“When I took a testosterone test, I got my score and panicked,” said Eugene, a 42-year-old film director and editor in Beverly Hills who started noticing hair and energy loss in 2016 and realized he was suffering from low testosterone. That’s when he started a two-year regimen of DHEA, a supplement that promises to boost testosterone, taking the pills daily.
“Unfortunately, I didn’t notice much of a change,” he said. His doctor told him to stop taking any supplements. Eugene (The New York Times allowed him and others to use just first names to keep medical histories private) took another testosterone test, still scored low and “asked around about getting testosterone injections in my skin and decided against it.” Instead, a friend recommended pine pollen.
He started buying the pollen on Amazon. He opted for a brand that delivered raw pollen and became more conscious of his diet and exercise, although he was still plagued by fatigue.
When he shared his new routine in a checkup, “my doctor shrugged and put his hands in the air. He said, ‘I don’t know if it works, and it’s up to you.’”
A study published in 2017 in the Journal of Urology found a fourfold increase in the rate of testosterone use among 18- to 45-year-old men between 2003 and 2013, especially in areas of the United States where TV ads for low-testosterone treatments were common. According to the Urology Care Foundation, however, only about 2 in 100 men may have testosterone deficiency.
Prescriptions for testosterone, the study said, have risen 300% since 2001. Alongside prescription testosterone, the wellness industry is promoting supplements, like DHEA, pollen, deer antler and more, many of which don’t contain testosterone, and are under-researched and not regulated.
This industry plays to fears about masculine archetypes like strength and libido. Sales in this supplement market are projected to approach $300 billion by 2024, according to a study by Grand View Research, up from $26 billion in 2015.
Testosterone production tends to decline with age, and diagnosis is often preceded by pronounced fatigue, diminished sexual desire, reduced muscle mass and a host of symptoms ranging from the mundane, like irritability, to the major, like erectile dysfunction.
Dr. Charles Welliver, a urologist at Albany Medical College in New York, said that often patients see common signs of aging — hair loss, decreased libido — as a cause to worry and seek a quick fix.
He added that most men who want to supplement their levels have no need for it, especially patients under 40. Most are after muscularity, he said.
“Young guys get this idea in their head, and they’re totally uninterested in what their physician has to say about it,” Welliver said. “Everybody wants to think they’re the biggest, toughest dude. The guys reading this stuff online come in with these weird treatments where they say their testosterone has to be at 5,000, when the normal is 400.”
There’s a long list of supplements that claim to boost T, all with little — or unknown — scientific backing. DHEA, a hormone naturally produced by the adrenal glands, can be taken as a supplement, though its ability to improve one’s sex life is unproven.
Another popular supplement is deer antler, a traditional Chinese medicine touted by athletes and Instagram fitness gurus for its T-enhancing powers, despite the lack of research to back that claim. Deer antler spray has been banned by the NFL and MLB because it contains insulinlike growth factor 1, or IGF-1, which is considered a performance-enhancing drug.
In 2013, seeking to lift heavier weights, Peter, then a 29-year-old technical recruiter from New York, began experimenting with supplements. He bought a 500-gram tub of API Health Deer Antler Manuka Honey, a mixture of honey native to New Zealand and deer antler extract. It was an impulse buy, he said, prompted by internet research and reports of deer antler’s curative powers by NFL star Ray Lewis.
Peter noticed no increased anabolic output and hasn’t used the supplement in years.
“There are no studies that show any effectiveness of these supplements, and they’re certainly a cause for concern for safety and toxicity,” said Mark Peterson, who researches the relationship between testosterone deficiency and muscle strength at the University of Michigan. “If you’re taking an obscure supplement bought online and not even in a health store, you’re taking a chance.”
Dr. Abraham Morgentaler, director of Men’s Health Boston and an associate clinical professor of urology at Harvard Medical Center, said that some supplements “have been shown to contain undisclosed Viagra or similar medications, which can provide some benefits that suggest the supplement is working.” He also said that some supplements include caffeine or other additives to give users the feeling of increased stamina and power.
Very good bad marketing
Dr. Bradley Anawalt, an endocrinologist at the University of Washington, said the demand for low-T treatments is nothing new and was spurred by pharmaceutical companies in the early 2000s. Back then, Solvay Pharmaceuticals (which was pushing AndroGel, which does include testosterone) rebranded the male menopause term from “andropause” to low T.
“How do you sell a Tesla or Lexus?” Anawalt said. “You put an image of a young attractive person having your hair flow as you drive a zippy little convertible at high speed.”
Jeff Hephner, a 44-year-old actor, has not taken testosterone or supplements but remains tempted as he has noticed a trend of older actors building chiseled bodies.
“These guys are all jacked,” Hephner said. “One guy put on 40 pounds. We did a show together, then he became a Marvel guy all of a sudden.” Hephner, whose routine includes two days a week of weights and boxing sandwiched between Pilates with his wife, said he feels the pressure to keep up.
“Especially when you hit 40,” he said. “I’ve got to look a certain way.”
Daniel Broukhim, 35, co-CEO of FabFitFun, a subscription beauty service (which does not include low-T supplements in its subscription boxes) thinks the marketing is “caricaturish.”
“It’s going to take a lot of reeducation about the male psychology about how men really feel versus how they’re supposed to present themselves,” he said.
The risks of prescription testosterone
In 2011, after years of feeling chronically tired and lethargic, Bill, a 63-year-old retired lawyer in upstate New York, began using creams that promised the benefits of increased testosterone. Frustrated, and with his testosterone levels dipping and his symptoms intensifying by 2014, Bill began an aggressive regimen of testosterone injections, undergoing hormone replacement therapy that included testosterone pellets implanted every six weeks.
Soon after starting the program at his hospital, Bill’s doctors reported his numbers had rebounded. So had his energy.
Bill’s doctors moved him to a less invasive method: weekly home injections. After a few weeks, his testosterone levels mirrored those of a much younger man. In 2016, Bill suffered a major stroke.
His doctors couldn’t agree on whether his hormone therapy was the cause, and he gave up the treatment. But now, at 71 and fully recovered, he experienced another energy lull and restarted testosterone injections, after he said his urologist advised him there was not a link between the treatment and his stroke.
Some research, however, indicates that men using testosterone therapy have a higher risk of heart attack or stroke, including several studies and the Food and Drug Administration. Testosterone drugs even carry a warning. When prescription testosterone is administered as a topical gel, it can be transferred to others through physical contact.
Fixing testosterone issues for most young men, according to Anawalt, can be as easy as improving nutrition and working out.
“Exercising 30 minutes a day can do good things for health and your sex life,” he said. “That advice can be more important than taking any supplement or prescription.”