In the television commercials, men with salt-and-pepper hair drive speedboats and make bedroom eyes at their ladies while a narrator asks, “Do you have a decreased sex drive? Lack of energy? Moodiness? The problem may be low testosterone.”
These direct-to-consumer ads are a drug-industry triumph. Since 2000, the number of American men using supplemental testosterone products, such as AndroGel, Axiron, and Fortesta, has nearly quadrupled.
Testosterone (“T” for short) is now a $2.4 billion industry. The explosive growth is due, in part, to easier delivery options, such as gels and roll-ons, as well as treatment centers that supply injections.
But there’s more to this story. “If something sounds too good to be true, it probably is,” warns Bradley Anawalt, MD, an endocrinologist and chief of medicine at University of Washington Medical Center in Seattle.
He heads the Hormone Health Network, the public-education arm of the Endocrine Society, which releases clinical guidelines for testosterone therapy.
“These commercials try to convince men that there is something wrong with them,” Anawalt says. “But men need to remember that drug companies are there to make a profit.”
Recent research into the safety of testosterone therapy has yielded mixed results. One study, funded by the National Institutes of Health, showed no adverse effects. Other studies, however, have shown an increased risk of heart attack and stroke.
The findings prompted the FDA to start investigating the safety of testosterone products. (The FDA findings are forthcoming.)
Male testosterone levels drop 1 to 2 percent annually after age 30 as part of andropause, or male menopause. But recent studies have found that the decrease is often more the result of lifestyle factors than it is the natural consequence of aging.
A common risk factor for low testosterone is being overweight. And nearly 70 percent of American men are overweight or obese.
For every one-point increase in body mass index, or BMI, it turns out, a man’s testosterone decreases by 2 percent. That’s bad because testosterone calibrates libido, bone density, muscle mass, strength, motivation, memory, and fat burning.
The good news, says fitness expert Adam Bornstein, coauthor of Man 2.0: Engineering the Alpha, is that testosterone is quite sensitive to lifestyle changes, and men rarely need a prescription to boost their T levels. Using lifestyle fixes instead of supplemental T, Bornstein says, is like fixing up a broken engine versus simply putting different fuel in it.
Anawalt, who routinely sees men in his practice lose a few pounds, feel better, and increase their testosterone naturally, agrees.
“More often than not,” he says, “healthy living is the solution.”
Weight loss is a good place to start, but it’s not the only avenue to upping your testosterone. Read on to find out how to harness your body’s power to make more T.
10 Ways to Boost Your Testosterone
1. Lose the Visceral Fat
The science is clear: Men’s body fat drains testosterone. We’re not talking pinchable back fat or squishable love handles. We’re talking classic belly fat. In medical parlance, it’s called visceral fat. Unlike fat that lies just beneath the surface of the skin, visceral fat nestles deep in the abdomen around the organs. It’s tenacious, dangerous, and hormonally active. The more visceral fat a man has, the higher his risk of type 2 diabetes, heart disease, high cholesterol, hypertension, insulin resistance, and colon cancer.
Visceral fat, which is often driven by consumption of flour, sugar, and the high-glycemic processed foods that contain them, depletes testosterone. Visceral fat makes aromatase, an enzyme that turns testosterone into estrogen. “Men don’t realize their belly fat can steal their masculinity,” says John La Puma, MD, author of Refuel.
“I talk to men about how they need to lower their cholesterol and reduce their blood pressure,” he says. “But I don’t get their full attention until I tell them that if they don’t let me help them address their belly fat, their testicles will shrink, they’ll lose their erections, and their libido will disappear.”
If you’re wondering if your weight could be affecting your manhood, wrap a tape measure around your abdomen under your shirt, right at your belly button. Check the number. Ideally, your waist size is half your height. If your waist is more than 40 inches, says La Puma, “your belly could be turning you into a girl.”
2. Up Your Vitamin D
Deficient vitamin D levels often go hand in hand with low testosterone. Get 15 minutes of sun three times a week to stabilize your vitamin D. If you can’t get enough sun, many experts suggest taking at least 1,000 to 2,000 international units (IU) of supplemental vitamin D daily. For best results, take vitamin D3, which is more active than D2.
Remember, megadoses of vitamin D can cause toxicity, so don’t get carried away. It’s always a good idea to know your current vitamin D levels, so ask your doctor for a 25-hydroxy vitamin D blood test. (Learn more about vitamin D at “The Vitamin D Debate“.)
