don’t get caught up in them. Become the ultimate observer of the body and life you are inhabiting right now.

If you still feel completely depleted, reach out for help. Consider checking your hormone levels and explore whether pharmaceutical or nutraceutical support may be needed. Speak to someone you trust, massage, energy work, cardio—whatever your body, mind, and emotions need at the time. Don’t be afraid to rest and regroup."

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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.

First, prioritize sleep. Deep sleep with meditation or hypnosis can increase delta brain waves, promoting restoration. Try mouth taping at night and explore the work of James Nestor’s ‘Breath’ for better oxygenation. Increased oxygen intake overnight means more energy in the morning. Deep rest supports testosterone production, replenishes energy, and calms your nervous system.

Next, incorporate movement and breath into your day. Begin with a few sun salutations, a full workout, or simply some deep breathwork.

Third, evolve your mindset. Keep an open mind and practice non-judgment. Pay attention to how judgment—especially of yourself—can drain vitality and trap you in a state of “not enough.” Make every thought count by choosing awareness and compassion instead."

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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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