This particular blog does NOT pertain to middle-aged men or older who may require testosterone supplementation due to low blood levels of the hormone.  It is well known that natural testosterone levels decrease with age.  Rather, I want to focus on the worrisome trend of young men in their twenties and thirties opting for testosterone supplementation.  Why should this be of concern?  Because in most cases these young men do NOT need testosterone supplementation.  
     The real issue is the supplement industry marketing test supplement products as anabolic boosters (remnants of "energy" supps come to mind for those who feel they need an energy boost) as the means to build muscle mass.  My question is why take any supplemental testosterone when there's no clinical evidence that you're deficient in this hormone.  Have you taken a blood test to verify that your testosterone level is low?  If not, then why would you consider taking a supplement that has unwanted side effects?  It makes no sense to me.  
     More concerning is the possibility that your natural test levels will be compromised from taking the supps and as a result, testicular shrinkage may occur (your testicles produce most of the testosterone in your body).  You might as well inject yourself with steroids while you're at it.  Do you see my point?  Taking artificial hormones is not something to be trifled with as the side effects can be very undesirable.  In other words, the risks will undoubtedly outweigh the benefits.  Let me count the ways:  infertility due to low sperm count, liver problems, male breast growth, increased male pattern baldness, possible harm to prostate health, increased risk of blood clots, congestive heart failure, and worsening of urinary symptoms (JAMA Internal Medicine, 2013).  
     There are legitimate reasons for low T.  Lifestyle is primarily the reason why many men are low in test.  Regular exercise is known to boost test along with having enough saturated fat (i.e., lean red meat, egg yolks, etc.) and certain micronutrients (e.g., zinc, magnesium, etc.) within the diet.  Endurance training (e.g., marathon running) can compromise test levels as well as overtraining (i.e., high intensity level, lack of recovery time, etc.).  Lack of sleep, daily stress, medication usage, as well as overindulgence in alcohol may also lower testosterone levels.

BOTTOM LINE:  Testosterone supplements are being oversold to consumers who, for the most part, should NOT be taking them.  Simply exercising will boost your natural testosterone level.  So instead of relying on potentially dangerous supplements, you should get adequate exercise, eat healthier foods, reduce medication usage if possible, and lose bodyweight (there is a correlation between obesity and lower testosterone levels in men).    
         

     Here are the worst foods you should avoid eating before you hit the pillow:

• Caffeinated coffee--avoid drinking caffeinated coffee after 4pm
• Chocolate--particularly dark chocolate due to its caffeinated content
• Alcohol--disruptive to the later stages of sleep
• Fatty foods--some evidence indicates a link between high-fat foods and disruption to circadian rhythms
• Meat--it takes awhile for the body to digest meat and this may disrupt sound sleep
• Spicy foods--may trigger heartburn and the possible increase in body temperature from eating spicy foods may disrupt sleep
• Grapefruit--due to the increased stomach acidity from eating this citrus fruit which may disrupt sleep

     So what are some foods that you should eat before going to sleep?

• Cottage cheese
• Herbal tea (just a cup)
• Casein protein shake
• Nuts (just a handful)
• Peanut butter
• Eggs
• Milk (just a cup)
• Cheese

     You may be surprised to learn that sleeping pills, in many cases, work not because of the ingredients within the pills, but rather because you believe they will work.   This is commonly referred as the placebo effect.  If you think or believe that a pill will do what it is supposed to do, then chances are it will.   A recent study published in BMJ investigated the efficacy of several popular sleep drugs including Ambien, Lunesta and Sonata.  The researchers concluded that the drugs worked as advertised for many people but that even more people who took a placebo pill also experienced positive benefits.  There are some risks when taking sleep aids including the potential for addiction and certain side effects including memory loss, daytime sleepiness and increased risk of falls.   Health problems usually arise when people take the drugs far longer than they are commonly prescribed.  Also, in many instances, these drugs are overprescribed.     

