Good medicine doesn’t just start treatment—it knows when to pause.
By Prof. MarkAnthony Nze
Living on TRT: Monitoring, Longevity, and Knowing When to Reassess or Stop
On an ordinary Tuesday, in the kind of clinic where the fluorescent lights make everyone look slightly more tired than they are, a man scrolls through his phone as if it holds the verdict. He is not reading messages. He is watching numbers—testosterone, hematocrit, blood pressure—stacked like receipts from a life he’s trying to manage more responsibly than his father ever did.
He looks calm. But his calm is the kind that requires maintenance.
This is the part of testosterone therapy no one advertises: the long middle. The months after the glow of “I feel like myself again,” when the therapy is no longer a revelation and becomes a routine—like flossing, like paying bills, like any relationship that lasts long enough to reveal its real terms.
TRT doesn’t fail most men dramatically. It fails them quietly—through drift. Drift looks like missed labs, casual dose adjustments, a little more gel “because I’m busy,” a longer gap between injections “because I felt fine,” and the slow surrender of clinical seriousness to convenience. Drift is the enemy because testosterone is not a motivational vitamin. It is a system-level intervention. And systems don’t tolerate negligence; they tolerate it until they don’t.
Systems thinking matters in hormone care because testosterone is not a switch you flip—it’s a signal you steward. The men who do well on TRT aren’t the ones with the highest numbers; they’re the ones with the most disciplined feedback loop: baseline measures, repeat testing, trend interpretation, and the humility to revise decisions when the biology changes. That is the quiet argument embedded in the series’ opening frame: the question is not simply “Do I have low T?” but “What system am I living in—sleep, stress, weight, medications—and how is that system shaping the lab?” (Africa Digital News, New York, 2026a).
Once you accept that, monitoring stops feeling like bureaucracy and starts functioning like intelligence work. You’re not collecting labs to satisfy a protocol; you’re building a timeline of cause and effect—what changed after dose adjustments, what shifted after sleep improved, what stabilized when alcohol dropped. That’s the practical discipline that separates therapy from improvisation (Africa Digital News, New York, 2026b; Africa Digital News, New York, 2026c).
And it’s inseparable from prostate awareness: PSA trends, urinary symptoms, hematocrit drift, blood pressure creep—the slow variables that punish bravado and reward structure (Africa Digital News, New York, 2026d; Africa Digital News, New York, 2026e). In the end, resilience isn’t adrenaline. It’s governance.
Because responsible TRT is not a decision. It’s a practice.
Read also: Male Menopause & Prostate: What Men Should Know—Part 6
The day after the prescription: why starting is easier than continuing well
The first weeks of TRT often feel like proof. Not always dramatic, but unmistakable: improved libido, more steady energy, less emotional drag, better training response. Some men describe it as waking up inside their own body again.
That early improvement is real for many people. It is also a psychological trap.
When you feel better, you start to believe you’re safer. You loosen your grip on the guardrails. You skip the blood pressure check. You delay the hematocrit follow-up. You stop treating labs as intelligence and start treating them as paperwork.
This is how men end up surprised by results that were never sudden. Erythrocytosis does not usually announce itself with a siren. Blood pressure rises don’t always come with symptoms. They creep. They accumulate. They wait for your attention the way a small leak waits for you to stop listening.
A clinical analysis of testosterone therapy–induced erythrocytosis makes the key point in a way that cuts through casual clinic culture: “just do phlebotomy” is not a trivial response, and its justification deserves more scrutiny than routine practice often provides (Bond et al., 2024). Translation: if your follow-up plan depends on improvisation, you don’t have a plan—you have a hope.
Monitoring as intelligence, not anxiety
A well-monitored patient is not a paranoid patient. He’s a serious one.
Monitoring is often framed as “checking for problems,” which makes men feel like something is waiting to go wrong. A better frame is this: monitoring is how you preserve the benefits while preventing side effects from quietly rewriting your risk profile. It’s not surveillance because you’re fragile. It’s surveillance because you’re human—and because therapy changes the body whether you feel it or not.
