What if we told you 'normal for your age' doesn't need to look or feel below average? While the dad bod had its internet moment, for men over 30, it's time we got to the root of those extra lbs, low libido, and lethargy — and what you can do about it.
“Low testosterone is one of the most underdiagnosed conditions in American men,” says Dr. Vinita Tandon, Lifeforce’s Medical Director, a board certified endocrinologist, and previous national medical director for 12 hormone optimization clinics. “An epidemiological study found that out of a group of men who visited their primary care doctor with a variety of symptoms, up to 55% of them tested positive for low testosterone," says Dr. Tandon.
If you’re a man, or know one, you’re probably familiar with testosterone, the hormone that regulates sex drive, muscle mass and strength, fat distribution, and more. "Although many refer to age-related testosterone decline as andropause, it's a bit of a misnomer since it's not an abrupt 'pause' like the female counterpart of menopause. Rather, it's a progressive decline that can negatively impact health, happiness, and performance of millions of men once it hits a certain threshold," says Dr. Tandon. "The term 'functional hypogonadism' is more often used now than either andropause or late onset hypogonadism."
Functional hypogonadism (FH) is typically defined as low or borderline low testosterone (T) secondary to aging and/or co-morbidities such as obesity and diabetes. "The relationship is usually bidirectional and can be treated by proactively addressing the underlying cause, improving nutrition, exercise, sleep as well as sometimes testosterone therapy," says Dr. Tandon. Here’s your guide.
When and Why Do Testosterone Levels Drop?
Testosterone levels peak during puberty and stay high through your 20s. On average, levels decline about 1 to 2% each year starting in your mid-30s. That can result in a 5-8% decline in muscle mass each decade, as well as accelerated bone loss and declines in energy and physical performance. One theory about why this occurs is that life expectancy has outpaced evolution. The life expectancy of a man born in the 1900s was 40 compared to 75 in 2021. We are asking our bodies to perform for decades longer but our biology has not kept pace.
By the time men reach their early 40s, testosterone levels are often 40% lower than their peak, Dr. Tandon explains. That is also often when men start to experience "I’m getting old” problems like more belly fat, a harder time maintaining muscle, rising blood pressure, declining bone density, decreased sleep quality, higher cholesterol, lower sexual appetite, reduced energy levels, and slower cognition.
From her experience working on testosterone optimization with thousands of men, Dr. Tandon describes what many men feel during this time as a general apathy that robs them of the motivation they once had to pursue the things that are most important to them. Cue the stereotypical midlife crisis. After 50, testosterone levels begin to drop up to 20% from their peak, coinciding with men reporting their lowest levels of general life satisfaction.
Moreover, the decline in testosterone levels appears to be accelerating in each generation, potentially due to exposure to plastics, pollution, and estrogens in the food and water supply. A longitudinal study published in The Journal of Clinical Endocrinology & Metabolism revealed there was a 20% decline in the median testosterone levels from one generation to the next, over a 20 year span. “If we were to use similar data today, then a man in his 30s might have similar testosterone levels to what his father had in his 50s or 60s,” explains Dr. Tandon. On an individual basis, certain lifestyle factors that have been shown to suppress testosterone including:
Chronic Stress: This affects pituitary gland function, which messes with the testes’ ability to make testosterone.
Obesity: Fat cells turn testosterone to estrogen, which means guys with higher BMIs are more likely to have low testosterone. In fact, one study of men ages 40 and up found that each one-point increase in BMI was associated with a 2% decrease in testosterone.
Poor Sleep: Less than seven hours of sleep also impedes pituitary gland function and interrupts testosterone output.
Drugs and Alcohol: Recreational drugs, alcohol, and antidepressants have all been shown to lower testosterone.
Head Injuries: Prior concussions or brain trauma have been linked to sub-optimal testosterone levels, even many years after the event.
Help at Hand
The good news is that several well-established, clinically validated strategies exist to pause or reverse testosterone decline. “People are becoming less tolerant of the conventional aging process,” says Dr. Tandon. “They still want to maximize their potential. They are out there in their 40s, 50s, 60s, living full and demanding lives. It's pretty amazing to see what a role testosterone replacement can play in that.”
A study published in The Journal of Clinical Investigation brings some of the most common benefits of testosterone replacement therapy (TRT) to life:
Improved sexual function: Men with low libido who receive TRT experience an improvement in overall sexual activity and desire, as well as erectile function.
Increased muscle strength & mass: TRT increases muscle mass, strength, leg power, mobility, and even the ability to climb stairs and walk.
Better aerobic capacity: Although modest, testosterone can also improve aerobic capacity and mitigate the age-related decline in peak oxygen uptake (VO2peak).
More balanced mental health: In men with hypogonadism (without depressive disorder), testosterone can improve depressive symptoms.
