Men's Health
Strength, energy, desire, fertility and long term health are connected, and treating one in isolation is how the real cause gets missed. My training carried unusually heavy exposure to andrology, which is the part of urology that deals with male hormones, fertility and sexual function.
A single testosterone value taken out of context is the most common reason symptomatic men get told they are fine. Timing, SHBG, free testosterone and your age all change what the number means, and reading them together is how treatable men get treated.
A large share of low testosterone in men is functional, meaning something correctable has turned the signal down. Obesity is the biggest driver, and each point of BMI is associated with roughly a two percent lower testosterone.
Untreated sleep apnea, opioids, heavy alcohol use and poorly controlled diabetes all do the same thing.
Conventional testosterone therapy suppresses sperm production. If you may want children, that conversation happens before the first prescription, not after. There are alternatives that raise your own production instead of replacing it.
I have performed over five thousand vasectomies, and I still do every one myself. The technique is no needle, no scalpel, with laughing gas from start to finish: the gas keeps you relaxed, the no-needle local does the numbing. The whole thing is an office procedure that takes under fifteen minutes, with no hospital, no stitches to remove, and most men back to a desk job in a day or two. It remains the most reliable form of permanent birth control there is, and recovery is far easier than most men have been led to expect.
Male pattern hair loss is driven by DHT shortening each growth cycle until thick hairs become fine ones. The window that matters is while follicles are still miniaturizing rather than gone, so earlier treatment preserves more of them.
There are several independent levers here: extending the growth phase, lowering or blocking the DHT signal, calming the scalp, and improving how well a topical is actually absorbed. Microneedling adds another. Pulling two or more of them beats pulling one, which is why a single prescription and nothing else often underperforms.
Hair restoration is part of what I treat. Care at Peri Health & Hormones →
Men are told testosterone falls with age, roughly one percent a year after thirty, and that it is simply what happens. A great deal gets sold on the back of that belief.
Australian researchers tested it directly in men who reported excellent health, sampling them repeatedly rather than relying on a single draw. In that group testosterone did not fall with age at all. Larger pooled analyses since have found the same shape: once you account for body fat and general health, the age effect largely disappears between roughly seventeen and seventy. A real age-related decline shows up after seventy. Across that whole span, testosterone runs inversely with body mass index.
Put plainly, when you control for body fat, testosterone does not drop the way people assume. Much of what gets labeled age-related decline is tracking adiposity rather than birthdays.
I am a believer in testosterone therapy, and I prescribe it. When a man is low, replacement changes how he feels, how he trains, and how he holds muscle, and I treat it with the seriousness it deserves.
One thing worth understanding is where “normal” comes from. A lab reference range is built from the population that walks into the lab, and that population has been getting heavier and less healthy for decades. So the range has drifted down with it. Sitting inside that range means you resemble the average man tested, and the average man tested is not a picture of health. Normal and optimal are different questions, and I treat toward optimal for you, your symptoms, your goals and your labs read together.
Plenty of men also have more room to gain than they think from the other levers, body composition, sleep, alcohol and metabolic health, and the best results usually come from pulling those alongside testosterone rather than instead of it. Sorting out what the right mix is for the man in front of me is the entire job, and it is not something a single number can tell you.
Direct answers first. The details follow.
Low drive is the famous one, but fatigue is the most common. Men describe less motivation, slower recovery from workouts, muscle that shrinks despite effort, more belly fat, low mood, brain fog and softer erections. None of those is specific, which is exactly the problem: each one alone gets blamed on age, stress or work. The pattern together is what earns a proper evaluation, and that means labs done right alongside an honest look at sleep, weight, alcohol and medications.
The usual cutoff is around 300 ng/dL, and I treat that number with suspicion in both directions. Normal on a lab report means the middle 95 percent of men who got tested. It tells you where you sit compared to other men, not where you function best. So why should a man in the bottom five percent be told he is normal? A man at 250 with no symptoms may need nothing. A man at 400 with classic symptoms or a high SHBG may have very little usable testosterone at all. A man who has lived his life in the 800s and dropped to 450 has lost nearly half of what his body ran on, and he can have severe symptoms of low testosterone while the report calls him normal. The number needs to be read along with the other labs, free testosterone and LH among them, and alongside the man in front of me. I work from the symptoms and the numbers together, because neither alone makes the diagnosis.
Because testosterone peaks early and falls through the day, an afternoon draw can make a normal man look low. Morning, ideally before ten, is when the number means something. The textbooks also ask for a second draw, and repeating the test is often wise because levels bounce day to day. But I do not always check twice. When the first draw is a well-built panel, with estradiol, LH and FSH alongside the testosterone, I can usually see the whole picture at once. If a man is symptomatic and clearly low on that panel, I may offer treatment without making him wait for another stick.
Yes, and together they are the biggest reversible causes there are. Each point of body mass index runs with roughly two percent lower testosterone, untreated sleep apnea suppresses it further, and alcohol and opioids pile on. This is why I evaluate the whole man before writing anything: some men do not need replacement so much as repair. Fix the sleep apnea and drop the weight and testosterone often climbs on its own. And when a man is symptomatic and low despite that work, I treat him, with the seriousness it deserves.
Yes, and for some men that is the better path. Low testosterone is a lab finding, not a single disease, and the fix depends on the cause. Sometimes the hypothalamus has downregulated and settled where it is, often dragged there by weight, sleep or medications. Sometimes the raw materials are short: statins lower cholesterol, and cholesterol is where pregnenolone, the first hormone in the chain that ends at testosterone, comes from. A heavier man also converts more of the testosterone he does make into estradiol, so his numbers sag even though the factory works. Each of those has its own treatment, and there are medications that raise your own production instead of replacing it, which is the route I use for men who want to protect fertility or simply avoid testosterone therapy. The workup comes first. The prescription is a choice, not a foregone conclusion.
Yes, because testosterone sits upstream of all three. It drives desire directly, it contributes to the erectile machinery, and it powers energy and muscle. That said, ED in particular is usually a blood vessel problem more than a hormone problem, which is why fixing testosterone alone does not always fix erections. When the three arrive together, the workup covers hormones and cardiovascular health both, because the same cluster can be the first visible sign of either.
Last medically reviewed August 2026 by Roscoe S. Nelson, MD, FACS, board-certified urologist.
Peri Health & Hormones is where Dr. Nelson provides current clinical care in hormones, metabolic health, sexual health, recurrent UTI and selected procedures.
807 E. Pioneer Rd. Suite 105
Draper, UT 84020
Straight answers. No hype. Just practical information you can use.
