Project Supplements

CHAPTER 7

The supplements
to improve the
sex hormones and
the libido
7.1 Let's discover testosterone: what are the
your functions
Brain

Hypothalamus
GnRH
Gonadotropin-releasing hormone

Pituitary gland

LH
Luteinizing hormone
+
Leydig cells FSH
Follicle-stimulating hormone
Also called cells
Leydig interstitials
Testicles

OH

H
H

H
Testosterone
O

Figure 7.1 Regulation of testosterone production.

Testosterone is a steroid hormone produced by our body from cholesterol.

sterol. Its production, and therefore its concentrations, are well regulated by a
body in physiological conditions (that is, in a good state of health). The signals sent by
The brain and the pituitary gland at the base of the brain control the production of te-

Chapter 7 |369
Project Integrators

testosterone in men; the pituitary gland then sends signals to the testicles to
produce testosterone. A 'feedback cycle' closely regulates the amount of hormone.
in the blood. When testosterone levels increase too much, the brain sends signals
to the pituitary gland to reduce production, figure 7.1.
Testosterone is the main sex hormone in males and plays a number of roles.
important, not only concerning the sexual sphere and all that pertains to it
reproduction, but also for many aspects of general health; for example, growth.
and the good condition of the skeletal system and the good functionality and muscle strength.
Less known to the general public (and not yet fully studied by the community
scientific and clinical) are the effects of testosterone on cognitive abilities, on health
of the brain and on mood. Indeed, the gender differences in spatial recognition
Age-related declines in cognition and mood indicate testosterone.
as an important modulator of brain functions. The increase in testosterone
improves spatial cognition in hypogonadal men. Furthermore, the reduction of
Testosterone is associated with depressive disorders.

Testosterone is also important for women.

Testosterone is produced in the ovaries and in the adrenal gland. It is one of the gods-
androgens (male sex hormones) in females. It is believed that these hormones
have important effects on ovarian function and bone strength, as well as for the
sexual performance. The correct balance between testosterone (along with other androgens)
and estrogen is important for the ovaries to function normally. Although the specific-
that are uncertain, it is possible that androgens also play an important role in-
normal brain function (including mood, sexual desire, and cognitive function).

What happens when testosterone is high

The blood levels of testosterone vary significantly over time and also during the course of
day. Furthermore, what may seem like a symptom of excess testosterone (see
Under) may actually not be related to this hormone. In fact, the majority of
I gave you what we know about abnormally high testosterone levels in men.
those athletes who use anabolic steroids, exogenous testosterone, or related hormones for
to increase muscle mass and athletic performance. In any case, although rare,
The problems associated with abnormally high testosterone levels in men include:

• Low sperm count, shrinkage of the testicles, and impotence (po-

It may seem counterintuitive, but it is.
• Cardiac disorders and increased risk of heart attack.
• Prostate enlargement with difficulty urinating.
• Liver diseases.
• Acne.
• Fluid retention with swelling of the legs and feet.
• Increase in hunger and appetite.
• Weight gain, possibly partially related to increased appetite.

Chapter 7
 Integrators Project

• High blood pressure and cholesterol.

• Insomnia.
• Increase in muscle mass.
• Increased risk of blood clots.
• Mood swings.

Among women, perhaps the most common cause of a high level of testosterone is the syndrome-
me polycystic ovary syndrome (pcos). This disease is common: it affects between 6% and 10% of the
women in premenopause. The ovaries of women with PCOS contain more cysts. The symptoms
irregular cycles, reduced fertility, excessive or coarse hair on the face, extremities,
trunk and pubic area, male pattern baldness, thickened and darkened skin, weight gain,
depression and anxiety. In any case, I will talk about it more thoroughly later.
Women with high levels of testosterone, due to diseases or drug use, can
to experience a reduction in breast size and a change in tone
of the voice, in addition to many of the problems that men can have.

What happens when testosterone is too low?

