Written by Dr. Jewel Alfoure, ND
Men Deserve Attention
The idea that women's health is complex and that men's bodies are simple is vastly incorrect. Many of those who assume that men's bodies are hormonally simple wrongly assume that the best results for boosting men's sexual health can be obtained with testosterone therapy. While there is no doubt that testosterone plays an important role in improving male sexual performance, the male body is far from being mono-hormonal!
Fascinating Facts About Men's Health
Like women, men also have a cycle, their cycle is about 70 days in length (1)
Men also need estrogen and progesterone for health maintenance
Excess exogenous testosterone can significantly reduce male fertility
Low testosterone levels are linked to poor cardiovascular health, low mood and male sexual disorders (2)
Why We Should ALL Care About Men's Hormonal Health
Men tend to live about 5 years less than women
Inactivity makes men 60% more likely to suffer from depression
Every hour 6 men are diagnosed with testicular cancer
Regulating men's health and hormones is directly reflected in cardiovascular health
Emotional health is strongly tied to hormonal health in men
Inflammation and joint health can be significantly impacted by the same factors that lower male libido
Men’s health is a complex and often confusing topic. There are so many hormones and pathways that are interconnected. It can be difficult to know where to start. In this article, we will focus on the effect of testosterone and neighbouring pathways on men’s health.
The Role of Testosterone In Men's Health
Testosterone is responsible for many important aspects of male physiology, including energy levels, stress resilience, mood, hair growth, and sperm production. Low testosterone can lead to several problems such as fatigue, weight gain, depression, insomnia, and erectile dysfunction. Fortunately, there are many ways to increase testosterone levels naturally. It is important to note that testosterone is not the only hormone important for men's health (5,6). Ensuring healthy hormone balance means the adequate synthesis of all gonadal hormones, including testosterone, estradiol, and progesterone (7). Testosterone supplementation on its own is never truly adequate for solving the hormonal issues of all men. It is critical to dive deep and understand the levels of significant hormonal players that affect male health (8).
Other Players that Significantly Affect Men's Health
5 alpha-reductase is an enzyme that catalyzes the reduction of testosterone to dihydrotestosterone (DHT). DHT is a more potent androgen than testosterone and is responsible for the development of male secondary sex characteristics such as facial and body hair growth (9).
Aromatase is an enzyme that converts testosterone to estradiol, the primary female sex hormone. In men, estrogens are produced in small amounts by the aromatization of testosterone. The relationship between testosterone levels, aromatase activity, and 5α-reductase activity is complex. It also depends on many factors, including age, obesity, and lifestyle choices. By understanding the role of these enzymes in hormone metabolism, we can better understand how to maintain optimal men's health throughout their lifespan (10).
The Medical Definition of Low Hormones in Men
Hypogonadism is a condition in which the body does not produce enough of the hormone testosterone. There are two types of hypogonadism: primary and secondary. In Secondary hypogonadism, the brain does not produce enough of the hormone that signals the testicles to produce testosterone (11). Primary hypogonadism occurs when the testicles do not respond properly to the hormone signal from the brain (12). As a result, testosterone production is decreased. Male hypogonadism can lead to symptoms such as low sex drive, erectile dysfunction, and reduced muscle mass. If left untreated, it can also cause osteoporosis.
Hypogonadism is diagnosed using blood tests that measure testosterone levels. It is important to note that though many practitioners attempt to rely on blood work to diagnose hormonal disorders, blood tests do have their limitations.
A blood test measures the serum levels of hormones. As hormones are not soluble in water, the levels of hormones in serum are thought of as a momentary depiction of hormone levels. Their fluctuations make them a less useful tool in the diagnosis of hormonal issues.
Salivary tests and dry urine hormone tests are usually much better at giving an accurate measure of hormone levels. It is always important to evaluate hormone tests for accuracy and reliability as treatment should largely depend on the results of lab evaluation. Treatment depends on the underlying cause but may involve testosterone replacement therapy (13, 14).
Male hormone issues are not all hormone deficiency issues. Many hormone clinics have a one size fits all approach. Many men are promised that all their issues - from weight regulation issues to mood disorders and sexual dysfunction - will be solved. Unfortunately, even after reaching very high levels of testosterone due to hormone replacement, many men don't get the results they were promised (15, 16). Additionally, those men are not sufficiently warned against the potential side effects of testosterone therapy (17). Scientific research points towards many lifestyle factors and natural ingredients that can act as effective testosterone boosters. Many of those factors include holistic factors like a healthy diet, lifestyle changes that include aiming to get more, higher quality sleep and common ingredients like vitamins and botanicals that are well recognized to improve overall health.
