Testosterone Optimization for Better Hormone Health

What Dr. Peter Attia and Dr. Andrew Huberman Get Right About TRT

Introduction

Testosterone therapy is trending — from social media influencers to fitness subreddits, young men are chasing quick fixes and aesthetic shortcuts. But while testosterone optimization can be life-changing for those with clinical deficiencies, it’s not a one-size-fits-all solution. Misuse and misinformation abound, and few are addressing the deep science and nuance behind hormone health.

Experts like Dr. Peter Attia and Dr. Andrew Huberman are changing that. Their recent conversations on male hormone therapy offer a more grounded, clinical approach — one that moves beyond the hype and dives into personalized, data-driven care.

This guide breaks down the most critical insights from Attia and Huberman, while also highlighting best practices from real-world clinics who share their philosophy.

Why Testosterone Isn’t the First Step
Understanding Free vs. Total Testosterone
Why SHBG, Estrogen, and Thyroid Matter
Can Supplements Like Tongkat Ali Help?
The Truth About Anavar and Oxandrolone
When Clomid Is Better Than TRT
Smarter Dosing Strategies for Testosterone
The Insulin Sensitivity Connection
Top Mistakes People Make With TRT
Frequently Asked Questions
Conclusion
References

Why Testosterone Isn’t the First Step

Many men start HRT hoping for a shortcut to energy, muscle, and drive. But testosterone is not a Band-Aid for lifestyle neglect. According to Attia and Huberman, sleep, nutrition, exercise, sunlight, and emotional regulation must come first. Otherwise, HRT won’t fix the root problem.

Here’s why it matters:

Poor sleep lowers testosterone
Overtraining without recovery impairs LH/FSH
Chronic dieting suppresses hormones
High stress increases cortisol and suppresses libido

Before prescribing testosterone, the goal should be to optimize the system that produces it naturally.

Understanding Free vs. Total Testosterone

In the U.S., “normal” testosterone is defined as 300–1,200 ng/dL total. But total T doesn’t tell the full story.

Dr. Attia emphasizes that free testosterone — the unbound form your body actually uses — is the better predictor of symptoms. It should make up ~2% of your total T.

Example:

Total T = 900 ng/dL
Free T = 8 ng/dL → Less than 1% → Symptoms of low T despite “normal” labs

Takeaway: You could feel exhausted, depressed, and have zero libido — even if your total number looks good.

Why SHBG, Estrogen, and Thyroid Matter

Free testosterone is often reduced due to elevated SHBG (sex hormone-binding globulin), which binds T and makes it inactive.

Three key drivers of high SHBG:

Estradiol: Elevated estrogen raises SHBG
Insulin: Low insulin (due to fasting, keto, or low-carb diets) increases SHBG
Thyroxine (T4): High thyroid levels = higher SHBG

This explains why some lean men on clean diets still feel awful — they’re over-suppressing insulin, increasing SHBG, and locking up their free T.

Clinical tip: Always test SHBG alongside total and free testosterone, estradiol, insulin, and thyroid.

Can Supplements Like Tongkat Ali Help?

There’s been buzz around Tongkat Ali, Fadogia agrestis, and stinging nettle root as natural testosterone boosters or SHBG-lowering agents.

Huberman and Attia agree:

Effects are modest
Studies are often small or poorly controlled
Some may reduce DHT, which is key for male drive and strength

Instead of relying on over-the-counter testosterone supplements, focus on targeted labs, lifestyle optimization, and clinician-supervised protocols.

The Truth About Anavar and Oxandrolone

In earlier days, Attia experimented with Anavar (Oxandrolone) — a synthetic oral steroid — at microdoses (5–10mg) to lower SHBG.

While this increased free testosterone, the risks were significant:

One patient swallowed it (instead of sublingual) → liver enzymes tripled
Risk of hepatotoxicity, lipid changes, shutdown of natural testosterone

Even Attia no longer uses it. And most ethical clinics have moved away from it entirely.

Bottom line: Oral anabolic steroids aren’t worth the risk — even at “micro” levels. The margin of safety is too narrow.

When Clomid Is Better Than TRT

For men under 35 or those looking to preserve fertility, Clomid (Clomiphene Citrate) is often a better first-line option than testosterone injections.

