By Dr. Mercola
Testosterone plays many important 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 vigor and 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. Common symptoms of declining testosterone levels include:
- Decreased sex drive
- Erectile dysfunction and/or problems urinating
- Difficulties with concentration and memory
- Weight gain and/or breast enlargement
Lifestyle changes such as limiting sugar/fructose in your diet while boosting your intake of healthy fats, engaging in high-intensity exercises and strength training, optimizing your vitamin D levels and reducing stress are all helpful strategies shown to boost your testosterone levels naturally. But what about testosterone treatment?
Beware of Testosterone Drug Ad Promises
Hormone replacement therapy is a tricky business due to the complexities of how different hormones work together, mode of administration, timing, dose and many other variables. It's virtually impossible to make responsible recommendations that apply to most people.
When it comes to hormones, you really need to work with a competent doctor who is well-versed in the subject and keeps up on the latest advancements in testing and treatment.
Unfortunately, direct-to-consumer drug advertising, which is permissible in the U.S., drives many men to use testosterone even though they're not good candidates for it. Lacking energy and sex drive does not automatically mean you have a testosterone deficiency warranting taking this hormone.
Previous research1 has found significant individual variations in the amount of testosterone required for any particular man to maintain lean body mass, strength and sexual function.
Other hormones, even the female sex hormone estrogen (albeit in very low concentrations), also play a critical role in men's health, so the singular focus on testosterone replacement may be inappropriate — and unnecessarily risky.
Benefits and Risks of Testosterone Therapy
Most recently, a set of seven interconnected, federally funded clinical trials2,3,4,5,6,7,8 involving 790 men over the age of 65 revealed both benefits and risks of testosterone treatment.9,10,11,12,13,14,15
In older men with low testosterone levels, short-term (one year) treatment was found to boost bone density and strength16 (especially in the spine) and reduce anemia.17 As far as cognition is concerned, no significant improvements were noted in the men's memory or problem-solving skills.18
On the downside, one year of testosterone treatment also increased the risk of cardiovascular events in men aged 65 or older who had a serum testosterone level below 275 nanograms per deciliter (ng/dL) and symptoms of hypogonadism.19,20,21
Compared to the placebo group, those receiving testosterone had a greater increase in coronary artery plaque — a 20 percent increase, compared to a 1 percent increase in the placebo group, which is a rather significant difference.
However, a separate study by the Southern California Permanente Medical Group in Pasadena found that in androgen-deficient men aged 40 and over with documented low morning testosterone levels of less than 300 ng/dL, testosterone therapy was not associated with an increased cardiovascular risk.22
In fact, follow-up over the course of three years suggests the risk of cardiovascular outcomes was 33 percent lower in those receiving testosterone than the placebo group. However, this study was not a placebo controlled trial.
It merely examined the medical records of 8,800 men who were prescribed testosterone therapy, to identify instances of heart attacks, unstable angina, stroke or sudden cardiac death over a period of three years.
Still No Hard and Fast Rules on Testosterone Therapy
As noted by Susan Ellenberg, professor of biostatistics in the Perelman School of Medicine at the University of Pennsylvania, who co-authored four of the studies,23 "There are definitely benefits and potential risks. It's not an overwhelming conclusion that every man over 65 should be on this or stay away from it."
Indeed, three testosterone trials published last year produced a similarly mixed bag of results.24 While men over 64 with low testosterone levels experienced modest improvements in libido when using testosterone gel, the treatment had no beneficial impact on general vitality or walking ability.
The same kind of mixed results are found in other previous studies. For example, one using data from 83,000 U.S. veterans found that men with low testosterone who used testosterone gels, patches or injections had a reduced risk of heart attack, stroke and even all-cause mortality, compared to untreated men.25
Meanwhile, a study26 published two years prior found that men aged 65 and older who took testosterone DOUBLED their risk of heart attack within the first three months of use, even if they did not have heart disease prior to starting the therapy. The result was similar in younger men diagnosed with heart disease.
Another 2013 study27 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 did suggest that low testosterone and heart disease might both be caused by "poor overall health."28 I agree, and this is one of the reasons I recommend focusing your efforts on a healthy diet and lifestyle rather than taking hormone replacement, as the risk/benefit ratio of testosterone therapy remains unclear, especially over the long term.
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 study29 looking at the sensitivity and specificity of total testosterone as an indicator of biochemical hypogonadism, a total testosterone level below 150 ng/dL is indicative of hypogonadism, while levels above 350 ng/dL exclude the condition in most cases.
