A growing number of men are being told they have low testosterone, but some experts argue the condition is being overdiagnosed and marketed as a cure-all. Social media influencers and direct-to-consumer health companies are driving a surge in testosterone replacement therapy (TRT) prescriptions, which have jumped 135% in the UK between 2021 and 2024.
What is low testosterone?
Testosterone is a key hormone for male development, produced primarily in the testes. It plays a role in muscle growth, bone density, red blood cell production, and sex drive. Medically, low testosterone, or hypogonadism, is diagnosed when blood levels are low and accompanied by symptoms such as erectile dysfunction, low libido, depression, or infertility. Normal total testosterone levels range from about 8 to 30 nmol/L, according to NHS guidelines.
Rise of TRT clinics
Companies like Voy (formerly Manual) offer online tests and consultations, bypassing traditional healthcare. They advertise tests for low T, which is legal even though advertising the drug itself is not. Critics say this creates a market for a condition that may not exist. Dr Richard Quinton, a consultant endocrinologist, calls it a "spurious pseudo-disease."
Patient stories
Many men report life-changing benefits from TRT. Nick Dooley, a train driver, says TRT helped him lose weight and overcome depression. George, a social care worker, says his confidence soared after starting treatment. However, some obtained TRT privately after being turned away by the NHS, which uses stricter thresholds.
Concerns about overdiagnosis
Endocrinologists warn that healthy men are being misled. A journalist for The Guardian took a Voy test and was told his free testosterone was low, despite total levels being normal. Voy then encouraged further tests and a consultation, costing over £180. The company uses a threshold of 15 nmol/L for low T, while many guidelines consider 12 nmol/L as the cutoff.
Studies suggest only 2-8% of men have true hypogonadism, but Voy claims one in four men over 30 suffer from low T, citing a 20-year-old study that included men without symptoms. The evidence for TRT in otherwise healthy men is mixed, and risks include infertility, blood thickening, and psychological effects.
The bottom line
While some men genuinely benefit from TRT, the booming industry may be medicalizing normal aging and masculinity. As one expert put it, "They've invented a spurious pseudo-disease to sell a cure."
