How to Increase Testosterone With or Without Medication

Testosterone-boosting supplements (T boosters) account for well over $2 billion in annual global sales, and manufacturers commonly promise that their products will boost T levels, improve libido, and build strength and muscle mass.

Despite a marked lack of evidence supporting these claims, consumers increasingly turn to natural remedies to fix low T levels. This includes older males who commonly experience hypogonadism (low testosterone) and also females and younger males who can also be affected.

If you believe you have the signs of low testosterone, you first need to undergo a hormone panel to measure your testosterone levels. Afterward, you can work with your healthcare provider to explore ways to raise your T levels, including lifestyle changes (like weight loss, diet, and exercise), dietary supplements, and testosterone replacement therapy.

Nondrug Approaches to Increase Testosterone

Testosterone is a hormone produced in people of any sex but in greater amounts by the testes. It is associated with male sexual development and characteristics. But in people of all sexes, it is also essential to bone health, muscle mass, sexual function, fertility, energy levels, and cognition.

When testosterone levels are low, a person can experience fatigue, a loss of muscle mass, low libido (sex drive), weight gain, bone loss, depression, and other symptoms.

When T levels are moderately impaired, many healthcare providers will recommend a nondrug approach to naturally and safely boost testosterone.

Here are some options to consider.

Weight Loss

Aromatase is an enzyme produced by the body that converts testosterone into the hormone estrogen. While the conversion is essential to the synthesis of sperm, the overproduction of aromatase can cause testosterone levels to drop below the expected value for your age.

One of the main causes is being overweight (defined as a body mass index, or BMI, of over 25). As adipose tissues (also known as body fat) increase, aromatase levels can also rise, sometimes precipitously.

Weight loss is a remedy for this. Studies have shown that for every one-point drop in your BMI, your testosterone levels can rise by as much as one point.

Exercise

A combination of aerobic exercise and resistance (weight) training has been shown in multiple studies to increase testosterone production. Although the mechanism for this effect is not entirely clear, several factors appear to have a positive effect:

• Exercise intensity: High-intensity exercise (in which respiration is increased to 90% of your aerobic capacity) boosts T levels more than low-intensity workouts (where aerobic capacity is 60% or less).
• Trained muscle groups: Exercising larger muscles like the quadriceps tends to increase testosterone levels more than smaller muscles like the biceps. Moreover, training with free weights appears to be more effective in boosting T levels than exercise machines.

A personal trainer can help reach these fitness goals,

Changes in Diet

There is no such thing as a “testosterone diet.” While certain foods may nominally boost testosterone levels—mainly by inhibiting aromatase activity—the main dietary culprit is poor nutrition rather than any single food that you may or may not eat.

Many nutrients, including protein, vitamin D, magnesium, and zinc, are essential to maintaining optimal T levels. A healthy, balanced diet can meet the recommended daily intake (RDI) of these nutrients.

In addition to following recommended dietary guidelines, some health experts suggest that certain food types can help support your testosterone health, including:

• Multicolored fruits and vegetables
• Nuts (particularly Brazil nuts)
• Seeds (particularly flaxseeds)
• Soy (including soy milk and tofu)

On the other hand, you should limit your intake of red meat, refined sugar, processed foods, and excessive dairy, which can increase adiposity and the production of aromatase.

Stress Management

Stress can affect T levels by stimulating the release of the stress hormone called cortisol. This is the hormone that triggers the fight-or-flight response which helps the body better cope with real or perceived threats.

However, a persistently high cortisol level blocks the production of luteinizing hormone (LH), which triggers the release of testosterone from the testicles or ovaries. Cortisol can also “compete” with testosterone, attaching to the same cellular receptors that testosterone usually binds to, making testosterone less effective.

To better manage stress and reduce cortisol levels:

• Get plenty of sleep: Sleep deprivation is associated with chronic cortisol elevations. Improving your sleep hygiene can better ensure a full night’s rest regularly.
• Avoid caffeine: Studies have shown that caffeine independently stimulates cortisol production, causing a modest decrease in testosterone levels even without stress.
• Practice mind-body therapies: Meditation, yoga, guided imagery, deep breathing exercises, and progressive muscle relaxation (PMR) have all proven effective in reducing cortisol levels.

Change of Medications

Opioid drugs sometimes prescribed to treat chronic pain are known to decrease T levels. They do so by suppressing the hypothalamus-pituitary-adrenal (HPA) axis, a trio of endocrine organs that interact in a feedback loop to regulate the body’s stress response.

This included opioids like:

The effect of these drugs on testosterone is almost immediate. When used for longer than 30 days, they could lead to the clinical signs of hypogonadism in both men and women.

Though some healthcare providers will prescribe testosterone replacement therapy to compensate for the imbalance, others recommend the gradual discontinuation and substitution of the opioid.

Supplements

The evidence supporting the use of dietary or herbal supplements to boost T levels is generally weak. Even so, T boosters remain popular with consumers who seek a more “natural” solution to raising testosterone. This is especially true with older men whose T levels are generally 35% lower than their younger counterparts.

That’s not to say that some supplements may not help. According to a 2020 review of studies published in the World Journal of Men’s Health, the following supplements showed some promise based on the available research:

On the other hand, supplements widely promoted for their T-boosting properties—like Ashwagandha, ginseng, maca root, vitamin D, and zinc—either showed mixed results or no results when taken in supplement form.

