A little piece of me dies inside every time I meet a man in his 30s who’s been put on testosterone replacement therapy without anyone asking him what he eats, how he sleeps, or how much time he spends outside.

I’m not anti-TRT. I want to be clear about that from the start, because I know how this can sound—like another health coach dismissing something that has genuinely changed lives for the better. TRT has a place. For some men, it’s the right tool at the right time. What concerns me is how often it becomes the first tool instead of the last—how often the conversation skips over everything upstream and lands directly at a prescription.

In my experience working with private clients and clinic patients, most of the men I see who are not on TRT find meaningful improvement in their testosterone levels when they do two things: remove the parts of their diet and lifestyle that are actively suppressing production, and start doing the things that support it. That’s the pattern—and it repeats itself with enough consistency that I think it’s worth unpacking.

The Standard American Diet Is a Hormone Suppressor

This isn’t a dramatic claim; it’s what the research and clinical observation keep pointing to.

The mechanism is relatively straightforward. The standard American diet—high in refined carbohydrates, seed oils, ultra-processed foods, and sugar—drives insulin resistance. Insulin resistance drives increased body fat, particularly visceral fat. Visceral fat tissue contains aromatase, the enzyme that converts testosterone into estrogen. More body fat means more aromatase activity, which means more testosterone is being converted before it can do its job. Less circulating testosterone signals the hypothalamus to downregulate production even further, and the cycle deepens.

Research has repeatedly confirmed this bidirectional relationship. A meta-analysis published in Frontiers of Hormone Research showed that low testosterone at baseline predicts the development of metabolic syndrome—and metabolic syndrome at baseline increases the risk of developing hypogonadism by nearly 2.5 times. The obesity-hypogonadism link isn’t a one-way street; each condition fuels the other.

What’s encouraging—and what I see clinically every day—is that this form of hypogonadism is functional. That means it’s reversible. It’s not a permanent state; it’s a response to an environment the body is trying to survive in. Change the environment, and the hormones start to shift.

Keto and Carnivore as the Biggest Lever

Switching from a standard American diet to a well-formulated ketogenic or carnivore diet seems to be the single biggest lever for testosterone improvement in the people I work with. That tracks with what the research shows, too—though there’s an important nuance most people miss.

A 2020 study co-authored by Jeff Volek and Dominic D’Agostino found that men on a ketogenic diet saw total testosterone increase by 118 ng/dL over 11 weeks, while men on a Western diet saw a decrease of 36 ng/dL over the same period. That’s a meaningful swing in both directions.

A 2022 meta-analysis of 230 patients confirmed that ketogenic diets improved testosterone levels, and the effect was more pronounced in men who were older and who lost more weight—which makes sense given the aromatase connection.

Here’s the nuance that matters: a 2022 systematic review and meta-analysis of 27 studies found that moderate-protein, low-carbohydrate diets had no negative effect on testosterone, while high-protein (35% or more of calories), low-carbohydrate diets actually decreased total testosterone significantly—by roughly 5.23 nmol/L at rest.

This is worth sitting with. The protein-to-fat ratio matters. A ketogenic diet that’s too heavy on protein and too light on fat can actually work against testosterone production. In my experience, this is where a lot of men trip up—especially guys coming from a bodybuilding or high-protein background who switch to carnivore and just eat chicken breast all day. The dietary fat isn’t optional; it’s the raw material the body needs for steroid hormone synthesis. Cholesterol, which dietary fat provides, is the literal precursor to testosterone.

This is one of the reasons I’m always emphasizing that cholesterol isn’t inherently the enemy. Your body needs it—and testosterone production is one of the most immediate examples of why.

The Lifestyle Foundations

Diet is the biggest lever in my experience, but it’s not the only one. The rest of the lifestyle foundations play a substantial role in hormonal health, and most men aren’t getting the message about how much these factors matter.

Sleep

Sleep loss and testosterone have a relationship that I don’t think gets enough attention.

Research published in Reviews in Endocrine and Metabolic Disorders paints a clear picture: sleep debt and circadian disruption lower testosterone and raise cortisol, creating what the researchers describe as an anabolic-catabolic imbalance. Testosterone is your body’s primary anabolic signal; cortisol is the primary catabolic one. When sleep is chronically short or disrupted, that ratio flips in the wrong direction.

An NHANES analysis of over 8,700 participants found that the relationship between sleep and testosterone varies by age—which tracks with what I see in practice. What doesn’t vary is that chronic sleep deprivation is consistently associated with hormonal disruption. I wrote a longer piece on the sleep problem and how to fix it if this resonates.

