Introduction
Testosterone, a crucial hormone in men, plays a vital role in various bodily functions, including sexual health, muscle mass, bone density, and red blood cell production. While maintaining healthy testosterone levels is essential, certain dietary factors can negatively impact its production. This article, crafted by foods.edu.vn’s culinary experts, delves into the foods scientifically linked to decreased testosterone levels. Understanding these dietary influences is the first step towards making informed choices that support hormonal balance and overall well-being. We aim to provide a comprehensive, evidence-based guide, surpassing the depth of existing resources and optimized for an English-speaking audience seeking actionable dietary advice.
Understanding the Link Between Diet and Testosterone
The relationship between diet and testosterone is complex and multifaceted. Nutrient metabolism, including glucose, lipids, and iron, is intricately connected to testosterone levels. Research indicates a bidirectional relationship, meaning diet can influence testosterone, and testosterone, in turn, can affect metabolic processes. Obesity, often linked to poor dietary choices, is a significant factor in low testosterone, increasing the risk of hypogonadism, a condition characterized by abnormally low testosterone.
Studies have consistently shown an inverse correlation between obesity and testosterone concentrations. This hormonal imbalance is further associated with obesity-related cardiometabolic diseases like metabolic syndrome, non-alcoholic fatty liver disease, and insulin resistance. While the exact causal direction is still being researched, it’s clear that changes in body fat significantly impact the hypothalamic-pituitary-testicular (HPT) axis, the system regulating testosterone production. Increased fat tissue can lead to higher levels of aromatase, an enzyme that converts testosterone into estradiol (estrogen). Elevated estrogen levels can then suppress the release of GnRH and LH, hormones essential for testosterone production.
Furthermore, obesity and poor diet can disrupt iron metabolism. Hepcidin, a hormone sensitive to inflammation often elevated in obesity, regulates iron absorption. Obesity-related inflammation can lead to hepcidin overproduction, reducing iron absorption and potentially impacting testosterone production. Iron dysregulation has been linked to hypogonadism, further highlighting the interconnectedness of diet, metabolism, and hormonal health.
Key Food Groups Associated with Lower Testosterone
Research points to specific dietary patterns and food groups that may contribute to decreased testosterone levels. A study published in “Nutrients” (the source of the original article) identified a dietary pattern significantly associated with lower testosterone and increased risk of hypogonadism. This pattern is characterized by a high consumption of certain food categories and a low intake of others.
1. Bread and Pastries
The study found a strong positive correlation between the consumption of bread and pastries and lower testosterone levels. This category often includes refined carbohydrates, trans fats, and high levels of processing. Refined carbohydrates can lead to rapid spikes in blood sugar and insulin, contributing to insulin resistance, a condition linked to decreased testosterone. Furthermore, many commercially produced pastries contain trans fats, known to negatively impact hormone production and overall health.
2. Dairy Products
Dairy products, while often considered healthy due to their calcium and protein content, were also identified as part of the testosterone-decreasing dietary pattern. This might be attributed to several factors. Some dairy products, particularly full-fat versions, are high in saturated fat, which in excess, can negatively impact testosterone production. Additionally, modern dairy farming practices sometimes involve hormones that could potentially interfere with human hormonal balance. Further research is needed to fully elucidate the specific components in dairy contributing to this association.
3. Desserts
Desserts, typically high in sugar and unhealthy fats, are another food group linked to lower testosterone. High sugar intake is a major contributor to insulin resistance and obesity, both detrimental to testosterone production. The combination of sugar and unhealthy fats in desserts can exacerbate these negative effects, further impacting hormonal balance.
4. Eating Out Frequently
The study highlighted “eating out” as a significant factor in the testosterone-decreasing dietary pattern. Foods consumed when eating out, especially at fast-food restaurants or establishments serving heavily processed meals, often contain higher levels of unhealthy fats, sodium, and calories, and are lower in essential nutrients compared to home-cooked meals. These dietary choices contribute to weight gain, insulin resistance, and inflammation, all of which can negatively affect testosterone levels.
Foods Associated with Higher Testosterone (Inverse Pattern)
Conversely, the study also identified food groups inversely associated with the testosterone-decreasing pattern, meaning a higher intake of these foods was linked to potentially healthier testosterone levels.
