What's with all the testosterone talk?

Today, we're going to help you debunk the myths behind the hormone all over the headlines. That hormone is testosterone. Our story starts with US Defense Secretary Pete Hagseth, who announced in early July that the military would implement testosterone screenings for soldiers over 30. He calls it the "high-tee department of war." Hagseth said the test would be part of the regular annual health assessment. There's memories younger than 30 can voluntarily get their testosterone levels tested as well. Pete Hagseth says, "By addressing these health markers early, we're keeping you on the leading edge of lethality." Now, there's a lot wrapped up in the idea of lethality here, but I'm curious about something else here as well. What does a "high-tee" military mean exactly? And what are the facts and fictions that let us hear to this cultural moment where testosterone is fascinating men from TikTok bros to the high halls of the US military? Find out. I'm here with NPR Health correspondent Will Stone and Dr. Helen Bernie, director of mail, sexual and reproductive medicine at Indiana University, and associate professor of urology at Indiana University. Helen, will. Welcome to it's been a minute. Hey there. Thanks for having me. Hello, hello. I'm Brittany Loose and you're listening to it's been a minute from NPR. A show about what's going on in culture and why it doesn't happen by accident. And a reminder, if you love it's been a minute, which from the sweet comments y'all have been leaving, it sounds like maybe you do. Be sure to follow or subscribe to the show on your favorite podcast app. That way you get new episodes the moment they drop. So testosterone is often talked about as if it explains everything about men. I'm wondering biologically, who has testosterone and what does it actually do? Helen, let's start with you. So testosterone is a hormone, right? It's not a personality trait. And men and women have testosterone and we need healthy, normal levels of testosterone. So biologically, it plays a really important role in our sexual function and sperm production for men, maintaining your muscle and your bone mass, red blood cell production, your energy levels, your mood, your overall health. So it's just one hormone among many that really helps the body function normally. Okay. Okay. So what does it not do? Like, what are some of the biggest myths about what testosterone does? Yeah. So testosterone doesn't determine whether someone is a great guy or a successful leader or masculine, right? It doesn't create character. But you know, often times what we do is we confuse biology with someone's identity, right? So testosterone influences certain biological processes. It doesn't define who someone is. So I think the biggest myth, I think is either that like higher testosterone is always better. And medicine just rarely works that way, right? Like there's that healthy, normal, physiologic range. It's not a contest. And also that like testosterone is only about sex, right? Or it's this fountain of youth. It's actually really important for a lot of biological processes in our body. It's involved in bone health, red blood cells, your metabolism, fertility, all of these things. Okay. I'm wondering. Well, you have been looking into this for quite some time. What are some of the biggest myths about testosterone that you've seen floating around? Like what are some of the beliefs people are espousing either on the news or on social media? It's not all that subtle. I'll tell you. If you look at the messaging online, you know, you are told that if you don't have enough testosterone, if you're low T, you could be sacrificing your confidence as a man, your energy, your mood, you know, your gains in the gym. And just more broadly, I think kind of your vitality. And there's a lot of appeal to that idea by many of these companies that market testosterone replacement therapy. And then you know, folks online who talk about this, I mean, to the extent that people are actually told, you know, your endanger of becoming a woman because your testosterone levels are so low, that is what the rhetoric is certainly in some circles online. Huh. Interesting. Interesting. Okay. And all of that definitely sounds at odds with what you have described Helen as far as what testosterone does and who has it. Okay. So in medical settings, why does the idea of prescribing testosterone or even asking for a testosterone screening provokes such strong reactions from both patients and physicians? Like what's going on with testosterone being prescribed in medical settings? Yeah. So I, it was really strong opinions and reactions, right? Because on one hand, people think of it as this like found of youth, this great medication. And then there's these dangers and people are really scared of it. It's going to harm men, you know, previously the FDA also had different labeling warnings on testosterone. It's such as that it could cause cardiovascular disease or that it could cause prostate cancer, you know, it was contraindicated or prescribing it to someone that had prostate cancer. So now these labeling, because we have years and decades of science and data that shows that isn't true as of last year, February, 2025, and just last month, June of 2026, the FDA removed these labeling in these black box warnings on testosterone. So I think that's one of the biggest reasons where people were just scared to death of prescribing it. And from the 