It’s no secret: today’s men face a crisis of falling testosterone. What most don’t realize is this affects far more than libido or sexual health. Testosterone drives energy, sharp thinking, muscle growth, heart and bone strength, and even influences how we age. Yet, even as millions suffer from low T, testosterone replacement therapy (TRT) remains underused, misunderstood, and burdened by old myths.
In an eye-opening conversation, Dr. Greg Jones sat down with Shalin Shah, CEO of Marius Pharmaceuticals and a leader behind Kyzatrex—the first FDA-approved oral testosterone capsule that skips the risks of past pills. Together they explored why low testosterone is rising fast in younger men, what common symptoms to watch for, how lab tests can mislead, and how Kyzatrex may change long-term wellness for both men and—potentially—women.
If you’re a provider, a patient, or just want to know how to keep your energy up as you age, this is essential reading.
The Testosterone Crisis: More Than a Libido Problem
Something startling is happening: men today have much less testosterone than their fathers did at the same age. This isn’t only about declining sex drive or erectile function. Healthy testosterone levels power:
- Metabolism and weight control
- Muscle growth and strength
- Mental sharpness
- Cardiovascular and bone health
- Daily energy and mood
Yet, testosterone therapy often sits on the sidelines, overlooked by many providers and out of reach for countless men. That may be about to shift, as new therapies and better awareness push this health issue to the front.
Why Are Younger Men’s Testosterone Levels Dropping?
We’re seeing a drop that spans generations. Men in their late 20s or early 30s now show testosterone readings that used to appear only in much older age groups. The reasons are everywhere around us:
Lifestyle and Environmental Factors That Lower Testosterone
- Obesity: At least half of overweight or obese men have low T. It works both ways—low T promotes weight gain, and more weight suppresses testosterone.
- Poor Sleep: Deep sleep drives testosterone production. Less sleep means lower T, which then worsens sleep, forming a negative cycle.
- Chronic Stress: High cortisol from modern stress disrupts hormone signals, actively blocking testosterone.
- Sedentary Living: Less movement, less sunlight (hence low vitamin D), and less outdoor activity all take a toll.
- Processed Foods and Chemicals: Endocrine disruptors in plastics, food wrappers, cleaning products, water, and fragrances interfere with hormone production.
- Substances: Marijuana (THC) can slow testosterone while boosting estrogen; excess alcohol (especially beer) suppresses hormone balance.
- Key Nutrient Shortages: Zinc and vitamin D are critical for hormone health, but many diets fall short.
You can do your best like avoiding plastics, eating better, getting more sleep, but modern life makes it nearly impossible to dodge every risk factor.
The Sleep/Testosterone Loop
Low T and poor sleep intensify each other. You need “deep sleep” to make testosterone. But if T is low, you don’t get quality deep sleep, and so the slide continues:
Low Sleep → Low T → Worse Sleep → Lower T → …and on
Everyday Choices That Raise Risk
Quick coffee in that plastic Keurig pod? Take-out in microwaved containers? Those tiny hits of endocrine disruptors add up. Even routine cleaning products, bottled water, and daily exposures set the stage for hormone imbalances.
How to Spot Low Testosterone: Symptoms and Why Labs Can Be Misleading
Most men with low T feel off before they ever see abnormal bloodwork. Here are the most common warning signs:
- Fatigue and low energy (this improves fastest on TRT)
- Low sex drive (libido loss—not just erectile issues)
- Difficulty gaining muscle or losing fat
- Mood changes, less motivation
- Overall decline in well-being
If you recognize these, it’s time to pay attention.
Why Traditional Lab Results Are Tricky
The standard “total testosterone” blood test can mislead both doctors and patients. That’s because testosterone in your blood comes in three main forms:
Analogy:
Total testosterone is your total money—savings, checking, investments.
Bound to albumin = money on a debit card (accessible if needed).
Bound to SHBG (sex hormone-binding globulin) = locked away in a trust fund (nearly impossible to use).
Free testosterone = cash in your pocket—ready to spend, makes the real difference in how you feel.
Only free testosterone gives real metabolic benefits. You can have a normal “total T,” but if your free T is low, symptoms will persist.
The problem is, most doctors only check total T. Without SHBG and free T measurements, you may never find the cause of your fatigue or low drive.
TRT Delivery: Pros, Cons, and the New Oral Option
Testosterone therapy has come a long way. What started as simple pills in the 1940s has evolved into shots, topical gels, under-the-skin pellets, and now new oral capsules that bypass the liver altogether.
Comparing TRT Methods
Here’s how the main options stack up:
| Method | How It’s Given | Pros | Cons |
| Injections | Weekly/biweekly | Potent, predictable | Levels spike too high, side effects (estrogen/DHT up), risk of thickened blood (hemoglobin/hematocrit up), needle fear |
| Topical Gels | Daily | Easy to use, no needles | More skin conversion to DHT (acne, hair loss, prostate), risk of transferring to others, can irritate skin |
| Pellets | Implanted 3-6 mos | Consistent release, low maintenance | Minor surgical procedure, not easily adjusted, risk of dosing errors that last months |
| Old Oral Pills | Swallowed daily | Simple | Liver toxic, underdosed, raised SHBG, not widely used |
| Kyzatrex (new oral) | Swallowed twice daily | FDA approved, skips liver, easy dosing, high absorption, low risk for side effects | Still new, must take with food containing fat |
Older oral testosterone pills were largely abandoned because they damaged the liver. They also weren’t absorbed well and sometimes actually made testosterone less available by pushing up SHBG.
