Men's Hormonal Health: Understanding and Optimizing Testosterone Naturally

The Growing Concern About Male Hormonal Health

Testosterone levels in men have been declining for decades. Studies show that average testosterone levels today are significantly lower than they were in previous generations, even when comparing men of the same age¹. This population-wide decline cannot be explained by aging alone and points to environmental, lifestyle and dietary factors affecting male hormonal health.

In my naturopathic practice in Halifax, I see increasing numbers of men concerned about symptoms that may relate to suboptimal testosterone levels: fatigue, reduced motivation, difficulty building muscle, weight gain (particularly around the midsection), reduced libido, mood changes and cognitive complaints. Some have been told their levels are “normal” despite experiencing these symptoms. Others have been offered testosterone replacement therapy without first exploring why their levels are low.

The goal of naturopathic approach to male hormonal health is not simply to boost testosterone numbers but to understand why levels may be suboptimal and address those underlying factors. This often results in improved testosterone levels along with better overall health. For some men, this approach is sufficient. For others, it may complement testosterone replacement therapy when that is indicated.

Understanding Male Hormones

Testosterone: More Than a Sex Hormone

Testosterone is often thought of primarily in terms of its effects on libido and sexual function. While these are important, testosterone’s influence extends much further.

Testosterone supports muscle mass and strength, making it harder to maintain muscle and easier to gain fat when levels are low. It maintains bone density, with low testosterone being a risk factor for osteoporosis in men. It affects mood and motivation, with deficiency associated with depression, irritability and reduced drive. It supports cognitive function, including memory, concentration and mental clarity. It influences cardiovascular health, with complex effects on heart disease risk that are still being understood. It maintains red blood cell production and energy levels. It supports overall vitality and quality of life.

The symptoms of low testosterone are often non-specific and overlap with many other conditions. This is why proper evaluation is important before assuming testosterone is the issue.

The Hypothalamic-Pituitary-Gonadal Axis

Testosterone production is controlled by a hormonal feedback loop called the hypothalamic-pituitary-gonadal (HPG) axis. The hypothalamus releases gonadotropin-releasing hormone (GnRH), which signals the pituitary gland to release luteinizing hormone (LH) and follicle-stimulating hormone (FSH). LH then stimulates the testes to produce testosterone. Rising testosterone levels feed back to the hypothalamus and pituitary, reducing GnRH and LH release to maintain balance.

Disruptions anywhere in this axis can affect testosterone production. Primary hypogonadism involves problems with the testes themselves. Secondary hypogonadism involves problems with the pituitary or hypothalamus. Most age-related testosterone decline is secondary, meaning the regulatory signals rather than the testes themselves are primarily affected.

Understanding where in this axis the problem lies helps guide treatment. A man with primary testicular failure has different options than a man whose pituitary signaling is suppressed by obesity or chronic illness.

Other Important Male Hormones

While testosterone gets the most attention, other hormones matter for men’s health.

DHEA (dehydroepiandrosterone) is a precursor hormone produced by the adrenal glands that can convert to testosterone and estrogen. It declines with age and may contribute to some symptoms attributed to low testosterone.

Estrogen is present in men in small amounts and is actually important for bone health, brain function and libido. However, excessive estrogen relative to testosterone (often from increased conversion via the aromatase enzyme) can cause symptoms including breast tissue growth, fat accumulation and mood changes.

Cortisol is the stress hormone that, when chronically elevated, suppresses testosterone production. High cortisol and low testosterone often occur together.

Thyroid hormones affect metabolism and energy. Low thyroid function can cause symptoms overlapping with low testosterone and should be evaluated.

What Causes Low Testosterone?

Age-Related Decline

Testosterone levels naturally peak in late adolescence and early adulthood, then gradually decline by approximately 1-2% per year starting in the 30s. This slow decline means that by age 70, many men have testosterone levels 30-50% lower than in their youth.

However, “normal” age-related decline is different from pathological deficiency. Many older men maintain healthy testosterone levels and vitality. The goal is to age well, not to accept every symptom as inevitable.

Obesity and Metabolic Dysfunction

Excess body fat, particularly visceral (abdominal) fat, is one of the most significant modifiable causes of low testosterone. Fat tissue contains the enzyme aromatase, which converts testosterone to estrogen. More body fat means more conversion. Additionally, obesity promotes insulin resistance, which independently suppresses testosterone. The relationship is bidirectional: low testosterone promotes fat accumulation, and fat accumulation lowers testosterone, creating a difficult cycle².