1980s and 1990s athletic doping scandals, everyone was scared that, oh, this is so bad and this is dangerous. And we turned testosterone, which is just a hormone, into a class III schedule drug. That means that it is prescribed the same way and managed the same way as narcotic pain medication. Wow. Right? So people are scared to prescribe this stuff. Patients were scared to ask for it, but the truth is, testosterone is just another hormone, right? People think of low testosterone, and like Will said, they hear less of a man. Even though medically, those aren't even the same thing. So you have patients asking for testosterone because they've heard it can solve everything. And then physicians worry about this inappropriate prescribing. And so, you know, the answer isn't to ignore testosterone or screening or to prescribe it to everyone. It's really, we should be doing thoughtful, evidence-based evaluation for every guy that comes in. I mean, the other thing that I think about too, in terms of like the sort of stigma that can be carried around testosterone and testing for it and all of these things, to the point that you brought up about it being considered a controlled substance is something that could be a performance-enhancing drug. I'm thinking about like female Olympic athletes being tested for their testosterone levels and how degrading and often racist that process could be. I mean, I remember watching all the trials and tribulations that, you know, an athlete like Costa Semenia went through as recently as like 10, 15 years ago and bringing up all of these questions about, you know, who's real, who's not real that don't seem very productive and more than a bit discriminatory, it sounds like there's just a lot of baggage and a lot of sort of weight there. Have you seen that show up in your reporting, Will? Well, I think when you speak to, you know, men out there who are, you know, searching or trying to get answers about whether they have low T, whether they need treatment, you do hear from them that they felt disregarded, dismissed when they went to their primary care physician because of what Helen is talking about, outdated views or just the fact that the science has been changing, the guidelines are changing and there are men who feel as though they end up being dismissed by their doctor and then they end up in this online sphere where there's a huge amount of marketing around this direct to consumer marketing and clinics and that they feel someone is actually taking their concern seriously and actually listening to their symptoms and I mean part of the challenge which we can get into is that, you know, you ask for symptoms, they're quite vague and just on the face of it and so this can make all kinds of things feel like you have low T if you ask anyone, including me at a given time, you know, is my energy off, you know, am I feeling like I'm not making the progress I want to even the gym? I mean, maybe I'd say yes, right? That doesn't necessarily tell you anything about whether I truly have low T. I feel like, you know, as we're discussing, obviously Americans often use high testosterone as like shorthand for being masculine, aggressive, dominant or having, you know, certain sexual prowess, you know, conversely low T, as we described, it means that you are feminine, weaker, less capable. What happens when we equate hormone with an entire identity? You know, you bring up such a good point, right? Again, it's so important to separate masculinity from medicine, right? Like masculinity and someone's prowess, like that's shaped by so many factors, right? Your culture, your family, your faith, your experience as your personal values, right? testosterone is just a hormone. It's a hormone just like insulin, just like thyroid hormone. It's an important hormone in our body that makes everything function like it's supposed to be, right? And so I think, you know, when we go to these extremes where everyone either thinks, "Oh gosh, is it, is my fatigue this or is it that?" I'm excited because I like that it's getting then maybe engaging with the healthcare system more and getting into talking about health. Oh, going to doctor. Yeah, that's the idea. Yeah. That's a positive thing, but I think again, it's, you need to equate it with evidence-based guidelines. It requires an evaluation, it requires a discussion. It's not just this endo-be-all testosterone is everything because it's not. It's just a good hormone that we all need. Men and women for our healthy body functions. And let's be real. I mean, if you look at the messaging online in some of these areas, it's certainly an appeal to a very traditional kind of normative narrow version of masculinity. And it's very blatant. I mean, I spent a little time going to some of these sites. I'm a 36-year-old man. So I think I'm a prime target for them. And filled out some of the questions they ask you and then you get this video sometimes that says, you know, men have been told a lie. You've been told that aging, it's okay to slow down. This has been called wisdom. I want one said that. And then they say, no, you should wake up hungry every day. And then there's like a cheetah running around. You should be hungry, ready, eager to take the day, you know, ready to dominate, right? I mean, this is the form of masculinity that is being sold in the form of testosterone therapy. No, it's true, right? Like this idea of straight competitiveness, athletic performance, sexuality, right? Like those