How To Stop Losing Testosterone

Written by Eusebius Baca

How do I Increase my testosterone?

Wrong my friend, the right question in this day is: how do I stop losing testosterone? Total testosterone which is causatively linked with total sperm count has been dropping at least since the early 1970s. https://doi.org/10.1093/humupd/dmx022 -> Found that the sperm count of males in the western world has fallen by more than half from 1973 to 2013. And there is no sign that this case has improved.

So many people might celebrate this devastating occurrence because it makes societies more complacent and reduces “Toxic masculinity” or whatever but it’s a dangerous thing for all of society for many reasons but most especially for males. Less testosterone is associated with many health deficits in males for example: cardiovascular morbidity, metabolic syndrome, type 2 diabetes mellitus, atherosclerosis, osteoporosis, sarcopenia (pathological loss of muscle mass), general mortality risk, alzheimer’s disease, worse cognitive function, depression, and more that the following meta-analyses did not cover (10.1210/jc.2011-1137, https://academic.oup.com/jcem/article/91/3/843/2843326, 10.1007/s12035-015-9315-y, 10.1097/01.pra.0000358315.88931.fc). As you can see, the more testosterone for men, the better.

One more thing before we get into all the beautiful research comes from this meta analysis which looked at over 14 thousand men (10.1371/journal.pgen.1002313), and shows that testosterone is mostly genetically determined. Which, again, is why asking how you can increase testosterone isn’t necessarily the right question and why we will present first and foremost what causes a deficiency of testosterone in this article which is Part 1 of the free pamphlet on Testosterone, and secondarily, what you can do to reclaim it or improve from there in the Part 2 article.

SEED OILS AND OTHER CHEMICALS

In case you missed the article from The Way on seed oils, read it here. Seed oils are likely the largest cause of inflammation in the American diet. And inflammation, of course causes a lot of problems. If the immune system is using a lot of your vitamin D to “put out” the fires caused by inflammation, then Vitamin D will be scarcely used to make cholesterol which in turn makes testosterone (10.3390/nu13103375).

One of the things seed oils do very well is they lower your LDL cholesterol, just ask the FDA and CDC. This study from the American Journal of Medicine states, “Total cholesterol was associated with total testosterone after controlling for age, adiposity, and the presence or absence of CAD, but not with calculated free testosterone (https://doi.org/10.1016/S0002-9343(89)80480-2).” Therefore, it seems like you could use some of your untapped testosterone if you stopped eating seed oils!

This meta-analysis has a lot of information regarding other potentially harmful aspects of our mass produced wheats and grains (10.1590/S1517-83822013005000037). A compound called ZEA (Zearalonone) is an estrogenic toxin that can irreversibly harm the male gonads. It is a toxin produced by a fungus that is more likely to grow during seasons with intense rains. You might think that this is irrelevant since cracked wheat is produced with cooking and drying so as to remove the fungus, and you’d be right in presuming that the fungus would be gone, but Zearalone is very stable at high temperatures, so if this toxin is already on the wheat, it will not be removed in the baking process.

Some studies found it to be present in 58% of cracked wheat samples in 2005 and 2006 in State of Paraná, Brazil. Another study looked at 54 lots of wheat flour and found it contaminated with ZEA, although it was a relatively low concentration and from Rio Grande so Sul, Brazil.

ZEA can also be found in corn and corn based products, Brazil in 2001 found 7.8% of 380 fresh corn samples tainted with this mycotoxin in a study while most other studies found the toxin present at around 1% or less of corn samples.

Those concentrations are only in the samples tested. There are billions of ears of corn and wheat produced each year and much of that goes into feeding livestock. The Department of Poultry Science of the University of Georgia, Athens presents, “The concern of mycotoxin ZEN (Zearalonone) in relation to livestock is vital” (10.3390/toxins12060377). This study says that ZEN (another name for ZEA) occurs “with other mycotoxins in grain and complete feed” in “relatively high” rates. Also, “the special structure of ZEN mimics the effects of estrogen…the continuous consumption of ZEN contaminated feed could lead to a detectable amount of ZEN and/or its metabolites in the blood liver, intestine content, urine, and feces."

