14 min readTEN YEARS AGO, I turned 40. When I went in for my annual checkup, I did so with the resolute intention of giving myself a little birthday gift: At long last, I was going to ask about testosterone replacement therapy, or TRT.
I suspected many of the guys around my age at the gym were dabbling in some form of T—their demeanors steelier, their shapes cutting harder lines. The people in my social circles (read: gay men who frequent the gym) who did confide in me about their TRT regimens tempted me with their testimonies of a night-and-day difference in their quality of life. They described greater energy and vitality, better sleep, heightened libido, vanishing body fat, and increased muscle mass.
But it all still felt quite shrouded in privacy. In fact, the only men I heard openly speaking about testosterone at the time were more typically typing about it, often in all caps. Conspiracy types had already indicted an alleged deep state program as the culprit behind the steady decline in American men’s testosterone levels. (If you need evidence, look no further than the surge in the gay frog population.)
Elsewhere online, I encountered men in fitness forums and on bodybuilding message boards wielding testosterone more as a rhetorical cudgel. In the primordial ooze of the manosphere that was just beginning to bubble, “low T” was already a common insult flung at perceived “betas.” That or its cousin, “soy boy,” a reference to the estrogenic reputation of soybeans.
Maybe it was rubbing off on me. In the months leading up to my appointment, I found myself reading my physical features in the mirror as something more like symptoms: my iffy, patchy beard. My stubbornly pudgy midsection. My tortoise-slow progress making gains in the gym, despite busting my ass there three or four times a week. I was also starting to feel a creeping physical indifference, a heavy malaise that now and then teetered on the precipice of depression. I wasn’t unhappy, but I sure wasn’t happy. (I was also very not horny, which felt new.)
But for as long as I’d been thinking about T, I’d had hesitations about starting it. For one thing, I’m not big on needles. Or pills. Or doctors. For another, my dad’s bout with prostate cancer several years earlier—and the regimen of androgen deprivation therapy required to suppress his androgens, including testosterone—had left me with the impression that T was hormona non grata. As a result—or possibly a coping mechanism—I developed a kind of stubborn pride in remaining “natty.” I had superimposed a notion of honor on the idea of working with what I had.
Still, my patience with my body was wearing thin, and my wariness on these fronts was waning. The milestone of 40 seemed as good an occasion as any to get the fluids topped off, and not a moment too soon: At around this age, T levels in men start declining by around 1 to 2 percent per year. Surely, I thought, sitting on the exam table in my paper gown, my blood would spill its long overdue story and the doctor would return to confirm that I was objectively, numerically, and obviously (*gestures around body*) qualified to receive restorative doses of the good stuff.
“You’re perfectly normal,” he said instead. My heart sank.
Seemingly aware that his good news had landed as bad news, the doctor adopted an apologetic melody that sounded as if he’d sung it many times before, gently explaining to me that I didn’t, in fact, need more testosterone. (It didn’t feel helpful to clarify that I just wanted it.) He also wasn’t a fan of the family history of prostate cancer and cardiovascular disease. And at this point in the consult, I wasn’t a fan of his tone.
His concerns, however, were rooted in the science available at the time. The medical community has long believed testosterone is linked to prostate cancer, and research published in 2013 found a concerning link between TRT and “adverse cardiovascular events.” The FDA issued a Drug Safety Communication in 2014, followed by a label change in 2015 that required listing the possible increased risks of stroke and heart attack on all testosterone products. The agency approved its use only for men with certain medical conditions and stated that using these products for age-related declines in testosterone required further investigation.
But not even a scarily worded label could effectively ward off the impending testosterone boom. Within a few years, testosterone had undergone a cultural rebrand from hush-hush hormonal helper (and building block of many a bodybuilder’s performance-enhancing drug stack) to something more like a longevity protocol—the motor oil of the modern man’s body shop and an essential element of an “optimized” lifestyle. The very same federal agency that warned against treating low T due to aging is trying to increase American men’s access to TRT.
Helping to fuel the demand is a squad of T-teasing celebrities, influencers, podcasters, and politicians, from Joe Rogan to Alan Ritchson to Andrew Huberman to RFK Jr., all of whom have openly spoken about their TRT regimens. Now everyone from your Gen Z cousin to your dad to your grandpa seems to be focused on maintaining the peak levels of their youth, and a swath of online clinics are eager to offer up the goods. How did we get here, and what are we all really seeking?
