Testosterone is the main sex hormone that is important for sexual function and overall health in men. Men experience fluctuation in their testosterone levels throughout their lives.
Some men develop a health condition called hypogonadism, during which gonads fail to produce testosterone in sufficient amounts. Its symptoms include lack of energy, change in mood, trouble in getting an erection, low sperm count, a decline in bone density and muscle strength.
If you have been diagnosed with hypogonadism, your doctor will design a testosterone boosting treatment plan to help you restore your testosterone levels. For this, he will first have to determine the real cause of low testosterone.
Once the real issue is found out, he may prescribe different medications, each having its particular effect. In this article, we have talked about popular medications used to increase testosterone.
What can cause low testosterone in men?
Testosterone levels decline in men as they age. They are the highest when men are in their late teens and then start declining as they hit 30.
Testes produce testosterone in response to LH (luteinizing hormone) synthesised by the pituitary hormone. Sometimes, testes fail to produce sufficient testosterone, which is categorised as hypogonadism. It can happen during any phase of life and can be divided into three types. More than 4 million American men suffer from hypogonadism. 
It occurs when your gonads do not produce sufficient testosterone even after receiving brain signals. As a result, the serum testosterone level gets low, but the level of FSH and LH stays high. Its origin can be acquired or congenital.
Examples of possible inherited causes are chromosomal abnormalities, nutation in FSH/LH receptor gene, and Klinefelter syndrome.
Examples of the possible acquired conditions that contribute to primary hypogonadism are chemotherapy, injury to testes, and testicular torsion.
Secondary hypogonadism occurs due to damage to the brain part that sends signals to testes to produce testosterone. In this condition, the serum FSH and LH level may also be low, like testosterone. It can also be congenital or acquired.
A few examples of inherited causes are Kallmann syndrome, pituitary disorder, and genetic abnormalities.
A few examples of acquired causes are trauma, sleep deprivation, and pituitary tumour.
Mixed primary and secondary hypogonadism
As the name suggests, it is a mixture of both the above-mentioned types of hypogonadism, meaning it happens when there is a defect in testes as well as pituitary. It occurs only due to acquired reasons. The person suffering from this issue has a decreased testosterone level and variable levels of LH and FSH.
A few examples of mixed primary and secondary hypogonadism are cancer, cirrhosis, obesity, and hemochromatosis.
Screening for hypogonadism
The serum total testosterone level test is an inexpensive test performed in the morning to measure the total amount of protein-bound testosterone plus free testosterone. Testosterone levels lower than <300 ng/dL (10.4 nmol/L) indicate hypogonadism. A second assay is performed to confirm the condition.
Once hypogonadism is confirmed, a luteinizing hormone (LH) test is performed to determine whether it is primary or secondary hypogonadism. Results of LH test indicate:
|Test component||Serum level||Condition|
|LH||>10 ng/mL||Primary hypogonadism|
|<2 ng/mL||Secondary hypogonadism|
|Within normal range||Age-related testosterone decline|
Medications to increase testosterone
Your doctor will design a testosterone boosting treatment plan for you based on the cause of low testosterone. The purpose of the treatment or prescribed medication will be to balance your hormones and reduce low testosterone symptoms. These medications will help you to:
Bio-identical hormones are duplicated or synthetic forms of natural human hormones. They are provided to help men and women restore their testosterone or estrogen levels. Their prescriptions can either be pre-made (by the manufacturing company) or custom-made (by a pharmacist), and they are used during testosterone replacement therapy.
They come in different routes of delivery and doses. Your doctor will choose the dose that best suits your condition. He may also change the dose from time to time according to how your body responds to the treatment.
Medication to increase testosterone can be divided into the following categories based on their route of delivery.
Injectable testosterone: This form is injected directly into the muscles, from where it slowly gets absorbed into the blood.
Testosterone gels: This is a topical form of testosterone. It is applied directly to the skin, from where it gets absorbed into the blood.
Testosterone creams: It is another form of topical testosterone. It works like testosterone gel.
Oral androgens: These bio-identical hormones come in the form of tablets and capsules. Their main goal is to reduce the concentration of SHBG protein that binds to the testosterone and makes it unavailable for tissues. It is used when your level of SHBG protein is higher than the normal level.
