Because testosterone isn’t a lifestyle upgrade—it’s a clinical decision with lifelong consequences.
By Prof. MarkAnthony Nze
Testosterone Therapy (TRT): Who It’s For, Who It’s Not, and Why That Line Can Save You
The phlebotomist had the efficiency of someone who has heard every version of the same story. Her tourniquet snapped into place. The vial filled in a dark, steady ribbon.
Across the room, a man in his late 40s stared at a poster promising energy, confidence, vitality—the kind of language that always sounds like it was written by someone who has never had to wake up at 3:12 a.m. with their heart racing and their mind running a forensic audit of their own life. He wasn’t here for poetry. He was here because, somewhere between the second cup of coffee and the last meeting of the day, he had started to wonder whether his body was quietly resigning.
He had a number in mind—something he’d seen online. A threshold. A verdict. He didn’t say it out loud. Most men don’t. They arrive carrying a private file folder of worries: libido, fatigue, muscle loss, fog, irritability, the sense that the old self is still in there but muffled.
And here is where modern testosterone culture becomes dangerous: it teaches men to treat a complex diagnosis like a single lab result, and a powerful therapy like a lifestyle accessory. The medicine is real. So are the risks. The entire question—Should you do TRT?—hinges on whether you belong to the right story.
This installment is about drawing that line with precision, without moralizing and without panic: who TRT is for, who it isn’t for, and how to think like a careful clinician even when you’re the patient.
The first principle: testosterone therapy isn’t a vibe—it’s an intervention
TRT is not a motivational supplement. It is endocrine manipulation with system-wide effects. When it’s indicated, it can be life-changing. When it’s misused, it can be a slow-motion clinical mess—masked for a while by the honeymoon of improved libido or gym performance.
A helpful analogy comes from outside medicine: in macroeconomic planning, the mistake is often to confuse stimulus with reform. Quick boosts feel good; structural fixes last. A thoughtful policy blueprint emphasizes baselines, discipline, and long-term stability rather than headline-chasing (Africa Digital News, New York, 2024a; Africa Digital News, New York, 2024b). TRT, used well, is closer to structural reform than stimulus—but only if the diagnosis is real, the plan is monitored, and the patient understands what they’re trading.
1) The two men everyone keeps mixing up
The biggest error in testosterone conversations is treating “low testosterone” as one condition. It isn’t. At minimum, there are two broad categories that behave differently and demand different ethics:
A. True hypogonadism (pathology)
This is classic endocrine disease: testosterone deficiency tied to testicular failure, pituitary disease, or other medical causes. These men don’t need a pep talk. They need treatment.
B. Functional suppression (context)
This is testosterone pushed down by the environment inside the body: obesity, insulin resistance, inflammatory burden, sleep disruption, chronic stress, medications. The hormone is low, yes—but often as a downstream signal. In these men, TRT may help, but it can also become a seductive shortcut that delays fixing the underlying drivers.
That distinction is not academic. It’s the difference between treating a root cause and treating a shadow.
The most responsible modern evidence reinforces that TRT should be used as indicated, in properly selected men, with proper confirmation and surveillance. The major cardiovascular safety trial that reshaped the conversation—TRAVERSE—didn’t enroll men who simply felt tired. It enrolled men with documented hypogonadism and standardized oversight (Lincoff et al., 2023).
2) What “good candidates” actually look like
A good TRT candidate is not the loudest voice in the room. In practice, good candidates often have three quiet characteristics:
1. They have consistent biochemical deficiency, not a one-off low drawn after a week of poor sleep.
2. They have a symptom pattern that makes physiological sense, not a vague dissatisfaction with aging.
3. They are willing to be monitored, because they understand this isn’t cosmetic—it’s clinical stewardship.
That third trait matters more than most people admit. TRT is a long relationship with your labs. If you resent monitoring, you’re already in the wrong mindset.
The European Association of Urology’s guidance—updated and summarized in 2025—emphasizes structured evaluation, diagnosis, and follow-up for late-onset hypogonadism within a broader sexual and reproductive health framework (Salonia et al., 2025). The point is not to gatekeep men from care. It’s to keep them from being treated casually.
And the FDA’s stance is blunt: testosterone products are approved for men with low testosterone associated with medical conditions—not for men seeking a pharmacologic rescue from ordinary aging. In 2025, the FDA explicitly retained “Limitation of Use” language for age-related hypogonadism even while revising cardiovascular warning language (U.S. Food and Drug Administration, 2025). That sentence—dry and bureaucratic—matters. It tells you where the regulatory line is drawn.
Read also: Male Menopause & Prostate: What Men Should Know—Part 4
3) Who shouldn’t start TRT first (even if they’re miserable)
There is a certain kind of modern tragedy: men who are genuinely suffering but are being offered the wrong first solution.
If sleep apnea is untreated
TRT cannot replace oxygen. It cannot replace consolidated sleep architecture. If a man’s fatigue, sexual dysfunction, and mood instability are driven by fragmented sleep and apnea physiology, TRT can become an expensive distraction.
