#106 How To Increase Your Testosterone Levels Naturally | Derek from MPMD
Dr. Rhonda Patrick and Derek from More Plates More Dates delve into testosterone's critical roles, from muscle and bone health to mood and cognition. They discuss accurate measurement, natural optimization strategies, evidence-based supplements, and the benefits, risks, and monitoring protocols for testosterone replacement therapy (TRT) in both men and women, including its impact on hair loss.
Deep Dive Analysis
21 Topic Outline
Introduction to Testosterone and Its Core Functions
Testosterone's Role in Men's Health
Testosterone's Role in Women's Health
Testosterone and Longevity: Trade-offs and Historical Context
Measuring and Interpreting Testosterone Levels: Total vs. Free T
Understanding Reference Ranges and Symptoms for Testosterone
Red Flags: High Testosterone and Gonadotropin Levels
The Impact of SHBG on Testosterone Availability
Symptoms of Low Testosterone in Men
Lifestyle Factors that Negatively Impact Testosterone
Dietary Fat and Carbohydrates for Hormone Health
Exercise and Micronutrients for Testosterone Optimization
Evidence-Based Testosterone-Boosting Supplements
When to Consider Testosterone Replacement Therapy (TRT)
Expected Benefits and Risks of TRT
TRT Delivery Methods and Their Implications
TRT and Fertility Preservation
Key Biomarkers to Monitor While on TRT
Testosterone Therapy for Women: Considerations and Risks
Understanding Male Pattern Hair Loss and DHT
Strategies and Medications for Hair Loss Mitigation
8 Key Concepts
Total Testosterone
This number reflects the total production of testosterone detectable in a blood sample, including both biologically active and bound forms. It indicates the overall capacity of the body to produce the hormone.
Free Testosterone
Representing about 2-3% of total testosterone in healthy males, this is the unbound, freely circulating testosterone readily available to be used by target tissues. It's the biologically active form that binds to androgen receptors.
Sex Hormone Binding Globulin (SHBG)
A binding protein produced by the liver that transports sex hormones like testosterone and DHT. High SHBG levels can bind a significant portion of testosterone, reducing the amount of free, active hormone available to tissues.
Dihydrotestosterone (DHT)
A potent androgen converted from testosterone by the 5-alpha reductase enzyme. DHT is crucial for male sexual maturation in adolescence and plays a primary role in androgenic alopecia (hair loss) in susceptible individuals.
Primary Hypogonadism
A condition where the testes themselves are not producing adequate testosterone, despite receiving sufficient or even elevated signaling (LH/FSH) from the pituitary gland. This often indicates a structural or functional issue within the testes.
Secondary Hypogonadism
A condition where the testes are functional, but the pituitary gland is not producing enough luteinizing hormone (LH) or follicle-stimulating hormone (FSH) to signal the testes to produce testosterone. This can be influenced by lifestyle factors, age, or issues upstream in the brain.
Androgenic Alopecia
Commonly known as male (or female) pattern hair loss, this is the miniaturization of hair follicles mediated primarily by androgens, particularly DHT. It's a cumulative and insidious process leading to thinner, weaker hair over time.
Nocebo Effect
A phenomenon where a person experiences negative side effects from a treatment or intervention due to their belief or expectation that it will cause harm, even if the treatment itself is inert or has a low actual risk of those side effects.
11 Questions Answered
Testosterone is fundamental for men's health, supporting muscle tissue growth, bone health, insulin sensitivity, neurological health, red blood cell production, and is critical for fertility. It is also necessary for full sexual maturation in adolescence via its conversion to DHT.
In women, testosterone is necessary for cognitive health, some level of cardiovascular support, bone integrity, and anabolic activity in muscle tissue, albeit at much lower concentrations than in men. Intra-gonadally, it primarily serves as a substrate for estrogen production.
Testosterone levels should ideally be measured early in the morning after fasting, avoiding certain supplements like biotin. It's crucial to measure both total testosterone (total production) and free testosterone (biologically active), and to get repeat measurements to confirm findings before making any decisions.
SHBG binds to testosterone and DHT, making them biologically inactive. High SHBG levels, which increase with age and can be influenced by diet (e.g., ketogenic diets) and medications (e.g., oral contraceptives), can significantly reduce free testosterone and DHT, leading to low androgenic signaling even with adequate total testosterone.
Symptoms often include decreased libido, reduced erection quality, difficulty building or maintaining muscle mass, loss of strength, inhibited recovery, mood dysregulation, and irritability. These symptoms often appear as a constellation and can be compounded by lifestyle factors.
