The number one TRT mistake: what the science actually says

What did @gilletthealth actually say?

The claim is straightforward: the biggest mistake men make on TRT is skipping follow-up monitoring. Specifically, the creator flagged body composition, red blood cell count, blood pressure, and testosterone levels as things that should be tracked and used to adjust dosing. That is a narrow, clinical argument, not a lifestyle pitch.

To be precise, the creator said men should be following up on "health metrics that can be affected by that testosterone in a positive or negative way." The framing is appropriately cautious. They are not promising outcomes, just arguing that you cannot optimize what you are not measuring. That is a defensible starting point.

Does the science back this up?

Yes, substantially. The evidence for routine monitoring during TRT is not controversial, and the specific markers named here are the right ones to watch. Hematocrit elevation is one of the most documented dose-dependent adverse effects of testosterone therapy. A 2010 meta-analysis by Calof et al. in the Journals of Gerontology found hematocrit increases were significantly more common in testosterone-treated men than controls, with polycythemia rates climbing with higher doses.

Blood pressure is trickier. The relationship between exogenous testosterone and cardiovascular risk is still being untangled. The TRAVERSE trial (Lincoff et al., 2023, New England Journal of Medicine), which enrolled over 5,000 hypogonadal men, found non-inferiority on major cardiac events, but also a higher rate of atrial fibrillation in the testosterone group. That is not nothing. Monitoring blood pressure and cardiac markers matters, and the creator is right to name it.

Body composition changes on TRT, specifically lean mass gains and fat mass reduction, are well-documented (Bhasin et al., 2001, NEJM), though magnitude varies significantly by baseline status, age, and dose.

What did they get wrong, or right?

Mostly right, with one gap worth naming. The creator listed red blood cell count, which is good but incomplete. Clinicians tracking hematocrit on TRT are really watching for erythrocytosis, not just a generic RBC bump. The threshold that typically prompts intervention is a hematocrit above 54%, per Endocrine Society guidelines (Bhasin et al., 2018, Journal of Clinical Endocrinology and Metabolism). Saying "red blood cell count" without that context could leave someone thinking a mildly elevated RBC is the thing to worry about, when the real risk is hyperviscosity from elevated hematocrit.

Also absent from the list: estradiol. Testosterone aromatizes to estrogen, and estradiol levels affect everything from libido to bone density to mood. Most clinicians treating hypogonadism check it routinely. Leaving it off a monitoring checklist is a real omission, not a technicality.

That said, the overall message, get labs, see a clinician, adjust based on data, is sound. This video is not selling anything dangerous.

What should you actually know?

If you are on TRT through any legitimate channel, including a regulated telehealth platform, you should expect to get blood work done before starting, at follow-up intervals during dose adjustment, and periodically once stable. This is not optional and it is not upselling. It is how the therapy is supposed to work.

The Endocrine Society recommends checking hematocrit, PSA (in men over 40), and testosterone levels at 3 and 6 months after initiating therapy, then annually. Blood pressure should be tracked at every clinical contact. Some clinicians also check a lipid panel and liver enzymes depending on individual risk factors.

The creator's framing, that skipping these checks is the "number one mistake," is probably accurate from a population-health standpoint. Most serious adverse events tied to TRT, including polycythemia, blood clots, and cardiovascular events, are more manageable when caught early through routine monitoring rather than after symptoms appear.

• Hematocrit above 54% is the standard threshold for pausing or reducing testosterone dose.
• Estradiol monitoring is not optional for many patients and was conspicuously missing from this video's list.
• Blood pressure monitoring matters, especially given the TRAVERSE trial's atrial fibrillation finding.
• Testosterone level targets vary by formulation and individual, which is why periodic measurement matters for dose adjustment.