If you’re a man over 35, you’ve probably seen the ads by now. Tired all the time? Brain fog? Libido not what it used to be? Struggling to keep muscle no matter how hard you train?
The ad has an answer: it’s your testosterone. And there’s a clinic ready to fix it with a quick online quiz and a prescription.
Here’s the thing — for some men, that’s actually true, and TRT can be genuinely life-changing. But the testosterone industry has exploded so fast and so aggressively that it’s worth asking: how much of this is medicine, and how much is marketing aimed at men who are simply tired, stressed, and out of shape?
Why TRT Is Suddenly Everywhere
The scale of this is genuinely remarkable. Testosterone prescriptions in the United States jumped from 7.3 million in 2019 to over 11 million by 2024. That’s not a niche treatment anymore — it’s a mainstream industry, grown almost entirely through online clinics competing for the same customer.
Part of this growth is legitimate. Testosterone does decline with age, starting in a man’s mid-30s and dropping at roughly 1.6 percent per year. For some men, that decline becomes clinically significant and genuinely affects quality of life. That’s a real condition — hypogonadism — and treating it can meaningfully help.
But here’s what’s changed, and it’s worth paying attention to: the diagnostic bar has shifted. For decades, a “Low T” diagnosis required a specific numerical lab range — generally 300 to 1,000 nanograms per decilitre. Increasingly, clinics are emphasizing symptoms over that hard number. Tired? Foggy? Low drive? Struggling in the gym? For some providers, those symptoms alone are now enough to write a prescription — even without a clear medical cause for the low testosterone in the first place.
The problem is obvious if you think about it for ten seconds: tired, foggy, low drive, and struggling in the gym describes almost every overworked, under-slept, stressed-out man in his 40s. It also describes someone who’s twenty pounds overweight, sleeping five hours a night, and hasn’t lifted a weight in three years. Symptom-based marketing is effective precisely because the symptoms are universal.
What the Research Actually Shows About TRT
TRT isn’t snake oil. There’s real clinical evidence behind it — for the right person.
For men with genuinely low testosterone, TRT can improve insulin sensitivity and modestly reduce blood sugar — one trial found a third of men achieved diabetes remission after about nine years of treatment combined with medication. It increases muscle mass and bone density, with some studies showing spine bone strength gains of nearly 11 percent in men over 65. That’s meaningful, particularly for fracture risk.
But there are real trade-offs that don’t get nearly the airtime in the advertising.
TRT increases red blood cell production, which can thicken blood and slightly raise clotting risk. The TRAVERSE study — the largest and most rigorous trial on testosterone safety ever conducted, following over 5,200 men — found a small but measurable increase in blood pressure among men using testosterone gel. That finding was significant enough that the FDA mandated new safety labeling on testosterone products in February 2025. The relationship between TRT and heart attack or stroke risk has historically been a concern, and while more recent long-term data is reassuring, the full picture isn’t entirely settled.
There’s also a less-discussed practical issue: TRT can suppress your body’s own natural testosterone production. Long-term use sometimes means becoming dependent on treatment indefinitely, because your body stops producing its own.
None of this makes TRT bad. It makes it a real medical intervention with real risks and benefits — which is exactly why it should involve bloodwork, a clear diagnosis, and ongoing physician monitoring. Not a ten-minute online quiz and a credit card.
What Actually Moves the Needle First
Here’s what almost never gets mentioned in a TRT ad: lifestyle factors move testosterone significantly — and for a lot of men, they close most or all of the gap before medication is ever necessary.
Body fat is the biggest lever. Fat tissue converts testosterone into estrogen through an enzyme process. The more excess body fat you carry — especially around your midsection — the more testosterone gets converted away. Research consistently shows obese men have testosterone levels roughly 30 percent lower than men at a healthy weight. The reverse is true too: losing weight through diet and exercise has been shown in some research to raise testosterone production by up to 30 percent. That’s potentially the entire “Low T” diagnosis, solved without a prescription.
Resistance training has a direct, measurable effect. Compound lifts that recruit large muscle groups — squats, deadlifts, bench press, overhead press — produce the strongest hormonal response of any training style. This isn’t really about one workout spiking testosterone for an hour. It’s about what consistent strength training does to body composition over months: more muscle, less fat, a meaningfully different hormonal environment.
Sleep might be the single most underrated variable. Researchers at the University of Chicago restricted young, healthy men to five hours of sleep a night for one week. Their testosterone levels dropped 10 to 15 percent — in healthy men, in just seven days. Most daily testosterone release happens during sleep. If you’re consistently getting five or six hours a night, you are very likely manufacturing your own low-T symptoms regardless of what your lab work eventually shows.
Chronic stress works against you too. Elevated cortisol directly suppresses testosterone production — the same mechanism covered in our episode on stress and weight gain. It’s not a coincidence that the hormone wrecking your waistline is also undermining your testosterone.
Put those four together — body composition, resistance training, sleep, and stress — and you’ve addressed almost everything an online TRT clinic is selling a prescription for, without a single injection.
Three Things to Do Based on the Evidence
1. Fix the fundamentals before you fix your hormones. Strength train two to four times a week with real compound lifts. Get your sleep to seven hours minimum, consistently. Work on body composition if you’re carrying excess weight. Give this an honest three to six months before assuming a prescription is the answer.
2. If you genuinely think you have low testosterone, get real bloodwork from a real doctor. Not a ten-minute online quiz. A proper diagnosis means morning blood draws, a clear numerical threshold, and a physician who monitors you over time — not a subscription business model that profits from keeping you on the product indefinitely.
3. Be skeptical of any clinic that diagnoses you off symptoms alone. Fatigue, brain fog, and low drive are real — but they have dozens of possible causes, most of which have nothing to do with testosterone. If a service skips lab work or treats vague symptoms as sufficient for a prescription, that’s a business model, not medicine.
The Bottom Line
TRT is a legitimate treatment for a legitimate medical condition — but the industry marketing it has exploded by targeting symptoms that describe almost every tired, stressed, out-of-shape man in his 40s. Before reaching for a prescription, the evidence says: fix your sleep, fix your body composition, and start lifting heavy. For a lot of men, that closes the gap entirely.
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Coach Chris Cooper is the owner of Catalyst Fitness in Sault Ste. Marie, Ontario. The Catalyst podcast releases new episodes weekly at catalystgym.com/blog.
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