Testosterone: What Every Man Should Know About Low T, Bloodwork, and TRT
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Testosterone: What Every Man Should Know About Low T, Bloodwork, and TRT

The information in this article is for educational purposes only and is not intended as medical advice. Always consult a licensed healthcare provider before starting any hormone therapy or supplement protocol.

IMPORTANT NOTE FOR ACTIVE FIGHTERS: Testosterone replacement therapy (TRT) and all exogenous testosterone are banned substances in professional and amateur boxing. Fighters have been stripped of titles, suspended, fined, and permanently disqualified for testing positive. VADA, USADA, WADA, and state athletic commissions all prohibit testosterone use. If you hold or are pursuing a boxing license, TRT is not an option. This article is written for the general male population, not active competitors.

The Conversation Nobody Was Having

Ten years ago, nobody at the gym was talking about their testosterone levels. Now it’s everywhere. Podcasts, social media, billboards on the highway, ads during football games. “Low T” has gone from a clinical diagnosis to a cultural talking point. Clinics offering testosterone replacement therapy have popped up in every city. Online TRT providers will prescribe you testosterone after a video call and ship it to your door.

Something real is happening underneath the marketing. Testosterone levels in men have been declining for decades. A 2007 study in the Journal of Clinical Endocrinology & Metabolism showed that average testosterone levels dropped by roughly 1% per year from 1987 to 2004 — independent of age. A man born in 1970 has significantly lower testosterone at 35 than a man born in 1940 had at 35. The causes are debated — environmental chemicals, obesity rates, sedentary lifestyles, sleep deprivation, stress — but the decline is documented.

That doesn’t mean every man who feels tired needs testosterone injections. But it does mean the conversation is legitimate, the problem is real, and understanding what testosterone actually does and how to know if yours is low is worth your time.

What Testosterone Does

Testosterone is the primary male sex hormone. It’s responsible for:

  • Muscle mass and strength
  • Bone density
  • Fat distribution (lower testosterone = more body fat, especially abdominal)
  • Red blood cell production
  • Sex drive and erectile function
  • Mood, motivation, and mental clarity
  • Energy levels
  • Hair growth (and loss — testosterone’s relationship with hair is complicated)
  • Sperm production

It’s not just a “gym hormone.” Testosterone affects every system in the male body. Low testosterone doesn’t just mean you can’t build muscle — it means fatigue, brain fog, depression, irritability, loss of motivation, poor sleep, reduced libido, and increased body fat. Most men with low T don’t feel “sick.” They just feel like a diminished version of themselves.

How to Know If You’re Low

Get your bloodwork done. That’s the entire answer. You cannot diagnose low testosterone by how you feel. The symptoms overlap with depression, poor sleep, stress, bad diet, and a dozen other things. The only way to know is a blood test.

What to test:

  • Total testosterone — The headline number. Most labs list the “normal” range as 264-916 ng/dL. That’s an absurdly wide range. A 30-year-old at 280 is technically “normal” but is nowhere near optimal. Many functional medicine practitioners consider 500-900 ng/dL a healthier target range for adult men.
  • Free testosterone — Total testosterone is how much is in your blood. Free testosterone is how much is actually available for your body to use. A significant portion of your total testosterone is bound to sex hormone-binding globulin (SHBG) and is inactive. You can have “normal” total testosterone but low free testosterone and still feel like garbage. This is the number that matters most.
  • SHBG (sex hormone-binding globulin) — The protein that binds testosterone and makes it unavailable. High SHBG means less free testosterone even if total levels look fine.
  • Estradiol (E2) — Estrogen in men. Testosterone converts to estrogen through an enzyme called aromatase. Too much estrogen relative to testosterone causes water retention, mood issues, fat gain, and gynecomastia. This needs to be monitored, especially if you go on TRT.
  • LH (luteinizing hormone) and FSH (follicle-stimulating hormone) — These hormones from the pituitary gland signal the testes to produce testosterone. If your testosterone is low and your LH/FSH are high, your brain is sending the signal but your testes aren’t responding (primary hypogonadism). If both testosterone and LH/FSH are low, the problem is upstream — your brain isn’t sending the signal (secondary hypogonadism). The distinction matters for treatment.
  • Prolactin — Elevated prolactin can suppress testosterone production. Usually checked to rule out pituitary issues.
  • Thyroid panel (TSH, free T3, free T4) — Thyroid dysfunction mimics low testosterone symptoms. Rule it out.
  • CBC (complete blood count) — Testosterone increases red blood cell production. If you go on TRT, this needs to be monitored because too many red blood cells thicken the blood and increase cardiovascular risk.

When to test: Morning, fasted. Testosterone peaks in the morning and drops throughout the day. An afternoon blood draw can show levels 20-30% lower than a morning draw. Always test in the morning to get an accurate baseline.

