For thousands of years, masculinity has been associated with testosterone — the hormone that helps maintain muscle mass, bone density, energy, sexual desire, and performance in bed. However, testosterone levels naturally decline with age: Beginning as early as the fourth decade of life, there is an average annual decrease of about 2% in the hormone. Among men aged 60 and older, one in five will suffer from low levels defined as hypogonadism.
In recent decades, a massive market has developed for testosterone replacement therapy (known medically as TRT), designed to restore hormone levels to more “youthful” values. Between 2001 and 2013, the number of prescriptions increased by 300% in the United States, accompanied by campaigns promising energy, concentration, improved memory, and libido. But within a few years, there was a dramatic decline — after studies linked the treatment to an increased risk of cardiac events.
Possible Benefits
Testosterone therapy can affect several health areas, but findings are not conclusive:
• Muscle mass and physical function: Clinical trials found that TRT increases muscle mass and reduces fat, but its impact on strength and daily performance is less consistent. Some studies showed improvement in upper body strength or stair climbing, while others found no change in walking or balance.
• Bone health: Some studies found no effect on bone density, while others showed improvement in the lumbar spine area. The impact appears to depend on hormone levels before starting treatment.
• Sexual desire and function: This is where the clearest benefits were found. TRT may improve libido and sexual function in men with very low testosterone. However, not all men report significant improvement.
• Mood and cognition: Studies in older men have not found clear effects on depression or cognitive decline. The connection between testosterone, memory, and mood is still not established.
Risks and Challenges of Treatment
Alongside its benefits, TRT may entail a series of side effects and risks:
• Cardiovascular health: In 2014, the FDA required an added warning of increased risk of heart attack and stroke. Some studies indicated a rise in cardiovascular events, while others found no connection. The current consensus: There is no conclusive evidence for long-term safety.
• Prostate: Testosterone increases PSA levels and may enlarge the prostate. So far, no clear link has been found to prostate cancer, but studies are too small to rule out the risk.
• Polycythemia: TRT increases the production of hemoglobin and red blood cells. In cases of excessive blood viscosity, it may raise the risk of blood clots and stroke.
• Fertility: The treatment suppresses sperm production. Most men regain fertility after stopping, but in rare cases, the damage is permanent.
Not for Everyone, and Not Always
Despite media hype and high expectations, medical guidelines state: TRT is recommended only for men with low testosterone confirmed by lab tests and with clear clinical symptoms — such as weakness, decreased libido, or loss of muscle mass.
According to Dr. Michael Eisenberg of Stanford University, “It’s important to emphasize that men with unusually low levels who are untreated may be at higher risk for heart disease, osteoporosis, and other illnesses. But the benefits versus the drawbacks must be carefully weighed.”
Natural Ways to Boost Testosterone
Before rushing into hormone therapy, there are simpler options:
• Weight loss in men with excess fat.
• Regular physical activity, especially resistance training.
• Ensuring sufficient sleep and reducing stress.
These steps can moderately raise hormone levels and improve overall health — even without medication.
The aging of the global population ensures that the conversation around testosterone will only intensify. The number of men over 65 is expected to double by 2050, and with it, the demand for solutions that promise a better quality of life.
For now, TRT is a tool in use — but not a magic solution. Research continues, and the answers to the big questions — whether the therapy is safe in the long term, and whether it truly improves function and life — are still far from final.