BOTTOM LINE:  If you truly have insomnia (i.e., unable to get to sleep for several nights in a row), then taking sleeping pills may be warranted.  Just be sure to follow the label recommendations for dosage amount and duration of usage.  

     Your lifestyle is the predominant factor affecting your hormone levels.  In other words, if you live a mostly sedentary existence, your testosterone level will most likely be lower than someone who exercises regularly.  Thus, exercise is a natural way to boost your testosterone level.  
     Here are some lifestyle-related factors that affect your testosterone level:

• Sleep quality and quantity

              If you don't get the needed amount of good, restful sleep that your body needs to function optimally, your testosterone level will dip.  

Solution:   Get  6 to 8 hours of sleep per night. 

• Bodyweight

              If you're gaining bodyweight, your testosterone level will drop.  

Solution:   Maintain a healthy bodyweight.  See elsewhere within this blog for tips.

• Exercise

              If you rarely exercise, this will adversely affect your testosterone level. By being sedentary, your body gets the message from your brain (via the pituitary gland) that you don't need as much testosterone to function.  

Solution:   Become more active by walking briskly at least 20 minutes daily and performing some strength training exercises 2 to 3 days per week.

• Stress

             If you experience persistent stress, your body reacts by releasing a steady stream of cortisol.  When this occurs, your testosterone level drops.

Solution:   Reduce your work hours to less than 10 hours daily and spend at least 2 hours daily doing something you like (e.g., reading, listening to music, playing games, etc.).

• Medications

             If you take opioid drugs (e.g., oxycontin), glucocorticoid drugs (e.g., prednisone), or anabolic steroids, you may need to check with your doctor to make sure the dosage taken does not adversely affect your testosterone level.

• Supplements

            If you take supplements which promote the boosting of testosterone (e.g., DHEA),  STOP!  Your body will build an adaptation to the hormone-like effects of the supplement to the point where it fails to release testosterone naturally.  For the men out there:   Can you say, "testicular shrinkage"?  Not pretty.   

     Studies have established a link between sleep quantity and performance level in any skill-based sport.  It is the central nervous system (CNS) and in particular, the brain, that's intimately associated with control of the body and athletic performance.  The body and mind need rest to recover from the fatigue brought on by intense training.   Sleep provides the opportunity for the body and mind to recharge from hard training.  
     Cognitive and physiological impairment inevitably results when the CNS is fatigued.  Brain scans have indicated that lack of sleep affects blood flow within the brain.  The lack of blood within the brain can affect cognitive and physical performance.  Cognitive impairment is characterized by an inability to focus, memory loss, increased anxiety, decreased reaction time, decreased motivation, irritability, and emotional instability.  Physiological impairment is characterized by physical exhaustion, increased susceptibility to infections, fatigue and decreased  speed and power.
     Catabolic hormones (e.g., epinephrine, norepinephrine, cortisol) are emitted due to sleep deprivation, inhibiting muscle growth.   On the other hand, anabolic hormones (e.g., testosterone, human growth hormone) are released when adequate sleep has occurred, enhancing muscle growth.  Performance potential is therefore predicated on sleep quality and quantity.    
     Here are some tips to get better quality sleep:

• Make sleep a priority
• Strive to get at least seven hours of sleep each night by going to bed at an earlier time (i.e., 15 minutes)
• Keep a regular sleep-wake schedule by going to bed and waking up at about the same time every day including weekends
• Take a brief nap (e.g., less than 20 minutes) during the afternoon (i.e., 2-4pm)
• Avoid stimulants (e.g., caffeine, nicotine) as well as depressants (e.g., alcohol)  two hours prior to bedtime
• Exercise regularly but avoid exercising within two hours before bed
• Take a bath before bedtime
• Avoid eating a big meal before bedtime
• Spend less time watching TV and using the computer at night
• Develop a routine conducive to sleep (i.e., light reading, soft music)
• Make your sleep environment comfortable and conducive to sleep (i.e., comfortable bed, dark and quite room, cool ambient temperature)
• Use earplugs or a white-noise machine to block out sounds

