Alternatives To Testosterone Replacement Therapy

If you are an adult male, it’s normal as you get older to have less testosterone in your body.  The male sex hormone testosterone plays a critical role in, among other things, sexual desire and arousal.  Therefore, it’s not surprising that as men experience decreases in testosterone levels, one of the noticeable effects they experience is decreased sex drive and increased sexual function issues.  This can lead many men to seek out treatments and therapies, such as testosterone replacement therapy, to attempt to regain the same kind of sex drive, stamina, and so on that they had in their youth.

One of the medically-approved ways to improve testosterone levels is with testosterone replacement therapy.  However, this is not usually prescribed for age-related testosterone loss, but rather for low testosterone levels caused by other medical conditions or pathologies.  It comes with great risks for many patients as well.  The good news is there are several other therapies available, all of which work in different ways.  Some have a high degree of risk associated with them or are considered off-label use.  Others may boost libido, sex drive, and sexual performance capabilities with little risk. 

Below, we’ll briefly talk about testosterone replacement therapy, and then examine some of the alternatives that men should consider for similar or better outcomes with fewer side effects or risks.

Testosterone Loss Due To Aging

Most men are aware that their testosterone levels naturally decrease over time as they age.  This is backed up by science – on average, from the time men reach their mid- to late-30s, their levels of testosterone production drop by around 1% per year, or 10% per decade (Feldman et al, 2002).  This is one of the contributing factors to a decrease in libido, increase in sexual function issues and erectile dysfunction, and the associated psychological and relationship issues that can develop in men as they age.  Despite this, it’s considered a normal part of aging.  But, that doesn’t mean that men have to simply accept this change, and can’t do anything about it.

There are a variety of treatments as well as lifestyle changes that can be made to boost energy levels, libido, stamina, and related traits.  The first and most direct is by boosting testosterone levels with testosterone replacement therapy.  That comes with a lot of risks, however, and while we won’t go into great detail here, we’ve covered those risks and side effects in separate articles on testosterone replacement therapy. 

Testosterone Replacement Therapy Is Not Usually Prescribed For Age-Related Loss

Even for men who consider the risks associated with testosterone replacement therapy to be worthwhile, it may not be that simple.  In most cases, doctors will not prescribe or consent to testosterone replacement therapy simply for age-related testosterone decline.  It’s almost exclusively reserved for treating what is formally known as hypogonadism – an abnormally low testosterone level for the patient’s age, often resulting from medical conditions, illnesses, disease, congenital disabilities, or other endogenous causes. 

Testosterone replacement therapy usually consists of a gel, injection, implanted capsule, or another mechanism for allowing the testosterone to be absorbed into the body and boost circulating testosterone levels.  Each of the various methods used for testosterone replacement therapy has its own risk/reward profiles, on top of the inherent risks associated with testosterone replacement therapy.  In general, simply supplying replacement hormones to the body is seen as high risk, whether in the form of testosterone or any other substances that are so critical for so many biological processes (Osterberg et al. 2014).

Other Sex Hormone Treatments

There are other sex hormone treatments, which aim to improve testosterone levels directly or indirectly, but without using testosterone itself.  These have varying evidence for their efficacy, and only the first highlighted below is considered FDA-approved for treating hypogonadism.  In all cases, none of these treatment options are considered approved or on-label for boosting testosterone levels that have declined due to aging.  That can make them difficult to impossible for most men to obtain explicitly for that purpose.  For more information on these specific treatments, to discuss with your doctor, you can read this excellent literature review paper on the topic.

Human Chorionic Gonadotropin

Human chorionic gonadotropin, or hCG, is a compound that is found within the placenta of pregnant women, and is chemically homologous to lutenizing hormone.  This hormone plays important roles during the fetal development, triggering, among other things, testosterone production in male babies.  It has been shown to be effective in stimulating testosterone production in a certain class of cells within the testes of adult men suffering from hypogonadism.  However, as with most of these treatments, it is not generally prescribed or approved for age-related testosterone loss.  The long-term safety and health risks associated with hCG therapy have not been well-established.  Unlike pure testosterone replacement therapy, however, hCG has been shown to maintain or trigger the production of sperm, allowing men to retain their fertility – something that is often inhibited in testosterone replacement therapies.

Aromatase Inhibitors

Aromatase is an enzyme that is responsible for breaking down testosterone into estradiol in the body.  Aromatase inhibitors, as their name suggests, inhibits the action of this enzyme.  This results in both direct and indirect increases in the testosterone levels in the body.  Though effective, this treatment for testosterone therapy is considered off-label use.  Treatment for low testosterone has been shown to cause side effects, including hot flashes, weight gain, insomnia, joint aches, low bone mineral density/osteoporosis, and similar problems.  On the upside, they are available via oral medications, rather than injection or other application methods common to most other forms of treatment.  Long-term use for low testosterone and the associated side effects and risks have not been established.

Selective Estrogen Receptor Modulators

Selective estrogen receptor modulators, or SERMs, act as either antagonists or agonists on estrogen receptors (tissue-dependent).  For our purposes, they act as estrogen receptor antagonists in the pituitary gland and hypothalamus, and thus prevent the normal inhibitory effects of estrogen on other sex hormones.  The net result is an increase in testosterone levels, with spermatogenesis stimulated as well.  It is currently used as an off-label medication for the treatment of hypogonadism.  Much like our other treatments, however, it is not typically prescribed for age-related testosterone loss treatment.  Specifically, clomiphene citrate is usually used for this purpose, and provided in oral pills of 25 mg or 50 mg strength daily.  Typical side effects include headache, dizziness, and fatigue.  Long-term risks and side effects have not been established.  Higher dosages may result in lower sperm counts, however.

