The Dr. Gabrielle Lyon Show

Episode: TRT Risks & Rewards: Your Testosterone Replacement Therapy Questions Answered

Date: October 21, 2025
Host: Dr. Gabrielle Lyon
Guest/Co-Host: Nick

Overview

This episode delivers a comprehensive, myth-busting guide to testosterone replacement therapy (TRT), answering common questions about its risks, rewards, and practicalities. Dr. Gabrielle Lyon, a muscle-centric medicine physician, and her co-host Nick discuss the latest science on testosterone’s role in men’s (and women's) health, how low testosterone links to broader health risks, why much conventional wisdom is outdated, and how to approach TRT responsibly. The discussion covers symptoms, diagnostics, treatment protocols, misconceptions, risks (including fertility), and the social stigma around hormonal health.

Key Points & Insights

Testosterone and Health: Breaking Down the Evidence

• Low Testosterone & Health Risks
  • Men with low T are at increased risk for cardiovascular disease, bone fractures, obesity, diabetes, depression, and even certain cancers (00:00, 00:32).
  • “If you have erectile dysfunction, you are at a greater risk for heart attack or stroke. Erectile dysfunction can predict a heart attack within three to five years.” – Dr. Lyon (00:19)
• Testosterone & Aging
  • Contrary to popular belief, testosterone levels do not have to dramatically decline with age. Some 75-year-olds may have testosterone levels comparable to men in their 20s (00:36, 02:32).
  • “Testosterone in, say, a 75-year-old could be potentially just as good as your testosterone in your 20s, which is shocking.” – Dr. Lyon (00:36)

Symptoms and Diagnostics: How to Know If You Need TRT

• Symptoms Indicating Low Testosterone (02:47)
  • Erectile dysfunction (ED) is the most alarming symptom.
  • Other signs: increased fat deposition, fatigue, depression, low motivation.
  • “The thing that would get a man to the doctor almost immediately is if his penis doesn’t work.” – Dr. Lyon (02:47)
• Testing & What to Ask For (03:41)
  • Request: Total testosterone, free testosterone, FSH, LH, estradiol. Also check thyroid and prolactin to rule out other causes.
• Interpreting Results
  • The “300 ng/dL” total testosterone cutoff is somewhat arbitrary; symptoms and androgen receptor sensitivity matter (06:22).
  • “That 300 number was just picked…you also have to look at how people feel.” – Dr. Lyon (06:22)

Myths, Stigma & Medical Misinformation

• Heart Disease & Prostate Cancer Myths (08:20)
  • decades-old myths connected testosterone to prostate cancer leading to “castration” treatments in the past.
  • The Traverse trial and recent evidence show TRT does not increase risk for cardiac events or prostate cancer, and is instead potentially protective (09:41).
  • “TRT is really critical for a number of reasons. If you have low testosterone, it makes you at greater risk for cardiovascular disease.” – Dr. Lyon (09:23)
• Stigma
  • Ongoing taboo around sexual health and fears around “steroids” deter proper diagnosis and treatment (12:19).
  • Media and non-experts often conflate TRT with anabolic steroid abuse.

TRT vs. Steroids

• TRT at physiological doses for health is not the same as using supraphysiological “steroid” doses for performance (13:17).
• “The idea of steroids and testosterone replacement therapy being one and the same is just not true.” – Dr. Lyon (13:17)

Risks of TRT

• Infertility (14:25)
  • Most significant for younger men who intend to have children; sperm banking and HCG/TRT combinations are recommended (14:25).
• Other Monitoring
  • Monitor hematocrit/hemoglobin to prevent thickened blood; manage sleep apnea risks; avoid TRT with active prostate cancer (15:19, 37:01).
  • “From my perspective…there is no risk for replacing low testosterone, which is crazy…” – Dr. Lyon (15:19)
• No Medical Reason With Normal Levels
  • If testosterone is normal and you feel good, more is not better (15:19).
  • “Would there be dangers for an individual with low testosterone going on testosterone? No.” – Dr. Lyon (15:19)

Practical Treatment Guidance

When and How to Treat

• Concurrently treat obesity and low testosterone; don’t delay TRT waiting for weight loss if depression/lack of motivation is an issue (17:29).
• “I would have them do it concurrently. Here's why. When an individual has low testosterone, it's setting them up for issues later on.” – Dr. Lyon (17:29)

What About “Natural” Boosters?

• Ashwagandha, tongkat, other supplements are not first- or second-line therapies; evidence is weak (19:42).
  • Ashwagandha may help with stress, not testosterone directly.
• Preferred non-TRT options: hCG or clomiphene/enclomiphene may stimulate natural production (41:48, 42:08).
• Lifestyle: Sleep, maintain healthy weight, resistance training, sufficient dietary fat (under 20% total fat intake may lower T), regular sex (39:24, 41:48).

Influencers and Information Hygiene

• Be wary of health advice on social media from non-experts. The popularity of a message doesn’t validate its content (22:17).
  • “Influencers…are not experts. …It’s like taking medical advice from a mechanic.” – Dr. Lyon (22:40)
• Making medical decisions based on influencer soundbites can cause harm, especially if normal T men self-medicate with TRT and damage fertility (24:15).

