What is the main driver of male vitality and overall quality of life?
For men, it is having a healthy (optimal) level of testosterone.
Unfortunately—as I have experienced both as a practitioner and personally—men rarely prioritize self-care. Men tend to ignore, dismiss or “power through” symptoms of potential health problems that are completely reversible if caught in time.
An important way that men can stay on top of their health is to know what their testosterone level is. It’s as easy as ordering a testosterone panel yourself—no doctor’s visit required—on sale now for just $149! More info below.
Why testosterone matters
Testosterone is the major sex hormone for men. Testosterone is what makes men “men” and is essential for male growth and masculine characteristics.
Testosterone contributes to important bodily functions including (1):
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- Development of the penis and testes
- Deepening of the voice during puberty
- Appearance of facial and pubic hair
- Muscle mass
- Body fat distribution
- Strength
- Bone mineral density (2)
- Regulation of red blood cell production (3)
- Balanced mood
- Healthy sex drive
- Normal erections
- Sperm production
- Urinary health (4, 5)
Over the last 40-plus years, low testosterone—also referred to as “low T” and “testosterone deficiency”—has become widespread among men of ALL ages in the U.S..
While declining levels of testosterone are typically associated with aging males, starting from around age 40…results from the 2020 American Urological Association Virtual Experience (and later published in the European Urology Focus) revealed that:
Testosterone deficiency has a prevalence of 20% among adolescent and young adult males, aged 15 to 39 (6, 7).
This would explain why, 10 years ago, I found myself working with several male clients, between their late 20s and early 30s, who had low testosterone levels and struggled with their metabolic health.
As it turns out…testosterone levels have been declining over the last 40 years. In fact, several studies, but one retrospective study, in particular, that was published in the British Medical Journal in 1992, suggested that sperm quality had declined over the last 50 years, from around the early 1940s (8, 9).
The Massachusetts Male Aging Study, a landmark study, highlighted a significant decline in testosterone levels among men over a nearly two-decade period and across different generations. Study participants consisted of a random sample of men, between ages 45 to 79 (born between 1916 and 1945), who lived in the greater Boston area. The data was collected in three waves. In each wave, researchers took blood samples and conducted extensive interviews. The men were first interviewed between 1987 to 1989, establishing a data baseline. Two follow-up interviews took place between 1995 to 1997 and between 2002 to 2004 (10).
What the researchers found (11, 12):
–There was a substantial decline in testosterone among U.S. men from when the baseline data was first drawn (1987 to 1989) to the final data collection (2002 to 2004).
–The decrease in testosterone concentrations was independent of age. In other words, declining testosterone was not just an “old man” phenomenon. There were notable declines in testosterone levels across all age groups sampled.
Why has low testosterone become so prevalent—even among young men?
Several potential causes for this low T trend include (13):
—Poor metabolic health as evidenced by the dramatic rise in overweight and obesity: approximately 43% of American men, aged 20 and older, are obese; 34% of American men are overweight (14).
—An increasingly sedentary lifestyle with little to no physical activity.
–Engaging in habitual (heavy, chronic) marijuana use (15). A Danish study of 1,215 men, between the ages of 18 and 28, reported that sperm concentration, total sperm count, percentage of mobile sperm and percentage of morphologically normal forms were all lower among men smoking marijuana more than once per week.
—Heavy alcohol consumption (16). Since the early 1980s, alcohol has been known to lower testosterone in men. In a study published in Pharmacological Biochemical Behavior, healthy men were given the equivalent of a pint of whiskey to drink every day for 30 days. Their testosterone levels were then compared to those of men with chronic alcoholism. (By the way, virtually all the alcoholic men had “low-normal” to “low” levels of testosterone). The testosterone levels of the healthy men began dropping after just 72 hours (3 days). By Day 30, the healthy men had testosterone levels similar to those of the alcoholic men (17).
–A dramatic rise in the use or abuse of opioids, including fentanyl, heroin and morphine(18).
