Hormone Therapy: What You Need to Know About Men’s Health

Find out how hormone therapy for men’s health can play a crucial role in maintaining optimal health and longevity for men.

Abstract

I am Dr. Alex Jimenez, DC, APRN, FNP-BC, CFMP, IFMCP, ATN, CCST. In this educational post, I take you through a clear, clinically grounded journey into two interconnected pillars of men’s health: erectile dysfunction (ED) and testosterone deficiency (low T). You will learn how erections work at the neurovascular level, why ED often reflects deeper cardiometabolic issues, and how we diagnose and treat ED with lifestyle foundations, oral medications, low-intensity shockwave therapy, injections, and surgical options. You will also learn how I evaluate testosterone deficiency using rigorous criteria and how I personalize treatment, from correcting root causes such as sleep apnea and obesity to offering judicious testosterone replacement therapy (TRT) or fertility-preserving alternatives.
At Injury Medical Clinic PA, also known as Mission Plaza Injury Medical Clinic in El Paso, Texas, our multidisciplinary team integrates chiropractic care, functional medicine, personal injury care, rehabilitation, and medical oversight. Our Medical Director and Collaborative Physician, Dr. Maria Guadalupe Cardenas, MD (Board Certified in Internal Medicine, NPI #1164426749, Texas MD License #J2933), brings over 40 years of internal medicine expertise to ensure our protocols are safe, evidence-based, and patient-centered. Together, we combine modern research with practical, whole-person care to restore sexual function, hormonal balance, and overall vitality.

Our Integrative Men’s Health Model in El Paso, Texas

As a clinician with dual training in chiropractic and advanced practice nursing, my work is centered on viewing health through multiple lenses. At Injury Medical Clinic PA (Mission Plaza Injury Medical Clinic), I collaborate closely with Dr. Maria Guadalupe Cardenas, MD, our Medical Director and Collaborative Physician. Dr. Cardenas is Board Certified in Internal Medicine and has more than four decades of clinical experience. Her oversight strengthens our multidisciplinary approach and ensures that our diagnostic and treatment plans align with contemporary medical standards.
Here is how we blend disciplines to produce comprehensive and effective care:

• Chiropractic care with a neuromusculoskeletal focus
  • I emphasize optimizing spinal alignment and nervous system signaling, particularly in the lumbar and sacral regions that contribute to pelvic organ function. Targeted adjustments may reduce neurogenic impediments, support autonomic balance, and improve pelvic floor dynamics that influence sexual function.
• Medical oversight by Internal Medicine
  • Dr. Cardenas provides diagnostic leadership and pharmacologic management for comorbidities such as hypertension, diabetes, dyslipidemia, and sleep apnea—conditions that are often at the core of ED and low T. Her clinical judgment ensures treatment safety, efficacy, and adherence to guidelines.
• Functional medicine and metabolics
  • We investigate root causes through comprehensive testing (hormone panels, inflammatory markers, lipids, A1C, thyroid function) and implement structured plans for nutrition, sleep, stress management, and targeted supplementation to recalibrate physiology.
• Rehabilitation and personal injury care
  • We design programs to restore circulation, mobility, and strength. Improved vascular health and functional capacity are indispensable for erectile performance and hormonal resilience.

In my clinical observations across spine and integrative care practice, I have seen how coordinated improvements in neuromusculoskeletal function, metabolic health, and cardiovascular conditioning can elevate sexual function and endocrine balance. Our goal is to address both the symptom and its systemic roots.

Erectile Dysfunction Basics: What Every Man Should Know

The physiology of an erection

An erection is a precisely timed neurovascular event. When sexual stimulation triggers cortical and spinal pathways, cavernosal nerves release the neurotransmitter nitric oxide (NO). NO activates guanylate cyclase, increasing cyclic guanosine monophosphate (cGMP) inside smooth muscle cells of the penile arteries and the corpus cavernosum. Elevated cGMP drives smooth muscle relaxation, arterial dilation, and rapid blood influx. As the cavernosal bodies expand, venous outflow is mechanically restricted, trapping blood and producing rigidity. After ejaculation or the cessation of stimulation, phosphodiesterase type 5 (PDE5) degrades cGMP, and detumescence follows.
Why this matters:

• Any pathology that diminishes endothelial NO production (e.g., diabetes, hypertension, smoking) or impairs neural input (e.g., neuropathy, spinal pathology) can disrupt erectile function.
• This is why ED often prefaces or parallels broader cardiometabolic disease.

