Testosterone replacement therapy (TRT) has been getting a lot of attention these days as the population ages. And although it’s advertised as safe and effective, does testosterone therapy really improve health in older men?
It really depends. The waters surrounding testosterone boosters and TRT can be a little murky. For example, there are plenty of supplement products that claim to boost testosterone, but are ineffective and potentially dangerous. These are the products you’ll hear advertised on the radio and see on television commercials and in magazine ads, as well as online and in health food stores. If I were you, I’d stay away from these products regardless of the claims because they are often waste of money. It’s doubtful they will do anything to make you feel more energized, stronger, adventurous, or boost your libido. And if they do boost energy, it will likely be a short-term rise coming from caffeine or some other stimulant—not any sort of increase in blood testosterone levels.
But TRT, on the other hand, is less definitive. Studies show conflicting results on how it works, which symptoms it can address, and where health risks may lie. TRT has been found to improve sex drive, youthfulness, strength, and energy in some men, while it hasn’t worked as well in others. And studies for its impacts on cardiovascular health—another area where benefits are often highly touted—have mixed results. So at this point, it’s difficult to say where TRT is effective and for whom.
What Is Testosterone?
Although testosterone is present in women, it is largely a male sex hormone. Men have much higher blood levels of testosterone than their female counterparts; and for the purposes of this article, we’ll be focusing on TRT in regard to men. Testosterone is largely produced in the testicles and is responsible for sustaining sperm production, sex drive, facial and body hair growth, muscle size and strength, fat distribution, bone density, and red blood cell production.
According to the Mayo Clinic, men start to experience reductions in testosterone levels at about a rate of 1 percent per year from age 30 or 40. There is also a substantial range classified as “normal” testosterone levels, going from the lower end at 270 nanograms per deciliter of blood (ng/dl) up to 1,070 ng/dl. Blood levels outside of that range are classified as “low” or “high.”
What Are the Effects and Symptoms of Low Testosterone?
If you’re in your 60s and wondering where the feelings of your youth have gone, it could be due to reduced levels of testosterone in your blood. If you’re not as strong as you once were, as lean, or are simply unmotivated about life, it could also be due to lowering testosterone levels.
But “low T” is not just associated with age. Testosterone is also affected by weight, diet, and activity levels, so being overweight, obese, or having a poor diet can wreak havoc on your hormones and cause them to diminish faster. Conversely, increasing activity, losing weight, and maintaining a healthy diet can boost T levels.
Some of the noticeable symptoms of low testosterone can be:
- Change in sleep patterns
- Reduced sex drive
- Erectile and sexual dysfunction
- Emotional changes
- Decreased strength
- Weight gain
What Is Testosterone Replacement Therapy?
If blood tests reveal low testosterone, your doctor may suggest TRT. TRT, also known as Androgen Replacement Therapy (ART), is basically the replacement of testosterone. It’s typically administered through injections, skin creams, patches, gels, or pellets implanted under the skin. TRT should be prescribed and administered by a professional—not obtained by a guy who works out in your gym! And once again, supplements sold in health food stores, advertised in magazines, online or on the radio boasting amazing results to fight low T should be avoided.
Is TRT Effective for Aging or Older Men?
The results for testosterone replacement therapy are mixed. While it’s shown to be very effective in some areas, others need further research. The results of five studies on TRT—called the Testosterone Trials (TTRIALS)—were published in February in JAMA, and they did little to offer further insight on the efficacy of TRT for certain symptoms. This particular set of tests was a follow up to earlier TTRIALS released last year, exploring its effects on a different set of symptoms. These latest tests looked at TRT’s impact on cardiovascular and bone health.
1. TTRIALS Findings
Researchers took a look at 788 men with below normal levels of testosterone, studied across 12 sites in the United States over the course of a year. The men were randomly assigned to one of two groups: one that used a testosterone gel called AndroGel and another given a placebo. Overall, the researchers noted improvements in bone density and strength among the group who used the gel, seeing T-levels boost to that of younger men. It also helped boost iron levels in men with unexplained anemia. However, using the AndroGel offered no noticeable improvements to cognition and memory, while also presenting some worrisome signs for increased risk in cardiovascular problems.
