The Saturday Standard — Vol. 21

Saturday, September 26, 2026

As always, coffee first, fellas — and let's talk about testosterone, who actually needs it, and why some men are on it without ever being properly tested.

The Research

Should you be on TRT?

Testosterone and men's wellness clinics are riding a high right now. From the Hims commercials about libido, weight loss, hair loss and the like, to local shops leaving flyers on your car, to your buddy at the gym who swears by this clinic up the street. You see it everywhere.

A lot of men are starting on TRT without the one thing that should always come first: a proper diagnosis.

Many men never got tested.

Researchers looked at insurance records for men who started testosterone in the U.S. between 2001 and 2011. Only about 75% of them had their testosterone measured in the year before they started. Roughly one in four new users had no documented test at all.

(Baillargeon J, et al. JAMA Intern Med. 2013;173(15):1465-1466. PMID: 23939517)

Put simply, one in four men were put on a hormone to treat low testosterone without anyone checking whether their testosterone was low.

To be fair, that data is from over a decade ago, and most clinics today run bloodwork at the very first visit. But a blood draw isn't the same as a diagnosis. The prescription should still come down to two things: a low number and real symptoms.

What a real diagnosis looks like.

The Endocrine Society's clinical guideline sets a two-part standard. You need symptoms of testosterone deficiency, and testosterone levels that are unequivocally and consistently low. That means morning, fasting blood draws, repeated. Not one number on one day.

(Bhasin S, et al. J Clin Endocrinol Metab. 2018;103(5):1715-1744. PMID: 29562364)

The repeat test matters more than most men realize. According to the Endocrine Society, about 30% of men who test in the low range come back normal when they're retested.

Symptoms without low numbers isn't low testosterone. Low numbers without symptoms isn't either. You need both.

What "normal" actually is.

In 2017, researchers pooled data from four large cohorts in the U.S. and Europe and standardized the lab methods so the numbers could be compared. For healthy, non-obese men aged 19 to 39, the harmonized range came out to 264 to 916 ng/dL, with a median of 531.

(Travison TG, et al. J Clin Endocrinol Metab. 2017;102(4):1161-1173. PMID: 28324103)

That's a wide range, and it should tell you something. A man at 350 and a man at 850 can both be completely normal.

Your number isn't the whole story.

Testosterone only does its job when it binds to androgen receptors in your tissues. And how sensitive those receptors are is partly genetic. A section of the androgen receptor gene varies in length from man to man. Shorter versions tend to make the receptor more responsive. Longer versions tend to make it less responsive, even when testosterone levels are normal.

(Zitzmann M, Nieschlag E. Int J Androl. 2003;26(2):76-83)

In simple terms, two men with the same testosterone number can feel very different. A man on the lower end with sensitive receptors may be doing just fine. That's one more reason a number alone can't tell you whether you need treatment.

Sleep is doing more than you think.

Ten healthy young men were cut to about five hours of sleep a night for one week. Their daytime testosterone dropped 10 to 15%. That's roughly the drop you'd expect from 10 to 15 years of aging, and it took seven days.

(Leproult R, Van Cauter E. JAMA. 2011;305(21):2173-2174. PMID: 21632481)

If you're sleeping five or six hours and your testosterone came back low, the first thing to fix is not your hormones.

So is body weight.

A meta-analysis of 24 studies found that losing weight raised testosterone in men with obesity. Men who lost weight through diet saw total testosterone rise by about 2.9 nmol/L (roughly 83 ng/dL). After bariatric surgery, the rise was about 8.7 nmol/L (roughly 250 ng/dL). The more weight a man lost, the more his testosterone went up.

(Corona G, et al. Eur J Endocrinol. 2013;168(6):829-843. PMID: 23482592)

What about lifting?

Hard training does cause a spike in testosterone. But it's short. Levels come back down after the session, and that spike doesn't seem to do much.

In one study, twelve young men trained each arm separately for 15 weeks. One arm trained alone, with no hormone spike. The other arm trained right before a heavy leg session, which drove testosterone and growth hormone up. Both arms grew by about the same amount (12% versus 10%) and got stronger by about the same amount.

(West DW, et al. J Appl Physiol. 2010;108(1):60-67. PMID: 19910330)

Keep lifting. It's one of the best things you can do for your health. Just don't expect it to fix your testosterone.

What symptoms actually look like.

I've said twice now that you need symptoms and low numbers. So here's what the symptom side means.

The ones most specific to low testosterone:

• Low libido
• Fewer spontaneous erections, or trouble getting them
• Breast tenderness or growth (gynecomastia)
• Loss of body and facial hair
• Small or shrinking testicles
• Trouble with fertility

The ones that show up commonly but have a hundred other causes:

• Low energy and fatigue
• Low mood
• Poor concentration and memory
• Poor sleep
• Losing muscle and strength
• Gaining body fat

That second list is the trap. Every one of those can be caused by bad sleep, extra weight, stress, or a job you hate. That's exactly why a number alone doesn't make the diagnosis, and why symptoms alone don't either.

