James Ries, DO | Flight Surgeon

Navy flight surgeon ✈️ Straight truth on TRT, peptides, GLP-1, and hormones. No bro-science, no fear-mongering. Telehealth in 37 states. Not medical advice.

[James Ries, DO | Flight Surgeon @JamesRiesDO]

I've spent the past decade as a military flight surgeon. Let me take the politics out of the testosterone headline and tell you what actually matters.

Testosterone drops with age, that's just physiology. And when it drops, it takes energy, strength, focus, mood, sleep, and recovery with it. Every one of those is a readiness issue. A depleted force is a real problem, not a meme.

Most men never get tested, because nobody offered or they were told low energy is just getting older. Making a testosterone check part of a routine physical is how you catch the guys running on empty who do not know it.

You can argue about the messenger all day. The underlying medicine is sound: Test, find the men who are actually low, and treat the ones who need it. That is good care, in uniform or out.

[Secretary of War Pete Hegseth @SecWar]

The High-T Department of War.

[James Ries, DO | Flight Surgeon @JamesRiesDO]

@Dmnted32 🫡

[James Ries, DO | Flight Surgeon @JamesRiesDO]

I've spent the past decade as a military flight surgeon. Let me take the politics out of the testosterone headline and tell you what actually matters.

Testosterone drops with age, that's just physiology. And when it drops, it takes energy, strength, focus, mood, sleep, and recovery with it. Every one of those is a readiness issue. A depleted force is a real problem, not a meme.

Most men never get tested, because nobody offered or they were told low energy is just getting older. Making a testosterone check part of a routine physical is how you catch the guys running on empty who do not know it.

You can argue about the messenger all day. The underlying medicine is sound: Test, find the men who are actually low, and treat the ones who need it. That is good care, in uniform or out.

[Secretary of War Pete Hegseth @SecWar]

The High-T Department of War.

[Homeschool with Hannah @hannahcenters]

For real, get Dr. Ries to fix you up.

[James Ries, DO | Flight Surgeon @JamesRiesDO]

@taradublinrocks What’s pathetic is wasting years of your life suffering from a treatable condition instead of seeking help.

[James Ries, DO | Flight Surgeon @JamesRiesDO]

@travisakers What’s dumb about it?

[James Ries, DO | Flight Surgeon @JamesRiesDO]

@erikaberry644 No fighting here! https://t.co/ioKO7UfdZA

[James Ries, DO | Flight Surgeon @JamesRiesDO]

I encourage all providers to take hormonal health more seriously, for both men and women. It affects every aspect of life: Career, marriage, relationships.

[KILLED IN ACTION Game @KIA_WarGame]

@JamesRiesDO It's baffling that t-level tests aren't a strandard part of men's physicals. I started getting mine tested because I wanted to track it over time while lifting, and had to argue with my Dr every time and come up with some excuse she thought the insurance would cover.

[James Ries, DO | Flight Surgeon @JamesRiesDO]

@Pr0phet16 Thank you! TRT is life-changing for many men.

[James Ries, DO | Flight Surgeon @JamesRiesDO]

Agreed that men's hormonal health is understudied and under-discussed. One tweak: we do have decades of testosterone data and established reference ranges. The real gap is optimal versus merely normal, and how it ties to performance and longevity. A large tracked cohort like this could actually move that forward.

[James Ries, DO | Flight Surgeon @JamesRiesDO]

Insulin resistance and excess body fat are two of the biggest drivers of low testosterone in men past 30, so anything that improves insulin sensitivity and drops fat, keto or otherwise, tends to help the number. The diet is a tool for the underlying problem. Dial in metabolism first, then test to see where you actually stand.

[James Ries, DO | Flight Surgeon @JamesRiesDO]

Honest concern, worth answering straight. For a man who is genuinely low, TRT is maintenance the same way treating thyroid or blood pressure is. Coming off is far smoother with a proper taper and restart protocol than going cold. The dependency horror stories mostly come from guys self-sourcing and stopping abruptly. Managed properly, it is stable and predictable.

[James Ries, DO | Flight Surgeon @JamesRiesDO]

You are not off base at all, this is the nuance most screening misses. Total testosterone is the blunt first look. Free and bioavailable T plus SHBG tell you how much is actually usable, which is why a man can have "normal" total T and still feel hypogonadal. Receptor sensitivity is real but not something we can easily measure in clinic yet. A good workup runs total, free, and SHBG together, never total alone.

[James Ries, DO | Flight Surgeon @JamesRiesDO]

@Moke1966758 Lift heavy and often, get lean since body fat converts testosterone to estrogen, sleep 7 to 8 hours because most of your production happens overnight, and keep stress and alcohol down. Fix those, and a lot of men climb back on their own.

[James Ries, DO | Flight Surgeon @JamesRiesDO]

Fair question. The ones that matter: A rise in red blood cell count, shifts in estrogen, and suppressed natural production and fertility while you are on it. Each one is manageable when a physician is watching your labs and adjusting. Side effects are a reason to be supervised, not a reason to avoid treatment when you genuinely need it → https://t.co/h6FEcSriap

[Lady Catherine @sienesecath]

An objective view on this:

[James Ries, DO | Flight Surgeon @JamesRiesDO]

@StephaneLa45018 @SecWar 💯

[James Ries, DO | Flight Surgeon @JamesRiesDO]

@valiant_scroggy You are not wrong that it is underdiagnosed and overstigmatized. A lot of men are walking around low and being told it is normal. The change in energy, strength, and mood is real. This should not be witchcraft.

[James Ries, DO | Flight Surgeon @JamesRiesDO]

@jffry8902 You are onto something real. Women have the same hormonal story, estrogen and testosterone both, and when they drop in perimenopause, desire often goes with them. The difference is nobody screens for it or takes it seriously. Same problem, half the attention.

[James Ries, DO | Flight Surgeon @JamesRiesDO]

If you’re a man experiencing these symptoms, visit us at Twenty Mile Medical for an evaluation: https://t.co/NvYlmBM2P7

[James Ries, DO | Flight Surgeon @JamesRiesDO]

@starsandstripes As a Naval flight surgeon, I welcome this. Our fighting force's health should be optimized, and hormones are an essential component.

[James Ries, DO | Flight Surgeon @JamesRiesDO]

You are half right: Sleep, food, and training are the foundation, and no shot fixes a bad lifestyle. But plenty of disciplined guys who do everything right still come back genuinely low, and they have spent years being told to try harder. Fix the fundamentals, yes. And test, because some men need more than discipline.