Do You Need Testosterone Replacement Therapy?

Just a few decades ago, if you were over 40 and felt fatigued, had a lower libido and maybe noticed a few extra pounds around your stomach, it simply meant you were aging normally. But in recent years, “low testosterone” has emerged as the new health boogeyman. Last spring, Fox host Tucker Carlson even bemoaned the “total collapse of testosterone levels in American men.”

If that sounds a bit apocalyptic, it is: A slight decline in testosterone as you age is perfectly normal; in fact, the hormone drops an average of 0.4 percent a year after we hit 40. One study found that nearly 39 percent of men 45 and older have low testosterone, although that study lumped Gen-Xers and their dads into the same group. 

But low T isn’t just about more naps and fewer erections. New research has found it can negatively affect brain function. It can also play a role in bone health, red blood cell production and other important healthy processes. So if you suspect your go-get-’em hormone is going, start with a few simple changes.

Eat, Play, Love

Low T-level counts can be caused or exacerbated by lack of physical activity, eating poorly, not getting enough sleep, stressing out and generally not taking care of yourself. So, you know … what men do. Recent research found that 38 percent of men take better care of their pets than themselves.

While experts aren’t sure if it is a symptom or a cause, low T is connected to comorbidities like type 2 diabetes and obesity, which makes losing weight your first step. Acute and chronic lack of sleep have been shown to have a negative correlation with T levels, so skimping on your REM sleep isn’t a luxury you can afford anymore either. 

It’s obvious, but guys with more muscle have more testosterone, and guys with more testosterone have more muscle. A solid mix of cardio and weight training will help keep your strength up and your weight in check. Aim for at least 150 minutes a week of exercise. Excessive exercise can negatively affect your testosterone levels, however, so if you notice a sudden drop in your energy levels or have trouble sleeping, that’s a warning sign. Not giving yourself enough recovery time between workouts can also lead to low T levels.

There’s a plethora of supplements on the market that claim to boost testosterone, but they are unregulated and backed up by dubious claims. Nutrients are more effective when they come in food form rather than pill form. Foods high in zinc like oysters, pomegranate, onions, fatty fish and fish oil, ginger, and vegetables high in magnesium like spinach, Swiss chard and kale can help. 

What if That Still Doesn’t Work? 

That’s when it’s time to consult your doctor. A simple blood draw will be able to measure your T levels and associated biomarkers. Your doctor can order this lab, but a variety of other services like InsideTracker, Hone and Let’sGetChecked will let you purchase the test without needing to consult  your primary care practitioner.

A doctor or practitioner will have you take the test in the morning, likely before 11 a.m. when levels are highest. Due to standard fluctuations, if the readings are low, you will need a second test to confirm the results. 

Testing will give you a baseline number for your genetic disposition of testosterone. 

The range for normal T levels varies widely: The accepted normal range is 300 to 1,000 nanograms per deciliter (ng/dL). But what matters is how you feel, not what the tests say: Some guys just have naturally lower levels, and that’s not a cause for concern if they’re still feeling strong and energetic. Testing your T levels will help to rule out other health issues and give a proper diagnosis of hypogonadism or testosterone deficiency syndrome.

If there’s a true dysfunction in how your body produces testosterone that can’t be fixed with lifestyle interventions, your doctor might prescribe TRT, or testosterone replacement therapy, where you receive synthetic testosterone via gels, injections, patches, pills or creams. 

There are pros and cons to this type of treatment — according to the Food and Drug Administration, some medications bring a higher risk of heart attack or stroke — but it’s worth bringing up with your doctor. Always talk first to a medical professional, who can evaluate your total health history and biomarker data.

You can get that testosterone back. But try the natural approach, too. Have some fish, get some sleep, and maybe skip that extra glass of wine tonight.