Improved body composition: Testosterone can reduce overall and visceral fat mass.
While the benefits of testosterone optimization are clear, embarking on hormone optimization is a serious health decision that requires research and due diligence.
Check out a few key questions for selecting a testosterone optimization partner here, and how Lifeforce can help.
Testosterone Optimization Approaches
The goal of testosterone optimization is not about creating "super-physiological" levels of testosterone (leave that to bodybuilders). It’s about finding and maintaining the range that works best for each individual. There are multiple well-established approaches to doing that, Dr. Tandon explains:
Exogenous Testosterone (what most people commonly think of as TRT):
What it is: A daily cream or weekly injection of bioidentical synthetic testosterone
How much it can improve levels: 50% or more
How fast it works: 2-4 weeks
Pros: Largest and most reliable way to increase levels, with the fastest response time
Cons: Often leads to decreased natural testosterone production, which can affect fertility. It’s also expensive, and involves either needles or a cream that must be carefully managed to avoid accidental transference to other people by skin on skin contact. May require additional pharmaceuticals to maintain balance and mitigate side effects.
Exogenous testosterone is often coupled with additional pharmaceuticals:
Anastrozole: “When you use exogenous testosterone, some converts to estrogen,” Dr. Tandon explains. “If there’s too much of that conversion, men may develop a little breast tissue or tenderness. Anastrozole helps block that conversion.” Your Lifeforce performance doctor will keep tabs on your estrogen levels via your blood work to determine whether or not this is right for you.
Clomiphene: If a man doesn’t want TRT (perhaps due to concerns over fertility), this pharmaceutical can help improve your innate testosterone production. Some men will do a combination of testosterone and Clomiphene in “pulses” to periodically restart natural testosterone.
Testosterone Boosting Supplements
What it is: Over-the-counter supplements for people reluctant to start exogenous testosterone, or those requiring only a mild increase in levels. Zinc, Ashwagandha, Vitamin D, and magnesium, for example, can help the body naturally process testosterone.
How much it can improve levels: 0-50 ng/dl
How fast it works: 1-2 months
Pros: Affordable, non-invasive (usually tablets or powders), minimal side effects
Cons: Modest and unreliable impact, lack of research validation, difficulty finding trusted, high-quality supplements
Lifestyle Changes
What it is: Making key changes to your lifestyle that will positively impact testosterone levels, e.g. reducing body fat, getting adequate sleep, better stress management, avoiding drugs and alcohol. “There's definitely a bidirectional relationship between being overweight and testosterone levels,” says Dr. Tandon. When you have low testosterone, you easily gain weight — and when you gain weight, you make less testosterone. “Keeping your weight in a normal range will improve your testosterone levels to some degree.”
How much it can improve levels: 100-200 ng/dl
How fast it works: 3-6 months
Pros: Free and non-invasive approach that amplifies the effects of exogenous testosterone or testosterone supplements, while supporting general health and lowering risk of other conditions
Cons: Motivation and follow-through can be tough if you are already suffering from low testosterone
Normal Vs. Optimal: What Are Good Testosterone Levels?
As with many biomarkers, what constitutes a “normal” range of testosterone is up for debate. In most commercial labs it’s broadly defined as anywhere from 280-1,100 ng/dl. However, those ranges were created a long time ago in traditional medical institutions to diagnose disease, not to optimize everyday performance. Those ranges also do not account for the real-life experience of men living with different levels.
As Dr. Tandon explains, “A man who had previously performed well with 600+ levels in his 30s that is now living with sub-300 levels in his 50s is experiencing life very differently. Usually he is not aware of why, or that he can control that. He certainly isn’t getting any clues from his annual physical because he’s still considered “normal.” Generally speaking, men function at their best between 600 and 900 and really start to struggle below 300.”
How Safe Is Testosterone Therapy?
“I always want to reassure people that testosterone therapy is super safe,” says Dr. Tandon. “We've come a long way in terms of our finesse in dosing, treating, and monitoring to ensure people are not having any side effects or lab changes that we need to address.”
“In terms of benefits versus risks,” Dr. Tandon says, “this is a very attractive therapy and new research is only supporting that further.”
The Bottom Line
Lifeforce’s mission is to improve the quality of midlife, and testosterone optimization is a foundational piece of that mission. “We intentionally do not aim to earn our members by being the cheapest or the easiest to get a prescription from,” says Lifeforce Co-Founder Dugal Bain.
“Instead, we are committed to giving more men access to support that is safe, highly effective, personalized, and high-touch — equipping men with everything they need to manage their testosterone in the right way and at the right time in their lives,” Bain says.
Learn more about hormone optimization and the Lifeforce membership here.
This article was medically reviewed by Vinita Tandon, MD, ABIM Board Certified in Endocrinology and Metabolism.
Originally published February 7, 2022. Updated on July 1, 2024.