First of all: this is not an article to back up an alleged testosterone crisis in the western world. I find it off-putting and actually a bit sad how a medical condition has been instrumentalized in recent years either in the political context or to the benefit of some aggressive drug marketing campaigns.
Of course, low testosterone or testosterone deficiency is a real issue and sometimes can have severe effects on a man’s health (and sometimes on women’s too, by the way). This makes it all the more important to keep the facts to the ground when looking for reasons and causes as opposed to obscure speculations, whether low testosterone is resulting in a crisis of masculinity or not.
So with that in mind, let’s first look at the facts about testosterone. Why it’s so crucial for our health and what role sleep or the lack of plays for healthy testosterone levels.
What is testosterone?
Testosterone is the most important male sex hormone, but women also have small amounts of it. It is a steroid hormone that is produced in the testicles of men and the ovaries of women. The adrenal glands also produce small amounts.
When a male baby develops, this hormone helps the sex organs to form. During puberty, testosterone is one of the main drivers in boys of physical changes such as muscle building, deeper voice, and hair growth.
In adults, healthy values are essential for overall health, disease risk, body composition, sexual function, and just about everything else. And an optimal testosterone level is crucial even in old age.
Is low testosterone dangerous to your health?
Testosterone is crucial for many aspects of health, and a lack of testosterone can sometimes have long-term, severe effects on the body. Men with testosterone levels below 300 ng/dL may have some degree of low T symptoms.
Testosterone is most commonly associated with sex drive and plays an essential role in sperm production and fertility. Men with low testosterone levels may have difficulty getting and maintaining an erection. The erections they have may be less frequent and not as strong as before.
A man’s desire for sex (libido) also decreases when testosterone falls. As all of these factors can lead to less frequent sex, there can be a very strong effect on partner relationships as well.
What are the effects of low testosterone other than decreased sex drive?
Low testosterone also affects bone and muscle mass, the way men store fat in the body, and even the production of red blood cells.
A man’s testosterone level can also affect his mood, self-esteem, or concentration. And research shows that there is also a strong correlation between low testosterone levels and obesity, increased risk of disease, and premature death from heart disease.
In men with very low levels, the bones can become weak and possibly cause a disease called osteoporosis. Osteoporosis makes people much more prone to injury.
Is low testosterone a problem for women too?
Yes! Most people think that a low testosterone level is only a male problem. The reality is that in women too, low testosterone levels can lead to a variety of unwanted side effects, including decreased sex drive, lack of muscle tissue, depression, obesity, osteoporosis, memory loss, heart disease, and painful sexual intercourse.
What’s the connection between aging and low testosterone levels?
In men, the production of testosterone begins to increase significantly during puberty and decreases after the age of 30. In their 60s, about 20 percent of men have a low testosterone level. For men in the 70s, this figure rises to 30 percent. And by the time men reach their 80s, about half of them will have seen a decrease in testosterone levels.
So declining testosterone levels are a natural part of the aging process. And unlike women who experience a rapid decrease in hormone levels during menopause, men experience a gradual decrease in testosterone levels over time.
What are the causes of low testosterone other than aging?
Low testosterone levels, which are atypical of normal aging, are due to other primary or secondary causes of testosterone deficiency, also known as hypogonadism. Hypogonadism in men occurs when the testicles do not produce enough testosterone, sperm, or both.
Hypogonadism can occur during fetal development, puberty, or adulthood. There are two basic types of hypogonadism – primary and secondary hypogonadism.
Underactive testicles cause primary hypogonadism. This is because they do not produce enough testosterone for optimal growth and health. This can either be caused by a genetic predisposition or by accident or disease.
Inherited diseases include:
- Undescended testicles: If the testicles cannot descend from the abdomen before birth.
- Klinefelter’s syndrome: A condition in which a man with three sex chromosomes is born: X, X and Y.
- Hemochromatosis: Too much iron in the blood causes testicular failure or pituitary damage.
Types of testicular damage that can lead to primary hypogonadism include:
- Physical injury to the testicles: Both testicles must be injured to lower testosterone levels.
- Mumps Orchitis: A mumps infection can injure the testicles.
- Cancer treatment: Chemotherapy or radiation can damage the testicles.
Secondary hypogonadism is caused by damage to the pituitary gland or hypothalamus, those parts of the brain that control hormone production through the testicles.
Hereditary or pathological conditions include:
- Pituitary disorders caused by drugs, kidney failure, or small tumors.
- Kallmann syndrome, a disease associated with abnormal hypothalamic function.
