Testosterone: The Complete Guide for Men to Feel Great

Testosterone is one of the many hormones that regulate your body function. In this article, we explore testosterone in detail. What is it? What does it do? How does it fit in with your overall endocrine function?

Millions of men live with the side effects of low testosterone. But the condition often goes undiagnosed and untreated because of outdated and imprecise testosterone scales. As a result, too many men live with weight gain, fatigue, reduced sex drive and function, and mood disorders like anxiety and depression. 

Our aim with this guide is to help you learn about testosterone so that if you have symptoms of low testosterone, you can get the help you need. We want you to know when and why to ask for help and the details you need to share with your doctor to get the testosterone therapy you need. 

In addition to equipping you to talk to a doctor about your needs, we also provide some information about the best lifestyle choices to enhance your testosterone and other hormone levels for optimal health and wellness. 

You don’t need to accept your symptoms as an inevitable part of aging. Read on to learn more about testosterone, and remember, when it comes to hormones — normal doesn’t mean optimal. 

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    Chapter 1 - Testosterone 101

    Your body produces around 50 different hormones. Your hormones control or regulate almost all of your body functions, including your metabolism, sexual development, libido, heart rate, blood pressure, and more.

    Testosterone is identified as a male hormone, although women’s bodies also produce testosterone [1]. It stimulates and supports the appearance of adult male characteristics from facial hair to sperm production.

    But these are just the surface facts. Let’s dig a little deeper.


    The effects of testosterone have been recognized throughout time. However, the hormone wasn’t discovered and named until 1935, when scientist Ernst Laqueur isolated the hormone in bull testes[2] and discovered how removing or adding testosterone changed physical and mental characteristics.
    Scientists performed a wide range of experiments on testosterone over the years. The road to isolation began in 1786 when John Hunter transplanted testes into capons — cockerels that had been castrated. Then in 1849, Adolph Berthold based his testicular transplant experiments on the premise that testicular secretions were critical to success. His research led to the self-experiments of Brown-Séquard in 1889. Sergio Voronoff transplanted testes from animals to men in the 1920s. While the Royal Society of Medicine proved this approach was ineffective in 1927, it led to the chemical synthesization of testosterone in 1935 by Adolf Butenandt and Leopold Ruzicka [3].

    Further research determined that oral testosterone wasn’t effective, so the substance was pressed into subcutaneous pellets or a derivative of testosterone (17a-methyl T) was given orally. 17a-methyl T was eventually found to have toxic side effects, and it’s now obsolete.

    In the 1950s, an injectable form of testosterone became available, which led to a focus isolating and enhancing the anabolic effects of testosterone to create anabolic steroids. On a side note, anabolic steroids quickly disappeared from clinical medicine, although some still use them for illegal doping.

    In the 1970s, an effective oral form of testosterone became available, and soon a transdermal patch was developed. In recent years short-acting buccal T and long-acting injectable T undecanoate have become available.


    We know that testosterone is the male sex hormone that’s primarily produced in your testes. Both men and women also produce small amounts of testosterone in their adrenal glands, and women’s ovaries also make a small amount of the hormone.

    Your testosterone levels begin to rise during puberty as you start to develop adult male characteristics. For example, increasing testosterone levels trigger the change in your larynx that deepens your voice. It helps your genitals, pubic hair, body, hair, and overall muscle mass grow. Additionally, it triggers the emergence of your sexual desire.

    Your testosterone levels peak in your late teen years, but around the age of 30, your testosterone levels begin to decrease slightly every year. While decreasing testosterone levels are normal, the range that’s considered healthy is too broad, and many men suffer the effects of low testosterone while their blood work still shows a “normal” amount of the hormone.

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    Testosterone production begins in your brain. Your brain sends a signal to your hypothalamus, telling it to produce testosterone. Then, your hypothalamus releases gonadotropin that your pituitary gland picks up. Next, your pituitary gland releases luteinizing hormone and follicle-stimulating hormone (FSH). These hormones trigger the Leydig cells in your testes to produce testosterone.

    The process doesn’t stop there. The testosterone enters your bloodstream and either binds to sex hormone-binding globulin and albumin, or stays in its free form and waits to bind to other targeted cells. Eventually, testosterone reduces to dihydrotestosterone or estradiol. Estradiol controls your libido, erectile function, and sperm production [4]. Dihydrotestosterone is at its highest level during puberty as it helps you develop adult male characteristics like facial hair [5]. When you have enough testosterone in your bloodstream, your body starts the hypothalamic-pituitary-testicular axis — a negative feedback loop that sends messages to your pituitary gland to slow the production of luteinizing hormone and eventually FSH [6]. This cycle continues, and eventually, your testosterone production slows as you age.


    While the years before menopause and menopause get all the attention because of the way this change disrupts a woman’s life, men also go through hormonal changes that affect their health and well-being. Whether your hormonal decline is due to age or another issue, low testosterone causes a variety of disruptive and distressing symptoms [7].


    Testosterone controls your sex drive, which means that as your testosterone levels decline, so does your desire and erectile function. A healthy sex life is a critical part of your overall wellness.

    Changes to your desire and performance can be extremely distressing.


    While your sexual energy decreases, you might also notice that you have less energy overall. You might find yourself dozing off on the couch after dinner or struggling to get going in the morning. Perhaps instead of being able to power through your day, you become a little fatigued around 3:00 or 4:00 pm and turn to caffeine or sugary snacks to get you through the rest of your day.


    Whether you’re snacking more often to make up for low energy or not, low testosterone levels lead to weight gain on your own. Testosterone contributes to your metabolism, and low testosterone levels equal slow metabolism. If nothing else has changed in your life, but the number on your scale or waist size is creeping up, reduced testosterone could be the cause.


    Somehow, even though you’re gaining weight, you’re simultaneously losing muscle mass. How does this even happen? Testosterone increases the neurotransmitters that stimulate tissue growth and protein synthesis. It also increases your growth hormone levels. These are all critical to maintaining muscle mass.


    The same factors that contribute to muscle mass loss also contribute to reduced bone density. If your bones become too porous, you have an increased risk of fracturing a bone at a time when your body’s regenerative and healing abilities are also declining.


