Men's Hormones and Low Testosterone

Why it's often missed or oversimplified

Testosterone is often checked once, sometimes in the afternoon when levels are naturally lower, and sometimes only as total testosterone. One result can be misleading. Testosterone varies from day to day, and how much is actually available to your body depends on other factors, such as SHBG, the protein that binds it.

The opposite problem is common too: starting testosterone quickly without asking why it's low. Poor sleep and sleep apnea, insulin resistance and weight, alcohol, chronic stress, some medications, and environmental exposures can all lower testosterone. If those drivers aren't addressed, treatment may only cover them up. Testosterone therapy also suppresses sperm production, which matters if you want children now or later.

How I sequence treatment

My approach follows The Longevity Hierarchy™, a framework I developed for organizing care around what your body can handle right now. It has two aims: reduce the load your body is carrying, and expand its capacity. Hormones both respond to that load and influence your capacity, so I treat them as part of the whole system rather than as a single number to raise.

In practice, that usually means:

1. Build the foundation. Sleep, strength training, protein, blood sugar and alcohol have a large effect on testosterone, and they help any treatment work better.
2. Address what's underneath. That can mean evaluating sleep apnea, insulin resistance, stress, nutrient deficiencies or environmental load.
3. Treat when it fits. When treatment makes sense, I most often use testosterone cypionate injections or transdermal testosterone gel. For men who want to protect their fertility, enclomiphene can help the body make more of its own testosterone without shutting down sperm production.
4. Monitor closely. I check labs and see you for follow-up about every three months at first. Once things are stable, many men can move to every six months.

Every prescription has a clear reason, goals, and a plan to reassess.

Frequently asked questions

Do you treat men outside the Bay Area?

Yes. I see men for low testosterone and hormone care anywhere in California. I'm licensed in California, so patients need to be located in the state. If you live outside California, your own doctor can still get my guidance: clinicians can book a one-on-one case consult with me about your care, while they remain your treating physician.

My testosterone came back "normal," but I still feel off. What now?

A single result, especially from an afternoon draw or a total testosterone level alone, doesn't tell the full story. I repeat morning testing, measure free testosterone and SHBG, and look at thyroid function, iron, blood sugar, sleep and stress, which can cause the same symptoms. Sometimes hormones are the main issue, and sometimes they're one piece of it.

Will testosterone therapy affect my fertility?

It can. Testosterone from outside the body signals the brain to slow your own production, which can sharply reduce sperm count. If you're trying to conceive now or want to keep that option, we discuss alternatives such as enclomiphene, which supports your body's own production. I also work with couples on fertility; see fertility and preconception.

Injections, gel or enclomiphene: which is right for me?

It depends on your labs, your goals, your fertility plans and your preferences. Injections and gels both replace testosterone directly. Enclomiphene works differently, by encouraging your body to make more of its own. We go through the options together and choose the one that fits.

How is this different from a testosterone clinic?

My focus is finding out why your testosterone is low, not only raising the number. That means repeated morning testing, looking for underlying causes, talking through fertility before starting anything, and monitoring safety over time. Treatment is part of a broader plan for your energy, sleep, metabolism and long-term health.

Do you use anastrozole or hCG?

Sometimes, when your labs and symptoms call for it. Some men convert more testosterone into estradiol, and an estrogen-lowering medication such as anastrozole can help in that case. hCG can help some men on testosterone maintain their own testicular function and fertility. I don't add either one routinely. We decide based on your results and goals.

Is testosterone therapy safe?

For men with confirmed low testosterone, treatment can be safe when it's well monitored. I check your red blood cell count (hematocrit), PSA, estradiol and testosterone levels regularly, about every three months at first and then every six months once you're stable. If you have heart disease, prostate concerns or other conditions, we weigh the risks and benefits together, and I coordinate with your other doctors.