When I give my seminar on hormones and aging, I tell men (and their significant others) that after age 30, testosterone levels drop by one-to-three percent per year. Meaning, between age 30 and 50, your testosterone level will drop at least 20%– but could drop as much as 60%! A huge difference! Usually, someone asks the obvious question: Is there anything we can do to make sure we are in the “20%” group? Or even better, the “10%” group? As it turns out, yes. In 2007, the Journal of Endocrinology and Clinical Metabolism published a paper that looked at testosterone levels by age. Here is what they found:
Both chronological age and changes in health and lifestyle are associated with declines in Testosterone levels. [Health problems such as diabetes], and lifestyle influences, may be as strongly associated with declining T levels as aging itself. These results suggest that age-related hormone decline may be slowed, through the management of health and lifestyle factors.
They made a complicated graph to illustrate that simple concept:
If the graph makes sense to you, great. If you want me to walk you through it, click here.
First, look at the two thin, solid lines: the ones labeled BMI30. Those lines show that, whether you are obese (BMI>30) or not (BMI<30), you lose testosterone production at about the same rate: both groups lost about 13% of their testosterone production over the course of ten years. The obese group, however, had an additional 12% “penalty” in their testosterone levels: obese people make less testosterone (or convert more of it to estrogen). But what happens if you don’t stay at the same weight for those ten years? Men who started off at a healthy weight but then became obese, lost testosterone production over those 10 years at the usual 13% rate PLUS the additional 12% loss due to worsening lifestyle. So “jumping the tracks” (becoming obese, illustrated by the thick line) caused them to lose 25% of their T production over those ten years (illustrated by the dotted line), rather than just 13%. This is a bit of a catch-22, because as you lose testosterone production, it becomes much more difficult to maintain lean muscle mass—so MOST men will become fatter as their T levels drop. That said, if you can manage to stay in shape as you age, it generally gives you a significant improvement in your testosterone level as compared to your obese peers.
The bottom line:
- an illness such as diabetes, or even just being on multiple medications, lowered testosterone significantly.
- So did stressful events, such as divorce or being laid off.
- And of course, weight gain made a big difference, as the graph above shows.
Although hormone declines appear to be an integral aspect of the aging process, rapid declines [are not necessarily] inevitable. Further investigation may reveal opportunities to prevent T decline [by] focusing on modifiable health and lifestyle characteristics.
So: we don’t have to whither away as we age. Even if we don’t want to use supplemental testosterone, there is a lot that we can do to mitigate our declining T levels. Which begs the question:
HOW HIGH CAN YOU GET YOUR HORMONE LEVELS NATURALLY?
I have two good friends who take diet and exercise very seriously. I figured they might be willing to help answer that question. Meet Buff and Buffer Michael H. has been a friend of mine for about 20 years. He has never been in bad shape, and has always eaten well, but over the last few years has really taken it up a notch. Here is a photo that…well, was probably not originally intended for me, but now I have it, so you can gaze upon his masculine beauty:
Michael agreed to come into my office for testing a few months ago, just so he could get an idea of what his baseline levels are. This was his body composition:
…The dude has 3% body fat. THREE! Ridiculous.(I don't believe you. My friend/ my mom/ my dog is more ripped than he is...!)
He described his exercise regimen to me. Here are a few of his favorites:
“Pistols”: Stand on one leg. Hold the other leg straight out in front of you as you lower yourself down into a one-legged crouch, without the extended leg touching the floor. Then press back to standing. Michael says,
I alternate legs and repeat 10 reps. It gets all the muscles above the knee, plus abs like crazy. Lately I’ve been wearing a 12lb weight vest and holding 10lb in each hand (32lbs extra). I typically do four sets of this as part of my lower body workout.
San Francisco is famous for its hills. I wear the 12lb vest, then sprint uphill as fast as I can for about 30 seconds. Turn around and walk back to the bottom, repeat ten times. Often provokes vomiting in the uninitiated.
I do these with my feet against the wall for balance. Lately I have added a footstool under each hand, which adds 9 inches of range of motion. Legs straight with feet against the wall, lower slowly until forehead touches the ground. Repeat until maxed out.
He has a variety of other similarly masochistic endeavors, but you get the idea: he takes his workouts seriously. In addition, his diet is extremely low in processed sugar, and generally quite low in carbs. So what were his lab values? Michael H., age 43: Igf-1 – 250 Total Testosterone – 980 (Quest Laboratories, 7/11/2012) Let me put those numbers in context for you. Here are the norms by age group for IGF-1:
…and here are the norms for total testosterone:
He’s 43 years old. His IGF-1 level is at about the 98th percentile for his age… and his Total Testosterone isn’t even on the chart. In other words, diet and exercise can help… a lot. So can reducing stress: losing your job or losing a spouse were also found to lower testosterone levels in the
study mentioned at the top of this post. For more info on high-tech tools to reduce stress, see my previous post. But interestingly, there is more to the story. Michael isn’t my only friend who works out like a fiend. Let’s talk about Donny, who I’ve known even longer. Here are Donny and I in the glory days of 1987: At some point during that party, Donny decided he no longer wanted to be overweight. So he hit the gym… hard. …and here we are on my 40th birthday, 2009: In case you can’t fully appreciate the transformation, here’s one more picture:
I should point out that neither Donny nor Michael have used any anabolic hormones– just very clean living and a LOT of exercise.