Why?
Clomid stimulates the pituitary gland, boosting your body’s natural production of LH and FSH — the hormones that trigger your testicles to make testosterone.

This keeps the hypothalamic-pituitary-gonadal (HPG) axis intact, avoids testicular shrinkage, and maintains sperm production.

Typical outcomes from Clomid (25mg every other day):

Increased total and free testosterone
Preserved fertility
Improved LH/FSH signaling
Better estrogen balance (in many cases)

But it’s not perfect.
Clomid can cause mood swings or vision changes in some men. Labs must be closely monitored, and dosing may need to be adjusted or combined with enclomiphene or HCG.

Smarter Dosing Strategies for Testosterone

Attia and Huberman both agree: Less is more.

The days of 200mg/week once weekly are outdated. This creates hormonal spikes, followed by crashes. Instead:

Best practice:

50–60mg subcutaneous or intramuscular, twice weekly
Monitor trough and peak levels
Adjust based on free T, estradiol, DHT, SHBG, and symptoms

Subcutaneous injections are especially useful for smoother levels, fewer mood swings, and easier administration.

For those sensitive to estrogen or DHT, lower doses with more frequent injections (e.g., daily microdosing) may offer the best results.

The Insulin Sensitivity Connection

Here’s something most clinics miss: Insulin resistance reduces testosterone — and testosterone resistance reduces insulin sensitivity.

It’s a vicious cycle.

Dr. Attia emphasizes that testosterone affects mitochondrial function, fat metabolism, and insulin signaling.

Low T =

Reduced glucose uptake
Increased fat mass
More inflammation
Worse insulin sensitivity

Fixing both matters.
Men on TRT with poor metabolic health often need to integrate GLP-1s, metformin, or aggressive lifestyle changes to unlock the full benefits.

It’s not just about adding testosterone — it’s about fixing the system that supports it.

Top Mistakes People Make With TRT

If you’re going to optimize testosterone, avoid these common pitfalls:

❌ Only testing total T
Always assess free testosterone, SHBG, estrogen, and thyroid.

❌ Using AI drugs (like Arimidex) too aggressively
Over-suppressing estrogen leads to joint pain, low libido, and increased cardiovascular risk.

❌ Ignoring root causes of low T
Sleep apnea, poor diet, and chronic stress need to be addressed alongside any protocol.

❌ High doses without monitoring
More is not better. Super-physiologic levels can create harm over time, even if they feel good short term.

❌ Skipping follow-ups or lab reviews
Hormones shift with time, age, stress, and lifestyle. Labs every 3–6 months are essential.

Frequently Asked Questions (FAQs)

Q1: Can TRT affect fertility?
Yes — testosterone shuts down LH/FSH, reducing sperm production. Options like HCG, Clomid, or Enclomiphene can help preserve fertility.

Q2: Does testosterone increase prostate cancer risk?
Current data shows no direct link. In fact, the Saturation Model suggests that above a certain threshold, additional testosterone does not increase prostate growth or risk.

Q3: How soon will I feel results from TRT?
Some men feel better in 2–4 weeks, but full changes in energy, mood, libido, and muscle mass take 3–6 months.

Q4: What labs should I test before starting?

Total & Free Testosterone
SHBG, Estradiol, DHT
LH, FSH
TSH, Free T3, Free T4
Insulin, HOMA-IR
CBC, CMP, Lipids
PSA

Q5: What are signs your TRT is too high?

Irritability, aggression
Acne
Hair loss
High hematocrit

Conclusion

Testosterone optimization is not a shortcut — it’s a precision tool. What Dr. Peter Attia and Dr. Andrew Huberman bring to the conversation is depth: the context, the caution, the science, and the sequence.

It’s not about chasing a number or blindly following protocols. It’s about:

Testing thoroughly
Understanding your body’s signals
Honoring metabolic, thyroid, and brain health
Aligning treatment with long-term goals, not short-term aesthetics

Testosterone is one piece of a much larger puzzle. When combined with intentional lifestyle changes, metabolic support, peptide therapy, and personalized protocols — it can help men reclaim vitality and purpose.

But it must be done right.

Author Bio

Joe Miller is the Founder of 1st Optimal, a performance health company delivering high-touch, lab-guided care for men and women. With decades of experience in health optimization, Joe’s mission is to make world-class protocols accessible, ethical, and effective.

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