Low Testosterone: Is It a Real Problem or Just Marketing Hype?

Healthcare guidance, pricing, and availability may change. This episode is for educational purposes only and is not medical advice.

Rebecca: I don't wanna piss anybody off.

Tristin: Yeah, I was chopping burnt bushes

it's pretty up there for 20 years though. That's kind of a big deal.

Rebecca: I finished it yesterday afternoon,

Why is my Surface just burning up? It is so hot I can hardly touch it

Welcome to Please Health Me. I'm Tristan, and each week I bring real health questions from around the internet to my mom, Rebecca, a board-certified family nurse practitioner with 45 years of experience. Together, we try to make healthcare a little easier to understand so you know more about what's happening, what questions to ask, and what options you might have.

Tristin: We're here to educate, not diagnose or treat medical conditions. What we discuss should never replace advice from your own healthcare provider.Today's episode of Please Health Me is about one of the fastest growing conversations in men's health

Seth: (excited) Feeling tired?

Willow: (confident) Low testosterone could be why.

Joe: (confident) Get your confidence back.

Max: (excited) Take control of your health.

Marie: (confident) Is your testosterone low?

Tristin: It's on social media, in podcasts, on billboards, and in ads promising more energy, more muscle, and a better life. But do we have a testosterone deficiency problem, or are we just hearing about testosterone more than ever?

Rebecca: according to the American Urological Association, up to a third of men taking testosterone have never even been diagnosed with a deficiency.

Tristin: All right, so let's start with the first question. Testosterone seems to be everywhere lately. It feels like every other ad is for a men's clinic or some influencer talking about low T. Is this just marketing, or is this actually a growing medical problem?

Rebecca: I think it's a little of both. there's been a real jump, obviously, in the last few years, in the use of testosterone therapy in men, and there's several factors. One, there has been an increase in testing, and prescribing by providers that are feeling a little more comfortable, doing that with synthetic testosterone for patients with low T.

and studies do indicate there's been a drop in testosterone levels in men in the past few years. but another cause is the increase in the emergence of questionable clinics that cater to, the craze of looksmaxxing, and promoted by, social media, promoted by our government leaders like RFK and Pete Hesketh.

So that's just equally,if not more causing the increase

Tristin: And like you just mentioned that there has been studies that indicate there's been a drop in levels. Are they, are these men actually low in testosterone or are some people just getting it because of this popularity that we're seeing by government leaders, by some of these looksmaxing craze that's happening?

Rebecca: they do believe with studies that there has been a drop in, testosterone levels. But also there's this, huge increase in interest, because of the social media part. according to the AUA, the American Urological Association, up to a third of men taking testosterone have never even been diagnosed with a deficiency.

So you can see there is a lot of that going on. I was really straight with young men seeking a script for testosterone in my clinic. they'd come in, young men, and I said, "Look, I'll be glad to test you for low T, but I won't prescribe testosterone if you're not out of the range." And most then just didn't bother with the testing after hearing that.

But, those young men that I did test, most of them did not have low T. I tried to explain that there's dangers if you're over-prescribing, which can be, it can happen in many clinics out there. there are just what they call men's clinics or,testosterone clinics.

I saw one man in his early 50s that went to one such clinic, and he had multiple, and I mean multiple testosterone pellets injected into his buttocks. he ca- he came to my clinic only because he was directed to see a provider in three days after he had been discharged from the hospital after a heart attack.

Tristin: Whoa

Rebecca: So that, know, something can happen

Tristin: Yeah. it's interesting that you mentioned the younger guys when you said I'm not gonna prescribe testosterone unless your levels are low," and then they just left. Do you think it was just 'cause they wanted that, that was what they were

Rebecca: Yes. Yes, they were definitely wanting that. I think that it needs to be understood that, if you're out of the range high, if you're high and above the normal range, you can have a host of, risk factors. and I think they didn't understand that, but they were after testosterone, and they realized I wasn't gonna give it to them, so I'm sure they found it.

I'm sure they did because there's clinics out there that'll do it for you.

Tristin: that. Wow. And so what would actually cause testosterone to become low in the first place?

Rebecca: just like women experience a decrease in estrogen as we age, so do men. their testosterone decreases as they age. So that's just a natural aging process. So that's one thing. But also as we age, chronic disease like obesity, diabetes, high blood pressure, they all play a part in declining levels, of obesity being one of the biggest causes of decline in testosterone.

chronic stress, sleep disorders, all those things can cause a level of decline. and there's studies looking at our processed food diets and exposure to plastics because, as I said, they're realizing there's been a decrease in testosterone levels even in younger men. So they're trying to figure out why is that happening.

low T in real young men or any age, can be due to congenital causes and, lots of things, cancer treatments, mumps, trauma, pituitary problems, those kind of things. in a seemingly healthy person has a low T, that can be the cause.

