1. Thou shalt engage in regular physical exercise
“No man has the right to be an amateur in the matter of physical training. It is a shame for a man to grow old without seeing the beauty and strength of which his body is capable.” – Socrates
• Resistance Exercise
“Everybody wants to be a bodybuilder, but nobody wants to lift no heavy-ass weights.” – Ronnie Coleman.
I lift weights but I’m not sure I fancy prancing on a stage in tiny fluorescent panties I stole from the Mrs, all greased up like a prized turkey, with enough fake tan on to have my ethnicity questioned. Not my idea of ‘manly’. However, horses for courses, you do have a right to be proud of your achievements.
Lot of studies demonstrate that lifting weights and engaging in regular resistance exercise increases your testosterone level(1,2,3). You don’t have to subscribe to the whole “No Pain, No Gain” mantra, or start wearing Gold’s Gym vests, just appreciate that in order for your body to adapt and grow, you need to place it under stress. It seems that the brain is the hardest organ to train, once you have conquered that, the rest is easy.
• High Intensity Interval Training & Steady State Cardio
High Intensity Interval Training can increase testosterone levels(4). HIIT is a form of training that involves repeated bouts of high intensity effort followed by varied recovery times. The idea is to push yourself to your anaerobic threshold, then recover long enough for the lactic acid to disperse and your heart rate to recover so that you can then push yourself back up to that point. The stress caused by repeating this process time and time again will force your body to adapt. Your body has an amazing reserve, most people aren’t functioning even close to their maximum capability, it will only improve if you force it to improve.
My favourite home HIIT workout programme is ‘GSP Rushfit’. George St Pierre is a UFC fighter and the workout was designed by one of his trainers, Eric Owens. I think it’s cracking. If you can keep up with George you are doing well! It’s hard, GSP throws in some unintentional funny moments that always make me giggle as I try to catch my breath…
“I’m pretty much tight everywhere.”
• Steady State Cardio
Whilst not as effective as HIIT for stimulating testosterone, it’s still worth doing in a comprehensive training programme. In my opinion, it’s pointless building big muscles in the gym that require large amounts of oxygenated blood to function outside of the squat rack, without training the heart to cope!
I’ve never been a massive fan of steady state cardio in the gym, watching people running on the treadmill has always reminds me of hamsters running endlessly on a wheel, or tethered swimming, never actually getting anywhere. Saying that, we’ve just conquered Man vs Mountain 2017, 24 miles up and down Snowdon, I’m actually starting to enjoy running. The first 5 minutes is still pure hell, presumably because I’m switching over energy systems. I’ve always been a weights and HIIT guy, so to go over to the dark side, endurance, means its predominantly aerobic using Type 1 (slow twitch) muscle fibres. If you don’t challenge yourself, you won’t change.
Whatever you do, just do something! We weren’t designed to be sat on the couch drinking bottles of beer and family sized packets of crisps, watching crap on TV. Get active, it will have a positive impact on your testosterone levels and overall health!(5)
“Watching television is like taking black spray paint to your third eye.” – Bill Hicks
2. Thou shalt eat a healthy clean diet
• Natural fats, proteins, carbohydrates, calorie control
• Try and avoid anything processed
It is hard to over-emphasise the importance of maintaining a healthy balanced diet. But what does that actually mean? Who on earth do you believe? There is so much differing opinion out there it’s hard to see the wood from the trees.
We know obesity is a risk factor for low testosterone, and having a lean body mass is associated with an increased testosterone, so it appears weight is an important determinant(6,7). However, there are plenty of healthy weight individuals having heart attacks and strokes. The cause is obviously multifactorial, but being of normal weight does not mean you are healthy.
If you believe the so-called internet fitness experts, it all boils down to calories in vs calories out, nothing else matters. No need to count your macros anymore, no need to time your meals, no need to eat regularly etc etc. If you want to lose weight you simply eat less calories than you consume, to gain weight eat more, stay the same weight eat the same. This is a perfect example of The Dunning Kruger Effect. It’s difficult arguing with people who have fixed beliefs without a true understanding behind those beliefs.
