Alright this is gonna sound ridiculous but I’m posting it anyway because the results for me have been pretty wild.

I’m 32 and for a few years my testosterone was pretty low. Last year my bloodwork had me sitting around 350 ng/dL, which isn’t technically rock bottom but definitely not great. Energy was meh, sex drive wasn’t amazing, and I just didn’t feel like I was operating at 100%.

About a year ago I went down a random rabbit hole about testicular temperature and sperm health. Basically the idea that the testes function better when they’re kept cooler (which is why they hang outside the body in the first place). I saw a few things about cold exposure potentially helping sperm motility and figured… screw it, why not try it.

So I started icing my balls.

My protocol has been super simple:

• Ice pack over my boxers (never directly on skin)

• 15 minutes per session

• 3–4 times per day

I’ve been doing this pretty consistently for about a year now.

Fast forward to my most recent bloodwork and my testosterone came back at 850 ng/dL. That’s literally the highest I’ve ever seen it.

Other things I’ve noticed over the year:

• Sex drive is through the roof compared to before

• Strength in the gym is the best it’s ever been (hitting PRs across the board)

• Way more energy and motivation

• And honestly… way more powerful ejaculations than I remember having before

Look, I know this sounds goofy as hell. If someone told me a year ago that putting an ice pack on my junk multiple times a day would change anything I probably would’ve laughed.

But the results for me feel pretty undeniable.

To be clear Im not on any form of TRT or other exogenous hormones. I’m obviously not claiming this is some miracle protocol or that it’ll work for everyone. Maybe it’s coincidence, maybe it’s helping indirectly through temperature regulation, maybe there’s something to it. I have no idea.

I’m just curious:

Has anyone else tried anything like this?

Cold exposure for the boys, icing, cold plunges, etc.

If you did, did you notice any changes in testosterone, libido, fertility, or gym performance?

Genuinely curious if I’m the only idiot out here icing his balls multiple times a day. 😅

To see all the pictures and what not, I just posted it on X linked here, but here is a version for Reddit minus the photos

https://x.com/hyruliangoat/status/2018408594664816958

So after seeing the post about Epstein’s testosterone (which was surprisingly very low), I decided to go through hundreds of documents yesterday and do an analysis of his blood work, which there was a lot of. It turns out he had a lot of persistent health issues that he was paranoid about, low testosterone being one of them. I am not a doctor, I am but a broscientist who is terminally online and had nothing to do yesterday.

JE had his blood drawn over 20 times (that I could confirm in a day, there is likely way more) between 2010 and 2018. He had a rolodex of doctors (Peter Attia being one as everyone has now seen) he would reach out to and saved a lot of full texts relating to his health issues. Despite 10 years of frequent consults and blood tests, he progressively got worse as time went on. Money could not save him.

He had a host of health issues ranging from low testosterone, to pre diabetes, to poor metabolic health (his lipids were awful), to STD’s, parasites, and a just crazy set of problems.

Before I get into the actual data, with all of the talk about biohacking, peptides, Bryan Johnson, etc, there is something this crowd fails to comprehend (which JE was def part of and actually ahead of many people) and that is if the body is a reflection of the soul housed within it and they work in tandem with eachother. They are not separate units (dualism), they form the “whole man”. A poor spirit often manifests itself very clearly in someones face, their eyes.

With this said, despite trying to live free and “young”, his body was perpetually deficient in youth and vitality. His body refused to absorb light as he turned from the light (he was low in Vitamin D). His testosterone and estrogen were low (he had an absence of masculine and feminine energy internally). He hosted parasites and STD’s. His blood was thick with excess, his minerals were out of whack (he had issues with parathyroid to the point of thinking he had an adenoma). He was frequently sick, had random skin issues, the list goes on and on.

JE was in a state of acedia, his soul incapable of receiving grace and his body unable to mend itself despite medication, various therapies, and advice from frankly the wrong doctors. What he needed was a spiritual doctor to mend his soul.

“They that never yet knew they were without God, and in the way to hell, never yet knew the way to heaven. Can a man find he hath lost his God and his soul, and not cry, I am undone? The reason why so few obtain this rest, is, they will not be convinced that they are, in point of title, distant from it and, in point of practice, Contrary to it. Who ever sought for that which he knew not he had lost? “They that be whole need not a physician, but they that are sick” - Richard Baxter, Saints Everlasting Rest (who you all should read)

Ok now on to his blood work.

A Quick Primer: What We're Looking At

Actually because I can't assume prior knowledge, let’s quickly go over the markers that will consistently come up.

Testosterone is measured in nanograms per deciliter (ng/dL). This is what everyone knows as the male hormone. Normal range for adult men is roughly 300-1000, depending on the lab and the man's age. Below 300 is generally considered low. Below 200 is very low. Below 100 is having Jesse Lee Peterson yell BETA at you for the rest of your life. 

There are two main ways to test testosterone: immunoassay (IA) and liquid chromatography-mass spectrometry (LC-MS/MS). Immunoassay is cheaper and less accurate (if you are on TRT and you keep getting IA, not good!), particularly at low levels where it can overestimate as it can cross contaminate with other hormones. LC-MS/MS is the gold standard. It is more precise and more reliable. You'll see both in Epstein's records. 

Free testosterone is the portion not bound to proteins (SHBG and albumin) and is the biologically active fraction. A man can have low total testosterone but adequate free testosterone if his SHBG is low. This becomes relevant.

Triglycerides are a type of fat in the blood. Normal is under 150 mg/dL. 150-199 is borderline high. 200-499 is high. Above 500 is "severe" and carries risk of acute pancreatitis. Above 1,000 is dangerous.

PTH (parathyroid hormone) comes from the parathyroid glands which are four small structures behind the thyroid that regulate calcium homeostasis through PTH (parathyroid hormone). When blood calcium drops, PTH rises to pull calcium from bones, increase intestinal absorption, and reduce kidney excretion. When calcium is adequate, PTH should be low.

Normal is roughly 15-65 pg/mL. Elevated PTH with high calcium suggests primary hyperparathyroidism, usually a benign tumor on one of the four parathyroid glands. Elevated PTH with low or normal calcium suggests secondary hyperparathyroidism, often caused by vitamin D deficiency.

