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Warnings about low T - low testosterone - are all over social media, and the military plans to start screening service members for their hormone levels. NPR's Will Stone reports on who really needs testosterone therapy.
WILL STONE, BYLINE: A few times, Jamin Brahmbhatt suspected he might have low testosterone, so he got his numbers checked. Turned out they were normal.
JAMIN BRAHMBHATT: It was more my sleep and stress and everything else that was causing these symptoms, so (laughter)...
STONE: Brahmbhatt is a urologist at Orlando Health in Florida, so he knows what to look for - depressed mood, fatigue, reduced libido, weight gain, trouble concentrating. All of these can be signs.
BRAHMBHATT: Most of the questions were so vague. So it can also be very situational.
STONE: That's why guidelines recommend that men get tested twice and evaluated by a clinician to consider all the possible causes. Unfortunately, Brahmbhatt says, that's not always happening.
BRAHMBHATT: Testosterone has gotten a bad rap because you can just walk into these clinics, get testosterone. They don't even do all the testing. They don't do the follow-up.
STONE: In fact, one study published in 2022 sent secret shoppers to online clinics. It found most were ready to prescribe, even though the patient in question had normal levels. Social media is full of low-T content. It's often framed as a crisis of masculinity, even for younger men. Some clinics tap into these fears and pitch testosterone for optimization, longevity, confidence, focus and strength.
HELEN BERNIE: The goal of testosterone therapy isn't peak performance. It's not some drug to promise this fountain of youth.
STONE: Dr. Helen Bernie is director of male sexual and reproductive medicine at Indiana University.
BERNIE: It is restoring normal physiology in men who have a true deficiency.
STONE: She says testosterone isn't just about sexual health either.
BERNIE: It's really, really important for our overall health - for muscle, for bone, for energy, for moods.
STONE: The underlying causes for testosterone deficiency vary. There are some relatively rare medical conditions, for example, related to genetics. For most men, it's not that. Testosterone declines with age. But Bernie says in younger and middle-aged men, it's related to more than aging. Obesity, diabetes, sleep apnea and other medical conditions can all contribute, and while you can try to correct those issues first, that's not always realistic.
BERNIE: Think of the 60-year-old guy who's got low testosterone. He's tired, he's overweight, you know, he feels terrible. And now I'm telling him, go to the gym, man. Go work out. Well, it's kind of like pushing a huge boulder up an up-battle (ph) hill, right?
STONE: So, she says, sometimes a patient can start testosterone therapy while making these other lifestyle changes too. There are downsides. It suppresses sperm production and, over time, can lead to permanent infertility. About a decade ago, concerns about heart attack and stroke led drugmakers to launch a big safety study. That ultimately did not find an increased risk of major cardiovascular events, though it did find some other harms, like fractures. Dr. Steven Nissen is a cardiologist at the Cleveland Clinic who led that trial. He points out they used a gel, not injectables, and made sure testosterone levels did not go above the upper limit of normal.
STEVEN NISSEN: We used the drug in a very specific way, and we have a very reasonable answer. But I would not feel good if our study resulted in the unrestrained use of testosterone in ways that we didn't study.
STONE: It's a message that can be tough to get across in a culture brimming with high-T content.
Will Stone, NPR News.
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