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14 min read<\/span><\/div>\nTEN YEARS AGO, <\/strong>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.<\/p>\n I suspected many of the guys around my age at the gym were dabbling in some form of T\u2014their 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.<\/p>\n 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<\/a> in American men\u2019s testosterone levels. (If you need evidence, look no further than the surge in the gay frog population.)<\/p>\n 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, \u201clow T\u201d was already a common insult flung at perceived \u201cbetas.\u201d That or its cousin, \u201csoy boy,\u201d a reference to the estrogenic reputation of soybeans.<\/p>\n 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\u2019t unhappy<\/em>, but I sure wasn\u2019t happy. (I was also very not horny, which felt new.)<\/p>\n But for as long as I\u2019d been thinking about T, I\u2019d had hesitations about starting it. For one thing, I\u2019m not big on needles. Or pills. Or doctors. For another, my dad\u2019s bout with prostate cancer several years earlier\u2014and the regimen of androgen deprivation therapy required to suppress his androgens, including testosterone\u2014had left me with the impression that T was hormona non grata.<\/em> As a result\u2014or possibly a coping mechanism\u2014I developed a kind of stubborn pride in remaining \u201cnatty.\u201d I had superimposed a notion of honor on the idea of working with what I had.<\/p>\n 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.<\/p>\n \u201cYou\u2019re perfectly normal,\u201d he said instead. My heart sank.<\/p>\n Seemingly aware that his good news had landed as bad news, the doctor adopted an apologetic melody that sounded as if he\u2019d sung it many times before, gently explaining to me that I didn\u2019t, in fact, need<\/em> more testosterone. (It didn\u2019t feel helpful to clarify that I just wanted it.) He also wasn\u2019t a fan of the family history of prostate cancer and cardiovascular disease. And at this point in the consult, I wasn\u2019t a fan of his tone.<\/p>\n 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<\/a> found a concerning link between TRT and \u201cadverse cardiovascular events.\u201d The FDA issued a Drug Safety Communication in 2014<\/a>, followed by a label change in 2015<\/a> that required listing the possible increased risks of stroke and heart attack on all testosterone products. The agency approved<\/a> its use only for men with certain medical conditions and stated that using these products for age-related declines in testosterone required further investigation.<\/p>\n 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\u2019s performance-enhancing drug stack) to something more like a longevity protocol\u2014the motor oil of the modern man\u2019s body shop and an essential element of an \u201coptimized\u201d lifestyle. The very same federal agency that warned against treating low T due to aging is trying to increase American men\u2019s access to TRT.<\/p>\n 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?<\/p>\n TRT TRACES ITS <\/strong>roots to the 1930s, after German biochemist Adolf Butenandt and Swiss chemist Leopold Ru\u017ei\u010dka successfully achieved the first chemical synthesis of testosterone, the primary sex hormone in our bodies that\u2019s 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\u2019t produce enough sex hormones.<\/p>\n This testosterone also found its way into the mix of a nascent bodybuilding culture\u2014though unlike with TRT, which \u201creplaces\u201d natural T levels in your body (typically ranging from 300 ng\/dL to 1,000 ng\/dL in healthy men), bodybuilders\u2019 dosages exceeded \u201cnormal\u201d 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.<\/p>\n 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\u2019s 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\u2019s use of T was to show off one\u2019s shortcut\u2014you can\u2019t spell cheating<\/em> without T.<\/p>\n \u201cIt used to be that you would never answer questions about what drugs you were using,\u201d 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\u2019s New York Pro. But in the years since then, the stigma around talking about and even using T, he says, has significantly decreased. \u201cNinety-nine percent of bodybuilders are willing to talk about it because it\u2019s no longer taboo.\u201d<\/p>\n 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\u2019s Health<\/em>\/SurveyMonkey study<\/a> 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\u2019s on TRT.