By Dr. Mercola
The male sex hormone testosterone plays many roles in men’s health. Besides affecting your sex drive, it also helps maintain muscle mass, bone density, red blood cells, and a general sense of well-being.
Beginning around age 30, a man’s testosterone levels begin to decline, and continue to do so as time goes on—unless you proactively address your lifestyle. Symptoms of declining testosterone levels can include:
- Decreased sex drive
- Erectile dysfunction and/or problems urinating
- Difficulties with concentration and memory
- Weight gain and/or breast enlargement
Unfortunately, direct-to-consumer drug advertising, which is permissible in the US, is driving men to use testosterone when they’re really not good candidates for it. There are studies showing that testosterone therapy can be quite helpful and beneficial, but that’s in men who actually have very low testosterone.
Lacking energy and sex drive does not automatically mean you have severe testosterone deficiency warranting taking this hormone. Yet “low T” has become a well-recognized mantra—created by some pharmaceutical PR department—even though there’s no hard and set “normal” testosterone level.
Your Lack of Libido Could Be Due to Other Hormonal Imbalance
For example, a recent study published in the New England Journal of Medicine (NEJM)1 found that there were significant individual variations in the amount of testosterone required for any particular man to maintain lean body mass, strength, and sexual function.
Other hormones, such as estrogen, also play a critical role in men’s health, so the heavy focus on testosterone may be inappropriate. The NEJM study2 determined that while testosterone deficiency accounted for decreases in lean mass, muscle size, and strength, estrogen deficiency was the primary culprit when it came to increases in body fat.
Both hormones were found to be important for sexual function, and a deficiency in either had a negative impact on the men’s libido.
Please note that men are NOT advised to take estrogen replacement therapy, as this could cause feminization, such as enlarged breasts. As your testosterone levels rise, your body will automatically produce more estrogen,
So the key is to maintain your testosterone level—ideally by incorporating the strategies I will discuss below. Interestingly, simply having more sex has also been shown to boost testosterone levels in men.3 As reported by PeakTestosterone.com:
“One 1992 study4 examined four couples on days that they did and didn’t have sexual activity… [T]hey found that testosterone levels increased on nights after sexual activity and did not on nights where there was no intercourse. The authors noted that their study showed that it was likely sex that increased testosterone and not the other way around.”
Low Testosterone—An Invented Condition?
It’s important to realize that all of this fake “low T” advertising is merely a PR strategy to sell an expensive treatment. In 2012, prescription testosterone gels generated over $2 billion in US sales. Abbott Laboratories alone spent $80 million on seductive direct-to-consumer advertising for its testosterone product AndroGel that same year.
According to a survey by CMI/Compass, 63 percent of physicians polled feel that drug ads misinform patients.5 And truly, it’s worth keeping in mind that advertising is far from realistic or even truthful in most cases. It’s about creating a perceived need where there might not be one, in order to sell a product. As reported by theNew York Times:6
“In the view of many physicians, [low testosterone] is in large part an invented condition…
Once a niche treatment for people suffering from hormonal deficiencies caused by medical problems like endocrine tumors or the disruptive effects of chemotherapy, the prescription gels are increasingly being sold as lifestyle products, to raise dipping levels of the male sex hormone as men age.”
Many people feel so bad they’re willing to take just about anything to feel better. Unfortunately, many fail to realize that that “something” probably isn’t a drug treatment. Instead, flagging energy levels may be an indication that you’re eating too much processed food. Perhaps you’re not exercising enough, or failing to address chronic stress or lack of sleep.
How Stress Affects Your Testosterone Levels
Chronic stress may in fact be a major contributing factor to decreasing testosterone levels. Stress, when chronic and unaddressed, can result in hypercortisolemia, which in and of itself inhibits testosterone production.7 The cortisol produced in response to stress also interferes with your insulin. As described by chiropractor Kyl Smith, D.C.:8
“This is seen when healthy men exhibit fasting plasma glucose concentrations and degrees of insulin resistance that are directly correlated with fasting plasma cortisol concentrations(i.e., when cortisol goes up, insulin goes up, insulin resistance goes up, and insulin sensitivity correspondingly goes down)…
The subject of insulin and insulin sensitivity ties directly into testosterone, as ‘testosterone and insulin status are also directly correlated.’ Among adult men, the insulin secretion rate and fasting plasma insulin concentration are inversely proportional to serum testosterone concentrations (i.e., high insulin levels are associated with low testosterone and low insulin levels are associated with high testosterone), while whole-body insulin sensitivity is shown to be positively correlated with serum testosterone concentrations.
