Everything You Need to Know About Low Testosterone: Causes, Diagnosis, and Treatments

Testosterone is a primary sex hormone mainly associated with males. It is mostly responsible for the development of sexual characteristics in men (1). 

Testosterone stimulates sperm production, maintains reproductive health, and increases muscle tone in men (2). It is produced by the Leydig cells in the testicles. A small quantity is also produced by the adrenals (3).

Women also produce testosterone in low quantities. It is produced by the ovaries and adrenals. Testosterone is believed to have an important effect on ovarian function, bone strength, and female sexual behavior.  In women, the optimum balance between testosterone and estrogen is vital for the ovaries to function correctly.

Testosterone is crucial for maintaining good health and in the prevention of osteoporosis in both males and females. Therefore any imbalance in its production has serious consequences. Any decline or spike in testosterone production can lead to a range of symptoms.

Here is a complete guide to the functions of testosterone, as well as, the causes, signs, symptoms, diagnosis, and treatment of low and high testosterone.

The Role of Testosterone in Men

Androgens are hormones that are mainly responsible for the development and maintenance of the male reproductive system. They aid in the synthesis of protein which supports the growth of tissues.

The two principal androgens in males are testosterone that is produced by testicular cells and dihydrotestosterone (DHT), produced from testosterone in peripheral tissues such as skin and liver by 5-alpha reductase. 

Testosterone is primarily bound to sex hormone-binding globulin (SHBG) when in circulation while the unbound, or free testosterone, is the most available form.

Testosterone helps in the formation of the male reproductive organs during fetal development and later during puberty. It has two kinds of effects: anabolic and androgenic.

The anabolic effect of testosterone

  • Making new blood cells that helps in the growth of muscle mass and strength
  • Helps in the increase in bone density and strength
  • Stimulates linear growth (height)

Androgenic effect of testosterone

  • Maturation of sex organs particularly the penis and the formation of the scrotum in the fetus and at puberty
  • Deepening of the voice
  • Growth of Adam’s apple
  • Growth of facial hair and axillary hair
  • Enhances libido
  • Development of testes, and prostate gland
  • Body fat distribution
  • Production of red blood cells and sperm
  • Enlargement of sebaceous gland
  • Increases muscle tone
  • Discourages obesity

The Role of Testosterone in Females

Predominantly, testosterone is a male sex hormone. However, some amount is also produced in the ovaries, adrenals, fat cells, and skin cells of women. The androgen production in women is about one-twelfth as much as men. Androgens are essential precursors of estrogen (female sex hormone) and no estrogen can’t be produced without them. Testosterone is usually converted into estrogen by the aromatase enzyme.

Along with estrogen, testosterone helps in the growth, maintenance, and repair of a woman’s reproductive tissues, bone mass, and human behavior. Testosterone in females also:

  • Regulates the secretion of luteinizing hormone and follicle-stimulating hormone
  • Improves bone density and maintains bone health
  • Maintains breast health
  • Fertility
  • Enhances sex drive
  • Menstrual health
  • Improves mood and memory
  • Increases the muscle tone
  • Improves pelvic floor
  • Maintains female genital system

Most females do not develop male characteristics because testosterone and other androgens act differently in their bodies, being quickly converted to estrogen.

The Causes of Low Testosterone

What causes low testosterone in men is obviously not the same as that for women. So here, we will first discuss what all may trigger a decrease in testosterone production in men. Then we shall move on to causes of low T in women.

Causes of Low T in Men

Ninety-five percent of the testosterone is synthesized by the interstitial cells of Leydig of the testis in males. This is done under the influence of the luteinizing hormone (LH) that is secreted from the pituitary gland (4).

If there is a defect, acquired or congenital, that directly interferes with this testosterone (T) production from the testis, it can be the cause of low T. Anything that interferes with the interactions with the hypothalamic-pituitary-gonadal axis (HPGA) can also cause decreased T.

Hypogonadism

Hypogonadism is a medical condition in which the testicles do not produce enough testosterone. It may be caused by problems related to the testicles, hypothalamus, or pituitary glands which are responsible for testosterone production (5).  The normal range of morning T in a male is between 300 and 1000 ng/dL (6).

