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

Hormones control almost all central bodily functions. They influence energy, sleep, metabolism, libido, muscle growth, mood, stress response, fertility, weight, cardiovascular system, and regeneration (Badiu, 2019). When discussing a man's hormone balance, many first think of testosterone. For men, testosterone is indeed one of the most important hormones, but it is only one part of a much larger system (Society, 2022).

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

The following article explains which hormones are particularly relevant for men, how they interact, what complaints can arise from hormonal dysregulation, and what medically sound diagnostics look like. The goal is not to rush to treat individual lab values, but to understand the hormone balance in its overall context.

Key takeaways

Hormones are messenger substances that transmit information between organs, tissues, and cells. Among other things, they regulate metabolism, energy balance, reproduction, growth, stress response, and sleep. The endocrine system includes the hypothalamus, pituitary gland, thyroid, adrenal glands, pancreas, and testicles. 

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 nonspecifically. Common indicators include persistent fatigue, loss of libido, erectile dysfunction, weight gain, reduced resilience, sleep problems, depressed mood, irritability, or concentration disorders.

The diagnosis of testosterone deficiency should not be based solely on a single laboratory value. The combination of appropriate symptoms and repeatedly clearly low testosterone levels is crucial. Guidelines recommend confirmation through repeated measurements (Bhasin et al., 2018).

Lifestyle factors such as sleep, strength training, body fat percentage, nutrition, alcohol, stress, and metabolic health can influence hormone balance. However, they do not replace medical clarification if significant symptoms or abnormal lab values exist.

What is hormone balance?

The hormone balance refers to the interplay of all hormone-producing organs and the hormones they release. Hormones act as messengers. They are released into the blood, reach target organs, and trigger specific reactions there. This allows the body to, for example, regulate blood sugar, cope with stress, adjust body temperature, initiate sleep, or control reproductive functions.

Important to note: hormones rarely act in isolation. Testosterone influences muscle mass, libido, blood formation, and bone metabolism. At the same time, testosterone itself depends on sleep, energy availability, thyroid function, stress hormones, body fat, and signals from the brain. An abnormal 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:

Hypothalamic-Pituitary-Gonadal Axis (HPG Axis)

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

Hypothalamic-Pituitary-Thyroid Axis (HPT Axis)

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

Hypothalamic-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 responses, and stabilizes circulation (Lightman et al., 2020). However, chronically elevated cortisol levels can adversely affect sleep, blood sugar, body fat distribution, immune system, and sex hormones.

Pancreas and metabolic hormones

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

Adipose tissue as a hormonally active organ

Adipose tissue is not only an energy store but also hormonally active (Kershaw & Flier, 2004). It produces leptin, pro-inflammatory messengers, and influences aromatase activity. Aromatase converts testosterone into estradiol (Simpson, 2003). Visceral belly 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, among other things, influence the development of male sexual characteristics, libido, muscle mass, body hair, sperm formation, and certain metabolic processes. Testosterone is primarily produced in the Leydig cells of the testis, and to a lesser extent in the adrenal cortex. Its production is controlled by LH (Winters & University of Louisville, 2026). 

In addition to testosterone, other important androgens in men include dihydrotestosterone (DHT), androstenedione, dehydroepiandrosterone (DHEA), and DHEA sulfate (DHEA-S). 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 sexual characteristics

• Fat distribution and metabolism

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

When is testosterone deficiency diagnosed?

A testosterone deficiency, medically known as hypogonadism, is not diagnosed solely when a single laboratory value is low. The decisive factor is the combination of typical symptoms and repeatedly reduced testosterone levels. The Endocrine Society recommends diagnosis only in men with appropriate symptoms and clearly and consistently low testosterone concentrations. Confirmation should be made by repeated measurement (Bhasin et al., 2018).

Typical symptoms of testosterone deficiency can include:

• Loss of libido

• Erectile dysfunction

• Decreased morning erections

• Fatigue and lack of drive

• Reduced muscle strength

• Increase in abdominal fat

• Depressive mood

• Irritability

• Concentration problems

• Reduced resilience

• Decrease in bone density

• Anemia

Important to note: These symptoms are not specific. They can also be caused by lack of sleep, depression, thyroid disorders, obesity, medications, chronic illnesses, or stress. Therefore, a thorough medical assessment is always crucial (Khera et al., 2016).

Overview of the most important hormones

The following hormones are particularly relevant for men:

LH and FSH: The control hormones of the testicles

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

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

In cases of low testosterone and elevated LH, a primary testicular dysfunction is more likely. The pituitary gland then tries to stimulate the testicles more strongly, but testosterone production remains insufficient.

In cases of low testosterone and low or normal LH, a secondary or functional disorder is more likely. In this case, the signal from the hypothalamus or pituitary gland is not adequately transmitted. This can occur with obesity, chronic stress, sleep deprivation, certain medications, severe illnesses, or pituitary disorders (Bhasin et al., 2018).