    Mood changes, including the emergence of depression and anxiety, can also be exacerbated by low testosterone levels. While the specific connection between low testosterone and depression isn’t fully understood, many patients find their mood improves with testosterone replacement therapy [8].

    Chapter 2 - Biological Effects of Testosterone

    Testosterone is well known as the hormone that drives the development of adult male characteristics and sexual development. However, testosterone, like your other hormones, plays various roles throughout your life. 


    Even before you’re born, testosterone supports your development. The role of testosterone in your prenatal stages depends on how far along you are in gestation. 

    For example, the earliest signs of male characteristics occur between four and six weeks, although dihydrotestosterone plays a more critical role at this stage. At this point, your genitals start to develop, including a phallic urethra, scrotal thinning, and the emergence of a penis. You also begin to form a prostate gland and seminal vesicles. 

    Then during your second trimester of development, testosterone is even more closely aligned with sex formation. Testosterone, along with anti-Müllerian hormone (AMH), triggers the growth of the Wolffian duct and degeneration of the Müllerian duct. 

    The Wolfian duct is a structure that eventually forms the male internal genitalia. The Müllerian ducts, on the other hand, are the structures that start the development of the female reproductive tract. 


    The effects of testosterone and androgens in early infancy aren’t understood completely. We do know that in the first weeks of life after birth, male infants’ testosterone levels increase, but remain in barely detectable prepubescent range for several months. Some theories speculate that masculinization is already occurring at this stage. Still, there isn’t any clinical evidence to support these theories as there are no other changes in other parts of the body. 


    Testosterone continues to rest at barely detectable levels throughout childhood. However, as you approach puberty, your testosterone and androgen levels begin to increase, and you start to show early signs of puberty, including increased body odor, oil and sebum production, acne, and public and underarm hair. Some children also experience a growth spurt right before puberty, which is triggered by hormonal changes, including the beginning of the increase of testosterone. 


    As you reach puberty, your testosterone levels are higher than ever before and have been elevated for months or even years. At this point in your development, testosterone works with other hormones, such as the human growth hormone, to trigger:

    • Development of spermatogenic tissue in your testicles
    • Penis enlargement
    • Libido emergence

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    You also begin to develop male facial characteristics, including the growth of your jaw, brow, chin, and nose. As you progress through puberty, you reach your full height, and your bones mature. You start to develop enhanced muscle mass and strength. Your shoulders get broader, and your ribcage expands. 

    Your Adam’s apple enlarges, and your voice deepens. Your sebaceous glands continue to grow, which can lead to acne, and your face becomes more angular as you lose your subcutaneous “baby” fat. Your public, body, and underarm hair becomes thicker and spreads across your body. 


    As an adult male, testosterone activates genes in your Sertoli cells, which are responsible for the differentiation of spermatogonia and normal sperm development. It also supports platelet aggregation, which helps your blood clot appropriately.

    Testosterone also regulates your hypothalamic-pituitary-adrenal (HPT) axis, which controls your central stress response system. These glands work together to produce the hormones that fuel your fight-or-flight response and help you respond to the challenges of life.

    Testosterone also drives your libido and sexual arousal. Your testosterone levels also spike during sexual arousal.

    While there is a decrease in testosterone production as you age, the drop off in testosterone and the increase in disruptive symptoms that many men experience is due to environmental factors and endocrine system issues. We cover this in more detail in chapters 3 and 10.

    Chapter 3 - Hypogonadism

    Hypogonadism is the clinical term for low testosterone [9]. You might also hear it called low T or testosterone deficiency. Clinically, an adult man should have testosterone levels of 240-950 ng/dl [10]. This is a vast range for adult men of all ages. Men who experience symptoms of hypogonadism often have testosterone levels within this range, and their concerns are often dismissed. That doesn’t happen here. But let’s explore hypogonadism in more detail. After all, the more you know, the better equipped you are to make the best decisions for your health.


    Hypogonadism occurs when your testes don’t produce testosterone the way they should. There are two types of hypogonadism, primary and secondary. 

    Primary hypogonadism occurs when there is a defect or problem with your testes. For example, if you are involved in an accident that causes physical trauma to your testicles, it could interfere with their function. Or, in some cases, you might have a problem with your hypothalamic-pituitary-adrenal (HPA) axis. Increased luteinizing hormone (LH) and/or follicle-stimulating hormones (FSH) are often signs of problems with your HPT axis. 

    Secondary hypogonadism occurs because of defects in your hypothalamus or pituitary gland. These problems are sometimes linked to obesity, diabetes or insulin resistance, or environmental factors. Your LH and FSH levels are typically normal or low, which shows that the problem could be due to your HPA axis or your hypothalamic-pituitary-gonadal (HPG) axis.  Secondary hypogonadism is the most common diagnosis associated with adult men suffering from low T. 


    Secondary hypogonadism is an endocrine disorder. Your endocrine system includes the glands that produce and secrete the hormones that regulate your body function. Secondary hypogonadism is due to dysfunction in other parts of your endocrine system. Primary hypogonadism, on the other hand, is due to a physical issue in the testes that prevents normal testosterone production.


    Hypogonadism causes a variety of disruptive and distressing changes in your body. The effects vary, depending on the age that the condition develops. For example, if you have low testosterone levels before the end of puberty, you could:

    Low testosterone levels before the end of puberty:
    Look younger than your age
    Have small genitalia and testicles
    Lack of facial hair
    Have trouble gaining muscle mass
    Have enlarged breasts (gynecomastia)

    However, if you develop hypogonadism as an adult, you might have symptoms such as:


    Low testosterone levels as an adult:
    Decreased libido
    Low energy and lethargy
    Decreased concentration
    Decreased sperm count
    Erectile dysfunction
    Sleep disturbances
    Weight gain
    Muscle mass and strength loss
    Depression and irritability
    Loss of body and facial hair
    Hot flashes
    Breast enlargement


    Hypogonadism can contribute to erectile dysfunction. However, a wide range of issues ranging from high blood pressure to mental health can affect your erections, so make an appointment to talk to a doctor about your concerns for an accurate diagnosis of the cause of your erectile dysfunction. 


    Primary and secondary hypogonadism have different causes. For example, primary hypogonadism could be caused by cancer treatments like chemotherapy or radiation. Klinefelter’s syndrome, mumps, and trauma to the testes can also cause primary hypogonadism. 

