♂️Natural Testosterone Optimization Protocol
Our natural, non-pharmaceutical testosterone optimization protocol.
Last updated: May 16, 2024
Conflicts to declare: None. Please remember to consult with a healthcare provider prior to undertaking any of the protocols available here.
This protocol is currently being finalized from the following collected abstracts:
Sleep and circadian health
Leproult, R., & Van Cauter, E. (2010). Effect of 1 week of sleep restriction on testosterone levels in young healthy men. JAMA, 303(19), 1961-1962.
This study investigates the impact of sleep restriction on testosterone levels in young healthy men and demonstrates a significant decrease in testosterone levels following one week of sleep restriction.
Axelsson, J., Ingre, M., Akerstedt, T., & Holmbäck, U. (2005). Effects of acutely displaced sleep on testosterone. Journal of Clinical Endocrinology & Metabolism, 90(8), 4530-4535.
This study examines the effects of acute sleep displacement on testosterone levels and demonstrates a decrease in testosterone following sleep disruption.
Leproult R, Van Cauter E. Effect of 1 week of sleep restriction on testosterone levels in young healthy men. JAMA. 2011 Jun 1;305(21):2173-4. doi: 10.1001/jama.2011.710. PMID: 21632481; PMCID: PMC4445839.
Daytime testosterone levels were decreased by 10% to 15% in this small convenience sample of young healthy men who underwent 1 week of sleep restriction to 5 hours per night. This testosterone decline was associated with lower vigor scores but not with increased levels of cortisol, a stress-responsive hormone that can inhibit gonadal function.
Stress control
Chida, Y., & Steptoe, A. (2009). Cortisol awakening response and psychosocial factors: a systematic review and meta-analysis. Biological Psychology, 80(3), 265-278.
Chronic stress can elevate cortisol levels, which may suppress testosterone production. Incorporate stress-reducing activities like meditation, yoga, or deep breathing exercises into your routine to help manage stress levels
Exercise
Kumagai H, Zempo-Miyaki A, Yoshikawa T, Tsujimoto T, Tanaka K, Maeda S. Increased physical activity has a greater effect than reduced energy intake on lifestyle modification-induced increases in testosterone. J Clin Biochem Nutr. 2016 Jan;58(1):84-9. doi: 10.3164/jcbn.15-48. Epub 2015 Nov 27. PMID: 26798202; PMCID: PMC4706091.
We found a significant positive correlation between the changes in serum testosterone levels and the number of steps. Our results suggested that an increase in physical activity greatly affected the increased serum testosterone levels in overweight and obese men during lifestyle modification.
Resistance Training: Engaging in regular strength training exercises, such as weightlifting or bodyweight exercises, can stimulate testosterone production. Focus on compound exercises like squats, deadlifts, bench presses, and rows, as they target multiple muscle groups simultaneously.
West, D. W., & Phillips, S. M. (2010). Anabolic processes in human skeletal muscle: restoring the identities of growth hormone and testosterone. Physiological Reports, 98(3), 531-532.
West, D. W., & Phillips, S. M. (2010). Anabolic processes in human skeletal muscle: restoring the identities of growth hormone and testosterone. Physiological Reports, 98(3), 531-532.
Kraemer, W. J., Ratamess, N. A., & Nindl, B. C. (2017). Recovery responses of testosterone, growth hormone, and IGF-1 after resistance exercise. Journal of Applied Physiology, 122(3), 549-558.
High-Intensity Interval Training (HIIT): HIIT workouts involve short bursts of intense activity followed by brief rest periods. This type of exercise has been shown to boost testosterone levels effectively.
Ratamess, N. A., Faigenbaum, A. D., Bush, J. A., & Kang, J. (2015). The effects of high-intensity interval training on hormonal responses to resistance exercise in overweight young men. Journal of Strength and Conditioning Research, 29(5), 1446-1454.
Hackney, A. C., Hosick, K. P., Myer, A., & Rubin, D. A. (2012). Testosterone responses to intensive interval versus steady-state endurance exercise. Journal of Endocrinological Investigation, 35(11), 947-950.
Endurance Exercise: While intense, short-duration exercises are effective, moderate endurance activities like running, cycling, or swimming can also contribute to increasing testosterone levels, especially when done consistently.
Hackney, A. C. (1989). Effects of endurance exercise on the reproductive system of men: the “exercise-hypogonadal male condition”. Journal of Endocrinological Investigation, 12(4), 274-283.
Tosti, V., Bertozzi, B., Fontana, L., Bernardi, F., Cannata, D., Castellucci, M., ... & Brandi, M. L. (2016). Relationship between testosterone deficiency and cardiovascular risk and mortality in adult men. Journal of Endocrinological Investigation, 39(9), 1045-1053.