In other words, in men who have challenges with high postprandial blood sugar levels, simple carbohydrates that evoke an insulin spike/increase will sabotage the production of healthy testosterone.” [Emphasis mine]
Testosterone Is Widely Overprescribed
According to the Endocrine Society, which is responsible for setting the clinical guidelines for testosterone replacement therapy, testosterone should only be given to men with persistent symptoms and “unequivocally low testosterone levels,” a condition known as hypogonadism. According to a 2012 study9 looking at the sensitivity and specificity of total testosterone (total T) as an indicator of biochemical hypogonadism found that a total T level below 150 ng/dl is indicative of hypogonadism, while levels above 350 ng/dl excludes the condition in most cases.
Despite that, testosterone prescriptions have tripled since 2001, and men in their 40s represent the fastest-growing group of users. Only about half of men taking testosterone have an actual diagnosis of hypogonadism. Even more curious, recent findings10, 11, 12 also indicate that 25 percent of men given a prescription for testosterone did not even have their levels tested prior to receiving a prescription, and of the remaining 75 percent, it was unclear as to how many actually had a testosterone deficiency.
In short, there appears to be an awful lot of men out there taking testosterone who probably shouldn’t. Using hormones as a “cure-all” is a risky proposition, especially if your problems are related to lifestyle opposed to an actual medical condition that severely impairs your hormone production. What most men need is really a lifestyle change, in order to optimize their body’s natural secretion of testosterone and other hormones.
Recent Research Highlights the Dangers of Testosterone Misuse
According The result was similar in younger men diagnosed with heart disease. The study was prompted by a 2010 clinical trial that was shut down before completion due to the increase in heart-related problems occurring in the testosterone treatment group.13
Other research14 published earlier this year found that testosterone replacement therapy did not appear to have any positive effects on the cardiovascular health of men who took it, noting that the “cardiovascular risk-benefit profile of testosterone therapy remains largely evasive.”
Interestingly, the analysis does suggest that low testosterone and heart disease might both be caused by “poor overall health,” as stated by lead researcher, Dr. Johannes Ruige.15 This, again, is why I recommend focusing your efforts on healthy lifestyle strategies such as exercise rather than taking synthetic hormone replacement, the risk/benefit ratio of which is still largely unknown.
The latest results have caused enough concern that the US Food and Drug Administration (FDA) has launched a safety review16to ascertain the safety of testosterone therapy. In the meantime, the FDA has instructed doctors to “consider whether the benefits of FDA-approved testosterone treatment are likely to exceed the potential risks of treatment.”
Some Experts Disagree
Dr. Jen Lauda writing in the Feb 7 2014 newsletter summarizes the objections some physicians have with this study. “There are many problems with the data in this study and others like it that have lead to attention-grabbing headlines about how treatment of low testosterone levels may put men at undue risk. Similar to a November 2013 JAMA study of testosterone risks, However some have said that the featured study has multiple flaws that make its conclusions essentially meaningless as the study assess did not test testosterone levels of patients before and during therapy.
There are other important blood tests that should be done that were not being done during the treatment of the VA men or in the current study, including blood counts and estrogen levels. Higher red blood cell counts and higher estrogen levels are known issues that may occur in men given testosterone therapy. Without assessment of testosterone levels, red blood cell counts and estrogen levels prior to and during therapy, it is impossible to tell if a patient is a proper candidate for therapy and if they are tolerating the therapy well. Physicians should be educated on the possible issues they may encounter with patients on testosterone therapy, including higher levels of red blood cells and elevated levels of estrogen.