    Secondary hypogonadism has a wide variety of potential causes, including:

    Other factors [11] that can interfere with testosterone production include:


    Andropause describes the natural slowing of testosterone production that occurs with age. Think of it as the male version of menopause. This does happen, but you don’t have to accept the changes in your wellness and lifestyle as inevitable, especially as there are so many factors that can accelerate or exacerbate this process. 

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    A doctor can order the necessary bloodwork to assess your testosterone levels. In addition to evaluating your bound and unbound testosterone, your doctor should also test the levels of all the hormones produced by the HPG, HPA, and APT axes. 

    Your doctor should order multiple blood draws at different times of day, as most men’s testosterone levels peak in the morning. Multiple tests allow your doctor to track your testosterone levels throughout the day, which gives a more accurate representation of your hormone levels.

    You might have seen salivary tests available via the internet. While these tests can provide some information, they’re not extensive or accurate enough to confirm a hypogonadism diagnosis or inform an effective personalized treatment plan.

    In addition to blood work, your physician should review the Androgen Deficiency in the Aging Male questionnaire. It includes questions such as:

    Androgen Deficiency in the Aging Male questionnaire
    Do you have a decrease in sex drive?
    Do you lack energy?
    Have you experienced a decrease in strength or endurance?
    Have you lost height?
    Are you enjoying life less?
    Are you sad and/or grumpy?
    Are your erections less strong or absent?
    Have you had trouble maintaining an erection?
    Do you fall asleep after dinner?
    Has your work performance deteriorated recently?

    Other signs of a testosterone deficiency include losing the ability to interact with or relate to the people around you, not acting lovingly toward your partner, and losing concentration and focus. 

    If your answer is yes to many of these questions, it’s time to talk to a physician about your health and testosterone levels. Many conditions can cause similar symptoms, so it’s critical to start the testing process to find out what is interfering with your health and quality of life. 


    Fortunately, treatment is available for hypogonadism. You might have thought that hormone replacement therapy is just for menopausal women, but hormone therapy has a much broader scope. 

    Testosterone replacement therapy (TRT) is part of an effective treatment plan. It’s available in several forms, including topical gels, transdermal (skin) patches, subdermal pellets, and injections. TRT isn’t usually provided in an oral tablet as this form has a high risk of side effects. 

    TRT delivers the testosterone that your testes are no longer producing and relieves your symptoms. That said, TRT is not a miracle cure. You still need to take care of your health and wellness in other ways, too. 

    TRT doesn’t make up for an unhealthy diet and a sedentary lifestyle. If you want to improve your health and vitality, you have to adjust your diet and exercise habits and make other lifestyle changes.

    We explore how your diet, exercise, and other lifestyle factors affect your testosterone production and overall health in chapters 10-11.


    You might be able to reverse hypogonadism [12], depending on its cause. For example, if you have hypogonadism that’s related to obesity, drug abuse, or illness, you and your doctor might be able to reverse your condition with effective treatment. However, if your hypogonadism is due to congenital, structural, or destructive disorders, the permanent organ damage can’t be reversed.

    Chapter 4 - Testosterone Levels

    If you don’t know what your testosterone levels should be, you’re not alone. Around 36% of Americans have low health literacy [13] that impacts their ability to get the medical care they need and navigate the increasingly complex world of health insurance. In the context of testosterone and endocrine health, this means that the average person doesn’t necessarily know what their testosterone levels — or any other health indicators — should be. All you know is that you feel tired, your sex drive is nonexistent, and your body is getting soft and weak. Even if you get a complete blood panel, including hormone levels, do you know what your numbers mean? Since many physicians brush off the signs of low testosterone as side effects of aging, it’s critical to understand testosterone including what healthy levels are, how they change with age, and how to monitor your testosterone and related hormone levels. Let’s explore testosterone in more detail.


    Let’s preface this by saying that the average shows the central or typical value in a set of data. It doesn’t represent the highs or the lows. And, it’s also important to point out the massive range of numbers that are considered “normal” or average for each age range. Also, to preface this table, ng/dL stands for nanograms per deciliter. A nanogram is one-billionth of  a gram. A deciliter is one-tenth of a liter. Average total testosterone for males [14]
    Age ng/dL
    7 months to 9 years Less than 30 ng/dL
    10-13 years 1-619 ng/dL
    14-15 years 100-540 ng/dL
    16-19 years 200-970 ng/dL
    20-39 years 270-1,080 ng/dL
    40-59 years 350-890 ng/dL
    60+ years 350-720 ng/dL
    Your total testosterone includes your bound and free or unbound testosterone. Around 98% of your testosterone should be bound to either sex hormone-binding globulin (SHBG) or albumin [15]. The remaining testosterone is unbound or free to perform the other essential roles of testosterone, such as regulating your metabolism, sex drive, triggering body hair growth, and increasing your muscle mass. Many men experience symptoms of low T, even though their total testosterone is within the “normal” range because they have low levels of unbound testosterone. If you have insufficient unbound testosterone, your body can’t function normally. Considering this, let’s review the average ranges of free testosterone. The measurements for unbound testosterone are pg/mL or picograms per milliliter. A picogram is one-millionth of a gram, and a milliliter is one-thousandth of a liter. Free testosterone levels [16]
    Age pg/mL
    20-29 years 9.3-26.5 pg/mL
    30-39 years 8.7/25.1 pg/mL
    40-49 years 6.8-21.5 pg/mL
    50-59 years 7.2-24.0 pg/mL

    Again, despite the microscopic levels of hormones being studied, these are massive ranges for large age groups. 


    As you age, your body’s ability to produce new cells slows down. This includes everything from your skin, hair, and nails to your hormones. Some studies show that from the age of 30, men’s testosterone production decreases by 1% each year [17]. This decline is more gradual than the sudden drop in estrogen production that women experience as they approach and reach menopause, but that doesn’t make it any less disruptive or distressing. Your symptoms might just emerge more slowly.

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    However, factors that are a prevalent part of modern life also affect your testosterone production. For example, obesity has a significant effect on your overall endocrine function. According to the CDC, over 42% of American adults are obese [18], so it’s no surprise that issues like low testosterone, diabetes, and thyroid dysfunction are on the rise. Other factors that interfere with testosterone production [19] include:

    Dysfunction elsewhere in your endocrine system, including your hypothalamus, pituitary gland, adrenal glands, pancreas, and thyroid, can also impact your testosterone production and function. 

