Hormone replacement therapy for men is often understood narrowly as testosterone therapy. But men's hormonal health is a broader system involving growth hormone, cortisol, thyroid hormones, and several peptide-driven axes. A complete approach to men's HRT addresses all of the relevant hormonal levers, not just the most obvious one.
What Is Men's HRT?
Men's hormone replacement therapy (HRT) refers to any intervention that restores or optimises hormonal levels in men with confirmed hormonal deficiencies. The goal is to return functioning to a physiologically optimal state and address the symptoms, metabolic consequences, and long-term health risks of hormonal decline.
Modern men's HRT encompasses:
- Testosterone optimisation: TRT or peptide-based natural stimulation protocols
- Growth hormone optimisation: Growth hormone secretagogue peptides (sermorelin, ipamorelin, CJC-1295)
- Adrenal support: Addressing DHEA-S decline and HPA axis dysregulation
- Thyroid optimisation: Ensuring thyroid function is not a limiting factor in metabolic and energy status
Testosterone: The Central Pillar
Testosterone is the most clinically important hormone in men's HRT. As discussed throughout this series, declining testosterone drives muscle loss, visceral fat accumulation, insulin resistance, reduced libido, mood changes, and cognitive decline.
Options for testosterone HRT include:
- Direct TRT: Injectable testosterone cypionate/enanthate, gels, or pellets
- Peptide stimulation: Kisspeptin, enclomiphene, or sermorelin-based protocols that drive natural testosterone production without suppression
- Combination protocols: For men where GH and testosterone are both deficient
The right approach depends on your LH, FSH, and testosterone levels, as well as your fertility goals and personal preferences.
Growth Hormone: The Overlooked Decline
Most men do not know that growth hormone declines alongside testosterone. After age 30, GH secretion decreases at approximately 14 percent per decade. By age 50, many men are producing significantly less GH than they did at 25.
GH deficiency in adult men produces:
- Reduced muscle mass and strength
- Increased body fat, particularly visceral
- Reduced bone density
- Fatigue and reduced exercise capacity
- Impaired recovery from training and injury
- Disrupted sleep architecture
Growth hormone secretagogue peptides - sermorelin, ipamorelin, and CJC-1295 - stimulate the pituitary to restore physiological GH pulsatility without the risks and cost of direct HGH administration.
At Longegra, IGF-1 (the downstream marker of GH function) is tested as part of our comprehensive men's intake panel.
DHEA: The Adrenal Androgen
DHEA-S (dehydroepiandrosterone sulphate) is produced by the adrenal glands and is a precursor to both testosterone and oestrogen. It peaks in the mid-20s and declines significantly with age.
Low DHEA-S is associated with:
- Reduced energy and sense of wellbeing
- Impaired immune function
- Accelerated skin ageing
- Reduced libido in both men and women
DHEA supplementation in men with documented deficiency is a simple and effective component of comprehensive hormonal optimisation, though it requires physician oversight due to its androgenic activity.
Thyroid: The Metabolic Regulator
Thyroid hormones regulate metabolic rate, energy production, and are essential for testosterone metabolism. Subclinical hypothyroidism (mildly elevated TSH with normal T4) is more prevalent in Indian men than commonly appreciated and can:
- Suppress testosterone production
- Reduce GH secretion
- Cause weight gain, fatigue, and mood symptoms that mimic low testosterone
At Longegra, TSH is part of our standard intake panel. An untreated thyroid condition can significantly blunt the response to testosterone or GH optimisation.
The Longegra Whole-System Approach
At Longegra, men's HRT is designed as an integrated system. We test and optimise:
- Testosterone (total, free, SHBG, LH, FSH, oestradiol)
- IGF-1 and GH axis function
- DHEA-S
- TSH and thyroid function
- Cortisol patterns (stress axis)
- Metabolic markers (fasting insulin, HbA1c, lipids)
This comprehensive assessment ensures that no limiting factor is missed. Many men who do not respond as expected to testosterone therapy have an underlying GH deficiency, thyroid issue, or metabolic problem that is the actual limiting factor.
Frequently Asked Questions (FAQs)
When properly supervised with regular monitoring, evidence-based men's HRT has a favourable long-term safety profile. Testosterone therapy in particular has been extensively studied, with the 2023 TRAVERSE trial providing reassurance on cardiovascular safety under appropriate clinical oversight.