Male hormone imbalances can be caused by several factors, including aging, stress, diet, lifestyle choices, and underlying medical conditions. As a result, it's important to work with a healthcare provider who can help you determine the cause of your symptoms and develop an individualized treatment plan. With the right approach, you can improve your quality of life and reduce your risk of serious health complications.
Natural Pathways of Testosterone Synthesis
Testosterone is a steroid hormone that is produced in the testes in men and the ovaries in women. It is responsible for the development of male characteristics, such as facial hair and a deep voice. Testosterone levels are highest during adolescence and early adulthood, but they begin to decline after the age of 30 (18).
The decline is a steady, healthy decline that leaves the body with enough testosterone to support tissue health and libido, but removes the unnecessary excess that is experienced in peak reproductive years.
Male sexual health issues are not a normal part of healthy aging (19). Healthy men are expected to enjoy satisfying sexual relationships, maintain their mental health, and other issues with the natural levels of testosterone that their bodies are fully capable of producing (20).
Several nutrients are essential for testosterone synthesis, including vitamin D, cholesterol, vitamin K and vitamin C. Vitamin D is necessary for the conversion of cholesterol to testosterone, while vitamin C is involved in the maintenance of adrenal health, which is a key player in the regulation of hormone levels.
Factors that can disrupt testosterone synthesis include stress, obesity, and certain medications (21, 22, 23, 24). Chronic stress can lead to a decrease in testosterone levels by causing the body to release cortisol. Cortisol significantly lowers the production of testosterone in the long term (25) .
Obesity can also reduce testosterone levels by increasing aromatase activity, which converts testosterone to estrogen. Thus, in those situations, a significant amount of the testosterone produced is quickly turned into estrogen spiking up the estrogen level and leaving very little testosterone to bind to receptor sites and act physiologically. Additionally, certain medications, such as glucocorticoids and opiates, can also inhibit testosterone synthesis. Click Here for a list of the medications that play a role in lowering testosterone levels.
Natural Testosterone Boosters
Vitamin D is an important vitamin for overall health, but it is especially important for building hormones and improving testosterone levels. Vitamin D levels are closely linked to testosterone levels, and vitamin D deficiency can cause low testosterone levels. Vitamin D can be found in food sources such as eggs and fatty fish. However, the best way to increase vitamin D levels is to get regular sun exposure. The ultraviolet rays from the sun trigger the body to produce vitamin D, and just a few minutes of sunlight per day can significantly improve vitamin D levels. For people who don't get enough sun exposure, taking a vitamin D supplement can also help to improve their vitamin D levels (27).
Vitamin B 3
Niacin acts as a detoxifying agent in the brain. It removes toxic metabolites and facilitates the brain to focus. This is crucial for the person to be relaxed enough and mindful enough to feel the neurotransmitters the brain is putting the effort into producing. A dopamine, oxytocin, and phenylethylamine rush is only fun when you can get the chemicals into the right receptors. Making them and dumping them in a sea of adrenergic metabolites is pointless (28, 29).
Vitamin B 6
Vitamin B6 is a water-soluble vitamin from the vitamin B family. It participates as a bioactive coenzyme in over 4% of enzymatic reactions. The vitamin has to be obtained from our diet as humans can not synthesize it and it plays an active role in over 100 enzymes in the body. Vitamin B6 is required for the healthy function of the nervous system, for hemoglobin synthesis, mood regulation, and hormone synthesis.
Due to the complex interplay that Vitamin B6 has on gene expression and the activity of steroid receptors for hormones, some studies point to the effect of vitamin B6 as a protector from hormone-induced cancers. Additionally, Vitamin B6 is known to decrease inflammation and act as a protector of cardiovascular health by playing a role in reducing homocysteine through the partnership with folate and vitamin B12 (30).
Vitamin B6 is important for maintaining healthy testosterone levels, it also helps to keep SHBG (sex hormone-binding globulin) levels low, which in turn results in more free testosterone (31, 32). Vitamin B6 has also been shown to increase LH (luteinizing hormone) release from the pituitary gland, which is needed for testosterone production.
