It will come as no surprise to you that testosterone is an important men’s hormone. What may come as more of a surprise is that low levels of testosterone are common, especially in men over the age of 40 years.
Low testosterone or testosterone deficiency is a recognised disorder that may affect up to 20% of middle-aged men.
Testosterone gradually decreases naturally after around age 35 years, dropping by around 1.6% per year. This is normal. Decreases beyond this may not be normal and this is where diet and lifestyle changes may have a significant impact on a man’s overall health.
What are the symptoms of low testosterone?
Symptoms of low testosterone are not always obvious.
Testosterone is responsible for the obvious male sex traits – low voice, facial hair, muscle growth, sperm production – so it is logical that low levels may impact sex function, such as low libido and erectile dysfunction. But low testosterone also often impacts how men feel, with common symptoms being low energy, poor mood and depression. Low testosterone may also affect men’s ability to gain muscle or lead to changes in bone mass.
It is worth taking steps to see what you can do to improve testosterone levels as it is associated with major depressive disorder, type 2 diabetes, obesity, and cardiovascular disease.
How do I know if I have low testosterone: testing?
Your GP can do a blood test to measure your testosterone or you can do a private at home saliva test for around A$120.
Your level of ‘total testosterone’ should be around 9-30nmol/L or > 300ng/dL. But these numbers taken at face value can be misleading.
Here are few things to look out for.
· The time you measure testosterone matters. Around 10am is thought to be ideal as this captures the daily 24-hour peak of testosterone.
· You should be well slept, having had at least 6 hours sleep the night before, and ideally for the preceeding few weeks. I would however argue that 6 hours is inadequate. (FYI, this is because sleep influences cortisol which influences testosterone).
· You must measure ‘free testosterone’. Measuring only total testosterone may not give an accurate picture of what is happening as most testosterone (around 98%) is bound to a protein in the blood called sex hormone binding globulin (SHBG). When bound the testosterone can’t do anything. So the more important measure is ‘free testosterone’ which is the unbound 2% of testosterone floating around in your blood that can actually perform testosterone-related jobs. To find out the ‘free testosterone’ amount you can use a saliva test (direct) or a blood test (using a calculation with SHBG). Both are reasonably accurate, although cases of very low testosterone may appear higher when using saliva (Goncharov et al., 2006).
My testosterone is low: what diet and lifestyle tactics should I use?
While low testosterone isn’t something you want, it may act as a good wake up call. Plus, there are lots of diet and lifestyle changes you can make to support your testosterone levels to restore energy, mood and overall health.
Medicines and supplements may be sold to you as a quick-fix solution - just Google ‘low testosterone’, but I would caution against these as they may address the symptom (i.e. low testosterone) but not the underlying cause of your low testosterone and they may have unwanted side effects. Medication such as DHEA or testosterone replacement therapy are options that should always be discussed carefully with your GP.
Small diet and lifestyle changes can be very powerful for improving testosterone levels and men often find, in the process of addressing their testosterone, a whole raft of other niggling health issues improve.
Step 1: identify why testosterone is low
The diet and lifestyle approach is often guided by additional hormone testing which can be done privately or through your GP. The aim is to investigate why testosterone is low in the first place.
Testosterone is made by the testicles when stimulated by other hormones (LH and FSH) which are made by the brain. DHEA is the material that the testosterone is made from.
Checking levels of these hormones can be insightful. LH and FSH are a good first place to start as they give an indication of whether the problem is coming from hormones created by the brain (secondary hypogonadism) or the testicles just aren’t making enough (primary hypogonadism). DHEA is another insightful hormone as it is the source material from which testosterone is made. If DHEA-S (the storage form of DHEA) is low then inflammation may be at play. Specific dietary interventions such as omega-3 from oily fish or antioxidants from specific fruit and vegetables may prove useful. If DHEA itself is low then looking at stress and/or sleep may help as DHEA is made by your stress-management glands (i.e. the adrenals).
Other diet and lifestyle interventions may focus on insulin resistance which is commonly associated with low testosterone. People with Type 2 diabetes (a severe form of insulin resistance) are more than twice as likely to have low testosterone than men without. Less severe insulin resistance affects upwards of 88% of people living in the Western world. Therefore making diet changes targeted at insulin resistance is an obvious change that can have a significant impact. This is low-hanging fruit.
What about fasting? This is incredibly powerful, but needs to be done correctly. One study showed that a 13 hour fast increased men's testosterone by 1300%, while a 24 hour fast increased testosterone by 2000%! From an evolutionary perspective this makes sense - a fast signals a lack of food and a need to boost systems for men to go and hunt to find some more.
Finally, sleep is an easy, cost-free and enjoyable tool that can do wonders. One study from the University of Chicago tracked the testosterone of young men while depriving them of sleep. In one week it was as if they had aged a decade! Tracking tools such as Whoop bands or Oura rings are often useful to provide motivation for giving sleep the attention it needs and motivating better sleep behaviours. But be careful if you are easily anxious as these tools can drive sleep anxiety for some.
Conclusion
Low testosterone is common among men over the age of 40 years. Once you identify the underlying cause there are many simple diet and lifestyle changes that can make a huge difference. If you have had recent blood tests that are a ‘bit off’ then please get in touch. A few simple diet changes could make a huge difference. It will only take 45 minutes of your time – which we can do online – to put in place a plan designed for you. Book an online session here or get in touch.
References:
Goncharov, N., Katsya, G., Dobracheva, A., Nizhnik, A., Kolesnikova, G., Herbst, V., & Westermann, J. (2006). Diagnostic significance of free salivary testosterone measurement using a direct luminescence immunoassay in healthy men and in patients with disorders of androgenic status. The aging male : the official journal of the International Society for the Study of the Aging Male, 9(2), 111–122. https://doi.org/10.1080/13685530600713060
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