For many men, the idea of starting testosterone therapy comes with hesitation—and often, fear. Will it raise blood pressure? Increase clotting risk? Trigger prostate issues? These concerns have lingered for decades, fueled by early studies that left more questions than answers.
But times—and science—have changed. More recent research, presented by Dr. Andrew Sun (Director of the Center for Men's Health at Urology Partners of North Texas) in a recent Access Live is challenging the old narratives, showing that physiologic testosterone therapy, when monitored carefully, may not only be safe, but supportive of long-term health. And thanks to the arrival of next-generation oral testosterone, there’s now a simpler, more biologically aligned way to offer hormone support without sacrificing safety or fertility.
“Oral Testosterone Undecanoate brings testosterone therapy closer to biological reality. It preserves more natural signaling while delivering consistent symptom relief.”
— Dr. Andrew Sun, Access Live 2025
Much of the early concern about testosterone and heart health came from observational studies fraught with methodological flaws that lumped together very different patient groups. In many cases, the data didn’t distinguish between men using medically supervised therapy and those abusing anabolic steroids.
When you look at more recent, better-controlled studies, the results tell a different story:
“The enduring narrative that testosterone causes hypertension or thrombosis is unsupported by current scientific literature.” — Dr. Mark L. Gordon, MD
Neuroendocrinology and Integrative Physiology
Prostate Health: Looking Beyond Testosterone
Another major concern that often stops therapy before it starts is prostate cancer. But here too, the story has shifted.
In a now well-cited 2004 New England Journal of Medicine study, researchers found no link between higher testosterone levels and increased prostate cancer risk. In fact, low testosterone may be more frequently associated with aggressive disease.
A 2011 Journal of Urology review came to a similar conclusion: testosterone replacement, when prescribed appropriately, doesn’t raise the risk of prostate cancer—and might even offer benefits for tissue integrity and symptom relief.
“Testosterone isn’t the problem. It’s how your body metabolizes it—especially into DHT and estradiol—that matters most.”— Dr. Mitch Ghen
True Health News: Testosterone Therapy & Prostate Cancer
That’s why monitoring downstream metabolites is so important. Elevated DHT and unbalanced estradiol—not total testosterone itself—are more likely to be the culprits when prostate concerns arise.
Unlike earlier oral testosterone, which was associated with liver toxicity due to first-pass hepatic metabolism, TU is absorbed via the lymphatic system. This pathway bypasses the liver, improving bioavailability and minimizing hepatic strain.
Some patients choose to take the second dose earlier in the day to better match their energy and activity levels, allowing serum testosterone to decline naturally in the evening—a pattern more reflective of endogenous production.
“I consider oral TU a first-line option—especially for testosterone-naïve men who want a more physiologic and fertility-friendly treatment.”
— Dr. Andrew Sun, Access Live 2025
Oral TU isn’t for everyone, but it fits seamlessly into a growing number of patient care plans.
One of the most common mistakes with oral TU? Fasting labs. Unlike injectables, this formulation needs to be taken with food—and lab timing matters.
“If labs look low but the patient feels great, always ask: Did they take their morning dose? Was it with enough fat? Timing matters more than most realize.”
— Dr. Andrew Sun , Access Live 2025
Dr. Sun recommends drawing labs 2–4 hours after dosing, ideally with a meal that includes some fat. This provides a more accurate picture of circulating hormone levels.
These labs help you tailor dosing, catch metabolite imbalances, and ensure patient safety—especially in men at risk for cardiovascular or prostate complications.
“With oral TU, we’re not just replacing testosterone—we’re optimizing it in a way that respects how the body was designed to function.”
— Dr. Andrew Sun , Access Live 2025
Disclaimer: Content on the Access Medical Labs blog is for informational purposes only and reflects the views of individual contributors, not necessarily those of Access Medical Labs. We do not endorse specific treatments, products, or protocols. This content is not a substitute for professional medical advice. Always consult a qualified healthcare provider regarding any medical concerns.