Regulating Male Hormone Balance: Which Hormones Truly Influence Men's Health

Hormones control almost all major body functions. They influence energy, sleep, metabolism, libido, muscle building, mood, stress response, fertility, weight, the cardiovascular system, and recovery (Badiu, 2019). When talking about the male hormone balance, many people first think of testosterone. For men, testosterone is indeed one of the most important hormones, but it is only part of a much larger system (Society, 2022).

The male hormone balance consists of a finely tuned interplay between the brain, pituitary gland, testes, thyroid gland, adrenal glands, pancreas, adipose tissue, liver, intestines, and sleep-wake rhythm (O’Donnell & Smith, 2026; Badiu, 2019). Even small changes in one area can affect other hormonal axes. That is exactly why symptoms such as fatigue, loss of libido, weight gain, sleep disorders, concentration problems, or mood swings should not be viewed in isolation.

The following article explains which hormones are particularly relevant for men, how they work together, what symptoms can occur with hormonal dysregulation, and what a medically sound diagnosis looks like. The goal is not to treat individual lab values prematurely, but to understand the hormone balance in its overall context.

 

The most important things in brief

Hormones are messengers that carry information between organs, tissues, and cells. They regulate, among other things, metabolism, energy balance, reproduction, growth, stress response, and sleep. The endocrine system includes, among other things, the hypothalamus, pituitary gland, thyroid gland, adrenal glands, pancreas, and testes. 

In men, testosterone, LH, FSH, SHBG, estradiol, cortisol, insulin, thyroid hormones, growth hormone, prolactin, melatonin, leptin, and ghrelin play a particularly important role.

A hormonal imbalance can manifest non-specifically. Common signs are persistent fatigue, loss of libido, erectile dysfunction, weight gain, reduced exercise tolerance, sleep problems, depressive mood, irritability, or concentration difficulties.

The diagnosis of testosterone deficiency should not be based on a single lab value alone. Guidelines recommend the combination of appropriate symptoms and repeatedly clearly low testosterone levels (Bhasin et al., 2018).

Lifestyle factors such as sleep, strength training, body fat percentage, diet, alcohol, stress, and metabolic health can influence the hormone balance. However, they are no substitute for medical evaluation if there are significant symptoms or abnormal lab values.

What is meant by the hormone balance?

The hormone balance refers to the interplay between all hormone-producing organs and the hormones they secrete. Hormones act as messengers. They are released into the blood, reach target organs, and trigger specific reactions there. In this way, the body can, for example, regulate blood sugar, manage stress, adjust body temperature, initiate sleep, or control reproductive functions.

It is important: hormones rarely act in isolation. Testosterone influences muscle mass, libido, blood formation, and bone metabolism. At the same time, however, testosterone itself depends on sleep, energy availability, thyroid function, stress hormones, body fat, and signals from the brain. A striking value is therefore often only an indication of a larger regulatory disorder.

The most important hormonal axes in men

The male hormone balance is controlled via several axes. Particularly relevant are:

Hypothalamus-pituitary-gonadal axis (HPG axis)

This axis regulates testicular function. The hypothalamus secretes GnRH. This signal stimulates the pituitary gland to secrete LH and FSH. LH stimulates testosterone production in the so-called Leydig cells of the testes. FSH is important together with testosterone for sperm formation (O’Donnell et al., 2011). The testes produce androgens and sperm in men, with LH being relevant primarily for androgen production and FSH for optimal spermatogenesis (O’Donnell & Smith, 2026).

Hypothalamus-pituitary-thyroid axis (HPT axis)

This axis regulates energy metabolism. Via TRH and TSH, the thyroid gland is stimulated to produce T4 and T3. Thyroid hormones influence heart rate, body temperature, energy expenditure, intestinal activity, mood, and performance (Mullur et al., 2014).

Hypothalamus-pituitary-adrenal axis (HPA axis)

This axis controls the stress response. Under stress, cortisol is released. In the short term, cortisol is vital, as it provides energy, regulates inflammatory reactions, and stabilizes the circulation (Lightman et al., 2020). However, chronically elevated cortisol levels can adversely affect sleep, blood sugar, body fat distribution, the immune system, and sex hormones.

