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Conditions we evaluate

Start with what you are noticing. Each page explains likely causes and the evaluation that sorts them out.

Testosterone Therapy (TRT)

  • Andropause (male menopause) Andropause, or male menopause, is a popular name for the slow fall in testosterone that comes with age, roughly 1 percent a year after 40.
  • Borderline low testosterone Borderline low testosterone usually describes a morning total testosterone of roughly 300 to 400 ng/dL, just above the 264 and 300 ng/dL cutoffs major guidelines use.
  • Enlarged prostate (BPH) and testosterone In carefully screened men, testosterone therapy has not been shown to worsen BPH symptoms.
  • Irritability and mood swings in men Irritability and mood swings in men can come from low testosterone, from testosterone levels that peak and crash between injections, and sometimes from high estradiol.
  • Klinefelter syndrome and testosterone Klinefelter syndrome (47,XXY) is a chromosomal condition in which small testes make too little testosterone for life, a form of primary hypogonadism.
  • Low bone density in men Low testosterone, and the estradiol men make from it, both help keep bones strong, so deficiency can lead to bone loss.
  • Low libido in men Low libido in men usually has one of three roots. Hormonal causes include low testosterone, high prolactin and thyroid problems.
  • Low motivation and low testosterone Low testosterone can dull drive, but depression and burnout cause the same flat, unmotivated feeling far more often.
  • Low testosterone after testicular cancer Men treated for testicular cancer can develop low testosterone because one testicle is gone and chemotherapy or radiation may weaken the remaining one.
  • Low testosterone despite a healthy lifestyle When a lean, active man who sleeps well and drinks little still has low morning testosterone on two tests, lifestyle is unlikely to be the cause.
  • Low testosterone symptoms in men The common symptoms of low testosterone in men are lower sex drive, fewer morning erections, fatigue, loss of muscle and strength, more body fat, and trouble concentrating.
  • Muscle loss in men after 40 Men gradually lose muscle and strength from midlife on, a process that becomes sarcopenia when strength drops low enough to affect daily function.
  • Opioid-induced low testosterone Long-term opioid use can lower testosterone by suppressing the brain hormones, GnRH and LH, that tell the testes to make it.
  • Primary hypogonadism in men Primary hypogonadism is low testosterone caused by the testes themselves, from conditions such as Klinefelter syndrome, injury, mumps, chemotherapy or radiation.
  • Secondary hypogonadism in men Secondary hypogonadism is low testosterone caused by a weak signal from the pituitary or hypothalamus, seen on labs as low testosterone with a low or normal LH.
  • Sleep apnea and low testosterone Obstructive sleep apnea and low testosterone often travel together, linked by broken sleep, nightly oxygen dips and the excess weight that drives both.
  • Testicular atrophy (shrinking testicles) Testicular atrophy means one or both testicles have become smaller or softer.
  • Varicocele and low testosterone A varicocele is a cluster of enlarged veins above the testicle, usually on the left.

Preventative Blood Testing

  • Adrenal fatigue in men Adrenal fatigue is not a recognized medical diagnosis. The Endocrine Society says no scientific proof supports it, and a systematic review of 58 studies found no substantiation for it.
  • Brain fog in men Brain fog is not a diagnosis but a description of slowed thinking, poor focus and word-finding lapses.
  • Chronic stress and low testosterone Chronic stress can lower testosterone in two main ways. Raised cortisol suppresses testosterone production in the testes, and the short, broken sleep that comes with stress lowers it further.
  • Erectile dysfunction as an early sign of heart disease Erectile dysfunction can be an early warning of artery disease, because the same narrowing that limits blood flow to the heart often affects the smaller penile arteries first.
  • Family history of early heart disease Heart disease counts as early in your family if your father or brother was diagnosed before 55, or your mother or sister before 65.
  • Family history of prostate cancer If your father or brother had prostate cancer, your own risk is higher, and the American Cancer Society suggests starting the PSA screening conversation at 45, or at 40 if more than one close relative was diagnosed young.
  • Gynecomastia in men Gynecomastia is growth of true breast gland tissue in men, felt as a firm, rubbery disc under the nipple, unlike the soft, even fat of a heavier chest.
  • Heavy drinking and low testosterone Regular heavy drinking lowers testosterone by damaging the testosterone-making cells in the testes, dampening the brain's signal to them, and straining the liver that clears hormones.
  • High cholesterol in men High cholesterol usually causes no symptoms and is found on a lipid panel that measures LDL, HDL and triglycerides.
  • High estrogen in men In men who are not on testosterone therapy, high estrogen usually means estradiol is being overproduced from excess body fat, regular heavy drinking or a strained liver.
  • High prolactin in men High prolactin suppresses the brain's signal to the testes, so testosterone and libido fall.
  • Hormone imbalance in men Hormone imbalance in men usually means one of five systems is running too high or too low, testosterone, estradiol, thyroid, cortisol or prolactin.
  • Hot flashes and night sweats in men Hot flashes in men usually follow a sudden, steep drop in testosterone, such as stopping TRT or anabolic steroids, or starting androgen-deprivation therapy for prostate cancer.
  • Low testosterone after a head injury A traumatic brain injury can damage the pituitary gland, which controls testosterone, cortisol, thyroid and growth hormone.
  • Low thyroid vs low testosterone in men Low thyroid and low testosterone share fatigue, weight gain, low libido and low mood, so symptoms alone cannot separate them.
  • Overtraining and low testosterone Heavy training paired with too little food or recovery can lower testosterone by quieting the brain's signal to the testes.