Physicians should monitor their patients’ blood cell counts and estrogen levels on testosterone therapy to assess for these risk factors for cardiovascular disease. If a patient has a high red blood cell count, the dose of the testosterone can be decreased or the patient can be sent for blood donation to reduce the high red blood cell count and thus any increased risks of clots or heart attacks. Additionally, high estrogen levels may increase the risk of heart attack and stroke. There are medications that can be prescribed to control high estrogen levels and keep estrogen in the proper, low risk range. These precautions need to be used when prescribing testosterone therapy and studies need to be done reflecting results of testosterone use when these precautions are followed.
Additional concerns are that the researchers compared the groups of men started on testosterone therapy to men who were started on PDE5 inhibitors and found a lower risk of heart disease in the PDE5 inhibitor group. PDE5 inhibitors are drugs used to treat men with erectile dysfunction — Viagra and others are in this class. The authors state they used this group so there would theoretically be an increase in sexual activity in both groups. They ignored one very important point, though. PDE5 inhibitors work in many tissues throughout the body, including having significant positive effects on the cardiovascular system. Two of the PDE5 inhibitors have recently been approved for treatment of idiopathic pulmonary hypertension because of the ability of PDE5 inhibitors to relax blood vessels. A new study out this month in the Journal of Cardiovascular Pharmacology and Therapeutics states that PDE5 inhibitors have potential as cardiovascular drugs in patients with coronary artery disease and even possible improvement in heart failure patients.
With the data that PDE5 inhibitors can decrease the risk of heart disease and help to relax blood vessels in men with heart disease, how can the authors of the testosterone therapy study possibly think that men on PDE5 inhibitors would be a good control group against the men placed on testosterone therapy? The results of the Plos One study run counter to a large body of literature of the last 20 years that supports testosterone treatment as an important therapy that can improve cholesterol levels, decrease blood sugar levels, reduce body fat and increase lean muscle mass, all factors that would reduce the risk of heart disease. A new review article was published in December 2013 in the esteemed Journal of the American Heart Association with the goal of providing a comprehensive review of the clinical literature that has examined the associations between testosterone and cardiovascular disease.
Well over 100 studies were reviewed, and the authors concluded that low levels of testosterone are associated with higher rates of mortality and cardiovascular- related mortality, higher rates of obesity and diabetes. Additionally, the severity of disease correlated with the degree of testosterone deficiency. Testosterone therapy has been shown to relax coronary arteries and improve ability of patients with congestive heart failure to exercise. Testosterone therapy has been shown to lower blood sugar in diabetics and to lower body mass index in obese patients. Finally, studies have associated lower testosterone levels with thicker walls of some of the major blood vessels. This thickening increases the risk of atherosclerosis thus leading researchers to conclude that low levels of testosterone increase the risk for atherosclerosis.
All of these factors point to the conclusion that optimal testosterone levels decrease the risk of cardiovascular disease. Testosterone therapy can be an excellent way to help men to enhance their quality of life and decrease their risk of multiple diseases, as shown in many studies. Importantly though, the therapy should not be undertaken lightly and should be properly monitored by a hormone specialist that is well versed in the risks of therapy and the treatment of possible side effects for patients to have optimal benefits from the therapy.”
Lifestyle Factors Influence Your Hormone Levels
Despite the above objections it would seem a more conservative approach would be warranted. While a man’s testosterone level does decline with age, starting around the age of 30, there are many other factors that play a role. Think of generations past, when men were active and healthy well into old age. Clearly, it’s possible to grow old without losing your “oomph.” It really boils down to lifestyle. Diet and exercise are critical factors. But chemical exposures, including prescription drugs like statins, can also play a role by having an adverse effect on your testosterone production. And, as reported in another more recent New York Times17 article:
“Testosterone appears to decline naturally with aging, but internal belly fat depresses the hormone further, especially in obese men. Drugs like steroids and opiates also lower testosterone, and it’s suspected that chemicals likebisphenol A (or BPA, commonly found in plastic food containers) and diseases like Type 2 diabetes play a role as well.” [Emphasis mine]
Testosterone production follows a similar decline with age as human growth hormone (HGH), illustrated below. Fortunately, your body has a natural ability to optimize hormones, even as you age. It does require you to address important factors such as your diet and exercise, however.
