For the last few years, testosterone ("T") has been one of the biggest swinging dicks of the prescription drug business. According to IMS Health, a leading healthcare and pharmaceutical analysis firm, sales of testosterone-related drugs hit $1.9 billion in 2011—a 90 percent increase in sales over the previous five years. And IMS doesn't see any future sagging in the market either: Experts predict testosterone sales will top $5 billion by 2017.
While much of the interest is driven by aging baby-boomers hoping to cling to their precious youth, T is gaining popularity even among 20- and 30-somethings. Why? In addition to driving the creation of manly reproductive parts, T increases muscle mass and bone density, provides a general sense of vim and vigor, and may even boost happiness and confidence (though it's odd that men don't seem happier than women given that they secrete 10 times more of the hormone than females).
Unfortunately there's widespread confusion about what T is, how to diagnose low levels of it, and what the medical profession can really do to help. Below are some are myth-busting answers to questions you probably didn't even know you had.
Whose T levels drop, and so what if they do?
T levels start to decline by one to three percent a year in guys over 30. This is natural, but if levels dip too low, things like sex drive and erection strength plummet while fatigue, depression, diabetes, and body fat may increase. And the older you get, the more dire the situation: A 2008 study found that low T in older men was associated with increased risk of death. Thus, all men have an abiding interest in keeping it up (T levels, that is).
How do I know if I have low T?
If you're young (or even not so young) and healthy and notice the symptoms of low T described above, you should get a series of blood tests that can determine if you have a condition called hypogonadism, in which the testes don't produce enough T. But just because you're feeling down, having trouble getting it up, and are less frisky than you'd like, these are not legit medical reasons, on their own, to badger your doc for a T prescription. If your doctor diagnoses low T, he or she will closely monitor your treatment, consisting of injections, prescription creams, gels, patches, or oral meds.
But wait, can't T levels be low even if I don't have hypogonadism?
Yes, they can—and this is the point where direct-to-consumer pharma-marketing hype and reality collide. The truth is that for the overwhelming majority of men—young and old—the best solutions for fixing tanked T levels isn't some pill or gel, but rather boring old lifestyle changes. Are you eating like crap, waking up a lot in the middle of the night, and avoiding exercise? All of those factors will wreak havoc on your T levels, but no one wants to hear that such basic stuff is the secret behind yet another health woe.
What about cortisol?
No discussion of T is complete without a quick word about cortisol (let's call it "C"). When you treat yourself like shit not only do T levels drop; cortisol rises. C is a stress hormone that's historically played a crucial role in the body's fight-or-flight mechanism. It's what helped keep us alive when our ancestors faced saber-toothed tigers, and it's still critical today when we confront danger—like muggers or psycho exes. But C is also released when the body is under chronic stress (which may occur with too little sleep and bad eating habits). And when C production goes up, testosterone production goes down, so your goal is not only to bolster T but also to minimize C.
All that said, there are five things you can do to bump up T levels:
1. Lift heavy weights
A 2010 study found that resistance exercise can increase T, specifically lifting heavy objects. Stick to compound lifts that work multiple muscles, like squats, for the most time-efficient T boost.
A 2011 study found that a four-week regimen of short sprints greatly increased study subjects' total T levels. Run with it.
3. Avoid "chronic cardio"
Multiple studies have shown that excess amounts of intense aerobic exercise (like lots of long, hard runs or bike rides) results in lowered T levels. No one in his right mind is going to say aerobic exercise is bad for you, but if you want to train for a marathon or a triathlon, understand that you risk lower T levels.
4. Eat more healthy fats
Yeah, more fat. Higher consumption of saturated and monounsaturated fat has been shown to lead to higher T levels.
If you're a meat eater, chow down on steak (grass-fed over corn-fed, preferably). Meat provides protein for muscle-building and the fats and cholesterol the body needs to make testosterone. Don't eat meat? Up your intake of eggs, avocado, olives, coconut, and coconut oil, as well as raw nuts like pecans, almonds, and Brazil nuts (meat eaters should eat more of these too).
5. Get more sun or take vitamin D
In 2011, Austrian researchers found that upping your vitamin D—via supplements or just getting outdoors—can also up your T.
Why Not Use Prescription T?
There are well-known risks associated with testosterone supplementation—things like enlarged breasts, reduced fertility, blood clots, heart attacks, liver damage, and an enlarged prostate. If you don't have a true medical problem that's causing chronic lowered T levels, you could be setting yourself up for some nasty side effects.
What About Over-the-Counter Supplements That Claim to Boost T?
Don't waste your cash. First of all, in the U.S. testosterone is a controlled substance that can only be sold via prescription, so any supplement sold legally over the counter cannot contain actual testosterone. Given that fact, supplement makers employ other chemicals and herbal extracts that they claim boost T levels. But, of course, none of those claims have been verified by the U.S. Food and Drug Administration, because they don't regulate such supplements. The dude working out next to you may swear his libido and muscles have grown exponentially thanks to X brand of T booster, but the few times T supplements have been subjected to rigorous study by researchers the results have indicated that they produce virtually no rise in T levels.
In the end there is no magic bullet (or pill, gel, cream, or injection) that will compensate for subpar lifestyle choices that are wrecking your T levels and overall health. Instead, talk to your doctor; eat, sleep, and exercise better; and let your email spam filters keep all those miracle T ads far, far away from you.