Understanding hormone optimization after 40

Testosterone declines roughly one percent per year after the age of thirty in men. For women, the perimenopausal transition brings a less linear and often more disruptive shift in oestradiol and progesterone.

The difficulty is that the symptoms of hormonal decline are almost identical to those of thyroid disease, sleep apnoea, iron deficiency, depression and simple chronic under-sleeping.

This is why we require bloodwork. Prescribing testosterone to a man whose real problem is untreated sleep apnoea does not fix him, it just adds a medication and a suppressed natural axis to an unsolved problem.

For men, a proper panel includes total and free testosterone, oestradiol, LH, FSH, SHBG, PSA, haematocrit and a metabolic panel. For women, oestradiol, progesterone, FSH, testosterone and thyroid markers, interpreted against cycle timing.

If you are considering children now or later, say so before starting. Testosterone therapy suppresses fertility, and alternatives such as enclomiphene or HCG exist precisely for that situation.