Pancreas and metabolic hormones

The pancreas produces, among other things, insulin and glucagon. These hormones control blood sugar (Saltiel & Kahn, 2001). Insulin resistance, obesity, and type 2 diabetes are often closely interrelated with testosterone deficiency and low SHBG levels (Grossmann, 2011; Souteiro et al., 2018).

Adipose tissue as a hormone-active organ

Adipose tissue is not only an energy store but is also hormonally active (Kershaw & Flier, 2004). It produces, among other things, leptin and pro-inflammatory messengers and influences aromatase activity. Aromatase converts testosterone into estradiol (Simpson, 2003). Visceral abdominal fat, in particular, can thereby alter the balance between androgens and estrogens.

Testosterone: The central male hormone

Testosterone is the most important androgen in men. Androgens are male sex hormones that influence, among other things, the development of male sex characteristics, libido, muscle mass, body hair, sperm formation, and certain metabolic processes. Testosterone is predominantly produced in the Leydig cells of the testes, and to a lesser extent in the adrenal cortex. Production is controlled by LH (Winters & University of Louisville, 2026). 

In addition to testosterone, dihydrotestosterone, or DHT, androstendione, dehydroepiandrosterone, or DHEA, and DHEA sulfate, or DHEA-S, are among the most important androgens in men. Testosterone is important for:

• Muscle mass and strength

• Libido and sexual function

• Erectile function

• Sperm formation

• Bone stability

• Blood formation

• Energy and drive

• Mood and motivation

• Body hair and male sex characteristics

• Fat distribution and metabolism

Testosterone exists in the blood in various forms. A large part is bound to SHBG, another part to albumin. Only a small proportion circulates freely. For biological effects, free testosterone and albumin-bound testosterone are particularly relevant. Free testosterone and albumin-bound testosterone are together referred to as bioavailable testosterone, as they are directly or easily solubly available to the body for biological effects (Vermeulen et al., 1999). Therefore, in many cases, it is not enough to consider only total testosterone.

When is it referred to as testosterone deficiency?

A testosterone deficiency, medically hypogonadism, is not present simply when a single lab value is low. The deciding factor is the combination of typical symptoms and repeatedly low testosterone levels. The Endocrine Society recommends the diagnosis only in men with appropriate symptoms and clearly as well as consistently low testosterone concentrations. Confirmation should be carried out by a repeated measurement (Bhasin et al., 2018).

Typical symptoms of testosterone deficiency can include:

• Loss of libido

• Erectile dysfunction

• Morning erections are decreasing

• Fatigue and lack of motivation

• Reduced muscle strength

• Increase in belly fat

• Depressive mood

• Irritability

• Concentration problems

• Reduced resilience

• Decrease in bone density

• Anemia

It is important: These symptoms are not specific. They can also be caused by sleep deprivation, depression, thyroid disorders, obesity, medications, chronic illnesses, or stress. That is why a clear medical assessment is always crucial (Khera et al., 2016).

An overview of the most important hormones

The following hormones are particularly relevant in men:

LH and FSH: The control hormones of the testes

LH stands for luteinizing hormone, FSH for follicle-stimulating hormone. Both are produced in the pituitary gland and control important functions of the testes.

LH and FSH help to assess the cause of a testosterone deficiency.

In the case of low testosterone and elevated LH, this is more likely to be a primary disorder of testicular function. The pituitary gland then tries to stimulate the testes more strongly, but testosterone production remains insufficient.

In the case of low testosterone and low or normal LH, a secondary or functional disorder is more likely. Then the signal from the hypothalamus or pituitary gland does not reach sufficiently. This can occur, among other things, in cases of obesity, chronic stress, sleep deprivation, certain medications, severe illnesses, or pituitary disorders (Bhasin et al., 2018).

FSH is particularly relevant for sperm production. Abnormal FSH may indicate impaired spermatogenesis (EAU Guidelines Sexual and Reproductive Health, 2026).

