Men’s Hormone Health: Testosterone, Vitality & Aging Well

The Male Hormonal Landscape

Men are often told their hormones are simple. One hormone — testosterone — and it either works or it does not. This is a dangerous oversimplification. The male endocrine system is an interconnected web, and understanding it properly is the difference between treating a lab number and restoring a man’s vitality.

Testosterone is the king hormone — driving muscle mass, bone density, libido, motivation, confidence, red blood cell production, fat distribution, and mood. But it does not rule alone.

DHEA (dehydroepiandrosterone) is the adrenal precursor — the raw material from which the body manufactures both testosterone and estrogen. It declines steadily from its peak in the mid-20s.

DHT (dihydrotestosterone) is testosterone’s more potent androgen metabolite, created by the enzyme 5-alpha reductase. DHT drives male pattern hair loss in genetically susceptible men and is a factor in prostate growth — but it also supports libido, confidence, and neurological function. It is not simply a villain.

Estradiol (E2) — yes, men need it. Estradiol is essential for bone density, joint health, brain function, cardiovascular protection, and libido. The problem is not estradiol itself but excess estradiol, typically driven by aromatase enzyme activity in visceral fat. Too much estradiol causes gynecomastia (breast tissue enlargement), water retention, emotional volatility, and erectile difficulty. Too little causes joint pain, bone loss, depression, and poor libido. The target is balance.

Cortisol is testosterone’s metabolic antagonist — when cortisol goes up, testosterone goes down. They share a common precursor (pregnenolone), and under chronic stress, the body preferentially produces cortisol at the expense of testosterone. This is sometimes called “pregnenolone steal.”

Thyroid hormones regulate metabolic rate and interact with every hormone in the body. Low thyroid function mimics low testosterone symptoms — fatigue, weight gain, brain fog, low libido.

Insulin — insulin resistance is one of the most common and most overlooked drivers of hormonal dysfunction in men. Elevated insulin increases aromatase activity (more T-to-E2 conversion), increases SHBG dysregulation, and promotes visceral fat accumulation.

Growth hormone declines with age (somatopause), contributing to loss of lean mass, increased body fat, decreased recovery, and reduced vitality.

The Modern Testosterone Crisis

Unlike menopause, male hormonal decline is gradual — approximately 1-2% per year after age 30. By age 50, a man may have 20-40% less testosterone than he did at 25. This is natural aging.

What is not natural is the accelerated decline that population studies reveal. Research comparing testosterone levels of men at the same ages across decades shows that the average testosterone level in 2020 is approximately 20% lower than it was in men of the same age in the 1990s. A 40-year-old man today has significantly less testosterone than a 40-year-old man in 1985 — at the same age, same BMI, same demographic.

The culprits are environmental and behavioral: endocrine-disrupting chemicals (BPA, phthalates, PFAS — all anti-androgenic), increasing obesity rates, chronic stress and sleep deprivation, sedentary lifestyles, ultra-processed diets, and certain medications (opioids, statins, SSRIs, PPIs).

Symptoms of Low Testosterone

The symptom picture extends far beyond the bedroom:

Persistent fatigue that does not improve with rest. Low motivation and drive — the feeling that the fire has gone out. Progressive loss of muscle mass despite training. Increased body fat, especially visceral abdominal fat. Decreased libido. Erectile dysfunction. Depression or low mood — a flat, gray emotional landscape. Brain fog and difficulty concentrating. Poor sleep quality. Decreased bone density. Irritability and reduced stress tolerance. Loss of morning erections — one of the most reliable clinical indicators of testosterone status.

Many men tolerate these symptoms for years, attributing them to aging, work stress, or life circumstances. They are often told their labs are “normal.” Which brings us to testing.

Comprehensive Testing: Beyond Total Testosterone

Checking only total testosterone is like checking only the balance in your checking account without looking at your savings, debts, or spending. You get a number, but you do not get the picture.

Total testosterone — The sum of all testosterone in the blood, bound and unbound. The reference range on most lab reports is absurdly wide: 264-916 ng/dL. This means a 30-year-old man at 280 ng/dL is flagged as “normal” even though he is at the bottom of the range and almost certainly symptomatic. Optimal functional range is 700-1000 ng/dL for men under 60.