If you want a metaphor that fits: TRT is like moving into a house with a powerful heating system. It can make your life more comfortable. But if you stop checking the thermostat, the ducts, the filters, the carbon monoxide detector, you’re not being brave—you’re being inattentive. And your comfort becomes an illusion maintained by luck.
The most mature TRT mindset sounds like this:
“I want the benefits. I will pay the cost of vigilance. I will not confuse convenience with safety.”
The core monitoring triad: what to track, and why it matters
If Part 6 taught you that delivery method creates a waveform, Part 7 teaches you that monitoring is how you keep that waveform within a safe, sustainable range. The triad is not glamorous, but it is the backbone.
1) Testosterone levels: timing, context, and the myth of “one good number”
Testosterone levels on therapy are meaningful only when you interpret them in context—especially timing relative to dosing.
● Injectables can create peaks and troughs that mislead if you test at the wrong time.
● Transdermals can fluctuate based on absorption and routine.
● Oral formulations may have their own variability and cardiovascular signatures.
If you test at the peak and panic at the trough, you will chase numbers rather than physiology. Your body will become a lab experiment run by your mood.
And even if the number is “perfect,” it is not the only indicator of success. One of the sharper lessons in modern TRT research is that expected outcomes don’t always materialize the way common sense predicts. In a large trial examining fractures, testosterone treatment did not reduce fractures compared with placebo; fracture incidence was numerically higher in the testosterone group (Snyder et al., 2024). That finding forces humility: health outcomes don’t always follow the story we want to tell.
So yes—measure testosterone. But treat it as a data point, not a trophy.
Read also: Male Menopause & Prostate: What Men Should Know—Part 5
2) Hematocrit / hemoglobin: the “blood thickness” conversation men deserve early
Erythrocytosis is among the most important TRT-related adverse effects to monitor because it is common enough to matter and serious enough to require action.
Bond and colleagues’ analysis doesn’t merely describe erythrocytosis—it interrogates the reflex response of phlebotomy and asks whether it is truly justified as a long-term management strategy (Bond et al., 2024). The subtext is clinical discipline: don’t treat lab abnormalities with ritual. Treat them with reasoning.
If hematocrit rises, the grown-up questions are:
● Is the dose too high?
● Is the waveform too peaky?
● Is the delivery method contributing?
● Are there co-factors (sleep apnea, dehydration) making the physiology worse?
Sometimes the answer is dose reduction. Sometimes it is switching formulations. Sometimes it’s a pause. The goal is not to “stay on TRT no matter what.” The goal is to remain healthy enough that TRT is still worth it.
3) Cardiovascular parameters: blood pressure is not optional
If hematocrit is the quiet risk, blood pressure is the risk that pretends it isn’t there until it is.
Ambulatory blood pressure monitoring studies remind us that testosterone therapies can affect blood pressure in measurable ways, including transdermal therapy (Efros et al., 2024; Weber et al., 2025) and oral testosterone undecanoate (White et al., 2021a; White et al., 2021b). These are not philosophical concerns. They are physiological realities.
At the same time, large outcome data provide an important anchor: in appropriately selected men with hypogonadism and elevated cardiovascular risk, testosterone replacement was noninferior to placebo for major adverse cardiovascular events (Lincoff et al., 2023). That finding reduces fear-driven narratives. But it does not excuse casual practice. “No increased major events in a studied population” is not the same as “ignore blood pressure.” You can be noninferior in outcomes and still physiologically drift into hypertension, especially if your lifestyle is deteriorating or your monitoring is lax.
TRT does not replace the fundamentals of cardiovascular health. If anything, it demands them.
The secondary surveillance layer: what matters once the basics are stable
Once the triad is handled, responsible TRT becomes more nuanced. The secondary layer is where good clinicians differ from pill mills.
PSA trends and prostate symptoms: not fear, but pattern recognition
Prostate monitoring often becomes emotionally charged. Men hear “PSA” and think “cancer,” even though PSA is not a verdict; it’s a signal. The wise approach is trend-based and symptom-aware: urinary changes, stream issues, nocturia, pelvic discomfort—these are data too.
