TRT is NOT the Strategy. It's a Tool. What the "Traverse Trial" Left Out

TRT Is Not the Strategy. It’s a Tool. Why Metabolic Mastery — Not a Prescription — Is the Real Answer for Men Over 40

Here’s the uncomfortable truth nobody tells men in their 40s, 50s and 60s:

You’re being sold two stories.

Story #1:
“You’re tired because your testosterone is low. Take TRT. Problem solved.”

Story #2:
“You’re just getting older. Accept it.”

Both are wrong.

Low testosterone is not random. It is often the downstream result of inflammation, visceral fat, insulin resistance, sleep disruption, mitochondrial dysfunction, and chronic stress chemistry. If you don’t address those — I don’t care what your total testosterone number is, you will not feel like yourself again.

Let’s go deep. We’re going to look at:

1. What the TRAVERSE trial on TRT really showed — the good and the bad.

2. Why most TRT clinics are not following anything close to that level of screening or monitoring.

3. Why simply “raising your testosterone” doesn’t equal health, energy, performance, or longevity.

4. How an upstream model — what we do in the Peak Performance Protocol — creates a completely different outcome for men in their 50s and beyond.

This is for the man who’s serious about his second half.

PART 1. WHAT TRAVERSE ACTUALLY STUDIED (AND WHY THAT MATTERS)

The TRAVERSE trial was the largest, most rigorous safety study yet on testosterone replacement therapy (TRT). It was designed to answer two questions older men (and their doctors, and the FDA) worry about:

1. Does TRT increase the risk of major cardiovascular events like heart attack, stroke, or cardiovascular death?

2. Does TRT increase prostate cancer or dangerous prostate enlargement?

Who they studied

Over 5,000 men, ages 45–80.
These were not healthy, shredded, low-inflammation, 10%-body-fat men.

To qualify, you had to:

• Have clinically low testosterone (under ~300 ng/dL, twice, in the morning, with symptoms).

• ALREADY have cardiovascular disease (history of heart attack, stroke, stent, etc.)orbe at high cardiovascular risk.

Let’s pause there.

This trial was not: “What happens if you give TRT to a 52-year-old high performer who lifts 4 days a week and eats clean?”

This trial was:
“What happens if we give TRT to men who are already inflamed, insulin resistant, vascularly compromised, tired, and in decline?”

That’s critical.

Because if you’re a relatively healthy but tired 52-year-old executive, and you take this study and assume, “See? TRT is safe. I’m good,” you are already off track. You are not the population this trial was designed around, and your delivery method probably isn’t what they studied. More on that in a minute.

How the study worked

• It was randomized, double-blind, placebo-controlled.

• Men either got a 1.62% testosterone gel or a placebo gel.

• Doses of testosterone gel were adjusted to keep blood testosterone in a mid-normal physiological range (roughly 350–750 ng/dL).

• Nobody was allowed to “blast.” This wasn’t 1100+, 1300+, 1500+ ng/dL.

• The men and the clinicians were blinded.

• The primary outcome was cardiovascular safety (heart attack, stroke, cardiovascular death).

• Prostate outcomes were tracked (high-grade prostate cancer, urinary retention, need for BPH surgery or meds, worsening lower urinary tract symptoms).

How long they watched them

On average:

• ~22 months actually on TRT or placebo.

• ~33 months of total follow-up (a little under 3 years).

That’s decent for medium-term safety data. It’s still not a 10-year aging study.

What they screened out

This part matters a lot.

Before you could get in:

• Your PSA had to be under certain thresholds.

• Your prostate exam could not be suspicious.

• You could not already have high-grade prostate cancer.

• Men with severe urinary symptoms / obstructive BPH were excluded.

Also:

• They did not study men jacking up supraphysiologic levels through aggressive injections.

• They did not study pellet clinics.

• They did not study compounded “kitchen sink” hormone stacks.

• This was controlled, transdermal gel, physician titration, labs, surveillance.

Translation:
TRAVERSE was testosterone therapy under ideal medical supervision and controlled exposure — not the way most men in the wild are using testosterone.

PART 2. WHAT THEY FOUND — AND WHAT EVERYONE MISSES

Cardiovascular outcomes

“You’ll die of a heart attack if you go on TRT” has been a fear for years.

The TRAVERSE trial did not show an increase in major adverse cardiovascular events (heart attack, stroke, cardiovascular death) over ~3 years in the TRT arm compared to placebo. The rates were basically the same.

That’s the headline most people heard:
“Testosterone didn’t increase heart attack and stroke.”

But they stop reading right there.

