Everyone whether on testosterone or not should address adequate sleep, stress reduction, adequate nutrition, and exercise. We are not always in control of how much we sleep or how much stress we have in our lives but we are in control of what I call the three pillars of health or what I usually say the trifecta of health. We are 100% in control of what we eat, if we exercise, and whether or not we optimize our hormones. Hormone optimization is simply understanding that each hormone has beneficial effects, and the goal is to simply maximize the beneficial effects of each hormone by optimizing levels. It's all about prevention of age related disease, disability, dependence, and frailty. Testosterone therapy is just that -- it's testosterone alone and it is most likely adequate for a younger man in his 20s and maybe early 30s but after the late 30s and definitely after the age of 40 it becomes about hormone optimization. Why wait until you get a deficiency or a disease that was preventable? Hormone optimization is not that different than Starting Strength and it's four main lifts. Let's say a man just wanted to do bench press only and wanted to forget about the other three lifts. He could get really strong in the bench press, and let's say he's benching over 400 pounds. I would say that's pretty impressive but when the day is done without doing the other lifts he's going to be deficient in those areas. Starting Strength makes you harder to kill and so does hormone optimization. One can choose just to do testosterone, just like one can choose to just bench press, but without the other hormones you're not as strong as you could be.
I always ask the question, how many of you would take a pill from your family doctor if he told you it would do this: It's going to increase your lean muscle mass, strength, endurance, healing capacity, exercise tolerance, bone mineral density, energy, motivation, self-confidence, libido and sexual function. It's going to decrease your visceral body fat as well as subcutaneous body fat. It's going to decrease your fatigue and improve your cholesterol. It's going to help protect you against cardiovascular disease, insulin resistance, and diabetes. How many of us would take that pill? Well that pill is testosterone, and there is a dose/response relationship, which means the better the levels the better the response. There is a fear of testosterone that is not based on any medical literature showing harm. The problem is we as physicians were never trained on hormones we were only trained to use medications for the management of diseases and to treat symptoms. We have no training in prevention. So those of us that understand hormone optimization in its most pure sense would say that everyone should consider hormone optimization after the age of 40 because maintaining optimal levels of hormones combined with nutrition and exercise is your best defense against age related disease, disability, dependence, and frailty. Testosterone and the other hormones absolutely change lives and maximize health, but there is still such a stigma attached to it because of what occurs in the bodybuilding world, and many men simply using it only for performance enhancement at young ages.
When it comes to fertility and testosterone therapy a man has several options he can choose from. He could of course choose to never do testosterone, he could use hCG or Clomid as monotherapy which will raise testosterone levels and preserve fertility at the same time, but what I don't see them doing very well is resolving symptoms in a really symptomatic man. A man can choose to do testosterone along with hCG from the very beginning and that will maintain spermatogenesis. If a man wanted to do testosterone only he can then add hCG later when he's ready to get someone pregnant, and if that was not sufficient then you could add Clomid and or HMG. Many younger men with true hypogonadism will actually bank sperm as a failsafe. So your physician should give you all of your options and then you can choose which one best fits your lifestyle and needs.