Kade was 21 years old when he started injecting testosterone. On the surface, he looked like the picture of health, but he didn’t feel like it. He felt unmotivated and anxious, so anxious he couldn’t drive.
“I had very low energy. I had very low motivation. I struggled to get out of the bed in the morning,” Kade, who lives between Idaho and Florida, told me over the phone.
Things changed when his primary-care doctor ran extensive blood work and found just one red flag. He had low testosterone levels, in the range of 219 to 239 nanograms per deciliter. Doctors disagree on the “typical” range, but generally say men in their 20s have around 400 to 600. For Kade, this was a glimmer of hope: finally, something he could try to fix.
Four years later, you can find Kade on TikTok, telling 74,000 followers he transformed his well-being — and body composition — with a regimen of twice weekly testosterone injections. At 25, he feels like a new man, he said. He’s healthy, muscular, lean, full-bearded, and horny. He said his sex drive is “uncaged.”
“If you wake up in the morning and your soldier is not standing at full salute or your tent is not fully pitched, you have low testosterone,” Kade, who doesn’t use his last name publicly, said in one video, punctuating his sentences with the occasional swing of a syringe. People comment on his page asking for more information about his doses. He tells them to check out LaSara Medical Group, a virtual clinic for men’s sexual health. (LaSara confirmed Kade gets free treatments in exchange for referrals.)
Kade’s story is not unique. He represents a growing swath of young men turning to testosterone-replacement therapy (also known as TRT or simply T) to, in their view, optimize their bodies.
Once taboo — a private matter for an older guy with erectile dysfunction or a hormonal deficiency — it has now become a point of pride for men to proactively track their testosterone levels and confront dips.
Take Alexis Ohanian, the 41-year-old Reddit cofounder and Serena Williams’ husband, who recently posted on X about his (relatively high) testosterone levels. He credited weightlifting, cutting down on meat and alcohol, and taking testosterone-support supplements from the healthcare company Ro, in which he is an investor. In 2018, Joe Rogan told podcast listeners he started TRT when he turned 40 to make his body “work way better.” In 2021, the actor Dax Shepard, then 46, said on his podcast that he had gained 24 pounds of muscle thanks, in part, to “heavy testosterone injections.”
While primary-care doctors may recommend diet tweaks and better sleep to naturally boost testosterone levels, a booming industry of men’s clinics offers more potent alternatives.
Prescriptions for testosterone-replacement therapy have dramatically increased across the US over the last two decades, rising 20% from 2016 to 2019. More recent data, while limited due to inconsistent monitoring, suggests the rate is steadily climbing. Only a tiny fraction of that can be attributed to trans healthcare; 0.3% of the US population is trans, according to the CDC.
This trend tells a story of a new kind of gender-affirming care, but for cisgender men. Testosterone is prescribed to treat a set of vague symptoms for men hoping to feel “better,” though it’s not exactly clear what it does or who needs it. In his 2007 analysis of the testosterone market, the legendary medical sociologist Peter Conrad said: “Testosterone became a drug in search of a disease to treat.” Nearly two decades later, the search continues, with male insecurity as a stand-in condition.
The house that Viagra built
Our fascination with testosterone dates back to over a century ago, when endocrinologists found that testosterone is associated with male aging. In 1889, Charles-Édouard Brown-Séquard, an eccentric French physiologist, injected himself with testicular blood and seminal fluids from dogs and guinea pigs, saying the experiment rejuvenated his energy and libido at 72.
While we now know that is impossible based on how testicles store hormones — at best, it was a placebo effect — the concept kick-started a new era of hormone research. What followed was a century of patchy research, with some groundbreaking discoveries that shaped the modern era of trans care but not enough clarity to warrant widespread testosterone prescriptions for cisgender men.
But the story of today’s testosterone clinics begins in 2017, with Viagra coming off patent.
Viagra, a vasodilator that can help men achieve an erection, created an industry to medically treat masculinity in a way never seen before. When the generic form entered the market, the little blue pill dropped in cost from $88.45 a pill to $1 to $4 apiece. Direct-to-consumer telehealth companies — including the startups Hims and Ro — popped up, offering consultations and treatments for conditions that were historically taboo to talk about, such as erectile dysfunction and hair loss.
Popularly known as the hormone responsible for making a man “manly,” testosterone was the natural next step in this growing healthcare market. Now, you can go to a clinic to fix more than just the strength of your erections and the hair on your head. Testosterone therapy promises to make you more muscular, hornier, and more driven. By conventional definitions, it promises to make you more of a man.