TRT TRACES ITS roots to the 1930s, after German biochemist Adolf Butenandt and Swiss chemist Leopold Ružička successfully achieved the first chemical synthesis of testosterone, the primary sex hormone in our bodies that’s largely produced in the testicles and responsible for stuff like muscle mass, sperm production, and bone density. This breakthrough laid the groundwork for modern hormone replacement therapies. By 1952, testosterone cypionate, a long-acting, injectable synthetic form of testosterone, was introduced to the U.S. market under the brand name Depo-Testosterone. Shortly after its development, the anabolic potential of T was discovered. In 1953, another popular form of synthetic T, testosterone enanthate, came on the market and became available by prescription to men with hypogonadism, a condition in which the body doesn’t produce enough sex hormones.
This testosterone also found its way into the mix of a nascent bodybuilding culture—though unlike with TRT, which “replaces” natural T levels in your body (typically ranging from 300 ng/dL to 1,000 ng/dL in healthy men), bodybuilders’ dosages exceeded “normal” levels. By the 1960s, testosterone was among the many steroids commonly used in bodybuilding circles. A very public athletic doping scandal during the 1988 Seoul Olympics led the U.S. government to categorize testosterone as a Schedule III controlled substance in 1990. This would put testosterone and other anabolic steroids under the same regulatory oversight as ketamine and opioids due to rising concerns over nonmedical use and athletic doping.
By the early aughts, the cultural stigma around T was as pervasive as the many PED investigations that were rocking the MLB. It started with Jose Canseco and Barry Bonds, who admitted to taking T and the steroid THG, and continued with A-Rod, who took HGH and T. It all came to a head with the Biogenesis scandal, which involved more than 20 big-name players taking performance-enhancing drugs (including T). It only served to confirm testosterone’s bad reputation. The taboo around T persisted, even in bodybuilding circles, not least of all because it was illegal to purchase without a prescription. To admit one’s use of T was to show off one’s shortcut—you can’t spell cheating without T.
“It used to be that you would never answer questions about what drugs you were using,” recalls IFBB pro Jose Raymond, 51, an accomplished bodybuilder who started his journey on T (among other PEDs) back in 2009, while eyeing that year’s New York Pro. But in the years since then, the stigma around talking about and even using T, he says, has significantly decreased. “Ninety-nine percent of bodybuilders are willing to talk about it because it’s no longer taboo.”
That sentiment has expanded beyond bodybuilding circles. The combined forces of telehealth marketing, the manosphere, and optimization culture have converged to push a blitz of TRT normalization. Today, 70 percent of U.S. men say their T levels are important to them, according to a Men’s Health/SurveyMonkey study of 2,191 guys across the country. Four in 10 men say their T levels are more important to them now than they were a year ago, and nearly a quarter of men across generations currently know someone who’s on TRT.
The COVID telemedicine boom increased the hormone’s accessibility via online clinics. From 2018 to 2022, TRT prescriptions among men between the ages of 35 and 44 grew by 58 percent, according to a 2024 study. The increase in TRT use by men between the ages of 25 and 34 was even more profound. According to our survey, half of Gen Z men believe that the more testosterone you have, the better-looking you are. This idea is currently playing out in the T-maxxing trend, in which young men attempt to boost their levels using TRT or other protocols. Overall, the global market for TRT is projected to continue growing, from $2.03 billion in 2024 to $2.7 billion by 2033.
Listen, I get the appeal. I’ve spent the decade since that bummer of a doctor’s appointment searching for ways to accomplish what late-night infomercials and supplement ads in magazines like the one you’re reading right now assured me was possible: boost my testosterone “naturally,” a project that might sound easy but requires lots of time, patience, and, apparently, pumpkin seeds.
Inspired by some meme a friend sent me listing the top T-boosting foods, I trained myself to snack on said seeds and spring for zinc-rich oysters. I tried amplifying my exercise regimen, recommitting to lifting heavy weights, convinced my glands could be wrung out like little rags if I never skipped leg days. I tried shocks to the system(s)—I sauna’d and plunged and repeated. I tried everything to boost my T short of sunning my nethers—and not for lack of manfluencers advising me to do just that. (Also, I have neighbors.)
And I’m still not even sure if any of it worked. Belly: still there. Gym: still going. Libido: approaching monkish. I also haven’t had the heart to get my numbers checked again. I still feel the sting of the first rejection, but I started to get curious as I began to report this story. One Google search for “testosterone therapy” later, the gates of T were thrown wide open.