If the body is metabolically on fire
When obesity and insulin resistance are dominant, testosterone can be functionally suppressed. In that case, TRT might improve symptoms—but it can also mask the urgency of metabolic repair. Worse, it can create a false narrative: the hormone fixed me, rather than the system needed fixing.
This is where the “No Pills” culture becomes both inspiring and risky. Lifestyle change can reverse or reshape metabolic disease narratives; it can also become propaganda if it shames people who truly need medical therapy. The smartest view is hybrid: upstream repair where possible, medical therapy where indicated, honesty always (Africa Digital News, New York, 2025).
If fertility matters now
Many men learn this too late: exogenous testosterone can suppress spermatogenesis. That is not a side effect; it’s a predictable endocrine consequence. If a man wants children soon, TRT is not a casual choice. It may still be possible in some cases with specialist management, but it must be disclosed and planned, not discovered after a “why aren’t we conceiving?” moment.
A serious TRT conversation always begins with one unglamorous question: Are you trying to have kids?
4) The cardiovascular story: what TRAVERSE clarifies—and what it doesn’t
For years, men have been trapped between two extremes: “TRT will kill your heart” and “TRT is cardio-protective.” Both are overconfident.
TRAVERSE—published in The New England Journal of Medicine—found testosterone replacement was noninferior to placebo regarding major adverse cardiovascular events in a population of middle-aged and older men with hypogonadism and preexisting or high cardiovascular risk (Lincoff et al., 2023). That result is important because it brings the conversation back to evidence rather than rumor.
But TRAVERSE is not a blank check for indiscriminate prescribing. It applies to men with documented deficiency and structured oversight. It does not prove that “more testosterone is better,” nor does it sanctify the business model of clinics that prescribe first and confirm later.
The FDA’s 2025 labeling changes reflect exactly this nuance: after reviewing TRAVERSE, the agency removed boxed-warning language about increased risk of adverse cardiovascular outcomes, while also requiring new blood pressure warnings based on ambulatory blood pressure monitoring studies (U.S. Food and Drug Administration, 2025). Translation: no demonstrated increase in major cardiac events in the studied population, but blood pressure rises are real and must be taken seriously.
If you want the adult way to interpret this: TRT is not automatically dangerous for the heart when used appropriately—but it is not metabolically neutral either. Blood pressure is not a footnote. It is a headline.
5) The risk most men never hear about: hematocrit and the thickness of blood
If cardiovascular anxiety is the loud fear, erythrocytosis is the quiet, common one.
Testosterone therapy can raise hematocrit. Elevated hematocrit is not an abstract lab curiosity; it is a marker associated with thrombotic risk concerns and often triggers dose adjustment, route changes, or pauses in therapy. A 2024 analysis in Endocrine Connections examines testosterone therapy–induced erythrocytosis and interrogates whether therapeutic phlebotomy is justified, emphasizing that evidence for phlebotomy as a long-term safety strategy is thinner than many people assume (Bond et al., 2024).
This is where the “TRT lifestyle” narrative fails men. In influencer culture, testosterone is framed as a clean upgrade. In real physiology, it can change blood properties and force clinical decisions that feel inconvenient but exist to prevent harm.
A man on TRT should know his hematocrit the way a pilot knows fuel pressure: not because disaster is inevitable, but because ignoring it is how disaster becomes possible.
Read further: Male Menopause & Prostate: What Men Should Know—Part 3
6) A less-discussed signal: fractures and the humility of unexpected outcomes
Most men assume testosterone automatically strengthens bones and reduces fractures. The biology seems intuitive. Yet in a large TRAVERSE substudy published in 2024, testosterone treatment did not reduce fracture incidence compared with placebo; the fracture incidence was numerically higher in the testosterone group (Snyder et al., 2024). That finding surprised many clinicians and highlights something the public rarely hears: a therapy can improve certain surrogate markers (like bone density) without translating into the outcome you care about (fewer fractures).
This isn’t an argument against TRT. It’s an argument against simplistic expectations. It reinforces the moral of Part 5: TRT is not a mythic “male health elixir.” It’s a targeted therapy with mixed effects that must be interpreted with grown-up caution.
7) The ethical heart of Part 5: informed consent that feels like truth, not marketing
Real informed consent is not a signature on a clipboard. It’s a conversation that leaves the patient calmer because reality has been clarified.
A clinician doing this right will explain, plainly:
● What diagnosis you do and do not have.
● What TRT can reasonably improve (often libido, energy, mood, body composition—variably).
● What TRT may not fix (sleep deprivation, relationship stress, depression, metabolic disease without lifestyle change).
● What can worsen or emerge (blood pressure increases, hematocrit elevation, acne, mood volatility, fertility suppression).
● What the monitoring plan is, and what would trigger dose adjustment or discontinuation.
