Is Boosting Your Testosterone Level a Good Idea?

Is testosterone therapy a good idea? A low level of testosterone has been associated with negative health effects as insulin resistance and type 2 diabetes, inflammation, and elevated cholesterol and triglycerides leading to an increased risk for cardiovascular disease. However, testosterone replacement comes with its own set of concerns, in particular, potential negative effects on the cardiovascular system.

Since 2015 the FDA has required that testosterone products be labeled to warn consumers about the potential increase in the risk of heart attack and stroke. Prior to this warning, prescriptions rose three-fold between 2001 and 2011, appearing to indicate that testosterone was being prescribed without true evidence of low levels.

Why Testosterone Levels Drop

Testosterone is present in all bodies regardless of sex assigned at birth. The hormone is only socially associated with masculinity and virility. The loss of it may be disturbing to some people assigned male at birth as a result of this socialization, but it is a natural process. The hormone peaks in people assigned male at birth when they are in their twenties, and then a natural decline begins to occur. This decline is slow and steady, unlike the suddenness of menopause that people assigned female at birth experience.

Although testosterone declines with age, advancing age is not the only reason for levels to drop. Greater amounts of body fat are associated with lower testosterone, and environmental factors such as exposure to endocrine-disrupting chemicals found in plastics, opiods, some pesticide residues, and pollutants found in fish and other animal foods also may contribute.

There is a likely cycle in which high body fat promotes lower testosterone, which promotes more body fat, leading to diabetes and cardiovascular disease. In addition, cholesterol-lowering statin drugs may exacerbate this. However, healthier lifestyle habits such as not smoking, regular physical activity, lower meat and salt intake, and maintaining a healthy weight, are associated with higher testosterone levels in older people assigned male at birth.

The hormone is known for its effects on sexual function, but it also plays a role in energy, metabolism, body composition (muscle mass versus fat mass), and bone mineral density. In addition, the hormone affects blood vessels, favoring relaxation of the smooth muscle layer to promote lower blood pressure and better blood flow.

A Cardiovascular Concern With Hormone Therapy

In people assigned male at birth with low testosterone, testosterone therapy has improved LDL cholesterol, blood pressure, insulin sensitivity, and exercise performance. However, a clinical trial of testosterone therapy conducted in older assigned males with a high prevalence of cardiovascular disease was halted in 2009 because of a high rate of heart attacks and strokes.

Another study published in 2013 retrospectively studied veterans assigned male at birth with low testosterone who either received or did not receive testosterone therapy. That study found the hormone’s use was associated with greater risk of all-cause mortality, heart attack, and stroke.

Further, there are questions about the association between testosterone therapy and cardiovascular events like heart attack. While some studies have highlighted the connections between this therapy and chances of developing heart problems, others note that evidence is as yet scant and warrants more research. However, in studies of people assigned male at birth who used anabolic steroids, researchers found an increase in heart disease, leading them to question whether testosterone therapy also raises the risk.

A Natural Approach May Be Best

The evidence supports keeping testosterone levels within the moderate range. Although extremely low testosterone can be problematic, restoring youthful levels is risky. Over a seven-year follow-up study, older people assigned male at birth with midrange levels of testosterone had lower death rates compared to highest or lowest quartiles.

The healthiest thing to do is to prevent testosterone from becoming too low by living healthfully, so you will not need to take replacement hormones. Current research suggests that those assigned male at birth can increase testosterone hormone naturally. One study of overweight people assigned male at birth who participated in a 12-week diet and exercise intervention found that they lost weight, improved their blood pressure, and increased circulating testosterone levels. A proper diet, combined with exercise, reduces body fat and increases muscle mass and strength.

If you are concerned about maintaining adequate testosterone levels, you should strive for low levels of body fat by eating a high-nutrient (Nutritarian) diet, limit processed foods and animal products, get regular, vigorous exercise and ensure adequate vitamin D and zinc status. All are safe, natural ways to maintain vitality, health, and strength as you age.