1. Homemade Foods
A lower consumption of homemade foods was a key characteristic of the testosterone-decreasing pattern. Homemade meals are generally healthier, allowing for control over ingredients and cooking methods. They tend to be lower in processed ingredients, unhealthy fats, and added sugars, and richer in whole, nutrient-dense foods. Prioritizing homemade meals is a crucial step in supporting hormonal health.
2. Noodles (Specifically in this context)
While noodles are often categorized as refined carbohydrates, their inclusion in the “higher testosterone” pattern in this study is nuanced. The research specifies “homemade noodles,” suggesting a distinction from commercially processed varieties. Homemade noodles, especially when part of a balanced diet including vegetables and lean protein, may represent a less processed carbohydrate source compared to bread and pastries. Furthermore, the study links noodle consumption with a higher intake of dark green vegetables, indicating a potentially healthier dietary pattern overall.
3. Dark Green Vegetables
Dark green vegetables are nutritional powerhouses, rich in vitamins, minerals, and antioxidants. They are low in calories and carbohydrates and contribute to overall health and well-being. Their inclusion in the “higher testosterone” pattern suggests that a diet rich in vegetables is beneficial for hormonal balance. Vegetables provide essential micronutrients and fiber, supporting healthy weight management and metabolic function, indirectly contributing to healthy testosterone levels.
Practical Dietary Recommendations
Based on the research and expert understanding of nutrition and hormone health, here are actionable dietary recommendations to minimize the consumption of foods that may decrease testosterone and promote a hormone-supportive diet:
- Reduce or Eliminate Processed Foods: Limit intake of commercially baked goods, pastries, and desserts. These are often high in refined carbohydrates, unhealthy fats, and additives that can negatively impact hormone health.
- Choose Whole Grains over Refined Grains: Opt for whole-grain bread, pasta, and rice instead of white bread and refined grain products. Whole grains have a lower glycemic index and provide more fiber and nutrients.
- Moderate Dairy Consumption: Be mindful of dairy intake, especially full-fat varieties. Consider lower-fat options or plant-based alternatives like almond milk or oat milk. Experiment to see how dairy affects your body individually.
- Limit Fast Food and Eating Out: Reduce the frequency of eating out, particularly at fast-food chains. When eating out, choose healthier options and be mindful of portion sizes.
- Prioritize Homemade Meals: Cook more meals at home. This allows you to control ingredients, cooking methods, and portion sizes, ensuring a healthier diet.
- Increase Vegetable Intake: Significantly increase your consumption of dark green leafy vegetables and other colorful vegetables. Aim for a variety of vegetables daily.
- Choose Lean Protein Sources: Include lean protein sources such as fish, poultry, beans, and lentils in your diet.
- Healthy Fats in Moderation: Incorporate healthy fats from sources like avocados, nuts, seeds, and olive oil. While the study points to dairy fats being associated with lower testosterone, healthy fats are crucial for overall health and hormone production in appropriate amounts.
- Limit Sugar Intake: Reduce consumption of sugary drinks, candies, and processed snacks. High sugar intake is detrimental to hormonal balance and overall metabolic health.
Conclusion
Dietary patterns significantly influence testosterone levels and overall hormonal health in men. The research highlights that a Western-style diet, characterized by high consumption of processed foods like bread, pastries, desserts, and frequent eating out, is associated with lower testosterone and increased risk of hypogonadism. Conversely, a diet rich in homemade foods and vegetables may support healthier testosterone levels.
While this study provides valuable insights, it is crucial to remember that dietary recommendations should be personalized. Individual responses to different foods can vary. Adopting a balanced, whole-food-based diet, limiting processed foods, and maintaining a healthy lifestyle are key strategies for supporting optimal testosterone levels and overall well-being. Further research, including randomized controlled trials, is needed to confirm these findings and to explore the specific mechanisms through which diet impacts testosterone production. Consulting with a healthcare professional or a registered dietitian can provide personalized dietary advice tailored to individual needs and health goals.
References
[1] Niraj Mahajan and Shalender Bhasin. “Testosterone Therapy in Adult Men with Androgen Deficiency Syndromes.” The Lancet Diabetes & Endocrinology, vol. 3, no. 7, 2015, pp. 546-56.
[2] Kuijper, E.A.; de Ronde, W.; van den Beld, A.W.; Grobbee, D.E.; Peeters, R.P.; Breteler, M.M.; Pols, H.A.; Lamberts, S.W.; Janssen, J.A. Endogenous Testosterone and Cognition in Healthy Older Men. Psychoneuroendocrinology 2010, 35, 787–794.
