What's It Like To Have Low Testosterone?

A case study

Welcome back to the latest instalment of my new series of essays to coincide with the release of my new book, The Last Men: Liberalism and the Death of Masculinity, which is available now in hardcover, Kindle and audiobook formats from Amazon and all good bookstores.

My eyelids slowly rise, contacts dry and stuck to my eyes. I grab my bag full of sweaty training gear from that morning’s threshold ride and stand up. Whoa. I feel sluggish. Of course I do. I got up at 5 this morning, did an intense session on the bike for an hour and a half, worked a full day on Wall Street, and now I’m commuting home on the train. I have a hill workout tonight that I don’t feel like doing, but I need to push through and get it done. I’m training for the IRONMAN World Championship after all.

Even after running hard up a hill for 5 minutes with a heart rate north of 180, somehow my legs still felt sluggish, and not just for the first rep, but all five of them. What’s happening!? I must just be off today….

But it wasn’t just that day. Week after week, I got off the train feeling lazy, and it continued right through any of the evening workouts I had. I’d trained hard for 5 years and had never felt this way before. In addition to the fatigue, I had no interest in sex for days, or even weeks on end. Now that’s weird. I’m only 28 and too young to have libido problems!

That was Matt Bach, an iron-man competitor in his late 20s. He might seem like an unlikely candidate for low testosterone—young, very fit—but you’d be wrong: many endurance athletes, after years of training and competition, end up with levels typical of an old retired woman.

Bach wrote a piece for Men’s Health a few years ago about his experience with having low testosterone, and it’s well worth looking at in more detail. Anecdotal evidence is a great way to get to the heart of just how much it sucks to have low testosterone; how difficult it can be to get the medical profession to take you seriously; and how you can increase your testosterone without the aid of testosterone-replacement therapy. Just fixing your sleep schedule, for example, can work wonders.

Bach was suffering from a very specific kind of testosterone deficiency, often referred to as RED-S, or “relative energy deficiency in sport.” This is a condition that often afflicts sportsmen and -women, especially endurance athletes like iron-man competitors, long-distance runners and cyclists.

The range of symptoms can vary. Bach experienced chronic fatigue, low libido, body-fat retention and, as he later discovered when he developed a stress fracture, low bone density. These are all recognisable and common symptoms of low testosterone in men.

It’s worth reiterating that Bach was around 28 when he was suffering these symptoms, and apparently at the peak of physical fitness.

He was puzzled, until he read a blog by another triathlete who had suffered similar symptoms and discovered he had low testosterone. Bach booked an appointment with his doctor, but as is too often the case, the doctor simply didn’t believe a young man—let alone a triathlete in his late 20s—could have low testosterone. The doctor did, at least, agree to have him tested, presumably by means of a blood panel.

The results came back: 153 ng/dL. That’s very low. Not quite post-menopausal or Jeffrey Epstein-low, but pretty close.

Bach says the normal range is between 264 and 916 ng/dL, but really the low end of that range is much too generous. One of the problems with our current understanding of low testosterone is that a standard reference range—a “low,” “normal” and “high” that everyone agrees one—hasn’t been established. One doctor will tell you 264 ng/dL is normal, and another will tell you it’s low. I’d be heavily inclined to side with the latter. Often the best way to determine whether a man has low testosterone isn’t a blood panel on its own, but a consideration of the symptoms he displays.

The first thing Bach did was take two weeks out from his gruelling training regimen and eat more. The effect was immediate. His testosterone nearly doubled—in two weeks.

Over the next year, Bach did seven things to improve his testosterone and bring it back to a level where he felt healthy again. Or, rather, he did six things and didn’t do a seventh.

Let’s look at each of them.

First, he found the right doctor. Bach says he consulted multiple doctors before he found one who understood his problem. Among the rejected candidates was an endocrinologist—a specialist hormone doctor—who was completely unaware of the possible link between endurance sport and low testosterone.

It’s not entirely necessary to consult a doctor, but it can help, especially if you want blood work done. Just don’t be surprised if even specialists don’t really know what’s going on.