are the ones that are traditionally associated with masculinity. And, you know, I think just over time, these biological associations have just been exaggerated into these cultural ones. I think about a lot of other situations where people have higher levels of testosterone due to for instance, conditions like PMOS, which is polyondromedabolic ovarian syndrome, or even paramedicos. And I don't think this is who Pete Hegseth is trying to recruit to be on the front lines. You know, it seems like you ended up losing a lot of nuance when testosterone gets equated with one identity or one gender, one almost cartoonish idea of what it means to be sort of like a tough guy. And there's an interesting tension here because, as Ellen can talk about, there's a real risk to testosterone, especially when you're younger in terms of fertility. So at the same time that there is an appeal to masculinity in terms of, you know, making sure you have enough testosterone and maybe, you know, taking, taking some, there's also been an appeal to we need to bring our birth rate up, you know, and there's a fertility crisis. And if you start a young man on testosterone, there's a real risk here. Coming up after the break, testosterone is seen as part of this broader package of kind of how you can become better or confident, more productive, and, yeah, stronger man. Stick around. I can certainly understand, especially like there are people who, you know, pursue testosterone as a part of like gender-affirming healthcare. I can definitely understand, you know, having a personal relationship to how, you know, a higher dose of testosterone may like affect your experience of the world and affect your life. But again, this sort of things that people are talking about, these blanket ideas about what different genders are like. Like you are strong, you will be on the front lines. You're going to wake up every day, hungry like the Cheetah. It's just, it just seems, it, it, you know, again, these are also ideas that don't necessarily have to do with gender either. It's interesting that this is association there. I wonder, like are there moments in our culture or history that have helped make testosterone the cultural symbol that it is today? Like are there milestones that shaped how we think about it today? Yeah, so, you know, testosterone was actually isolated back in the 1930s. So it's been around for a long time. And when it was first isolated, it was viewed almost like this scientific key to masculinity that we discovered, right? And then you fast-forward to like the 1970s, 80s, 90s, when this anabolic steroid era came in. And then this reinforced this public idea that testosterone equals strength and dominance. And even though anabolic steroid abuse is very different from medically replacing testosterone and men who actually need it, that's still stuck, right? And people still kept continuing to associate testosterone with anabolic steroid abuse. And then, you know, you get this direct to consumer advertising, which will as being accosted with, you know, and that like started around the early 2000s where low tea advertising became extremely common. And suddenly, many of these normal experiences of aging or just being human, right? We're not always going to be in a great mood every day. And that's part of being human. That's part of also as an indication of our diet, our exercise, our sleep, our overall health, right? Like, it doesn't necessarily mean that, oh, they're definitely testosterone deficient, you know? But that really helped to move testosterone from like endocrinology clinics into everyday conversations. And then now we have social media that oftentimes portrays testosterone as this shortcut to confidence, to success, to longevity, to becoming the true alpha male, right? And so those messages just frequently go well beyond what the science supports, you know? I think these were probably the biggest milestones. And then when we had black box warnings saying that it was unsafe or as dangerous. And then the class three scheduling, like all of those things not only scared patients from seeking health care and asking about it, but also physicians from prescribing it and getting comfortable with it, treating it just like we do anything else, like insulin or thyroid hormone. It is just a hormone that is important for bodily functions. As I was reporting this, I mean, I was just struck by, you know, what we see a lot in medicine, the kind of pendulum, right? There was this huge boom in the early 2000s. It was one of the fastest growing prescription drugs, I believe. And then then there was this course correction because of these safety concerns that more evidence came out. And you know, I think the clinicians and the folks in this field are still trying to, yeah, that middle ground where it isn't stigmatized for people who actually would benefit. And so that's kind of the process that's I think that's moment we're in right now. And but certainly we are in a moment given the leadership, you know, the federal government. And we have, you know, Health Secretary Robert F. Kennedy, Jr., saying he uses test astronauts part of his anti-aging protocol. And then all the ways that masculinity is being constructed, you know, from the pull-ups with heads that to all of this in the genes that, yeah, we are in a moment where this is getting a lot of visibility. And I think it remains to be seen, you know, how that actually translates into kind of consumer awareness