    Medications like opioids, steroids like prednisone, and hormonal treatments for prostate cancer can also lower testosterone production. Chemotherapy and radiation can impact your testosterone production, as can health conditions like HIV/AIDS, renal failure, and inflammatory conditions.


    As mentioned in Chapter 3, you can order saliva tests online, but we don’t recommend this as the results aren’t accurate or reliable. The best way to check your testosterone level is to have a doctor order a comprehensive blood panel. If you’re under the age of 30 and experiencing low T symptoms, you should have tests every year. If you’re older than 30, you might need more frequent tests. In addition to testing your testosterone levels, your physician should also order a series of standard anti-aging tests [20] including your:

    The most crucial step in monitoring your testosterone levels and getting personalized treatment is to find a physician who takes your symptoms and health seriously. Your symptoms should be the key indicator in when and how to measure your testosterone and start a testosterone replacement treatment program. 

    Chapter 5 - Effects of Low Testosterone

    We’ve covered the effects of low testosterone in previous chapters, but let’s take a deep dive into some of the most common effects of low testosterone.

    It’s important to remember that your body is complex and many hormones and tissues work together to regulate your body functionality. Often, the relationship between low testosterone and common symptoms isn’t fully understood.


    Around the time you reach puberty, you begin to experience sexual desire. It’s normal and healthy to think about sex and feel desire for another person.

    While men aren’t the sex-mad neanderthals modern media makes them out to be, sexual desire and activity is a critical part of your health and wellness.

    That being said, there’s no correct level of sexual desire that you should have. While it’s a myth that men think about sex every seven seconds[21], men (and women) do think about sex, have desire, masturbate, and seek out sexual contact. Your sex drive typically peaks in your late teens or early 20s, when your testosterone levels are usually at their highest. Then your libido gradually declines with age. In addition to driving your libido, testosterone also helps regulate your mood and energy levels. Testosterone also contributes to your metabolism, body fat, and muscle mass. The function of your testes also affects how other critical glands in your endocrine system function — for example, your adrenal glands, which help you manage stress.

    Sexual desire is a complicated process. While your testosterone drives it, your libido might lower during times of stress, fatigue, illness, or even if you don’t feel comfortable in your body.


    Let’s preface this section by saying that low testosterone isn’t the only cause of erectile dysfunction. If you are having problems achieving or maintaining an erection, talk to your doctor. Get your blood pressure checked. Check your cardiovascular health and cholesterol levels. Have a diabetes screening. Also, have your hormones tested. While the link between testosterone and erectile function isn’t fully understood — some men with low T have healthy erectile function — there is a link between low T and other conditions that can affect your erectile function, including obesity, Type 2 diabetes, and heart disease [22].


    Around 50 million American men have male pattern baldness [23], also known as androgenic alopecia. The condition develops as your hair follicles shrink and eventually become dormant. Your genes and hormones are the primary drivers of hair loss. Dihydrotestosterone (DHT) is a hormone that occurs when the 5-alpha reductase enzyme acts on testosterone. Enzymes can only act on free or unbound testosterone, so there is a misconception that elevated testosterone levels lead to baldness. You can have normal total testosterone levels, but higher than average free testosterone.

    However, DHT doesn’t cause baldness on its own. Your genes have to respond to DHT levels with hair follicle sensitivity for hair loss to occur.


    If you’ve had a rough week, you might want to spend your weekend resting and relaxing, but you typically feel refreshed before Sunday night rolls around. However, if you have chronic low energy, where you feel tired all the time, no matter how much you sleep, it could be due to decreasing testosterone levels. Low T causes a wide range of symptoms, including insomnia and decreased motivation, which add up to mental and physical fatigue [24]. It’s also important to note that the glands in your endocrine system all work together to a certain extent. Low testosterone levels could link to thyroid dysfunction, depression, and anemia, which can all contribute to chronic fatigue.

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    Your brain cells include testosterone receptors, and if you don’t have sufficient levels of unbound testosterone, your testosterone receptors remain empty, which can upset the balance of your brain chemistry and cause mental health symptoms ranging from mood swings and irritability to depression and anxiety. While the precise relationship between testosterone, mood, and mental health isn’t completely understood, research [25] shows a significant correlation between low testosterone and depression. Also, the other symptoms of low T are often distressing and can contribute to a depressed mood.


    One of the critical functions of testosterone is to maintain muscle mass and bone density. Studies also indicate that testosterone could limit fat gain [1].

    The relationship between testosterone and your body composition is multi-directional. Consider these details:

    This creates a dangerous cycle [27]. If you develop low T and lose muscle mass, your daily caloric needs decrease, but chances are you’re also fatigued, so you keep eating the same way you always did or even increase what you eat to try to boost your energy — we’re looking at you, 3 pm snack break. But your body doesn’t need these extra calories, so you gain fat. Which interferes with your testosterone production, and so continues the cycle.


    Low testosterone levels are one of the most common causes of osteoporosis [28] in men. Currently, around 2 million American men have osteoporosis, and many more have osteopenia [29] — a less severe degree of bone loss. In men, bone loss is associated with a decrease of estradiol and testosterone [30]. Estradiol is a type of estrogen that emerges when unbound testosterone breaks down into DHT. As a result, when your total testosterone levels decrease, your trabecular bone thins and becomes weak. (In comparison, when women have decreased estrogen, they experience trabecular bone loss.)


    Gynecomastia, sometimes called “man boobs,” is the development of breast tissue in men. While all men produce small amounts of estrogen, when your ratio of testosterone to estrogen is unbalanced, you can develop breast tissue [31]. For example, when boys reach puberty and their hormones change and fluctuate rapidly, gynecomastia can develop. In adult men, gynecomastia is due to low T. While gynecomastia isn’t dangerous, it can cause sore or tender breasts and emotional distress.


    The relationship between testosterone and quality sleep is complicated. Your body replenishes its testosterone levels while you sleep — during your REM sleep in particular [32]. Studies show that insufficient quality sleep reduces your testosterone levels [33]. Additionally, low testosterone is linked to sleep apnea and other sleep-disordered breathing, which disrupts your quality and quantity of sleep and interferes with testosterone production. So, if you have low T, you have an increased chance of a sleep disorder, which can lead to lowered testosterone levels.


