Exceeding exercise guidelines may reduce likelihood of low T in men

Men whose activity exceeded guideline-based exercise levels experienced a decreased likelihood of lower serum testosterone, according to study results presented at the American Urological Association 2020 Virtual Experience.

Richard J. Fantus, MD, from the University of Chicago, explained during a press briefing that the AUA republished guidelines in 2018 stating that all men with testosterone deficiency should be counseled regarding weight loss programs as an initial treatment strategy.

“(Weight loss programs) are relatively inexpensive and safe and reversible,” he added, saying that losing weight can improve a man’s testosterone and improve the signs and symptoms associated with testosterone deficiency.

In 2018, the Physical Activity Guidelines Advisory Committee (PAGAC) set a target activity goal of 500-1000 metabolic equivalent of task (MET) minutes per week.

Using the National Health and Nutrition Examination Survey (NHANES) database from 2011-2016, the researchers evaluated 7597 men between the ages of 18 to 80 who answered the physical activity questionnaire and underwent serum T testing to determine if PAGAC activity thresholds were associated with the likelihood of having low testosterone.¹

Men were divided into 3 groups of activity levels using PAGAC recommendations: less than recommended (<500 MET minutes/week), recommended (between 500 and 1000 MET minutes/week), and greater than recommended (>1000 MET minutes/week). Activity was categorized as work, recreational, or for transportation, then further divided into vigorous or moderate.

The association between activity level and low T (<300 ng/dL) was analyzed using a multivariable logistic regression controlling for known confounders. Men with prostate cancer were excluded from the study.

The majority of men (n= 4461; 58.7%) accumulated > 1000 MET minutes/week, while 703 (9.3%) met the recommended activity level and 2433 (32%) did not meet the recommended level of activity. Men who did not meet the 500 MET minutes per week tended to be older, with higher BMIs, a higher likelihood of comorbidity, and a higher likelihood of diabetes.

The average testosterone level of the entire cohort was 413.1 ng/dL. Among the entire cohort, lower serum testosterone was detected in 2201 men (29%)-occurring more often in men who were older, obese, had 1 or more comorbidities, and were less physically active.

According to the multivariate analysis, those whose activity exceeded the recommended guidelines demonstrated a significant decrease in the likelihood of lower serum testosterone (OR, 0.631; 95% CI, 0.549-0.72; P < .001), compared with men whose activity levels were lower than recommended. Using the same covariates, the researchers found the association between lower activity level and low testosterone to be significant in the obese group of men (P < .001).

Fantus noted the study was limited by its cross-sectional design, the self-reported activity leading to potential bias, as well as testosterone levels only being measured once and no data reported on participants’ symptoms. However, he added, the study is the largest of its kind with a generalizable cohort.

“Exercise is an important lifestyle modification that should be offered to everyone,” Fantus said. “More is better. Greater than 1000 MET minutes per week has been shown to have numerous additional benefits. That being said, when counseling men regarding low testosterone and exercise, it is incredibly important to really counsel the obese population as exercise, independent of weight loss, may show additional benefits.”

1.      Fantus R. The Association Between Exercise and Serum Testosterone Among Men in the United States. Presented at: AUA 2020 Virtual Experience; May 15, 2020. Abstract PD25-03.