Even in a “hormone series,” it’s worth stating: prostate health is not an optional subplot. It’s part of the contract you sign when you choose long-term therapy (Africa Digital News, New York, 2026a).
Sleep quality and apnea reassessment: the upstream factor that can sabotage everything
Men often assume TRT will fix energy. Sometimes it does. But if sleep is collapsing—snoring worsens, daytime sleepiness returns, morning headaches appear—TRT can become a mask over a bigger risk. Sleep apnea doesn’t just drain libido; it strains the cardiovascular system and may worsen hematocrit dynamics. If you stop reassessing sleep, you stop practicing TRT safely.
Mood and relationship feedback: the “unofficial lab”
A surprising amount of good clinical monitoring happens outside the clinic. Your partner’s observation that you are more irritable two days after injections, or flatter at the end of the dosing interval, is not gossip. It’s pattern recognition. It can indicate dosing volatility, peaks and troughs, or other physiological shifts.
A man serious about TRT learns to treat the people closest to him as early-warning systems—not because they are judging him, but because they are witnessing what he cannot easily see from inside his own nervous system.
Red flags that demand reassessment
A safe TRT plan has clear “stop and think” moments. These aren’t punishments. They are prompts for clinical humility.
Red flags include:
● Persistent or significant hematocrit elevation (Bond et al., 2024)
● Blood pressure increases or sustained hypertension signals in monitoring (Efros et al., 2024; Weber et al., 2025; White et al., 2021a; White et al., 2021b)
● New cardiovascular events or significant change in risk profile, requiring re-evaluation of benefits versus risks (Lincoff et al., 2023)
● Diminishing symptom benefit despite “good numbers” (a sign that upstream life variables are driving symptoms or that the therapy has plateaued)
● Evidence of adverse outcomes that challenge assumptions, such as fracture findings that complicate simplistic “testosterone strengthens bones” narratives (Snyder et al., 2024)
The key is not to panic. The key is to respond decisively and calmly. TRT is not a religion. It’s a tool.
The plateau problem: when “more” becomes the wrong instinct
Most long-term TRT complications are not dramatic. They are boring. That’s why they win.
A man starts at a dose, feels better, stabilizes, then months later notices the glow dimming. His instinct is to raise the dose. The clinic that wants his business agrees quickly. The clinician who wants his health asks harder questions.
The hard questions are these:
● Has sleep worsened?
● Has stress increased?
● Has alcohol crept back in?
● Has training consistency collapsed?
● Has weight increased?
● Are we treating endocrine deficiency, or are we trying to medicate a life that is out of alignment?
The plateau is often where TRT stops being a medical therapy and becomes an emotional crutch. Not because the man is weak, but because modern life is engineered to grind down recovery. TRT can blunt that pain for a while. It cannot rewrite the laws of physiology.
Sometimes the most therapeutic act is not increasing testosterone—it is reducing chaos.
That is why systems thinking matters even in hormone care. Many management and service-delivery conversations in health systems emphasize resilience, structured oversight, and strategic management rather than reactive firefighting. The same logic applies to your body: resilience is built through systems, not adrenaline.
The courage to adjust: why dose reduction can be optimization, not failure
There is a particular kind of masculinity that makes men treat dose reduction as defeat. It’s the same mindset that treats rest as laziness and monitoring as weakness. It’s childish, and it kills outcomes.
Dose reduction is sometimes the most sophisticated move a patient and clinician can make—especially when hematocrit rises, blood pressure drifts upward, or mood becomes volatile. Adjustment can also mean switching delivery methods to stabilize the waveform, rather than chasing higher peaks.
This is why living on TRT is not about “staying on TRT.” It’s about staying well.
Stopping TRT: the conversation no one markets
There’s a reason the “stop” conversation is rare: it scares men, and it doesn’t sell.
But clinically, stopping—or pausing—is sometimes the smartest decision. Not because TRT is “bad,” but because circumstances change.
