(Note: Sex and gender exist on spectrums. In this post, we are using the term ‘male’ and ‘female’ to refer to sex assigned at birth.)

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When it comes to testosterone, most people just think of it’s as a ‘guy thing’ but in actuality, it’s not. What’s often overlooked is that the hormone testosterone is important for women as well, as they too produce testosterone. The main difference is that in females that happens in the ovaries and the adrenal glands and the testosterone produces plays a significant role in female sexual desire as well as overall health and well-being.

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Males, however, have about fifteen times more testosterone coursing through their systems than women do, and it is vital to their healthy libido, as well their ability to maintain muscle mass, bone density and just being able to get through life, most of the time anyway, feeling reasonably optimistic and energetic.

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So, although my thoughts here on the subject of low testosterone, are more aimed at men, it is for women too, and offers some food for thought on how to keep your testosterone tank from running on empty. So, let’s fire up the engines:

The testosterone struggle is real.

First up, if you’ve ever been bombarded by those TV ads nattering on about “Low T” or websites that offer supplemental testosterone prescriptions like they were candy, you might be tempted to think the whole business built around the world of low testosterone is a scam. But it’s not.

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The problem of not having enough is very real – even if the solution they’re pushing, for most men, is rarely the right one. What guys don’t hear on the TV ads is that when you take control of your lifestyle, most importantly, your body weight, your sleeping habits and your exercise, you can bring back your testosterone levels to a more youthful and healthy place without getting lost in a sea of patches, gels and injections.  We’ll get to them in a moment. But first, let’ take a closer look at the problem of low testosterone.

The slide starts sooner than you may think.

Whereas women’s primary sex hormone, estrogen, stays at a fairly steady level until it drops dramatically at menopause, testosterone levels, for most men, decline slowly and steadily from their thirties on, roughly by about 1% a year. While some of this drop is likely inevitable, the important thing to keep in mind is that most of it isn’t caused by aging per se but by how we age: how we eat, how we sleep, how we exercise. In other words, if you’re eating crap, burning the candle at both ends and don’t move much, don’t expect to be brimming with testosterone as your 40’s approach.

The numbers aren’t quite what they seem.

About a quarter of American men have total testosterone levels that mainstream medicine regards as low-normal: the number comes back from the lab in the 200-400 range. By itself, the number is almost meaningless. Always get a free testosterone level checked because that is the amount of testosterone that is getting to the tissues and by far the more important number to check. If your sex drive, your energy and your mood don’t feel radically different than when you were in your twenties, you’re fine. The testosterone circulating in your system is doing what it’s supposed to do. But, if you have a nagging sense that you’re ‘not the man you used to be’ – you’re dragging, your physique is sagging, you’re in the dumps –  then low free testosterone levels could be a culprit that’s at least partly to blame. So, if you have many of the symptoms of low T, even if your testosterone levels are normal, enough testosterone may not be reaching the tissues to perform it’s “functions.” Some call these symptoms the ‘middle-age blues’ or even ‘male menopause,’ and it needs to be addressed.

Re-rev your engines in a healthy way.

The good news is that you can reverse the downward trend and reclaim your zest for life, and I recommend you start now! You can do a lot of the heavy lifting simply by incorporating a few healthy behaviors that will help slow the slide and get you back on a more positive testosterone track. Where to start? Try these techniques:

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1) Lighten your load.

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Probably the single most effective thing you can do to boost drooping testosterone production is to shed body fat. In case you need a little extra inspiration to drop a few pounds, here it is: research studies have found that a 10% drop in body fat can translate into an 100 point increase in total T levels. Like so much in health and wellness, it’s about finding the right balance. Fat secretes a hormone, aromatase, which cues the body to convert some of the testosterone in the system into estrogen, throwing off the sex hormone balance in men.

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2) Don’t eat like a careless teenager.

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Especially when you’re trying to lose weight, the key is to pack in as much nutrition and as few junky, unnecessary calories with each bite-ful as possible. So, cut aggressively eliminate or cut back on the refined carbs (sugar, flour, etc.) and go big on non-starchy veggies, especially the leafy greens, healthy fats and clean proteins. Keep processed foods far away from your lips. Make your morsels count, and think all nutrients, all the time. And taking it a step further and going keto may be worthwhile too. A recent meta-analysis of 7 studies with 230 patients showed that a keto diet increased testosterone levels.

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3) Slash your stress, pump up your sleep.    

