The goal was never a hormone. It was a life you can sustain.
By Prof. MarkAnthony Nze
Beyond Testosterone: Stewardship, Identity, and the Long View of Men’s Health
He didn’t come to the clinic because he wanted to be twenty-five again. That’s the lie people tell about men who ask for help—especially when the help involves a hormone that the culture has mythologized into a kind of masculine currency. He came because he was tired of waking up as a stranger to his own mornings.
It was late winter, the kind of gray day when even a well-lit waiting room feels like it has absorbed the weather. A television murmured above a row of chairs. Someone coughed with the frankness of a person who had stopped apologizing for being human. The man held his phone in one hand, a coffee in the other, and tried to look indifferent to the thing he was actually doing: waiting for numbers.
Not just testosterone. The whole constellation—hematocrit, blood pressure, PSA, lipids, the rest of the quiet evidence that doesn’t flatter you the way a mirror can. He had learned, over the course of this series, that the body keeps records with a kind of bureaucratic fidelity. It writes down what you eat in your glucose. It writes down what you avoid in your waistline. It writes down what you refuse to sleep through in your stress hormones. It writes down your shortcuts in your blood pressure and pretends it isn’t doing it until the bill arrives.
That’s what the epilogue is for: not to sell you closure, but to give you a final map. Because men do not usually need more hype. They need a clearer way to live with the truth.
This series began in the recognizable place—the broad, human confusion about “male menopause,” symptoms that blur together, and the anxious feeling that something is slipping. The opening framing set the tone: testosterone and prostate health aren’t separate anxieties; they’re part of the same story of aging, risk, and responsibility (Africa Digital News, New York, 2026a). Then the series did what good health writing should do: it refused to let symptoms masquerade as diagnosis and refused to let therapy masquerade as identity (Africa Digital News, New York, 2026b; Africa Digital News, New York, 2026c). It demanded testing discipline, context, and humility. And it insisted that any honest conversation about testosterone eventually becomes a conversation about systems: sleep, weight, insulin, alcohol, stress, and the hard physics of time (Africa Digital News, New York, 2026d; Africa Digital News, New York, 2026e).
Now we land the plane. And the landing, if it’s done well, is quiet.
Read also: Male Menopause & Prostate: What Men Should Know—Part 7
The man after the series
The first thing the man after the series understands is that testosterone is not a referendum on his worth.
That sounds like a small point until you see how many men treat a lab value like a moral score. They don’t say it out loud, because it would embarrass them. But it lives in the background: If I’m low, I’m failing. If I’m high, I’m winning. This is a childish way to interpret biology, but culture encourages it because it sells products. A number is easy to sell. A system is harder.
The man after the series thinks differently. He knows that testosterone is one indicator—important, yes, but not sovereign. He knows symptoms can mislead. He knows one lab draw can be a fluke. He knows the body is not a courtroom where one test result convicts you.
He also knows something more subtle: that care is not the same thing as intensity.
Intensity is what you do when you’re scared and want to feel in control quickly. Care is what you do when you’re serious enough to keep going when it becomes boring.
In that sense, the series wasn’t really about testosterone. It was about training a different kind of attention.
Testosterone as a teacher, not a savior
TRT, when correctly indicated, can be a genuine relief. Some men experience the return of libido, better mood stability, improved energy, more favorable body composition. It can feel like the fog lifts.
But TRT is also instructive in a way men don’t anticipate: it teaches you what it cannot fix. It reveals the difference between endocrine deficiency and existential depletion. It highlights the role of sleep architecture. It exposes the metabolic state you’ve been negotiating with—sometimes for years—without knowing its name.
This is why the most honest clinicians treat TRT like a tool, not like a promise. A tool belongs inside a plan. A promise becomes a religion.
The best evidence we have about cardiovascular outcomes, for example, is more mature than the public conversation. The TRAVERSE trial—carefully designed and published in The New England Journal of Medicine—found testosterone replacement was noninferior to placebo for major adverse cardiovascular events in men with hypogonadism and elevated cardiovascular risk (Lincoff et al., 2023). That matters because it pushes back on simplistic fear. But it also pushes back on simplistic bravado. TRAVERSE does not mean “TRT is harmless.” It means: in properly selected men under structured care, major cardiovascular event rates were not worse than placebo. That’s a grown-up result, not a hype slogan.