TRT Modalities & Administration

• Types: Intramuscular (IM) injection, subcutaneous (sub-Q) injection, intranasal, oral, and gel/patch (26:13).
• Sub-Q Injection Preferred
  • Fewer peaks/troughs, less reactive side effects (26:38, 29:03).
  • “Sub Q testosterone a few times a week allows for a steady state as opposed to a weekly injection.” – Dr. Lyon (26:38)
• Intranasal and oral (Kaiser) have less effect on fertility; gel is avoided in households with children (27:50, 28:42).
• Onset: Most people start feeling better within the first month, but give it 3 months for full benefit (30:35).
  • Improvements: Joint pain, energy, libido, mood, recovery, overall “the world looks different” (30:43).

Dosing and Monitoring

• Typical starting dose: 125–200 mg/week for men (33:57).
• Dosage needs can vary widely due to androgen receptor sensitivity—blood tests and subjective well-being both matter (35:10).
• Monitoring Guidelines
  • Check baseline (fasted, morning), reassess at 4–6 weeks, then every 3–4 months (37:01).
  • Aim for total T 500–1000 ng/dL, individualized (38:25).
  • Monitor hemoglobin/hematocrit, and donate blood if necessary.

Body Composition & Physical Changes

• Study cited: 600mg T for 10 weeks added 13 lbs lean mass (with training) vs. 7 lbs without training (33:07).
• Dr. Lyon notes such high doses are not medically appropriate for TRT.

Diet and Lifestyle for Hormonal Health

• Maintain ~20% or more fat in diet; avoid obesity (39:18).
• Regular aerobic and strength training improves both testosterone and erectile function (39:18).
• ED can be markedly improved with 150 minutes/week of exercise; penis pumps are also effective (39:02).
• Semen analysis emerging as a biomarker of overall health; poor sperm health predicts higher cancer risk (40:13).

Cialis & Viagra: Additional Benefits

• Daily low-dose Cialis (2.5–5mg) is advocated for cardiovascular and erectile health, even for healthy men (42:23).
  • “I think most people should be taking it…It’s really important for blood flow.” – Dr. Lyon (43:32)
• ED as a marker: If present, act—it predicts heart trouble within 1–3 years (43:04).

Notable Quotes & Memorable Moments

• Viral Warnings on Penis Shrinkage: “When you tell a guy his penis is going to shrink 1cm if he doesn’t have sex, the world is listening.” (01:27)
• On the “Natty or Not” Debate: “The conversation is totally wrong and misleading…The idea of steroids and testosterone replacement therapy being one and the same is just not true.” (13:17)
• Social Commentary: “You have to attack diet and lifestyle early. It’s much easier to raise kids.” – Dr. Lyon
  Nick: “I’ll stop you there. Yeah, there’s nothing easy about raising kids.” (41:33)
• On Influencers: “The question is: are they competent? The Dunning-Kruger effect, right?” (23:24)
• Being Responsible: “The smartest people…have a scope of knowledge and they will tell you where that knowledge ends because there is intellectual integrity.” (25:54)
• Summing Up:
  Nick: “No, I think you should charge everybody for this episode because you gave them a free consultation.” (44:34)
  Dr. Lyon: “I’m going to hold you to that.” (44:38)

Timestamps for Key Segments

• Links Between Low Testosterone and Major Health Risks: (00:00–02:40)
• Symptoms and When to Test: (02:45–04:30)
• Diagnosing and Interpreting Labs: (03:49–06:22)
• Debunking Myths about Heart & Prostate Cancer: (08:20–10:14)
• TRT vs. Steroids and Social Stigma: (12:37–14:25)
• Risks: Fertility, Hematocrit, Monitoring: (14:23–17:14)
• Treating Low T Concurrently with Weight Loss: (17:14–18:52)
• Natural Boosters, Supplements (Ashwagandha, etc): (19:42–21:22)
• Cautions against Non-Medical Social Media Advice: (21:35–24:15)
• TRT Modalities & Administration Options: (26:02–29:03)
• What to Expect When Starting TRT: (30:35–31:42)
• Body Composition Changes with T: (33:07–35:10)
• Dosing Nuances and Individualization: (35:10–38:10)
• Diet, Exercise, and Sexual Health: (39:01–41:00)
• Cialis/Viagra for Heart and Erectile Health: (42:23–43:52)
• Closing Remarks and Recap: (44:06–44:45)

Summary Table: What to Do if Considering TRT

| Step | Rationale & Details | |--------------------------------------------|-------------------------------------------------------------------| | 1. Get Symptoms Assessed | ED, fatigue, depression, fat gain, low libido | | 2. Full Blood Test Panel | Total & free testosterone, FSH, LH, estradiol, thyroid, prolactin | | 3. Baseline Testing (Morning, Fasted) | True peak value; repeat for confirmation | | 4. Consider risks: current/future fertility| Consider sperm banking, hCG if desiring children | | 5. Discuss Administration Options | Sub-Q injection preferred; other options: intranasal, oral, gel | | 6. Start TRT if Indicated & Monitor | Initial check at 4–6 weeks, then 3–4 months thereafter | | 7. Address Lifestyle Concurrently | Exercise, weight management, 20%+ dietary fat, adequate sleep | | 8. Disregard Non-Expert Advice | Stick to physician-led, personalized care |

Conclusion

Dr. Lyon persists in advocating for transparency, individualized care, skepticism of influencer hype, and prioritizing both physical and mental health in men. Conventional testosterone dogma is outdated; responsible, evidence-based TRT under medical supervision carries few risks for hypogonadal men and can significantly improve quality of life as well as long-term health. If you’re experiencing possible symptoms, get tested, get informed, and work with a hormone expert—don’t take advice from TikTok.