What is Low Testosterone?
Testosterone is the male sex hormone. It’s just as important for men as estrogen is for women. At puberty, boys experience a sharp rise in testosterone, which helps increase muscle mass, exercise capacity, and the number of red blood cells in the body by 15 to 20 percent (maybe this explains the term red-blooded male).
It also deepens the voice, increases sex drive, and causes spontaneous erections (those were always interesting, especially when I had to read a book report in front of the class and decided to wear tight pants to school that day—bad move, Moyad!). This is all driven by the brain, of course, which sends a hormone signal (luteinizing hormone or LH) to the testicles to make testosterone. If the signal is disrupted in any way or if the Leydig cells in the testicles, which make testosterone, are damaged, less of the hormone may be produced. Aging, genetics, lifestyle changes (weight gain!), medications, and certain diseases (like diabetes) can reduce testosterone count. However, adding more testosterone to normal “T” levels can increase the risk of stroke.
The symptoms of low testosterone are diverse (see “Low T Q&A,” opposite), so a blood test is the easiest way to tell if you have a problem. Depending on your situation, your doctor will usually look at three things in the blood first.
- Free testosterone or percent-free testosterone (testosterone that’s not bound to anything else)
- Total testosterone (free T plus T bound to two proteins)
- Bioactive/bioavailable testosterone (free T plus T attached loosely to one protein)
There are numerous other blood tests that may help your doctor decipher the cause of low testosterone, including SHBG (sex hormone-binding globulin) protein level, prolactin, and LH and FSH (follicle-stimulating hormone).
The same concerns and contraindications that apply to prescription testosterone replacements apply to dietary supplements. For example, individuals with prostate enlargement, a history of prostate or breast cancer, or urinary issues or who are at greater risk for prostate cancer should not use these products because testosterone can increase the risk of these cancers and exacerbate urinary and prostate problems.
People with a history of liver or kidney problems or breathing issues while sleeping (sleep apnea) are not necessarily good candidates for testosterone replacement either. You’ll need regular blood tests to monitor testosterone, cholesterol, hematocrit (red blood cell count), and liver function, even if you’re taking a supplement versus a prescription. Finally, testosterone replacement can reduce the size of the scrotum and inhibit mature sperm development, so if you’re trying to have a baby, this is not a good option, nor is it a reliable method of birth control! (Men with low T who want to increase it and maintain their fertility should talk to their doctors.)
Home Remedies For Low Testosterone
1. DHEA (dehydroepiandrosterone) 25 to 300 milligrams a day
Note: I cringed when making this my top supplement because it’s not only inconsistent in raising testosterone, it also has safety issues. Unfortunately, it has the most favorable clinical research. I do believe that some men who are nervous about prescription testosterone’s side effects and cost may want to try this for 3 to 6 months to see if it makes a difference.
DHEA is converted into testosterone in the body, so the thinking is that if you give the body more of the building blocks of the hormone, you get more of the hormone. That’s generally true, but it’s also a building block for estrogen. Small to large quantities (25 to 300 milligrams a day) of this fairly inexpensive dietary supplement can increase a man’s testosterone if it’s low, but it can also cause liver toxicity and potentially increase estrogen levels, and large increases in estrogen can be problematic. I have watched so many men take this stuff and see only a slight bump in testosterone with very little symptomatic benefit.
In one of the better randomized trials, which was done at the Washington University School of Medicine and published in the American Journal of Clinical Nutrition, older men and women took 50 milligrams of DHEA daily for 1 year.
By the end, total testosterone in the men had increased from 420 to 491 ng/dL on average, but the placebo group also saw increased T, from 420 to 448. Free testosterone and growth factors also increased, as did estrogen levels.
Women in this study saw HDL (good) cholesterol levels drop more than 4 points. A 2-year randomized trial from the Mayo Clinic (published in the New England Journal of Medicine) showed no increase in testosterone in men who took 50 milligrams of DHEA daily. And HDL levels dropped 6 points in men and 8 in women.
2. L-arginine aspartate 2,800 milligrams a day and Pycnogenol 80 milligrams a day combined or L-citrulline by itself 1,500 to 3,000 milligrams a day
L-arginine gets turned into nitric oxide in the body, which can increase bloodflow to the penis. It can also stimulate the production of creatine, which body builders use in supplement form to boost strength, and growth hormone. (L-arginine is discussed in detail in the Erectile Dysfunction section.) What’s up with all the Arnold Schwarzenegger talk, you ask?
Since L-arginine does many of the same things that testosterone does, such as impact growth hormone and increase muscle strength, some researchers believe it can also increase testosterone. Unfortunately, the conversion of L-arginine into nitric oxide just isn’t very efficient; the liver and intestines get rid of most of it, so higher doses are needed to see a small impact. However, when you combine L-arginine with Pycnogenol, the results are much better, and in fact, two well-done clinical trials have found that the combo raised testosterone in men.
One of the studies was a 6-month clinical trial comparing Prelox, the best- selling L-arginine-Pycnogenol combination product, to a placebo. While the main focus was its impact on erectile dysfunction, participants also significantly increased testosterone by almost 75 to 100 points.