<\/p>\n The COVID telemedicine boom increased the hormone\u2019s 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<\/a>. The increase in TRT use by men between the ages of 25 and 34 was even more profound<\/a>. 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<\/a>, from $2.03 billion in 2024 to $2.7 billion by 2033.<\/p>\n Listen, I get the appeal. I\u2019ve spent the decade since that bummer of a doctor\u2019s appointment searching for ways to accomplish what late-night infomercials and supplement ads in magazines like the one you\u2019re reading right now assured me was possible: boost my testosterone \u201cnaturally,\u201d a project that might sound easy but requires lots of time, patience, and, apparently, pumpkin seeds.<\/p>\n 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)\u2014I sauna\u2019d and plunged and repeated. I tried everything to boost my T short of sunning my nethers\u2014and not for lack of manfluencers advising me to do just that. (Also, I have neighbors.)<\/p>\n And I\u2019m still not even sure if any of it worked. Belly: still there. Gym: still going. Libido: approaching monkish. I also haven\u2019t 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 \u201ctestosterone therapy\u201d later, the gates of T were thrown wide open.<\/p>\n Since the algorithms first picked up the scent of my interest, I\u2019ve 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 \u201cactually listen,\u201d sweetening their deals with the additional assurance that I won\u2019t have to leave the house.<\/p>\n \u201cMy hubby went from dad bod to daddy<\/em> after his testosterone went from 276 to 824,\u201d boasts the copy of a Hone Health ad. Shortly after, an ad from Maximus offers convenient home delivery of T to help defeat \u201cbrain fog,\u201d \u201cpoor decisions,\u201d and \u201csinking confidence.\u201d<\/p>\n MaleExcel wants to know if I\u2019m feeling \u201ctired, soft, unfocused, or unmotivated\u201d and, if so, what I plan to do about it: \u201cYou\u2019ve seen men your age who are sharper, stronger, more driven.\u2026 So why aren\u2019t you feeling the same?\u201d I even found a source for \u201cfaith-centered\u201d testosterone replacement therapy: The telehealth portal PeterMD actually takes its name from the saint, which was not my first guess.<\/p>\n Hims urges me<\/a> to feel like \u201cyou [me], boosted\u201d by starting a regimen of enclomiphene citrate, a selective estrogen receptor modulator (SERM) that hasn\u2019t been approved by the FDA but has been clinically shown<\/a> to stimulate the body\u2019s own testosterone production while preserving sperm count. (Somewhat surprisingly, the telehealth platform doesn\u2019t offer TRT\u2026yet.)<\/p>\n It\u2019s 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\u2019re being told that we don\u2019t 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 \u201cover the hill,\u201d what if we\u2019ve 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\u2014a culture that preys on men\u2019s 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.<\/p>\n That\u2019s probably because we\u2019ve 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\u2019s testosterone level as proof of his health and manliness: \u201cDr. Oz looked at his medical records and said he\u2019s got the highest testosterone level that he\u2019s ever seen for an individual over 70 years old,\u201d adding, \u201cI know the president will be happy that I repeat that.\u201d<\/p>\n 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\u2019s podcast<\/a>, the then-69-year-old secretary admitted to \u201can antiaging protocol from my doctor that includes testosterone replacement.\u201d Kennedy quickly added that he \u201cdoesn\u2019t take steroids\u201d (testosterone is technically a steroid) and that his TRT was \u201cbioidentical\u201d to what the body produces.<\/p>\n 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<\/a> 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\u2019s status as a controlled substance, \u201cgiven the potential clinical benefits and the barrier that scheduling may present.\u201d<\/p>\n 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<\/a> that he plans to screen all troops for low testosterone. The goal? A \u201cHigh-T Department of War.\u201d) 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. \u201cThis is not a lifestyle drug,\u201d he said. \u201cWe need to fast-track an approval to use testosterone alongside GLP-1s in order to prevent a frailty crisis.\u201d<\/p>\n The panel participants seemed most buoyed, however, by the results of a 2023 study called TRAVERSE<\/a> (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<\/em>, the study of over 5,000 men with hypogonadism is credited with debunking suggested links between testosterone therapy and \u201cmajor adverse cardiac events.