The Dr. Gabrielle Lyon Show

Episode: TRT: Your Complete Guide to Safe Dosing, Risks, and Boosting Longevity
Release Date: November 18, 2025
Host: Dr. Gabrielle Lyon
Guests: Dr. Abraham Morgentaler (Urologist & Testosterone Expert), Dr. Brian (Men’s Health/Urology), Dr. David (Urologist, Sexual Dysfunction/Fertility)

Episode Overview

This deep-dive episode explores testosterone replacement therapy (TRT): its clinical applications, safe dosing, risks, misconceptions, and its broader implications for longevity, muscle health, sexual function, and overall well-being. Dr. Lyon, with a panel of internationally recognized experts, untangles the myths and realities around TRT—addressing diagnostic criteria, appropriate patient populations, fertility concerns, sexual health, and how TRT interfaces with lifestyle factors like exercise, nutrition, and sleep.

Key Themes & Discussion Points

The Central Role of Testosterone

• Testosterone as a "Brain Hormone":
  “Testosterone is a brain hormone. Yes, it also works on muscle and fat and all these other organs, but it’s a brain hormone.” — Dr. Abraham Morgentaler [00:07], [66:00]

• Influence on Male Sexual Function:
  "If testosterone is very low, then penis ain’t gonna work." — Dr. Brian [00:03], [37:50]

  • Testosterone deficiency impacts erectile function, libido, energy, and overall quality of life.
  • TRT may resolve these symptoms if rooted in hormone deficiency.

• Testosterone and Aging:
  The classic concept of “male menopause” doesn’t exist; age alone doesn’t lower T levels—comorbidities like obesity, chronic illnesses, and certain lifestyle factors do.
  “As men get older, aging alone doesn't drop their testosterone level. It's the acquisition of comorbid conditions, which the drops are level.” — Dr. David [00:17]

Defining Testosterone Deficiency and Guidelines

• Diagnostic Nuances:

  • No single, definitive T level defines deficiency. Different organizations set cutoffs from 264–400 ng/dL [03:04–05:06].
  • “The idea that there's a single number that separates everybody is just... it's anti-scientific.” — Dr. Morgentaler [03:38]
  • U.S. endocrinologists: <264 ng/dL; urologists and FDA: <300 ng/dL; Europe: <350 ng/dL, and some treat below 400 ng/dL [04:36–05:07].
  • Age is not a criterion in most guidelines.
  • Guidelines are “guidance,” not rigid rules; individual clinical context matters significantly.

• Total vs. Free Testosterone:

  • Many with “borderline” total T have low free T due to elevated sex hormone-binding globulin (SHBG), especially with age.
  • “Free testosterone is the most reliable indicator of a man's testosterone status.” — Dr. Morgentaler [07:38]
  • Providers must assess symptoms and not rely solely on labs.

TRT: Indications, Myths, and Individualization

• When to Treat:

  • Treat men with low T plus relevant symptoms/signs, not based purely on labs alone.
  • “The goal of treatment is not to get the total testosterone into the normal range. The goal is to improve the symptoms that the man is having and hopefully resolve them.” — Dr. Morgentaler [12:50]
  • “Millions of men” have low testosterone, but only a small percentage are treated (~3%).
    — Dr. Lyon [23:29]

• TRT ≠ Supraphysiologic Steroid Abuse:

  • TRT restores physiologic levels; “steroids” used for bodybuilding are synthetic, supraphysiologic, with different risks.
  • “The idea of steroids and testosterone replacement therapy being one and the same is just not true.” — Host [21:27]

• Risks of TRT:

  • Infertility: TRT can suppress sperm production—advise sperm banking or use of hCG/Clomid for fertility preservation.
    — [21:32], [75:48], [94:07]
  • Other risks: Elevated red blood cell count (erythrocytosis)—not as dangerous as once thought, but still monitored.
    — [87:45–91:55]
  • No clear evidence linking TRT to prostate cancer.
    — [07:07], [41:54–48:48]

• No “More is Better”:

  • If T is normal, adding more offers no extra benefit for libido or energy, though can increase muscle mass at supraphysiologic doses (bodybuilder levels).
    — [67:25], [69:08]

TRT and Fertility

• Suppression of Natural Sperm Production:

  • “If you give testosterone, it will shut down his natural production. Right. So I think that's very important to have those discussions with the patients.” — Dr. David [75:48]
  • Recovery after stopping TRT can take 3–7 months and isn’t always complete.
    — [94:07–95:15]

• Alternatives for Younger Men:

  • hCG or clomiphene citrate (Clomid) can stimulate natural testosterone production, less impact on fertility.
    — [77:57], [93:29]

Sexual & Erectile Function: Pills, Lifestyle, and Innovation

• Lifestyle as First-line Therapy:

  • “Don’t go for the pill, go for the diet, exercise, sleep, and stress reduction.” — Dr. David [50:09]
  • 150–300 mins/week moderate-vigorous exercise: up to 40% lower risk of ED [36:16]
  • Muscle mass and grip strength strongly link to sexual function and overall male health.

• PDE5 Inhibitors (Viagra, Cialis):

  • “I write for these drugs a lot because I find every excuse I can to give them to men, whether they have problems with erections or they have problems with urination. And then they get this likely benefit of cardiac protection. So it’s like this triple threat drug.” — Dr. Brian [25:34]
  • Cialis daily (5mg) is particularly cardioprotective and helps with urinary tract symptoms. [27:52–28:02]

• Emerging Therapies:

  • Shockwave Therapy: Mechanically induces tissue healing, possible benefit in mild-moderate ED—but buyer beware (many machines are unregulated, placebo effect high) [51:21–54:13].
  • Stem Cells & PRP: Promising but not yet proven for ED. [54:13]

• Penile Tissue Atrophy:

  • “As you stop using the penile tissue, you can start developing fibrosis and scarring, which I cannot reverse.” — Dr. David [56:30]
  • Regular sexual activity is important for long-term tissue health.