     What I've found with the majority of my clients is that they're not getting enough sleep.  It becomes very apparent when, for instance, a client feels sluggish and yawns during the exercise session (!).  Not giving your body and mind the needed recovery time via sleep is a recipe for disaster in terms of losing body weight.  In fact, I would go so far to say that the time working out in the gym is virtually wasted if there is a lack of sleep.   In essence, sleep is what the body and mind need to recover from the day's events and to feel refreshed and more energized upon waking up.  
     Getting adequate sleep (e.g., 7 to 8 hours) is just as important as nutrition and exercise in staying healthy and fit.  There is a growing body of research that indicates that lack of sleep is a contributing factor for the obesity epidemic that is plaguing our country.  Hormones such as leptin, ghrelin and cortisol are affected by sleep quality and quantity.  Not surprisingly, all of these hormones are also involved in governing appetite.   Thus, there is a correlation between lack of sleep and increased appetite.  In other words, inadequate sleep makes you feel more hungry, especially for high-fat, high-calorie foods during the evening.   
     What can you do to increase the amount of sleep you're getting?  Start by watching less television at night and restrict the amount of time spent on the computer.  
     Need more reasons to get more sleep at night?  Here's eight benefits of getting more shut-eye:

1. Better health  (i.e., lessens the risk of heart disease, hypertension, heart attacks, diabetes, and obesity)
2. Better sex life  (i.e., increases energy and testosterone levels)
3. Less pain  (i.e., may increase pain threshold)
4. Lower risk of injury  (i.e., lessens the risk of auto accidents)
5. Better mood  (i.e., less likely to be cranky or uptight)
6. Clearer thinking  (i.e., improves cognition, attention and decision-making skills)
7. Better memory (i.e., increases the brain's ability to store memories)
8. Stronger immunity  (i.e., lack of sleep may make you more susceptible to getting sick) 

     When you lose bodyfat a whole multitude of positive healthy outcomes takes place including:

• Reduction in migraine headaches
• Decreased cholesterol levels
• Decreased bodily inflammations
• Decreased risk in fatty liver disease
• Lessening of metabolic syndrome
• Decreased risk of type-2 diabetes
• Decreased risk of polycystic ovarian syndrome
• Reduction in depression
• Lessening of obstructive sleep apnea
• Reduction in asthma
• Decreased risk of cardiovascular disease
• Decreased risk of hypertension
• Decreased risk of GERD (Gastrointestinal Esophageal Reflux Disease)
• Reduction in urinary incontinence
• Decreased degenerative joint disease (e.g., arthritis)
• Reduction in gout risk
• Decreased mortality
• Increased quality of life

     BOTTOM LINE:  Exercise and a healthy diet can resolve many chronic conditions plaguing  humans today.  Instead of reaching for quick-fix medications which may have side-effects, reach for a dumbbell and eat your broccoli.  

    Recent research from the online journal BMJ Open has found that prescription sleeping pills (e.g., Ambien, Restoril, Lunesta, Sonata, Halcion) as well as over-the-counter (OTC) pain relievers (e.g., Tylenol PM) may cause an increased risk of death.  The risk of dying over a 2.5-year period was four times higher for those taking sleeping pills.  The more frequent the usage, the greater the risk of premature death.  The sleeping pills do not directly cause death but may increase the risk of death due to unforeseen circumstances (i.e., accidental falls, auto accidents, etc.).   The indicators of possible health problems (i.e., heart disease, cancer) may be hidden when taking sleeping pills regularly.  OTC pain relievers contain acetaminophen, which when consumed in high doses over time may increase the risk of liver damage.   
    If you feel it necessary to take sleeping pills, be sure to take them for a relatively short period of time (i.e., 3 to 4 days)--the drugs are not recommended for long-term usage.  Generally, sleeping pills are not recommended for chronic insomnia as the drug loses its effectiveness over time.  Try to make it a habit of getting to bed at about the same time each night and avoid physical exercise in the evening.  By the way, there is some evidence to support that regular exercise (when performed earlier in the day) does promote a better night's sleep.  People who exercise regularly are less likely to have trouble falling asleep.  

