As you review your session notes, especially those pertaining to male clients, you may notice some concerning issues. Perhaps clients have had difficulty getting out of bed in the morning or are suffering from low mood or libido. You may have noticed that a formerly on-point client is making less progress in his carefully crafted program. If this sounds like a familiar pattern, testosterone levels may be to blame.
Ten years ago, the Endocrine Society reported that men had approximately 20% less testosterone than their father’s generation at exactly the same age (Travison et al. 2006). This has led to a growing trend of people using testosterone creams and gels to boost lagging levels. But is that the best approach? This article reviews common signs and symptoms of low testosterone and what you can do as a fitness professional to assist clients in finding solutions.
Andropause Signs and Symptoms
Many physical, psychological and nutritional factors contribute to low testosterone. Uncovering the root cause of the decline in testosterone levels is crucial for getting back on track, as testosterone products have limitations. Unlike menopause in middle-aged women, where hormone output dramatically shifts and symptoms are obvious, the testosterone decline in aging men—i.e., andropause—is very gradual. Symptoms are therefore often dismissed as “aging.”
What are the symptoms of low testosterone? While the relative ranges for men and women obviously differ, psychological symptoms of low testosterone in both groups may include anxiety, grumpiness, loss of interest in previously enjoyed activities, impaired memory and depression. Physical symptoms can include increased abdominal fat, loss of muscle mass, decreased libido, sleep disruption, fatigue and erectile dysfunction in men.
If a client complains about high stress levels, decreased stamina and a bulging waistline, then it may be time to suggest he gets his testosterone levels tested by a qualified medical practitioner.
Measuring Testosterone Levels
What’s the marker for low testosterone? A quick naked-eye test can often serve as a basic gauge. Men who carry extra weight around the waistline (i.e., a “beer belly”) or hold a little extra fat around the upper chest are showing common red flags that testosterone levels are likely on the decline. For women, it’s not so straightforward; however, low levels are often associated with high stress.
The naked-eye test has its limitations, of course. In someone with no physical symptoms, there may still be indications of relative testosterone deficiency, which means testosterone levels are depleted relative to what they used to be. This can occur even in younger men and in those who are fit and strong. Energy levels sag, libido lessens, recovery from exercise begins to suffer, and it’s more difficult to build muscle.
The trouble with traditional medical testing is that it’s possible to have testosterone levels well within “normal” range and yet well below what they used to be. Relative deficiencies are very common and more difficult to diagnose, so doctors believe there is nothing wrong. It’s therefore important to compare against a personal baseline.
If testing is something your clients are interested in pursuing with a qualified medical professional, it’s important to get the full panel of testosterone lab tests. The first, calledtotal testosterone, represents the total amount of testosterone in the blood. However, not all of this testosterone is biologically active and available for use. Approximately 50% of total testosterone is bound to a carrier protein (meaning the testosterone cannot be used by the body). Consequently, it’s important also to measure bioavailable testosterone levels, about 5% of which is free testosterone (completely unbound), with the remaining 45% bound to a protein called albumin. The combination of these two forms makes up bioavailable testosterone levels, or the amount that cells can actually utilize (Dunn, Nisula & Rodbard 1981).
What Causes Low Testosterone?
While testosterone levels do decline with age, the rate of decline in recent years has accelerated. After the age of 40, bioavailable testosterone levels have been shown to decrease approximately 1% per year in the general population (Feldman et al. 2002). This gradual decline diminishes the ability to build lean muscle, burn fat and stay healthy. While you can’t put the brakes on this decline indefinitely, you can slow it, especially compared with the ever-accelerating rate we see in the general population today.
Even for clients in their late 20s or 30s, relative testosterone deficiencies are more and more common, as various factors conspire to deplete stores. Let’s take a closer look at the top 10 factors that lead to testosterone deficiency and review simple tips that will get clients back on track.
1. Being Overweight
Two-thirds of the American population is classified as overweight or obese (Flegal et al. 2012). Convenience and processed foods impact our waistlines in big ways. The average sugar consumption per person per year has now topped 160 pounds—a far cry from the 40 pounds per person two generations ago (Sowers 2010). Not surprisingly, prediabetes and diabetes (between them) now impact almost 50% of Americans (Menke et al. 2015).
