Introduction
Testosterone is the main sex hormone in men that develops male characteristics including increased muscle mass, facial hair, and a deeper voice. In addition to its reproductive purpose, testosterone affects almost all aspects of men’s health that include bone density and fat distribution, and feelings of energy, mood, and brain health. Therefore, appropriately (optimal) maintaining testosterone levels helps to sustain quality of health and vitality for years to come.
Over the past few decades researchers and doctors have reported a steady decline in the average testosterone level in men around the world. Often attributed to lifestyle, environmental toxins, obesity or aging, the decline in total testosterone is a growing concern for men’s physical and mental health.
The following article will discuss the biological action of testosterone ,the effects of testosterone on men’s health, indicators of low testosterone, and low testosterone causes, as well as provide evidence based suggestions to sustain or restore testosterone balance.
The Science of Testosterone: The Male Hormone
1.1. What is Testosterone?
Testosterone is an androgen (male hormone) mainly produced in the testes (as well as smaller quantities in the adrenal glands). It is important for male sexual development, sperm production, and sustaining male secondary sex characteristics.
In women, testosterone is produced in smaller amounts in the ovaries and adrenal glands, adding to muscle and bone strength, as well as libido.
1.2. How Testosterone Works
The hypothalamic-pituitary-gonadal (HPG) axis regulates testosterone production:
The hypothalamus produces and releases gonadotropin-releasing hormone (GnRH).
GnRH causes the pituitary gland to release luteinizing hormone (LH) and follicle-stimulating hormone (FSH).
LH stimulates Leydig cells in the testes to make testosterone.
The testosterone then travels into circulation in the blood. Only about 2% is considered ‘free’ in other words available, the remaining is bound to proteins such as sex hormone-binding globulin (SHBG) and albumin.
Biological Functions of Testosterone
2.1. Physical Development
. Stimulates male sexual differentiation while in utero.
. Stimulates growth of muscle mass, bone, and reproductive organs at puberty.
. Contributes to voice deepening and increases body and facial hair.
2.2. Sexual Function
. An essential factor for libido and normal erectile function.
. Stimulates sperm production and fertility.
. Supports health of reproductive tissue.
2 3. Metabolism and Body
. Composition
. Promotes lean muscle growth and fat metabolism
. Sustains bone density and decreases risk for osteoporosis.
. Regulates red blood cells via stimulation of erythropoietin.
2.4.Mental and Emotional Health
. Improves mood, motivation, and self confidence .
. Contributes to improvements with memory, focus, and cognitive performance .
. Low testosterone has been linked with, and correlates to depression anxiety, and lack of energy .
3. Factors Contributing to Low Testosterone (Hypogonadism)
A man’s testosterone level starts to decline, roughly, after the age of 30, at a rate of about 1% per year and some causes may accelerate this decline.
3.1. Primary Causes (Testicular Etiology)
. Genetic conditions – Klinefelter syndrome.
. Trauma or infection of the testicles (mumps orchitis).
. Chemotherapy or radiation.
. Undescended testes (cryptorchidism).
3.2. Secondary Causes (Central Etiology)
. Pituitary disease (tumors).
. Hypothalamic issues.
. Chronic conditions, diseases, and inflammation.
. Chronic stress or impaired sleep.
3.3. Lifestyle and Environment
. Obesity: increases action of the aromatase enzyme and conversion of testosterone to estrogen.
. Diet: lack of zinc, vitamin D, or omega-3 fatty acids.
. Alcohol and recreational drug use: sabotage aspects of synthesis of testosterone and other hormones.
. Sedentary lifestyle: lower metabolic and endocrine output.
. Environmental toxins: e.g., BPA and phthalates, disrupt endocrine system.
. Chronic stress: raises levels of cortisol in the body, impeding testosterone production.
4. Indicators and Symptoms of Low Testosterone
Men having low testosterone (usually below 300 ng/dL) may show:
Physical Indicators
. Decrease in muscle mass and strength
. Increase in body fat (more so in the abdomen area)
. Low energy and persistent fatigue
. Decreased bone density
. Erections failure
. Loss of hair (or decremented beard growth)
Psychological Indicators
. Decreased libido or poor sense of satisfaction with sex life
. Feeling down, being moody, or feeling anxious
. Foggy brain and not able to focus
. Low motivation or confidence
Serious Health Risks – Long-Term Effects
Low testosterone levels which are not treated, may cause an increased risk for:
. Metabolic syndrome
. Type 2 diabetes
. Cardiovascular disease
. Osteoporosis
. Cognitive decline
5. Diagnosis of Testosterone Deficiency
The diagnosis will first need first-hand knowledge of the clinical symptoms. The physician will then perform biochemistry tests to check testosterone levels.
5.1. Lab Studies
. Total testosterone (morning measurement when most elevated)
. Free testosterone (better precision in diagnosis)
. LH and FSH (to determine primary vs secondary)
. Then prolactin levels and thyroid function
. SHBG
5.2. Normal ranges on physical labs
. Adult male normal: 300-1000 ng/dL
. Borderline low: 250-350 ng/dL
. Above 250 ng/dL = clinically low testosterone levels.
6. Natural Strategies for Increasing Testosterone
Generally, lifestyle changes are the best path to raising testosterone levels naturally without any shortcomings.
6.1. Diet
. Protein: lower-fat animal protein, eggs, fish, legumes.
