Testosterone, Aging, and Performance: Personal Reflections on How Much Is Enough

This is not a new question, but it’s one I’ve begun to revisit more seriously as I work with patients and assess how to optimize my health and performance over the next few decades. The appeal of testosterone therapy is obvious, but the nuance lies in how much is helpful, when it’s warranted, and at what point benefits give way to risks.

Have My Testosterone Levels Really Declined?

I don’t have testosterone labs from my 30s or early 40s. Most men don’t. So the question “have my levels declined?” is as much historical as physiological. It’s customary to assume that age alone causes testosterone to drop, but the reality is more complex.

There’s increasing evidence that testosterone decline isn’t an inevitable feature of aging. In healthy men without chronic disease, testosterone levels often remain stable well into later life. Much of the observed decline is attributable to chronic illness, obesity, metabolic dysfunction, and sleep disorders, not age itself.

Research shows that men with optimal metabolic health tend to maintain testosterone levels across decades [1]. Also, inflammatory markers, visceral adiposity, insulin resistance, and medications (especially opioids and SSRIs) correlate with declining T more than chronological age alone [2,3].

That’s both encouraging and cautionary. Encouraging, because it means testosterone preservation is largely in our hands. Cautionary, because it reminds me that chasing levels via replacement therapy might miss the root causes: diet, sleep, stress, body composition.

The Lure of a “Magic Pill”

There’s always a temptation in medicine and in life for the magic pill. The thing that gives us back what time has taken. The path to the Fountain of Youth. Testosterone fulfills many of the promises men are looking for:

• Increases muscle mass
• Decreases visceral fat
• Enhances bone density
• May improve sleep, libido, energy, and motivation
• Often restores the feeling of being in command of your workouts again

But is it truly restorative, or are we sometimes overreaching? Is “more” always better?

What the Research Says

• Men with testosterone levels in the lowest quartile do benefit from supplementation to the normal physiological range, with improvements in survival, energy, mood, body composition, and hemoglobin levels.
• In men who already have mid- or high-normal levels, supplementing above physiologic range does not improve survival, and the benefits become smaller while the risks increase.
• Studies like the TRAVERSE trial confirm that testosterone replacement does not increase major adverse cardiovascular events when used appropriately, but supraphysiologic dosing carries elevated risks for atrial fibrillation, polycythemia, and pulmonary embolism [4,5].
• The T-Trials showed increased non-calcified coronary plaque volume with TRT, highlighting the need for long-term vigilance even in low-risk men.

Where’s the Sweet Spot?

That leads to the central question for me personally: Is there an optimal level that balances benefits without drifting into risky territory?

Possibly. But the margin for error narrows significantly above the physiological range. This is not a supplement like creatine or vitamin D. Testosterone shifts dozens of metabolic, hematologic, and cardiovascular variables, and those shifts accelerate once you cross into supraphysiological territory.

It’s also worth asking whether more physiological methods of boosting testosterone might be preferable.

Alternative Approaches: Enclomiphene and Prevention

• Enclomiphene, a selective estrogen receptor modulator (SERM), can stimulate the hypothalamic-pituitary-gonadal (HPG) axis, increasing luteinizing hormone (LH) and preserving endogenous production. It’s being increasingly used in younger men or those hoping to avoid testicular atrophy and fertility loss.
• Lifestyle measures remain foundational. Maintaining a healthy waist circumference, lifting heavy, sleeping well, managing stress, reducing inflammation, and keeping insulin levels in check are all ways to prevent decline. In many cases, they raise testosterone naturally or at least stabilize it.

My Personal Decision Framework

• Track symptoms (sleep quality, mood, performance, libido) and objective labs (total T, free T, SHBG, LH, estradiol, hematocrit).
• Rule out contributing factors such as sleep apnea, insulin resistance, and inflammation that may be lowering T unnecessarily.
• If levels trend low and symptoms are present, consider enclomiphene first.
• If I do pursue TRT, it will be at low to moderate doses, enough to reach the high-normal range, not exceed it.
• Monitor closely: hematocrit, PSA, sleep health, and lipid profile.

Looking Ahead

There’s no question that testosterone can enhance how we feel and function, but only when used judiciously. At 55, I’m more interested in preserving what works, not overhauling what isn’t broken. Testosterone might be part of that plan in the future, but for now, I’m focused on optimizing from within.

If I can feel strong, sleep well, and stay vital without needles or gels, that’s the path I’ll take first.