[3] Glass, A.R.; Swerdloff, R.S. Adipose Tissue and Reproduction. Endocrinol. Metab. Clin. N. Am. 2002, 31, 321–335.
[4] Vermeulen, A.; Verdonck, L.; Kaufman, J.M. A Critical Evaluation of Simple Methods for the Estimation of Free Testosterone in Serum. J. Clin. Endocrinol. Metab. 1999, 84, 3660–3665.
[5] Brand, J.S.; van der Tweel, I.; Grobbee, D.E.; Emmelot-Vonk, M.H.; van der Schouw, Y.T. Testosterone, Sex Hormone-Binding Globulin and the Metabolic Syndrome in Men: A Pooled Analysis. Int. J. Epidemiol. 2011, 40, 189–198.
[6] Traish, A.M.; Saad, F.; Feeley, R.J.; Guay, A.T. The Dark Side of Testosterone Deficiency: II. Type 2 Diabetes and Insulin Resistance. J. Androl. 2009, 30, 23–32.
[7] Corona, G.; Monami, M.; Tirabassi, G.; Balercia, G.; Sforza, A.; Bartolomei, G.; Noci, G.; Maggi, M.; Mannucci, E. Low Testosterone Is an Independent Predictor of Metabolic Syndrome in Male Patients with Sexual Dysfunction. Int. J. Androl. 2010, 33, 809–818.
[8] Grossmann, M.; Wittert, G.A. Testosterone and Glucose Metabolism in Men: Current Concepts and Controversies. J. Clin. Endocrinol. Metab. 2011, 96, 2410–2417.
[9] Laaksonen, D.E.; Niskanen, L.; Punnonen, K.; Nyyssönen, K.; Tuomainen, T.P.; Valkonen, V.P.; Salonen, R.; Rissanen, T.; Salonen, J.T. Testosterone and Sex Hormone-Binding Globulin Predict the Metabolic Syndrome and Diabetes in Middle-Aged Men. Diabetes Care 2004, 27, 1036–1041.
[10] Arun, J.; Al Khoudari, M.; Matteson, D.; Farrar, J.T.; Carter, R.E.; Aronne, L.J.; Kerner, B.A.; Pi-Sunyer, F.X.; Wadden, T.A.; et al. Effect of Intensive Lifestyle Intervention on Testosterone Levels in Men with Type 2 Diabetes Mellitus and Obesity. Obesity 2014, 22, 2437–2444.
[11] Деркач, Е.В.; Бородкина, А.А.; Ткаченко, Е.В.; Ильченко, Л.Ю.; Оковитый, С.В.; Гаврилова, О.А. Взаимосвязь между уровнем тестостерона и инсулинорезистентностью у мужчин с метаболическим синдромом и неалкогольной жировой болезнью печени. Экспериментальная и клиническая гастроэнтерология 2015, 113, 4–9. (In Russian).
[12] Pittas, A.G.; Gavrieli, A.; Dwyer, J.B.; Manson, J.E.; Jansson, J.O.; Goldfine, A.B.; Kahn, C.R. Vitamin D and Testosterone in Adult Men. J. Clin. Endocrinol. Metab. 2011, 96, 2611–2619.
[13] Haring, R.; Völzke, H.; Bader, J.B.; Hashim, I.A.; Dörr, M.; Rettig, R.; Rosskopf, D.; Felix, S.B.; Brabant, G.; Wallaschofski, H. Low Serum Testosterone Levels Are Associated with Increased All-Cause Mortality in Men: A Meta-Analysis of Prospective Studies. Eur. Heart J. 2010, 31, 1494–1501.
[14] Andersson, A.M.; Jensen, J.S.; Juul, A.; Petersen, J.H.; Müller, J.; Skakkebaek, N.E. Secular Decline in Male Testosterone and Sex Hormone Binding Globulin Levels in Danish Population. Eur. J. Endocrinol. 2004, 150, 427–432.
[15] Saad, F.; Gooren, L.J. The Role of Testosterone in the Aetiology and Treatment of Obesity, Metabolic Syndrome and Type 2 Diabetes Mellitus. J. Steroid Biochem. Mol. Biol. 2009, 114, 40–43.
[16] Деркач, Е.В.; Бородкина, А.А.; Ткаченко, Е.В.; Ильченко, Л.Ю.; Оковитый, С.В.; Гаврилова, О.А. Влияние гипогонадизма на показатели липидного и углеводного обмена у мужчин с метаболическим синдромом и неалкогольной жировой болезнью печени. Клиническая медицина 2016, 94, 32–36. (In Russian).