FSH is particularly relevant for sperm production. An abnormal FSH can 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 like testosterone and estradiol in the blood and influences their availability.

When SHBG is high, total testosterone may appear normal, even though less free testosterone is available. When 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:

• 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 usually the most biologically relevant estrogen, while estrone can play a role primarily as another marker of estrogen metabolism, and estriol usually has a subordinate significance outside of special contexts. In fact, estradiol is also important in men (Ramasamy et al., 2016). Part of testosterone is converted into estradiol by the enzyme aromatase. This process occurs, among other places, 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 than testosterone alone in certain areas (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 can be increased, leading to more testosterone being converted to estradiol. However, this does not automatically mean that estradiol should always be lowered. Laboratory values, symptoms, and medical assessment are crucial.

DHT: The potent androgen

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

It plays a role in, among other things:

• Pubertal development

• Beard growth

• Body hair

• Prostate growth

• Sebaceous gland activity

• Androgenetic hair loss

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

Cortisol: Stress hormone with a major impact

Cortisol is produced in the adrenal cortex and normally follows a diurnal 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 responses. Cortisol secretion 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 strain, and overtraining can disrupt cortisol regulation. A persistently unfavorable cortisol profile can affect blood sugar, fat distribution, sleep quality, immune system, and sex hormones (Azmi et al., 2021).

Typical indications of a disturbed stress axis may include:

• Sleep problems

• Inner restlessness

• Exhaustion

• Cravings

• Increase in abdominal fat

• Decreased performance

• Irritability

• Reduced regeneration

Cortisol should not be interpreted hastily. Individual values are highly dependent on time of day, sleep, stress, infections, and measurement method.

Insulin: Metabolic hormone influencing testosterone

Insulin regulates blood sugar and enables the uptake of glucose into cells. When cells respond less effectively to insulin, it is called 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 gain and metabolic deterioration (Stanworth & Jones, 2008).

Therefore, metabolic values are often included in meaningful diagnostics 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 primarily serves as a precursor. T3, or triiodothyronine, is the more biologically active form and is largely converted from T4 in the tissues. The free fractions, i.e., fT3 and fT4, are particularly relevant because they are not bound to transport proteins.

Your hormones control basal metabolic rate, heat production, heart rate, bowel activity, concentration, and energy. Both hypothyroidism and hyperthyroidism can cause symptoms similar to testosterone deficiency.

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

• Fatigue

• Cold sensitivity

• Weight gain

• Constipation

• Depressed mood

• Dry skin

• Slow pulse

• Concentration problems

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

• Restlessness

• Weight loss

• Rapid heartbeat

• Sweating

• Sleep disturbances

• Tremors

• 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 regulating hormone is too high

Prolactin is best known for its role in milk production but also occurs in men. It can be referred to as a regulating hormone because it not only has an effect on the body itself but can also influence the overarching hormonal regulation of the reproductive axis, particularly by inhibiting GnRH secretion in the hypothalamus. Elevated prolactin can inhibit the hypothalamic-pituitary-gonadal axis and thereby impair testosterone production, libido, and erectile function (Dabbous & Atkin, 2017).

Possible causes of elevated prolactin include:

• Stress

• Sleep deprivation

• Certain medications

• Hypothyroidism

• Pituitary adenomas

• Kidney dysfunction

• Intense physical exertion

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

Growth hormone and IGF-1

Growth hormone is produced in the pituitary gland and primarily released during deep sleep at night. Among other things, it stimulates 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, older age, visceral fat, and chronic diseases can affect this axis (Chennaoui et al., 2019). However, growth hormone should not be misunderstood as a lifestyle hormone. Medical therapy is only advisable with a clear indication.

Melatonin: Sleep hormone and pacemaker

Melatonin is released in darkness and signals the body's night phase (Brzezinski, 1997). It is closely linked to the circadian rhythm. Evening light, especially bright screen light, late meals, shift work, and irregular sleep times can disrupt melatonin rhythm (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 consistently sleep poorly should consider not only stress but also a disturbed biological rhythm.

Leptin and Ghrelin: Hunger, satiety, and body fat

Leptin is primarily produced in adipose tissue and signals to the brain how well energy stores are filled. Ghrelin is primarily produced in the stomach and increases hunger. Sleep deprivation and stress can shift this system. Many men then notice more hunger, a stronger craving 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 forgotten, 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 sodium, potassium, and blood pressure, among other things (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 influence performance, the cardiovascular system, and general health.

Typical symptoms of a hormonal imbalance in men

A hormonal imbalance can manifest in various ways. Common symptoms include:

• Chronic fatigue

• Loss of libido

• Erectile dysfunction

• Fewer morning erections

• Sleep disturbances

• Weight gain, especially abdominal fat

• Muscle loss or reduced strength

• Mood swings

• Irritability

• Depressed mood

• Concentration problems

• Reduced stress resilience

• Sweating or feeling cold

• Rapid heartbeat

• Skin changes

• Hair loss

• Breast gland swelling

• Unfulfilled desire for children

Important: These symptoms do not prove a hormonal disorder. They are indications that should be medically evaluated.

