Testosterone is a male sex hormone made primarily in the testicles, but also in other parts of the body, such as the adrenal glands. It’s responsible for a man’s sexual development (e.g., the growth of his testes and penis) and his sexual function (including sex drive and sperm production). It also helps give men their characteristic male traits—things like facial hair, a deepened voice, and increased muscle mass. Women also naturally produce testosterone, but at levels significantly lower than men’s.
Low testosterone (also called hypogonadism or low T) affects 40% of men age 45 and older, according to the Cleveland Clinic. That can spell trouble for men’s physical and mental well-being. It can cause weight gain, fatigue, bone loss, depression, and even cardiovascular problems like heart attack and stroke.
Normal testosterone levels
Normal testosterone levels range between 300-1,000 ng/dL (nanograms per deciliter of blood). But a lot of factors—a man’s weight, the time of day blood samples are tested, and even the lab itself performing the testing—can influence his testosterone levels (sometimes referred to colloquially as T levels). Another big factor is age.
“We don’t know the exact ‘normal’ based on age ranges,” explains Petar Bajic, MD, an assistant professor of urology at Case Western Reserve University and a spokesperson for the American Urological Association. “In general, though, the professional societies for urology and endocrinology—the two types of doctors who manage low testosterone—have agreed on a universal cutoff of 300 ng/dL as the threshold for ‘low.’ However, we know that younger men have a higher ‘normal’ testosterone than older men.”
Research published in the journal PLoS One finds that total testosterone in males is low before puberty, rises at about age 11, and peaks in the late teen years. Other research, however, says testosterone peaks around age 30 to 40 before it starts to steadily decline—at about 1% to 2% annually.
“We don’t fully understand why testosterone decreases with age,” Dr. Bajic says. “There are likely to be many different components—some genetic, some environmental, and others inherent to aging. Those inherent to aging are most likely due to either decreased signaling from the brain to the testicle (via a hormone called LH), or due to decreased ability of the testicles to produce testosterone.”
Total testosterone levels in males by age
|Up to 9 years of age||7-20 ng/dl|
|10-11 years||7-130 ng/dl|
|12-13 years||7-800 ng/dl|
|14 years||7-1,200 ng/dl|
|15-16 years||100-1,200 ng/dl|
|17-18 years||300-1,200 ng/dl|
|19 and over||240-950 ng/dl|
*Source: Mayo Clinic Laboratories
Symptoms of low testosterone
How do you know if you have hypogonadism? Symptoms include:
- Low sex drive
- Erectile dysfunction
- Reduced muscle strength
- Problems concentrating
- Increase in body fat/weight gain
- Loss of body hair
- Breast growth
- Anemia (a lack of healthy red blood cells)
- Bone thinning (osteoporosis)
Low testosterone can also have a serious impact on your cardiovascular health. Experts are still researching the connection between testosterone and heart health. They do know that men with low (and extremely high) levels are more at risk to have heart attacks and stroke. However, when symptomatic men with lab-confirmed low testosterone receive testosterone therapy, their risk of cardiovascular events decreases. In one study, men under 55 with symptomatic low testosterone levels had a 25% reduced risk of heart attack and stroke when they received adequate testosterone therapy. Men over 60 had a 15% lower risk.
“A too-low or too-high testosterone level is not favorable,” says S. Adam Ramin, MD, a urologist and medical director of Urology Cancer Specialists in Los Angeles. “And studies have shown that mid-range levels are cardio-protective, meaning they can help guard the heart from potential damage.” The goal is to replace testosterone so that it is within the normal range. Some men desire testosterone replacement when their levels are within the normal range to help with symptoms of hypogonadism. This is harmful to the patient and has not been significantly shown to help with symptoms. If the testosterone is within the normal range, then the physician should look for alternate diagnoses for why the patient is symptomatic.
How to increase testosterone naturally
Making healthy lifestyle changes and eating a healthy diet can do a lot to boost testosterone levels, help you feel better, and improve your overall health. Some natural ways to raise lower testosterone levels include:
1. Lose weight
“Weight loss is essential because fat cells in the body convert testosterone into estrogen,” Dr. Bajic explains. “Losing weight can prevent this conversion and increase testosterone levels naturally. However, not all men with low T are overweight.”
Research shows that over 50% of obese men have lab-proven hypogonadism, which is when testosterone levels below 300 ng/dL. Confirming this, one study of obese men who underwent weight loss surgery found that within one year of their procedure, their testosterone rose from a pre-surgery average of 295 ng/dL to 423 ng/dL post surgery.
If you need to lose weight, talk to your healthcare provider about the best plan for you. Some research shows that low-fat diets can actually lower testosterone. Talk to your doctor about including healthy fats in your diet, such as olive oil and avocados.
Besides its ability to help you lose weight, exercise has also been shown to boost testosterone. In one study that compared both men and women who either lifted free weights or used weight machines for a total of eight weeks, the men who used the free weights had a greater increase in what’s known as “free testosterone” (testosterone that isn’t bound to proteins and can connect to testosterone receptors in the cells) than the men who used the weight machines.