- Inflammatory diseases such as tuberculosis, sarcoidosis, and histiocytosis, which can affect the pituitary gland and the hypothalamus.
- HIV/AIDS, which can affect the pituitary gland, the hypothalamus, and the testes.
Among the acquired circumstances that can lead to secondary hypogonadism are:
- Normal aging: Aging affects production and response to hormones.
- Obesity: High body fat can affect hormone production and response.
- Medication: Opioids, painkillers, and steroids can affect the function of the pituitary gland and hypothalamus.
- Simultaneous disease: Severe emotional or physical stress from an illness or surgery can cause the reproductive system to stop temporarily.
You can be affected by primary, secondary, or mixed hypogonadism. Mixed hypogonadism is more common with age. People undergoing glucocorticoid therapy (e.g., taking cortisone) may develop the disease. It may also affect people with sickle-cell anemia, thalassemia, or alcoholism.
What effect has testosterone insufficiency in fetal development and puberty?
If hypogonadism occurs during fetal development, the primary consequence is impaired growth of the external sex organs. Depending on when hypogonadism occurs and how much testosterone is present during fetal development, a male child may develop:
- female genitals
- ambiguous genitalia, neither clearly male nor female
- underdeveloped male genitals
Normal growth may be compromised if hypogonadism occurs during puberty. There are problems with it:
- Muscle building
- Deepening the voice
- deficiency of body hair
- underdeveloped genitals
- limbs too long
- enlarged breasts (gynecomastia)
How does chronic stress affect testosterone levels?
Another reason for reduced testosterone production might be chronic stress, resulting in a decline in sex drive or libido or even causing erectile dysfunction or impotence.
Your testosterone level is not a priority for your body when you are in a flight-or-fight situation. When fighting for survival, what your body needs is the stress hormone cortisol. And high levels of cortisol are associated with low testosterone.
What are the primary symptoms of low testosterone?
1. Low sex drive
As testosterone plays a vital role in a man’s sex drive, some men may experience a decrease in sex drive with age. However, someone with low testosterone is likely to experience a more drastic decline in their desire to have sex.
2. Difficulties with erection
Testosterone also helps achieve and maintain an erection. Testosterone alone does not cause an erection, but it stimulates the receptors in the brain to produce nitric oxide, a molecule that helps trigger a number of chemical reactions necessary for an erection to occur. If testosterone levels are too low, it may be difficult for a man to achieve an erection before sex or to have spontaneous erections (e.g., during sleep).
Testosterone, however, is only one of many factors that help to achieve a proper erection. Other health problems often play a role in erectile dysfunction. These may include:
- thyroid problems
- high blood pressure
- high cholesterol
- alcohol use
3. Low sperm volume
Testosterone plays a role in the production of sperm. Men with low testosterone values will often notice a decrease in the volume of their semen during ejaculation.
4. Smaller testicle size
Since the male body needs testosterone to develop the penis and testicles, low levels can contribute to a disproportionately smaller penis or testicles compared to a man with normal testosterone levels.
However, there are other causes of smaller than normal testicles in addition to low testosterone levels, so it is not always a low testosterone symptom.
5. Hair loss
Testosterone plays a crucial role in hair production. Balding is a natural part of the aging process for many men. While there is a hereditary component to hair loss, men with low testosterone values can also experience a loss of body and facial hair.
You might have low testosterone if you are tired all the time despite getting plenty of sleep, or if you find it harder to get motivated to exercise.
7. Loss of muscle mass
Since testosterone plays a role in muscle building, men with low T may notice a decrease in muscle mass.
8. Increased body fat
Men with low testosterone can also notice an increase in body fat. They sometimes develop gynecomastia or enlarged breast tissue. This effect is probably due to an imbalance between testosterone and estrogen in men.
9. Reduced bone mass
Osteoporosis or the dilution of bone mass is a disease that often occurs in women. But men with low testosterone can also suffer from bone loss because testosterone helps to produce and strengthen the bone.
10. Mood swings
Men with low testosterone can experience mood swings and decreased mental performance and memory. Also, men with low testosterone levels are more likely to experience depression, irritability, or lack of concentration.
11. Low blood counts
Medical studies show that there is a connection between low testosterone and an increased risk of anemia. Anemia can cause are concentration problems, dizziness, leg cramps, insomnia, and an unusually fast heart rate.
How can you find out if your testosterone levels are too low?
You can determine testosterone levels with a simple blood test. The usual range of testosterone for men is between 280 and 1,100 nanograms per deciliter (ng/dL) for adult males and between 15 and 70 ng/dL for adult females.