And then there are outcomes that force deeper humility. In another major trial, testosterone treatment did not reduce fractures compared with placebo; the fracture incidence was numerically higher in the testosterone group (Snyder et al., 2024). Again, this does not “cancel” TRT. But it does puncture the myth that testosterone automatically converts into predictable wins. Biology is not always linear. It does not always honor our assumptions.
If TRT is a teacher, its most consistent lesson is this: you cannot medicate your way out of a disorganized system.
Read more: Male Menopause & Prostate: What Men Should Know—Part 6
The ethical framework of monitoring
Men often hear “monitoring” and interpret it as suspicion—like the clinician expects them to get in trouble. That reaction is partly cultural: many men have been trained to see checkups as weakness and vigilance as anxiety.
The correct frame is different. Monitoring is intelligence.
● Testosterone levels tell you whether you’re in physiologic territory, but only if timed correctly for your delivery method and interpreted as a trend.
● Hematocrit is a safety signal that can drift upward quietly, long before you “feel” anything wrong.
● Blood pressure changes can be silent and cumulative.
In other words: monitoring is how you prevent a therapy that helps you from gradually converting into a therapy that harms you.
Erythrocytosis is a sharp example. Testosterone therapy can increase hematocrit; when it rises, many clinics reflexively recommend phlebotomy as a solution. A 2024 analysis in Endocrine Connections questions the casualness of that reflex—asking whether phlebotomy is truly justified and noting that it may not be as benign or evidence-supported as routine practice implies (Bond et al., 2024). This is what mature medicine looks like: not reflex, but reasoning.
And blood pressure—often ignored because it isn’t “sexy”—has become increasingly central. Ambulatory blood pressure monitoring studies have examined blood pressure parameters among men treated with testosterone transdermal therapy (Efros et al., 2024) and have also looked at testosterone gel and blood pressure outcomes (Weber et al., 2025). Separately, studies of oral testosterone undecanoate showed measurable effects on ambulatory blood pressure (White et al., 2021a; White et al., 2021b). The point isn’t that every man on TRT will become hypertensive. The point is that physiology shifts can occur even when you feel great—and feeling great is a terrible substitute for measurement.
If Part 7 insisted on anything, it was this: good TRT is not optimism; it is governance.
Prostate awareness without paranoia
PSA has become a cultural boogeyman. Men hear it and think it means cancer. That’s not what PSA is. PSA is a signal. It can move for benign reasons. It can move slowly. It can move meaningfully. The skill is interpretation—trend-reading, symptom context, and risk stratification.
The series’ prostate framing was meant to replace two bad modes with one better one. The bad modes are:
1. Denial: “I don’t want to know.”
2. Catastrophe: “If it changes, I’m doomed.”
The better mode is stewardship: you track, you interpret, you act proportionately.
Guideline-level documents exist to support that maturity. The American Urological Association’s testosterone deficiency guideline emphasizes structured evaluation and monitoring as part of responsible testosterone care (American Urological Association, 2024). The Society for Endocrinology also provides clinical guidance for testosterone replacement therapy in male hypogonadism, reflecting the field’s focus on appropriate selection and ongoing safety (Jayasena et al., 2022). And urology literature continues to update clinicians on guideline revisions and how they should be interpreted in practice (Trost, 2024).
These aren’t mere academic documents. They are guardrails against two forces that routinely injure men: panic and marketing.
Masculinity, rewritten at the cellular level
There is an emotional storyline that often hides beneath TRT decisions: a man’s fear that he is losing power.
Not political power. Not social power. The intimate power of waking up with energy. The ability to concentrate. The sense of physical competence. The self-trust that comes from a body that responds.
That fear is understandable. But it becomes toxic when it is translated into the wrong kind of action—dose escalation, peak-chasing, the desire to “feel it” rather than to be stable.
