Testosterone is having a moment at the Department of Health and Human Services.
Late last year, the Food and Drug Administration convened an expert panel to discuss easing access to testosterone replacement therapy, including the prospect of removing the hormone from the list of scheduled, or restricted, substances and taking the black box warning off testosterone products. Shortly after, Adm. Brian Christine — a urologist and men’s health expert — was sworn in as assistant secretary for health, and WIRED reported that a National Men’s Initiative may be on the way.
Health secretary Robert F. Kennedy Jr. himself takes testosterone as part of what he describes as an anti-aging protocol, and now, the hormone has made an appearance in a surprising place: Supplementary materials issued with the revised dietary guidelines last week includes a section called “Supporting testosterone health in men.”
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For the first time, the guidelines, specifically an appendix on their “scientific foundations,” include diet advice tailored to men concerned about maintaining healthy levels of testosterone. But leading testosterone experts said the evidence that diet alone can help men avoid low-T is scant.
The section’s top line is consistent with the broader guideline framework, putting an emphasis on fat consumption: “Men seeking to maintain healthy testosterone levels should focus on a balanced diet that includes foods rich in healthy fats,” said the report, which goes on to discourage low-fat diets, saying research has linked them to modest decreases in testosterone.
Other suggestions include DHA-rich fish oil supplementation, zinc, and vitamin D support, and avoiding an excess of protein in the diet — something that seems at odds with the overall emphasis on proteins in the guidelines more broadly.
“I would caution that the quality of the evidence on diet and serum T is weak,” said Abraham Morgentaler, a urologist specializing in testosterone replacement therapy and the Blavatnik faculty fellow in health and longevity at Harvard Medical School. “A key point is that there is no single magic substance that can be eaten that will increase T to an appreciable degree,” he said, using the popular shorthand for testosterone.
STAT asked HHS for comment but has not received a response.
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The guidelines also recommend staying active and maintaining a “healthy body weight,” promoting weight loss in overweight and obese men. Experts agree this is important. “Overweight men often have elevated estrogen levels,” said James Smith, a professor of urology at the University of California San Francisco and chief medical officer of semen analysis company Fellow. “An enzyme in fat cells converts testosterone to estrogen, [which] has a suppressive effect on the pituitary mechanisms that tell the testicles to make sperm and testosterone,” he said.
Morgentaler agrees this is a key point. “The most important point in this section is that obesity lowers T and losing weight in obese individuals increases T,” he said, cautioning however that significant weight loss — about 15% of body weight — is necessary to see meaningful improvements in testosterone levels.
Whether the broader dietary recommendations could help maintain healthy testosterone levels isn’t as clear. “I’m a supporter of eating less processed food, food without pesticides, and minimizing other toxins in our environment” such as BPA, phthalates, and microplastics, said Smith, though he added that how various meats, dairy products, and animal fats “play into health has not been studied well enough for me to give you a strong opinion.”
Overall, experts welcome the attention, however. “It’s interesting that the FDA elected to include a special section on supporting testosterone,” said Morgentaler. “That’s quite remarkable by itself!”
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