Declining Testosterone in Men and What We Can Do About It

Decreasing testosterone levels among adolescents and young men presents a significant health concern going into 2021. Testosterone is a hormone naturally produced in the human body, but we will refer to low testosterone in men only for this article. It is synthesized in the testicles and profoundly affects several vital physiological functions in men including sex drive, sperm production, muscle mass and strength, red blood cell production, bone density, and lipid distribution. Because of its role in these processes, decreased production may have severe health implications.

The American Urological Association held a virtual meeting in 2020 where results of a recent study were discussed. The findings revealed that from 1999-2016, testosterone levels were on the decline in both adolescent and young adult men. The statistics were staggering, with a testosterone deficit of 10-40% among adult men and up to 20% for males ages 15-39 years old. Testosterone levels naturally decline as men age, so we expect a decrease in the 40 and over age group. However, age was not a factor in the adolescent and young men's categories which was one reason the findings were alarming.

The data used was from the National Health and Nutrition Examination Surveys from 1999-2016. Serum testosterone levels were tested over time in 4045 young adult males. Interestingly, testosterone levels decreased as BMI increased; however, testosterone levels were below average even in men with normal BMI.

There may be multiple reasons for the decrease in testosterone levels, including a stark rise in obesity rates that continue to climb and commonly lead to diabetes. A sedentary lifestyle, low-quality diet, body fat percentages increasing, potential environmental factors such as BPA, and the recent rise in marijuana use in the specified age group are likely contributing factors.

OBESITY

With at least half of the world's population expected to be obese by 2050, it poses significant societal and environmental challenges. Consider these facts from the World Health Organization:

• · Worldwide obesity has nearly tripled since 1975.

• In 2016, more than 1.9 billion adults, 18 years and older, were overweight. Of these, over 650 million were obese.

• · 39% of adults aged 18 years and over were overweight in 2016, and 13% were obese.

• · Thirty-eight million children under the age of 5 were overweight or obese in 2019.

• · Over 340 million children and adolescents aged 5-19 were overweight or obese in 2016.

Obesity is partially responsible for cardiovascular disease, lower sleep quality, a higher risk of some cancers, and lowered testosterone levels.

Additionally, testosterone plays a significant role in metabolic diseases like obesity. Lowered testosterone levels are associated with higher percentages of body fat and lower amounts of lean mass in men and young boys. This often leads to metabolic dysfunction and may lead to impaired glucose control and decreased insulin sensitivity.

Even moderate obesity decreases total testosterone due to insulin resistance associated with metabolic complications related to sex hormone regulation. This decrease in testosterone may be reversible but requires weight loss. The good news is that once some weight loss is achieved, testosterone levels may likely increase.

BPA

BPA stands for bisphenol A. BPA is an industrial chemical used to make certain plastics and resins since the 1960s. It is found in polycarbonate plastics and epoxy resins often used in containers that store food and beverages, such as water bottles. They may also be used to coat the inside of canned goods, bottles, and some water supply lines. Some research shows that it can leach into foods or beverages from food containers.

The Food and Drug Administration has stated that BPA occurs at deficient and safe levels in the environment and food containers. BPA continues to be monitored, and more conclusive research needs to be conducted to implicate BPA definitively as one of the causes of decreased testosterone. In the studies I have looked at, BPA levels are a concern only when there is chronic exposure, as in factory employees who work daily with the substance. If one is genuinely concerned about BPA, there are a few steps that can be taken to decrease exposure:

*Use glass or stainless steel containers as opposed to plastic

*Don't put polycarbonate plastics in the microwave or dishwasher because the heat may break them down over time and allow BPA to leach into foods.

*Use BPA-free food containers. Fortunately, more options on store shelves specifically state "BPA free" on the label.

WHAT CAN YOU DO TO INCREASE TESTOSTERONE?

Diet, Exercise and Strength Train

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I typically recommend a regular exercise/strength training routine for anyone regardless of age or gender. As it turns out, according to this study, it can help boost testosterone levels. Weight lifting was shown to help increase levels more than weight loss. High-Intensity training was also beneficial.

The results of this study seem to suggest that physical activity can increase serum testosterone levels in obese and overweight men in a 12-week lifestyle modification study. The increase was more profound after an exercise program compared to weight loss alone.

Unsurprisingly your diet has a significant impact on hormone levels and specifically testosterone. Yo-yo dieting and weight loss may have lasting, damaging effects on testosterone levels, so developing a consistent strategy to promote health and weight is the most productive way to influence testosterone availability.

Eating adequate, high bioavailable protein and a balance of high fiber, high-quality carbohydrates, and plant-based fats can ensure testosterone levels stay normal.

Get Good Quality Sleep

Getting adequate amounts of sound sleep is equally as crucial to health as a diet and exercise routine. Not only does it affect your immune system and how your body handles stress, but it also impacts testosterone levels.

In one study, published in the Journal of the American Medical Association, testosterone levels of 10 young men were compared after one week of regular sleep. They retested again after one week of a sleep deficit.

Testosterone levels decreased by 10-15% after the week of sleep deficit compared to the typical sleep week. Although this is a very small study and more research in this area is needed, it does underscore the importance of the often-overlooked importance of quality sleep and its impact on health.

While there is no magical number of hours spent sleeping that is ideal, in one study that I came across, it was hypothesized that getting 5 hours or less may lead to a 15% reduction in testosterone levels. Less than 5 hours may lead to a deficiency. This isn't much of a surprise, considering sleep habits also impact hormonal fluctuations. Most research concludes that roughly 8-10 hours of sleep per night is best for positive health implications and keeping testosterone levels optimal.

Avoid Excessive Alcohol Use

According to the 2020 Dietary Guidelines, moderate drinking for men is up to 2 drinks. Excessive drinking would be four drinks or more. This can lead to decreased testosterone levels and, over time, health issues such as liver and heart disease, cancer, obesity, and metabolic complications.

Alcohol may interrupt testosterone production by interfering with the glands responsible for its production: the hypothalamus and the pituitary, responsible for releasing hormones that direct the testes to produce testosterone.