Turn on the TV these days, and you’d think every guy on the planet was dragging through life, depleted of testosterone, the vital hormone that makes a man, well, a man.
That’s because of all the advertising for products promising to boost “low T,” to help guys get stronger, leaner, and to have more stamina—in and out of the bedroom.
“Be the man you used to be,” extols one ad, as a series of buff, middle-aged men parade across the screen, biking, swimming, running and—for all those women who fantasize about hot plumbers—fixing a kitchen sink.
Another spot tries a different approach: “Over 40? Feeling tired? Losing muscle and romantic drive? Well, man up.”
Yet, even as advertisers urge men to buy these products as a way to turbo-charge low testosterone, the truth is that the vast majority of males, including older men, have normal levels of the hormone.
Feeling tired? Not as interested in sex? Feeling down or depressed? It could be just the effects of aging or of not getting enough exercise.
As men age, their testosterone levels naturally decline, says Ronald Swerdloff, a professor of medicine at Harbor-UCLA Medical Center.
But for most men, it doesn’t decline to the point where they need a prescription.
Adam Cifu, professor of medicine at the University of Chicago, and co-author of Ending Medical Reversal, says that many of the men who complain to him that they’re tired, overweight, and not really interested in sex, aren’t below normal levels for testosterone.
“They’re just getting older,” he says.
Many of their symptoms, he adds, can be alleviated with exercise, a healthier diet, more sleep, and better stress management. In fact, in his research he’s found that “depression in men is 100 times more common than a clinical deficiency in testosterone.”
How the hype got started
We can thank Big Pharma for this latest wave of low-T mania.
Beginning in the early 2000s, the FDA approved newer, more convenient forms of testosterone such as pills, gels, and patches. Prior to this, the only way for men to receive supplemental testosterone was through an injection in the thigh or buttocks, says Cifu.
Pharmaceutical companies, looking to spread the word about these newer formulations, began heavy direct-to-consumer advertising campaigns, extolling their benefits for men.
“The one thing that drives men is ego and sexuality,” says Craig Cooper, 55, a health and wellness advocate for men over 40 and author of the book Your New Prime: 30 Days to Better Sex, Eternal Strength, and a Kick-Ass Life After 40.
“We’re all looking to maintain our energy and virility as we age,’’ he says. “Pharmaceutical companies took advantage of this by creating a new market for testosterone based on this desire.”
The problem with the ad campaigns, says Bradley Layton, a research epidemiologist with RTI Health Solutions, is that they worked. Between 2000 and 2011, the number of men starting the use of testosterone supplements increased 300%.
In fact, in numerous cases, men complaining of fatigue and a waning libido were walking out of their doctors’ offices with a prescription even before they were tested. In one study, Layton found that 40% of men who were newly started on testosterone hadn’t even had their blood testosterone levels checked in the previous six months.
Of course, there are men that have a real medical need for a testosterone when their bodies aren’t producing enough. The normal level for the hormone in adult men ranges from 300 to 1,100 nanograms per deciliter of blood.
Cifu says blood tests showing two to three morning readings of less than 300, along with a loss of libido, indicates that a man is clinically deficient in testosterone.
“For someone like this, supplemental testosterone would be absolutely appropriate,” he says. “It’s the same as if a man’s thyroid levels weren’t normal.”
For the majority of men, though, there’s scant evidence to support the idea that supplemental testosterone is necessary, research shows.
“In many ways, the use of testosterone during the 2000s really outpaced the evidence for effectiveness or safety in older men with normal, age-related decreases in testosterone levels,” Layton says.
In fact, by 2013, a few high profile studies about testosterone’s risks caught the FDA’s attention. The research suggested that men using the supplements could be at increased chance for heart attacks or strokes.
Along with issuing a warning, the FDA also clarified that only men with a clear medical condition causing below normal levels of testosterone should take these drugs. The warnings were enough to prompt drug makers to voluntarily discontinue their direct-to-consumer ad campaigns in 2014.
The FDA began investigating, and in 2014 the agency issued a safety announcement, requiring pharmaceutical companies to list testosterone’s risks on the drug’s label.
Since then, Layton says data shows that the number of prescriptions being written for testosterone has dropped significantly.
A shift to over the counter
In their place, there’s now a new wave of over-the-counter products promising to bring back energy and sex drive.
With names like Ageless Male, Nugenix, and TestoMax, to name a few, they profess to boost free testosterone in man’s body. Most testosterone is hitched to two proteins—albumin and the sex-hormone binding globulin—but testosterone that is unattached is referred to as free.
Despite the claims—and the commercials filled with buff men and the equally fit women they’re attracting—none of these products have been verified by the FDA, says Swerdloff, or have clinical data to back up their statements.
“If things are not tested and proven, we have to be skeptical,” he says.
Cifu is a bit more blunt: “These products, which rarely even contain the ingredients they advertise, are completely worthless.”
So if you’re looking to feel the way you used to, what do you do?
Get tested, experts say. If you are found to have a clinical deficiency, testosterone supplements can help.
Follow-up care is crucial, though. According to the Endocrine Society, an organization specializing in hormone research, men who have started testosterone should have their blood levels checked every six months for the first year and then annually thereafter.
If your testosterone level is found to be normal, you don’t need supplements.
So take a walk. Go to the gym. Improve your diet. Maybe step back from the social media and take your spouse or special someone out to dinner.
It could be just what the doctor ordered.