Implement a holistic approach to boost testosterone by getting leaner, improving diet, addressing micronutrient deficiencies, quitting smoking and drinking, and optimizing sleep.
Reduce body fat, especially if obese, as excess fat elevates aromatization (testosterone to estrogen conversion), which can suppress the brain’s signal to produce testosterone.
Choose a diet and exercise regimen that you can consistently adhere to, as long-term adherence is often more effective than strictly optimal but unsustainable plans.
Incorporate resistance training into your exercise regimen as it is the most directly impactful form of exercise for boosting testosterone and building muscle and bone.
Minimize alcohol consumption as it directly inhibits testosterone production in the testicles and negatively impacts sleep, further hindering hormone output.
Avoid smoking as it is detrimental to overall health and likely negatively impacts testosterone levels.
Maintain a diet with sufficient fat intake, as fats serve as the necessary substrate for producing cholesterol-derived hormones like testosterone.
Ensure adequate carbohydrate intake in your diet, as insulogenic signaling from carbohydrates is somewhat necessary to facilitate the liberation of free, biologically active hormones.
Consume enough protein to support muscle building and recovery from workouts, which indirectly improves body composition and hormone levels.
Ensure adequate fueling and nutrition, especially for intensive endurance training or calorie deficits, to prevent malnourishment and hormone deficiency, which can lead to hypogonadism.
Minimize exposure to endocrine-disrupting chemicals by using glass instead of plastic for heating food, ensuring high-quality air, and maintaining good water quality.
Measure testosterone levels early in the morning to assess peak levels, as testosterone secretion is pulsatile and highest then.
Avoid taking biotin or biotin-containing supplements before a testosterone test, as they can confound results.
Be hydrated before blood tests to ensure an accurate hematology profile, preventing misinterpretation of elevated hematocrit levels due to dehydration.
Get repeat measurements of testosterone levels, especially if initial readings are low or concerning, to confirm findings before deciding on any interventions.
Focus on both total testosterone (reflects total production capacity) and free testosterone (biologically active, unbound) for a comprehensive assessment of hormone status.
Interpret testosterone blood values in combination with symptoms, as individual androgen receptor sensitivity means absolute levels don’t always dictate health outcomes.
Be aware that exceptionally high natural total testosterone levels (e.g., 1300 total T) can sometimes indicate an underlying issue where the body is overcompensating to achieve adequate activity.
Supplement with zinc, magnesium, and vitamin D if deficient, as these micronutrients significantly impact testosterone production and receptor activity.
Prioritize magnesium supplementation, as it is rarely adequately dosed in multivitamins due to its weight, despite its importance for hormone health.
Supplement vitamin D, ensuring the dose is adequate, as it’s fat-soluble and often underdosed in multivitamins, impacting testosterone production and response.
Consider supplementing 6-12 milligrams of boron, as it may help suppress SHBG levels, thereby increasing free testosterone.
If considering ashwagandha, choose a patented extract like Sensorial (10% withanolides) or KSM-66 (5% withanolides) to ensure potency and efficacy.
Take 600mg of standardized ashwagandha (e.g., KSM-66 or Sensorial) to potentially suppress cortisol and stress response, which can indirectly boost testosterone by over 100 points for those who benefit.
Be cautious with ashwagandha, as overdoing it can lead to anhedonia (numbing of emotion) by excessively suppressing the stress response; adjust dose based on individual response.
Consider Tonkat Ali, which may suppress SHBG and upregulate intratesticular testosterone production, potentially boosting total testosterone by 100-200 ng/dL for some.
When selecting Tonkat Ali, ensure it is HPLC tested for Eurycomanone, as this is the active ingredient responsible for its bioactive effects.
Consider high-quality shilajit, which may act as a potent antioxidant to improve intratesticular antioxidant activity and support local hormone production.
Assess cortisol stress response using a Dutch test (salivary cortisol) rather than a single blood test, as it provides a more indicative average curve of daily fluctuations.
Work with a highly educated medical professional for TRT and hormone optimization, rather than self-administering or relying solely on online content.
Educate yourself on TRT mechanisms and protocols to identify reputable clinics and avoid being pressured into unnecessary or suboptimal lifelong hormone support.
Do not delay TRT if symptomatic and quality of life is suffering, but also perform due diligence to understand the underlying cause of low testosterone.
Expect TRT to primarily ameliorate symptoms of low testosterone, with the goal of achieving a physiological replacement level, not necessarily to feel like a ‘superman’.
Avoid making rash decisions about TRT based solely on blood test numbers; consider symptoms, genetics, and individual response.
Be aware that testosterone administration, especially at higher doses, will increase erythropoiesis (red blood cell production), which requires monitoring.
