Lifestyle Changes To Keep Testosterone Healthy
In this article we're continuing our discussion about optimizing testosterone, but now we're looking at it through the lens of lifestyle.
FAIR WARNING: This is definitely a longer read...but in my opinion, has some very actionable and helpful information.
While we don't have much control over our genetics, trauma, tumors, or toxicity, the one place we have the most control over is our lifestyle. (If this statement seems completely random, consider reading the previous article in the series).
In fact, for the majority of men with lower than average testosterone levels, simple changes to sleep, stress, nutrition, exercise, alcohol use, and sexual habits can have major influences on your testosterone levels. This in turn influences all the reasons a man would want to boost his testosterone in the first place:
Increased energy
Fat loss
Muscle gain
Improved cognitive function, focus and productivity
Increased libido and strength of erection
Increased healthspan
Most guys don't think about it, but our day-to day-decision and current habits all affect our testosterone levels.
To demonstrate how this works, I’ll use an example of a client I recently worked with.
We’ll call him Joe.
Joe initially came to me for sexual performance issues, difficulty concentrating at work, and a lack of motivation to exercise.
He’s 46, married with 2 teen-aged children, and runs a successful law practice. Over the past 5 years he’s gained 20 lbs of fat which has settled around his belly and waist, and has noticeably lost muscle mass in his neck, shoulders, chest, arms and thighs.
He goes to the gym sporadically but mostly walks or slow jogs for 20-30 minutes on the treadmill while scrolling through his instagram or answering emails. He drinks 2-3 glasses of wine every night after work for the “health benefits,” and to help him relax and fall asleep.
For the past year he’s been falling asleep easily but wakes up at about 3 am most nights to pee and then sleeps fitfully, if he's actually able to fall asleep.
He feels low energy most of the day and has tried over 10 different nootropics or “brain drugs” to help him focus at work, which sometimes help, but usually make him feel agitated by midday.
He has a prescription for viagra which sits unused on his nightstand because he and his wife haven’t had sex for 2-3 months…he thinks….it’s probably been longer.
Most of you can probably see a few issues here even without some fancy medical degree. For some of you this might even seem a little familiar. I've definitely been in Joe's shoes myself from time to time, so I can surely relate.
Every client without fail knows well before we work together that they need to sleep better, exercise more and start cleaning up their diet. They know it, I know it, and you know it….but the problem is…knowing something and doing something are two very different things.
Youtube fitness gurus and medical doctors alike all say “hey just change your lifestyle to change your health,” but we all know it’s not that easy.
In fact, changing your lifestyle is one of the most challenging things to do. It’s much easier to take a drug or supplement, or undergo a procedure than it is to change how you live each day.
People…all people…completely overestimate their ability to change even one aspect of their lifestyle successfully and to maintain it for just 1 year.
80% of people trying a new diet, weight-loss or fitness program end up abandoning it in less than 30 days!
So, as we explore these various lifestyle factors that can influence your testosterone levels, know that I’m doing it with two intentions.
The first is to encourage you to pursue a healthier lifestyle and adopt behaviors I believe to be helpful for your overall health.
The second thing is that after being a healthcare provider for over 25 years I know that changing your lifestyle and habits can be hard, so take it one step at a time, be strategic, and seek support if you need it...most of us do.
Sleep
Poor sleep causes a hormone that’s responsible for alertness and stress, called cortisol, to build up in your blood. One proposed mechanism for how poor sleep disrupts testosterone production is a mechanism called “cortisol steal” where the building blocks needed to produce testosterone are “stolen away” to create more cortisol by the adrenal glands instead.
Also, the brains of people inadequately rested have higher levels of glutamate, an excitatory brain chemical that turns brain activity on. Glutamate is necessary for everything your brain does but too much can cause big problems.
Excess glutamate can lead to feelings of anxiety and overwhelm, but can also result in migraine headaches and even seizures when the levels climb too high, a process called excitotoxicity.
It can also drive down dopamine levels in the brain leading to a depressed mood and lack of motivation.
I’m sure you can see the cycle here:
Poor sleep reduces mood, drive, and self control.
It’s then harder to do things like exercise.
It’s easy to revert back to comforting habits like alcohol, sugar, cannabis, and long TV viewing, all of which disrupt sleep.
This can cause another night, or multiple nights, of poor sleep.
After just a few days of poor sleep you'll have higher baseline stress, lower emotional resilience, lower drive, poor cognitive performance, decreased mood, and lower testosterone.
So, if you need yet another reason to start improving your sleep, low testosterone can be a pretty good motivator…it has been for me.
Body Mass
This is a classic chicken and egg situation!
The more more testosterone you have, the more lean mass and less body fat you’ll have. This works the other way around too. Low testosterone (hypogonadism) is associated with high body fat and obesity, meaning that when you have high amounts of fat and low amounts of lean muscle on your body, your ability to produce testosterone is negatively affected.