As men age, testosterone levels decrease significantly.

dually, from about 1% to 2% each year, unlike the relatively rapid decline of the
estrogens that cause menopause in women. The testes produce less testosterone, there
there are fewer signals from the pituitary gland telling the testicles to produce testosterone, and a protein-
The sex hormone-binding globulin (SHBG) increases with age.
Thus, bound testosterone increases and free testosterone decreases.
More than a third of men over the age of 45 may have testosterone levels
Reduced compared to those that could be considered normal (although, as
we will see, defining the optimal levels of testosterone is complicated and somewhat controversial.
The symptoms of testosterone deficiency in men include:

• Sparse hair on the body and face (beard).

• Loss of muscle mass.
• Low libido, impotence, small testicles, reduced sperm count, and sterility.
• Hot flashes.
• Mood swings.
• Fragile bones and increased risk of fractures.

No matter how surprising it may be, women can also have problems.
the symptoms due to testosterone deficiency: can manifest low libido, reduced
bone mass and muscle strength, poor concentration ability and mood swings.

7.2 Improve testosterone levels

Few people are aware of the role played by testosterone in libido.
give, in mood, in muscle gain and in fat loss, so that the donors-

Chapter 7 |371
Project Supplements

they never think about their levels. On the contrary, some men are obsessed with it.
state of their testosterone. The boys are right to be concerned about their testosterone.
no (T), because we are indeed talking about a very important hormone.
Studies have shown that testosterone replacement therapy (TRT) can
improve cognition, mood, libido, muscle mass, mineral density
bone and the production of red blood cells, with the only noteworthy disadvantage that it is a
uncertain (but probably null) effect on prostate cancer.
Testosterone was artificially synthesized for the first time in 1935. Shortly after,
began to be used as a potential therapy in clinical studies, with pro-
putting. And then some bad news arrived: in the early 1940s, it was established
a link between testosterone and prostate cancer, with one of the researchers who won the
Nobel Prize for discovering connections between hormones and cancer.
For several decades, this discovery has cast a shadow over the therapeutic use of T.
But recent studies suggest that the "androgen hypothesis" is misleading: high
testosterone do not seem to cause prostate cancer; rather, levels of
Very low testosterone levels allow for the regression of prostate cancer (reason
for which men with prostate cancer are often given medication
that drastically lower testosterone levels)

What does a low concentration of testosterone depend on?

Testosterone plays a central role in well-being and vitality. In men, the

Low testosterone is particularly linked to inflammation, weight gain, and problems.
cardiovascular. For almost 40% of men over the age of 45 who could
having a low T, this is bad news. But if you have a low T, what does it mean? I
Can T levels be naturally/physiologically lower than average? Is it normal-
is there a decline related to age or is there something wrong? And if there is, what is the culprit or,
more likely, who are the guilty parties?
First of all, let's try to understand what the actual concentration ranges are.
considered normal. Testosterone levels in males appear to have decreased over the course of
last decades, both for total T and free T. Total T indicates everything
the testosterone that circulates in the blood. It has three components:

1. Testosterone closely linkedAbout two-thirds of testosterone in the san-

it is linked to sex hormone-binding globulin (shbg). Testosterone
strictly related cannot be used.
[Link] bound testosteroneAbout a third of testosterone in the blood is the-
albuminous cat. The body can utilize it, in certain cases, with some difficulty.
[Link] testosteroneA small percentage of testosterone in the blood (1-
4%, as a rule) circulates freely. It is testosterone that can be ready-
mind used by the body.

Together, the slightly bound T and the free T make up what is known as
"bioavailable testosterone", which has a greater impact on health compared to T
total. For this reason, SHBG is often tested simultaneously with total T
(The higher the SHBG, the lower the bioavailable testosterone). Over-reliance on numbers

Chapter 7
 Integrators Project

It is still a mistake.
One of the reasons is that normal levels of T can vary greatly between an in-
the individual and the other. If a person feels in a bad mood or with low energy levels,
he decided to analyze his testosterone levels and the latter appears
at medium-low levels, it will then become automatic and instinctive to think that the problem is the
testosterone. However, things could be more complicated.
No one tells us that the levels weren't already low when one felt perfectly fine.
; in other words, the tested levels could be below average but not low for
that individual, who indeed was fine before! If, for example, the androgen receptors
they are more sensitive than average, the body should produce less T than average
of the population. The sensitivity of androgen receptors is highly individual.
Another reason to avoid relying too much on numbers is that the range
Normal for the total T can vary considerably from laboratory to laboratory: from 160
a 300 ng/dl at the bottom of the range, and from 726 to 1,130 ng/dl in a more generous range. How
Should I say that I have good or bad testosterone levels?
A concentration of 280 ng/dl is measured, depending on the laboratory, I can
to say you have normal or low testosterone!