Since the algorithms first picked up the scent of my interest, I’ve been on the receiving end of a relentless barrage of ads for mail-order TRT. My Facebook is now a minefield of targeted pitches for patches, pellets, pills, and pokes. Every 10 swipes or so, they beseech me to schedule telehealth sessions with doctors who “actually listen,” sweetening their deals with the additional assurance that I won’t have to leave the house.
“My hubby went from dad bod to daddy after his testosterone went from 276 to 824,” boasts the copy of a Hone Health ad. Shortly after, an ad from Maximus offers convenient home delivery of T to help defeat “brain fog,” “poor decisions,” and “sinking confidence.”
MaleExcel wants to know if I’m feeling “tired, soft, unfocused, or unmotivated” and, if so, what I plan to do about it: “You’ve seen men your age who are sharper, stronger, more driven.… So why aren’t you feeling the same?” I even found a source for “faith-centered” testosterone replacement therapy: The telehealth portal PeterMD actually takes its name from the saint, which was not my first guess.
Hims urges me to feel like “you [me], boosted” by starting a regimen of enclomiphene citrate, a selective estrogen receptor modulator (SERM) that hasn’t been approved by the FDA but has been clinically shown to stimulate the body’s own testosterone production while preserving sperm count. (Somewhat surprisingly, the telehealth platform doesn’t offer TRT…yet.)
It’s a lot, and not all of it looks legit. But a lot of it does. Through these ads and social media and pop culture, we’re being told that we don’t have to suffer the exhaustion and impotence and flabbiness that our dads and grandpas once did. The idealist in me wonders if TRT might shake loose the expectations that, for generations, have attended middle age. Rather than imagining ourselves “over the hill,” what if we’ve found a way to stop at the summit and enjoy the view? The cynic in me wonders if the push toward a high-T populace represents something darker—a culture that preys on men’s insecurities by drawing simplistic equivalencies between our hormone levels and our sense of self. After all, nearly half the men in our survey believe their testosterone level is a measure of their masculinity.
That’s probably because we’ve got some of the most powerful people in government blurring the lines between health and manhood and what it means to age well. On the podcast of Katie Miller, wife of U.S. homeland security advisor Stephen Miller, U.S. Health and Human Services Secretary RFK Jr. cited President Trump’s testosterone level as proof of his health and manliness: “Dr. Oz looked at his medical records and said he’s got the highest testosterone level that he’s ever seen for an individual over 70 years old,” adding, “I know the president will be happy that I repeat that.”
Beyond the public displays of pushups and situps during a sweat session with Kid Rock (my apologies for that image), RFK Jr. has openly discussed his own seemingly off-label use of TRT. On a 2023 episode of Lex Fridman’s podcast, the then-69-year-old secretary admitted to “an antiaging protocol from my doctor that includes testosterone replacement.” Kennedy quickly added that he “doesn’t take steroids” (testosterone is technically a steroid) and that his TRT was “bioidentical” to what the body produces.
Currently, the FDA approves TRT only for men diagnosed with hypogonadism due to physical damage or malfunction of hormone-producing glands, genetic conditions, infections, tumors, or inflammatory diseases. Last December, however, the agency assembled a panel to discuss revising the testosterone therapy guidelines for men, which included potentially improving access to TRT for age-related testosterone deficiency. In his opening remarks, former FDA commissioner Marty Makary, MD, noted that more than one-third of men over 45 have testosterone levels below normal and challenged testosterone’s status as a controlled substance, “given the potential clinical benefits and the barrier that scheduling may present.”
Army major and urologist Theodore Crisostomo-Wynne, MD, emphasized the importance of appropriate access for active-duty military members with low T to optimize fitness, energy levels, and recovery time. (Secretary of Defense Pete Hegseth recently backed this up when he announced that he plans to screen all troops for low testosterone. The goal? A “High-T Department of War.”) FDA principal medical advisor Richard Iorio, MD, pointed to testosterone, shown to maintain bone mineral density, as a potential preventive measure against osteoporosis in men. And Shalin Shah, CEO of Marius Pharmaceuticals, put his pitch in bold. “This is not a lifestyle drug,” he said. “We need to fast-track an approval to use testosterone alongside GLP-1s in order to prevent a frailty crisis.”
The panel participants seemed most buoyed, however, by the results of a 2023 study called TRAVERSE (testosterone replacement therapy for assessment of long-term vascular events and efficacy response in hypogonadal men), which many experts say provides evidence that the benefits of TRT outweigh the risks. Published in The New England Journal of Medicine, the study of over 5,000 men with hypogonadism is credited with debunking suggested links between testosterone therapy and “major adverse cardiac events.” A subsequent publication of the study found that TRT does not increase the risk of prostate cancer in men with low T.