Why ED is a vascular health signal

ED shares risk factors with cardiovascular disease:

• Age-related endothelial decline
• Hypertension, diabetes, dyslipidemia, obesity
• Smoking and alcohol overuse
• Medications that blunt neural or vascular tone (e.g., some SSRIs, thiazides)
• Neurological diseases and spinal injuries
• Psychological stressors, anxiety, depression

From a systems perspective, the penis can serve as an early “barometer” of endothelial and autonomic function. When a patient reports new-onset ED, I look upstream to vascular and neurologic health with careful history, exam, and labs.

How I evaluate ED

I start with:

• A detailed medical and sexual history, often including the Sexual Health Inventory for Men (SHIM) to categorize severity and monitor progress.
• Focused physical examination (cardiovascular, neurologic, genitourinary, prostate).
• Morning total and free testosterone, fasting lipids, A1C, thyroid panel, and PSA when indicated.

In my clinic, this structure promotes candid discussion and helps distinguish vasculogenic from neurogenic and psychogenic factors. It also guides whether integrative strategies, medications, or procedures are likely to succeed.

Treatment Options for Erectile Dysfunction: Evidence and Rationale

Lifestyle and functional foundations

Before medications, I emphasize core physiology:

• Quit smoking: Nicotine is a potent vasoconstrictor that accelerates endothelial dysfunction.
• Exercise consistently: Aerobic activity and resistance training increase endothelial NO synthase activity, improve insulin sensitivity, and enhance vascular compliance.
• Lose excess weight: Reduced visceral fat improves inflammatory tone and hormone signaling.
• Moderate alcohol: Excessive intake impairs neural conduction and can lower testosterone.
• Optimize sleep and stress resilience: Better autonomic balance supports erectile function.

From a chiropractic and functional lens, I also target:

• Lumbar-sacral alignment and pelvic mechanics: Adjustments, soft tissue work, and mobility training may improve neural conduction and pelvic floor synergy.
• Core stability and hip mobility: These influence venous return, pelvic circulation, and endurance performance.
• Breath mechanics and diaphragmatic function: They support autonomic tone and vascular reactivity.

These foundations often turn marginal medication responses into robust, sustainable outcomes.

Oral PDE5 inhibitors

• How they work:
  • Sildenafil and tadalafil inhibit PDE5, slowing cGMP breakdown and prolonging smooth muscle relaxation during sexual stimulation.
• Practical points:
  • Sexual arousal is still required to trigger NO release.
  • Sildenafil is typically taken as needed about 60 minutes before activity; tadalafil can be used as needed or daily (e.g., 5 mg) to support spontaneity.
• Safety:
  • Common side effects include headache, flushing, nasal congestion, and dyspepsia.
  • Absolute contraindication with nitrates due to hypotension risk.
• Clinical pearl:
  • If sildenafil produces inconsistent rigidity, switching to tadalafil (with a longer half-life and smoother kinetics) often improves confidence and function.

Low-intensity shockwave therapy (LiST)

• Mechanism:
  • Focused acoustic waves generate controlled microstress in penile tissue, thereby stimulating angiogenic pathways and neovascularization. Improved arterial inflow addresses vasculogenic ED at its source.
• Protocol:
  • Commonly six weekly sessions, with ongoing evaluation of hemodynamic response.
• Evidence and role:
  • Favorable data for mild-to-moderate vasculogenic ED continues to expand, though many insurers still classify it as investigational.
• Why I integrate it:
  • LiST aligns with our regenerative model—enhancing tissue-level blood flow rather than relying solely on pharmacologic support.

Intracavernosal injections (ICI)

• What they are:
  • Direct injection of vasoactive agents such as alprostadil or compounded Bimix/Trimix into the corpora cavernosa to induce a reliable erection.
• Why they work:
  • They bypass endothelial dysfunction by directly relaxing cavernosal smooth muscle.
• Safety and technique:
  • Proper training is essential to avoid vascular bundles and fibrosis.
  • Priapism risk requires patient education and a clear action plan if an erection persists beyond four hours.
• When I recommend them:
  • For men who fail PDE5 inhibitors or who desire more consistent rigidity. Many patients appreciate the predictability once trained.