Free testosterone — Only 2-3% of total testosterone circulates unbound (free) and available for the body to use. This is the bioactive fraction. A man can have normal total testosterone but low free testosterone if his binding proteins are elevated. Optimal range: 15-25 pg/mL.

SHBG (Sex Hormone-Binding Globulin) — The protein that binds testosterone and makes it unavailable. Optimal: 25-45 nmol/L. High SHBG (caused by hyperthyroidism, liver disease, aging, certain medications, excessive endurance exercise) means more testosterone is bound and less is free. Low SHBG (caused by insulin resistance, obesity, hypothyroidism, high-dose androgens) can paradoxically mean high free T with symptoms of excess.

Estradiol (E2) — Optimal: 20-35 pg/mL in men. Too low (below 15) causes joint pain, bone loss, depression, and poor libido. Too high (above 40-50) causes gynecomastia, water retention, emotional lability, and erectile difficulty. Elevated E2 in men is almost always driven by aromatase activity in visceral belly fat — the more visceral fat, the more testosterone is converted to estrogen.

DHT — The androgenic metabolite. Elevated DHT combined with genetic susceptibility drives male pattern baldness. Medications like finasteride block DHT production but can have significant sexual side effects.

DHEA-S — Optimal: 250-500 mcg/dL. The adrenal androgen precursor. Low DHEA-S suggests adrenal depletion and limited raw material for testosterone production.

LH and FSH — These pituitary hormones tell you where the problem originates. Low LH combined with low testosterone (secondary hypogonadism) means the brain is not sending the signal — often caused by chronic stress, obesity, opioid use, or pituitary dysfunction. High LH combined with low testosterone (primary hypogonadism) means the brain is shouting but the testes are not responding — testicular failure, varicocele, or damage.

Prolactin — Should be below 15 ng/mL. Elevated prolactin suppresses GnRH, which suppresses LH, which suppresses testosterone. Causes include pituitary adenoma (prolactinoma — usually benign), medications (antipsychotics, SSRIs, PPIs), and hypothyroidism.

Additional essential labs: full thyroid panel (TSH, free T3, free T4, antibodies), fasting insulin (insulin resistance is a testosterone killer), CBC (baseline hematocrit before any testosterone therapy), and PSA (prostate-specific antigen baseline).

Natural Testosterone Optimization: The IFM Lifestyle-First Approach

Before reaching for any prescription, optimize the foundations. In many men — especially those with secondary hypogonadism driven by lifestyle factors — natural optimization can raise testosterone 200-400 ng/dL.

Sleep: The Testosterone Factory

Testosterone is produced primarily during deep sleep. The Leproult study (2011, JAMA) demonstrated that restricting healthy young men to five hours of sleep per night for one week reduced testosterone by 10-15% — equivalent to aging 10-15 years. This is not a marginal effect. Seven to nine hours of quality sleep is non-negotiable for testosterone production.

Obstructive sleep apnea (OSA) is a massive, under-diagnosed testosterone killer. The repeated oxygen desaturation events during apnea suppress testicular function. Men with untreated sleep apnea consistently show lower testosterone levels that improve with CPAP therapy. If you snore, are overweight, and have low testosterone — get a sleep study.

Resistance Training: The Most Powerful Natural Intervention

Heavy compound resistance training is the single most effective natural testosterone booster. The key variables: compound movements (squat, deadlift, bench press, overhead press, rows) that recruit large muscle groups, heavy loads (70-85% of one-rep maximum), moderate volume (3-5 sets of 5-8 reps), and adequate frequency (3-4 sessions per week).

The caveat is critical: chronic overtraining — excessive volume, insufficient recovery, endurance-heavy programs without adequate rest — elevates cortisol chronically, which directly suppresses testosterone. The dose makes the medicine. Train hard, recover harder.

Body Composition: Lose the Visceral Fat

Visceral fat is an endocrine organ that actively works against you. It contains high concentrations of aromatase enzyme, which converts testosterone to estradiol. More belly fat means more testosterone-to-estrogen conversion. This creates a vicious cycle: low testosterone promotes fat storage, which increases aromatase activity, which lowers testosterone further.

The data is clear: every 1-point increase in BMI is associated with approximately 2% lower testosterone. A waist circumference above 40 inches in men is a strong predictor of low testosterone and metabolic dysfunction. Weight loss — specifically visceral fat loss — directly increases free testosterone.

