Why a Silent Epidemic of Hormone Deficiency Threatens Heart-Brain Longevity—and How to Fix It
(Companion video: — watch or listen while you read. Full transcript at the end below.)
1. Morning Coffee in the Hyperbaric Chamber: Setting the Scene
This live stream came from inside my clinic’s hyperbaric chamber—a fitting metaphor, because testosterone science, like HBOT, is often trapped between therapeutic potential and regulatory anxiety. Today’s post distills that 35-minute conversation into an evidence-backed guide you can share with patients, colleagues, or anyone curious about hormone health and healthy span.
2. The Unspoken Numbers: How Low Is “Low” Now?
Drivers
Ultra-processed food & fructose burden
Visceral adiposity → aromatase → excess estrone
Endocrine-disrupting chemicals (micro- & nano-plastics, phthalates)
Blue-light-induced circadian chaos
Post-COVID hypophysitis (pituitary inflammation) lowering LH/FSH drive
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3. Case Files & Cautionary Tales
The Civil-Servant Bodybuilder
History: Prior teenage anabolic-steroid use → suppressed HPG axis
Intervention: Medically managed TRT, labs within target… but clandestine “bro-science” peptides & orals
Outcome: Sudden death; finger pointed at TRT until toxicology revealed illicit compounds.
Lesson: Supervised hormone care isn’t dangerous—unsupervised stacking is.
Regulatory Knock-Knock
Many clinicians still fear the “DEA + pharmacy board” door-knock. We’ve seen colleagues lose sleep (and sometimes licenses) for prescribing a Schedule III hormone that—ironically—reduces MI & stroke when used appropriately (see VA cohort, Sharma R et al. JAMA Cardiol 2022).
4. Myth-Busting Flash Round
5. Managing TRT the Longevity-Medicine Way
Baseline & Follow-up Labs
Total T, free T (equilibrium dialysis preferred)
SHBG, albumin, IGF-1
LH, FSH, prolactin, Estrone and Estradiol
CBCD with hemoglobin / hematocrit and erythropoietin
PSA total and free (men 35 +) or breast ultrasound ± CA 15-3 (women high-dose T)
CMP, fasting lipids, HbA1c. Lp(a), ApoB
High-sensitivity CRP & ferritin (iron + inflammaging check)
Goal free T: upper-third of age-adjusted range without erythrocytosis (>19 g/dL).
Managing Hematocrit
Hct > 57 % or Hgb > 19 g/dL → temporize
Hold dose 2 weeks
Encourage therapeutic phlebotomy (500 mL)
Re-check EPO & ferritin (avoid iron overload)
In Women
Optimal free T ~2.5-4.0 pg/mL improves libido, bone mass, mood.
Monitor DHT (alopecia) & voice change; use 1–2 mg/day compounded cream to clitoris/labia majora or 0.5 mg IM monthly pellets.
6. Special Section: Post-COVID Pituitary Injury
SARS-CoV-2 spike protein is linked to hypophysitis → LH/FSH drop → secondary hypogonadism. Evaluate any post-COVID fatigue/low-T case with MRI sella if headaches, visual changes, or pan-hypopituitarism signs emerge. Early intervention may preserve fertility and endocrine resilience.
7. Policy & Practice: From Black-Box to Box-Checked
FDA removed the cardiovascular black-box (Oct 2023), yet state boards still cite it—know your statutes.
Advocate for distinguishing physiologic TRT from illicit anabolic cocktails (<- your voice matters in CME & policy forums).
Consider pre-emptive “TRT informed-consent” documents that cover erythrocytosis, fertility suppression, and regulatory context.
8. Quick-Glance Action Plans
For Physicians
Screen early (age 25 + with metabolic syndrome, infertility, or persistent fatigue).
Treat boldly, track meticulously—quarterly labs first year, then semi-annual.
Educate about lifestyle levers (blue-light hygiene, micro-plastic avoidance, ultra-processed food detox).
Join or start a local endocrine-longevity roundtable to share audit data; strength in numbers against stigma.
For Patients
Know your numbers—test, don’t guess.
Fix foundations first: sleep 7-8 h, lift heavy things, sunlight AM.
Work with a clinician who understands both hormones and longevity (cookie-cutter tele-TRT mills rarely monitor EPO, ferritin, or estrone).
Avoid “bro-science stacks.” Unsourced peptides/orals negate every longevity gain TRT offers. Concierge Medical offers properly sourced peptides to keep patients safe!
9. Final Word
Criminalizing carefully monitored testosterone therapy is—not hyperbole—an act of public-health negligence. It swaps a treatable risk factor (hypogonadism) for an epidemic of cardiovascular events, mood disorders, and dwindling human vitality. Let’s flip the script: treat hormones like thyroid—measure, replace, monitor—and give our next generation the biochemical footing to thrive.
Have stories, lab pearls, or policy wins? Drop them in the comments or email me. Together we’ll keep hormone science—and society—out of the dark ages.
To A Life Well Lived,
Steven Murphy, MD
Disclaimer: This Substack is for educational purposes only and does not constitute medical advice. Consult your own physician before starting or changing any therapy.
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