HOW TO

MAINTAIN HEALTHY
TESTOSTERONE LEVELS

Prof Kristian Leisegang

University of the Western Cape ·
School of Natural Medicine

www.nfsupplementseu.com Copyright Natural Foundation Supplements

 TABLE OF
CONTENTS
Introduction 02

Consequences of Male Hypogonadism 03

Diagnosis of Male Hypogonadism (Low testosterone) 04

Causes of Male Hypogonadism (Low testosterone) 05

Testosterone Replacement Therapy for Hypogonadism 06

Lifestyle Strategies 09

Consume A Diet With A Variety Of Nutrient-Rich Foods 10

To Support Testosterone Levels

Limit Alcohol Consumption To 7 Units Per Week Or Less 13

Soy Consumption Does Not Reduce Testosterone 14

Drugs & Medications That Reduce Testosterone 14

Environmental Chemicals to Avoid 15

Micronutrients, Antioxidants, Supplements 16

Watch The Podcast With Prof Kristian Leisegang 20

About Natural Foundation Supplements 21

Scientific Research References 23

 Male Hypogonadism = Low Testosterone

INTRODUCTION
Hypogonadism in males may cause reduced
sexual desire, erectile dysfunction, infertility,
increased fat and reduced muscle size,
reduced bone density and osteoporosis,
fatigue, depression reduced quality of life and
well-being1.
Hypogonadism affects up to 12% of the
general population and 25% of elderly males1,
and is increasing particularly with increasing
life expectancy 1.

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 CONSEQUENCES OF MALE
HYPOGONADISM

Hypogonadism is also associated

with high blood pressure,
unfavourable cholesterol changes,
high blood sugar, chronic
inflammation and oxidative stress,
and therefore, associated with
cardiovascular disease and diabetes
2,3
.
Healthy patients with lower levels of
normal testosterone are at an
increased risk to develop obesity,
metabolic syndrome, cardiovascular
disease and diabetes in later life 2,3.

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DIAGNOSIS OF MALE HYPOGONADISM
(LOW TESTOSTERONE)

It is important to be clinically assessed by an

appropriate practitioner should you be concerned
for hypogonadism.

Hypogonadism is established through a blood test

for testosterone in males with persistent clinical
symptoms4.

Total testosterone is best measured in the morning

(before 10 am) and requires two separate measurements
4 weeks apart to confirm hypogonadism4.

Free testosterone should be measured in patients

with near-normal total testosterone or with
increased SHBG levels4.

LH is used to help differentiate primary (testes) or

secondary (hypothalamus or pituitary) causes once
hypogonadism is established4.

Further assessment should include body weight,

blood pressure, cholesterol, triglycerides, blood sugar
and insulin, and inflammatory markers such as CRP1.

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 CAUSES OF MALE HYPOGONADISM
(LOW TESTOSTERONE)
[If you have been diagnosed with hypogonadism, it is important to investigate for underlying causes]

30 25 20 15 13 10 7
High level Medium level Low level

Testosterone declines at 0.4% - 2% per year in males

> 30 years old 5.

Diagnostic threshold for hypogonadism affects 13%

Ageing of males > 65 years old5 (termed late-onset
hypongadism or androgen decline in ageing men).

Lower testosterone with ageing is associated with

obesity, metabolic syndrome, cardiovascular disease &
diabetes1.

Lifestyle & environmental exposures that reduce testosterone6

Poor nutrition Radiation

Endocrine-disrupting
Sedentary lifestyle chemicals (e.g. pesticides
& heavy metals)

Obesity Air pollution

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 TESTOSTERONE REPLACEMENT
THERAPY FOR MALE HYPOGONADISM
Testosterone replacement therapy (TRT) as injections or transdermal administration7.

Pros

Weight loss Reduction of Improvements Blood sugar

high blood in cholesterol and insulin
pressure regulation sensitivity8

Use of TRT in obese or diabetic males has mixed results that are not consistent,
and should only be used when there are clinical symptoms of hypogonadism9.