    The size of testicles varies between men. Instead of comparing your testicles to other men, you should pay attention to any changes in your own testicles. Low testosterone can lead to a reduction in the size of your testicles. Although, not all men with low T experience testicular shrinkage. At the same time, if another condition like testicular cancer, varicocele, or testicular torsion reduces the size of your testicles that affects your Leydig cells, your testosterone production can decrease [34].


    It’s common for men with low testosterone also to have anemia — low levels of hemoglobin in their blood. Research shows that when men with testosterone deficiency and idiopathic anemia have testosterone replacement therapy, their hemoglobin levels increase [35][36].

    Chapter 6 - Benefits of Testosterone Therapy on Your Body

    Now that we’ve explored how low testosterone can affect your health and well-being let’s take a look at how testosterone therapy can potentially benefit your body function and overall wellness. 


    While early studies indicated a positive correlation between testosterone therapy, memory, and cognitive function, more recent studies published in the Journal of the American Medical Association [37] show that testosterone treatment doesn’t improve:
    However, other studies [38] seem to show that low testosterone levels can increase your risk of developing Alzheimer’s disease. New research is being done on the role of testosterone all the time. In the meantime, take care of your brain and body health with a nutritious diet, regular exercise, and intellectually stimulating activities.


    As mentioned in Chapter 5, testosterone helps maintain healthy brain chemistry. When you have low levels of unbound testosterone, you are more likely to experience depression, anxiety, mood swings, and irritability. Additionally, depression is notoriously difficult to treat. Around a third of adults with depression have treatment-resistant depression [39], which means that they don’t get better with traditional treatments like antidepressant medicine. Medical researchers are studying the potential to treat depression with testosterone therapy. However, different studies have different results. Some show that testosterone is a factor in some men, others show no link between testosterone levels and depression, while others show that testosterone therapy boosts serotonin production in rodents. At the moment, medical professionals do not recommend treating depression with testosterone as the current evidence is inconclusive. However, watch this space. There is a chance that some men with depression might benefit from testosterone therapy, and more research is needed.


    Studies [40] show that dopamine and testosterone influence sexual function. Additionally, during research, scientists found that dopamine and testosterone influence each other. Their work on rats indicates that low testosterone or low dopamine can reduce sexual function and libido and that both need to be present to stimulate any type of motivation.

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    Your body’s endocrine system is precisely balanced, and low testosterone affects your insulin levels, which helps your body convert glucose into energy and regulate the storage of energy as fat. However, this relationship is cyclical. While low testosterone can affect how your body produces and stores fat, obesity also reduces your testosterone production. If you have low T, testosterone therapy can restore your ability to build and maintain muscle mass by supporting protein synthesis [41]. Testosterone therapy can also help you lose fat and increase muscle mass, which increases your overall caloric burn. But testosterone has to be part of a total wellness plan, including changes to your diet and exercise habits. Testosterone therapy supplements healthy choices — it doesn’t replace them. But more on this in Chapters 10-11.


    Testosterone therapy keeps your hormone levels balanced so you don’t experience thinning bones that can contribute to osteoporosis. Additionally, resistance training is an important part of a testosterone treatment plan. It not only boosts your body’s testosterone production but also helps keep your bones strong and healthy. 


    Like many aspects of testosterone therapy, there are several opinions on whether or not testosterone therapy is beneficial for your cardiovascular health. Depending on the study you review, testosterone therapy can reduce your risk of cardiovascular health problems [42], or it could increase your risk [43]. Not all studies are created equal. Some research included participants who were morbidly obese and had elevated blood pressure, and testosterone therapy — despite its many benefits — can’t undo a lifetime of bad decisions. However, when testosterone replacement therapy is appropriate and combined with lifestyle changes to improve not only your testosterone production but also your overall health, you should see improvements in your cardiovascular health.


    Inflammation is another health and wellness buzzword these days, but just because it’s trending on social media doesn’t mean it’s nonsense. Inflammation is your body’s way of fighting against perceived threats, like infections, toxins, and injuries. However, chronic inflammation is becoming a prevalent wellness issue [44]. Modern life exposes us to toxic materials in the air we breathe, the food we eat, and the substances we use to clean our bodies, clothes, and homes. The standard American diet [45] is woefully nutritionally deficient but rich in preservatives, salt, fat, sugar, and other substances that are toxic and damaging to our bodies. As a result, we’re getting fatter, more lethargic, and sicklier. Inflammation disrupts your hormone production, and as mentioned in previous sections, when one part of your endocrine system becomes dysfunctional, the effects cascade through your body, often creating cycles of poor health and causing even more inflammation throughout your body. Testosterone therapy, when combined with the healthy choices needed to optimize your health and body function, can help reduce inflammation throughout your body [46]. We’ve said it a few times now, but testosterone therapy is not a panacea for all that ails you. But it can help as part of a comprehensive treatment plan.

    Chapter 7 - Monitoring Your Health with Testosterone Therapy

    Every medical treatment has some potential side effects, even the over-the-counter medicines you have in your home, like ibuprofen and antihistamines. 

    Testosterone replacement therapy (TRT) is no different. However, you have close supervision from a physician while you have TRT. Many of the reported side effects and problems that you hear about are due to people taking unregulated, unsupervised testosterone from “some guy at the gym” or buying it from an unprofessional, nonmedical online source.

    Some of the more serious TRT-related concerns that have come up over the years include prostate health, liver function, blood pressure, and cholesterol. Let’s take a closer look at these potential risks.  


    The relationship between testosterone and prostate health is complicated. In the 1940s, scientists discovered that prostate cancer stopped growing when a patient’s testosterone levels decreased. Also during this study, the researchers found that giving prostate cancer patients testosterone made their cancer grow. These results led to the belief that testosterone promoted prostate cancer [47]. Additionally, hormone therapy, one of the most common treatments for prostate cancer, slows tumor growth by lowering testosterone levels. However, more recent studies [48] show that there’s no link between testosterone and prostate cancer. Other studies [49] revealed that testosterone doesn’t even increase prostate-specific antigen (PSA) levels. PSA is a protein that’s found in larger amounts in the bloodstream of men who have prostate cancer. That said, if you have a family history of prostate cancer or have had it yourself, make sure to let your physician know when you have your consultation and testing to determine if TRT is right for you.