The American Urology Association (AUA) identifies low blood testosterone (Low T) as less than 300 nanograms per deciliter (ng/dL).  However, recently the range has been modified to 270 – 1070 nanograms per decilitre. Dipping below 270ng/dL may be reasonably considered to be low testosterone and hypogonadism is officially determined.

There are two types of hypogonadism. They are:

1. Primary hypogonadism:

Primary hypogonadism or primary testicular failure normally occurs when there is a problem in the testicles.

Common causes of primary hypogonadism

  • Klinefelter syndrome: Klinefelter syndrome is a genetic condition in which a male is born with an extra copy of the X-chromosome. It is also called XXY syndrome. The extra X-chromosome causes abnormal development of the testicles, which in turn results in the underproduction of testosterone.
  • Undescended testicles: Usually before birth, the testicles develop in the abdomen and descend normally to the scrotum, which is its permanent place. But sometimes one or both the testicles do not move down at birth. Even though this condition corrects itself within the first few years of life without treatment, in case not corrected can lead to testicle malfunctioning. This in turn can reduce the production of testosterone.
  • Injury to the testicle: If there is an injury to the testicle that causes damage to the normally developed testicles, it can lead to hypogonadism. 
  • Infection of the testis: An infection that involves the testicles called mumps orchitis can cause damage affecting the function of the testicles and testosterone production. The mumps infection usually occurs during adolescence or adulthood.
  • Hemochromatosis: This is a medical condition where there is too much iron in the blood. This causes testicular failure or pituitary gland dysfunction that affects testosterone production.
  • Cancer treatment: Chemotherapy or radiation therapy related to cancer treatment may interfere temporarily with testosterone and sperm production.

2. Secondary hypogonadism:

Usually, a problem in the hypothalamus or the pituitary gland that signals the testicles to produce testosterone results in secondary hypogonadism. Hypothalamus produces the gonadotropin-releasing hormone (GnRH), which signals the pituitary gland to make a follicle-stimulating hormone (FSH) and luteinizing hormone (LH). The latter then signals the testes to produce testosterone.

Causes of Secondary hypogonadism

  • Kallmann’s syndrome: Hypothalamus, is the part of the brain that controls the secretion of pituitary hormones. An abnormality of the hypothalamus can cause low testosterone. It can also affect the ability to smell and red-green colorblindness.
  • Pituitary disorders: A pituitary tumor or any other type of brain tumor located near the pituitary gland may cause testosterone or other hormone deficiencies.
  • Inflammatory diseases: Diseases such as sarcoidosis, histiocytosis, and tuberculosis that involve the hypothalamus and pituitary glands can adversely affect testosterone production.
  • HIV/AIDS: This medical condition affects all three i.e., hypothalamus, the pituitary, and the testis. This can cause low levels of testosterone.
  • Medications: Medications that include opioids, hormones that are used to treat prostate cancer, steroids, lower testosterone levels. Licorice and spearmint tea also decrease the production of testosterone and this effect is greater in females.
  • Obesity: The single most significant risk factor for testosterone deficiency in men is obesity. Obesity increases the levels of leptin, insulin, proinflammatory cytokines, and estrogen. These can cause functional hypogonadotropic hypogonadism with the defect present at the level of hypothalamic gonadotropin-releasing hormone neurons (7), (8). 
  • High insulin: The other most common reason for low T is high levels of insulin. High insulin suppresses testosterone. This is why men who have insulin resistance or diabetes have low testosterone (9).
  • Nutrients: Certain nutrient deficiencies such as Vitamin A deficiency, zinc deficiency can result in low T. It is also believed that low-fat diets may reduce total and free testosterone levels in men. However, there are limited studies to confirm the statement. 
  • Age: The aging process naturally lowers testosterone. Also known as andropause or late-onset hypogonadism, the effect usually starts in their mid-30s at an average rate of 1.6 percent per year. About 20 percent of men older than 60 and 30 percent of men older than 70 experience low testosterone (10). This is also the case of around 50 percent of men older than 80. However, some do experience low T in their 20s. It is not a natural decline and is likely caused by external factors or health issues.
  • Liver damage such as cirrhosis: Patients with liver cirrhosis show low testosterone levels due to a central hypothalamus-pituitary mechanism, an increased peripheral aromatization of androgens, and gonadal failure (11). It has been noted that up to 90% of men with cirrhosis have low T with the levels falling as the disease advances (12).
  • Alcohol abuse: Heavy alcohol consumption can lower your testosterone levels which in turn can impair fertility. Alcohol abuse can also result in liver damage which leads to low T (13).
  • Chronic kidney failure: Kidney failure can lead to decreased luteinizing hormone production and decreased prolactin clearance that could reduce or impair testosterone production (14).
  • Obstructive sleep apnea: Both the quantity and quality of sleep affect testosterone levels. Patients suffering from OSA have reduced sleep time, wake up more often, have reduced sleep efficiency which leads to a low testosterone level (15).
  • Severe primary hypothyroidism: Thyroid hormone deficiency or primary hypothyroidism is associated with hypogonadotropic hypogonadism. It is reversible though with thyroid hormone replacement therapy (16).
  • Trauma to the head: Studies have suggested that head trauma in men can be associated with low testosterone levels and sexual dysfunction. The mechanism includes hypopituitarism (17).