If the testosterone level of a male adult is below 300 ng/dL, a doctor may perform a workup to determine the cause of a low testosterone level. However, keep in mind that ranges can vary among different labs, so it’s essential to speak with your doctor about your results, especially before starting any testosterone replacement therapy!
When is it time for testosterone replacement therapy (TRT)?
Reduced testosterone production does not always require treatment. You may want to start a testosterone replacement therapy if low testosterone affects your health and quality of life, and if lifestyle changes do not work for you. Artificial testosterone can be administered orally, through injections or with gels or patches on the skin.
Replacement therapy can lead to desired results, such as increased muscle mass and sex drive. But the treatment may have some side effects such as oily skin, fluid retention, testicular atrophy or a decrease in sperm production.
Whether testosterone replacement therapy leads to a higher risk for prostate cancer or not still remains a topic of ongoing research.
Is TRT suitable for teenagers?
TRT can be crucial for helping teenage males with hypogonadism experience normal masculine development. But again, in young men
TRT can have side effects, including:
- enlarged prostate
- sleep apnea
- testicle shrinkage
- breast enlargement
- increased red blood cell count
- decreased sperm count
A carefully formulated TRT treatment plan should avoid many of these undesirable side effects. However, always talk with your doctor to evaluate your options.
What are evidence-based ways to increase testosterone levels naturally?
If you exhibit symptoms of low testosterone, lifestyle changes may help to relieve your symptoms. A good first step is to increase physical exercising and maintain a healthy diet to reduce body fat. Here are some proven ways to help increase testosterone levels.
1. Exercising and lifting weights
Exercise is still one of the most effective ways to prevent many lifestyle-related diseases. And it can also increase your testosterone.
People who exercised regularly have higher testosterone levels. In older people, exercise increases testosterone levels, fitness, and reaction time.
All forms of exercise can increase your testosterone levels. However, resistance training, such as weight lifting, is the best way to increase testosterone levels in the short and long term. Highly intensive interval training (HIIT) can also be very effective.
2. Eat protein, fat, and carbs
What you eat has a significant influence on testosterone and other hormone levels. Therefore, you need to pay attention to your long-term calorie intake and nutrition strategy. Constant dieting or overeating can disrupt your testosterone levels.
Eating enough protein can help maintain health and support the fat loss associated with your testosterone.
Carbohydrate intake also plays a role, with research showing that carbohydrates can help optimize testosterone levels during resistance training. However, enough healthy fats are also beneficial for testosterone and health.
So don’t overeat and don’t limit calories too long. In general, a diet based mainly on whole foods is best, with a healthy balance of fat, protein, and carbohydrates. This can optimize both hormone levels and long-term health.
3. Minimize stress and cortisol levels
Long-term stress increases the level of the hormone cortisol. Unnatural high levels of cortisol can quickly reduce testosterone levels. These hormones act like a seesaw: when one goes up, the other goes down.
Stress and high cortisol can also increase food intake, weight gain, and the storage of harmful body fat around the organs. These changes can, in turn, adversely affect your testosterone levels.
For optimal health and hormone levels, you should try to reduce repetitive stressful situations in your life. Focus on a balanced lifestyle that reduces stress and learn appropriate stress coping strategies.
4. Get some sun or take a Vitamin D supplement
Vitamin D is rapidly becoming one of the most popular vitamins in the world as it has several health benefits and can also act as a natural testosterone booster.
Despite its importance, almost half of the U.S. population is insufficiently supplied with vitamin D, and an even higher percentage has suboptimal levels. A 12-month study found that supplementation with about 3,000 IU of vitamin D3 per day increased testosterone levels by about 25%.
To increase testosterone and take advantage of the other benefits of vitamin D, try sun exposure regularly, or take about 3,000 IU of vitamin D3 daily.
5. Make sure you get enough Zink
Zinc is an essential food supplement. You need zinc for your immune system to work properly and for cell division to work. Zinc helps enzymes to break down food and other nutrients. It also plays an essential role in enzymes that form proteins. It can be found in certain foods, but it is also available in dietary supplements and even in certain cold medications.
Zinc deficiency can lead to low testosterone levels. Exactly why zinc deficiency affects testosterone levels is not fully understood. The mineral can affect the cells in the testicles that produce testosterone.
One study investigated the effects of a magnesium and zinc supplement. It found that men who received 30 milligrams of zinc per day showed an increased level of free testosterone in their bodies.
The use of a dietary supplement may not be necessary if you are already getting enough of the mineral from your regular diet.
