Skip to main content

You are listening to Who Cares About Men's Health?:

22: Will Testosterone Really Cure Everything?

Oct 22, 2019

“Low energy? Get some T! No libido? Get T! Overweight. T will fix it!” You’ve heard the ads, but are they true? Dr. Alex Pastuszak explains everything you need to know about testosterone therapy and whether it’s right for you.

Episode Transcript

This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.

The Path to Intuitive Eating

Maintaining a healthy diet today seems nearly impossible. The built environment of modern day America makes it so easy to eat poorly. 100 years ago we had to work to get food and spend energy to get energy. Today there's no limit on the foods we can eat, and it's a little too easy to indulge in our built in biological drive to consume high fat and high sugar foods.

Dr. Alex Pastuszak has worked hard to become an "intuitive eater." He's practiced for years to get a good understanding of how much food and the types of food his body needs to stay healthy. He even finds himself looking forward to eating food that makes him feel good like a salad for lunch.

His secret is to make sure that he's never on a "diet." Diets are short term and focused on getting a person to lose weight or gain muscle. These quick-fix approaches to look better don't necessarily lead to good dietary habits. Dr Pastuszak urges people to focus on their health and forming good eating habits that can last a lifetime, rather than a fad diet that will help you lose a couple pounds for just a couple months.

Scot is working towards getting to a place where he can eat intuitively. He watches his diet closely and still weighs out his food. He hates weighing his food all the time, but is teaching himself what portion sizes should look like and how much he should be eating. He looks forward to the day he can stop weighing his food and eat intuitively.

Is Testosterone Therapy Right for You?

You may have seen the ads about testosterone therapy or "T" treatments. They make it sound like testosterone can cure just about anything that ails you. Have low energy? Testosterone is the answer. Putting on a few pounds of fat? Get T. Having trouble sleeping? Testosterone will help you sleep like a baby.

"In the right person, testosterone can help a lot," says men's health specialist Dr. Alex Pastuszak, but he admits that it isn't the cure-all the advertisements lead you to believe. Most of Dr. Pastuszak's patients will come in with complaints of low sex drive and general fatigue. They can't seem to power through a day and find themselves tired by lunch time.

The difficulty with diagnosing low-testosterone is that the symptoms are extremely non-specific. For example, if a guy is feeling fatigue, it can be caused by just about anything- lack of sleep, poor diet, depression, etc. Same goes for symptoms like low sex drive and insomnia.

The only way to know if a man is experiencing the symptoms of low testosterone is to get a testosterone level test.

What is a Normal Range for Testosterone?

A testosterone level test measures the amount of male hormones in the bloodstream. The results are measured in nanograms per deciliter. A healthy range for a guy is 300 to 1000 ng/dl, with around 600 being average. Anything around or below 300 is considered low by most physicians.

According to Dr. Pastuszak, most men feel better with a level of 600 or higher. Any man with a level below 600 will likely feel better with testosterone therapy and it's worth trying out. It's important to remember that testosterone therapy is typically considered a "lifestyle therapy" meaning you can use the treatment as long as you'd like if it helps you feel better.

Having a low testosterone level between 300 to 400 isn't dangerous to you health. However, if a man's testosterone drops below 300, there is an increased risk for osteoporosis and cardiovascular issues.

What Kind of Testosterone Therapy is Available?

Testosterone therapy can be administered in several different ways depending on the patient's needs, wants, and expectations.

The very first question Dr. Pastuszak asks is whether or not a guy plans on having kids in the near future. It may come as a surprise, but testosterone does not improve a guys fertility. In fact, testosterone does the exact opposite. After six months to a year of taking testosterone, most men see a dramatic drop in fertility.

Testosterone therapy is often made up of several different medications:

The basic form of the treatment is to add more of the male hormone to the body. This can be through injections, creams, pills, or even injections under the skin. These hormones aim to raise a man's testosterone levels to a more typical range.

Human chorionic gonadotropin or hCG
hCG is a drug that helps to stimulate the testes to produce testosterone naturally. It is prescribed with testosterone to prevent the testicles from shrinking during treatment. If testosterone is taken by itself, it interrupts the connection between the brain and testicles. The testes will stop producing testosterone and over time will begin to shrink. In some cases, the testicles will shrivel up to the size of raisins. hCG helps keep them the right size during testosterone therapy.

Clomid is an oral medication that stimulates the brain and testes to make more testosterone. Clomid has less of an impact on fertility, but is less effective at raising testosterone levels as significantly as T creams and gels. It is often prescribed to men with slightly low levels of testosterone or men looking to have children.

