Find the cause, then treat
Low testosterone, also called hypogonadism or andropause, means the testes aren’t making enough testosterone. It can happen at almost any adult age, for several reasons.5 It affects roughly 30% of men aged 40 to 79 and is closely tied to obesity, diabetes and high blood pressure.11 Dr. Madeira tests hormone levels with blood and urine testing, then works with you to find and treat the cause. Testosterone is prescribed only when it’s medically necessary, at a low dose, as part of a whole-person plan.
In his clinical experience, men who went through puberty after 1980 often have lower levels than older generations, which he attributes to greater exposure to environmental toxins. Population research has also found declining testosterone in American men.4
More than a testosterone level
Dr. Madeira has treated thousands of men for hormone imbalance, low testosterone and adrenal hormone problems. Along with testosterone, he screens for:
- Thyroid function
- Adrenal function
- Cardiovascular risk markers
- Gut health
- Micronutrient levels
- Endocrine disruptors and toxicants in blood and urine
- Mitochondrial health
Testing is chosen case by case, based on what’s medically necessary.
Quick self-check
Dr. Madeira uses 10 yes-or-no questions to decide whether testing is worth discussing. Take the self-check below: it takes about 2 minutes, and your answers stay on your device.
Benefits, with safety first
For men with confirmed low testosterone, restoring levels aims to improve energy, focus, mood and sexual function.1 In the TRAVERSE trial, men with low testosterone and low libido on testosterone had more sexual activity, more desire and fewer low-testosterone symptoms over two years than men on placebo.9 Dr. Madeira has also seen erections improve once low testosterone is corrected, and a 2017 analysis of 14 placebo-controlled trials (2,298 men) found testosterone therapy improved erectile function, most in men with the lowest levels,13 although erections didn’t change in the TRAVERSE sexual function study.9 Results vary from man to man. Before starting, every man is screened for cardiovascular risk with a blood test.
What the research says about the heart and prostate
For decades, testosterone was blamed for prostate cancer and heart problems. The work of Dr. Abraham Morgentaler, MD, a Harvard urologist, overturned much of that thinking, and in 2025 an international expert panel he served on updated its recommendations on testosterone and heart, metabolic and prostate health:10
- Prostate: his “saturation model” shows prostate tissue is fully stimulated at low testosterone levels, so restoring normal levels doesn’t keep fueling prostate growth.7 In the TRAVERSE trial, carefully screened men on testosterone had no more prostate cancer or prostate problems than men on placebo.8
- Heart: his review of the research found no convincing evidence that testosterone therapy raises heart risk, and linked normal testosterone with better heart health and lower mortality.6,12 TRAVERSE later confirmed no rise in major heart events.3
Building on this research, Dr. Madeira sees restoring testosterone in men who are truly deficient as part of optimizing long-term heart and prostate health, unless a man has prostate cancer. Official guidelines still frame TRT as treatment for the symptoms of low testosterone, and TRAVERSE found more atrial fibrillation and blood clots in the lungs, so screening and monitoring stay part of every plan.1,3
The whole hormone picture
In Dr. Madeira’s clinical view, the balance between testosterone and estradiol is often overlooked, and low-normal testosterone with high estrogen deserves attention. That’s why his plans monitor estrogen along with testosterone, blood count and prostate markers,1 and why he individualizes dosing to keep side effects low.
How testosterone is given
When testosterone is prescribed, Dr. Madeira typically uses testosterone cypionate or propionate from a licensed compounding pharmacy, as an injection or a cream or gel. Compounded medications aren’t FDA-approved, so ask about the options and their trade-offs.
When TRT isn’t an option
Dr. Madeira doesn’t start testosterone therapy if you have:
- Untreated sleep apnea
- Cancer (neoplasia)
- Prostate cancer
- Liver disease
- Kidney (renal) disease