So out of all the vitamins and minerals available, Vitamin D and zinc seem to have the most reliable evidence as testosterone boosters.
6. Eat delicious ginger
There are hundreds of supplements available that claim to boost testosterone. However, only a few have been researched as thoroughly as ginger and ashwagandha.
Ginger is a common household spice that has been used in alternative medicine for centuries. It is a delicious herb that has many health benefits, with strong research showing that it can reduce inflammation and perhaps even increase testosterone levels.
Most of the research on ginger has been done on animals. Studies in rats have shown that ginger has positive effects on testosterone levels and sexual function. In a 30-day study, researchers found elevated testosterone and luteinizing hormone in diabetic rats.
In one of the few human studies, 75 infertile men received a ginger supplement daily. After three months, they had experienced a 17% increase in testosterone levels, and their luteinizing hormone levels had almost doubled.
Although it is still in the early stages of research on ginger and testosterone, eating ginger is very safe and offers many other health benefits.
7. Include ashwagandha in your diet
Also known as Withania somnifera, ashwagandha is another herb used in ancient Indian medicine.
Ashwagandha is primarily used as an adaptogen; i.e., it helps the body to deal with stress and anxiety. One study tested its benefits on sperm quality in infertile men who received 5 grams per day for three months. The men in this study had an increase in testosterone levels of 10-22%. The partners of 14% of the participants also became pregnant (33Trusted Source).
Ashwagandha seems likely to help increase testosterone levels in stressed individuals, possibly by reducing the stress hormone cortisol.
8. Avoid estrogen-like chemiclas and excessive alcohol or drug use
High exposure to estrogen-like chemicals like BPA, parabens, or other chemicals found in some types of plastics or skincare products can also affect your levels, so try to minimize daily exposure.
To return to hormonal homeostasis, you need to reduce your toxin load and improve your internal detoxification systems.
It is probably no surprise that excessive alcohol or drug use, whether in medicine or leisure, can also lower testosterone levels. In contrast, laughter, happiness, and success can help increase your health and testosterone levels – so make sure they are part of your daily life.
Your doctor can perform a blood test and recommend treatment if necessary. You can also discuss the potential benefits and risks of testosterone medications.
Most of all: Get plenty of restful, high-quality sleep
We all know that a balanced hormonal balance is essential for daily well-being and health. And it is no secret that sleep deprivation can significantly affect our hormonal balance. I must confess, however, that I was not aware of how much sleep deprivation can affect testosterone levels until I read this study published in the JAMA.
It showed that testosterone levels in healthy young men in their mid-twenties who have slept less than five hours a night for a week drop by 10 to 15 percent! This means that the decrease in testosterone compared to when they are fully rested was so significant that it effectively “aged” these men by ten to fifteen years in terms of testosterone virality.
The reason for this is that men produce much of their testosterone during sleep. So it’s no problem as long as you get enough sleep. But unfortunately, in our sleep-disturbed society, this has become less and less the case.
Sleep-deprived men show a 30 percent lower sperm count
In his groundbreaking book Why We Sleep, Matthew Walker refers to the same study. He continues that this result confirms that men who suffer from sleep disorders, especially sleep apnea associated with snoring, have significantly lower testosterone levels than men of similar age and background with normal sleep.
Also, these men often show an almost 30 percent lower sperm count the sperms themselves are more often deformed than in men who get a full and restful night’s sleep. But that’s not all: sleep-deprived men also often have significantly smaller testicles than well-rested men.
The crucial relation between sub- and infertility in women and sleep
Walker also mentions that men are not the only ones who are reproductively impaired by sleep deprivation. Sleeping regularly less than six hours a night leads to a 20% decrease in the follicular releasing hormone in women – a critical female reproductive element that reaches its peak just before ovulation and is necessary for conception.
In addition, women who worked irregular hours were 80 percent more likely to suffer from subfertility problems affecting their ability to become pregnant. And women who become pregnant and routinely sleep less than eight hours per night are also significantly more likely to miscarry in the first trimester compared to those who consistently sleep eight hours or more per night.
Walker concludes: “Combine these deleterious effects on reproductive health in a couple where both parties are lacking in sleep, and it’s easy to appreciate why the epidemic of sleep deprivation is linked to infertility or sub-fertility…” (Walker, Matthew. Why We Sleep p. 180).
The quality of your sleep greatly influences your testosterone levels. If you have any plans to make a baby, have continuously great sex, and stay overall healthy and fit, you do well on prioritizing your sleep every day. And this refers to both men and women!