Causes of Low T in Females

In women aged 50 and older, testosterone levels lower than 20 ng/dL is considered low. If a woman still has her periods, she should ideally take the blood testosterone test about 8 to 20 days after her menstrual period starts to confirm low T.

The possible cause of low testosterone in females are:

  • Adrenal insufficiency, where the adrenal glands are not as active
  • Surgical removal of ovaries also known as oophorectomy
  • Hypopituitarism
  • Oral estrogen therapy that can reduce the production of testosterone
  • Early menopause
  • Genetic where the ability to produce the compounds DHEA and DHEA-S into testosterone is lower because of enzyme deficiency

Causes of High Testosterone in Men and Women

High Testosterone Levels in Men

Not only low but cases of abnormally high testosterone levels are seen in men as well. Also known as hypergonadism, the condition is diagnosed if your:

1. Total testosterone level is above 950ng/dL and 2. Free testosterone level is above 30ng/dL.

The factors that can cause high testosterone are:

  • Tumor growth
  • Anabolic steroid abuse for muscle mass building r enhanced athletic performance
  • Testosterone supplementation or T-replacement therapy for abnormally low T-levels
  • Testosterone gel 

High Testosterone Levels in Women

In women, excess production of androgen such as testosterone occurs as a result of adrenal disorders, ovarian disorders, ingestion or injection of androgens, and disorders of fat or other non-endocrine tissues. The other factors are:

  • PCOS (polycystic ovarian syndrome)
  • Hirsutism 
  • Congenital adrenal hyperplasia (CAH)
  • Tumor of the interstitial cells and other cells of the ovary
  • Adrenal or ovarian cancer
  • Anabolic steroid use

Signs and Symptoms of Low Testosterone 

Low testosterone is not a number. It is a combination of lower than normal testosterone levels in the blood along with physical symptoms or changes that pointedly affect men’s health, well-being, and lifestyle.

Adolescents and Young Men

The clinical symptoms of low T or hypogonadism are not so specific, making it very challenging to diagnose low T in adolescents and young men (18). However, some of the signs and symptoms include:

  • Reduced sexual desire and activity
  • Erectile dysfunction
  • Decreased spontaneous erection
  • Incomplete or delayed sexual development
  • Small testes
  • Gynecomastia
  • Loss of body hair/ reduced shaving
  • Subfertility
  • Reduced bone mass

The less specific symptoms are:

  • Decreased energy and motivation
  • Reduced physical performance
  • Depressed mood
  • Poor concentration and memory
  • Sleep disturbances
  • Anemia
  • Reduced muscle mass
  • Increased body fat

Adulthood

The signs and symptoms of Low T or hypogonadism in adulthood are similar to the ones observed at the outset of adolescents (19). In addition to the ones mentioned above, certain other symptoms are:

  • Decreased libido
  • Decreased volume of ejaculate
  • Loss of body and facial hair
  • Decreased bone density
  • Prostate enlargement
  • Decreased lean body mass
  • Increased anxiety
  • Profuse sweating
  • Weakness
  • Fatigue
  • Older look
  • Wrinkle in face
  • Depressed attitude
  • Tachycardia
  • Pale dry skin
  • Poor concentration/ memory
  • Small flaccid penis
  • Loss of collagen
  • Infertility 

Symptoms of Low Testosterone in Females

A woman should have a total of 15-70 nanograms per decilitre of testosterone in her blood. Amongst the factors that cause low T, menopausal women are most likely to experience them. The other factor can be a problem with the ovaries or pituitary or adrenal glands (20). The symptoms include:

  • Persistent fatigue
  • Blunted or diminished motivation
  • Decreased sense of personal well being
  • Small clitoris
  • Atrophic vagina
  • Night sweat
  • Joint pain
  • Palpitation
  • Constipation
  • Sluggishness
  • Poor sleep

High Testosterone Symptoms

Abnormally high testosterone levels can cause problems for both males and females. 

High Testosterone Symptoms in General

Some of the common symptoms which are generally manifested with high T levels in both men and women are:

  • Acne
  • Thinning of hair
  • Blood pressure change
  • Weight gain
  • Mood swings
  • Infertility
  • Anxiety
  • Depression
  • Deepening of voice

High Testosterone Symptoms in Men

Other than that, some symptoms are gender-specific. Men with high testosterone can experience a variety of troubling symptoms and health consequences. Excess amount of testosterone leads to symptoms such as:

  • Headache
  • High sex drive
  • Increased appetite
  • Aggression and risk-taking behavior
  • Irritable behavior
  • More acne and oily skin
  • Worse sleep apnea
  • Insomnia
  • Increased muscle mass
  • Erectile dysfunction
  • Early male pattern balding on the head
  • Excessive body hair growth

Other non-specific signs and symptoms include:

  • Pain in the chest
  • Having trouble breathing
  • Slurred or difficult speech
  • Polycythemia vera, caused by an overproduction of red blood cells
  • Lower levels of HDL cholesterol
  • Heart attack
  • Peripheral edema
  • Abnormal prostate gland growth
  • Sleep apnea
  • Deep vein thrombosis
  • Pulmonary embolism

High Testosterone Symptoms in Women

In women with high T, the symptoms are:

  • Enlarged clitoris
  • Increased muscle mass
  • Loss of libido
  • Reduced breast size
  • Infertility
  • Irregular periods
  • Body hair
  • Vaginal dryness
  • Reduced sex drive
  • Infertility
  • Weight gain
  • Painful clitoral swelling and sensitivity

Diagnosis for Low Testosterone Levels

The investigation of testosterone deficiency includes:

Medical History

The doctors discuss your current symptoms and also your family’s medical history to get a complete picture. They ask you about any current or past illness and any genetic conditions in your family. A nice talk with your doctor can help him identify testosterone deficiency if you have the classic symptoms.

Blood Tests

In young and aging men, testosterone secretion follows a circadian rhythm. The highest levels generally occur in the early morning hours. Therefore blood samples for testosterone should be ideally taken in the morning.

The blood tests your doctor may advise are total testosterone levels. Total testosterone (TT) should be measured before 11 am with a reliable method, on at least two separate occasions, preferably 4 weeks apart. Fasting levels should be obtained as and when possible. This is because non-fasting levels may be up to 30% lower. If TT is or below (12nmol/L) then you should do the following low T blood test:

  • Luteinizing hormone (LH) to differentiate between primary and secondary hypogonadism
  • Blood prolactin level
  • Blood hemoglobin or Hgb
  • Follicle-stimulating hormone (FSH) if fertility is an issue

These values allow distinction between gonadal disease and hypothalamic-pituitary disease (21).

  • Primary hypogonadism: This is diagnosed when there is elevated gonadotropin levels and low testosterone levels.
  • Secondary hypogonadism: This is diagnosed when there is low to normal gonadotropin levels with low testosterone levels.