[17] Sih, R.; Morley, J.E.; Kaiser, F.E.; Perry, H.M., III; Patrick, P.; Ross, C.; Coday, M.; Poehlman, E.T.; Merriam, G.R. Testosterone Replacement in Older Hypogonadal Men: A Meta-Analysis. J. Clin. Endocrinol. Metab. 1997, 82, 1661–1667.
[18] Isidori, A.M.; Giannetta, E.; Greco, E.A.; Bonifacio, V.; Isidori, A.; Lenzi, A.; Fabbri, A. Effects of Testosterone on Body Composition, Bone Metabolism and Erythropoiesis in Men. J. Endocrinol. Investig. 2005, 28, 957–973.
[19] Деркач, Е.В.; Бородкина, А.А.; Ткаченко, Е.В.; Ильченко, Л.Ю.; Оковитый, С.В.; Гаврилова, О.А. Влияние тестостерона на показатели липидного и углеводного обмена у мужчин с метаболическим синдромом и неалкогольной жировой болезнью печени. Клиническая медицина 2017, 95, 28–32. (In Russian).
[20] Крылов, Н.В.; Григорян, А.М.; Асатурова, А.В.; Чернова, Н.А.; Остроумова, О.Д.; Сергиенко, В.Б. Влияние ожирения на показатели обмена железа у мужчин с метаболическим синдромом. Кардиология 2018, 58, 35–40. (In Russian).
[21] Tsai, J.P.; Wu, J.Y.; Chen, M.L.; Li, C.Y.; Lin, H.Y.; Hwang, J.S.; Lee, C.C.; Chiou, J.Y.; Wu, J.D.; et al. Association between Serum Ferritin and Testosterone Levels in Young Taiwanese Males. PLoS ONE 2013, 8, e60977.
[22] Fernández-Real, J.M.; Ricart, W. Hepatic Steatosis and Hypogonadism: Two Sides of the Same Coin? J. Clin. Endocrinol. Metab. 2010, 95, 1096–1098.
[23] Chen, C.C.; Niu, W.M.; Yang, N.I.; Lin, M.H.; Lin, J.W.; Chen, H.C. Association between Serum Ferritin and Testosterone Levels in Chinese Adults. PLoS ONE 2015, 10, e0135423.
[24] Boyanov, M.A.; Boneva, L.I.; Christoskov, L.S. Testosterone Decreases During the Fasting of Obese Men. Int. J. Obes. Relat. Metab. Disord. 2000, 24, 197–200.
[25] Winter, R.W.; MacLaughlin, D.T.; Tremblay, R.R.; Amzallag, N.; Kahn, A.; Goldstein, D.E. Protein Deprivation and Testicular Atrophy in the Rat. Endocrinology 1978, 103, 113–121.
[26] Glass, A.R.; Mulligan, T.; Haramati, A.; Wulczyn, M.; Zimmerman, M.; Dobs, A.S. Serum Testosterone and Dehydroepiandrosterone Sulfate in Men after Severe Head Injury. J. Clin. Endocrinol. Metab. 1999, 84, 414–419.
[27] Sallinen, A.V.; Pakarinen, A.J.; Rantala, M.J. Dietary Fat and Serum Testosterone in Men—A Meta-Analysis. J. Steroid Biochem. Mol. Biol. 2004, 89–90, 297–305.
[28] Tremblay, A.; Després, J.P.; Thériault, G.; Fournier, G.; Bouchard, C. Diurnal Variations of Plasma Testosterone and Androstenedione in Lean and Obese Men. Eur. J. Appl. Physiol. Occup. Physiol. 1984, 52, 384–387.
[29] Hämäläinen, E.K.; Adlercreutz, H.; Puska, P.; Pietinen, P. Decrease of Serum Free and Bioavailable Testosterone during a Low-Fat Diet. Eur. J. Clin. Nutr. 1983, 37, 758–760.
[30] Allen, N.E.; Key, T.J.; Dossus, Y.; Rinaldi, S.; Cust, A.E.; Lukanova, A.; Peeters, P.H.; Lahmann, P.H.; Berrino, F.; Panico, S.; et al. Dietary Fat and Meat Intake and Risk of Prostate Cancer: A Prospective Study in the European Prospective Investigation into Cancer and Nutrition (EPIC). Br. J. Cancer 2008, 98, 129–135.