Where to test: Your primary care doctor can order these labs. If your doctor won’t order a comprehensive hormone panel, companies like Marek Health, InsideTracker, Function Health, and DiscountedLabs offer direct-to-consumer blood testing. Walk into a lab, get drawn, results in a few days.

Before TRT: Fix the Basics

Most men with “low” testosterone don’t need injections. They need to fix the things that are suppressing their natural production. Testosterone is a downstream signal of overall health. When your body is healthy and functioning well, it produces adequate testosterone. When it’s not, production drops.

Sleep. This is number one. Testosterone is primarily produced during deep sleep. Men who sleep 5 hours per night have testosterone levels 10-15% lower than men who sleep 7-9 hours. If you’re not sleeping enough, no amount of supplements or injections will fix the root problem. Fix your sleep first.

Body fat. Excess body fat — particularly visceral abdominal fat — increases aromatase activity, which converts testosterone to estrogen. The fatter you are, the more testosterone you convert to estrogen, the lower your effective testosterone. Losing body fat is one of the most powerful natural testosterone interventions available.

Resistance training. Heavy compound lifts — squats, deadlifts, bench press, overhead press — stimulate testosterone production. Men who lift consistently have higher testosterone levels than sedentary men. You don’t need to be a powerlifter. You need to put heavy things down and pick them up a few times a week.

Stress management. Chronic stress elevates cortisol. Cortisol and testosterone have an inverse relationship — when cortisol stays high, testosterone drops. Chronic work stress, financial stress, relationship stress — all of it suppresses testosterone over time.

Nutrition. Zinc, magnesium, vitamin D, and healthy fats are all required for testosterone production. Deficiencies in any of these will suppress your levels. This is why the supplement stack we cover in our Supplements 101 article matters — most men are deficient in at least one of these.

Alcohol. Regular heavy drinking suppresses testosterone production, increases estrogen, disrupts sleep, and adds empty calories that increase body fat. Reducing or eliminating alcohol is one of the fastest ways to improve hormone levels.

Fix these six things first. Get retested in 90 days. Many men see significant improvement without ever touching TRT.

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Natural Supplements That May Help

Once the lifestyle foundations are solid, certain supplements show evidence for supporting natural testosterone production. None of these will transform your levels the way exogenous testosterone does — but they can help optimize what your body produces on its own.

Tongkat Ali (Eurycoma longifolia) — The most commonly recommended natural testosterone support supplement. Multiple human studies show modest increases in free testosterone, particularly in men with suboptimal levels. Andrew Huberman takes 400mg daily. Look for standardized extracts.

Ashwagandha (KSM-66) — An adaptogen that lowers cortisol and may increase testosterone as a downstream effect. Research shows improvements in testosterone, strength, and recovery in men who resistance train. 600mg daily.

Zinc — Essential for testosterone synthesis. Supplementation improves testosterone levels in men who are deficient. 15-30mg daily. Don’t overdo it — excess zinc depletes copper.

Magnesium — Supports over 300 enzymatic reactions including those involved in hormone production. Glycinate form before bed.

Vitamin D3 — Low vitamin D is correlated with low testosterone. 5,000 IU daily with K2.

Boron — A trace mineral that may reduce SHBG, freeing up more testosterone for the body to use. 6-10mg daily. Small studies show modest benefits.

DHEA — A precursor hormone that the body converts into testosterone and estrogen. Available over the counter. More commonly recommended for men over 40 whose DHEA levels have declined. 25-50mg daily. Monitor estrogen levels if you take this.

These supplements work best as part of a comprehensive approach — not as standalone fixes. Get bloodwork, fix the lifestyle factors, supplement strategically, retest.

TRT: What It Actually Is

Testosterone replacement therapy is the medical administration of exogenous (external) testosterone to bring levels into the normal-to-optimal range. It’s prescribed for men with clinically diagnosed hypogonadism — testosterone levels that are low enough to cause symptoms and that haven’t responded adequately to lifestyle interventions.

How it’s administered:

  • Injections — The most common form. Testosterone cypionate or enanthate injected intramuscularly or subcutaneously, typically once or twice per week. This is what most TRT clinics prescribe.
  • Topical gels and creams — Applied daily to the skin. More stable blood levels than injections but lower dose ceiling. Risk of transference to women and children through skin contact.
  • Pellets — Implanted under the skin every 3-6 months. Consistent release but requires an in-office procedure.
  • Clomiphene (Clomid) — Not testosterone itself. A selective estrogen receptor modulator (SERM) that stimulates the body to produce more of its own testosterone by increasing LH and FSH. Sometimes prescribed as an alternative to TRT for younger men who want to maintain fertility, since exogenous testosterone suppresses sperm production.

What TRT does and doesn’t do:

TRT will bring low testosterone levels into the normal range. Men with genuinely low T who go on TRT typically report significant improvements in energy, mood, motivation, libido, body composition, and mental clarity. The improvements are real and often dramatic.

