The Low T Boom: Do Men Really Need Testosterone Boosters?

If you’re a man in your 30s or older and trying to stay on top of your health, performance, and overall well-being, or you’ve noticed some of these starting to slip, there’s a good chance you’ve come across content suggesting you might have low testosterone, should test it, or might benefit from a boost.

The internet has been seeing more and more advice on optimizing testosterone. Some of it is aimed at men with clinically low levels. But quite a substantial portion of it targets otherwise healthy men, framing testosterone as something to tweak for better energy, physique, focus, or any other wellness-enhancing reason.

At the same time, testosterone replacement therapy (TRT) clinics are growing, along with the market for various over-the-counter supplements marketed as natural alternatives.

In the midst of this low T boom, the conversation around testosterone deserves a more balanced and grounded discussion.

The testosterone narratives in the public sphere

Testosterone can be a sensitive topic for many men. It’s often perceived almost as a marker of masculinity, tied to ideas of strength, dominance, and status. Things that challenge the idea of having enough testosterone can feel personal, especially in a culture that still places pressure on men to live up to a certain image of masculinity.

Against this backdrop, and within today’s broader health optimization culture, it’s not surprising that messages like ‘maybe you have low testosterone’ circulating on the internet can linger in the mind. It’s fairly natural, then, to begin wondering whether something might be off, whether there’s a problem to fix, or whether there’s room for improvement.

The sheer volume of searches on how to increase testosterone and the amount of different kinds of content aiming to answer that question reflect just how much this topic resonates.

A noticeable share of that content comes from male influencers and online personalities. Some of them frame low testosterone as a common problem that is not a stranger, even among younger men. These narratives are often paired with recommendations that range from lifestyle changes to supplements, and more often than not come with financial incentives attached.

For some, this search for answers leads to men’s health clinics offering a ‘stronger’ remedy: testosterone replacement therapy (TRT).

Looking through their websites, you may come across a list of familiar symptoms: low energy and fatigue, poor sleep, reduced motivation, difficulty focusing, and lower sex drive or sexual dysfunction. If any of these sound familiar, it might be low testosterone to blame, they suggest, and TRT could be a way to help you feel more like yourself again.

That’s not entirely wrong. These symptoms can indeed occur in men with clinically low testosterone. But it’s not entirely right either. And this is where it’s worth not skipping over a bit of nuance.

Low testosterone explained

Testosterone is a sex steroid hormone that our bodies make from cholesterol. In men, the main ‘testosterone factory’ is the testes. Smaller amounts of testosterone are also produced by the adrenal glands, which sit on top of the kidneys.

While it is often referred to as the ‘male hormone’ because it contributes to traits we usually associate with male physiology, like facial and body hair or muscle mass, it goes well beyond that. Testosterone is involved in a range of important bodily processes, such as reproductive function and libido, as well as muscle and bone health, metabolism, and brain function.

What are the signs of low testosterone?

In medical settings, low testosterone, or hypogonadism, is a clinical condition in which the body does not produce enough of the hormone to levels where it can begin to affect health and daily functioning.

According to major clinical guidelines such as those from the American Urological Association and European Association of Urology, to diagnose hypogonadism, a person typically needs to show two main things:

1. consistently low testosterone levels that show up across repeated laboratory tests
2. sexual symptoms such as low libido or erectile dysfunction

There are also less specific symptoms that can come with low testosterone, like fatigue, reduced motivation, or low mood. However, since they can also come from many other conditions, they’re considered secondary and aren’t enough for a diagnosis on their own.

The threshold to call testosterone clinically low is typically around ~300 ng/dL (roughly 10–12 nmol/L), though this can vary depending on the laboratory and the test used. Testosterone levels can vary depending on many factors, such as time of day, food, exercise, and overall health. To make measurements more consistent and less influenced by these factors, they are usually taken in the morning, in a fasted state, and repeated multiple times.

What causes low testosterone?

Hypogonadism can broadly arise from two types of problems.

Problems in the testes (primary hypogonadism)

Primary hypogonadism occurs when the testes themselves are unable to make enough testosterone. This can happen due to genetic conditions, injury, infections, or treatments like chemotherapy. These cases are less common and, in many situations, not reversible.

Problems in the brain-testes signaling (secondary hypogonadism)

Secondary hypogonadism happens when the issue isn’t that the testes can’t make testosterone, but that the instructions to do so aren’t coming through properly. Testosterone production is regulated by signals from the brain (the hypothalamus and pituitary gland), and if that signaling is disrupted, the testes don’t receive the right message and may end up producing less testosterone than normal.

This second category is where the most common, everyday cases fall. In other words, in a large proportion of cases, low testosterone isn’t coming from the testes failing, but from something interfering with that signaling system.

Aging and low testosterone

Aging is one of the most commonly mentioned causes of low testosterone in public conversations. Testosterone levels do indeed gradually decline with age. On average, levels decrease by around ~1% per year after the age of 30 (with some estimates slightly higher).

However, while some public figures say that ‘it adds up,’ in most men, aging on its own rarely leads to levels dropping below clinical thresholds. The majority of men remain within the normal range well into older age, and aging alone is thought to account for only a small proportion of clinically low testosterone cases. Even later in life, when low testosterone becomes more common (typically from the 60s onward), it’s often not age by itself, but age combined with other health issues that contribute to it.

The more realistic #1 testosterone killer

The most common contributors linked to low testosterone are obesity, type 2 diabetes, and poor overall health.

Unlike primary causes, many of these are potentially reversible (or at least manageable). In such cases, low testosterone is often what’s called functional, meaning the testosterone-producing system is being suppressed rather than permanently impaired. Much of what is popularly described as ‘low T’ in midlife falls into this functional category.

