Nope. Pay attention to risks, too.

Testosterone, you might say, makes a man a man. It gives us stronger muscles and deeper voices than women (at least on average!). It plays a leading role in our sex drive. 

And yet it’s falling these days. Average levels have been declining in American men. Environmental causes such as the endocrine-disrupting chemical BPA may play a role. Rising obesity, especially around the middle, certainly contributes. Diabetes, too, lowers testosterone levels. 

So does aging. After age 40, free testosterone, the active form, declines by more than one percent a year, according to one study. 

It’s no wonder than the market for testosterone therapy has now become a two billion dollar business. After all, women discovered the benefits of estrogen therapy for menopause decades ago. Shouldn’t men consider testosterone therapy? 

Actually, no. Really, no. It’s not a good idea. In fact, it’s likely a really bad idea. Except in rare clinical cases, testosterone therapy has unproven benefits—and serious risks. “Pharmaceutical companies have seized on the decline in men’s testosterone levels as pathological and applicable to every man,” says John La Puma, MD, a board-certified internist, director of ChefMD, and author of Refuel: A 24-day eating plan to shed fat, pump up testosterone, and boost strength and stamina. “They aim to convince men that common effects of aging like slowing down a bit and feeling less sexual actually constitute a new disease, and that they need a prescription to cure it. This is a seductive message for many men, who just want to feel better than they do, and want to give it a shot, literally.” 

To quote The Colbert Report, “A man on TV is selling me a miracle cure that will keep me young forever. It’s called Androgel…for treating something called Low T, a pharmaceutical company-recognized condition affecting millions of men with low testosterone, previously known as getting older.” 

Perhaps we should learn from our friends on the other side of the gender divide. After all, women were sold on estrogen replacement therapy in the 1960s and ‘70s as a wonder drug to restore womanly sexual vitality and eternal youthfulness. It wasn’t until the beginning of the 21st century that a large-scale study found that estrogen therapy may increase the risk of heart disease, stroke, and breast cancer in many women. 

We don’t yet know everything we need to know about the risks for men in testosterone therapy.  But what we do know isn’t reassuring. 

Trading “Low T” for high risks 

So what’s the risk? Heart attack, stroke, shrunken testicles, and dependence.  “Most men have heard by now about a greater chance of heart attack or stroke with testosterone therapy,” says La Puma.  “But most don’t know that testosterone therapy shrinks your testicles, shuts off your own supply of testosterone, and for many men, does so permanently. So once you start, you probably need to take it for life.” 

The heart risk is one of the major reasons why the Food and Drug Administration (FDA) is considering seriously reigning in the testosterone-therapy juggernaut. Three large studies have now shown an increased risk of heart attack in men who took testosterone. In September, an expert FDA panel voted to tighten labeling controls on the marketing of these drugs, and to require better studies. “The whole idea is to try to rein in the inappropriate advertising and use of these drugs,” Michael Domanski, MD and the director of heart failure research at Mount Sinai School of Medicine, told The New York Times

Big benefits? Think again

Nor are the benefits for middle-aged men without other medical conditions clear at all. While the ads may indirectly suggest that testosterone therapy may boost sexual vitality to men whose flags stay at half staff, “Very, very rarely does low testosterone cause erectile dysfunction (ED),” says La Puma. “Instead, most ED is caused by hardening of the arteries; it other words, ED is a blood flow problem, not a hormone problem.” 

Another myth is that adding testosterone can reverse common aging issues such as low libido, fatigue, and muscle loss. “That’s false, and again, the FDA called out manufacturers for promoting these potential benefits, when in fact, there is no evidence for them.” 

Doesn’t anyone benefit? 

Of course. Who needs it? “Men who have pituitary, hypothalamic or primary testicular failure or disease, or a congenital, chromosomal disease,” says La Puma. “Men who have low testosterone levels on repeated tests, and who have symptoms and signs of hypogonadism (e.g., hot flashes, very low bone density), often need testosterone replacement, and should get it. But this is far fewer than the 1 in 20 men that’s promoted widely; in Australia, where there is no direct-to-consumer advertising for medication, it’s estimated that the need for testosterone replacement is 1 in 500.” 

If your testosterone is flagging, there’s a better way: a healthy lifestyle. “The real cause of lower testosterone levels in men is excess belly fat, which converts testosterone to estrogen,” says La Puma. If men paid more attention to that root cause, he says, “a lot more men would be healthy, strong, and energetic.” 


  1. National Institute on Aging