Vacuum erection devices (VED), urethral suppositories, and prostheses

• VED:
  • Mechanical negative pressure draws blood into the penis; a constriction ring maintains erection. Effective but sometimes cumbersome.
• Urethral alprostadil (MUSE):
  • Less invasive than ICI, but often less potent and more costly.
• Penile prosthesis:
  • Inflatable or malleable implants offer the highest satisfaction when other therapies fail. They provide on-demand rigidity and long-term reliability.

A practical case: ED in a man with cardiometabolic comorbidities

When a 66-year-old man presents with hypertension, diabetes, obesity, and dyslipidemia, with a moderate SHIM score and limited response to sildenafil, I typically:

• Transition to on-demand tadalafil to leverage steadier kinetics.
• Add low-intensity shockwave therapy to repair vascular supply.
• Implement a structured plan for weight reduction, glucose optimization, sleep quality improvement, and smoking cessation, if applicable.
• Use chiropractic adjustments and pelvic floor-informed rehab to enhance lumbosacral function and autonomic balance.
• If needed, introduce intracavernosal injections as a highly effective second-line option.

The objective is not only to restore erections but also to reverse the physiologic terrain that produced ED.

Signs of Hormonal Imbalances In Men *THIS IS WHY*- Video

Testosterone Deficiency: Definitions, Drivers, and Diagnostics

What constitutes low testosterone

Clinically, testosterone deficiency (hypogonadism) requires:

• Biochemical confirmation: Two separate morning total testosterone levels below approximately 300 ng/dL.
• Compatible symptoms: Low libido, fatigue, decreased morning erections, reduced muscle mass, mood changes, and cognitive dulling.

Testosterone naturally declines about 1–2% per year with age. However, accelerated or symptomatic decline often reflects modifiable drivers such as obesity, insulin resistance, chronic inflammation, or untreated sleep apnea.

Primary vs. secondary hypogonadism

• Primary hypogonadism (testicular origin):
  • Testicular injury, infection, genetic conditions (e.g., Klinefelter), autoimmune damage, chemotherapy/radiation, or orchiectomy.
• Secondary hypogonadism (hypothalamic-pituitary origin):
  • Obesity (aromatase converts testosterone to estrogen), diabetes, chronic illness, medications, and obstructive sleep apnea (OSA) that suppress hypothalamic-pituitary-gonadal signaling.

In my practice, I prioritize correcting secondary factors first. For example, with OSA, I insist on consistent CPAP use for at least three months, then recheck morning testosterone. Many men improve without hormones when sleep, weight, and insulin sensitivity normalize.

Recognizing symptoms

• Specific:
  • Decreased libido, fewer morning erections, erectile dysfunction, reduced body hair, gynecomastia.
• Nonspecific:
  • Fatigue, low mood, irritability, brain fog, sarcopenia, increased visceral fat.

Because nonspecific symptoms overlap with other conditions, rigorous testing and reassessment are essential to avoid overdiagnosis or inappropriate TRT.

My diagnostic algorithm

• Step 1: Morning total testosterone. If above 300 ng/dL and symptoms persist, I search for alternative explanations.
• Step 2: If low, repeat morning total testosterone to confirm.
• Step 3: Concurrent labs with confirmation draw:
  • Luteinizing hormone (LH) to distinguish primary vs. secondary etiology.
  • Hematocrit for baseline erythrocytosis risk.
  • PSA for prostate health screening.
  • Prolactin if secondary causes are suspected (pituitary concerns). Elevated prolactin may prompt endocrinology referral and pituitary MRI.

I use these data to map causal chains and select treatments that align with the patient’s physiology and goals.

Treating Low Testosterone: Lifestyle First, Medications When Needed

Foundational strategies

• Stop smoking and moderate alcohol
• Improve diet quality: Emphasize nutrient-dense, anti-inflammatory patterns that support insulin sensitivity and micronutrient sufficiency.
• Exercise: Resistance training and cardio increase androgen receptor sensitivity and favorably shift body composition.
• Correct sleep disorders (especially OSA): Restorative sleep rebalances the HPG axis.

