Testosterone Optimization in Athletes: A Scientific Review

Introduction

Testosterone, a vital steroid hormone, plays significant roles in muscle growth, bone formation, and psychological functions relevant to athletic performance. Given its importance, athletes often explore methods to optimize their testosterone levels. This article reviews a recent narrative review that synthesizes current scientific understanding of legal strategies for testosterone optimization in athletes.

The Study in Detail

The narrative review, titled "Testosterone-Optimizing Strategies in Athletes," was authored by Lazarev A et al. and published in Sports Health (2026 Feb 2:19417381251411933). The authors are affiliated with various departments at Mayo Clinic and the University of North Carolina, Chapel Hill. This Level 5 evidence review systematically examined existing literature to identify and evaluate legal strategies for optimizing testosterone levels in athletes.

The review highlighted several key findings:

• Nutrition and Energy Balance: Maintaining healthy testosterone levels is strongly linked to adequate energy balance and optimal nutrition, including sufficient macronutrients and micronutrients. This is particularly crucial for athletes who may be prone to dieting or food restriction.
• Testosterone Boosters: Widely marketed testosterone boosters generally lack strong evidence of efficacy and may carry potential risks. Further research is needed to validate any promising substances.
• Sleep: Adequate sleep is critical, as testosterone secretion is closely tied to the rapid eye movement (REM) phase. Emphasizing proper sleep hygiene and addressing sleep disorders are important.
• Exercise: Moderate-to-high intensity free-weight resistance exercises appear to be most effective for increasing testosterone levels. The impact of sexual activity on testosterone levels remains unclear.
• Environmental Factors: Endocrine-disrupting chemicals should be avoided due to their potential to lower testosterone. While cold-water immersion may decrease testosterone, sauna bathing appears to have a neutral effect. Radiofrequency electromagnetic radiation from electronic devices might negatively impact the hypothalamic-pituitary-gonadal axis, suggesting a need for limited use.
• Medications: Over-the-counter analgesics, such as nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen, may decrease testosterone levels, warranting cautious use.
• Seasonal Changes: The influence of seasonal changes on testosterone levels requires further investigation.

The authors concluded that educating athletes on safe and effective testosterone-optimizing strategies is crucial, and ongoing research is necessary to explore additional methods.

Assessment

This narrative review provides a comprehensive overview of various factors influencing testosterone levels in athletes, distinguishing between evidence-based strategies and those lacking strong scientific support. Its strength lies in synthesizing information from diverse areas, offering a holistic perspective on testosterone optimization beyond banned substances. The multidisciplinary author team, including specialists in family medicine, orthopedics, endocrinology, urology, and exercise science, enhances the credibility of the review.

However, as a narrative review (Level 5 evidence), it primarily summarizes existing literature without conducting new statistical analyses. While valuable for identifying trends and knowledge gaps, it does not provide the same level of evidence as systematic reviews or meta-analyses. The review highlights the need for more rigorous research, particularly concerning the efficacy of many marketed testosterone boosters and the long-term effects of certain environmental factors.

Practical Relevance

For athletes and individuals interested in maintaining healthy testosterone levels, this review offers several actionable insights:

• Prioritize Nutrition: Ensure a balanced diet with adequate macronutrients and micronutrients, avoiding extreme dieting or caloric restriction.
• Optimize Sleep: Focus on consistent, quality sleep, as it is a fundamental regulator of testosterone secretion.
• Engage in Resistance Training: Incorporate moderate-to-high intensity free-weight resistance exercises into training routines.
• Be Skeptical of Boosters: Exercise caution with over-the-counter testosterone boosters, as many lack robust scientific evidence for their effectiveness and may pose risks.
• Minimize Exposure to Endocrine Disruptors: Be mindful of environmental chemicals that can interfere with hormone function.
• Consider Medication Impact: Be aware that common analgesics might affect testosterone levels and discuss their use with a healthcare professional if concerns arise.

These strategies emphasize a holistic approach to health and performance, focusing on fundamental physiological needs rather than quick fixes.

Conclusion

The review by Lazarev et al. underscores that optimizing testosterone levels in athletes through legal means primarily involves foundational lifestyle factors: balanced nutrition, adequate sleep, and specific types of resistance exercise. While many commercial products lack scientific backing, a focus on overall well-being provides the most reliable path to healthy testosterone levels. Continued research is essential to further refine our understanding and identify additional safe and effective strategies.