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Low Testosterone Symptoms? Here is how to boost it

by: Dr. Keoni Teta

 

 

Introduction:

It appears, that with each subsequent generation of men, testosterone (T) levels are decreasing. A study in the Journal of Clinical Endocrinology and Metabolism shows that testosterone levels in American men have been declining steadily for at least the past two decades. 1 The reasons for this are unclear, but likely, have to do with multiple factors, including negative lifestyle habits and environmental contaminants.
It is true, that as men get older, their T levels decline naturally.  This is sometimes referred to as, andropause, and usually begins around the age of 30. Testosterone gives men their “maleness.”  It is responsible for muscle growth, bone strength, facial hair and is the primary force of sex drive for both sexes.  Many middle aged men suffer from the effects of low testosterone, which can present as fatigue, erectile dysfunction, belly fat, depression, low libido, and lack of motivation.  Low levels also play a major role in promoting heart disease and diabetes risk.
A model of a molecule of testosterone, a steroid hormone produced by the sex glands in mammals.

Biochemistry:

In men, T is synthesized primarily in Leydig cells of the gonads or testes. Leydig cells, in turn, are regulated by luteinizing hormone (LH) and follicle-stimulating hormone (FSH) from the pituitary gland. In plasma, about 98% of T is bound to protein, 65% bound to sex hormone-binding globulin (SHBG), and 33% bound weakly to albumin. Like other steroid hormones, T is derived from cholesterol and is metabolized mainly in the liver. Normal levels of total T (bound and unbound) and Free T (unbound only) are between 300 – 800 ng/dL and 9 – 30 ng/dL, respectively.  Free T levels are biologically active. Of course these levels vary with age, with lower levels seen the older you get.

 

 

Factors that Lower T:

Besides age, there are several factors that can lower T levels:

  • Obesity
  • Medications
  • Injury to the testes
  • Diabetes
  • Liver disease
  • Kidney disease
  • Infections
  • HIV/AIDs
Obesity, diabetes, and certain medications are the most common causes of low T levels, not aging.

 

Obesity and Diabetes Negative Influencers on T:

Men with obesity, metabolic syndrome or type 2 diabetes tend to have low total and free T.  They also tend to have low SHBG. This is a vicious cycle, because the presence of low T and/or SHBG also predicts the development of metabolic syndrome and type 2 diabetes.
With age, men tend to gain fat in their abdominal area.  But, more significantly, is they also become more sedentary without creating a concomitant decrease in caloric consumption.  This a recipe for fat gain. As fat increases, especially visceral abdominal fat, the person becomes more inflamed.  This visceral fat starts to pump lots of  pro-inflammatory factors, which contributes to vascular endothelial dysfunction, with devastating effects on the cardiovascular system.  This significantly increases cardiovascular disease and erectile dysfunction risk.
Obesity causes a significant increase in inflammatory factors which plays a negative role in the optimization of T levels and T function.  Furthermore, extra fat increases the secretion of estrogen in the body.

Yes, it is true that excess fat has a feminizing effect on men by changing or aromatizing Testosterone into estrogen.

Aromatase is the enzyme that converts testosterone to estrogen and is highly concentrated in adipose tissue. The elevated estrogen level activates hypothalamic estrogen receptors, which cause inhibition of the hypothalamic-pituitary-gonadal axis. Ultimately, this causes hypogonadism, which is a another name for low T or more specifically, a failure of the testes to function properly.
So, excess fat in men increases inflammation and estrogen levels, which triggers the body to lower T levels.  Low T levels and obesity give you a double whammy by significantly increasing your risk of diabetes, cardiovascular disease, dementia, high blood pressure, as well as erectile dysfunction.
It is also well known, that as adiposity increases, so does insulin resistance.  I think of insulin resistance as the stage right before pre-diabetes.  This is one the reasons I encourage all my clients to get their insulin levels checked annually, whether they are diabetic or not.  It is not true that you become a type 2 diabetic or even a pre-diabetic over night.  You first start losing your sensitivity to insulin.  As you become more insulin resistance, you correspondingly lower T levels.  The reverse is also true; as you become more insulin sensitive (move away from diabetes) your T levels go up.
So insulin resistance is obesity’s best friend.  If your body is not sensitive to insulin or cannot hear its signal, then you will have difficulty burning excess fat. The fatter you get, the lower your T level goes; eventually causing androgen deficiency, which further increases your risk of all chronic disease.

