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  • Writer's pictureDr. Karen F. Miller

Here's the T on 'T' (testosterone)

Updated: Nov 18, 2023

November 19, 2023, is International Men's Day, and to celebrate men in all their glory, I wanted to focus on how to help men maintain their hormone health as they age and show how hormones can be impacted by lifestyle choices. If it weren't for testosterone, they would be women. I'm serious about this—look up Testicular Feminization syndrome, now called Androgen Insensitivity syndrome—babies born with this defect have female secondary sex characteristics (breasts, vagina), but no uterus or ovaries because they are genetically male.

Stress is a major factor contributing to men's (and women's) health issues for a variety of reasons, one being a resulting hormone imbalance. For men, that means declining levels of testosterone. This is widely interpreted as a normal phenomenon of aging, but it is actually not normal for a man to have low testosterone.

A man's body runs on testosterone.

Besides stress, low testosterone can result from obesity, abnormal blood sugars or diabetes, exposure to toxins—including heavy metals and endocrine disruptors like plastics, styrofoam, and pesticides, among others—hypothyroidism, and some would say aging, but the graph below from Clinical Endocrinology tells us that men have "normal" testosterone levels up to age 80.

And if you know a little bit about how these ranges are calculated, you can see that 'average' testosterone only changes from 584 +/- 2.5% at 40-49 y.o. to 488 +/- 2.5% at ages 70-79 yrs of age, assuming a bell curve distribution to determine the reference ranges.

And who wants to be just average? Most men I treat with testosterone feel better when their free testosterone is above 14 pg/mL or in the top quartile of the reference range (top 25% of the range).

So what are some of the signs of declining testosterone in men?

There may be a change in mood, a slight decline in energy and strength, a noticeable change in sexual function (lack of ability to achieve or maintain erection) and/or sex drive (lack of libido or desire), inability to build muscle mass, and/or lack of 'mojo' or motivation.

The first step to achieving your optimum testosterone level is to recognize that there is a problem and take steps to see if a few lifestyle changes result in improvements in symptoms.

Basic changes that can make a huge difference include:

1. Exercise - regular exercise, at least 150 minutes weekly, can dramatically improve testosterone levels. Start with weight training 30 minutes for 5 days a week and work up from there. A good online option is if you can't get to the gym. You can also find live-stream yoga and pilates exercise sessions on the free app Insight Timer.

2. Nutrition - eat whole foods and avoid processed and fast foods. Eat organic whenever possible. Check out the Environmental Working Group's website for a list of the 'Dirty Dozen' foods that have the highest levels of pesticides and the 'Clean 15' with the lowest levels. Avoid alcohol. If you are pre-diabetic or diabetic then get your blood sugar under control and your Hemoglobin A1c under 5.7 by following a low glycemic or low-carb diet, see a Functional Medicine practitioner for personalized advice on diet and supplements to support a lower average blood sugar. See the end of this post for a great nutritious shake recipe.

3. Stress - stress management is a huge piece of the puzzle in restoring normal testosterone and function. It is important that the adrenal glands not be compromised as increased demand for cortisol can affect the ability to make testosterone. Plan to incorporate a daily mindfulness exercise to help balance stress and lessen the impacts of stress on testosterone levels. For most men, this means making time for daily meditation, breathing exercises, or some type of mindful activity that they enjoy (listening to music or playing music if you have that talent, reading a book for fun, walking the dog, painting, doing woodworking, etc) and getting adequate sleep - 7- 8 hours of quality sleep nightly. For more on balancing hormones check out our detox to balance hormones post.

4. Supplements - nutrition is always key to maintaining health and the production of testosterone is optimized when the body has plenty of the following:

  • Folate

  • Magnesium

  • Zinc

  • Vitamin B6

  • Vitamin C

  • Vitamin D

  • Vitamin E

  • Vitamin K

  • Carnitine

To ensure you are getting these and other vital nutrients essential to hormone health, it is important to have a good basic supplement regimen as we cannot get therapeutic doses of these nutrients through food alone.

A list of our recommended supplements is available at our Fullscript online supplement store.

If your testosterone levels are still suboptimal after committing to lifestyle changes, consider scheduling with a functional medicine provider like Dr. Miller who specializes in male hormones to discuss hormone replacement therapy options.


Dr. Miller

Tasty Maca Shake

1 cup organic red-leaf romaine lettuce

1 organic red pear, cored and chopped

1/2 c (or 10) frozen pitted cherries (organic)

1 T organic red maca root powder

1 T organic cacao powder

1 T organic unsweet cacao nibs

2 -3 organic pitted Neglet dates

1 cup ice cubes (or more to taste)

1 cup water or non-dairy milk

optional - dash of cinnamon

optional - unsweet, unflavored protein powder - 1 T.

Blend in a high-speed blender (like Vitamix) until completely blended and enjoy.

Karen Miller, MD is an OB/GYN and Certified Functional Medicine provider who specializes in Functional hormone therapies for men and women and in addressing complex medical illnesses. She is owner and Medical Director of Miller Functional Medicine Consulting, LLC.

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