Testosterone Deficiency: Lifestyle-Based Approaches

Young man working out and doing a squat in his living room, using functional medicine treatments to increase testosterone levels and balance his testosterone deficiency.
Read Time: 3 Minutes

As men age, testosterone levels naturally begin to decline, estimated at one to three percent per year after the age of 40.1 When testosterone production drops below certain levels and patients experience low-testosterone symptoms such as decreased sex drive, erectile dysfunction, loss of energy, fatigue, and reduced muscle mass or bone density, this may lead to a testosterone deficiency diagnosis. Testosterone deficiency is often associated with chronic comorbidities such as:2-4

  • Hypertension
  • Cardiovascular disease
  • Type 2 diabetes
  • Obesity
  • Metabolic syndrome
  • Chronic kidney disease

Optimal ranges for testosterone levels have not been well established; therefore, the global prevalence of testosterone deficiency is estimated anywhere from 10 to 40% due to the wide range of total testosterone thresholds used for diagnosis.5 Reports also indicate significant differences in prescription patterns of testosterone replacement therapy (TRT) worldwide, with the United States showing significantly higher rates of TRT prescriptions than other countries.5 The 2018 American Urological Association (AUA) guidelines state that a clinical diagnosis of testosterone deficiency is made when patients have low testosterone levels (under 300 ng/dl) combined with signs and symptoms and recommend that testosterone levels be measured every six to twelve months during testosterone therapy.1

Testosterone therapy may be an appropriate treatment option for some patients6,7 but has been associated with a range of potential risks and adverse effects such as fluid retention and obstructive sleep apnea.8 What about lifestyle-based interventions and benefits for low testosterone levels? In the following video, IFM educator Mark Holthouse, MD, IFMCP, discusses how optimizing diet and gut health, among other lifestyle approaches, may benefit declining testosterone levels in men.

(Video Time: 2 Minutes) Mark Holthouse, MD, IFMCP, is a pioneer in the field of functional and integrative medicine and is the Chief Medical Officer for Functional Medicine of Idaho (FMI) and FMI Center for Optimal Health. Dr. Holthouse was board certified as a fellow in the specialty of integrative medicine by the American Board of Integrative Medicine and has been teaching with The Institute for Functional Medicine since 2014.

Lifestyle-Based Interventions

Suboptimal testosterone levels may be amenable to lifestyle interventions. For instance, high-intensity interval training has been found to increase free testosterone in older, sedentary men,9 as well as masters athletes.10 In addition, a 2022 systematic review found that exercise training of any intensity increased basal levels of testosterone in older adults.11 Studies also suggest that alcohol consumption may reduce circulating concentrations of total testosterone.12

In addition to exercise, nutritional interventions that focus on natural aromatase inhibitors and 5-alpha reductase inhibitors may be appropriate in personalized treatment interventions. The two enzymes, aromatase and 5-alpha reductase, affect the conversion of testosterone to estrogen and the conversion of testosterone to dihydrotestosterone, respectively. Modulating these enzymes may therefore impact the levels of testosterone and estrogens circulating in the body. Studies indicate that a range of nutrients, from vitamins to herbs to flavonoids, affect these enzymes.13-15


For men with suboptimal testosterone, addressing lifestyle considerations and nutritional interventions first is not only safe but may lead to the desired results. In addition, as with other hormonal imbalances, low testosterone may indicate a change in a patient’s overall physiology. From a functional medicine perspective, low testosterone levels or a testosterone deficiency diagnosis may be markers for the presence of an underlying physiological imbalance.

The functional medicine model assesses an individual patient’s genetic, biochemical, and lifestyle factors to help create a personalized treatment plan for their low testosterone levels or testosterone deficiency diagnosis. Learn more about optimizing testosterone function at IFM’s Hormone Advanced Practice Module (APM).


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  1. American Urological Association. AUA releases new clinical guideline for diagnosis and treatment of testosterone deficiency. Published April 10, 2018. Accessed May 6, 2024.
  2. Gryzinski GM, Bernie HL. Testosterone deficiency and the aging male. Int J Impot Res. 2022;34(7):630-634. doi:1038/s41443-022-00555-7
  3. Kumari N, Khan A, Shaikh U, et al. Comparison of testosterone levels in patients with and without type 2 diabetes. Cureus. 2021;13(7):e16288. doi:7759/cureus.16288
  4. Erenpreiss J, Fodina V, Pozarska R, Zubkova K, Dudorova A, Pozarskis A. Prevalence of testosterone deficiency among aging men with and without morbidities. Aging Male. 2020;23(5):901-905. doi:1080/13685538.2019.1621832
  5. Anaissie J, DeLay KJ, Wang W, Hatzichristodoulou G, Hellstrom WJ. Testosterone deficiency in adults and corresponding treatment patterns across the globe. Tranl Androl Urol. 2017;6(2):183-191. doi:21037/tau.2016.11.16
  6. Diem SJ, Greer NL, MacDonald R, et al. Efficacy and safety of testosterone treatment in men: an evidence report for a clinical practice guideline by the American College of Physicians. Ann Intern Med. 2020;172(2):105-118. doi:7326/M19-0830
  7. Al-Qudimat A, Al-Zoubi RM, Yassin AA, et al. Testosterone treatment improves liver function and reduces cardiovascular risk: a long-term prospective study. Arab J Urol. 2021;19(3):376-386. doi:1080/2090598X.2021.1959261
  8. Bhasin S, Brito JP, Cunningham GR, et al. Testosterone therapy in men with hypogonadism: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2018;103(5):1715-1744. doi:1210/jc.2018-00229
  9. Hayes LD, Herbert P, Sculthorpe NF, Grace FM. Exercise training improves free testosterone in lifelong sedentary aging men. Endocr Connect. 2017;6(5):306-310. doi:1530/EC-17-0082
  10.  Herbert P, Hayes LD, Sculthorpe NF, Grace FM. HIIT produces increases in muscle power and free testosterone in male masters athletes. Endocr Connect. 2017;6(7):430-436. doi:1530/EC-17-0159
  11.  Zouhal H, Jayavel A, Parasuraman K, et al. Effects of exercise training on anabolic and catabolic hormones with advanced age: a systematic review. Sports Med. 2022;52(6):1353-1368. doi:1007/s40279-021-01612-9
  12.  Santi D, Cignarelli A, Baldi M, et al. The chronic alcohol consumption influences the gonadal axis in men: results from a meta-analysis. Andrology. 2024;12(4):768-780. doi:1111/andr.13526
  13.  Smith SJ, Lopresti AL, Teo SYM, Fairchild TJ. Examining the effects of herbs on testosterone concentrations in men: a systematic review. Adv Nutr. 2021;12(3):744-765. doi:1093/advances/nmaa134
  14.  El-Kersh DM, Ezzat SM, Salama MM, et al. Anti-estrogenic and anti-aromatase activities of citrus peels major compounds in breast cancer. Sci Rep. 2021;11(1):7121. doi:1038/s41598-021-86599-z
  15.  Csikós E, Horváth A, Ács K, et al. Treatment of benign prostatic hyperplasia by natural drugs. Molecules. 2021;26(23):7141. doi:3390/molecules26237141

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