The research is clear: Obese men have 25%–45% lower testosterone levels than average-weight males (Isidori et al. 1999). When body fat levels increase, a carrier protein—sex hormone–binding globulin (SHBG)—gobbles up bioavailable testosterone, rendering it unusable by the body. In short, the more overweight you are, the more active SHBG is, and the lower your testosterone levels become.
Recently, the National Health and Nutrition Examination Survey (NHANES III) in the United States examined 1,265 men, aged 20–90 and older. Researchers measured body mass index, waist circumference, percent body fat and circulating levels of sex hormones, including testosterone levels. They found that increases in BMI, waist circumference, and percent body fat were associated with relative decreases in total and free testosterone levels (Rohrmann et al. 2011).
The fix: If a client is overweight, chances are his testosterone levels are on the decline. The top priority may need to be fat loss, which you can target with strength training and HIIT cardio (more on this below). Work with a registered dietitian to counsel the client in trying a low-carb diet or something suitable for his biological make-up.
2. Poor Insulin Sensitivity
Expert researchers now agree that one of the main underlying causes of weight gain is high levels of circulating insulin (Kahn & Flier 2000). The more a person is overweight, out of shape or in poor health, the worse his insulin function (commonly known as insulin sensitivity) may be. This leads to chronically high levels of insulin in the blood, directly inhibiting the body’s primary fat-burning enzyme, hormone-sensitive lipase. Poor insulin sensitivity is strongly associated with lower total testosterone levels (Chandler, Byrne & Patterson 1994). This is a very common scenario for those struggling with weight gain. The end stage of poor insulin sensitivity is insulin resistance, a hallmark of type 2 diabetes.
Over time, overconsumption of sugars and processed carbohydrates leads to poor insulin sensitivity and weight gain. High insulin levels also shift the body’s testosterone to a far weaker form called androstenedione, which then takes up the receptor sites or “parking spots” intended for regular testosterone. The net results: a much weaker anabolic effect. As discussed above, gaining weight itself further suppresses testosterone production and can quickly set in motion a downward weight-gain spiral.
The fix: Insulin dysfunction and weight gain go hand in hand. Again, work in concert with a registered dietitian and medical professional to help clients address insulin dysfunction.
3. Too Much Alcohol
Drinking too much alcohol—beer, wine or spirits—may compromise testosterone production. Alcohol-associated weight gain increases the action of an enzyme called aromatase, which converts muscle-building, fat-burning testosterone into estrogen. Regardless if you’re male or female, the increase in estrogen and reduction in testosterone typically promote weight gain and are harmful, not just to the waistline, but to overall health.
This is commonly seen in men with increased central adiposity, or the classic beer belly. A chronically high intake of beer (which has a mildly estrogenic effect on the body) can rapidly increase aromatase activity and lead to weight gain. When you combine increased aromatase activity with poor insulin sensitivity and weight gain—a fairly common scenario—it adds up to more pounds on the scale and less testosterone in the tank.
The fix: If clients are looking for the quickest path to increased testosterone levels, it may be necessary for them to ditch the alcohol completely for 4–8 weeks. The next best option would be to swap out calorie-rich beer and sugary cocktails for red wine. Red wine contains resveratrol, a potent antioxidant that also acts as an aromatase inhibitor to block the conversion of testosterone to estrogen. (Remember, no more than one glass if testosterone and weight loss are top priorities.)
4. Not Enough Sleep
Today, most people are busy from the start of the day until they rest their heads at night, burning the proverbial candle 24 hours a day, 7 days a week, 365 days a year. The average person gets less than 7 hours of sleep per night, which translates to 500 hours less per year than our grandparents’ generation (Van Cauter et al. 2008).
This has a tremendous impact on testosterone levels. During sleep, the body rebuilds itself, producing anabolic hormones like testosterone and growth hormone that rejuvenate the body. Lack of sleep can deplete testosterone levels by as much as 10%– 15% and is associated with fatigue, poor concentration and low libido (Leproult & Van Cauter 2011).
The fix: To maximize testosterone production, most people should aim for 7–8.5 hours of sleep per night, 6 hours minimum. Studies show that sleeping less than 6 hours per night can dramatically limit hormone production. Encourage clients to pay attention to sleep hygiene and make sure their bedroom is set up for deep, rejuvenating sleep. Turn off phones and lap- tops 1 hour before bed, don’t watch television, and make sure the bedroom is cool. Block out ambient light to ensure optimal rest, recovery and testosterone output.
