Is there a ’low T’ crisis? What young men need to know about testosterone therapy
Here’s what science actually shows about declining testosterone in young adults, and why treatment is rarely the first answer.
Scroll through any social media app right now, and you’ll find teenage boys and men in their early 20s debating testosterone levels. Some champion “testosterone maxxing, which means naturally increasing production through diet, workouts, or supplements. Others take it further, promoting testosterone replacement therapy (TRT) injections as a shortcut to better energy, muscle growth, or confidence. Viewed through the lens of social media, it can seem like a modern health crisis: a generation of young men convinced their hormones are failing them.
There is a kernel of truth to this. Studies have found that average testosterone levels have been declining in males of all ages over the last two decades. “The way we live our lives—we're not as active, we’re eating a lot more processed foods, [and] have high stress levels. All those things confound and really lead to a lower testosterone level for young people,” says Justin Houman, a urologist at Cedars-Sinai Medical Center.
But the online narrative flattens a much more nuanced reality. Even with these declining levels, most young adults still fall within healthy ranges. Yet as young men rush to optimize their hormone health based on social media claims, some are jumping straight to TRT, which can permanently disrupt their endocrine system. Here’s what experts want young adults to know before considering treatment.
Who actually needs TRT
Since the 1950s, TRT has been used for a narrow set of medical cases. “It was for men that had testicular cancer, and they either had one or both testicles removed, or a man with hypogonadism from birth, who has never produced enough testosterone,” says Greg Novacheck, partner at Live Forever Health, a telehealth clinic specializing in testosterone optimization, and a TRT patient himself. Over time, as studies showed that testosterone naturally declines by one to two percent per year after age 30, more men began seeking treatment to address age-related drops.
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For young adults under 30, the need is much less defined. A widely cited statistic from the National Cancer Institute estimates that 20 percent of men aged 15 to 39 have low testosterone, a misleading range that groups teenagers with men in their late 30s who are already experiencing decline. Houman says that for those under 30, the true deficiency may be closer to 10-15 percent.
Potential misuse aside, medically guided TRT is not controversial. According to the American Urological Association (AUA), any level below the healthy cut-off—300 nanograms per deciliter (ng/dL)—can negatively affect cardiovascular health, mental health, energy levels, cognitive function, and bone mass.
When someone truly has low testosterone, the AUA suggests restoring levels into the mid-normal physiologic range—roughly 450 to 600 ng/dL—where symptoms tend to improve without pushing the body beyond what it would usually produce. (Other experts extend the “normal range” up to 1000 ng/DL.) For those who genuinely need it, the benefits can be significant—improved mood, better sexual function, more energy, and better quality of life.
Why young men seek TRT
As testosterone content grows on social media, many young men are seeking out TRT not to treat a medical deficiency, but to enhance how they feel or perform. Influencers say it can benefit everything from energy levels to sexual performance to gym gains. Novacheck says 22-year-olds regularly call his clinic saying they’re tired and asking for a prescription. “That’s not the business we’re in,” he tells them.
But it’s not just young men asking for it; doctors are prescribing it much more liberally. According to a 2017 study in Translational Andrology and Urology, prescription of TRT has increased threefold in the last 10 years, especially among men with healthy levels. Up to a quarter of patients don’t even have their levels tested before treatment, and one third of those who do get tested don’t meet the levels for testosterone deficiency, according to the AUA.
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For someone without a deficiency, TRT can still produce noticeable improvements—initially. But when you use testosterone to push levels beyond what’s medically necessary, “you are really talking about black market anabolic [steroids],” says Novacheck. “That gives the industry a bad name, because you have a 25-year-old kid that's like, ‘oh, I'm doing TRT.’ You are not. You are in fact doing black market steroids, and you are calling it TRT.” He notes that once testosterone exceeds about 1200 ng/DL—and “definitely” beyond 1500—that’s no longer replacement therapy.
Access through direct-to-consumer companies also makes overuse easier. “With telehealth, everything is so easy to access now,” says Houman. “Even if people don't have low testosterone, you will find an online resource out there that will provide you with testosterone placement therapy.”
Novacheck says the issue isn’t telehealth itself—both virtual and in-person practices vary widely. Patients should look for practices that follow FDA regulations and providers who are willing to discuss alternatives rather than push medication.
Risks of taking TRT too young
The biggest concern with starting testosterone therapy too early is that it can interfere with the body’s own hormone production. Traditional TRT works by supplying testosterone from an external source, which tells the brain there’s no need to make more. For a healthy man in his early 20s who naturally sits around 400 ng/dL, a prescription might raise his levels to 800 ng/dL.
“He’s going to feel awesome, it’s going to be a night and day difference,” says Novecheck. “But if the lifestyle changes are never done, then when he’s 25, he’s at 400 ng/DL. When he’s 35, he’s going to be at 300 ng/dL. When he’s 45, it’s only going to get worse.”
For some men, that early decision can mean relying on medication indefinitely. “Did an uneducated decision at 25 years old do so much damage that you are now experiencing lifelong effects?” asks Novacheck.
Another temporary risk is to fertility, so it should not be used for people looking to conceive. “Testosterone replacement therapy will take your sperm counts to zero,” says Houman. “It’s temporary, but it's something to be aware of.” Most men can recover sperm production once they come off TRT, but the timeline varies, and in some cases, it can take months.
How to get treated for low testosterone levels
If you have symptoms of testosterone deficiency—fatigue, low sex drive, lack of motivation, depression—it is smart to get tested at the earliest sign, says Houman. But for young adults, true deficiency is uncommon, and symptoms often have multiple causes.
A significant challenge is that these symptoms are extremely nonspecific. “Most of the time, it's actually related to mental health issues in young adults,” Houman says. That’s why it’s important to see an endocrinologist and a urologist for diagnosis before treatment.
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For men under 30, lifestyle changes are usually the most powerful—and safest—intervention. Regular exercise, balanced nutrition, consistent sleep, and stress reduction can all help restore hormone levels without medication.
And if lab tests do confirm low levels, classic TRT isn’t the only treatment option. Several therapies, including medications such as Clomid and HCG, can stimulate the body to make more of its own testosterone rather than shutting down natural production. “We have so many options nowadays that they’re custom-tailored towards most patients’ preferences,” says Houman. “Learn more about what's out there and figure out which one of these options is best for you.”
