Boost Your Levels: Exploring the Reality Behind Testosterone Supplements

Today, men are inundated with online, TV, and radio ads, as well as social media influencers, hawking supplements that claim to boost their testosterone (T) levels. Are these over-the-counter testosterone boosters (T-boosters) safe and effective? Healthnews spoke with several men’s health experts to get their take on the science, benefits, and risks involved with T supplements.

What is testosterone?

Testosterone, a sex hormone primarily produced in the testicles, plays a crucial role in the development and maintenance of male reproductive tissues and secondary characteristics, such as body hair growth, voice deepening, and growth spurts during puberty. Testosterone builds muscle, supports bone health, and can increase a man’s production of sperm and red blood cells.

Research shows that testosterone levels decline in men as they get older. After age 30, T levels drop about 1% every year. The Baltimore Longitudinal Study of Aging showed low testosterone (low T) incidence was about 20% of men over 60, 30% over 70, and 50% over 80. Low T is associated with a variety of health issues, including cancer, diabetes, heart disease, and Alzheimer’s disease, according to research.

What are the signs of low testosterone?

Common signs and symptoms of low T include:

• Fatigue
• Low sex drive
• Erectile dysfunction
• Loss of body or facial hair
• Loss of muscle mass
• Obesity
• Depression
• Cognitive issues
• Reduced motivation
• Irritability

While there are many sexual and non-sexual symptoms that come with low T, one of the most telling symptoms is low sex drive, according to Justin Dubin, M.D., a urologist and men’s health specialist in South Florida and co-host of the Man Up Podcast.

“It’s one of the more sensitive symptoms when it comes to identifying patients with low testosterone,” Dubin said.

Low T can be a “chicken-or-the-egg” issue, according to T. Mike Hsieh, M.D., a professor of urology at the University of California San Diego and director of the university’s Men’s Health Center.

“Are you not healthy because you have low T? Or is your T low because you’re not healthy?” Hsieh said.

According to the American Urological Association (AUA), low testosterone in adult men is defined as having a blood testosterone of less than 300 nanograms per deciliter (ng/dL).

What's the link between diet and testosterone?

Researchers are attempting to find a natural testosterone boost with diet, Hsieh said.

“Unfortunately, there’s not one specific type of food or diet that’s been shown to boost a man’s testosterone production,” Hsieh said. “Most of the research on diet has been things that can turn off our hormone production. Usually, it has to do with other comorbidities like obesity and diabetes.”

A high-fat, high-sugar diet, for example, can lead to obesity, which causes type 2 diabetes. Men with type 2 diabetes are twice as likely to suffer from low T as men without diabetes, according to the American Diabetes Association.

Dubin noted that diet is very difficult to study in a general population.

“Who really knows if the patients are being as compliant as they say?” Dubin said. “A lot of the studies are not randomized trials.” A randomized trial is a study that measures the effectiveness of a treatment by dividing the participants by chance and comparing the results of the separate groups.

However, there have been some compelling studies looking at diet and testosterone.

One study published in the World Journal of Urology showed that plant-based diets are not associated with a decrease in testosterone. Another study published in the Journal of Urology found that American men who adhered to a low-fat diet had lower testosterone levels.

Can supplements increase testosterone?

Some clinical trials have suggested that certain T supplements may improve T levels. However, according to a review in the Journal Androgens, the current medical literature “does not provide adequate data to support the use of T-boosters or their underlying components.”

Christina Bookwalter, PharmD, a clinical pharmacist practitioner based in Minneapolis, Minnesota, said she does not typically recommend natural products and supplements to treat low T.

“The body of research around supplements is not nearly as robust as the research surrounding prescription products due to the differences in regulations,” Bookwalter said. “There are many forms of prescription testosterone which can be used safely in patients who meet the indication. Prescription testosterone in any formulation that is appropriate for the patient will increase testosterone levels.”

Dietary supplements are not regulated by the FDA in the same rigorous way that drugs are. Supplements are not guaranteed to be safe or effective.

