The Testosterone Hustle
Low T or High BS?
Hello, Health Enthusiasts!
Welcome to this week’s installment of our Informative Health Blog, lovingly written by yours truly and posted every Saturday morning, my attempt to keep you informed, entertained, and hopefully learning something new! If health blogs aren’t your thing, you can easily opt out. But if there’s a topic you’d love to see covered, drop me a line.
Stay healthy, stay curious, and as always, thanks for reading!
By the way, our busy urological practice is always on the lookout for medical assistants and medical scribes to join our team. Most of our scribes are gap year college graduates taking a year off before applying to medical school or physician assistant school. If you know of anyone interested, please have them send their resume to practice manager Elias Gomez: EGomez@summithealth.com.
Warm regards,
Andrew Siegel MD
The Testosterone Hustle: Low T or High BS?
The Miracle Molecule That Won’t Quit
If hormones were Marvel characters, testosterone would be Iron Man—flashy, over-confident and convinced the world can’t spin without him. Every billboard, podcast ad, and late-night scrolling session now screams “Feel like a beast again—get your T-shot today!” But here’s the inconvenient truth: most of those ads are selling Iron Man suits to guys who are already iron-clad.
The Goldilocks Rule of Hormones
Your body likes its testosterone just right: not too low, not too high, and preferably measured twice, on two different mornings, in a reputable lab (no, the strip-mall “Bro-Longevity Lounge” doesn’t count).
Normal range: roughly 300 – 1,000 ng/dL.
Treatment range: below ~300 ng/dL plus real-life symptoms—flagging libido, fatigue, loss of muscle, mood crashes, even osteoporosis.
Think of testosterone like coffee. One cup perks you up; nine shots of espresso turn you into a jittery YouTube fail compilation. Yet many online clinics hand out the hormonal equivalent of a venti Nitro Brew to perfectly caffeinated men.
Meet the “T-Rex” Clinics
In a recent “mystery-shopper” study, a urologist with an excellent testosterone level (675 ng/dL) and future baby plans contacted seven online men’s-health outfits. Six eagerly wrote a testosterone prescription on the first date—despite knowing TRT would nuke his sperm count faster than you can say “Daddy issues.” That’s like your dentist offering braces because “straight teeth are fun.” Sure, but… they’re already straight!
Side Effects Your Influencer Forgot to Mention
Infertility & Shrinking Testicles – Imagine replacing your home Wi-Fi with public hotspots. Your router shuts down; your testes do the same when outside T floods the system. Full recovery can take up to two years, and sometimes Mother Nature’s warranty never quite resets.
Erythrocytosis – Fancy word for “blood too thick to sip through a straw.” Translation: higher risk of clots, strokes and ER phlebotomists giving you the side-eye.
Acne & Breast Pain – Because nothing screams alpha male like acne and tender man-boobs.
Mystery Fractures – In the giant TRAVERSE trial (5,000 men, three years) testosterone neither stoked prostate cancer nor heart attacks—but weirdly, fracture rates ticked up. Iron skepticism, anyone?
Decades-Long Commitment – Start at 35 and you may be injecting, gelling, or pelleting until Social Security kicks in. Quit abruptly and expect an internal winter worthy of “Game of Thrones.”
But Doctor, I Feel Low…
Exhausted? Brain fog? Can’t bench-press your emotional baggage? Those symptoms have more suspects than an Agatha Christie novel: sleep apnea, stress, extra pounds, doom-scrolling, toddler tyranny. Low testosterone can be marker, not culprit. Good medicine fixes the foundation first—sleep, nutrition, exercise, glucose, thyroid—then checks T twice. Only when the numbers and the story match do we break out the syringe.
The Responsible TRT Checklist
Two Morning Tests below 300 ng/dL (or low free T)
Symptoms that can reasonably be blamed on low T
Baseline PSA (prostate cancer marker), blood counts, fertility discussion
Follow-up labs—no “set-it-and-forget-it”
Clear exit strategy if side effects or life goals (hello, babies) change
Miss any box? Step away from the vial.
The Punchline (and Take-Home)
Testosterone replacement can be life-changing for men with true hypogonadism. For that population of men, TRT can function as male "rocket fuel" and substantially increase one's mojo. For everyone else, it’s a pricey placebo with potential booby-traps (sometimes literally). Before you sign up for Autoship Vials of Virility:
Test don’t guess. Twice. Morning. Accredited lab.
Fix the basics first. Sleep, diet, stress, lifting something heavier than your phone.
Choose a real clinician. If they don’t ask about fertility, run faster than a rooster on Red Bull.
Understand side effects. Thick blood, thin patience, and the possibility your swimmers take an extended sabbatical.
Commit to follow-up. TRT is a relationship, not a Tinder fling.
Bottom line: Sadly, unscrupulous testosterone and men’s health clinics have sprung up all over the country in the last few years. Many engage in actions that exploit patient vulnerabilities for profit, prioritizing financial gain over good health practices, over-diagnosing low T and offering unnecessary or unproven treatments for erectile dysfunction, while downplaying risks. When it comes to T, being average is awesome. The guy chasing “super-physiologic” numbers may look like a superhero on Instagram, but inside he’s one lab slip away from a cautionary blog post—probably this one. Stay skeptical, stay balanced, and remember that sometimes the most masculine move is not pressing “Add to Cart.”
Wishing you the best of health,
A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”: www.HealthDoc13.com
Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery. His mission is to “bridge the gap” between the public and the medical community.
He is an Assistant Clinical Professor in the Department of Urology at Hackensack Meridian School of Medicine and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. He is a urologist at New Jersey Urology, a Summit Health Company.
Dr. Siegel is the author of several books. The second edition of his prostate cancer book is available in print and Kindle formats at Amazon: Prostate Cancer 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families. The audiobook version is available at Amazon: Prostate Cancer 20/20 Audiobook.
Video trailer for Prostate Cancer 20/20
Preview of Prostate Cancer 20/20
Andrew Siegel MD Amazon author page
Dr. Siegel’s other books:
THE KEGEL FIX: Recharging Female Pelvic, Sexual, and Urinary Health
MALE PELVIC FITNESS: Optimizing Sexual and Urinary Health
PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food