\u201d A subsequent publication<\/a> of the study found that TRT does not increase the risk of prostate cancer in men with low T.<\/p>\n Today, more than half the men in our survey don\u2019t believe TRT is dangerous to their health, and they\u2019re 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.<\/p>\n It makes sense: You\u2019ve 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\u2019s been on \u201clow-dose TRT\u201d<\/a> for about five years, some commenters on the r\/HubermanLab subreddit were furious. They claimed that TRT goes against the basic lifestyle interventions he\u2019s known to suggest on his Huberman Lab<\/em> podcast, like sleep, exercise, and good ol\u2019 sunlight. They then started to debate whether Huberman was \u201cjuicing\u201d if he didn\u2019t already have a low T level and what else was in his stack that he hadn\u2019t disclosed.<\/p>\n As normalized as TRT has become, these online debates are a reminder of how nuanced this stuff can get\u2014and the capital-F Feelings people have about testosterone and TRT\u2014depending 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<\/a> high testosterone levels with more \u201cconviction, clarity, and backbone\u201d and promoting TRT as a way to \u201cage backwards.\u201d<\/p>\n But for the dozens of men we spoke to for this article (their stories are featured here<\/a>), the point of going on therapy wasn\u2019t to feel more like a man or \u201cascended.\u201d The goal was to feel more like themselves\u2014the type of gender-affirming care more typically associated with transgender and gender-nonconforming people. Do some of them want to feel \u201coptimized\u201d? Yes. But many felt so shitty\u2014the fatigue, the insomnia, the loss of drive\u2014that they just wanted a sense of normalcy again. Is that really such a bad thing?<\/p>\n \u201cI do believe that for some people, increasing their testosterone is probably good news,\u201d says Lyndon Haviland, DrPH, a distinguished scholar at the CUNY Graduate School of Public Health and Health Policy. \u201cBut when you do a good marketing campaign, you shorten all the information\u2014you get the black and white and you don\u2019t get any of the gray.\u201d<\/p>\n In a recent opinion piece<\/a>, Haviland warned that testosterone therapy won\u2019t help men address their higher rates of diabetes, hypertension, or heart disease. Nor, she warned, will it address mental health issues or men\u2019s resistance to getting treatment for them: \u201cStigma associated with seeking help is often to blame.\u201d One review of the TRAVERSE study<\/a>, however, pushes back on this point. \u201cIn reality,\u201d writes urologist Geoffrey Ian Hackett, MD, \u201cmen on TRT are likely to be at an advantage by seeing physicians regularly and being able to discuss a range of men\u2019s health issues.\u201d<\/p>\n Whichever camp you\u2019re in, the testosterone craze likely isn\u2019t gonna chill out anytime soon. While Dr. Makary\u2019s 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 \u201cErection Connection<\/a>.\u201d)<\/p>\n \u201cSexual health is an important component of overall well-being and quality of life,\u201d he said in a statement in April when the FDA indicated<\/a> 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\u2019s goal is to reevaluate the issue of TRT through the lenses of \u201cscientific rigor, clinical practice, patient experience, and public health impact\u201d\u2014or, put more succinctly, living the Make America Healthy Again (MAHA) agenda.<\/p>\n However things shake out, men would be wise to bear one thing in mind: What makes you a better man won\u2019t come through an injection or a pill, and it won\u2019t happen overnight. But if you\u2019ve been running on fumes for too long, a change of course might be worth a shot (no matter how much some of us\u2014errr, me<\/em>\u2014may hate needles). And with that, I\u2019m off to get some blood drawn.<\/p>\n Meet the men on T and read their stories here<\/a>. Learn more about the survey, including the methodology, here<\/a>.<\/p>\n Photographs: <\/strong>Cory Vanderploeg This story originally appears in the Summer 2026 issue of <\/em>Men\u2019s Health.<\/p>\n![\"70%](\"https:\/\/hips.hearstapps.com\/hmg-prod\/images\/3eb68cda-588f-47ee-8f24-3a862c3a747f.jpg?crop=1xw:1xh;center,top&resize=980:*\" "\\"70%")
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Grooming: <\/strong>Walton Nunez
Deputy Visual Director: <\/strong>Muzam Agha
Art Director: <\/strong>Gillian MacLeod
Features Director: <\/strong>Rachel Epstein<\/p>\n
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