. Healthy fats, or beneficial fats: avocado, nuts, olive oil, omega-3 fish oils.
. Foods containing zinc: oysters, Pumpkin seeds, spinach.
. Vitamin D: sun exposure, or fortified milk, fish (salmon).
. Magnesium and selenium: almonds, whole grains, Brazil nuts.
. Detach from processed foods and consume less/more refined sugars.
6.2. Exercise and Physical Activity
. Strength training resistance exercise leads to increases in testosterone and muscle mass.
. High Intensity Interval Training (HIIT enhances hormonal balance and fat loss.
. Avoid overtraining which increases cortisol leading to a lower testosterone production.
6.3. Sleep and Rest
. Aim for 7–9 hours of sleep per night.
. Deep-sleep stages of sleep are essential for the genesis of testosterone.
. Manage sleep apnea and avoid screens before bed as well.
6.4. Stress Management
. Chronic stress elevates cortisol which negatively impacts testosterone production.
. Meditation, yoga, or breathing techniques.
. Support social relationships and emotional support.
6 5. Weight Management
. Reducing excess fat reduces estrogen production in men .
. Intermittent fasting or equivalent to calorie restriction provides a way to manage hormones.
6.6. Avoid Toxins
. Limit exposure to plastic, pesticides, or personal care/plastics that have endocrine disruptive properties.
. Maybe even drink in glass/stainless steel containers.
7. Medical Treatment for Low Testosterone
If you cannot decrease your testosterone levels naturally, you may require medical treatment.
7.1 Testosterone Replacement Therapy (TRT)
TRT may be given in the following manners:
. Injections (intramuscular and/or subcutaneous)
. Transdermal gels or patches
. Oral capsules
. Pellet implantation
The benefits of TRT may include:
. Increased libido and sexual activity
. Increased muscle mass and bone mineral density
. Improved focus and energy levels
. Cognitive improvement
The risks and side effects may include:
. Acne or oily skin
. Sleep apnea
. Shrunken testicles
. Fertility suppression
. Elevated red blood cell count (erythrocytosis)
. Possibly cardiovascular (still under debate)
TRT must be supervised by a physician, with periodic blood draws.
7.2 Alternative Medical Management
. Clomiphene citrate- stimulates natrual testosterone production
. Human chorionic gonadotropin (hCG)- maintain fertility while on TRT.
. Aromatase inhibitors- decreasing estrogen transformation in obese men.
8. Testosterone and Aging
8.1. Andropause: The Male Menopause
As men age, gradual decline in testosterone (i.e., andropause) results in:
. Fatigue and loss of energy
. Loss of muscle mass
. Decrease in libido
. Instability of mood
And unlike females who go through menopause, andropause is gradual and variable; men can still produce testosterone at advanced ages with care.
8.2. Aging and Risk of Disease
Low testosterone in older men correlates with:
. Type 2 diabetes
. Obesity
. Alzheimer’s disease
. Depression
. Frailty and falls
Healthy lifestyle choices can offset much of this decline.
9. Testosterone and the Brain
9.1. Cognitive Function
Testosterone has been shown to play a role in memory, attention, and spatial abilities. Individuals with low testosterone may experience “brain fog” or cognitive decline.
9.2. Mood and Emotion
Studies have found that men with low testosterone experience higher incidence of depression, irritability, and sensitivity to stress.
9.3. Motivation and Drive
While less researched, optimal testosterone levels seem to predict values like goal and goal-directed activity which are often associated with better vitality and confidence.
1o. Testosterone, Fertility, and Sexual Health
10.1. Fertility
Testosterone helps with sperm production, but an excess of testosterone can inhibit fertility due to low LH and FSH levels. A male taking testosterone for fertility should consult with a physician rather than self-administering testosterone.
10.2. Erectile Function
Testosterone affects libido, and testosterone is involved in the pathways leading to an erection via nitric oxide. However, the causation of erectile dysfunction can also stem from non-low testosterone vascular or psychological parameters.
10.3. Sexual Satisfaction
Having an adequate testosterone level can enhance sexual endurance, pleasure, and intimacy satisfaction.
Frequently Asked Questions (FAQ)
Q1: What is the ideal age to test testosterone levels?
Any adult male who is exhibiting symptoms such as fatigue, reduced libido, or mood changes, should be tested—typically, this can occur at 30.
Q2: Can diet solve low testosterone levels?
In mild cases, yes—if low levels of testosterone are due to a lack of nutrients or obesity. A physician should evaluate more severe cases.
Q3: Is TRT safe in the long term?
TRT can be safe, effective, and without adverse effects when monitored responsibly by a medical physician. Blood work is performed regularly to check for red blood cell count, prostate health, and hormone balance.
Q4: Does masturbation or sexual activity affect testosterone hormone levels?
Normal sexual activity will not lower testosterone levels, nor will sexual activity lower testosterone levels—exciting sexual behaviors will increase testosterone slightly.
Q5: Will any supplements raise testosterone levels?
A handful of supplements may raise testosterone, such as ashwagandha, vitamin D, and zinc. There are very few supplements supported by specific research.
The End
Testosterone is not just a sex hormone—it is an incredibly important regulator of male health, including physical strength, mental clarity, energy, and emotional equanimity. A multitude of poor health habits, anxiety, and toxins in our environment lead to, what we call, a quiet epidemic of low testosterone among men around the world.
