I'm a nutritionist and here's why we don’t need to worry about testosterone in our diet

Discover 7 ways your diet can help ease hormone symptoms, easy steps for a diet that will tackle the symptoms of menopause and mid-life, plus some healthy seasonal recipes for the winter months.

Testosterone is a hot topic at the moment, and if you’ve been on the internet in the last couple of years, you probably haven’t escaped the attention it’s receiving from influencers and public figures. People like Joe Rogan and Elon Musk have outwardly spoken about testosterone, with Rogan being an overt advocate of Testosterone Replacement Therapy (TRT), and Musk suggesting that the government should be replaced by ‘alpha’ males with high testosterone. In the US, it’s estimated that 40% of men under 40 have considered using testosterone replacement therapy, with around 14% actually using it, and these figures are showing a steady year on year increase.

But it’s not only men for whom testosterone has been getting lots of press attention. With testosterone prescriptions for women soaring in the UK for women over 40, headlines suggest that it has become ‘out of control’.

With testosterone high in the public agenda, it’s worth taking a look and separating fact from fiction.

What does testosterone do in your body?

Testosterone is a steroid hormone (an androgen) present in all of us - regardless of sex - although men typically produce it in much higher quantities. For those assigned male at birth, testosterone is produced in the testes (the clue is in the name!), with input from the brain; for females, it’s primarily produced in both the ovaries and the adrenal glands, via the same brain axis. This axis includes parts of the brain and nervous system, along with the thyroid, reproductive organs and adrenal glands. All these parts of the body play a central role in producing testosterone, along with other hormones.

Testosterone is involved in voice deepening, facial hair and balding patterns, muscle development, bone health, libido and sperm production for those with typical male reproductive organs.

For people with typical female reproductive organs, it supports ovarian function, bone health and libido.

Anecdotally, testosterone is also associated with energy, vitality and motivation, although evidence on this is not conclusive.

It’s worth noting that excess testosterone can also be an issue. Typically for people assigned male at birth, this only occurs when artificial replacement is present, though higher testosterone levels can be present naturally for as many as 10% of people assigned female at birth, and is typically associated with the condition PCOS.

What affects testosterone levels?

There are many contributing factors influencing your testosterone production.

A review of evidence suggests these all play a part:

age
body composition
nutrient intake
exercise
sleep
endocrine disrupting chemicals such as BPA
stress and the nervous system
medical conditions
genetics
overall health.

So whilst diet and diet-related factors certainly play a role, they are only a part of the picture.

When is low testosterone a problem?

Low testosterone becomes an issue when it impacts quality of life. There’s no set ‘approved limit’ for testosterone, as it differs from person to person.

Signs of low testosterone in men include:

Fatigue, low mood, irritability
Decline in muscle mass and strength
Increased body fat, especially abdominal
Decreased libido or erectile function
Possibly lower sperm count/fertility issues

In women, low testosterone occurs most commonly in menopause when ovarian function declines. Signs are less well-publicised, but can include:

Low libido
Reduced muscle mass or bone density decline
Low mood and energy

All of these symptoms are not specific only to testosterone, so it’s important to get any suspicions of low testosterone confirmed medically.

How to test for testosterone

Urine is not a reliable mode of testing testosterone. Low or high testosterone on a dried urine test should always be checked with a blood test.

As testosterone is only part of the picture, ask for other blood markers (including other sex hormones) to be included in the test to gain a fuller clinical picture.

To what extent can diet influence testosterone levels?

The evidence suggests that diet can influence testosterone levels in men although, perhaps unsurprisingly, there are fewer studies on women.

Low-fat diets tend to be associated with lower testosterone in men. This is likely because dietary fat contributes to healthy cholesterol levels which are the building blocks for all steroid hormones.
Low calorie diets in lean men can further lower testosterone. However, for men with type 2 diabetes and metabolic syndrome, a low calorie diet has been shown to improve low testosterone.
Nutrient-rich whole foods (fatty fish, dark greens, nuts, oysters) contain zinc, magnesium, vitamin D and healthy fats which support hormone health. But it’s thought that individual nutrients will only improve testosterone levels if you were deficient in those nutrients.

What are the most effective ways to address testosterone levels?

First of all, we need to remember a few caveats:

Many studies show associations rather than strong causal proof.
Dramatic claims like “eat this one food for testosterone” are simplistic and unsupported.
Diet changes may make modest changes to testosterone, but generally only if those dietary factors have contributed to the cause of low testosterone in the first place. To turn around a clinically significant deficiency you’ll also need to address wider factors.

Stress: Remembering that testosterone production is connected to the brain and nervous system as discussed earlier, it makes sense that some of the key lifestyle interventions surrounding testosterone are around sleep and stress, although once again the research is very male-centric.

Sleep: Multiple studies demonstrate that even mild sleep deprivation can lower testosterone levels in both older and younger men, suggesting that prioritising sleep may help improve them.

Exercise: There is some evidence to suggest that endurance exercise can decrease testosterone in female athletes, whilst resistance training can increase it. The same pattern is seen in males.

Medication: Whilst diet and lifestyle factors can contribute toward healthy testosterone levels, the medical management for low testosterone is hormone replacement therapy, which is available in the UK for men with diagnosed hypogonadism, and menopausal women who are experiencing a low sex drive. Despite TRT being increasingly available online and in the private sphere, care should be taken to ensure that suitability of treatment is ensured.

Gender affirming testosterone therapy

The discussion so far has focused on cisgendered people, but when discussing sex hormones, it’s important to include trans and non-binary perspectives too, for whom testosterone and other gender affirming hormone therapies can be a critical part of their journeys and lives.

AJ Johnson, a queer mental health clinician based in Brisbane, demonstrates the importance of testosterone therapy in their life by saying, “I started testosterone HRT in hope that I might feel more comfortable in my physical appearance, to feel ‘more like myself’. I was looking to experience changes in my face and voice that would prevent me from getting consistently read as female and subsequently reduce the distress that experience causes me. What I did not expect was that as my body became more aligned with my identity, it became easier for me to fully inhabit it. I am more present with and responsive to my own thoughts, feelings, wants, needs and preferences. Testosterone HRT has not only allowed me to feel more like myself physically, it has allowed me to come alive, to cultivate an existence that is more authentic than it has ever been before.”

Gender affirming therapy should be done alongside an experienced clinician.

So are we overthinking testosterone?

Testosterone is certainly getting plenty of attention, and as with any trending topic, should be considered as part of a nuanced and wider picture. To suggest that boosting your testosterone levels is a solve-all is reductive in most instances, particularly for cisgendered people.

Having said that, it can be an overlooked aspect of health for many, and proper assessment and holistic treatment protocols can have dramatic effects on overall health, as well as quality of life.

If you’re worried that testosterone could be an issue for you, pay a visit to your GP to discuss your concerns.