Weight management and caloric restriction
https://pubmed.ncbi.nlm.nih.gov/25982085/ - A bidirectional relationship between testosterone and obesity underpins this association indicated by the hypogonadal-obesity cycle and evidence weight loss can lead to increased testosterone levels
https://pubmed.ncbi.nlm.nih.gov/23482592/ - Body weight loss is also associated with a decrease in estradiol and an increase in gonadotropins levels. When males starts gaining weight from extra fat tissue, he’s got more and more aromatases converting his testosterone into estrogen. And thus, his testosterone levels will begin to fall.
https://pubmed.ncbi.nlm.nih.gov/24407187/ - More severe obesity is additionally associated with reductions in free testosterone levels due to suppression of the HPT axis. Low testosterone by itself leads to increasing adiposity, creating a self-perpetuating cycle of metabolic complications. Obesity-associated hypotestosteronemia is a functional, non-permanent state, which can be reversible, but this requires substantial weight loss.
Cangemi, R., Friedmann, A. J., Holloszy, J. O., & Fontana, L. (2010). Long-term effects of calorie restriction on serum sex-hormone concentrations in men. Aging Cell, 9(2), 236-242.
Isidori, A. M., Giannetta, E., Greco, E. A., Gianfrilli, D., Bonifacio, V., Aversa, A., ... & Lenzi, A. (2005). Effects of testosterone on body composition, bone metabolism and serum lipid profile in middle-aged men: a meta-analysis. Clinical Endocrinology, 63(3), 280-293.
Kapoor, D., Goodwin, E., Channer, K. S., & Jones, T. H. (2006). Testosterone replacement therapy improves insulin resistance, glycaemic control, visceral adiposity and hypercholesterolaemia in hypogonadal men with type 2 diabetes. European Journal of Endocrinology, 154(6), 899-906.
Vitamin D and testosterone
Relationship between Vitamin D & Testosterone
Holick, M. F. (2007). Vitamin D deficiency. New England Journal of Medicine, 357(3), 266-281.
This review article discusses the importance of vitamin D, its synthesis in the skin through sunlight exposure, and its role in various physiological processes, including hormone regulation.
Pilz, S., Frisch, S., Koertke, H., Kuhn, J., Dreier, J., Obermayer-Pietsch, B., ... & Zittermann, A. (2011). Effect of vitamin D supplementation on testosterone levels in men. Hormone and Metabolic Research, 43(3), 223-225.
This study investigates the effect of vitamin D supplementation on testosterone levels in men with vitamin D deficiency and found a significant increase in testosterone levels following supplementation.
Nimptsch, K., Platz, E. A., Willett, W. C., & Giovannucci, E. (2012). Association between plasma 25-OH vitamin D and testosterone levels in men. Clinical Endocrinology, 77(1), 106-112.
This research examines the association between plasma vitamin D levels and testosterone levels in men and suggests a positive correlation between the two, with higher vitamin D levels associated with higher testosterone levels.
Wang, N., Han, B., Li, Q., Chen, Y., Chen, Y., Xia, F., ... & Xia, Y. (2020). Relationship between serum 25-hydroxyvitamin D and testosterone levels in men. Clinical Endocrinology, 93(6), 631-637.
This study explores the relationship between serum vitamin D levels and testosterone levels in men and finds a positive correlation between the two, indicating that adequate vitamin D status may support healthy testosterone levels.
Wehr, E., Pilz, S., Boehm, B. O., März, W., & Obermayer‐Pietsch, B. (2010). Association of vitamin D status with serum androgen levels in men. Clinical Endocrinology, 73(2), 243-248.
This study investigates the association between vitamin D status and serum androgen levels in men and suggests a positive correlation between vitamin D levels and testosterone levels.
Supplementing with Vitamin D for testosterone
Pilz S, Frisch S, Koertke H, Kuhn J, Dreier J, Obermayer-Pietsch B, Wehr E, Zittermann A. Effect of vitamin D supplementation on testosterone levels in men. Horm Metab Res. 2011 Mar;43(3):223-5. doi: 10.1055/s-0030-1269854. Epub 2010 Dec 10. PMID: 21154195.
Compared to baseline values, a significant increase in total testosterone levels (from 10.7 ± 3.9 nmol/l to 13.4 ± 4.7 nmol/l; p < 0.001), bioactive testosterone (from 5.21 ± 1.87 nmol/l to 6.25 ± 2.01 nmol/l; p = 0.001), and free testosterone levels (from 0.222 ± 0.080 nmol/l to 0.267 ± 0.087 nmol/l; p = 0.001) were observed in the vitamin D supplemented group. By contrast, there was no significant change in any testosterone measure in the placebo group.
Health risks of excessive vitamin D supplementation
Galior K, Grebe S, Singh R. Development of Vitamin D Toxicity from Overcorrection of Vitamin D Deficiency: A Review of Case Reports. Nutrients. 2018 Jul 24;10(8):953. doi: 10.3390/nu10080953. PMID: 30042334; PMCID: PMC6115827.
Excess amounts of vitamin D are toxic because vitamin D increases calcium absorption in the gastrointestinal tract, vitamin D toxicity results in marked hypercalcemia (total calcium greater than 11.1 mg/dL, beyond the normal range of 8.4 to 10.2 mg/dL), hypercalciuria, and high serum 25(OH)D levels (typically greater than 375 nmol/l [150 ng/mL]).
