Men's Hormone Health & Testosterone · San Diego · La Jolla · Poway · La Mesa
Testosterone care built on a diagnosis — not a number.
Low testosterone isn't simply a number, and testosterone replacement isn't simply a prescription. Understanding testosterone means understanding the man: the symptoms, the laboratory testing, the underlying cause, fertility goals, other hormones, metabolic health, and the real benefits and real risks of treatment.
Where to start
Five ways men arrive at this question.
I have symptoms and I have never been tested.
Fatigue, low libido, poor concentration, declining strength. Start by understanding how nonspecific these are — and what else causes them.
Read →I have a number and I do not know what it means.
340? 280? Was it a morning sample? Was it fasting? Was it repeated? A single result is wrong about 30% of the time.
Read →I have been offered testosterone and I am deciding.
Ten steps to work through, and ten questions to take into the appointment.
Read →I am on testosterone and something has come up.
Rising hematocrit. A PSA change. A partner who wants children.
Read →I want to know what the evidence actually says.
What TRAVERSE showed, what it did not, and where the major societies disagree.
Read →Three different things, routinely confused
Replacement is not optimization, and neither is enhancement.
Replacement
Restores testosterone to the normal range in a man whose own production is inadequate. It is what the drug is approved for and what the evidence supports.
Optimization
Pushes a man with normal or borderline testosterone toward the top of the range or beyond, on the theory that more is better. No trial evidence supports it.
Enhancement
Supraphysiologic doses for muscle or performance. Different regimen, different risk profile, different conversation.
Almost every argument in this field is really an argument about where the first ends and the second begins. Most sites blur that line. This one doesn't.
Where things actually stand
Six questions men arrive with, answered as honestly as the evidence allows.
Does testosterone therapy cause heart attacks?
The largest trial — 5,246 men at elevated cardiovascular risk — found no increase in heart attacks, strokes or cardiovascular death. It did find more pulmonary embolism, atrial fibrillation, acute kidney injury and fractures.
Does it cause prostate cancer?
No detected increase across 41 randomized trials in 11,161 men. That is not the same as proven safety over decades.
Does it make you infertile?
It suppresses sperm production in most men — 65% became azoospermic in contraceptive trials. Usually reversible, over months to more than a year.
Do testosterone boosters work?
With the exception of correcting a genuine zinc or vitamin D deficiency, no supplement has been shown to raise testosterone meaningfully in men who are not deficient.
Will it fix erectile dysfunction?
It improves sexual desire. In the largest trial it did not improve erectile function. Most erectile dysfunction in older men is vascular, not hormonal.
Is it an anti-aging treatment?
Low testosterone predicts mortality. Nothing shows that raising it prevents mortality. No trial has been designed to answer the question.
Don't treat the number. Treat the man.
Twelve percent of men starting testosterone had a proper workup.
Research presented at ENDO 2026 reviewed 200 men started on testosterone in primary care. Twelve percent had a guideline-concordant diagnostic workup — two low morning samples, gonadotropins measured, contraindications screened.
Of the rest: 63% were obese. 55% had obstructive sleep apnea. 52% had hypertension. 40% had depression. 28% had diabetes. These were not men with an unexplained hormone problem. They were men with several excellent explanations for their symptoms, receiving a hormone.
The reverse failure is just as common. Klinefelter syndrome — the most common cause of primary hypogonadism, affecting roughly 1 in 500 to 1,000 men — goes undiagnosed in up to two-thirds of cases.
Men who need testosterone are missed. Men who don't are treated. Both are failures of diagnosis, not of pharmacology.
No hype. No hormone fear. No bro-science.
Endocrinologist-led evaluation in La Jolla, Poway and La Mesa.