Introduction

Testosterone therapy, broadly referred to as Testosterone Replacement Therapy (TRT), increased approximately 27% from 2008 to 2022 with up to approximately 3% of all US adults having a prescription.

When a diagnosed need exists, testosterone therapy can help return sexual function, mood and energy, bones and muscles, and body composition back to normal. However, optimizing lifestyle factors, particularly, sleep, stress, nutrition, and resistance training, could also keep testosterone production normal, eliminating the need for such treatment.

Other factors can also contribute to a provider’s decision to prescribe testosterone. For example, androgen receptor density increases when testosterone levels are low, which can at least partially mitigate low testosterone symptoms. Additionally, evaluating bioavailable testosterone levels and symptoms, rather than relying solely on total testosterone, is often essential for accurate diagnosis and appropriate treatment decisions.

Lifestyle Optimization: The First Line

Chronic sleep deprivation significantly lowers testosterone secretion. Sufficient protein, healthy fats, and micronutrients like vitamin D and zinc support endogenous hormone synthesis, while an anti-inflammatory diet fosters overall endocrine health. Additionally, regular resistance training stimulates testosterone release and improves long-term hormonal balance and physical composition. And chronic stress raises cortisol, which suppresses testosterone.

Clinical Testing and Interpretation

Accurate measurement of testosterone begins with timing. Levels peak in the early morning typically between 7 and 10 a.m. Reference ranges vary, but generally span from 300–1,000 ng/dL in men and 15–70 ng/dL in women. However, because total testosterone includes the non-active, sex hormone binding globulin (SHBG) bound fractions, determining free or bioavailable testosterone may be insightful, especially when SHBG-bound testosterone is abnormal.

Benefits

When medically indicated and closely supervised, testosterone therapy enables individuals with low levels to regain diminished functions such as sexual desire and performance and body composition through greater muscle mass and reduced fat in response to resistance training. Improved mood, energy, bone density, can also result. In women with hypoactive sexual desire disorder, therapy may likewise improve sexual health.

Side Effects

Testosterone therapy comes with well-documented side effects, most notably testicular atrophy in men. This suppression reduces spermatogenesis, often resulting in reduced fertility, which may be reversible but remains a serious consideration for those wanting children. Other risks include acceleration of pre-existing prostate cancer, exacerbation of sleep apnea, gynecomastia (enlargement of male breast tissue), and changes in mood or behavior. Particularly in men, testosterone therapy can increase blood thickness (increased hematocrit/red blood cells) which increases the risk of blood clots. Therefore, regular monitoring is warranted.

In women, excessive testosterone can cause masculinizing changes such as acne, a deepening of the voice, and increased growth of coarse body or facial hair.

Conclusion

In cases of testosterone insufficiency, prescribed testosterone can restore vitality, sexual health, and metabolic balance. After confirming low assessed testosterone levels, free and bioavailable fractions should be evaluated along with symptoms before prescribing. More importantly, lifestyle factors should be optimized. This includes getting sufficient sound sleep, minimizing chronic stress, engaging in adequate resistance training, and consuming a healthy diet, with adequate protein, healthy fats, and whole, antioxidant-rich, plant-based foods. Consulting a registered dietitian, experienced in sports and hormone-related nutrition, can be vital in supporting healthy testosterone levels.

About the Author

Patrick Traynor, PhD, MPH, RD, CPT, is a registered dietitian and founder of MNT Scientific, LLC, an insurance-based nutrition practice serving South Lake Tahoe, CA; Minden, NV; and Ashland, OR. He holds the Interdisciplinary Specialist Certification in Obesity and Weight Management from the Commission on Dietetic Registration. Virtual appointments are also available via telehealth. To request a consultation, visit MNTScientific.com. For inquiries, email patricktraynor@patricktraynor.com.