Keto and Low Testosterone: How Keto Diets and Testosterone Work Together

A keto or ketogenic diet is a low-carb, moderate protein, higher-fat diet and a good tool for those on testosterone replacement therapy (TRT) when trying to lose or manage weight. According to research, ketogenic diets only indirectly impact testosterone but it’s clear that a fat first diet can help men on TRT feel great because keto involves good cholesterol, weight loss, and inflammation reduction.

When on a low carb diet, the body uses fat rather than carbohydrates at its main source for energy. The liver breaks down fatty acids into ketones, which are essentially the fatty version of energy.

  • Carbs provide glucose to fuel the body and brain.
  • Fat provides ketones to fuel the body and brain in absence of glucose.

Keto or low carb diets have become popular in recent years among doctors because they have seen patients come off insulin and reverse diabetes, correct their hypertension and most importantly, reduce inflammation and chronic pain, improve cognitive scores, and correct their HDL/LDL cholesterol scores.

At first thought, people might think that eating fatty foods might increases “bad” cholesterol levels and clogs your arteries, but that’s simply not the case. With the amount of good and bad cholesterol produced within the liver, the body’s natural response is to flush out bad LDL as more good HDL enters the bloodstream *(there are many complexities to this topic, but that is the gist. Call us if you would like to discuss further).

Let’s consider diabetes for a second, if the body has too much glucose in the bloodstream, overtime the body can’t convert the overload into energy as glucose production overpowers insulin production. While some body’s may not have the ability to convert fat into keto in the same fashion, research shows that a majority of body’s do react positively to keto.

Some may find it tough to manage keto as a lifestyle, day-to-day diet, but keto is for sure a great tool for dropping weight and keeping it off. If you can’t fathom low carbs in your daily life, perhaps committing to keto for 1-2 months would be a good place to start. This should help with common keto side effects when the body rapidly drops weight. Commonly called keto flu, dropping weight naturally leads dizziness, headaches, irritability and sometimes insomnia. These symptoms are caused by glycogen loss, low insulin levels, dehydration, and poor metabolic flexibility.

Chronic low carb/high fat diets may lead to a release of toxic lipophile fats throughout the body but proper management and adjusting fat-to-carb ratios will combat any risks.

Keto flu, like any other diet, can be managed by drinking plenty of electrolytes like waters high in PH.

It may take a few weeks for the body to respond to ketones for fuel, but once it does you’ve entered full keto-adaptation.

Your body’s hormone-producing glands use cholesterol to make hormones such as estrogen, testosterone, and cortisol.


Jessica Zimmer PA-C Dr. Valentine Rise Mens Health telehealth provider for Texas Testosterone replacement therapy online Keto and low testosterone treatment

How does cholesterol produce testosterone?

Cholesterol is an essential chemical that helps the body run. The body produces cholesterol cells all throughout body and uses them for critical bodily functions.

  • Cholesterol is needed to make testosterone, estrogen, cortisol, and many other hormones that the body uses to digest food and keep the pipes greased.
  • Cholesterol help at a granular level helping to maintain cell structure and fluidity.
  • The liver converts cholesterol into bile acids, which helps process fat and absorb important vitamins like A, D, E and K.

The creation of testosterone begins in the testicles and cholesterol is the fuel that produces it. Through a series of brain signals that release stimulating hormones (LH and FSH), the Leydig cells in the testicles convert cholesterol into testosterone. Leydig cells get most of what they need to produce T by simply absorbing the cholesterol floating through the bloodstream.

Enter Low Testosterone (hypogonadism). As men age the Leydig cells stop converting properly leading to a decrease in testosterone production. Many medical researchers believe the Leydig cells stop converting due to an imbalance or changes to chemical reactions within cells. These changes lead to DNA, protein, or lipid damage which in turn creates functional changes.

While on TRT, adopting a keto or hybrid keto diet can improve overall experience by stabilizing the body’s BMI thus improving any athletic performance goals (walking or running, lifting, skiing or boating). A low carb diet can also indirectly improve TRT by reducing any potential side effects from other ailments like prediabetes, high blood pressure, or high cholesterol.

Reference, Reference

Is a ketogenic diet safe for the heart?

A proper ketogenic diet for nutritional purposes is safe and researchers have confirmed that dietary cholesterol does not raise blood cholesterol nor clog arteries. If you have been diagnosed with high cholesterol, it’s typically a concern around elevated LDL or bad cholesterol. Some studies have found that keto does not impact statins or other mediations.

It’s generally okay to elevate your total cholesterol (HDL and LDL) while on keto, but small changes to the overall keto plan should help reduce LDL and promote HDL. Here are a few tips on how to alter your LDL intake on keto:

  • Use intermittent fasting – studies have shown that skipping breakfast and using the standard 16/8 IF method works well to reduce LDL (16 hours fasting, 8 hours eating).
  • Reducing saturated fat – eliminating excess saturated fat can normalize LDL levels. Most people limit their saturated fatty foods to cheese, beef and eggs to keep things simple.
  • Switch from saturated fats to unsaturated fats – more fish, avocadoes, olive oil and less butter, cheese, and beef.
  • Fiber is your friend – Fiber rich foods like avocados, greens, and nuts can help “grab” onto necessary nutrients and flush out unwanted LDL.


How does a keto diet help with blood sugar and cortisol levels?

