If you are an executive searching for alternatives to TRT, you are not alone. Many symptoms attributed to low testosterone have a significant vascular component that hormone replacement does not address.
Last updated: January 25, 2026
Testosterone replacement therapy has become the default intervention for men experiencing fatigue, low libido, cognitive dullness, and declining exercise performance. The men's health industry has streamlined access: a blood test, a prescription, weekly injections. The model is convenient.
The trade-offs are less frequently discussed. Exogenous testosterone suppresses endogenous production through hypothalamic-pituitary-gonadal axis feedback. Once initiated, TRT typically becomes a lifelong commitment. Cessation results in a period of hypogonadism until (and if) natural production recovers.
Additional considerations include polycythemia (elevated red blood cell count, increasing stroke and clot risk), potential fertility impairment through testicular atrophy, and the logistical complexity of traveling with a controlled substance that requires verification at international borders.
Many symptoms associated with low testosterone overlap with symptoms of vascular insufficiency. Fatigue results when oxygen delivery to muscle tissue is impaired. Cognitive dullness results when cerebral perfusion declines. Low libido and erectile dysfunction result when blood flow to sexual organs is restricted.
When endothelial function is compromised and nitric oxide production is reduced, these symptoms emerge regardless of testosterone levels. A man with healthy testosterone but damaged vasculature will experience many of the same complaints as a man with genuinely low testosterone.
The question becomes: which system is actually dysfunctional? Adding testosterone when the underlying problem is vascular may provide partial symptom relief while leaving the root cause unaddressed. In some cases, the addition of exogenous testosterone can worsen vascular strain through increased blood viscosity.
The GRN protocol assesses vascular function before recommending hormonal intervention. If endothelial dysfunction is present, the priority is to support nitric oxide production, support the glycocalyx, and optimize blood flow to high-demand organs.
For some individuals, vascular support resolves symptoms that were incorrectly attributed to low testosterone. Energy returns because oxygen delivery improves. Cognition sharpens because cerebral perfusion normalizes. Sexual function improves because blood flow to the corpora cavernosa improves.
This approach does not preclude TRT for individuals with genuinely low testosterone levels and intact vascular function. It does suggest that fixing the delivery system should precede adding more fuel to a compromised engine.
This protocol is appropriate for executives who have been offered TRT but wish to explore alternatives before committing to lifelong hormone replacement. It is appropriate for those currently on TRT who have not achieved full symptom resolution and suspect vascular factors may be contributing. It is not appropriate as a replacement for legitimate hormone deficiency in cases where testosterone levels are clinically low and vascular function is intact.
Optimize the vascular delivery system. Energy requires oxygen. If blood flow is restricted by endothelial dysfunction, tissues starve regardless of hormonal status. Restoring nitric oxide production often restores energy by improving perfusion.
Vascular insufficiency, sleep apnea, poor metabolic health, and chronic inflammation are primary drivers. We specifically test for vascular restriction, which acts as a mechanical limiter on energy (ATP) production.
Learn more about the GRN Vascular Review.
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