Men's Health

What a Visit Involves

Men most often come in for fatigue, weight gain around the middle, lost strength, poor sleep, low motivation, or changes in libido. The first visit covers all of it, along with alcohol intake, training, work stress, and sleep, because those move testosterone as much as anything else does. Testing typically includes morning total and free testosterone drawn on two separate days, plus thyroid, metabolic, and other markers that explain low energy. At the review visit we go through what the numbers actually show. If levels are genuinely low and symptoms match, we discuss testosterone replacement therapy, including how it is monitored, its effect on fertility, and what it will not fix. If levels are normal, we keep looking, because low energy has many causes and testosterone is only one. Anyone on therapy is monitored on a set schedule.

What Men Usually Come In For

Men most often present with fatigue, declining strength or exercise tolerance, weight gain around the midsection, poor sleep, low motivation, low libido, or erectile changes. Those symptoms are frequently attributed to testosterone alone, and testosterone is worth checking, but it is rarely the only factor. Untreated sleep apnea, insulin resistance, alcohol intake, medication effects, thyroid dysfunction, iron or vitamin D deficiency, depression, and chronic stress all produce the same complaints, and several of them also lower testosterone directly. Erectile changes in particular can be an early cardiovascular signal and deserve a real evaluation rather than a prescription alone. The first task is establishing which of these is actually driving the picture.

Testing, Treatment, and Follow-Up

Testing usually includes morning total and free testosterone confirmed on more than one occasion, along with markers that give context, such as SHBG, LH, estradiol, prolactin where indicated, a complete blood count, metabolic and lipid panels, A1C or fasting insulin, thyroid markers, ferritin, and PSA where age appropriate. Sleep apnea screening is part of the conversation when symptoms suggest it. If treatment is indicated, the plan begins with what improves hormone status and health independent of any prescription: resistance training, protein, sleep, weight and blood sugar management, and alcohol reduction. Testosterone therapy is discussed only where it is clinically appropriate, with a candid review of fertility effects, red blood cell changes, cardiovascular considerations, monitoring requirements, and the commitment involved. Anyone on therapy is monitored on a fixed schedule, and urology or cardiology referral is made when the situation calls for it.

Treatment Focuses On

• Testosterone optimization when testing supports it
• Fatigue and low motivation
• Weight gain and body composition change
• Muscle loss and reduced strength
• Sexual health and libido
• Sleep quality, including screening for sleep apnea
• Metabolic health, including blood sugar and lipids
• Preventive wellness and long-term risk

How Low Testosterone Is Evaluated

• Morning draws, since testosterone is highest early in the day
• Two separate measurements before any diagnosis, because single values fluctuate
• Free testosterone and SHBG, not total testosterone alone
• LH and FSH to help distinguish where the problem originates
• Prolactin, estradiol, thyroid, A1C, and CBC as part of the workup
• Sleep apnea screening, which is a common and reversible driver of low levels

Symptoms alone are not enough to justify therapy, and normal levels do not mean nothing is wrong. Both get taken seriously.

If Testosterone Therapy Is Appropriate

• Full discussion of benefits, risks, and monitoring before you decide
• Effects on fertility and sperm production, which matter if you may want children
• Baseline and follow-up labs including hematocrit, PSA where appropriate, and estradiol
• Dose adjustment based on both labs and how you feel
• Nutrition and resistance training as part of the plan, not an afterthought

Therapy is generally long term. That commitment is discussed openly before starting.

When Testosterone Is Not the Answer

• Untreated sleep apnea, which can cause every symptom on this page
• Iron deficiency or anemia
• Thyroid dysfunction
• Insulin resistance and high visceral fat
• Alcohol intake, chronic under-recovery, and heavy training loads without rest
• Depression, which frequently presents as fatigue and low drive in men

Frequently Asked Questions

Do I need testosterone therapy if my energy is low?

Not necessarily. Low energy is common and testosterone is one of several possible reasons. We test, and we also look at sleep, iron, thyroid, blood sugar, alcohol, and mood. If levels are normal, therapy is not the answer and we keep working the problem.

Will testosterone therapy affect fertility?

It can. Testosterone therapy typically suppresses the body's own production and can reduce sperm production, sometimes significantly. If you may want children, tell us before starting, because there are alternative approaches to discuss.

How is testosterone monitored once I start?

Labs before starting, again several weeks after beginning or changing a dose, and then periodically. Monitoring usually includes testosterone, hematocrit, estradiol, and PSA where appropriate, along with blood pressure and symptom review.

Can I get my levels checked without committing to treatment?

Yes. Many patients come in specifically to find out where they stand. Testing and a clear explanation of the results do not obligate you to start anything.

Is this available by telehealth?

Consultations and lab reviews work well by telehealth on Thursdays and Fridays. Labs are drawn locally, and some visits are better handled in office in Salt Lake City, which we will tell you when it applies.