The long way is the only way that lasts

Abraham Morgentaler is a Harvard urologist who has spent forty years studying testosterone, and in 2008 he wrote the book on it, Testosterone for Life, that most of the clinics selling it have not read. His order is the opposite of theirs.

First: sleep, strength and body fat. Low testosterone in a forty-five-year-old who sleeps six hours, lifts nothing and carries forty extra pounds is usually those three things wearing a hormone's name. Second: measure, twice, in the morning, before anyone says the word low. Third, and only then: treat, with a physician who follows you.

Testosterone in men falls about one percent a year from the thirties, which is slow. It falls much faster with poor sleep, belly fat, heavy drinking and some medications, which is fast and, here's the good news, reversible. The symptom list is honest: low drive, low energy, low mood, poor recovery, loss of muscle. The trouble is that every one of those is also a symptom of a sixty-hour week with a toddler and a bottle of wine. Morgentaler's rule is that nobody should be diagnosed from a symptom list. That's Vault Human's rule too. A single afternoon blood draw is nearly worthless, because the level is highest in the morning and varies day to day. Two morning draws, read by a doctor who knows the ranges, is the floor.

Why is this a key for the first month? Because the three things that come before any test, sleep, strength and body fat, are three numbers already in your log. The body you've been learning about this month is the body that makes the hormone. The men's health industry sells the shortcut. The long way is the only one that lasts, and you've been walking it for sixteen days.

This letter goes to everyone. For men it's a mirror. For women it's the other half of the clock you read on day eight.