SHBG: Why total testosterone alone is often not enough

SHBG stands for sex hormone-binding globulin. It is not a hormone in the true sense, but a transport protein that binds sex hormones such as testosterone and estradiol in the blood and influences their availability.

If SHBG is high, total testosterone may appear normal even though less free testosterone is available. If SHBG is low, total testosterone may appear lower while free testosterone is still within the normal range (Souteiro et al., 2018).

SHBG is influenced by, among other things, by:

• Age

• Thyroid function

• Liver function

• Insulin resistance

• Obesity

• Medications

• Inflammation

• Nutritional status

Therefore, when investigating a possible testosterone deficiency, in addition to total testosterone, SHBG, albumin and calculated free testosterone should also be considered (Stellato et al., 2000).

Estradiol in men: Not just a female hormone

Estradiol is often referred to as a female sex hormone. In addition to estradiol, there are two other estrogens, estrone and estriol. In men, estradiol is generally the most biologically relevant estrogen, while estrone may play a role primarily as another marker of estrogen metabolism, and estriol is usually of minor importance outside of specific contexts. In fact, estradiol is also important in men (Ramasamy et al., 2016). Some of the testosterone is converted into estradiol by the enzyme aromatase. This process takes place, among other things, in adipose tissue.

Estradiol is relevant in men for:

• Bone metabolism (Finkelstein et al., 2016)

• Libido

• Joint health

• Mood

• Fat distribution

• Vascular function

Interestingly: According to current understanding, estradiol can also play a very important role in male sexual function and may even be more relevant in certain areas than testosterone alone (Finkelstein et al., 2013).

Estradiol levels that are too low can be problematic, as can significantly elevated levels. In men with a high body fat percentage, aromatase activity may be increased, causing more testosterone to be converted into estradiol. However, this does not automatically mean that estradiol should always be reduced. Laboratory values, symptoms, and medical assessment are crucial.

DHT: The potent androgen

Dihydrotestosterone, or DHT, is produced from testosterone by the enzyme 5-alpha reductase. DHT has approximately a 2- to 5-fold higher affinity for the androgen receptor compared to testosterone and therefore has a stronger androgenic effect (McEwan & Brinkmann, 2021; Purushottamachar & Njar, 2012). 

It plays a role, among other things, in:

• Pubertal development

• Beard growth

• Body hair

• Prostate growth

• Sebaceous gland activity

• Androgenetic hair loss

DHT is not necessarily bad. It is a physiologically important androgen. It can become problematic when genetic sensitivity of the hair follicles, prostate problems, or certain dermatological issues are also present.

Cortisol: A stress hormone with a major impact

Cortisol is produced in the adrenal cortex and normally follows a daily rhythm. It is higher in the morning and lower in the evening (Lightman et al., 2020; Yamanaka et al., 2018). It helps the body provide energy, stabilize blood pressure, and regulate inflammatory reactions. Cortisol release is controlled, among other things, by ACTH, the adrenocorticotropic hormone, from the pituitary gland. It stimulates the adrenal cortex to produce and release cortisol.

Chronic stress, sleep deprivation, shift work, psychological stress, and overtraining can disrupt cortisol regulation. A persistently unfavorable cortisol profile can affect blood sugar, fat distribution, sleep quality, the immune system, and sex hormones (Azmi et al., 2021).

Typical signs of a disrupted stress axis can include:

• Sleep problems

• Inner restlessness

• Exhaustion

• Cravings

• Increase in belly fat

• Performance decline

• Irritability

• Reduced recovery

Cortisol, however, should not be interpreted too hastily. Individual values depend heavily on the time of day, sleep, stress, infections, and the measurement method.

Insulin: A metabolic hormone that affects testosterone

Insulin regulates blood sugar and enables the uptake of glucose into cells. When cells respond poorly to insulin, this is known as insulin resistance. This is closely linked to obesity, visceral fat, fatty liver, lack of exercise, and type 2 diabetes.

For men, insulin resistance is particularly relevant hormonally because it can be associated with lower SHBG levels, altered testosterone metabolism, and an increased risk of functional hypogonadism (Dhindsa et al., 2004).

