The Pentagon is preparing to screen service members for low testosterone. The Trump administration wants the FDA to loosen who qualifies for hormone therapy. And between podcast ads, Instagram clinics, and RFK, Jr.’s public enthusiasm for testosterone injections, more men are asking for a prescription than ever. As Will Stone reported for NPR, the evidence on who actually benefits hasn’t kept pace with the hype.
Testosterone therapy does work, for the right patient. A 2023 trial published in the New England Journal of Medicine, called TRAVERSE, followed middle-aged and older men using testosterone gel and found no increased risk of heart attack or stroke compared with placebo, as long as levels stayed within a normal range. It did flag a higher risk of bone fractures, a reminder that “safe” is relative.
The Deficiency Problem
The bigger issue is diagnosis, not the drug. A 2022 study in JAMA Internal Medicine sent secret shoppers with normal testosterone levels to direct-to-consumer clinics. Most got prescribed anyway.
“Now these benefits apply only to men who have low testosterone, unequivocally low testosterone,” Dr. Peter Snyder, an endocrinologist at the University of Pennsylvania, told NPR. “The lower, the more likely are the benefits.”
Dr. Helen Bernie, director of Sexual and Reproductive Medicine at Indiana University, puts it more bluntly. “The goal of testosterone therapy isn’t peak performance,” she says. “It’s not some drug to promise the fountain of youth. It is restoring normal physiology in men who have a true deficiency. I think it’s really important to separate marketing from actual medicine.”
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That distinction matters more as the FDA weighs expanding access. Widening the criteria without fixing how clinics screen patients could mean more men on testosterone who were never deficient in the first place, chasing symptoms — fatigue, low libido, a few extra pounds — that have plenty of other causes.
Testosterone therapy isn’t a scam, and it isn’t a miracle. It’s a treatment for a specific, diagnosable condition. The politics may be moving fast, but the biology, as usual, is taking its time.