3. Eat More Zinc
Our bodies need zinc to make testosterone. Zinc also blocks the action of aromatase, the enzyme that converts testosterone to estrogen. Oysters offer the highest amount of zinc per serving of any food. Just six oysters contain about 500 percent of the mineral’s recommended daily allowance (RDA). Other zinc-rich foods include lean meats and spinach. (See “Zinc Essentials” to learn how to optimize your your zinc levels.)
4. Crunch on Cruciferous Vegetables
Cabbage, broccoli, Brussels sprouts, kale, watercress, and cauliflower are rich sources of glucobrassicin, which breaks down into a substance that lowers levels of visceral fat and suppresses estrogen in men. (Discover more ways to include these vegetables into your diet at “The Power of Cruciferous Vegetables“.)
5. Choose Healthy Fats and Proteins
Cholesterol is the building block of testosterone, and eating healthy fats, including saturated fats, helps your body make “good” cholesterol while also supporting healthy hormone balance. Give your body a dose of healthy fats and proteins by consuming moderate amounts of meats from hormone-free animals, grassfed cattle, and wild-caught fish. Nosh on healthy-fat sources such as olives, nuts, seeds, avocados, and coconut oil.
6. Consume Hot Chilies
Not only do spicy chilies and hot-chili powder help the body burn fat, they also contain high levels of antioxidants, which can cool inflammation.
Inflammation sets the stage for belly fat and insulin resistance, which precedes type 2 diabetes. Other anti-inflammatory spices include turmeric, black pepper, cinnamon, ginger, and oregano.
7. Do High-Intensity Interval Training
Short bursts of timed intense activity — known as high-intensity interval training or HIIT — trigger the body to make more testosterone than less-than-intense aerobic or endurance exercise, says La Puma. Spurts of activity stimulate androgen-sensitive tissue, he explains, which tells the body to make more testosterone. Strength training has also been shown to increase testosterone.
8. Get Better, Longer Sleep
Our bodies make testosterone while we sleep. In one study, men who got five hours of sleep a night had testosterone levels 10 to 15 percent lower than when they got a solid eight hours. The study, conducted by the University of Chicago, found that skimping on sleep reduced the men’s T levels by an amount equivalent to aging 10 or more years. While it can be challenging to change your sleep habits, says Natasha Turner, ND, you can “start going to bed 15 minutes earlier each week until you reach your target time.”
9. Stop Using Screens at Night
Backlit computer screens use light-emitting diodes (LEDs) that contain short-wavelength blue light. This light significantly suppresses the pineal gland’s release of melatonin, an essential ingredient for restful sleep, and thus, for testosterone. Smartphones, tablets, and laptops are all offenders, so turn them off as close to dusk as possible.
10. Clean Up Your Personal-Care Products
Most men probably don’t give a lot of thought to the chemicals in their soap, shampoo, and deodorant, but many personal-care products are rife with chemicals that interfere with hormone balance, including testosterone.
Check the Environmental Working Group’s searchable database at www.ewg.org/skindeep to find out whether your products are safe. The database rates personal-care products, including those specifically for men, with scores for overall hazard, cancer, developmental and reproductive toxicity, and
allergies and immunotoxicity.
Women and Testosterone
While many men experience the negative effects of too little testosterone, women tend to suffer from a surplus of the stuff.
Contrary to popular belief, women do make — and need — testosterone. A part of the androgen family of hormones, testosterone does many of the same things for women that it does for men: builds muscle and bone strength, aids immune function, and stokes the libido.
The difference boils down to quantity. On any average day, a woman makes about 250 micrograms of testosterone, while a man typically makes 10 to 20 times that.
Although they produce far less of it, “women’s bodies are exquisitely sensitive to testosterone, especially when it comes to emotional well-being and assertiveness,” says Sara Gottfried, MD, author of The Hormone Cure. “Androgens are the biochemical underpinnings of dominance and desire.” (For more from Sara Gottfried, see “Stress Buster”.)
Unlike men, who are apt to feel the effects of low testosterone, women tend to suffer from high testosterone (though they, too, can have low testosterone levels). “Excess androgens — including testosterone — is one of the top hormonal imbalances I see in my practice,” says Gottfried.
In women, signs of too much testosterone include acne, excess pubic and facial hair, and a deepening voice. (Too little may manifest itself as a lack of confidence and libido.)
Women in menopause can have high testosterone levels, says Erin Lommen, ND, a naturopath in Portland, Ore. During menopause, especially early in the process, testosterone often remains steady while estrogen and progesterone plunge due to the stopping of ovarian production, she explains.
