STEP 1. Do You Have Low Stomach Acid or Enzymes? One thing I see over and over again on the Peak Testosterone Forum is men who are feeling lousy and assume their issues can be solved by testosterone. Sometimes it can of course, but very often the real reason they feel lousy are GI (gastrointesting tract) issues. And GI issues can definitely lower testosterone as well.
On this page I want to discuss the experience of one man who went through what many of us experience in modern, industrialized societies on Western diets and lifestyles. If you see his symptoms below, it will sound very familiar to most of you reading this. And, as is typical, his doctor did not want to research the root cause of his issues and haded this man out a pharmaceutical to get rid of this "troublesome" patient - antidepressants and benzodiazepines!
Just giving someone a prescription instead of trying to solve the underlying issue is deplorable in my opinion and the antithesis of what medicine should be. However, there was a happy ending though: Xrayguy - that is his screen name on our Forum - ended up seeing an anti-aging naturopath that decided to test the acid level in his stomach. This page documents Xrayguy's miraculous recovery, protocol and some of the bumps he ran into along the way:
CAUTION: Always do the protocol below with a doctor, naturopath or dietician. It is possible to hurt yourself and there are certain contraindications to the supplements below.
What is stunning - at least to me anyway - is that this man saw six different doctors and none of them ever considered that that it might be a GI issue. In my opinion, if a man has that many issues, that should be the first place you look! And that is especially true considering that GI issues are an epidemic here in the U.S. and Canada. (He is from Canada.)
Also, not that another common symptom of low stomach acid is GERD (reflux or heartburn). Xrayguy explained that "GERD can actually be caused from low stomach acid, rather than too much. Not enough acid and your food ferments in the stomach putting pressure (gas) on the LES causing acid to reflux into the esophagus. My ND said GERD in most cases is not having too much stomach acid, but rather stomach acid being in the wrong place because there is not enough. In addition, both the pancreas and gall bladder are triggered by the increase in stomach acid so if you have low stomach acid you will not get proper emulsification of fat from bile and proper enzyme release which can lead to weight gain." 
I want to keep this page as short as possible and to the point. Read below for the profoundly positive change that occurred in Xrayguy's life within one month of starting this treatment:
"My ND then wondered why we were not seeing better results with all the supplements and diet changes over the past 7 months and raised his eyebrows about the undigested food and increasing bowel issues. He then told me to try Betaine HCL (stomach acid pills) and digestive enzymes until I could see the GI specialist. Here are the products:"
"The very first time I took these my digestive issues reduced by about 90%. Over the following weeks, I had slow improvement with a few bad days here and there. After about 30 days however, the bad days reduced to the point where I have had several weeks now with NO bowel issues whatsoever. It gets better though. Over several weeks I noticed everything improving. Anxiety decreasing, sleep improving, fatigue disappearing, strength returning. Seriously folks, it was like magic. In the past week, I have been doing physical things I have not done in years. I have had many days where I felt NO FATIGUE at all and could get through an entire day, when normally I would fatigue part way through the day." 
"There is 520 mg of Betaine Hydrochloride (HCL) and 23.5mg of Pepsin (porcine pancreas) in each capsule. My ND told me to start with one capsule per meal taken with the first bite of food. If I did not feel a "warming sensation" in the stomach to increase it by one capsule at the next meal until I felt this sensation."
"Once you feel the "warming sensation", then reduce it by one capsule and this is your "threshold dose". So if you feel a warming sensation at 5 capsules, then reduce to 4 capsules moving forward."
"He told me not to exceed 5...capsules per meal." (NOTE: Again, always work with a doctor or naturopath.)
"I got up to 5 capsules per meal after about 2 days and didn't really notice a "warming" sensation per say, but I noticed some indigestion at that dose so I backed off to 4 capsules for the next while. "
"At the same time, I started these digestive enzymes. They are based on plant enzymes and contain various enzymes for the breakdown of fat, protein, lactose, cellulose, etc. So essentially, it is a "broad spectrum" digestive enzyme designed to digest whatever you happen to be eating. The digestive enzymes are taken one capsule with the first bite of food."
"I was told to "test" the quality of the digestive enzyme by cooking up a bowl of oatmeal and then breaking the digestive enzyme capsule open and pouring it into the oatmeal and stirring it in. If the enzyme is a good quality, within 5 minutes you should see some liquification of the oatmeal. I emptied one capsule in to a bowl of oatmeal and within 30 seconds, it went from thick and clumpy to nearly a complete fluid. So, it passed the test." 
DO YOU HAVE TO BE ON THIS INDEFINITELY?
No, many men on this protocol will find that the combination of Betaine HCL, pepsin and enzymes actually "restarts" them, and they no longer have to continue with the Betaine HCL.
You do NOT want to go too high with Betaine HCL. Above, Xrayguy wrote that you should hold down the number of pills, but he PM'd me with the following story:
"I have yet to update my thread with the info, but, the Betaine is tough to determine what your ideal dose is. They say you are supposed to start with one pill per meal and then increase it by one pill per meal until you get a "burning sensation", then backoff one pill and that is your maintenance dose. I never really felt a burning sensation so I increased it up to 8 pills per meal at one point. Then, it backfired after a few days as I developed really bad stomach pain and cramping resulting in a hospital visit."
In addition, there are some medications and situations where you should not use Betaine HCL and when you should not use the pepsin. As always, if you attempt this protocol, do it with a pro!
WHY YOU SHOULD BE CAUTIOUS ABOUT PPI's (Proton Pump Inhibitors):
Xrayguy did a nice job of explaining the dangers of these medications and how they should only be used in the short term except in extremem cases: "So if you have GERD, a conventional doctor will give you an antacid or even a protein pump inhibitor (like Nexium, Prevacid, etc). This then takes your stomach acid down to almost nothing, and your GERD symptoms disappear. Its not possible to have GERD if there is no stomach acid present. PPI's are 90%+ effective in shutting down HCL production so if you are already low, it will shut it down to almost nil. The problem is with no stomach acid, you can no longer denature protein into amino acids and there is no stomach acidity to trigger other processes downstream (like bile and digestive enzyme release). Over time, you will become depleted in essential nutrients and become very unwell. PPI's were designed as a SHORT TERM treatment (2-4 weeks) for healing bleeding ulcers etc. If you even read the warning sheets on PPI's they will state they are only for short term use, but doctors have people on them for years completely shutting down their stomach acid production. Inevitably these patients end up with a host of health issues as a result." 
PPI's also put you at risk of arterial plaque and bedroom issues. See this page for details: PPI's and Erectile Dysfunction.