You may stop because:
● risk signals rise beyond acceptable thresholds,
● benefits no longer justify tradeoffs,
● lifestyle factors worsen and TRT becomes a mask rather than a therapy,
● new health conditions emerge that alter the risk-benefit balance.
Stopping is not just physiological. It can be psychological. Men sometimes identify with the therapy. They fear that stopping means returning to a diminished version of themselves. That fear deserves empathy—but it also deserves honesty: your identity cannot depend on a prescription.
A disciplined clinician helps a patient plan cessation or reassessment the way a good pilot plans for turbulence: not as a catastrophe, but as a scenario you prepare for.
TRT and longevity: the long view is not a number—it’s a pattern of choices
Men ask, sometimes quietly, sometimes bluntly: “Will TRT help me live longer?”
The evidence does not give a simplistic answer. What it does give is a structure for adult thinking: in properly selected men, major cardiovascular outcomes data offer reassurance against some fears (Lincoff et al., 2023), while other outcomes remind us not to over-assume benefits (Snyder et al., 2024). Meanwhile, blood pressure findings across multiple modalities underscore that physiologic drift is real and requires vigilance (Efros et al., 2024; Weber et al., 2025; White et al., 2021a; White et al., 2021b).
So the longevity equation is not “testosterone yes or no.” It is:
● TRT plus monitoring plus lifestyle stability plus cardiovascular stewardship.
If you remove those other pieces, TRT is not a longevity strategy. It’s a gamble.
The exit strategy framework: a clinician-grade way to decide “continue, adjust, pause, or stop”
Here is a pragmatic framework you can use with your doctor, built from the evidence and from the logic of safe stewardship:
Continue unchanged when:
● symptoms are meaningfully improved,
● testosterone levels are appropriate for your regimen and timing,
● hematocrit remains acceptable (Bond et al., 2024),
● blood pressure is stable (Efros et al., 2024; Weber et al., 2025),
● and no new risk signals have emerged.
Adjust dose or method when:
● you see volatility—mood swings, symptom cycling—suggesting waveform problems,
● hematocrit trends upward,
● blood pressure creeps upward,
● or benefits plateau while risks rise.
Pause when:
● you need to clarify whether symptoms are still hormone-driven or life-driven,
● you need to stabilize cardiovascular risk factors,
● or adverse signals require immediate de-escalation.
Stop when:
● risks outweigh benefits,
● serious adverse outcomes occur,
● or the original indication no longer holds.
This is not alarmist. This is how grown-up medicine behaves.
Closing: the goal is not testosterone—it’s stewardship
If you remember one idea from Part 7, let it be this:
TRT is not the finish line. It is an ongoing agreement with your biology.
The therapy is not merely a substance you take. It’s a rhythm you impose. And rhythms either harmonize with a life—or they start to conduct it.
The men who do best on TRT are not the ones who chase the highest number. They are the ones who respect the triad, listen to trends, take blood pressure seriously, treat hematocrit like a real warning light, and remain willing to reassess—even to stop—when the facts change.
That willingness is not fear. It is maturity.
And it is, in the deepest sense, what makes a man free.
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)
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Africa Digital News, New York. (2026, February 8). Male menopause & prostate: What men should know—Part 1. https://africadigitalnewsnewyork.com/2026/02/08/male-menopause-prostate-what-men-should-know-part-1/
Africa Digital News, New York. (2026, February 9). Male menopause & prostate: What men should know—Part 2. https://africadigitalnewsnewyork.com/2026/02/09/male-menopause-prostate-what-men-should-know-part-2/
Africa Digital News, New York. (2026, February 10). Male menopause & prostate: What men should know—Part 3. https://africadigitalnewsnewyork.com/2026/02/10/male-menopause-prostate-what-men-should-know-part-3/
Africa Digital News, New York. (2026, February 11). Male menopause & prostate: What men should know—Part 4. https://africadigitalnewsnewyork.com/2026/02/11/male-menopause-prostate-what-men-should-know-part-4/
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