To top off the ZEA implications, in rats, “we found that ZEA exposure can cause considerable damage to the reproductive system of rodents of all ages… the theories of oestrogen-like effects and oxidative stress damage are promising” (10.1016/j.ecoenv.2021.112457). It would be wise to either stop consuming wheat because it is bad for other reasons, or you could buy from locally sourced farms, even better, grow your own (see right)!

Pesticides often follow the mass production in the agricultural business. Pesticides do not just hurt bugs. The glyphosates used in industrial farming result in a “statistically significant decrease in testosterone and Luteinizing hormone” according to this systematic review and meta-analysis (https://doi.org/10.1007/s11356-021-16145-x).

Luteinizing hormone is produced in the pituitary gland in the brain. Does this mean that the glyphosates get to our head? It appears so. The same systematic review and meta-analysis proposes, “the close and strict monitoring of the residual glyphosate contents in drinking water, agricultural crops, and food products.” So think about getting a water distiller or a reverse osmosis water filter for your water (see right) to limit your intake of this endocrine disruptor.

What other chemicals do we see commonly? How about pyrethroids which are also insecticides. A meta-analysis found that in rats, Pyrethroid exposure affected sperm count, sperm motility, sperm morphology, testis weight, epidydimal weight, and serum testosterone level in the studies of rats. It also found that gestational and lactational exposure to pyrethroids can reduce sperm count, sperm motility, testis weight, and epidydimal weight (10.3389/fendo.2021.656106). So protect your women and your children and looking into the insecticides you normally use to seed what the active ingredient is.

That’s all that can hurt us from our environment right? No, unfortunately there is more but I would like to point out that most of this is not your fault, it’s the consequence of industrialization and lack of care for the environment by the companies who are making to look a profit… which are the same companies tell you, dear consumer, to protect the environment!

The last meta-analysis I would like to share regarding how common chemicals affect our testosterone levels is this one from Frontiers of Endocrinology (10.3389/fendo.2022.877292). This one tells about another result from increasing urban industrialization, discharging the pollutants straight into rivers, lakes, and therefore some sources of drinking water. Microcystins (MC), it claims, “are a kind of toxoid produced by freshwater cyanobacteria… Recently, with the frequent outbreaks of cyanobacteria blooms, more and more lakes are facing MC pollution… MC primarily accumulates in the liver followed by the gonads.”

Cold Showers

There is a decent amount of hype about taking cold showers to increase testosterone and to improve health in general. There aren’t many studies that fit the parameters of the question exactly, but there are some and some other interesting physiologic facts that can be put together for a supportive hypothesis.

First, according to University Hospital in Basel, Swizterland, “cold water immersion had significant and positive effects on metabolic and catabolic processes, neurotransmitters and hormones, immune parameters as well as on more global markers of health, such as sick leave and quality of life” (https://clinicaltrials.gov/ct2/show/NCT04130126).

This study (10.1177/15579883211008339) indicates that testosterone increases after cold water immersion at about 50 degrees Fahrenheit for 12min, testosterone increased and cortisol decreased. Cortisol is the stress hormone (catabolic) so it follows that testosterone would have a greater effect on the male as it is anabolic.

Another study (10.1265/jjh.46.635) found that while testosterone increased during 20min cycling, it did not notably increase during the cold water immersion right after, but most studies regarding cold water immersion are in the context of sports science and particularly, right after a bout of exercise.

That being said, directly after a bout of exercise, it is common for testosterone to drop for an hour or two, especially after cardio or HIIT workouts (https://doi.org/10.1111/sms.13999). So the fact that the above study found that testosterone increased at all after the bout of exercise does suggest that cold water immersion does help with testosterone levels.

Since I could find no study to directly answer the question of cold showers and testosterone, let’s apply physiology to try to answer this question.

Ray Peat, PhD. Makes it very clear that estrogen is an hormone that responds to and causes inflammation. So estrogen is not really a good thing for men or women (except during the proliferative phase of the woman’s cycle). What happens when you take a hot shower? You become inflamed to a certain extent. In some way its like giving yourself a fever.

What is your body’s response to inflammation? Releasing estrogen! What does estrogen do to this type of inflammation? It “promotes heat dissipation and lower body temperatures” (https://www.sciencedirect.com/science/article/pii/S1566070215300321). This review says that estrogens implement vasodilation by attaching to their receptors in the peripheral blood vessels. Also:

“Interestingly, the steady-state vasodilation at higher core temperatures was approximately 40–50% higher during exercise in the luteal phase, likely due to a peripheral effect of estradiol to promote endothelium-dependent vasodilation.”

