The ‘Low T’ craze and rise of TRT has a dangerous catch men need to know

Today’s influx of online and TV commercials about “Low T” might convince you that American men are facing a widespread epidemic of low testosterone.

But is it really that common?

Medically known as male hypogonadism, this condition occurs when the testicles do not produce enough testosterone, an essential hormone driving a wide range of male bodily functions and traits, from libido, muscle building and strength to blood cell production, bone density and even memory.

While it is true that testosterone levels naturally decline by about 1% per year after age 30, true hypogonadism is actually quite rare, affecting less than 1% of men.

Yet, public interest is skyrocketing.

According to a Men’s Health survey, 40% of men say their testosterone level matters more to them now than it did just a year ago.

A major byproduct of this boom is that testosterone replacement therapy (TRT) — the prescription medical treatment for low testosterone — is increasingly being marketed as a lifestyle supplement for performance and optimization. This growing visibility has sparked trends like “testmaxxing” where men without a medical deficiency take TRT without a doctor’s guidance to accelerate their gym gains. 

Unnecessary TRT carries serious health risks ranging from thickened blood to impaired cardiovascular health, and can also lead to physical dependency and infertility.

Here’s what men should know about low testosterone, including what’s normal, what’s not and when treatment is actually necessary.

Myth: Low testosterone only affects your sex drive

While a drop in libido is the most widely recognized sign of low testosterone, mood changes are actually the most significant and frequently overlooked effects. 

Depressed mood is a common symptom when testosterone drops significantly, though most people mistakenly attribute it to outside causes.

A testosterone deficiency can also trigger physical changes, such as a loss of muscle mass, which often leads to fat gain and can ultimately contribute to obesity. 

Additionally, testosterone plays a vital role in signaling the bone marrow to produce red blood cells. When these hormone levels fall, red blood cell production drops as well. 

Myth: Low testosterone is an inevitable, normal part of aging

The cause of low testosterone generally falls into three main categories:

Primary hypogonadism (testicular damage): Since testosterone is produced in the testicles, any direct harm — whether from chemotherapy, physical trauma, surgery or developmental issues — prevents them from functioning properly.

Secondary hypogonadism (pituitary dysfunction): The pituitary gland, a small gland that sits outside the brain, acts as the body’s master regulator, signaling organs like the testes to produce hormones. If the pituitary is impaired, the testes do not receive the instructions they need and shut down production.

Stress-induced suppression: A temporary level drop can be trigged by psychosocial stress, grief, sleep deprivation, exhaustion, infection or financial stress. It can also routinely occur after childbirth. To conserve energy, the brain suppresses testosterone, planning to restore it later. 

Myth: Taking TRT without a doctor’s approval is low-risk

When you introduce external testosterone, your brain signals the pituitary gland to stop natural production. This can cause secondary hypogonadism and testicular shrinkage, ultimately leading to infertility.

Excessive testosterone also overstimulates red blood cell production, thickening blood and increasing the risk of blood clots, embolisms or strokes. Furthermore, it can negatively impact your cholesterol levels, elevating long-term risks for cardiovascular disease.

As multiple tissues respond to testosterone, an improper dosage can cause the prostate to enlarge — making urination difficult — or thicken throat tissues, which can trigger or worsen sleep apnea.

Because of these complexities, a doctor must manage TRT, monitoring your red blood cells, cholesterol, sleep and PSA levels.

Myth: Healthy testosterone never fluctuates or drops

Testosterone levels naturally fluctuate throughout the day, typically peaking in the early morning between 7:00 AM and 10:00 AM before declining by up to 50% toward the evening. 

Because medical reference ranges are standardized to early morning values, clinicians recommend drawing blood in the morning to ensure an accurate baseline.

Testing later in the day can yield artificially low results that don’t reflect true hormonal health.

Seasonal shifts can also cause minor variations in overall levels.

Myth: TRT is the only way to raise low testosterone levels

TRT is designed and FDA-approved to restore testosterone to the normal levels in cases of a true clinical deficiency.

In men, testosterone levels are closely tied to estrogen, much of which is produced in fat tissue. When a man experiences significant weight gain or obesity, increased fat tissue can cause more testosterone to convert into estrogen, naturally lowering testosterone levels.

Consequently, shedding that extra weight can help reverse this process and boost testosterone naturally.

Foundational lifestyle habits like getting proper sleep, maintaining a healthy diet and avoiding extreme physical overexertion play a vital role in supporting natural hormone production.

Myth: Quitting TRT on your own is safe

For most men, natural testosterone production will eventually recover after stopping TRT, especially if they haven’t been on it for long. 

However, the exact timeline is highly unpredictable. 

While some individuals see their levels bounce back in about six weeks, for others it can take nine months or even longer. Recovery tends to be much slower for those who used high doses over an extended period. 

During this transition, it is common to experience symptoms of clinically low testosterone, such as fatigue and a depressed mood, as the body works to restore its baseline.

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Dr. Marcus D. Goncalves is director of the Holman Division of Endocrinology, Diabetes and Metabolism at NYU Langone Health. An endocrinologist and biomedical researcher, he specializes in metabolic disorders, including diabetes, high cholesterol, cachexia, and muscle wasting. His research focuses on the role of insulin resistance and dietary sugars in metabolic disease, obesity, and cancer progression.