about the who should and should not use this. You know, the military has long been a place where ideas about strength and toughness and masculinity are amplified. Secretary Defense Pete Hexeth has described wanting to have a militia quote on the leading edge of lethality, end quote, and wants to implement this, you know, testosterone screening as a means to that end. What message does an increased focus on testosterone and its connection to lethality? What kind of messages that said to service members and to the broader public? So again, I think we're mixing up science and culture, right, medicine and masculinity, right? So I think we're more interested in mental health than we've been in decades. And I think testosterone has become a symbol of that conversation. But my hope is that we don't just stop at testosterone, right? We should also be talking about obesity, diabetes, cardiovascular disease, sleep, mental health, exercise, smoking cessation, you know, preventative care and man. Yeah, 100%. You know, Will and I were talking the other day. Testosterone is probably one of the most important biomarkers of a man's overall health, but screening doesn't mean treatment, right? It doesn't mean that everyone we screen is going to automatically get treatment. It means we need to evaluate these patients and we need to look for underlying causes. Is there low testosterone due to undi-nosed obstructive sleep apnea? Is it due to pre-diabetes or diabetes? Like other health conditions that we can implement preventative health care initiatives in and really improve the overall health of men in the United States, right? Because when men are healthier, then they're healthier people. They're healthier partners. They're healthier family members. They're healthier spouses. They're healthier members of the community, right? When you feel better, you do better. So, it's an important conversation, but not lethality. I mean, yeah, look, you're not going to find a a randomized controlled trial showing, you know, testosterone replaced with therapy, you know, increases lethality, I don't think. Clearly it's connected to overall health. And when I did, you know, the initial reporting around this policy, I mean, there was a range of views I heard from from Helen's colleagues. Not everyone, leaders in the field, not everyone thought it was totally out, you know, crazy. They said, "Well, yeah, there's an argument to be made that this gives you an essence of a man's overall health. There are others who were deeply concerned. It's not part of the, the guidelines right now, this kind of general screening, unless someone has symptoms, etc. And there's a concern about implementation. I mean, that's where it comes down to. If you're screening everyone, and then men who don't have symptoms are getting prescribed in huge numbers. I mean, I think that's really where the rubber meets the road type of thing. Yeah, you know, the biggest argument that people go back to is that none of our guideline committees recommend routine screening in the absence of symptoms, Science and symptoms. testosterone. And so if you look at the endocrine society and the AUA, which is our American urological association guidelines, I'm traditionally recommend that you screen someone that has signs and symptoms and you base it on two early morning blood tests. I wonder is stepping back, how does our fascination with testosterone fit in with other cultural trends and how people are reconsidering masculinity and what it means to be a man? How is this fitting into the current moment around those discussions right now? Certainly this is part of this whole ecosystem of kind of wellness, optimization, you know, kind of protocols and marketing and podcast and all the rest that many men are plugged into these days, whether we're talking about peptides, which I've been talking a lot about, or other ways that men are trying to kind of optimize and regain a sense of vitality. I think you have very prominent voices who are talking about this and testosterone is seen as part of this broader package of kind of how you can become, you can bioengineer yourself, biohack to become you know, a better or confident, more productive and yeah, stronger man. And I just see it very much in that space and the marketing material and the content talks a lot, uses a lot of that same language. Is you nodding Helen? Yes, yes, right, is become the symbol of a much broader conversation about mental, but a lot of the marketing doesn't match the medicine. Oh my gosh, you both are giving me so much to think about today. I knew that there was something going on, something kind of looking into the surface with all of this high T talk and thinking about the high T army, but yeah, hearing more about both the science behind this and also the cultural shifts that are underpinning this, it's been very clarifying. Helen, well thank you both so much. Thank you. Thanks so much for having us and covering this. That was NPR Health Correspondent, Will Stone and Dr. Helen Burney, director of male sexual reproductive medicine at Indian University and associate professor of neurology at Indian University. This episode of it's been a minute was produced by Corey Antonio Rose. This episode was edited by Nina Patuck, our supervising producer is Shervenson. Our executive producer is Barton Gurdwood. Our VP of programming is Yolanda Sanguini. All right, that's all for this episode of it's been a minute from NPR. I'm Brittany Luce. Talk soon!