How to Increase Testosterone Naturally: Causes and Treatment of Low Testosterone

Low testosterone is common, frequently reversible, and often misunderstood. This is general information — bring it along to talk things through with your GP.

Low testosterone can cause reduced sex drive, fewer morning erections, erectile difficulties, low energy, reduced motivation and loss of muscle mass. However, these symptoms do not always mean that your testes have permanently stopped producing enough testosterone.

In many men, testosterone is temporarily or functionally reduced by factors such as excess weight, metabolic disease, poor general health, certain medications, inadequate nutrition or disrupted sleep. This is sometimes called functional testosterone deficiency or functional hypogonadism.

Unlike permanent testosterone deficiency caused by damage to the testes or pituitary gland, functional testosterone deficiency may improve when the underlying cause is addressed. For this reason, the most effective way to increase testosterone naturally is not usually a particular food or supplement. It is to identify and treat the factors suppressing your normal hormone system.

What does testosterone do?

Testosterone is the main male sex hormone. It plays an important role in:

• Sexual desire and erectile function
• Sperm production and fertility
• Muscle mass and physical strength
• Bone density
• Red blood cell production
• Body-fat distribution
• Mood, motivation and general wellbeing

Testosterone levels are normally highest during early adulthood and tend to decline gradually with age. However, ageing alone usually causes only a modest reduction. Obesity, diabetes, chronic illness and poor overall health often have a much greater effect.

A low testosterone result is not always testosterone deficiency

A diagnosis of testosterone deficiency should not be made from a single blood test.

Testosterone levels vary according to the time of day, sleep, food intake, recent illness, medications and laboratory methods. Testosterone may also fall temporarily when the body is under physical stress. Studies of this natural variability show that a substantial proportion of mildly low results are normal when the test is repeated — which is precisely why one result is never enough.

True hypogonadism is generally diagnosed only when a man has:

1. Symptoms or physical signs consistent with testosterone deficiency; and
2. Consistently low testosterone levels on properly collected blood tests.

Sexual symptoms — particularly reduced libido, loss of spontaneous or morning erections and erectile dysfunction — are more suggestive of testosterone deficiency than general symptoms such as tiredness, poor concentration or low mood. This is not just clinical opinion: the European Male Ageing Study, which examined thousands of middle-aged and older men, found that these three sexual symptoms were the ones that genuinely clustered with low testosterone. Fatigue and reduced motivation have many other possible causes.

What is functional testosterone deficiency?

The brain regulates testosterone production through signals sent from the hypothalamus and pituitary gland to the testes.

In functional testosterone deficiency, this system is structurally intact, but its activity has been reduced by another health or lifestyle factor. Common contributors include:

• Excess abdominal weight or obesity
• Insulin resistance, metabolic syndrome or type 2 diabetes
• Severe or chronic illness
• Obstructive sleep apnoea
• Long-term opioid medication
• Long-term or high-dose corticosteroid treatment
• Previous use of anabolic steroids or testosterone
• Excessive alcohol consumption
• Severe calorie restriction, undernutrition or overtraining
• Some pituitary-affecting or prolactin-raising medications

Functional testosterone deficiency is a diagnosis of exclusion. Your doctor must first consider whether there is an underlying testicular, pituitary, genetic or other medical disorder. European and Australian guidelines both recommend treating reversible health conditions, reviewing contributing medications and addressing excess weight before considering testosterone therapy.

How can you increase testosterone naturally?

1. Lose excess abdominal weight

For men who are overweight, sustained weight loss is usually the most effective natural strategy for improving testosterone.

Excess body fat — particularly visceral fat around the abdomen — is strongly associated with lower measured testosterone. Obesity also reduces sex hormone-binding globulin, or SHBG, which can make the total testosterone level appear lower even when the testes and pituitary gland remain capable of functioning normally.

As weight is lost, testosterone and SHBG commonly rise. A systematic review and meta-analysis of weight-loss studies found the improvement is broadly proportional to the amount of excess weight lost, with the largest increases following substantial weight loss. Weight loss may also improve erectile function, sleep apnoea, diabetes risk, energy, mobility and cardiovascular health.