Hypercalcemia, in turn, can lead to nausea, vomiting, muscle weakness, neuropsychiatric disturbances, pain, loss of appetite, dehydration, polyuria, excessive thirst, and kidney stones.
In extreme cases, vitamin D toxicity causes renal failure, calcification of soft tissues throughout the body (including in coronary vessels and heart valves), cardiac arrhythmias, and even death.
The combination of high intakes of calcium (about 2,100 mg/day from food and supplements) with moderate amounts of vitamin D (about 19 mcg [765 IU]/day from food and supplements) increased the risk of kidney stones by 17% over 7 years among 36,282 postmenopausal women who were randomly assigned to take 1,000 mg/day calcium and 10 mcg (400 IU)/day vitamin D or a placebo
Zinc and testosterone
Relationship between Zinc and testosterone levels
https://pubmed.ncbi.nlm.nih.gov/8875519/ - Zinc supplementation of marginally zinc-deficient normal elderly men for six months resulted in an increase in serum testosterone from 8.3 +/- 6.3 to 16.0 +/- 4.4 nmol/L (p = 0.02). We conclude that zinc may play an important role in modulating serum testosterone levels in normal men.
https://pubmed.ncbi.nlm.nih.gov/36577241/ - We concluded that zinc deficiency reduces testosterone levels and zinc supplementation improves testosterone levels. Furthermore, the effect degree of zinc on serum testosterone may vary depending on basal zinc and testosterone levels, zinc dosage form, elementary zinc dose, and duration. In conclusion, serum zinc was positively correlated with total testosterone, and moderate supplementation plays an important role in improving androgen.
https://onlinelibrary.wiley.com/doi/10.1111/iju.15138?af=R - serum testosterone concentration decreased as serum zinc concentration decreased, although sexual symptoms were not associated with this decrease.
Supplementing with Zinc
Health risks of excessive Zinc supplementation
From CUA TRT Q & A document: “It is worrisome that two supplements had greater than the UL of zinc. Relatively low levels of zinc over-supplementation have been shown to interfere with the utilization of copper and iron and to adversely affect high-density lipoprotein cholesterol concentrations. Slightly higher doses have been shown to result in anemia and neutropenia, as well as impaired immune function.”
High zinc intakes can cause nausea, dizziness, headaches, gastric distress, vomiting, and loss of appetite
Very high doses of zinc from supplements (142 mg/day) might also interfere with magnesium absorption and disrupt magnesium balance
Recommended Dietary Allowance (RDA):
For adult males, the recommended daily intake of zinc is typically around 11 milligrams (mg).
For adult females, the recommended daily intake is generally lower, around 8 mg.
Tolerable Upper Intake Level (UL):
The tolerable upper intake level is the maximum daily intake unlikely to cause adverse health effects. For zinc, the UL for adults is 40 mg per day.
Zinc testing
Sensitivity: Moderate for detecting severe zinc deficiency, but may be lower for detecting mild or moderate deficiency.
Specificity: Generally higher, meaning that the test is more likely to correctly identify individuals who do not have zinc deficiency.
Magnesium and testosterone
Relationship between magnesium and testosterone:
https://pubmed.ncbi.nlm.nih.gov/20352370/ - Our results show that supplementation with magnesium increases free and total testosterone values in sedentary and in athletes. The increases are higher in those who exercise than in sedentary individuals.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3958794/ -The permissive role that several micronutrients, such as magnesium, might exert on the serum concentration and the biological activity of T could be of undoubted interest for future clinical approaches. Male individuals with impaired magnesium status and T deficiency (accurately assessed) could benefit from magnesium and/or T treatment targeting physical performance.
Magnesium Dosing
Magnesium dosing - https://ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/
Health risks of excessive magnesium
Too much magnesium from food does not pose a health risk in healthy individuals because the kidneys eliminate excess amounts in the urine
However, high doses of magnesium from dietary supplements or medications often result in diarrhea that can be accompanied by nausea and abdominal cramping
Magnesium Recommended Daily Intake
Recommended Dietary Allowance (RDA):
For adult males, the recommended daily intake of magnesium is typically between 400 to 420 milligrams (mg).
Tolerable Upper Intake Level (UL):
The tolerable upper intake level is the maximum daily intake unlikely to cause adverse health effects. For magnesium, the UL for adults from dietary sources is 350 mg per day.
Magnesium testing
Sensitivity: Plasma magnesium tests typically have moderate sensitivity for detecting magnesium deficiency, especially severe cases. However, the sensitivity may be lower for mild or moderate deficiencies.
Specificity: Plasma magnesium tests tend to have higher specificity, meaning they are more likely to correctly identify individuals who do not have magnesium deficiency.
Disclaimer: The information provided on this page is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no healthcare-provider/patient relationship is formed. The content of this article is not intended to be a substitute for professional medical advice, diagnosis, or treatment and the use of this information is provided. Prior to taking any action based on the information on this page, you should speak to your licensed healthcare provider. Our licensed PHC-Nurse Practitioner coaches can assist you with individualized implementation of this protocol and others.
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