—Use or abuse of anabolic steroids, synthetic derivates of testosterone (19).
—Eating a Western-style diet, also known as the “Standard American Diet” (SAD for short), which consists primarily of ultra-processed foods, including refined carbohydrates, fried foods, inflammatory seed oils, high-sugar foods and a low overall nutrient intake (20).
–Having greater exposure to environmental toxins, many of which are endocrine-disrupting chemicals (EDCs). They include xenoestrogens, synthetic compounds that have estrogen-like effects in the body (21, 22). Xenoestrogens are in plastics, pesticides, tap water, personal care products, household products, in our conventionally grown food supply as well as in ultra-processed foods, including food packaging (23).
Men: be mindful of overconsuming soy, especially conventionally grown, highly processed soy “foods”. Keep in mind that, as of 2020, 94% of soybean crops were genetically modified (24). Considered a “natural” plant-derived xenoestrogen, soy is a phytoestrogen that can exert estrogenic effects (25).
Estrogen, especially estradiol (the most potent form of estrogen), is the primary sex hormone that defines a woman. Estrogen gives women their hips and breasts and is responsible for the first half of a woman’s menstrual cycle.
However, men, too, produce a small, but critical, amount of estrogen (estradiol).
In men, regular exposure to xenoestrogens can disrupt the normal male testosterone (high)-to-estrogen (low) ratio; and, instead, create a state of “estrogen dominance”, where the ratio of a man’s estrogen level is high—relative to his testosterone level.
What does “estrogen dominance” look like in men?
Estrogen dominance in men can manifest as decreased testosterone production; lower sperm counts; and may contribute to the development of prostate cancer. High estrogen levels in men can have a physically feminizing effect, presenting as: weight gain; less muscle mass (softer and flabbier); higher overall body fat and fat deposits (think love handles); excess belly fat and enlarged breast tissue (26).
Back to testosterone… Low testosterone is often associated with co-morbidities such as (27):
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- Obesity
- Belly fat (abdominal obesity)
- Metabolic syndrome
- Type 2 diabetes
- Hypertension
- Heart disease
- Chronic kidney disease
As men age, testosterone levels decline at the rate of 1% to 2% every year, starting around age 40 (28).
However, younger men are not immune from having low T. Even from age 30, testosterone levels can drop in men who have a chronic disease (e.g., diabetes, obesity); experience prolonged emotional stress; or take medications, such as statins, anti-anxiety, anti-depressants, opioids, chemotherapy, hypertension and beta-blockers, where lowered testosterone levels are often a side effect (29, 30).
For men, having low testosterone can significantly diminish quality of life; affect the functionality of multiple organs; and impact fertility.
Symptoms of low testosterone include (31, 32):
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- Low libido (sex drive)
- Erectile dysfunction / impotence
- Oligospermia (low sperm count) or azoospermia (zero sperm count), which causes male infertility
- Low energy
- Lack of drive / motivation
- Difficulty concentrating
- Depression
- Mood swings
- Irritability (as in “Grumpy Old Man Syndrome”)
- Changes (for the negative) in sleep patterns or disrupted sleep
- Fatigue
- Increased frailty
- Decreased bone density
- Decreased muscle strength and mass
- Low stamina / endurance
- Gynecomastia, colloquially known as “moobs” (male boobs), characterized by enlarged breast tissue in men (33)
- Difficulty building muscle—even when working out
- Excess belly fat (34)
What you can do
The good news? It is possible to raise testosterone levels naturally.
First and foremost, get tested! Consider ordering the Testosterone and Prostate Health panel, which I love for men, because it enables a more insightful takeaway of male hormonal balance (e.g., testosterone to estrogen ratio).
The Testosterone and Prostate Health panel will accurately measure your bioavailable testosterone and also measures your level of estradiol (estrogen), which can be created by excess belly fat. This panel includes a comprehensive testosterone panel (including total, free and bioavailable testosterone and sex hormone binding globulin), estradiol, prostate specific antigen (PSA) as well as a Complete Blood Count.
