Do You Really Need to Take Testosterone?

June 21, 2013

Testosterone replacement therapy is only clinically advised for men with “unequivocally low testosterone levels,” a condition known as hypogonadism. To determine this, you have to test your testosterone level

Story at-a-glance

• After age 30, a man’s testosterone levels begin to decline, and continue to do so as he ages, leading to symptoms such as decreased sex drive, erectile dysfunction, depressed mood, and difficulties with concentration and memory
• Testosterone replacement therapy is only clinically advised for men with “unequivocally low testosterone levels,” a condition known as hypogonadism. To determine this, you have to test your testosterone level
• According to recent research, the number of testosterone prescriptions have tripled over the past decade, causing researchers to sound the alarm that men may be abusing the hormone
• Dietary and exercise changes, particularly limiting sugar/fructose, eating healthy saturated fats and engaging in high-intensity exercises, Power Plate, and strength training, can be very effective at boosting testosterone levels naturally
• Other strategies to boost testosterone include optimizing your vitamin D levels, getting sufficient amounts of zinc, reducing stress, and supplementing with saw palmetto and DHEA in conjunction with astaxanthin

By Dr. Mercola

Testosterone is an androgenic sex hormone produced by the testicles (and in smaller amounts in women’s ovaries) that is typically associated with “manhood.” Beginning around age 30, a man’s testosterone levels begin to decline, and continue to do so as the years go on.  

A wide range of chemical exposures, including prescription drugs like statins, can also have an adverse effect on your testosterone production.
While primarily associated with male sexuality and reproduction, testosterone also plays a role in maintaining muscle mass, bone density, levels of red blood cells, and a general sense of vigor and well-being.  

Symptoms of declining testosterone levels include decreased sex drive, erectile dysfunction, depressed mood, and difficulties with concentration and memory. Men with low testosterone may also experience weight gain, breast enlargement, and problems urinating. 

According to recent research^{1, 2, 3} the number of testosterone prescriptions have tripled over the past decade, causing researchers to sound the alarm that men may be abusing the hormone. 

This should come as no surprise considering the many direct-to-consumer ads now promoting a testosterone prescription as the answer if you feel you’ve lost the spring in your step... In fact, in a related commentary medical ghostwriter Steven Braun says⁴ that the sales of testosterone are being driven by:

"A sophisticated marketing effort to define low testosterone as a disease for which the treatment is [testosterone-replacement therapy]. I know this because, as a professional medical writer, I have helped craft that message for transmission in a range of media to both physicians and consumers."

While declining testosterone levels can certainly be problematic, I know first-hand that such a fate is not an automatic outcome of aging, provided you incorporate certain lifestyle strategies that can naturally boost your testosterone levels, which I’ll review in this article.

Many Men Are Taking Testosterone Without Evidence of Deficiency

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. 

To determine this, you have to actually test your testosterone level, which is done with a blood test—ideally more than once, as your testosterone level can rise and fall during each day.  

The current findings indicate that 25 percent of men given a prescription for testosterone did not have their levels tested prior to receiving a prescription, and of the remaining 75 percent, it was unclear as to how many actually had a testosterone deficiency. In all, the study tracked 11 million men through a large health insurer, and found that:

• Since 2001, testosterone prescriptions have tripled
• More than two percent of men in their 40s and nearly four percent of men in their 60s were on testosterone therapy in 2011. Men in their 40s represent the fastest-growing group of users
• About half of men prescribed testosterone had a diagnosis of hypogonadism
• About 40 percent of men prescribed testosterone had erectile or sexual dysfunction
• One-third of men prescribed testosterone had a diagnosis of “fatigue”

Potential Side Effects and Benefits of Testosterone Therapy

While your levels can rise and fall daily, the average testosterone levels for most men range from 300 to 1,000 nanograms per deciliter (ng/dl) of blood. Again, hypogonadism can be a bit tricky to diagnose based on total testosterone (total T) alone, and since your levels can rise and drop dramatically from day to day depending on factors like sleep and stress, you need to measure your levels more than once.

That said, according to a 2012 study⁵ looking at the sensitivity and specificity of total testosterone (total T) as an indicator of biochemical hypogonadism found that a total T level below 150 ng/dl is indicative of hypogonadism, while levels above 350 ng/dl excludes the condition in most cases. If you fall within that range of 150-350 ng/dl, the authors advised measuring free or bioavailable T levels, which are thought to identify biochemical hypogonadism more accurately. 