One proposed mechanism for this is that body fat, especially around the organs, called visceral adipose tissue (VAT), secretes chemical messengers called cytokines that inhibit testosterone production and increase estrogen levels in men.
The “man boobs” associated with men who are overfat isn’t just caused by more fatty tissue on their chest. In many cases it’s a condition called gynecomastia (female-like breast development in men) that’s a direct response to low testosterone and higher than normal estrogen levels caused by having too much body fat.
Low testosterone is one of the reasons so many men over 40 who are trying to lose weight get discouraged and fail in their weight-loss efforts.
When testosterone is low, you’re at a hormonal disadvantage. If your testosterone is very low, even if you eat all the right things and work out regularly, progress is so slow that your motivation just falls apart.
This is a situation where working with an androgen specialist (a healthcare provider who specializes in men’s health) could be helpful. With the right guidance you could take certain drugs or supplements to boost your testosterone which could kickstart a healthy hormonal balance naturally.
As your testosterone levels increase, so will your motivation to exercise and eat well. You’ll be more physiologically able to lose body fat and build lean mass which will help increase testosterone production naturally over time.
So when debating between chickens and eggs just skip the debate and make a chicken omelet instead!
Fitness
This naturally brings us to fitness and exercise. It’s already been mentioned above that high body fat and low lean muscle mass actually reduces testosterone and increases estrogen. Exercise plays another key role in testosterone production aside from body composition.
Physical exertion stimulates your body to produce more testosterone and human growth hormone (HGH). When people are sedentary, two things happen. First, their hypothalamus reduces the production of gonadotropin releasing hormone (GnRH) which is required to turn on testosterone production in the testes. Also, a sedentary lifestyle causes insulin resistance meaning the pancreas has to produce more insulin to manage blood sugar.
Middle-aged sedentary men often have high blood glucose PLUS high blood insulin levels!
Insulin, like testosterone, is an anabolic hormone though it’s not often thought of in this way. While testosterone increases bone and muscle growth, insulin’s main anabolic feature is to increase body fat.
When insulin levels increase, then human growth hormone and testosterone production are both suppressed. This is one of the reasons that type-2 diabetics and pre-diabetics often have very low levels of both total and free testosterone. As I mentioned in the previous section, situations like these can create a downward spiral where:
high insulin drives down testosterone and human growth hormone
which results in lower muscle mass and more body fat
which further reduces insulin sensitivity, driving up insulin levels
and driving down testosterone further….
Etc, etc, etc……..
So, one sure-fire way to kickstart testosterone production is to exert yourself through exercise, and improve your fitness.
If you're currently sedentary and don’t know where to start, I'm slowing curating a collection of exercise videos on my youtube channel that you can use to get started.
The key is to build a habit of exercising specifically to improve your:
Strength
Lean muscle
Stamina / endurance
Mobility
Agility
Once you have a habit of exercising even a little bit every day, then you can work with a trainer to help you create an exercise program that works for you in the long-run and includes both strength training and aerobic efficiency training.
Diet and Nutrition
Aside from its effects on your body composition, your diet plays a big role in testosterone production. Here are some factors to consider.
High blood sugar, which means high carbohydrate diets, reduces testosterone production.
Preservatives and some vegetable oils (soy, palm and canola) used in the production of processed foods can also drive down testosterone levels.
Inadequate protein intake can negatively impact testosterone indirectly. A higher protein intake helps to build more lean body mass, which makes protein a key contributor to testosterone levels.
Consuming dairy produced from cows whose growth has been stimulated by hormones has been shown to increase estrogen levels in men.
Vitamin and mineral deficiencies can drive down testosterone levels:
Magnesium
Zinc
Selenium
Vitamin D3
So, aside from diet’s influence on our waist-size, what we eat or don’t eat can have a large impact on testosterone levels.
The goal isn't perfection, but to consistently move in the right direction!
Diet is often one of the most challenging things for most people to change. My advice for most people is to choose the one most important change and then make small efforts toward achieve that goal.
Stress
Ok, we all know stress is the “silent killer,” but exactly how it silently kills us is not often discussed.
Just as poor sleep is associated with an increase in all-cause mortality, so is chronic stress. One simple mechanism that can explain this is the cortisol steal example from the previous section on sleep.
If you remember, abnormally high cortisol production can compete with testosterone production. Cortisol is a very necessary hormone in the body because it’s responsible for keeping us alert when we need to be. When our level of alertness rises beyond what’s useful for our immediate task at hand, this creates hyper-alertness or vigilance which are just fancy ways to describe stress.
For example, if you’re driving home from work and replaying a stressful conversation you had with an employee, your cortisol system will be activated and your adrenals will produce more cortisol to help you deal with the stressful situation. The problem is that the situation now is only in your head, but your brain and alertness system didn't get the memo.