Conversely, low testosterone levels can promote body fat accumulation and metabolic deterioration (Stanworth & Jones, 2008).

Therefore, metabolic values are often part of a sensible diagnostic assessment for hormonal complaints.

Thyroid hormones: TSH, fT3, and fT4

The thyroid gland affects almost every organ system. Its most important laboratory parameters are TSH, fT3 and fT4. TSH stands for Thyroid-Stimulating Hormone and is produced in the pituitary gland. It controls the thyroid gland. T4, or thyroxine, is the most abundant thyroid hormone in the blood and serves primarily as a precursor. T3, or triiodothyronine, is the biologically more active form and is largely produced by the conversion of T4 in the tissues. The free fractions, namely fT3 and fT4, are particularly relevant because they are not bound to transport proteins.

Its hormones control the basal metabolic rate, heat production, heart rate, intestinal activity, concentration, and energy. Both hypothyroidism and hyperthyroidism can cause symptoms that resemble testosterone deficiency.

Possible symptoms of hypothyroidism (Chaker et al., 2017):

• Fatigue

• Sensitivity to cold

• Weight gain

• Constipation

• Depressive mood

• Dry skin

• Low pulse

• Concentration problems

Possible symptoms of hyperthyroidism (Lee & Pearce, 2023):

• Restlessness

• Weight loss

• Racing heart

• Sweating

• Sleep disturbances

• Tremor

• Nervousness

• Diarrhea

Since thyroid disorders can affect libido, energy, mood, and body weight, they should be considered in cases of unclear hormonal symptoms.

Prolactin: When a regulatory hormone is too high

Prolactin is primarily known for its role in milk production, but it is also found in men. It can be described as a regulatory hormone because it not only has an effect on the body itself, but can also influence the overall hormonal regulation of the sex axis, particularly by inhibiting the release of GnRH in the hypothalamus. Elevated prolactin can inhibit the hypothalamus-pituitary-gonadal axis and thus impair testosterone production, libido, and erectile function (Dabbous & Atkin, 2017).

Possible causes of elevated prolactin include:

• Stress

• Sleep deprivation

• Certain medications

• Hypothyroidism

• Pituitary adenomas

• Renal dysfunction

• Intense physical exertion

In cases of low testosterone with low or normal LH, prolactin may be an important additional parameter (Gill-Sharma, 2008).

Growth hormone and IGF 1

Growth hormone is produced in the pituitary gland and is primarily released at night during deep sleep. It stimulates, among other things, the production of IGF-1 in the liver (Van Cauter & Plat, 1996). This axis is important for body composition, regeneration, bones, fat metabolism, and muscle tissue.

Sleep deprivation, advanced age, visceral fat, and chronic diseases can affect this axis (Chennaoui et al., 2019). However, growth hormone should not be understood as a lifestyle hormone. Medical therapy is only useful with a clear indication.

Melatonin: Sleep hormone and pacemaker

Melatonin is released in the dark and signals the body that it is night (Brzezinski, 1997). It is closely linked to the circadian rhythm. Light in the evening, especially bright screen light, late meals, shift work, and irregular sleep times can disrupt melatonin rhythmicity (West et al., 2010).

Since testosterone production, growth hormone release, and cortisol rhythm are closely linked to sleep, melatonin is also indirectly relevant for male hormones. Those who sleep poorly on a regular basis should consider not only stress, but also a disrupted biological rhythm.

Leptin and Ghrelin: Hunger, Satiety, and Body Fat

Leptin is primarily produced in adipose tissue and signals to the brain how well the energy stores are filled. Ghrelin is primarily produced in the stomach and increases hunger. Sleep deprivation and stress can disrupt this system. Many men then notice increased hunger, stronger cravings for high-calorie foods, and poorer satiety (Spiegel et al., 2004).

These hormones are relevant for men because weight gain, visceral fat, and insulin resistance can in turn affect testosterone, SHBG, and estradiol (Taheri et al., 2004).

Aldosterone, ADH, and Parathyroid Hormone: Often Overlooked, but Important

Not all hormones are directly related to libido, energy, or muscle mass. Some regulate fluid balance, blood pressure, and mineral metabolism. 

