Originally billed simply as "A Conversation with Dr. Julian Gershon" — recorded when Mark Anthony's show still went by the AI Edge Podcast — this episode turns out to be a fairly specific primer on one question: what does it actually mean for a man's testosterone to be optimal, as opposed to merely "normal" on a lab report? Dr. Gershon, a sports medicine physician who spent more than 40 years working with Division I and Olympic athletes, has built a second career answering exactly that question.
Gershon's own path into hormone optimization started with skepticism. More than 20 years ago, two colleagues — Bob Goldman and Ron Klatz, who went on to found the American Academy of Anti-Aging and Regenerative Medicine — first told him about the field, and he says he initially "thought they were nuts." It took roughly a decade before the philosophy started to make sense to him, and the real turning point was personal: at 50 (he's now 71), he ran his own bloodwork and became, in his words, "patient number one." His total testosterone came back at 500 — a number his primary care doctor called normal. Gershon, who has since built his practice, Aspen Regenerative Medicine, in Aspen, Colorado, around hormone therapy, says that framing misses the point entirely.
Key Takeaways
- "Normal" and "optimal" aren't the same thing — only about 1 to 2% of total testosterone circulates free and usable in the body. Gershon says it typically takes a total testosterone in the 1,000 to 1,200 range to get free testosterone into what he considers optimal (20 and above), even though a total of 500 is often labeled "normal" on a standard lab report.
- Pellet therapy is his most common delivery method today: small pellets are inserted under the skin near the hip through a small incision, dissolve gradually over about five to six months, and require follow-up bloodwork before the next round is scheduled.
- Younger men often get a different approach — rather than prescribing testosterone directly, which can suppress the body's own production, Gershon frequently uses HCG and a clomiphene-type medication to stimulate a man's natural testosterone output instead.
- He says his patient population has gotten younger: 20 years ago his average patient was in his 50s or 60s; today he regularly sees men in their 30s, which he attributes partly to environmental factors like BPA and herbicide exposure.
- He pushes back on two persistent fears — that testosterone therapy causes prostate cancer and that growth hormone causes cancer — citing studies of veteran populations and what he describes as an absence of supporting literature, respectively.
Why "Normal" Testosterone Isn't the Same as Optimal
The distinction Gershon returns to throughout the conversation is the gap between a lab report that says "normal" and a hormone level that's actually doing useful work in the body. Total testosterone is the number most men get back from a standard panel, but Gershon says only 1 to 2% of that total circulates unbound — the "free" testosterone that tissue can actually use. At a total of 500, he said, a patient is lucky to have a free testosterone reading around 10; an optimal free testosterone, in his view, is 20 and above, which for most men means a total testosterone somewhere in the 1,000 to 1,200 range.
"We don't do anything normal. We do everything optimal."
— Dr. Julian GershonThat reframing carries through to how he talks about aging generally: he told Mark Anthony that hormone output starts declining as early as age 30, and that the goal of treatment isn't to chase youth indefinitely but to stay closer to a person's own baseline for longer.
Inside Pellet Therapy — and Why Younger Men Get a Different Protocol
Gershon has used several testosterone-replacement methods over the years: sublingual lozenges, a cream he's largely moved away from because it converts more heavily into DHT (a hormone he associates with hair loss and prostate concerns), and self-injection with a thin 25-gauge needle, which he did for about 13 years and says is far less uncomfortable than the thick needle used for a penicillin shot. For roughly the past nine years, his primary method has been pellet therapy: an area over the hip is numbed, a quarter-inch incision is made, and several rice-sized pellets — he calls them "Tic Tacs" — are inserted under the skin, where they dissolve gradually over about five to six months. The area gets steri-strips and a waterproof dressing for about a week, is slightly tender to the touch, and the insertion itself takes roughly three minutes. He requires follow-up bloodwork — around four weeks for women and six weeks for men, then again near the third-to-fourth month for women or the fifth month for men — to confirm levels are back in range before scheduling the next round, typically about twice a year.
For younger men, Gershon said he frequently skips testosterone altogether. Giving testosterone directly can signal the body to stop producing its own, so instead he'll use HCG (human chorionic gonadotropin) alongside a fertility medication like clomiphene or its derivative, enclomiphene — compounds that act like luteinizing hormone (LH) and tell the testes to keep making testosterone naturally. As an example, he described a recent follow-up with a patient he identified only as a well-known NHL player, 42 years old, who takes a couple of HCG injections a week plus a capsule three times weekly and had a testosterone level near 1,000 at his most recent check — with no direct testosterone prescribed at all. Gershon said the patient reported feeling stronger in the gym and recovering faster than before treatment.
Why Low Testosterone Is Showing Up in Younger Men
Twenty years ago, Gershon said, his typical patient was in his 50s; the average dropped to around 45, and today he regularly sees men in their 30s. He pointed to a mix of environmental factors — glycation, herbicides, and estrogenic compounds from sources like plastic water bottles and BPA — as contributors, alongside a broader increase in awareness driven partly by direct-to-consumer "low T" advertising, though he was skeptical that the supplements pushed in those ads do much on their own.
He was clear that diet and exercise remain foundational — something he says he's preached for more than 40 years — but argued that even people eating well often fall short on micronutrients because modern soil has grown less nutrient-dense over the past 50-plus years. His practice uses micronutrient testing and biological-age testing, including a DNA-methylation-based test he referred to as True Diagnostics, to estimate telomere length and the pace of aging, with a stated goal of not letting biological age advance faster than one year for every chronological year. On two commonly cited risks, Gershon pushed back directly: he cited studies of veteran populations showing men with the highest levels of free testosterone had the lowest rates of prostate cancer, and said he's not aware of a single study in the medical literature linking growth hormone therapy to cancer.
Who This Conversation Is For
If you've had bloodwork come back "normal" but still don't feel like yourself, or you're curious about the reasoning behind hormone optimization rather than the marketing around it, this episode is a plain-language starting point. Gershon also discussed the book that grew out of these conversations with patients, "Beyond the Fountain of Youth" — 16 chapters, written in a conversational format after roughly five years of thinking about the topic, aimed at readers "irregardless of age" who want to understand the reasoning before making any decisions about their own health.
