Why Low Testosterone Is Not Just a Bedroom Problem

In the second part of our conversation with Edward Karpman, M.D., medical director of men’s health at El Camino Health, the focus shifts to two topics that are reshaping how clinicians think about aging men: testosterone and GLP-1 medications. Both, he argues, are far more consequential to long-term health than most people realize.

Low testosterone is often dismissed as a cosmetic or sexual concern, but Karpman is quick to reframe it. Men with low testosterone face elevated risks of cardiovascular disease, obesity and bone health conditions, including osteopenia and osteoporosis, conditions many people associate exclusively with women. The parallel to menopause is instructive. When women reach menopause, estrogen drops sharply and the effects are immediate and unmistakable. In men, testosterone decline is gradual, beginning around age 30 and decreasing by roughly 1% to 2% per year. By the time a man reaches 50, he may have lost up to 40% of his testosterone production without ever connecting the dots between that loss and the fatigue, weight gain or cardiovascular changes he is experiencing.

Karpman frames this not as a disease but as a consequence of modern longevity. A century ago, average life expectancy hovered around 40 years. The human body was not designed to sustain optimal hormone levels into the seventh and eighth decades of life. Medicine has dramatically extended lifespan, and now it needs to support the body through that extended arc.

On the innovation front, Karpman is unambiguous: GLP-1 medications represent the most exciting advance he has seen in men’s health, and arguably in medicine broadly. Obesity, he notes, is the single most significant driver of the conditions he treats every day. It is the No. 1 cause of erectile dysfunction, the No. 1 cause of sleep apnea, and one of the top two causes of low testosterone. Having an effective, nonsurgical, easy-to-administer tool to address it is, in his view, transformative.

He does push back on one common criticism of GLP-1s, the concern around muscle loss. Muscle wasting, he explains, accompanies any weight loss program, whether driven by diet, exercise or medication. The solution for his patients is to monitor and optimize testosterone simultaneously, which can help preserve muscle mass during weight loss.

That focus on muscle and bone health is increasingly central to his practice. Research consistently shows that quad strength, leg strength and grip strength are among the strongest predictors of longevity. Keeping people moving, he argues, is the foundation of keeping people healthy.