9 Body Hacks to Optimize Your Testosterone Level Naturally
While a man's testosterone level does decline with age, starting around the age of 30, there are many factors besides aging 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."
So, unless you're working with a hormone specialist, your safest bet is to simply address lifestyle factors known to influence your testosterone level. The video above describes nine helpful strategies, including:
✓ Weight loss. Visceral fat (internal belly fat) is known to suppress testosterone production30
✓ High-intensity exercise
✓ Strength training
✓ Limit or eliminate sugar from your diet, as insulin spikes sabotage production of testosterone.
Having good insulin sensitivity is positively correlated with healthy testosterone concentrations31
✓ Optimize your vitamin D level. To produce testosterone, your body requires several different nutrients.
Among the nutrients more often depleted are vitamin D3 and zinc
✓ Increase zinc and magnesium intake.
✓ Eat healthy fats, and do not shun cholesterol-rich foods as your body cannot produce testosterone without cholesterol.
Research shows a diet with less than 40 percent of energy as fat (mainly from animal sources, i.e. saturated) lead to a decrease in testosterone levels33
✓ Boost intake of branch chain amino acids. This is best accomplished by whole foods like whey protein concentrate (not Isolate)
Sex, Drugs and Food — Other Considerations That Affect Your Testosterone Production
Also, while low libido and erectile dysfunction are symptoms of low testosterone, know that having sex will in and of itself boost your testosterone level.34,35 In fact, the study concluded that the act of intercourse is likely what increases testosterone in men and not the other way around. Meaning, elevations in testosterone are not what get you in the mood. Rather it's the "doing it" that sets into motion a positive feedback loop that leads to a boost in libido.
Also avoid drugs that lower testosterone as a side effect. Statins, for example, are associated with a number of symptoms commonly attributed to testosterone deficiency, including cognitive loss and sexual dysfunction. Statins also nullify many of the benefits of exercise, so if you're on a statin and exercise to boost your testosterone, your results may be less than satisfactory. Steroids and opioid painkillers also lower testosterone.
As mentioned, your body requires a number of different nutrients to efficiently produce testosterone, including vitamin D and zinc. To give your body the necessary building blocks, consider adding more of the following foods to your diet:
✓ Authentic extra virgin olive oil. In research, participants who consumed olive oil daily experienced an increase in testosterone levels between 17 and 19 percent over a three-week period37
✓ Zinc-rich foods such as oysters, sardines, anchovies, cashews, wild-caught Alaskan salmon and raw pumpkin seeds
✓ Coconut and coconut oil will improve your body's ability to make cholesterol, which is necessary for testosterone production
✓ Garlic. While it does not contain any necessary nutrients to produce testosterone, it does contain allicin, a compound that lowers cortisol.
With your cortisol levels lowered, your body can more effectively and efficiently use the testosterone that is produced39
Another effective strategy for enhancing testosterone is intermittent fasting. It helps boost testosterone by improving the expression of satiety hormones like insulin, leptin, adiponectin, glucacgon-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.40 When choosing a saw palmetto supplement, make sure it's 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 study41 found that an optimal dose of saw palmetto and astaxanthin decreased 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 201042 found that men taking Ashwagandha experienced a significant increase in testosterone levels.
Ashwagandha also helps promote overall immune function, and can help increase your resistance to occasional stress.43 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 percent organic Ashwagandha root, free of fillers, additives and excipients, to ensure quality.
DHEA Is Another Alternative Route, but Lifestyle Changes Are Safest
The take-home message from all these studies 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.
Women and young children can absorb it via skin contact, and neither should ever use testosterone. Personally, I've successfully raised my hormone levels into 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 recommend 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 sex hormones, including testosterone. 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.)
The preferred routes of administration to most closely mimic normal levels are trans mucosal applications (intrarectal or intravaginal). You will likely only need a few milligrams a day, not the 50 to 100 mg or more that is typically used. Keep in mind, though, that there are still questions about long-term safety, and there's still the potential for side effects.44
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 DHEA and other hormones, even bioidentical ones. Doing so can trick your body into halting its own DHEA production and could potentially impair your adrenal function. It is also best to regularly monitor hormone levels if you choose to use hormone administration. My favorite and recommended is the DUTCH test that I discuss in depth with Mark Newman, the founder of this test.
In the final analysis, your best bet is to address your diet, and incorporate high-intensity exercise and strength training into your routine. Certain foods, nutritional supplements and herbs may further boost your results, making hormone treatment completely unnecessary.