Cons The benefits and long-term safety of TRT remain unclear,

especially in ageing males10 TRT is unsuitable for people with11:

Prostate Benign Increased Patients who Patients with

cancer prostate prostate-specific want to a history of
enlargement antigens preserve cardiovascular
(PSA) fertility events

Alternative pharmacological treatments include hCG, GnRH, hMG, 5α-reductase

inhibitors and aromatase inhibitors12,13.

It is important to consider treatment for any underlying medical cause that may
be identified in clinical assessment.

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 Testosterone Replacement Therapy
[in patients with hypogonadism]
Pros
• Maintains secondary sexual
characteristics61.
• Improves libido and erectile
function 61.
• Reduces body fat61.
• Increases muscle mass and
strength61.
• Increases bone density61.
• May improve cognitive
function in older men61.
• Improves mood and sense of
well-being61.
Tongkat ali
Pros
• Increases testosterone in
males with or without
hypogonadism62.
• Reduces oestrogen in males63.
• Improves libido and erectile
function in males with or
without hypogonadism62,64.
• Improves male fertility
parameters through
increased sperm
production63,65.
• Improves bone density in
males with hypogonadism66.
• Increased muscle strength
and endurance in males
(ergogenic effects) 68,69.
www.nfsupplementseu.com
Cons
Adverse effects such as acne, fluid retention, sleep apnoea,
breast tenderness and breast tissue enlargement in males 1.
These remain relatively low in young adults61.
Erythrocytosis (increased red blood cells) is the most common
adverse event61.
May cause infertility through reduced sperm production61.
Contraindicated in any prostate pathology and/or lower urinary
tract symptoms (e.g. urinary hesitancy, weak urinary flow,
dribbling, etc)61.
Contraindicated in those with a history of cardiovascular
disease (e.g. heart attack or stroke)61.
Contraindicated in elevated haematocrit (red blood cells),
increased platelet count (thrombophilia) and severe sleep
apnoea61.
Often requires injections, although transdermal patches,
surgically inserted pellets and nasal inhalants are available61.
Transdermal patches increase the risk of transfer to a partner
or children61.
Cons
Limited scientific evidence in clinical trials available62.
Clinical evidence is relatively short term duration in small
sample sizes62.
Adverse effects may include gastrointestinal irritability,
insomnia, increased heart rate and restlessness [unpublished
data]
Dosage and duration are not well established63. Generally
considered non-toxic at dosages of 200 – 300 mg/Kg in animal
toxicity studies; dosages above 1200 mg/Kg cause acute liver
toxicity63. In humans, acceptable daily intake of a maximum of
1200 mg/adult/day63.
Caution is recommended in elderly patients, and those with
prostate pathology, although there remains little evidence of
detrimental effects63.
Caution is recommended in immunocomprimised and/or
autoimmune patients67.
07
 • Has beneficial
anti-inflammatory and
antioxidant activity in male
reproduction, as well as
obesity and diabetes67,71.
Quality and authenticity of products available varies widely,
and regulatory concerns may lead to poor quality control and
safety issues70.

• Improves stress hormone

profile and mood parameters,
including tension, anger and
confusion72.
• Does not affect the ratio
between urinary testosterone
glucuronide and
epitestosterone glucuronide,
and hence does not breach
international sports doping
laws73–75.
• May improve blood sugar and
cardiovascular risk factors in
ageing males76.
• Has anti-proliferation
properties in many human
cancer cell lines63,77.

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 LIFESTYLE STRATEGIES
FOR MALE HYPOGONADISM
In this comprehensive guide, we will explore foods to eat and
avoid, chemicals and products to steer clear of, lifestyle
modifications, exercises, and supplements that can help
prevent hypogonadism.

DIET & LIFESTYLE TIPS

• Being overweight or obese decreases testosterone and increases
oestrogen, associated with increase in chronic inflammation, leptin,
insulin, oestrogen and oxidative stress 4,14.

• Obesity (BMI> 30) is associated with 30% lower testosterone, 45%

lower SHBG, 22% lower LH & 5% lower free testosterone compared
to BMI < 20 in British males15.

• Increased waist circumference is associated with 12% lower

testosterone in British males15.

