Testosterone Is Declining Among Young Men. But One of the Proposed Solutions Simply Won’t Help Anyone.

Medical Examiner The Low-T Myth It’s true that testosterone levels are declining among young men. But is more really better? Clavicular. Francois Durand/Getty Images Sign up for the Slatest to get the most insightful analysis, criticism, and advice out there, delivered to your inbox daily. As Pete Hegseth calls for a “high-T” military (and walks back “premature” plans for mandatory testosterone testing for male troops over 30) while looksmaxxer Clavicular admits he secretly ordered the hormone as a teen, testosterone therapy is center-stage in the male wellness space. Advocates claim that testosterone therapy for young men will transform their faces and help them attract women, revamp already healthy bodies into superhuman physiques, and generally make them be more “manly,” regardless of the risks or the actual medical necessity. Yet, while testosterone therapy is a well-documented medical treatment for people who have a deficiency, and a key element of gender-affirming care, it’s not really something that the average young man needs. “Part of the problem with testosterone is everything thinks they know what it is,” says Abraham Morgentaler, a urologist who’s been at the forefront of testosterone research for over 25 years. “There’s this concept out there that if your testosterone number is higher, then all these magical benefits will accrue to you, and it’s simply not true.” One of the most central myths in online testosterone research is that the more is always better, without qualification. But for the vast majority of men in their 20s, testosterone therapy is unnecessary. A normal testosterone level is anywhere from 300 to 1,000 or so nanograms per deciliter (for Morgentaler, a floor of 400 ng/dL is ideal). Not only are the vast majority of young men within this range, the difference between being at the lower end or the higher end of this limit is largely meaningless. “If you looked at 10 guys with normal testosterone, you would have an impossible time trying to pick out the guy with the most testosterone,” says Morgentaler. “The truth is that within the normal range, no matter your age, if you’re not symptomatic, it’s not going to do anything for you until you go way above the upper limit.” Using testosterone supplements to drive hormone levels beyond the upper limit of normal will result in greater muscle mass—it’s why testosterone is sometimes seen as the “poster child” for anabolic steroid misuse. That muscle mass comes at a cost: Misuse is associated with infertility and various heart conditions. The promotion of black market testosterone from looksmaxxing and fitness influencers who often gloss over the risks sets off alarm bells for experts. Influencer Clavicular has openly spoken about buying testosterone illegally from the age of 14, motivated by bodybuilders and looksmaxxing forums filled with tips for teenagers looking to bypass medical safeguards and purchase testosterone online. Buying drugs (any drug!) from unnamed and unregulated online dealers or fitness trainers presents the real danger of simply not knowing what you’re getting. Outright dangerous ingredients like heavy metals could be present, or “unexpected” ingredients, like Viagra, says Morgentaler. Even in cases where there are no unknown additives, the lack of regulation and expert guidance presents a worrying level of uncertainty. Winstrol, for example, is a common anabolic steroid often mentioned in the same breath as testosterone for its similarities. It was at one point used on humans to treat hereditary angioedema, or intense swelling under the skin, but is now almost exclusively used in veterinary medicine, and has no comprehensive research on the risks it presents to young men. “We just don’t have data on their safety,” says Morgentaler. Even beyond the black market, the glamorization of testosterone often glosses over the primary, life-altering side effect: reduced fertility. For men using testosterone therapy under the guidance of a physician, there is a “recovery” period between ending testosterone therapy and sperm counts returning to within normal levels, but it’s often not pre-testosterone levels. “Eventually sperm counts do recover, but they usually don’t recover to where they started,” says Morgentaler. Young men often don’t know their fertility status and might have a low sperm count to begin with. For this group, unregulated testosterone use could have permanent impacts: “They make [their sperm count] reduced, and it may never come back to a point where they can get a woman pregnant.” So, arbitrarily boosting testosterone is not good for young men without deficiencies. “Most of the stuff that’s out there is bullshit; it’s almost like folklore,” Morgentaler says. “The part that I care about as a physician is lost in the publicity of it all.” For him and other urologists, that’s testosterone deficiency, which can be catastrophic for men of all ages. “I call testosterone deficiency a ‘reduced form of the human condition,’ ” says Morgentaler. Symptoms of testosterone deficiency include physical weakness, depressed moods, and sexual symptoms like erectile dysfunction or low libido. For decades, testosterone deficiency was overlooked and under-researched, and, for many men, symptoms were brushed off as natural signs of aging. “For a long time, the medical community didn’t care about testosterone. There was a lack of awareness that there were men who had low levels and could benefit from treatment,” says Morgentaler. When he began practicing urology in the 1980s, the common misunderstanding was that testosterone injections caused prostate cancer, further suppressing research and treatment of testosterone deficiency. “The testosterone story is new,” says Morgentaler. Still, even with testosterone in the spotlight, it can be difficult for those who need it to access treatment for a true deficiency. Morgentaler describes getting calls “all the time”—for instance, from men completely unable to find a physician to prescribe testosterone therapy. He’s worried that the frenzied online discourse will only make the problem worse. “My fear is that general MDs see [it], know it’s wrong, and say, ‘I don’t want to have anything to do with that,’ ” says Morgentaler. (For trans men, testosterone, which is used to aid in medical transitioning, is already increasingly difficult to access thanks to increasingly hostile anti-trans lawmaking, furthered by the same gender-essentialist discourse that compels healthy cis men to take testosterone supplements.) Testosterone levels are decreasing in young men today compared to earlier generations, and conservative influencers and politicians are quick to point this out as evidence of a “masculinity crisis.” Robert F. Kennedy described lowered testosterone in young men as a “existential problem.” Some so-called tradwife influencers allege that “elites” lowered testosterone to encourage men to vote left and become more ”feminine.” “When we say that testosterone has declined, it’s declined for the average man within the normal range,” says Morgentaler, meaning that the vast majority of men today—even if they have slightly lower testosterone than previous generations—are still far from deficiency. Moreover, a growing body of research on lowering levels of testosterone points to factors like obesity and stress as being likely causes, and not the rise of feminism or veganism, as some far-right influencers might like to believe. Many young men are struggling with mental health concerns, unemployment (or underemployment), and financial insecurity. It is a stressful time for young people, generally. The widening gulf between research and online discourse around testosterone and men’s health isn’t helping men with hormone deficiencies, nor is it helping men with normal hormone levels who are suffering for other reasons, including, perhaps, a narrow and bizarre definition of what it means to be a real man. Health Internet Culture Medicine Men