Low testosterone is much more common than what you might think. In over 7000 blood tests more than 80% of men tested for less than optimal testosterone levels.
The Journal of Clinical Endocrinology & Metabolism stated that 1 in 4 men over 30 has low testosterone out of the normal ranges.
Knowing that low testosterone is such an issue in males, it is crucial for us to find methods to be able to combat this and rebalance male hormones.
What can low testosterone cause?
Low testosterone is much more than a sex hormone, relating to sexual function. Testosterone plays a crucial role in energy levels, motivation, self-confidence, memory, anemia, body fat levels, muscle tissue, low mood, irritability and decreased pain threshold. High normal levels of testosterone also decrease the risk of diabetes, hypertension and increased fat mass.
You can complete my online health questionnaire to determine are experiencing low testosterone symptoms. Click link below and look for the testosterone column in section B.
Major contributors to inadequacies in testosterone production
1. Stress / High Cortisol
Cortisol is one of the major stress hormones secreted by the adrenal glands in response to stressful situations. The trouble is, we live in a world of physical and psychological stress, where our body can feel chronically stressed. Work, money, relationships, training, food, environment, chemicals can all cause a significant amount of stress, chronically elevating this hormone.
The trouble is when cortisol levels are increased out of their normal range this has a significant lowering effect on our own production of testosterone.
One simplified quote I got from Dr Bob Rakowski states “When you are making stress hormones you are not making sex hormones”
Whilst not biochemically accurate there is certainly an inverse correlation between the two hormones, thus it makes sense to where ever possible reduce total stress, or use supplementation that are able to blunt our response to stressful situations, particularly away from training. More on that later.
Again you can use my online health questionnaire to see if you have signs of high cortisol (adrenals high column in section B), along with any significant nutrition and lifestyle stressors from section A.
What is the science?
Cortisol directly inhibits testosterone production by the Leydig cells, via inhibition of the expression of the (StAR) steroidogenic acute regulatory protein – the first step in testosterone synthesis. (1-3)
Hypercortisolemia inhibits testosterone synthesis and reduces the total testosterone concentration and accelerate death of the Leydig cells (1-7)
2. High Insulin
Insulin is the major hormone secreted to help prevent blood glucose levels form rising too high. Unfortunately modern diets loaded with sugars and excess processed grains create peaks and elevations not normally experienced on a whole food well balanced diet.
Chronic consumption of these types of foods is one of the major causes of elevations in insulin and eventually one of the major contributors towards insulin resistance (our cells inability to communicate with insulin, effectively preventing the transport of glucose from the blood to the cells), which in turn chronically elevates insulin levels.
Elevated insulin is another hormone that is inversely related to testosterone, meaning chronically elevated levels will result in depressed testosterone levels. Unfortunately then low testosterone also reduces insulin sensitivity of cells creating a vicious cycle.
Again using my online health questionnaire you can assess the symptoms relating to high insulin in the section ‘blood sugar high’ (section B), likewise it is crucial to lower your scores in section A for the “what you eat” and your “eating habits” sections which will undoubtedly influence insulin management.
Interestingly increased stress may also be an issue for someone with raised blood glucose symptoms and potential insulin issues, due to the blood sugar increasing effects of the hormone cortisol, another negative effect of mismanaged stress responses.
Whats the science?
Insulin secretion and fasting plasma insulin are inversely proportional to serum testosterone concentrations (8-10).
Whilst estrogen is typically famous for being a “female hormone”, this is not completely accurate. We all have these hormones present just in varying distributions. Of course males you expect to see much lower estrogen levels and higher testosterone levels comparative to females, but what happens when estrogen levels raise in males and what are the probable causes?
Raised cortisol levels appear to be one factor behind increases in estrogen by increasing the levels of aromatase, an enzyme that assists in the conversion of testosterone into estrogen. There has also been links made between low levels of melatonin (sleep hormone) and increased aromatase levels, meaning that poor sleep and evening routine habits may actually be lowering testosterone levels.
Interestingly body fat also has the ability to produce aromatase, meaning the fatter you become the more aromatase activity, the less testosterone, the more estrogen, the harder it is to lower body fat and thus a vicious cycle can begin.
Interestingly there are trends in where we store body fat and our hormone profile. Commonly those with stubborn umbilical body fat will often have issues with high stress, inflammation and increased aromatase activity, and probable low testosterone levels if the body fat is particularly stubborn around the stomach, even with good nutrition and training. Elevated estrogen levels may also be linked with increased fat gain around the legs and chest area in males.
You can see a further relationship between raised cortisol and low testosterone but this time being caused by an increase in the activity of the aromatase complex, and thus increase of testosterone conversion into estrogen, and not just the suppression of testosterone production in the Leydig cells of the testes. (1-6 & 11-14)
Estradiol is the most potent estrogen. It is crucial to strike a balance; both low estrogen and high estrogen levels have their risks, so a balance of your sex hormones is crucial, thus aiming for optimal ranges, not norm reference ranges is an important consideration.