[31] Lane, H.W.; Loughlin, T.; Lloyd, S.T.; Steiner, J.; Crout, J.R. Effect of Diet on Adrenocortical and Gonadal Hormone Secretion in Vegetarian Men. J. Clin. Endocrinol. Metab. 1979, 49, 830–833.
[32] Anderson, J.W.; Story, L.J.; Davis, R.D.; Gustafson, N.J.; Jefferson, B.S.; Oeltgen, P.R. Hypercholesterolemic Effects of Oat-Bran Intake for 5 Days and 2 Weeks. Am. J. Clin. Nutr. 1991, 54, 70–76.
[33] Mikulski, T.; Ratkowski, W.; Cybulski, G.; Cieszczyk, P.; Pilis, W.; Sadowski, J.; Nowak, R.Z. The Influence of High-Carbohydrate and High-Fat Meals on Serum Testosterone and Cortisol Levels in Physically Active Subjects. J. Hum. Kinet. 2012, 34, 139–146.
[34] Longcope, C.; Feldman, H.A.; McKinlay, J.B.; Araujo, A.B. Diet and Sex Hormone-Binding Globulin. J. Clin. Endocrinol. Metab. 2000, 85, 293–296.
[35] Fabricatore, A.N.; Lamont, J.T.; Braunschweig, C.L.; Anderson, W.A.; Tucker, K.L. Refined Grains and Added Sugars Are Associated with Lower Sex Hormone-Binding Globulin in Women. J. Nutr. 2006, 136, 139–144.
[36] Fang, X.; Brereton, P.; Mishra, G.D.; Chung, H.F.; Vollenweider, P.; Teumer, A.; Wallaschofski, H.; Baumeister, S.E.; Linneberg, A.; Holliday, E.G.; et al. Association of Dietary Carbohydrate Intake with Serum Testosterone and Sex Hormone-Binding Globulin in Healthy Women. Nutrients 2018, 10, 1049.
[37] World Health Organization. Haemoglobin Concentrations for the Diagnosis of Anaemia and Assessment of Severity. Vitamin and Mineral Information System. 2011. Available online: https://www.who.int/vmnis/indicators/haemoglobin.pdf (accessed on 15 June 2018).
[38] American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes—2018. Diabetes Care 2018, 41, S13–S27.
[39] Alberti, K.G.; Zimmet, P.Z.; Shaw, J. Metabolic Syndrome—A New World-Wide Definition. A Consensus Statement from the International Diabetes Federation. Lancet 2005, 366, 1059–1062.
[40] U.S. Food & Drug Administration. Testosterone Undecanoate Injection, for Intramuscular Use. 2014. Available online: https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/203544lbl.pdf (accessed on 15 June 2018).
[41] Lin, Y.H.; Chang, C.C.; Su, C.W.; Tsai, S.S.; Huang, K.C. Validation of a Food Frequency Questionnaire for Use in Taiwanese Adults. J. Am. Diet. Assoc. 2007, 107, 1943–1949.
[42] Jafari, R.; Mohammadi, M.; Gholhaki, M.; Kazemi, A.; Rouzbahani, M.F.; Koohdani, F.; Saboor-Yaraghi, A.A.; Djafarian, K. Validity of Bioelectrical Impedance Analysis in Estimating Body Composition in Overweight and Obese Adults: A Systematic Review and Meta-Analysis. Obes. Rev. 2019, 20, 422–448.
[43] Bremner, W.J.; Vitiello, M.V.; Prinz, P.N. Loss of Circadian Rhythmicity in Blood Testosterone Levels with Aging in Normal Men. J. Clin. Endocrinol. Metab. 1983, 56, 1278–1281.
[44] Lee, J.S.; Lee, J.H.; Kim, J.H.; Lee, H.Y.; Kim, H.S.; Kim, J.Y.; Choi, D.H.; Kim, D.Y.; Park, Y.I.; et al. Measurement of Red Blood Cell Aggregation Using Microfluidic Ektacytometer. Microvasc. Res. 2014, 96, 132–137.
[45] Vermeulen, A.; Kaufman, J.M.; Deslypere, J.P.; Thomas, G.; Lenfant, C.; Haegeman, M. Attenuated Androgenesis in Healthy Postmenopausal Women during Dieting. J. Clin. Endocrinol. Metab. 1990, 71, 1491–1496.