“We have no idea that what they say in these products is actually in them,” Dubin said. “And if so, how much is actually in them? We also don’t know if they’re putting in other things not on the label.”

JAMA Network researchers looked at sports performance-enhancing supplements and found that 23 of the 57 products (40%) did not contain a detectable amount of the labeled ingredient, and 89% did not have accurate ingredient labels. Most concerning, 12% were found to contain at least one ingredient that had been prohibited by the United States Food and Drug Administration (FDA).

Popular testosterone-boosting ingredients

Many supplements claim to boost testosterone levels. However, the results from studies have been mixed. Some of the most popular supplement ingredients include:

D-aspartic acid

There is insufficient reliable evidence to rate the use of this for the indications of athletic performance, fatigue, or muscle strength, according to the Natural Medicines Comprehensive Database (NMCD), one of the most authoritative and reliable resources on supplements.

“There are some animal studies for D-aspartic acid that showed that giving it can enhance your testosterone levels in animals, but the evidence has not really been consistent in humans,” Dubin said.

Fenugreek

According to a literature review published in Phytotherapy Research, results from clinical trials suggested that fenugreek influences serum total testosterone levels in men. Some research indicates that oral fenugreek seed might also help improve sexual arousal. According to a study published in Translational Sports Medicine, taking a specific fenugreek seed extract at 600 mg daily for 12 weeks increased sexual function by 15% over baseline, compared with no change in the placebo group. However, the study size was small.

Zinc

There have been studies showing zinc deficiency reduces testosterone and zinc supplementation in zinc-deficient people can improve their testosterone levels, according to Dubin.

“But the effect of zinc on serum testosterone really hasn’t been showing an important role in those who are not deficient,” he said.

Tongkat ali

Also known as Eurycoma longifolia or longjack, this plant was found to improve T levels in men with low T. The authors of a systematic review and meta-analysis of clinical trials wrote that tongkat ali “may represent a safe and promising therapeutic option” for men with low T. However, they wrote that more research was needed before clinical use. When picking Tongkat Ali supplements, make sure they contain a safe dosage.

Tribulus terrestris

Tribulus terrestris does not appear to increase T in humans. The Journal of Ethnopharmacology found the claim that Tribulus boosts T was “at best, inconclusive” and “analysis of empirical evidence from a comprehensive review of available literature proved this hypothesis wrong.”

Recommended dosage and ways to take it

The AUA does not currently recommend any supplements for testosterone levels.

“We don’t really have a standardized amount to use and how often to use it,” Dubin said.

Dubin said the clinical trials looking at T supplements have different ways in which they administered the supplement in the study.

Compound that with the fact that it’s not known if the purported ingredients are accurate, and Dubin “always gets worried about taking these supplements.”

“Are you getting exactly what you say you’re signing up for? What’s the correct amount? How often should you be taking it? I’m not 100% sure,” he said.

Risks of using testosterone supplements

While some supplements can potentially be beneficial, Dubin said it’s still “user beware” regarding how to properly take the supplement and how to find a supplement that contains what it says it does.

Hsieh noted that many supplements contain actual testosterone, even though that’s not disclosed on the label.

“They are basically just giving guys oral testosterone,” Hsieh said.

If a man does not have testosterone deficiency and ingests testosterone, it can lead to health problems, including suppressed sperm production.

“Sometimes I’ll see guys for infertility, and they say they take these over-the-counter T boosters,” Hsieh said. “Their sperm count is zero because they don’t even know it contains testosterone.”

When ingested orally, testosterone gets processed by the liver, which can lead to liver failure.

“It’s not uncommon for young men to go to the ER [emergency room] with liver failure from some of the over-the-counter supplements that they took,” Hsieh said.

In short, there are much better options for low testosterone than T supplements.

“If you’re interested in improving your testosterone, and you think the supplement is going to be your solution, it’s probably not,” Dubin said.