Low Testosterone as You Age? New Research Suggests Looking at Lifestyle Before Medication

Testosterone replacement therapy is increasingly popular among aging men, but is it always the best first step? A newly published scientific review examines the benefits, risks, and an often-overlooked opportunity to address the underlying causes of declining testosterone through lifestyle changes.

Feeling tired, noticing changes in strength, or experiencing a decline in sex drive can be frustrating, especially for men who have always considered themselves healthy and active.

For some, these symptoms lead to a conversation about testosterone replacement therapy (TRT), a treatment that has become increasingly common over the past two decades.

But before assuming that declining testosterone is simply an inevitable part of aging that requires medication, new research encourages a closer look at the bigger picture.

A September 2026 review published in the International Journal of Disease Reversal and Prevention, titled Testosterone Replacement Therapy in Aging Men: A Critical Appraisal of Evidence, Risks, and Benefits, takes a comprehensive look at the science.

Authored by David Goldman, Cassandra Warbeck, MD, and Michael Greger, MD, the paper examines when testosterone therapy may be beneficial, where its limitations lie, and why lifestyle interventions deserve greater attention.

The central message is especially relevant to the Plant Strong community:

Sometimes, declining testosterone isn't simply a consequence of getting older. It may also reflect underlying health conditions that can be improved.

Low Testosterone: Aging or a Signal of Something More?

Testosterone levels often decline as men age. But the researchers highlight an important distinction between testosterone deficiency caused by irreversible dysfunction and what clinicians call functional hypogonadism.

Functional hypogonadism occurs when testosterone production is suppressed by potentially reversible factors rather than permanent damage to the testes.

Excess body fat, metabolic dysfunction, and other chronic health conditions can contribute to lower testosterone levels.

That distinction matters.

If a man's testosterone is low partly because of underlying metabolic health problems, addressing those problems may help his body restore some of its natural testosterone production.

Rather than automatically treating a laboratory result with medication, the researchers encourage clinicians to consider why testosterone has declined in the first place.

It's a perspective that aligns with a foundational principle of lifestyle medicine: whenever possible, address the underlying causes of poor health, not just the symptoms.

What Does Testosterone Replacement Therapy Actually Do?

The review doesn't dismiss testosterone therapy. Instead, it carefully examines where the evidence supports its use and where expectations may exceed demonstrated benefits.

Here's what the researchers found.

1. Sexual function may improve, but the benefits are generally modest.

Testosterone therapy can improve certain aspects of sexual function, particularly libido.

However, improvements in erectile dysfunction may be smaller than patients expect, especially among men experiencing moderate-to-severe symptoms.

Low testosterone is also not the only possible cause of sexual difficulties. Cardiovascular, metabolic, psychological, and medication-related factors may contribute.

2. Testosterone can help correct certain types of anemia.

One of the more meaningful benefits identified in the review is improved anemia in some men with testosterone deficiency.

But this benefit comes with an important consideration.

Testosterone stimulates red blood cell production. In some patients, this can lead to excessively elevated red blood cell concentrations, a condition called erythrocytosis, requiring careful monitoring.

3. Bone density may improve, but fewer fractures haven't been demonstrated.

Research shows that testosterone therapy can increase bone mineral density.

However, clinical trials have not demonstrated that these improvements translate into fewer fractures.

This is a valuable reminder that changes in a health measurement do not always produce the clinical outcomes we hope to achieve.

4. Improvements in energy, mood, cognition, and physical function are less certain.

Testosterone therapy is sometimes promoted as a solution for fatigue, declining vitality, mental fog, and age-related physical changes.

But according to the review, the evidence is much less compelling in these areas.

Large clinical trials found no significant benefits on their primary measures of cognitive function or physical function, although some secondary measures of mood and vitality showed small improvements.

For men hoping testosterone therapy will dramatically restore youthful energy or performance, the research suggests keeping expectations realistic.

What About the Heart?

Cardiovascular safety has been one of the biggest concerns surrounding testosterone therapy.

The review discusses the important TRAVERSE trial, which evaluated cardiovascular outcomes among men receiving testosterone treatment.

Over an average treatment period of approximately 22 months, testosterone therapy did not produce a higher rate of major adverse cardiovascular events than placebo within the trial's prespecified safety margin.

In February 2025, the FDA removed the cardiovascular boxed warning from testosterone products based on newer evidence.

However, that doesn't mean testosterone therapy is risk-free or that it has been proven safe for every patient over decades of use.

The FDA also maintained restrictions on testosterone products for age-related hypogonadism.

The takeaway: testosterone therapy can be appropriate for some men, but it should be based on a confirmed medical need, realistic expectations, and an informed conversation with a healthcare professional.

The Often-Overlooked First Step: Lifestyle Change

Perhaps the most actionable conclusion of the review is that lifestyle interventions deserve a more prominent role in conversations about low testosterone.

The authors highlight two particularly important strategies: weight reduction in men with excess adiposity and structured physical exercise.

For men with obesity-related functional hypogonadism, improving metabolic health can sometimes help restore the body's own testosterone production.