    Some over-the-counter and unregulated supplements that claim to boost your testosterone  or growth hormone levels can interfere with your liver function and cause elevated liver enzyme levels. Additionally, they actually don’t work — so don’t waste your money or risk your health [50]. However, when you work with a physician and have a personalized TRT program, there is no risk to your liver function. If you have hepatitis, you should make sure your prescribing physician knows about your condition. Your overall health, hormone levels, and other body function indicators need to be monitored closely, especially in the early days of your TRT program. Ensuring your doctor knows everything about your health allows them to understand your needs in greater detail and know what to look for as they evaluate your response to treatment.

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    Some men can develop high blood pressure while they have TRT. When you have higher levels of unbound testosterone, your estradiol levels also increase. Estradiol can cause water retention, which increases your blood pressure. 

    If you have high blood pressure, you should get it under control before starting TRT. Many patients can lower their blood pressure by cutting salt, sugar, and fat from their diets, getting more exercise, and reducing their stress levels. In some cases, you might need prescription medicine to lower and regulate your blood pressure. 

    You should also monitor your blood pressure regularly while you have TRT. You can pick up a reliable at-home blood pressure monitor for around $50. If you notice an upward trend, talk to your doctor.


    There’s a significant amount of disagreement in the medical community about the effects of TRT on your cholesterol levels and heart health. Over the years, different studies have provided mixed results [51]. For example, some studies show that testosterone lowers your low-density lipoprotein (LDL) and your high-density lipoprotein cholesterol. Other studies have found that TRT doesn’t affect your cholesterol at all, including your triglycerides. As with all potential health risks, make sure your physician knows your personal and family medical history. This information lets them know they should monitor certain aspects of your health more closely.

    Chapter 8 - Testosterone and Dysfunction

    While testosterone might be primarily viewed as a sex hormone, it’s a critical component of your overall endocrine system function and body function. The hormones in your body work together to stimulate and control every aspect of your body function. When you have low testosterone, it can have a severe impact on other aspects of your well-being. 


    Your thyroid is regulated by the thyroid-stimulating hormones (TSH) produced by your pituitary gland. This small butterfly-shaped gland at the front of your neck produces triiodothyronine (T3) and thyroxine (T4), which contribute to hormone balance, metabolism, and protein synthesis. Your thyroid hormones and testosterone are responsible for several of the same bodily functions. Given the precise hormonal balance necessary for optimal body function, it shouldn’t be a surprise that if you have abnormal testosterone or thyroid hormone levels that the other would be affected [52]. For example, if you have hypothyroidism, it can lead to decreased unbound testosterone levels [53]. An example of how this relationship works in practice is protein synthesis. Protein synthesis is the process for building muscles. Your thyroid hormones drive this process, but they need help from testosterone and growth hormones. Testosterone and thyroid hormones also work together to regulate your metabolism. Your metabolism includes the chemical changes your body needs to obtain energy and make the compounds your cells need. For example, testosterone drives the conversion of fat to muscle tissue, which is a metabolic process. Your body needs testosterone to kick start that metabolic process that your thyroid hormones regulate. Without the testosterone jump-start, your thyroid hormones can’t do their job.


    Your pituitary gland secretes the luteinizing hormone (LH) and follicle-stimulating hormone (FSH) that tell your testes to produce testosterone. If you have a pituitary tumor or disease, the gland doesn’t provide the right amounts of LH and FSH needed to trigger testosterone production. Testosterone, LH, and FSH also have a negative feedback loop. This means that when you have enough unbound testosterone in your blood, it signals to your pituitary gland that it can slow the production of LH and FSH. Now, if you have primary hypogonadism (low testosterone due to a problem with the testes), you don’t have enough unbound testosterone to tell your pituitary gland to stop producing LH and FSH. This can lead to further hormone imbalances as other endocrine glands are affected [54].


    Your endothelial layer is the inner lining of your arteries that regulates the flow of your blood to your tissues. It controls the dilation and constriction of your blood vessels, which determines how much blood moves into the various tissues of your body. It also protects your body from toxins and controls the movement of fluid, electrolytes, and other substances between your blood and your body tissues. While the relationship isn’t fully understood, a testosterone deficiency has a negative impact on the availability of nitric oxide in the blood vessel walls [55]. If your blood vessels don’t effectively deliver oxygen and other nutrients to your muscles, organs, and other body tissues, you have an increased risk of cardiovascular disease as well as atrophy and dysfunction in the rest of your body [56].

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    Low testosterone is one of several factors that contribute to erectile dysfunction. However, it’s rarely low testosterone on its own that inhibits your ability to achieve or maintain an erection. In most cases, low testosterone contributes to issues like diabetes, high blood pressure, and atherosclerosis, which interfere with the blood flow to your penis [57].

    Chapter 9 - Testosterone Replacement Therapy (TRT)

    Hormone replacement therapy (HRT) is most often thought of as a treatment for menopause and perimenopause. While this is a valuable therapy that helps many people, HRT has much broader applications.


    HRT is available for several of the hormones your body needs to function correctly. In addition to testosterone therapy, doctors prescribe estrogen for women, thyroid hormones for men and women who have thyroid deficiencies, as well as HRT for pituitary [58], parathyroid [59],  adrenal [60] disorders. TRT is available in many injectable and non-injectable forms.


    Depending on who you talk to, you’ll find different opinions on TRT creams and gels. Some say that creams and gels are easy to use and an excellent way to increase the testosterone in your body with few side effects. Supporters also say that creams and gels provide testosterone peaks and troughs that mimic your natural hormonal fluctuations.

    Others say that the absorption rate is difficult to control. Not only is it a nuisance to have to apply the solutions throughout the day, but you can’t sweat, swim, or bathe for hours after you apply your treatment. Also, all gels and creams are not created equal. Not only does the percentage of testosterone in different products vary, but the other components in the cream or gel can increase or inhibit effective absorption.


    Dermal patches are another popular transdermal TRT option. You wear a patch for 24 hours and then replace it.