Lifestyle Changes

Non-medication treatment options for low testosterone, both naturally-occurring from aging and occurring due to other medical pathologies, are also viable.  These can work whether or not you are on testosterone replacement therapy or one of our alternative options. Many of the following lifestyle changes have been shown to not only increase testosterone production and libido, but provide numerous other benefits as well.  In many cases, however, it is not clear if the lifestyle change alone results in the positive benefits, or serves to reduce or modify other health and medical conditions themselves, which then provide the benefits.  In any case, these lifestyle changes include:

• Eating a healthy, well-balanced diet.  This is key to maintaining a healthy weight, low body fat percentage, and sufficient lean muscle mass.  Additionally, it is essential to managing potential health conditions that develop with age and reducing your risk for them.  Obesity, diabetes, and similar conditions can depress libido and decrease testosterone levels in the body.
• Exercising regularly throughout your life.  Adults need 2 to 3 hours of moderate exercise each week to remain healthy.  Staying active increases muscle mass, helps keep weight in check, boosts the immune system, and can help increase testosterone production in men.
• Get 7 to 8 hours of good quality, restful sleep every night.  Sleep plays a key role in regulating all of the hormones and their production in your body, and that includes the sex hormones.
• Address any underlying health problems and/or medication side effects with your doctor.  Many medical conditions and medication side effects can result in decreased testosterone or depressed sexual function.
• Address any mental health and/or relationship issues with professionals, as these can artificially depress your libido and may be the cause of sexual health issues rather than any physical problem.
• Vitamin D has been shown to increase testosterone production, so be sure you are getting sufficient vitamin D in your diet or through supplements (around 3,300 IUs daily) (Pilz et al., 2010).
• Caffeine in moderation has been shown to boost testosterone, so have an extra cup of coffee each day.
• Low zinc levels can cause low testosterone, so be sure to take a supplement or multivitamin that includes your recommended daily intake of zinc (Prasad et al., 1996).

Treatment With Non-Hormonal Peptides: Sermorelin

There is one other treatment option that differs from all of the others we have discussed, in that it is not directly a hormone, nor does it directly stimulate testosterone production.  Instead, it works to stimulate human growth hormone production in the pituitary.  It’s an amino acid peptide compound known as Sermorelin. 

Sermorelin aims to increase the levels of human growth hormone in the aging adult body.  It does this safely, by triggering your own production of natural human growth hormone, rather than injecting or ingesting artificial hormones.  This reduces the number of risks and side effects and makes the compound much safer than the other options we have discussed in this guide.

Human growth hormone, as the name implies, is important for growth and development, but it also plays many other roles in the body – especially among adults.  HGH plays an important role in cellular replication and repair, injury recovery, circulation, energy metabolism, muscle maintenance and repair/building new muscle, the immune system, and libido.  Increased levels of human growth hormone boost your body’s performance in all of these key areas, providing more energy, greater physical health and fitness, more lean muscle mass, a lower body fat percentage, boosted healing and immunity, and of course, an increased sex drive, increased stamina, and better health overall. 

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Sermorelin Injections

Sermorelin is arguably one of the most powerful Anti-Aging medications, which offers a long list of benefits: More energy, increased libido, muscle building, recovery, strength, weight loss, and much more.

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Concluding Thoughts

There are many alternatives to traditional testosterone replacement therapy.  Each comes with its own risk and reward profile, though the vast majority of hormone treatments come with considerable risks.  They also are all off-label uses or unapproved uses for treating age-related testosterone loss.  However, one option – Sermorelin – is considered safe and effective, and isn’t made up of synthetic hormones.  It treats a lot more than low libido, with a number of valuable benefits for your sex life and your overall health and wellness.

DISCLAIMER

While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider.  You should always consult a practicing professional who can diagnose your specific case.  The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice. 

References:

• Feldman HA, Longcope C, Derby CA, et al. Age trends in the level of serum testosterone and other hormones in middle-aged men: longitudinal results from the Massachusetts male aging study. J Clin Endocrinol Metab. 2002;87:589–98. https://academic.oup.com/jcem/article/87/2/589/2846777
• Osterberg, E. C., Bernie, A. M., & Ramasamy, R. (2014). Risks of testosterone replacement therapy in men. Indian journal of urology : IJU : journal of the Urological Society of India, 30(1), 2–7. https://doi.org/10.4103/0970-1591.124197 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3897047/
• Lo, E., Rodrguez, K., Pastuszak, A., & Khera, M. (2017). Alternatives to Testosterone Therapy: A Review. Sex Med Rev 2018;6:106e113 https://doi.org/10.1016/j.sxmr.2017.09.004
• Pilz S, Frisch S, Koertke H, Kuhn J, Dreier J, Obermayer-Pietsch B, Wehr E, Zittermann A. Effect of vitamin D supplementation on testosterone levels in men. Horm Metab Res. 2011 Mar;43(3):223-5. doi: 10.1055/s-0030-1269854. Epub 2010 Dec 10. PMID: 21154195. https://pubmed.ncbi.nlm.nih.gov/21154195/
• Prasad AS, Mantzoros CS, Beck FW, Hess JW, Brewer GJ. Zinc status and serum testosterone levels of healthy adults. Nutrition. 1996 May;12(5):344-8. https://pubmed.ncbi.nlm.nih.gov/8875519/

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