What to Do about Low Testosterone

What to Do about Low Testosterone

What to Do about Low Testosterone

French-born, Los Angeles–based physician Dominique Fradin-Read, MD, MPH, is known for fixing hormones. For decades, she has seen testosterone levels plummet in otherwise healthy young men. “It used to be that this only really happened to people who had been under major physiological stressors, like radiation or chemotherapy,” she says. But, she says, more and more men are going to their doctors with complaints of symptoms—like mood volatility and erectile dysfunction—that mimic andropause, the testosterone drop that happens later in life. “I’m extremely surprised to see how low testosterone can go.”

The answer to these complaints, she says, isn’t Viagra. Or any other symptom Band-Aids. Testosterone levels in the body are a response, largely, to lifestyle, including diet, exercise, stress, and environmental exposures. And behavior change in each of these dimensions is vital to correcting—not just covering up—low testosterone.

While Fradin-Read’s advice—eat well, sleep well, stress less, have sex, consider other interventions carefully—might at first look like a repetition of every men’s health article out there, it’s important to understand exactly how these lifestyle choices create a snowball effect. And that making smart, informed decisions about testosterone (and every system linked to it, which is to say: all of them) may be the key to total, holistic well-being—for men at any age.

A Q&A with Dominique Fradin-Read, MD, MPH

What is the role of testosterone in men’s bodies?

Testosterone is important for men to function well physically, mentally, and emotionally. When testosterone levels dip below normal, we start to see some dysfunction in each of these areas.

Physically: Testosterone strengthens your cardiovascular system. And when the myocardium, the muscular tissue of the heart, is stronger, the heart has better resistance to exercise—meaning your heart rate doesn’t shoot up as fast or as easily—and recovers faster following a workout.

Second, testosterone provides general muscle support. A healthy level of testosterone translates to a generally stronger body. And when your body is strong, it’s more likely to continually support testosterone production.

Mentally: Not many men know that testosterone is important for their cognitive function and memory, as well as for limiting cognitive decline as they get older. Men who have low testosterone might start having memory loss and brain fog, the same way that women with low estrogen do.

Then there is all the stamina, virility, and willpower that men often value: things they say make them feel like a man, give them an impression of power. Those feelings are related to testosterone.

Emotionally: Men who have a healthy level of testosterone usually have fewer problems with depression. They tend to be happy. They enjoy their lives. I have one patient who came to me with very low testosterone, and the first thing he told me was that he had lost his sense of joy. Once we brought his testosterone levels back up, he was saying, “I have my life back.”

And sexually, of course, testosterone plays a big, big part in stimulating libido and helping with performance. When testosterone falls below normal, we start seeing problems with sexual performance and sex drive. Furthermore, testosterone facilitates the way men feel about themselves during sex and how they perceive their sex life. That’s one problem with using Viagra as a Band-Aid: It helps with the vascularization of the testes and penis, but it doesn’t bring much blood to the brain, which is one of the major, testosterone-controlled drivers of men’s sex life.

Is there a normal level of testosterone for men?

There are norms at each age. So it’s going to be different for a teenager starting puberty, versus the testosterone peak between twenty-five and thirty-five years old, versus someone whose testosterone levels have been declining as they’ve aged.

Testosterone range1 (nanograms/deciliter) by age:
Under one year old: 12 to 21
One to six years old: 12 to 32
Seven to twelve years old: 12 to 68
Thirteen to seventeen years old: 28 to 1,110
Over seventeen years old: 348 to 1,197
Over sixty years old: 218 to 929

Men also go through a steep decline in testosterone called andropause, which happens around age sixty-five, about a decade later than women go through menopause; for some men, it’seven later than that. We see some men who are still not in testosterone decline at the age of eighty—they have full testosterone and full fertility potential.

That said, testicular failure, which mimics andropause, can happen at any age. It’s when the testes produce abnormally low levels of testosterone. It used to be that this happened largely to people who had undergone radiation or chemotherapy or similar major stressors on the body—but now we’re seeing testicular failure in young, otherwise healthy men in large numbers, which seems to be due to a slew of environmental factors.

What lifestyle factors can drive testosterone below normal, help boost it back up, or support a healthy level?

Diet: If you have what we call an American-style diet—processed foods, high fat, refined carbohydrates, sweets—that’s not a good way to produce more testosterone. To make the hormone, you need to have enough protein in your diet. For maintenance, it’s usually at least 1.2 grams of protein per kilo of your ideal body weight. If you want to build muscles and produce even more testosterone, you need to go higher than that: 1.5 to 2 grams per kilo.

(Editor’s note: For example, a man who weighs 180 pounds is about 81.6 kilograms. If he’s eating for maintenance—1.2 grams of protein per kilogram of body weight—he should be eating 98 grams of protein per day. And to bulk up on both muscle and testosterone, he would need about 122 grams of protein per day.)

If you eat good, healthy fats, like avocado and olive oil, you’re going to have a better foundation for hormone production. Omega-3s are especially helpful; they help regulate some of the hormone receptors.

Sugar and sweets favor the production of female hormones, and too much creates insulin resistance and a bit of belly fat—which, if you’re a man, impacts your ability to produce testosterone. And it’s a vicious circle: The less testosterone you have, the more belly fat you’re likely to grow, and so on.

Alcohol also impacts your ability to produce testosterone and to keep testosterone; when you have too much alcohol, you stimulate an enzyme in the liver that transforms testosterone into estrogen.

