Few topics in men's health generate more confusion than testosterone. Social media is full of clinics promising that testosterone therapy will restore energy, build muscle, sharpen your mind, and transform your life. What they're less enthusiastic about mentioning is the largest randomized trial ever conducted on the subject — and what it found.
The TRAVERSE trial: 5,246 men, one clear message
Published in the New England Journal of Medicine in 2023, the TRAVERSE trial randomized 5,246 men aged 45–80 with low testosterone and either existing cardiovascular disease or high cardiovascular risk to receive either testosterone gel or placebo. The trial ran for 33 months.
The results: testosterone replacement did not reduce cardiovascular events — and it came with a statistically significant increase in several serious adverse events:
- Atrial fibrillation: significantly higher in the testosterone group
- Acute kidney injury: significantly higher
- Pulmonary embolism: significantly higher
These aren't minor side effects. Atrial fibrillation is the most common cardiac arrhythmia and a major risk factor for stroke. Pulmonary embolism can be fatal. And these harms occurred in men who actually had low testosterone — not in men with normal levels being treated for lifestyle reasons.
When testosterone replacement is appropriate
This does not mean testosterone therapy is never warranted. It is — but only in a specific clinical context. The Endocrine Society guidelines are clear: testosterone replacement is indicated for men with both documented low testosterone on repeated morning measurements and clear clinical symptoms of hypogonadism (fatigue, loss of libido, erectile dysfunction, muscle wasting, depressed mood).
Both parts are required. Low testosterone without symptoms doesn't need treatment. Symptoms without confirmed low testosterone don't need testosterone — they need a different workup.
And "low" means genuinely low — typically below 300 ng/dL on multiple morning draws, ideally confirmed with free testosterone or calculated bioavailable testosterone. A single measurement of 310 ng/dL in the afternoon is not a diagnosis.
What we see in practice
Many men arriving at executive health programs have been told their testosterone is "low" based on a single measurement, often taken in the afternoon (when testosterone is naturally at its lowest). Some are already on replacement therapy prescribed by wellness clinics without proper workup. Part of our role is to verify whether the diagnosis was correct in the first place — and if it was, whether the treatment is appropriate and being monitored safely.
The "optimization" trap
A growing industry of testosterone clinics markets "optimization" — treating men who have normal testosterone levels to push them higher. The theory is that more testosterone equals more energy, more muscle, more vitality. The evidence says otherwise.
In men with normal testosterone, supplementation does not reliably improve any clinically meaningful outcome. What it does do is suppress your body's natural testosterone production (the hypothalamic-pituitary-gonadal axis shuts down when external testosterone is supplied), which means that once you start, stopping is difficult — your natural production may not recover fully.
Add the TRAVERSE safety signals, and the risk-benefit calculation for "optimization" in men with normal levels is clearly unfavorable. This is why Health Detectors does not offer testosterone therapy at normal levels. It's listed on our exclusion list alongside IV infusions and supplement sales — interventions where harm exceeds benefit.
What we do instead
Our HORMONE-M module is available for men with genuine symptoms. It includes SHBG, free testosterone, DHEA-S, prolactin, and LH — a complete workup that distinguishes primary hypogonadism (testicular failure) from secondary (pituitary) causes and rules out conditions that mimic low testosterone (thyroid dysfunction, depression, sleep apnea, medication effects).
If replacement therapy is genuinely indicated, we coordinate with the patient's US physician for ongoing management and monitoring — including regular PSA, hematocrit, and cardiovascular surveillance, as recommended by the Endocrine Society.
References
- Lincoff AM, et al. Cardiovascular safety of testosterone-replacement therapy (TRAVERSE). N Engl J Med. 2023;389(2):107-117.
- Bhasin S, et al. Testosterone therapy in men with hypogonadism: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2018;103(5):1715-1744.
- Snyder PJ, et al. Effects of testosterone treatment in older men (TTrials). N Engl J Med. 2016;374(7):611-624.