Medical Weight Loss for Men

  • Constant food cravings and food noise Food noise is the constant, intrusive thinking about food that many people describe, often between meals and soon after eating.
  • Fatty liver disease in men Metabolic fatty liver disease, now called MASLD, is fat buildup in the liver linked to excess weight, insulin resistance and high triglycerides rather than alcohol.
  • Insulin resistance in men Insulin resistance means muscle, fat and liver cells respond poorly to insulin, so the pancreas makes more to keep blood sugar normal.
  • Knee pain and excess weight Extra weight multiplies the load on your knees: in one trial, each pound lost took about four pounds of force off the knee with every step.
  • Metabolic syndrome in men Metabolic syndrome is diagnosed when a man has at least three of five markers: a waist over 40 inches, triglycerides of 150 mg/dL or more, HDL under 40 mg/dL, blood pressure of 130/85 or higher, or fasting glucose of 100 mg/dL or higher.
  • Obesity and low testosterone Excess body fat lowers testosterone in two ways: fat tissue converts testosterone into estradiol, and estradiol, insulin, leptin and inflammation quiet the brain's LH signal to the testes.
  • Visceral fat in men Visceral fat is fat stored deep in the abdomen around the liver, gut and other organs.
  • Weight gain after 40 in men Weight creeps up after 40 mostly because muscle slowly declines, testosterone drifts down and sleep gets shorter, not because metabolism suddenly breaks.
  • Weight loss plateau in men A weight loss plateau happens because a smaller body burns fewer calories, appetite rises to defend the old weight, and lost muscle lowers energy use further.

ED Medications

  • ED pills not working ED tablets often fail for fixable reasons, such as a dose that is too low, sildenafil taken after a heavy meal, too little time before sex, no sexual stimulation, or low testosterone.
  • Erectile dysfunction after a heart attack or stent The American Heart Association considers sex reasonable for many men at least a week after an uncomplicated heart attack, or several days after a stent with a healed access site, if mild to moderate activity causes no symptoms.
  • Erectile dysfunction after prostate radiation After radiation for prostate cancer, erections often stay close to normal at first and then decline gradually, typically starting 24 to 36 months after treatment as small blood vessels and nerves scar.
  • Erectile dysfunction after prostatectomy After radical prostatectomy, erections usually return slowly as the nerves beside the prostate recover, commonly over 12 to 24 months and sometimes up to 36.
  • Erectile dysfunction from antidepressants SSRIs and related antidepressants commonly cause lower desire, weaker erections and delayed orgasm.
  • Erectile dysfunction with diabetes More than half of men with diabetes develop ED, because high blood sugar damages the nerves and blood vessels erections depend on.
  • Performance anxiety and erectile dysfunction Performance anxiety ED is likely when erections are normal in the morning, during sleep or alone, but fail with a partner, especially after one bad experience.

Aesthetics for Men

  • Acne scars in men Acne scars are permanent changes in skin texture left by deep or picked breakouts, most often shallow depressions on the cheeks, temples and jaw.
  • Dark spots after acne or razor bumps The dark marks left after a pimple or razor bump heals are usually post-inflammatory hyperpigmentation, extra pigment made by irritated skin.
  • Melasma in men Melasma is a pattern of blotchy brown or gray-brown patches, usually on both cheeks, nose and forehead.
  • Sun spots on the face in men Sun spots (solar lentigines) are flat tan to brown patches caused by years of ultraviolet exposure, most often on the cheekbones, temples, forehead and nose.
  • Sun-damaged skin in men Sun-damaged skin is the cumulative result of years of ultraviolet exposure, showing up as rough or leathery texture, blotchy tone, scattered brown spots and fine lines, most often on the face, neck, ears and hands.

