Doctors Are Divided on TRT Boom and Warn That Patients Could Be Getting Prescriptions They Don’t Need
Testosterone prescriptions in the U.S. increased about 50% between 2019 and 2024, and the boom has split doctors over whether patients are finally getting care they needed or being sold a hormone they don’t. Here’s what readers are actually asking about testosterone therapy right now.
If you’ve been following the broader conversation about hormones and how they affect everyday health, testosterone is one of the most important pieces of that picture.
Why Are Testosterone Prescriptions Rising So Fast?
Prescriptions climbed from 7.3 million in 2019 to more than 11 million in 2024, per CBS News, a surge driven by genuine unmet need, aggressive marketing and a sharp regulatory shift in early 2025.
A 2024 study in PLoS One found a 27% increase in TRT patients between 2018 and 2022, with the steepest jumps in men aged 35 to 44, up 58%, and 45 to 54, up 35%. Injectable testosterone cypionate alone doubled between 2019 and 2025, according to STAT News.
Roughly 5.6% of men aged 30 to 79 have symptomatic deficiency, but historically only 12% of those men were being treated, per the Boston Area Community Health Survey published in the Journal of Clinical Endocrinology and Metabolism.
A January 2026 review in the International Journal of Molecular Sciences also confirmed a population-level, age-independent decline in testosterone linked to obesity, endocrine-disrupting chemicals and sedentary lifestyles.
But STAT News reported that up to a quarter of patients start testosterone therapy without ever being tested, and 325 new Low T clinics have opened since early 2024, fueled by private equity money and heavy social media presence. The FDA removed the cardiovascular black box warning in February 2025 after the TRAVERSE trial, and a December 2025 panel recommended loosening restrictions further.
That has made it easier for online clinics to market the drug to a broader audience. The result is a market expanding from two directions: more men with legitimate deficiency finally entering treatment, and more with mild or unverified symptoms being funneled into prescriptions through telehealth.
What Does Testosterone Actually Do in the Body?
Testosterone regulates muscle mass, bone density, libido, mood and key cardiovascular and metabolic functions in men, per a February 2025 systematic review in Cureus. When levels drop meaningfully, symptoms can include fatigue, low sex drive, muscle loss, weight gain, brain fog and depressed mood.
It also plays a larger role in women than most people realize. A November 2025 paper in Medical Research Archives noted that testosterone levels in women are 10 to 20 times higher than estradiol throughout the lifespan, making it the predominant sex hormone in female physiology.
Doctors stress that low T is a clinical diagnosis, not a feeling. Symptoms like tiredness and weight gain overlap with sleep apnea, depression, thyroid disease and obesity, which is why endocrinologists typically require at least two morning blood tests before prescribing, a step many online clinics skip.
Testosterone also interacts with estrogen, cortisol, thyroid hormones and insulin, which is why mainstream endocrine groups caution against treating it in isolation based on a symptom checklist alone.
Is Testosterone Replacement Therapy Safe for Your Heart?
The cardiovascular safety of TRT is still unresolved despite the FDA’s February 2025 decision to remove the black box warning. The TRAVERSE trial did not find a higher rate of major cardiac events in treated men, but a 2025 study in the Journal of the Endocrine Society found a 55% increased risk of major cardiovascular events in long-term TRT users.
Patients with a history of heart attack, stroke, blood clots, prostate cancer or untreated sleep apnea are typically steered away from testosterone. The practical takeaway: TRT is not the cardiovascular hazard the old black box implied, but long-term safety in younger men who may take it for decades remains an open question.
Should Women Take Testosterone and Are Online Clinics Safe?
Women’s testosterone prescriptions rose 2.6-fold between 2016 and 2025, with a 58.7% jump from 2024 to 2025 alone, according to a 2026 study in JACC: Advances. Women aged 45 to 64 account for 62.2% of those prescriptions.
Most major medical societies currently endorse testosterone for women only to treat hypoactive sexual desire disorder after menopause, and at doses within the normal female range. Off-label use for energy, mood or general wellbeing is widespread but not yet backed by the same level of evidence.
For anyone considering treatment, specialists converge on a few practical checkpoints: insist on at least two morning blood tests before starting, confirm the clinic monitors hematocrit and PSA on a regular schedule, and be cautious of any provider that prescribes after a single questionnaire. Testosterone therapy can be legitimate medicine. The question doctors are now wrestling with is whether the current delivery system, particularly online, is capable of telling the patients who need it from those who’ve simply been sold on it.
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