Stress is another major drain on testosterone levels. In today’s society, most people are constantly on the go and stuck in fight-or-flight (sympathetic nervous system) mode, which is very tax- ing on hormone production. The busier the days, the longer the work hours or the greater the intensity of training, the more catabolic stress hormones a person produces, at the expense of anabolic hormones like testosterone.
This scenario is classically seen in endurance sports like distance running and cycling, where longer training sessions and greater training volume often suppress testosterone production. However, you don’t have to be an athlete to experience the detrimental impacts of stress on your testosterone levels; similar effects occur at work from the stress of long, busy days (or at home, for people caring for young children).
Stress also has a big impact on food cravings. When stress levels are high, the body craves more simple sugars and carbohydrates (not wild Alaskan salmon or grass-fed beef, unfortunately). This can lead to steady weight gain over time and to insulin dysfunction in the long run.
The negative effects of stress don’t stop there. High stress levels can interfere with the sleep hormone melatonin, which can lead to trouble falling asleep or staying asleep. The problem impacts total sleep time and sleep quality, diminishing the amount of time spent in deep, restorative sleep.
The fix: Coach clients who spend too much time stuck in fight-or-flight mode to prioritize activation of their parasympathetic “rest-and-digest” nervous system. This will increase resilience and mitigate the detrimental effects of long, busy days. That said, the first priority should be getting enough sleep. If sleep is squared away, the focus can shift to boosting the parasympathetic nervous system by activating the vagus nerve. See the sidebar “Breath Exercise” for a simple technique to try with clients.
6. Nutrient Deficiency
For optimal testosterone production, the body needs certain key nutrients. Common deficiencies in the mineral zinc and in fat-soluble vitamin D may hinder the quest to boost lagging testosterone levels (Prasad et al. 1996; Wehr et al. 2010).
Zinc acts directly on the testes and ovaries to stimulate the production of luteinizing hormone, the main trigger for testosterone production. A zinc deficiency compromises the body’s natural ability to produce testosterone. Notably, certain foods— grains, beans, unfermented soy, etc.—contain antinutrients called phytates, which bind to minerals and make them difficult to absorb. Alcohol can dramatically reduce zinc stores.
Vitamin D is another key testosterone-supporting vitamin. It acts as a “pro-hormone” to testosterone production. Low lev- els of vitamin D have been associated with lower levels of testosterone (Dahlquist, Dieter & Koehle 2015). This can become a serious problem for people living in cold climates between November and March, when the sun is too low in the sky to provide adequate amounts of vitamin D. Athletes have an increased risk of deficiency due to overtraining and inflammation, which can drive levels down.
The fix: Suggest to clients that they review their zinc and vitamin D intake with a qualified professional. Fantastic food sources of zinc include oysters, beef, pork, lamb and crab. The next-best options for zinc-rich foods include pumpkin seeds, ginger and dark chocolate. Vitamin D–rich foods include wild salmon (and various other fish), eggs, pork and mushrooms. During the winter months, however, it’s difficult to get adequate vitamin D from food alone. If you live in a city with a true winter climate, adding 1,000–2,000 IU daily of a vitamin D supplement may help prevent deficiency. Note: A doctor should clear doses higher than this.
7. Not Enough Compound Lifts
Physical activity is crucial for healthy hormone production and ideal testosterone levels. For men, there is no drug or food that benefits testosterone production more than safe and effective movement. In particular, compound movements such as squatting, bending, pushing and pulling all trigger significant increases in testosterone production (Cumming et al. 1987). Interestingly, while strength training definitely benefits women, the research shows it doesn’t impact their testosterone output (Nindl et al. 2001).
What lifts in particular provide the biggest bang for the testosterone buck? In the research, lower-body-dominant exercises like squats and dead lifts, along with Olympic lifts— snatch; clean and jerk—all come out head and shoulders above the rest when it comes to eliciting a testosterone boost (Kraemer et al. 1992; Fahey et al. 1976; Volek et al. 1997). Incorporating more compound lifts—lower-body exercises in particular—into an exercise program is a direct line to improving testosterone levels and supporting weight loss or hypertrophy goals.