Bottom line:  Sleeping pills have limited effectiveness, have potential side-effects, and long-term safety is unknown.   If you do decide to take sleeping pills, be sure to take the smallest dose needed.  Avoid mixing alcohol with sleeping pills.  Avoid driving the morning after taking sleeping pills.

     If you find it difficult to sleep during most nights you may be suffering from a sleep disorder called insomnia.  If you can answer "yes" to any of the following questions, you may have insomnia:

1. Do you have trouble going to sleep or staying asleep?
2. Do you snore loudly and/or heavily?
3. Are you excessively sleepy or do you lack energy in the daytime?
4. Do you have trouble with concentration or memory loss?
5. Do you fall asleep while driving, in meetings, while reading a book, or while watching TV?

      Nowadays, insomnia can be brought on by the ubiquitous technological devices which incessantly capture our attention 24/7 (e.g., iphones, blackberries, ipads, etc.).  The body has a natural tendency to be regulated by its own biorhythms.  This means that your body prefers consistency.  Therefore you should develop the habit of retiring to bed about the same time each and every night.  Consider it your goal and plan to get at least seven hours of nightly sleep and then do it.  Here are some tips to get more restful sleep:

• Avoid alcohol, caffeine and nicotine at least two hours before bedtime--caffeine and nicotine are stimulants which can enhance your metabolic rate while alcohol causes fragmented sleep.

• Refrain from exercising within 4 hours before bedtime--you're more likely to get to sleep when your body temperature and metabolism have decreased.

• Turn off all electronic devices and light--your room should be quite and very dark (wear an eye mask to block out all light) to avoid stimulating your brain's pineal gland which regulates melatonin, the hormone which promotes drowsiness.  Exposure to light suppresses the release of melatonin keeping you alert.  Blue light emitted from a computer LED screen in a darkened room can delay the onset of sleep and reduce deep sleep if the computer is left on while sleeping.

• Reduce your thermostat temperature (i.e., down to 65 degrees Fahrenheit)--decreased ambient temperature encourages better sleep (bonus:  cooler temperatures stimulate your body's metabolic rate which aids in keeping you lean).

• Avoid using your snooze alarm--your snooze alarm will not be needed as your body has its own internal "alarm" for waking up, provided you go to bed at a regular time and make an allowance for at least seven hours of sleep prior to wake-up time.  By the way, if the first sound you hear in the morning upon waking up is an alarm then you are sleep-deprived!  You should not have to rely on an alarm clock to wake you up.  If you do, then strive to get to sleep earlier so that you can awaken feeling completely refreshed and full of energy.     

• Go to bed only when feeling sleepy and if while in bed you find yourself unable to get to sleep, get out of bed and do a non-arousing activity (i.e., light reading, reciting lyrics from favorite songs, listening to calm instrumental music).      

• If you can't get to sleep because your mind is racing with thoughts about the next day or whatever, jot your ideas down on note paper in order to let your thoughts go.

• Get yourself a white-noise machine and use it to drown out ambient noises outside (esp. in a big city).

• Perform sleep rituals (i.e., listen to relaxing music, do some light reading, drink decaffeinated tea, stretch, take a hot bath, etc.)--this gives the body/brain cues that it's almost time to get to sleep.

• Only use your bed for sleeping with the exception of extracurricular activities (i.e., sex)--avoid watching TV, reading mail, doing work while in bed.

• Have sex before going to sleep--performing sex releases hormones like serotonin which causes sleepiness. 

• Have a light snack before bedtime (e.g., milk, turkey, cottage cheese, etc.)--feelings of hunger can interfere with sleep.