Testosterone is a hormone, it’s one of many hormones that exert its effects on the body to maintain health. As I’ve said before, it’s all about balance, you don’t want to have too much or too little of a particular hormone, you want an optimal level. Hormonal imbalances, both high and low, have a negative impact on weight, but more importantly, on overall health.
Cholesterol is the precursor to all of your steroid hormones, including testosterone. So, it makes perfect sense that you need to eat a diet high in natural fats(8,9,10,11). Eggs are the perfect food source in my opinion.
Protein is necessary for growth and repair which is facilitated by testosterone. If you don’t have enough protein in your diet, you disrupt the process which has a knock on effect on the HPG axis(12,13). It turns out that carbohydrates are also necessary. As a rule of thumb, I’d stay away from refined sugars, I’d actually stay away from ANYTHING refined.
Carbohydrates are especially important in resistance training, glycogen is stored within your muscles and the liver, when used, it needs to be replenished. Again, if you disrupt this system and don’t replenish glycogen stores, this has a knock-on effect on the HPG axis(14,15).
The problem is, we are not good at moderation. We are very good at excess, we are very good at choosing convenience – carbs are convenient, we eat way too many carbs, including breads, potatoes and pasta, for our requirements. I always advocate a high fat, low carb diet, just so people think twice before making their food choices.
3. Thou shalt minimise stress
• Cortisol is catabolic, testosterone is anabolic
A number of my guys come to me with essentially ‘burnout’, whether it be primarily physical, mental, emotional, or a combination of all three. Stress ultimately exerts a negative effect on your psychological and/or physical well-being. They often say “I thrive on stress”. Recognising their ability to cope well with stress at an early age, often leads them down a path or career that feeds that mechanism. It’s only in their late 30s/40s they wonder why they are now struggling to cope. It shouldn’t be considered failure, or that your coping mechanisms and strategies are now wrong, it’s the fact that you are human-being and this big civilised machine is a lie.
Restoring testosterone and continuing to live in the same stressful manner that lowered your testosterone means you will STILL ultimately crash and burn. It’s really difficult to tell someone to stop doing what they are doing and take a step back and reflect on why they feel different to their younger selves. The rationalisation process is a hard pill to swallow.
The stress hormone cortisol is a catabolic hormone, testosterone is anabolic. You need both but, as always, it’s a matter of balance. If you place your body under too much repeated physical stress and not allow it sufficient time to recover, then that will have a negative impact on your testosterone levels(16).
4. Thou shalt sleep, per chance to dream
Again, the importance of sleep cannot be over-exaggerated. It’s a massive problem in this modern civilised world of perceived stress, noise, blue light exposure, alcohol etc. One must remember, testosterone is an anabolic hormone that exerts its effect when we are resting, so adequate sleep is pivotal to a healthy testosterone. The current consensus is that we need at least 5 hours sleep, but increasing hours increases testosterone. Sleeping more than 8 hours isn’t practical for most people, however, it’s a good target to aim for. Sleep hygiene is so important, not only for testosterone, but overall health(17,18,19,20). A recent study linked lack of sleep to an increased risk of dementia, which essentially means I’m ######!
5. Thou shalt ‘Just Say No’ to drugs
It is important to remember that drugs are everywhere, and the distinction between legal and illegal is an arbitrary one. Drug abuse or misuse is a social problem, not a criminal problem. The hypocrisy of the oddly termed ‘War on Drugs’ is a fascinating topic, but it’s not appropriate for this blog.
“Just say no to drugs!” – Nancy Reagan, unless you are “Too busy sayin’ yeah” like NWA.
It is common sense and so I’m not going to labour the point too much. Androgenic Anabolic Steroids, alcohol(21,22,23) and smoking, to name a few drugs, can all have a negative impact on your Hypo-Pituitary Gonadal axis, thereby reducing testosterone. Let’s not forget prescribed drugs though, drugs that are prescribed by your doctor to address other health issues. There are loads!(24,25)
As with everything, there is a benefits/risks analysis with every decision we make. The lines can be pretty blurry at times. As a rule of thumb, less is more when it comes to drugs. The impact preventable diseases can have on your body and the healthcare system cannot be over-emphasised. The fact that they are ‘preventable’ should give you a clue as to who should be primarily responsible for addressing them, YOU!