Aldosterone is produced in the adrenal gland and affects, among other things, sodium, potassium, and blood pressure (Physiology, Aldosterone, 2026).

ADH regulates water balance and urine concentration.

Parathyroid hormone, together with vitamin D and calcium, controls bone metabolism (Khundmiri et al., 2016; Dawson-Hughes et al., 1997).

These systems can also indirectly affect performance, the cardiovascular system, and overall health.

 

Typical Symptoms of Hormonal Imbalance in Men

A hormonal imbalance can look very different. Common symptoms include:

• Chronic fatigue

• Loss of libido

• Erectile dysfunction

• Fewer morning erections

• Sleep disturbances

• Weight gain, especially around the abdomen

• Muscle loss or reduced strength

• Mood swings

• Irritability

• Depressive mood

• Concentration problems

• Reduced stress resistance

• Sweating or chills

• Racing heart

• Skin changes

• Hair loss

• Breast tissue swelling

• Infertility

Important: These symptoms do not prove a hormonal disorder. They are clues that should be evaluated by a doctor.

You can find out more about the connection between testosterone, libido, and sexual function in our article "Potency, Libido, Testosterone: How to Keep Your Sexual Health Stable".

Causes of Hormonal Dysregulation in Men

Hormonal changes rarely occur without context. Common influencing factors include:

• Sleep deprivation

• Chronic stress

• Overweight, especially visceral fat

• Insulin resistance

• Type 2 diabetes

• Alcohol consumption

• Nicotine

• Lack of exercise

• Overtraining

• Crash diets

• Very low energy intake

• Chronic inflammation

• Medications

• Thyroid disorders

• Liver or kidney diseases

• Pituitary disorders

• Testicular dysfunction

• Aging processes

• Shift work

• Obstructive sleep apnea

It is particularly important to distinguish between primary, secondary, and functional hypogonadism. In functional forms, the hormonal axis may be impaired by lifestyle, weight, sleep, or chronic diseases without permanent structural damage to the testes or pituitary gland.

Diagnostics: Which laboratory values are useful?

In men suspected of having hormonal dysregulation, diagnostics should be targeted. An isolated single value is rarely sufficient.

The basic parameters for suspected testosterone deficiency include:

• Total testosterone

• Free testosterone or calculated free testosterone

• SHBG

• Albumin

• LH

• FSH

• PSA depending on age and context

• Complete blood count for existing or planned testosterone therapy

Depending on the symptoms, the following may also be useful:

• TSH

• fT3

• fT4

• Prolactin

• Estradiol

• DHT in selected cases

• Fasting glucose

• HbA1c

• Insulin

• Lipid profile

• Liver values

• Kidney values

• Ferritin

• Vitamin D

• Cortisol in selected cases

• IGF 1 in cases of specific suspicion

• For fertility issues, additionally semen analysis

The EAU (European Association of Urology) guidelines address male hypogonadism in the context of the sexual and reproductive health of adult men and emphasize the medical classification of diagnostics, therapy, and follow-up control (EAU Guidelines Sexual and Reproductive Health, 2026).

When should testosterone be measured?

For men with a regular sleep-wake cycle, testosterone should be measured in the morning, typically between 8 and 11 a.m.. Ideally, the blood sample should be taken while fasting or at least under comparable conditions. If the result is abnormal, a second measurement should be taken, as testosterone fluctuates depending on the day and situation (Brambilla et al., 2007).

For shift workers, the classic time is often less meaningful. In this case, the blood draw should be more closely oriented to the individual sleep rhythm, ideally after a stable sleep phase and not immediately after a night shift.

You can find out more about how night work and changing shift systems can affect the hormonal balance in our article “Shift Work & Hormonal Disorders: How Shift Work Affects Men's Health”.

Regulating the hormonal balance naturally: What really makes sense

Not every hormonal change requires medication. Often, sleep, metabolism, body fat, stress, and exercise are decisive levers. However, it should be clear: lifestyle measures do not replace medical diagnostics if severe symptoms or relevant laboratory abnormalities exist.