For further diagnosis, the following can also be conducted (22):

  • Estradiol hormone tests are done if there are symptoms related to the breast. Also called the E2 test, it measures the amount of the hormone estradiol in your blood.
  • Estrone (E1) testing is also done to detect estrogen excess that is due to a testosterone deficiency. Both E2 and E1 testing in boys or men are ordered to help diagnose delayed puberty.
  • HbA1C blood test to see whether you are diabetic
  • MRI (magnetic resonance imaging) of the pituitary gland
  • Bone density tests
  • Karyotype (chromosomal tests)

The other blood tests that should be done to diagnose testosterone deficiency are:

  • Haematocrit as part of FBC
  • Prostate-specific antigen (PSA) 
  • SHBG test: 40-70 percent of total testosterone is tightly bound to sex hormone-binding globulin (SHBG). This testosterone can’t be released and is not available for work. However, SHBG controls how much testosterone is delivered to the body’s tissues. SHBG levels help indicate if there is too much or too little testosterone being used by the body.
  • Albumin test: Free testosterone comprises only 1-2 percent of the total testosterone. Half of the remaining hormone is attached to a protein called albumin. As they are loosely attached, like free testosterone they are available for work. The two together represent bioavailable forms of testosterone hormone in the body. Therefore, albumin tests can also help in detecting low T.
  • DHEA Sulfate test: DHEAS plays an important role in making testosterone and estrogen. DHEAS test is often done to find out if the adrenal organs are working fine, whether there is an adrenal tumor, to detect disorders of the testicles or ovary, and to find out the cause of early puberty in boys.

Total testosterone is usually used to determine whether or not testosterone levels are normal, whereas free testosterone is often used to assess the underlying causes of an abnormal total testosterone level. 

These measures are highly correlated. Therefore to rule out misclassification in men with low SHBG, a more comprehensive method of assessing total androgen metabolite (AG or androsterone glucuronide) is conducted (23).

Other Investigations

Other investigations that may be done to indicate a testosterone deficiency are:

  • Skull radiology including a pituitary CT scan
  • Semen analysis
  • Chromosomal analysis e.g., Klinefelter’s disease
  • Bone age estimation

With an accurate diagnosis of low T, the right course of action can be determined.

Downstream: The Long Term Effects of Low Testosterone 

Beyond the initial symptoms that crop up due to a dip in your testosterone levels, there are serious medical complications that can arise if this testosterone deficiency is not corrected.

In other words, a decline in your testosterone levels can have long-term, serious effects on the body, if left untreated.

Osteoporosis and Decreased Bone Density

Men with untreated low levels of testosterone are prone to osteoporosis, a condition in which the bones become brittle and weak.

Nocturia

Nocturia is a condition in which you urinate multiple times at the night. It is associated with long-term low T or testosterone deficiency.

Metabolic Syndrome

A metabolic syndrome is a group of medical conditions that occur together and increase your risk of diabetes, heart disease, and stroke. These conditions include blood pressure, high blood sugar, excess body fat around the waist, and high triglyceride levels. Low testosterone levels are associated with all these symptoms and increased mortality (33).

Type-2 Diabetes

Testosterone influences the fat deposits in the body. Now body fat can be either stored as subcutaneous fat, that is fat stored just underneath the skin, or as visceral fat, which is stored around abdominal organs. The latter is closely associated with diabetes, Alzheimer’s, and cancer. Studies have shown that long-term low T increases the deposition of visceral fat that leads to insulin resistance and type-2 diabetes (34).

Cardiovascular Damage and Heart Attack

When the testosterone level is low, the cholesterol levels rise. Even within the normal range, men who have the lowest testosterone level will have the highest cholesterol levels, which can consequently lead to cardiovascular diseases and heart attack. Low testosterone leads to diabetes and obesity which are the two most important cardiac risk factors.

Peripheral artery disease (PAD) is an important form of atherosclerosis and it signals an increased risk for heart disease. A Swedish study of over 3000 men with an average age of 75 linked low testosterone and high estradiol levels to an increased risk of PAD (35).

Cancer

Studies have shown a higher risk of prostate cancer among men with untreated low testosterone (36). Some studies have also concluded that TRT can lead to cancer, especially prostate cancer. However contradictory studies have also been observed (37).

