When men and women feel unusually fatigued, notice changes in mood, or experience a decline in libido, many leap to the conclusion that their testosterone is low—and in turn, hop online in search of quick-fix supplements. But medical experts now caution that this narrative is oversold, and that so-called “testosterone supplements” rarely live up to their promises.
The hype vs. reality of testosterone supplements
Though the figure varies, commonly cited estimates suggest only about 2 per cent of men truly have clinically low testosterone (also called hypogonadism). As men age, low testosterone becomes more common: for instance, one study estimated deficiency rates of 4–12 per cent in men aged 50–59, 9–23 per cent in those 60–69, and 28–49 per cent in men over 70. However, the phenomenon is much less frequent in women. In one U.S. study, just 4 in 10,000 women were prescribed testosterone in 2017.
Medical professionals—including OB/GYNs and hormone specialists—argue that symptoms such as tiredness, low libido or fluctuating mood are not specific to testosterone deficiency, and may stem from underlying conditions like low iron, thyroid problems, vitamin D deficiency, sleep apnea or other hormonal imbalances. In some documented cases, patients with initially low testosterone responded fully to correction of those root problems, without needing hormonal therapy.
Over-the-counter “testosterone boosters” (sometimes dubbed “T boosters”) often tout herbal and vitamin ingredients like fenugreek, zinc, maca or ashwagandha. But systematic reviews have not found convincing evidence that they meaningfully increase testosterone levels. One analysis of 50 such supplements found many included only vitamins or minerals and lacked solid clinical data to back their claims.
In fact, some products even include ingredients that might reduce testosterone, or that carry unknown risks—especially since supplements are less tightly regulated than prescription medicines.
Prescription testosterone therapy: mechanisms, benefits, and risks
When medically appropriate, testosterone is delivered in forms such as injections, gels, patches or implants, under strict medical supervision. Unlike supplements, these therapies deliver pharmacologic doses to bring testosterone into a normal physiological range—but they are not without potential adverse effects.
Some well-documented risks associated with testosterone therapy include:
- Suppression of the body’s natural testosterone production, which may impair fertility and shrink testicles
- Elevated red blood cell production, which can thicken the blood and raise the risk of clot events
- Acne, skin reactions, swelling, and worsening of sleep apnea
- Potential effects on the prostate (for example, stimulating benign prostate enlargement)
Elevated blood pressure
Indeed, in early 2025, the U.S. Food and Drug Administration (FDA) issued a class-wide labeling update for all testosterone products. The new labels remove language about increased risk of heart attacks or strokes (based on findings from the TRAVERSE trial that showed no detectable increase in cardiovascular events) but add warnings about elevated blood pressure, following post-market ambulatory blood pressure studies that showed consistent blood pressure rises across products.
U.S. Food and Drug Administration
Other major studies give a nuanced picture. For example, a large New England Journal of Medicine trial involving over 5,200 men aged 45–80 found that carefully monitored testosterone treatment did not increase risk of heart attack, stroke or cardiovascular death compared to placebo.
Still, additional risks emerged: higher incidences of atrial fibrillation, acute kidney injury and pulmonary embolism were observed in the treatment group.
Another concern is that rising testosterone levels (even naturally) may correlate with increased risk of atrial fibrillation (AFib) in older men, a common cardiac arrhythmia associated with stroke risk.
In short: testosterone therapy is not a universal remedy. It carries trade-offs and must be applied selectively and monitored closely.
Common pitfalls & misguided uses
One growing concern is off-label or overprescribing of testosterone, particularly among middle-aged women. Some social media influencers and even some clinicians are promoting testosterone for general energy, mood or vitality—despite a lack of strong evidence for benefit in those settings. Experts warn this could lead to long-term harms such as virilization (deepened voice, facial hair), liver effects, increased cardiovascular risk or hormonal imbalances.
Likewise, in the “manosphere” and among performance influencers, testosterone therapy is often marketed as a shortcut to muscle gain or improved masculinity. But enhancing testosterone in otherwise healthy individuals with normal levels is unlikely to yield dramatic effect—and might carry risks.
Another emerging finding:
newer obesity therapies such as GLP-1 drugs (e.g., semaglutide, dulaglutide, tirzepatide) may indirectly boost testosterone in men with obesity or type 2 diabetes—possibly by promoting weight loss and metabolic health. This suggests some improvements in testosterone may arise through metabolic interventions rather than direct hormone supplementation.
What readers should take away
Symptoms such as fatigue, low libido or mood changes are non-specific and have multiple possible causes.
Over-the-counter testosterone supplements have very weak evidence for efficacy and may carry unknown risks.
Medically supervised testosterone therapy can help in cases of confirmed deficiency, but requires careful selection, monitoring and awareness of side effects.
Health authorities are tightening labels and risk warnings for testosterone products, especially around elevation of blood pressure.
For many individuals, improving diet, exercise, sleep quality, weight management and correcting nutrient deficiencies may yield better and safer results than hormone supplementation alone.
If you’re concerned about your hormone levels or related symptoms, the safest path is to consult a qualified medical professional. A doctor can order baseline and follow-up tests, assess likely causes, and guide you toward treatments—whether lifestyle, medication, or hormone therapy—that match your health profile.
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