Researchers noted an increase in arterial plaque buildup, which is a known risk factor for heart disease, high blood pressure, heart attack, and stroke. This is an interesting finding because previous studies have suggested TRT might improve cardiovascular health. Clearly, more work needs to be done to see exactly how TRT impacts heart health.
The previous round of TTRIALS reported last year in the New England Journal of Medicine showed TRT (administered from gel) was significantly effective for sexual function and sexual desire. It also noted improvements in mood.
So, it appears TRT is likely effective for muscular strength, bone density and strength, sex drive, sexual function, and mood. It might not be great effective for memory and cognition. Of course, if it increases the risk of heart attack, the risks of TRT may outweigh the benefits for most.
How to Improve Testosterone Naturally
You can make improvements to testosterone without taking therapy, and there are both scientific and case studies to prove it. This is especially true for those segments of the population that seem to be at the highest risk for low T, including overweight and obese Americans in addition to those over age 60.
1. Physical Activity
A study out of Tsukuba University in Japan was presented at the American Physiological Society meetings last November. Researchers found that overweight or obese men participating in a 12-week aerobic exercise program experienced significant boosts in blood testosterone levels. Being overweight or obese is a leading risk factor with low T, and is likely the result of little exercise and a poor diet.
The study was rather small in scale—only 44 men participated—but the results are quite telling and echo the results of similar research. Of the 44, 28 men were overweight or obese, while the remaining 16 were of “normal” weight; none of the participants engaged in regular exercise prior to the study.
Each participant was required to take part in an aerobic exercise program—so something like jogging or walking—for 40 to 60 minutes, one to three times per week for 12 weeks. T-levels were measured prior to and following the trial. Although men of normal weight experienced no changes in T-levels, the overweight and obese participants saw their T jump from 15.4 nanomoles per liter (nm/L) (444ng/dL) to 18.1 nm/L (522 ng/dL). Not only were the increases impressive, but another telling result is that the more vigorously the participant exercised, the greater their T-level increase was.
Aerobic exercise comes with a number of other health benefits including lower blood pressure and a reduced risk for heart disease, so it’s definitely something worth considering.
Vigorous activity was associated with increased T-levels, so the intensity with which you work also plays a big role. I’d also suggest that weight training and resistance programs can benefit T levels. Holding on to and building muscles is important for T production and maintenance. Whole weight training is a great way to exercise vigorously.
The food you eat can also play a big role in testosterone levels. Processed foods can lead to weight gain, while making it hard to acquire the nutrients most highly associated with T maintenance. Protein can help build muscle, and healthy fats like omega-3 can also help. Therefore, eating a balanced diet of unprocessed foods is recommended.
Specific nutrients like vitamin D and zinc are associated with T production and maintenance. Therefore, some foods that may help include:
- Eggs (with yolk)
- Fortified milks and cereals
- Vitamin D supplements
- Omega-3 fish oil supplements
TRT: A Last Resort?
Because the jury remains out on testosterone replacement therapy’s impact on heart health, it isn’t something you should be rushing towards. Work with your doctor to come up with a plan to improve testosterone levels naturally, opting for therapy as a last resort. This is mainly true if you have existing heart problems or have borderline high-blood pressure. Be aware that the natural method takes a long time and requires hard work, but it’s likely to provide a host of additional health benefits.
Cheetham, T., “Association of Testosterone Replacement With Cardiovascular Outcomes Among Men With Androgen Deficiency,” JAMA Intern Med. 2017;177(4):491-499. doi:10.1001/jamainternmed.2016.9546.
Neighmond, P., “Does Testosterone Improve Older Men’s Health? It Depends,” NPR, February 21, 2017; http://www.npr.org/sections/health-shots/2017/02/21/515456194/does-testosterone-improve-older-mens-health-it-depends, last accessed April 12, 2017.
Whiteman, H., “Aerobic exercise boosts testosterone for overweight men,” Medical News Today, November 5, 2016; http://www.medicalnewstoday.com/articles/313909.php, last accessed April 12, 2017.
Brink, W., “Natural T Rebound: A Case Study,” Brinkzone, April 12, 2017; http://www.brinkzone.com/bodybuilding/natural-t-rebound-a-case-study/, last accessed April 12, 2017.