New guidelines for low T completely miss the mark

I spent the first half of last week talking about new research on the benefits of hormone replacement therapy (HRT). And today, I have another bit of news to share—this time, for men, specifically.

The American College of Physicians (ACP) has finally released new clinical guidelines for HRT in men with low testosterone (T). And, well… they’re about as foolish as you might expect.

Low T is more than just a number

Let’s start with the first thing that really bugs me: They state the obvious, while misrepresenting the facts.

Specifically, they point out that “testosterone levels drop as men age, starting in their mid-30s, and approximately 20 percent of American men older than 60 years have low testosterone.”

The first half of that statement is true—the second half is a load of rubbish.

I invite any one of these authors to come to my practice, where they will find a much higher percentage of men with low T. Why? Because I actually know how to interpret the reference range.

Now, your result is considered “normal” if your T level is anywhere between 200 and 1,200. (If that sounds ridiculous, that’s because it is.)

If a 20-year-old had a testosterone level of just 200, wouldn’t that be cause for concern? Yet by the numbers, the ACP is prepared to call it “normal.” Right…

The powers-that-be have chosen to stick to the conventional wisdom that there’s no clear threshold below which a man is going to experience symptoms of low T—or more prevalent health risks.

And they’re not completely wrong. But do you know why?

Every man is going to feel their deficiency differently. Because, frankly, women are raised to think about how their hormones affect their health—men, generally, are not. So when they feel tired and sluggish, when their workouts at the gym are suffering, when they find their brains aren’t as sharp or that they’re losing muscle mass… they just attribute it to “old age.”

Unfortunately, most conventional doctors do, too. And that’s the real crux of the problem, here.

Practicing by the rulebook

The reason men don’t completely understand their own bodies is because modern medicine regularly turns a blind eye to testosterone replacement.

And the ACP’s new guidelines won’t do a thing to change that, considering they don’t even address how to properly diagnose low T… or how to monitor patients once they’ve started HRT.

In fact, one of the things that maddens me the most about these guidelines is that they suggest doctors should only recommend testosterone replacement to patients with complaints about their sexual function.

WHAT?! I’ve said it before, but it bears repeating: T does so much more than that.

But, according to the clowns at the ACP, current evidence shows no improvement in physical function, mood, energy, or cognition with testosterone treatment.

I don’t even know what to say to this. Perhaps they’re studying the wrong patients? Because as a doctor with decades of clinical experience treating patients with low T, I can unequivocally tell you otherwise.

Believe it or not, it gets worse: The ACP recommends injectables rather than transdermal treatments because they’re cheaper. Cheaper, yes—but with way more side effects. (Not to mention that you can count on compliance going way down if patients have to give themselves an injection every week.)

I’ll stop there. Because I am just so sick of this nonsense.

There’s a reason why these groups urge everyone to follow these watered-down rules—and it’s not because it’s best for the patient. It’s to prevent malpractice suits should anything ever go wrong, plain and simple.

But make no mistake… I will always choose to go the extra mile for my patients and treat them—and I’ll never need a recipe book to do it right, either.

P.S. What if I told you that, like low T, you also don’t have to accept poor vision as a “normal” part of aging? That’s right! There are safe, affordable, drug-free ways to see the world as a 20-year-old, even as you enter your 60s, 70s, and beyond. And I’ll tell you all about them during my Ultimate Vision Summit this Sunday, June 21st at 3PM (EST).But hurry, space is limited. Click here to reserve your spot NOW—before it’s too late! (Believe me, you won’t want to miss it!)


“New Guideline for Testosterone Treatment in Men With ‘Low T.’” Medscape Medical News, 01/07/2020. (