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Natural Methods to Manage Andropause

"Try some of these natural ways to increase your testosterone without some of the risks associated with hormone replacement."

In part one of his series on andropause, Dr. Keller Wortham, MD, went over the basics of this little known life change many men go through. We talked about the symptoms of this phenomenon, which is caused by a decrease in testosterone during aging, and can includefatigue,weight gain, decreasedlibido,loss of muscle mass, and even symptoms ofdepression.

In today's part 2, Dr. Keller will provide some tips for combating andropause, including the pros and cons of testosterone replacement. Stay tuned to find out how to deal with low testosterone, and the symptoms that come along with it.

Video Highlights

  • 01:28: Hormone Replacement
  • 02:19: Testosterone Replacement Methods
  • 07:01: Risks of Hormone Replacement
  • 12:51: Natural Ways to Boost Testosterone
  • 17:51: Wrap-Up

As we discussed inpart 1, andropause has to do with declining testosterone levels. Testosterone is the predominant male hormone in sexual development, and is associated with competitiveness, aggression, muscle mass, and sex drive.  But what happens when that level goes down? Well, it results in a lot of the symptoms that we've talked already, which can seem like a natural part of aging. However, there is a lot of medical debate over whether or not we should do something about andropause, or let it run its course. What we’re talking about here, is basically hormone replacement.  

Hormone Replacement

Forfemale menopause there's a lot of research onhormone replacement. As a woman goes through menopause, she may start taking estrogen or progesterone supplements to counteract the symptoms she's experiencing as she goes into that next phase of life.  But hormone replacement therapy for men just hasn't been as widely studied. So, we're in a little bit of a limbo right now about what to do as men reach a certain age, their testosterone levels go down, and they start to experience some negative symptoms.

Today, we’re going to tackle low testosterone and what the options are for men with low testosterone. It's easy to check your testosterone levels with your doctor, so if you're having some of these symptoms, go ahead and ask them to draw a blood test to see what your levels are. If you find out that you have low levels then start the discussion with your doctor about whether or not replacement could be right for you.

Testosterone Replacement Methods

So, let's talk about testosterone replacement. It's a big question — in fact, there are many pros and cons to the different ways to boost testosterone levels. 

Testosterone Injection

The first and oldest way to replace depleted testosterone is by injection. You can get testosterone in different forms and testosterone cypionate is a very common one that is injected by syringe. The hormone is injected into the muscle, so it's an intramuscular injection and it has to be done every two or three weeks to help boost testosterone levels back up to a normal level. Some of the benefits of that include the fact that it's really well absorbed since it goes directly into the muscle, and you know you're getting the proper dose, and can monitor that dose level with blood tests subsequently. On the drawback side, you have to go to a doctor or a nurse who can give you this intramuscular injection, and you have to do it every few weeks.  

Topical Hormone Replacement

Another way to replace testosterone is with a topical gel or cream. You can go to a pharmacy and get something like AndroGel, a cream that's applied daily to the skin. It needs to be applied to a hair-free spot, so that it absorbs into the body.  You don't have to worry about needles, but there are some drawbacks to it. When you're using a topical testosterone, there can be differences in the way you absorb it based on your skin type, so the levels can fluctuate a little bit more than in the case of an injection. Gels are thought to rush into the bloodstream a little more quickly and can cause some ups and downs, whereas some of the compounded creams absorb a little slower and might give you a more natural, even level of testosterone. Another drawback with a topical testosterone is that they can rub off on other people, such as your spouse or a child, and those people do not need higher levels of testosterone. 

One big drawback regarding any kind of testosterone direct replacement is that when it's given as an exogenous product, meaning you're adding it to your body, it tends to send a signal to the testicles, where your natural testosterone is made, and tell them to shut down.  Your body can start to believe the work of producing testosterone is already handled, and that it doesn’t need to keep doing it. So, by adding testosterone in a different exterior form you can cause your body to lower its own testosterone levels, and your testicles just might stop making their own testosterone, meaning that once you've started on testosterone supplements and replacement you might have to be on them for life.