A ketogenic diet may help some people with type 2 diabetes or blood sugar issues because it allows the body to maintain glucose levels at a low but manageable level.

A low carb diet may help eliminate large spikes in blood sugar, reducing the need for insulin allowing the body to “reset.”

High blood sugar (glucose) leads to chronic inflammation due to elevated stress on the body.

There is a physiological link between stress and testosterone. This link is another hormone called cortisol. As cortisol levels increase, testosterone levels decrease. High glucose and cortisol levels inflame the organs, which can lead to cardiovascular, kidney, and periodontal (gum) diseases.

A low carb keto diet can reduce the physical and emotional stress that occurs from blood sugar spikes and dips. As for testosterone, normalizing blood sugar allows for less cortisol to be released taking the stress off your adrenal glands, so they can function properly and produce testosterone.

In short, less sugar in your diet means less cortisol is being produced which in turn allows your body to produce more testosterone. So, low carb diets are great for your testosterone levels.

Reference, Reference, Reference

Can keto help reverse fatty liver disease?

One common concern people raise against keto has a focus on the amount of fatty acids keto sends through the liver, which is warranted as nonalcoholic, fatty liver disease (NAFLD) impacts close to 100 million Americans.

However, eating a high-fat, low carb diet has shown to reverse fatty liver disease. As the body switches to ketosis, the body transitions from burning glycogen (sugar and carb-based energy) to burning fat (ketones) naturally reducing the volume of fatty acids. It’s important to note that you should consult with your provider before starting keto if you suffer from liver disease.

With low testosterone’s strong connection to inflammation (visceral adipose tissue) and insulin resistance many researchers have found that normalizing testosterone through testosterone replacement will help balance metabolism disorders and liver function. Observation studies have confirmed that androgen (T) clearly impacts liver function and that low T is more prevalent in men with NAFLD.

Reference, Reference, Reference, Reference

The original ketogenic diet was designed in 1923 by Dr. Russell Wilder at the Mayo Clinic for the treatment of epilepsy. All keto diets are a variation of classic keto, which is the most strict, seen by it’s ratio of fat to protein and carbs, also called the macronutrient ratio.

What’s the most important thing to do to reach ketosis?

It’s important to eat low carb foods like meat, fish, eggs, vegetables and natural fats like butter or olive oil.

  • Unprocessed meats are important because they are generally low carb and nutrient rich. Organic and grass-fed meat are healthier than most alternative options.
    • Beyond Meat or Impossible Burgers are a good alternative to meat and taste great. They actually taste exactly like real meat and are very low in carbs.
  • Fish and seafood are all keto approved, especially fatty fish like salmon or fish like tuna, sardines, mackerel and herring.
  • Many people eat eggs. Eggs are versatile in that you can boil, fry them in butter, scramble or make an omelet.
  • Vegetables are the most important part of the keto journey because they are fiber rich and you can eat as many as you want. Vegetables should grow above ground like leafy and green veggies or cauliflower, cabbage, avocado, broccoli and zucchini.
    • Above-ground vegetables are generally lower in carbs while below-ground or root vegetables have more carbs like starchy potatoes and sweet potatoes. Fresh or frozen veggies are fine. Frozen is generally easier and faster to cook if you’re short on time.
  • Using high fat sauces for cooking is encouraged. Oils like olive oil or coconut oil are healthier options. Feel free to add plenty of olive oil to salads or light butter to vegetables. You can also eat delicious high-fat sauces like vinaigrette or garlic butter.
  • Butter is good and high in fat dairy. Other options like high fat cheese are fine, but avoid milk due to the amount of sugar per serving.
    • Butter is good for cooking and you will reach your fat intake much faster by adding butter, but do keep in mind that clean keto is more effective than its dirty version. You will feel better restricting your butter and dairy consumption.
  • Nuts like cashews are relatively high carbs so people commonly go for macadamia or pecan nuts.
  • Berries are fine in moderation but should not be a mainstay in your diet.

What are the negative effects of a keto diet?

During the keto adaption period, as the body switches metabolism from burning carbs to fat and ketones, some side effects as your body gets used to its new fuel.

Symptoms like headache, tiredness, muscle fatigue, cramping, and heart palpitations can occur.

These side effects are short-term and manageable by staying hydrated and consuming enough electrolytes. If you feel like a carb adjustment is necessary to feel more comfortable, we definitely encourage that. Being comfortable and happy with your diet will help you stick with it over a longer time frame. Increasing carbs from 5-10% to 10-20% will not impact ketosis and testosterone in the long run. If symptoms worsen to moderate or severe, please dial 911 immediately.

It’s important to stop sugar and starches altogether. While much of the initial rapid weight loss is water weight and swelling, it’s the most important step and that is simply starting.

Can endurance athletes do the keto diet?

Most people stray away from keto thinking that a high protein, high carb diet is the only way to train at a high-level. These high carb thoughts were challenged in an interesting study published in 2018, where a group of ultra-endurance athletes used a keto diet for over a year. Runners showed promising results on keto’s functionality in amateur and professional activities. Performance and nutritional profiles were not impacted. Lipid (fat transporters) actually improved showing that the body uses fat ketone energy to fuel high intensity training in the same manner as it does with carbs and glucose.

Medically peer reviewed by Dr. Kenneth LeCroy, MD. Written by Our Editorial Team.

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