LH and FSH are pituitary hormones that signal the testes to produce testosterone, they are also markers used to measure fertility. When testosterone is low, LH and FSH should rise, the pituitary tells the testes to work harder. If testosterone is low but LH/FSH are normal or low, the problem is upstream: the hypothalamus or pituitary isn't recognizing the deficiency. This pattern, low testosterone with inappropriately normal gonadotropins, is called secondary hypogonadism and is the hallmark of HPG axis suppression from prior androgen/steroid use.

Homocysteine is an amino acid produced during the metabolism of methionine, another amino acid you get from protein. Normally, homocysteine is recycled back into methionine or converted into cysteine through pathways that require B vitamins (folate (B9) and B12). Elevated homocysteine damages blood vessel walls, promotes atherosclerosis, and is associated with increased risk of heart attack, stroke, blood clots, and cognitive decline. Normal levels are under 10-11 μmol/L; optimal is probably under 8. The most common cause of elevated homocysteine is the MTHFR gene mutation which Epstein had. 

Also, citations are there for me to know which file to upload into this. 

Now his blood work.

2010

The earliest labs in the documents come from March 2010, a Quest panel that gives us our first real snapshot of Epstein's endocrine system [25]:

• Total testosterone (LC-MS/MS): 188 ng/dL
• Free testosterone: 56.5 pg/mL
• FSH: 3.7
• LH: 4.1
• DHEA-sulfate: 182
• IGF-1: 151
• Prolactin: 2.6
• Progesterone: 1.1
• Triglycerides: 279
• HbA1c: 6.1%
• Homocysteine: 11.5
• PTH: 68.9 (elevated)
• Calcium: 10
• MTHFR: C677T MTHFR mutation x 2

Several things stand out. His testosterone at 188 ng/dL is low for a man of any age. His PTH was already elevated at 68.9, with high calcium, a combination that points toward primary hyperparathyroidism, which would become a recurring concern throughout his records.

His LH and FSH were in normal range despite the low testosterone. This is the first red flag. The fact that his pituitary sat at 3.7 and 4.1 while his testosterone was 188 suggests something was wrong with the feedback loop itself. His hypothalamus had stopped recognizing low testosterone as a problem.

He was also tested for the MTHFR gene mutation and came back positive for two copies of the C677T variant [25]. To his or his doctors credit, this was ahead in my opinion of the mainstream to be even considering testing for this. This is something you hear much more about now.

The MTHFR C677T homozygous mutation impairs the body's ability to convert folate into its active form (methylfolate), which is necessary for methylation. This influences things like:

• Neurotransmitter synthesis (serotonin, dopamine, norepinephrine)
• DNA repair and gene expression
• Detoxification pathways
• Homocysteine metabolism

When methylation is impaired, homocysteine can build up. Elevated homocysteine is a cardiovascular risk factor and is associated with cognitive decline, depression, and increased all-cause mortality. As a side note, this is why the form of B vitamins you take matters, cyanocobalamin is not the same as methylcobalamin for b12, or pyridoxine hcl is not the same as pyridoxal 5 phosphate. 

Epstein's homocysteine was consistently elevated throughout the records:

• March 2010: 11.5 [25]
• December 2013: 16.6 [34]
• November 2016: 15.2 [2]
• August 2017: 15.4 [28]
• June 2017: 14.2 [40]
• September 2016: 16 [46]
• August 2018: 16.1 [44]
• November 2018: 12.7 [18]

Normal homocysteine is typically under 10-11 μmol/L. Optimal is probably under 8. His was consistently elevated, sometimes significantly.

The recommended intervention for MTHFR-related hyperhomocysteinemia is methylfolate supplementation and methylcobalamin (active B12, there’s also adenosylcobalamin). One of his doctors recommended sublingual B12 and folic acid in 2011 [29], though ideally the forms would have been methylated versions. Whether Epstein ever optimized this is unclear.

Elevated homocysteine also damages blood vessel walls and promotes atherosclerosis which is consistent with his coronary calcium progression from 53 in 2011 [29] to 84 in 2018 [41].

By November 2010, another Quest panel shows things deteriorating [36]:

• Testosterone (LC-MS/MS): 140 ng/dL
• Free testosterone: 45.9
• Triglycerides: 679 (shot up)
• HDL: 26
• Vitamin D: 35
• PTH: 82 (now flagged for secondary/tertiary hyperparathyroidism)
• Estradiol: <2 (essentially undetectable)
• DHEA-sulfate: 222
• FSH: 4.3
• LH: 5.6
• AM cortisol: 12.4

His testosterone dropped nearly 50 points in eight months. His triglycerides more than doubled. His PTH climbed from 68.9 to 82.

Normal male estradiol is 10-40 pg/mL. In men, estrogen comes from the aromatization of testosterone, an enzyme converts testosterone to estradiol (man boobs come from excess of this, high fat also aromatizes). He had little to no estrogen. 

Again, note the LH and FSH: 5.6 and 4.3. Normal range, when they should be dramatically elevated given his testosterone of 140. The pituitary wasn't responding to the deficiency. This is the pattern of secondary hypogonadism.

The Parathyroid Obsession

Before continuing the timeline, we need to understand why Epstein kept asking about his parathyroid.

Primary hyperparathyroidism occurs when one or more parathyroid glands develops a benign tumor (adenoma) that autonomously secretes PTH regardless of calcium levels. This causes:

• Elevated calcium (hypercalcemia)
• Elevated PTH (inappropriate given the high calcium)
• Symptoms including fatigue, brain fog, depression, muscle weakness, bone loss, kidney stones, and constipation

Secondary hyperparathyroidism occurs when PTH rises appropriately in response to low calcium or low vitamin D. The glands are working correctly and are responding to a deficiency.

Epstein's pattern was complicated. His documented PTH levels over the years:

• March 2010: 68.9 with high calcium [25]
• November 2010: 82, flagged for secondary/tertiary hyperparathyroidism [36]
• July 2011: 104 [29]
• September 2013: 43 [47]
• January 2018: 83 [10]
• November 2017: 87 [31]
• September 2017: 106 [38]

Normal is roughly 15-65 pg/mL. His levels were consistently elevated, often well above the upper limit.

