What are the ways to increase testosterone levels?

Ways to Increase Testosterone Levels

Lifestyle changes such as weight loss for overweight/obese men, regular physical activity, adequate sleep, stress reduction, healthy diet, moderate alcohol consumption, and smoking cessation are the most effective non-pharmacological approaches to increase testosterone levels, particularly in men with metabolic disorders or obesity. 1

Diagnosis of Low Testosterone

Before attempting to increase testosterone levels, it's important to confirm if levels are actually low:

• Morning total testosterone level is the recommended screening test for men with symptoms of hypogonadism 2, 1
• Symptoms of low testosterone include:
  • Sexual symptoms (decreased libido, erectile dysfunction)
  • Physical symptoms (fatigue, reduced muscle mass)
  • Cognitive symptoms (mood changes, decreased concentration) 1
• Laboratory evaluation should include:
  • Morning total testosterone levels
  • Free testosterone
  • Luteinizing hormone (LH) and follicle-stimulating hormone (FSH)
  • Complete blood count
  • Prostate-specific antigen (PSA) in men over 40 1

Effective Non-Pharmacological Interventions

1. Lifestyle Modifications (First-Line Approach)

• Weight loss: Particularly effective for overweight/obese men 1
• Regular physical exercise: Both resistance and aerobic training can improve testosterone levels 1, 3
• Adequate sleep: Sleep deprivation is associated with reduced testosterone 1, 3
• Stress reduction: Chronic stress increases cortisol which can lower testosterone 1
• Healthy diet: Focus on balanced nutrition with adequate protein 1, 3
• Moderate alcohol consumption: Excessive alcohol can lower testosterone 1
• Smoking cessation: Smoking is associated with lower testosterone levels 1

2. Nutritional Supplements with Evidence

Only a select few supplements have promising results based on well-controlled studies:

• Vitamin D: Effective in cases of vitamin D deficiency 3
• Zinc: Has shown promising results in men with low testosterone 3
• Ashwagandha (Withania somnifera): Possibly effective for healthy men 4
• Eurycoma longifolia (Tongkat Ali): Possibly effective for men with late-onset hypogonadism and healthy men 4

3. Less Supported Supplements

The following have limited or mixed evidence:

• Tribulus terrestris: Limited evidence for testosterone increase 3, 4
• D-aspartic acid: Mixed results in studies 4
• DHEA: Limited evidence in older men 5
• L-arginine: May help with related symptoms 3

Medical Testosterone Therapy

For men with confirmed low testosterone (hypogonadism), medical intervention may be warranted:

• Consider testosterone replacement therapy (TRT) when:
  • Total testosterone level is below 350 ng/dL with symptoms
  • Levels between 231-346 ng/dL may warrant a 4-6 month trial if symptomatic
  • Levels below 230 ng/dL usually benefit from treatment 1

Contraindications to Testosterone Therapy

TRT is contraindicated in patients with:

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

Special Considerations for Fertility

• Traditional testosterone therapy suppresses spermatogenesis and should be avoided in men seeking fertility 1, 6
• Alternative options for men seeking fertility include:
  • Human chorionic gonadotropin (hCG)
  • Selective estrogen receptor modulators
  • Aromatase inhibitors 6

Monitoring and Safety

For those on testosterone therapy:

• Regular monitoring of total testosterone, hematocrit, PSA, and digital rectal examination 1
• Target testosterone range: 450-600 ng/dL
• Discontinue therapy if hematocrit exceeds 54% 1
• Monitor for potential side effects including erythrocytosis, sleep apnea, and skin reactions 1

Common Pitfalls to Avoid

1. Unverified "testosterone boosters": Most marketed testosterone boosters fail to increase total testosterone 4
2. Ignoring underlying conditions: Low testosterone may be a marker of pre-existing disease rather than the primary issue 7
3. Self-medication: Using unregulated supplements without medical supervision can lead to adverse effects
4. Unrealistic expectations: The effects of non-pharmacological interventions on testosterone levels are modest 3
5. Neglecting comprehensive approach: Focusing solely on supplements while ignoring lifestyle factors is ineffective 3