Is Every Man On TRT Right Now?

On sports radio. In between Instagram posts. Every 15 minutes during a podcast. More and more of our male patients tell us that they are being inundated with ads for testosterone testing, men’s clinics or cures for “low-T” symptoms. If you’re a man over 29, you’ve likely experienced the steady stream of TRT clinics, before-and-afters and “optimize your T” videos.

There is a lot of “buzz” out there regarding testosterone therapy — & for good reason. TRT can be quite effective for men with clinically low testosterone and compatible symptoms. But there’s also a lot of information, misinformation and hollow “marketing” out there that can muddy the water.

We combine our experiences as healthcare professionals with emerging science research to answer a question that we’re starting to hear from our women patients, too: “Is every man on TRT right now?“

Why Is Testosterone Therapy Becoming More Popular?

A few simultaneous factors contribute to the rise in testosterone therapy interest:

• Less stigma around men’s health
• More robust research characterizing who benefits (& who doesn’t)
• More convenient ways to take testosterone (topical gels, longer-acting injections, implants)
• Lower barriers to prescription access due to greater telehealth capabilities
• Increased advertising budgets, with popular brands like HIMS & HERS spending $679,000,000 (roughly 46% of their revenue) on marketing in 2024

“You’re also seeing more success stories on Reddit & social media. Men get together online to talk about their symptoms, labs & what works best. The published research is giving a good ‘baseline’ of education. So, guys can now focus on what the real-world experience looks like for them.”

-Courtney Gilbert, PA-C

“Is TRT Safe for the Heart?”

Yes, RTR is safe for the heart — with the usual caveats about individual risk. Large contemporary data (the TRAVERSE trial) found TRT non-inferior to placebo for major cardiovascular events in appropriately selected men. Providers continue to monitor for signs such as elevated hematocrit, edema and rare events (e.g., pulmonary embolism or atrial fibrillation, which were numerically higher in some analyses).

“While your comfort is incredibly important to us, we also personalize dosing & the method of administration route for your safety. Finding the optimal minimal effective dose is so important in reducing any potential risk of side effects.”

-Courtney Gilbert, PA-C

“I get this question a lot from my patient & the most honest answer? There’s evidence that suggests, yes, but the cause isn’t crystal clear. One thing is constant — your existing health, lifestyle & those little decisions we make each day matter a lot. Being in good health certainly isn’t going to hurt your testosterone!”

-Courtney Gilbert, PA-C

What Causes Decreased Testosterone?

Testosterone levels tend to decline gradually beginning around age 35, which is a normal, age-related physiologic change. Additional factors that can lead to decreased testosterone include: 

• Excess Weight & Insulin Resistance: Increases aromatase (which converts testosterone into estrogen) & dampens the brain-to-testes signals that drive testosterone production.
• Obstructive Sleep Apnea: Chronically poor sleep fragments the deep sleep where much of testosterone is made; a lack of consistent, good sleep is often tied to weight gain & negative cardiometabolic health.
• Circadian Disruption & Night-Shift Work: Misaligned sleep–wake schedules blunt normal hormone rhythms & are linked with lower T & increased clinical complaints about sexual-function.
• Chronic Opioid Use: Suppresses the HPG axis, which reduces testicular testosterone output.
• Glucocorticoids (cortisone, hydrocortisone, prednisone): Even at modest daily doses, these drugs inhibit testosterone synthesis; with sustained/high doses they can impair Leydig-cell function (& in lab models, promote cell death).
• Hyperprolactinemia or Pituitary Disorders: Elevations in prolactin (or pituitary disease) disrupt GnRH and gonadotropins, lowering testosterone.
• Iron Overload (Hemochromatosis): Excess iron can deposit in the pituitary/testes, damaging hormone signaling & leading to hypogonadism.
• Anabolic-Androgenic Steroid Use or Recent Withdrawal: Exogenous androgens shut down the HPG axis via negative feedback, often dropping sperm counts and native testosterone after cycles.
• Over-Training & Low Energy Availability: Training too hard in the gym without enough fuel tells the body to prioritize recovery over reproduction, which can lower testosterone.

“Getting the tests back & looking at the results — that’s all great, especially if it clearly indicates high or low testosterone. But our job isn’t just to right a prescription & send you off. We identify which causes are potentially relevant for you & correct what’s correctable before or alongside TRT.”

-Courtney Gilbert, PA-C

What If a Man Takes Testosterone but Doesn’t Need It?

Men who take testosterone without a medical indication may experience:

“Reputable clinicians confirm two morning levels, symptoms & root causes before writing a script to prevent this at all costs. My male patients may walk in, saying they want a TRT prescription because they heard these great things — but they don’t actually want to be on another medication if there are more root-cause ways to address their symptoms.”

-Courtney Gilbert, PA-C