Testosterone levels have dropped 45% in men in the last 20 years! This crisis causes suffering for too many men. Learn from Dr. Tracy Gapin, how to avoid the low testosterone crisis, without fads of guesswork.
Find out how to have the best love and sex of your life!
How to Avoid the Low Testosterone Crisis: Show Notes
I’ve been thinking a lot about hormones these days, as they wreak havoc on my life. I hope you haven’t had to think about them, but if you’re in a middle aged body, and you’ve had mood, energy or body changes, they could be caused by changing hormones.
If you’re a man, it might blow you away to realize that over the past 20 years, testosterone levels in men have plummeted by ~45%. That’s enough to call this a Testosterone Crisis.
I had a conversation with Dr. Tracy Gapin on today’s Man Alive podcast, a board certified urologist for 25 years, and founder of the Gapin institute, helping men achieve peak performance through personalized health programs. He talked about why testosterone levels are low, and how to get back in control of your testosterone levels, without guesswork or following fads.
We discussed…
- How many men are being told they’re “normal” when they’re far below where they should be for optimized health
- Why Testosterone Levels Have Plummeted in the past couple decades
- What endocrine disruptors are and how they mess with your hormonal system
- The trifecta to balance your testosterone levels
- The telltale signs of low testosterone in your sleep, mood, energy, drive, including feeling “wired but tired”
If you’ve been feeling off — low drive, low energy, more tired than usual, this episode is for you. And if you’re lucky enough to feel good now, but want to make sure you don’t experience this in the future, this is also an important episode.
When you’re done with this one, check out another episode that gives you the 8 key factors to total sexy health, and how to get there.
Links:
Connect with Shana James
Best love and sex of your life quiz
Get a Free copy of Honest Sex: A Passionate Path to Deepen Connection and Keep Relationships Alive.
Whether you’re dating or in a relationship it shows you how to take the self-doubt, struggle and shame out of your love life.
Curious what you’d need to become a better leader and lover? Take the quiz
For Women: Modern dating doesn’t have to be a nightmare for women
Connect with Dr. Tracy
Bio:
Tracy Gapin, MD, FACS, is a renowned expert in men’s health optimization and longevity, with over 25 years of experience as a board-certified urologist. He founded the Gapin Institute to help high-performing individuals, including entrepreneurs, executives, and athletes, achieve peak performance through personalized health programs.
Dr. Gapin integrates advanced diagnostics, epigenetics, hormone therapy, and wearable technology to monitor and transform his clients’ health, focusing on sustainable, measurable outcomes. A thought leader and author of bestsellers Male 2.0 and Codes of Longevity, Dr. Gapin has been featured on NBC, Entrepreneur Magazine, and at Dave Asprey’s Biohacking Conference. He is a member of the American Academy of Anti-Aging, the Age Management Medical Group, and the International Peptide Society.
Transcript:
Shana James (00:11)
Hello and welcome to this episode of Man Alive. I’m your host, Shana James. I’m so happy to be here today. This topic is near and dear to my heart in ways you might not expect — we’re going to talk about hormones and health. I’ve been going through my own journey with hormones, but today we’ll focus on men’s hormones, especially testosterone, and the journey of feeling healthy, alive, and vital — escaping the testosterone crisis and understanding how to to increase testosterone without side effects and how to fix low energy and sex drive after 40.
So, Dr. Tracy Gapin, welcome.
Tracy Gapin, MD (00:51)
Thanks so much.
Shana James (00:52)
Great. Tracy is a renowned expert in men’s health optimization and longevity with over 25 years of experience as a board-certified urologist. He founded the Gapin Institute to help high-performing individuals achieve peak performance through personalized health programs. Is there anything you’d like to add, especially about your shift from urology into broader men’s health?
