Testosterone treatment is unequivocally needed in classical hypogonadism for reasons discussed in subsequent subsections. In classical hypogonadism, testosterone production is usually clearly below the lower limit of normal and patients are highly symptomatic; the various symptoms are easily related to the deficiencies in various bodily systems where testosterone action is important. Symptoms of testosterone deficiency are listed in Table 2. A few prominent causes of classical hypogonadism are listed in Table 3.
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Exercise boosts testosterone in two important ways. First, specific types of exercise actually cause our body to produce more testosterone. We’ll talk more about those in a bit. Second, exercise helps to increase muscle mass and decrease body fat. As we’ve discussed previously, adipose tissue converts testosterone into estrogen. The less fat we get, the more T we have.
These researchers took saliva samples from recreational women athletes before and after playing 10 minutes of flag football. The data showed that this short, intense burst of competitive sport triggered the immediate release of testosterone. Interestingly, the subjects' mental state also contributed to the data. Self-rated performance scores were directly related to testosterone levels.
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Dr. Darryn Willoughby, a professor of health, human performance and recreation and the director of the Exercise and Biochemical Nutrition Laboratory at Baylor University, told us that even in studies where there was an increase in testosterone, it was only around 15–20 percent. “In men with clinically normal testosterone levels, this modest increase will most likely not be anabolic enough to improve exercise performance,” he says. So if you have normal testosterone levels, and are simply trying to get an extra edge in gaining muscle, losing weight, or some extra time in the bedroom — you might see some results from taking a testosterone booster. But really, these will be most useful for men with low testosterone trying to get back to a healthy testosterone range.

Mood disturbance and dysthymia are part of the clinical syndrome of hypogonadism. Epidemiological studies have found a positive association between testosterone levels and mood, and depressed aging males have lower testosterone levels than controls (Barrett-Connor, Von Muhlen et al 1999). Furthermore, induction of a hypogonadal state during treatment of men for prostate cancer leads to an increase in depression scores (Almeida et al 2004). Trials of testosterone treatment effects on mood have varied in outcome. Data on the effects on men with depression are conflicting (Seidman et al 2001; Pope et al 2003) but there is evidence that testosterone treatment of older hypogonadal men does result in improvements in mood (Wang et al 1996) and that this may occur through changes in regional brain perfusion (Azad et al 2003).


In order to discuss the biochemical diagnosis of hypogonadism it is necessary to outline the usual carriage of testosterone in the blood. Total serum testosterone consists of free testosterone (2%–3%), testosterone bound to sex hormone binding globulin (SHBG) (45%) and testosterone bound to other proteins (mainly albumin −50%) (Dunn et al 1981). Testosterone binds only loosely to albumin and so this testosterone as well as free testosterone is available to tissues and is termed bioavailable testosterone. Testosterone bound to SHBG is tightly bound and is biologically inactive. Bioavailable and free testosterone are known to correlate better than total testosterone with clinical sequelae of androgenization such as bone mineral density and muscle strength (Khosla et al 1998; Roy et al 2002). There is diurnal variation in serum testosterone levels with peak levels seen in the morning following sleep, which can be maintained into the seventh decade (Diver et al 2003). Samples should always be taken in the morning before 11 am to allow for standardization.

Take 1 teaspoon. Incredibly dense in nutrients and feed by bees to the larvae who grows on to be the queen bee. I found one human study where a 4g daily serving led to an small increase in testosterone in older men (ref 78). There are also numerous animal studies (ref 79) showing positive effects. Personally I source NZ manuka royal jelly from Manuka Health.

There is increasing interest in the group of patients who fail to respond to treatment with PDE-5 inhibitors and have low serum testosterone levels. Evidence from placebo-controlled trials in this group of men shows that testosterone treatment added to PDE-5 inhibitors improves erectile function compared to PDE-5 inhibitors alone (Aversa et al 2003; Shabsigh et al 2004).
In contrast to steroids, testosterone boosters have a fully different mechanism of action. They are the products which contain the natural ingredients only. These ingredients act by stimulating the man’s body to synthesize own testosterone. So, testosterone levels grow naturally without negative health effects associated with the intake of steroids.
Testosterone functions within the brain. There are several lines of evidence for this: there are androgen receptors within the brain; testosterone is converted to both dihydrotestosterone (DHT) and estradiol by the actions of 5-α-reductase and aromatase respectively in the brain; steroid hormones promote neuronal cell growth and survival (Azad et al 2003). Testosterone enhances cerebral perfusion in hypogonadal men and that perfusion takes place specifically in Brodman areas 8 and 24, regions of the brain that are concerned with: strategic planning, higher motor action, cognitive behaviors, emotional behavior, generalized emotional reaction, wakefulness and memory (Greenlee 2000; Azad et al 2003). Studies of cognition demonstrate that older men with higher levels of free testosterone index (a surrogate measure of bioavailable testosterone) have better scores in tests of: visual memory, verbal memory, visuospatial functions and visuomotor scanning. Hypogonadal men have lower scores in tests of memory, visuospatial function, with a faster decline in visual memory (Moffat et al 2002). In a very small, short term placebo-controlled study hypogonadal men with Alzheimer’s Disease (AD) treated with testosterone demonstrated a modest improvement in a cognition assessment score in AD (Tan and Pu 2003).
When you’re under stress (be it from lack of sleep, workplace stress, emotional stress, stress from a bad diet, overtraining etc.), your body releases cortisol. Cortisol blunts the effects of testosterone (47), which makes sense from an evolutionary point of view – if we were stressed as cavemen chances are it was a life or death situation – not running late to a meeting - in this state (i.e. running from a lion) the body wouldn’t care if you couldn’t get it up, there was more to worry about!

Let’s do a quick review of what I shared in the introduction to this series. August of last year was a tough month for me, primarily because of a huge and grueling project we were in the midst of here on the site. I was stressed out and my sleeping, healthy eating habits, and workout regimen all suffered. At the end of the month I got my testosterone levels tested and found that my total T was 383 ng/dL and my free T was 7.2 pg/mL – close to the average for an 85-100-year-old man.
Sharma, R., Oni, O. A., Gupta, K., Chen, G., Sharma, M., Dawn, B., … & Barua, R. S. (2015, August 6). Normalization of testosterone level is associated with reduced incidence of myocardial infarction. European Heart Journal, 36(40), 2706-2715. Retrieved from https://academic.oup.com/eurheartj/article/36/40/2706/2293361/Normalization-of-testosterone-level-is-associated
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