Here’s what men learn, usually the hard way: the body respects restraint more than it respects aggression. It is the same principle you see everywhere in long-term performance. Training works because recovery is honored. Investing works because risk is managed. Parenting works because consistency beats intensity.
If you want a definition of masculine strength that holds up under lab values, it is not the ability to push harder. It is the ability to regulate—to stay consistent, to stay honest, to tolerate boredom in pursuit of stability.
This is why dose reduction is sometimes the bravest choice a man makes on TRT. Not because it feels good. Because it is responsible.
The marketplace: why some men get care and others get a transaction
TRT is not only a therapy. It’s an industry.
Industries have incentives. Some clinics are built like medical practices: careful diagnosis, structured follow-up, patient education, transparent risk discussion. Other clinics are built like storefronts. They sell feelings. They sell speed. They sell certainty.
If you want to recognize the difference, don’t look at their slogans. Look at their monitoring behavior.
A serious clinic will talk about blood pressure as a first-order issue, not a footnote—especially given evidence from ambulatory monitoring studies across modalities (Efros et al., 2024; Weber et al., 2025; White et al., 2021a; White et al., 2021b). It will treat hematocrit as a meaningful safety metric, not as paperwork (Bond et al., 2024). It will understand that large trials provide reassurance but not amnesty (Lincoff et al., 2023). And it will communicate uncertainty honestly, as any adult discipline must—especially when outcomes don’t align with common assumptions (Snyder et al., 2024).
The FDA’s 2025 class-wide labeling changes for testosterone products are also a reminder that the regulatory world is paying attention to risk communication (Food and Drug Administration, 2025). Men should, too.
If you’re paying for TRT, you deserve to know whether you’re paying for medicine or for theater.
Identity without the injection
There’s a moment, usually unspoken, when TRT crosses from therapy into identity. The man begins to think: This is who I am now. This is what keeps me functional. He may not articulate it. But it shapes behavior. He becomes reluctant to reassess. He treats any suggestion of change as an attack.
This is where the epilogue has to be honest, even if it discomforts.
If your identity depends on a prescription, you have built a fragile self.
The healthier posture is not anti-TRT. It is pro-autonomy. It recognizes that the therapy is a tool you can use—intelligently, responsibly, with humility—and that you remain the same person with or without it. Your worth is not produced by an injection.
And yes, stopping TRT can be difficult physiologically and psychologically. But the ability to stop—or to pause, or to reduce—when the evidence demands it is the mark of real strength.
The goal was never to become chemically fearless. The goal was to become clinically honest.
The final framework: four rules for a life that holds
If you’ve read Parts 1–7, you’ve encountered a lot: testing protocols, timing, prostate signals, sleep physiology, metabolic drivers, delivery-method pharmacokinetics, monitoring intervals, red flags.
Here’s the epilogue’s gift: the condensed blueprint. Keep it. Put it somewhere you’ll see it. It’s the closest thing to a philosophy of men’s health that survives contact with real life.
1. Test carefully.
Don’t diagnose on vibes. Don’t treat one lab result like scripture. Test correctly, repeat when indicated, interpret in context.
2. Treat selectively.
TRT when it’s truly indicated and aligned with goals and risks. Lifestyle and upstream repair always, whether or not you do TRT. Guidelines exist for a reason (American Urological Association, 2024; Jayasena et al., 2022).
3. Monitor relentlessly.
Not obsessively. Intelligently. Blood pressure deserves seriousness (Efros et al., 2024; Weber et al., 2025; White et al., 2021a; White et al., 2021b). Hematocrit deserves respect (Bond et al., 2024). Major outcomes evidence deserves accurate interpretation (Lincoff et al., 2023). And surprising findings deserve humility (Snyder et al., 2024).
4. Adjust courageously.
Dose down when necessary. Change method when patterns destabilize. Pause when risk rises or benefits plateau. Stop when the contract no longer makes sense. This is not failure. It is governance.
These four rules are not just TRT rules. They are life rules. Because long-term health is not a single intervention. It is a posture toward reality.