Muscle, Longevity, and Sexual Health

• Muscle Mass = Longevity.
  “If you want to live a long time, you have to move iron. You’ve got to be strong, you got to keep it that way.” — Dr. Brian [32:56]

  • Men with more muscle have better erection quality and sexual outcomes [34:51–36:59].
  • Sarcopenia nearly triples risk of moderate or severe ED in older men.

• Testosterone and Muscle Gain:

  • TRT can produce significant increases, but there is an upper genetic and physiologic cap. Supraphysiologic (bodybuilder) dosing has different risks and is not medically appropriate [62:21–65:21].

Women, Testosterone, and Sexual Health

• SHBG and Free Testosterone:
  Women generally have higher SHBG, so free T is even more important to assess than total T [11:30].
  • “Their total testosterone is even less reliable in women than it is in men.” — Dr. Morgentaler [11:30]
• Female Libido & TRT:
  • After menopause, women see a sharp drop in T and often in libido; testosterone therapy may help with desire more than in men [97:46–98:54].
  • Assessment and treatment should be symptom-based as blood test correlation is less clear in women [79:43–83:07].

Misinformation, Social Media, and Trusted Resources

• The Dangers of Influencer Advice:

  • “The problem that I’m seeing is that it’s like taking medical advice from a mechanic. Maybe you want that mechanic to read your MRI.” — Dr. Lyon [59:01]
  • Only seek advice from qualified, trained medical professionals. Influencers are not experts.

• Intellectual Integrity:

  • “The smartest people, the most impactful individuals, have a scope of knowledge, and they will tell you where that knowledge ends because there is intellectual integrity.” — Dr. Lyon [61:48]

Unlocking the Best Outcomes: Summary Guidelines

1. Proper Assessment

• Diagnose hypogonadism using both symptoms (low libido, fatigue, sexual issues, etc.) and labs (especially free testosterone).
• Recognize guideline cutoffs are arbitrary and geography-specific; clinical judgment is essential.

2. Treatment Options

• TRT is safe and effective when indicated; restores normal function and quality of life.
• For fertility preservation, favor stimulation protocols (hCG, Clomid) over exogenous testosterone.
• Lifestyle modification (exercise, weight loss, alcohol reduction, sleep) is foundational for hormone and sexual health.

3. Monitoring & Safety

• Monitor hematocrit, fertility, and symptom improvement, not just numbers.
• Don’t fear modestly elevated hematocrit or rely on total T alone.
• Risk of prostate cancer with TRT is unproven/falsely maligned.

4. Beware of Misinformation

• Ignore non-expert social media advice; seek credentialed medical voices.
• Avoid overhyped “testosterone boosters” or unregulated devices.

Memorable Quotes & Moments (with Timestamps)

• “Testosterone is a brain hormone. Yes, it also works on muscle and fat and all these other organs, but it’s a brain hormone.” — Dr. Abraham Morgentaler [00:07]
• “If testosterone is very low, then penis ain’t gonna work.” — Dr. Brian [00:03], [37:50]
• “The idea that there’s a single number that separates everybody is just... it’s anti-scientific.” — Dr. Morgentaler [03:38]
• “The goal of treatment is... to improve the symptoms that the man is having and hopefully resolve them.” — Dr. Morgentaler [12:50]
• “The story made sense that lowering testosterone helped these guys. And if lowering testosterone is effective for guys with advanced prostate cancer, then raising it has to be dangerous. Like, that story kind of made sense.” — Dr. Morgentaler [47:06]
• “If you want to live a long time, you have to move iron. You’ve got to be strong, you got to keep it that way.” — Dr. Brian [32:56]
• “The best way to do this is to [implement] lifestyle modification, because it’s not just your erections, your overall health is going to improve.” — Dr. David [50:09]
• “The problem that I’m seeing is that it’s like taking medical advice from a mechanic. Maybe you want that mechanic to read your MRI.” — Host [59:01]

Timestamps for Major Topics

• [00:00–05:07] – Testosterone’s role, deficiency definitions, guideline disparities
• [07:31–14:17] – The primacy of free T & importance of symptoms
• [21:27–23:29] – Distinguishing TRT from steroids, risks/benefits, fertility issues
• [24:53–36:59] – Erectile dysfunction, PDE5 inhibitors, muscle, and sexual health
• [50:09–57:01] – Lifestyle, shockwave/PRP, penile atrophy, natural “boosters”
• [61:43–65:21] – Social media myths, more is not better, androgen sensitivity
• [66:00–70:23] – Non-deficient T, supraphysiological dosing, muscle receptors
• [73:42–83:54] – Sexual health differences in men & women, treatment in women
• [84:07–91:55] – Modes of TRT delivery, oral/testosterone, erythrocytosis risks
• [93:29–98:54] – Natural/hormonal methods to boost T, fertility considerations

Closing Takeaways

• TRT is transformative when used appropriately: assess robustly, treat the person, not the lab.
• Familiarize yourself with real risks and benefits; weigh them for individual values/goals.
• Lifestyle is always bedrock—muscle mass is a longevity asset for all.
• Be relentlessly discerning about the source of your health information.

For further exploration and resources, see Dr. Lyon’s “Forever Strong” community and check out Dr. Morgentaler's and Dr. David's publications and podcasts.