Stress Management: The Cortisol-Testosterone Seesaw

Cortisol and testosterone sit on opposite ends of a metabolic seesaw. Chronic psychological stress keeps cortisol elevated, which directly suppresses GnRH pulse frequency at the hypothalamic level, reducing LH secretion and downstream testosterone production. The pregnenolone steal hypothesis — where the body diverts the shared precursor pregnenolone toward cortisol production at the expense of sex hormones — further explains why chronically stressed men have low testosterone.

Meditation (even 10 minutes daily), controlled breathing (box breathing: 4 seconds in, 4 hold, 4 out, 4 hold), time in nature, and establishing firm boundaries around work and recovery are not optional wellness luxuries. They are testosterone optimization strategies.

Nutrition: Feed the Machinery

Dietary fat — Cholesterol is the raw material from which all steroid hormones (including testosterone) are synthesized. Very low-fat diets (below 20% of calories from fat) consistently show lower testosterone levels. Include healthy fats from eggs (whole, with yolks), olive oil, avocados, nuts, fatty fish, and grass-fed meat.

Zinc-rich foods — Oysters are the single richest dietary source of zinc. Beef, lamb, pumpkin seeds, cashews, and dark chocolate also provide significant amounts. Zinc deficiency alone is sufficient to cause hypogonadism — it is required for every step of testosterone synthesis.

Adequate calories — Severe caloric restriction (crash diets, prolonged aggressive deficits) rapidly tanks testosterone. The body interprets starvation as a survival threat and down-regulates reproductive function. Moderate, sustainable caloric deficits (300-500 calories below maintenance) preserve testosterone while still enabling fat loss.

Adequate protein — 1.6-2.2 grams per kilogram of body weight daily for training men. Protein supports muscle protein synthesis, provides amino acids for hormone production, and helps maintain lean mass during fat loss.

Limit alcohol — More than two drinks per day significantly reduces testosterone. Beer contains phytoestrogens from hops that add insult to injury. Acute binge drinking suppresses testosterone for up to 24 hours.

Limit sugar — Glucose ingestion acutely drops testosterone by approximately 25% for up to two hours (Caronia 2013, Clinical Endocrinology). Chronic sugar intake drives insulin resistance, which drives aromatase activity, which drives testosterone-to-estrogen conversion.

Key Supplements for Testosterone Support

Zinc — 30-50mg daily (as picolinate or bisglycinate). The single most important mineral for testosterone production. Zinc is a cofactor for the enzymes that convert cholesterol to testosterone. Deficiency is common in athletes (lost through sweat), vegetarians, and men with GI dysfunction.

Magnesium — 400-600mg daily (as glycinate or malate). Magnesium binds to SHBG, liberating free testosterone. It also supports sleep quality, which supports testosterone production.

Vitamin D3 — 5,000-10,000 IU daily, targeting serum levels of 50-70 ng/mL. Vitamin D is technically a hormone precursor, and the testes have vitamin D receptors. Multiple studies show that men with vitamin D levels above 50 ng/mL have significantly higher testosterone than men below 30 ng/mL.

Boron — 6-10mg daily. A trace mineral that reduces SHBG (increasing free testosterone by approximately 25% in studies), reduces estradiol, and supports vitamin D metabolism. One of the most under-appreciated testosterone support nutrients.

Ashwagandha KSM-66 — 600mg daily. This standardized extract of Withania somnifera has robust clinical trial evidence showing 15-17% increase in testosterone, significant reduction in cortisol (by 27%), and improvements in muscle strength and recovery. It works through HPA axis modulation and direct effects on Leydig cell function.

Tongkat Ali (Eurycoma longifolia) — 200-400mg daily of a standardized extract. Malaysian research shows it reduces SHBG, increases free testosterone, and improves sperm parameters. It has been used in traditional Southeast Asian medicine for centuries.

Fenugreek (Trigonella foenum-graecum) — 500mg daily. Contains furostanolic saponins that inhibit both aromatase (reducing T-to-E2 conversion) and 5-alpha reductase (reducing T-to-DHT conversion), effectively keeping more testosterone as testosterone.

DIM (diindolylmethane) — 100-200mg daily. Derived from cruciferous vegetables, DIM supports healthy estrogen metabolism by promoting the 2-hydroxy estrogen pathway over the more proliferative 4-hydroxy and 16-hydroxy pathways. Most useful in men with elevated estradiol.