Weight loss, particularly loss of visceral fat, reliably improves testosterone levels. In obese men, significant weight loss can increase testosterone by 50% or more without any hormonal treatment.

Chronic Stress and Sleep Deprivation

Chronic stress elevates cortisol, which directly suppresses the HPG axis and testosterone production. The body prioritizes survival over reproduction when under threat, even if that “threat” is work deadlines rather than predators.

Sleep deprivation has a dramatic effect on testosterone. Studies show that one week of sleeping only 5 hours per night can reduce testosterone levels by 10-15%, equivalent to 10-15 years of aging³. Most testosterone is produced during sleep, particularly during REM sleep.

For more on optimizing sleep, see my article on evidence-based sleep strategies.

Environmental Factors

Endocrine-disrupting chemicals in our environment may contribute to declining testosterone levels at a population level. Chemicals of concern include phthalates found in plastics, personal care products and fragrances. BPA (bisphenol A) is found in plastics and can linings. Pesticides and herbicides are found on non-organic produce. Heavy metals including lead, cadmium and mercury accumulate from various sources.

While individual exposures may seem small, cumulative lifetime exposure to multiple endocrine disruptors may have significant effects. Reducing exposure where practical is prudent.

Alcohol and Substance Use

Chronic alcohol consumption suppresses testosterone through multiple mechanisms: direct toxicity to the testes, increased aromatase activity and disruption of the HPG axis. Even moderate alcohol consumption may reduce testosterone⁴.

Opioid medications (and opioid drugs) profoundly suppress testosterone, often to castrate levels. This is increasingly recognized as “opioid-induced androgen deficiency” (OPIAD).

Cannabis may also affect testosterone, though research is mixed. Chronic heavy use appears more problematic than occasional use.

Medical Conditions

Various health conditions affect testosterone, including type 2 diabetes and metabolic syndrome, sleep apnea, chronic kidney or liver disease, HIV/AIDS, hemochromatosis (iron overload) and pituitary tumors or disorders. Treating underlying conditions often improves testosterone levels.

Medications

Several medication classes can suppress testosterone. Opioid pain medications are among the most significant suppressors. Corticosteroids (prednisone, etc.) suppress the HPG axis. Some antidepressants, particularly SSRIs, may affect sexual function and hormones. Statins may modestly reduce testosterone in some men. Spironolactone has anti-androgen effects.

If you suspect medications are affecting your hormones, discuss with your prescriber rather than stopping medications on your own.

Symptoms of Low Testosterone

Low testosterone can cause a wide range of symptoms, though none are specific to testosterone deficiency alone.

Sexual symptoms include reduced libido, erectile dysfunction and reduced spontaneous erections.

Physical symptoms include fatigue and reduced energy, loss of muscle mass and strength, increased body fat particularly around the abdomen, decreased bone density, breast tissue development (gynecomastia) and reduced body hair.

Cognitive and mood symptoms include depression, irritability, reduced motivation and drive, difficulty concentrating and memory complaints.

Other symptoms include sleep disturbances, hot flashes (in severe deficiency) and reduced sense of wellbeing.

These symptoms overlap with many other conditions including depression, thyroid disorders, sleep disorders and chronic illness. Evaluation should include consideration of these alternative or contributing diagnoses.

Testing and Evaluation

What Tests to Request

Total testosterone is the standard initial test. It should be drawn in the morning (levels peak around 8 AM and decline throughout the day) after adequate sleep. A single low result should be confirmed with repeat testing, as levels fluctuate day to day.

If total testosterone is low or borderline, additional tests provide useful information. Free testosterone measures the unbound, biologically active fraction. SHBG (sex hormone-binding globulin) affects how much testosterone is free versus bound. LH and FSH help determine whether low testosterone is primary (testicular) or secondary (pituitary/hypothalamic). Prolactin elevation can suppress testosterone. Estradiol shows whether excessive conversion is occurring. Complete metabolic panel and CBC provide general health assessment. Thyroid function tests rule out thyroid contributions to symptoms.

Interpreting Results

“Normal” reference ranges for testosterone are broad and represent the statistical range for the population, not necessarily optimal levels. A man with a level of 350 ng/dL is technically “normal” but may have been 700 ng/dL in his youth and genuinely feel the difference.

Context matters. A 25-year-old with testosterone of 350 ng/dL is more concerning than a 70-year-old with the same level. Symptoms matter alongside numbers. Some men feel well at levels others would find inadequate.

