IN CASE YOU MISSED WEDNESDAY
The scale is telling you the wrong story
Belly fat in the second half is a muscle problem wearing a weight costume. Three moves replace eat-less, move-more, and today's issue is the hormone sitting underneath all three.
The alarm goes off and the drive to get up is not there. The weights feel heavier than the number on them. Desire has gone quiet. The middle has grown and the arms have not.
Men who say this out loud usually get told it is age. Women usually get told nothing, because nobody has ever checked.
Testosterone is not only his story.
It is the hormone most tied to the muscle Wednesday was about. For men, it is the one that matters most by a long way. For women, it is the one almost nobody measures, and it starts falling decades before menopause.
Reading this for someone else? If there is a man in your life who has not felt like himself lately, this issue is for him too.
The Evidence
Two stories. Here is what each one feels like, then what the research found.
His story
What it looks like. It rarely announces itself. It looks like a man who is just getting older. The Endocrine Society lists the signs:
Less interest in sex, fewer spontaneous erections, or erections that do not hold.
Energy that runs out long before the day does.
Muscle that shrinks even though he still trains.
A shorter fuse, a harder time concentrating, a low mood he puts down to work.
When levels drop very low, hot flushes. Yes, men get them too.
The same source estimates about 35% of men over 45, and 30 to 50% of men with obesity or type 2 diabetes, have low testosterone. Here is what moves it.
His. Sleep can take a decade off it in a week. In a University of Chicago study, 10 healthy young men slept under 5 hours a night for 1 week. Their daytime testosterone fell 10 to 15%, about the same drop as 10 to 15 years of natural aging. The lowest readings landed between 2pm and 10pm, right when the day asks for the most of you.
His. Weight is the lever most men never pull. Across 24 studies, losing weight raised testosterone, whether it came off through diet or surgery. Surgery, which takes off the most weight, raised it the most. For a lot of men, the first testosterone treatment is a smaller waist.
His. The big lifts send the strongest signal. Compound lifts, squats, deadlifts, presses and rows, load a lot of muscle at once and produce the largest rise in testosterone, according to a review of the resistance training research. That rise fades within 30 minutes. The lasting win is the muscle it builds and the waist it takes off.
Her story
What it looks like. Quieter, and easy to put down to everything else. The International Menopause Society's checklist asks about:
Desire and sexual thoughts that have faded.
Less response to a partner, or to touch.
Orgasm that takes longer, or does not arrive.
Whether any of this bothers you. That is the question that decides whether it needs treating.
Tiredness, low mood and brain fog get pinned on testosterone too. They overlap heavily with the perimenopause shift from Monday, although most of the research suggests there is no clear evidence testosterone fixes them.
Hers. It falls earlier than most people think. Women make testosterone too, in the ovaries and adrenal glands, and levels peak in the 20s. By menopause they sit at roughly a quarter of that peak, according to the International Menopause Society. In an Australian study of 1,104 midlife women, levels kept falling through the 40s and 50s, whatever the menopause stage, and bottomed out at 58 to 59. After about 65 to 70, they drift back up toward the levels of young women. And there is no blood level that diagnoses low testosterone in a woman.
One hormone, two very different stories. Testosterone is not only his story.
What This Means For You
It comes down to three moves, whichever story is yours.
Guard your sleep like a prescription. 7 hours or more, with the same wake time 7 days a week. One short week was enough to dent it in young men, which makes this the cheapest lever on the list.
Lift twice a week, built around the big lifts. Squats, deadlifts, presses and rows, the same plan as Wednesday. For men, heavy compound lifts plus a smaller waist is the most reliable natural way to support testosterone. For women, the muscle is the point, whatever the number does.
Test it properly, once. Men: 2 fasting blood tests, taken between 7am and 10am on different mornings, before anyone talks treatment. The Endocrine Society guideline found about 30% of men with a low first result are normal on retest. Women: total testosterone and SHBG, the protein that decides how much testosterone is free to work, as a baseline rather than a diagnosis.