Stabilize sleep

Sleep is one of the most important regulators of the hormonal balance. Testosterone, growth hormone, cortisol and melatonin are closely linked to sleep duration and sleep quality. Sleep deprivation can significantly impair testosterone production. One study was able to show that testosterone levels had dropped by about 10 to 15 percent after just one week of sleep restriction (Leproult, 2011).

Useful measures:

• Regular sleep times

• Dark bedroom

• Cool room temperature

• Less bright light in the evening

• No heavy meals right before bedtime

• Reduce alcohol

• Have sleep apnea investigated if you snore and feel daytime sleepiness

Use strength training specifically

Strength training supports muscle mass, insulin sensitivity, bone metabolism, and body composition. It can make an important contribution to hormonal health. The key is a realistic workload with sufficient recovery. Chronic overtraining, sleep deprivation, and insufficient energy intake can, on the other hand, be counterproductive.

Reduce body fat, but not radically

Especially abdominal fat is hormonally relevant. Moderate weight loss can positively influence insulin resistance, inflammatory activity, and aromatase activity (Corona et al., 2013).

However, crash diets or extreme calorie deficits can negatively affect testosterone, thyroid hormones, and libido.

Nutrition as a hormonal foundation

A hormone-friendly diet is not a special diet. It should provide sufficient protein, healthy fats, fiber, micronutrients, and a stable energy supply.

Useful are:

• Sufficient protein

• Lots of vegetables and high-fiber foods

• Omega-3 sources

• Nuts, seeds, and high-quality plant oils

• Sufficient zinc, magnesium, selenium, and vitamin D in case of deficiency

• Few highly processed foods

• Less alcohol

• Stable meal rhythms

You can find out more about nutrition and men's health in our article “The Best Foods for Men - How to Optimize Your Diet”.

Take stress management seriously

Chronic stress can affect sleep, cortisol rhythm, eating behavior, libido, and recovery (Hirotsu et al., 2015).

Useful approaches are regular exercise, breathing exercises, breaks, psychological support in case of high stress, and realistic work structures.

Critically assess alcohol and nicotine

Alcohol can impair sleep quality, liver metabolism, body weight, and sexual function. Nicotine has an adverse effect on blood vessels, the cardiovascular system, and erectile function. Therefore, a reduction can also make sense hormonally and metabolically.

 

When is medical treatment useful?

Treatment depends on the cause, symptoms, laboratory values, age, desire for children, pre-existing conditions, and risk profile. In case of proven hypogonadism, testosterone therapy can be medically useful. However, it should not be started solely based on non-specific symptoms or a single borderline laboratory value.

You can find out more about testosterone therapy in our article “Testosterone Replacement Therapy: Everything You Need to Know”.

Before testosterone therapy, among other things, the desire for children, PSA, blood count, cardiometabolic risks, sleep apnea, prostate history, and causes of testosterone deficiency should be considered. Testosterone therapy can suppress the body's own sperm production and is therefore particularly critical to evaluate in case of current desire for children.

The Endocrine Society recommends testosterone therapy for men with symptomatic testosterone deficiency, if the diagnosis is confirmed and there are no relevant contraindications (Bhasin et al., 2018).

Our conclusion, your knowledge

The male hormonal balance is significantly more complex than just testosterone. Testosterone is central to libido, energy, muscle mass, bones, blood formation, and well-being. At the same time, it is closely linked to sleep, stress, body fat, insulin, the thyroid, prolactin, estradiol, and regulation by the hypothalamus and pituitary gland.

Anyone who notices symptoms such as fatigue, loss of libido, weight gain, sleep problems, concentration difficulties, or performance decline should not prematurely consider individual hormones in isolation. A structured diagnostic approach with appropriate laboratory values, clinical assessment, and medical advice is useful.

A stable hormonal balance is usually created through the interplay of good sleep, metabolic health, strength training, balanced nutrition, stress management, and targeted medical clarification. The earlier men take their symptoms seriously and have them objectively checked, the better the causes can be identified and effectively treated.