Chiropractic Rehabilitation Overview for Testosterone Health

Chiropractic rehabilitation can improve testosterone levels and overall body wellness. Find out how it can benefit you.

Abstract

Low testosterone, or hypogonadism, is often reduced to a single lab number and a cream. That approach misses the physiology. Testosterone supports muscle, bone, insulin sensitivity, red blood cell production, mood, libido, and recovery. When comorbidities such as obesity, sleep apnea, chronic pain, opioid use, and inflammation are present, the same number means something different. The body often enters a loop in which low testosterone worsens the comorbidity, and the comorbidity further suppresses testosterone.

This article explains what testosterone does, why a total testosterone near 370 ng/dL can matter even inside a wide reference range, and how to separate central hypogonadism (a signaling problem) from peripheral hypogonadism (a testicular production problem) with luteinizing hormone (LH), follicle-stimulating hormone (FSH), free testosterone, and estradiol. It reviews the limits of transdermal gels and creams, then explains how chiropractic care fits into a nonsurgical plan that includes massage therapy, physical therapy, and functional wellness. Clinical observations are drawn from the published educational work of Dr. Alexander Jimenez, DC, APRN, FNP-BC, at the El Paso Health Coach Clinic and from his LinkedIn profile.

At Injury Medical Clinic PA in El Paso, Texas, chiropractic and functional medicine care is provided by Dr. Jimenez and supported by medical oversight from Medical Director Dr. Maria Guadalupe Cardenas, MD, a board-certified internist (NPI 1164426749, Texas MD License J2933). When used, hormone prescriptions and other medical therapies are directed within that collaborative model. Chiropractic care is not a treatment for hypogonadism and is not a substitute for indicated medical evaluation.

What Testosterone Does in the Male Body

In men, Leydig cells in the testes produce most testosterone after the pituitary releases LH. A smaller amount comes from the adrenal glands. About 98% of circulating testosterone is bound to sex hormone-binding globulin (SHBG) or albumin. Only the free fraction readily enters muscle, brain, bone, and other tissues.

Testosterone is both an anabolic and an androgenic signal. It helps maintain lean mass and strength, supports bone mineral density, contributes to red blood cell production, influences libido and erectile physiology, and participates in motivation and mood. It also improves insulin sensitivity and helps limit visceral fat gain. The Endocrine Society recommends diagnosing hypogonadism only when compatible symptoms and signs are present and morning fasting testosterone is unequivocally and consistently low on an accurate assay (Bhasin et al., 2018).

Most daily testosterone production depends on sleep, especially deep sleep. Anything that fragments sleep, raises chronic stress, or reduces training capacity sits upstream of the hormone itself.

What Happens When Comorbidities Affect the Body

Low testosterone rarely travels alone. In clinical teaching at the Health Coach Clinic, Dr. Jimenez has described how hormonal imbalance in men overlaps with fatigue, brain fog, low libido, joint and muscle stress, higher body fat, and lower bone mineral density, and how those changes limit the back, hips, shoulders, and neck (Jimenez, 2022). The same teaching links low testosterone with metabolic syndrome: higher insulin, more visceral fat, and more aromatase activity in adipose tissue, which converts testosterone to estradiol and further suppresses the hypothalamic-pituitary-gonadal (HPG) axis.

Common comorbidity loops include:

• Visceral obesity and insulin resistance. Fat tissue expresses aromatase. More conversion to estradiol can suppress LH. Low testosterone then favors further fat gain and muscle loss.
• Obstructive sleep apnea. Fragmented sleep cuts the nightly testosterone pulse and raises sympathetic stress.
• Chronic pain and inflammation. Persistent pain increases cortisol demand, reduces training capacity, and is linked to lower androgen tone. Opioids used for that pain can directly suppress gonadotropin release.
• Liver stress and high SHBG. In one teaching case, Dr. Jimenez described a man with total testosterone of 188 ng/dL, free testosterone of 2 pg/mL, and SHBG of 65 nmol/L, in whom inflammation and liver stress left almost no usable hormone (Jimenez, 2026).
• Low activity and andropause. Less muscle and higher insulin resistance reinforce each other. Dr. Jimenez has noted that this pattern can travel with metabolic syndrome and cognitive complaints, not only sexual symptoms (Jimenez, 2022).