Free testosterone and the ratio of testosterone to SHBG are often more clinically relevant than total testosterone alone, particularly in men with borderline total levels.

Lifestyle Approaches to Optimize Testosterone

Weight Management

For overweight or obese men, weight loss is the single most effective natural intervention for improving testosterone. Reducing body fat lowers aromatase activity, improves insulin sensitivity and removes a major suppressor of the HPG axis.

Even without reaching an “ideal” weight, meaningful improvements in testosterone can occur with 5-10% weight loss. Focus on sustainable changes rather than crash dieting, which can temporarily suppress testosterone further.

Resistance Training

Exercise, particularly resistance training with progressive overload, supports testosterone levels through multiple mechanisms. It improves insulin sensitivity, promotes fat loss and muscle gain, acutely increases testosterone and enhances overall metabolic health⁵.

Compound movements (squats, deadlifts, bench press, rows) that engage large muscle groups are particularly effective. Training to near-failure with adequate recovery time appears optimal.

Avoid overtraining, which can actually suppress testosterone. Balance challenging workouts with adequate recovery.

Sleep Optimization

Given that most testosterone is produced during sleep, optimizing sleep is essential. Aim for seven to eight hours of quality sleep nightly. Maintain consistent sleep and wake times. Address sleep apnea if present (a common cause of low testosterone in men). Limit alcohol before bed (disrupts sleep architecture). Create a dark, cool sleep environment.

Stress Management

Chronic stress and elevated cortisol suppress testosterone. Effective stress management varies by individual but may include regular exercise, mindfulness or meditation practices, time in nature, adequate leisure and recovery time, boundaries around work and addressing sources of chronic stress where possible.

Reduce Alcohol

If you drink, moderation is key. Heavy or chronic drinking clearly suppresses testosterone. Even moderate daily drinking may have effects for some men. Consider reducing consumption or taking regular breaks from alcohol.

Reduce Environmental Exposures

While we cannot eliminate all exposure to endocrine disruptors, reducing them where practical may help. Choose glass or stainless steel over plastic for food storage. Avoid heating food in plastic containers. Choose personal care products without phthalates and fragrances. Eat organic when possible, particularly for high-pesticide produce. Filter drinking water. Avoid handling thermal receipts unnecessarily.

Nutrition for Testosterone

Macronutrient Balance

Extreme diets in either direction can affect testosterone. Very low-fat diets may reduce testosterone, as cholesterol is the precursor for hormone production. Very low-carbohydrate diets may reduce testosterone, particularly when combined with high training loads. Severe caloric restriction suppresses the HPG axis.

A balanced diet with adequate calories, protein, healthy fats and carbohydrates supports hormonal health. Do not fear dietary fat, but emphasize monounsaturated (olive oil, avocados) and omega-3 fats over saturated and trans fats.

Key Nutrients for Testosterone

Zinc is essential for testosterone production. Deficiency reduces testosterone, and supplementation in deficient men improves levels. Good food sources include oysters, red meat, pumpkin seeds and legumes.

Vitamin D acts as a hormone and influences testosterone production. Deficiency is common, especially in northern climates. Multiple studies show correlations between vitamin D status and testosterone levels⁶. Sun exposure and supplementation can optimize levels.

Magnesium is involved in hundreds of enzymatic reactions including testosterone production. Many men are deficient. Good sources include leafy greens, nuts, seeds and dark chocolate.

Healthy fats including omega-3 fatty acids, monounsaturated fats and even some saturated fat are needed for hormone production. Extremely low-fat diets can impair testosterone synthesis.

Foods to Emphasize

Eggs are rich in cholesterol (hormone precursor), protein and vitamin D. Fatty fish like salmon and sardines provide omega-3s and vitamin D. Shellfish, especially oysters, are extremely high in zinc. Beef and lamb provide zinc, iron, B vitamins and quality protein. Cruciferous vegetables like broccoli and cauliflower support healthy estrogen metabolism. Garlic contains compounds that may support testosterone. Olive oil and avocados provide monounsaturated fats. Pomegranate has shown interesting effects on testosterone in some studies.

Foods to Limit

Excessive alcohol suppresses testosterone. Soy in very large quantities may have mild estrogenic effects, though moderate consumption appears fine. Excessive sugar and refined carbohydrates promote insulin resistance. Trans fats from processed foods should be avoided. Excessive licorice contains compounds that can lower testosterone.