Here are the popular medications used in testosterone replacement therapy.
|Form of medication||Medication||More info|
|Contains testosterone propionate 30 mg, testosterone phenylpropionate 60 mg, and testosterone isocaproate 60 mg|
|Nebido®(Bayer)||Contains testosterone undecanoate 250 mg/mL in a 4ml amp|
|Testosterone Enantate (Non-proprietary)||Contains testosterone enantate 250 mg/mL|
|Virormone®(Nordic)||Contains estosterone propionate 50 mg/mL, 2-mL amp Short Acting Testosterone ester|
|Topical testosterone||TESTIM®(Ferring) gel||Testosterone 50 mg/5 g tube|
|TESTOGEL®(Besin) gel||Testosterone 50 mg/5 g sachet|
|TOSTRAN®(ProStrakan) gel||Testosterone 2%|
|Lipoderm based Testosterone creams||Generally applied to the scrotum|
|Oral androgen||Tablet/capsule||Reduces SHGB protein|
HCG: Human Chorionic Gonadotrophin is used for delayed puberty or low sperm count. It is also used to supplement testosterone replacement therapy. It signals testes to keep producing testosterone.
Aromatase inhibitors: When you start testosterone replacement therapy, you may notice an increase in the serum concentration of estrogen. It happens when aromatase enzymes start converting testosterone into estrogen. That is where aromatase inhibitor comes to help. It is given in minute amounts to inhibit the aromatase enzyme effect and restore estrogen and testosterone levels in the body.
How does a doctor determine testosterone dose?
Your doctor will determine the testosterone dose based on how low your normal testosterone levels are. Once your testosterone replacement therapy starts, it is important to have follow-up sessions to monitor the effect of the dose and its side effects.
Your doctor may adjust your testosterone dose depending on your body’s changing hormone needs. He will try to keep it to the minimum required to get the desired results.
Other ways of increasing testosterone levels
If you do not have hypogonadism but want to naturally boost your testosterone levels, here are the best methods that can help you improve testosterone levels.
Get plenty of sleep
During sleep, your body recharges and heals different organs and tissues. But when you do not get enough sleep, your normal hormonal balance gets disturbed. Studies also show that men experience low testosterone when they do not get proper sleep at night. 
It is suggested to get 7 to 9 hours of sleep every day. If you have any problem falling asleep, it is better to get help from a doctor.
Maintain your bodyweight
Overweight people tend to have low testosterone levels. Research also says that young overweight males have around 50% low testosterone levels than normal-weight males of the same age.  You should keep a healthy lifestyle and try maintaining a healthy body weight if you want to boost your testosterone levels naturally.
Prolonged stress increases cortisol hormone levels. When cortisol level rises, testosterone naturally declines. That is why you should try your best to stay out of stressful conditions and adopt a healthy lifestyle.
Get more physically active
Getting more physically active is one of the most effective ways of increasing testosterone levels naturally. You should make exercise a part of your lifestyle. Resistance training and high-intensity interval training (HIIT) is very beneficial in bringing testosterone levels back to normal.
Avoid alcohol abuse
There are many adverse effects of alcohol abuse, and one of them is the reduction in testosterone levels. When you drink alcohol frequently, it starts interfering with your body hormones, including testosterone, and causes hormonal imbalance.
Testosterone medications have unique effects and come in different doses. Your doctor will prescribe medication according to the cause of low testosterone. He may use a combination of different medications to achieve goals.
Testosterone medications are commonly used in oral, injectable, and topical forms. Each form has its own effect and takes a different time to show results. Talk to your doctor about the effect of each form of medication before you select one.
References/Scientific Studies/Further Reading/Bibliography/Study Material
- Seftel, A.D., 2006. Male hypogonadism. Part I: Epidemiology of hypogonadism. International journal of impotence research, 18(2), pp.115-120.
- Leproult, R. and Van Cauter, E., 2011. Effect of 1 week of sleep restriction on testosterone levels in young healthy men. Jama, 305(21), pp.2173-2174.
- Mogri, M., Dhindsa, S., Quattrin, T., Ghanim, H. and Dandona, P., 2013. Testosterone concentrations in young pubertal and post‐pubertal obese males. Clinical endocrinology, 78(4), pp.593-599.