Mens Health

Why test at all? I have a separate post dedicated to that, and in brief, the value includes establishing your own personalised norms, highlighting potential root causes, creating baselines for test-change-retest protocols, validating intervention outcomes, and offering novel personalised insights.

These are the tests and biomarkers I would often consider for a client seeking to improve their natural testosterone:

1. Total and Free Testosterone

The ‘free’ testosterone is critical, since only this is actually available for active use, and knowing both provides two signals. One on testosterone production, and the other on testosterone availability.

2. Sex Hormone-Binding Globulin

If total testosterone is okay but free testosterone is low, this is often a root cause. SHBG binds to testosterone, making it unavailable for active use. If this is true, interventions to reduce SHBG may be high value.

3. Luteinizing Hormone (LH) & Follicle-Stimulating Hormone (FSH)

These hormones regulate testosterone production within the male testes, so if their levels are exceptionally lower or higher in the presence of low testosterone they are suggestive of a root cause, and a target for intervention.

4. Estrogen

Males and females both produce and need estrogen(s) and testosterone, whilst the levels of course are very different. Testosterone may be converted to estrogen via aromatisation, and if the fraction being converted is excessive it can result in too little of the former and too much of the latter.

5. DHEA-Sulfate

DHEA-S is a precursor building block for both testosterone and estrogen. Just as with testosterone, normal levels decline with age and low levels can indicate issues, and opportunities, with diet, lifestyle and body composition.

6. 24-Hour Cortisol

Used to inform whether the daily oscillating pattern of cortisol has peaks and troughs at the appropriate times, and whether its activity may be suppressing testosterone production

7. Vitamin D3, Magnesium & Zinc

By no means the only essential micronutrients, but those for which insufficiency may be common, and with strong links to testosterone production.

8. Omega-3 Index

Omega-3 fatty acids are essential (hence essential fatty acids) for cellular activity including hormone production. If this is below optimal, it is very easily addressed via diet and supplementation.

9. Inflammatory Markers

Chronic inflammation, regardless of source, can impair endocrine organ function, including and not limited to testosterone production. If present, identifying and addressing the root cause is a high priority.

10. HbA1C Blood Glucose

Poor blood glucose regulation, leading toward prediabetes and diabetes, can impair testosterone production, with the good news being that insulin sensitivity is highly manageable, for most people, via diet and lifestyle practices.

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Together with lifestyle factors, your dietary approach can hugely influence your natural testosterone production, male or female, and most ages.

Doing *all the right things* within your diet will not raise your natural testosterone to super-physiological levels but if your dietary approach is currently not addressing most or all of the key points then it could be a significant contributory factor if you have lower testosterone.

I personally went through a period of several years on a relative-energy deficit ketogenic diet combined with high intensity exercise where my testosterone fell to below even the standard reference ranges. I say “below even” as those ranges are not based on optimal health, and the normal reflects the results from a population containing many people with metabolic syndrome, high stress, high toxic exposures, and other factors that may be impacting upon their natural testosterone production.

After multiple tests confirming below-reference testosterone, and with disease factors ruled out, I was offered testosterone-replacement therapy (TRT) Before taking up TRT I made some major changes to my diet, lifestyle and supplementation, including reintroducing more carbohydrates, more total calories, reducing the frequency of very intense exercise, and adding in some specific supplements. This was enough to raise my free testosterone by several mmol/L, back at least into the “normal” range.

Even if you are considering testosterone therapy, putting in place all the supportive lifestyle and dietary approaches is a great first priority to ensure that your natural production has all the opportunity you can possibly give it.

Decoding those chemical symbols - the key minerals are Boron (B), Magnesium (Mg), Selenium (Se), Zinc (Zn) and Iron (Fe) and Copper (Cu) with the latter two in specific balance with one another, with males and females both often struggling to have appropriate levels of iron, not too much and not too little.

In practice, whilst the vitamins and minerals indicated are those that most often, if insufficient or deficient have a negative impact on testosterone, ensuring regular intake of all required vitamins and minerals, and trace minerals, through diet and where helpful or necessary, supplementation, is more effective than following a reductionist approach.

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When seeking to support your best possible *naturally* produced testosterone your overall diet and lifestyle are likely to have far more significant impact than supplements. If your sleep quality or quantity is poor, if you are highly stressed, if your toxins exposure is high, if you have a high processed foods or nutrient poor diet, these are by far the most fertile grounds for intervention.

If you bring your diet and lifestyle to a place where most of the boxes are ticked for the things that support a healthy hormonal environment, what else? This is where some supplements, some of the time, for some people, do show some evidence for positive effect. Caveat that none of these compare to testosterone replacement therapy (TRT) but the combination of diet + lifestyle + supplementation all together can absolutely provide enough support for very desirable levels of natural testosterone production. Since most of the interventions are also broadly supportive of vitality, energy and healthspan, they have a strong case for action that goes beyond testosterone alone.

