Dr. Abraham Morgentaler

Part of testosterone's problem is it has a bad rap.

Part of testosterone's problem is it has a bad rap.

It has a bad rap.

It has a bad rap.

Blood vessels. Blood vessels.

Blood vessels. Blood vessels.

Right. No, we're treating a tiny fraction of the men who have it. And it's funny because in some ways, testosterone is, the men who really need it don't get treated, not enough of them. And a lot of the men who don't need testosterone are getting it, right, through whatever, gyms or, you know, there's a trend to give it to people who aren't even deficient. Can we talk about that?

Right. No, we're treating a tiny fraction of the men who have it. And it's funny because in some ways, testosterone is, the men who really need it don't get treated, not enough of them. And a lot of the men who don't need testosterone are getting it, right, through whatever, gyms or, you know, there's a trend to give it to people who aren't even deficient. Can we talk about that?

Yeah, I have feelings about that.

Yeah, I have feelings about that.

Yeah, good. So I think there's broad agreement, and I certainly agree with it, that people should be treated if they have low levels of testosterone, they have either symptoms or what we call signs of Symptoms are things that people experience, like my sex drive is down.

Yeah, good. So I think there's broad agreement, and I certainly agree with it, that people should be treated if they have low levels of testosterone, they have either symptoms or what we call signs of Symptoms are things that people experience, like my sex drive is down.

Signs are something you can measure, like their hematocrit, their red blood cell count is reduced, or their bone density is down. Something you can measure. So traditionally, all the guidelines say you should have both. The challenge is, what's a low level of testosterone? And critics of testosterone therapy say, the experts can't even agree on what a low level is. And that's true. And that's true.

Signs are something you can measure, like their hematocrit, their red blood cell count is reduced, or their bone density is down. Something you can measure. So traditionally, all the guidelines say you should have both. The challenge is, what's a low level of testosterone? And critics of testosterone therapy say, the experts can't even agree on what a low level is. And that's true. And that's true.

And part of it is that some of the decisions about what a low level is has been arbitrary. So the FDA uses a number below 300 nanograms per deciliter. And if you look at any of their writing, they have no citations for that. There's no reference that says where they got that number from.

And part of it is that some of the decisions about what a low level is has been arbitrary. So the FDA uses a number below 300 nanograms per deciliter. And if you look at any of their writing, they have no citations for that. There's no reference that says where they got that number from.

So the urban myth that I think is true is, based on talking to people, is that when there was a first new testosterone product brought to the FDA in the late 1998, I think it was a patch, the FDA said, well, you have a drug that's supposed to normalize testosterone. Please tell us what a low level is. Fair. I mean, that's totally fair.

So the urban myth that I think is true is, based on talking to people, is that when there was a first new testosterone product brought to the FDA in the late 1998, I think it was a patch, the FDA said, well, you have a drug that's supposed to normalize testosterone. Please tell us what a low level is. Fair. I mean, that's totally fair.

And so they had a very senior expert and he said, well, people disagree on the number, but some people think it should be 400. Some say 350, some say 250. And free testosterone was not discussed. Nobody's talked about, we have to talk about free testosterone, but nobody's, that has been part of the conversation for forever.

And so they had a very senior expert and he said, well, people disagree on the number, but some people think it should be 400. Some say 350, some say 250. And free testosterone was not discussed. Nobody's talked about, we have to talk about free testosterone, but nobody's, that has been part of the conversation for forever.