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Testosterone is getting a lot of attention lately. The military will be screening service members for low testosterone. Meanwhile, the Trump administration is trying to expand men's access to the hormone more broadly. NPR's Will Stone reports.
WILL STONE, BYLINE: It's not always clear why the men who come to Dr. Jamin Brahmbhatt have low testosterone. Typically, they're dealing with a range of symptoms.
JAMIN BRAHMBHATT: Anywhere from low libido to loss of muscle mass or memory issues or mood issues, sleep disorders.
STONE: Brahmbhatt, a urologist at Orlando Health, checks their levels twice, and if the number's low...
BRAHMBHATT: Then I replace it.
STONE: This approach reflects the guidelines from mainstream medical groups. Technically, though, it's not in line with FDA criteria for who should get testosterone replacement therapy, which are fairly narrow. It's only approved for men with certain clear-cut medical conditions. In fact, the FDA specifically cautions against using it for age-related declines in testosterone. But the Trump administration wants to make it easier for men to access, removing some of the warning language and potentially broadening the criteria.
BRAHMBHATT: The FDA is trying to catch up with reality and how these medications are being prescribed. And I think it's a really good thing for men because men have truly been ignored when it comes to, like, advocating for, like, hormone replacement therapy.
STONE: The debate around testosterone, its safety and how widely it should be used goes back decades. During the early 2000s, it was one of the fastest-growing drugs in the U.S. Topical gels came on the market. Drug companies pushed low-T advertising. But after data suggested testosterone increased the risk of heart attack and stroke, the FDA placed warnings on the products. Two major trials in the last decade have brought new evidence, though.
PETER SNYDER: I think the benefits and the risks are now reasonably clear.
STONE: Dr. Peter Snyder is an endocrinologist at the University of Pennsylvania. He led a landmark study on testosterone in older men, which found...
SNYDER: That it improved libido considerably, sexual function considerably, energy a little bit, red blood count, bone density and strength.
STONE: Bottom line, he says, these benefits only apply to men with unequivocally low testosterone. The other big trial focused on safety. It showed testosterone did not increase the risk of heart attacks and stroke or prostate cancer, though it raised some other concerns like blood clots and fractures. Dr. Steven Woloshin isn't convinced. He says testosterone levels were not raised high enough in that safety study to know the risks.
STEVEN WOLOSHIN: The idea of changing the label and opening up the floodgates, I don't think that's in anyone's interest.
STONE: Woloshin is a professor of medicine at the Dartmouth Institute and has testified in court against a drug company that makes testosterone. He was especially troubled by an FDA meeting last year on the proposed changes.
WOLOSHIN: There was a lot of sort of breathless claims about what testosterone replacement can do.
STONE: Including the idea that giving testosterone improves longevity. Woloshin says, yes, some studies find men with low T are at a higher risk of dying, except these men also tend to have other underlying health problems.
WOLOSHIN: There's an association between those really low levels and a risk of dying from a variety of causes, but that doesn't mean, you know, giving them a bunch of testosterone is going to change that.
STONE: To him, the push by the Trump administration and some in the men's health space is reminiscent of the hype from drug companies. In fact, Health Secretary Robert F. Kennedy Jr. has said in a podcast he uses testosterone as part of a, quote, "antiaging" protocol. There's a huge market of direct-to-consumer clinics, and it's promoted widely in wellness and longevity circles. The pitch is often around health optimization. Dr Martin Miner co-directs the Men's Health Center at Brown University and consults for testosterone companies.
MARTIN MINER: What I worry about is that these clinics that don't just necessarily prescribe to men with low levels, they give it to men solely based on symptoms. They start men at higher doses, and I'm not sure there's focus on safety.
STONE: He says men should know the risks, particularly its effect on fertility. But Miner does support the administration's effort to expand access. It could improve insurance coverage and remove some of the stigma.
MINER: I have a lot of patients come to me and say, my doctor won't prescribe it. He's against it.
STONE: While testosterone does decline with age, Miner says factors like obesity, sleep, stress, all of that can lower levels. So if you can get men back into a normal range...
MINER: They feel so much better in every domain, in every realm. It can be quite dramatic.
STONE: That's how it was for George Bove, who lives outside Knoxville, Tennessee.
GEORGE BOVE: I've been using testosterone for right at 15 years. I'm 60 years old now.
STONE: Bove was constantly exhausted and couldn't keep the weight off, even though he exercised and watched his diet. He says the weekly injections changed his life.
BOVE: You know, you stay awake a little bit longer. You got the energy to do things throughout the day instead of having to constantly retire to the couch to recharge your batteries.
STONE: He does feel younger. Not like he's in his 20s again, but maybe his 40s. Will Stone, NPR News. Transcript provided by NPR, Copyright NPR.
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