The shocking link between low T and COVID-19

Plus, how you can preserve your levels throughout the pandemic and beyond

I’ve been preaching about the metabolic dangers of low testosterone for years now.

And luckily, it’s one topic that men usually pay attention to—despite all the misguided controversy swirling around testosterone replacement.

But now, there’s some more urgent news about your T to discuss. And it’s something that every older man should pay close attention to… at least, as long as the COVID-19 pandemic continues.

Here’s everything you need to know…

Low T raises risk of severe COVID-19

A new study shows that men with lower testosterone levels are more likely to wind up with severe COVID-19 infections than men with higher levels.

The researchers looked at data from 84 male COVID-19 patients, hospitalized between March and May 2020. Half showed up at the hospital with severe illness, while the other half got worse after admission, typically by the second day of their stay.

Ultimately, 66 were considered severe cases—requiring supplemental oxygen, mechanical ventilation, or ICU treatment, or resulting in death. (Thirty-eight percent of these men died.) As you might expect, these men tended to be older with more comorbidities.

But here’s where things get interesting: Compared to men with milder COVID-19 cases, the men with severe illness had dramatically lower testosterone levels. (At 53 ng/dL versus 151 ng/dL—both abysmally low, but I’ll get back to that in a moment.)

This association held true throughout hospitalization, too: By the third day of infection, men with severe cases of COVID-19 had an average testosterone level of just 19 ng/dL—with levels returning to their original baseline by day 28.

More specifically, median concentrations were 65 percent lower among the men with severe COVID-19. And they dropped as much as 83 percent lower over the first week of illness, compared to men with milder cases of the virus.1

This is an especially important finding because even when men didn’t show up at the hospital severely ill, low testosterone levels were a reliable indication that they were likely to wind up with a serious infection within a matter of days.

So in addition to remaining vigilant in the age of coronavirus, this is a wake-up call to pay attention to your testosterone levels.

Especially because the number of men with low T is a rising problem. In fact, I see it more now than ever—even in younger patients—for a number of reasons. Like skyrocketing obesity rates and estrogen-mimicking environmental toxins.

But as with most public health crises, bad diet advice is probably one of the biggest factors.

Low-fat leads to low T

Fat consumption has dropped from about 45 percent of the diet back in 1965, to around 35 percent of the diet in 1991—the heyday of the low-fat craze. And mainstream health authorities still blindly favor this way of eating.

But according to a recent study, low-fat diets lead to lower testosterone levels in men (among other health concerns).

Researchers used a cross-over design to better analyze the effects of fat in the diet on testosterone levels. They had the men eat a high-fat diet and then a low-fat diet, and compared the results.

Ultimately, they found that average testosterone levels were 10 to 15 percent lower during the low-fat phase.2 But here’s the worst part: The steepest drop in testosterone levels—by a whopping 26 percent—was in men who ate a low-fat, vegetarian diet.

These diet interventions ranged from just two to 10 weeks. Meaning things went south… quickly.

Still, the study authors stated: “It is controversial, but our results also indicate that foods with saturated fatty acids may boost testosterone.” Then, they went on to warn that these foods also have links to high cholesterol. Which highlights just how preposterous mainstream medicine’s attitude about dietary fat still is.

Eat the right kinds of fat 

The bottom line is this: Saturated fats are perfectly healthy, provided they come from good sources—like organic, wild, pastured, grass-fed and -finished animal sources. But that doesn’t mean you have to go full-on paleo or keto to preserve your T.

Simply following a Mediterranean-style diet is a great way to boost your intake of fat. This diet is full of healthy, whole foods that are naturally packed with healthy fats—like monounsaturated fatty acids and polyunsaturated fats (including the omega-3s DHA and EPA)—to help lower heart disease risk, increase longevity, and boost testosterone.

Mediterranean-diet staples include healthy oils (olive oil, avocado oil, and my personal favorite, macadamia nut oil); nuts; fresh produce (like avocados and leafy greens); wild-caught fish and seafood; red meat; poultry; and eggs. And needless to say, if more men ate like this, they’d be better off for it.

Because it should be clear by now that testosterone
isn’t just for sex drive. It affects men’s physical performance and mental health, too. And low levels aren’t just linked to severe COVID-19 infection—they’re also associated with heart problems, diabetes, and Alzheimer’s.

It’s true that levels are bound to drop as you age. But the steep declines we see nowadays are a whole different ballgame.

And it’s a trend that absolutely can be reversed—not just by eating more fat, but by losing weight, too. (Overweight men are also more likely to have low T.)

Nevertheless, testosterone replacement has gotten quite a bit of flak in recent years. And as usual, I’ve often felt like the sole voice of reason in this groundswell of misguided hysteria… even as published research continues to make the vital case for treating low T.

So let’s go over a few basics…

The rules of replacement

First and foremost, ask your doctor to test your testosterone levels regularly. (I test all of my patients’ levels as a matter of routine. It really is that important.)

Just remember, the range is broad. There’s “normal,” and then there’s” optimal”.

As a rule of thumb, optimal testosterone levels are dependent on age. The younger you are, the higher it should be. Ideal T levels for a 20-year-old man (when testosterone is at its peak) are usually somewhere around 1,500 ng/dL. That would drop to 1,200 ng/dL at age 30, 1,000 ng/dL at 40, 800 ng/dL at 50, 700 ng/dL at 60,
600 ng/dL at 70, and so on.

For women (yes, women can have low testosterone, too) the range is a little less predictable. An optimal testosterone level is one where she feels her best. That could be as low as 20 ng/dL, but in my experience, it’s usually closer to 80 ng/dL.

To achieve these levels, I generally start with 1 mg/gram dosages for women and 100 mg/gram dosages for men. I also use bioidentical compounded testosterone almost exclusively.

(All of T is bioidentical, it’s just the delivery system that makes up the “patentable” part of the formulation. The difference ultimately boils down to price. If your insurance doesn’t cover testosterone replacement therapy, bioidentical compounded products will be significantly cheaper than commercial brands.)

But the most important thing to remember is that testosterone therapy should always be individualized. And since your dosage will depend on your baseline numbers and other clinical factors, you’ll need to work with a doctor who knows what he or she is doing.

If you don’t already have one, the American College for Advancement in Medicine (ACAM) is a great resource for locating a holistic practitioner in your area. All you have to do is plug your zip code into their search engine at, and their exhaustive database will do the rest of the legwork for you.


  1. Dhindsa S, et al. “Association of Circulating Sex HormonesWithInflammation and Disease Severity in Patients With COVID-19.” JAMA Netw Open. 2021 May 3;4(5):e2111398.  
  2. Whittaker J, et al. “Low-fat diets and testosterone in men: Systematic review and meta-analysis of intervention studies.”J SteroidBiochem Mol Biol. 2021 Jun;210:105878.