A closing scene: the quiet dignity of maintenance
The man from the waiting room gets called back. The clinician explains the results without drama. A small adjustment is recommended—not because something is wrong, but because the goal is stability, not thrill. The man asks questions. He doesn’t perform bravado. He doesn’t demand maximal doses. He listens with the calm attention of someone who finally understands the difference between feeling powerful and being well.
Outside, the day is still gray. The world does not applaud his discipline. That’s fine. Health doesn’t need applause. It needs maintenance.
And that is the last lesson of the series, the one that doesn’t fit neatly on a social media card: the work is ordinary. It’s labs on schedule. It’s sleep protected. It’s blood pressure tracked. It’s food chosen like fuel, not consolation. It’s exercise as a habit, not an event. It’s stress treated as physiology, not personality.
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. (2026, February 7). Male menopause & prostate: What men should know—Intro. https://africadigitalnewsnewyork.com/2026/02/07/male-menopause-prostate-what-men-should-know-intro/
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/
American Urological Association. (2024). Testosterone deficiency guideline.
Bond, P., Verdegaal, T. A., Smit, D. L., & de Vries, F. (2024). Testosterone therapy-induced erythrocytosis: Can phlebotomy be justified? Endocrine Connections, 13(10), e240283. https://doi.org/10.1530/EC-24-0283
Efros, M. D., Kaminetsky, J. C., Sherman, N. D., Chan, A., & Thomas, J. W. (2024). Ambulatory blood pressure parameters among men with hypogonadism treated with testosterone transdermal therapy. Endocrine Practice, 30(9), 847–853. https://doi.org/10.1016/j.eprac.2024.05.015
Food and Drug Administration. (2025, February 28). FDA issues class-wide labeling changes for testosterone products.
Jayasena, C. N., Anderson, R. A., Llahana, S., Barth, J., MacKenzie, F., Wilkes, S., Smith, N. D., Sooriakumaran, P., Minhas, S., Wu, F. C. W., Tomlinson, J. W., & Quinton, R. (2022). Society for Endocrinology guidelines for testosterone replacement therapy in male hypogonadism. Clinical Endocrinology, 96(2), 200–219. https://doi.org/10.1111/cen.14633
Lincoff, A. M., Bhasin, S., Flevaris, P., Mitchell, L. M., Basaria, S., Boden, W. E., Nissen, S. E., & TRAVERSE Study Investigators. (2023). Cardiovascular safety of testosterone-replacement therapy. The New England Journal of Medicine, 389(2), 107–117.
Snyder, P. J., Bauer, D. C., Ellenberg, S. S., Cauley, J. A., Buhr, K. A., Bhasin, S., Miller, M. G., Khan, N. S., Li, X., & Nissen, S. E. (2024). Testosterone treatment and fractures in men with hypogonadism. The New England Journal of Medicine, 390(3), 203–211. https://doi.org/10.1056/NEJMoa2308836
Trost, L. (2024). Update to the testosterone guideline. The Journal of Urology, 211(4), 608–610. https://doi.org/10.1097/JU.0000000000003855
Weber, M. A., Aslam, S., Efros, M. D., Chan, A., Khan, N., Li, X., Dubcenco, E., & Miller, M. G. (2025). Single-arm study of testosterone gel replacement therapy and ambulatory blood pressure outcomes in men with hypogonadism. Andrology, 13(6), 1390–1401. https://doi.org/10.1111/andr.13779
White, W. B., Bernstein, J. S., Rittmaster, R., & Dhingra, O. (2021a). Effects of the oral testosterone undecanoate Kyzatrex™ on ambulatory blood pressure in hypogonadal men. The Journal of Clinical Hypertension, 23(7), 1420–1430. https://doi.org/10.1111/jch.14297
White, W. B., Dobs, A. S., Carson, C. C., DelConte, A., Khera, M., Miner, M. M., Shahid, M., Kim, K., & Chidambaram, N. (2021b). Effects of a novel oral testosterone undecanoate on ambulatory blood pressure in hypogonadal men. Journal of Cardiovascular Pharmacology and Therapeutics, 26(6), 630–637. https://doi.org/10.1177/10742484211027394