    You need to rotate your patch locations, and some men develop skin irritation from the adhesive in the patches. While you can exercise and shower with the patch, you need to wait for at least three hours after you apply it, and there’s always a risk that the sweat or water will reduce the stickiness of the patch.

    Nasal spray

    The FDA has recently approved a testosterone nasal spray. While the treatment effectively increases testosterone levels, many uses report uncomfortable side effects like nosebleeds, headaches, sore throats, and sinus pain and congestion.

    Buccal preparations

    You tuck a tablet between your gum and cheek, where it’s absorbed into your bloodstream. Unfortunately, this is proving to be an inefficient delivery method. The tablets offer poor bioavailability of testosterone and are often dislodged. Some users also report side effects like sores, ulcers, and bleeding gums. 


    Many men like taking testosterone tablets orally. The formulations currently available are absorbed by your lymphatic system, which bypasses your liver. There are few side effects, and physicians report increased compliance.

    Subdermal pellets

    Subdermal pellets are a popular method of TRT and other HRT products. Your physician makes a small incision in your skin, usually on your hip or upper buttock, and inserts the pellet. Many men have a positive experience with subdermal testosterone pellets.

    However, if the dose isn’t quite right, your physician has to make another incision in your body to remove and replace your pellet, which is time-consuming for you. Additionally, the more incisions you have in your body, the higher your risk of infection.


    While many people balk at the idea of giving themselves a shot every day, injectable TRT is proving to be the most reliable, effective, and customizable method of delivery. There are four main types of injectable testosterone available today: 

    Each of these types of injectable testosterone has different absorption rates. Per 100 mg, testosterone propionate has the highest absorption rate of 83 mg. Testosterone ethanate has the next highest absorption rate at 72 mg, followed closely by testosterone cypionate at 70 mg. Testosterone undecanoate has the lowest absorption rate, with 63mg per 100 mg [61].
    The absorption rate of your TRT isn’t the only detail to consider or study while researching your TRT options. TRT is not without side effects. Remember, unbound testosterone eventually converts into estradiol, a type of estrogen that can cause gynecomastia and other unwanted side effects.

    Your physician should order blood tests before starting your TRT and throughout your treatment to make sure that your dose is and remains appropriate for your needs. Depending on your specific needs, you might need a small daily injection or a larger weekly injection, or anything in between. When it comes to TRT, there’s no single approach that works best for everyone — it’s a highly individualized treatment.

    Safe injection protocol

    If you and your physician move forward with injectable TRT, you need to learn how to draw your dose and inject yourself safely. Your physician gives you instructions, and honestly, it gets easier with practice.

    You might need to use different gauged (sized) needles to draw your TRT into the syringe and to inject it into your body. Some find it easier to draw with a larger gauge and then switch to a thinner needle to insert into your body.

    It’s safest and most comfortable to inject muscle tissue. Depending on your preference, you can inject your buttocks, quadriceps, or deltoids. You can rotate your injection sites to minimize the risk of scar tissue formation. We also recommend foam rolling after injecting your TRT. It helps reduce the risk of scar tissue and can help move the TRT into your body.

    You should use clean needles every time. The safest way to dispose of them is to purchase a Sharps Container Biohazard Needle Disposal container. And of course, keep your needles and TRT out of the reach of children.

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    Common TRT mistakes

    TRT needs to be precise to deliver the results you want, and there are a few common mistakes that can harm your experience [62]. You need to take the right dose, in the right form for your needs and lifestyle. You need to use TRT consistently. Follow your physician’s instructions on taking your TRT, whether you’re injecting it or using another option. Some men think they can cycle on and off TRT, but this is a mistake. TRT is a lifetime commitment to your health and vitality. Cycling causes abnormal hormonal fluctuations that can not only cause distressing symptoms but filters to the rest of your endocrine system, causing widespread hormonal problems. You also need to commit to a healthy lifestyle. If you carry on drinking, using tobacco, skipping the gym, and choosing unhealthy foods, TRT isn’t going to give you the results you want. TRT is part of an overall wellness plan to enhance your health — it’s not a magic treatment to make you feel incredible while you continue to make unhealthy lifestyle choices. And finally, it’s common not to monitor your estrogen levels or take steps to manage any potential side effects. Working with your trusted physician can help you avoid these mistakes.

    TRT benefits

    TRT can have a significant impact on your health and wellness. Your energy level — and your sex drive — increase and you feel more like yourself. Overall, you feel less moody and irritable, and your motivation is through the roof. You start to see a difference in your body, and you no longer feel like you’re just wasting time at the gym. You’re losing fat, and you can finally see definition in your muscles again. In addition to the changes you can feel, your LDL (the bad) cholesterol is decreasing, and other heart disease indicators are reducing or disappearing. Your glucose levels are under control, and your PSA levels are well within the healthy range [63].

    TRT side effects

    When incorrectly prescribed and unmonitored, TRT can cause some unwanted side effects. Some men develop acne on their backs or chest. Additionally, if your TRT increases your DHT levels, it can accelerate male pattern baldness. TRT can also increase your estrogen levels, leading to issues like gynecomastia. Fortunately, when you work with a reputable physician, they monitor how your body responds to TRT and how it affects your other hormones. They can adjust your prescription and recommend other treatments to manage side effects like selective estrogen receptor modulators (SERM) and aromatase inhibitors [64].

    Chapter 10 - Optimizing Testosterone Naturally

    Your lifestyle has a significant effect on your hormone levels and overall health. Understanding your body’s needs and how your choices affect your health gives you the information you need to make the best decisions about what to eat and do.


    Making sure that you have a healthy and balanced diet can help you provide your body with what it needs for optimal hormone production and use. Your body needs several vitamins and minerals, including vitamin D, zinc, and magnesium, to produce testosterone. Over 41% of American adults have a vitamin D deficiency [65], which causes a variety of health problems, including contributing to low testosterone production.
    When it comes to vegetables, leafy greens like spinach, kale, and swiss chard are a great source of magnesium. Zinc is neither fat nor water-soluble, so how you prepare your greens doesn’t affect how well your body absorbs what you need. However, leafy greens are also rich in vitamins A and K, which are fat-soluble. Cooking them with a small amount of oil or putting a tablespoon of dressing on a salad can help your body absorb the other vitamins [66]. Cruciferous vegetables like broccoli, cauliflower, brussels sprouts, and cabbage are also good for your testosterone levels. Cruciferous vegetables help your body remove extra estrogen, which can boost your testosterone levels. You can prepare your vegetables by sauteing, roasting, or steaming. Boiling or slow-cooking them can reduce their nutrient content [67].