It must be noted that this review focused mostly on how women’s bodies in particular respond to estrogen.

Estrogen, even is produced all around the body even outside of the ovaries or testes, especially in fat cells, cardiovascular tissue, and immune cells (https://doi.org/10.1152/physrev.00018.2016).

If this is the case, then it would makes sense that estrogen increases during hot showers. "During heat shock, these functions [of estrogen] appear to operate in the prevention and repair of protein damage caused by denaturation… hence the heat shock response can be considered a defense against general protein damage,” states Annual Review of Cell and Developmental Biology (https://www.annualreviews.org/doi/pdf/10.1146/annurev.cb.11.110195.002301).

Let’s put the physiologic concepts together: if estrogen is protective against physiologic “trauma,” and estrogen in made by converting testosterone by the aromatase enzyme, and estrogen increases when the body tries to diffuse heat, then testosterone probably decreases in hot showers. Cold or at least lukewarm showers seem to be the way to go.

SOFT PLASTICS, BPA, PHTHALATES, AND POLYESTERS

This is a big one because these endocrine disrupters are in so many items and places, even where you might not expect them! Dr. Paul Saladino seems to think that these microplastics which have estrogenic effects are even in most table salts! These endocrine disruptors can be found in basically anything plastic including but not limited to: “medical products, cosmetics, gelling agents, dispersants, adhesives, lubricants, emulsifying agents, and also found in many consumer goods. Therefore, they are considered as ubiquitous environmental contaminants” (https://doi.org/10.1016/j.envpol.2019.01.026).

That meta-analysis takes a unique perspective to the measurement of how much these chemicals affect us. By measuring the distance from the anus to the gonad (AGD), one can estimate the hormonal health effects of these chemicals because AGD is a marker of testosterone levels during fetal development and “may also be a marker of hormonal status, fertility, and gonadal health in adulthood."

The results of the meta-analysis regarding phthalates is that phthalates are linked with a lesser AGD in boys, so “reducing the usage of phthalates in various products, and limiting the exposure to phthalates should be emphasized, especially in the prenatal period.

Another chemical found in everyday life that may be limiting your maximum testosterone production is PFOA (perfluorooctanoic acid) which according to an Environmental Health Perspectives meta-analysis is found in “items such as Teflon nonstick coating, Gore-Tex water-repellent gear, microwave popcorn bags, carpet, and firefighting foam (https://ehp.niehs.nih.gov/doi/10.1289/ehp.121-A340).” Many rat studies have been done with PFOA and there is confirmation that it is a potent endocrine disruptor in their systems.

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There was a significant study regarding PFOA just completed by the Environmental Health Perspectives which included more than 32,000 individuals. Of those tens of thousands, 2,507 had primary cancers (mostly testicular and kidney cancers). The frequency of the cancers increased with an increase of “dose” of PFOA.

A meta-analysis of the rat studies with PFOA concluded that “Testosterone is mainly secreted by Leydig cells, and it is required to maintain spermatogenesis in mammals. The level of serum testosterone in our study decreased with the increase of exposure time and dose of PFOA (https://doi.org/10.1016/j.chemosphere.2020.128608).”

DON’T BE FAT, RATHER, EAT FAT

Fat is demonized. It is that simple. We are here to undemonized it. Fat is delicious because it absorbs a lot of nutrients. One of the reasons that most people don’t realize for why they put dressings on salads is that fats slow down the rate of your stomach emptying into your intestines, so it helps you to feel more full, but most importantly, when your body is digesting the fat and the salad together, the nutrients can diffuse into the fat which in turn helps your body to absorb them more efficiently (please, do not use dressing based in seed oils though)!

This review put together by Arne Astrup, et al. is probably all you ever need to read to understand why fats – saturated fats in particular, and nearly solely – are the most essential part of a healthy diet (10.3390/nu13103305). This review states,

“The last decade has seen nearly 20 papers reviewing the totality of the data on saturated fats and cardiovascular outcomes, which, altogether, have demonstrated a lack of rigorous evidence to support continued recommendations either to limit the consumption of saturated fatty acids or to replace them with polyunsaturated fatty acids.”