Exercise: Exercising increases testosterone in the body, but you need to have an appropriate program. If you do cardio, cardio, cardio, that might not help much. It has to be a balance: a little bit of cardio to shed body fat, and then weight training to build muscle and bump up testosterone.

“A life of laughter and happiness are the secret to boosting testosterone—and to good health as a whole.”

Stress: Chronically elevated cortisol can impact your body’s ability to produce testosterone. When you allow life stress to build up, you are in fact creating a detour in your hormonal pathways. Your body will prioritize cortisol over testosterone, and that pushes your testosterone levels low. Stress is also linked with adrenaline; the impulse to run at high speed and continue running, running. That can also impact the ability to produce testosterone because you’re not going to sleep very well.

It’s important to keep stress to a minimum. Find something personal to you. Everybody has a different way: You go surfing. You go hiking. You meditate. You spend time with your kids. Whatever you do to keep your stress levels down, your health and hormone levels depend on it. So stay consistent. A life of laughter and happiness is the secret to boosting testosterone—and to good health as a whole.

Sleep and light exposure: Men produce testosterone overnight, while they’re asleep. So men who work night shifts, for example, are known to be at a higher risk of low testosterone for two reasons: First, because they don’t sleep during the night, when the body should really be making the bulk of its testosterone. Second, working the night shift means they are not exposed to enough daylight, which stimulates the pineal gland to regulate the body’s overall hormone production.

Vitamin D, the hormone our bodies make in response to sunlight, is also extremely important for hormone production in both men and women. Sometimes we need to evaluate the level of vitamin D in the blood and, if necessary, supplement to help bring up testosterone.

Lack of sleep is also a driving factor behind low testosterone in young men. Many high school and college students don’t prioritize a good night’s rest, if they’re up late studying or partying, and it affects their bodies’ ability to produce enough testosterone.

Hormone disruptors: Hormone disruptors, especially parabens and pesticides, can alter normal hormone action by binding to hormone receptors—and those for testosterone in particular. Not only can they push hormone levels down but they can also diminish the activity of what’s left.

The people at the highest risk are field workers, who have high levels of pesticide exposure, as well as those working with certain chemicals and heavy metals in labs. But to some extent, we’re all exposed to pollutants in the air, in our food, and in our personal care products.

How does testosterone replacement therapy work?

Testosterone replacement is sometimes recommended when a man’s body has lost the ability to produce enough of this hormone on its own.

If the body responds to it, I typically try to increase the natural production of testosterone with a medication called clomiphene or injections of hCG (human chorionic gonadotropin). This generally works for young men, with a trained physician adjusting dosage as needed.

In other cases—generally, as men get older—we consider testosterone replacement. This can be done with creams or gels applied to the skin every morning, allowing the hormones to penetrate subcutaneous tissues and diffuse throughout the body. For some men, weekly intramuscular injections of testosterone work better. Men undergoing this therapy will need to be monitored; it is prudent to do blood work a few times a year for testosterone, estrogen, red blood cell count, and other values influenced by the treatment.

In the hands of an educated physician, testosterone replacement can be enormously beneficial to a man’s health, with minimal risk. However, done poorly or without proper monitoring, it can have extremely detrimental effects. Testosterone levels that are too high can have some scary symptoms: aggression, impatience, mood swings, high blood pressure, and increased risk of cancer, cardiovascular disease, and blood clotting. Good follow-up is vital.

What are some supplemental approaches to testosterone support?

DHEA can increase testosterone—it’s a hormonal precursor to testosterone. Most of the men I treat for low testosterone are on DHEA, especially if they’re under stress and I see that DHEA shows up a bit low in their blood test.

Vitamin D, again, is very, very important. If someone is testing a little low, it may help to supplement.

There are also some plants and herbs worth trying. In my practice, I’ve seen that maca, tribulus, mucuna, ginger, nettle leaf, and adaptogens, like ashwagandha, can help a little. We have to note that their actions are not especially potent—but some people may find them a helpful adjunct to lifestyle modifications if their situation is mild, and to testosterone replacement therapy as well, if that’s necessary.

But the foundation, the really essential thing to protect healthy testosterone, is to go back to the basics: Lifestyle is number one.

Dominique Fradin-Read, MD, MPH, is board-certified in preventative and anti-aging medicine. After receiving her medical degree from Université Libre de Bruxelles, she completed fellowships in Europe and moved to the US in 1999. Fradin-Read completed an internship in internal medicine through UC San Francisco and a residency in preventative medicine at Loma Linda University, where she also earned her master of public health degree. She worked with dermatologist Dr. Howard Murad before opening her own practice, Vita Life MD, in Los Angeles.

This article is for informational purposes only, even if and regardless of whether it features the advice of physicians and medical practitioners. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment and should never be relied upon for specific medical advice. The views expressed in this article are the views of the expert and do not necessarily represent the views of goop.

1These are the ranges Dr. Fradin-Read uses to guide diagnosis and treatment in her clinical practice. However, these ranges are not necessarily the same ones used by every doctor. For example, the pediatric reference ranges used by Mayo Clinic are slightly different from those listed here. And the clinical guidelines for adults recommended by the Endocrine Society are new; these recommendations were published in 2018 following a landmark 2017 study on total testosterone.

Regular testing is not recommended for those who are asymptomatic and not undergoing treatment.