Supplements for Testosterone Support

Evidence-Based Options

Vitamin D supplementation improves testosterone in deficient men. Testing and optimizing levels is recommended. Most men in northern climates need 2,000-4,000 IU daily to maintain optimal levels.

Zinc supplementation benefits men who are deficient, which is common. Typical doses are 25-50mg daily. Zinc should be balanced with copper for long-term use.

Magnesium may support testosterone, particularly in deficient individuals. Forms like magnesium glycinate are well-absorbed. Typical doses are 200-400mg daily.

Ashwagandha (Withania somnifera) is an adaptogenic herb that reduces cortisol and may modestly increase testosterone. A 2019 systematic review found consistent evidence for improvements in testosterone and sperm quality⁷. Typical doses are 300-600mg daily of root extract.

Fenugreek contains compounds that may inhibit aromatase and support free testosterone. Some studies show modest benefits for testosterone and sexual function⁸.

D-Aspartic Acid may acutely increase LH and testosterone, though long-term effects are less clear. It may be more useful for men with suboptimal hypothalamic signaling.

Supplements with Limited Evidence

Many supplements marketed for testosterone have limited human evidence. These include tribulus terrestris (popular but evidence is weak), tongkat ali (some positive studies but quality varies), maca (may improve libido without changing testosterone levels) and boron (may modestly increase free testosterone).

I recommend focusing on well-researched options and addressing foundational factors before experimenting with unproven supplements.

When to Consider Testosterone Replacement Therapy

Testosterone replacement therapy (TRT) may be appropriate when testosterone levels are clearly low (not just borderline), when symptoms are present and affecting quality of life, when reversible causes have been addressed or ruled out, when the patient understands the commitments and risks and when supervised by a knowledgeable physician.

TRT has genuine benefits for men with true hypogonadism but is not without risks and considerations. It typically requires lifelong commitment (stopping can leave you worse than baseline). It suppresses natural production and can impair fertility. There are ongoing debates about cardiovascular risks. Regular monitoring is required.

Natural approaches should generally be tried first for men with borderline levels and mild symptoms. For men with clearly deficient levels and significant symptoms, TRT may be the most appropriate option, ideally combined with lifestyle optimization.

Comprehensive Men’s Health in Halifax

Male hormonal health is influenced by multiple factors including body composition, sleep, stress, nutrition, exercise and environmental exposures. Addressing these foundational factors often improves testosterone levels naturally while providing broader health benefits.

For men with symptoms of hormonal imbalance, proper evaluation is important to identify underlying causes and guide treatment. A naturopathic approach focuses on understanding why levels may be suboptimal and addressing those root causes, whether through lifestyle modification, targeted supplementation or appropriate referral for medical management.

If you are experiencing symptoms of low testosterone or want to optimize your hormonal health naturally, please contact Dr. Colin MacLeod ND to book an initial appointment. Dr. MacLeod provides comprehensive men’s health assessments and individualized treatment plans.

References

1. Travison TG, Araujo AB, O’Donnell AB, et al. A population-level decline in serum testosterone levels in American men. J Clin Endocrinol Metab. 2007;92(1):196-202.
2. Kelly DM, Jones TH. Testosterone and obesity. Obes Rev. 2015;16(7):581-606.
3. Leproult R, Van Cauter E. Effect of 1 week of sleep restriction on testosterone levels in young healthy men. JAMA. 2011;305(21):2173-2174.
4. Emanuele MA, Emanuele NV. Alcohol’s effects on male reproduction. Alcohol Health Res World. 1998;22(3):195-201.
5. Vingren JL, Kraemer WJ, Ratamess NA, et al. Testosterone physiology in resistance exercise and training: the up-stream regulatory elements. Sports Med. 2010;40(12):1037-1053.
6. Pilz S, Frisch S, Koertke H, et al. Effect of vitamin D supplementation on testosterone levels in men. Horm Metab Res. 2011;43(3):223-225.
7. Chauhan S, Srivastava MK, Pathak AK. Effect of standardized root extract of ashwagandha (Withania somnifera) on well-being and sexual performance in adult males: A randomized controlled trial. Health Sci Rep. 2022;5(4):e741.
8. Rao A, Steels E, Inder WJ, Abraham S, Vitetta L. Testofen, a specialised Trigonella foenum-graecum seed extract reduces age-related symptoms of androgen decrease, increases testosterone levels and improves sexual function in healthy aging males in a double-blind randomised clinical study. Aging Male. 2016;19(2):134-142.