Watch enough sports or listen to any male-centric podcasts long enough and you’re bound to encounter an advertisement about hypogonadism (or “low T” as it’s often referred to). Many of these ads promote new, “natural” ways to boost your testosterone levels. Magic pills, potions, and powders that will make you feel decades younger. But why is there so much attention given to this particular health condition?
Low testosterone is certainly a growing problem. As men get older, it’s almost an inevitable one. Nearly 40% of men aged 45 years or older have low T. And the prevalence of low T increases with age: estimates suggest it affects 12% of men in their 50s, 19% in their 60s, 28% in their 70s, and 49% in their 80s. That’s a lot of potential clients for the various testosterone boosting products out there.
The American Urology Association (AUA) considers low T to be less than 300 nanograms per deciliter (ng/dL) for adults. Generally this is determined by a blood test, sometimes two, taken first thing in the morning. But it’s important to keep in mind that symptoms and blood tests don’t always correlate. Some men have low T and feel fine. They might never even know they have a problem. In fact, only a small percentage (<15%) of men over the age of 40 experience symptoms as a result of low T. However, it is equally important to consider that young men—sometimes even those younger than you’d expect—can experience low T and the symptoms associated with it.
Let’s pause for a minute to discuss those symptoms. Most people associate testosterone with sex, but it is a hormone that does so much more. Sure, testosterone is important for achieving and maintaining an erection and for supporting a healthy sex drive. But it’s also crucial for cognitive function, regulating mood, anxiety, metabolism, and sleep, building muscle and decreasing body fat, and keeping up your energy. Many of the aforementioned ads highlight some of these symptoms while promoting their testosterone-enhancing products.
All those ads must be working because the number of men asking their doctor about low T has increased dramatically in the last 30 years. And so too have prescriptions for testosterone. One study out of British Columbia found a 1.57-fold increase in prescriptions overall from 1998–2013, with a transient increase between 2001 and 2004, and a rising trend from 2008 onwards in men under age 80 (Locke). Another found that testosterone use in the United States tripled from 2001 through 2011, but then saw a steady decline from 2013 through 2016. (Baillargeon).
As a sexual health expert, my male patients constantly ask me for the best ways to boost their testosterone (T). Many of these men and their partners are interested in avoiding prescribed medications in favour of more “natural” methods, the kind they hear about on TV, radio, and their favourite podcast.
What follows is a comprehensive outline of the best things that you can do aside from prescribed medication to take your T to the next level.
Diet and Exercise
Despite what you’ve heard, the jury is still out on the potential benefit of diet and exercise on testosterone production. If you’re overweight, switching up your diet to shed some pounds may help, since carrying excess weight is a common cause of low testosterone. For men of normal weight, the data are not as clear.
A Mediterranean diet has been shown to reduce the prevalence of erectile dysfunction and have a positive association with total sperm count in certain men (Esposito, Maiorino, Cutillas-Tolín). In obese men with erectile dysfunction at baseline, reducing overall caloric intake to achieve a loss of 10% or more in total body weight can improve sexual function. A diet high in protein, carbohydrate-reduced, and low in fat can reduce systemic inflammation and induce a rapid improvement in sexual, urinary, and endothelial function (Khoo). While these dietary changes have shown improvements in certain markers of testicular function (like sperm production) and sexual function (like erections), their direct effect on testosterone levels is less convincing.
We’ve written previously about improving sexual performance and the potential benefit of physical activity and male sexual performance. But that was mostly about bedroom performance, not overall testosterone health. Like is true with diet, the benefits of exercise on testosterone production have mostly proven true in overweight or obese men. One randomized controlled trial in 44 obese men found that a 12-week lifestyle modification program involving aerobic exercise three times per week and a diet limited to 1,680 kcal/day increased mean testosterone levels (Kumagai). But this, and many of the studies out there, leave unanswered whether exercise has the same effect on testosterone levels of men of a healthy weight.
According to one medical review, lifestyle modification such as aerobic exercise and diet resulting in weight loss provide a relatively risk-free approach to increase testosterone levels and should generally be recommended as a first-line, drug-free approach in overweight men (Lo). The same cannot be said for healthy-weight men, at least according to the medical literature we have at the moment. Still, regular diet and exercise have proven beneficial for overall and other aspects of sexual health, so it couldn’t hurt to try.