There’s a fair amount of controversy on the subject of testosterone replacement therapy. Some of the evidence suggests it may cause worrisome side effects (especially if you’re not actually deficient), including: 

Thickening of the blood / blood clots	Acne
Reduced sperm count	Increased risk of heart disease
Increased risk of prostate cancer	Male infertility6
Liver problems	Male breast growth
Increased male pattern baldness	Worsening of urinary symptoms

Others disagree. For example, according to Dr. Abraham Morgentaler, MD, a professor of urology at Harvard Medical School and the author of Testosterone for Life, men with low testosterone are the ones at greater risk for prostate cancer and other health problems, including heart disease and osteoporosis. For an interesting article that contains a lot more information about this, read Dr. Morgentaler's report Destroying the Myth About Testosterone Replacement and Prostate Cancer.⁷

You Can Raise Your Testosterone Levels Naturally Through Exercise

Personally, I do not recommend using testosterone hormone replacement to enhance your performance. If you indeed have low testosterone, you can consider trans rectal DHEA cream, which I’ll discuss below. But I believe many of you may not even need that, were you to take full advantage of your body’s natural ability to optimize hormones like testosterone and human growth hormone (HGH).  

 

Just like testosterone and ubiquinol levels, your HGH levels also sharply decline after the age of 30, as illustrated in the graph above. Both of these hormones are also boosted in response to short, intense exercise. As an example, I’ve been doing Peak Fitness exercises for just over three years now, and at the age of 59, my testosterone and HGH levels (listed below) are still well within the normal range for a young adult male without the aid of ANY prescriptions, hormones and hormone precursor supplements:

• Total testosterone: 854 ng/dl (normal test range: 250-1,100 ng/dl)
• Free testosterone: 117 pg/ml (normal test range: 35-155 pg/ml)
• HGH: 14,000 pg, more than three times the normal test range of 1,000-4,000 pg/24 hours

Below is a summary and video demonstration of what a typical high-intensity Peak Fitness routine might look like. As you can see, the entire workout is only 20 minutes, and 75 percent of that time is warming up, recovering or cooling down. You're really only working out intensely for four minutes. It's hard to believe if you have never done this, that you can actually get that much benefit from only four minutes of intense exercise, but that's all you need!

• Warm up for three minutes
• Exercise as hard and fast as you can for 30 seconds. You should feel like you couldn't possibly go on another few seconds
• Recover at a slow to moderate pace for 90 seconds
• Repeat the high-intensity exercise and recovery 7 more times  

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How to Further Boost Testosterone and HGH Release...

Interestingly, Whole Body Vibration Training (WBVT) using a Power Plate can also independently increase growth hormone levels. Like high-intensity exercise, WBVT also works all three types of muscle fibers, and it does so more effectively and efficiently than straight cardio or weight lifting. You can accomplish more from 15 minutes on the Power Plate than from an hour of traditional strength training. By stimulating your white muscle fiber, the Power Plate kick-starts your pituitary gland into making more growth hormone, which helps you build lean body mass and burn fat.  

Another effective strategy for enhancing both testosterone and HGH release is intermittent fasting. Intermittent fasting 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. When it comes to an exercise plan that will complement testosterone function and production (along with overall health), I recommend including both high-intensity interval training and strength training.  

When you use strength training to raise your testosterone, you’ll want to increase the weight and lower your number of reps. Focus on doing exercises that work a wider number of muscles, such as squats or dead lifts. You can take your workout to the next level by learning the principles of Super-Slow Weight Training. For more information on how exercise can be used as a natural testosterone booster, read my article “Testosterone Surge After Exercise May Help Remodel the Mind.”

Why I Recommend DHEA Over Testosterone Replacement

I personally do not use any hormone treatments as I have been able to get my hormone levels within the healthy young adult range using the protocols described above. However, if you choose to use hormones it is really crucial to use bioidentical versions. There are synthetic and bioidentical hormone products out on the market, but I advise using bioidentical hormones like DHEA if you opt for this route. DHEA is a hormone secreted by your adrenal glands. This substance is one of the most abundant precursor hormones in your body. It is crucial for the creation of vital hormones, including testosterone and other sex hormones. 

Prior to puberty, your body produces very little DHEA. Production of this prohormone peaks during your late 20’s or early 30’s. With age, DHEA production begins to decline. The adrenal glands also manufacture the stress hormone cortisol, which is in direct competition with DHEA for production because they use the same hormonal substrate known as pregnenolone. Chronic stress basically causes excessive cortisol levels and impairs DHEA production, which is why stress is another factor for low testosterone levels. 

It’s important not to use any DHEA product without the supervision of a professional. Find a qualified health care provider who will monitor your hormone levels and determine if you actually require supplementation.  