Tracy Gapin, MD (01:19)
Yes. As you mentioned, I was a urologist for many years, doing robotic surgery and treating prostate cancer. I was running a very high-volume surgical practice. But, like so many other entrepreneurs, executives, and founders, I hit a wall myself. I was about 30 pounds overweight, felt terrible, wasn’t sleeping well, stressed out, and not taking care of myself.
I had to humbly recognize that I didn’t know what to do about it — even though I was supposed to be the men’s health expert. That led me on a journey to discover cutting-edge ways to optimize health, things our traditional medical system doesn’t teach doctors or patients. With this new knowledge, I turned my own health around. It became a passion project that has now grown into a business — the Peak Launch Program — and I’m even teaching other doctors to take this same approach. It’s been an amazing journey, both personally and professionally.
Shana James (02:22)
Yes. I really appreciate Western medicine for what it does — surgeries, robotics, life-saving interventions. I’m sure you helped so many people in those ways. But when it comes to vitality, energy, and optimal health, I also haven’t found Western medicine to be a great solution for myself.
Tracy Gapin, MD (02:46)
Exactly. Western medicine is great if you have a kidney stone, prostate cancer, need to deliver a baby, or are in a car accident or trauma situation. Acute issues like heart attacks — yes, Western medicine excels.
But if you want more energy, sharper focus, better performance at work, or the ability to come home and still have energy for your kids and intimacy with your partner — our healthcare system isn’t made for that. It’s not set up to help you burn belly fat, feel vital, or truly optimize your health.
Shana James (03:32)
Right. So what exactly is the testosterone crisis for men? I know men often ask questions like: As a man over 40, why am I tired all the time? And how can I decrease stress and optimize my health?
Tracy Gapin, MD (03:38)
We have three massive longitudinal studies — hundreds of thousands of men from around the world. One study was in the U.S., two in Europe (Sweden and Finland). All three followed men for over 20 years, tracking various lab values. What we found is that testosterone levels have plummeted by almost 50%.
Shana James (04:04)
Wow — 50%?
Tracy Gapin, MD (04:06)
Yes, it’s crazy. Free testosterone — which is the form your body can actually use — is down about 45% over the last 20 years. To be clear, testosterone does naturally decline somewhat with age, but we’re not talking about that. We’re talking about a 50-year-old man today having about half the free testosterone of a 50-year-old man 20 years ago. That’s a massive difference.
Yet doctors still tell men they’re “normal” because they’re using the wrong reference ranges. So men are suffering with low testosterone without being taken seriously.
Shana James (04:37)
That’s wild. Why has it decreased so much in just the past 20 years?
Tracy Gapin, MD (05:04)
The biggest culprit, without question, is endocrine disruption. These are chemicals and toxins in our environment that crush hormone production and function.
Take synthetic estrogen from women’s birth control — it gets excreted in urine, ends up in our water supply, and treatment plants can’t filter it out. So every man listening is essentially “on the pill” through drinking water, exposed to synthetic estrogen that impacts testosterone production.
Other culprits include herbicides like atrazine (common in Midwestern crops), plastics (bottles, containers), and personal care products like soap, shampoo, deodorant, laundry detergent, and sunscreen. We’re bathing in a soup of endocrine disruptors every day, and it’s crushing our hormones.
Shana James (06:19)
Wow — even things like soap and sunscreen?
Tracy Gapin, MD (06:27)
Yes. Add to that stress, sedentary lifestyle, poor nutrition, lack of sunlight — all of these contribute too. It’s cumulative, layer upon layer, and the effects are exponential over time.
To make it worse, there’s also a transgenerational effect. Epigenetic changes are passed down, so the next generation is already starting out with lower testosterone. Each generation is more affected. It’s a serious problem that doesn’t get nearly enough attention.
Shana James (07:04)
Yes. Being in midlife, I know many men exploring this issue — and some have been helped by testosterone therapy. I know it’s part of a bigger picture, but if we start with testosterone, what do you recommend? After someone gets tested and finds their levels are low, is that the first step?
