HolSpan MD

06/23/2026

Make sure that your “ride” is in alignment
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06/23/2026

“Why Testosterone Became Controversial”

Testosterone therapy didn’t become controversial overnight—it was shaped by decades of mixed signals, limited data, and cultural bias. Some of the most entrenched fears were built on surprisingly thin evidence.

The Prostate Cancer Paradigm

The belief that testosterone “fuels” prostate cancer became medical dogma after Charles Huggins and Clarence Hodges published their work in 1941. Their observation that castration caused metastatic prostate cancer to regress—and that testosterone administration could accelerate disease—became the foundation for the androgen saturation model.

But here’s what most clinicians don’t know: that conclusion was based on a remarkably small patient sample. The original study included only a handful of men with advanced prostate cancer. Dr. Abraham Morgentaler and others have noted that this single observation—treated as biological law—influenced urologic practice for over 60 years.

The 2014–2015 FDA Warning Cycle

In the early 2000s, testosterone prescriptions surged. Then a few observational studies suggested possible cardiovascular event increases. That was enough to trigger FDA warnings in 2014–2015, restricting labeling to men with clearly defined medical causes of low testosterone—not “age-related” decline.

So the narrative became:
- Testosterone may increase heart attacks
- Testosterone may cause prostate cancer
- Testosterone is overprescribed

Why Paradigms Are Hard to Change

Once a medical paradigm is established—like the testosterone-prostate cancer link—it becomes extraordinarily difficult to dislodge. This typically occurs over generations, not years. Even as better data emerges, institutional memory, training patterns, and defensive medicine practices keep the old narrative alive.

Dr. Morgentaler’s 2004 review was a turning point: it challenged the assumption that testosterone therapy increases prostate cancer risk, noting the absence of compelling scientific evidence supporting this fear. Yet nearly two decades later, many clinicians still hesitate to prescribe testosterone appropriately—demonstrating how long it takes for evidence to overcome entrenched medical culture.

The result? A therapy with real physiologic importance became viewed with skepticism, and appropriate patients were denied treatment based on outdated assumptions.

But medicine evolves—and so does the data.

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06/22/2026

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Don't let urinary issues keep you off the course. Our team of Urologists are here to help you feel like yourself again.

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06/22/2026

“Testosterone Therapy: Why the Conversation Is Changing” (Series Introduction)

There has been a quiet—but important—shift happening at the federal level around testosterone therapy.

Recently, the Department of Health and Human Services (HHS) and FDA signaled updates to testosterone labeling and safety language. These changes are not random—they reflect something bigger:

The science around testosterone has evolved.

For years, testosterone therapy has existed under a cloud of uncertainty:

- Concerns about cardiovascular risk
- Long-standing fears about prostate cancer
- Restrictions limiting use to narrowly defined medical conditions

Much of this was driven by early data that was incomplete, conflicting, or later challenged.

Now, after more than a decade of additional research, we’re seeing:

- Better cardiovascular safety data
- A more refined understanding of prostate risk
- Greater clarity on who actually benefits from therapy

Policy is beginning to catch up with physiology and evidence.

This doesn’t mean testosterone is a cure-all—or that it should be widely prescribed without caution.

It means we are moving away from fear-based medicine toward evidence-based, individualized care.

Over the next few days, I’ll break this down into a series:

- How testosterone became controversial
- The stigma that still surrounds it
- What newer data actually shows (heart, prostate, metabolic health)
- And how this should change the way we approach patients today

Because the goal isn’t to promote testosterone.

It’s to understand it correctly.

06/22/2026

Be aware
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This , the data is clear: men’s health needs national attention.

📉 Men face higher rates of chronic disease, higher su***de rates, and live nearly 6 years less than women
💸 This crisis costs $420B annually—impacting families, communities, and the workforce
🏥 A dedicated Office of Men’s Health would drive strategy, close gaps, and support better health outcomes for men

👉 Make your voice heard during Men’s Health Week: urge your member of Congress to co-sponsor and click the link in our bio.
🔗 https://bit.ly/3QEcxMV

06/22/2026

Be aware
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📣 New science is reshaping testosterone therapy guidance.

U.S. Department of Health and Human Services, through the U.S. Food and Drug Administration, is requesting updates to testosterone therapy product labels following a comprehensive review of new clinical data and existing scientific evidence. The proposed changes would remove outdated limitations on use and revise safety information related to prostate health—giving patients and healthcare providers clearer, more current guidance to support informed treatment decisions.

🔗 Read more: https://bit.ly/4ejbISO

06/21/2026

Sleep & Performance: The Most Overlooked Lever in Men’s Health

Avoid treating sleep like it’s optional. Chronic sleep deprivation directly impacts hormone production, recovery, cognitive function, and overall performance—but it’s still one of the most ignored factors in men’s health.

This is something seen every day in practice. Men come in concerned about low energy, low libido, and “low testosterone”—but when you dig deeper, they’re sleeping 4–6 hours a night, consistently.

There’s an important truth here:
There is no amount of testosterone you can prescribe that will overcome chronic sleep deprivation.

Sleep is not passive—it’s biologically active.
It’s when the body resets its hormonal environment:
- Testosterone production is closely tied to sleep quality and duration
- Growth hormone is released in deep sleep, driving recovery and repair
- Sleep loss shifts the balance toward higher cortisol and lower testosterone
- Chronic deprivation impairs metabolism, insulin sensitivity, and vascular health

If sleep is broken, the entire system is disrupted.

