Should I take testosterone?

Our read is that testosterone replacement therapy (TRT) is well-supported for individuals with a plausible biochemical profile, such as total testosterone below the 30th or 40th percentile with commensurate free testosterone levels, and for primary hypogonadism after ruling out other causes. Experts like Peter Attia, Andrew Huberman, and Rhonda Patrick emphasize that intervention is not necessary for those with low-normal levels who feel good and function well, as increasing testosterone could lead to negative effects.

However, our read is that testosterone is often overused, with treatment frequently based solely on total testosterone levels without considering free testosterone or symptoms, as noted by Peter Attia and Paul Saladino. Young men taking testosterone when not medically indicated risk shutting down sperm production and potential permanent infertility, a concern raised by Peter Attia and Andrew Huberman.

Our read is that a plausible biochemical profile for initiating TRT includes total testosterone below the 30th or 40th percentile, with commensurate free testosterone levels, as noted by Peter Attia, Andrew Huberman, and Rhonda Patrick. For hypogonadal patients on TRT, Andrew Huberman suggests steady-state testosterone levels are preferable to avoid side effects from peaks and troughs. Peter Attia notes that daily injections of testosterone appear to provide the smoothest hormone level curve. Paul Saladino suggests standard blood work should include CBC, comprehensive metabolic panel, fasting insulin, PTH, full thyroid panel, testosterone, prolactin, DHT, estrogens, progesterone, pregnenolone, cortisol, DHEAS, hs-CRP, liver enzymes, and lipid panel. Peter Attia also notes that increasing testosterone and estradiol levels is a priority for osteopenia with low estradiol and testosterone to improve bone mineral density. For individuals with gynecomastia, Peter Attia suggests switching to daily testosterone TRT dosing and discontinuing aromatase inhibitors can resolve the condition.

• 01Peter Attia, Andrew Huberman, and Rhonda Patrick (5x) state that a plausible biochemical profile for initiating TRT includes total testosterone below the 30th or 40th percentile, with commensurate free testosterone levels.
• 02Rhonda Patrick (2x) notes that primary hypogonadism typically requires exogenous testosterone after ruling out other causes.
• 03Andrew Huberman (1x) states that intervention is not necessary for individuals with low-normal testosterone levels who feel good and are functioning well, as increasing testosterone could lead to negative effects.
• 04Peter Attia (2x) notes that higher levels of both testosterone and estrogen resulted in the best outcomes for body composition, mood, libido, and erectile function in a 2013/2014 NEJM study.
• 05Peter Attia (1x) states that long-term outcome data for testosterone therapy in women exists for up to four to five years from extension trials and up to two years from randomized trials.
• 06Paul Saladino (1x) suggests that Whole Package from Heart and Soil supplements may improve depression, anxiety, panic attacks, night sweats, lack of energy, and inability to gain weight in males with severely low testosterone.
• 07Peter Attia (1x) notes that a testosterone level of 800 pg/dL or higher is manageable in discussion with a prostate cancer diagnosis for symptom relief.
• 08Peter Attia (2x) states that increasing testosterone and estradiol levels is a priority for osteopenia with low estradiol and testosterone to improve bone mineral density.
• 09Peter Attia (1x) emphasizes vetting the need for TRT and understanding AR content and expression, as high AR may mean lower total testosterone is sufficient.
• 10Andrew Huberman (1x) states that for hypogonadal patients on TRT, steady state testosterone levels are preferable to avoid side effects from peaks and troughs.
• 11Andrew Huberman (1x) notes that exercise protocols that increase testosterone versus those that diminish it may be separated by a narrow margin.
• 12Peter Attia (2x) explains that testosterone binds to an androgen receptor, causing a conformational change that dislocates heat shock proteins and leads to dimerization.
• 13Peter Attia (3x) notes that switching to daily testosterone TRT dosing and discontinuing aromatase inhibitors can resolve gynecomastia in some individuals.

Our read is that there are significant caveats to taking testosterone. Peter Attia and Paul Saladino (4x) highlight that testosterone is overused, with treatment often based solely on total testosterone levels without considering free testosterone or symptoms. Peter Attia and Andrew Huberman (4x) warn that young men (teens, 20s, 30s) taking testosterone when not medically indicated can shut down sperm production, potentially causing permanent damage and future infertility. Rhonda Patrick (1x) advises that exogenous testosterone and growth hormone supplementation should generally be avoided by men unless clinically indicated for deficiency due to potential risks outweighing benefits. Andrew Huberman (1x) cautions individuals undergoing testosterone replacement therapy to avoid skin contact with others, especially children, to prevent estrogenic activity. Rhonda Patrick (1x) also notes that increased neck size and muscle mass, potentially worsened by supra-physiological hormone levels, can exacerbate sleep apnea. Peter Attia (3x) states that administering 150mg of testosterone weekly can cause supraphysiological spikes in testosterone, estrogen, and DHT, negatively impacting sympathetic nervous system activity and sleep quality. Peter Attia (1x) points out that preserving fertility on testosterone replacement therapy requires near-perfect compliance (95%) with dual therapy (testosterone and HCG), as monotherapy with testosterone alone can lead to a complete loss of sperm production if HCG is missed. Peter Attia and David Sinclair (2x) suggest that testosterone supplementation may aggravate existing prostate cancer tumors. Rhonda Patrick (1x) warns that irreversible voice deepening from testosterone replacement therapy can be quality-of-life destroying for women. Andrew Huberman (1x) notes that dosing testosterone at 600mg per week can lead to significant edema, and that high-dose testosterone supplementation should not be taken for extended periods. Peter Attia (1x) finds auto-injector pens for testosterone problematic because the dose cannot be modulated or metered, unlike testosterone cypionate in a jar. Rhonda Patrick (1x) also notes that pharmaceutical companies may promote infrequent, high-dose testosterone injections that deviate from a physiological daily production model. Peter Attia (1x) states that the FDA-approved injectable testosterone formulation for women has a concentration that is too high for precise dosing in treating HSDD.

Our read is that the verdict would change if long-term safety data for supraphysiological doses of testosterone (10x normal) becomes available, as Peter Attia notes its current unknown status. Additionally, if supplements containing testosterone as a hidden ingredient are definitively proven to reduce or shut down endogenous testosterone production, as Andrew Huberman suggests, this would also alter the assessment.