From a chiropractic perspective, I complement these with:

• Spinal adjustments to optimize autonomic regulation and reduce physiologic stress burden.
• Movement prescriptions that reinforce posture, mobility, and neuromuscular efficiency—key to sustaining training adaptations and hormonal benefits.

Testosterone replacement therapy (TRT)

When low T is confirmed twice in the morning, symptoms are significant, and reversible drivers have been addressed, TRT becomes a reasonable option. It is a Schedule III therapy that requires medical oversight and consistent monitoring.

• Intramuscular injections (testosterone cypionate or enanthate):
  • Typical dosing: 75–100 mg weekly or 150–200 mg every two weeks.
  • Pros: Cost-effective, potent.
  • Cons: Peaks and troughs can lead to symptom variability; some men prefer weekly dosing to smooth out the dosing profile.
• Topical gels (e.g., AndroGel, Fortesta):
  • Pros: Stable daily levels.
  • Cons: Risk of transference (black box warning); requires application discipline.
• Pellets (Testopel):
  • Pros: Set-and-forget, steady release for 3–6 months.
  • Cons: Minor surgical insertion; less flexibility in dose adjustments.
• Oral formulations (e.g., Jatenzo, Tlando) and nasal (Natesto):
  • Orals bypass first-pass hepatic metabolism but can raise blood pressure and are often expensive.
  • Nasal forms may cause local irritation and are less commonly used.

Monitoring and safety

• Follow-up labs: Testosterone and hematocrit within the first 3 months, then every 6–12 months.
• Target range: I generally aim for 450–650 ng/dL to balance symptom relief and safety.
• Manage erythrocytosis: If hematocrit exceeds ~52–54%, we may reduce dose or arrange therapeutic phlebotomy.
• Contraindications:
  • Known or suspected prostate or breast cancer, severe untreated OSA, high hematocrit, severe LUTS, poorly controlled heart failure, recent MI or stroke, and active desire for fertility.

Preserving fertility: Off-label options.

• Clomiphene citrate (Clomid)
  • Mechanism: Selective estrogen receptor modulator that increases LH/FSH, stimulating endogenous testosterone and spermatogenesis.
  • Typical dosing: 25–50 mg three times weekly.
  • Advantages: Helps men who need higher testosterone without suppressing fertility.
  • Caveats: Potential side effects include headaches, visual changes, and breast tenderness.

Supplements and the “T-booster” marketplace

Many commercial “boosters” are expensive and underwhelming. Evidence-based points:

• Zinc is essential for Leydig cell function, but supplementation above sufficiency does not reliably increase testosterone in eugonadal men.
• Fenugreek and certain botanicals show mixed, small-scale data; robust, consistent benefits are not well-established.
• My advice: Invest in verified nutrient sufficiency (quality multivitamin, diet), then focus on sleep, training, body composition, and stress control. These reliably move the needle.

A Practical Case: Low Testosterone with Sleep Apnea and Metabolic Risk

Consider a 56-year-old man with hypertension, hyperlipidemia, obesity, and obstructive sleep apnea (OSA) who reports fatigue, low libido, mild ED, and declining exercise capacity. An afternoon testosterone measurement of 150 ng/dL was obtained before presentation.
My plan:

• Step 1: Correct the testing method—obtain a fasting morning total testosterone level.
• Step 2: Require nightly CPAP adherence for at least 3 months, alongside nutrition and training protocols to reduce visceral fat and improve insulin sensitivity.
• Step 3: Provide PDE5 inhibitor support (e.g., sildenafil or tadalafil) to improve quality of life while systemic drivers are corrected.
• Step 4: Reassess with a second morning testosterone. If both are below threshold and symptoms persist despite OSA control and lifestyle improvements, we discuss TRT versus fertility-sparing options like clomiphene.
• Step 5: If TRT is chosen, initiate with a form that aligns with preferences and adherence, and implement our monitoring protocol for hematocrit, testosterone levels, and PSA.

This sequence respects physiology, minimizes unnecessary hormone exposure, and often yields broader cardiometabolic gains.

