In today’s medical landscape, one significant issue is the lack of a balanced approach where patients receive both rigorously scientific, evidence-based treatment and a broader, holistic evaluation of their health. Under the traditional medical model, doctors often focus on ordering and interpreting tests, spending little time understanding the myriad factors influencing a patient’s health, like nutrition, exercise, sleep, stress, and spiritual aspects. Conversely, alternative medicine practitioners might look at these broader aspects but sometimes lack the depth of scientific knowledge needed for nuanced medical interpretation.
A Unique Approach to Men’s Health
Let me give you some examples of how I combine my expertise in traditional endocrinology and knowledge of functional medicine for the benefit of my patients. Let’s take men’s health. Everyone knows that men’s health is often an overlooked area in traditional medicine. Few doctors, outside of urology and endocrinology, order testosterone tests, and even when they do, other factors influencing testosterone production and metabolism are rarely addressed. Naturopaths, while attentive to symptoms, might not have the expertise to interpret complex or borderline lab values. What if an overweight man is experiencing chronic fatigue and has somewhat low total testosterone levels? Is this hypogonadism? Should he automatically start testosterone replacement?
My approach involves a detailed initial conversation about the patient’s lifestyle, including nutrition, sleep, stress, and even sexual health. Then, I order high-quality, gold-standard testing, delving deep into the results. Understanding that “normal” values from lab tests are based on population averages rather than individual norms, I go well beyond just those tests, however. I check pituitary hormones that control testosterone production, like luteinizing hormone (LH) and follicle-stimulating hormone (FSH). I also order sex hormone binding globulin (SHBG), which can affect how much free testosterone is biologically active in the body. A slightly low total testosterone may not necessarily signify hypogonadism if SHBG is low, leading to normal free testosterone levels. But the evaluation does not stop there.
Equally important is detailed information about nutrition, type and frequency of exercise, quantity and quality of sleep, various stress factors, issues relating to relationships, presence or absence of chronic diseases, and so on. All those factors, separately and when taken together in various combinations, can influence both testosterone levels and symptoms a patient may experience. Then and only then, putting all the pertinent factors together, do I start a detailed discussion with the patient regarding his condition.
A Brand-New Functional Endocrinology Practice – and a New Approach to Treatment
This complexity in men’s health requires time, expertise in various medical fields, and an understanding of both laboratory science and functional medicine. I explain every step of evaluation and management in plain, understandable language, making sure that my patients grasp the implications of their healthcare data. I take my time to answer all the questions that may arise, especially in the era of confusing and complex information on the Internet and from other sources. The decision to pursue testosterone optimization or replacement therapy is made collaboratively, considering both benefits and potential drawbacks like impacts on prostate health or cardiovascular risks.
Similarly, thyroid conditions are approached with meticulous care. The interpretation of thyroid function tests can be tricky; TSH (thyroid-stimulating hormone) from the pituitary is literally ten times more sensitive than T4 and T3 thyroid hormones. To illustrate, a five percent change in the level of T4 or T3 results in a fifty percent change in the level of TSH, going in the opposite direction. One needs to understand this dynamic when interpreting thyroid tests.
And then there is an issue of antibodies against the thyroid. What do they mean? Where do they come from? Can they be changed? I answer all those questions, but not before carefully examining the lifestyle issues that may impact the function of the thyroid gland, such as stress, nutrition, medications, and inflammatory changes, to name a few. Then, I synthesize the available data into a comprehensive plan, incorporating scientific/laboratory and lifestyle information. The result is a much more comprehensive evaluation and a better health outcome.
In an era when healthcare can feel fragmented and rushed, my practice offers a model of integrated, patient-centered care, ensuring that each individual receives the attention, understanding, and treatment tailored to their unique health narrative.
Dr. Michael Duben graduated magna cum laude from NYU and attended Mount Sinai School of Medicine. He completed his residency at Montefiore and Mount Sinai hospitals and obtained his endocrine training at the Albert Einstein College of Medicine/Montefiore Hospital. He is a clinical instructor at the Albert Einstein College of Medicine, is board-certified in diabetes, endocrinology, and metabolism, and has been in private practice since 2003. He finished his functional medicine training in 2024.
His office is located at 501 Kings Hwy. E., Ste. 103, Fairfield, CT 06825. His office number is 203.760.5544, fax 203.502.8570, website: www.restorehealthmd.com
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