Also, rather than using an oral hormone supplementation, I recommend trans-mucosal (vagina or rectum) application. Skin application may not be wise, as it makes it difficult to measure the dosage you receive. This may cause you to end up receiving more than what your body requires. Applying a trans-mucosal DHEA cream to your rectum (or if you are a woman, your vagina) will allow the mucous epithelial membranes that line your mucosa to perform effective absorption. These membranes regulate absorption and inhibit the production of unwanted metabolites of DHEA. That said, I do NOT recommend prolonged supplementation of hormones, even bioidentical ones. Doing so can trick your body into halting its own DHEA production and may cause your adrenals to become impaired.

Three Additional Supplements That Can Be Beneficial for Symptoms of Low T

Another supplement that can address certain symptoms commonly associated with low testosterone is saw palmetto. This herb may also help increase testosterone levels by inhibiting up-conversion to dihydrotestosterone.⁸ There are about 100 clinical studies on the benefits of saw palmetto, one of them being a contributed to decreased prostate cancer risk. When choosing a saw palmetto supplement, you should be wary of the brand, as there are those that use an inactive form of the plant. According to industry expert Dr. Moerck, what you want to look for is 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. 

There is also solid research indicating that if you take astaxanthin in combination with saw palmetto, you may experience significant synergistic benefits. A 2009 study published in the Journal of the International Society of Sports Nutrition found that an optimal dose of saw palmetto and astaxanthin decreased both DHT and estrogen while simultaneously increasing testosterone.⁹ 

Also, in order to block the synthesis of excess estrogen (estradiol) from testosterone, there are excellent foods and plant extracts that may help to block the enzyme known as aromatase, which is responsible producing estrogen. Some of these include white button mushrooms, grape seed extract and nettles.¹⁰

Five More Ways to Naturally Increase Your Testosterone Levels

In addition to what I’ve already covered above (high intensity exercise, intermittent fasting, saw palmetto, and DHEA in conjunction with astaxanthin), the following lifestyle strategies can also help you normalize your testosterone levels, without resorting to hormone replacement:

1. Lose Weight by Optimizing Your Diet. If you're overweight, shedding the excess pounds may increase your testosterone levels, according to recent research.¹¹ Testosterone levels decrease after you eat sugar, which is likely because the sugar leads to a high insulin level, which is another factor leading to low testosterone. The most efficient way to shed excess weight is to strictly limit the amount of sugar/fructose and grains in your diet, and replacing them with vegetables and healthy fats.
Ideally, keep your total fructose consumption below 25 grams per day. If you have insulin resistance and are overweight, have high blood pressure, diabetes or high cholesterol, you’d be well advised to keep it under 15 grams per day.
In addition to eliminating or severely limiting fructose, it will be vital to eliminate all grains (including organic grains) and milk in your diet. Milk has a sugar called lactose, which has been shown to increase insulin resistance so it will be wise to avoid it if you are seeking to lose weight. Replace these dietary troublemakers with vegetables and healthy fats, such as organic pastured egg yolks, avocado, coconut oil, butter made from raw grass-fed organic milk, and nuts like almonds and pecans. Saturated fats are essential for building testosterone.
Research shows that a diet with less than 40 percent of energy as fat (and that mainly from animal sources, i.e. saturated) lead to a decrease in testosterone levels.¹² My personal diet is about 70-80 percent healthy fat, and other experts agree that the ideal diet includes somewhere between 50-70 percent fat. I've detailed a step-by-step guide to this type of healthy eating program in my comprehensive nutrition plan, and I urge you to consult this guide if you are trying to lose weight.
2. Consume Plenty of Zinc: The mineral zinc is important for testosterone production, and supplementing your diet for as little as six weeks has been shown to cause a marked improvement in testosterone among men with low levels.¹³ Likewise, research has shown that restricting dietary sources of zinc leads to a significant decrease in testosterone, while zinc supplementation increases it¹⁴ -- and even protects men from exercised-induced reductions in testosterone levels.¹⁵
   Your diet is the best source of zinc; along with protein-rich foods like meats and fish, other good dietary sources of zinc include raw milk, raw cheese, beans, and yogurt or kefir made from raw milk. If you decide to use a zinc supplement, stick to a dosage of less than 40 mg a day, as this is the recommended adult upper limit. Taking too much zinc can interfere with your body's ability to absorb other minerals, especially copper, and may cause nausea as a side effect.
3. Optimize Your Vitamin D Levels: Vitamin D, a steroid hormone, is essential for the healthy development of the nucleus of the sperm cell, and helps maintain semen quality and sperm count. Vitamin D also increases levels of testosterone, which may boost libido. In one study,¹⁶ overweight men who were given vitamin D supplements had a significant increase in testosterone levels after one year.To get your levels into the healthy range of 50-70 ng/ml, appropriate sun exposure is your best bet. If sun exposure is not an option, a safe tanning bed (with electronic ballasts rather than magnetic ballasts, to avoid unnecessary exposure to EMF fields) can be used.
   As a last resort, a vitamin D3 supplement can be taken orally, but research suggests the average adult needs to take 8,000 IU's of vitamin D per day in order to elevate their levels above 40 ng/ml, which is the absolute minimum for disease prevention. Furthermore, if you opt for a supplement, you also need to make sure you’re getting sufficient amounts of vitamin K2, as these two nutrients work together. In fact, vitamin K2 deficiency is frequently the cause of symptoms associated with vitamin D toxicity, which includes inappropriate calcification that can lead to hardening of your arteries.
4. Have Effective Strategies to Address Stress: When you’re under a lot of stress, your body releases high levels of the stress hormone cortisol, which actually blocks the effects of testosterone.¹⁷ Chronic stress, and subsequently elevated levels of cortisol, could mean that testosterone’s effects are blocked in the long term, which is what you want to avoid. My favorite overall tool to manage stress is EFT (Emotional Freedom Technique). It's a handy, free tool for unloading emotional baggage quickly and painlessly, and so easy that even children can learn it. Other common stress-reduction tools with a high success rate include prayer, meditation, laughter and yoga, for example. For more tips, see my article 10 Simple Steps to Help De-Stress.
5. Ancient Indian Herb, Ashwagandha, May Help: This perennial herb is known as an adaptogen, which can help boost stamina, endurance, and sexual energy. Research published in 2010¹⁸ found that men taking the herb Ashwagandha experienced a significant increase in testosterone levels. Ashwagandha helps promote overall immune function, and can help increase your resistance to occasional stress.¹⁹ It also supports healthful levels of total lipids, cholesterol, and triglycerides already in the normal range. 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% organic Ashwagandha root, free of fillers, additives and excipients, to ensure quality.