Today, more than half the men in our survey don’t believe TRT is dangerous to their health, and they’re more aware of the symptoms of low testosterone (low energy, low libido, loss of muscle mass, mood changes, increased body fat) than the symptoms of high testosterone (acne, hair loss, infertility, heart or liver problems, mood changes, enlarged breasts). In fact, half the men believe that a high testosterone level will help them live longer. Those who primarily get their information from podcasts, influencers, or online communities are more likely to hold this belief than those who get their information from medical professionals.
It makes sense: You’ve got longevity bros like Andrew Huberman, PhD, and Peter Attia, MD, who have spoken about the relationship between testosterone levels and aging well. But when Huberman himself disclosed during an interview with six-time Mr. Olympia winner Dorian Yates that he’s been on “low-dose TRT” for about five years, some commenters on the r/HubermanLab subreddit were furious. They claimed that TRT goes against the basic lifestyle interventions he’s known to suggest on his Huberman Lab podcast, like sleep, exercise, and good ol’ sunlight. They then started to debate whether Huberman was “juicing” if he didn’t already have a low T level and what else was in his stack that he hadn’t disclosed.
As normalized as TRT has become, these online debates are a reminder of how nuanced this stuff can get—and the capital-F Feelings people have about testosterone and TRT—depending on what corner of the Internet you find yourself in. And sometimes those corners can get very dark. People like biohacker Dave Asprey are out there equating high testosterone levels with more “conviction, clarity, and backbone” and promoting TRT as a way to “age backwards.”
But for the dozens of men we spoke to for this article (their stories are featured here), the point of going on therapy wasn’t to feel more like a man or “ascended.” The goal was to feel more like themselves—the type of gender-affirming care more typically associated with transgender and gender-nonconforming people. Do some of them want to feel “optimized”? Yes. But many felt so shitty—the fatigue, the insomnia, the loss of drive—that they just wanted a sense of normalcy again. Is that really such a bad thing?
“I do believe that for some people, increasing their testosterone is probably good news,” says Lyndon Haviland, DrPH, a distinguished scholar at the CUNY Graduate School of Public Health and Health Policy. “But when you do a good marketing campaign, you shorten all the information—you get the black and white and you don’t get any of the gray.”
In a recent opinion piece, Haviland warned that testosterone therapy won’t help men address their higher rates of diabetes, hypertension, or heart disease. Nor, she warned, will it address mental health issues or men’s resistance to getting treatment for them: “Stigma associated with seeking help is often to blame.” One review of the TRAVERSE study, however, pushes back on this point. “In reality,” writes urologist Geoffrey Ian Hackett, MD, “men on TRT are likely to be at an advantage by seeing physicians regularly and being able to discuss a range of men’s health issues.”
Whichever camp you’re in, the testosterone craze likely isn’t gonna chill out anytime soon. While Dr. Makary’s sudden departure from the FDA throws the future of T reform into question, there are still plenty of T advocates in the administration. One is Admiral Brian Christine, MD, the assistant secretary for health at the U.S. Department of Health and Human Services, whose appointment to lead the hantavirus outbreak response drew fresh attention to his past life as a urologist specializing in penile implants. (He also hosted a YouTube series titled “Erection Connection.”)
“Sexual health is an important component of overall well-being and quality of life,” he said in a statement in April when the FDA indicated it may be open to expanding the use of TRT to treat low libido in men with idiopathic hypogonadism (low T without a known cause). Dr. Christine’s goal is to reevaluate the issue of TRT through the lenses of “scientific rigor, clinical practice, patient experience, and public health impact”—or, put more succinctly, living the Make America Healthy Again (MAHA) agenda.
However things shake out, men would be wise to bear one thing in mind: What makes you a better man won’t come through an injection or a pill, and it won’t happen overnight. But if you’ve been running on fumes for too long, a change of course might be worth a shot (no matter how much some of us—errr, me—may hate needles). And with that, I’m off to get some blood drawn.
Meet the men on T and read their stories here. Learn more about the survey, including the methodology, here.
Photographs: Cory Vanderploeg
Grooming: Walton Nunez
Deputy Visual Director: Muzam Agha
Art Director: Gillian MacLeod
Features Director: Rachel Epstein
This story originally appears in the Summer 2026 issue of Men’s Health.
Michael Andor Brodeur is the author of SWOLE: The Making of Men and the Meaning of Muscle.