Here’s what almost no one tells you:

Warning signals: atrial fibrillation, pulmonary embolism, and acute kidney injury

Men on TRT in this trial had higher rates of:

• Atrial fibrillation (AFib)

• Pulmonary embolism (PE)

• Acute kidney injury (AKI)

Let’s translate that.

Atrial fibrillation is an abnormal heart rhythm.
AFib sounds harmless until you understand its consequences.
AFib means:

• Electrical instability in the atria.

• Reduced cardiac efficiency.

• Higher stroke risk.

• Often, a lifetime of anticoagulation (blood thinners).

In aging men, AFib is one of the first signs that the underlying system is straining. When AFib shows up more often in the TRT group, it tells you something: this therapy is not metabolically neutral. There is cardiovascular stress emerging in the electrical system of the heart.

Pulmonary embolism is a blood clot that travels to the lungs.
That’s not “you felt a little off on Tuesday.” That can kill you — fast.

Why might TRT increase clot risk?
Testosterone can drive red blood cell production (erythropoiesis). More red blood cells → higher hematocrit → thicker blood → more viscosity → greater risk of clotting events in susceptible men. Guys call this “feeling thicker and more pumped.” Cardiologists call it “more thrombotic.”

This is especially concerning in men who are already sedentary, inflamed, insulin resistant, not hydrating, not moving lymph, not breathing well when they sleep.

Acute kidney injury is not just about the kidney.
AKI can reflect sudden stress in blood pressure, perfusion, oxygen delivery, and systemic hemodynamics. It basically says: “The system took a hit.”

So now look at that trio:

• Irregular heart rhythm (AFib),

• Clot to the lung (PE),

• Acute kidney injury (AKI).

Those are not random, isolated annoyances. That is a picture of a stressed cardiovascular system under load.

Now ask yourself:
Does your local cash-and-carry TRT clinic tell you that?
Do they screen you for AFib risk?
Do they monitor hematocrit every 8–12 weeks?
Do they monitor kidney response?

Most don’t. They sell “optimization” without acting like a cardiac surveillance program. TRAVERSE acted like a cardiac surveillance program.

Prostate outcomes

This part caused a lot of noise, too.

TRAVERSE did not show a significant increase in:

• High-grade prostate cancer

• Acute urinary retention

• Needing BPH procedures or meds

• Worsening urinary symptoms

That’s good. It directly challenges the old myth that “testosterone causes prostate cancer in all men.”

BUT.

Remember:
They excluded men who already had red flags — high PSA, bad digital rectal exam, severe urinary obstruction, known cancer.

That means they kind of “pre-cleaned” the population. They didn’t throw high-risk prostates into the pool to begin with. So of course the outcomes look safer. That’s not dishonesty — that’s responsible study design — but it means you cannot apply this blindly to every man walking into a clinic with an enlarged, angry prostate and a PSA of 4.7.

And again, they didn’t follow these men for 10+ years. Prostate cancer, especially the aggressive kind you actually care about, can have a long runway.

PART 3. HOW TIGHTLY THEY MONITORED THESE MEN VS. HOW MEN ARE ACTUALLY MANAGED

In TRAVERSE:

• Dosing was adjusted.

• Labs were repeated.

• Events were tracked and adjudicated.

• Cardiovascular symptoms were documented.

• Prostate changes were watched in a defined, standardized way.

• Men were kept in physiological ranges, not bodybuilder ranges.

That’s not the “lifestyle clinic model,” where:

• A guy gets 200 mg testosterone cypionate twice a week, no real pre-screen, no sleep study, no cardiovascular risk panel, no inflammatory panel, no visceral fat assessment, marginal PSA monitoring, and a pat on the back.

• No one’s talking to him about apnea.

• No one’s talking to him about hematocrit.

• No one’s talking to him about why his triglycerides and hs-CRP are high in the first place.

Also: TRAVERSE used transdermal gel, not high-peak injections.

That matters.

Injectable testosterone (especially when dosed aggressively) behaves differently:

• Bigger peaks.

• More rapid aromatization at the peaks.

• Higher hematocrit spikes.

• More estradiol swings.

• More blood pressure volatility for some men.

You absolutely cannot assume that safety data from controlled, titrated gel in a high-surveillance trial automatically applies to clinics doing large-dose weekly or twice-weekly injections. Different delivery route, different pharmacokinetics, different risk curve.

That’s like saying, “We studied drinking one glass of red wine nightly… therefore six tequila shots on Friday must be safe.”

No. The route, the spike, and the supervision matter.

PART 4. NOW LET’S TALK ABOUT THE “OPTIMIZED MAN”

Let’s flip the script.