The best approach will differ between individuals and may include:

• A sustainable calorie-controlled eating plan
• Support from a GP, dietitian or exercise physiologist
• Treatment of binge eating or emotional eating
• Evidence-based weight-management medication where appropriate
• Bariatric surgery for selected people with severe obesity

The aim is not rapid or extreme dieting. Severe calorie restriction can temporarily reduce testosterone, particularly while weight is falling rapidly. Hormone levels are best reassessed after nutrition and weight have become reasonably stable.

A note on getting help: if you would like tailored dietary support, ask your GP about a referral to one of our dietitians at The Local Doctor. You may be eligible for a care plan, which can give you Medicare-subsidised access to a dietitian.

2. Combine resistance training with aerobic exercise

Regular exercise supports testosterone indirectly by reducing abdominal fat, improving insulin sensitivity, preserving muscle and improving sleep and cardiovascular fitness.

A balanced program should usually include:

• Resistance training: exercises such as squats, presses, rows, weights or resistance machines two to three times each week
• Aerobic exercise: brisk walking, cycling, swimming, running or similar activity
• Daily movement: reducing long periods of sitting and increasing general activity

Exercise does not need to be extreme. Consistency matters far more than chasing a brief post-workout hormone “spike”. In men with obesity or metabolic disease, structured physical activity combined with weight loss can produce a meaningful improvement in testosterone and sexual health.

Excessive endurance exercise combined with inadequate calorie intake can have the opposite effect. Training should be supported by sufficient nutrition, recovery and sleep.

3. Improve sleep and investigate possible sleep apnoea

Testosterone production is closely linked to sleep. In a controlled study, restricting healthy young men to around five hours in bed for a single week lowered their daytime testosterone by roughly 10–15% — the equivalent of ageing them by more than a decade. Poor-quality sleep also causes fatigue, poor concentration, low mood, weight gain and reduced libido, all of which can resemble testosterone deficiency.

Most adults should aim for a consistent sleep schedule that allows approximately seven to nine hours of sleep, although individual needs vary.

Speak with your GP about obstructive sleep apnoea if you have:

• Loud snoring
• Witnessed pauses in breathing
• Waking while choking or gasping
• Morning headaches
• Significant daytime sleepiness
• Resistant high blood pressure
• A large neck circumference or excess weight

Treating sleep apnoea is important for cardiovascular health, alertness and quality of life. Honesty about the evidence matters here: a meta-analysis found that CPAP alone does not reliably raise testosterone. But treating sleep apnoea and the associated excess weight may substantially improve the symptoms that prompted testosterone testing in the first place.

4. Eat enough — but avoid a chronically excessive intake

There is no single “testosterone-boosting diet”.

A useful eating pattern is one that helps you reach a healthy weight while supplying adequate energy, protein, fibre, healthy fats, vitamins and minerals. This may include:

• Vegetables and fruit
• Legumes and whole grains
• Fish, eggs, poultry, lean meat or other protein sources
• Nuts, seeds and olive oil
• Minimally processed foods most of the time

Both chronic overeating and severe under-eating can contribute to hormonal problems. Crash diets, prolonged fasting without medical supervision and very low-energy diets may temporarily suppress reproductive hormones.

Protein intake should be sufficient to support muscle maintenance, particularly during weight loss. However, consuming large quantities of protein, meat or dietary fat does not automatically increase testosterone.

5. Reduce excessive alcohol consumption

Occasional low-level alcohol consumption is unlikely to be the sole cause of significant testosterone deficiency. However, regular heavy drinking can interfere with testosterone production, worsen sleep, increase abdominal weight, impair liver function and contribute to erectile dysfunction.

Australian guidelines advise no more than 10 standard drinks a week and no more than 4 on any one day. Reducing alcohol may improve both hormone-related symptoms and general health, particularly where drinking is contributing to weight gain or poor sleep.

6. Review medications and hormone use with your doctor

Some medications can suppress the signals controlling testosterone production. Important examples include:

• Long-term opioid pain medication
• Corticosteroids such as prednisolone
• Some medications that substantially increase prolactin
• Anabolic steroids
• Testosterone obtained through bodybuilding or non-medical sources

Long-term opioids are a particularly common and under-recognised cause: a systematic review and meta-analysis found that men taking opioids regularly have significantly lower testosterone than men who are not.

