Updated: Nov 3
Exercise after cold stimulation
At the age of 51, a routine blood test revealed elevated prostate specific antigen (PSA), which could indicate possible prostate cancer.
Rather than have a biopsy, I resolved to treat myself with ketosis.
Three months of cycling in and out of keto dropped my PSA to normal.
Adding a regular ice bath practice took my PSA to 0.8 ng/mL, and my testosterone jumped to levels typical of a teenager.
Does every man my age have a prostate problem?
Back in September of 2017, before Jason C Stauffer and I started ice baths, I had a health scare based on an elevated prostate specific antigen (PSA) blood test result. Normal for a man my age at that time was less than 3.5 ng/ml.
Mine came back at 7.
I started doing some reading and I came to learn that only 25% of elevated PSA results are indicative of cancer. Still, at my last prostate exam ten years earlier, my doctor commented that my prostate was enlarged and it was probably nothing to worry about, but she'd like to "keep an eye on it."
I haven't had any exams since.
Prostate cancer typically grows slowly, so I thought it was conceivable that whatever enlargement was detected ten years ago had grown into a full-blown cancer.
Was I becoming incontinent? Feeling the urge to pee all the time? Experiencing difficulty urinating?
I didn't even know. I became hypersensitive to any perceived change in my urination habits, and that didn't help me at all. The more I tried to be aware of difficulties in urination, the more paranoid I got about my pee.
Although the normal thing to do would be to go back to my doctor for another exam. I wasn't so sure.
I decided to talk to other men, first.
How does allopathic medicine treat the prostate?
You might be surprised how little men talk about the aspects of their anatomy they all have in common. There's no customary way to raise topics of male reproductive health among other men. Yet here I was, trying to chat up any man approximately my age, and especially my older friends, about the condition of their prostate.
As it turned out, almost every man had a story to tell, Some had their prostates removed. Others had biopsies. Others had radiation.
Each and every one of their stories sounded like a nightmare to me. I resolved to treat my elevated PSA without further contact with the medical establishment, which I became certain would set in motion a cascade of catastrophic and painful procedures that would eventually render me impotent.
I decided that before I had a biopsy, I'd try a ketogenic diet.
Cancer is a metabolic disease
I didn't share my diet decision with anyone but one of my closest confidants. At that time, the idea that a ketogenic diet could treat or reduce the risk of cancer was still very controversial, and because most of my older male friends are academics with doctorates like me, they don't trust anything that seems to contradict established medical science.
But the metabolic theory of cancer isn't new. In medicine, it's called the Warburg Effect (e.g., Liberti & Localsale 2016) and it's been documented by scientific studies for over 90 years. It demonstrates that cancer cells require glucose to grow (Seki et al. 2022), because most forms of cancer are incapable of metabolizing fat. Instead, they thrive on excess glucose in the bloodstream. A ketogenic diet starves the cancer cells of glucose because it requires reducing carbohydrate intake to levels that are insufficient to maintain basic metabolic function with glucose alone (Seyfried 2012). At near-zero carb intake, the body switches to a fat-based metabolism that produces ketones.
I found that out the hard way in 2001, when my 6 year old son was diagnosed with Type 1 diabetes. Because his pancreas wasn't producing insulin, he was incapable of glucose metabolism, and his body was producing so many ketones that he was at risk of ketoacidosis -- a life-threatening condition that results from changes in the pH of the blood.
It is partly because ketosis can be dangerous for Type 1 diabetics that the diet has a bad reputation. Many medical doctors will discourage their patients from experimenting with ketosis, but I already knew from 15 years of managing my son's diabetes that ketosis presented no danger to me.
The ketogenic diet for treatment of cancer has become much more popular since publication of Tripping Over the Truth: The Return of the Metabolic Theory of Cancer (Cristofferson 2016). As it turns out, a ketogenic diet not only starves cancer cells, but kills them outright, as if ketosis was the body's own natural chemotherapy (e.g., Weber et al. 2018, and Weber et al. 2020).