Medical Treatments for Low Testosterone

The best low T treatment is said to be Testosterone Replacement Therapy (TRT) although many other medications and natural treatments are also used for improving testosterone levels.

Testosterone Replacement Therapy (TRT)

Millions of men use testosterone replacement therapy (TRT) to restore low levels and feel healthier. In most cases though, men need to have both low levels of testosterone in their blood and several symptoms of low testosterone to go on therapy.

Even if your levels are low and you have symptoms, low T therapy is not always the first course of action. In case your doctor identifies the source for declining levels, for instance, weight gain or a particular medication, he or she may address the problem first.

Testosterone replacement therapy is administered in five different ways. They are:

  • Transdermal: These are topical gels, creams, liquids, and patches. Also known as a topical medicine, they most often last for about four days. An air or water-tight dressing covered on top of the applied area ensures better absorption. The topical patch is more like a band-aid with medicine on it.
  • Intramuscular: Testosterone injections are of two types. Short-acting and long-acting. The short-acting can be given under the skin or in the muscle while the long-acting one is usually given in the muscle. Injections are generally taken weekly, or every two weeks, or monthly.
  • Oral/Buccal: These testosterone doses are usually administered via the mouth. The buccal dose comes in a patch that is placed above your incisor. The medication looks like a tablet. The drug is slowly released over 12 hours. This way of administration is less likely to have side effects on the liver as compared to the ones that are swallowed.
  • Intranasal: This is a testosterone gel where the given dosage is pumped into each nostril and taken normally three times daily.
  • Implants: Testosterone pellets are implanted inside the fatty tissues underneath the skin of your upper hip or buttocks. Normally local anesthesia is used to place it. The pellets dissolve slowly and are released over about 3-6 months.

Most men experience improvement in symptoms within four to six weeks of taking TRT, although changes like an increase in muscle mass may take from three to six months.

Creams, buccal tablets, nasal spray, gels, and underarm solutions such as Axiron, and patches can be administered on your own. They have to be done daily. Make sure women and children do not come in contact with them. Injections last longer and do not produce contact problems.

Low Testosterone Medications

Testosterone Products

Testosterone products such as patches, topical gels, nasal gels, and pellets are usually used as has been mentioned in the TRT section. Testosterone gel and transdermal patches are the most used because of the cost, ease of use, insurance coverage, and their ability to keep testosterone levels more or less stable.

Estrogen Blockers

Testosterone replacement therapy typically reduces sperm counts and lowers testosterone production in the body. Both of these can be a problem for younger men who would like to start a family.

Estrogen, a female sex hormone, naturally occurs in men too. It works in the brain and inhibits testosterone production. Estrogen blockers prevent this from happening, so the brain provides more hormonal stimulation of testosterone production.

Healthcare providers generally prescribe clomiphene citrate off-label to younger men with low testosterone. These medications are also used in older men who are not candidates for testosterone therapy.

Aromatase Inhibitors

People who are overweight or obese often have an excess of the enzyme called aromatase that is produced via body fat. This enzyme converts testosterone to estrogen. High estrogen levels in turn inhibit testosterone production. Aromatase inhibitors are used as breast cancer drugs that are used off-label to prevent this process. Aromatase inhibitors can increase serum testosterone dramatically and decrease estrogen in men with age-related or obesity-related low testosterone.

Side Effects of Low Testosterone Treatments

Testosterone therapy also comes with certain side effects which range from mild to serious. Some of the side effects are (24):

  • Acne and other skin reactions. For gels and liquids, some redness can occur at the skin site. Patches can lead to itching and a rash around the area. Though rare, some have complained of back pain as well.
  • For injections, short-acting injections can have a little local skin reaction. However, long-acting injections can cause serious allergic reactions and when administered are closely observed for a while.
  • Testosterone pellets can possibly lead to swelling, pain, bruising, and rarely hematoma.
  • TRT also increases the risk of erythrocytosis (abnormal raising of blood hemoglobin and hematocrit).