• The rise in testosterone is proportional to the extent of weight loss

achieved:
• Minor weight loss (<15%) in obese people is associated with a modest
increase in testosterone levels16
• Increased weight loss (>15%) is associated with marked increase in
total testosterone and free testosterone16.
• Undernutrition and underweight (BMI <18) results in reduced
testosterone due to reduced LH17.
• Proper weight management (BMI 18 – 25) is critical in maintaining
and improving testosterone levels and sexual function in males16,18.

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 CONSUME A DIET WITH A VARIETY OF
NUTRIENT-RICH FOODS
TO SUPPORT TESTOSTERONE LEVELS

Intake of omega 3 polyunsaturated fatty acids (i.e. fish

oils) is associated with increased testicular size 21,22, but
lower LH and FSH levels with no association with
testosterone levels22.

Eggs

FOODS GOOD FOR

TESTOSTERONE LEVELS

Dark Green
Eggs
Vegetables20

Mediterranean Diets
Rich in carbohydrates (whole grain), vegetables and fruits, seafood, nuts, seeds, and
vegetable oils and antioxidants, reduces risk of obesity, diabetes, cardiovascular
disease and cancer19.

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 FOODS & DIETARY PATTERNS THAT
LOWER TESTOSTERONE

Breads Pastries Dairy Sugar rich Deserts Eating out

products foods regularly20.

Intake of monounsaturated fatty acids is associated with reduced total and free
testosterone levels and LH21 (Luteinizing Hormone - LH stimulates Leydig cell
production of testosterone in the testes)

Examples of monounsaturated fatty acids:

• Olive oil, canola oil, sunflower oil, safflower oil, almonds, cashews,
peanuts, and avocados.

Intake of trans fatty acids is associated with reduced total and free
testosterone levels and testicular size21.

Examples of trans fatty acids:

• Partially hydrogenated oils (often listed as an ingredient in
processed foods)
• Some margarines and shortening
• Processed baked goods like cookies, cakes, and pastries
• Some snack foods, such as chips and crackers
• Fried foods in some restaurants, especially those fried in partially
hydrogenated oil
• Some microwave popcorn.

Intake of omega 6 polyunsaturated fatty acid is associated with

reduced testicular size21.

Examples of polyunsaturated fatty acid:

• Vegetable oils like safflower oil, sunflower oil, corn oil, and
soybean oil. It's also found in nuts and seeds.

Polyunsaturated fatty acid intake, particularly omega 6, is positively

associated with LH21 (Luteinizing Hormone - LH stimulates Leydig
cell production of testosterone in the testes)

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PHYSICAL ACTIVITY

Regular moderate physical activity may

increase testosterone, particularly in
overweight & obese males23,24.

Vigorous exercise of >3 hours per week

is associated with 11% higher
testosterone & 16% SHBG in British
males15.

However, excessively intense short- or

long-term exercise may have a negative
effect on testosterone25.

Appropriate endurance or aerobic exercise

training programmes suited to individual
ability are recommended to improve
testosterone 26–28; whereas resistance training is
less effective 27,28.

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 LIMIT ALCOHOL CONSUMPTION
TO 7 UNITS PER WEEK OR LESS
Moderate alcohol consumption (≤ 7 units per week) may not be detrimental to
testosterone levels29 Heavy alcohol consumption (≥ 8 units per week) disrupts
hormonal balance with reduced testosterone, FSH (sperm production) and LH
levels29 (testosterone production).

UNITS CONVERSION

Beer or Cider Single shot Wine

Standard (4% alcohol by (25 ml) of spirits like Standard glass (175 ml)
volume) pint (568 ml): whisky, vodka, rum, of average strength (12%
~2.3 units gin (typically 40% alcohol by volume) wine:
alcohol by volume): ~2.1 units
Strong (5.2% alcohol by ~1 unit
volume) pint (568 ml): Large glass (250 ml)
~3 units of average strength (12%
alcohol by volume) wine:
~3 units

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 SOY CONSUMPTION
DOES NOT REDUCE
TESTOSTERONE
Soy-based products and isoflavones
classified as ‘phytoestrogens,’ which is
hypothesized to reduce testosterone in
males.

Clinical evidence in humans shows that

soy protein consumption does not affect
testosterone or oestrogen in males, &
can be considered safe for
consumption30,31.

CAFFEINE INTAKE
Caffeine does not appear to have a negative
effect on testosterone in men32.

