TRT myths vs. reality: separating hype from clinical evidence

What did @ohmedgroup actually say?

The creator, apparently a clinician affiliated with OhMed Group, ran through five claims about testosterone replacement therapy (TRT): that primary care doctors miss low testosterone, that TRT causes heart attacks and strokes, that it thickens blood dangerously, that elevated hemoglobin and hematocrit are fine, and that routine lab monitoring every few months is unnecessary. The altitude analogy was the rhetorical centerpiece: your body adapts to Denver's thin air by making more red blood cells, and TRT works the same way, so neither Denver residents nor TRT patients need to donate blood or worry about clots. The monitoring claim is where things got clinically shaky. They said checking testosterone levels and organ function "every few months" is a "complete myth."

Does the science back this up?

Partially, yes. The cardiovascular fear around TRT has been overstated for years, and the creator deserves credit for pushing back on it. But the monitoring claim is where the video steps into genuinely problematic territory, and the altitude analogy, while clever, is doing more rhetorical work than it can actually support.

On cardiovascular risk: the TRAVERSE trial (Lincoff et al., 2023, New England Journal of Medicine), a large randomized controlled trial specifically designed to assess TRT safety in men with hypogonadism and elevated cardiovascular risk, found no significant increase in major adverse cardiac events compared to placebo. That is a meaningful result. Earlier fears were largely traced back to a deeply flawed 2010 study by Basaria et al. that enrolled a high-risk elderly cohort and was widely overcorrected in clinical guidelines. So the creator is not wrong that the heart attack narrative is overblown.

On hematocrit elevation: this is where the altitude analogy breaks down. TRT-induced erythrocytosis is real and documented. A 2021 review by Golds, Houdek, and Arnason in the Journal of Clinical Medicine found hematocrit rises above 54 percent in a meaningful subset of TRT patients, and that elevation is associated with increased blood viscosity and thromboembolic risk. The comparison to altitude acclimatization ignores a key difference: altitude response is self-limiting, while TRT-driven erythrocytosis can continue to climb without monitoring. Calling the risk "untrue" is too strong.

What did they get wrong (or right)?

They got the cardiovascular narrative mostly right. The science really has shifted. The Endocrine Society updated its clinical practice guidelines in 2018 to reflect that well-managed TRT in genuinely hypogonadal men does not appear to carry elevated cardiac risk, and TRAVERSE reinforced that. Credit where it is due.

They got the monitoring claim wrong. The suggestion that you do not need to check labs "every few months" contradicts the actual clinical standard of care. The American Urological Association and the Endocrine Society both recommend monitoring hematocrit, PSA, and testosterone levels at three to six months after initiation, then annually once stable. The creator's logic, that testosterone levels should be the same in January as August, applies to stable, long-term patients, not people starting or adjusting therapy. Flattening that distinction is misleading to a general audience.

They also said testosterone "does not affect liver function" without qualification. Oral and certain injectable testosterone formulations have historically shown hepatotoxic effects, though injectable cypionate and enanthate carry much lower risk. The blanket statement is imprecise.

What should you actually know?

TRT is not the cardiovascular boogeyman it was portrayed as a decade ago, but it is also not consequence-free and self-managing. Here is what the evidence actually supports:

• Hematocrit should be checked before starting TRT and monitored during treatment. If it climbs above 54 percent, dose adjustment or temporary discontinuation is the clinical standard, not reassurance that it is fine because Denver exists.
• Routine monitoring, especially in the first year of therapy, is not a myth. It is how clinicians catch erythrocytosis, PSA changes, and dosing issues before they become problems.
• Primary care variability is real. Many generalists are undertrained in hormone optimization, and the creator is right that specialty knowledge matters. But that is an argument for better-informed prescribers, not for skipping follow-up labs.
• The 22-year-old analogy does not hold up clinically. Young men with naturally high testosterone are not the same as middle-aged men with comorbidities receiving exogenous testosterone. Pharmacological administration and endogenous production have different physiological profiles.