Other symptoms include (25):

  • Enlarging breast (gynecomastia)
  • Worsening sleep apnea
  • Excess red blood cell production can be a contributory factor in forming a blood clot. This can lead to embolism which can be fatal.
  • Shrinking of the testicle also known as hypotonic lax testicle
  • Limited sperm production
  • Increase the risk of heart disease
  • Erectile dysfunction
  • Dry eyes
  • Cellulite

Apart from that, some studies have observed exacerbation of prostate cancer, male breast cancer, worsening benign prostatic hyperplasia (BPH), polycythemia, and an increased risk of obstructive sleep apnea (OSA). However, to make a proper assessment more studies are needed.

Natural Treatments or Remedies for Boosting Low Testosterone Levels

Ayurvedic Treatment for Low T levels

There are a lot of herbs and supplements available which assist the body to stimulate the production of testosterone. These herbs work by treating the underlying cause of hormonal imbalance which results in low T secretion. 

  • Tribulus Terrestris/ Puncturevine: This tropical herb has been in use since ancient times as one of the best natural testosterone boosters. Also known as Tribulus Terrestris, the herb boosts testosterone production, increases sperm count, and promotes libido. The leaf, root, and fruit can be taken in the form of tea, capsules, and tablets.
  • Horny Goat Weed/ Epimedium: The active compound present in this weed is Icariin, which plays a vital role in stimulating testosterone production. Horny goat weed is believed to possess powerful aphrodisiac properties which are also effective in treating erectile dysfunction.
  • Tongkat Ali: Scientifically named as Eurycoma longifolia, Tongkat Ali is a flowering plant native to Indonesia. It has been in use as a herbal remedy as to a part of traditional Southeast Asian medicine. Studies have suggested that supplementing with its extract showed a surge in testosterone production and alleviated aging males’ symptoms (32).
  • Ashwagandha: This Ayurvedic herb has been used as a traditional medicine for boosting testosterone production. Studies have stated that Ashwagandha can increase sperm count, the volume of ejaculation, and sperm motility. It also aids in luteinizing hormone production that causes the testicles to make more testosterone.
  • Pine Bark extract: Pine bark extract contains a natural compound called proanthocyanins that help stimulate blood flow and circulation in the body. Studies have inferred that along with L-arginine, pine bark extract can effectively increase testosterone production.

Lifestyle Changes to Boost Testosterone Naturally

  • By losing weight
  • Exercise and weight lifts
  • Building muscles through resistance training
  • Getting enough sleep
  • Reducing stress and cortisol levels
  • Eat protein, good carb, and healthy fat
  • Get some sun or vitamin D supplement
  • Certain natural herbs such as Ashwagandha and fenugreek are frequently singled out as effective testosterone boosters in Ayurvedic medicine. Studies have shown that Ashwagandha raises testosterone levels in saliva. This may be due to its ability to lower stress and cortisol levels in the body.
  • Avoid medications that lower testosterone production such as opioids, and anabolic steroids. Corticosteroids and too many NSAIDs also contribute to reduced testosterone levels.
  • Minimize daily exposure to BPA, parabens, and other chemicals found in some types of plastic.
  • Whether it is recreational or medical, reduce or stop alcohol or drug use.

Best Foods for Increasing Low Testosterone

People with low testosterone can raise their levels with certain foods that are proven to be natural testosterone boosters. 

The foods that are rich in these essential nutrients such as zinc, vitamin D, and magnesium will therefore increase testosterone levels (26). These foods are:

Ginger: Findings state that a daily ginger supplement for 3 months did increase testosterone levels by 17.7 percent (27). Ginger contains several bioactive compounds along with antioxidants such as vitamin C, vitamin E, beta-carotene, lutein, lycopene, quercetin, genistein, and tannin. In addition to that, essential elements such as manganese, copper, selenium, and zinc are also present. These together boost testosterone production.

Oysters: Oysters are extremely rich in zinc which plays a very important role in the production of testosterone and the maintenance of healthy sperm (28). Oysters also boost dopamine, a hormone that helps increase libido in both men and women.

Pomegranate: This fruit is an age-old symbol of fertility and sexual function. Studies have shown that pomegranate may boost testosterone levels in men and women. Pomegranates when taken consistently for two weeks, can increase testosterone levels by 24% (29).

