Important Things to Know About Over-the-Counter Testosterone Supplements

By Madelyn Heikkila, pharmacy Intern at Network Health
7/16/2024

You may have seen ads promoting over-the-counter supplements that claim to boost testosterone levels, helping you gain muscle mass or increase libido. But do these kind of supplements actually work and do you really need to increase your testosterone levels? To answer this, it’s important to understand the role testosterone plays in the body and why someone may need more testosterone.

What Is Testosterone and What Is Its Purpose?

Testosterone is the dominant natural sex hormone in males, which is essential to the development and growth of masculine features. Testosterone production and release is controlled in the body, and it plays important roles in the male body such as development of male genitalia, deepening of the voice, facial hair development, balding, muscle size and strength, bone growth and strength, sperm production and sex drive (libido). Females also have a small amount of testosterone that helps with ovarian function, bone strength and libido.

Reasons for Needing More Testosterone

As people age, levels of testosterone naturally start to decrease in the body. For males, testosterone levels gradually decrease by 1-2 percent each year.

Two common reasons for the decrease in testosterone levels include the testes producing less testosterone and an increase in sex hormone binding globulin (SHBG), which binds to testosterone circulating in the bloodstream. Both mechanisms will lead to a reduced amount of free (active) testosterone in the body.

When there is reduced free testosterone levels, males can experience the following symptoms.

• reduced body and facial hair
• loss of muscle mass
• low libido, irritability
• depression
• brittle bones

Females can also be affected by low testosterone levels resulting in low libido, reduced bone strength, poor concentration or depression.

Testosterone replacement therapy (TRT) is approved by the Food and Drug Administration (FDA) for the use of delayed puberty and hypogonadism, a condition where the body does not produce enough testosterone. TRT for these purposes places testosterone into the body and eliminate the side effects experienced with testosterone deficiency.

Additionally, there is an off-label use for TRT in hormone therapy for transgender men (assigned female at birth). When TRT is used for hormone therapy, it will lead to elevated serum testosterone levels to the normal male range, cessation of menstruation, decreased fat mass and fertility, deepening of the voice, increased acne, body and facial hair, muscle mass, sexual desire and male pattern baldness (in those genetically predisposed).

Over-the-Counter Testosterone Supplements/Boosters

There are numerous testosterone supplements and boosters that are available over the counter (OTC). In this article, Nugenix® and Testogen® were analyzed.

Nugenix® is one of the many testosterone supplements available OTC that comes as either Nugenix® Free T or Nugenix® Total-T. Nugenix® Free T’s ingredients include Testofen® which contains Fenuside from Fenugreek, zinc, vitamin B12 and vitamin B6. Nugenix® Free T’s main ingredient, Testofen®, works by helping the body restore healthy levels of free testosterone. On the other hand, Nugenix® Total-T is comprised of vitamin B6, vitamin B12, zinc, L-citrulline malate, Tesnor, elevATP blend (ancient peat extract and apple fruit extract), Eurycoma longifolia extract and boron. Nugenix® Total-T boosts total testosterone to help maximize strength, muscle, energy, endurance and libido.

Testogen®, another testosterone supplement, contains a separate set of ingredients compared to the Nugenix® supplements. Testogen® is made up of D-aspartic acid, zinc, vitamin D3, vitamin K1, fenugreek, Korean red ginseng extract, boron, nettle leaf extract, magnesium, vitamin B6 and bioperine 95% piperine. D-aspartic acid in Testogen® aids in increasing the production of luteinizing hormone to signal to the testes that more testosterone needs to be produced and released. Additionally, D-aspartic acid helps to decrease SHBG, which will increase free testosterone levels. Lastly, Testogen® slows the conversion of testosterone to estrogen, allowing for more testosterone to be available in the body.

Both Nugenix® and Testogen® claim to have no side effects associated with their use. However, every individual can react to supplements differently, so there is always a potential for side effects with use.

So, What is the Difference Between Nugenix® and Testogen®?

The main differences between Nugenix® and Testogen® include their ingredients and how they work in the body. When comparing the two supplement brands, the main ingredient difference is D-aspartic acid in Testogen®, among other differing ingredients. Also, as mentioned above, each supplement works slightly different based on the ingredients.