    Citrus fruits like lemons and oranges lower your cortisol levels, which supports healthy testosterone production. Bananas are also a great fruit to support healthy testosterone production. They contain bromelain, an enzyme that promotes healthy testosterone levels. 


    Garlic, ginger, and honey include testosterone boosting properties. Garlic is rich in allicin, a compound that lowers your cortisol and your physiological stress response. As a result, your adrenal gland can produce testosterone correctly. Ginger also reduces inflammation in your body, which supports healthy endocrine system function. Honey includes boron, a mineral that promotes testosterone production as well as healthy bones and muscle growth.


    When it comes to oils, stick to high-quality extra virgin olive oil and the omega-3s found in fish and nuts. Make sure to consume these products moderately.


    Seafood is an excellent source of vitamin D, zinc, and omega-3s. Oily fish like tuna, salmon, sardines, and mackerel are excellent options, although you shouldn’t have more than three servings in a week as fish is also high in mercury. Shellfish and oysters are also excellent sources of zinc. 


    Beef products are an excellent source of the nutrients your body uses for testosterone production. For example, beef liver provides vitamin D, ground beef and chuck roast have zinc. You should always choose the leanest cuts of meat from organic, hormone-free sources.


    Brazil nuts are an excellent source of selenium, zinc, and natural cholesterol, which help your body produce testosterone. These delicious nuts are also rich in antioxidants, which help your body flush out toxic substances that can affect your hormone health. You only need two brazil nuts each day and should eat them raw for maximum nutrient absorption.


    Porridge oats are rich in B vitamins, including B6, which suppresses estrogen production, which increases your testosterone. They’re also an excellent supply of energy and a great breakfast option. You can add chopped brazil nuts, almonds, or bananas for extra testosterone-boosting nutrients. 


    You should also make sure to drink low-fat milk or fortified nut mylk products. Both are an excellent source of vitamin D. Eggs are a complete protein and another excellent source of vitamin D. Additionally, white, kidney, and black beans provide vitamin D and Zinc and as well as an alternative source of protein.


    Many of the foods that you should avoid to maintain healthy testosterone levels, like vegetable oils and refined carbohydrates, don’t directly affect your testosterone levels. However, these products often contribute to obesity, which can interfere with your hormone production, including testosterone. 

    You might also have heard that soy-based products like edamame, soymylk, and yogurt, and meat-replacement products decrease testosterone. Studies show that overconsumption of these products can increase your estrogen levels and lead to estrogen dominance. You don’t have to give up soy, but you should limit your consumption. 

    Re-energize your life!


    In addition to the food you choose to eat, other aspects of your lifestyle, including your exercise habits, sleep, and stress levels also contribute to optimal testosterone production and your overall health. 


    Studies show that getting daily exercise, including resistance training, can help increase your testosterone levels. Weight lifting can increase both your short and long-term testosterone production. Additionally, regular exercise can help you lose weight, which in turn regulates your testosterone production as well as your overall endocrine activity.

    Finding a physical activity that you enjoy and want to do regularly is critical. Any exercise, whether it’s high-intensity interval training, hiking, weight lifting, or functional training, can improve your health and testosterone production. While a combination of resistance training and cardio is ideal, the routine of daily exercise is essential.


    Getting enough high-quality sleep is important to maintaining healthy testosterone levels. Everyone has different needs, but in general, you should aim for 7-10 hours each night. Your body replenishes itself while you sleep, including your testosterone levels. This process mostly occurs during your REM sleep cycles [68]. Studies show that men who sleep four hours a night are more likely to have deficient levels of testosterone [69]. Research also indicates that getting five hours of sleep each night can reduce your testosterone levels by 15% [70]. However, for every extra hour of quality sleep, your testosterone can increase by 15% [71].


    Research shows that obese men have up to 50% less testosterone [72] than men who are within a healthy body weight range. The combination of following a healthy diet and getting daily physical activity provides multiple benefits. For example, these lifestyle choices not only help you lose weight but also regulates your insulin production and use as well as your testosterone levels.


    Long-term elevated stress levels lead to increased cortisol production, which can cause a variety of health problems including weight gain, increased caloric intake, and fat storage. Additionally, continuously elevated cortisol also interferes with testosterone production. 

    Finding a stress management activity that works for you can help your body optimize your testosterone production and enhance your overall health. Whether you unwind with exercise, meditation, or another enjoyable activity, taking time to destress is essential to your testosterone levels and your health. 


    One of the best ways to get vitamin D, which your body needs for testosterone production, is to spend 15 minutes in the sun. Your skin produces vitamin D but needs sunlight to trigger the synthesis. You could also take a vitamin D supplement, but getting outside is also a great way to add some physical activity to your day and improve your physical and mental health. 


    You should talk to your doctor before taking any supplements. Your doctor might recommend taking vitamin D, magnesium, and zinc [73]. Some men might benefit from taking dehydroepiandrosterone (DHEA). Your doctor might also recommend other natural supplements [74] such as:
    If you’re at all concerned about low testosterone and its effect on your health and quality of life, start the process at HRT Wellness by completing the initial questionnaire to identify the signs of low testosterone and get the personalized treatment you need to thrive.


    13.  https://www.chcs.org/resource/health-literacy-fact-sheets/

    14.  Testosterone: A Man’s Guide, Second Edition, Nelson Vergel, BsChe, MBA, 2011

    15.  https://gainswave.com/blog/total-testosterone-vs-free-testosterone/

    16.  Testosterone: A Man’s Guide, Second Edition, Nelson Vergel, BsChe, MBA, 2011

    17.  https://medcraveonline.com/EMIJ/EMIJ-03-00065.php

    18.  https://www.cdc.gov/obesity/data/adult.html

    19.  https://my.clevelandclinic.org/health/diseases/15603-low-testosterone-male-hypogonadism

    20.  The Testosterone Optimization Bible, Jay Campbell, 2018


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