Why You Should Know Your Testosterone Level and How to Improve It

By Tom Nikkola, CSCS, CISSN, Pn1

“What’s your testosterone?”

I’ve heard more guys asking this question than “How much do you bench?” recently. Men seem to becoming more aware of the value of this hormone, as they should be. Testosterone’s benefits go way beyond building muscle and maintaining libido.

Testosterone drives many of the behaviors and characteristics that make men, men.

Testosterone is important for women, too. There is growing evidence that many women have suboptimal levels of testosterone, even though the average female produces only 5-10% of the testosterone of a male.

However, this article will focus more on testosterone and men’s health. We’ll address the effects of high or low testosterone levels in women in a different article.

Testosterone Basics

Testosterone is found in three forms in the body: free testosterone, albumin-bound testosterone and sex hormone binding globulin-bound testosterone. Approximately 50-60% of testosterone is bound to sex hormone binding globulin (SHBG) and is unavailable for use.

Just 1-2% is free testosterone, and the rest is bound to albumin. The albumin-bound and free testosterone is considered bioavailable testosterone.[i] Accurately testing free testosterone is difficult because it’s such a small amount, so total testosterone is usually used as the standard measure for talking about whether someone is low, normal or high.

Testosterone, like most hormones, is secreted in pulses rather than constantly throughout the day, and should be measured in the morning.

The “normal” range of testosterone is 300-1100 ng/dl. This is a large range as it encompasses the “normal” range for adult men of all ages.

Testosterone decreases with age. After the age of 40, testosterone levels typically fall 1.6% per year. [ii]

The question is, “Is a fall of testosterone inevitable, or do most men see a fall in testosterone because of their lifestyle and nutrition choices?”

Some suggest that the fall in testosterone is from nutrition, lifestyle and exercise choices more than it being a direct result of age.[iii]

A study on males of varying testosterone levels showed that those in the lowest quartile, with levels less than 241 ng/dl, had a 40% increased risk of dying from any cause compared to those at the highest levels.[iv]

Maintaining testosterone levels is pretty important.

Testosterone and Body Composition

There is a strong correlation between obesity and low testosterone levels. However, there is debate as to which comes first; the low testosterone or the weight gain. Or, do they occur together, as a result of poor lifestyle and nutrition choices?

Loss of muscle, especially while maintaining or gaining body fat, makes body composition worse. The loss of muscle contributes to a rise in blood sugar levels, which can lead to an increase in insulin resistance, but low testosterone by itself is associated with the development of insulin resistance as well.[v]

As body fat levels rise, fat tissue can cause the conversion of testosterone to estradiol, which leads to development of female sex characteristics, like a change in emotional state or growth of breast tissue, known as gynecomastia.[vi] The drop in testosterone and rise in estradiol can also lead to increased belly fat.

Testosterone may convert to estradiol for other reasons than excess body fat, which is why it’s important to get a complete sex hormone panel rather than testing testosterone alone. Rarely do individual hormones act alone.

A one-year, random, controlled trial of healthy men with low testosterone levels compared the use of testosterone replacement therapy (TRT) plus resistance exercise against TRT alone, and against no TRT or exercise. Testosterone therapy plus resistance training resulted in a greater improvement of body composition than resistance training alone, but the testosterone therapy did not appear to improve strength or physical function beyond resistance training alone.[vii]

Testosterone therapy, like resistance training, increases levels of insulin-like growth factor-I (IGF-I), which is likely one of the ways testosterone increases and lean mass even though it may not increase strength.[viii]

Testosterone and Cardiovascular Health

Conventional thought has been that raising testosterone levels could increase heart disease risk. This is because TRT may lower HDL cholesterol levels. Since higher HDL cholesterol levels are seen as beneficial for heart disease risk, the perception was that if testosterone lowered HDL cholesterol, it raised heart disease risk.[ix] This has not panned out.

Based on data from 25,000 men, 6300 of whom received TRT, there was no evidence of an increased risk of heart attack from testosterone therapy.[x]

There is no indication that men with higher testosterone levels are at a greater risk of cardiovascular problems. It’s actually the opposite. Testosterone levels are frequently low in those with cardiovascular disease.[xi]

Raising testosterone may reduce cardiovascular disease risk by increasing vasodilation and vascular function.[xii] TRT has also been shown to improve total and LDL cholesterol levels.[xiii],[xiv] TRT has also been shown to reduce blood pressure alone, or even better when in combination with a diet and exercise program.[xv],[xvi],[xvii]

Another, smaller study showed over five years of TRT, the risks of Metabolic Syndrome and cardiovascular problems was significantly reduced.[xviii]

These TRT studies are valuable as they point at the value of elevated testosterone levels. Fortunately, many men can significantly improve their testosterone levels without TRT.