To Raise Your Hormone Levels, Exercise Intensely, But Briefly
Both testosterone and HGH are boosted in response to short, high intensity exercises. I personally do not take any hormone or prohormone supplements. Instead, I’ve been doing Peak exercises for just nearly four years now, and at the age of 59, my testosterone and HGH levels are still in the normal ranges for a young adult male without the aid of ANY prescriptions, hormones, and hormone precursor supplements.
Keep in mind that high intensity interval training is the only type of exercise that will help boost your testosterone and HGH levels. A slow one-hour jog will not have this effect, so it’s critical to make sure you’re exercising correctly if you want to affect your hormone levels. Below is a summary and video demonstration of what a typical high-intensity Peak Fitness routine might look like:
- Warm up for three minutes
- Exercise as hard and fast as you can for 30 seconds. You should feel like you couldn’t possibly go on another few seconds
- Recover at a slow to moderate pace for 90 seconds
- Repeat the high intensity exercise and recovery seven more times
Weight training will also have a beneficial impact on your testosterone levels. When you use strength training for this purpose, you’ll want to increase the weight and lower your number of reps. Focus on doing exercises that work a wider number of muscles, such as squats or dead lifts. You can take your workout to the next level by learning the principles of Super-Slow Weight Training. Whole body vibration training using a Power Plate is yet another effective ancillary method.
Besides raising testosterone and HGH, aerobic exercise in general is known to benefit your heart, in part by promoting the production of beneficial nitric oxide, which helps relax your heart and improves blood flow.18 Recent research also suggests that skin-derived nitric oxide metabolites may also play a key role in heart health by normalizing blood pressure when your skin is exposed to UV rays from the sun19 –yet another reason for making sure you’re getting enough sun exposure.
Your Diet Affects Your Testosterone and HGH
While high intensity exercise is perhaps the most effective strategy to raise your testosterone levels, your diet also plays a critical role. First of all, if you’re overweight, research shows that simply shedding the excess pounds may increase your testosterone levels.20
Testosterone levels also decrease after you eat sugar. This is likely because sugar and fructose raises your insulin level, which is another factor leading to low testosterone. Ideally, keep your total fructose consumption below 25 grams per day. If you have insulin resistance and are overweight, have high blood pressure, diabetes, or high cholesterol, you’d be well advised to keep it under 15 grams per day.
The most efficient way to shed excess weight and normalize your insulin levels at the same time is to strictly limit the amount of sugar/fructose and grains in your diet, and replace them with vegetables and healthy fats, such as organic pastured egg yolks,avocado, coconut oil, butter made from raw grass-fed organic milk, and raw nuts. Saturated fats are in fact essential for building testosterone. Research shows that a diet with less than 40 percent of energy as fat (and that mainly from animal sources, i.e. saturated) lead to a decrease in testosterone levels.21 My personal diet is about 70-80 percent healthy fat, and other experts agree that the ideal diet includes somewhere between 50-70 percent fat. I’ve detailed a step-by-step guide to this type of healthy eating program in my optimized nutrition plan.
Another effective strategy for enhancing both testosterone and HGH release is intermittent fasting. It helps boost testosterone by improving the expression of satiety hormones, like insulin, leptin, adiponectin, glucagon-like peptide-1 (GLP-1), cholecystokinin (CKK), and melanocortins, which are linked to healthy testosterone function, increased libido, and the prevention of age-induced testosterone decline.
There are also nutritional supplements that can address some of the symptoms commonly associated with low testosterone. Some may even help boost your testosterone levels as well. These include:
- Saw palmetto. Besides addressing symptoms of low testosterone, this herb may also help to actually increase testosterone levels by inhibiting up-conversion to dihydrotestosterone.22 When choosing a saw palmetto supplement, you should be wary of the brand, as there are those that use an inactive form of the plant. According to industry expert Dr. Rudi Moerck, what you want is an organic supercritical CO2 extract of saw palmetto oil, which is dark green in color. Since saw palmetto is a fat-soluble supplement, taking it with eggs will enhance the absorption of its nutrients.