Second, Bach ate more. Bach was eating at least a thousand calories less than he should have been: 3,500 instead of 4,500. If you’re not eating enough, especially when you’re exercising as hard as Bach was, you’re not going to be producing optimal levels of testosterone.

He doesn’t say anything about exactly what he was eating, but it’s possible he wasn’t eating much meat or animal products. Long-distance athletes generally tend to favour consumption of large amounts of carbohydrates, including sugar, to provide ready energy for exercise. Cholesterol—perhaps the most demonised substance in medicine over the last century, apart from tobacco—is key here. Cholesterol is a precursor molecule for all the sex hormones, and although your body produces cholesterol in the liver, it’s better to get more via your diet. Studies have shown a closer relationship between cholesterol consumption and muscle growth than between protein consumption and muscle growth, almost certainly because the cholesterol is helping to produce more testosterone.

Bach does mention prioritising key nutrients like vitamin D, zinc and magnesium, which are essential for hormonal health. The best way to get them is from food—eggs, dairy, shellfish, red meat—but you can also take supplements.

Third, he slept. This is key. In fact, it’s one of the most potent ways you can improve your testosterone. The vast majority of your testosterone is produced at night, so if you aren’t sleeping enough, you won’t be producing as much testosterone as you can.

Research by a scientist called Plamen Penev has shown that older men who double their sleep from four to eight hours a night can double their testosterone. An acute sleep disturbance—a single night of bad sleep—doesn’t normally lead to a significant decrease in testosterone, but chronic sleep deprivation, over multiple days and weeks and months or even years, will reduce testosterone greatly.

Fourth, Bach trained less. It can be very hard as an athlete or a dedicated amateur to accept that more is not necessarily better, but it’s absolutely true. Overtraining is real, and it leads to chronic buildup of the stress hormone cortisol, which is antagonistic to testosterone. Many bodybuilders will say things like “90% of all growth is achieved outside the gym”—i.e. through rest and diet—and while we can dispute the exact percentage, they’re right. “Stimulate, don’t annihilate,” said eight-time Mr Olympia Lee Haney, and then let your body rest and grow.

Fifth: lifting weights.

“Under the supervision of my orthopedist and a physical therapist, I embarked on a regimented strength training program that involved some heavy lifting,” Bach writes.

“Twice per week I did deadlifts, squats, weighted lunges, plyometrics, and Olympic lifts.”

Of all the forms of exercise, lifting weights is by far the best to increase testosterone. You’ll also notice the emphasis on compound (multi-muscle) lifts—deadlifts, squats, Olympic lifts. These are the lifts that give the biggest testosterone boost, because they activate the most muscle fibres. (This is why the old bodybuilding chestnut of “train legs first if you want big arms” works. The testosterone boost provided by a leg workout carries over and provides more growth stimulus for the biceps and triceps.)

Sixth, Bach had regular blood work done. This isn’t essential, but if you want to quantify exactly how much of an effect your labours are having—and whether you have low testosterone in the first place—this is the way to go. Bach started out having blood drawn once a month, then once a quarter. If you don’t get blood work done, the way to know things are getting better is just to pay attention to whether the symptoms—the loss of libido, the lack of motivation, etc.—start to disappear. If they do, you’re on the right track.

Number seven is the thing Bach didn’t do. He didn’t take “supplemental testosterone,” or testosterone-replacement therapy. This involves the administration of testosterone, usually by doctor’s prescription. As an athlete, Bach didn’t want to fall foul of anti-doping regulations, and he was also wary of doing permanent damage to his body, which can happen if your protocol isn’t properly managed.

Many young men with low testosterone will almost inevitably reach straight for supplemental testosterone. But the truth is, unless you have a congenital defect that prevents you from producing adequate testosterone, or you’ve nuked your testicles from abusing steroids, you absolutely can restore your testosterone to healthy levels by natural means. All it takes is some willpower and planning—which is perhaps easier said than done if low testosterone has sapped you of the will even to get out of bed. But, even so, the habits you form if you do take the natural route will remain with you and benefit your life more broadly. Having healthy testosterone is a true virtuous circle, an upward spiral: you do things to increase your testosterone, your testosterone increases and you want to do more of the things that increase your testosterone.