Severe late-onset hypogonadism is not a cosmetic issue. In the European MaleAging Study, men with severe late-onset hypogonadism had a multivariable-adjusted hazard ratio of 5.5 for all-cause mortality compared with men without that syndrome, and men with testosterone below 8 nmol/L (about 230 ng/dL) had about a twofold higher mortality risk (Pye et al., 2014). A level of 370 ng/dL (about 12.8 nmol/L) isn’t a particularly severe range. It can still be functionally low for a symptomatic man in his 40s or 50s, especially if free testosterone is low or estradiol and SHBG are unfavorable. “Normal” on a lab report is a population statistic, not a personal target.

Central Versus Peripheral Hypogonadism

The practical question is where the signal fails.

Central, or hypogonadotropic, hypogonadism is a communication problem. The testes can still work, but LH is low or inappropriately normal while testosterone is low. Contributors include obesity, sleep apnea, opioids, significant illness, pituitary disease, and chronic stress. When fertility and testicular reserve allow, the first goal is to restore signaling rather than replace the hormone alone.

Peripheral, or hypergonadotropic, hypogonadism is a production problem. LH and FSH are high because the pituitary is already signaling hard, and the testes cannot answer. Causes include Klinefelter syndrome, trauma, chemotherapy, radiation, infection, and primary age-related Leydig cell failure. Stimulating the pituitary will not fix broken machinery. Direct replacement may be appropriate after medical evaluation.

Exogenous testosterone without this distinction suppresses LH and FSH and can reduce sperm production. Fertility goals change the plan (Bhasin et al., 2018).

Signs of Hormonal Imbalances In Men *THIS IS WHY*- Video

Four Blood Tests That Change the Plan

A single total testosterone measurement is not enough. Morning, fasting, and repeated measurements are the standard starting point (Bhasin et al., 2018).

LH shows whether the pituitary is quiet or loud. Low or inappropriately normal LH with low testosterone points to a central cause. Clearly high LH with low testosterone points to a peripheral cause.

FSH corroborates that pattern and speaks to sperm production. Low LH and low FSH together support central suppression. High LH and high FSH support primary testicular failure.

Free testosterone, read with SHBG, is the usable fraction. A middling total testosterone with high SHBG can still leave a man functionally deficient. Dr. Jimenez has repeatedly emphasized the gap between total testosterone and how the patient feels (Jimenez, 2026).

Estradiol matters because aromatase in fat, liver, and other tissues converts testosterone to estradiol, and higher estradiol participates in negative feedback on LH. It should be interpreted in context, not driven to zero. Men need some estradiol for bone, brain, and libido.

Why Creams and Gels Are Often a Poor First Choice

Transdermal gels can raise total and free testosterone into the reference range. Still, absorption varies by site, skin, and skin thickness; estradiol and dihydrotestosterone often rise as testosterone rises (Swerdloff et al., 2000). In that pharmacokinetic work, estradiol rose while LH and FSH fell in proportion to the increase in testosterone. Clinically, that can mean water retention, breast tenderness, mood volatility, and a further shutdown of the man’s own axis.

Injections, subcutaneous protocols, and, in selected cases, pellets produce a different exposure pattern. They still suppress endogenous LH unless a stimulatory strategy is chosen. Delivery should follow the diagnosis, fertility goals, hematocrit, prostate monitoring, and sleep apnea status, not marketing (Bhasin et al., 2018). Medical direction for these therapies sits with the collaborating physician.

How Chiropractic Care Supports Testosterone Health

Chiropractic care does not directly turn on Leydig cells. A systematic review of biochemical markers after spinal manipulation found low-quality evidence for short-term cortisol changes and very low-quality evidence that manipulation does not meaningfully change testosterone itself (Rist et al., 2024). The supportable claim is indirect and clinical.

Dr. Jimenez’s published observation is that low testosterone loads the muscles and joints, and that ongoing pain then keeps the nervous system in a stress pattern (Jimenez, 2022). Adjustments improve joint motion and reduce mechanical stress so the patient can sleep, train, and downshift sympathetic load. Later teaching ties the spine-protected nervous system to stress physiology, posture-related muscle ache, and the ability to exercise, the behavior most consistently linked to healthier androgen status (Jimenez, 2026). Experimental work has linked four weeks of chiropractic care to changes in sensorimotor processing, mood, sleep-stage distribution, and quality-of-life scores (Haavik et al., 2024). Sleep and pain relief are plausible routes to better hormonal conditions. They are not a guarantee of a higher lab value.

In practice, that means restoring motion in the cervical and thoracic spine and hips so breathing, sleep position, and lifting are less guarded; reducing pain that drives opioid use and inactivity; and enabling resistance training. It also means coordinating care when symptoms suggest sleep apnea, depression, pituitary disease, or primary hypogonadism that needs medical workup.

