Male HRT for Health & Longevity - Quick Reference Sheet
evipedia.ai
← Back

Male HRT for Health & Longevity

Created on 09/14/2026 – Quick Reference based on Evidence Review created using AI4L / Opus 5 – Audit

Supplying testosterone to men whose own production has fallen reliably improves sexual desire, lean tissue, bone density, red blood cell production and glucose handling. Everyday physical function, mood and thinking respond much less. Harms rise with the dose: thickened blood, halted sperm production, shutdown of the body's own output. No trial shows it lengthens life; several safety questions stay open. (Full Review)

Protocol

Diagnostic threshold
Below ~300 ng/dL
Two fasting morning measurements (10.4 nmol/L) with symptoms; luteinizing hormone and prolactin separate the causes.
Injectable esters, the most used regimen
50–100 mg weekly, split
Cypionate or enanthate split into two subcutaneous administrations; or 100 to 200 mg weekly intramuscularly.
Transdermal gel
20.25–81 mg daily
1.62% gel once daily to shoulders or upper arms, titrated on a trough measurement; avoids peaks but carries the transfer risk.
Time to effect
Sexual desire and mood
3–6 weeks
Plateau by 6 weeks.
Body composition and red cell mass
3–12 months
Red cell rise is fastest in the first year.
Bone density
Up to 3 years
Still improving at 3 years.

Benefits

Contraindications
  • Active or previously untreated prostate cancer, or prostate-specific antigen above 4 ng/mL (above 3 where risk is elevated), pending urological assessment
  • Male breast cancer
  • Baseline hematocrit above 54%, or untreated primary polycythemia
  • Untreated severe obstructive sleep apnea (apnea-hypopnea index above 30 per hour)
  • Uncontrolled heart failure (New York Heart Association Class III or IV)
  • Within 3 to 6 months of myocardial infarction or stroke
  • Seeking conception within 12 months, or thrombophilia such as factor V Leiden
  • Severe untreated lower urinary tract symptoms (International Prostate Symptom Score above 19)
Key Interactions
  • Warfarin and other vitamin K antagonists (caution)
  • Insulin and sulfonylureas such as glipizide (monitor)
  • SGLT2 inhibitors, the sodium-glucose cotransporter-2 blockers such as empagliflozin (monitor)
  • 5-alpha-reductase inhibitors such as finasteride (caution)
  • Aromatase inhibitors such as anastrozole (caution)
  • Corticosteroids including prednisone (caution)
  • Opioids including oxycodone (monitor)
  • Iron and erythropoiesis-stimulating agents (caution)
  • Non-steroidal anti-inflammatory drugs such as ibuprofen (monitor)
  • Decongestants such as pseudoephedrine (caution)
  • Supplements raising free testosterone such as boron (monitor)
  • Supplements raising blood pressure or red cell mass such as licorice root (caution)
  • Phlebotomy and blood donation (mitigating)
    •

Risk & Side Effects

  • High: Erythrocytosis and elevated hematocrit; suppression of sperm production and infertility; suppression of the body's own testosterone production; reduced high-density lipoprotein cholesterol; acne and oily skin
  • Medium: Atrial fibrillation; increased clinical fracture rate; pulmonary embolism and venous thromboembolism; elevated blood pressure; prostate events and rising prostate-specific antigen; gynecomastia and breast tenderness; acute kidney injury
  • Low: Worsening of obstructive sleep apnea; mood lability and irritability; secondary transfer of topical testosterone; accelerated male-pattern hair loss; pulmonary oil microembolism and anaphylaxis
  • Speculative: Acceleration of occult prostate cancer; cardiac structural remodeling

Monitoring

Marker Target Why
Total testosterone 500–800 ng/dL at trough (17.4–27.8 nmol/L) Confirms the dose reaches target
Free testosterone 15–25 ng/dL by equilibrium dialysis Fraction available to tissues
Sex hormone-binding globulin 20–50 nmol/L Explains total-free mismatch
Estradiol, mass-spectrometry assay 20–40 pg/mL Mediates bone and libido effects
Hematocrit 40–50%; action above 52% Commonest dose-limiting effect
Hemoglobin 13.5–16.5 g/dL Tracks red cell mass
Prostate-specific antigen Below 1.5 ng/mL under 60; 2.5 over 60 Detects prostate growth or disease
Luteinizing hormone and follicle-stimulating hormone Baseline luteinizing hormone above 9 IU/L indicates testicular failure Testicular versus pituitary cause
Blood pressure, home or 24-hour ambulatory Below 120/80 mmHg Testosterone raises systolic pressure
Apolipoprotein B Below 80 mg/dL; below 60 mg/dL at high risk Counts atherogenic particles
Glycated hemoglobin 4.8–5.4% Tracks the glucose benefit
Estimated glomerular filtration rate Above 90 mL/min/1.73 m2 Kidney injury is a safety signal
Sperm concentration Above 15 million/mL where fertility matters Testosterone suppresses sperm output
Bone mineral density by dual-energy X-ray absorptiometry T-score above −1.0 Target tissue and a safety signal

Cadence: Hematocrit, total testosterone and blood pressure at 6 to 8 weeks; full panel at 3 and 6 months; then every 6 to 12 months. Prostate-specific antigen at 3 to 12 months, then annually. Bone density every 2 years with a fracture history.

Qualitative Assessment

  • Frequency of spontaneous morning erections
  • Sexual desire and frequency of sexual thoughts
  • Daytime energy and sense of vitality
  • Mood stability, irritability and emotional volatility
  • Sleep quality, new snoring or breathing pauses
  • Training performance, recovery and perceived strength
  • Waist circumference and body composition
  • Cognitive clarity and sustained concentration
Not medical advice. Educational distillation of a single evidence review. Confirm any decision with a qualified clinician, especially in the presence of prescription drugs or chronic conditions.