The testosterone asterisk
Growth in testosterone prescriptions · 2018–2022
The takeaway: the boom is youngest-led. Prescriptions for men under 35 are rising two to three times faster than for the over-55s — the opposite of who the therapy was built for.
The FDA dropped testosterone's heart warning in 2025. A 2026 genetics study just added a quieter one back.
Testosterone prescribing keeps climbing — up 45% among men 35–44[1] from 2018 to 2022 — and in February 2025 the FDA dropped the cardiovascular boxed warning[2] from every testosterone product, citing TRAVERSE[3] (5,246 men), which found no rise in major cardiac events.
The same document added a new warning that testosterone raises blood pressure[2]. Then in April 2026, Cambridge researchers used genetics to test cause, not correlation[4], and found men with naturally higher lifelong testosterone carried about 17% more coronary artery disease. There was no effect in women.
Read together, the trials describe something narrower than the ads: testosterone looks reasonably safe for men who genuinely need it and get monitored, the benefit is real but bounded, and the heart question now runs through blood pressure. Tomorrow we look at whether a higher number actually changes how men feel.
Every week a man emails asking how to raise his testosterone. Almost no one asks the question underneath it: do I actually have low testosterone, or do I just feel worse than I did at 30?
They're different problems. Hypogonadism is a diagnosis[5] — low morning testosterone on two draws, plus symptoms. Feeling flat, sleeping badly, soft around the middle is not that. It's also the picture that improves most with training and sleep.
This week's data doesn't say testosterone is dangerous. It says it raises blood pressure, and the heart cares about lifelong exposure. So before chasing a number up, the free wins come first: lift, walk, and own a cuff.
— Zach, MD
- A 2024 meta-analysis[6] found creatine's effect on thinking is small and mostly limited to memory under stress — the muscle case is far stronger than the brain case.
- Each 1-MET of cardio fitness is associated with roughly 13% lower all-cause mortality[7] — an association, not proof, but among the most replicated findings in the literature.
- Up to ~40% of the weight people lose on semaglutide is lean mass, not fat, per the ADA[8]; pairing the drug with protein and lifting shifts that back toward fat.
Ultracrepidarian — (n.) someone who gives opinions on subjects beyond their knowledge. Useful this week.
A man lives on the 10th floor. Every morning he takes the elevator to the ground and goes to work. Coming home, he rides to the 7th floor and walks the rest — except on rainy days, when he rides all the way to the 10th. Why?
Citations
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