The dosage of L-arginine was 2,800 milligrams per day and Pycnogenol was 80 milligrams daily. Other trials have revealed some potential safety issues— including increased cardiovascular risk in people with a history of heart attack or peripheral artery disease—when taking L-arginine by itself, so I only recommend the combination product.
L-citrulline—a compound found naturally in watermelon rind—also gets turned into nitric oxide in the body, and that pathway is much more efficient, so you can take smaller dosages (1,500 to 3,000 milligrams per day).
The research on L-citrulline and testosterone is ongoing, though, so I’m keeping an eye on it and you should, too; you can speak with your doctor about it.
3. Tongkat ali (Eurycoma longifolia) 200 to 300 milligrams a day in divided doses
Many years ago I spent almost 2 weeks in Malaysia speaking to various groups about supplements, and almost every store I walked into was selling this stuff. I also noticed it everywhere when I was in Singapore. This is a dietary supplement (taken from a plant or a common shrub found along the slopes of hilly areas in the Malaysian rainforest) to keep your eyes on because it has preliminary human data showing it might improve various aspects of male health, including sex drive, testosterone levels, and sperm quality—at only 200 to 300 milligrams divided into two daily doses.
The tongkat ali product that has the most research—and the only one with real clinical data—is the standardized, water-soluble extract of Eurycoma longifolia root called Physta (manufactured by Biotropics Malaysia). The company’s aqueous extract has multiple ingredients—including tannins, high-molecular- weight polysaccharides, glycoprotein mucopolysaccharides, and quassinoid alkaloids—that may play some role in testosterone production. The company is currently funding many clinical studies, and results from the last one showed an increase in testosterone of 76 ng/dL in men with very low testosterone, which is not much, but for a supplement it’s as good or better than DHEA. The only problem is that, while it was a well-done study, it did not include a placebo group.
A better study (published in the journal Evidence-Based Complementary and Alternative Medicine) followed men who took 300 milligrams daily of either Physta or a placebo for 12 weeks. The participants reported improved erectile function and libido, but did not increase their testosterone significantly (50 points) compared to the placebo.
I believe this supplement can potentially directly stimulate some testosterone production, and I will be keeping my eye on further studies with it. So far, I haven’t been able to identify any significant side effects or drug interactions with tongkat ali, which is also referred to as Malaysian ginseng.
I am often asked whether the inexpensive tongkat ali sold in many health food stores is similar to what has been used in the clinical trials, and the truth is that no one knows, but I do not have confidence in them. The Physta product has batch-to-batch consistency and quality control studies, which basically means I trust this company more than other suppliers of tongkat ali.
What Supplements Are Useless For Treating Low Testosterone?
This has to be one of the most overhyped dietary supplements for raising testosterone that I have ever come across in my career. Tribulus contains a compound called protodioscin that, along with other ingredients, is supposed to act like DHEA. This sounds good in theory, but the research—and my experience with it—hasn’t panned out. It’s a dud, in other words. One Australian study with rugby players found no increase in testosterone with it.
This is a popular ingredient in testosterone-enhancing supplements, and there’s some research to suggest it can increase testosterone by itself or when combined with other supplements, but the research has not been consistent. “Experts” claim fenugreek works by blocking the enzyme aromatase, which converts testosterone into estrogen. I don’t believe it, but if it really does this, I don’t recommend it anyway because, as I mentioned earlier, men need some estrogen to support their bones (and even sex drive).
Without it, they can experience accelerated bone loss, as seen with drugs called aromatase inhibitors. I find it interesting that fenugreek used to be sold as a female breast enlargement supplement and is used in some areas of the world to improve breast milk production! And now somehow it’s a magical product for testosterone? One of the best studies to look at fenugreek actually found it significantly lowered free testosterone levels in healthy men compared to the placebo group.
There are so many “experts” who continue to support the idea that zinc increases testosterone levels. The truth is that there may be a small benefit, but this really only applies to those individuals who are profoundly deficient in zinc, which is rare today. However, the so-called experts will take results with a very specific population, such as people with chronic kidney disease, and try to say oral zinc will raise testosterone for all men. Don’t believe it!
This amino acid is advertised as being able to promote higher testosterone levels, but based on my experience and a recent study, I’m skeptical.
Sorry, it may help with erectile function, but researchers haven’t seen any consistent increase in testosterone in clinical trials.
Here are some other supplements that just don’t have adequate evidence.
- Boron (this particular supplement should get more research)
- Potency wood
- Vitamin D
- Wild oats
- Wild yam
What Lifestyle Changes Can Help With Low Testosterone?
Heart healthy = testosterone healthy
Again, excess weight is a huge cause of reduced testosterone. Exercising and eating a healthy diet will help you control your weight and will improve your cardiovascular disease risk.
Here’s some scary info: Obese male teenagers appear to have 25 to 50 percent less testosterone than their healthy-weight peers. This is stunning research because in the past it was thought that it took time for weight gain to impact testosterone production, but these newer studies with children clearly show that teens are just as vulnerable as older adults.