Factors that can lower testosterone include alcohol consumption (dose-dependent toxicity), smoking, fat-deficient or carbohydrate-deficient diets, micronutrient deficiencies (zinc, magnesium, vitamin D), obesity (due to increased aromatization to estrogen), excessive endurance training, and poor sleep.
The most reliable supplements, if deficient, are zinc, magnesium, and vitamin D. Other notable supplements include boron (may suppress SHBG), ashwagandha (reduces cortisol, indirectly boosts T), and Tongkat Ali (may suppress SHBG and upregulate intratesticular testosterone production).
TRT should be considered after exhausting all natural lifestyle interventions, if clinically low testosterone is confirmed by repeat measurements, and if significant symptoms are present. It's especially indicated for primary hypogonadism where the testes cannot produce testosterone, or secondary hypogonadism where the pituitary signal is insufficient.
Risks include increased erythropoiesis (thicker blood), potential cardiac remodeling if pushed too high, dyslipidemia, and exacerbation of sleep apnea. Side effects can also include acne, hair loss, gynecomastia, and deepening of the voice, especially if doses lead to supra-physiologic levels or disproportionate metabolite conversion.
TRT typically crushes natural fertility by suppressing the brain's signaling to the testes, leading to testicular atrophy and inhibited spermatogenesis. However, fertility can be maintained or restored with adjunct therapies like HCG and recombinant FSH, which manually stimulate testicular activity, though this can be costly and requires careful management.
Hair loss, specifically androgenic alopecia, is primarily caused by the miniaturization of hair follicles mediated by androgens, with DHT being the most potent. The scalp has a high density of 5-alpha reductase, which converts testosterone to DHT, leading to cumulative damage and eventual follicle death in genetically susceptible individuals.
67 Actionable Insights
1. Optimize Holistic Lifestyle Factors
Implement a holistic approach to boost testosterone by getting leaner, improving diet, addressing micronutrient deficiencies, quitting smoking and drinking, and optimizing sleep.
2. Reduce Body Fat (Obesity)
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.
3. Prioritize Adherence in Diet/Exercise
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.
4. Engage in Resistance Training
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.
5. Minimize Alcohol Intake
Minimize alcohol consumption as it directly inhibits testosterone production in the testicles and negatively impacts sleep, further hindering hormone output.
6. Avoid Smoking
Avoid smoking as it is detrimental to overall health and likely negatively impacts testosterone levels.
7. Ensure Adequate Dietary Fat
Maintain a diet with sufficient fat intake, as fats serve as the necessary substrate for producing cholesterol-derived hormones like testosterone.
8. Include Carbohydrates for Free Hormones
Ensure adequate carbohydrate intake in your diet, as insulogenic signaling from carbohydrates is somewhat necessary to facilitate the liberation of free, biologically active hormones.
9. Consume Sufficient Protein
Consume enough protein to support muscle building and recovery from workouts, which indirectly improves body composition and hormone levels.
10. Fuel Adequately for Intense Exercise
Ensure adequate fueling and nutrition, especially for intensive endurance training or calorie deficits, to prevent malnourishment and hormone deficiency, which can lead to hypogonadism.
11. Minimize Endocrine Disruptor Exposure
Minimize exposure to endocrine-disrupting chemicals by using glass instead of plastic for heating food, ensuring high-quality air, and maintaining good water quality.
12. Optimal Testosterone Measurement Timing
Measure testosterone levels early in the morning to assess peak levels, as testosterone secretion is pulsatile and highest then.
13. Avoid Biotin Before Testosterone Test
Avoid taking biotin or biotin-containing supplements before a testosterone test, as they can confound results.
14. Stay Hydrated Before Blood Tests
Be hydrated before blood tests to ensure an accurate hematology profile, preventing misinterpretation of elevated hematocrit levels due to dehydration.
15. Confirm Low Testosterone Readings
Get repeat measurements of testosterone levels, especially if initial readings are low or concerning, to confirm findings before deciding on any interventions.
16. Monitor Total and Free Testosterone
Focus on both total testosterone (reflects total production capacity) and free testosterone (biologically active, unbound) for a comprehensive assessment of hormone status.
17. Prioritize Symptoms with Blood Work
Interpret testosterone blood values in combination with symptoms, as individual androgen receptor sensitivity means absolute levels don’t always dictate health outcomes.
18. High Testosterone Can Signal Problems
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.
19. Supplement Zinc, Magnesium, Vitamin D
Supplement with zinc, magnesium, and vitamin D if deficient, as these micronutrients significantly impact testosterone production and receptor activity.