Another cause of Low Testosterone: Medications and Drugs…

  • Cholesterol Lowering Meds (Statins) –  Cholesterol is the foundational building block of T.  Without it, men do not make T efficiently.  Cholesterol levels that are too low upset the balance of all hormones that are derived from it, including estrogen, progesterone, and other steroid hormones.
  • Anti-fungals (Ketoconazole) – Ketoconazole blocks sterol synthesis in fungi.  This is why it is so effective against fungal infections. Unfortunately, this anti-sterol effect also inhibits T production in humans.
  • Anti-histamines/H2-Acid Blockers (Tagamet, Zantac, Pepcid, etc.) – These meds bind to the H2-histamine receptor in the stomach, and thus, block the production of stomach acid.  These drugs have been found to competitively displace T from it’s receptor so that it cannot do its job.  They also have the potential to raise estrogen levels by inhibiting detoxification pathways (CYP450) in the body. In addition, having the potential to raise another hormone, prolactin.  As T goes down, prolactin levels tend to go up.
  • Anti-depressants (SSRIs: Celexa, Prozac, Paxil, Lexapro, etc.) – These meds can wreak havoc on your sex drive, sperm quality, and function.  Although the mechanistic lowering effect of T has not been clearly elucidated with these meds, men with anxiety or depression tend to be low in T anyway,  and giving them SSRIs could make things worse.
  • Opioids (Vicodin, OxyContin, etc.) – These meds negatively affect T levels by strongly blocking the HPG (Hypothalamic Pituitary Gonadal) axis.  This can lead to loss of libido and sexual function, as well as lead to depression and anxiety.
  • Anabolic Steroids – These drugs are just different forms of androgens.  If they are used long-term or at high doses, they will lower your natural testosterone production through negative feedback mechanisms.
  • Illicit Drugs – Cocaine, methamphetamines, and even marijuana have been associated with lower T levels and male infertility. With that being said, much more study is needed to confirm this, especially with marijuana.

Chronic Stress and Testosterone:

One of the biggest influencers of low T is chronic stress.  Chronic stress diverts T synthesis towards making more cortisol, your stress hormone.  Basically, your body will prioritize cortisol synthesis in “fight or flight” situations.  Overtime, chronic stress lowers T and rises cortisol, which can bring on all the signs and symptoms associated with low T: fatigue, apathy, depression, anxiety, low libido, and sexual dysfunction.  Lack of sleep and lack of activity are forms of stress that also make this worse.  This is why the best lifestyle treatments for chronic stress are rest, sleep, meditation, and sustainable/consistent exercise.

Supplements with evidence for supporting and increasing T Levels:

1) Mucuna pruriens 2 – This study showed that Murcuna pruriens improved T levels and sperm quality in infertile males.
2) Magnesium 3,10,12 – There is plenty of evidence showing that Magnesium boosts T levels in humans, both directly and indirectly.
3) Epimedium sagittatum (Horny Goat Weed/Icariin) 4  In animal studies, this herb has been shown to boost T levels.
4) Turnera diffusa 5,6 – This herb was shown, in animal studies, to improve sexual function. It is not evident that this has anything to do with rising T levels though.
5) Tribulus Terrestri 7,8 – There is some evidence, in both animal and human studies, that Tribulus can increase testosterone and other androgens; however, at this point, much more evidence is needed to be conclusive.
6) Trigonella foenum-graecum (Fenugreek) 9,11 – Both of these studies were double blind, placebo controlled studies in humans, men and women, respectively.  Both showed increases in T.  Many people have this herb in their spice cabinet.
7) DHEA 13-15 – DHEA (Dehydroepiandrosterone) is a precursor to T, and there is a small amount of evidence supporting its use for raising T levels; especially when combined with resistance training.  There is more evidence for DHEA blunting the effects of cortisol, and this effect may be beneficial for maintaining T levels.
9) Zinc 16,17 – Zinc appears to help maintain T levels after exhaustive chronic exercise.  It does not appear to increase T with supplementation alone.  There is, however, some evidence of a positive correlation  between zinc levels and semen quality. Zinc deficiency is associated with low T levels.
10) Adaptogenic herbs (Rhodiola, Schizandra, Ginseng, Ashwagandha,  Eleutherococcus, etc.) 23-25 – Adaptogenic herbs have evidence showing positive modification of the stress response, so that the perceived stressors have less of a negative physiological effect.  They have the potential to indirectly maintain hormone balance, and may have a positive effect on maintaining T levels.
11) Supplements that inhibit aromatase (DIM, Gingko Biloba, Quercitin, Resveratrol, Grape Seed Extract, etc.) 20-22 – Many phytonutrients have the ability to inhibit the aromatase enzyme.  This may prevent testosterone from converting to estrogen in the body.
12) Optimize your vitamin D levels 18,19 ​​​​​​​- Vitamin D levels do appear to be positively correlated with T levels.  Having low Vitamin D probably means you also have low T.  It is very important to optimize Vitamin D in order to help prevent all chronic disease.
13) Tongkat Ali (Eurycoma longifolia) 59,60  This herb has some pretty good evidence supporting its use as a direct T booster.  Much more study is needed though.
14) Maca (Lepidium meyenii) 61,62 – This herb has been shown to increase sexual desire in humans, but not necessarily T levels.  However, in animals, it has been shown to boost T.