Young women also struggle with high testosterone. “What we’ve come to understand in the last 10 years is that younger women may be making too much testosterone in response to blood-sugar imbalances,” says Lommen.
It’s easy to forget that insulin is also a member of the hormonal milieu, and if insulin goes awry, so does everything else. During insulin resistance, the body’s cells ignore insulin’s call to mop up sugar (glucose) in the bloodstream. This stimulates the ovaries to make more testosterone.
That excess insulin also makes the liver produce less sex-hormone-binding globulin, the key protein that binds testosterone and keeps it from causing trouble, says Gottfried.
Approximately 82 percent of women with excess androgens also have polycystic ovary syndrome, the No. 1 cause of infertility. “The good news is that this type of infertility is easily reversible once we get the hormones balanced,” Gottfried says.
If you struggle with high testosterone, you have more control than you think. Here are a few places to start.
- Maintain a healthy weight. In this sense, men and women are alike: Losing excess weight is a great way to balance testosterone levels. Even a 5 percent weight reduction can normalize hormone levels for women, says Gottfried.
- Cut flour, sugar, and all refined carbs. One study showed that women can reduce androgenic hormones (including testosterone) by up to 20 percent by eating a diet low in refined carbs and rich in low-glycemic foods, monounsaturated and polyunsaturated fatty acids, and phytoestrogens. Cut sugar, too: “Sugar is a big factor in excess androgens,” Gottfried says.
- Add fiber. If testosterone hangs around too long in the gut, the body picks it back up and returns it into circulation, which adds to overall levels. The solution? Eat more fiber. Testosterone clings to fiber like cat hair on a sweater: The more fiber you eat, the more testosterone you excrete.
- Avoid dairy. All dairy is laden with hormones. Even milk from the happiest, most chemical-free cows on the planet is hormone-rich because lactating cows are producing milk for their calves to help them grow. These natural bovine hormones are capable of disrupting our bodies’ natural balance.
Another strike against dairy is that milk and cheese can drive up inflammation, which leads to higher androgens, says Gottfried. She suggests cutting out dairy for six weeks to see if symptoms related to high testosterone improve.
If you think you have a testosterone imbalance and you want to be tested, the first order of business is to not put too much stock in the number. The results of a testosterone test can be a moving target because of three complicating factors.
- There is no agreed-upon definition of a “normal” testosterone level. Every person is different. A testosterone level that prompts symptoms, such as low libido, in one person may not faze someone else. Likewise, for men there is no guideline as to what constitutes “low testosterone.” The bottom threshold ranges from 200 to 350 nanograms per deciliter (ng/dL) of blood all the way up to 1000 nano grams per deciliter.
- Testosterone levels fluctuate throughout the day. The best time to get tested is between 7 and 10 a.m. That’s when testosterone levels peak in both men and women. For good measure, don’t eat or drink anything but water before the test. New evidence shows that glucose can suppresses testosterone, says Bradley Anawalt, MD, an endocrinologist and chief of medicine at University of Washington Medical Center in Seattle. “If you have a borderline T level and you ate sugar at breakfast, you may be diagnosed with low T when in fact your levels are normal.”
- Results vary from lab to lab. Every lab in the country measures testosterone levels a little differently, says Anawalt. He likens it to a bathroom scale vs. a doctor’s scale, which may be a few pounds off. “The only way to correct the inconsistency is to calibrate the scales, and we have yet to calibrate our testosterone tests around the country.”
Given the complexity of testing T, if your score comes back unusually low (for men) or high (for women) number or even borderline (both sexes), it’s worth taking it again just to be on the safe side. While conventional docs rely on blood tests, functional-medicine providers often test saliva, which can indicate how much testosterone the body is actually using, says Erin Lommen, a naturopath in Portland, Oregon. “Saliva shows me the body’s hormonal fingerprint.”
Keep in mind that some men do suffer from a physiological hormonal imbalance that leads to non-weight-related low testosterone (aka hypogonadism). Signs include muscle wasting, thinning body hair, low libido, and fatigue. But these men are in the minority. Researchers estimate that hypogonadism affects between 0.1 and 3.2 percent of all men.
A word of caution: With so much fuzziness inherent in the diagnosis, practitioners have a lot of leeway when prescribing testosterone, so see a health care provider you trust — not someone in a pop-up hormone clinic who seems out to make a buck.