The Testosterone Question: Does HRT Shorten or Lengthen Lifespan? And What Are the Alternatives?

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by Nils Osmar – Updated August 12, 2022 – Medical disclaimer

It’s important to maintain strong muscles as the years go by. The progressive loss of muscle due to the aging process (sarcopenia) can lead to numerous health problems.

A recent Cleveland Clinic article lists several symptoms of sarcopenia, including:

  • Muscle weakness
  • Loss of stamina.
  • Difficulty performing daily activities.
  • Walking slowly.
  • Trouble climbing stairs.
  • Poor balance and falls.
  • Decrease in muscle size.

One item on the list, falls, deserves special attention. Falls are extremely dangerous in the elderly; in fact, according to the CDC website:

Falls are the leading cause of injury-related death among adults age 65 and older, and the age-adjusted fall death rate is increasing. The age-adjusted fall death rate is 64 deaths per 100,000 older adults. Fall death rates among adults age 65 and older increased about 30% from 2009 to 2018.

Falls are associated both with the loss of strength in our muscles and the loss of density in our bones. Both correlate with a drop in the level of our sex hormones, particularly testosterone (in both sexes).

Resistance training vs. sarcopenia

According to an article called “The Intensity and Effects of Strength Training in the Elderly”, the right kind(s) of exercise can help prevent and reverse sarcopenia, prevent falls, and keep our bones and muscles strong and flexible. We don’t necessarily need to build massive muscles (though we’re free to go in that direction if we want to). But maintaining muscle can make a profound difference in our health, mobility and quality of life.

The role of testosterone

Testosterone is an essential hormone. In both sexes, it drives gains in muscle mass and strength, supports strong bone density, helps to regulate libido, and supports the production of red blood cells. Both men and women experience a decline in their testosterone after the age of 30, which accelerates as we age. The more our testosterone drops, the more difficult it is to increase our muscle mass.

One obvious way to increase testosterone would be to do hormone replacement therapy, assuming that your doctor agrees to prescribe the hormones. But is it the healthiest? Or should we focus on other approaches?

Possible benefits of HRT

Hormone replacement does have numerous benefits. Several studies have also shown that having higher “T” levels improves brain health and cognitive function in both sexes.

For males, studies suggest that restoring testosterone to youthful levels with medical intervention can result in both a longer and healthier lifespan.

Of course, testosterone isn’t the only hormone that can be replaced as we age. Women’s hormones drop precipitously during and following menopause. Some studies show evidence that in women, HRT is associated with better health and a longer lifespan. Under some circumstances, HRT appears to increase the lifespan in both men and women.

Life shortening effects?

But what about the evidence that for athletes, taking anabolic steroids to improve performance – when it involves raising testosterone levels higher than those found in healthy young men – may shorten the lifespan – at least in athletes under 50?

Understanding the evidence can be a little tricky. According to this article, pro bodybuilders are actually dying at a slightly lower rate than the­ average American man. However, they are still dying at a much faster rate than pro athletes in major sports. Performance-enhancing drugs, including steroids, do appear to be a possible culprit.

It’s interesting to note, though, that past the age of 50, there’s no evidence of a life shortening effect from taking anabolic steroids. It may be that the benefits of gaining muscle are great enough in people in this age group as to counterbalance the damage done by steroids. Anabolic steroids don’t make people over 50 years live longer, but they also don’t appear to shorten the lifespan in men older than 50.

What about supplements?

The discussion about maintaining healthy testosterone levels often assumes that we have two choices: watching passively while our hormone decline, or medical hormone replacement therapy. An alternative which is often overlooked is taking nutritional supplements which increase testosterone levels, not by injecting exogenous testosterone, but by increasing the body’s production of it.

To me this is preferable because it utilizes the body’s own mechanisms to increase testosterone. For males, doing TRT can shut down the body’s own production of testosterone; taking the right supplements increases that production.

Effects of exercise

Both endurance exercise and resistance training have been found to increase testosterone levels (and also increase levels of human growth hormone) in both males and females. However, this effect is more pronounced in young adults, and is not long lasting. (See article.)

What about women?

According to a study called “Mortality Associated with Hormone Replacement Therapy in Younger and Older Women“,

Hormone replacement therapy (in females) reduced total mortality in trials with mean age of participants under 60 years. No change in mortality was seen in trials with mean age over 60 years.