15. Vitamin A 67 – Deficiency in this vitamin can reduce T levels.

 

 

The Best Ways to Increase T:

​​​​​​​For most men, there is no better way to boost, and maintain, T levels than through healthy lifestyle habits. The following healthy habits have the most evidence for supporting, and boosting T levels.
1) Get plenty of sleep 26-28 – Lack of sleep is a form of stress that may lower T and promote sexual dysfunction.
2) Meditation 29,30 – Meditation helps to lower cortisol and also alleviates negative perceptions of stress.  It seems to have an optimizing effect on all hormones, including T.
3) Lift heavy weights (resistance training) 31-34 – Resistance training builds strength and muscle, and also boosts T levels.
4) Hang out with the opposite sex 35-37 – Research shows that, even a brief, conversation with an attractive women boosts T levels.
5) Watch sexually explicit content 39,40 – Yes, it appears that pornography can help boosts T levels.
6) Do not OVER consume calories 42,43 – Over consumption of food increases your risk of all chronic disease, especially obesity and type 2 diabetes, both of which, lower T levels.
7) Avoid or minimize medication use 44-46 – Most medications have the potential to upset hormonal balance.  See the list above for specific meds that can lower T.
8) Have sex 38,41 – Yes, sexual activity can boost T levels, and more seems better.
9) Avoid tobacco products 47 – Chronic use of tobacco products, especially smoking, lowers T.  Moreover, it is common knowledge that smoking increases the risk of all disease, especially lung cancer.
10) Minimize alcohol intake 48,49 – Alcohol intake, greater than two drinks per day, may be detrimental to your T levels.  Excessive alcohol intake is a tremendous burden on the liver, and alcoholism will also eventually cause muscle wasting; both of which can further lower T levels.
11) Avoid or minimize xenobiotics 50-52 – Xenobiotics are  chemicals (BPA, pthlalates, organophophates) found in the environment that do not occur naturally in the body. They are environmental contaminants that can act like hormones. Research has shown that the average T level in men has gradually dropped over the years. This may be due, in part, to all the potential toxins that have accumulated in our environment.
12) Wear loose fitting underwear 53,54 – Unlike the ovaries in women, the testes in men hang in the scrotum because they need to be at a temperature slightly lower than the body for optimal function.  This is why always wearing briefs or underwear that position the testes closer to the body may lower T levels. It also has the potential to cause other male fertility issues.
13) Minimize or avoid soy consumption 55,56 – Soy products do have slight estrogenic effects, and some studies have shown, soy consumption lowers T.
14) Avoid long-term dieting 65 – Long term dieting is a significant stress to the body and may cause a lowering of T.
​​​​​​​15) Eat your cruciferous vegetables (broccoli, cauliflower, bok choy, brussel sprouts, etc.) 20 – Cruciferous vegetables have compounds in them that help optimize detoxication of estrogens.  This can help optimize T levels indirectly.
16) Eat your protein 63 – Making sure you are getting enough protein, along with resistance training, can help optimize T levels.
17) Do not overtrain 69 – Overtraining, or exercising too much, will cause an imbalance in hormones.  Like with any prolonged stressor, cortisol can rise, and T levels can decrease.
18) Be careful with long duration aerobic training 64,66 – Prolonged long distance running, without adequate rest, can put you in a catabolic state and will lower T levels.
19) Lose the excess fat weight 57,58 – Extra fat is inversely related to T levels, and losing it helps raise T levels.
20) Be a winner as opposed to a loser 68 – Winning at anything appears to boost T levels, and yes, this seems to include competing with yourself.  So, keep and make your goals. On the other hand, losing seems to lower T levels.

Conclusions:

 

Optimizing T levels translates to better health especially for men, but also for women.  It is true that T levels decrease with age, but this can be slowed down significantly with healthy lifestyle changes as outlined above.  Also, there are supplements and herbs that can boost T levels, both directly and indirectly.  And, according to the evidence, everything outlined above is considered safe, and all have a long history of use in food and/or medicine.  My favorite supplements for boosting T, for most people, is magnesium.  It has the most evidence, is very safe, and also helps mitigate ailments such as heart palpitations, headaches, constipation, muscle spasms and cramps, insomnia, fatigue, osteoporosis, etc.  By far, the best lifestyle change to boost T, is to reduce all forms of stress, and incorporate lifestyle habits like, more sleep, meditation, and exercise; all of which help your physiology perceive stressors as less threatening.  Once your body perceives stress as something of a challenge, instead of threat, losing fat weight becomes easier, and T levels go up.

Interested in testosterone replacement options?   Find all the information you need with:

Metabolic Effect’s Testosterone Replacement Program

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Other Related Blogs/Resources:

1. https://www.t-nation.com/diet-fat-loss/lifters-guide-to-alcohol
2. https://www.t-nation.com/training/lifters-guide-to-marijuana
3. http://www.metaboliceffect.com/muscle-building-secret-knows/
4. http://www.metaboliceffect.com/expert-advice-on-building-muscle-why-it-is-usually-wrong/1

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