How can males increase their testosterone levels?

How to Raise Testosterone in Males

For men with low testosterone levels, lifestyle modifications should be the first-line approach, followed by testosterone replacement therapy only when clinically indicated for those with confirmed hypogonadism. 1

Diagnosis and Assessment

• Morning total testosterone levels should be measured between 8 AM and 10 AM to establish a diagnosis of low testosterone, with normal range typically being 300-800 ng/dL 1
• Free testosterone levels by equilibrium dialysis and sex hormone-binding globulin should be measured, especially in men with obesity 1
• If testosterone levels are low, they should be repeated and luteinizing hormone (LH) and follicle-stimulating hormone (FSH) should be measured to distinguish between primary and secondary hypogonadism 1
• Men should be evaluated for signs and symptoms of hypogonadism including decreased energy, libido, muscle mass, body hair, as well as hot flashes, gynecomastia, and infertility 1

Lifestyle Modifications

• Weight loss and maintaining weight within recommended range is crucial as obesity is strongly associated with low testosterone levels 1, 2
• Regular physical exercise, particularly resistance training, can increase testosterone levels naturally 1, 3
• Adequate sleep and stress reduction can help optimize testosterone production 3
• Addressing sleep apnea if present, as it is associated with lower testosterone levels 1
• Varicocele repair may improve testosterone levels in affected individuals 3

Medical Therapy Options

For Confirmed Hypogonadism:

• Testosterone replacement therapy (TRT) should target total testosterone levels in the middle tertile of the normal reference range (450-600 ng/dL) 1
• Available formulations include:
  • Intramuscular injections (testosterone enanthate) administered every 2-4 weeks 4
  • Transdermal preparations (gels, patches) which are preferred to intramuscular options by some clinicians 1
  • Oral preparations should be avoided due to potential hepatotoxicity 1

Alternative Medical Therapies:

• Human chorionic gonadotropin (hCG) may be considered for men wishing to preserve fertility 3
• Selective estrogen receptor modulators (SERMs) or aromatase inhibitors may be options for men with low testosterone and low/normal LH levels 1, 3

Important Considerations and Cautions

• TRT should not be prescribed to men currently trying to conceive as it can suppress spermatogenesis 1
• TRT should be delayed for 3-6 months after cardiovascular events 1
• Prior to starting TRT, patients should have baseline hemoglobin/hematocrit measured, as TRT can increase risk of polycythemia 1
• Prostate-specific antigen (PSA) should be monitored, with biopsy considered if PSA rises above 4.0 ng/mL or increases by more than 1.0 ng/mL in a year 1
• Patients should be counseled that the relationship between TRT and cardiovascular events remains unclear 1
• TRT is not FDA-approved for age-related hypogonadism without an established medical cause 4

Benefits of Optimizing Testosterone

• Improved sexual function and libido 1, 5
• Increased lean body mass and reduced fat mass, particularly abdominal fat 1, 6
• Improved bone mineral density 1, 6
• Potential improvements in energy levels, mood, and quality of life 1, 5
• Enhanced insulin sensitivity and glucose control 1, 2

Monitoring During Treatment

• Testosterone levels should be checked 3-6 months after initiating therapy 1
• Regular monitoring of hematocrit, PSA, and symptoms is essential 1
• If patients do not experience symptomatic relief after reaching target testosterone levels, therapy should be reconsidered 1