And while weight lifting and strength training are what most people think about when they envision exercise that will build muscle and raise testosterone, other physical activity—including walking and high-intensity interval training (HIIT) have also proven effective. For example, a study that examined men’s daily step counts and their testosterone levels found that those who took more than 4,000 steps a day had significantly lower odds of having low total testosterone levels than those who took fewer steps. What’s more, for each additional 1,000 steps the men took, total testosterone levels increased by 7 ng/dL.
3. Get adequate sleep
Testosterone levels increase as you sleep, which may explain why men who are chronically sleep deprived can have lower levels of testosterone. One study examined the testosterone levels in young, healthy men after they slept eight to 10 hours for a series of nights and then restricted sleep to five hours per night for eight nights. Overall, the men’s testosterone levels decreased 10%-15% after the eight days of restricted sleep.
“Anything that negatively affects sleep, such as shift work, sleep apnea, or stress, will negatively affect testosterone production,” Dr. Bajic says. “Shoot for eight hours of sleep per night and exercise good sleep hygiene.” If you have a sleep disorder such as snoring or sleep apnea, see your physician for confirmation and possible treatment with CPAP. CPAP is a device that you wear on your face at night that can help you breathe and sleep better. Sleeping better also helps energize you during the day so that weight loss is easier.
4. Live clean
Substance abuse is an important cause of low testosterone levels. Research shows that low testosterone can result from things like chronic alcohol abuse (but not low-to-moderate alcohol intake) and opioid use. Other substances, such as cigarette and marijuana smoking, can also negatively affect testicular tissue and sperm health—although not testosterone production, per se.
5. Getting more vitamin D and zinc
In one study, subjects who received vitamin D supplementation showed significant increases in testosterone compared to those in the control group. The American Academy of Family Physicians recommends that men with low testosterone get 600 IUs (international units) of vitamin D daily and also 11 milligrams of zinc, another testosterone-boosting mineral, per day. You can opt to eat more foods rich in zinc, which includes meat, poultry, shellfish, whole grains, beans, and nuts or take a zinc supplement. Both vitamin D and zinc supplements are available over the counter.
Testosterone boosters: Which supplements are effective?
Judging by the selection on health food store shelves, testosterone boosters (or T-boosters) are a big business. You should know there’s little scientific evidence that any of them raise testosterone levels. T-boosters are not regulated by the Food and Drug Administration (FDA), which means there’s no oversight of what they’re composed of (and some may include banned substances or steroids) or what they claim to do.
Research published in the Journal of Sexual Medicine looked at five T-boosters found on Amazon. Researchers performed a literature search looking at the effectiveness of the 10 most common ingredients used across all five supplements. Only 19% of those studies were even conducted in humans. Of those, 30% showed an increase in testosterone levels, 3% a decrease, 46% no effect, and 22% were indeterminate.
“I generally recommend that men avoid testosterone-boosting supplements as some of these might contain substances whose effects on hormonal function we do not fully understand,” Dr. Bajic cautions. “If a man has low testosterone with associated symptoms, he should see an experienced physician to discuss the various available treatment options, which are very effective.”
When to see a doctor for low T
If you’re experiencing any symptoms of low testosterone, see your doctor. You can see a urologist, endocrinologist, family physician, or internist for help. Your healthcare provider will take a health history and, if symptoms point to low testosterone, order a blood test for a definitive diagnosis. Several blood draws may be needed, as testosterone levels naturally fluctuate throughout the day. Physicians generally don’t treat low testosterone unless you are symptomatic and blood test results confirm low levels.
“As men age, it can be typical for their testosterone levels to drop,” assures Dr. Ramin. “This drop does not necessarily indicate there is a problem, especially if the man is not experiencing any related symptoms.”
Low T medications to try when natural remedies don’t work
If you haven’t been able to normalize low testosterone with lifestyle measures, your doctor may recommend testosterone replacement therapy. These medications work in different ways. Testosterone replacement is available to place topically on the skin, pellets placed under the skin, injected in the muscle, or orally.
“Treatment is usually advisable if the low testosterone levels are causing symptoms or if the levels are so low that the individual is at risk of physiologic complications like cardiovascular disease or osteoporosis,” says Dr. Ramin. Some drugs prescribed for testosterone deficiency include:
|Common low T medications|
|Drug name||How it’s taken||Learn more||Get coupon|
|Depo-testosterone||Injected||Learn more||Get coupon|
|Jatenzo||Orally||Learn more||Get coupon|
|Androgel||Gel applied to skin||Learn more||Get coupon|
|Testim||Gel applied to skin||Learn more||Get coupon|
|Aveed||Injected||Learn more||Get coupon|
|Androderm||Patch placed on skin||Learn more||Get coupon|
|Xyosted||Injected||Learn more||Get coupon|
|Testopel Pellets||Pellet placed under the skin||Learn more||Get coupon|
|Fortesta||Gel applied to skin||Learn more||Get coupon|
If you do opt for testosterone hormonal therapy, realize that there can be risks and side effects. According to the Mayo Clinic, some of those include:
- Worsening of sleep apnea
- Growth of existing prostate cancers and noncancerous prostate growths
- Breast enlargement
- Smaller testicles
- Decreased sperm count
- Increased risk of blood clots
“No matter the treatment type, a conversation with your doctor should always be the first step,” Dr. Ramin advises. “The good news is, restoring normal testosterone levels is typically achievable and has helped many men feel better in no time.”