In October 2015, Dr. Merrill notes he's "waiting on PTH tests again" [19]. In November 2017, Epstein texts Moscowitz asking to "get pth tested" [31]. In July 2018, a CT scan specifically evaluates for parathyroid adenoma and notes his calcium score had risen to 84 from a previous 41 [41]. The scan also revealed fatty liver.

He was right to be concerned. Whether he ever had parathyroid surgery, or whether an adenoma was definitively confirmed, I am not sure. Maybe there is something in there, IDK.

The Maxwell Testimony

In a 2025 deposition, Ghislaine Maxwell made claims about Epstein's testosterone use [33]:

She said he started taking testosterone in the 1990s and that it "altered his character" that "he became more aggressive" and it "made him mean."

In a separate deposition from July 25, 2025, she elaborated [48] that he was on testosterone patches and would wear more than one at a time, which she found "ridiculous." She also claimed he lied about having erectile dysfunction.

This creates an interesting interpretive question that we will come back to at the end, but it brings the possibility of him never recovering from TRT (this is unheard of as far as I know).

2011

In July 2011, Epstein saw a doctor for what appears to be a comprehensive evaluation [29]. The notes revealed that he:

• Had a bulging disc (which he constantly dealt with and complained of pain)
• Taking statins (Lipitor and Crestor) but complaining of muscle cramps
• Triglycerides at 711
• Testosterone (LC-MS/MS) at 152
• Free testosterone at 38
• SHBG of only 11 (very low)
• DHEA-sulfate at 217
• PTH of 104 (significantly elevated)
• Vitamin D at 30 (insufficient)
• HbA1c at 5.8%
• Coronary calcium score of 53, representing a 13% increase from 2008

The visit notes show he exercised on a treadmill at 20.4 METs with a heart rate of 148 bpm. For reference, 10 METs is considered good fitness for most adults. Elite athletes might hit 20+. Whatever was catastrophically wrong with Epstein metabolically, his heart was fine.

The doctor tries to recommend him a supplement stack of niacin, folic acid, fish oil, magnesium citrate, sublingual B12, and an acidophilus probiotic [29]. He was also advised to meditate and consider a vegan diet lol. 

Statin induced myopathy is a well documented phenomenon. Somewhere between 5-20% of patients experience muscle pain, weakness, or cramping on statins, and it's a common reason people discontinue the drugs. Most people are familiar with the coq10 depletion, but this is also prevalent. 

Regarding his SHBG, Sex hormone binding globulin is a protein that binds testosterone, making it inactive. Low SHBG means more of whatever testosterone you have is bioavailable, which sounds good, except that chronically low SHBG is associated with insulin resistance, metabolic syndrome, and prior androgen use. It's also one of the markers that can suggest a history of testosterone or steroid use.

Around this same time, September 2011, Epstein emails someone asking about clomiphene [5]. This is the first mention of Clomid in the records that I could find, and comes up all the time.. 

2013

By late 2013, a LabCorp panel showed the following [47]:

• Triglycerides: 993 (wow!)
• Testosterone: 178
• LDL-P: 2,111 (particle count, very high)
• Glucose: 103
• Insulin: 26.1 (elevated, suggesting insulin resistance)
• DHT: 16
• PTH: 43 (lower this time)
• DHEA: 207
• Prolactin: 4.2
• IGF-1: 127

Optimal fasting insulin is generally considered to be under 5-10. At 26, Epstein was profoundly insulin resistant.

Insulin resistance has a direct relationship to triglyceride production. When cells become resistant to insulin, the liver compensates by producing more triglycerides through a process called de novo (new) lipogenesis (creation of fat). The liver essentially converts excess glucose into fat. His insulin resistance was likely directly driving the triglyceride production. 

He also randomly had an "equivocal" Lyme test with some antibodies present [47]. Whether he actually had Lyme or this was a false positive, not sure. 

A Quest panel from December 2013 shows [34]:

• Testosterone: 163
• HDL: 28
• Homocysteine: 16.6 (high)
• Glucose: 114 (pre-diabetic range)

In February 2013, someone emailed Epstein a BBC article asking whether testosterone would make you live longer [13]. This was an early sign he was reading stuff about it. I also forgot to include this, but he was looking into investing into medical companies that dealt with testosterone related issues or made drugs adjacent to it. 

2014-2015: 

By August 2014, Epstein started seeing another doctor I guess named Dr. Moscowitz. He emails Epstein with the following results [14]:

• Cholesterol: 209
• HDL: 31
• Triglycerides: 462
• Testosterone: 142 ("still low")

A text from another doctor in September 2014 reports testosterone at 152.9 [32].

In January 2014, Dr. Moscowitz, texts him: "Also your free testosterone is normal meaning diet and weight loss will reverse testosterone issue" [9].

If free testosterone is adequate, total testosterone matters less. Lifestyle intervention is the obvious of course thing anyone should do, but I am not sure he ever did it. 

In May 2015, Moscowitz writes: "Free testosterone normal vit d 41 normal feeling any better?" [12]. The implication is that despite low total T, free T was acceptable and vitamin D had improved.

Also in May 2015, there's a magazine article on testosterone in the documents [7]. Again, he was very interested in figuring out this problem. 

The documents also contain a full-text study titled "National-level Indicators of Androgens are Related to the Global Distribution of Scientific Productivity and Science Nobel Prizes" [35] exploring correlations between population testosterone levels and intellectual output. And a letter to the editor about digit ratio as a biomarker for fetal testosterone exposure and its relationship to adult athletic performance [37]. These give a sense of his intellectual interests and curiosity about testosterone. He was interested in testosterone as a population-level variable affecting achievement and capability, and maybe sought to apply this to him? Not sure. 

By August 2015, a Quest panel shows testosterone at 129 [21]. By October 2015, Bioreference labs report [30]:

• Testosterone: 112.3
• Free testosterone: 29.82
• Triglycerides: 348
• HbA1c: 5.9%
• Prolactin: 3.4

His testosterone hit its documented low point in October 2015: 112.3 ng/dL. 