When this happens often, as is the case with people who deal with chronic stress, testosterone levels can be suppressed. You can imagine the cascade of effects with high stress causing you to stress eat high-carbohydrate foods or drink alcohol which could affect your sleep, making you feel grumpy and less able to deal with stress the next day.
These are the insidious cycles that can have such a detrimental effect on our health and quality of life. The problem is, we get used to them and just think of them as normal parts of life and aging.
High stress can also drive down your libido which may reduce your frequency of having sex…also a factor in testosterone levels. In fact, this is our next topic.
Sex
In the same way that physical exertion creates a whole chemical cascade that causes the body to produce more testosterone, sex has a very similar effect.
People who report having sex less than once per week have lower baseline levels of total and free testosterone.
But, when those same people begin having sexual intercourse at least once per week, their testosterone levels increase. Most guys know that low testosterone is associated with low libido and sex drive. What a lot of people don’t know is that regular sexual activity can actually increase testosterone production.
Medications
Certain common drugs like statins (for cholesterol), antidepressants, anti-anxiety drugs, sleep medications, and opioid pain relievers can drive down testosterone levels in men.
This doesn’t mean we should’t take these medications. We definitely should, as long as they’re medically necessary. But, it’s possible we can strive to change certain factors in our lifestyle which could help reduce our reliance on them.
No need to throw the baby out with the bathwater, but I believe a pharmacologic strategy should be based on the following framework:
Be very precise with your medications, taking the most effective drugs for your specific condition, and that works optimally with your unique biology.
Take the fewest drugs required to have the optimal outcome.
Take the lowest dosage needed to have the optimal outcome.
Use your lifestyle choices and activity to reduce your reliance on drugs.
Your body is a literal pharmacy stocked with hundreds of thousands of drugs already in their most usable form.
If you can align your behavior with your biological needs, your body will often dispense the exact drugs you need to thrive.
Sometimes though, we need some pharmaceutical assistance, but it should be very specific and with the fewest side effects possible.
Alcohol, Cannabis (Marijuana), And Other Recreational Drug Use
The relationship between recreational drug use (including alcohol) and testosterone is rife with controversy.
I think the reason it’s so controversial, even in medicine, is that most people use some form of recreational drug, and people don’t want to acknowledge the real health hazards.
This is especially true of testosterone where epic battles rage on platforms like Reddit, Youtube, and Facebook.
From all the sources I've read, it’s clear to me that chronic use of almost all recreational drugs like alcohol, cannabis, cocaine, methamphetamines, and heroin have a negative impact on testosterone levels.
The degree of impact completely depends on frequency and potency of usage. There are many proposed mechanisms for how chronic recreational drug use drives down testosterone levels but a simple one that you’re already familiar with is the cortisol steal.
Alcohol is sneaky! It actually increases physiological stress while decreasing your awareness of it at the same time.
All these drugs increase stress levels in your body which increase cortisol. I know you’re saying “but I thought alcohol decreased stress.” The fact is that alcohol increases actual stress on your body through elevating your heart rate, increasing blood pressure, increasing cortisol and adrenaline production, and disrupting sleep quality…all while reducing your awareness of the stress as it’s occurring.
This is one of the reasons people feel alcohol helps them to relax…by reducing their awareness of the actual stress that’s happening in their body. It’s a mean trick that while we feel we’re relaxing, our body is actually stressing more.
Cocaine, in a similar way, elevates stress levels in the body but causes a huge surge of dopamine which reduces your perception of stress, especially emotional stress. This is one of the reasons it’s so addictive.
Heroine, on the other hand, damages the opioid system in the body. Your opioid system does more than reduce pain and elevate mood. It's responsible for so many processes in the body, some of which affect the brain's ability to maintain healthy testosterone levels.
Fortunately, once a person has been off of heroin for 6 months or longer, the opioid system rebounds and testosterone levels can naturally rise.
Chronic high THC cannabis use can lower testosterone levels in men.
Ok, now for the most controversial one…cannabis (marijuana). And the verdict is….chronic high THC cannabis use (THC >23%) does drive down testosterone levels in men. If you're a regular user don't worry, the best research I've read about this suggests this is a reversible situation.
I'll be doing a deep dive into the specifics of cannabis and testosterone in a later article so be sure to subscribe and stay tuned!
Summary Of Key Ideas
To summarize, testosterone is a critical hormone that affects every aspect of male physiology, health and performance. It naturally declines as we age but there is good evidence to show it’s declining faster than normal due to a variety of factors including:
Stress
Infections
Cancer
Environmental toxins
Poor diet
Poor sleep
Sedentary lifestyle
Excessive use of recreational drugs
We need optimal levels of testosterone as we age to maintain our health and ensure a long, healthy, and active life.
Our habits and day-to-day choices do impact our testosterone levels and if we pursue a life that's in alignment with our biological needs, we will thrive.
In the remaining articles we’ll explore some more specific strategies you can use to improve and maintain healthy testosterone levels as you age.
So, be sure to subscribe to the newsletter and stay tuned!