Tristin: Oh, okay. And if, if someone really does have low testosterone, like what symptoms would you notice if it was low?

Rebecca: low testosterone, it can cause symptoms like low sex drive or difficulty maintaining an erection. It can cause men to gain fat and lose muscle. It can cause lower red blood cell count, which can lead to anemia because testosterone plays a role in the production of red blood cells. it also helps regulate mood, so you can have, low levels can cause depression, fatigue, difficulty concentrating.

a lot of these things you can have, for other reasons, of course. But long-lasting symptoms or intense symptoms, that should be investigated

Tristin: And how do doctors figure out whether it's actually the low testosterone versus like something else that seems very generic, some of those things?

Rebecca: yeah, that's what I'm saying. that doesn't just mean you have low T if you have these things. Can be other causes for sure. And, but ruling out, a low testosterone is really, it's a really simple thing. It's a simple blood draw for a serum, total testosterone level. if your BMI is greater than 27, meaning you're overweight,or you would-- if you're a diabetic, then the guidelines indicate you should also have an additional test called a free testosterone with the total test.

if you have a normal total T level, then your symptoms, if you have them, are not from a low T level. So then you do need to move on and figure out what's going on. If you have a low T, then you need to do the free testosterone test next. And if you have a low T and a normal free testosterone, you still do not need treatment.

It's complicated to explain, but the normal free T shows you have adequate circulating testosterone. But of course, if you have a low T and a low free T, then you need to have some replacement. And I would tell you to seek a urologist or a primary care provider, not a men's clinic for that, workup.

And the blood should be drawn, for the test after a six-hour fast between 7:00 and 10:00 in the morning, 'cause those levels fluctuate. And some insurance companies require two tests before they cover treatment. So the normal levels are from 300 to 1,000, and that's a pretty big span, but that's the normal range because they do fluctuate.

another part of the diagnosis once you have that low T is also again,trying to figure out if there are any other conditions contributing like,diabetes or, chronic fatigue, hypothyroidism, sleep apnea, depression. All those things can be, there also and or also that's the problem.

But if you have a low T, that doesn't mean it's just that two

Tristin: I would have to look this up and maybe I will later, but, I-- we were talking about it in a different podcast how you could do labs yourself and go to some of these places and just run this test yourself. is that something people do?

Rebecca: Y- I actually in my clinic, because I think I've talked about this before, that, there are-- the labs in town, LabCorp, uh, Sonora Quest, they'll have a cash pay price that if you, order the test yourself and you pay cash for it, you can get that test and you don't have to have an order. And testosterone is one that we did that way all the time because my clinic, they would not give us as low a cost, for the test as they would for a cash pay person.

So I could order a test and it would cost the patient 100 bucks, and they could walk in and order it for cash much cheaper. So I would always tell them, "If you want a testosterone test, I'd be happy to order that, or you can walk in and pay cash and get it cheaper." So a lot of people would do that.

So yes,if you're, wanting to have a level or if you're over 40, the AUA again recommends now that men over 40 should get their levels checked and know where they stand. And, or certainly if you're having these symptoms, get your level checked. Or if you're-- even if you're not, they recommend it just so you know what your baseline is.

So you can do that. You can order a testosterone test at the lab yourself. And it's not rocket science. We said levels range from 300 to 1,000, and they'll give you that, they'll give you that with your result. They'll say, "This is normal," or, "This isn't normal." so but that's why I said the blood should be drawn after a six-hour fast between 7:00 and 10:00 in the morning.

That's important so you get a, a good number. So yes, if you don't have a provider, if you don't wanna see a provider, if you don't have insurance, you can easily do this. This is something you can do and have, a lot of knowledge about what's going on with yourself.

Yeah. And probably better for you to do that before you start maybe embarking on some of these yeah. if you go to a clinic, a men's clinic or whatever, most of them, I hope, would do a testosterone test. but where are all these, w- what's the 30% that never even had been diagnosed? I don't know where they got that statistic. But, so somebody's giving testosterone just saying, "Yeah, I want it," and, "Give it to me."

so yeah. they should do baseline tests for sure. But if they don't, you can certainly do it on your own because you wanna know what that number is if you're gonna start taking testosterone.

Tristin: And let's say that someone truly is diagnosed with low testosterone. What are the treatment options?

Rebecca: the treatment options are injections of testosterone. there's gels, there's pellets or pills. the goal is to raise it enough to reduce symptoms, right? So injections are reasonably inexpensive, but they're injections, so if you don't like shots, that's not the way to go. it's also-- it also needs to be done weekly or twice a week.

gels and creams are out there, but they're quite expensive and, and you have to be careful. You can't, slather yourself with your cream and then go be intimate with someone. you can expose family members to thetestosterone. you have to be careful with that.

