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The biological cost of high-stress lifestyles For many high achievers, the quest for peak performance often involves a frantic search for the latest supplement or hormone replacement therapy. However, Dr. Peter Attia argues that the most potent levers for endocrine health are far more fundamental. The physiological toll of chronic stress and sleep deprivation can drive testosterone levels into the 10th percentile, effectively rendering a healthy man hypogonadal. When cortisol remains chronically elevated, it disrupts the pituitary-gonadal axis, suppressing the body's internal production of testosterone. Fixing these behavioral pillars can swing levels by as much as 300 to 400 nanograms per deciliter, a shift that dwarfs the efficacy of most over-the-counter products. Gender differences in hormone precursors The conversation around hormone optimization often overlooks the significant role of DHEA, specifically regarding gender biology. While DHEA supplementation is largely ineffective for men—as the resulting adrenal testosterone boost is negligible in the context of male physiology—it represents a vital tool for women. A woman struggling with low libido or poor energy may see her testosterone levels double with oral DHEA, moving from a symptomatic 30 ng/dL to a healthy 70 ng/dL. This shift offers substantial benefits for mood and vitality without the severe virilization risks associated with high-dose testosterone therapy. Longevity lessons from a 93-year-old rower The potential for late-life transformation is best illustrated by a remarkable case study of a 93-year-old athlete. This individual did not begin his journey in his youth; he took up rowing in his 60s. Decades of consistent effort resulted in a VO2 Max comparable to a fit 40-year-old. His success provides a powerful mental model for the "Centenarian Decathlon," proving that physical capacity is an investment that compounds over time. Whether starting at 30 or 60, the goal is to build a reservoir of fitness that ensures high functioning in one's ninth decade.