We’ve all seen the ads promoting gels and pills to treat “low T”, or testosterone deficiency. The ads make testosterone replacement therapy sound like a no-brainer (Hey, I can look better; feel better; get the girl; etc.), but do you really need more testosterone?

The number of men over 40 with prescriptions for testosterone has tripled since 2001, according to a report in JAMA Internal Medicine. And that raises concerns. Do all these men actually have “low T”, with symptoms of mood swings, hot flashes, fatigue, sexual dysfunction, and a reduced muscle mass/increased fat mass?

Testosterone deficiency is due to a medical condition called hypogonadism. The Endocrine Society recommends testosterone replacement therapy to treat hypogonadism, but a blood test for testosterone is required for accurate diagnosis. According to the JAMA report, more than 25% of the men who were prescribed testosterone never even had a blood test. And of those who were tested, it is not clear how many were actually “low T”.

This may be another classic situation where intense advertising has lead to increased demand, regardless of actual need. Men who think they need testosterone for their perceived symptoms should have a blood test first, and they should be prescribed testosterone only if their testosterone is below normal limits for their age. Testosterone levels decline naturally with age, by the way. Testosterone therapy was never intended to improve sexual prowess or make a 50-year-old feel like a 20-year-old again, despite what the advertisements imply.

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