Dermal Fillers

  • Deep smile lines (nasolabial folds) in men Nasolabial folds deepen when the cheeks lose fat and bone support and the tissue above the fold slides forward and down.
  • Facial volume loss after GLP-1 weight loss Large, fast weight loss on semaglutide or tirzepatide removes fat from the face along with the body, which can hollow the cheeks and temples and loosen skin.
  • Hollow under-eyes in men Under-eye hollows form when fat and bone support along the lower eye socket thin out, casting a shadow that reads as tiredness.
  • Jowls in men Jowls form when the jaw and midface lose bone and fat support and the skin loosens, so tissue settles below the jawline.
  • Loss of jawline definition in men A jawline loses definition when the jaw angle, chin and the bone beneath them lose projection, or when fat and loose skin soften the edge.

Hair Restoration (PRP)

  • Early hair loss in men in their 20s Hair loss in your 20s is usually early male pattern loss, and this is the stage where treatment does the most, because thinning follicles are still alive.
  • Male pattern hair loss Male pattern hair loss is inherited, hormone-driven thinning that follows a set path from the temples and crown toward the top of the scalp.
  • Receding hairline in men A receding hairline in men usually starts at the temples and is driven by inherited androgen sensitivity.
  • Sudden hair shedding in men Sudden, heavy shedding all over the scalp a few months after illness, surgery, major stress or rapid weight loss is usually telogen effluvium, and it typically settles within six to nine months once the trigger passes.
  • Thinning crown in men Crown thinning is usually spread-out miniaturization, with many weakened follicles still alive across the area, so it often responds better to PRP and medical therapy than a receding hairline does.

Erectile Dysfunction Treatment

  • Erectile dysfunction in men under 40 ED is not rare under 40. In one clinic study, one in four men seeking help for new ED was 40 or younger, and almost half of them had severe ED.
  • Erectile dysfunction with normal testosterone When testosterone is normal on repeat morning testing, adding more will not fix ED.
  • Losing an erection during sex Losing an erection partway through sex, without trouble getting one, usually points to anxiety or distraction, condom-related loss, or a vascular problem where blood drains out too quickly, known as venous leak.
  • Loss of morning erections Morning erections are the tail end of erections that happen several times during sleep.
  • Weaker erections than before Erections that are still usable but noticeably less rigid usually score a 3 instead of a 4 on the four-point Erection Hardness Score.

NEO Slim Body Sculpting

  • Lack of ab definition despite training Visible abs need two things, enough muscle and a thin enough layer of fat over it.
  • Skinny fat in men Skinny fat describes a man whose weight and BMI look normal but who carries too much body fat and too little muscle.
  • Stubborn belly fat in men Belly fat comes in two layers. Subcutaneous fat sits under the skin and can be pinched, and NEO Slim body sculpting is designed for that layer.

PRP Injections

  • Reduced penile sensitivity Reduced penile sensitivity usually comes from nerve or blood-flow changes: diabetes-related nerve damage, aging, prolonged pressure from cycling, some antidepressants, and sometimes low testosterone affecting arousal.
  • Tennis elbow (lateral epicondylitis) Tennis elbow is overuse damage to the tendon on the outside of the elbow, causing pain with gripping and lifting.

Wrinkle Relaxers

  • Forehead lines in men Forehead lines in men come from years of raising the brows with the frontalis muscle, deepened by sun and thicker skin.

Sermorelin

  • Growth hormone decline in men Growth hormone output falls gradually with age in every man, and that normal decline is different from adult growth hormone deficiency, a diagnosis usually confirmed with stimulation testing by an endocrinologist.

Peptide Therapy

Wolverine Stack (BPC-157 + TB-500)

  • Tendon pain in lifters Tendon pain in lifters is usually overuse tendinopathy at the elbow, shoulder or knee, triggered by jumps in volume, intensity or new movements.

Shockwave Therapy for ED

  • Vascular erectile dysfunction Vascular erectile dysfunction happens when the arteries that fill the penis cannot widen and deliver blood fast enough, or the tissue cannot hold it.

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