According to current guidelines, testosterone therapy is recommended when deficiency is confirmed and not reversible. Which means that in many cases, men don’t need to start with testosterone, but rather with managing the underlying health problems. In practice, that usually means focusing on weight loss, improving metabolic health, and addressing broader lifestyle factors such as diet, physical activity, and sleep.

In other words, not every case requires medication. Which brings us to the next big part of the testosterone conversation.

Testosterone replacement therapy

Testosterone replacement therapy is a medical treatment where one takes additional testosterone in the form of injections, gels, or patches. Current clinical guidelines support this therapy only for the purpose of bringing diagnosed, abnormally low levels back to normal in cases of confirmed, symptomatic testosterone deficiency, when that’s not possible by managing the underlying causes.

That cautious approach exists for a reason. While testosterone deficiency can affect quality of life and is associated with issues like impaired sexual function or reduced bone density, testosterone therapy also carries risks that need to be weighed, such as:

1. Reduced fertility
2. Thickened blood
3. Potential increases in blood pressure

There is also a less obvious aspect to consider. When you take testosterone externally, the body reads it as a signal to turn down its own production. For some men, stopping therapy can then lead to a period of low testosterone that may take months to recover from.

So TRT is not a supplement. It is a medical treatment that requires a clear indication, careful monitoring, and a careful weighing of risks and benefits. For men with normal testosterone levels, current medical consensus does not support using TRT for performance, physique, or anti-aging purposes, and using it outside of these indications may put their health at risk.

Nevertheless, TRT use has been on the rise in recent years.

Why testosterone therapy is on the rise

An analysis of U.S. prescription data found that TRT prescriptions have been increasing, and that increase was highest among younger men aged 35 to 44. The study didn’t look at diagnoses or reasons for treatment, but it does raise some questions. As discussed in an FDA panel on TRT, there is no clear evidence that younger men are becoming more testosterone-deficient. So what’s behind this, then?

One possible explanation is easier access to treatment and, in some cases, looser prescribing practices, especially through increasingly popular direct-to-consumer men’s health clinics. And there is some basis to suspect this.

In one study using a ‘secret shopper’ approach, a hypothetical 34-year-old man contacted several clinics and, during the consultation, said he was experiencing low libido and low energy. Despite having normal testosterone levels confirmed by each clinic’s lab tests, and mentioning that he wanted to preserve his fertility (something testosterone therapy is known to put at risk), 6 out of 7 clinics still offered TRT.

Looking more broadly at how TRT is presented, another study analysed 253 clinic websites globally. It found that 86% included at least one claim not aligned with clinical guidelines. These ranged from general claims about improved energy, mood, or well-being to more specific ones, such as suggesting TRT reduces cardiovascular risk (around 20% of websites) or has anti-aging effects (around 10%). About 12% suggested treatment for men with normal testosterone levels. At the same time, potential risks were not always communicated with the same emphasis. For example, only about 28% of websites mentioned possible impacts on fertility.

This doesn’t mean that all clinics are problematic or driven by profit alone, but it does suggest it’s worth approaching this space with a cautious and critical mind, as some practices may sit on the edges of current medical guidelines.

There’s clearly more awareness around testosterone. And while in some cases that may lead to unnecessary testing or treatment, awareness itself is not all bad. Hypogonadism is a real condition that can affect quality of life and often carries a degree of stigma. More open discussion may encourage some men to seek help when they actually need it. In fact, recent regulatory discussions have also focused on improving access for those with clear clinical indications.

For the rest, those who fall outside of hypogonadism, it’s worth keeping in mind that TRT isn’t a wellness procedure, and shouldn’t be treated as such. Hormones aren’t something to experiment with, and until there’s a better understanding of long-term safety, it’s best not to go down that path.

Do testosterone boosters really work?

Alongside TRT, there’s also a growing market of supplements marketed as ‘natural’ testosterone boosters. However, the evidence so far is not too promising.

For example, a systematic review of 52 clinical trials looking at 27 supplements found that most products marketed as testosterone boosters failed to reliably increase testosterone levels. Generally, where effects were seen, they tended to be small, inconsistent, or absent.

Some positive signals did emerge, but they were limited and context-dependent. In men with low testosterone, compounds such as shilajit and tongkat ali were considered potentially effective. In healthy men, tongkat ali and ashwagandha showed some promise, but the evidence was based on relatively few studies and wasn’t consistent enough to draw any confident conclusions.

More broadly, it’s still difficult to interpret many of these findings. A large proportion of the trials were small, had a high risk of bias, and in some cases involved industry funding.

So at this point, whether someone is trying to correct a deficiency or looking for a ‘boost,’ the evidence doesn’t really support supplements as a reliable or impactful solution.

Bottom line

While testosterone is often presented as something to check or boost, the broader idea that many men are unknowingly deficient and in need of intervention isn’t strongly supported by current evidence. Clinical guidelines do not recommend routine testing in otherwise healthy men without symptoms, yet such messaging around ‘low T’ is something many men are exposed to.

Within that same information bubble, there are also promotions for solutions. Sometimes, that’s supplements that largely lack (or are still awaiting) supporting evidence. In other cases, it’s full-on hormonal medical treatment, bringing its own risks. A treatment many men who don’t actually have low testosterone may not need in the first place.

Testosterone is an area that touches not only on health, but also, in some way, on identity. In such a vulnerable space like this, it’s worth approaching internet claims with a degree of healthy skepticism, especially when they’re simple, confident, and come with a product attached.