Picture a 55-year-old man:

• ~10% body fat

• Low visceral fat

• High lean tissue

• Trains with intent (strength and conditioning)

• Insulin sensitive (low fasting insulin, great triglyceride:HDL ratio)

• Low systemic inflammation (low hs-CRP)

• Blood pressure under control without a pharmacy in his kitchen

• Sleep apnea either resolved or aggressively managed

• Micronutrient status addressed

• Mitochondrial capacity trained (not just cardio, but output and recovery)

This is what we build in the Peak Performance Protocol.

This man still ages, yes. Testosterone may still drifts down with time but not guaranteed. But here’s what’s different:

1. His androgen axis is still alive.
   Hypothalamus → pituitary → testes → peripheral conversion. It’s intact. We haven’t shut down LH and FSH using outside testosterone. He’s still capable of producing.

2. His internal environment is working with his hormones, not fighting them.
   Low visceral fat means less aromatase activity converting testosterone into estradiol in belly fat. Lower inflammation means his Leydig cells in the testes can still make testosterone. Good sleep means he still gets nocturnal testosterone pulses.

3. His receptors are responsive.
   You can take two men with the exact same total testosterone level and one of them feels unstoppable and the other feels dead inside. Why? Receptor sensitivity, mitochondrial response, nitric oxide signaling, insulin signaling, cortisol balance. Hormones don’t act in a vacuum.

4. His cardiovascular risk is already low.
   He’s not walking around with silent plaque instability, sky-high inflammation, and a clot waiting to happen. His VO2 capacity, autonomic flexibility, and metabolic profile have already dropped his stroke and MI risk curve dramatically.

5. His prostate is living in a calmer hormonal soup.
   Less chronic pelvic inflammation. Less estrogen-dominant environment from visceral fat. Less constant sympathetic tone sitting in his pelvis all day. That matters for LUTS, BPH pressure, and long-term urologic quality of life.

This is upstream work.

We’re not “treating low T.”
We’re treating the reasons his T is low.

We’re treating mitochondrial suffocation.
We’re treating chronic dietary inflammation.
We’re treating sarcopenia.
We’re treating visceral fat-driven aromatase load.
We’re treating insulin resistance that strangles nitric oxide and endothelial function.
We’re treating sleep debt and apnea that wreck growth hormone and testosterone at night.
We’re treating chronic sympathetic dominance and cortisol excess that literally suppresses gonadotropin signaling.

Do you see the difference?

One model says:
“Your number is low. Take testosterone.”

Our model says:
“Your number is low because your system is on fire. Let’s put out the fire, rebuild the system, then re-check the number.”

PART 5. THE PROBLEM WITH “JUST GIVE ME TRT”

Here’s what I hear from men every single week:

“My total testosterone is now 1,100… 1,200… even 1,400 ng/dL.
Why don’t I feel better?”

Answer:
Because your total testosterone level was never the only problem.

You still have:

• Visceral fat driving inflammation.

• Elevated hematocrit thickening your blood.

• High triglycerides and low HDL.

• Blood pressure you’re pretending isn’t a problem.

• Sleep apnea that’s slowly killing your brain and heart.

• Statins, beta-blockers, SSRIs — some medications are known to blunt energy, libido, nitric oxide signaling, and sometimes testosterone synthesis itself. You can chemically raise your testosterone level and still feel numb if you’re simultaneously taking drugs and living in physiology that shuts down vitality.

You didn’t fix the organism.
You just adjusted a lab value.

So now you’re “on TRT,” you’re “optimized,” and you’re still exhausted, still foggy, still inflamed, still prediabetic, still gassed walking up stairs.

That’s not optimization. That’s dependence plus denial.

PART 6. WHAT THIS MEANS FOR A MAN IN HIS 40's, 50's, 60's WHO WANTS TO WIN HIS SECOND HALF

Let’s stack these two 55-year-old men side by side:

TRT-Only Model (Downstream / Symptom Model):

• Comes in inflamed, insulin resistant, with visceral fat and fatigue.

• Gets put on TRT.

• Serum testosterone climbs. He feels some initial lift.

• His LH/FSH shut down; he is now externally supported.

• He is told he’s fixed, so he never fixes the real engines: mitochondria, insulin, inflammation, sleep architecture, cardiovascular resilience, prostate inflammation.

• Over time, he may run into hematocrit issues, BP creep, arrhythmia, clot risk.

• He’s still on statins, BP meds, maybe SSRIs — and nobody’s looking at how those interact with his hormonal state or energy.

• He thinks he “did the work,” but all he did was medicate the dashboard light on his car.