Let’s look at some support for this review other than the many studies cited within in. First, “for the hormonal system to function optimally, fat becomes an important macronutrient as it’s the backbone for steroid hormone production (10.1111/j.1753-4887.1998.tb01728.x).” This tells you that if you do not eat fats, then you cannot produce hormones. In this pamphlet we are talking specifically about testosterone which of course has already been shown to be the most important hormone in men. Again, with a lack of testosterone, men are at risk of basically any bad health outcome.

There is a slight catch, however, which is that if you are carrying too much fat, then you should try to lose it, but not necessarily by cutting fat out from your diet. You should try to lose the excess fat you have because in the European Journal of Cancer Prevention, there was a review published which outlined the “role of oestrogen in the pathogenesis of obesity, breast cancer, and prostate disease (10.1097/cej.0b013e328338f7d2).” It explained:

“This review, in collaboration with hundreds of evidence-based clinical researchers, correlates the significant interactions these hormones [“unopposed” oestrogen and leptin] exert… reveals the way that poor diet, increased stress, unopposed endogenous oestrogens, exogenous oestrogens, pesticides, xeno-oestrogens and leptin are associated with increased aromatase activity, and how its products, increased endogenous oestrogen and lowered testosterone, are associated with obesity, type 2 diabetes, Alzheimer's disease and oestrogenic disease.”

I know that’s a mouthful. Basically it is saying that because body fat stores and produces oestrogens and leptin, the more fat one has, the more at risk they are of an overproduction of oestrogen and leptin which leads to many pathological results.

The “increased aromatase activity” is referring to an increase of testosterone being converted into estrogen because aromatase is also found in fat cells, and can therefore convert your good testosterone into estrogen! Trading testosterone for estrogen is dangerous given that estrogen is nearly 100x more active in the body than testosterone (https://doi.org/10.1152/physiol.00054.2015)!"

I think this leaves us with a pretty good incentive to start working out and eating higher quality foods.

This results of this meta-analysis from The Journal of Steroid Biochemistry and Molecular biology lead them to conclude, “Low-fat diets appear to decrease testosterone levels in men, but further randomized controlled trials are needed to confirm this effect.” And an interesting aside, “Men with European ancestry may experience a greater decrease in testosterone, in response to a low-fat diet (10.1016/j.jsbmb.2021.105878).”

The best sources of saturated fat are grass-fed beef, properly fed chickens

and pork (properly meaning, not seed-based diets), and eggs. Well, if you eat a diet high in those animals then you will likely get an extra dose of cholesterol, vitamin D, and denser calories! We have often been told to be scared of at least cholesterol and calories, but do not fear those for the sake of your testosterone levels. Here is why: A systematic review and meta-analysis from Nutrition Reviews showed that,

“In normal-weight, healthy men, Calore Restriction (CR) appears to result in a decrease in testosterone concentrations, whereas in overweight or obese men, CR appears to result in an increase in testosterone concentrations… This information may then be used to help maintain testosterone concentrations, particularly as men age (https://doi.org/10.1093/nutrit/nuab072).”

Another Meta-analysis from Etiology and Pathophysiology strongly suggests that:

“Meta-analysis indicated that overweight and/or obesity categories were associated with lower sperm quality (i.e., semen volume, sperm count and concentration, sperm vitality, total motility and normal morphology), and underweight category was likewise associated with low sperm normal morphology. In conclusion, our results suggest that maintaining a healthy body weight is important for increasing sperm quality parameters and potentially male fertility.”

Again, a systematic review done concerning athletes shows that:

“The Low Fat Diet (LFD) had a small-to-moderate effect on decreasing total testosterone concentrations compared to the High fat Diet (HFD). Although evidence points to a positive effect of dietary fat on circulating testosterone concentrations, it should not be dismissed that fat is not the optimal fuel source for athletes.”

Finally, cholesterol, which is the precursor to hormones. If you look up a picture of cholesterol and then a picture of testosterone, you will understand why they are related. Cholesterol is the essential ingredient to make testosterone, and Vitamin D helps to synthesize it (10.3390/nu13103375). More on Vitamin D later, but to wrap up this section, here is a study on how cholesterol helps to increase testosterone (https://doi.org/10.1007/BF03401520).

