'My wife is on testosterone. Should I be?' How docs can navigate the surge in male hormone questions

Male patients are asking about testosterone earlier, more often, and with more certainty.

In a physician-facing Reddit discussion, one clinician wrote, ”Several of my co-interns and I have had patients in our primary care clinics asking for testosterone testing, insisting they have Low T. One patient has a family member taking testosterone supplements (though it seems they didn’t have low testosterone levels either) and symptoms which could be attributed to low testosterone - or hypothyroidism or a rheumatologic disease or depression or so many other things.”^[]

Some patients are influenced by partners using hormone therapy. Some have seen direct-to-consumer ads. Others arrive with labs from a men’s clinic and a prescription already in hand.

A 2026 Guardian report described a surge in social media and direct-to-consumer testosterone marketing, with endocrinologists reporting more men seeking evaluation for “low T.”^[]

But that is not the same as approval for fatigue, aging, reduced gym performance, or a “higher-normal” testosterone target. FDA-approved testosterone products remain indicated for men with low testosterone linked to a medical condition.^[]

Start with diagnosis, not a number

Board-certified endocrinologist  Omodamola Aje, MD, says, “When men ask about testosterone, the first question is not ‘How low is your level?’ It’s ‘What symptoms are we actually trying to explain?’ Fatigue, low libido, reduced muscle mass, mood changes, and brain fog can overlap with testosterone deficiency, yes, but they can also reflect poor sleep, untreated sleep apnea, depression, chronic stress, obesity, thyroid dysfunction, medication effects, or simply inadequate recovery.”

The AUA uses total testosterone below 300 ng/dL as a reasonable biochemical cutoff in support of diagnosis. Cleveland Clinic’s summary of AUA guidance stresses the same point: diagnosis requires symptoms plus biochemical evidence.^[]

So, when to test your patients?

Dr. Aje says, “Testosterone testing is appropriate when symptoms meaningfully raise suspicion for hypogonadism, but “feeling off” alone should not automatically trigger replacement therapy.”

She further adds, “One of the biggest misconceptions I see is the idea that testosterone is a wellness upgrade rather than a medical treatment. There is an important difference between treating true hypogonadism and selling “optimization.” Evidence-based testosterone therapy is for carefully selected patients with compatible symptoms and confirmed biochemical deficiency, not as a shortcut for normal aging, poor lifestyle habits, or social-media-driven expectations.”

But what about erectile dysfunction (ED)?

Testosterone treatment has its clearest effect on libido and several sexual function measures in men with low testosterone and low libido.^[]

Board-certified psychiatrist Sangeeta Hatila, MD, states assertively, “Testosterone is not first-line treatment for vasculogenic ED with normal testosterone. It is not a stand-alone obesity treatment. It is also not a reliable answer for nonspecific fatigue.”

Fertility needs to come up before the first dose

Dr. Aje says, “Before prescribing testosterone, I have very explicit conversations about fertility, because exogenous testosterone can significantly suppress sperm production. We also discuss erythrocytosis (elevated hematocrit), cardiovascular history, blood pressure, prostate considerations, and whether untreated sleep apnea could worsen on therapy.”

The Endocrine Society recommends against testosterone therapy in men planning near-term fertility or with breast or prostate cancer, elevated hematocrit, untreated severe obstructive sleep apnea, severe lower urinary tract symptoms, uncontrolled heart failure, recent MI or stroke, or thrombophilia.^[]

Monitoring is part of the prescription

Discussing the details of how to conduct and interpret the test, Betsy Greenleaf, DO, a quadruple board-certified physician, says, “It needs to be done in the morning, interpreted with symptoms, and ideally repeated if abnormal.” She adds, “I also like to look at the bigger picture: thyroid, metabolic health, sleep, stress, medications, insulin resistance, and inflammation.”