TRT will not turn you into a bodybuilder. Therapeutic doses bring you to normal levels — not supraphysiological levels. The men on social media who look enormous and credit “TRT” are usually taking bodybuilding doses, which is a different thing entirely.

The tradeoffs:

  • Fertility suppression — Exogenous testosterone tells your brain to stop producing LH and FSH, which shuts down natural testosterone production and sperm production. This is often reversible but not always. If you plan to have children, discuss this thoroughly with your doctor.
  • Lifelong commitment — Once you start TRT, your body’s natural production decreases or stops. Coming off TRT means going through a period of very low testosterone while your body attempts to restart production. Many men who start TRT stay on it indefinitely.
  • Monitoring required — TRT requires regular bloodwork to monitor testosterone levels, estrogen, hematocrit (red blood cell count), PSA (prostate marker), and liver function. It’s not “take a shot and forget about it.” It requires ongoing medical supervision.
  • Estrogen management — Testosterone converts to estrogen. On TRT, some men need an aromatase inhibitor (AI) to keep estrogen levels in range. Over-suppressing estrogen causes joint pain, mood issues, and reduced libido. This is a balancing act that requires regular monitoring.

The Online TRT Clinic Boom

The traditional path to TRT — see your primary care doctor, get referred to an endocrinologist, wait months for an appointment — has been disrupted by online clinics that offer the entire process remotely.

How they work: You do a blood test (either at-home kit or at a local lab), have a telemedicine consultation with a provider, and if you qualify, they ship testosterone and supplies to your door. Monthly cost typically runs $150-300 including the medication, supplies, and consultations.

Some of the major players:

  • Hone Health — Online platform for hormone testing and TRT prescriptions.
  • Marek Health — Founded by Derek (More Plates More Dates). Offers comprehensive bloodwork and hormone optimization including TRT.
  • Peter Uncaged MD — Telemedicine TRT and hormone optimization.
  • Fountain TRT — Online TRT clinic with home testing and prescriptions.
  • Defy Medical — One of the original telemedicine TRT clinics. Comprehensive approach.
  • Royal Medical Centers — Brick-and-mortar and telemedicine hormone clinics.
  • Local men’s health clinics — Most mid-size and large cities now have local clinics specializing in testosterone and hormone optimization.

The caution: The barrier to getting prescribed TRT through an online clinic is low — arguably too low. Some clinics will prescribe testosterone to men whose levels are technically normal but on the lower end. The financial incentive is obvious — a patient on TRT is a recurring monthly subscriber. Make sure you’ve genuinely addressed the lifestyle factors first and that your levels are truly low on repeated testing, not just one borderline result.

The Boxing Problem

This needs to be stated clearly: TRT is an unfair advantage in combat sports and it is banned.

Testosterone increases muscle mass, strength, bone density, red blood cell production, aggression, and recovery speed. In a sport where two people are trying to hurt each other, those advantages are dangerous and constitute cheating.

Fighters who have tested positive for testosterone or other performance-enhancing drugs have faced severe consequences — title losses, multi-year suspensions, permanent license revocations, and destroyed reputations. Athletic commissions test for exogenous testosterone through T/E ratios and carbon isotope ratio testing that can distinguish between testosterone your body made and testosterone that came from a vial.

There was a brief period when some fighters obtained “therapeutic use exemptions” (TUEs) for TRT, arguing they had medically diagnosed low testosterone. The commissions largely shut this down. The argument that a fighter “needs” testosterone replacement while competing in a sport where testosterone provides a direct competitive advantage didn’t hold up.

If you are an active amateur or professional fighter, or you plan to compete, TRT is not an option. Period.

This article is for the average man who trains, wants to feel better, and is curious about what his testosterone levels mean and what his options are if they’re low. That’s a legitimate conversation. Just not one that applies inside the ropes.

The Bottom Line

Step 1: Get comprehensive bloodwork done. Total testosterone, free testosterone, SHBG, estradiol, LH, FSH, thyroid panel, CBC. Morning draw, fasted.

Step 2: Fix the basics. Sleep 7-9 hours. Lift heavy. Lose excess body fat. Manage stress. Eat clean with adequate zinc, magnesium, vitamin D, and healthy fats. Cut alcohol.

Step 3: Retest in 90 days. If levels have improved, keep doing what you’re doing. If they haven’t, consider natural supplements — Tongkat Ali, ashwagandha, boron, DHEA.

Step 4: If levels are still clinically low after lifestyle optimization and supplementation, consult with a physician about TRT. Understand the tradeoffs. Commit to ongoing monitoring.

Don’t start at Step 4. Most men who jump straight to TRT without fixing the basics end up on testosterone for life when they might not have needed it. The injections are easier than fixing your sleep and your diet — but easier isn’t always better.

And get your bloodwork done. Whatever you decide to do, it starts with knowing your numbers.

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