Beyond Testosterone
Men need and deserve medical care that isn't determined by online trends
You’re exhausted and your midsection is softening. Your focus is fading. And a well-timed, targeted ad promises you’ll “get your twenties back” with a monthly subscription of testosterone. It may be a compelling narrative. But from an evidence-based medical perspective, it’s dangerously incomplete. It’s time we reject the misinformed premise that every problem a man faces can be solved with testosterone.
Is testosterone deficiency a genuine medical condition? Yes, and it matters. As a board-certified cardiologist and men’s health expert, I prescribe testosterone when it is clinically indicated. But what overhyped social media and marketing ploys miss is that testosterone is almost never the whole medical story. Handing a man a hormone prescription requires evaluating his cardiovascular health, stress burden, and his metabolic state. Prescriptions that come without that analysis ignore the reality of how a man’s body operates.
Here’s how that looks in my practice:
A fifty-two-year-old man sits down in my exam room at Men’s Health Boston for a second opinion. He is successful, driven, and carrying an extra 30 pounds. A telehealth clinic ran his blood and, seeing a total testosterone of 330, put him on testosterone replacement therapy. Eight months later, his lab numbers look fantastic. But he still feels terrible. He is still exhausted and the weight hasn’t budged, so he stops taking testosterone.
We run a comprehensive cardiometabolic workup and sleep study and find out the real story: severe sleep apnea. Dozens of times a night, my patient stops breathing, so his body wakes him repeatedly to gasp for air. He gets zero restorative sleep.
Untreated sleep apnea directly suppresses natural testosterone production. It’s not low hormone levels that are the problem; his hormone level was a symptom of a chronically exhausted nervous system. That’s solved with a CPAP machine that aids a patient’s breathing when they’re asleep.
Three months later, my patient’s testosterone level rose, his energy improved, and his weight started moving in the right direction–all without a prescription for “T.”
The same pattern applies to the heart. Men frequently come to my practice frustrated by erectile dysfunction, and declining energy and libido. Lab tests may show us low testosterone values and ask for a hormone fix, but a solution is not that simple. A more complete workup, including cardiovascular and metabolic testing, may reveal early-onset heart disease and a metabolic system buckling under years of chronic stress. Prescribing testosterone and moving on would miss the broader picture and a critical window to prevent a larger cardiovascular crisis.
The casual hormone prescription is about sales. Identifying and treating the underlying condition is about medicine–medicine that goes beyond trends and quick lab results. It takes more than a “T” prescription or new supplement to tackle that loss of energy, strength, or cardiovascular health. It takes a genuine, full-picture approach. And when we offer that, patients can start to accept a truth most men never hear: the steady decline you’re been told to expect in midlife and beyond is not predetermined. It is preventable, manageable, and, in many cases, reversible. But it is not a quick fix. It’s thoughtful, methodical, and data-driven.
That’s what The New Men’s Health is–and it’s the care men require and deserve. A thorough medical evaluation goes beyond a single number on a lab report and helps us leave behind misinformed, too-good-to-be-true narratives so we can understand what drives and changes our bodies.
Evan Appelbaum, MD, FACC, is a board-certified cardiologist and medical director of Men’s Health Boston. He specializes in the integrated assessment and optimization of men’s health across cardiology, urology, endocrinology, and performance medicine.