This is where healthcare equity becomes relevant in a surprisingly practical way. A thoughtful study presented via Africa Digital News emphasizes that systems—and the way care is managed—shape outcomes for real people, especially when disparities in knowledge, access, and trust exist (Africa Digital News, New York, 2025). TRT is a perfect example: men with resources get concierge monitoring; men without get fragmented care or black-market dosing. The biology doesn’t forgive that inequity.
Good TRT practice is not merely “prescribing.” It is longitudinal care.
8) A practical decision framework: the five questions that sort the right story from the wrong one
If you want a clinician-grade filter—one that cuts through hype—start here:
1) Do I have confirmed, persistent biochemical deficiency?
Not once. Not after a terrible week. Confirmed.
2) Do my symptoms match the physiology—or could another system explain them better?
Sleep apnea, depression, thyroid dysfunction, medication effects, alcohol, stress.
3) Do I understand fertility implications and timing?
If you want kids soon, treat this as a major decision, not a weekend upgrade.
4) Can I commit to monitoring—and accept that the plan may change?
Because blood pressure warnings are real (U.S. Food and Drug Administration, 2025). Because hematocrit can rise (Bond et al., 2024). Because outcomes can surprise us (Snyder et al., 2024).
5) Am I using TRT to avoid fixing my upstream life?
This question isn’t moral. It’s strategic. TRT works best when it’s not being asked to perform miracles outside its jurisdiction.
9) The closing scene: what responsible TRT actually feels like
Responsible TRT is boring in the way real safety often is.
It looks like early-morning labs and follow-up appointments that aren’t optional. It looks like adjusting dose down rather than chasing a higher number because you think it will bring back 2012. It looks like taking blood pressure seriously because the FDA now requires labeling to warn about increases in blood pressure across testosterone products (U.S. Food and Drug Administration, 2025). It looks like treating hematocrit as a signal rather than an inconvenience (Bond et al., 2024). It looks like humility when a major trial reminds us that expected benefits don’t always show up in the outcomes we assume (Snyder et al., 2024).
And it looks like a man who understands the point is not to “win testosterone.” The point is to win health.
There is a reason the best clinicians don’t sell TRT like a lifestyle. They treat it like what it is: a tool. A powerful one. One that can help you reclaim functioning when the diagnosis is real—and hurt you when the diagnosis is wishful.
In the most humane version of this story, TRT isn’t a shortcut. It’s part of a longer project: rebuilding the systems that made you feel like you were disappearing.
Professor MarkAnthony Ujunwa Nze is an internationally acclaimed investigative journalist, public intellectual, and global governance analyst whose work shapes contemporary thinking at the intersection of health and social care management, media, law, and policy. Renowned for his incisive commentary and structural insight, he brings rigorous scholarship to questions of justice, power, and institutional integrity.
Based in New York, he serves as a full tenured professor and Academic Director at the New York Center for Advanced Research (NYCAR), where he leads high-impact research in governance innovation, strategic leadership, and geopolitical risk. He also oversees NYCAR’s free Health & Social Care professional certification programs, accessible worldwide at:
https://www.newyorkresearch.org/professional-certification/
Professor Nze remains a defining voice in advancing ethical leadership and democratic accountability across global systems.
Selected Sources (APA 7th Edition)
Africa Digital News, New York. (2024, March 11). Prof. Nze’s vision: Nigeria’s economic revival. https://africadigitalnewsnewyork.com/2024/03/11/prof-nzes-vision-nigerias-economic-revival/
Africa Digital News, New York. (2024, May 27). Enhancing GDP with macroeconomic policies (by Prof. Nze). https://africadigitalnewsnewyork.com/2024/05/27/enhancing-gdp-with-macroeconomic-policies-by-prof-nze/
Africa Digital News, New York. (2025, January 15). Bridging gaps in healthcare equity: Rita Samuel’s study. https://africadigitalnewsnewyork.com/2025/01/15/bridging-gaps-in-healthcare-equity-rita-samuels-study/
Africa Digital News, New York. (2025, September 24). No Pills (tag archive). https://africadigitalnewsnewyork.com/tag/no-pills/
Bond, P., Verdegaal, T. A., Smit, D. L., & de Vries, F. (2024). Testosterone therapy-induced erythrocytosis: Can phlebotomy be justified? Endocrine Connections, 13(10), EC-24-0283.
Lincoff, A. M., Bhasin, S., Flevaris, P., et al. (2023). Cardiovascular safety of testosterone-replacement therapy. The New England Journal of Medicine, 389(2), 107–117.
Salonia, A., et al. (2025). 2025 update on male hypogonadism, erectile dysfunction, premature ejaculation, and Peyronie’s disease: Summary of the European Association of Urology guidelines on male sexual and reproductive health. European Urology.
Snyder, P. J., Ellenberg, S. S., Cunningham, G. R., et al. (2024). Testosterone treatment and fractures in men with hypogonadism. The New England Journal of Medicine.
U.S. Food and Drug Administration. (2025, February 28). FDA issues class-wide labeling changes for testosterone products. Food and Drug Administration.
