Managing Stress and Low Testosterone

Feeling anxious and stressed? The pressures in your life may manifest in many physical ways, including low testosterone. Here’s how to manage both stress and low testosterone.

You probably already know that stress can be bad for your health. But what you might not realize is that stress can impact hormones, particularly the testosterone that gives men their decidedly male characteristics, such as muscle mass, body hair, and a deep voice.
“Stress can cause lower testosterone levels and then turn into a vicious cycle — the lower testosterone level can cause stress, which can cause testosterone numbers to drop even lower,” says S. Adam Ramin, MD, a urologist and medical director of Urology Cancer Specialists in Los Angeles.
Some of the side effects of stress, such as the lack of motivation to exercise and poor sleep, can also contribute to lower-than-normal testosterone levels, says Elizabeth Kavaler, MD, a urologist at Lenox Hill Hospital in New York City.
On the flip side, managing your stress levels can help improve symptoms of low testosterone. “Lowering stress can help improve sexual function, decrease moodiness, and help men sleep better,” says Gregory Lowe, MD, a urologist at Wexner Medical Center at Ohio State University in Columbus.
The exact physiological connection between stress and low testosterone isn't known. “We think there are probably certain brain chemicals we secrete in response to stress, which then go to the part of the brain that controls testosterone production,” Dr. Ramin says.
Not only are stress and low testosterone physiologically intertwined, but they share some of the same physical symptoms. “The most prevalent are feeling sluggish and tired — what may be described as feeling ‘old and fat’ by many men,” Dr. Kavaler says. Other symptoms common with both low testosterone and stress include depression, loss of sex drive, and erectile dysfunction, Ramin says.
Coping With Low Testosterone and Stress
Any man can develop low testosterone, but you're at much higher risk if you are older, overweight, and under a lot of stress, Kavaler says. So, what’s a stressed-out guy who suspects low testosterone to do?
“See your doctor,” Ramin says. Start with your primary care doctor, who may refer you to a urologist or endocrinologist. He or she will review your symptoms and, if they are consistent with low testosterone, check your hormone levels with a blood test.
Normal testosterone levels vary based on the lab but usually fall in the range of 300 to 1,000 ng/dL, according to the U.S. National Library of Medicine. “Men in the region of 300 to 400 are at the low end of normal, and anything below 150 is considered very low,” Kavaler says.
Other blood tests may include those for precursor hormones to testosterone, including prolactin, luteinizing hormone, follicle-stimulating hormone, and thyroid hormones, Ramin says. “If all those levels are normal, you are hormonally healthy and your symptoms are probably due purely to stress,” Kavaler says.
If testosterone levels are indeed low, start with lifestyle changes to manage the symptoms of low testosterone, Ramin recommends. The following may help with both low testosterone and stress management:

• Lose weight. “Body fat makes estrogen, which can tip the ratio of estrogen to testosterone to make testosterone levels unfavorably low,” Kavaler says. Stress also tends to cause men to exercise less and eat fattening foods more, further contributing to low testosterone, she adds. When you lose weight, the process reverses, and testosterone levels tend to go back up.

• Get enough sleep. “Men under stress tend to be deficient in sleep, and lack of sleep can lead to low testosterone,” Ramin says. Sleeping better, on the other hand, can cause those levels to go back up. The National Sleep Foundation recommends that adults ages 26 to 64 get seven to nine hours of sleep a night and that those over 65 get seven to eight hours.

• Change your diet. To help boost testosterone, go for a high-protein, low-fat diet, recommends Ramin. Also limit certain foods — such as those high in refined sugars, salt, and saturated and trans fats — that can elevate triglycerides, cholesterol, and fatty acids.

• Exercise. “Regular cardiovascular exercise releases endorphins, which can reduce stress and boost testosterone,” Ramin says. “I recommend 30 to 45 minutes of cardiovascular exercise, such as running, swimming, or biking, three to four times a week.” Dr. Lowe also stresses the importance of adding strength training — which builds muscles and therefore may help boost testosterone levels — to your exercise routine.

• Breathe deep. “A simple breathing technique can instantly lower your stress level,” Ramin says. Take a deep breath through your nose and into your belly, hold it for a few seconds, and then let it out. “Repeat this a few times to calm your body and mind,” he says.

• Make time for yourself. “I tell my stressed-out patients to take an hour a day to do something for themselves and get their head together, be it exercise, a massage, listening to music, yoga, or a walk,” Kavaler says. “Even if it means getting up an hour earlier, it’s important to have this time to regroup.
• Consider testosterone replacement therapy.  Testosterone replacement therapy (TRT) can help return testosterone to a normal level and may help relieve some of the symptoms of low testosterone. However, TRT is not appropriate for everyone and may cause side effects, including increased risk of heart attacks, blood clots, and stroke, says Ramin. Talk to your doctor about whether TRT is right for you.