Peak Performance / Upstream Model (Root-Cause Model):

• We evaluate insulin resistance, visceral fat, inflammatory load, micronutrient sufficiency, gut-liver axis, sleep/apnea, autonomic tone, recovery capacity, strength and VO2, mitochondrial function — not just total testosterone.

• We build muscle, improve VO2, restore insulin sensitivity, lower systemic inflammation, improve nitric oxide signaling, stabilize blood pressure, fix sleep quality, and calm autonomic overdrive.

• Testosterone (total and free) often rises naturally. Libido rises. Drive returns. Mood stabilizes. Recovery improves. Brain fog lifts.

• Cardiovascular risk drops because we actually fixed the levers that cause heart attacks and strokes in men.

• Prostate pressure drops because you are not bathing your pelvis in chronic inflammation and estrogenic belly fat signaling.

• If testosterone is STILL clinically low after this work — and you’re still symptomatic — then and only then do we layer in TRT, tightly monitored, at physiologic levels, with full surveillance.

That last line is key:
TRT is not banned.
TRT is not evil.
TRT is not cheating.

What TRT should NOT be is Step 1.

TRT should be Step 2 — after we have already rebuilt the foundation you’re supposed to live in for the next 30+ years.

Because the goal is not to chase a number on a lab report.
The goal is to reclaim function, power, clarity, drive, performance, confidence, and longevity.

Your “second half” isn’t won by replacing hormones.
It’s won by rebuilding the machine that makes them.

THE BOTTOM LINE

1. The TRAVERSE trial showed that medically supervised, titrated testosterone gel did not raise heart attack and stroke rates over about 3 years in older, high-risk, hypogonadal men — but it DID show increased atrial fibrillation, pulmonary embolism, and acute kidney injury. Those are not minor side notes. Those are red flags that this therapy applies load to the system. Besides, is three years really enough time to make such broad sweeping conclusions?

2. TRAVERSE men were screened, filtered, and heavily monitored. PSA was controlled, prostates were pre-cleared, cardiovascular disease was tracked, bloodwork was repeated, and their testosterone levels were kept in a physiologic range — not bodybuilder range. Most “TRT mills” do not replicate this standard.

3. The study used daily gel, not aggressive injections that spike levels and hematocrit. You cannot automatically copy/paste TRAVERSE safety data onto high-dose injection protocols that many men are actually getting.

4. Even when testosterone levels shoot above 1,000 ng/dL, a lot of men still don’t feel better — because no one addressed the root causes: insulin resistance, chronic inflammation, visceral fat, mitochondrial decline, sleep disruption, autonomic overload, and medication-driven suppression of energy and libido.

5. At Peak Performance, the entire philosophy is different:

   • We don’t chase a single number.

   • We don’t medicate a symptom and call it “optimization.”

   • We rebuild the system — metabolically, hormonally, neurologically, cardiometabolically.

   • We go upstream.

Because aging is inevitable.
But how you age — how you perform, think, move, recover, and lead — that’s a strategy.

Your second half can be more powerful than your first half.

But not if you outsource it to a syringe.

👉🏻 Want to learn more about Dr. Andreas' Peak Performance Protocol complete with lab analysis and genetic testing to address root causes, CLICK HERE.

👉🏻 Ready to Book Your Peak Performance Consultation - CLICK HERE

Finish Strong,

Dr. Andreas

Founder and CEO of www.ItsOnlyHalftime.com

References

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2. “Long Term Cardiovascular Safety of Testosterone Therapy” (2024).World Journal of Men’s Health, etc. (PMC article).PMC+1

3. “Cardiovascular safety of testosterone‐replacement therapy” (2023).American College of Cardiology – Journal Scans.American College of Cardiology+1

4. “TRAVERSE Study Supports Cardiovascular Safety of Testosterone Therapy When Used as Indicated.” Cleveland Clinic Consult QD, June 2023.Cleveland Clinic

5. “Testosterone Replacement Therapy Does Not Increase Major Adverse Cardiac Events, but Does Increase Risk of Atrial Fibrillation, Pulmonary Embolism, Acute Kidney Injury, and …” (2023).American Family Physician.American Academy of Family Physicians

6. “Latest Research on Testosterone Replacement Therapy (TRT).” AetherMedicine.com (2024).aethermedicine.com

7. “Testosterone and Cardiovascular Risk: TRAVERSE Trial and New FDA Label Change.” Grand Rounds in Urology (2024).Grand Rounds in Urology

8. “Cardiovascular safety of testosterone replacement therapy—Insights from the TRAVERSE trial.” Wiley Online Library (2024).onlinelibrary.wiley.com