There’s so much to say about this post. Of course men shouldn’t be on TRT if it’s not indicated and if they want to have children. Or at least freeze their sperm beforehand.
I agree that the word andropause is misleading. I think we have the media to blame for the term “male menopause” too.
Also, TRT doesn’t cause prostate cancers or heart disease. Those claims have been debunked many times over now in the past 11 years. Please see Dr. Abraham Morgentaler, MD’s published papers on this matter.
And yes, of course not everyone needs TRT. Some men do need it and all men should be informed that TRT will decrease sperm production. Men should have their testosterone (free & total) tested before 10 am local time 2x in a 2-4 week time frame and do need to have signs and symptoms of low testosterone, such as listed in the quantitative ADAM questionnaire.
Further more, testosterone declines have many causes and should be ruled out prior to prescribing testosterone, such as TBIs, stress, sleep apnea, other sleep disorders, & severe chronic stress, etc. The root causes needed to be addressed. Yet with all due respect primary care physicians are failing men and don’t typically understand the complexities of men’s health, which is why men don’t want to go to doctors today. They don’t want an SSRI or Xanax when their depression and/or anxiety is related to low hormones and other factors in their life they can’t control.
Appreciate your perspective and thoughtful writing. I can especially get behind this "Most men don’t need a pill, they need trustworthy primary health care—something far too many men lack."
Nice perspective. Can you elaborate what you mean by “Most men don’t need a pill, they need trustworthy primary health care”? If you look at all the customer cases e.g. Hone, Ro and others have it seems like testosterone is helping, is that than just marketing bs?
hey Rik - there are certainly cases in which men experience symptomatic low testosterone as they age and may benefit from replacement therapy. The question is whether we should be marketing testosterone to all men and conflating the male experience of aging with menopause. For men experiencing weight gain, infertility, challenges with libido or sexual function, in many cases I do not think we should be jumping to testosterone as the first line solution.
I might suggest walking down the halls of Harvard to the urology department and discussing this more with Dr. Abraham Morgentaler, MD if he still teaches there or reading his papers since it seems you have been misinformed, sir. Testosterone doesn’t cause or lead to heart disease or cause prostate cancers. Here’s a paper for your reference: https://pubmed.ncbi.nlm.nih.gov/26683750/
Thanks Sam - I appreciate the reference. I assume, like with all things, context here matters. HRT is of course safe if prescribed as indicated however protracted periods of high estrogen exposure are not. The argument of this piece is that indiscriminate use of testosterone is not good medicine, and more fundamentally, there are sex-based biological differences between men and women that should not be conflated.
There’s so much to say about this post. Of course men shouldn’t be on TRT if it’s not indicated and if they want to have children. Or at least freeze their sperm beforehand.
I agree that the word andropause is misleading. I think we have the media to blame for the term “male menopause” too.
Also, TRT doesn’t cause prostate cancers or heart disease. Those claims have been debunked many times over now in the past 11 years. Please see Dr. Abraham Morgentaler, MD’s published papers on this matter.
And yes, of course not everyone needs TRT. Some men do need it and all men should be informed that TRT will decrease sperm production. Men should have their testosterone (free & total) tested before 10 am local time 2x in a 2-4 week time frame and do need to have signs and symptoms of low testosterone, such as listed in the quantitative ADAM questionnaire.
Further more, testosterone declines have many causes and should be ruled out prior to prescribing testosterone, such as TBIs, stress, sleep apnea, other sleep disorders, & severe chronic stress, etc. The root causes needed to be addressed. Yet with all due respect primary care physicians are failing men and don’t typically understand the complexities of men’s health, which is why men don’t want to go to doctors today. They don’t want an SSRI or Xanax when their depression and/or anxiety is related to low hormones and other factors in their life they can’t control.
appreciate this perspective
Appreciate your perspective and thoughtful writing. I can especially get behind this "Most men don’t need a pill, they need trustworthy primary health care—something far too many men lack."
Nice perspective. Can you elaborate what you mean by “Most men don’t need a pill, they need trustworthy primary health care”? If you look at all the customer cases e.g. Hone, Ro and others have it seems like testosterone is helping, is that than just marketing bs?
hey Rik - there are certainly cases in which men experience symptomatic low testosterone as they age and may benefit from replacement therapy. The question is whether we should be marketing testosterone to all men and conflating the male experience of aging with menopause. For men experiencing weight gain, infertility, challenges with libido or sexual function, in many cases I do not think we should be jumping to testosterone as the first line solution.
Dear Doctor,
I might suggest walking down the halls of Harvard to the urology department and discussing this more with Dr. Abraham Morgentaler, MD if he still teaches there or reading his papers since it seems you have been misinformed, sir. Testosterone doesn’t cause or lead to heart disease or cause prostate cancers. Here’s a paper for your reference: https://pubmed.ncbi.nlm.nih.gov/26683750/
Thanks Sam - I appreciate the reference. I assume, like with all things, context here matters. HRT is of course safe if prescribed as indicated however protracted periods of high estrogen exposure are not. The argument of this piece is that indiscriminate use of testosterone is not good medicine, and more fundamentally, there are sex-based biological differences between men and women that should not be conflated.