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Title: Dr. John Spencer Ellis Urges Men Over 40 to Rule Out Reversible Causes Before Starting TRT — Not Instead of It

Las Vegas, Nevada, United States, 4th Sep 2026— Dr. John Spencer Ellis wants to be clear about something at the outset."I am not anti-TRT. Testosterone replacement is a legitimate medical therapy with a substantial evidence base, and for men who genuinely need it, it can be life-changing," said the internationally recognized authority on men's health, longevity and human performance. "The 2023 TRAVERSE trial of 5,246 men found it noninferior to placebo for major adverse cardiac events, and the FDA removed the cardiovascular warning from testosterone labeling in 2025. That was a real and reassuring finding.""My argument is entirely about sequence. Before a man concludes his testosterone cannot be raised, he should find out what is currently lowering it. That is not a delaying tactic. It is a diagnostic one."The number most men land onThe Endocrine Society clinical practice guideline recommends treatment when total testosterone falls below 300 ng/dL, confirmed on two separate fasting morning draws, in a man with genuine symptoms of hypogonadism.Dr. Ellis notes that most symptomatic men over 40 do not return a result that clear."They come back somewhere between 300 and 450. That is a real conversation and a genuine grey area — the literature calls it functional hypogonadism. And the important word is functional. It describes suppression driven by an identifiable and frequently reversible cause rather than a primary failure of the testes or pituitary. Those are different situations that warrant different first responses."Sleep: the largest single factorThe most direct evidence comes from a study published in JAMA. Leproult and Van Cauter opened their paper with a statement Dr. Ellis considers the single most important sentence in this field:&nb...

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