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Declining testosterone has multifaceted origins and levels of the hormone can be augmented in numerous ways. Perhaps the most neglected medicine of all, exercise can improve an aging man's testosterone levels (in addition to offsetting andropause-related bone loss, weight gain, muscle loss, and sleep and mood disturbances). Moderate physical activity was shown to increase serum testosterone levels by 39%, SHBG by 19%, free testosterone by 23%, and total serum proteins by 13%, mainly during a period of exercise in one study.26 The transient elevation of testosterone observed in this study was thought to be partly the result of increased SHBG concentration. Testosterone levels returned to baseline in the subjects after the exercise, indicating that hemoconcentration may have contributed partially to the subjects' increased testosterone levels. However, a separate study sought to challenge the observation that perhaps this testosterone elevation was only related to increases in SHBG; investigators in this study concluded that, indeed, free testosterone does increase with moderately prolonged endurance-type exercise, and this increase was not associated with a change in the binding affinity of SHBG.27 Furthermore, the data from this study suggested that exercise-induced increases in testosterone were mediated by sympathetic stimulation of the testicles. This effect has been demonstrated in studies that evaluated pre- and post-exercise levels of LH, FSH, prolactin, testosterone, and free testosterone, showing no significant changes in LH, FSH, or prolactin either before or after exercise but showing an activity-related increase in both free and total testosterone.28 Physical fitness has such far-reaching benefits for patients in nearly all conditions that it can, most assuredly, help the andropausal man. Exercise can not only offset associated andropausal changes but, at least temporarily, increase testosterone levels in serum. This may explain in part the widely observed exercise-related increase in mood seen among older athletes as well.

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