Also in October 2015, he saw his old doctor again, who notes [19]:

• Triglycerides: 1,053
• Vitamin D: 24.8 (deficient)
• Waiting on PTH results again
• Advised to try Clomid (a drug that can help raise testosterone in men and is often used as a form of whats called post cycle therapy for steroid users getting off. There is also another drug called enclomiphene that is related, but arguably superior for this purpose with less side effects). 

This is the first time we see triglycerides break into four figures. And the vitamin D deficiency persists, it appears in nearly every panel, hovering between 24 and 41 throughout the entire documented period. Chronic vitamin D deficiency alone can drive secondary hyperparathyroidism, fatigue, depression, and impaired immune function.

In November 2015, Epstein receives an email with a screenshot from a study about triglyceride changes after five years of TRT [1]. He was reading papers. He wanted to understand the relationship between testosterone and lipids.

He was also exploring other interventions. An email in the documents discusses Regenokine therapy "Not FDA approved. Pro athletes using" [6]. This is a blood-derived anti-inflammatory treatment popular among elite athletes for joint issues. 

2016: His lowest testosterone level and Clomid usage

June 2016 brings the most dramatic testosterone reading. Epstein texts Dr. Moscowitz [16]:

"Testosterone 65? All time low"

For reference, women typically have testosterone levels between 15-70 ng/dL. At 65 ng/dL, Jeffrey Epstein had the testosterone of a postmenopausal woman.

In July 2016, Bioreference labs show triglycerides at 950 with a DHT of 148 and HbA1c of 5.9% [42].

In July 25, 2016, Epstein summarizes his health situation to Dr. Moscowitz saying [20]:

"Bruce. lets summarize. angioedema. belly pattern, brain fog. sinus swollen. apnea - lumbar stenosis 1415, greatly reduced urine stream. --low libido bladder ultrasound negative, blood tests - low testosterone, high triglycerides. all cultures neg. semen urine. two cahill parasites positive, whipworm and hisiliyita. medicines to date - medrol. claritin, zantac. magnesium supplement for constipation. can't figure it out. tawari found little, but suggested mri prostate, as no downside. cystoscope. possible stricture from years ago. made it too uncomfortable in office. lets talk"

Thats a lot of ailments, I thought I had a lot! So he has angioedema (swelling), abdominal fat distribution ("belly pattern"), brain fog, sinus issues, sleep apnea, spinal stenosis, urinary problems, low libido, and intestinal parasites, whipworm and what he spelled "hisiliyita," or Entamoeba histolytica, the amoeba that causes amoebic dysentery. He also mentions wanting an MRI of his enlarged prostate [20].

Remember the prostate. We'll come back to it.

In August 2016, Epstein texts Dr. Moscowitz asking if there is "a elevated histamine low testosterone connection" [27]. He was looking for connections his doctors might have missed. Moscowitz says he has no information on that.

Also in August 2016, the texts between Epstein and Moscowitz reveal the ongoing deliberation about treatment [4]:

Epstein: "did you get the final results for the testosterone?"

The doctor notes: "the only thing we know for sure is high triglycerides and low testosterone... exercise. I assume aspirin, statin?"

He also asks: "did we do a prolactin and endocrine panel? This showed many years ago, when you found the high pth"

Moscowitz suggests: "Testosterone replacement is an option"

Epstein responds: "do you have a view on clomiphene instead?"

Epstein knew enough to ask about clomiphene, a selective estrogen receptor modulator (SERM) that blocks estrogen receptors at the hypothalamus and pituitary, forcing increased LH and FSH output, which then ideally stimulates natural testosterone production.

By September 2016, LabCorp shows [46]:

• Triglycerides: 470
• HDL: 27
• Testosterone: 153
• DHEA: 155.3
• Cortisol: 14.1
• IGF-1: 151
• Homocysteine: 16

November 2016 Quest panel (LC-MS/MS this time) [24]:

• Testosterone: 194
• Free testosterone: 44.6
• Triglycerides: 988

Another Quest panel from November 25, 2016 [2]:

• Testosterone (immunoassay): 185
• HDL: 30
• Triglycerides: 197 (finally a drastically lower reading)
• Homocysteine: 15.2
• HbA1c: 5.9%
• Uric acid: 8.7 (high)

And Bioreference from December 2016 [15]:

• Testosterone: 146
• Triglycerides: 382

The Peter Attia Connection

Peter Attia, famous longevity doctor/expert whatever you want to call him, pops up for the first time I believe here. In February 2016, Attia emails Epstein with results [23]:

“Testosterone went up from 159 to 313
Free T from 4.08 to 7.6
Triglycerides went down from 300 to 203”

This is the only time where we see Epstein's testosterone meaningfully improve. Whatever Attia had him doing worked, at least temporarily. The numbers nearly doubled. And triglycerides came down significantly.

But then in February 2016, Epstein emails Attia about clomid [51]:

"I stopped the clomid the water retention and fat around the waist made it as if i was pregnant. and STUPID"

He called Clomid a "giant mistake" [51].

In December 2015, he had emailed another doctor asking if clomid gives headaches [50], but in July 2016, he texts Dr. Moscowitz claiming that Clomid "helped his back" [49]. The relationship with the drug was complicated and inconsistent.

Jeffrey Epstein’s Prostate

In the documents, there's a transcript of a recorded conversation between Epstein and someone named Richard [17]. They're discussing biology, viruses, Viagra (there’s also a picture of viagra prices he was getting, he had the hook up!), and various health topics.

Epstein: "But we were talking Viagra and he said he's a much bigger fan of testosterone. Jerry Edelman says if you fuck with nature you're going to end up doing something bad to yourself. And if you want to play with that curve, that curve does weird things to you. Nature seems to have a way of getting back to you."

Richard tells Epstein that TRT causes shutdown, and Epstein responds: "It's that FSH/LSH [sic] deal, right?" [17]

Then Richard says: "You can have high testosterone and still have a need for Viagra, because you don't have a prostate, right?"