By reference to multiple systematic reviews and some smaller studies, and my own experience supporting male clients, these are the top 10 supplements worth considering in pursuit of improving natural testosterone production. Note that this is not a recommendation for anyone to simply take these as a full stack. The appropriate approach is to personalise, considering your diet, other supplements, supplement cycling and appropriate dosing.

#1. Vitamin D3+K2
Vitamin D3 supports testosterone synthesis by influencing the activity of Leydig cells within the male testes. When you are supplementing with D3, K2 is very important to use in combination to assist with appropriate utilisation of the D3. Sunlight exposure during the months with sufficient UVB light to enable skin cell synthesis of vitamin D is a great alternative, with supplementation during other months to maintain or improve your target Vitamin D levels.

#2. Magnesium
The format does not matter hugely but by glycinate, bygylcinate, taurate and orotate are highly absorbable forms with fewer potential side effects. Mg has multiple pathways to support testosterone including reducing the amount of testosterone which is bound to sex-hormone binding globulin (SHBG)

#3. Zinc
Essential cofactor for testosterone synthesis and definitely possible from dietary sources too, but if your intakes are low, temporary supplementation may help close the gap whilst you add more into the diet.

#4. Boron
A trace mineral required a lower quantities than magnesium and zinc, but may be very important for improving free testosterone via reducing binding to SHBG

#5. Omega-3 Fatty Acids
If for any reason your diet is not already rich in omega-3s from fatty fish then supplementation can be used, ideally choosing a phospholipid form, such as from herring caviar & krill oil, for superb absorbability.

#6. Ahwaganda
Appears to mitigate stress hormone (cortisol), support Leydig cell activity and result in increased testosterone (and sperm quality)

#7. Tongkat Ali
May improve testosterone by stimulating luteinising hormone which in turn stimulates testosterone production

#8. Shilajit
The mechanisms are little known, but some trials have demonstrated positive impact.

#9. Fenugreek
Another compound which appears to improve free testosterone via reducing the amount of testosterone bound to SHBG. You can also consume fenugreek in the diet, in many ways but the dosing found to have significant impact requires a specific amount of saponins.

#10. DHEA
DHEA is a precursor to testosterone with its own direct health supporting effects. In the UK, DHEA is a Class C drug, unavailable to buy or import. Hence within my own professional scope I cannot recommend it. Some countries, including the US, have free distribution of DHEA, hence the mention here rather than omitting it from consideration.

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For males and females, supporting optimal natural testosterone production can have an incredible positive impact on quality of life, short term and long-term, including extending healthspan.

Many of my male clients are experiencing the andropause. Unlike menopause, this is not a single moment in time and is instead a steady, incremental reduction in key male health related hormones, including testosterone, often beginning from sometime between 30-40 years old.

Before analysing diet, considering supplements or even testosterone replacement therapy there are often key lifestyle factors which have a major impact and are highly modifiable.

Sometimes these lifestyle factors alone, especially if several are absent or in a poor state, can be the root cause for low testosterone and general poor health. To a large extent, they are highly modifiable and at minimal cost, except for effort!

Hence this is the place I often start with my clients, so that we establish a strong basis on which to build upon with diet and supplementation interventions.

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Your organs are body parts with specific functions, and endocrine organs are the specific types of organs that produce and release hormones into circulation via blood, with broad ranging effects. For example, our adrenal glands release adrenaline and noradrenaline, and specific cells within our pancreas release insulin.

Your muscle is also an organ. It is made of specialised cells and because of benefit #3, it functions as an endocrine organ. So long as it is gained *drug-free* more muscle is almost always more beneficial, both for enjoyment of life now, later, and much later. More muscle is protective against almost many major chronic diseases, including cardiovascular disease, diabetes and dementia, and even some forms of cancer.

So what does muscle do for us?

#1 Movement and function.

It is what lets you move, dance, run, lift, and all the mundane but essential activities for daily living. This is why there are tests like sitting up from a chair, from the floor, and grip-strength, that are strongly predictive of quality of life and health

#2 Metabolic Health.

Muscle helps regulate the clearance of both sugar and fats from our blood circulation, reducing the risk of developing diabetes or fatty liver.

#3 Myokines.

Muscle produces myokines during exercise, which help reduce inflammation, improve insulin sensitivity and promote the growth and repair of other tissues.

#4 Mental Health.

Muscle enables *living*, which helps keep us younger, but it also stimulates the increased production of neurotransmitters, like brain-derived neurotrophic factor (BDNF) that contribute directly to brain and mental health, reducing anxiety, depression and enhancing mood and memory.

It is *never* too late, or too early, to begin building more muscle. For inspiration, link goes to a meta analysis reporting on muscle gains by female subjects of up to 80 years old.