A lot of people are wrong about low testosterone. The “low testosterone” hashtag on TikTok features over 20,000 videos from real doctors, fake doctors, real doctors who seem like fake doctors, bodybuilders, wellness weirdoes, straight-up scammers, and, seemingly, everyone else. Some of the content is accurate, some is wildly inaccurate, some is in the middle, but the overall impression is a confusing miasma where solid medical information is given equal space with people recommending boosting your testosterone by exposing your privates to direct sunlight for 10 minutes a day. So let’s clear this up a little.
What low testosterone actually is
Testosterone is a hormone produced mainly in the testicles (and in smaller amounts in ovaries and adrenal glands) that helps regulate muscle growth, energy, sex drive, mood, and overall reproductive health. So it’s important.
Low testosterone, also known as clinical hypogonadism, is a medical syndrome defined by persistently low testosterone levels in the blood, coupled with the presence of specific, debilitating symptoms like reduced libido, erectile dysfunction, or unexplained loss of muscle mass. It’s a real medical condition, most common in older men, men with obesity, and is associated with poorly managed type 2 diabetes.
It’s difficult to determine how common low testosterone is because different studies are counting different things in different populations and the definition of “low” varies. Be warned: It’s going to get a little technical, but there’s a difference between biochemical hypogonadism and clinical hypogonadism. If you’re looking at people with both low levels of testosterone in their blood and specific symptoms, estimates range from 2% of men aged 40–79, according to a European cross-sectional study published in the New England Journal of Medicine to 5.6% according to the Massachusetts Male Aging Study (MMAS). If you’re strictly looking at testosterone levels in blood in men over 45, with no regard to symptoms, the same MMAS study says that 38.7% have “low testosterone,” using MMAS-specific lab cutoffs. These are the kinds of blurry lines that let people claim “nearly 40% of men suffer from low T!” and be telling something like the truth, but not really.
Why your doctor doesn’t routinely screen your testosterone levels
When you get a physical, doctors generally don’t check your testosterone level. This has led to an online conspiracy theory around testosterone that doctors are deliberately keeping patients from being diagnosed. The conspiracy theory goes like this: “The medical establishment, influenced by Big Pharma and insurance companies, is keeping a miracle cure from people because: A) It’s more profitable to treat other diseases. B) Society is inherently biased against men acting manly. C) Reverse vampires told them to.”
As with all conspiracy theories, the truth is much more mundane: You’re not routinely screened for low testosterone because the prevalence of hypogonadism in the general population, without clear symptoms, is very low; test results are highly unreliable and prone to false positives unless done under strict conditions; and having low testosterone levels isn’t even a medical problem unless you have specific, debilitating symptoms. If you do have symptoms like fatigue, low libido, erectile dysfunction, or loss of muscle mass, and you have low testosterone, it could still be because of other health issues like stress, poor sleep, diabetes, obesity, or sleep apnea.
What low testosterone is not
Hypogonadism is not the same thing as “toxic masculinity.” It doesn’t cause people to “follow random girls on social media.” It cannot be diagnosed with “one clue.” It doesn’t make you more likely to seek validation from others. Low testosterone doesn’t make you a “whiny bitch.” High testosterone doesn’t make you more jealous of your wife, either. Most importantly, low testosterone is not the reason you feel run down, stressed out, or depressed—probably.
That “probably” is really the issue, the wedge that makes “low testosterone” the perfect breeding ground for health misinformation. Having less energy and a lower libido are solidly on the “normal human experience” spectrum, but because they could be caused by low testosterone, some people are drawn to that explanation, and the idea of a quick fix for aging and/or general malaise. Others see an opportunity to make some cash.
Historical precedent: snake oil and goat balls
The discourse may be happening on TikTok and instagram, but scammy “low testosterone” sales pitches originate with 19th-century medicine shows and the patent medicine salesmen that followed. If you read between the lines of much online testosterone talk, the promise is to treat lack of strength, lack of energy, lack of virility, or overall lack of “manliness”— concerns that have been monetized for a long time. Back in the 1800s, it was literal snake oil. In 1920s, lack of virility was sometimes treated by surgical introduction of goat glands in the testicles. In the 2020s, we’re taking Tongkat Ali, ginger, Jamaican Chaney Root, and literally hundreds of other “supplements” marketed as testosterone boosters instead.
Despite testimony from satisfied customers back in the Jazz Age, goat tissue doesn’t actually engraft or function when injected into the testicles, so it doesn’t make men more goat-like. Herbs probably don’t work either, no matter what that bodybuilder on Instagram says. A review of 32 studies of 13 different herbs meant to raise testosterone concluded that only two (Fenugreek and Ashwagandha) showed any promise, but like many studies on herbal supplements, the research is shaky: The sample sizes are too small, and test subjects didn’t have a diagnosed clinical condition so the results may not apply to men who are genuinely deficient. So we have extremely scant evidence that herbs could raise your testosterone, and basically no evidence that raising your testosterone would provide a benefit anyway.
When should you ask your doctor about your testosterone levels?
If you actually suspect you have clinical hypogonadism, do not take herbs or listen to influencers. Talk to your doctor if you have these symptoms:
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Significant, unexplained decrease in libido
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Erectile dysfunction
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Depression
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Gynecomastia (unexplained swelling or tenderness of the breast tissue)
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Unexplained loss of body or facial hair
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Loss of muscle mass and strength (not explained by changes in your exercise routine)
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Infertility
Other symptoms, like not enjoying bitter food, or not “not getting a boner when you’re holding hands,” likely have other causes. If you want to dig deeper into symptoms of hypogonadism, check out the Mayo Clinic’s page.
How can you raise testosterone levels?
If you’re basically healthy, but you still think there’s something to the whole “I need more testosterone, now!” there’s good news and bad news. The good news is that it’s possible to raise testosterone levels without hormone replacement or taking supplements. The bad news: There is solid scientific research to support the idea that you can raise testosterone levels by losing weight, exercise, and getting enough sleep.