Crash and Burn
But a few months ago a funny thing happened: Donny’s energy level took a nosedive; he wasn’t getting nearly as much out of his workouts as he used to– and some days he could barely even finish them. (Now, I will bail on a workout for any possible excuse, but trust me when I tell you that it is not possible to keep Donny out of the gym.) So we ordered some labwork. Obviously, I
checked for horrible things like leukemia, etc, but much to my relief, that was all fine. The hormone numbers, however, were startling: Donny Z., age 42: IGF-1: 148 Total testosterone: 565 Free Testosterone 68 (!) (Labcorp, Jan 2013) I didn’t show you Michael’s free testosterone levels, but to clarify: much of our testosterone gets bound to proteins in our blood, and is not available to bind to receptors. So, Free (i.e. available) Testosterone is actually the more useful number. Here are the values by age: Despite his Herculean exercise regimen (and appearance), Donny’s free testosterone (68) is in the 5th percentile for his age! Wow! With levels that low, is he even considered a man anymore?? Click here to find out!
So what gives? How is it that despite Donny doing everything possible to maintain decent T levels, his free testosterone is that of a 75-year-old man?? The answer is likely a combination of factors, but the main reason is probably Overtraining syndrome.
OVERTRAINING SYNDROME: Way too much of a good thing
It is well known that young female athletes can “overdo it”, and actually stop getting their periods due to overzealous training. This is particularly true for endurance athletes (marathon runners). The reason: when a woman’s body perceives tremendous stress or a major drop in caloric intake, her brain makes the executive decision that this would be a bad time to have to feed a growing fetus. So, her brain stops producing “gonadotropins,” the hormones that allow her to ovulate. What is less often discussed is that the same is true for men: endurance training can sometimes cause profound changes in a man’s levels of Growth Hormone, testosterone, DHEA, cortisol and even thyroid hormone. As I mentioned above, stress is a major contributor to declining testosterone levels. When our body is under stress, we release cortisol from our adrenal gland as part of our response. Now, you have probably heard that exercise is an excellent way to mitigate the effects of stress—and that is true. But check out what happens to endurance athletes:
For the first 80 minutes or so of exercise, their cortisol levels go down—a sign of reduced stress. But somewhere around 90 minutes, the exercise stops being perceived as beneficial, and starts being a source of stress in itself, causing cortisol release. The runners in this study were working at moderate-intensity (long-distance runners at 55% of VO2Max). If you were to try to maintain high intensity exercise for prolonged periods, you’d hit the “stress boundary” much sooner… …Which is exactly what Donny does, six days a week– for the past 15 years. His workouts actually make Michael’s look reasonable. Michael works out for 70-80mins, 90mins at most. Donny works out for at least 2 hours, always ending his workout with a 5 mile run: not a light jog; a high intensity 5 miles with steadily increasing incline. On most days he likely exceeds the “stress threshold” even before the run, but if he didn’t, he is guaranteed to cross it on the treadmill. (By the way, what the heck is VO2Max?)
So cortisol goes up. What about testosterone?
Testosterone does pretty much the opposite of cortisol: over the first hour or two of working out, testosterone levels may rise. But look at what happens to endurance athletes over time:
The black circles are men who did high intensity exercise: 143 guys working out at 80% of VO2Max. The white squares are a separate 143 men who exercised “moderately”: at 60% of VO2Max. The two groups exercised five times a week for 60 weeks, each session lasting 120 minutes. (This was followed by a 36-week recovery period, to try to get their poor sleeping ‘nads back in shape.) As you can see, in both groups, Serum Testosterone began to decrease by 12 weeks even with just moderate-intensity exercise– and the decline was much greater in the high-intensity group. And these guys did five workouts a week– Donny does six. This study lasted five months; Donny has been doing this for 15 years. The decline in testosterone, and increased cortisol, explains why marathoners can be world-class athletes and yet may not look very healthy: …whereas sprinters look like superheroes. Speaking of superheroes... how is Donny maintaining his muscle mass?
- Work out, and work out often! …but if you are exercising hard enough that you can barely catch your breath, keep it to 90 minutes or less.
- You can increase your VO2Max by working out at an intensity that raises your heart rate to between 65 and 85% of its maximum for at least 20 minutes three to five times a week. If you know your resting heart rate, feel free to use my handy High Intensity Interval Training Workout to get your VO2Max up!
- If you’ve experienced a drop-off in energy or libido and you are over age 40, get your hormone levels checked… you may be surprised at what you find!
Lastly… don’t worry, Donny came in to the PhysioAge office a few days ago. We’ll have him fixed up in no time! ☺