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Health Guide

Men's hormonal health: what the numbers actually say

Salud hormonal masculina: lo que dicen los números

Latino man, 45, in his Miami kitchen

Illustrative image. Does not represent guaranteed results.

In a Journal of Clinical Endocrinology and Metabolism study of 1,475 men, 5.6% of men aged 30 to 79 had low testosterone together with clinical symptoms. In men over 70, it rose to 18.4%.

Notice how that's worded: low testosterone and symptoms. Both. That detail is the one almost nobody explains, and it's what decides whether hormone treatment makes sense for you at all.

Total and free: why they're two different numbers

Total testosterone is everything circulating in your blood. But most of it is bound to proteins — mainly sex hormone binding globulin, SHBG — and while it's bound, your tissues can't use it.

Free testosterone is the fraction that's actually available. That's why two men with identical total testosterone can feel completely different: if one has high SHBG, much of his is spoken for.

This doesn't mean a "normal" number is hiding a problem. It means a full panel measures more than one thing, and interpreting it is a clinician's job, not a reference table's.

What a full panel measures

Total and free testosterone, SHBG, estradiol — men need it too, for bone density and cognition — and DHEA-S. On the safety side: PSA, hemoglobin and hematocrit, lipid and glucose panels.

Age-related decline is real, and slower than it sounds

Longitudinal studies show roughly a 1% drop per year after 30. Real, but gradual — it doesn't by itself explain energy or mood falling off a cliff over a few months.

When someone feels bad suddenly, the usual causes are elsewhere: sustained poor sleep, chronic stress, undiagnosed sleep apnea, alcohol, certain medications, depression, or thyroid disease. Many of those show up on the same labs.

What the TRAVERSE trial actually found

TRAVERSE is the large study usually cited to say testosterone therapy is safe. It's worth reading in full.

5,246 men aged 45 to 80, with low testosterone and either existing cardiovascular disease or high risk of it, followed up to 5 years. The headline result: testosterone therapy was non-inferior to placebo for major adverse cardiac events. It did not increase heart attacks or strokes.

But the same study found more cases in the testosterone group of atrial fibrillation, pulmonary embolism, acute kidney injury, and fractures. That's also TRAVERSE.

The honest reading: it did not raise major cardiac risk, and it did show other risks worth monitoring. "Non-inferior" is not the same as "beneficial," and anyone showing you only the favourable half is telling you half the story.

What supervised treatment involves

If a licensed clinician determines treatment is appropriate, follow-up isn't optional: repeat labs including PSA and hematocrit, with adjustments based on how your body responds.

One thing to know before starting: testosterone therapy suppresses sperm production. If having children is in your plans, say so in the first conversation — it changes the approach.

Who this isn't for

If your labs are normal and you have no symptoms, there's nothing to treat. Being tired is not, on its own, an indication for hormone therapy.

If you have symptoms but your numbers are fine, the honest answer is to keep looking for the cause — sleep, thyroid, stress, mood — rather than starting hormones. A good clinician will tell you that, even when it isn't what you hoped to hear.

If you're trying to conceive, or have prostate or breast cancer, polycythemia, severe untreated sleep apnea, or uncontrolled heart failure, testosterone therapy is generally not appropriate.

And if you're after athletic performance beyond physiological levels — that's something else, with different risks.

Numbers first
A licensed clinician through our partner platform reviews your labs and your symptoms together. Sometimes the conclusion is that hormones aren't your problem — and that answer is worth as much as a prescription.
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Frequently asked questions

What if my labs are "normal" but I feel bad?

Then it's worth looking elsewhere before considering hormones. Fatigue, poor focus and low desire have many possible causes: insufficient sleep, apnea, thyroid, sustained stress, depression, medications. A full panel checks several at once.

How long before treatment shows results?

It varies considerably between individuals and no timeline can be promised. Individual results vary and are not guaranteed. Your clinician will set realistic expectations based on your case and your labs.

Does it affect fertility?

Yes. Testosterone therapy suppresses sperm production, and in some cases the effect takes time to reverse. If fertility matters to you, that's a conversation to have before starting, not after.

Is this the same as steroids?

No. The difference is dose, supervision and goal. A medical protocol aims for physiological levels with periodic monitoring labs. Unsupervised use involves far higher doses without monitoring — that's where the harm appears.

Do I need injections?

There are several routes — injection, cream, gel — and which fits depends on your clinical picture. Your clinician decides that with you, not a form.

Do you offer care in Spanish?

Yes. All of our content and support are available in Spanish.

Sources

This article is informational and is not medical advice. SCTS1 does not prescribe medication. All medical care, prescriptions, and treatment plans are provided by licensed healthcare providers through our partner platform. Treatment eligibility is determined by a licensed provider. Compounded medications contain the same active ingredient class but are not FDA-approved finished pharmaceuticals. Individual results vary and are not guaranteed.