A number is a starting point
Low testosterone (hypogonadism) means the testes aren’t making enough testosterone, and it can show up at almost any adult age.4 It affects roughly 30% of men aged 40 to 79 and is closely tied to obesity, diabetes and high blood pressure.10 Diagnosis needs symptoms that fit plus at least two early-morning, fasting blood tests.1,2,9 From there, Dr. Madeira looks for why levels are low and treats that, prescribing testosterone only when it’s medically necessary, at a low dose, within a whole-person plan.
What gets checked besides testosterone
Dr. Madeira has treated thousands of men for hormone imbalance, low testosterone and adrenal hormone problems, and he looks beyond testosterone: thyroid and adrenal function, cardiovascular risk markers, gut health, micronutrients, endocrine disruptors and toxicants, and mitochondrial health, chosen case by case. Sleep, blood sugar and body weight matter too. More on low testosterone causes.
What TRT can do
In the TRAVERSE trial, men with low testosterone and low libido who used testosterone for two years had more sexual activity, more sexual desire and fewer low-testosterone symptoms than men on placebo.8 Dr. Madeira has also seen erections improve once low testosterone is corrected. A 2017 analysis of 14 placebo-controlled trials (2,298 men) found testosterone therapy improved erectile function, most in men with the lowest levels,12 although erections didn’t change in the TRAVERSE sexual function study.8 Results vary from man to man.
Heart and prostate: what changed
Testosterone therapy was long thought to raise the risk of prostate cancer and heart disease. Research led by Dr. Abraham Morgentaler, MD, a Harvard urologist, challenged both ideas. Prostate tissue responds fully to testosterone at low levels, so restoring normal levels doesn’t keep driving prostate growth,6 and his review found no convincing evidence of added heart risk, linking normal testosterone with better heart health.5,11 An international expert panel, including Dr. Morgentaler, updated its recommendations on testosterone and heart, metabolic and prostate health in 2025.9 The large TRAVERSE trial also found no rise in major heart events and no more prostate cancer than placebo in screened men.3,7
Dr. Madeira sees restoring testosterone in truly deficient men as part of optimizing long-term heart and prostate health, unless a man has prostate cancer. Guidelines still treat TRT as care for low-testosterone symptoms, and TRAVERSE found more atrial fibrillation and blood clots in the lungs, so heart risk is screened with a blood test first, and estrogen (the testosterone-to-estradiol balance), hematocrit and prostate markers are monitored. TRT can also lower sperm production.1
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 or kidney disease.
Telemedicine across Washington
From Seattle, Bellevue, Kirkland, Issaquah and Sammamish to Tacoma and Spokane, visits are by telemedicine and labs are done close to home. Because testosterone is a controlled medication, any treatment decision follows federal rules and Washington law, and comes after your evaluation, never before.