Dietary patterns and testosterone balance: a review of clinical data and perspectives

Ketogenic diets may enhance testosterone synthesis through increased cholesterol availability, a key precursor, while reducing TNF-α and IL-6. Elevated ketone bodies can suppress both neuropeptide Y release and gastric hunger peptide. Vegetarian diets, conversely, frequently result in reduced cholesterol bioavailability owing to high fiber content and low fat intake, which may consequently impair testosterone synthesis. Nevertheless, their abundant antioxidants counteract oxidative stress, thereby supporting male reproductive health. Mediterranean diets enhance testosterone synthesis via synergistic actions of multiple bioactive nutrients within this dietary pattern. Oleocanthal inhibits COX-1 and COX-2 enzyme activity, while resveratrol reduces NO production, ROS levels, and LDL cholesterol. Additionally, olive oil enhances testicular antioxidant capacity and restores the SREBP2 cholesterol pathway. Western diets, characterized by excessive fat and sugar intake, promote obesity-associated testosterone decline through hepcidin overproduction, which disrupts iron homeostasis and testicular function. Furthermore, excess adipose tissue can increases production of TNF-α, IL-6, leptin, and NEFA, while cholesterol overload may trigger endoplasmic reticulum stress in testicular cells. For individuals with dysregulated androgen levels, targeted dietary modifications are advised as adjunctive therapy to help restore hormone balance.