It's different for everyone Do not compare yourself to others

345ng/dl 345 ng/dl If your high levels are

overwhelmed, your situation is
He feels lethargic Run half different from that of those who have
and depressed, not marathons, happy.
always had low levels.
lose weight.
There is no better level.

Diverse labs list with very diverse range

Man Lady
0 41.61 nmol/L 0 5.2 nmol/L
5.5 10.40 25.16 39.18 0.5 0.7 2,082,4

160300 726 1130 15 20 6070

0 Range Range Range Range
1200 ng/dL 0 150 ng/dL
bass high bass high

300If it is below 300 ng/dL and there are 70 If it is below 70 ng/dL and there are
symptoms, take the values seriously: ask symptoms, discuss with a doctor.
of the solutions and make other checks. 150Levels above 150 indicate that it is
an urgent medical check-up is requested.

Figure 7.2 What should my testosterone levels be?

Age is just a number...except when it comes to testosterone.

Men begin to experience an annual decline in total T (0.4-2.0%) and T

bioavailable (2-3%) after the age of 30. But this decline is entirely caused by the process
or it could also be found in men who age themselves

Chapter 7 |373
Project Supplements

They exercise much less and eat much worse as they approach middle age?
As for muscle mass, no one really knows what a decline looks like.
“natural” testosterone in the human species. We know we lose muscle mass-
decreases with age, but how much of this loss is attributable to the process of
aging itself (including the decline of testosterone) and regarding the fact that men
Do middle-aged people spend less time at the gym and more time at home?
The drop (or collapse) of testosterone that is experienced with aging can certainly
worsen fat increase and muscle loss, but not as much as the changes
the habits of the mind. The elderly, particularly the females, essentially
lower likelihood of meeting the recommended levels of physical activity compared to other adults.
That the elderly are less likely to exercise enough compared to
other adults unfortunately does not mean that the average middle-aged adult trains enough
There are extended working hours and other responsibilities, such as raising children, is
It's too easy to neglect diet and exercise.
A healthier diet in middle age translates to fewer health problems in
old age. And more exercise in middle age translates to less sarcopenia (muscle loss.
schooling linked to age) in old age.
Furthermore, even if I initially said that almost 40% of men over the age of
A 45-year-old man could have low T, it seems that only about 10% of men present
symptoms of low T levels.

10%
Estimate men with symptoms
of low testosterone.

40%
Estimation of men with
low testosterone.

Figure 7.3 Testosterone in men over 45 years old.

So there is a discrepancy: some men with low levels of T have symptoms, while
others feel well or even in great shape. Moreover, when testosterone is prescribed
in older men with low-normal T levels, their symptoms often do not change. This
it confirms a previous observation we made, namely that one can feel left out
To have a low T without the two factors being causally related.

18 years 30 years 40 years 65 years

Testosterone peak Declining testosterone Many men begin Much more than half of the
by 1-2% per year to worry men have low levels of
testosterone

Figure 7.4 Testosterone decreases with age.

Chapter 7
 Integrators Project

How to increase testosterone levels?

Increasing testosterone can change the game for some people.