Sleep
A poor night of sleep doesn’t just make you cranky. It can have detrimental effects on all kinds of functions, including testosterone production. A 2011 study found sleep deprivation (restriction of sleep to 5 hours a night) decreased testosterone levels by 10% to 15%. Getting good quality sleep helps keep your brain razor sharp, regulates blood glucose levels, supports a healthy immune system, controls weight gain, in addition to maintaining testosterone production (Leproult). Obstructive sleep apnea (OSA), insomnia, shift work disorder, and restless legs syndrome are all common sleep disorders that are associated with lower testosterone levels. One study suggested that men with OSA have lower serum testosterone levels, possibly because of nocturnal hypoxia and blunting of luteinizing hormone levels (that’s the brain hormone that stimulates testosterone production) (Burschtin). So if you’re looking for a fairly easy way to boost your testosterone levels, make a concerted effort to snooze more and get a good night’s sleep.
Supplements
The male sexual health industry is a rapidly growing market fueled mostly by straight-to-consumer advertising as we’ve already discussed. The male sexual health supplement world is a small microcosm of the larger dietary supplement industry, which has exploded in the last 30 years. Dietary supplement sales have increased dramatically in the last few decades from $9 billion in 1994 to more than $27 billion in 2016.
Perhaps now would be a good time to answer some of the most common questions I get regarding supplements. Here we go…
Are Men’s Sexual Health Supplements Safe? Effective?
The short answer is: in most cases, we don’t know. Recent independent analyses of several commercially available men’s health supplements have found that one or more compounds advertised on the label could not be identified. Some men’s health supplements have also been found to have contaminants. Furthermore, there is very little clinical research available on drug–supplement interactions (Moyad 2002). All this makes answering the safety and efficacy question difficult.
What supplements can a man take to boost testosterone?
There is no one supplement that will definitely improve your testosterone. Dehydroepiandrosterone (DHEA) has been marketed as a natural way to boost testosterone. This is based partially on its function as a prohormone to androstenedione and androstenediol, both precursors to testosterone. However, studies looking at the treatment of low T with DHEA have shown increases in DHEA, androstenedione, estradiol, but not testosterone (Corona).
Zinc deficiency is associated with low T, and supplementation in deficient individuals has been shown to reverse hypogonadal effects (Sandstead, Prasad). Despite the benefit of zinc on hypogonadal men, there is no evidence that zinc supplementation in normal individuals increases serum testosterone and no clear evidence that repletion improves sexual performance or libido (Cui).
Ashwagandha, also known as Withania somnifera, is an adaptogenic herb that is commonly used in Ayurvedic medicine to promote “youthful vigor,” enhance muscle strength and endurance, and improve overall health. A randomized, double-blind, placebo-controlled trial in 2019 found that as little as 8 weeks of ashwagandha intake was associated with a 14.7% greater increase in testosterone compared to the placebo (Lopresti). When considering possible “natural” testosterone-promoting compounds, ashwagandha is certainly a reasonable option.
What supplements can a man take to increase his sex drive?
Keeping what we just said in mind about what little we know about safety and efficacy, there are a few compounds that may improve sex drive. Tongkat ali is an herbal supplement that comes from the roots of the green shrub tree Eurycoma longifolia, which is native to Southeast Asia. It is thought to improve libido, erectile dysfunction, and testosterone but most of these presumed effects are based on in-vivo animal models (Ang). A few placebo-controlled trials have demonstrated increased serum testosterone levels as well as improvements in libido and overall sexual performance
Are there any common side effects of male sexual health supplements?
Thankfully most of the data on men’s health supplements have shown few and fairly minor side effects. The adverse effects of these compounds can include indigestion, diarrhea, headache, nausea, oily skin and acne, skin thickening, hair loss, high blood pressure, facial hair, fatigue, insomnia, and unfavorable changes in cholesterol levels. Significant toxicities of substances like Gingko biloba and horny goat weed, while rare, have led to some more serious adverse effects such as bleeding, seizures, arrhythmias, and hypomania.
Some men are concerned about the possible cancer risk associated with testosterone-promoting supplements. This specific question, of course, has not been studied, but we know that testosterone replacement therapy (when prescribed by a physician) is not associated with an increased risk of prostate cancer. Therefore, if your testosterone increases through supplementation, it may not necessarily increase your risk of cancer.
Still, it is important to keep in mind that supplements are nowhere nearly as tightly regulated as medications. So when it comes to taking supplements, it’s always best to discuss them with your doctor.
Conclusion
As with most things, there is no quick fix to boosting your testosterone. There’s still a lot we don’t know about potential non-medical therapies for low T. The evidence is clear for overweight and obese men regarding the benefit of diet and exercise, but less so for healthy-weight men. Improving your sleep may help, so turn off your phone, iPad, and TV and get to bed. Some of the supplements we discussed might also help. At the end of the day, if these strategies don’t work and you’re feeling the effects of low T, you may want to discuss testosterone-boosting medications with your doctor.
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