Stress

Chronic stress operates through a similar mechanism. When cortisol stays elevated—whether from work pressure, financial stress, relationship strain, or the physiological stress of chronic undereating—the body de-prioritizes reproduction. From an evolutionary standpoint, this makes sense: if your nervous system believes you’re in danger, making babies isn’t the priority. Testosterone production gets dialed back in favor of cortisol production, because both hormones compete for the same precursor pathways.

This is where I see stress management and time in nature do something that looks almost too simple to be real. Getting out of the sympathetic (fight-or-flight) state and into a parasympathetic state—through time outdoors, sunlight exposure, grounding, breathwork, or just being still for a while—sends signals to the body that it’s safe. Safe enough to produce hormones. Safe enough to recover. Safe enough to allocate resources toward long-term health instead of short-term survival.

I know how that sounds. I’m not saying a walk in the park will fix someone’s testosterone. I’m saying that chronic fight-or-flight signaling suppresses hormone production, and anything that breaks that pattern is removing an obstacle—not adding a supplement. I’ve written about how to start breaking that stress loop—the mechanism is the same whether the downstream casualty is testosterone, thyroid function, or digestion.

Sunlight and Vitamin D

This one is more straightforward than most people think.

A cross-sectional study of 652 men found that vitamin D deficiency was associated with a 2.65-times increased risk of testosterone deficiency. Testosterone and vitamin D showed similar seasonal variation—both peaking in summer and dropping in winter. That’s not a coincidence; it’s biology responding to environmental signals.

Sunlight is not just a vitamin D delivery mechanism. Morning and midday light exposure anchors the circadian rhythm, supports cortisol timing (high in the morning, low at night), and provides photonic signals that influence the hypothalamic-pituitary-gonadal axis—the same axis that regulates testosterone production. When we spend our lives under artificial light and behind glass, we’re removing an environmental input the endocrine system was built to rely on.

This connects directly to something I’ve explored in other writing—the idea that our modern environment actively works against the biological systems that keep us healthy. Hormonal health is one of the clearest examples.

Endocrine Disruptors: Not Just a Women’s Issue

While endocrine disruptors seem to affect women more acutely—particularly thyroid function and estrogen metabolism—men are not immune. Not even close.

A 2021 review found that endocrine-disrupting chemicals are present in everyday products that most men don’t think twice about: fragrances, cleaning products, food containers, cosmetics, plastic bottles, thermal receipt paper, and synthetic clothing materials. These chemicals—including phthalates, bisphenol A, and polychlorinated biphenyls—reduce testosterone levels and impair sperm quality.

The exposure is constant and cumulative. It’s the cologne, the body wash, the synthetic athletic wear, the plastic water bottle, the air freshener in the car, the receipts at the gas station. Each individual exposure might be small, but the total load adds up—and for men who are already metabolically compromised, those additional insults can be the difference between functional testosterone levels and a prescription.

I’m not suggesting anyone needs to live in a glass box. What I’m suggesting is that awareness matters, and that reducing the load where you can—switching to fragrance-free products, avoiding heated plastics, choosing natural fibers when possible—is a low-cost intervention with meaningful returns over time.

The Lab Number Conversation

Here’s where context matters more than most providers acknowledge.

“Normal” testosterone ranges are typically listed as something like 264–916 ng/dL for total testosterone. That range is so wide it’s almost meaningless without context—because a man at 300 ng/dL might be told he’s “within normal range” while feeling terrible, and a man at 600 ng/dL on a ketogenic diet with dialed-in sleep might feel better than he has in decades.

What I’ve noticed with clients is that the trajectory matters more than any single number. A man who starts at 350 and climbs to 550 after six months of dietary and lifestyle changes is in a very different clinical picture than a man who’s been at 550 his whole life. Labs are a snapshot—not a verdict, and reading them without understanding what the person was eating, how they were sleeping, and what their stress load looked like in the days and weeks before the draw is looking at a photo with half the image cropped out.

The other nuance: reference ranges are based on a population that is increasingly metabolically sick. “Normal” is being defined by a cohort that sleeps poorly, eats inflammatory food, rarely sees the sun, and is chronically stressed. Being “normal” within that group isn’t necessarily a win.

The TRT Question

I’ve worked with men on both sides of this—men considering TRT and men who want to get off it. My approach is the same for both: let’s make sure the foundations are dialed in first.

For men considering TRT: in my experience, so far, it’s worth exhausting the dietary and lifestyle levers before committing to exogenous testosterone. Not because TRT doesn’t work—it does—but because it’s not a temporary intervention for most people. Once you start, your body’s own production often downregulates further, which can make coming off it difficult. If the underlying drivers of low testosterone are still present (insulin resistance, poor sleep, chronic stress, inflammatory diet, environmental toxin load), TRT is treating the downstream number without addressing the upstream cause.