Pellets, like I discussed, I had the patient... they're implanted under the skin, usually the buttocks, and they dissolve slowly over three to six months. And pills, not much used because they're pretty pricey, and they have to be taken twice a day.

they're not as common. really the injectable is the most common

Tristin: Okay. And whenever hormones are involved, some people get a little bit nervous. Are there actual risks of testosterone therapy involved?

Rebecca: for a person that has a true deficiency, no, there's not a lot of risk, because they need that, right? if you really do have deficiency. 'Cause you'll have to be followed with blood tests and see how much, your level's coming up and w- how to adjust that.

it gets a little more dicey if you don't need replacement. so for those taking replacement, when they have a normal testosterone and your goal is to go above that normal range, it can signal the brain to reduce sperm production, so this could affect fertility and cause the testicles to shrink in size.

and that's, decrease in fertility is something to think about if you're thinking of having children in the future. most of the time, when you stop, that will,reverse, but not always, so you have to think about that. It also,a big one is it increases red blood cells, which thicken the blood, increasing the risk of clots, strokes, and heart attacks.

Tristin: Oh, like your

Rebecca: pa-- yeah, my, my patient, he was, early 50s. he ended up in an ICU with a, a heart attack 'cause he had excessive amounts of pellets injected, because, the more you inject, the more money you make. So when he hit the ICU, his testosterone level was almost

Tristin: and you just said the normal levels are between 300 and 1,000. That's insane

Rebecca: So that's why he had a heart attack.

It was caused by that. So y- that's again why you need levels. You need to be followed by your blood levels and not have crazy amounts of pellets injected. it can cause water retention, mood changes, development of breast tissue. once usually when you hit a normal level when you're taking it,it, you'll plateau.

It's not like you're gonna just get more and more, Superman. it is the biggest thing is it builds muscle and it helps lose fat, so that's why the looksmaxers and the gym bros want testosterone, right? But, as we discussed, upping your levels comes with risk too.

Tristin: Yeah. So if someone's listening and they think, "Hey, I might have low testosterone," what would you tell them to do first?

Rebecca: first, why do they think? They think because they have those symptoms. I d- you know, if you think you do, yes, definitely. You wanna get a level done. You wanna know where you are. that will tell you right there, is it my testosterone level that's making me feel like this? Because those are vague symptoms, right?

there can be other causes. and it's so simple, like I said, Even if you don't wanna go anywhere, you don't have the time, even though you have a provider, you can at least check this out on your own. you can always go get a level and see where you stand

Tristin: Okay. one of the things I was gonna ask, was like, I don't know how much you know about this or if it came up in any research, but like worldwide, is the rest of the world as seemingly infatuated with testosterone as we are?

Rebecca: That's a good question. I don't know. I guess you'd have to be on social media in China or the Europe. probably because I think, those kinds of crazes, they go around the world. and I don't know. it may be even not as simple to get yourself checked in other countries. I'm not sure.

That I don't know.

it's it's so easy here to do that you can do that. Now, again, Another thing is if you have some of these symptoms and you get your level done and you go, I am in the normal range," but maybe you're 350 or 400, then, it is worth you seeking a provider to say, "Look, I'm having these symptoms and I know I'm in the normal range.

Could we try some therapy,just to see if I feel better?" Because sure, you can safely elevate your level, up to 750 or higher. As long as you're staying within the normal range, you should be okay. And that would be just a trial to see, do I feel better? And I'm sure that a primary care or, or urologist would say, "Sure, let's try,a trial to see if this will help you feel better."

I'm not saying that if you're out of those parameters, if you're low, if you're 300, you're okay. I'm not saying that. I'm saying it's worth knowing what your number is and then how you're feeling. So there's nothing wrong with that either. the big thing, the big takeaway is get it done.

Get a serum test done, see where you are.

Tristin: Yeah. one of the other questions that I had is there seems to also be some discussion or I wouldn't say hype, but more chatter for women and testosterone. I feel like that's suddenly become more popular out there also. Can you talk a little bit about that?

Rebecca: yeah, I think that's true that, if you see-- like I have, I had a number of women that, would be seeing other people, and yet they'd come to me, you know, naturopaths and that sort of thing, and they were on all this type of a, a regimen, you know. It would be estrogen, and it would be, progestin, and it would be testosterone.

and I'm not sure that testosterone plays such a big role for women. I th- I-- they are given it because they feel like that will help boost their libido a little. but there was a lot of problems with, if you have too much of that, again, as a woman, then you start, having hair where you don't want it, things like that.

so there'd be little side effects that, wouldn't always be great and, but it, in a tiny amount, yes, we have testosterone too, just like men have estrogen too. But,it's not a big factor with us, just like estrogen isn't a big factor with men. So you have to be careful with those doses too.

And, a-again, if you want to, get into that kind of therapy, you really need to be followed by somebody who knows what they're doing and adjust that and have periodic labs.