Tracy Gapin, MD (07:27)
For sure. But first, it’s important to understand that testosterone is just one piece of a much bigger picture — longevity, cardiovascular health, mental clarity, and overall vitality.
That said, when it comes to testosterone, there are natural ways to boost it: strength training, improving sleep quality, good nutrition, reducing stress, sunlight exposure, micronutrient support, and removing endocrine disruptors. Those are all important, but by themselves they usually don’t move the needle enough.
Even if a man did everything perfectly — working out daily, eating clean, sleeping well, reducing stress, eliminating toxins — it often isn’t sufficient.
Shana James (08:33)
Right, and with everything else in life, who has time to do all that perfectly?
Tracy Gapin, MD (08:36)
Exactly. And often men are so exhausted and stressed that they don’t have the energy to even start those habits. It becomes a chicken-and-egg problem.
So while lifestyle practices are important, they rarely create enough change on their own. That’s why I typically recommend testosterone replacement therapy early on.
When testosterone levels are restored, men feel more energy, better mood, sharper focus, improved productivity, and greater efficiency. They come home with enough energy to enjoy their families and intimacy, sleep better, and build momentum toward healthier habits.
Shana James (09:42)
Yes — like an upward spiral.
Tracy Gapin, MD (09:44)
Exactly. It becomes, “What can I do next? How can I improve further?” Men become motivated and eager to keep building on that momentum.
Shana James (09:55)
Amazing. Is there anything specific you recommend around the different types of testosterone replacement? I know there are various methods.
Tracy Gapin, MD (10:06)
Yes. There are a couple of approaches. One is the natural methods we discussed, often combined with pharmaceuticals that stimulate your body to make more testosterone. I don’t use this often, except for younger men — say a 20- or 25-year-old whose testosterone is low.
In that case, I wouldn’t give testosterone directly because it shuts down the body’s own production and suppresses fertility.
Shana James (10:55)
I’ve heard that as well. Okay.
Dr. Tracy Gapin (10:59)
That’s where things like Clomid, Clomiphene, or HCG come in. These are ways we can stimulate internal testosterone production — a great option for younger men. For older men, we’ll often use testosterone replacement directly. I usually prefer testosterone cypionate or propionate, rather than some of the other esters out there.
Shana James (11:07)
So rather than giving testosterone directly, you’re helping the body produce it on its own.
Dr. Tracy Gapin (11:27)
Exactly. In some cases, though, we accept that a man simply isn’t going to make enough testosterone anymore. In those situations, we give testosterone replacement to immediately deliver the benefits. Even for men in their forties, fifties, and sixties, I strongly encourage testosterone therapy. It’s incredibly safe.
Shana James (11:32)
Mm-hmm. This is more for older men then.
Dr. Tracy Gapin (11:54)
Yes. The benefits are well studied and well documented. TRT massively lowers cardiovascular risk. About a dozen studies have shown that men with higher testosterone levels have significantly better cardiovascular health. Men in the lowest quartile of testosterone compared to the highest had a 30% higher risk of major heart attack or stroke.
Shana James (12:01)
That’s huge.
Dr. Tracy Gapin (12:24)
It is. Optimizing testosterone lowers risk by improving lipids, blood sugar control, and reducing inflammation. Testosterone is actually a powerful natural anti-inflammatory with all kinds of benefits. And the earlier we can optimize, the better — because we see not just longevity benefits, but massive quality of life improvements.
Shana James (12:26)
Wow, that’s incredible.
Dr. Tracy Gapin (12:53)
Exactly. That’s why I love TRT.
Shana James (12:56)
Okay, so testosterone is one spoke of the wheel. How do you recommend addressing the other spokes?
Dr. Tracy Gapin (13:09)
Great question. I usually group men’s health challenges into three main categories: hormones, inflammation, and system overload.