Combining Chiropractic Care With Other Nonsurgical Treatments

The useful model is a stack, not a single technique.

Chiropractic care is the mechanical and neurological entry point. Massage therapy reduces muscle guarding, improves circulation in overworked tissue, and lowers the pain that blocks sleep. Physical therapy adds graded strength, hip and trunk control, and return-to-load progressions so regained motion becomes muscle. Functional wellness and health coaching at the Health Coach Clinic use labs, nutrition, and habit design to address insulin resistance, low vitamin D, low zinc or magnesium, and low dietary fat intake that leave the steroid pathway underfed (Health Coach Clinic, n.d.; Jimenez, 2022).

A typical sequence for a man with low-normal testosterone, central adiposity, and back pain is medical labs first, then concurrent chiropractic adjustments, soft-tissue work, and a physical therapy strength plan, with nutrition aimed at protein, resistance training, sleep, and alcohol reduction. Stimulatory options such as clomiphene or hCG, and peptides such as kisspeptin, are medical decisions under Dr. Cardenas’s direction, used only when the diagnosis is central and fertility or endogenous production is the goal. They are not chiropractic procedures.

A Practical Close

A result of 370 ng/dL with fatigue, loss of strength, and low libido deserves a cause, not a shrug and a gel. Measure LH, FSH, free testosterone, and estradiol. Separate a quiet pituitary from tired testes. Treat the comorbidities that keep the axis offline. Use chiropractic care, massage, physical therapy, and functional wellness to restore motion, sleep, and training capacity, and use medical therapy when the diagnosis calls for it.

Injury Medical Clinic PA is at 11860 Vista Del Sol, Suite 128, El Paso, TX 79936, (915) 850-0900 and (915) 412-6677. Educational material from Dr. Jimenez is at Injury Medical Clinic PA, 11860 Vista Del Sol, Suite 128, El Paso, TX 79936; (915) 850-0900; and (915) 412-6677. Educational material from Dr. Jimenez is at healthcoach .clinic and LinkedIn.

References

• Bhasin, S., Brito, J. P., Cunningham, G. R., Hayes, F. J., Hodis, H. N., Matsumoto, A. M., Snyder, P. J., Swerdloff, R. S., Wu, F. C., & Yialamas, M. A. (2018). Testosterone therapy in men with hypogonadism: An Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 103(5), 1715–1744.
• Haavik, H., Niazi, I. K., Amjad, I., Kumari, N., Ghani, U., Ashfaque, M., Rashid, U., Navid, M. S., Kamavuako, E. N., Pujari, A. N., & others. (2024). Neuroplastic responses to chiropractic care: Broad impacts on pain, mood, sleep, and quality of life. Brain Sciences, 14(11), 1124.
• Health Coach Clinic. (n.d.). El Paso Health Coach and Wellness Center.
• Jimenez, A. (2022). Hormonal imbalances in men and chiropractic care. El Paso Health Coach Clinic.
• Jimenez, A. (2026). BHRT and pellet therapy for balanced hormonal health. El Paso Health Coach Clinic.
• Jimenez, A. (n.d.). Alexander Jimenez, DC, APRN, FNP-BC. LinkedIn.
• Pye, S. R., Huhtaniemi, I. T., Finn, J. D., Lee, D. M., O’Neill, T. W., Tajar, A., Bartfai, G., Boonen, S., Casanueva, F. F., Forti, G., Giwercman, A., Han, T. S., Kula, K., Lean, M. E. J., Pendleton, N., Punab, M., Vanderschueren, D., Wu, F. C. W., & the EMAS Study Group. (2014). Late-onset hypogonadism and mortality in aging men. The Journal of Clinical Endocrinology & Metabolism, 99(4), 1357–1366.
• Rist, P. M., Hernandez, A., Bernstein, C., Kowalski, M., Osypiuk, K., Vining, R., Long, C. R., Goertz, C., Song, R., & Wayne, P. M. (2024). Changes in biochemical markers following a spinal manipulation: A systematic review update. Chiropractic & Manual Therapies, 32, Article 3.
• Swerdloff, R. S., Wang, C., Cunningham, G., Dobs, A., Iranmanesh, A., Matsumoto, A. M., Snyder, P. J., Weber, T., Longstreth, J., & Berman, N. (2000). Long-term pharmacokinetics of transdermal testosterone gel in hypogonadal men. The Journal of Clinical Endocrinology & Metabolism, 85(12), 4500–4510.

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