The fix: Carefully review the client’s program design and include total-body workouts (3–4 days per week), rather than classic bodybuilding splits, to maximize testosterone production. How many sets should you include? The research shows higher-volume approaches are generally best for increasing anabolic hormones (Busso et al. 1992). For example, one work-out might be 10 sets of 10 reps of squats and back rows, while another might be 10 sets of 10 reps of dead lifts and bench presses. If you want to program additional moves, aim for two to three sets of 10–15 reps to round out the routine. Remember, maximizing an increase in testosterone will take about 10 weeks of training, so stress to your client how important consistency is (Kraemer et al. 1999). There are no “magic bullet” fixes for low testosterone except sweat and hard work!
8. Too Much Isolation Training
The classic “hard-gainer” typically has a taller, leaner ectomorph body type that reflects a high metabolism and moderate to lower levels of testosterone. While a split training routine can be highly effective for the pros, it isn’t ideal for the average person looking to increase testosterone. “Arms day” isn’t going to create an anabolic environment, as the research consistently shows it has no impact on testosterone output.
The fix: To stimulate the best anabolic response, include lower-body exercises like squats, dead lifts and Olympic lifts that have been shown to trigger the greatest testosterone response (Leproult & Cauter 2011; Cumming et al. 1987; Nindl et al. 2001). Among upper-body exercises, moves like overhead presses, bench presses, dips, chin-ups and inverted rows are all superior to biceps curls, triceps extensions and other single-joint movements.
When working with older clients or anyone with nagging injuries, note that you don’t necessarily need to give them heavy loads. Studies show that using 50% of a client’s one-repetition maximum for 15–20 repetitions to exhaustion can trigger significant testosterone output (Kraemer et al. 2003). This is a great option for anyone with old injuries or areas of weakness that limit the load they can lift. Testosterone increase is independent of strength, meaning you don’t have to lift like the Hulk to get the desired boost (Kraemer et al. 1998).
9. Not Starting Workouts
With Lower-Body Exercises
How many times do you see a member walk into your fitness facility, go straight to the bench press and spend 30 minutes working out his chest? This strategy is not conducive to boosting testosterone levels. Working out the legs is crucial for driving the anabolic response, yet all too often men skip leg exercises altogether or simply don’t perform enough of them. The research shows that starting workouts with lower-body-dominant barbell exercises such as squats, dead lifts and Olympic lifts triggers a greater release in testosterone than doing these moves later in the session (Hansen et al. 2001).
The fix: Start every training session with a lower-body-dominant exercise. This will promote the greatest testosterone response. As a general guideline, encourage clients to use a barbell-based movement for the first two exercises of every training day (e.g., squats followed by overhead press, or cleans followed by barbell rows). This simple rule will boost testosterone levels, add lean muscle mass and burn body fat. Remember that programming total-body routines is the key to long-term success. Note: If you work with a bodybuilder and his progress is lagging, including total-body training phases as part of your annual periodization will help overcome plateaus.
10. Excessive Cardio
A lot of people who are trying to lose pounds add more cardio training in an attempt to get leaner. While this can support effective fat loss, if the volume is excessive it may hinder testosterone output. In fact, cardiocentric training without proper planning and periodization (gradually increasing the difficulty level of the sessions throughout an entire calendar year) can easily ramp up cortisol and leave testosterone levels stuck in the mud.
For example, let’s say that in addition to seeing you twice a week, a client takes classes at your fitness facility. This can be a great way to add more cardio, but properly periodizing group-based training is very difficult. The client will get optimum benefits for 4–8 weeks, then progress will taper off. This is typically when people start adding more cardio, to overcome a weight loss plateau, and as cardio volume rises dramatically, so unfortunately does stress hormone production.
The fix: High levels of cardio training are not desirable when the goal is to add lean muscle and boost testosterone levels. The research is clear: Strength training is the best way to increase testosterone levels (Tremblay, Copeland & Van Helder 2004). Program sprint-based training or high-intensity interval train-
ing (HIIT) instead of steady-state cardio. Try this with clients: Do five to eight sets of 50-meter sprints (i.e., running outside or on a bike in the gym) to improve metabolic fitness and fat burning, without the added burden of chronic cardio.
Curb Loss Thoughtfully
While testosterone levels are declining at a faster rate than they did in previous generations, it’s important to uncover the root causes and not just automatically reach for a cream or gel. Most people don’t need more testosterone; they need to slow their testosterone losses. Nutrition, physical activity and lifestyle are the biggest factors influencing a person’s natural genetic testosterone output. By incorporating the tips in this article into your training programs, you help give clients a strong foundation for burning fat, building muscle and upgrading their overall health.
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