DHEA — 25-50mg daily, taken in the morning. As a precursor hormone, DHEA supplementation can increase both testosterone and estrogen. MUST be guided by lab testing of DHEA-S levels. Inappropriate use can elevate estradiol.

Reduce Endocrine Disruptor Exposure

Plastics containing BPA and phthalates are specifically anti-androgenic — they suppress testosterone production and block androgen receptors. Pesticides (particularly atrazine and organochlorines) feminize male wildlife and are linked to reduced testosterone in agricultural workers. Switch to glass food storage, filter your water, eat organic when possible, and use clean personal care products.

A brief note on soy: moderate soy intake (traditional fermented forms like tempeh, miso, natto) is fine for most men. Excessive soy protein isolate consumption (multiple soy-based protein shakes daily) can provide enough phytoestrogens to affect sensitive individuals. Topical lavender and tea tree oils have shown mild estrogenic and anti-androgenic effects in case reports involving prepubertal boys — probably not a concern for adult men at typical exposure levels but worth mentioning.

When to Consider TRT (Testosterone Replacement Therapy)

Testosterone replacement therapy should be considered when: total testosterone is persistently below 300 ng/dL (or free testosterone below 5 pg/mL), symptoms are present and affecting quality of life, AND lifestyle optimization has been diligently pursued for 3-6 months without adequate improvement.

Options

Topical gel or cream (testosterone cypionate or compounded testosterone in a cream base) — applied daily, provides steady-state levels, easy to adjust. Most common starting approach.

Injections (testosterone cypionate or enanthate) — typically 100-200mg weekly or split into twice-weekly injections for more stable levels. Some men prefer the predictability and cost-effectiveness of injections.

Pellets — subcutaneous implants (Testopel) placed every 3-4 months. Convenient but less flexible for dose adjustment.

Clomiphene citrate — an off-label option that stimulates the pituitary to produce more LH, which stimulates the testes to produce more testosterone naturally. This preserves testicular function and fertility, making it a preferred option for younger men who want to maintain fertility. Typical dose: 25-50mg every other day or daily.

Critical Monitoring on TRT

PSA — monitor prostate-specific antigen at baseline and every 6-12 months. TRT does not cause prostate cancer (this myth has been debunked), but it can accelerate the growth of an existing undetected prostate cancer. A rapidly rising PSA warrants urological evaluation.

Hematocrit/hemoglobin — TRT stimulates erythropoiesis (red blood cell production). Hematocrit above 54% increases blood viscosity and clotting risk (polycythemia). Monitor every 3-6 months. If hematocrit rises too high, therapeutic phlebotomy (blood donation) or dose reduction may be needed.

Estradiol — monitor E2 and manage with aromatase inhibitors (anastrozole 0.25-0.5mg twice weekly) only if E2 rises above 40-50 pg/mL with symptoms. Over-suppression of estradiol causes joint pain, mood disturbances, and bone loss.

Lipid panel — TRT can affect HDL (sometimes lowering it) and other lipid markers. Monitor annually.

The Fertility Warning

This is critical: exogenous testosterone shuts down the hypothalamic-pituitary-gonadal (HPG) axis through negative feedback. LH and FSH drop to near zero. The testes, no longer receiving the signal to produce testosterone or sperm, atrophy and sperm production ceases. Exogenous testosterone is effectively a male contraceptive. This effect is usually reversible upon discontinuation, but recovery can take months, and in some men, full recovery of spermatogenesis is not guaranteed.

For men who want to preserve fertility: use clomiphene citrate instead of exogenous testosterone, or add HCG (human chorionic gonadotropin, 500-1000 IU two to three times weekly) to TRT to maintain intratesticular testosterone and preserve testicular size and sperm production.

The Integrated Approach

The functional medicine approach to male hormone health is not about chasing a number on a lab report. It is about restoring the conditions under which a man’s body can produce optimal hormones naturally — and using bioidentical replacement judiciously when the body needs additional support.

Sleep, lift heavy things, manage stress, eat real food, maintain a healthy body composition, minimize toxin exposure, address nutrient deficiencies, and build meaningful relationships. These are not vague wellness platitudes. They are the evidence-based foundations of male hormonal health, each backed by specific physiological mechanisms that directly influence testosterone production, metabolism, and receptor sensitivity.

Your hormones are a readout of your overall health. Optimize the system, and the hormones follow.