Testosterone is big business. One report found nearly $2 billion sales worldwide in 2019, with the vast majority of them in the United States. It is currently prescribed to improve sexual function, muscle strength, heart health, mood and cognitive function. Yet there is little evidence that it helps these conditions.

In an effort to cut down on unneeded and ineffective testosterone prescriptions, the American College of Physicians (ACP) has recently issued guidelines on the treatment of men with low testosterone.

The main thrust of these guidelines is that doctors should only prescribe testosterone to treat sexual dysfunction and only in older men who have low testosterone. They also call for stopping the treatment if sexual function does not improve within 12 months.

The ACP suggests switching from skin patches to intramuscular injections which are estimated at around $156, compared to $2,135 for patches. The savings alone should help boost mood.

The ACP describes these as conditional recommendations with low-certainty evidence backing them. The organization conducted its own systematic literature review and did find sufficient evidence to recommend that testosterone supplements can help some older men who are having sexual problems. It did not find similar evidence for other conditions, such as mood or cognitive function.

It's sad but true: testosterone levels start to drop in a man's mid-thirties and continue to decline as he ages. Unfortunately, there is no universally accepted testosterone level or threshold below which health problems will surely occur. And no known level at which testosterone supplements are likely to improve a man's health.

Most testosterone supplements work through the skin, or transdermally, and are applied as a gel or patch. The new guidelines suggest switching to intramuscular injections. Annual cost for these injections is estimated at around $156, compared to $2,135 for transdermal preparations. Most men are able to give themselves these injections at home and do not require a separate clinic or office visit for them. The savings alone should help boost mood.

Doctors who prescribe testosterone generally refer to the treatment as testosterone replacement therapy, or TRT. Men interested in whether testosterone treatment could help them might consider asking their doctor for the answers to these questions:

  • Will taking testosterone help my symptoms?
  • What are the risks and side effects of treatment?
  • How long will it take for testosterone to work, and what if it does not work?
  • What form of testosterone would be best for me?
  • They also might consider that, as one researcher in the field puts it, older men looking to boost their testosterone would be better off making some lifestyle changes than taking testosterone supplements. Losing weight or joining a gym are two possibilities.

    Annals of Internal Medicine offers three articles on the guidelines in addition to the evidence review. The guidelines themselves and a short patient summary are free to read. There is also an editorial.