Take Advantage of Your Body’s Innate Ability to Self-Correct and Heal

The fact that testosterone prescriptions have tripled over the past decade is a testament to the fact that men are increasingly suffering from feeling less than their best.  

Unfortunately, we still don’t know for sure whether hormone replacement therapy is entirely safe. Personally, I strongly recommend implementing lifestyle strategies that are known to optimize testosterone levels naturally before you do anything else.  

If you’re still deficient in testosterone after implementing high-intensity exercise and strength training, along with the dietary strategies detailed above and, ideally, intermittent fasting, then you could try trans-mucosal DHEA. Again, remember to confer with a qualified health care practitioner and get your levels tested before supplementing with DHEA or any other hormone, including testosterone. 

Personally, I’ve been able to maintain both testosterone and HGH levels comparable to that of men half my age, simply by implementing high intensity exercise and intermittent fasting, along with my standard dietary recommendations, which apply to everyone, regardless of age or gender. You have nothing to lose to give these strategies a try, and everything to gain.

[-] Sources and References

• ¹ JAMA Internal Medicine 2013;():1-2
• ² The New York Times June 3, 2013
• ³ WebMD.com June 3, 2013
• ⁴ JAMA Internal Medicine 2013;():1-4
• ⁵ Journal of Urology April 2012; 187:1369
• ⁶ WebMD.com June 3, 2013
• ⁷ LifeExtension.com, Destroying the Myth About Testosterone Replacement and Prostate Cancer, December 2008
• ⁸ Livestrong.com August 20, 2011
• ⁹ J Int Soc Sports Nutr. 2008 Aug 12;5:12. doi: 10.1186/1550-2783-5-12
• ¹⁰ GreenMedInfo.com, Natural Aromatase Inhibitors
• ¹¹ Study presented at The Endocrine Society’s 91st Annual Meeting, June 13, 2009, Washington, D.C.
• ¹² J Steroid Biochem. 1984 Jan;20(1):459-64.
• ¹³ Arch Androl. 1981 Aug;7(1):69-73.
• ¹⁴ Nutrition. 1996 May;12(5):344-8.
• ¹⁵ Neuro Endocrinol Lett. 2007 Oct;28(5):681-5
• ¹⁶ Horm Metab Res. 2011 Mar;43(3):223-5. Epub 2010 Dec 10.
• ¹⁷ Horm Behav. 2010 Nov;58(5):898-906. Epub 2010 Sep 15.
• ¹⁸ Fertility and Sterility 2010 Aug;94(3):989-96
• ¹⁹ Pharmacol Biochem Behav. 2003 Jun;75(3):547-55

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