This study saw that both the regular diet group and the ketogenic (mostly protein, usually animal protein based) diet group both had a similar increase in muscle anabolism and lean body mass and strength after 10 weeks of resistance training. The scientists suggest that the “significant” increase in testosterone in only the men who followed the ketogenic diet was due to the high increase of cholesterol due to that diet.

SLEEP WELL AND STAY HEALTHY

This rule is pretty simple. Sleeping is rest and restoration for the body and it simply makes sense for you to get enough sleep in order to keep up your testosterone production… BUT YOU’RE PROBABLY NOT DOING IT, considering that one of the highest percentages of those who do not get enough sleep in America are men (https://www.cdc.gov/sleep/data-and-statistics/adults.html). So stop yourself from chronic sleep deprivation and rest well.

Many studies are all over the place and do not provide results that are clean-cut enough to draw a good conclusion such as this one from the American Journal of Men’s Health (https://doi.org/10.1177/155798831773541) which says that there seems to be an increase in testosterone in sleep deprived (<5hrs) men. However, the results show a p value of >.25 which means the results not statistically significant. Also, the standard deviation in the study was wildly large. Other human studies have similar p values and standard deviations that say that sleep deprivation does cause decrease in testosterone. We will need meta-analyses for this topic.

This meta-analysis from the journal Sleep Medicine says, “Sleep duration plays a pivotal role in maintaining male serum levels (https://doi.org/10.1016/j.sleep.2021.10.031).” But it is interesting that this article supposes that only total sleep deprivation (so probably also chronic, or long term sleep deprivation) harms the production of testosterone. Also, this systematic review and meta-analysis regarding sleep apnea shows the same thing, which is a very high severity of sleep apnea negatively affects testosterone levels, but a low severity does not necessarily damage it (https://doi.org/10.1111/andr.13111).

These articles provide interesting insight that perhaps humans were made to handle a certain amount of disruptions in sleep schedules, but we should not let it get out of control or our testosterone levels can suffer a lot! There is also hope in these articles in my opinion, that if you do have a couple hard nights of sleep, do not sweat it. Sometimes the natural things we cannot control are just part of making you stronger and more virtuous in the long run.

This (10.5334/jcr.190) article from The Journal of Circadian Rhythm reviewed much of the existing information on sleep and sex hormones, and they found:

“In summary, research reveals that infertility across all ages is affected by the quality, timing, and duration of sleep. Human and animal models clearly show that sleep deprivation alters the level of reproductive hormones that are key players in determining the tendencies of male and female fertility. Findings from this study show that sleeplessness produces physiological alterations similar to oxidative stress which stimulates the activation of the HPA axis and inhibits the HPG axis, thereby resulting in a high level of corticosteroids in the blood. High corticosteroids are implicated in several cases of infertility in men and women. Circadian disruption induced by shift work affects reproductive health by deregulation of sex steroids, gonadotropins and prolactin production.”

Interestingly, the same study found that the consequence from sleep deprivation can even be passed on to the offspring of those conceived during their parents’ sleep deprived time of life. The problems in the offspring include alteration of the aromatase enzyme (the enzyme which involves the conversion of testosterone to estrogen), reduction in sexual motivation, and overall decrease in testosterone. These results, claim the study, are mostly a consequence of the “contemporary lifestyle.”

Interesting, in rats at least, chronic noise exposure of more than 100 decibels (dB) - which is very loud, proportionate to a busy subway or a diesel truck – during sleep leads to “a significant reduction of serum testosterone in male rodents (10.5603/EP.2015.0007).”

Ask anyone (except the hypercompetitive people) and they’ll tell you that the most fundamental aspect of a healthy life is quality sleep, so while poor sleep itself is not inherently bad for testosterone or a primary cause, it is, in fact, a secondary cause for lessening testosterone levels. A meta-analysis by Jelle J. Boonekamp, et. al. done in non-human mammals says (10.1098/rsbl.2008.0347):

“We present a meta-analysis to test for this effect [the relation of immune response to plasma testosterone levels]. Overall, there was a strong suppressive effect of experimental immune activation on testosterone levels (r=−0.52), regardless of whether live pathogens or non-pathogenic antigens were used to challenge the immune system. The latter is important because it shows that immune activation per se suppresses testosterone levels. Thus, a trade-off between immunocompetence and sexual displays may primarily be generated by the effect of immune activation on testosterone, rather than the opposite effect that has received most attention.”