Human Chorionic Gonadotropin

Another way to replace testosterone indirectly is called human chorionic gonadotropin (hCG). hCG is another hormone that can be injected in the skin, and it canstimulate your body's own production of testosterone. It is an analog luteinizing hormone, meaning it mimics the hormone that's made in the brain and in the pituitary, and that hormone then sends a signal to the testicles to increase production of testosterone. So if you're on the younger side, say in your 50s or 60s, you still might have enough reserve of testosterone in the Leydig cells of your testes and if you just stimulate them, then you can get them to do the work that they've started to slack off on.  

Another benefit of hCG is that you can do the injection yourself, just as you might do with insulin. You only have to do it a couple of times a week, and it is considered a more natural way to stimulate testosterone production because you're not shutting off your body’s natural production process. This also tends to mean that you won't overshoot your target levels quite as easily, and end up with levels that are too high, which can happen when it comes to straight testosterone injections.  

Risks of Hormone Replacement

There are some things to take into consideration, and risks associated with replacing hormones directly using products. Yes, there are benefits to replacing testosterone: we see an improvement in bone mass, quicker healing of muscles, and leaner body mass. There can also be increased libido, better erectile strength, and relief from some of the psychological issues associated with andropause like depression, sluggishness, loss of focus, and poor sleep. 

These things will be improved by the testosterone injection or replacement, but there is always a flip side to the coin. There are two main arenas when we consider the potential negative side effects of testosterone replacement.

Cardiovascular Issues  

We know thatcardiovascular disease is a serious threat in our country — it's the number one killer for many people. In fact, one in four people will die of some kind of cardiovascular event. So that means we need to be really careful about anything that has the potential to make that worse. There are conflicting studies out there, suggesting that giving men testosterone to replace low levels could increase the risk for some cardiovascular events.  This might have to do with altering thecholesterol profile and making the cholesterol a less healthy variety. Also, testosterone tends to beef up the hematocrit, which is the amount of red blood cells you have in your body, and as you increase the amount of red blood cells, the blood can get a little thicker, putting you at a higher risk for clots.

Currently, researchers are doing a more long-term study to see if testosterone, when given appropriately using various methods, can actually reduce cardiovascular risk, or at least not cause an increase in it. Unfortunately, that study will probably be 10 years in the making. So, right now, the jury's still out on whether or not supplementing with testosterone could have potentially negative effects on your heart. If you have any concerns about heart health or a history of heart disease in the family, then you need to really think long and hard about it, and have a discussion with your doctor.

Prostate Issues

A second arena where there’s potential for negative side effects has to do with the prostate.  The prostate is a gland only men have. It sits just below the bladder and it is responsible for creating most of the fluid in the semen that's not the sperm. The prostate is susceptible to two categories of problems. The first is that with time the prostate can grow, becoming larger and larger as you age. So, why is this a problem? Well, as the prostate gets larger it can start to restrict the bladder flow through the urethra. The prostate sits right below the bladder, and the urethra travels through it, so as the prostate grows, it can start to squeeze off the outflow from the bladder and lead to urinary issues — maybeoveractive bladder, or difficulty urinating.  If it gets really bad, it can actually block the urine flow altogether. 

A second issue with the prostate is that it is susceptible to cancer. Prostate cancer is the most common cancer in men who arenonsmokers — it's very prevalent, and it can be stimulated by testosterone. Some current theories suggest that going on testosterone won't cause prostate cancer, but if prostate cancer cells already exist (sometimes undetected) and then you start to take testosterone, you could stimulate the growth of that cancer. Then if the cancer goes haywire, it could to the bones and create a lot of problems.

Testosterone replacement may seem like an ideal solution at first blush: you’ve got a situation where testosterone levels drop, causing all kinds of symptoms like low libido, decreased energy, loss of muscle mass, and depression. Replacing the testosterone might sounds like a great idea, but it introduces several other things we have to worry about — namely, the prostate growing too large and potentially developing cancer, as well as potential issues with heart attack and stroke. So how do we marry those two together and come up with a solution?