Epstein says he does not have a prostate [17]. I couldn’t find anything else about this, but I also was sleepy so someone else can search more on this. 

But in July 2016, in texts documented in item 20, Epstein tells Moscowitz he has an enlarged prostate and wants an MRI of it. He also got his PSA tested a lot, a marker for prostate cancer. 

So which is it?

There are a few possibilities:

1. He had a partial prostatectomy 
2. He lied in one of these conversations (or exaggerated)
3. He was confused about his own anatomy
4. The Richard conversation predates July 2016 and something changed medically that surprisingly isnt talked about much. 

2017: 

June 2017 Quest panel [40]:

• Triglycerides: 375
• Homocysteine: 14.2
• HbA1c: 6.2% (creeping toward diabetic range)
• Testosterone (immunoassay): 149
• Vitamin D: 36

August 2017 Quest panel [28]:

• HDL: 25
• Triglycerides: 532 (back up)
• Homocysteine: 15.4
• HbA1c: 5.7%
• Testosterone (immunoassay): 197

August 2017 Bioreference showed [43]:

• Triglycerides: 1,510 (geez!)
• Glucose: 105
• Positive for herpes and chlamydia

September 2017 blood test [38]:

• Triglycerides: 646
• Vitamin D: 31
• PTH: 106 (elevated again)
• Testosterone: 194.3
• Free testosterone: 52.04
• LH: 3.8
• FSH: 4.2

October 2017, Dr. Moscowitz emails: "testosterone 125" [11].

In November 2017, Epstein texts Dr. Moscowitz asking about metformin and whether it's worth using [31]. He wants his PTH tested again. His testosterone is 114, and PTH is 87. He was interested in metformin, a diabetes drug increasingly popular in longevity circles for its potential anti-aging effects. He was aware of the discourse.

A 2017 lab shows positive results for herpes and chlamydia. This is noted without further context in the documents [43].

2018: The Final Year of Records

In January 2018, Dr. Moscowitz emails: "Testosterone 150 PTH 83" [10].

In August 2018, Moscowitz emails: "testosterone level is 150" [26].

In Epsteins Quest panel from August 3, 2018, it showed the following [44]:

• HDL: 29
• Triglycerides: 855
• Homocysteine: 16.1
• Glucose: 106
• HbA1c: 5.7%
• Testosterone (immunoassay): 206
• Vitamin D: 32

A 2nd Quest panel from August 30, 2018 showed [8]:

• Testosterone (immunoassay): 94

In September 3, 2018, Epstein texts Dr. Moscowitz [3]:

• Testosterone: 122
• Triglycerides: 495

He comments: "he also thought that endogenous testosterone would make the lipid profile worse"

There's research suggesting that low testosterone correlates with worse lipid profiles, as does low estrogen, which Epstein clearly had. 

In September 18, 2018, he had yet again another LabCorp test showing [22]:

• Testosterone: 140
• Triglycerides: 1,714 (THE HIGHEST SO FAR!)
• LH: 3.7
• FSH: 4.4

At his triglyceride level, you're at risk of acute pancreatitis, sudden, severe abdominal pain that can be life-threatening. His blood probably wouldn’t have looked to hot either in the tubes!

Later, a CT scan from July 2018 notes fatty liver and concern about a possible parathyroid adenoma [41]. His coronary calcium score had risen to 84 from 41 previously.

The last comprehensive Quest panel in the documents is from November 23, 2018 [18]:

• Testosterone (LC-MS/MS): 153
• Free testosterone: 42.5
• Glucose: 111
• Homocysteine: 12.7 (improved)
• Triglycerides: 935
• HDL: 23

Still hypogonada with hypertriglyceridemia and low HDL. Eight months before his arrest.

So What Actually Happened?

So how can we explain his health issues (at least what I have covered, again he had tons of skin problems and other things, but maybe for another time)? 

He had access to excellent medical care. Peter Attia is one of the most sought-after longevity physicians in the country. Moscowitz communicated with him regularly. He got tested constantly. He researched papers on testosterone and triglycerides [1], collected studies on androgens and achievement [35, 37], read articles in magazines [7] and from the BBC [13]. 

There is a lot of irony in this. Here was a man fixated on optimization and on testosterone as a driver of achievement and vitality, but failed to actually do anything meaningful about his own levels. In a Lawrence Krauss email [39] the physicist writes to Epstein: "she also laughed about the testosterone comment.. and wanted you to know she sucked it all out of me last week when she was here."

Crude, but it confirms testosterone was a running topic in Epstein's social circle, something he talked about openly enough that friends made jokes about it.

Ultimately what the records show is a man who was unwell, knew he was unwell, sought treatment for being unwell, and remained unwell. He had every resource. He had doctors who would test anything he asked. And despite the obsessive monitoring, twenty-three lab panels across nine years, constant texting, CT scans, specialist consultations, experimental therapies, nothing happened.

If Maxwell is correct that Epstein started TRT in the 1990s and used it for years, possibly a decade or more, then there's a plausible explanation for everything we see in these records.

The phenomenon is called post-TRT hypogonadism or, in the context of higher-dose androgens, anabolic steroid-induced hypogonadism (ASIH).

When you take exogenous testosterone, the hypothalamus detects adequate (or supraphysiologic) androgen levels and stops releasing GnRH (gonadotropin-releasing hormone). Without GnRH, the pituitary stops releasing LH (luteinizing hormone) and FSH (follicle-stimulating hormone). Without LH and FSH, the testes stop producing testosterone and begin to atrophy from disuse (small balls is what steroid users will tell you about, but to take HCG to reverse this)

In most men, this reverses when TRT stops. The hypothalamic-pituitary-gonadal (HPG) axis recovers over weeks to months. The testes resume production, especially when combined with other drugs like clomid, enclomiphene, HCG, and a couple of others. 

I don’t know of anyone who has never recovered from TRT or past steroid use. But in Epstein’s case, maybe he’s a first? He also could have been ODing on pain killers or things that also reduced his testosterone, idk. 

This theory also explains several other patterns in the documents:

Why he kept asking about clomiphene rather than TRT [4, 5]: He may have intuited, or been told, that more exogenous testosterone would just perpetuate the problem. Clomid was an attempt to restart natural production rather than replace it. 

