Low Testosterone in Men Over 40: Symptoms, Optimal Ranges, and When You Actually Need TRT
Episode Summary
Cole Siefer and Colin Renaud, PA-C discuss testosterone replacement therapy (TRT) for men, covering why it is underutilized in conventional medicine, what symptoms signal low or suboptimal testosterone, the difference between a functional medicine approach and testosterone-only clinics, and how stress, lifestyle, and other hormones all interact with testosterone. The episode includes a live Q&A where a viewer with a testosterone level of 88 (at age 32) shares his experience being dismissed by both his PCP and a urologist. The episode also covers the role of estrogen in men, when estrogen blockers are and are not appropriate, and oral medication alternatives to TRT for younger men and those who want to preserve fertility.
Key Topics
- 1
Colin Renaud's personal introduction to TRT and his experience as a patient
- 2
Why testosterone is undertreated in conventional medicine (longevity is not a conventional medicine focus)
- 3
Symptoms of low testosterone in men: fatigue, depression, irritability, decreased strength, abdominal fat gain, gynecomastia
- 4
Symptoms of low testosterone in women: decreased libido, fatigue, depression, hair changes, skin changes, vaginal dryness, pain with intercourse
- 5
The difference between "normal" and "optimal" on lab reference ranges
- 6
Optimal testosterone range for men: approximately 700 to 1,000 total testosterone on a blood test
- 7
Standard reference range (300 to 1,000) vs. what functional medicine targets as optimal
- 8
What functional medicine looks at beyond just testosterone (lifestyle, sleep, vitamin D, stress, alcohol, diet, insulin resistance)
- 9
Why testosterone-only clinics fall short: no personalized approach, no addressing of other health factors
- 10
How stress (HPA axis) depletes testosterone
Quotable Moments
“The conventional medical model just doesn't do a great job addressing longevity. It's not that they're doing it wrong. It's just not part of the philosophy. And that's where hormone replacement for men and women just gets missed.”
“If you're a guy and you've got a stressful job, a bunch of kids, modern day life is stressful. Stress is one of the most toxic things on the body, physically, mentally, spiritually, physiologically.”
“A man in his early 40s comes in with a testosterone of 320. His conventional doctor says, 'You're totally fine.' But he's not, though. That's the thing.”
“We do NOT want to lower estrogen too much. Most men do not need estrogen blockers. Estrogen is really, really important to maintain a man's mood. And believe it or not, men need estrogen to maintain and get an erection.”
“Once men get going on testosterone, they don't care how long they have to be on it.”
Treatments Mentioned
FAQ
Testosterone FAQ
Functional medicine targets a total testosterone range of approximately 700 to 1,000 on a standard blood test. The conventional reference range starts at 300, which means a man with a level of 320 may be told he is "normal" even though he feels fatigued, depressed, and is gaining weight.
Common symptoms include persistent fatigue, depression, irritability, loss of muscle mass, increased abdominal fat, decreased libido, and gynecomastia. Many men also experience brain fog and poor motivation that they attribute to aging but is actually driven by suboptimal hormone levels.
No. The 2023 Traverse Trial showed testosterone replacement did not increase the risk of heart attacks, strokes, or prostate cancer. Men with low testosterone are actually at greater risk for serious health conditions because the absence of the hormone drives poor long-term outcomes.
Most men do not need estrogen blockers. Estrogen at appropriate levels is essential for mood stability, erection quality, and overall health in men. Unless a man is symptomatic from high estrogen, blocking it is often unnecessary and can be counterproductive.
Enclomiphene is an oral medication that stimulates the body to produce more testosterone without suppressing natural production or reducing sperm counts. It is ideal for younger men or those trying to conceive, since direct TRT can reduce fertility.
In most cases, yes. Because testosterone naturally declines with age, stopping TRT typically means returning to suboptimal levels. However, most men find the improvement in energy, mood, and body composition so significant that it becomes a welcome part of their health routine.
Yes. Chronic stress works through the HPA axis and is one of the most significant factors that depletes testosterone. This includes physical stress from overtraining, emotional stress from work or relationships, and physiological stress from poor sleep or diet.
Men lose approximately 1 to 2% of their total testosterone per year after age 30 to 35. This natural decline means even men who eat well, exercise, and manage stress may still develop low testosterone over time and benefit from optimization.
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