Regularly monitor your hematology panel (red blood cell count, hematocrit, hemoglobin) while on TRT to ensure levels remain within a healthy range.
Understand that androgens will dose-dependently drive erythropoiesis, induce cardiac remodeling (if pushed too hard), and increase dyslipidemia risk; these are crucial considerations for TRT.
Undergo a basic sleep study before starting TRT to establish a baseline for sleep apnea, as TRT can exacerbate obstructive sleep apnea.
Avoid infrequent, high-dose testosterone injections (e.g., once a week) as they cause supra-physiological peaks and crashes, leading to more problematic biomarker elevations compared to stable, daily administration.
Strive for a TRT protocol that mimics daily physiological testicular output (e.g., daily micro-injections or twice-daily scrotal cream) for the most stable hormone levels and reduced side effects.
Avoid testosterone pellets and Androgel for men, as they may not provide optimal or consistent physiological replacement.
Use scrotal testosterone cream from compounding pharmacies for a natural-mimicking absorption and pharmacokinetic profile, offering a favorable outcome for TRT.
Opt for subcutaneous testosterone injections, potentially every other day, to achieve more stable blood levels and a more predictable hormone concentration curve compared to less frequent intramuscular injections.
If using testosterone cream, be highly cautious of transference to children or pets due to the risk of accidental exposure and masculinization.
Understand that TRT will significantly suppress, if not entirely eliminate, fertility by shutting down natural signaling to the testes.
If on TRT and desiring to maintain fertility, implement an adjunct protocol (e.g., HCG + recombinant FSH) to replicate natural signaling and prevent testicular atrophy.
Be aware that testicular shrinkage will occur within weeks to months of starting TRT due to the suppression of natural signaling.
Obtain a comprehensive baseline blood panel before starting TRT to accurately monitor changes and identify any issues that may arise.
Regularly monitor a comprehensive set of biomarkers on TRT, including hematology, kidney function (Cystatin C, SDMA), metabolic parameters (fasting insulin, HbA1c), lipid panel (especially HDL), LH/FSH (should be suppressed), estradiol (LCMS), clotting risks, LP(a), thyroid hormones, and IGF-1.
Ensure total testosterone is measured using Liquid Chromatography with Tandem Mass Spectrometry (LCMS) for accuracy, especially at lower levels, avoiding less accurate immunoassay tests.
Measure free testosterone directly using equilibrium ultrafiltration or dialysis, rather than relying on calculated estimates, for accurate assessment.
Always use sensitive assay testing for estradiol, total testosterone, and free testosterone to ensure accurate measurements, particularly for women and at lower hormone levels.
Women should ensure their testosterone levels are assessed accurately using LCMS methodology due to their lower concentrations, which are prone to inaccurate measurement by less sensitive tests.
If using oral contraceptives, assess your testosterone levels, as they can artificially suppress hormones into a hypogonadal range for women.
Women considering testosterone therapy must be extremely cautious of irreversible virilization side effects like voice deepening, which can be quality-of-life destroying.
Women on testosterone therapy should use a vetted app to monitor their voice tone for any changes in inflection or deepness, as voice deepening can be irreversible.
If a woman is found to be adrenal insufficient and has low DHEA-S, a DHEA oral supplement (25-50mg, starting lower) may be beneficial for testosterone conversion.
When supplementing DHEA, women should start with a low dose (e.g., 25mg) and monitor for androgenic side effects like acne, as individual responses vary.
Take preventative and proactive measures against hair loss, as it is cumulative and insidious, and once follicles undergo fibrosis, recovery is difficult.
Carefully weigh the risk-to-reward ratio of inhibiting DHT for hair loss, considering potential side effects versus the benefit of preventing miniaturization.
Research the scientific literature on finasteride and dutasteride to understand the actual prevalence and nature of side effects, rather than relying on anecdotal claims.
Use ketoconazole shampoo as a mild antiandrogen and 5-alpha reductase inhibitor to provide additive protection against hair loss, especially when combined with other treatments.
Use FDA-approved minoxidil as a hair growth stimulant, understanding that its efficacy depends on individual enzymatic conversion capacity in the scalp.
If minoxidil is ineffective, consider compounding it with tretinoin to upregulate sulfotransferase enzyme activity in the scalp, improving conversion to its active form.
Incorporate microneedling (e.g., 0.6mm depth once a week) to enhance minoxidil absorption and upregulate sulfotransferase enzyme activity, potentially improving hair growth results.
Understand that minoxidil stimulates hair growth but does not prevent further miniaturization caused by DHT; DHT inhibitors are necessary for prevention.
To effectively prevent hair loss, it is generally necessary to inhibit DHT, as it is the primary driver of androgenic alopecia.