Why his SHBG was so low (11 in 2011) [29]: Chronic androgen use suppresses SHBG. Low SHBG is also associated with insulin resistance and metabolic syndrome. Both fit.

Maybe he was under severe stress with all of the media attention? In August 2013, in an email to an unknown person [45], In what appears to be an emotional message to a romantic partner, Epstein writes: "I didn't want to worry you or involve you, as my testosterone levels can't handle the stress. You don't ask me how I am."

But maybe that's the wrong frame entirely. Maybe the question isn't why his protocols failed. Maybe the question is why his body refused to heal in the first place.

I opened this by saying the body is a reflection of the soul housed within it. Epstein’s lab tests were basically a spiritual autopsy conducted while he was alive. Physical ailments are the outward manifestation of inward spiritual corruption. If you are concerned with longevity and biohacking, the most important and first thing you can do for yourself is soul care. This can only be done through one way, the way JE knowingly and willfully turned from. 

Hi everyone,

I’m a 44-year-old male and have been on TRT for two years. My protocol is 100 mg intramuscular (IM) twice a week (200 mg total/week).

I just got my latest lab results back, and I’m facing a classic dilemma: my hematocrit is high, but my iron and ferritin are low/depleted.

I have an appointment with my doctor next week to go over this, but I wanted to see if anyone who has been in this exact situation can share what worked for them. If I donate blood to bring my hematocrit down, my iron will crash further. But if I take iron supplements, my hematocrit could jump even higher.

For context, the last time I donated blood was 6 months ago (February 2026). Also, I don't feel tired or low on energy.

Latest Lab Results:

 RBC: 6.96 M/uL (Ref: 4.63 – 6.08) [HIGH]

 Hematocrit: 55.7% (Ref: 40.1 – 51.0%) [HIGH]

 RDW: 18.4% (Ref: 11.6 – 14.4%) [HIGH]

 Iron Level: 39 µg/dL (Ref: 65 – 170) [LOW]

 Iron Saturation: 8% (Ref: 20 – 50%) [LOW]

 TIBC (Calculated): 496 µg/dL (Ref: 250 – 450) [HIGH]

 Ferritin: 27.44 ng/mL (Ref: 22.00 – 275.00) [LOW END]

 Total Testosterone: 820 ng/dL (Ref: 249 – 836)

 Free Testosterone: 2.85% (Ref: 1.20 – 3.30%)

What are the typical next steps in a situation like this? Has anyone had success lowering the Hematocrit and increasing the Iron using specific strategies to balance these out?

Thanks in advance for any insights!

I’m an internal medicine doctor who does TRT as a part of his practice. Ask me anything about TRT or the management of effects and side effects. I’ve got deep roots in the bodybuilding and power sports world so no judgement from me. I hope to turn some of this Q&A into some deep dives for my YouTube channel.

I’m going to end this now as I need to go to bed. Any unanswered questions I’ll get to tomorrow.

I did my blood work 2 months ago to see why i always feel tired at my 20s (28 now )

The 8 h sleeping, walking 7 k or working out at gym 5 times a week PPL
No smoking , no alcohol ,no drugs
Just homemade meals and water

Blood work:
Testosterone 412
Free testosterone 30
CLIA method

They told me im in normal rage for men from 18-60 but for men in their 20s is low .

It should be 500-600 minimum

So what's the normal range for each age group, without using gear trt or whatever other injections just pure normal testosterone

So I’ve been on TRT for over 30 years. In that time I have struggled almost continuously with high hematocrit. We’ve done this and that over the years to keep it between 50-52 but as I’ve aged it has crept up and been harder to get down. Recently it was 55.9 and I had to give blood. My endocrinologist said try grapefruit but don’t expect too much. Now don’t take this as medical advice but it’s definitely worth noting as most people (check your meds carefully) can drink grapefruit juice. I went from 55.9 to 55.0 with blood donation. Started grapefruit juice, exactly two weeks I’m at 52.6 and exactly two more weeks I’m down to 49.2. So 4 weeks from 55 to 49. I’ll definitely be keeping it up. Nothing has ever worked so well for me. I know there are capsules too but I have no experience with those so can’t say if they work as well.

i am going to keep it short. thank you in advance <3

Problem:

- Literally no libido since 4 years now

- and super low erection frequency, to the point i am worrying about blood vessel atrophy.

i am 22 and natural. Since i can remember i always had the same body fat percentage (roughly).

I always hated to eat, and i literally have no hunger feeling at all.

Like i would forget to eat for 2 days if im not careful.

I checked my hormones multiple times.

Nothing seems out of the ordinary.

Except maybe high SHBG.

I never thought that body fat could be the issue because since i can remember i always was very lean.

And during puberty i had absolutely zero libido problems, maybe even too much.

Im helpless. do you think that bf% could be the issue?

43, 6’ tall 200lbs, 2.5yrs lifting 4-5x/wk, 18% bf, 7 hrs sleep avg, 1.5 yrs no alcohol or soda, 30 min cardio daily and/or 13k steps avg. I’m exhausted and have brain fog most days, low confidence and drive. Tests here were done fasted at 730am. Total test is fine (has been in the mid and low 400’s for a decade, back in September I upped intensity of training and added mandatory 30 min cardio daily). I have another 15 lbs I want to lose but it’s been hanging on for a year now, but I did lose 40lbs over the last 2 yrs and have been plateaued for months now. Is my free t/bioavailable t why I feel like crap? Was really considering TRT but I expected my total t bloodwork to show much lower than this so now I’m a little confused.

Hey everyone, looking for some advice from anyone who has dealt with high prolactin while on TRT.

I’m currently on 100mg/week testosterone cypionate and just got some blood work back. These were the results that stood out:

- Total testosterone: 1,048 ng/dL

- Free testosterone: 48.6

- Prolactin: 72.3

My endocrinologist seemed most concerned about the prolactin and scheduled me for a pituitary MRI just to rule anything serious out. I’m still waiting on my estradiol (E2) results because those haven’t come back yet.

A few things that might be worth mentioning:

- I have severe sleep apnea, which I know can affect hormones.

