Dr. Sam Madeira, NMD
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    Low testosterone & men’s health

    Low testosterone & men’s hormone health

    Low energy, low libido and losing your edge aren’t just “getting older.” Dr. Sam Madeira, NMD helps men in Arizona, Montana and Washington find out why testosterone is low and what can be done about it, by telemedicine.

    Book a free discovery callHow telemedicine care works

    Free · 30 minutes · by Zoom · no obligation

    Medically reviewed by Dr. Sam Madeira, NMD, licensed naturopathic physician · Updated

    Low testosterone is common, but not normal

    Studies suggest testosterone levels in men have declined over recent decades, beyond what aging alone explains.7 Aging plays a part, but so do sleep, metabolic health, stress and exposure to endocrine-disrupting chemicals in plastics and other everyday products. Dr. Madeira has discussed these overlooked causes on many podcasts.

    Overlooked causes

    • Poor or insufficient sleep
    • Insulin resistance, excess body fat and metabolic syndrome
    • Chronic stress and overtraining
    • Endocrine disruptors and environmental toxins, including heavy metals and mold toxins
    • Thyroid problems, medications and pituitary conditions

    How Dr. Madeira approaches low testosterone

    1. Proper testing: repeated morning levels and related hormones to find the cause.
    2. Address root causes with sleep, nutrition, training, stress, and environmental exposure changes, plus personalized nutritional and botanical support.
    3. Discuss hormone therapy when appropriate and permitted under federal rules and your state’s laws, with ongoing safety monitoring.

    Prefer to learn the foundations first?

    Dr. Madeira’s online course, Introduction to Optimizing Testosterone Naturally, explains how testosterone and related hormones work, the overlooked causes of imbalance, and the basics of labs, supplements and lifestyle strategies. Anyone can take it, wherever you live.

    Testosterone is only one piece of erectile health. Learn more about erectile dysfunction.

    From The Dr. Madeira Show

    Listen and learn more

    Frequently asked questions

    What causes low testosterone?

    Causes include aging, poor sleep, excess body fat and metabolic problems, chronic stress, certain medications, pituitary or testicular conditions, and environmental endocrine disruptors. Several overlooked causes are reversible.

    How is low testosterone diagnosed?

    Diagnosis is based on symptoms plus repeated early-morning testosterone tests, usually with related hormones such as free testosterone, LH, FSH, SHBG and estradiol, to understand why levels are low.

    Is testosterone therapy right for me?

    TRT can help some men with confirmed low testosterone and symptoms, but it isn’t right for everyone and it has risks and trade-offs, including effects on fertility. Dr. Madeira starts by finding why levels are low, and discusses whether hormone therapy makes sense for you.

    Can I get testosterone therapy by telemedicine?

    It depends. Testosterone is a federally controlled medication, and whether and how it can be prescribed by telemedicine depends on current federal rules and your state. Dr. Madeira focuses first on finding and addressing root causes, and discusses hormone therapy options when appropriate and permitted.

    Can low testosterone be raised naturally?

    Sometimes. Improving sleep, body composition, nutrition and stress, reducing endocrine-disruptor exposure, and addressing medical contributors can meaningfully improve levels for some men. Results vary.

    Do you help with erectile dysfunction?

    Yes. Erectile dysfunction often has hormonal, vascular, metabolic and psychological contributors. It can also be an early sign of cardiovascular disease, which is worth evaluating. Read what the research shows about erectile dysfunction.

    Can low testosterone cause anxiety, weight gain or fatigue?

    Yes. Low testosterone can contribute to anxiety and low mood, weight gain (especially more body fat and less muscle) and fatigue, along with reduced sex drive. These symptoms can also have other causes, such as poor sleep, thyroid problems, stress and blood sugar issues, so lab testing and a full evaluation are important.

    Sources

    1. Bhasin et al. (Journal of Clinical Endocrinology & Metabolism, 2018): Testosterone Therapy in Men With Hypogonadism: An Endocrine Society Clinical Practice Guideline
    2. Su et al. (Andrology, 2021): Association between obstructive sleep apnea and male serum testosterone: A systematic review and meta-analysis (18 studies, 1,823 men)
    3. Tiraboschi et al. (Urology, 2025): Rethinking Low Testosterone in Older Men: Association With Obesity Rather Than Aging (3,489 men)
    4. Zhao et al. (Journal of Sexual Medicine, 2019): Erectile Dysfunction Predicts Cardiovascular Events as an Independent Risk Factor: A Systematic Review and Meta-Analysis (25 studies, 154,794 people)
    5. Li et al. (Environment & Health, 2024): Association of Di(2-ethylhexyl) Phthalate Exposure with Reproductive Hormones in the General Population and the Susceptible Population: A Systematic Review and Meta-Analysis (37 studies, 28,911 people)
    6. NIH MedlinePlus: Hypogonadism
    7. Travison et al. (Journal of Clinical Endocrinology & Metabolism, 2007): A population-level decline in serum testosterone levels in American men (1,532 men aged 45–79, Boston)

    Telemedicine care for adults in Arizona, Montana and Washington.

    Related: Thyroid · Heavy metals · Who I serve · Energy & vitality quiz · Concierge medicine

    Thinking about next steps? See how care works, programs and pricing and patient reviews, or browse the frequently asked questions.

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    “Dr. Madeira is compassionate and truly listens. He takes the time to look beyond band-aid solutions and digs deeper to look at the root cause.”

    Dr. Shelly Sethi, D.O.

    From Google reviews. Individual experiences and results vary.

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    Ready to find out why your levels are low?

    Book a free 30-minute discovery call with Dr. Madeira. We’ll start with your why: what you want your health and life to look like, what’s been getting in the way, and whether working together feels right for you.

    • 30 minutes by Zoom, free, with no obligation
    • We talk about your goals and what’s been getting in the way
    • A non-clinical conversation: no diagnosis or treatment yet
    • For adults who live in Arizona, Montana or Washington
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    Concierge, private-pay practice (no insurance accepted) · 100% telemedicine for adults in Arizona, Montana & Washington.