A study called Increased longevity in older users of postmenopausal estrogen therapy: the Leisure World Cohort Study, concluded that:

Long-term users of ET seem to have a lower death rate in the Leisure World population. The reduction in the risk of death from all causes was 15%. Considering only mortality as the index of therapeutic success or failure, these results suggest that long-term therapy may extend life.

Our results add to the complexity of issues surrounding the risk-benefit equation of hormone therapy. However, with the results of recent clinical trials and other observational studies, our findings suggest that after an initial period of increased risk, use of ET may be without excess adverse effect.

From a 2017 article called Hormone Therapy Doesn’t Increase Mortality in Postmenopausal Women:

Whatever the other controversies surrounding use of hormone therapy in postmenopausal women, an estrogen-progestin combination or estrogen alone do not appear to affect total mortality or deaths from cardiovascular disease, cancer, or other major illnesses.

That’s according to a study in JAMA based on the Women’s Health Initiative (WHI) hormone therapy trials. Brigham and Women’s Hospital researchers note that earlier reports did not focus specifically on all-cause mortality and cause-specific mortality.

The results of studies have varied a bit over the years. But the consensus in 2022 appears to be that women live at least as long, in better health, if they find ways to restore their sex hormones to youthful levels, than if they don’t.

The Cancer Question

When I posted this article in an online forum, some people mentioned in their comments that some studies show a relationship between cancer and hormone supplementation.

This is accurate. But it’s also accurate that people live longer, on the average, if they raise their hormone levels.

We don’t know yet whether the cancer increase is because hormones are being raised, or because of the way they’re being raised. l suspect that raising them using herbal supplements will not have the same side effects as doing so by injecting hormones. Time and more studies will clarify whether this is true. Either way, though, if it’s a choice between dying at 80 without raising hormone levels, or living to 90 then getting cancer, I’d choose the latter. But I don’t think those have to be our only two choices.

What I’m Doing

I’ve never taken testosterone injections, and I hope I never have to (though I won’t turn up my nose at hormone replacement therapy if my current approach ever stops working). I do take testosterone-boosting supplements such as tongkat ali, longjack, ashwagandha, boron, L. reuteri 6475, HMB, and one prohormone (DHEA), and have found that they work well as long as I also eat a high nutrient diet and do resistance training.

The relationship between diet and our hormones is complex, but it’s clear that we can at least postpone the decline in testosterone levels by eating specific nutrients, such as foods high in zinc, healthy fats, and cholesterol (which our body actually needs to make testosterone). (The notion that cholesterol is “bad” is greatly oversimplified.)

Should we stop eating meat? Or eat more of it?

Opinions will obviously vary on this question.

Speaking for myself (and speaking anecdotally for a moment) I can say that the worst approach I ever tried, in terms of my testosterone and general health, was going vegan.

I found that when I cut all animal-based foods out of my diet, my sex drive faded away after a few months, I lost muscle mass, developed mood and memory problems, felt depressed and low-energy, and my testosterone levels dropped precipitously. I thought these changes were age-based, but they were not; adding meat back into my diet reversed them.

I’m not alone in having this experience. According to a 2021 New York Times article, “A recent British review that pooled data from 206 volunteers, for example, found that men on high-fat diets had testosterone levels that were about 60 points higher, on average, than men on low-fat diets. Men who followed a vegetarian diet tended to have the lowest levels of testosterone, about 150 points lower, on average, than those following a high-fat, meat-based diet.”.

So these days, I eat a balanced omnivorous diet that includes foods from all three kingdoms (plant, animal and fungi). I work out in my home gym three times a week, and do two 36 hour fasts per week.

  • I describe the supplements in more detail in this section.
  • I discuss the workout I’m doing with the aim of building muscle in this article.
  • If my protocol ever stops working, I’ll consider injections. For now, I’m getting good results with exercise and supplements..
  • This video shows at a glance how my body has changed by following an approach I developed called the Rekindle Protocol. One element of the protocol has been restoring my testosterone to youthful levels. (Mine has gone from the low 300s to the mid 900s during the past two years – again while taking supplements, not testosterone injections.)

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