What is the Difference Between OTC Testosterone Supplements and Prescribed Testosterone?

The main differences between OTC testosterone supplements and prescribed testosterone are their ingredients, how they work in the body and how they can be acquired.

OTC testosterone supplements consist of various vitamins and herbs, as listed in the ingredients for each product above. In contrast, testosterone replacement therapies consist of testosterone, the steroid. Therefore, neither of the OTC supplements we looked at contain steroid-based ingredients. Based on the different ingredients, the supplements and testosterone therapies will work differently in the body.

Lastly, testosterone supplements can be bought OTC at a local pharmacy, grocery store or online, whereas testosterone therapies require a prescription written by a provider who is authorized to prescribe testosterone.

It is important to remember that OTC supplements are not regulated by the FDA. The FDA requires the manufacturer to comply with safety standards, labeling requirements and current good manufacturing regulations, but there are no regulations that limit the serving size of a dietary supplement or the ingredient in a serving of the supplement. The FDA states, “Unlike drugs, supplements are not intended to treat, diagnose, prevent or cure diseases.” Both Nugenix® and Testogen® are manufactured under the FDA’s guidelines for good manufacturing practices, but this does not ensure safety or effectiveness of the supplement, or the actual allotted amounts of each ingredient in the product as listed on the label.

Evaluating the Effectiveness of Testosterone Supplements

A 2020 review conducted by the World Journal of Men’s Health analyzed 50 “T Booster” supplements based on their active ingredients and product claims. The authors of the review concluded that 90 percent of “T Booster” supplements claimed to boost testosterone, yet only 24.8 percent of these supplements had data to support their claims. Additionally, it was found that 10.1 percent of the “T Booster” supplements contained ingredients that had a negative effect on testosterone. Many supplements also contained ingredients in higher doses than suggested based on the upper tolerable intake level.

There are no specific trials or data related to the use of Nugenix® or Testogen®. The Testogen® website lists several clinical references to support claims related to each ingredient and how it will benefit the user.

If testosterone supplementation is needed, it is recommended to contact your personal doctor who will test your testosterone levels to evaluate if they are low. Testosterone prescription therapy is FDA-approved and has been shown to directly increase testosterone levels in male patients with low testosterone levels.

Why Would Someone Use Testosterone Supplements? When or Why Should They Not Be Used?

There are many reasons why individuals may choose to take supplements. Testosterone supplements such as Nugenix® or Testogen® may be used by males who are looking to increase muscle mass or libido. Other ingredients contained in these products can also have effects on energy, mood, performance and other characteristics to improve quality of life. Additionally, some individuals may prefer a more “natural” option for therapy which could lead to supplement use.

If true testosterone supplementation is needed based on a clinical diagnosis, the use of supplements should be discussed with your personal doctor. It is important to always discuss the use of supplements with your personal doctor prior to initiation of therapy to know about the supplement’s effectiveness, pros and cons, and if it will work for you and your health. It is also important to consult with your pharmacist on the use of a supplement to ensure it will not interact with any current medications.

Alternative Options to Achieve the Desired Impact

It is important to remember ways to help achieve the desired impact without medication or trying supplements. A combination of aerobic exercise and resistance training can increase the production of testosterone, while also helping to manage or prevent other health conditions.

Foods in the diet can help or worsen testosterone levels as well. Foods to avoid include excessive alcohol consumption (more than two drinks per day for men and one drink per day for women), excessive sugar, excessive caffeine, red meat and other sources of animal fat, and processed foods. Foods to help boost testosterone include salmon, tuna, lean beef, chicken, fish, eggs, oysters, shrimp, pumpkin seeds, spinach, almonds, cashews, peanuts, onions, garlic, and multicolored fruits and vegetables. Avoiding tobacco products can also help with testosterone levels.

Sleep is another critical component to testosterone production, as most of the testosterone in the body is produced while we are in rapid eye movement (REM) sleep. An adequate amount of sleep will lead to a greater outcome on testosterone levels.

Lastly, stress management is also important in testosterone production. If stress is high, cortisol levels become high leading to a greater fat deposition and increased conversion of testosterone to estrogen. Therefore, if stress can be managed, there will be less conversion of testosterone to estrogen, leading to greater testosterone available.