For more on the connection between testosterone, libido, and sexual function, see our article "Potency, Libido, Testosterone: How to maintain your sexual health".

Causes of hormonal dysregulation in men

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

• Sleep deprivation

• Chronic stress

• Obesity, 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 diseases

• Liver or kidney diseases

• Pituitary disorders

• Testicular dysfunction

• Aging processes

• Shift work

• Obstructive sleep apnea

Particularly important is the distinction between primary, secondary, and functional hypogonadism. In functional forms, the hormonal axis can be impaired by lifestyle, weight, sleep, or chronic diseases, without permanent structural damage to the testicles or pituitary gland.

Diagnostics: Which laboratory values are useful?

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

Basic parameters in case of 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 replacement 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 case of specific suspicion

• In fertility questions, additionally spermiogram

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

When should testosterone be measured?

In men with a regular sleep-wake rhythm, testosterone should be measured in the morning, typically between 8 and 11 am. Ideally, blood sampling should be done on an empty stomach or at least under comparable conditions. If the result is abnormal, a second measurement should be taken, as testosterone fluctuates depending on the time of day and situation (Brambilla et al., 2007). The Endocrine Society recommends a morning measurement of total testosterone with a reliable test method for initial diagnosis and confirmation by repeat measurement.

For shift workers, the classic time is often less meaningful. Here, blood collection should be more aligned with the individual sleep rhythm, ideally after a stable sleep phase and not immediately after a night shift.

You can find more information on how night work and changing shift systems can affect hormone balance in our article "Shift Work & Hormonal Disorders: How Shift Work Affects Men's Health".

Naturally regulating hormone balance: What really makes sense

Not every hormonal change requires medication. Often, sleep, metabolism, body fat, stress, and exercise are crucial levers. Nevertheless, 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 hormone balance. Testosterone, growth hormone, cortisol, and melatonin are closely linked to sleep duration and sleep quality. Sleep deprivation can significantly impair testosterone production. A study showed that testosterone levels decreased by about 10 to 15 percent after just one week of sleep restriction (Leproult, 2011).

Sensible measures:

• Regular sleep times

• Dark bedroom

• Cool room temperature

• Less bright light in the evening

• No heavy meals directly before sleeping

• Reduce alcohol consumption

• Check for sleep apnea in case of snoring and daytime sleepiness

Use strength training purposefully

Strength training supports muscle mass, insulin sensitivity, bone metabolism, and body composition. It can make an important contribution to hormonal health. Crucial is a realistic load with sufficient regeneration. Permanent overtraining, sleep deprivation, and insufficient energy intake, however, can be counterproductive.

Reduce body fat, but not radically

Belly fat, in particular, is hormonally relevant. Moderate weight loss can positively influence insulin resistance, inflammatory activity, and aromatase activity (Corona et al., 2013). Crash diets or extreme caloric deficits, however, 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 stable energy intake.

Useful are:

• Sufficient protein

• Plenty of vegetables and fiber-rich foods

• Omega 3 sources

• Nuts, seeds, and high-quality vegetable oils

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

• Few highly processed foods

• Less alcohol

• Stable meal rhythms

For more on nutrition and men's health, read 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 regeneration (Hirotsu et al., 2015). Useful approaches include regular exercise, breathing exercises, breaks, psychological support in times of high stress, and realistic work structures.

Critically review alcohol and nicotine

Alcohol can impair sleep quality, liver metabolism, body weight, and sexual function. Nicotine has an unfavorable effect on blood vessels, the cardiovascular system, and erectile function. A reduction can therefore also be hormonally and metabolically beneficial.

When is medical treatment appropriate?

Treatment depends on the cause, symptoms, laboratory values, age, desire for children, pre-existing conditions, and risk profile. In proven hypogonadism, testosterone therapy may be medically appropriate. However, it should not be started solely due to unspecific symptoms or a single borderline laboratory value.

More information on testosterone therapy can be found in our article "Testosterone Replacement Therapy: Everything You Need to Know".

Before testosterone therapy, factors such as the desire for children, PSA, blood count, cardiometabolic risks, sleep apnea, prostate history, and the causes of testosterone deficiency should be considered. Testosterone therapy can suppress the body's own sperm production and should therefore be critically evaluated if there is a 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 hormone balance is significantly more complex than just testosterone. Testosterone is central for libido, energy, muscle mass, bones, blood formation, and well-being. At the same time, it is closely linked to sleep, stress, body fat, insulin, thyroid, prolactin, estradiol, and control by the hypothalamus and pituitary gland.

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

A stable hormone balance usually results from the interplay of good sleep, metabolic health, strength training, a balanced diet, stress regulation, and targeted medical clarification. The sooner men take their symptoms seriously and have them objectively checked, the better the causes can be identified and treated appropriately.