Since at least 1965, medical science has understood that one of the fastest ways to produce ketones is acute cold exposure (Hanson & Johnson 1965).
Cold therapy can get you into keto
Because I live in Phoenix Arizona, there is no such thing as a cold shower in August. Phoenix is the hottest major city in North America, and the tap water here reaches temperatures in the upper 80's during the summer.
But temperatures start to cool off by November, and I started thinking I might produce more ketones if I dropped the water temperature of my showers.
I struggled, until I read Scott Carney's account of Wim Hof's remarkable stamina and health in What Doesn't Kill Us (Carney 2017). Carney's description of Hof's breathing technique helped relax me during those showers, and that helped me extend my cold shower practice and stay in ketosis longer.
By December 2017, just 3 months later, my PSA had dropped into the middle of the normal range.
I don't really know if the cold showers brought my PSA levels down, or if they would have come down all by themselves. But I was relieved and impressed and convinced that deliberate cold exposure was an essential part of my improvement.
To be sure it wasn't some sort of anomaly, I tested again six months later. That was the summer of 2018, and by then Jason and I had started a regular practice of ice baths and founded Morozko Forge for the purpose of manufacturing equipment that would freeze water for us and save us the hassle of buying ice from the store.
To my satisfaction, my PSA dropped a little lower.
And something else jumped off the lab results page, highlighted in red.
What ice baths did for my testosterone
My total testosterone (T level), after less than a year of deliberate cold exposure, was way above normal, because 1180 ng/dL in a 52 year old is almost unheard of. Back in 2017, when I first got my elevated PSA results, my testosterone measured 768 ng/dL, which would be considered excellent for a man my age.
After less than a year of ice baths, my testosterone was now off the charts.
The figure below shows the results of total testosterone measured in 130 men participating in a 2003 study on erectile dysfunction. In this graph, the units are ng/ml so the results have to be multiplied by 100 to compare with the units in my report. That means that half the study participants had T levels below 500 ng/DL and only 3 reached levels that exceeded mine.
My urologist was alarmed.
He ordered another test, this time for something called Luteinizing Hormone (LH), which stimulates the natural production of testosterone by the gonads. If my LH levels were also elevated, that would tell my urologist that I was producing these extraordinary T levels naturally. But if LH was low, he'd probably call me a liar and accuse me of taking anabolic steroids.
These were my results, from Dec 2018.
Once again, off the charts.
Although Morozko Forge was still a month away from its first sale, I'd been practicing deliberate cold exposure for almost a year, and the anabolic hormonal benefits thus far had been practically miraculous.
The science of testosterone and cold therapy
Studies that investigate the relationship between cold exposure and testosterone in men are rare. The few that do typically show that an ice bath will reduce total T levels for at least an hour.
The results in this 1991 Japanese study are typical (Table 1, below).
Notice how the group in column "Experiment I" used bicycle exercise to raise their testosterone from 480 ng/dL to 580ng/dL? But when they got in the ice bath after exercising, their testosterone plummeted to levels lower than before their exercise, meaning that cold exposure wiped out all their T gains and then some. This tells us that cold exposure for exercise recovery is not a good way to boost either T levels or LH.
Now check "Experiment II," in which the order of the exercise and the cold exposure were reversed. In this group, the exercise was used to recover from the cold (rather than the other way around, which is normal).
Just like with the Experiment I group, cold exposure reduced testosterone in the blood stream. But in Experiment II, starting cold exposure before exercise boosted LH levels, suggesting that more testosterone would be produced over the long term.
What's even more amazing is this:
When exercising after cold exposure, T levels in the Experiment II group jumped just as much as it did in the group exercising before cold exposure and luteinizing hormone made even further gains.
Because I never use deliberate cold exposure to recovery from exercise, but instead use exercise to recover from deliberate cold exposure, my experience of increased T and LH is consistent with this unusual study of Japanese men. That suggests that I may have accidentally stumbled upon a new technique for boosting my testosterone from levels that were excellent for a man my age to levels normally reserved for oversexed 19 year olds.