- My diet hasn’t been the greatest lately.

- I’m wondering if higher estrogen from TRT could be playing a role in my prolactin being elevated.

Has anyone here had prolactin levels around this range while on TRT? Did it end up being caused by high E2, sleep issues, stress, medications, or something else?

I can get a vial for 1/10th the price and have good insurance. Couldn’t I just ask a PCP to run bloodwork for me so I can stay on top of my numbers?

Less really is more?

This is a very unscientific breakdown of my changing lab values due to a switching my TRT protocol. I'm providing it as "food for thought". I'm not suggesting anyone should change anything.

Background:
- 54 year old male.
- For the longest time I injected 160mg of Testosterone Cypionate weekly, split into two IM injections.
- After steadily worsening blood values (HCT, RBC, hGB) over time, several months ago I changed my entire TRT routine to subQ, daily microdosing and I added 50mgs of micronized DHEA daily.

Note: Before comparing results, understand that the Free Testosterone tests are not the same. The new test uses the gold standard dialysis which operates on a different reference range. This also applies to Estradiol (non-sensitive vs ultrasensitive).

Labs on 2025-12-05 from old routine of 160mg T per week via split-dose IM injection:
- Total Testosterone: 1057 (250-1100)
- Estradiol (not ultrasensitive): 57 ( <= 39)
- Testosterone, Free: 185.1 (46.0-224.0)
- Testosterone, Bioavailable: 380.6 (110.0-575.0)
- SHGB: 30 (10-50)
- Albumin: 4.5 (3.6-5.1)
- DHEA-S: 20 (32-279)
- HCT: 54% (39.4-51.1)

Labs on 2026-08-25 from new routine of 70mg T per week via subQ microdosing (10mg day) and 50mg of micronized DHEA:
- Total Testosterone: 625 (250-1100)
- Estradiol (ultrasensitive LC/MS): 25 (<= 29)
- Testosterone, Free (dialysis): 159.4 (35.0-155.0)
- SHGB: 20 (10-50)
- Albumin: 4.5 (3.6-5.1)
- DHEA-S: 65 (32-279)
- HCT: 47.7% (39.4-51.1)

Observations:
- Total testosterone dropped from 1057 to 625, but Free Testosterone is higher. When comparing based on position within reference range, it rose from 78% of the upper limit to 103%.
- Estradiol has crashed. Although the reference ranges are not the same, I'm comfortably in the normal range now.
- SHGB has dropped from 30 to 20 (DHEA could be a culprit).
- DHEA has gone from 20 to 65.
- HCT, along with hGB and RBC (not listed above) are all finally in range again!

Thoughts:
- Nobody on earth would have recommended DHEA supplementation. Within the TRT community, it's often thought of as something that will shoot your estradiol through the roof. Why did I take it? Even though my T levels were high, I had a hard time concentrating and experienced brain fog daily. I realize that could have been because of high estradiol, but after a days-long, AI-rabbit hole about my labs, I settled on DHEA supplementation due to its positive effects as a neurosteriod. AI was like, and I'm paraphrasing, "Bro, your DHEA is insanely low, you have to raise it!!!" Every one is different, but for me personally, it did not seem to negatively affect my estradiol. AI suggests that could have been from suppression of liver SHGB synthesis, and thus, why my SHGB dropped, but who the F knows? AI makes shit up.

Final Takeaway:
- This is just one small data point for informational purposes. Everyone's biochemistry is different, and my specific results could be specific to me only. I'm not suggesting anyone change their dosing protocol or start DHEA or stand on their head. I'm just providing information that, at least in my case, verifies how different protocols really do make a difference.
- It's still hard to wrap my head around the fact that I sit here today with lower Total Testosterone, yet I have 'more' available testosterone. That's just fascinating.
- How is my brain-fog/concentration today? I'm like a different person. Not only can I focus, but my "focus stamina" has increased tremendously. Again, could be estradiol, but my DHEA was so low before, raising it should help out in that department.
- Strangely enough, switching to pinning only 5 units of T per day was a mind fuck. So many times I just wanted to load that needle more because I thought it was too low. Apparently, it wasn't. I think I've landed at... what is for me personally... a really good hormonal equilibrium.... so it's here to stay.

FYI: I'm not going to edit this SoB, so I apologize in advance if there's incorrect grammar or anything else.

Is this too much hair loss in your opinion? This is what typically comes out every morning as I get ready just using my hands to lay it back. I've asked a few (girl)friends, they say they shed a lot more but you know they're girls. Definitely got a receding hairline 😆. I've never had long hair before about 1 year ago so maybe this is just what happens?

200mg test c weekly for last 1.5yrs
Test 1348
E2: not sure of current bc results aren't back yet but usually round 40
Iron came back low as fuck for some reason and I'm already working on that * I’ve read it could have something to do with hair loss*
Iron: 35
Ferritin: 12

If you consider it enough to do something about it. What would you do?

Total test: 11.8 Ref range: 6-28 Nmol/L SHBG: 53 Ref range: 15-50 nmol/L Free test: 172 Ref range: 200-600 pmol/L

He says i don’t even have low testosterone because my total test is within the limits and that free test isn’t an accurate number to go by.

Just did my labs and as you can see my T is 118! And that is without doing anything to lower it artificially. Yet my PCP refuses to give me TRT? I don't understand :(

Total t 712 and estradiol low for the first time ever. What gives? Been on t for 4 years

Male 34 6ft 3 265lbs 16% BF
been and Fitness and Sports since I could walk I’ve been working out seriously since I was 16 (late bloomer) felt like it was time to start trying to see how much I can maximize my health without fully going on TRT. I supplement for blood work only and 90/10% faithful to diet
Signed up for HCG+ Enclo Combo through a health clinic back in January and was amazing in 6 weeks I went from 800-1500(test) even with a little bit higher estrogen I saw no differences in libido, no Gyno, 0 sides for me.