DRUGS & MEDICATIONS THAT

REDUCE TESTOSTERONE
• Tobacco products and nicotine may increase
cellular dysfunction and reduce testosterone
production, as well an increase testosterone
metabolism into oestrogens in the liver25.
• Cannabis reduces testosterone levels and
impairs sexual function and fertility in males25.
• Cortisol medications have up to 7.5 fold
increase risk of developing hypogonadism35.
• Opioid analgesics reduce testosterone
through reduced LH production 36
(testosterone production hormone).
• Sedatives, tranquilizers and antidepressants
may reduce testosterone production37.

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 SLEEP
Sleep abnormalities, such as disruption or
restriction of sleep reduce testosterone levels38.

Sleep restriction of < 5 hours per night over 1

week may reduce testosterone by 10 – 15%39.

Low testosterone also results in sleep

disturbances38.

ENVIRONMENTAL
CHEMICALS TO AVOID
Numerous environmental factors are
known to disrupt hormonal functioning,
and are termed endocrine-disrupting
chemicals. Here are some guidelines to
increase awareness and reduce exposure:

AVOID BISPHENOL-A & PHTHALATES40

• These are common in plastic packaging, including wrapping, bottles &
containers.
• Opt for BPH-free products and look to reduce use of plastic wrapping or
containers on food or liquid products for consumption

AVOID PESTICIDES USED AS HERBICIDES,

FUNGICIDES OR INSECTICIDES41,42
• These are commonly found on agricultural food products, as well as
water
supply through agricultural run-off of pesticides into water sources.
• Opt for organic food where possible

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 MICRONUTRIENTS,
ANTIOXIDANTS, SUPPLEMENTS
Tongkat ali
• Improve testosterone in males with hypogonadism, as
well as males with normal testosterone levels43.
• This is particularly evident using standardised root
extracts with 0.8-1.5% eurycomanone as an important
constituent43.
• Improves sexual function in humans with sexual
dysfunction44.
Learn More

TONGKAT ALI CLINICAL

EVIDENCE

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Lorem ipsum 16
 See More Tongkat Ali Studies

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 Other Herbs with some clinical evidence45
• Trigonella foenum-graecum
• Withania somnifera (ashwagandha)
• Coleus forskoli (Forskohlii)

Herbs that have not shown convincing

clinical evidence for improving
testosterone in clinical trials45,46.

• Lepidium meyenii • Cordyceps sinensis

• Rhodiola rosea (Cordyceps)

• Tribulus terrestris • Ganoderma lucidum

• Panax ginseng (Reishi)

(Korean Ginseng) • Garcinia cambogia

• Urtica dioca (Garcinia)
(Stinging Nettle)
• Chorophytum

borivilianum (Musali)

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 VITAMIN D
Adequate vitamin D levels are essential for testosterone regulation54.
Reduced vitamin D levels are associated with reduced testosterone levels
on males, including obesity and healthy young males54,55. However, the
effect of vitamin D supplementation on testosterone remains unclear56.
Males with vitamin D deficiency may improve testosterone levels with
appropriate supplementation57,58.
Vitamin D supplementation may not improve testosterone in males with
normal vitamin D levels59,60.

Caution: Vitamin D supplementation should be done in

cases of sub-optimal or deficient levels of vitamin D after
testing, and should be done under professional guidance
to avoid vitamin D toxicity.

Learn More

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 STRESS
Acute stressors, including exercise, temporally increase testosterone as part of the
fight-or-fight response47–49.
Prolonged or chronic stress can result in reduced testosterone levels50–52, mediated
through increased cortisol (glucocorticoids) that inhibits the production of
testosterone and initiates cell death in these cells51.

A reduction in chronic stressors in recommended for healthy testosterone

levels; this can include sleep deprivation, food restrictions, strenuous
physical activity, long working hours (> 50 per week), financial stress and
problems with relationships53.

WATCH THE PODCAST WITH

PROF KRISTIAN LEISEGANG
HERE

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 ABOUT NATURAL
FOUNDATION SUPPLEMENTS
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 TONGKAT ALI SUCCESS
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 SCIENTIFIC RESEARCH
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