It would be easy to write my experience off as unscientific, non-systematic, attributable to changes in my diet, or maybe even my divorce. There is lots of evidence that suggests married men with children have lower testosterone, compared to unmarried men.
For that matter, married men in committed relationships have lower testosterone than unmarried men without a commitment to a girlfriend (e.g., Burnham et al. 2003)
On the other hand, Jason is married with children. So, a year ago I asked him to check his testosterone, too.
In Oct 2019, at age 40, Jason's total testosterone was a respectable 550 ng/dL .
A year later, at age 41, he was up to 715 ng/dL.
These are Jason's latest results, after three years of practicing ice baths:
2019 Age: 40 Total: 550 ng/dL Free: 72.8 pg/mL
2020 Age: 41 Total: 715 ng/dL Free: 92.7 pg/mL
2021 Age: 42 Total: 913 ng/dL Free: 154.8 pg/mL
His results parallel mine so well, it seems unlikely to be a coincidence.
Moreover, my gains have been long-lasting. I'm now in an exclusive, committed relationship to a woman with four daughters, which means I'm practically surrounded by estrogen, and we might expect my T-levels to slip somewhat as a result.
So now that I'm 56 years old, and I've gained maybe ten pounds since my last test, it's time to have my testosterone checked again.
My total testosterone is now 1075 ng/dL.
The Prostate Protocol
I wish I had taken detailed notes on my ice bath and exercise sessions, so I could tell you exactly what worked for me. Unfortunately, I discovered the cancer-fighting and testosterone boosting effects of the ice bath by accident, so I can't say exactly what worked.
However, I'm not alone in my experience.
Author AJ Kay used ketosis and ice baths to both reverse her Type 2 diabetes and shrink her inoperable liver tumor. And Dean Hall swears that his practice of cold water swimming reversed his untreatable leukemia. In Cryotherapy for Cancer, I described the two mechanisms by which cold exposure inhibits tumor growth: 1) activation of brown fat to starve tumor cells of glucose, and 2) production of endogenous ketones, which kill cancer cells.
Søberg et al (2021) demonstrated that an average of 11 minutes a week, no matter how it was broken up, was sufficient to activate brown fat in winter swimmers. While the Japanese only submerged one wrist, for a just few minutes (Sakamoto et al. 1991), the Søberg study is a better benchmark for metabolic regulation, because the longer, whole-body cold water immersion is proven to activate brown fat. However, we shouldn't ignore the fact that Sakamoto showed that only 20 minutes on an exercise bike after an ice bath was sufficient to raise testosterone and luteinizing hormone (LH), because while we're activating brown fat for management of metabolism, we may as well get hormone balancing benefits, too.
This is what worked for me:
Ice bath at 36F (or less) for 2-4 minutes, at least five days a week. On average, this results in about 15 minutes a week of extreme cold exposure -- more than enough to satisfy the 11 min/week suggested by Søberg to activate brown fat, and equivalent to the dose that worked for me.
Use exercise after your ice bath to restore circulation to your limbs. I often used a 25lb steel mace for a few minutes after my ice bath, but sometimes I would also do pushups, pullups, kettlebells, or jumping jacks. This video shows my favorite workout for rewarming after my ice bath. You'll notice that it isn't much, but it is active.
Finally, it's important to incorporate intermittent fasting (IF) and carbohydrate restriction into your protocol. AJ Kay will sometimes go a week consuming less than 20 carbs, but I was never that restrictive. I performed a 24 hr fast one day a week -- usually Mondays. It sometimes took four or five cups of black coffee to get me thru my afternoon cravings, but as long as I could make to dinner time, my 24hr fast was complete. In my case, intermittent fasting complemented the cold exposure I was getting from my ice bath to accelerate my transition into ketosis and keep me there for longer.
