James Harrington was accustomed to solving problems. As the 47-year-old CFO of a growing tech company in Seattle, troubleshooting complex challenges was literally in his job description. But the problem that began affecting every aspect of his life proved frustratingly elusive.
“It was like someone was gradually dimming the lights,” James recalls, sitting in his corner office overlooking Lake Union. “There wasn’t a single moment when I thought, ‘something is wrong.’ Instead, over maybe 18 months, I watched myself slowly disappear.”
The symptoms crept in so gradually that James initially attributed them to normal aging or work stress. First came the fatigue—not normal end-of-day tiredness, but a bone-deep exhaustion that sleep couldn’t remedy. Then cognitive changes: brain fog during important meetings, difficulty concentrating on financial projections, and memory lapses that left him relying increasingly on digital reminders.
“I built my career on mental sharpness,” he says. “When I found myself struggling to recall details during board presentations or losing my train of thought mid-sentence, I started to question whether I was developing early-onset dementia.”
Physical changes followed. Despite maintaining his usual workout routine, his body composition shifted—muscle mass declined while stubborn abdominal fat accumulated. The final blow came in the bedroom, with a noticeable decline in libido and sexual function that put strain on his 15-year marriage.
“My wife Sarah was incredibly supportive, but I could see the confusion and hurt in her eyes,” James says. “We went from a passionate relationship to one where I was constantly too tired or uninterested. I felt like half a man—failing at work, failing at home, and completely disconnected from the driven, energetic person I’d always been.”
The Breaking Point
The wake-up call came during a leadership retreat in Aspen. After struggling through an uphill hike that would have been effortless a year earlier, James found himself sitting alone on a boulder, fighting back tears of frustration.
“One of our board members, a man in his sixties who had summited Kilimanjaro the previous year, hiked back down to check on me,” James remembers. “Instead of platitudes, he looked me in the eye and said, ‘This isn’t normal, James. And it’s not just aging. Something medical is going on, and you need to get it checked.'”
That conversation led to James’s first appointment with his primary care physician, where routine bloodwork revealed a testosterone level of 248 ng/dL—well below the 300-1000 ng/dL reference range for men his age. The diagnosis: hypogonadism, commonly known as low testosterone or “Low T.”
“When the doctor explained my testosterone was at the level of a man in his 80s, everything suddenly made sense,” James says. “The relief of having an explanation was immediately followed by the realization that I’d been suffering needlessly for over a year.”
The Hormone Reality
Low testosterone affects approximately 40% of men over 45, yet remains significantly underdiagnosed. While aging naturally reduces testosterone production, the dramatic symptoms James experienced were far from inevitable.
Dr. Katherine Matheson, an endocrinologist specializing in men’s hormonal health at the Pacific Northwest Endocrine Center, explains: “Testosterone is often misunderstood as just a ‘sex hormone,’ but it’s actually critical for cognitive function, energy regulation, mood stability, muscle maintenance, and overall metabolic health. When levels drop significantly, it affects virtually every system in a man’s body.”
Multiple factors can accelerate testosterone decline beyond the natural aging process: chronic stress, poor sleep, certain medications, environmental factors, and underlying health conditions. In James’s case, a combination of extreme work stress, sleep deprivation, and an undiagnosed thyroid condition had created a perfect storm.
“Executives like James are particularly vulnerable,” Dr. Matheson notes. “The high-stress, high-performance lifestyle that drives their success can simultaneously drive their hormones into the ground. Unfortunately, the symptoms often mimic normal stress or aging, making it easy to miss the underlying cause.”
The Treatment Dilemma
With diagnosis in hand, James faced difficult treatment decisions. His primary doctor offered a prescription for testosterone replacement therapy (TRT), but James had concerns about potential side effects and wanted to understand all his options.
“I’m an analytical person by nature and profession,” he explains. “I wasn’t going to jump into hormone therapy without thoroughly researching alternatives and potential long-term implications.”
James sought second and third opinions, eventually working with a clinic specializing in men’s health that offered a comprehensive approach. After thorough testing, including complete hormone panels, metabolic markers, and genetic screening, he and his new medical team developed a multi-faceted treatment plan:
- Addressing underlying factors: Treatment for his previously undiagnosed hypothyroidism and targeted supplements to address significant vitamin D and zinc deficiencies
- Lifestyle optimization: Working with a performance coach to implement science-based sleep protocols, stress management techniques, and nutrition plans specifically designed to support hormonal health
- Targeted TRT: A carefully monitored testosterone replacement protocol beginning with a modest dose of testosterone cypionate injections twice weekly
“I was resistant to the TRT component initially,” James admits. “There’s still stigma around testosterone replacement. People immediately think of steroid abuse or question whether you’re looking for an unfair advantage. What I came to understand is that I wasn’t trying to become superhuman—I was simply trying to restore what my body should be producing naturally.”
The Transformation
The changes didn’t happen overnight, but they were profound. Within three weeks of beginning treatment, James noticed improved energy and mental clarity. By six weeks, his mood had stabilized, and the persistent brain fog had lifted. Three months in, his body composition began visibly changing—abdominal fat decreasing while muscle tone returned.
“The bedroom issues resolved too,” James says carefully. “That alone would have been worth the treatment, but it was actually one of many improvements across every aspect of life.”