Additionally, vitamin B 6 is shown to decrease the levels of prolactin which is the hormone of lactation. Endocrine disorders that increase prolactin levels usually result in weight gain, lower mood, breast development and lower libido in men. Vitamin B6 is demonstrated to have an anti-prolactin effect that helps to maintain healthy sex hormone levels during periods of endocrine stress (33).
Vitamin B6 is found in meat, poultry, fish, nuts, seeds, and legumes. Vitamin B6 supplementation can be beneficial for people with low testosterone levels or those who are looking to increase their testosterone levels naturally.
Vitamin B9, also known as folate, plays an important role in hormone synthesis and regulation. In particular, folate is necessary for the synthesis of testosterone. A lack of folate was found to be associated with erectile dysfunction. In addition to its role in hormone synthesis, folate is also important for vascular health. It helps to reduce inflammation and cardiovascular risk by keeping blood vessels healthy and preventing the buildup of plaque. For these reasons, it is important to make sure that you are getting enough folate in your diet. Folate can be found in leafy green vegetables, legumes, and fortified foods such as cereal and bread (34).
Low folate levels have been linked to depression, heart disease and high levels of homocysteine. Homocysteine is an inflammatory by product produced in the body. Metabolizing, or getting rid of homocysteine keeps the blood low in inflammation. Having low folate levels predisposes the body to an elevation of homocysteine and thus inflammation. It is important to keep in mind that lower inflammatory metabolites in the blood may lead to a significant improvement in vascular function. Healthy erections are based on healthy blood vessels that can carry the erectile signal from the brain to the pelvic region (35).
In a 2014 study, an association was found between folate deficiency and erectile dysfunction (36). Following the 2014 study, a more recent 2020 study found that supplementation of folate leads to improvement in erectile function (37).
The proposed mechanism is attributed to the role folate plays in the production of Nitric Oxide (NO) the vasodilator required to kickstart a healthy, firm erection.
Serum folic acid studies linked the severity of erectile dysfunction to the deterioration of the condition. Compared to baseline, ED sufferers who were supplemented with folic acid had a significant decrease in the severity of the ED. The study based its findings on a standardized questionnaire that examined the condition of the men before, and after supplementing with folic acid.
Even more interestingly, diabetic men, who were treated with Cialis had a significant increase in erection quality with the supplementation of a mega-dose of folic acid (39).
Many view vitamin C as the immune vitamin or the collagen production vitamin. While it is correct that vitamin C is important for building healthy tissues, preserving skin health, maintaining bone flexibility and ensuring stronger immune health, it is important to keep in mind that vitamin C is another significant player in adrenal health.
While the adrenal glands do require B vitamins to function optimally, in periods of prolonged stress, the daily requirement of Vitamin C by the adrenals skyrockets. Keeping in mind that vitamin C is a vitamin that can not be made by humans and that our adrenal requirement of vitamin C is viewed as a survival mechanism by the body, supplementation of vitamin C becomes crucial to maintain hormone levels (40, 41).
In one study, supplementation of 1000 mg of vitamin C improved cortisol levels and significantly reduced high blood pressure.
As previously mentioned, cortisol significantly lowers testosterone levels. The healthy management of cortisol levels results in healthier hormone levels (42, 43).
Vitamin C is also shown to improve nitric oxide production, promote healthy androgen levels and improve progesterone levels. Progesterone is quite important for men as it is used to synthesize testosterone (44).
Further, studies show a positive effect on thyroid health, blood sugar control and blood fats when vitamin C levels are supplemented.
Even more, interestingly, Vitamin C is shown to support the release of oxytocin which is the bonding hormone, or the hormone of intimacy. and acetylcholine which is important for short-term memory, focus and concentration (45).
Vitamin B 12
Vitamin B12 is important for male health in several ways. First, it helps to reduce levels of homocysteine in the blood. High homocysteine levels are associated with an increased risk of cardiovascular disease, so vitamin B12 can help to improve heart health. In addition, vitamin B12 is involved in the production of testosterone (46).
Finally, vitamin B12 is necessary for the proper development and function of the nervous system. Vitamin B12 deficiency can lead to neurological problems such as depression, so getting enough of this vitamin is essential for maintaining good mental health (47).
Zinc is an essential mineral that plays a role in many different bodily functions. One of the most important roles of zinc is in male health. Zinc is essential for the production of testosterone, and it also helps to keep the prostate gland healthy. In addition, zinc is involved in the synthesis of sperm, so it is important for male fertility. Zinc also has a range of other benefits, including boosting mental health and immunity. Because of all these important roles, men must make sure they are getting enough zinc through their diet or supplements (48, 49).