Three moves. You have them now.
To test directly: in the US, Function Health includes total and free testosterone and SHBG in its $365 membership, or Ulta Lab Tests sells a men's hormone panel and a women's hormone panel on their own. In the UK, Medichecks runs a male hormone check. In Australia, i-Screen offers a testosterone test and a female hormone test, no GP referral needed.
When Therapy Is The Answer
Lifestyle is the first lever, not the only one. For the right person, hormone therapy is life-changing, and the research says the trade-off is usually worth making.
His guide.
Who it is for. Men with symptoms and 2 low morning results. Not men who simply feel older.
What it can give back. In the Testosterone Trials, 790 men aged 65 and over with low levels saw moderate but real gains in desire, sexual activity and erections, and a lift in mood. Energy did not change.
What it costs. In the largest safety trial, 5,246 men with low levels and existing heart risk, therapy did not raise heart attacks or strokes. Atrial fibrillation and other rhythm problems were more common. It also lowers sperm production, so it is not for men still planning children.
How to do it well. With a clinician who rechecks testosterone, PSA and red blood cell count at regular visits, as the Endocrine Society advises.
Her guide.
Start with HRT, not testosterone. For most women, the bigger conversation is menopausal hormone therapy, worth having with your primary care physician or a hormone specialist. The North American Menopause Society's 2022 position: for women under 60, or within 10 years of their final period, with no reason to avoid it, the benefits outweigh the risks for hot flushes and protecting bone.
The route matters. Patches and gels through the skin, and lower doses, may lower the risk of clots and stroke.
Testosterone is the add-on. If desire has faded after menopause and it bothers you, testosterone dosed to a young woman's levels is the one use the global experts back. Skip the compounded creams sold as hormone balancing. The panel recommended against them.
One honest caveat. Timing changes the maths for women. Start HRT after 60, or more than 10 years past the final period, and the society says the balance is less favorable, because the absolute risks of heart disease, stroke, clots and dementia are higher. That calls for a closer conversation, not an automatic no.
SHARE THIS WITH HIM
Is he feeling like himself?
Most of you reading this are women. Many of you have a partner, husband, brother or dad who has never had his testosterone checked. On Monday we said that if you are not feeling yourself, it could be your hormones. The same is true for him.
Send him this issue. Two morning blood tests is all it takes to know.
FROM OUR INSTAGRAM
Creatine, the muscle lever women were never told about
Our most-saved post this week, saved nearly 2,000 times. Only 9% of creatine studies have been done in women alone. The dose that worked in postmenopausal women: 5 g a day, alongside 2 strength sessions a week. It works the same for men.
If you want a tub you can trust, Thorne Creatine is plain creatine monohydrate and NSF Certified for Sport, so what is on the label is what is in the tub. It is our pick.
The Week in Longevity
Three studies making news this fortnight. Thirty seconds each.
01 · MEN'S HEALTH
In 272,475 UK Biobank adults, higher blood tyrosine, a building block of protein, went with higher death risk, and genetic analysis tied it to shorter lifespan most clearly in men. The authors say their results do not support tyrosine supplements for longevity. Go deeper →
02 · CONNECTION
Across 277,489 adults, being both lonely and isolated went with 5.8 fewer years free of mental disorders in men and 3.7 in women, plus 1.7 and 2.4 fewer years free of major physical disease. A healthy lifestyle softened the toll of isolation, but not of loneliness. Observational. Go deeper →
03 · BONE
In 715 adults, lower bone density read off routine chest CT scans went with faster cognitive decline and more white matter damage. The authors point to shared drivers like insulin resistance and menopausal change, not bone causing brain decline. Go deeper →
Worth Your Time
Has anyone ever tested your testosterone? Hit reply and tell us, men and women both. We read every one.
Monday Preview
Monday we move from hormones to the plate, starting with the three hours after dinner. What you eat last, and when, shapes your sleep, your digestion and the morning you wake up to. Insulin is a hormone too.
Until Monday.
Longevity Daily / The Building Decades