On the hormone side, testosterone is important, but it’s rarely the only issue. We often see low DHEA, low thyroid, low nitric oxide — which is key for brain, muscle, and cardiovascular health. Growth hormone levels drop significantly after 40. Vitamin D, which is actually a hormone, is often deficient. When these are all low together, it creates an environment for poor metabolism, weight gain, brain fog, and accelerated aging.
The second category is inflammation — specifically chronic inflammation. Acute inflammation is normal for healing, but chronic low-grade inflammation comes from things like gut issues, poor nutrition, alcohol, nutrient deficiencies, infections, or toxins like mold. Inflammation crushes brain function, blocks fat loss, makes it hard to build muscle, and disrupts sleep.
Shana James (15:01)
Yeah, I know for myself I’ve dealt with chronic inflammation, and it doesn’t always show up as pain. For me it’s more like brain fog. Do you think a lot of men have it without knowing?
Dr. Tracy Gapin (15:25)
Exactly. Most men don’t realize it. The signs can be subtle — like not recovering from workouts, not burning fat the way you should, or just feeling “off.” That’s why I push for men to get tested. We can run simple labs to identify inflammation triggers that might be holding them back.
Shana James (15:41)
And sadly, many men are taught not to seek help. I often ask my clients when the last time was they went for a physical, and many haven’t in years.
Dr. Tracy Gapin (15:58)
Right. Men often don’t seek help unless something feels broken. That’s part of why I’m so passionate about this work — getting men to be proactive, get tested, and catch things early.
The third category is what I call system overload. I don’t like the word “stress” because men will deny it. But system overload is that feeling of being in the red all the time — wired and tired. You wake up exhausted, can’t burn fat, can’t build muscle, and your body just isn’t functioning. At the cellular level, your mitochondria — your energy powerhouses — aren’t producing energy the way they should. That spirals into more inflammation, more hormone disruption, and it becomes a vicious cycle.
Shana James (17:30)
Yeah, and with everything moving so fast these days, most people feel overloaded. Phones, computers, constant work — it’s epidemic.
And I also saw in your write-ups that you’re a dad.
Dr. Tracy Gapin (17:34)
That’s right. That’s really my “why.” When I talk about peak performance, I don’t mean being an Ironman or a bodybuilder. For me, peak performance is being a badass dad when I get home. I can crush it at work, give talks, lead a team — but what really matters is showing up for my kids.
Shana James (18:30)
I love that. How old are your kids?
Dr. Tracy Gapin (18:35)
My son is 11, almost 12, and he’s a competitive golf prodigy. My daughter is nine, almost 10. She’s a self-proclaimed “sleigh queen princess” and into figure skating.
Shana James (18:40)
Amazing. I love that. It really touches my heart that fatherhood is your big why.
So before we wrap, what are we missing? What else would be helpful for men to know?
Dr. Tracy Gapin (18:54)
We’ve touched on a lot — nutrition, gut health, sleep, lifestyle. Hormones are key, but many guys also ask about the quick fixes. And that’s where peptides come in.
Shana James (19:35)
I’ve never actually heard of peptides. What are they?
Dr. Tracy Gapin (19:40)
Peptides are simply short chains of amino acids — basically tiny proteins with very specific functions. Some reduce inflammation, some help repair the gut, some speed up injury recovery, some improve sleep. They’re incredibly exciting tools for optimizing health.
Dr. Tracy Gapin (20:09)
Peptides can help with cognitive function, focus, memory, anxiety, depression — you name it. There are peptides for weight loss as well. Semaglutide, for example, is a commonly prescribed peptide for weight loss. Tirzepatide is another in the GLP-1 category that’s very powerful. I love peptides. However…
Shana James (20:29)
Mm-hmm. Okay, I’m getting the sense there’s a “but” coming.
Dr. Tracy Gapin (20:39)
Exactly. The problem is that most people put the cart before the horse. They want to take a peptide to lose weight, have more energy, or sleep better — but they haven’t addressed the foundations. I like to think of peptides as the icing on the cake.