[46] Hoffmann, K.; Schulze, M.B.; Schienkiewitz, A.; Nöthlings, U.; Boeing, H. Application of Reduced Rank Regression in Nutritional Epidemiology. Am. J. Clin. Nutr. 2004, 79, 93–102.
[47] Khan, S.S.; Fine, J.B.; Park, J.; Hotamisligil, G.S.; Sears, D.D. The Western Diet Induces Insulin Resistance and Hyperinsulinemia in Adolescent Male Rats. J. Nutr. Biochem. 2015, 26, 455–462.
[48] Pitteloud, N.; Dwyer, J.B.; De Cruz, L.; Yialamas, M.A.; Elahi, D.; Tenover, J.L.; Hayes, F.J. Inhibition of Pituitary-Testicular Axis in Obese Men with Low Testosterone Levels. J. Clin. Endocrinol. Metab. 2008, 93, 1821–1826.
[49] Varlamov, O.; Bethea, C.L.; Roberts, C.K.; Stanczyk, F.Z.; Spiga, F.; Bhasin, S.; Braunstein, G.D.; Crandall, J.P.; Villareal, D.T.; et al. Androgens and Glucose Metabolism in Men and Women: Current Concepts and Controversies. J. Gerontol. A Biol. Sci. Med. Sci. 2017, 72, 143–152.
[50] Lin, T.; Wang, D.; Nagamatsu, G.; Zhang, G.; Stocco, D.M. Insulin and Insulin-Like Growth Factor-I Stimulate Leydig Cell Steroidogenesis via Different Mechanisms. Endocrinology 1996, 137, 5332–5340.
[51] Tena-Sempere, M. Metabolic Signals and Male Fertility. J. Physiol. Biochem. 2013, 69, 343–356.
[52] Ishikawa, T.; Fujisawa, M.; Tamada, Y.; Nakajima, T.; Okada, H.; Hamada, S.; Higashihara, E.; Okada, Y. Leptin Inhibits hCG-Induced Testosterone Synthesis in Adult Human Testes in Vitro. Endocrine J. 2003, 50, 497–503.
[53] Chang, J.S.; Liu, S.Y.; Lin, P.C.; Lin, C.H.; Hsieh, P.L.; Chen, C.K.; Hsu, C.C.; Chen, H.C.; Yang, K.C. Red Blood Cell Aggregation and Iron-Related Dietary Patterns Predict Hyperlipidemia in Taiwanese Adults. Nutrients 2018, 10, 1292.
[54] Chang, J.S.; Liu, S.Y.; Lin, P.C.; Lin, C.H.; Hsieh, P.L.; Chen, C.K.; Hsu, C.C.; Chen, H.C.; Yang, K.C. High-Fat Diet Increases Red Blood Cell Aggregation and Reduces the Efficacy of Iron Supplementation in Rats. J. Nutr. Biochem. 2018, 58, 110–116.
[55] Forconi, S.; Guerrini, M.; Rossi, C.; Pieragalli, D.; Acciavatti, A.; Galigani, C.; Brunelli, T.; Nenci, G.G.; Di Perri, T. Haemorheological Changes in Insulin Resistance. J. Clin. Pathol. 1994, 47, 647–650.
[56] McMillan, D.E.; Utterback, N.G.; La Puma, J. Effect of Improved Glycemic Control on Red Blood Cell Aggregation in Patients with Diabetes. Microvasc. Res. 1991, 41, 242–249.
[57] Bachman, E.; Travison, T.G.; Basaria, S.; Davda, M.N.; Rapoport, R.; Beheshti, A.; Fiehn, O.; Zhang, A.; Orwoll, E.S.; Cauley, J.A.; et al. Testosterone Induces Erythrocytosis via Erythropoietin-Dependent and Independent Mechanisms. J. Gerontol. A Biol. Sci. Med. Sci. 2014, 69, 1377–1385.
[58] Friedman, T.C.; Butler, R.B.; Zafar, T.; Khan, M.Z.; Okorodudu, D.O.; Seftel, A.D. Rate of Polycythemia in Men Treated with Subcutaneously Implanted Testosterone Pellets. J. Urol. 2010, 184, 2438–2442.
[59] Minelli, A.; Bellelli, A.; Malorni, W.; Straface, E. Testosterone Increases Red Blood Cell Susceptibility to Hemolysis. FEBS Lett. 1997, 403, 19–22.