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Again, it’s all about getting your lifestyle in synch with your hormones. The body produces most of its testosterone, as well as its growth hormone, during the deep sleep (or “slow wave”) portion of your nightly 7-8 hours. If you’re stressed out, the levels of cortisol, the primary stress hormone, stay high at night, interfering with deep sleep and T production. Even if don’t think you’re stressed, trying to economize on sleep, getting by on 5 or 6 hours a night, will have the same effect, upping your cortisol, lowering your  T – which is exactly the opposite of what you need to be doing. In one study that measured testosterone in healthy young men, a week of 5 hours of sleep a night reduced T levels by 10-15%.  That’s a research study you certainly do not want to replicate at home! Forgot how to sleep? Try these 14 ways to do it better tonight.

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4) I’ll say it again: Move it!

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Let’s be clear here, there’s no one special, sure-fire magic bullet exercise that will boost your levels, so first up, if you’re on the sedentary side, just focus on moving a lot more overall. Any kind of sustained movement will have the effect of tiring out the body, in a good way, and increasing your “deep sleep” at night (which, unfortunately, also tends to decline with age). Once you’re in a more frequent movement groove, add some resistance or strength training to the mix, which is super helpful for getting more testosterone flowing. You can also add some HIIT a few times a week and your body, and your T levels, will thank you.

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Here’s another pay-out. One common middle-age complaint, often associated with low T, is a loss of libido. But all too often it’s SSRI anti-depression drugs that do a number on libido. And exercise has proved out in any number of studies to be an effective depression-fighter. So, if you can sweat away the blues without libido-damping drugs, so much the better. One caveat here: intense endurance exercise regimens can suppress sex hormone levels (testosterone and estrogen) so moderation is best.

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5) Steer clear of toxins like plastic, pesticides and phthalates.  

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It’s time to get serious about dumping plastic containers in favor of glass and stainless steel for food and spice storage. Avoid chemical-laden personal care products and cleaning products, and opt for healthier, cleaner versions, like the ones recommended by the Environmental Working Group. Buy canned foods from time to time? Then only buy what’s packed in BPA-free cans and, as much as possible, avoid ingesting platefuls of chemical pesticides by buying fresh, organic and/or farmers’ market produce. Ultimately, it’s the chemical bad actors here, commonly called endocrine disruptors, like plastics, phthalates, BPA and chemical pesticides that you need to worry about. They all interfere with hormone signaling and wreak havoc on your entire endocrine system, in particular disrupting sex hormones. It’s just precautionary good sense to assume they might do something similar in us, so we say why take the chance.

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6) Alcohol is a testosterone-tanking toxin too.

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Bottom line, alcohol consumption may also be helping to tank your testosterone production, while also having a negative impact on fertility. Trouble is, the acetaldehyde in alcohol is toxic to the (‘Leydig’) cells in your testicles that help produce testosterone. If that weren’t enough, alcohol use over time can also lead to testicular shrinkage, further decreasing the testes’ ability to produce the hormone. Alcohol use may impact some folks more than others, so if low testosterone is an issue for you, ditch the stuff for a month or two and see if you experience a rebound. If the answer is yes, then significantly cutting back your consumption, or ditching the stuff altogether, will pay big hormonal dividends.

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7) Consider healthy supplements, not the late night TV ad kinds.

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While testosterone replacement therapy (TRT) is an option, it’s more of a last resort. Before you consider it, experiment with a  few tried-and-true supplements, like vitamin D, which is linked with increased testosterone levels, as are fenugreek seed extracts, Ashwagandha root/leaf extracts, Shilajit, and Asian Ginseng. Though the testosterone uptick may be modest, all are generally well-tolerated, with few negative side-effects. As always, if you are on other prescription meds, check with your health care provider to make sure there are no contraindications.

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8) Do testosterone replacement therapy the smart way.

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If you give the aforementioned 7 testosterone-boosting tips your absolute best shot and still, you don’t feel like you’re getting the desired result, discuss with your Doc if TRT would make sense for you. Always get a hormone workup including total and free testosterone, to check the amount of testosterone bioavailable to your tissues. In my practice, when I prescribe testosterone, it’s always the bio-identical kind, custom-made by a compounding pharmacist. If you do do testosterone replacement, always monitor the blood levels after starting, even though monitoring your symptoms and whether they are improving is probably more important. I have found testosterone hormone replacement to be extremely effective, especially for those for whom the aforementioned lifestyle approaches haven’t been quite enough to turn the tide.