The truth about testosterone: who actually needs treatment?

As the military prepares to roll out routine

As the military prepares to roll out routine screenings for low testosterone among its personnel, and influencers flood social media with promises of vitality and virility through hormone therapy, the question of who genuinely requires medical intervention has become increasingly muddled. While some men may indeed benefit from treatment, experts caution that the condition is often misunderstood and overhyped.

Testosterone is a key hormone that influences muscle mass, bone density, red blood cell production, and libido. Levels naturally decline with age—typically dropping about 1% per year after age 30. However, the clinical definition of "low testosterone," or hypogonadism, requires more than just a blood test result; it must be accompanied by clear symptoms such as fatigue, depression, reduced sexual desire, or difficulty concentrating.

The growing popularity of testosterone replacement therapy (TRT) has been fueled by aggressive direct-to-consumer marketing and celebrity endorsements, leading many men to self-diagnose based on anecdotal evidence. Yet, endocrinologists stress that TRT is not a lifestyle drug. It carries potential risks, including worsened sleep apnea, increased red blood cell count, which can raise the risk of blood clots, and possible effects on prostate health.

For most otherwise healthy men, lifestyle factors—such a…

For most otherwise healthy men, lifestyle factors—such as poor sleep, obesity, alcohol use, or chronic stress—are far more likely to lower testosterone than any underlying medical disorder. Addressing these root causes through exercise, better diet, and stress management can often restore hormone levels to normal range without pharmacological interventions.

Medical guidelines recommend that doctors confirm low testosterone with two separate morning blood tests before prescribing therapy. Furthermore, treatment should only be initiated after discussing fertility goals, since TRT can suppress sperm production. The decision to start therapy is a serious one that requires careful evaluation by a qualified physician, not a social media influencer or an online quiz.

As the military’s screening initiative unfolds, it will be crucial to ensure that monitoring and follow-up are robust, and that service members understand the difference between a treatable condition and a natural part of aging. The real need for testosterone therapy is narrow and specific—and for the vast majority of men, the cure lies not in a prescription, but in healthier daily habits.