Six months into treatment, James’s testosterone levels stabilized in the mid-700 ng/dL range—squarely within normal parameters for men his age. More importantly, the comprehensive approach had addressed the root causes of his hormone imbalance, reducing his reliance on TRT while maximizing his body’s natural production.
The professional impact was equally significant. James went from questioning his ability to continue in his role to leading his company through a successful merger and expansion.
“My CEO actually pulled me aside after a particularly complex negotiation and said, ‘The old James is back—maybe even better,'” he recalls. “That was a powerful moment of validation that I’d made the right decision in seeking treatment.”
Beyond Testosterone: The Full-Spectrum Approach
What James discovered throughout his journey was that optimal performance requires more than just addressing a single hormone.
“Testosterone was the obvious issue, but the comprehensive testing revealed multiple interconnected systems that needed support,” he explains. “My cortisol rhythm was completely dysregulated from years of stress. My insulin sensitivity had decreased. My inflammatory markers were elevated. It wasn’t just one thing.”
Working with his medical team, James implemented a holistic regimen:
Nutrition: A customized anti-inflammatory diet emphasizing whole foods with specific macronutrient timing around his workout schedule and work demands
Exercise: Restructuring his fitness routine to include more high-intensity interval training and heavy resistance training, both proven to naturally support testosterone production
Stress management: Implementing daily meditation and twice-weekly sauna sessions, which research has shown can help reduce cortisol and support hormonal balance
Sleep optimization: Using tracking technology to improve sleep quality and working with a specialist to address previously undiagnosed mild sleep apnea
Supplementation: Targeted supplements including ashwagandha, magnesium, zinc, and vitamin D based on regular blood work showing specific deficiencies
Hormone optimization: Carefully monitored TRT combined with other hormonal support including thyroid medication and pregnenolone
“The comprehensive approach means I’m addressing the systems that support healthy hormone production naturally, not just adding exogenous testosterone,” James says. “The goal is to eventually reduce or potentially eliminate the TRT component as my body’s natural production improves.”
The Executive Advantage
James’s experience eventually led him to become an unexpected advocate for hormonal health awareness among his peers.
“There’s an epidemic of low testosterone among high-performing men, particularly in demanding corporate roles,” he says. “The irony is that the drive and intensity that propel men to executive positions often create the physiological conditions that undermine the very qualities that got them there.”
He now encourages annual hormone panels as part of executive health screenings and has helped implement wellness initiatives at his company that support hormonal health—including limits on extreme late-night work sessions, which research shows can dramatically impact testosterone production.
“When executives talk about ‘bringing your whole self to work,’ there’s usually a focus on psychological safety and authenticity,” James notes. “But there’s a physiological component that’s rarely discussed. You simply cannot bring your best cognitive and creative capabilities when your hormonal foundation is compromised.”
The Balanced Perspective
James is careful to present a nuanced view of his experience with testosterone optimization, acknowledging both benefits and challenges.
“TRT isn’t appropriate for everyone, and it’s not a magic solution to all of life’s problems,” he emphasizes. “The benefits have been transformative for me, but the therapy requires careful monitoring, regular blood work, and ongoing medical supervision.”
He also notes potential complications, including the need to monitor hematocrit levels (as testosterone can increase red blood cell production), PSA testing for prostate health, and consideration of fertility impacts for younger men.
“There’s a responsibility that comes with hormone optimization,” he says. “It’s not just about feeling better—it’s about using that improved energy and capacity purposefully. I’ve seen men get the physical benefits but fail to address the psychological and lifestyle factors that contributed to their decline in the first place.”
Moving Forward
Today, at 49, James maintains testosterone levels within the optimal range for his age, and more importantly, the symptoms that once threatened his career and marriage have resolved. He continues working with his medical team on long-term health optimization and has gradually reduced his TRT dosage as his body’s natural production has improved.
“The journey from feeling like ‘half a man’ to performing at my peak wasn’t just about testosterone,” James reflects. “It was about recognizing that our bodies have limits that even the strongest willpower can’t overcome. In our achievement-oriented culture, we’re taught to push through pain and fatigue—but sometimes those signals are telling us something critical that we need to address.”
For executives and high-performers facing similar challenges, James offers this advice:
“Get comprehensive testing early rather than suffering through a gradual decline. Treat your hormonal health with the same strategic approach you’d apply to any other critical business system. And remember that optimization isn’t about becoming superhuman—it’s about maintaining the natural capabilities that allow you to perform at your best.”
Looking out over the Seattle skyline from his office, James concludes with a perspective gained through his experience:
“I used to believe that grinding myself down was the price of success. Now I understand that sustainable high performance requires maintaining the biological systems that make that performance possible in the first place. It’s not self-indulgence—it’s strategic maintenance of your most valuable asset.”
Sidebar: Key Signs of Low Testosterone in High-Performing Men
- Decreased mental sharpness, focus, and memory
- Persistent fatigue unrelieved by rest
- Reduced drive and motivation
- Difficulty maintaining lean muscle despite exercise
- Increased abdominal fat resistant to diet changes
- Mood changes including irritability and depression
- Reduced confidence and decision-making ability
- Decreased libido and sexual function
- Poor recovery from workouts or stress
- Sleep disturbances
When to get tested: Men experiencing multiple symptoms should request comprehensive hormone testing, ideally including total and free testosterone, SHBG, estradiol, DHT, cortisol (preferably with diurnal pattern), thyroid panel, and metabolic markers.