Between 2017 and 2019, some of the leading DTC men’s websites saw a 1688% increase in unique visits, averaging 5 million visits a month, a study published in Sexual Medicine found. DTC health companies and telehealth have continued to expand since their explosion during the pandemic, and these figures are even larger today. “This business model practically built itself,” Dr. Justin Houman, a urologist and assistant professor at Cedars-Sinai in Los Angeles, wrote in a recent analysis of the men’s health clinic industry.
When LaSara’s cofounder John Snedegar opened up his brick-and-mortar men’s health clinic in 2017, “nobody” was specializing in men’s sexual health, he said. A urologist might check your testosterone levels if you were over the age of 40 and struggling with sex or fertility. Seven years later, his clinic is a tiny fish in an ocean of thousands of competitors offering specialized testosterone therapies to healthy men of all ages.
“It used to be considered an old men’s treatment,” Snedegar, an entrepreneur and former yoga instructor, said. “Now we have patients in their 20s and their 30s and their 40s with low testosterone seeking treatment.”
Here’s how it typically works: You sign up on a clinic’s website, answer questions about your energy, happiness, erections, and sex drive, and maybe do a phone consultation. Some clinics, such as Maximus, a telehealth company, ship an at-home testing kit to you to assess your testosterone levels. In-house doctors review and approve your test results; the website assures prospective customers: “No need to sweat it. Most men are approved for treatment.” Other clinics, such as LaSara, require blood work to be done in an affiliated lab first.
Given that testosterone treatment is typically presented to patients as a lifelong endeavor (it can affect your natural production of testosterone, and attempting to stop TRT can have “withdrawal” effects such as weight gain), men’s health clinics typically offer all-inclusive membership models. You pay a couple of hundred dollars a month, and that covers your lab work and injection therapy. At LaSara, patients pay $170 a month for shots, consultations, and lab work. Low T Center, headquartered in Texas, offers prescriptions for $105 a month, after you pay $160 for two lab exams. Some clinics offer discounts if you sign up for six months or a year at a time.
Gameday Men’s Health, quickly becoming a main player in the space, does not offer telehealth, and regular lab work is required and performed on-site. In lieu of the convenience of telehealth, it offers “a man-cave environment,” Evan Miller, Gameday’s founder and CEO, said.
“Guys are hanging out in the lobby, watching ESPN, eating fruit snacks,” he said. “Every guy who walks in the door, we just make him feel like a brother, help him feel the best he can under medical guidelines.”
Does it work?
Testosterone deficiency requiring medical intervention is not common, nor is it an inevitability awaiting all men as they hit middle or even old age.
Research has found about 20% of young men are considered low in testosterone or hypogonadal, a condition in which the body’s sex glands produce little to no hormones. However, there’s disagreement about what’s considered a normal range, and attempts at establishing clinical definitions for low testosterone and andropause (“male menopause”) have stalled. Testosterone levels also fluctuate throughout a man’s life, even within a given day.
As is common in medicine, the symptoms that might warrant a prescription are vague and ubiquitous. Telltale signs of low testosterone are reduced libido, fatigue, osteoporosis and fractures, and erectile dysfunction — things that are relatively prevalent among men to varying degrees and for different reasons. Obesity and type 2 diabetes are associated with low testosterone, though it’s unclear whether a testosterone dip influences these conditions or the other way around.
I was like, ‘Well, are you on TRT?’ And they’re like, ‘Yeah.’ I was like, ‘Well, that kills your sperm.’
Dr. Justin Dubin, a urologist in Miami, Florida
A couple of years ago, Derek, a 38-year-old glazier from Southern California, was reading Men’s Health magazine when he came across an article about testosterone-replacement therapy. “A lot of the symptoms that were described in there were fitting my situation,” Derek, who asked to withhold his last name for privacy, told me. These were symptoms such as “a massive, massive amount of fatigue,” erectile dysfunction, poor sleep quality, excess body fat, and inability to put on muscle despite diet and exercise changes, he said.
Derek searched for clinics online and arrived at Gameday Men’s Health. A year and a half of weekly injections later, he can’t contain his excitement. “I love testosterone. I would never stop taking testosterone, ever,” he told me on the phone. These days, he said, he has enough energy to work two jobs seven days a week.