To summarize, sleep well and stay healthy in order to stop losing testosterone. Testosterone makes people feel good long term, and the effects of it are cumulative. So if you are making myopic decisions that make you feel bad the next day or long term, it is time to stop and reorient your life. No more weakness, only strength.

STAY AWAY FROM SOY

What would a discussion about testosterone be without talking about soy? It only takes a keen eye to see what soy does to other people, and it takes self-awareness to see what it can do to you… so do we really need studies on it? Well, the studies can’t hurt… or can they…

There are two meta-analyses that are confident that soy and isoflavones – the biochemicals which have estrogenic effects – DO NOT have any effect on testosterone or estrogen concentrations in men (10.1016/j.fertnstert.2009.04.038, 10.1016/j.reprotox.2020.12.019). Of course, I did not believe it when I saw it. A dive into the meta-analyses which support this framework of soy and isoflavones show that the studies incorporated are mostly done with men who had history of prostate cancer.

What about the studies done in otherwise healthy people like this one (https://doi.org/10.1017/S0007114500001872) which concluded, “Serum oestradiol did not differ on the two diets, the lower testosterone:oestradiol after the tofu diet is consistent with our hypothesis that a soyabean diet may result in lower androgen activity and is likely to be related to the increase in SHBG.” They also indicate that, “The results of the present study suggest that overall androgen activity, as measured by increased SHBG and lowered testosterone:oestrogen, may be lowered by dietary isoflavones.”

Another study says more confidently, “We have shown that soya supplements reduce serum testosterone and improve markers of oxidative stress (10.1038/sj.ejcn.1601495).” Further, this study shows that soy decreased serum testosterone (although not statistically significantly) and it had other effects on the males, including a decrease in LDL cholesterol and a decrease in flow mediated vasodilation which indicates a decline of cardiovascular function (https://doi.org/10.1210/jcem.86.7.7645). Moreover, here is another study claiming that “soy powder protein decreases serum testosterone levels in healthy men,” and triggers certain estrogen receptors (10.1158/1055-9965.EPI-06-0882). And another one states, “In conclusion, we found an inverse association between consumption of soy foods and sperm concentration which was more pronounced at the higher end of the sperm concentration distribution and among overweight or obese men.”

Wait there is another study that concurs? Yes, from Oxford Academic’s Human Reproduction, which states, “an inverse association between soy food intake and sperm concentration that remained significant after accounting for age, abstinence time, body mass index, caffeine and alcohol intake and smoking (distribution and among overweight or obese men (10.1093/humrep/den243).”

So maybe soy does have an effect on healthy men. Other studies suggest that while soy does not necessarily have a pro-estrogenic effect, it is far inferior to a regular non-soy based diet (DOI:10.1038/s41598-018-29591-4). This study found, “Collectively, these data suggest 12 weeks of resistance exercise training, in general, and the combination of resistance exercise training and whey protein concentrate (WPC) supplementation, in particular, increases serum testosterone concentration in college-aged men.” The soy group in the study did not have such a significant increase. It makes sense, however, that because resistance training increases testosterone, and soy probably has a negative effect, that the soy boys in that study did not increase their testosterone as much as the whey men.

The previous study suggest a mechanism for soy diets which looks like this: dadzein + genistein (isoflavones in soy) --> bind to estrogen ligand receptors in place of estrogen on fat tissue --> adipogenesis (increase of fat cells) --> “hence, it stands to reason that soy protein supplementation may increase whole-body adiposity.” And we know now, that we should not be fat, rather eat fat, and not soy!

One soy study, concudes that a higher soy diet did not have much effect on testosterone levels in hypercholesterolemic subjects (10.1207/s15327914nc5101_1). We know, however, that cholesterol is a precursor for testosterone, so it does not surprise me that in a person with a lot of “pre-hormone” can counteract the effects of an acute decrease in a given hormone.

In addition, many studies seem to suggest that soy has anti-inflammatory effects (https://doi.org/10.1016/j.nutres.2005.12.002). To me, this suggests that if the studies are using a person on the average American diet, then they have a lot more inflammation to lose, than testosterone to lose. So there may be a façade of an increase in testosterone through the decrease of inflammation, but really the answer is not to eat soy, but to fix other parts of the diet.

Overall, these are a few ways to stop losing testosterone. Part two will show how to gain testosterone.