Fortified Plant milk: Plant milk includes milk made from almonds, soy, hemp, and flax. These contain a good amount of vitamin D which is an essential nutrient that increases testosterone levels in men (30).

Leafy green vegetables: Vegetables such as spinach, swiss chard, and kale are rich in magnesium. This is a mineral that increases the body’s level of testosterone. A special mention goes to spinach which is a very rich source of magnesium. An increase in magnesium can bind to testosterone and help you increase any low levels over time.

Beans: Beans and legumes such as chickpeas, lentils, black beans are good sources of zinc which is an essential nutrient that boosts testosterone production.

Fatty fish and Fish oil: Fatty fishes are highly beneficial in boosting testosterone levels as they are rich in omega-3-fatty acids. Some of them include Atlantic mackerel, herring, salmon, cod, tilapia, sardines, and trout.

Tuna: Tuna is rich in vitamin D which is linked to testosterone production. Taken fresh or canned, tuna is a natural testosterone booster.

Shellfish: From the sea, fish and oysters aren’t only amazing food sources that can assist you with your low T’s, lobsters and crabs can also be a tasty way to boost your t-levels. They are very high in zinc that boost testosterone secretion.

Extra virgin olive oil: Olive oil is rich in monounsaturated fats and vitamin E that improves male reproductive health. Small-scale studies indicate that this oil can boost testosterone levels in healthy adult men. It increases the luteinizing hormone (LH) which in turn stimulates cells in the testes that produce testosterone.

Onions: Onions are believed to be an aphrodisiac food that increases libido and strengthens the reproductive organs. Onions enhance testosterone production in males by enhancing the production of luteinizing hormones. It also neutralizes the damage from free radicals, mainly in testes, enhancing the antioxidant defense mechanism in the testis (31).

Egg yolk: Eggs are a great source of protein, cholesterol, vitamin D, and omega-3s, all of which are testosterone boosters. The Leydig cells in the testicles take cholesterol and turn it into testosterone.

Cruciferous vegetables: Vegetables such as broccoli, cauliflower, Brussel sprouts, kale, turnips, and cabbage are cruciferous vegetables and help increase testosterone levels by lowering estrogen levels. They contain a compound called indole-3-carbinol that is converted into a safer form of estrogen for the male body. This transformation allows the body to regulate testosterone levels more easily.

Beef: Even though red meat, beef can be a food that can support you in increasing your T-levels. They are a rich source of vitamin D and zinc that help increase testosterone levels.

Dark chocolate: Dark chocolate contains essential minerals such as zinc, magnesium, iron, and manganese that are crucial in testosterone production.

Grapes: Grapes are rich in vitamins that greatly boost testosterone levels in the body. The skin of the grapes contains resveratrol which is good for sperm health. Around 5-10 grams of grape skin has been believed to raise testosterone levels. Red grapes also contain boron that encourages the production of estrogen and testosterone.

Beetroot: Beets also contain boron which is essential for the production of testosterone and also increases levels of free testosterone. Beetroot also increases nitric oxide which increases the blood flow to the penis by dilating blood vessels and works as a natural erectile dysfunction drug.

Bananas: Bananas are high in vitamin B6 and potassium and contain a special enzyme called bromelain that can boost your libido as well as testosterone production.

The Final Note

Testosterone, the primary sex hormone in males, plays an important role in men’s health. However, with age, there is a gradual decrease in this hormone. Even though the decline is normal, if it gets below 300 ng/dL and the person experiences low T symptoms, treatment is recommended after a thorough diagnosis. 

It is always recommended to discuss the potential benefits and risks of testosterone medication. These days a holistic approach is recommended to treat low T. This includes lifestyle changes, weight loss, exercise, nutritious food, essential nutrients, supplements, and ayurvedic medications. 

There is no magic solution for boosting your testosterone levels, but a well-planned approach under proper guidance can do the trick.

About Tilottama Bose 82 Articles
With a Masters in Food Science and Nutrition, Tilottama has carved a niche for herself in the Health Writing Industry. She is passionate about helping her readers make informed decisions about the food they eat. She believes in the healing power of food and in food as medicine. Tilottama is an editor and writer at Fitnesshacks.org.