Where that leaves you.

For men who are lean, this is almost a non-issue. In the European Male Ageing Study, late-onset hypogonadism showed up in 0.4% of lean men and 0.6% of healthy men. Obesity raised the odds roughly 13-fold. Other chronic conditions raised them about 9-fold.

(EMAS data as summarized in Grossmann M, Matsumoto AM. J Clin Endocrinol Metab. 2017;102(3):1067-1075)

Fewer than one in 200 lean men. That's the whole argument in one number.

Although, let me be clear: that's the age-related, lifestyle-driven kind. A lean man can still have the real thing — a pituitary problem, a testicular injury, a genetic condition, certain medications. If you're lean, sleeping well, and still have the specific symptoms above, get evaluated. Don't let this paragraph talk you out of it.

For keeping testosterone where it should be over the long run, two things matter most: keep a healthy body weight and sleep well.

If you've done both and you still have symptoms, that's when it's worth looking at testosterone more closely. Get tested properly: morning, fasting, more than once, with a doctor who treats the symptoms and the numbers together.

And if you're a younger man who wants kids someday, know this before starting: testosterone therapy suppresses sperm production. Have that conversation with your doctor before anything else.

The research on this will keep growing, but that's what we know right now.

Moral of the story: get the big boulders in place first before you go adding injections and other therapies.

If you want a deeper dive, the testosterone sections in The Heroic Man go into all of this in more detail.

Worth Remembering

Most of us are taking in far more news, media, and information than we can possibly process. At that volume, it's nearly impossible to sort out what's true, what's a half-truth, and what's a flat-out lie.

Staying up to date matters. We're citizens, and we have a responsibility to know what's going on. But it's easy to go from informed to addicted: needing the next hit of what just happened, living by the chyron at the bottom of the screen, and letting our emotions run wild over every headline.

There are other places your attention belongs. Your wife. Your kids. Your work. Your training. Your faith.

Keep a few good sources that tell you about the world. When something matters, investigate it and go from there. Then put it down.

Informed, my brother. Not over-informed.

Try This Week

Cottage cheese protein pancakes

Make these once this week. They are one of my favorite post-workout meals.

Ingredients

• 1 cup cottage cheese (2%)
• 1 cup old-fashioned oats
• 2 large eggs
• 1 medium banana
• 1 tsp vanilla extract
• 1 tsp baking powder
• ½ cup blueberries
• Optional: 1 scoop whey protein

Directions

1. Put everything except the blueberries in a blender and blend until smooth.
2. Let the batter sit for 5 minutes so the oats soak up some liquid.
3. Fold in the blueberries.
4. Heat a lightly greased pan over medium-low heat. Pour about ¼ cup of batter per pancake.
5. Cook 2 to 3 minutes per side, until golden. Keep the heat low. These burn faster than regular pancakes.

Makes about 8 to 10 small pancakes.

Macros

Calories: ~790 Protein: ~48g Carbs: ~104g Fat: ~21g

Want more protein? Throw in a scoop of whey. That puts the batch north of 70 g. It thickens the batter, so add a splash of milk if it gets too stiff to pour.

We started making these for my daughter and found out the whole family loves them. I have been known to eat a whole batch myself, or occasionally, I consider sharing with my wife and daughter.

From the Bookshelf

The 48 Laws of Power — Robert Greene

Everyone during my early college years recommended I read The 48 Laws of Power. It is one of the most popular books on self-help, self-mastery, business, and beyond. I didn't pick it up until graduate school, when my affinity for reading took over. I have notes written throughout, my typical underlines and overwhelming amounts of highlights, but the line above is the one I always come back to.

Every law has a judgment, a transgression, an observance, keys to power, and a reversal. That line is the last of Law 4's Judgment.

In our incredible stupidity, we think more is better. Words are a tool we wield without ever imagining what they can do. But words are powerful, for good or ill. Don't put all your cards on the table. Don't over-speak. And when you do speak, be succinct.

This advice has guided me more than most advice I have been given. The book often reads as near narcissistic, but when you dig into each chapter, the nuggets are invaluable.

Closing Thought

I must confess that though I understand the importance of words, I have and continue to fall short in using them. I have not held my tongue. I have allowed bravado to enter my tone. Hyperbole to overwhelm a message.

My brother, words are both salve and knife, and they cut far easier than they cure. People I love have been harmed by my words, and I know many of you can point to a time your tongue should have held, a tone should have calmed, or different words should have been chosen.

Apologies matter. But I think of them the way Ryan Cahill puts it in Of Darkness and Light: "Being sorry soothes nothing but your own ego, brother. Be better."

An apology for our words matters. It is hollow absent real change.

So learn from my transgressions. Words are powerful, and they can wound. All of us fall short here. But we must be better, so as not to leave scars on the world and the people we love.

Have a great weekend, lads.