For men who are already on TRT and want to come off: their best chance at maintaining quality of life seems to be rooted in the same principles. Dial in diet—ideally ketogenic or carnivore, with adequate fat to support steroid hormone synthesis. Clean up the sleep environment. Manage the stress load. Get into nature and get proper sunlight signaling. Reduce the endocrine disruptor exposure. Remove the constant insults to the system that were blunting hormone production and conversion in the first place, and layer in the lifestyle practices that support it.

I’m not saying this is easy, and I’m not saying every man can successfully come off TRT through lifestyle alone. Some men have underlying conditions—primary hypogonadism, pituitary issues, genetic factors—that require medical intervention regardless of how clean their lifestyle is. TRT exists for a reason, and there’s no shame in needing it.

What I am saying is that a lot of men end up on TRT without ever being given the chance to see what their body can do when the environment is right. That’s the part that concerns me. The prescription is quick; the lifestyle overhaul takes work. Both are valid paths—I just think the lifestyle path deserves a real shot before the needle becomes a permanent fixture.

What This Actually Looks Like in Practice

For the men I work with, the protocol isn’t complicated—it’s just thorough:

  • Switch to a whole-food ketogenic or carnivore diet with adequate dietary fat (not protein-dominant)
  • Prioritize sleep quality and duration—7+ hours, consistent timing, dark and cool environment
  • Build a morning sunlight practice—15–30 minutes of outdoor light exposure within the first hour of waking
  • Address chronic stressors—not just “reduce stress” as a vague directive, but identify specific sources and create real strategies
  • Audit personal care products and household chemicals for endocrine disruptors
  • Supplement where appropriate—vitamin D3 + K2, magnesium glycinate, zinc, and omega-3s are the most common ones I see making a difference in this population
  • Recheck labs after 90–120 days of consistent implementation, and compare the trajectory

None of this is revolutionary. It’s foundation work—the same foundational approach that seems to improve almost everything else in metabolic health, from blood sugar to blood pressure to inflammatory markers. Testosterone is part of the same system. When the system is supported, the hormones tend to follow.

All That to Say—

Testosterone levels are a reflection of how you live. They’re responsive to diet, sleep, stress, sunlight, environmental exposures, and the thousands of small signals your body processes every day about whether it’s safe enough to invest in long-term hormonal health.

The good news is that for most men, the decline isn’t inevitable—it’s environmental. Remove the suppressors, support the producers, and the body tends to figure it out. That’s not a guarantee under every circumstance; it’s a pattern I see consistently enough that I felt it was worth sharing.

If you’re dealing with low testosterone—or if you’ve been told your numbers are “normal” but you don’t feel like yourself—I hope this gives you some direction. The number on the lab report is information, not a sentence. What you do with that information, and how many of these levers you’re willing to pull, will determine a lot more than any single prescription can.

I hope this connects some dots and empowers you to start asking better questions—of your providers, of the research, and of yourself.

Sources

  • Wilson JM, Lowery RP, Roberts MD, et al. “Effects of Ketogenic Dieting on Body Composition, Strength, Power, and Hormonal Profiles in Resistance Training Men.” Journal of Strength and Conditioning Research, 2020. DOI
  • Furini C, Spaggiari G, Simoni M, Greco C, Santi D. “Ketogenic state improves testosterone serum levels—results from a systematic review and meta-analysis.” Endocrine, 2022. DOI
  • Whittaker J, Harris M. “Low-carbohydrate diets and men’s cortisol and testosterone: systematic review and meta-analysis.” Nutrition and Health, 2022. DOI
  • Liu PY, Reddy RT. “Sleep, testosterone and cortisol balance, and ageing men.” Reviews in Endocrine and Metabolic Disorders, 2022. DOI
  • Tak YJ, Lee JG, Kim YJ, et al. “Serum 25-hydroxyvitamin D levels and testosterone deficiency in middle-aged Korean men: a cross-sectional study.” Asian Journal of Andrology, 2015. DOI

Rance Edwards is a National Board Certified Health and Wellness Coach (NBC-HWC) with over 2,000 clinical hours of experience, specializing in chronic disease management and lifestyle medicine.

If you’re dealing with hormonal concerns and want to explore what diet and lifestyle can actually do before—or alongside—medical intervention, I’d genuinely love to have that conversation. Book a free discovery call—no pressure, no pitch, just an honest look at where you are and what might move the needle.

Hero photo by Artem Podrez on Pexels.