(males and females). But we should first ask ourselves: why is testosterone basic-
So? What else could happen?
Diet and testosterone are connected in many ways, but mainly in two aspects.
Firstly, very low-calorie diets reduce testosterone over time. There is
there is also a relationship between fat intake and testosterone, although it is much more im-
important caloric intake. Secondly, being overweight or having high levels
Abdominal fat can lead to a vicious cycle:

Extra body fat leads to a deterioration of metabolic health, and

Both of these conditions lead to a decrease in testosterone.
[Link] your low testosterone level makes you feel out of shape, you have greater
probability of eating, of being under stress, and a lower probability of exercising
physical exercise (or training well).
[Link] stress, more food, and less physical exercise are a recipe for weight gain.
weight, which brings us back to point 1 and thus to a vicious circle.

Testosterone levels can also decrease if you don't get enough sleep, if you are too stressed.
satiety, or even if one trains too much (in reality it is not the 'excess of training' in itself that
problem, but the combo that is created in people who train a lot and do not re-
they recover enough, perhaps because they sleep little and because they eat too little.
Other negative factors range from alcohol to bisphenol A (BPA, a chemical that ...
it is found in water bottles and in some kitchen objects). Over the millennia,
many different materials have been used to contain drinks and food. Glass or me-
stem, wood or animal leather: each material has its pros but also its cons,
from being fragile to being susceptible to altering the taste of what it touches.
For decades, starting from the 1960s, plastic produced with bisphenol A (BPA) has been
considered the ideal material: light, resistant, and with less likelihood than other pla-
stitches of absorbing odors and becoming malodorous. Since then, however, it has been proved-
the strato that lb painter interacts with estrogen receptors and therefore potentially causes
a plethora of adverse effects in fetuses, newborns, children, and adults (of both sexes).
Excessive training

Increase Testosterone
Nutrition cortisol lower
O OH

Exercise HO
H
OH

H H
O

Not enough exercise

Excess Excess of Testosterone
of fat estrogen bass
Exercise OH

Nutrition H

H H
HO

Figure 7.5 Effects of training volume and caloric intake on levels of

testosterone.

Chapter 7 |375
Project Supplements

Eating canned foods (like soups or canned fruit) can expose us to BPA.
the scrap is rarely used now to make plastic bottles, many plastic bottles
advertised as private can still release estrogenic chemicals
niche. These exposures will not necessarily increase testosterone levels,
but there are various alternatives, such as glass or metal bottles, and using less
Plastic is generally a good idea.

Pesticides, fertilizers
BPA Possible but there isn’t enough research
Defined effect
Chemical substances in meat
Possible but there is not enough research
Phthalates
Chemical substances in water
Defined effect
Possible but there isn't enough research

figure 7.6 Environmental factors.

One should not think that they need to take testosterone by prescription to feel
better. For some men, yes, this will be the only option that really works; but
For many others, a change in habits will bring about the desired effect. And for others
Again, testosterone is not even the cause of how they feel. There are many
motivations - not related to testosterone levels - for which a person might feel
fatigued, or having a low libido.

Lifestyle, diet, and testosterone

Lack of sleep causes numerous health problems. In particular, it can...

to hinder testosterone production and facilitate the increase in body fat (and the au-
the same fat hormone can compromise testosterone production). Having a
Sufficient quality sleep will help maintain healthy testosterone levels.
Weight training can temporarily increase testosterone levels.
for 15-30 minutes after exercise, but this is only an acute effect, and little significant
However, exercise can indirectly improve testosterone levels,
as it can promote long-term testosterone production by improving the
body composition and reducing insulin resistance.
The increase in fat and the associated increase in the risk of chronic diseases, such as the
cardiovascular diseases and type 2 diabetes are strongly linked to the decrease
of testosterone, particularly in middle-aged and elderly men. If it increases-
body weight (fat), testosterone production decreases. Fortunately, if you
losing weight, the production of testosterone starts to increase again.
A meta-analysis of 24RCTs examined the weight loss caused by diet or
bariatric surgery. In diet studies, the average weight loss of 9.8% was col-
linked to an increase in testosterone of 2.9 nmol/l (84 ng/dl). In surgical studies
bariatric, the average weight loss of 32% has been linked to an increase in testosterone
steroid of 8.7 nmol/l (251 ng/dl). It is not necessary to lose huge amounts of weight

Chapter 7
 Project Integrators

to see an increase in testosterone levels: a weight loss of 5% can already

increase total testosterone by 2 nmol/l (58 ng/dl).
14

12

10

0
0 5 10 15 20 25 30 35 40 45

Weight loss % of total

Figure 7.7 Effect of weight loss on testosterone levels.

