Male Hormone Replacement Therapy

What men should know about testosterone.

With Michael Roach, DO at Boone Medical Group – Ashland.

Just as women experience natural shifts in estrogen and progesterone with age, men go through their own hormonal transition. Testosterone typically peaks in early adulthood and gradually declines through the late 30s and 40s.

Testosterone’s primary biological role is reproduction. It drives sperm production and supports the body during the years when men are most fertile. As men move beyond those peak reproductive years, the body naturally slows testosterone production. This decline can contribute to increased fatigue and lower energy levels, especially later in the day. Many men notice they come home feeling too drained to tackle household tasks, play with their kids, or stay active.

Libido is another common concern. Testosterone influences sexual desire, not necessarily erectile function. Erectile dysfunction often has other causes, but a noticeable drop in libido can be a sign that testosterone levels have decreased.

“Testosterone therapy can be very effective for the right patient, but it is not a one-size-fits-all solution,” Dr. Roach explains. “With hormone replacement therapy becoming more visible through ads, influencers, and men’s health clinics, some places promote testosterone as something every man should take— regardless of age, symptoms or chronic conditions. That approach can be risky. Understanding both the benefits and the potential downsides is essential before starting therapy.”

Many men can improve their testosterone levels through lifestyle changes. Diet and exercise play a major role. Foods such as lean proteins, seafood, bananas, peppers, and onions can naturally support testosterone production. On the other hand, alcohol, high sugar foods, high fructose corn syrup, tobacco, mint, and soy can increase estrogen levels, which suppress testosterone.

Obesity is another major factor. Excess fat tissue converts testosterone into estrogen, lowering levels even further. As men lose weight through healthier eating and increased cardio activity, testosterone levels often rise naturally because the body becomes more efficient and less burdened by excess fat.

Hormone replacement therapy comes with important health considerations, which is why discussing it with a physician is crucial.

Sleep apnea is a major concern. Men who start testosterone therapy often gain weight in the first few months— sometimes 15–20 pounds. If sleep apnea is already present, this weight gain can worsen it, making HRT unsafe until the apnea is properly managed.

Psychological factors also matter. Testosterone can intensify existing anger, anxiety, or stress. Patients with significant mood or behavioral concerns may not be good candidates.

Cardiovascular and neurologic risks must be monitored closely. Testosterone thickens the blood, increasing the risk of heart attack and stroke. Regular bloodwork every 3–4 months is essential to ensure hemoglobin levels remain safe.

Prostate Specific Antigen (PSA) levels should be checked twice a year. Testosterone can stimulate PSA production, which may elevate PSA levels in the blood.

Blood pressure and circulation also require monitoring. Increased swelling in the legs can signal a higher risk of deep vein thrombosis (DVT), especially if the blood becomes too thick.

Cholesterol often rises as well, since testosterone binds to cholesterol in the bloodstream. Because of these risks, hormone therapy must be carefully supervised. While it can help men feel more motivated, build muscle, and improve energy, safety has to come first.

“A normal testosterone range for men is roughly 250–1,100 ng/dL. Many men’s clinics aim to push levels above 1,000 ng/dL, but a safer and more sustainable target is typically between 500–800 ng/ dL. This is another reason physician oversight is so important,” Dr. Roach said.

If a patient’s estradiol (estrogen) level rises during therapy, it often means the testosterone isn’t being used effectively— usually because the patient isn’t exercising or burning it off. In those cases, testosterone doses need to be adjusted until estradiol returns to a healthy range.

For some men, lifestyle changes are enough to improve testosterone levels. Others may stop producing testosterone altogether and require supplementation.

In clinical settings, testosterone is preferred to be given as an injection or in topical form. Some clinics use pellets inserted under the skin, but are very costly, and have to be done every 3-6 months depending on levels.

Before starting therapy, a full evaluation is essential. Even if a patient comes in for fatigue, underlying conditions such as thyroid disease, diabetes, sleep apnea, or depression must be ruled out first.

“There’s no right or wrong time to ask about testosterone,” Dr. Roach said. “Low testosterone isn’t life threatening; it’s more about quality of life. But men should be evaluated by a physician to ensure symptoms aren’t caused by a metabolic issue.”

It’s always better to get checked than to rely on internet advice or self diagnosis.

A conversation with a doctor can provide clarity, reassurance, and a safe path forward.

By Erin Wegner

If you need a primary care physician, visit boone.health/primarycare. To schedule an appointment at Boone Health Primary Care – Ashland, call 573-657-9354