The cake itself is built from proper nutrition, gut health, hormones, sleep, fitness, clearing toxins, managing stress, and reducing inflammation. Those are the key ingredients. Once you’ve baked a solid cake, then peptides are like the frosting that takes it to the next level.
Shana James (21:36)
That makes sense. Otherwise, it could become avoidance, right? Like, “If I just pop this pill, I don’t have to do the deeper work.” But there’s too much going on in the body for that to work.
Dr. Tracy Gapin (21:41)
Exactly. Quick fixes don’t work.
And it’s the same with a lot of popular biohacking tools — things like cryotherapy, cold plunges, red light therapy, saunas, PEMF tables, hyperbarics, or plasmapheresis. I love them all — in the right context. But if you have major gut issues, none of those things will do anything for you. You’ve got to start with the foundations first. Then you can layer on and optimize.
Shana James (22:29)
I love that. It feels really important. I’ve been on a lifelong gut health journey, and I know if my gut isn’t working well, anything else I try just won’t stick.
Dr. Tracy Gapin (22:44)
Exactly. I’ll give you an example. I had a client who had recurring sinus infections for years. He’d seen ENT doctors, had scopes, taken multiple rounds of antibiotics. Nothing worked anymore — he’d even developed resistance.
I told him, “This is coming from your gut.” He didn’t believe me. But when we tested, his microbiome was a mess. We cleaned it up, and five years later, all the sinus infections are gone.
Shana James (23:23)
Amazing. Western medicine doesn’t usually make those connections between gut health and something like sinus infections. Are there gut tests you recommend?
Dr. Tracy Gapin (23:27)
Yes — we run microbiome testing on all of our clients, along with food sensitivity testing. Often, microbiome imbalance breaks down the gut wall, leading to food sensitivities and chronic inflammation.
I had a client who was a race car driver. He struggled with focus and decision-making on the track. It turned out his “triggers” were bananas and coffee. Those foods aren’t bad in general, but for him, they were kryptonite. Once we removed them, his performance improved dramatically.
Shana James (24:14)
I can relate. For me it’s chocolate right now — painful to give up, but so worth it for the focus and energy.
So, any last things you want men to know before we wrap up?
Dr. Tracy Gapin (24:31)
Yes. I want to urge every man out there: get tested. Look at your hormones, inflammation, cardiovascular health, blood sugar, micronutrients, and cortisol levels. Don’t assume you’re healthy just because you feel okay. You might be shocked by what you find.
Shana James (25:28)
That’s so interesting. In my family, some are Western doctors, some more Eastern. It’s fascinating how differently health is viewed. A lot of people think, “I eat vegetables, I don’t eat too much red meat, so I’m fine.” But like you said, there are toxins in our food and water that most people never consider.
Dr. Tracy Gapin (25:51)
Exactly. It’s everywhere, which is why health requires a consistent, daily effort. It’s not about one magic supplement, hormone, or peptide. It’s about small, steady steps — being 1% better every day. That’s what creates real, lasting change.
Shana James (26:22)
Beautiful. Thank you so much. Where can men find you?
Dr. Tracy Gapin (26:25)
Thanks so much. You can find me at GapinInstitute.com. If you go to GapinInstitute.com/launch, you’ll get my High-Performance Health Handbook with 15 strategies you can start using today. There’s also our Ultimate Peptide Guide, which is a great resource for everything related to peptides.
Shana James (26:49)
Perfect. Thank you so much for being here and talking about high performance health for men
And testosterone optimization, so men can feel vital and healthy!
Dr. Tracy Gapin (26:50)
My pleasure.
Music from #Uppbeat (free for Creators!):
https://uppbeat.io/t/prigida/burble
License code: OHMHFXBSHHFV307Z
Podcast (practicing-love): Play in new window | Download | Embed
Subscribe: RSS