This is why sleep is such a powerful—and underutilized—intervention. It’s not just about feeling rested. It’s about restoring the hormonal and metabolic environment that men are often trying to “fix” with medication.

And yet, it remains one of the most overlooked topics in modern health.

Men will invest in supplements, medications, and training programs—while consistently sacrificing the one thing that makes all of those interventions more effective.

The message is simple:
Protect your sleep like you protect your training and nutrition—because it drives both.

Even at a broader level, the concept isn’t new.
Rest is built into the foundation of how we’re designed to function.

Even God rested on the seventh day.

Sleep is not weakness.
It’s a requirement.

Be HOL

06/20/2026

Diet & Nutrition: Avoid the Noise, Focus on What Matters

Avoid chasing fad diets that promise quick results but lack sustainability. The reality is simpler—and more honest: almost all diets “work”… at least for a period of time.

Whether it’s low-carb, keto, intermittent fasting, or plant-based—most approaches lead to early weight loss because they create a calorie deficit and improve structure. But over time, the differences between diets narrow, and adherence—not the diet itself—becomes the limiting factor.

That’s where most people lose ground.

Instead of chasing the next trend, reframe nutrition around three fundamentals:

What you eat.
Food quality matters. Diets built around whole, minimally processed foods—vegetables, fruits, lean proteins, healthy fats, and whole grains—consistently support metabolic and cardiovascular health. Beyond macros, food quality directly impacts the gut microbiome, which plays an increasingly recognized role in inflammation, insulin sensitivity, hormone regulation, and even mood. Highly processed foods tend to disrupt this balance, while fiber-rich, nutrient-dense foods support it.

How much you eat.
Caloric awareness still matters. You don’t have to obsess, but you do need visibility. This is where technology has changed the game—modern apps, wearables, and even AI-driven tracking tools make it easier than ever to understand intake patterns, portion sizes, and trends over time. Awareness drives accountability.

When you eat.
Timing can be a useful tool. Time-restricted eating or structured meal timing can improve consistency and may support metabolic health for some patients—but it’s not magic. It works best when it helps reinforce overall calorie control and better habits.

The goal isn’t perfection—it’s sustainability.

A Mediterranean-style pattern remains one of the most practical and evidence-supported approaches: real food, balanced intake, minimal ultra-processed products, and something you can maintain long term.

The bottom line:
Stop looking for the “best” diet.
Start building a system you can actually live with.

Individualize your approach
Long term consistency outperforms short term zealotry
Be HOL

06/19/2026

Testosterone Therapy Timing: Don’t Skip the Process

Avoid jumping into testosterone replacement therapy (TRT) too early without understanding the long-term implications. Exogenous testosterone can suppress your body’s natural production and significantly impact fertility.

What’s increasingly concerning is how many younger men are pursuing TRT as a shortcut—often in their 20s and 30s—without first addressing the fundamentals. Fatigue, low energy, decreased libido, and poor performance are frequently driven by sleep deprivation, excess body fat, poor nutrition, or lack of resistance training. Replacing testosterone in that setting treats the symptom, not the cause.

TRT is not a temporary boost—it’s often a long-term or lifelong commitment. Once exogenous testosterone is introduced, the hypothalamic-pituitary-gonadal axis is suppressed. Natural production declines, intratesticular testosterone drops, and s***m production can be significantly reduced or even halted. Recovery is variable and can take months to years—and in some cases, may not fully return to baseline.

This is especially critical for younger men who have not yet completed family planning. Fertility is not just a side effect—it is a central consideration. Starting TRT without understanding this can create unintended consequences down the road.

There is also a growing pattern of “androgen dependence,” where men who were not truly hypogonadal begin therapy, suppress their natural production, and then feel worse when trying to stop—locking them into continued use.

Instead of viewing testosterone as a shortcut, it should be approached as a targeted therapy for a confirmed diagnosis, after:

- Symptoms are clearly defined
- Low levels are properly documented
- Reversible causes are addressed
- Goals (including fertility) are clearly established

The right approach is individualized. It requires a thoughtful discussion, not a quick prescription.

TRT has a clear role (and is a very powerful treatment) — but only when used at the right time, for the right patient, and for the right reasons.

Be HOL

06/18/2026

Testosterone & Supplements: Focus on What Actually Works

Avoid wasting time and money on countless “testosterone boosters” that promise more than they deliver. Most over-the-counter supplements are poorly regulated, inconsistently studied, and rarely produce meaningful or sustained increases in testosterone. Many rely more on marketing than physiology.

This isn’t a new concept. Dr. Mark Moyad (University of Michigan) has long emphasized that while some supplements may have theoretical or modest benefit, the majority lack strong clinical evidence—and many ride on placebo effect or inconsistent data rather than reproducible outcomes.

The bigger issue: supplements are often used as a substitute for doing the harder, more effective work.

Testosterone is highly responsive to lifestyle inputs. The men who consistently optimize their levels are not relying on a pill—they are building the right physiologic environment:

- Resistance training and maintaining lean muscle mass
- Adequate protein and caloric intake (avoiding chronic under-fueling)
- High-quality sleep (critical for hormonal signaling)
- Weight management and reduction of visceral fat
- Limiting alcohol and managing stress

These lifestyle foundations are not optional—they are the primary drivers. Supplements, at best, are adjuncts. In isolation, they rarely move the needle in a clinically meaningful way.

If the foundation is weak, no supplement will fix it. If the foundation is strong, supplements become far less relevant.

Focus less on shortcuts—and more on building a physiology that supports optimal hormone production.

You cannot out-supplement (or even out-prescribe) a poor lifestyle…

Be HOL