From the Guidelines
Exercise can be beneficial for individuals undergoing testosterone replacement therapy (TRT) as it may help optimize overall testosterone levels, although it won't significantly increase the testosterone provided by the therapy itself. According to the American Urological Association guideline 1, lifestyle modifications, including increasing physical activity, have the potential to increase total testosterone levels and/or reduce signs and symptoms associated with testosterone deficiency.
Key Points to Consider
- Exercise, particularly resistance training and high-intensity interval training (HIIT), can enhance how the body responds to TRT by improving insulin sensitivity, reducing body fat, and increasing muscle mass - all factors that support healthy testosterone function.
- For best results, aim for 3-4 resistance training sessions weekly focusing on compound movements like squats, deadlifts, and bench presses, along with 1-2 HIIT sessions.
- This exercise regimen complements TRT by maximizing receptor sensitivity and metabolic health.
- Additionally, ensure adequate recovery with 7-9 hours of sleep nightly and manage stress levels, as these factors significantly impact how effectively the body utilizes testosterone.
- While exercise is beneficial alongside TRT, remember that base testosterone levels are primarily determined by the prescribed medication dosage, which should be monitored regularly by a healthcare provider.
Evidence Support
The most recent and highest quality study from the American College of Physicians 1 suggests that testosterone therapy may provide small improvements in sexual functioning and quality of life but little to no benefit for other common symptoms of aging. However, this study does not directly address the impact of exercise on TRT outcomes. The guideline from the American Urological Association 1 provides the most relevant evidence for the benefits of lifestyle modifications, including exercise, in men with testosterone deficiency.
Clinical Considerations
When considering exercise as part of a treatment plan for individuals on TRT, it's essential to weigh the potential benefits against the individual's health status, preferences, and ability to engage in physical activity. The cost and accessibility of different exercise regimens should also be considered, as well as the potential for long-term adherence to an exercise program.
From the Research
Effect of Exercise on Testosterone Levels
- Exercise has been proposed to increase serum testosterone concentrations, but the effect depends on various factors such as type of exercise, training intensity, and study population 2.
- Resistance exercise, in particular, has been shown to increase testosterone levels in men, with the response determined by factors such as exercise program variables, sex, and age 3.
- High-intensity interval training (HIIT) has also been found to increase free testosterone levels in male masters athletes, suggesting a potential benefit for this type of exercise in older adults 4.
Testosterone Replacement Therapy (TRT) and Exercise
- The effects of testosterone replacement therapy on muscle strength and physical function are inconclusive, with some studies suggesting a potential increase in physical function but not muscle strength 5.
- Exercise, particularly resistance training, may still be beneficial for individuals undergoing TRT, as it can help improve muscle strength and physical function, although the impact on testosterone levels is not fully understood 3, 6.
Factors Influencing Testosterone Response to Exercise
- The testosterone response to exercise can be influenced by factors such as rest interval length, with shorter rest intervals potentially leading to greater increases in testosterone levels 6.
- The type of exercise, intensity, and duration can also impact the testosterone response, with resistance exercise and HIIT potentially being more effective at increasing testosterone levels than endurance exercise 2, 3, 4.