TRT Has a Problem Nobody Wants to Admit

Added: 2026-05-25

[00:00:00]Guys, I don't know how to tell you this, but we've got a problem. Wait one second.

[00:00:07]Yes, that's better.

[00:00:13]Specifically, we have a problem with testosterone. And I know what you're thinking, like, oh, maybe there's a problem with like how we administer it.

[00:00:20]Oh, we need to do it more frequently, blah. No, no. We've got bigger problems than that. Specifically, we have a problem with number one, how we diagnose low testosterone, and two, how we treat it. Let me explain what I mean. When we're talking about trying to diagnose low testosterone, right now, we rely on some very simple numbers. We rely on two serum early morning draws if you're here in the United States. But see, there's a problem when it comes to interpreting those numbers. If you're below a specific threshold, you get the diagnosis of low testosterone and that means that you qualify for testosterone therapy. But if you're above those numbers, even by a little bit, then all of a sudden you no longer qualify and you're not a candidate. And those numbers can seem super arbitrary. Check this out. If we're looking at the AUA, so the American Neurologic Association, you have to be under 300 nanogs per deciliter to have a diagnosis of low testosterone. While and the EUA, the Europeans, well, apparently they just have much higher tests than us because they're saying anything below 350, that's a diagnosis. Meanwhile, the Endocrine Society, supposedly the experts on all things endocrine here in the United States, say you have to be below 264 in order to get a diagnosis of low testosterone. So you can see where the problem is because based on where you live, what doctor you happen to be seeing, and maybe what specialty they have, you can get a totally different answer with the exact same testosterone level. And not only does that change who gets a diagnosis of low testosterone, it also changes who gets access to treatment. This can even cause problems in the same clinic with the same doctor.

[00:01:57]Let's say this. Let's say that I have a patient who comes in and he has a testosterone level of 312 nanogs per deciliter. Well, by our own society's definitions, that's not someone that I should offer therapy to. I should give him a high five, tell him that he's doing just fine, and then see you when I see him. Meanwhile, that same type of patient, if they walk in the door and they have a testosterone level of 298, well, all of a sudden, according to our guidelines, that's someone I can offer treatment to.

[00:02:30]And this is a question that we need to figure out because we have a problem in this country. Right now, we are experiencing a population level decline of testosterone levels by estimated to be about 1% per year, not accounting for aging. That means that 60-year-olds this year have 1% lower testosterone than 60-year-olds did last year. That means that 20% of young men in this country right now are at risk for sexual dysfunction, fat gain, muscle loss, and ultimately like type 2 diabetes. Like we're talking profound risk factors for metabolic dysfunction, which we already know is the single biggest modifiable risk factor for long-term disease in the United States. And right now, it's affecting one out of five of young men.

[00:03:16]And we know that testosterone therapy works. I mean, if you just look at the data, the overwhelming majority of men who get started on TRT experience huge increases in mood, in drive, in muscle mass, fat loss. We can correct things like insulin resistance and, you know, reduce the risk of things like sarcopenia and osteoporosis as people age. But if we go back to that example I gave you earlier, that guy who comes into clinic with a testosterone of 312, well, he doesn't qualify for that. But that second guy who came in at 298, according to our guidelines, I'm allowed to start him on TRT. And then I can push him all the way up to, let's say, 6 7 800 or maybe even higher. And then he's going to be on probably injectable testosterone or some other option where his levels are going to stay persistently elevated throughout the day, which means that he gets to be three to four times more optimized than the guy who came in just 14 points higher than him at the time of initial evaluation. I mean, listen, I get that you have to have the cut off somewhere, but if you're that guy coming in at 312, does that seem fair to you?

[00:04:26]>> Thanks, man.

[00:04:33]You know, Atlanta is a crazy airport, but I actually grew up down here. So, in a way, this kind of feels like coming home for me. So, uh, spoiler alert in case you were wondering where I was going. Um, yeah, of course I have no idea what Ronic's going to put in the title, so maybe you'll know already.

[00:04:49]But, uh, yeah, we're going to Vegas.

[00:04:52]Totally unrelated, but uh, comment down below if getting a snack at McDonald's makes me a bad doctor.

[00:04:57]Thank you.

[00:05:00]>> I don't care what anybody says. There is nothing better than a McDonald's hash brown when you're traveling.

[00:05:08]>> Okay, so thought experiment. What would this look like? What would this world look like if we started offering testosterone therapy? If we started offering pharmacologic and hormonal enhancement to the guy with testosterone of 312, the guy of testosterone of 298 or god forbid a guy with a testosterone of 425, what would that world look like?

[00:05:28]And again, we're not talking over the counter. We're talking safe medically supervised hormonal and pharmacologic enhancement. What would that look like?

[00:05:38]Well, honestly, I'm not exactly sure, but um that's what I'm hoping to find out this weekend. And uh actually, that's why I'm traveling to Vegas.

[00:05:56]>> And while we're at it, why stop at just testosterone? Why not also include peptides, growth hormone, all of these really cool tools that we have at our fingertips, but we just really aren't using to their full potential right now.

[00:06:21]Well, lucky enough, I'm not the only one that's been asking these questions, which is why I'm here in Vegas for the enhanced games. The first major competition in sport that I've seen on this level where athletes are allowed to openly use performance-enhancing substances. and not just on their own or observed by just a coach, but these athletes have actually been part of an IRB approved study that's been going on in Dubai for months at this point. Some of the initial data was just published.

[00:06:50]And what we're going to see this Sunday is going to be absolutely historic.

[00:06:55]We're going to see for the first time what athletes are capable of, what people are capable of when you remove the limits that we've put on modern medicine, when you remove that sort of gatekeeping, and we can see what boundaries can be pushed and what records can be set. And I don't know about you guys, but I couldn't be more excited for it. So, uh, until next time, proceed accordingly.