What People Are Doing Wrong This Week: the Prevalence of Low Testosterone

Many people are mistaken about low testosterone. The hashtag “low testosterone” on TikTok has over 20,000 videos from real doctors , fake doctors , real doctors who look like fake doctors , bodybuilders , healthy lifestyle experts , outright scammers, and seemingly everyone else. Some of the content is accurate, some is completely false, and some is somewhere in between, but overall, it creates a confusing mess where reliable medical information sits alongside recommendations to boost testosterone levels by exposing your genitals to direct sunlight for 10 minutes a day. So, let’s clear this up a bit.

What is low testosterone really?

Testosterone is a hormone produced primarily in the testicles (and in smaller amounts in the ovaries and adrenal glands) that helps regulate muscle growth, energy, sex drive, mood, and overall reproductive health. That’s why it’s so important.

Low testosterone, also known as clinical hypogonadism, is a medical syndrome characterized by persistently low blood testosterone levels, accompanied by specific, debilitating symptoms such as decreased libido, erectile dysfunction, or unexplained muscle loss. It is a real condition, most often found in older men who are obese and associated with ineffective treatment of type 2 diabetes.

It’s difficult to determine how common low testosterone is because different studies look at different rates in different populations, and the definition of “low” varies. Keep in mind: this will get a bit technical, but there is a difference between biochemical and clinical hypogonadism. When looking at people with low blood testosterone 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) . When looking only at blood testosterone levels in men over 45, without considering symptoms, the same MMAS study shows that 38.7% of men have “low testosterone,” using MMAS-specific lab cutoffs. It’s these blurry boundaries that allow people to claim, “Nearly 40% of men suffer from low testosterone!”—something that’s close to the truth, but not quite.

Why Your Doctor Doesn’t Check Your Testosterone Levels Regularly

Doctors typically don’t check testosterone levels during medical examinations. This has led to an online conspiracy theory that doctors are deliberately concealing testosterone-related diagnoses. The conspiracy theory goes like this: “The medical community, under the influence of pharmaceutical giants and insurance companies, is hiding a miracle cure from people because: A) It’s more profitable to treat other diseases. B) Society is inherently biased against men who act masculine. C) They were told to do so by reverse vampires.”

As with all conspiracy theories, the truth is far more prosaic: you’re not tested for low testosterone because the prevalence of hypogonadism in the general population without obvious symptoms is very low; test results are highly unreliable and prone to false positives unless administered under strict conditions; and low testosterone isn’t even a medical problem unless you have specific, debilitating symptoms. If you have symptoms such as fatigue, low libido, erectile dysfunction, or muscle loss, and you have low testosterone, it could still be related to other health issues, such as stress, poor sleep, diabetes, obesity, or sleep apnea.

What is low testosterone?

Hypogonadism isn’t the same as ” toxic masculinity.” It doesn’t make people ” follow random girls on social media .” It can’t be diagnosed by ” one sign .” It doesn’t make you more likely to seek approval from others . Low testosterone doesn’t make you a ” whiny bitch .” High testosterone also doesn’t make you jealous of your wife . Most importantly, low testosterone isn’t the reason you feel exhausted, depressed, or stressed—it probably is.

This “probably” is the real problem, the very wedge that turns “low testosterone” into the perfect breeding ground for health misinformation. Decreased energy and decreased libido are firmly within the spectrum of “normal human experience,” but because they can be caused by low testosterone, some are drawn to this explanation and the idea of ​​a quick fix for aging and/or general malaise. Others see it as a money-making opportunity.

Historical precedent: snake oil and goat’s balls

It may be talked about on TikTok and Instagram, but the deceptive advertising slogans about “low testosterone” have their origins in 19th-century medicine shows and the patent medicine salesmen who followed. Reading between the lines of much online talk about testosterone, the promise is to treat lack of strength, lack of energy, lack of potency, or a general lack of “manliness”—problems that have long been monetized. In the 1800s, it was literally snake oil. In the 1920s, low potency was sometimes treated by surgically inserting goat glands into the testicles . In the 2020s, we instead take Tongkat Ali , ginger , Jamaican chaney root , and literally hundreds of other “supplements” marketed as testosterone boosters.

Despite testimonials from satisfied customers dating back to the Jazz Age, goat’s tissue doesn’t actually take hold or function when injected into the testicles, so it doesn’t make men look more like goats. Herbs probably don’t work either, despite what that bodybuilder on Instagram might say. A review of 32 studies of 13 different herbs purported to boost testosterone concluded that only two (fenugreek and ashwagandha) showed some promise, but like many herbal supplement studies, the research is shaky: the sample sizes are too small, and the subjects didn’t have a diagnosed clinical condition, so the results may not apply to men with a true deficiency. Therefore, we have extremely scant evidence that herbs can boost your testosterone, and essentially no evidence that boosting your testosterone will be beneficial at all.

When should I see a doctor about my testosterone levels?

If you truly suspect you have clinical hypogonadism, don’t take herbs or listen to experts. Consult a doctor if you experience the following symptoms:

• Significant, unexplained decrease in libido

• Erectile dysfunction

• Depression

• Gynecomastia (unexplained swelling or tenderness of breast tissue)

• Unexplained hair loss on the body or face

• Loss of muscle mass and strength (not explained by changes in your training program)

• Infertility

Other symptoms, such as a lack of pleasure in bitter foods or the inability to get an erection while holding hands , likely have other causes. For more information on the symptoms of hypogonadism, visit the Mayo Clinic page .

How can you increase testosterone levels?

If you’re generally healthy but still believe there’s some truth to the saying, “I need more testosterone, right now!” there’s good news and bad news. The good news is that testosterone levels can be increased without hormone replacement therapy or supplements. The bad news: There’s compelling scientific research supporting the idea that losing weight , exercising , and getting enough sleep can boost testosterone levels.

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