* The sale ($149) ends on Wednesday, July 31st, 2024. You can purchase the panel now—and schedule your blood draw later—up to 1 year from date of purchase.
***Note: This is direct lab testing. Meaning…you order your own labs online. No doctor’s visit required. IF you live in New York or New Jersey, you will NOT be able to access direct lab testing in these states. However, you CAN order your labs online, then travel to Connecticut, Pennsylvania or Massachusetts (this is where I go) for your blood draw. You will be emailed your results 1 week from your blood draw. You can then take your labs to the healthcare practitioner of your choice. OR, you can choose to do one of my Lab Review packages, where I review your labs with you, highlight potential red flags and give suggested action steps to improve testosterone levels.
Knowing your testosterone level can be highly motivating to make lifestyle changes that support hormone balance. To naturally boost testosterone levels, key lifestyle modifications include:
- Prioritizing sleep.
- Eating nutrient-dense whole foods vs. ultra-processed foods.
- Weight training. Building muscle.
- Sitting less. Moving more.
- Engaging in a regular relaxation practice.
- Cutting out or mindfully reducing alcohol consumption and/or recreational drug use, including marijuana.
- Reducing exposure to endocrine-disrupting chemicals, like plastics, pesticides and other xenoestrogens.
Sources:
1 Harvard Health Publishing, Harvard Medical School. “Testosterone: What it is and how it affects your health”. June 22, 2023.
2 Snyder PJ, Kopperdahl DL, Stephens-Shields AJ, et al. Effect of Testosterone Treatment on Volumetric Bone Density and Strength in Older Men With Low Testosterone: A Controlled Clinical Trial. JAMA Intern Med. 2017;177(4):471–479.
3 Bachman E, Travison TG, Basaria S, Davda MN, Guo W, Li M, Connor Westfall J, Bae H, Gordeuk V, Bhasin S. Testosterone induces erythrocytosis via increased erythropoietin and suppressed hepcidin: evidence for a new erythropoietin/hemoglobin set point. J Gerontol A Biol Sci Med Sci. 2014 Jun;69(6):725-35.
4 Yang, TK., Chang, CC., Chang, HC. et al. Factors Associated with Bothersome Lower Urinary Tract Symptoms in Middle-Aged Men Receiving Health Checkup. Sci Rep 9, 901 (2019).
5 Haider KS, Haider A, Doros G, Traish A. Long-Term Testosterone Therapy Improves Urinary and Sexual Function, and Quality of Life in Men with Hypogonadism: Results from a Propensity Matched Subgroup of a Controlled Registry Study. Journal of Urology [Internet]. 2018 Jan 1; 199(1):257–65.
6, 13 Kahl, K L. Testosterone levels show steady decrease among U.S. men. Urology Times Journal. Vol. 48. Issue 7. July 3, 2020.
7 Lokeshwar SD, Patel P, Fantus RJ, Halpern J, Chang C, Kargi AY, Ramasamy R. Decline in Serum Testosterone Levels Among Adolescent and Young Adult Men in the USA. Eur Urol Focus. 2021 Jul;7(4):886-889.
8 Shalender Bhasin, Secular Decline in Male Reproductive Function: Is Manliness Threatened?, The Journal of Clinical Endocrinology & Metabolism, Volume 92, Issue 1, January 2007, Pages 44–45.
9 Carlsen E, Giwercman A, Keiding N, Skakkebaek NE. Evidence for decreasing quality of semen during past 50 years. BMJ. 1992 Sep 12;305(6854):609-13.
