Testosterone is now firmly in the spotlight at the Department of Health and Human Services.
Recently, the Food and Drug Administration (FDA) gathered an expert panel to explore ways to ease access to testosterone replacement therapy. This included discussions about potentially removing testosterone from the list of scheduled substances, which are typically restricted, and lifting the black box warning that currently accompanies testosterone products. Following this event, Adm. Brian Christine, a urologist and expert in men’s health, was appointed as the assistant secretary for health. Reports suggest that a National Men’s Initiative may soon be underway.
Interestingly, health secretary Robert F. Kennedy Jr. himself uses testosterone as part of his anti-aging regimen. This focus on testosterone has now found its way into an unexpected arena: last week, supplementary materials released alongside the revised dietary guidelines included a section titled "Supporting Testosterone Health in Men."
For the first time, these guidelines include dietary recommendations specifically aimed at men who wish to maintain healthy testosterone levels. However, leading experts in the field have raised concerns about the limited evidence supporting the idea that diet alone can significantly prevent low testosterone levels.
The primary takeaway from this new section aligns with the overall framework of the dietary guidelines, emphasizing the importance of fat consumption. The report advises men interested in maintaining optimal testosterone levels to adopt a balanced diet rich in healthy fats. It also cautions against low-fat diets, noting that research suggests such diets may contribute to minor reductions in testosterone production.
Additional recommendations include taking DHA-rich fish oil supplements, ensuring adequate intake of zinc and vitamin D, and avoiding excessive protein consumption—an idea that seems somewhat contradictory to the broader emphasis on proteins within the guidelines themselves.
Abraham Morgentaler, a urologist who specializes in testosterone replacement therapy and holds a faculty position at Harvard Medical School, expresses caution regarding the strength of the evidence linking diet and testosterone levels. "It’s important to note that no single food can dramatically increase testosterone levels," he explains, using the popular abbreviation for testosterone.
When STAT reached out to HHS for comments, no response was received.
Moreover, the guidelines advocate for physical activity and maintaining a "healthy body weight," particularly encouraging weight loss among overweight and obese men—a recommendation that experts unanimously agree is crucial. James Smith, a professor of urology at the University of California, San Francisco, and chief medical officer of a semen analysis company, points out that overweight men often experience higher estrogen levels. He elaborates that an enzyme found in fat cells converts testosterone to estrogen, which can inhibit the pituitary mechanisms responsible for stimulating both sperm and testosterone production.
Morgentaler echoes this sentiment, highlighting a critical point: "Obesity significantly lowers testosterone levels, and losing weight can help increase them." However, he warns that substantial weight loss—around 15% of one’s body weight—is typically necessary to see significant improvements in testosterone levels.
The clarity around whether these broader dietary recommendations can effectively aid in maintaining testosterone levels remains uncertain. "I advocate for reducing processed foods, avoiding pesticides, and minimizing exposure to environmental toxins such as BPA, phthalates, and microplastics," states Smith. However, he adds that the roles of various meats, dairy, and animal fats in overall health have not been sufficiently studied to allow him to provide a strong opinion.
Overall, experts view the recent attention on testosterone positively. "It's remarkable that the FDA chose to include a dedicated section on supporting testosterone health," Morgentaler remarks. "This alone is quite noteworthy!"
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