The currently available scientific data recognize that the intake of fats, although
It is of secondary importance compared to the total caloric intake, it has a significant influence
advantages on the concentrations of some anabolic hormones that may be important
for maintaining a good body composition (and good health), how
testosterone.
Specifically, the reduction of the percentage of fats in two isocaloric diets, from
40% to about 20% has led to significant, albeit modest, reductions in levels of te-
testosterone. In the case of athletic individuals who are subjected to a caloric restriction
such that it is not possible to maintain a recommended intake of fats (0.8-1.5 g/kg of body weight
body or about 30% of the total caloric intake, when we talk about a normocaloric diet
(lorica), it could be an alternative to mitigate the drop in testosterone by increasing the
saturated fat consumption.
Let me clarify this suggestion: in this case, the assumption of some
gram more of saturated fats is valid because it finds context in a low-
caloric, for physically active individuals, who among other things consume a reduced amount
of fats with the diet. For this reason, a modest increase in saturated fats does not
it is neither harmful nor dangerous, as it could be (and it is recommended to you-
(under control) in the cases of normocaloric or hypercaloric diets that involve
an intake of about 30% saturated fats, for the general population which is
commonly overweight and/or sedentary.
In any case, as already mentioned, the basic body composition and the restriction ca-

Chapter 7 |377
Integrators Project

Typically, they play a greater role in influencing testosterone levels.

not just regarding the mere intake of fats. In fact, we know that during the restriction
During caloric restriction (or fasting periods), there is a physiological reduction in testosterone levels.
As if that weren’t enough, weight loss itself plays a role in influencing the...
testosterone concentrations, regardless of fat intake (higher
o minor).

In summary, although the general recommendation for intake

optimal fat intake for athletes is around 30% of calories (range
15-30%), in order to optimize testosterone levels, in some cases this
hiring may not be possible in the context of the restriction
caloric without compromising adequate protein intake or
carbohydrates. Therefore, in these cases, a fat intake that is around
at the lower extreme of the range (15-20%) that has been previously
specifically recommended for professional bodybuilders, it can be a
compromise.

Integration

Main supplements

Vitamin D Zinc

Vitamin D

Since vitamin D plays a role in regulating testosterone production

rone (T), it seems logical that maintaining adequate levels of D could help to ga-
maintain adequate levels of T. However, the effect seems to be rather modest.
study version on males with insufficient vitamin D levels (<20 ng/ml/<50 nmol/l)
they showed that an average daily dose of 3,000 IU (75μg) supplement of
D3 has not increased the levels of T or, at most, has increased them by 1.15 nmol/l (33.17
ng/dl). Similarly, the supplementation of D3 had a minimal or no effect.
on free testosterone and sex hormone binding globulin (SHBG) in perso-
with insufficient vitamin D levels.
Most women with polycystic ovary syndrome (PCOS) have levels
elevated levels of androgen hormones, including testosterone (T), free testosterone, dehydroepiandrosterone
dehydroepiandrosterone (dhea) and dehydroepiandrosterone sulfate (dheas). These elevated levels can cause the
growth of body hair, flare-ups of acne, and a type of hair loss more

Chapter 7
 Project Integrators

consistent with male-type hair loss compared to female-type hair loss.

Like in males, vitamin D plays a role in regulating testosterone.
not even in females. The levels of T in adult females typically range between
0.7 and 2.08 nmol/l (20-60 ng/dl), with the lowest levels typically observed during the
follicular phase of the ovarian cycle. Levels above this range indicate a
catore dipcos.
0 5.2 nmol/L
0.5 0.7 2.08 2.4
Woman
15 20 60 70
Range Range
0 150 ng/dL
bass high

70 If it is below 70ng/dL and there are 150 Levels over 150 indicate that it is
symptoms, discuss with a doctor. urgent medical check-up requested.