10, 11 Thomas G. Travison, Andre B. Araujo, Amy B. O’Donnell, Varant Kupelian, John B. McKinlay, A Population-Level Decline in Serum Testosterone Levels in American Men, The Journal of Clinical Endocrinology & Metabolism, Volume 92, Issue 1, January 2007, Pages 196–202
12 Kalvaitis, Katie. “Generational decline in testosterone levels observed.” Healio.com. 2 Oct. 2023.
14 NIH, National Institute of Diabetes and Digestive and Kidney Diseases. Overweight & Obesity Statistics.
15 Tina Djernis Gundersen, Niels Jørgensen, Anna-Maria Andersson, Anne Kirstine Bang, Loa Nordkap, Niels E. Skakkebæk, Lærke Priskorn, Anders Juul, Tina Kold Jensen, Association Between Use of Marijuana and Male Reproductive Hormones and Semen Quality: A Study Among 1,215 Healthy Young Men, American Journal of Epidemiology, Volume 182, Issue 6, 15 September 2015, Pages 473–481.
16, 17 Emanuele MA, Emanuele NV. Alcohol’s effects on male reproduction. Alcohol Health Res World. 1998;22(3):195-201.
18, 19, 29 Cohen J, Nassau DE, Patel P, Ramasamy R. Low Testosterone in Adolescents & Young Adults. Front Endocrinol (Lausanne). 2020 Jan 10;10: 916.
20 Hu TY, Chen YC, Lin P, Shih CK, Bai CH, Yuan KC, Lee SY, Chang JS. Testosterone-Associated Dietary Pattern Predicts Low Testosterone Levels and Hypogonadism. Nutrients. 2018 Nov 16;10(11):1786.
21 Toppari J, Larsen JC, Christiansen P, Giwercman A, Grandjean P, Guillette LJ Jr, Jégou B, Jensen TK, Jouannet P, Keiding N, Leffers H, McLachlan JA, Meyer O, Müller J, Rajpert-De Meyts E, Scheike T, Sharpe R, Sumpter J, Skakkebaek NE. Male reproductive health and environmental xenoestrogens. Environ Health Perspect. 1996 Aug;104 Suppl 4(Suppl 4):741-803.
22 Anna Katrina Loomis, Peter Thomas, Effects of Estrogens and Xenoestrogens on Androgen Production by Atlantic Croaker Testes In Vitro: Evidence for a Nongenomic Action Mediated by an Estrogen Membrane Receptor, Biology of Reproduction, Volume 62, Issue 4, 1 April 2000, Pages 995–1004.
23, 25 Paterni I, Granchi C, Minutolo F. Risks and benefits related to alimentary exposure to xenoestrogens. Crit Rev Food Sci Nutr. 2017 Nov 2;57(16):3384-3404.
24 Shahbendah, M. Percentage of genetically modified crops in the US by type 1997, 2018, 2019 and 2020. Statista. 16 Dec. 2022.
26 Gottfried, S. (2014). The Hormone Cure. Scribner.
27 Institute for Functional Medicine. Insights. Testosterone Deficiency: Lifestyle-Based Approaches.
28 Singh P. Andropause: Current concepts. Indian J Endocrinol Metab. 2013 Dec;17 (Suppl 3):S621-9.
30 Samadi, David. “Beware, these prescription medications may lower testosterone levels”. Prostate Cancer 911. 14 June 2021.
31 Goodale T, Sadhu A, Petak S, Robbins R. Testosterone and the Heart. Methodist Debakey Cardiovasc J. 2017 Apr-Jun;13(2):68-72.
32 Low Testosterone (Male Hypogonadism). Cleveland Clinic. 2 Sept. 2022.
33 Swerdloff RS, Ng JCM. Gynecomastia: Etiology, Diagnosis, and Treatment. [Updated 2023 Jan 6]. In: Feingold KR, Anawalt B, Blackman MR, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-.
34 Fillo J, Levcikova M, Ondrusova M, Breza J, Labas P. Importance of Different Grades of Abdominal Obesity on Testosterone Level, Erectile Dysfunction, and Clinical Coincidence. Am J Mens Health. 2017 Mar;11(2):240-245.