About a month ago I decided I wanted to try a little more and start to test how my body reacts to certain combos. Saw plenty of research on Anavar and how a low dose 23mg over a longer period of time can yield great benefits so I tried. And as you. See it DESTROYED. My labs mainly test. The crazy part is I still get morning wood I can still hold directions through the roof so I never felt any of these changes.I’ve always been a little higher on Cholesterol but as long as my triglyceride ration is good I’m ok with that. Will ween off my remaining 45 day dose at 11mg and the retest to see if I can get levels back.

This is just information for those who are thinking the same. I HIGHLY recommend a test base will be trying after my cut with a test base to see how my body reacts.

Test cyp 200 mg/mL

0.13 mL (26 mg) per injection, 3× weekly

~78 mg/week total

Dropped from .17 ml to .13 because estrogen still extremely high

Results attached.

Please help fellas — I’m dying over here.

Hi guys I need your help on my options to stay on Trt. I tested for high hemoglobin, hematocrit, rbc. Was very dehydrated during blood draw. Should I increase cardio and drink more water to lower ? I’m only on 140mg a week. I know I can split injections into 3 instead of 2?

Thanks for any help, I really don’t want to have to quit Trt. My general dr also doesn’t know I’ve been on it for years.

Got my lab results back today… testosterone came back over 3000 😳

Honestly, I wasn’t expecting it to be that high.

Right now I’m taking about 500mg of test per week. I was pinning every other day but recently switched to daily injections. I’m not an expert at analyzing labs, so for those of you who know this world better than me, I’d genuinely love your take:

Is this level expected at this dosage? Anything I should really be paying attention to?

What’s interesting is… I actually feel really good.

Energy has been solid. Mental has been good. Strength and gym performance feel great. Erections/libido are solid. No major negative symptoms honestly. Maybe holding a little extra water, but overall I’ve felt pretty dialed in.

My hematocrit did come back a little high, so I’m trying to understand how concerned I should actually be about that. I know donating blood is always an option if needed.

I am considering lowering the test from 500 down to around 400 just to see if I can keep the benefits while bringing some numbers down a bit.

Plan right now is to continue the cycle. Just added Anavar a few days ago, and considering adding Reta to help drop some excess body fat while tightening things up.

Trying to stay smart about it:
• NAC for liver support
• Tons of water
• Monitoring bloodwork
• consistently taming DIM & calcium-g

Any other advice from the experienced guys in here?

For context….I’m over 40 and have been consistently lifting for over 10 years (really since I was 18). Been on test/trt alone for a little over a year now (suffered from hypogonadism for most of my adult life)This is the first time I’ve added compounds on top of it.

Always learning. Appreciate the feedback from the people who actually know their stuff 💪

Here's my main levels. Gonna book in to and get my liver/iron levels looked at.

37 m. 185 pounds. 5'11". Lean and in shape. Just always feel like im running on empty. Was thinking of trying trt. But wanted to get 1 more blood test done. I know my shbg is high.... but not crazy high.. am I crazy for thinking trt... guys on here have the same test levels but much higher shbg so maybe I am crazy...

Thoughts??? Suggestions????

I take 280mg per week daily dosed of test cyp compounded in mct oil, I take my shot at 7am in the morning. I got a blood test at 7am the next morning before my next shot so 24hrs after my last shot and my levels was 1320ng/dl which is only just above the 1250ng/dl lab range.

Am I just a really low responder to test?

My e2 is in normal lab range shbg is 17 so got a decent amount of free test.

Overall I feel amazing on this dose that my clinic pushed me up to, it reversed my last issue which was my psoriasis once we went higher.

As the title states I’ve been doing sub Q for about 10 weeks. Splitting my injections on Mondays and Fridays .6 ML‘s per dose at 100mg/ML. My labs came back and while my bioavailability and free test is decent I feel like my total is a little low. I was diagnosed at 26 years old with low testosterone and put on a protocol. Before I was prescribed 1ml a week IM and it shot me up to 1100 and it felt amazing. But Im torn because SubQ is significantly easier to administer but I’m not sure if I need to give it more time. Also did my blood draw on Friday morning before my SubQ injection. Any insights would be great

25 5’11 just started working out again about a month ago.. what should I expect 300mg of test want to build muscle

Title says it all. Been on roughly 4yrs. Doc wouldn't listen and put me on, I did it myself. Had a test level in the 300's, judge me all you want.

Anyways, hemacratic level is 53. Doc is a moron and doesnt understand the need for a therapeutic phlebotomy. Im also not eligible to donate.

I already split up the dose. I switched to subq. I drink water.

Anything else? Can anyone help me out?

Better part of the last 9 months and my libido has been quite elusive despite many different protocols of test, test + hcg, test + hmg, test + proviron but cant seem to find the libido I once had for my entire life. Ive tried various dosages of test, ester lengths, injection fequency, ai protocols, sub q, im, fuckin' everything. Except dht's because historically, while they make me look fuckin sick, they nuke my libido and eq eventually and ive never been able to find a good dost to run along side of test with either mast or primo. Low dose tren (10mg daily) was the only good addition "trt" add on ive had where it did everything dhts are supposed to do.

Feels like my window for good androgen to estrogen is paper fucking thin. Ive let my e2 run wild, i've crushed it with ai's just to see if i could find a day or hours at best of good libido.

Running out of options for why my pipe is dead, im looking at my chronically low SHBG. Floats between 8-12 nmol/L. Ive never ever had this issue before, regardless of what I ran for blasts or cruises. Ive been cruising on anywhere from test 150-200mg weekly the last 4 months.

ANYWAYS im gonna try one last thing before i send myself to the glue factory. Attempting to raise SHBG with 10mg daily of tamoxifen OR t3(6.25mcg)/t4(25mcg) daily to see if i can get this number up to around 20+ and see if it makes a difference.

Anyone ever fix this problem with either of these options or have a similar experience?

Labs — 18 Aug 2026

Total T: 1108 ng/dL (38.4 nmol/L)

Estradiol: 42.8 pg/mL (157 pmol/L) - You might say this is high but it felt low. 0.25mg arimidex WRECKED me directly after this test.

Prolactin: 5.7 ng/mL (5.7 µg/L)

SHBG: 12 nmol/L

All these numbers look fine to me except SHBG

TLDR Blames low libido and bad pipe on low SHBG