The new generation, led by Kyzatrex, changes that structure and uses a different absorption path.
Kyzatrex: The FDA-Approved Oral Testosterone Capsule
Kyzatrex represents a real leap forward in how testosterone can be delivered safely and effectively.
Why Kyzatrex Stands Out
- Lymphatic absorption: Unlike old oral testosterone, Kyzatrex is absorbed through the gut’s lymphatic system, almost completely bypassing the liver. No liver toxicity.
- Phytosterol-based formula: Uses plant sterols (phytosterols), which are often found in heart-healthy foods, to boost absorption.
- High success: Clinical trials found 96% of patients hit the normal range. Most drugs only help 50-60% reach target levels.
- Dosing: Typically two capsules twice a day, taken with some fat for best absorption (like a spoon of peanut butter or a bit of olive oil).
Key Difference
Old oral testosterone was dismissed for liver risks and weak results. Kyzatrex, by using a new absorption route, removes these barriers and opens up oral TRT as a safe, predictable option.
Clinical Benefits and Safety Profile
Low Risk for Thickened Blood
- Less than 2% of Kyzatrex patients developed higher-than-normal hematocrit (a proxy for red blood cell count), compared with up to 66% using injections.
- If hematocrit rises, a simple dose cut usually brings it back.
Keeps Estrogen in Check
- Kyzatrex supports a balanced testosterone-to-estrogen ratio.
- No routine need for estrogen blockers (aromatase inhibitors), unlike injectable regimens where estrogen can rise too quickly.
- Estrogen itself is helpful for men—protects bones, heart, and supports sexual function.
SHBG and Free Testosterone
- Kyzatrex notably reduces SHBG by 30-50% in trials.
- Lower SHBG means more free testosterone—real, “spending money” T that your body uses to build muscle, energy, and drive.
- You get strong effects without pushing total testosterone to high (risky) levels.
Fertility and Testicular Effects
- Many worry that TRT will shrink the testicles or shut down sperm production.
- In studies, LH and FSH (key fertility hormones) stayed within normal range.
- Most did not experience testicular shrinkage or significant fertility drop. Research on this continues, with promising early findings.
Best Practices for Success on Kyzatrex
- Take with food (fat preferred): Even a spoonful of olive oil or peanut butter helps with absorption.
- Timing matters: Labs are most accurate 3-5 hours after a dose.
- Symptom changes: While blood level changes are quick, it may take up to 90 days for the main benefits to show.
- Transitioning from shots or pellets: Allow previous TRT to clear—usually waiting for a trough (low point) before starting Kyzatrex.
For more on switching protocols safely, see the Kyzatrex official site.
Managing Side Effects and Metabolic Pathways
Even with the best therapies, monitoring is essential. The main areas to watch:
Hematocrit (Red Blood Cell Count)
- Extra testosterone boosts red cell production, thickening blood in some people.
- With Kyzatrex, risk is far lower than shots, and even then, usually fixed by lowering the dose.
Estrogen Conversion
- Some testosterone naturally converts to estrogen.
- A healthy balance is vital for mood, sex drive, bones, and skin.
- Kyzatrex keeps this ratio steady, so most men don’t need estrogen blockers.
Fertility
- Exogenous testosterone can slow sperm production if given in high doses, but Kyzatrex maintains key fertility hormones near normal.
- The impact is much less than with injections. Ongoing research at Baylor shows 80% of patients retained normal sperm counts.
Mood, Motivation, and Breaking Myths about Testosterone
Many people worry that TRT makes men moody, impulsive, or aggressive. The truth is the opposite for most: Testosterone restoration often improves mood, motivation and reduces anxiety.
- Proper levels make people more confident, focused, and driven.
- Partners sometimes worry TRT will prompt a midlife crisis, but often it allows men to feel more like themselves again.
- Testosterone loss is a couple’s disease: it affects both partners, and checking both parties’ hormones often reveals shared low levels that can be addressed together.
- Recent studies suggest TRT can even help with certain cases of anxiety due to effects on key brain receptors.
The Future: Women’s Testosterone Health, Better Education, and Mainstream Medicine
Testosterone’s Role in Women
- Women need testosterone for mood, vitality, and healthy aging too.
- No FDA-approved female testosterone treatments exist yet.
- Marius Pharmaceuticals is developing a formulation specifically for women, and the FDA is showing more support for this area.
Education Gaps
- 80% of primary care providers surveyed were unaware that the FDA recently removed a black box warning related to testosterone, reflecting huge gaps in current medical understanding.
- Both patients and providers benefit from more up-to-date education on the full health impact and safe treatment of low testosterone.
Testosterone care should be foundational, right alongside diet, movement, and sleep, for anyone looking to improve health span and lifespan, not just sexual health.
Take Action for Your Health
Many men (and women) feel stuck and are tired, unmotivated, and told their labs are “normal.” Don’t settle. If you have lingering fatigue, poor muscle growth, foggy thinking, or low drive, ask your doctor about a complete hormone panel, including free testosterone and SHBG.
Educate yourself, use the latest science, and don’t let old myths keep you from the energy and health you deserve.
Ready to take back control of your energy and vitality? Schedule a comprehensive hormone evaluation with our Phoenix TRT specialists at Enovative Wellness Center and discover if testosterone therapy is right for you.
Call us at (602) 614-9905 or visit www.EnovativeWellness.com to learn more.