20. Magnesium Supplementation is Crucial
Prioritize magnesium supplementation, as it is rarely adequately dosed in multivitamins due to its weight, despite its importance for hormone health.
21. Ensure Adequate Vitamin D Dose
Supplement vitamin D, ensuring the dose is adequate, as it’s fat-soluble and often underdosed in multivitamins, impacting testosterone production and response.
22. Consider Boron for SHBG Suppression
Consider supplementing 6-12 milligrams of boron, as it may help suppress SHBG levels, thereby increasing free testosterone.
23. Use Standardized Ashwagandha Extract
If considering ashwagandha, choose a patented extract like Sensorial (10% withanolides) or KSM-66 (5% withanolides) to ensure potency and efficacy.
24. Ashwagandha for Stress & Testosterone
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.
25. Monitor Ashwagandha for Anhedonia
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.
26. Consider Tonkat Ali for SHBG & Production
Consider Tonkat Ali, which may suppress SHBG and upregulate intratesticular testosterone production, potentially boosting total testosterone by 100-200 ng/dL for some.
27. Choose HPLC-Tested Tonkat Ali
When selecting Tonkat Ali, ensure it is HPLC tested for Eurycomanone, as this is the active ingredient responsible for its bioactive effects.
28. Shilajit for Testicular Antioxidant Activity
Consider high-quality shilajit, which may act as a potent antioxidant to improve intratesticular antioxidant activity and support local hormone production.
29. Use Dutch Test for Cortisol Assessment
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.
30. Consult an Expert for TRT
Work with a highly educated medical professional for TRT and hormone optimization, rather than self-administering or relying solely on online content.
31. Educate Yourself on TRT Protocols
Educate yourself on TRT mechanisms and protocols to identify reputable clinics and avoid being pressured into unnecessary or suboptimal lifelong hormone support.
32. Address Symptoms, Investigate Causes
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.
33. Target Symptom Relief with TRT
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’.
34. Don’t Base TRT Solely on Numbers
Avoid making rash decisions about TRT based solely on blood test numbers; consider symptoms, genetics, and individual response.
35. Expect Increased Red Blood Cells with TRT
Be aware that testosterone administration, especially at higher doses, will increase erythropoiesis (red blood cell production), which requires monitoring.
36. Monitor Hematology Panel on TRT
Regularly monitor your hematology panel (red blood cell count, hematocrit, hemoglobin) while on TRT to ensure levels remain within a healthy range.
37. Be Aware of Dose-Dependent TRT Risks
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.
38. Get a Sleep Study Before TRT
Undergo a basic sleep study before starting TRT to establish a baseline for sleep apnea, as TRT can exacerbate obstructive sleep apnea.
39. Avoid Infrequent, High-Dose Injections
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.
40. Aim for Daily Physiological Replacement
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.
41. Avoid Pellets and Androgel for Men
Avoid testosterone pellets and Androgel for men, as they may not provide optimal or consistent physiological replacement.
42. Consider Scrotal Cream for TRT
Use scrotal testosterone cream from compounding pharmacies for a natural-mimicking absorption and pharmacokinetic profile, offering a favorable outcome for TRT.
43. Consider Subcutaneous Injections 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.
44. Be Cautious of Cream Transference
If using testosterone cream, be highly cautious of transference to children or pets due to the risk of accidental exposure and masculinization.
45. Expect Fertility Suppression on TRT
Understand that TRT will significantly suppress, if not entirely eliminate, fertility by shutting down natural signaling to the testes.
46. Maintain Fertility with Adjunct Therapy
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.
47. Expect Testicular Shrinkage on TRT
Be aware that testicular shrinkage will occur within weeks to months of starting TRT due to the suppression of natural signaling.
48. Establish Comprehensive Baseline Before TRT
Obtain a comprehensive baseline blood panel before starting TRT to accurately monitor changes and identify any issues that may arise.
49. Monitor Key Biomarkers on TRT
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.
50. Use LCMS for Total Testosterone
Ensure total testosterone is measured using Liquid Chromatography with Tandem Mass Spectrometry (LCMS) for accuracy, especially at lower levels, avoiding less accurate immunoassay tests.
51. Measure Free Testosterone Directly
Measure free testosterone directly using equilibrium ultrafiltration or dialysis, rather than relying on calculated estimates, for accurate assessment.
52. Use Sensitive Assays for Hormones
Always use sensitive assay testing for estradiol, total testosterone, and free testosterone to ensure accurate measurements, particularly for women and at lower hormone levels.
53. Women: Use LCMS for Testosterone Testing
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.
54. Evaluate Oral Contraceptives’ Impact
If using oral contraceptives, assess your testosterone levels, as they can artificially suppress hormones into a hypogonadal range for women.
