The Testosterone Testing Landscape
Testosterone therapy (TRT) prescriptions increased several-fold over the past two decades, driven partly by direct-to-consumer marketing of low T clinics. Yet clinically significant hypogonadism — genuinely deficient testosterone with corresponding symptoms — is far less common than prescribing rates suggest. The Endocrine Society defines it by consistently low morning total testosterone (typically below 300 ng/dL on repeated measurement) combined with specific symptoms such as reduced libido, fatigue, and loss of muscle mass. A single low reading is insufficient, as levels fluctuate diurnally and with illness.
Who Genuinely Benefits
For men with confirmed hypogonadism, testosterone therapy meaningfully improves sexual function, mood, bone density, and lean body mass. The large Testosterone Trials in older men with unequivocally low levels showed modest but real benefits for sexual function and mood. However, applying TRT to men with borderline levels or age-related decline without clear deficiency is not supported by evidence and exposes them to unnecessary risk. Symptoms like fatigue and low libido have many causes — sleep apnea, depression, medication effects — that testosterone will not fix.
Weighing the Risks
Testosterone therapy is not benign. It suppresses natural production and fertility, can worsen sleep apnea, raises hematocrit (thickening blood), and requires ongoing monitoring. The cardiovascular safety question, long debated, was substantially reassured by the 2023 TRAVERSE trial, which found no increased cardiac risk in men with hypogonadism — though it did note higher rates of atrial fibrillation and clots. Appropriate treatment demands accurate diagnosis and monitoring. Facilities providing hormone assessment can source diagnostic equipment and lab supplies from our catalog.