L-arginine may significantly enhance the body's ability to synthesize vasodilating compounds and lead to a long-term increase in physical fitness. It is important to note that though doses of 1.5 g to 5 g were shown to significantly help men with erectile dysfunction, those doses may not be safe for all men as they may interact with blood pressure medications and other drugs. It is better to use l-arginine as long term support of fitness than as a short term mechanism to engorge the pelvic region with as much blood flow as possible (50).
Testosterone Building Botanicals (Backed by Human Trials)
Mucuna prurience is an Ayurvedic bean with a high concentration of L-DOPA. L-DOPA is the natural precursor of dopamine. As the pleasure neurochemical in the brain, it is expected that the velvet bean would function as a mood enhancer. While Mucuna does play a role in improving mood and emotional health, its L-DOPA content makes it an excellent improver of hormone levels (51).
L-DOPA plays a role in the regulation of testosterone and other sex hormones. The connecting pathway is related to the antagonizing effect that dopamine has on prolactin. Prolactin the lactation hormone is known to have a suppressing effect on the production of sex hormones (52).
Mucuna is shown to work directly on the hypothalamic- Pituitary- Gonadal axis by stimulating the release of the gonadotropin-releasing hormone (GnRH). The hormone is released from the hypothalamus. The hypothalamic signal increases the production of luteinizing hormone (LH) and Follicular-stimulating hormone (FSH). The two hormones stimulate testosterone production from Leydig cells and spermatogenesis in Sertoli cells (53).
The increase in testosterone leads to several benefits, including improved metabolism, muscle gain, weight loss, and increased libido. The effects of L-dopa on testosterone levels are thought to be responsible for the improvements in male fertility that have been observed in studies (54).
While exogenous testosterone therapy can lead to some of the same benefits, the increase in natural testosterone levels that results from L-dopa supplementation is thought to be more effective and more sustainable. As such, L-dopa represents a promising option for those looking to improve their testosterone levels naturally (55).
Though many adaptogens may theoretically improve testosterone levels by modulating the increase of cortisol due to stress, some adaptogens have been demonstrated to significantly improve hormone levels.
Ashwagandha has been used as an aphrodisiac adaptogen for thousands of years. studies demonstrate that it can significantly enhance sperm parameters. All parameters from sperm count, sperm motility and even semen volume were improved by ashwagandha supplementation.
Additionally, it was noted that through the improvement of the stress response, ashwagandha does improve testosterone levels significantly (56).
Nigella sativa is viewed as an overall healer and improver of health. Many clinical trials demonstrate the capacity of black seed to improve gastrointestinal health, immune health, and even mental health.
Much of the activity of black seed oil has been attributed to its active constituent thymoquinone. While thymoquinone is a key player in black seed, the super-speed contains hundreds of other active constituents.
Studies drew the attention of the public to the potential role of black seed oil to act as a testosterone booster. A rabbit dose equivalent to 12ml daily significantly improved testosterone levels and sperm parameters (57, 58).
Further, a systematic review conducted in the year 2017 demonstrated that black seed oil is not only an improver of sperm parameters but also could mount positive effects on hormones including testosterone (59).
Natural Erection Boosters (Active Ingredients)
Horny Goat Weed, or Epimedium, is a flowering plant that has been used in traditional Chinese medicine for centuries. In a 2006 study, horny goat weed was evaluated for its effect on erectile dysfunction. The researchers found that the herb increased levels of nitric oxide, which relaxes smooth muscle and promotes blood flow to the sexual organs. The researchers concluded that Horny Goat Weed extract may significantly improve erectile dysfunction and that the herb may offer a natural alternative to conventional medications (60).
Horny Goat Weed contains the active ingredient icariin. It is shown to act as a phosphodiesterase type 5 inhibitor (PDE5 inhibitor). A PDE5 inhibitor is a vasodilating compound which dilates the smooth muscle layer lining the blood vessels supplying various tissues with extra blood flow. The spongy Component of the penis known as the corpus cavernosum and corpus spongiosum is directly impacted by PDE5 inhibitors. Though Horny Goat Weed is used for sexual enhancement on the premise of its activity as a vasodilator that assists with penile blood flow, it has many other health benefits that positively impact the sexual response indirectly (61).