55. Women: Be Wary of Irreversible Virilization
Women considering testosterone therapy must be extremely cautious of irreversible virilization side effects like voice deepening, which can be quality-of-life destroying.
56. Women: Monitor Voice Tone on TRT
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.
57. Consider DHEA for Adrenal Insufficiency (Women)
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.
58. Women: Start Low with DHEA and Monitor
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.
59. Be Proactive Against Hair Loss
Take preventative and proactive measures against hair loss, as it is cumulative and insidious, and once follicles undergo fibrosis, recovery is difficult.
60. Weigh Risks of DHT Inhibition
Carefully weigh the risk-to-reward ratio of inhibiting DHT for hair loss, considering potential side effects versus the benefit of preventing miniaturization.
61. Research Finasteride/Dutasteride Literature
Research the scientific literature on finasteride and dutasteride to understand the actual prevalence and nature of side effects, rather than relying on anecdotal claims.
62. Use Ketoconazole Shampoo as Adjunct
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.
63. Use Minoxidil as Growth Stimulant
Use FDA-approved minoxidil as a hair growth stimulant, understanding that its efficacy depends on individual enzymatic conversion capacity in the scalp.
64. Compound Minoxidil with Tretinoin
If minoxidil is ineffective, consider compounding it with tretinoin to upregulate sulfotransferase enzyme activity in the scalp, improving conversion to its active form.
65. Incorporate Microneedling for Hair Growth
Incorporate microneedling (e.g., 0.6mm depth once a week) to enhance minoxidil absorption and upregulate sulfotransferase enzyme activity, potentially improving hair growth results.
66. Minoxidil Regrows, DHT Inhibitors Prevent
Understand that minoxidil stimulates hair growth but does not prevent further miniaturization caused by DHT; DHT inhibitors are necessary for prevention.
67. Inhibit DHT for Hair Loss Prevention
To effectively prevent hair loss, it is generally necessary to inhibit DHT, as it is the primary driver of androgenic alopecia.
7 Key Quotes
Just because it's in your blood, though, it doesn't mean it's biologically active, if it's bound to these binding proteins produced by the liver, it could be either entirely inactive, or like readily available to be dissociated, but not yet fully active as well.
Derek
Just because you have less testosterone than the next guy, it doesn't necessarily even mean that you have less muscle growth potential or less, you know, you know, bone support capacity or less neurological support. Like it's not guaranteed any of these things based on absolute values.
Derek
If you are somebody who is not fueling yourself correctly to handle that amount of endurance training, like you were, let's just say you're in a calorie deficit and you're trying to be like, I don't know, six pack shredded for the summer and like feel your like endurance event efforts. Like you're probably like not doing two, you're not doing two birds one stone. Like you're doing two things like inadequately, almost certainly, and malnourishing yourself and ending up in a state of hormone deficiency as a result.
Derek
The problem is, is like the definition of symptom relief too is so vague because you could achieve some symptom relief at, you know, 450 total T maybe depending on the person, or it might be at like 800 or it might've been like, even if it was 450, like if you got up to 800, you're still in normal on paper. So like, is that bad? You know, like who's to say?
Derek
It's critical that you have adequate hormone production, similar to women in menopause. Like the, the benefit outweighs the risk. Like essentially every single time, essentially, and you just have to be responsible for your approach to what that is.
Derek
It's not uncommon even for bodybuilders who are on huge amounts of steroids to still accidentally get their wives, girlfriends, pregnant thinking that they're sterile when in fact they have so much testosterone in their body that it's like actually like producing the spermatogenesis effect via the exogenous hormone.
Derek
It's not like it's something that you can necessarily recover to baseline. If you're completely slick bald, the scalp environment is no longer habitable to like healthy hair follicles that are like, you know, your original hair. You're not gonna grow it back probably until they start like cloning hair follicles or something.
Derek
1 Protocols
Hair Loss Intervention Escalation Strategy
Derek- Start with topical minoxidil (over-the-counter) as a growth stimulant, and ketoconazole shampoo (mild antiandrogen) to improve scalp environment.
- If minoxidil alone is insufficient, consider microneedling (0.6mm depth, once a week) to enhance absorption and sulfotransferase enzyme activity.
- For increased efficacy, compound minoxidil with tretinoin to upregulate sulfotransferase enzyme activity.
- To attenuate miniaturization caused by androgens, consider pharmaceutical 5-alpha reductase inhibitors like finasteride (inhibits two isoenzymes) or dutasteride (near full systemic DHT inhibition), weighing the individual risk-benefit profile.