There are many different testosterone treatments available. Work with your doctor to find out what type of therapy will work best for your situation

The Side Effects of Testosterone Therapy

Like any medication, testosterone therapy comes with its own set of potential side effects. The two major side effects are infertility and testicular shrinkage. Infertility can be avoided by taking a less intense treatment route like Clomid. Testicle shrinkage is prevented with hCG and should always be taken with testosterone.

Testosterone therapy can also lead to an elevated level of estrogen. It may be confusing that increasing a male hormone would also increase a female hormone. Biochemically, testosterone is a precursor compound to estrogen. The human body needs testosterone to create estrogen. Therefore, in some men, having too much testosterone can lead to the overproduction of estrogen. If a guy's estrogen levels are too high they can develop tender, sensitive nipples, and in extreme cases, begin to develop breasts.

Additionally, testosterone can lead to erythrocytosis, or a significant increase in red blood cells in the blood. If a person's red blood count gets too high it can increase cardiovascular conditions like heart attack and stroke.

If you're on any sort hormone management like testosterone therapy, it's important to maintain regular follow up care. The hormones can keep you feeling really good for a really long time, but it's important to keep tabs on how they're affecting your body with a professional. After first starting testosterone therapy, your doctor may insist on frequent visits and tests to track your treatment and adjust medication as needed. After you and your doctor get the treatments zoned in, you can expect to visit your doctor every 6 months or so to make sure everything is running smoothly.

Choosing to Stop Testosterone: Scot's Story

Scot has had his own experience with testosterone therapy. After not feeling his best for a while, he went to a doctor to test his testosterone levels. The results showed that while he was within the acceptable range, his testosterone levels were on the lower end of the range. His doctor prescribed him a testosterone cream that he rubbed on his chest. After using the cream for a while, he didn't feel like he was feeling better. For him, the testosterone didn't turn out to be the cure-all he had been led to believe. He stopped the treatment and started focusing on other aspects of his health.

Scot recognized that his lack of energy may have been caused by something other than low testosterone. At the time, he was only getting around five hours of sleep a night. He says he was a little overweight and wasn't exercising as frequently as he should. Those bad habits were probably the real cause of his low energy levels, and he felt that testosterone couldn't cure his lifestyle.

After focusing on improving those aspects of his health, Scot began feeling better. Even better than he did when he was on testosterone therapy.

Dr. Pastuszak agrees that testosterone therapy isn't the cure for everything that the commercials will lead you to believe, but for some guys, it can get them on the right track. For example, an overweight thirty year old with low testosterone levels may be suffering from extremely low energy. That low energy leads him to not exercise or eat as well as he should. He comes in. Get tested and finds out he has low testosterone. The low testosterone level may likely be caused by the extra weight and lack of exercise, but with how low his energy levels are, it's going to be hard to be active.

Dr. Pastuszak would put this guy on hormone therapy as a "lifestyle intervention." The treatment makes him feel better and improves his energy levels. He then has the energy to go to the gym and exercise, which will bring his weight down, and get his body producing testosterone again. In a case like this, testosterone therapy can break the bad health spiral long enough for a man to improve his health and eventually stop using testosterone.

Testosterone therapy is a deeply personal and complicated issue. If you have any questions about treatments or suspect you may have low testosterone, submit your questions to Dr. Pastuszak by email at

ER or Not: Food Poisoning

You've decided to eaIf you've had food poisoning, you know how terrible it can be. You've eaten somewhere that's not so great and now you can't seem to stop throwing up. Should you go to the emergency room?

According to Troy, you don't necessarily need to go to the ER for food poisoning. Food poisoning usually strikes six to twelve hours after eating contaminated food, and will last for about just as long. Over the counter anti-nausea medication can help with the symptoms, but it'll have to run its course before you feel better.

However, if you are vomiting incessantly and can't keep even liquids down, you run the risk of becoming severely dehydrated. In this situation, go to the ER. An emergency room will be able to put you on an IV drip and help keep you hydrated during the food poisoning. Most urgent care facilities lack the means to start an IV, so if you're at risk for severe dehydration, an emergency room will be your best bet for treatment.

Just Going to Leave This Here

On this episode's Just Going to Leave This Here, Scot is thinking about the critters in his gut and how the microbiome could help your immune system stay strong and Troy is not ready for winter.

Talk to Us

If you have any questions, comments, or thoughts, email us at