- Astaxanthin in combination with saw palmetto. There is also solid research indicating that if you take astaxanthin in combination with saw palmetto, you may experience significant synergistic benefits. A 2009 study published in the Journal of theInternational Society of Sports Nutrition23 found that an optimal dose of saw palmetto and astaxanthin decreased both DHT and estrogen while simultaneously increasing testosterone.
- Ashwagandha. This ancient Indian herb is known as an adaptogen, which can help boost stamina, endurance, and sexual energy. Research published in 201024 found that men taking the herb Ashwagandha experienced a significant increase in testosterone levels.
Ashwagandha also helps promote overall immune function, and can help increase your resistance to occasional stress.25 It also supports healthful levels of total lipids, cholesterol, and triglycerides already in the normal range. While some adaptogens are stimulants in disguise, this is not the case with Ashwagandha. It can give your morning exercise routine a boost, and when taken prior to bed, it can help you get a good night’s sleep as well. I recommend using only 100% organic Ashwagandha root, free of fillers, additives, and excipients to ensure quality.
Do You Really Need Testosterone Therapy?
The take-home message is that taking testosterone if you’re otherwise healthy could jeopardize your health for virtually no gain. And, if you’re using a topical gel or cream, you’re also jeopardizing the health of anyone in your family that you end up having skin to skin contact with. I personally do not use any hormone or prohormone treatments as I’ve been successful in getting my hormone levels in the healthy young adult range using the protocols described above. However, if you do chose to use hormones, it is really crucial to use bioidentical versions.
I advise using bioidentical hormones like DHEA if you opt for this route. DHEA is a hormone secreted by your adrenal glands, and is one of the most abundant precursor hormones in your body. It’s crucial for the creation of testosterone and other sex hormones. However, it’s important to monitor your levels and work with an experienced professional before you start using DHEA (or any other hormone, bioidentical or not.) If you use trans-mucosal applications you will likely only need a few milligrams a day, not 50mg, 100mg, or more that is typically used. There are still questions about long-term safety, and there’s still the potential for side effects.26
I also recommend trans-mucosal (rectal) application, as this allows for the most effective absorption, and inhibits the production of unwanted metabolites of DHEA. All of that said, I do NOT recommend prolonged supplementation of hormones, even bioidentical ones. Doing so can trick your body into halting its own DHEA production and may cause your adrenals to become impaired.
Your best bet really is to address your diet, and incorporate high intensity exercise into your lifestyle. For even more information on how exercise can be used as a natural testosterone booster, read my article “Testosterone Surge After Exercise May Help Remodel the Mind.”
Sources and References
- 1 New England Journal of Medicine September 12, 2013; 369:1011-1022
- 2 New England Journal of Medicine September 12, 2013; 369:1011-1022
- 3 Peaktestosterone.com
- 4 Physiology and Behavior 1992 Jul;52(1):195-7.
- 5 New York Times October 15, 2013
- 6 New York Times October 15, 2013
- 7 Dynamicchiropractic.com
- 8 Dynamicchiropractic.com
- 9 Journal of Urology April 2012; 187:1369
- 10 JAMA Internal Medicine 2013;():1-2
- 11 The New York Times June 3, 2013
- 12 WebMD.com June 3, 2013
- 13 JAMA November 6 2013;310(17):1829-1836
- 14 Journal of Clinical Endocrinology and Metabolism 24 September 2013 [Epub ahead of print]
- 15 Medical News Today September 29, 2013
- 16 WebMD.com February 2, 2014
- 17 New York Times February 3, 2014
- 18 Wellnessresources.com
- 19 The Scientist January 20, 2014
- 20 Study presented at The Endocrine Society’s 91st Annual Meeting, June 13, 2009, Washington, D.C.
- 21 J Steroid Biochem. 1984 Jan;20(1):459-64.
- 22 Livestrong.com August 20, 2011
- 23 J Int Soc Sports Nutr. 2008 Aug 12;5:12. doi: 10.1186/1550-2783-5-12
- 24 Fertility and Sterility 2010 Aug;94(3):989-96
- 25 Pharmacol Biochem Behav. 2003 Jun;75(3):547-55
- 26 Naturalhealthsherpa.com