Cycled in and out of keto. In addition to IF, I would go low carb (< 35 g/day) for several days, then have a carb confusion day in which I would eat binge on bread and desserts about once a week. I don't know if that's the right way to do it, but it worked for me. My logic was that I did not want my body and microbiome to become adapted to a constant low carb, ketogenic diet. I wanted the hormetic stress of both low carb and high carb, so that I would starve my gut microbes of carbohydrates, then flood them right before the carbohydrate dependent microbes in gut would die off. In my imagination, I always thought that would prevent my metabolism from down regulating into some super-efficient state at low basal rates of energy expenditure.
I don't know if the Ice Bath Prostate Protocol will work for you. Maybe it's not detailed enough, or maybe you're find it too restrictive, Or maybe you'll adopt every practice that worked for me, only to discover that it does not work for you.
Every body is different.
Nonetheless, the key to your success will be to harness those two aspects of metabolic health that are critical to avoiding disorders like prostate cancer, Type 2 diabetes, and others.
Use your ice bath in combination with carbohydrate restriction to activate your brown fat, maintain insulin sensitivity, and keep your mitochondria healthy, and
Incorporate some exercise after your ice bath, to enhance your recovery. It doesn't have to be a lot. The most important thing is probably that you find something you can enjoy/
Ben Greenfield wrote a series of articles on testosterone for Men's Health magazine back in 2018. He summarized his findings in a subsequent article emphasizing that pills don't work, but a few other things do.
Magnesium supplements and Vitamin D are at the top of the Ben Greenfield Testosterone nutritional recommendations, and bathing his testicles in red light is his #2 biohacking technology (after electrical muscle stimulation).
Lots of people ask, "Will cold showers boost my testosterone?"
Despite what a lot of other articles might say, the science says that cold showers alone will not boost testosterone production.
However, exercise after a cold shower might.
Ben Greenfield never investigated the effectiveness of exercise after deliberate cold exposure, which is probably why describes the benefits of cold thermogenesis on testosterone as indirect (e.g., keeping the testes cool improves their function).
Nothing in our findings contradicts Ben Greenfield's experiences.
What we might discover is that a combination of these biohacks pushes testosterone levels up to the top of some natural, as-yet-undiscovered limit.
UPDATE 4 Nov 2022
I got an email from a younger reader:
Hi, I have recently read about your ice baths and testosterone increase when ice bathing before you exercise. I am an 18 year old and was wondering if you usually use a towel to get dry or put extra clothes on after the ice bath and before you workout -- or whether you get out of the ice bath and use exercise to recover entirely without clothes or a towel to dry (if you put your head under the water). Thank you, I appreciate your article.
This reader doesn't say why he's concerned about testosterone at his young age, or why toweling off or clothing might alter his results, but 25 years of teaching experience has taught me that if one student has a question, there are usually several others with the same question.
Unless I'm shooting video, I ice bath naked, because it saves me the hassle of having to change into and then dry my swim suit. Also, I don't like working out in a wet swim suit, and it's a lot faster to dry off when I'm in the buff.
Toweling off is also important to me because I don't want water between on my skin when I'm rewarming in the sunlight. The water drops attenuate the sunlight, and I want the full benefit of sunshine during my recovery -- especially when I'm plunging with my girlfriend. I usually leave the wet towel around my waist when I'm doing pull-ups for recovery, because I like the challenge of the extra weight, but by-and-large, I prefer to exercise without wearing any clothes at all.
I haven't quite been able to talk my girlfriend into taking the same approach.
UPDATE 31 Dec 2022
A 66 year old reader from Massachusetts reached out to send me his labs. He moved his testosterone levels from fair-to-middling (in Dec 2020) to outstanding in Dec 2022.
He says the only thing he changed about his fitness routine was adding a cold dip or shower, first thing in the morning, before his walk. He says he uses 7lb hand weights and walks at a brisk pace.
No weight training. No hormone therapies.
Just cold + exercise and what he describes as a "ketoAF" diet.
His results are consistent with mine & Jason's, albeit even more spectacular.
About the Author
Thomas P Seager, PhD is an Associate Professor in the School of Sustainable Engineering at Arizona State University. Seager co-founded the Morozko Forge ice bath company and is an expert in the use of ice baths for building metabolic and psychological resilience.