And while lifestyle interventions are not guaranteed to normalize testosterone, they offer benefits that extend far beyond a single hormone.

Improving cardiovascular fitness, building muscle, and addressing metabolic health can support overall well-being whether or not testosterone levels change.

At Plant Strong, we view these behaviors as part of a comprehensive approach to lifelong health.

Five Actionable Takeaways for Men Who Want to Age Well

1. Look at your overall health, not just your testosterone number.

If you're experiencing fatigue, changes in sexual function, or declining physical performance, talk with your healthcare professional about possible underlying causes.

Low testosterone should be confirmed with appropriate repeat morning blood testing and interpreted alongside symptoms and medical history.

2. Make metabolic health a priority.

Excess body fat and metabolic dysfunction can contribute to functional testosterone deficiency.

For men carrying excess weight, sustainable weight reduction may help improve hormonal health.

A dietary pattern built around vegetables, fruits, legumes, whole grains, and other minimally processed plant foods can support weight management and cardiometabolic health.

3. Include resistance training in your routine.

Building and maintaining muscle is especially important as we age.

Aim for muscle-strengthening activities at least twice a week, using weights, resistance bands, or bodyweight exercises appropriate for your abilities.

Resistance training supports muscle strength and function, even when changes in circulating testosterone are modest or absent.

4. Keep moving and prioritize recovery.

Walking, cycling, swimming, and other aerobic activities remain essential components of a healthy lifestyle.

Adequate sleep and recovery also deserve attention. Persistent fatigue or symptoms of sleep apnea should be discussed with a healthcare professional rather than automatically attributed to low testosterone.

5. Make treatment decisions with evidence, not marketing promises.

If you have persistently low testosterone levels and consistent symptoms, testosterone therapy may be appropriate.

Discuss the potential benefits, side effects, monitoring requirements, fertility implications, and alternative approaches with your clinician.

For men with irreversible causes of testosterone deficiency, lifestyle changes alone may not be sufficient, and medically indicated treatment should not be delayed.

Food as Medicine: Building a Foundation for Healthy Aging

The connection between metabolic health and hormone regulation reinforces something we emphasize throughout the Plant Strong community: our daily habits play an important role in how we age.

A whole-food, plant-based eating pattern can support several of the health goals discussed in this review, including sustainable weight management and improved cardiometabolic health.

Plant foods such as beans, lentils, intact whole grains, leafy greens, vegetables, fruits, nuts, and seeds provide fiber and essential nutrients that support overall health.

Combined with regular physical activity and strength training, these choices create a practical foundation for healthy aging.

It's important to distinguish between what the paper demonstrates and what we can reasonably apply to our own lives.

The review does not establish that a plant-based diet directly increases testosterone levels. Rather, it highlights the potential of improving metabolic health through lifestyle interventions, including weight management and exercise, to address some reversible causes of low testosterone.

For Plant Strong readers, that's an empowering message.

We don't need to chase a particular hormone number to begin making choices that support our health.

We can start by nourishing our bodies, moving consistently, building strength, and addressing the lifestyle factors within our control.

Celebrating David Goldman and the Advancement of Lifestyle Medicine Research

We're especially proud to recognize David Goldman, a valued member of the Plant Strong clinical research team, for his leadership as lead author of this important publication.

Alongside coauthors Dr. Cassandra Warbeck and Dr. Michael Greger, David brings a thoughtful, evidence-based perspective to a topic that is often dominated by commercial messaging and promises of reversing aging.

His work helps us ask better questions about modern healthcare: Are we addressing the underlying causes of declining health? Are the benefits of treatment supported by meaningful clinical outcomes? And are we giving people the tools to improve their health through sustainable lifestyle changes?

David's ongoing contributions to the Plant Strong research team are an important part of our commitment to advancing the science of lifestyle medicine and making its findings accessible to the people who can benefit from them.

We're grateful for his dedication, scientific curiosity, and continued support of our mission to demonstrate the power of lifestyle interventions in improving human health.

The Plant Strong Takeaway: Healthy Aging Is About More Than Hormones

For men navigating the changes that come with aging, it's understandable to want an explanation for declining energy, physical performance, or sexual health.

But the answer isn't always as simple as replacing a hormone.

This research encourages a more comprehensive approach, one that begins by understanding the causes of low testosterone and recognizing the potential benefits of lifestyle change.

Testosterone replacement therapy has a legitimate role in medical care. For some men, it provides meaningful benefits. For others, addressing underlying metabolic health and lifestyle factors may be a more appropriate first step.

The goal isn't simply to restore youthful hormone levels.

It's to preserve strength, vitality, independence, and quality of life for as many years as possible.

And that's a goal worth investing in, one meal, one workout, and one healthy choice at a time.

Read the Published Research

Goldman D, Warbeck C, Greger M. Testosterone Replacement Therapy in Aging Men: A Critical Appraisal of Evidence, Risks, and Benefits. International Journal of Disease Reversal and Prevention. 2026;8(2):1–18.

Read the full article

This article is for educational purposes and does not replace individualized medical advice. Anyone experiencing symptoms of testosterone deficiency should consult a qualified healthcare professional before initiating or changing hormone treatment.