Supplements for Increasing Testosterone Levels
Most marketed "testosterone booster" supplements lack scientific evidence to support their claims, with only a few specific supplements showing modest effects on testosterone levels in certain populations. 1
Evidence-Based Supplements That May Increase Testosterone
For Men with Documented Low Testosterone:
- Zinc supplementation: 220 mg of zinc sulfate (50 mg elemental zinc) twice daily for 1-4 months may increase total testosterone in men with zinc deficiency 2
- Vitamin D: Supplementation can improve testosterone levels, but only in men with documented vitamin D deficiency 3
- Ashwagandha (Withania somnifera): Has shown promising results in well-controlled randomized trials for men with low testosterone levels 3, 4, 1
- Eurycoma longifolia (Tongkat Ali): Possibly effective for men with late-onset hypogonadism and healthy men 1
For Specific Populations:
- β-hydroxy β-methylbutyrate and betaine: May be effective specifically for male athletes 1
- Punica granatum (pomegranate) fruit rind with Theobroma cacao seed extracts (Tesnor™): Possibly effective for men with late-onset hypogonadism 1
- Purified Shilajit extract (PrimaVie™): Possibly effective for men with late-onset hypogonadism 1
Important Limitations and Considerations
- Limited evidence: Only 24.8% of marketed testosterone boosters have any data supporting their claims to increase testosterone 5
- Potential harm: 10.1% of marketed supplements contain components with data suggesting a negative effect on testosterone 5
- Excessive dosing: Many supplements contain supra-therapeutic doses of vitamins and minerals, sometimes exceeding the upper tolerable intake level 5
- Modest effects: The effects of non-pharmacologic interventions on testosterone levels are modest and may not translate into clinical benefits 3
Medical Evaluation Before Supplementation
- Morning total testosterone levels should be measured between 8-10 AM on at least two separate occasions to confirm testosterone deficiency 6
- For obese patients, measuring free testosterone by equilibrium dialysis and sex hormone-binding globulin is recommended 6
- Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) should be measured to distinguish between primary and secondary hypogonadism 6
Lifestyle Modifications with Better Evidence
- Weight loss: Maintaining weight within the recommended range can increase total testosterone levels 7
- Physical activity: Regular exercise has been shown to increase testosterone levels 7, 3
- Adequate sleep: Proper sleep hygiene is imperative before considering supplements 3
Medical Testosterone Replacement Therapy
For men with confirmed testosterone deficiency and symptoms:
- Testosterone replacement therapy has been shown to increase muscle mass, decrease fat mass, and improve muscle strength 7
- It can improve sexual function, erectile function, and quality of life 7
- Therapy should be adjusted to achieve total testosterone levels in the middle tertile of the normal reference range 7
Monitoring and Safety Considerations
- Regular monitoring of hematocrit/hemoglobin is essential as testosterone therapy can cause erythrocytosis 7
- Prostate monitoring through digital rectal examination and PSA measurement is recommended before and during treatment 7
- Testosterone therapy should not be prescribed to men who are currently trying to conceive 7
- Therapy should not be commenced for 3-6 months in patients with a history of cardiovascular events 7
Conclusion
While some supplements show modest effects on testosterone levels in specific populations, the evidence for most marketed "testosterone boosters" is weak or nonexistent. Lifestyle modifications like weight loss, exercise, and adequate sleep should be prioritized before considering supplementation. For men with documented testosterone deficiency, medical evaluation and potentially testosterone replacement therapy under proper medical supervision may be more effective than supplements.