How Chiropractic Integrates With Medical and Functional Care

In our El Paso clinic, integration is not a slogan—it is our daily operating system:

• I coordinate spinal adjustments and neuromuscular rehabilitation to support autonomic equilibrium and pelvic biomechanics that influence both erectile function and exercise capacity.
• Dr. Cardenas anchors medical direction: optimizing blood pressure, lipids, glucose, and sleep disorders; selecting safe pharmacology; and monitoring labs for TRT and ED therapies.
• Our functional medicine lens uncovers nutrient gaps, inflammatory drivers, and endocrine disruptors, then addresses them with nutrition, movement, and targeted supplementation.
• For personal injury patients, we rebuild movement efficiency and cardiovascular conditioning, which frequently improves sexual function and vitality as “secondary wins.”

This synergy aligns with my clinical observations and practice philosophy: by removing structural impediments, normalizing metabolic signals, and stabilizing the autonomic nervous system, we create conditions in which sexual and hormonal health can recover more naturally—often with less medication or at lower doses.

Evidence, Standards, and Continuous Improvement

We track progress against validated measures (e.g., SHIM for ED), objective biometrics (lipids, A1C, blood pressure), and hormone panels. We incorporate guideline-driven care and peer-reviewed evidence:

• European Association of Urology (EAU) Sexual and Reproductive Health guidelines underscore the importance of structured evaluation of ED and the expanding role of regenerative therapies.
• American Urological Association (AUA) updates highlight best practices for ED management and careful indications and monitoring for TRT.
• StatPearls and clinical epidemiology reports help frame prevalence and the importance of methodical diagnostic pathways.

By combining these standards with hands-on clinical reasoning, we design treatment plans that are both personalized and reproducible.

Conclusion: A Clear Path Forward for Men’s Health

Erectile dysfunction and low testosterone are common, intertwined conditions with real solutions. When addressed through a comprehensive lens—neuromusculoskeletal function, vascular health, sleep quality, metabolic control, and appropriate pharmacology—men can reclaim sexual performance, energy, muscle mass, and mental focus.
At Injury Medical Clinic PA (Mission Plaza Injury Medical Clinic) in El Paso, Texas, our integrative model—chiropractic care, functional medicine, rehabilitation, and internal medicine oversight by Dr. Maria Guadalupe Cardenas, MD (NPI #1164426749, Texas MD License #J2933)—ensures safe, evidence-based pathways tailored to your physiology and goals. Whether you are starting with lifestyle changes, optimizing medication response, considering shockwave therapy, learning about intracavernosal injections, or evaluating TRT, we guide you step by step with clarity and data.
If you are experiencing ED or symptoms of low testosterone, schedule a thorough evaluation. With the right plan, you can restore function and build a foundation for long-term vitality.

References

• European Association of Urology. (2024). EAU Guidelines on Sexual and Reproductive Health.
• Montague, D. K., Jarow, J., Broderick, G. A., Dmochowski, R. R., Heaton, J. P., Lue, T. F., Nehra, A., & Sharlip, I. D. (2005). The management of erectile dysfunction: An AUA update. The Journal of Urology, 174(1), 230–239.
• Sooriyamoorthy, T., & Leslie, S. W. (2023). Erectile dysfunction. In StatPearls. StatPearls Publishing.
• Charles, J., Harrison, C., & Britt, H. (2011). Management of male-specific problems in Australian general practice. Medical Journal of Australia, 195(S10), S64–S68.
• Layton, J. B., Li, D., Meier, C. R., Sharpless, J. L., Stürmer, T., Jick, S. S., & Brookhart, M. A. (2014). Testosterone lab testing and initiation in the United Kingdom and the United States, 2000 to 2011. Journal of Clinical Endocrinology & Metabolism, 99(3), 835–842.
• Prasad, A. S., Mantzoros, C. S., Beck, F. W., Hess, J. W., & Brewer, G. J. (1996). Zinc status and serum testosterone levels of healthy adults. Nutrition, 12(5), 344–348.

Additional clinical observations:

• Dr. Alexander Jimenez, DC, APRN, FNP-BC. ChiroMed.
• Dr. Alexander Jimenez, DC, APRN, FNP-BC. LinkedIn profile.

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