Tristin: Yeah, I worry about like with the looksmaxing, going back to that, some of the influencers and like social media with younger kids, even like college kids. is there a way for them to get in trouble with that themselves?

Rebecca: certainly. just like we discussed all the risk factors, if you don't know what's going on with your level and you just keep giving yourself testosterone 'cause you can buy it somewhere or get it someplace, yes, you can get into trouble for sure. And that's why I say it's, it- it's fine to take testosterone if you need it or if you want a trial of it to see if you can feel a little better if you're having symptoms.

But don't take it for building muscle and, you've seen all the wrestlers there. They've all taken that. so a- and truly, if you're way above normal, it's very risky and it's also definitely changes your personality. you will get a little more aggressive, and that's what, our leaders would like in our military.

that's, I find that, that's okay, but you better not be getting way out of the range because then it's not safe.

Tristin: and they're testing both w- men and women

Rebecca: Yes, they are. Yes, they are

Tristin: That's why I was wondering for the women's side. So I guess the biggest takeaways, I think you had a f- quite a few actually. If you're curious or have symptoms, get your levels checked. You can do that on your own if you want to. be really cautious about those supplements

Rebecca: Yeah, about taking things,I'm sure it's easily accessible in some places where you can get it easily, and so therefore you think, "Okay, I'm good. I'm gonna just keep taking this." But there's a lot of risk factors for that if you get way too high.

Tristin: And then, yeah, making sure that you use a, like a trusted or qualified provider if you're going down that path, maybe starting it out yourself, maybe to not necessarily go into one of those clinics. I'm actually really curious to go maybe to one of those webpages and just see, what that's like.

But I know it's not just clinics. I know there's other providers out there like you had mentioned that are really into doing a lot of blood testing and then providing these things and

Rebecca: there, there's a range of different ways to obtain testosterone. Yes, it's a prescription,there's-- but there's different ways, and these clinics pop up and also, this p- particular person that I was talking about who ended up with the MI, I actually knew that person, and e- I knew the provider, and, she just did this, and I was appalled and felt that, this is really wrong.

But she was a provider, and she did it. after this happened, a couple of patients had problems. Suddenly she was up and gone. She had moved out of the state. the, the agony that man went through, and could have died, because she would just put way too many pellets in and obviously didn't check his levels because they were out, out of control.

so you have to be careful. You have to be informed, Now you know what the normal level is, and you know what the symptoms are, and you know that you need to be followed. even if you are able to obtain a lot of testosterone and you start giving it to yourself, you need to check, your levels, and you need to check what we call a CBC, a complete blood count, because this is gonna tell you if you have a high red blood cell count, which is, concerning for this.

So there are those two blood tests, and it's really just a couple like that, but you need to be aware of if you're gonna take this and take it, take too much of this.

Tristin: Yeah. and I think it'd be good. I'm pretty sure I'd wanna know how many pellets somebody was going to shoot into my butt

Rebecca: Right

Tristin: I'd let them shoot it into my butt.

Rebecca: it's true, but it's unfortunate because you should trust, you should be able to trust that your provider knows what they're doing and should have your welfare in mind. But, this is corporate health. This is why health is so bad now. It's all about making money.

It's not about health, and it's really unfortunate, but that's why we have these kinds of things happen

that's about it for testosterone, I think

Tristin: So Tristan here, post our podcast recording. After we ended, I was still curious about what my mom had said regarding corporate health and how these clinics actually operate

So I went down a bit of a rabbit hole, looking into map apps and industry data, and found some pretty interesting numbers. First, physical access really depends on where you live.

In states with flexible medical regulations and suburban sprawl, physical access has hit what I call the Vegas Strip effect, where over eighty percent of residents live within a fifteen-minute drive of a storefront TRT clinic. In areas with stricter regulations or higher real estate costs, you don't see as many storefronts, but the demand simply shifts online.

Across the country, at-home blood testing and video consults have made telehealth the fastest-growing sector, with direct-to-consumer platforms driving over four hundred million in testosterone spending. And the big engine behind all of this growth, whether it's a local storefront or an app on your phone, is the cash pay model.

Upwards of seventy percent of these clinics skip traditional health insurance entirely, charging around a hundred and fifty to three hundred dollars a month for fast, direct access. It's a massive shift in how healthcare is packaged and sold, and definitely something to keep in mind if you're navigating these options.

thanks for listening to Please Health Me. If you found this episode helpful, pass it along to someone else who might too. And if there's a health question you want us to talk about, send it our way at pleasehealthme.com. We'd love to hear what you're wondering about, because chances are, other people are wondering about it too.

And as always, this podcast is for education only. It is not medical advice, and it shouldn't replace the care from your own healthcare provider. If you enjoyed today's conversation, be sure to follow Please Health Me so you don't miss future episodes. You can also visit our website for all our episodes, show notes, and additional resources.