Between the male loneliness epidemic, spermpocalypse, and whatever the manosphere is on about, it’s easy to get the sense that we, as men, are all utterly screwed. Lately – perhaps capitalising on the vibe – Big Testosterone seems to be positioning itself as the solution to all male problems. If you’ve seen one of the increasing number of ads popping up everywhere from your Instagram feed to the London tube, you might think you’re the last remaining man on this earth who isn’t supplementing his testosterone levels.
Some men suffer from clinically low testosterone and need supplementation. That always has, and always will be true. But the symptoms of low testosterone – like chronic fatigue, weight gain, erectile dysfunction, and depression – can be tricky to differentiate from other conditions. How many of us would benefit from supplementation? Do we really have a testosterone epidemic? And how would physicians rate its seriousness – on a scale of one to Netflix documentary? We consulted doctors, patients and data to find out.
There is no universal guideline for what is considered low testosterone
At the heart of the question of whether or not we have a testosterone problem is the surprising absence of definitive criteria for what actually qualifies as low testosterone. “You'd think, by 2026, all the doctors of the world could agree on what constitutes an abnormal testosterone level,” says Dr Doug Savage, general practitioner and medical director at Leger, a membership-based clinic specialising in testosterone replacement therapy (TRT). “Oh, no. Nobody can agree.”
The British Society of Sexual Medicine, a sort of North Star for many practitioners in the UK, considers a total testosterone reading under 8 nmol/L to be a testosterone deficiency. However, because testosterone sits at the intersection of sexual health, hormonal health, and overall health, the BSSM isn’t the only group vying for authority in this space.
"There are different guidelines, depending on who you ask,” says Dr David Weinstein, NHS general practitioner and TRT clinician specialising in the diagnosis and treatment of low testosterone. For example, “there’s the guidance that the endocrinologists give, which will be slightly different. And then urologists kind of fall between those two,” he says. “And there’s also European guidance and US guidance, which are slightly different.”
This lack of definitive guidelines not only makes it incredibly complicated to identify a potential testosterone problem or place it in the requisite broader historical context, but it also creates unnecessary anxiety for patients who simply want to know where they stand. "I would say the NHS is certainly undertreating testosterone deficiency, and the private sector is perhaps overtreating it,” says Weinstein. “And for the average man on the street trying to navigate that path in the middle, it's very difficult.”
"There's a great reluctance to diagnose testosterone deficiency, and an absolute reluctance to treat it,” adds Savage. “And so this is what has led, particularly in the last five or six years, to a large increase in interest from commercial clinics.”
The private sector has a financial incentive to perpetuate the narrative of a global testosterone decline
According to a 2026 study published in The Journal of Clinical Endocrinology and Metabolism, testosterone prescriptions have increased up to 12-fold globally over the past two decades. But that’s not necessarily an accurate indication of need. In that same study, researchers audited the websites of over 250 private testosterone clinics, identifying rampant use of misleading and unsubstantiated health claims and leading the study’s authors to call for regulators to address a “widespread public health challenge, and align patient expectations with clinical guidelines for the safe treatment of men.”
Weinstein, a former employee of one such popular online clinic, has no illusions about the motives driving the private sector’s surging interest in the TRT business. Spoiler alert: it’s not patient welfare. “Their main purpose is profit and returns to their investors, and they will push quite hard for men to be started on testosterone,” he says.
While the medical community debates what should be considered low testosterone, private clinics are cashing in on the confusion, oftentimes operating independently of guidelines altogether. “They push the boundaries up,” Weinstein says. “They would maybe treat someone with a level of like 15 nmol/L. They're moving the goalposts so they can treat more men.”
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