Do not stop prescribed medication suddenly. Your GP can review whether a medicine is contributing, whether the dose remains necessary and whether an alternative is available.

Anabolic steroids and external testosterone suppress the body’s own testosterone production. After they are stopped, natural production may remain reduced for months and sometimes far longer — a study of former anabolic steroid users found lower testosterone and more hypogonadal symptoms than in men who had never used them, an average of more than two years after they had stopped.

7. Manage diabetes, cardiovascular risk and chronic illness

Low testosterone frequently occurs alongside:

• Type 2 diabetes
• Metabolic fatty liver disease
• High blood pressure
• High cholesterol
• Chronic kidney, lung or liver disease
• Chronic inflammatory conditions
• Depression and other mental health conditions

Treating these conditions may not always produce a dramatic rise in testosterone, but it can improve energy, sexual function, exercise capacity and overall wellbeing.

Erectile dysfunction can also be an early marker of cardiovascular disease. It should not automatically be attributed to low testosterone, particularly when there are risk factors such as smoking, diabetes, hypertension or high cholesterol.

8. Correct genuine nutritional deficiencies

Zinc, vitamin D and several other nutrients are involved in normal hormone and reproductive function. However, supplements generally improve testosterone only when a genuine deficiency is present.

Taking large doses when you are not deficient is unlikely to produce a meaningful benefit and may cause harm. Excessive zinc, for example, can cause copper deficiency and neurological or blood abnormalities.

A varied diet is preferable to relying on supplements. Blood testing may be appropriate when symptoms, diet or medical history suggest a specific deficiency.

9. Avoid over-the-counter “testosterone boosters”

Most commercial testosterone boosters have little reliable evidence that they improve clinically meaningful testosterone deficiency. When researchers analysed the most popular testosterone-boosting supplements sold online, they found that many had no supporting human data whatsoever, and that several contained ingredients at doses with the potential to cause harm.

Some products contain undisclosed hormones, stimulants or ingredients capable of interacting with medications or damaging the liver. A product being described as “natural” does not guarantee that it is effective or safe.

If testosterone is genuinely low, the priority should be finding the cause — not masking the problem with an unproven supplement.

How should testosterone be tested?

Testosterone should usually be measured:

• Early in the morning, generally between 7:00 am and 10:00 am
• While fasting
• After a reasonably normal night’s sleep
• When you are not acutely unwell

For shift workers, the blood test should be timed after an adequate period of sleep rather than automatically being performed at a conventional morning time.

An unexpectedly low result should be repeated on a separate day before a diagnosis is made. A significant proportion of initially low results return to normal when repeated under appropriate conditions.

Depending on the result and your symptoms, your GP may also request:

• Luteinising hormone, or LH
• Follicle-stimulating hormone, or FSH
• SHBG
• Prolactin
• Thyroid function
• Iron studies
• Blood glucose or HbA1c
• Liver and kidney function
• A full blood count

LH and FSH help determine whether a low testosterone level is arising from the testes themselves or from reduced stimulation by the pituitary gland — a distinction that changes the whole direction of the assessment.

When should an organic cause be considered?

Lifestyle factors should not be assumed to explain every low testosterone result.

Further investigation may be needed when there is:

• A very low testosterone level
• Small or unusually soft testes
• Infertility
• Breast development or loss of body hair
• Previous undescended testes
• Testicular injury, torsion, infection or surgery
• Previous chemotherapy or radiotherapy
• Headaches or changes in vision
• A substantially elevated prolactin level
• Absent or very low LH and FSH
• Iron overload or a relevant genetic condition
• Failure to progress through puberty normally

These findings can indicate an underlying testicular or pituitary condition that is unlikely to be corrected through lifestyle changes alone.

When is testosterone replacement appropriate?

Testosterone replacement can be very beneficial for men with confirmed pathological hypogonadism. However, it should not be prescribed simply because one blood test is near or below the laboratory reference range. Australian and international guidelines are consistent on this point.

Before treatment, the diagnosis should be confirmed, the cause assessed, and the possible benefits and risks discussed.