Testosterone and Brain Function

Testosterone affects one’s mood and cognitive function.

Low testosterone levels can result in a significant change in mood, self-confidence and drive or motivation. There is an association between depression and low testosterone levels as well.[xix]

Older men with higher testosterone levels have been shown to score better in memory and spatial awareness tests.[xx] Testosterone plays a role in strategic thinking, emotional behavior and emotional reactions.[xxi] Something as simple as driving through heavy traffic can become difficult because the driver needs to plan ahead on when to switch lanes or plan in advance to take an exit. This can become difficult if strategic thinking is hampered.

Testosterone and Bone Health

Testosterone is needed for proper bone metabolism. Although osteoporosis is thought of as a female concern, a large number of men suffer as well.

Males make up 10-20% of osteoporosis cases.[xxii]

Corticosteroids, often used to manage joint pain, may suppress testosterone. They’ve also been shown to negatively impact bone density.

Muscle mass and bone density often go hand in hand, so if testosterone levels are low, and the body decreases muscle mass, it will also likely reduce bone density.

Testosterone and Sexual Function

Decreased libido is one of the hallmark symptoms of low testosterone, but it’s not the only sign. Some men with low testosterone have a normal libido, and some with normal or high testosterone have a low libido.

Erectile dysfunction (ED) is sometimes associated with low testosterone as well, but low testosterone itself is not always the cause. Instead, reduced vascular function is a more likely cause of ED. Men with low testosterone often experience a reduction in nighttime erections.

Identifying Low Testosterone

The Endocrine Society’s Clinical Guidelines cite the following symptoms of low testosterone:[xxiii]

Primary Symptoms

  • Incomplete or delayed sexual development, eunuchoidism
  • Reduced sexual desire (libido) and activity
  • Decreased spontaneous erections
  • Breast discomfort, gynecomastia
  • Loss of body hair, reduced shaving
  • Very small or shrinking testes
  • Inability to father children, low or zero sperm count
  • Height loss, low trauma fracture, low bone mineral density
  • Hot flushes, sweats
  • Decreased energy, motivation, initiative, and self-confidence
  • Feeling sad or blue, depressed mood, dysthymia
  • Poor concentration and memory
  • Sleep disturbance, increased sleepiness
  • Mild anemia (normochromic, normocytic, in the female range)
  • Reduced muscle bulk and strength
  • Increased body fat, body mass index
  • Diminished physical or work performance

Secondary Symptoms

  • Decreased energy, motivation, initiative, and self-confidence
  • Feeling sad or blue, depressed mood, dysthymia
  • Poor concentration and memory
  • Sleep disturbance, increased sleepiness
  • Mild anemia (normochromic, normocytic, in the female range)
  • Reduced muscle bulk and strength
  • Increased body fat, body mass index
  • Diminished physical or work performance

Some additional symptoms include changes in mood, spatial orientation, depression, fatigue, loss of lean mass.i

One of the main issues with diagnosing low testosterone is the large range of acceptable levels. Testosterone at 300 ng/dl to 1100 ng/dl is considered normal, but these ranges are based on normal levels of men across a large age range. As a result, a doctor may consider a 35-year-old male with testosterone at 350 ng/dl as “normal,” even though it is a level more typical older men.

There is also a lot of variability in what the ideal level is for each individual. Some men feel and function best at a level of 600 ng/dl while others are at their best with levels much higher.

I always recommend people over the age of 30 get their hormones, and other lab markers, checked at least annually. That way they can see trends in hormone levels long before they result in unwanted symptoms.

Boosting Testosterone

As of 2007, about two out of three traditional physicians thought there were more risks than benefits for TRT.[xxiv]

The main claim against the use of TRT is that it can increase the risk of prostate cancer. This is based on research from 1941 showing that androgens stimulate prostate cancer. However, there is no evidence showing that TRT actually increases prostate cancer risk. Most men who suffer from prostate cancer actually have low testosterone.[xxv]

For those who have exhausted other options, testosterone replacement therapy may be a wise choice. But, before resorting to TRT, we’d recommend acting on all the nutrition, exercise and lifestyle choices that help optimize testosterone.

Nutrition

Eat animal-based proteins, and include some saturated fat and monounsaturated fat in your diet. Low-fat and vegetarian diets may lead to lower testosterone levels.