Every guy is specific, and your set of health issues is going to be unique to you. You should talk with your doctor about them. Luckily there's another category of steps you can take to naturally boost your testosterone levels and restore balance, without medications, creams, or injections. 

Natural Ways to Boost Testosterone


One of the first things you can do is exercise — especially anaerobic exercise, or training the muscles. Muscles stimulate testosterone production, especially if you're using larger muscles like those in theback and legs. That breakdown in the muscle that happens when you exercise sends signals throughout your body that it needs to make more testosterone to stimulate the repair of these muscles. So, exercising can have a profound effect on your testosterone levels. Remember that low testosterone can also slow down the repair of your muscles and lead to more frequentinjury.  So, if you haven't been working out or even if you are, go nice and slow. Be smart about it, be steady, and try to get a good anaerobic workout without pushing things too far. You want to achieve a balance between stimulating your testosterone production and not injuring yourself.  

Get Better Sleep

Sleep isprofoundly important for so many of your hormone cycles but testosterone levels definitely go up if you're getting adequate sleep. You want to shoot for about eight hours every night. If you're getting eight hours of good, restful sleep, you will see a boost in testosterone levels and start to counteract some of those symptoms that you're having.

Reduce Stress

If you're exercising well and getting good sleep, yourstress levels will go down anyway. But additional things you can do to reduce stress will also reduce your levels of cortisol, a hormone that has a suppressive effect on testosterone. So go out into nature, listen to some music, or do whatever you can to disengage from all the stresses at life. That will help lower your cortisol levels, thus improving your testosterone levels.

Eat a Healthy Diet

You need to eat a healthy diet rich in healthy fats, like avocados and nuts.Fats are the building blocks of our hormones, so, if you're getting good healthy fats, you'll have the natural raw materials you need for good testosterone levels.

Increase Vitamin D

The next thing you can do is take vitamin D. Dr. Keller recommendsSmarter Vitamin D3, an activated form of vitamin D, which has been shown to improve testosterone levels. So, get a vitamin D supplement, especially if you don't get a lot of time out in the sun, or if you wearsunscreen.

Herbal Testosterone Boosters

The last thing you can do is add natural testosterone boosters that are available in the herbal arena. Stay away from the products that promise long-lasting erections or increase in penis size. Those are not to be touched. But here's a list of tried and true natural herbal products that you can take to try to improve your testosterone levels:

  • D-aspartic acid — You can find this in blends of different male hormone compounds, or as an individual product.  
  • Tribulus terrestris — This is a root or an herb that's been shown to increase testosterone by up to 17%.  
  • Fenugreek — Fenugreek is what we call an aromatase inhibitor, meaning it blocks the conversion of testosterone to estrogen. It helps keep your testosterone robust.
  • Malaysian ginseng — Also known as Tongkat Ali, this has been shown to help improve testosterone levels.
  • Ashwagandha is an adaptogen, meaning that it helps modify stress and reduce cortisol levels, so you'll get the stress-reduction benefits we talked about, just by reducing your cortisol levels.  

Avoid Estrogens

Finally, you should try to avoid estrogens that are in other food products or chemical products. There are a lot of estrogens that we can get in our diets throughmeat anddairy, especially if they're notorganic.Soy can mimic estrogen, so that can also be an issue. The more estrogen you're getting into your diet through other foods and chemicals, the more it's going to counteract the testosterone balance there.


Today, we talked about andropause, a serious condition that’s affecting men. It reduces libido, causes a decrease in muscle mass, and leads to weight gain, among other things. When it comes to testosterone replacement, there are definitely some options: you can replace your testosterone with either testosterone injections, topical creams, or hCG, and that can help improve some of those symptoms. However, there are some side effects to that as well — namely concerns about heart health and prostate health.

So, talk about these things with your doctor. Every man is different: your testosterone level and risk factors are unique to you. In the meantime, try some of the natural things that we suggested in this article increase your testosterone without some of the risks and considerations associated with hormone replacement. These natural methods include exercise, improving your sleep, eating a healthy diet, taking a vitamin D supplement, reducing stress, and taking some herbal remedies.

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