External testosterone can:

• Reduce or stop sperm production
• Shrink the testes
• Increase the red blood cell count and haematocrit
• Cause acne or oily skin
• Require ongoing blood tests and prostate assessment where appropriate
• Suppress natural testosterone production

Testosterone treatment is therefore generally unsuitable for men currently trying to conceive. Men concerned about fertility should discuss this before starting any form of testosterone.

It is worth knowing what testosterone therapy is not for. A large Australian trial (T4DM) tested testosterone in men with excess weight who were at risk of type 2 diabetes and enrolled in a lifestyle programme. Testosterone did reduce the proportion who developed diabetes over two years — but the investigators were explicit that it is not a substitute for weight management and lifestyle change, and it is not currently recommended as a diabetes-prevention treatment in routine practice. The lifestyle work does not become optional.

How long does it take to improve testosterone naturally?

There is no fixed timeline.

Improvements in sleep, alcohol intake and medication use may affect symptoms over weeks to months. Changes associated with weight loss and improved metabolic health generally occur gradually and are more likely to be sustained when the weight loss is maintained.

Testing testosterone too frequently is rarely helpful. Your GP can advise when repeat testing is appropriate based on the original result, your symptoms and the changes being made.

The key message

The goal should not be to achieve the highest possible testosterone number. The goal is to identify whether a genuine deficiency exists, and to improve the health factors affecting your hormone system.

For many men with functional testosterone deficiency, the most effective treatment is a combination of:

• Sustainable weight loss
• Regular resistance and aerobic exercise
• Adequate sleep
• Assessment for sleep apnoea
• Reduced excessive alcohol intake
• Appropriate nutrition
• Medication review
• Management of diabetes and other chronic conditions

If you have reduced libido, erectile difficulties, loss of morning erections, infertility or persistent symptoms that concern you, make an appointment with one of our GPs at Ivanhoe or Diamond Creek. We can assess your symptoms, organise correctly timed blood tests and determine whether the cause is functional, medication-related or due to an underlying hormonal condition.

This information is general in nature and does not replace individual medical advice. Do not commence testosterone, anabolic steroids or hormone supplements without appropriate medical assessment.

References

Links open the PubMed record for each source.

• European Academy of Andrology (EAA) guidelines on investigation, treatment and monitoring of functional hypogonadism in males — Corona G, et al. Andrology, 2020.
• Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline — Bhasin S, et al. Journal of Clinical Endocrinology & Metabolism, 2018.
• Endocrine Society of Australia position statement on male hypogonadism (part 1): assessment and indications for testosterone therapy — Yeap BB, et al. Medical Journal of Australia, 2016.
• Endocrine Society of Australia position statement on male hypogonadism (part 2): treatment and therapeutic considerations — Yeap BB, et al. Medical Journal of Australia, 2016.
• Identification of late-onset hypogonadism in middle-aged and elderly men (European Male Ageing Study) — Wu FC, et al. New England Journal of Medicine, 2010.
• Body weight loss reverts obesity-associated hypogonadotropic hypogonadism: a systematic review and meta-analysis — Corona G, et al. European Journal of Endocrinology, 2013.
• Effect of 1 week of sleep restriction on testosterone levels in young healthy men — Leproult R, Van Cauter E. JAMA, 2011.
• Effects of CPAP on testosterone levels in patients with obstructive sleep apnea: a meta-analysis — Cignarelli A, et al. Frontiers in Endocrinology, 2019.
• Testosterone suppression in opioid users: a systematic review and meta-analysis — Bawor M, et al. Drug and Alcohol Dependence, 2015.
• Former abusers of anabolic androgenic steroids exhibit decreased testosterone levels and hypogonadal symptoms years after cessation — Rasmussen JJ, et al. PLoS One, 2016.
• Testosterone Imposters: an analysis of popular online testosterone boosting supplements — Balasubramanian A, et al. Journal of Sexual Medicine, 2019.
• Intraindividual variation in levels of serum testosterone and other reproductive and adrenal hormones in men — Brambilla DJ, et al. Clinical Endocrinology (Oxford), 2007.
• Testosterone treatment to prevent or revert type 2 diabetes in men enrolled in a lifestyle programme (T4DM) — Wittert G, et al. The Lancet Diabetes & Endocrinology, 2021.