Those following a diet with 20% versus 40% of calories coming from fat have had lowered testosterone levels. Saturated fat and monounsaturated fat (MUFA) enhanced testosterone better than polyunsaturated fats (PUFAs).[xxvi]

A study on endurance athletes showed that when they switched from a meat-rich diet to a lacto-ovo vegetarian diet, their resting testosterone fell, and they saw less of an increase in testosterone from exercise. These changes took place even though they ate identical amounts of carbohydrate, protein and fat.[xxvii] It’s just that the food came from different sources.

Avoid long-term calorie restriction. Long-term calorie restriction, often seen as the solution for controlling body fat, has been shown to lower testosterone levels as well.[xxviii]

Consider supplementing with extra zinc, magnesium, boron and vitamin D. Micronutrient deficiencies in general may disrupt hormone production, but zinc, magnesium and boron play key roles in testosterone production.[xxix]

Vitamin D, which is actually more of a hormone than a vitamin, is also extremely important for hormone balance. The majority of the population is far below the optimal range for vitamin D levels.

Limit alcohol consumption, and if you have a drink, drink red wine. In small quantities, alcohol can increase testosterone, but more than a drink or two can have the opposite effect. If you have a history of drinking large amounts, even if just once a week, it’s best to avoid alcohol if you have low testosterone.

If you’re put in a position where you feel you need to have a drink, make it red wine. Resveratrol, found in red wine, has been shown to increase testosterone levels.[xxx] Of course, you can supplement with resveratrol to get the health benefits of the red wine without drinking the alcohol.

There are also dozens of testosterone-boosting supplements on the market, which will be discussed at another time. Some work, some don’t. Most should be used for short periods of time and cycled off. They won’t make up for a lousy diet, though.

Exercise

Resistance training increases testosterone levels. One study showed that resistance training caused an acute 30% rise in testosterone levels.[xxxi]

In a more recent study, testosterone levels increased an average of 136% from a hypertrophy-style resistance training session. In the same study, men who completed a strongman style training session saw an average 74% increase in testosterone.[xxxii]

By stringing together consecutive days and weeks of intense resistance training sessions, the cumulative effect of exercise may be significant. On the other hand, some evidence suggests long-term endurance exercise may suppress testosterone production.[xxxiii]

This again brings up the importance of regular lab testing to check on the effects specific training programs may have on hormone production.

Lifestyle

Four controllable and common causes of low testosterone are chronic stress, excessive alcohol consumption, testicular or head trauma, and corticosteroid treatment.[xxxiv]

Stress and compromised sleep are without a doubt the two biggest lifestyle factors lowering testosterone levels.

Pregnenolone is a hormone made from cholesterol. It is a precursor to several hormones, including cortisol, the body’s main stress hormone, and testosterone. The more cortisol the body produces, the less pregnenolone that’s available for testosterone production. Getting stress levels under control may help bring testosterone levels back up to normal.

Closely related to high stress is poor sleep. Stress levels may go up due to sleep problems, or sleep may be disrupted due to high stress levels. Either way, when sleep time or quality is compromised, you miss out on the best opportunity to produce hormones.

Growth hormone peaks in the first third of sleep time, provided you get into deep sleep. Growth hormone helps maintain lower body fat levels. Testosterone levels rise as morning comes, provided individuals get sufficient time and quality of sleep.

Sleep is probably the most important factor in maintaining health, including optimizing testosterone.

Head and gonad trauma is often overlooked as a cause of low testosterone. The trauma may happen years, or decades earlier. Most hormones are regulated by the pituitary gland, found in the head. Head trauma from baseball, soccer, football, rugby or from sports like downhill skiing can lead to reduced testosterone levels later in life.

Corticosteroids are often prescribed for injuries or chronic pain and inflammation. While they may temporarily relieve pain, and manage inflammation, their use is also associated with a loss of bone density and decreased testosterone levels. They should be used conservatively. If you regularly use corticosteroids, consider some alternative options for dealing with pain and inflammation.

More Help

Do some people need testosterone replacement therapy? Yes.

Can you do a lot to support testosterone without it? Absolutely.

The great thing about first addressing nutrition, exercise and lifestyle choices is, not only might your testosterone levels improve, but your health and fitness will improve in a myriad of other ways.

Get your labs checked. If you find your levels are well outside the ideal range, consult with a physician who has experience in hormone therapy.

If you’re not dramatically outside the optimal range, make the recommended nutrition, exercise and lifestyle modifications.

Get your labs checked again 3-6 months later.

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