Korean Ginseng has been used for centuries in traditional Korean medicine to treat a variety of ailments. In recent years, it has been the subject of several clinical studies evaluating the adipogenic and hormonal effects of ginseng. In a 2013 study, Korean ginseng was assessed for its effectiveness on erectile dysfunction. The randomized, double-blind trial included 119 men with mild-to-moderate ED who were given 4 tablets of either Korean ginseng berry extract or placebo daily for 8 weeks. The study concluded that Korean ginseng berry extract improved all domains of sexual function, with no significant adverse side effects. These findings suggest that Korean ginseng berry extract may be a safe and effective treatment for ED (62).
Damiana is a well-known Mayan aphrodisiac with unique qualities. It is noted to be quite a unique booster of sexual function as it is noted as an aphrodisiac calming agent. Studies demonstrate that it facilitates sexual behaviour by acting as an anti-anxiety agent that improves sexual performance (63).
Ginkgo Biloba is a living fossil that has been in the world since the age of the dinosaurs. It is well studied as an improver of blood flow both to the brain and the pelvic region.
Ginkgo has demonstrated a remarkable ability to improve all phases of the sexual response in individuals who suffered sexual dysfunction due to the use of anti-depressant medications.
Ginkgo is known to be an effective long-term improver of erectile function as the use of the plant is shown to significantly improve erectile function within 6 months of supplementation. This points to the improvement of vascular health as a potential mechanism for the actions of the plant (64, 65).
Maca is a well-known adaptogen, hormone modulator and balancer. Maca has been demonstrated to affect both sexual desire and fertility of men. Studies show a significant improvement in sperm count, improvement in sperm motility and a potential increase in DHEA. Interestingly, there was an improvement in mood, well-being and anxiety reduction (66,67).
Maca was also demonstrated to improve libido and the symptoms of sexual dysfunction caused by anti-depressant drugs.
Tribulus Terrestris unlike other botanicals is not a stimulant, it is a modulator of testosterone levels. It maintains testosterone to levels that are most supportive of optimal health. Thus botanicals like Tribulus can safely decrease testosterone levels in females with Polycystic Ovarian Syndrome (PCOS) and at the same time significantly increase sexual function in males with diminishing testosterone levels (68, 69).
The Effect of 5-Alpha Reductase on Male Health
5-Alpha Reductase is increased inactivity due to:
Blood sugar status
Increase in body fat
5 Alpha reductase plays a role in the pathology of local testosterone symptoms. For example, cystic acne is one of the key features of too much DHT in young men. On the other hand, as men get a little older, male pattern baldness is significantly affected by DHT levels. For older males, the high amount of DHT manifests as anger, irritation and mood swings (70).
Regulating the activity of 5 Alpha reductase is crucial for balancing male health. the 2-5x stronger product DHT can be a significant reducer of overall health for men. many good quality studies out there point toward natural ingredients that inhibit the activity of 5 alpha-reductase including:
EGCG (Green Tea)
Foods that are naturally high in 5-alpha reductase inhibitors include:
One note on 5-alpha reductase inhibition: 5- Alpha reductase inhibition is usually most successful when multiple ingredients are used. Rarely does a single inhibitor function strongly enough to get the desired results. This trend is usually attributed to the strength of the enzyme and the fact that it functions peripherally, making it harder for inhibitors to reach it.
The Importance of Sleep
Like many components in the body, testosterone is made during the sleep hours. good quality sleep is vital for maintaining healthy hormone levels. Upon waking up in the morning, testosterone levels should be high enough to carry the man throughout the rest of the day. A significant afternoon crash may be one of the early indicators of inadequate testosterone production. A study noted that 1 week of sleeping only 5 hours per night results in a 10% decrease in daytime testosterone (71, 72)!
It is important to wake up with as much testosterone as possible because as many doctors would agree, epinephrine is the killer of testosterone. Upon getting stressed, there is a significant decrease in testosterone levels and that decrease is also followed by a significant decrease in erections. This effect is accentuated by caffeine intake, sugar intake and alcohol intake.
For many men, the use of caffeine along with sweets is a last attempt by the body to kick-start their adrenals that have been drained by continuous stress. Though caffeine might feel helpful in the short term and sugar may act as a quick energy fix, unfortunately, long-term use of both significantly decreases testosterone levels.
Important Nutrients to Protect Testosterone Levels From Stress
Essential Fatty Acids
Ingredients That Improve Sleep Quality To Maximize Testosterone Production
All Sex Hormones Start at the Mitochondria (Mitochondrial Sex Hormone Support)