6. Thou shalt avoid phytoestrogens & other environmental toxins
Phytoestrogens, as the name suggests, increase oestrogen which presumably has a negative impact on the signalling GnRH release in the brain, essentially telling the brain you have enough testosterone when you don’t. Phytoestrogens are predominantly found in soy products, flaxseed, tofu and donuts – doh! Sorry guys, but beer has a high level of phytoestrogens in it!(26). However, denial is strong in booze hounds around the globe.
“All right, brain, I don’t like you, and you don’t like me, so let’s just do this, and I’ll get back to killing you with beer.” – Homer Simpson
Plastics containing bisphenol-A (BPA), a chemical that mimics oestrogen in the body, exerts a similar effect to phytoestrogens. It essentially disrupts the HPG axis which will reduce your testosterone(27,28). Look for BPA free labels on the plastics you buy to reduce your exposure. The problem is, plastics are everywhere.
7. Thou shalt go fishing & bathe in the glory of the sun
Vitamin D is an important hormone in the synthesis of testosterone. You can increase your levels through sun exposure, although not so easy in the UK. It is also found in certain foods such as oily fish, eggs and cheese. One study suggested that supplementing your diet with 3,000 IU of vitamin D3 per day can increase your testosterone level by up to 25%(29).
8. Thou shalt remember MORE isn’t always better
Who hasn’t succumbed to the occasional bout of gluttony and excess? Who hasn’t falsely believed more is better? I can think of many personal examples, however, I’m not sure it would be wise to write them down!
When it comes to TRT, guys are obsessed with chasing high testosterone levels. Believing that more is better, they end up with side effects, normally from excess oestrodiol as the exogenous testosterone is broken down. They are too quick to reach for medications such as Anastrozole to halt the process of aromatisation. Polypharmacy is a massive problem in this modern progressive healthcare system.
It seems that some clinicians and patients aren’t willing to titrate their dose to a level based on qualitative parameters, a level that is best for their genetics and physiological state. We all like evidence, we all like statistics to rationalise our decisions, but I’m sure the quantitative markers will improve with the correct level for you.
With the continued ambiguity surrounding “What is an optimal level of testosterone?”, surely we’ve progressed so far as to conclude that my optimal testosterone level may not be the same as yours? You are not more ALPHA just because you have a high testosterone, you’re probably more of an idiot.
9. Remember that you grow when you rest
Some guys come to see me and they are frustrated because they have clean diets, they exercise every day (some train three times a day!), whether it be for a competition or to stay healthy. What they don’t realise is that it’s all very well pumping weights and getting ‘swole’, pushing your body to failure on every set, but unless you rest, you will never grow.
Exercise is a catabolic process, not anabolic. Whilst exercise causes a spike in testosterone, you need to be in a state of rest for it to exert its effects. It’s all about balance, a recurring theme in all my blogs, too much exercise causes the release of too much cortisol, which is catabolic(30).
10. Honor thy body and thy TRT doctor
As my mother always says, “Be your own best friend”. Sounds simple enough, but who hasn’t made mistakes in their life? I know I have. I also know that I’ll probably make a few more. The difference is, with advancing age those mistakes are more calculated. It doesn’t excuse them, it doesn’t justify them, it just means that through experience and learnt wisdom we hopefully have a more considered approach to the stupid things our ID is telling us to do! Men on TRT have often been there, done that and got the t-shirt. Some are just unlucky, but all should have had that eureka moment and realised that they need to address the aspects in their lives that they can affect a positive change in, BEFORE reaching for testosterone replacement therapy. We encourage all of our guys to address their lifestyle, nutrition and physical activity before considering TRT. To reap the long-term benefits of TRT your lifestyle still needs to be in check, your nutrition still needs to be on point and your exercise regime challenging enough and consistent. TRT allows you to be you!
Dr Robert Stevens MBChB MRCGP Dip.FIPT