Currently the best test available for hormone profiling appears to be the use of urinary metabolites to assess a variety of hormones and enzyme activity, even though blood work is probably the most accepted form of testing amongst most standard GP’s.
Nutrients that play a key role in testosterone production
Asides from looking at addressing insulin, stress and estrogen to optimise testosterone, are there any base supplements that may help our bodies own production of testosterone?
There are probably 3 nutrients that seem to have the biggest impact on testosterone production and if low in the body it may cause a potential block. The three crucial nutrients are:
- Vitamin D
The crucial point for each of these nutrients is that IF LOW they may have a negative impact on testosterone production, thus supplementation when levels are at the optimal, will probably have no impact on testosterone levels at all.
Athlete populations seem to be more prone to zinc deficiency, so stunt performers and those that training on a regular basis would fit into that same population. Red blood cell zinc is a much more effective measurement than serum zinc levels and test should be carried out before any high dose supplementation as high dose zinc can cause copper insufficiency, stomach upset and even stress liver and kidney function.
A dose of around 25-30mg of elemental zinc per day is a fairly standard dose, but dosages over 3 x that have been used in studies showing relationships between correcting low zinc and raising testosterone production or preventing reductions in testosterone caused by high training volume (15-19). Elemental zinc refers to the weight of zinc itself, excluding the weight of the compound it is supplemented with to aid absorption. Using a product that is clear about the level of elemental zinc is crucial.
Zinc may also compete for absorption in the stomach with magnesium, calcium and iron, so high dose supplementation should be taken at different times.
Like zinc, low magnesium levels are associated with lowered testosterone levels, thus magnesium supplementation has been shown to increase testosterone to normal ranges.
Similarly to zinc highly active populations seem to have to highest rates of magnesium deficiency, possibly due to the amount lost in sweat during training and magnesium requirements to create energy and muscular contraction. 200-400mg of elemental magnesium are good levels, however labeling on products makes it very hard to understand how much elemental magnesium is actually present.
There are various magnesium supplements available, some with better absorption than others. Magnesium oxide a very popular form of magnesium, probably due to manufacturing costs, is probably the least recommended and most likely to cause stomach upset along side oral supplementation of magnesium sulphate which is not recommended any way, unless you fancy spending the day on the toilet. Good magnesium tend to be, not not limited to citrate, glycinate and gluconate, with gluconate absorption best during a meal.
Red blood cell magnesium is undoubtedly the most accurate measure of true magnesium status, and serum is generally a poor indicator of magnesium insufficiency.
There are vitamin D receptors located on sperm cells and vitamin D also appears to play a direct role in the production of steroid hormones. Similar to Zinc and Magnesium those found with low levels, and given supplementation to increase their status, also experienced increases in testosterone levels.
Generally speaking many people do not get enough vitamin D and supplementation may be required. However given the press over vitamin D’s positive effects on various aspects of health, many are supplementing with extraordinarily high levels with little regard for what this might be having on other nutrients in the body. One of the major concerns with high vitamin D dosing is the effect it can have on the relationship with other nutrients and possible health implications.
High vitamin D can increase levels of calcium in the blood, and the risk may be that increased calcium levels in the blood may increase calcium levels in soft tissue including the arteries, potentially having a negative effect on cardiovascular health. (20)
Vitamin K plays a role in allowing the body to use calcium in the blood, thus high dose vitamin D with a vitamin K deficiency may contribute to an increased risk of calcification of the arteries as seen in vitamin K deficient populations (20-21)
Magnesium appears to play a role in the activity, metabolism and function of vitamin D. Because magnesium is used in the metabolism of vitamin D, there may be concern over high vitamin D supplementation contributing to even lower levels of magnesium in the body, and thus a recent study has shown that magnesium and vitamin D supplemented together is more effective than vitamin D supplementation alone. It has also be suggested that magnesium alone can have a significant impact on vitamin D status and directly correcting magnesium status may actually be a way of correcting vitamin D deficiency. (22)
Magnesium has also been shown to help prevent calcification of arteries (23-24), thus increase vitamin D and thus blood levels of calcium with a lack of magnesium in the body may contribute to the potential calcification of arteries.
When it comes to vitamin D it is crucial balance is taken into consideration, perhaps having mineral levels and fat soluble vitamin levels is wise before any direct supplementation of vitamin D. Low magnesium alone may be enough to increase D levels, but if you are to supplement with D, then vitamin K would be advisable.
A good dose can be anywhere from 1,000iu-10,000iu per day with vitamin K. Vitamin D should always be taken with a meal containing fat for optimal absorption, and my personal preference is to have someone take it at lunch when we would normally be exposed to sunlight.
The best test for vitamin D is the 25-hydroxyvitamin D, and can be added as a standard blood test or performed as part of a fat-soluble vitamin profile.