Figure 7.8 Assessing testosterone levels in women.

In various randomized studies on women with PCOS, the average effect of the supplement
the D3 administration was moderate, with an overall decrease in testosterone that
it goes from 0.26 to 0.62 nmol/l (from 7.59 to 17.85 ng/dl lower). The effect was greater in
participants who took D3 with additional pharmacological treatments for lapcos.

• Medications for PCOS + vitamin D: reduction from 0.29 to 0.76 nmol/l (from 8.36
a 21.92 ng/dl lower.
• Vitamin D alone: reduction from 0.00 to 0.52 nmol/l (from 0.09 to 15.00 ng/dl)
in less).

Furthermore, the effect depends on the initial state of vitamin D. Females with levels
insufficient vitamin D levels (<20 ng/ml/<50 nmol/l) have found improvements
major debts.

How to supplement Vitamin D

lacking Inadequate Adequate High Unknown

Initial dose 50,000 IU 800-2,000IU- - -

(1.250 μg) (20-50 μg)

1 time/week as long as the levels

6-8 weeks I am not
adjust

Take two 400-1,000UI 400-1,000UI 400-600UI - 400UI

maintenance (20-25 μg) (20-25 μg) (10-15 μg) (10 μg)

1 time/day 1 time/day 1 time/day 1 time/day

Table 7.1 Summary of vitamin D dosage recommendations.

Chapter 7 |379
Project Integratori

Zinc

Zinc, an important mineral for overall health and present in many foods,
it is often marketed as a testosterone booster. As with magnesium,
however, zinc supplementation can help only when testosterone levels are low
are linked to a zinc deficiency. If the body has enough zinc, taking it
it will no longer be of any use.
On the contrary, over time, high doses of zinc can irritate the gastrointestinal tract.
They can also cause a copper deficiency, as zinc initiates the process of
creation of metallothionein, a protein that binds zinc but also other metals,
in particular copper; the bound metals then leave the body as waste products. Furthermore-
three, higher doses of zinc can damage the liver and kidneys, so the doses that
I will indicate (up to 40 mg per day) also considering the protection from these risks.

Low intake Adequate intake High intake

Low testosterone, Normal testosterone, Gastrointestinal disorders,
immune function immune function liver damage, damage to
altered, diarrhea. normal, normal growth. rens, copper deficiency.

Figure 7.9 Effects of low, adequate, and high zinc levels.

How to incorporate zinc

In case of shortage or severe shortage, intervention under supervision will be necessary.

medication. Do not start taking supplements without first discussing it with the doctor. The
common medical interventions include taking a short-term oral dose of
1-2 mg/kg/day of elemental zinc; for a severe deficiency, a higher dose may be used.
short-term oral dosage of 3 mg/kg/day.
In case of mild deficiency, 30-40 mg per day of elemental zinc for 2-4 weeks should be
I am bringing the zinc levels to normal, at that point 10-20 mg/day can be
sufficient for maintenance. In individuals at the lower end of the normal range-
a dosage of 5-20 mg/day of elemental zinc can help
to maintain normal levels. In people at the upper end of the normal range (18.6-
24.3 µmoI/l, 121.5-159 mcg/dL), a zinc supplement may not be necessary,
taking 5 mg/day of elemental zinc may help maintain normal levels.
In case of poisoning (which can cause serious adverse effects), do not supplement with
zinc, stop using any supplements containing zinc and consult the
own doctor. Greater effects are more likely when baseline levels of zinc
and testosterone levels are lower. Zinc sulfate and zinc gluconate are the forms of supplementation.
Zinc citrate seems to have an absorption
comparable to gluconate, while zinc oxide is absorbed less well.
Zinc picolinate and bis-glycinate may have higher absorption rates.
of gluconate, but further research is needed. Zinc absorption can be
it will be reduced if consumed with foods rich in phytates, namely cereals, legumes, seeds, and fruit
dryness. If there are gastrointestinal symptoms when taking zinc on an empty stomach, to-
it is good to combine it with foods low in phytates.

380| Chapter 7