Dana, 45, a roofer and grip on movie sets in California, said he used to roll his eyes at “cheesy” commercials for “T-boosting” products that promised “you’ll have so much energy and you’ll perform better in the bedroom.” But things changed in his 40s. He said that after “hitting a plateau in the gym,” he decided to try out TRT, telling himself he could always stop if he didn’t like it. Within four weeks, he noticed increased energy levels, and his wife noticed a spike in his libido. A year later, he’s sold on the importance of maintaining your T levels. “The energy, the libido, and the physical gains in the gym are, like, the three top sellers for me,” Dana, who also asked to withhold his last name for privacy, told me. “I don’t know why it’s not more talked about.”
Will TRT work for every man like it has for Kade, Derek, and Dana?
There is no denying that low testosterone has genuine health impacts. “When you’re having lower testosterone levels, your vitality for life, your vigor for life, your vigor for sex, for exercise, for everything is just poor,” Houman said. But he typically recommends lifestyle changes, like more exercise, eating better, and getting good sleep, which all naturally help to boost testosterone levels.
Prescribing TRT to healthy young men is a controversial practice within mainstream medicine. Studies have found the benefits to be mixed. Most trials are too small to glean anything from or feature only older men, leaving unanswered questions about how TRT affects men below 35. There is solid evidence that hypogonadal men treated with TRT may experience increased muscle mass and reduced fat mass — at least for a few weeks. One of the few long-term studies found middle-aged and older men who took TRT to boost testosterone and libido had more energy, better sex, and more sexual desire for two years.
Plus, the downsides are real: hair loss, acne, and a possible worsening of sleep apnea. Infertility, too: Urologists across the country told me that they had fielded a surprising number of puzzled young patients who weren’t aware that boosting testosterone also decreases sperm production.
“I was seeing more and more young men come to the office on TRT,” Dr. Justin Dubin, a urologist in Miami, said. “They were coming for fertility care. And basically, I was like, ‘Well, are you on TRT?’ And they’re like, ‘Yeah.’ I was like, ‘Well, that kills your sperm.'”
Dubin was curious about this, so he did a secret-shopper study on direct-to-consumer companies, published in JAMA in 2022. Posing as a 34-year-old patient with above-average testosterone levels, he contacted these clinics and said he was interested in preserving his fertility. Six of the seven companies offered him testosterone despite the contraindication. “It was a pretty awakening study for me,” he said.
A new kind of gender-affirming care
Men’s health clinics are, in general, operating in a gray area of medicine. This is not your primary-care doctor taking a holistic perspective of your health needs. This is a business selling a supplement — a boost to add to your routine to feel more like the cultural ideal of a man.
I am on fire to help other men create a great community of people that are bettering themselves
Kade, a 25-year-old testosterone influencer
Crucially, these clinics do not cater to trans men. Clinic directors proudly shared with me the diversity of their patients — from bricklayers to CEOs. When I asked about transgender care, they demurred. That’s something else, they said. Too complicated, too specific. Snedegar told me his clinic took only “biological men.”
Some social scientists have expressed concern about the implications this trend has for broader cultural understandings of masculinity. Gwen Berumen, a sociologist at the University of Texas at Austin, has analyzed the emergence of testosterone discourse on TikTok and found clinics and influencers to be hyperfocused on the idea of “optimizing” your body to achieve an elusive masculine state. “Anything that’s about self-optimization is trying to reach this ideal that you’re never actually going to get to,” Berumen said.
In 2019, the American Psychological Association issued its first-ever warning about the perils of masculinity. The organization said the strict standards of what it means to be a man today were making boys and men feel isolated, weak, and unable to express themselves. Researchers such as Berumen worry the branding of men’s health clinics prop up impossible standards of manhood. The implication is that the only thing between you and unbridled manly perfection is a will and a syringe.
Medicalized masculinity has higher stakes, Berumen said. Gender-affirming care is becoming more accessible, but only for one kind of man: Testosterone clinics for cisgender men are proliferating amid a wave of anti-trans legislation that limits access for transgender Americans. While testosterone therapy for cisgender men may or may not be beneficial in the long term, there’s strong evidence that testosterone treatment is associated with improved mental and physical health and lower levels of suicidality for trans men.
There are some upsides to the expansion of DTC men’s health. Dubin, the Miami urologist, has his doubts about this industry but said inspiring men to care about their health is a good thing. Men have long underused the healthcare system and historically engage in less “healthy” behaviors than women, like eating well and seeing a doctor regularly. “It’s more approachable for many men to talk about their health problems this way, especially men’s health problems, which have a stigma around them,” Dubin said.
These clinics are also helping men forge networks of support.
“Every day I wake up, I read my DMs, I read my comments, and I go film again,” Kade told me. “I am on fire to help other men create a great community of people that are bettering themselves.”
Read the full article here
