How can I increase my testosterone levels?

How to Increase Testosterone Levels

Lifestyle modifications, including weight loss for overweight individuals, increasing physical activity, and improving sleep hygiene, are the first-line approach to increasing testosterone levels naturally, while testosterone replacement therapy should be reserved for men with confirmed hypogonadism with symptoms. 1

Diagnosing Low Testosterone

Before considering interventions to increase testosterone, it's important to determine if levels are actually low:

• Testing criteria: In men with symptoms of hypogonadism (decreased sexual desire/libido, erectile dysfunction, fatigue, low energy), a morning serum testosterone level should be measured 2
• Confirmation: If initial testosterone levels are borderline low, check free testosterone concentrations or sex hormone binding globulin 2
• Target range: Normal testosterone levels typically fall between 450-600 ng/dL (mid-normal range) 1

Natural Methods to Increase Testosterone

1. Lifestyle Modifications (First-Line Approach)

• Weight loss: High BMI is strongly associated with low testosterone; weight reduction can significantly increase testosterone levels 1

• Physical activity:

  • Regular aerobic exercise improves testosterone levels 1
  • Resistance training (weight lifting) has been shown to increase testosterone production

• Sleep optimization:

  • Adequate sleep hygiene is recommended for men with low testosterone 1
  • Poor sleep quality and sleep apnea are associated with reduced testosterone levels

• Dietary changes:

  • Mediterranean diet (emphasizing fruits, vegetables, beans, whole grains, nuts, fish, lean meats) 2
  • Moderate alcohol consumption (<21 units/week for men) 2

2. Address Underlying Conditions

• Screen for and treat obstructive sleep apnea, which is 4-10 times more common in individuals with diabetes and associated with low testosterone 2
• Manage metabolic conditions like insulin resistance, type 2 diabetes, and metabolic syndrome, which are associated with androgen deficiency 2

Medical Interventions for Confirmed Hypogonadism

For men with confirmed low testosterone and symptoms of hypogonadism:

1. Testosterone Replacement Therapy (TRT) Options

• Injectable testosterone (testosterone cypionate/enanthate): 50-100 mg weekly 1
• Transdermal formulations (testosterone gel 1%): 50 mg daily (range 50-100 mg) 1
• Avoid oral testosterone forms due to risk of hepatotoxicity 1

2. Monitoring During TRT

• Regular monitoring of:
  • Total testosterone levels (target: 450-600 ng/dL)
  • Hematocrit (discontinue if exceeds 54%)
  • PSA (consider biopsy if >4.0 ng/mL or increases >1.0 ng/mL/year) 1

Contraindications to TRT

TRT should not be used in men with:

• Active prostate or breast cancer
• Hematocrit >50%
• Severe untreated sleep apnea
• Uncontrolled heart failure
• Recent cardiovascular events (within 3-6 months) 1

Benefits of Optimizing Testosterone

• Improved sexual function (libido and erectile function)
• Increased energy levels and reduced fatigue
• Increased muscle mass and strength
• Improved bone mineral density
• Enhanced sense of well-being 1

Potential Risks of TRT

• Increased hematocrit (can contribute to hypertension)
• Potential exacerbation of sleep apnea
• Uncertain effects on cardiovascular risk (evidence is inconclusive) 1
• Acne and other skin conditions

Key Considerations

• Low testosterone may be a marker of poor general health rather than a primary condition 2
• Several epidemiologic studies have associated low testosterone levels with increased all-cause and cardiovascular mortality 2
• For young men who desire fertility, standard TRT can decrease spermatogenesis through negative feedback mechanisms 3

Remember that testosterone levels naturally decline with age, but symptomatic hypogonadism should be properly evaluated and treated when appropriate.