More and more clinics are offering men testosterone replacement therapy (TRT), the male hormone par excellence, to optimize their health. The idea is not to treat medical problems, but to “optimize” energy, concentration and masculinity. Those who promote these therapies promise their clients increased sexual desire, improved physical and mental agility, stronger and longer erections, decreased abdominal fat and increased muscle mass. A male panacea, in short.
But what is true? Testosterone therapy can certainly be life-changing for men with a medically confirmed deficiency known as hypogonadism, a condition in which the body does not produce enough testosterone because the testicles or the brain’s hormonal control system are not functioning properly.
This can be caused by injury, infection, genetic problems, or chronic diseases such as obesity and diabetes. When testosterone levels are very low, restoring them can improve mood, sex drive, muscle strength, and bone health.
There is also growing research into the broader metabolic effects of testosterone. In men with low levels who also have type 2 diabetes, obesity, or heart disease, the therapy may help improve insulin sensitivity (how well the body responds to insulin to regulate blood sugar), as well as fat distribution and blood vessel health.
The challenge of testing and diagnosis
However, it is advisable to be cautious. Many private clinics dedicated to “men’s health” point out that symptoms such as tiredness, stress or lack of motivation are possible signs of low testosterone levels. And they encourage men who suffer from it to get tested, at their own expense.
Self-diagnosis is dangerous and inaccurate. For starters, these tests are generally performed on samples obtained through a finger prick, rather than on blood drawn from a vein. While fingerstick tests can be faster and more convenient, they are also more prone to errors if the sample has not been collected carefully. Venous samples taken by qualified personnel, however, are more reliable and usually provide higher quality results.
Testosterone levels fluctuate naturally throughout the day, peaking early in the morning and decreasing throughout the day. For this reason, doctors recommend carrying out the test on two different mornings, preferably on an empty stomach. A single test without fasting can give misleadingly high or low results.
Low testosterone level?
There is no single definition of what is considered “low testosterone.” Reference ranges differ between labs, and “normal” varies depending on age, health and genetics. Some men with lower levels feel perfectly fine, while others experience symptoms at the same level.
The body’s response also depends on the sensitivity of its androgen receptors, i.e. the molecular switches that trigger the action of testosterone within cells. Therefore, blood concentration alone is not a reliable indicator.
Clinical guidelines insist that diagnosis should combine symptoms and blood test results. Without forgetting that many of the problems attributed to “low testosterone” (fatigue, lack of sleep, loss of motivation, weight gain) can often be linked to stress, depression or lifestyle factors such as alcohol consumption and inactivity.
The myth of optimization
Testosterone has become a cultural symbol of strength and virility. When testosterone therapy is seen as a shortcut to gaining confidence or masculinity, rather than a treatment for an actual deficiency, it can trap men in a cycle of insecurity and dependency.
More and more men are starting testosterone therapy even if their hormone levels are normal, attracted by the promises of greater vitality, greater concentration and better physical performance.
However, raising testosterone levels above about 12 nanomoles per liter – the standard unit used in blood tests – likely produces no additional benefit in areas linked to testosterone deficiency, such as sexual function, energy or mood. Men already in this range who add therapy may expose themselves to side effects with little or no benefit.
And once treatment begins, the body’s natural hormone production slows, so therapy often only has long-term effects. Additionally, quitting can cause a sort of temporary withdrawal, as it takes time for the body to restart testosterone production.
It can cause blood clots and infertility
When prescribed correctly and carefully monitored, testosterone therapy is generally safe. Initial fears that it might increase the risk of prostate cancer have largely been dispelled, and some studies even suggest that it might offer protection.
However, other research links the therapy to a slightly increased risk of atrial fibrillation (irregular heartbeat) and blood clots.
The most immediate concerns are fertility. The treatment reduces the signal from the brain that triggers the production of testosterone and sperm in the testicles. Over time this can lead to infertility, sometimes permanent if therapy is continued for more than 3-5 years.
In men who still want to have children, doctors may add drugs called gonadotropins, which mimic the brain’s natural fertility hormones to keep the testicles producing sperm. But they require specialized treatment.
Men’s health gap
Testosterone is a prescription drug for a reason: It requires careful diagnosis, regular blood tests, and careful monitoring by specialists trained in hormone medicine. When used correctly, testosterone restores health. But if used carelessly, there is a risk of weakening it.
When men trust advertisements online or private clinics, instead of undergoing a correct medical evaluation, they risk receiving treatment that is useless or even harmful to their health. The problem is that many men avoid going to the doctor and true testosterone deficiency often goes undiagnosed.
The rise of this trend has highlighted a long-existing gap in men’s health. In the UK, for example, endocrinology clinics are becoming saturated with men turning to health services seeking reassurance, monitoring or to manage the side effects of a therapy they may never have needed. With proper supervision and stronger connections with health systems, we would avoid unnecessary treatments.
Daniel Kelly He is a senior lecturer in Biochemistry at Sheffield Hallam University, England.
This article was originally published in The conversation.
