Low testosterone is a clinical condition with clinical answers — not a vibe.
Roughly 40% of men over 45 have clinically low testosterone. Most never get a proper workup. We test correctly, treat conservatively, and monitor closely — because both undertreatment and overtreatment have consequences.
What proper testing looks like
Total testosterone alone is not enough. We measure free testosterone, SHBG, LH, FSH, prolactin, and estradiol on the first visit, drawn before 10 a.m. and confirmed with a repeat measurement before treatment is offered.
A single afternoon testosterone level is the most common reason men get put on therapy who shouldn't be — and the most common reason men who need it are told they're fine.
Treatment options
Testosterone replacement therapy (TRT) by injection, gel, or pellet — selected with the patient based on lifestyle, fertility plans, and follow-up willingness.
Adjunct therapies (HCG, anastrozole, clomiphene) when indicated for fertility preservation or estradiol management. We monitor hematocrit, PSA, lipids, and symptoms on a structured schedule.
Common questions
Will TRT make me infertile?
Standard TRT suppresses sperm production. If fertility matters now or later, we use protocols (HCG, clomiphene) that preserve it. We ask about fertility plans before starting therapy.
What about cardiovascular risk?
The TRAVERSE trial (NEJM 2023) showed no increase in major cardiovascular events with appropriately monitored TRT in men with low T. Monitoring is the operative word.
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