More worrisome is the fact that T boosters often contain excessive amounts of minerals and vitamins—in some cases, up to 9 times the upper tolerable intake level (UL) established by the Food and Drug Administration (FDA).

With minerals like zinc and magnesium, overdosing at this level can lead to potentially serious side effects like anemia (a low number of healthy red blood cells), neutropenia (a low number of infection-fighting white blood cells), and hypotension (low blood pressure), particularly if the user takes more than the manufacturer-recommended dose.

Prescribed Approaches to Increase Testosterone

Hormone replacement therapy (HRT) is the primary form of treatment for hypogonadism, although it can take very different forms for men and women.

HRT is generally recommended if there are clinical signs of hypogonadism—like infertility, osteoporosis, erectile dysfunction in males, or irregular periods in females—along with consistently low hormone levels.

Testosterone Replacement Therapy in Males

Testosterone replacement therapy (TRT) is the primary form of treatment for male hypogonadism recommended by the Endocrine Society. TRT is prescribed on an ongoing basis and monitored by a healthcare provider to avoid possible side effects and complications.

TRT can be prescribed in seven forms:

• • Testosterone pills: Although testosterone pills have long been associated with liver damage and fluctuating hormone levels, a new drug called Jatenzo (testosterone undecanoate) has proven effective in overcoming these concerns. Jatenzo is taken twice daily with food.
  • Testosterone gel: These topical gels deliver testosterone transdermally (through the skin) and provide steadier testosterone levels. Options like AndroGel, Testim, and Vogelxo are applied once daily to the upper arm or shoulder, while others like Fortesta are applied once daily to the thigh.
  • Testosterone patch: Androderm is the brand name of a transdermal adhesive patch applied once daily to your thigh or torso. The patch doesn’t need to be removed during sex or bathing, and the testosterone won’t rub off onto someone else like testosterone gels can.
  • Testosterone oral paste: This is a puttylike substance that you apply to the space above your top teeth where your gum and lip meet, called the buccal cavity. Sold under the brand name Striant, it is applied three times daily and may provide better results than the skin gel or patch.

• Testosterone nasal gel: Natesto is the brand name for a testosterone gel that you squirt into your nostril via a metered dose pump. Natesto is applied three times daily—one squirt in each nostril—and, while less convenient, may achieve better results than the skin gel or patch.
• Testosterone injection: Depo-testosterone (testosterone cypionate) is injected into a muscle and Delatestryl (testosterone enanthate) is injected under the skin. As injections deliver more testosterone than the topical options, they tend to raise T levels better. Depending on the testosterone dose and type, a shot may be needed every two to 10 weeks.
• Testosterone pellets: These are tiny pellets sold under the brand name Testopel that your healthcare provider inserts subcutaneously (under your skin). The pellets break down at a steady rate, helping maintain T levels for up to four months.

Hormone Replacement Therapy in Females

At present, no testosterone product is approved by the FDA for the treatment of low testosterone in females.

The use of TRT in women is highly controversial and generally advised against by the Endocrine Society. This is due in part to the virilizing (masculinizing) effects it can have on women. There is also a lack of evidence of its effectiveness and safety.

Even so, the Endocrine Society acknowledges that TRT may be a short-term option for postmenopausal women with hypoactive sexual desire disorder (HSDD). This is a condition in which a woman has low or no sexual desire in the absence of any notable cause.

With females, a decline in testosterone typically occurs alongside drops in estrogen and progesterone due to aging, menopause, or the removal of the ovaries (oophorectomy). In such instances, a healthcare provider would more likely prescribe estrogen replacement therapy (ERT) to reduce the risk of osteoporosis and help relieve symptoms like hot flashes and vaginal dryness.

In cases where low testosterone is caused by hypothyroidism or diseases of the hypothalamus or pituitary gland, the focus would be placed on treating those conditions.

Considerations Before Testosterone Replacement Therapy

Testosterone replacement therapy is not without risks and complications, some of which can be serious. As such, TRT should only be used in diagnosed cases of male hypogonadism and, if requested, the treatment of HSDD in females.

In males, the side effects and risks of TRT include:

In females, TRT may cause side effects and complications like:

• Acne and oily skin
• An enlarged clitoris
• Breast shrinkage (breast atrophy)
• Increases in muscle mass
• Irregular periods or the cessation of periods (amenorrhea)
• Aggression and irritability
• Changes in skin texture, including darkening or thickening
• Male pattern baldness (androgenic alopecia)
• Abnormal facial or body hair (hirsutism)

How to Test Your Testosterone Levels

Testosterone levels can be measured with a blood test called a total testosterone (TT) test. This test measures both the active form of testosterone in your blood, called free testosterone (FT), and the inactive form, called bioavailable testosterone (BT).

TT levels are measured in nanograms per deciliter (ng/dL). The normal value differs by sex and age.

The blood sample should be taken in the morning between 7 a.m. and 10 a.m. During these hours, your testosterone levels are at their highest.

Your healthcare provider may also order a separate FT test, measured in picograms per deciliters (pg/dL). This can help characterize your low testosterone level and help narrow the possible cause.

A BT test is less commonly ordered and reflects biologically active testosterone in serum.