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How Testosterone Therapy Is Transforming Aging

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Every wonder why old rich guys are looking a little more muscular these days?

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Illustration by GQ; Photographs by Getty Images

Shivin Devgon just couldn’t shake that sluggish feeling. Toward the end of 2021, the San Diego software engineer thought his health was on the right track. He exercised regularly and was able to perform well at work. Still, he lacked energy, and his mood always felt off.

“I would feel tired a lot of the time,” Devgon told GQ. “I wouldn’t feel happy. I would just feel kind of dead.”

While Devgon was wondering what was wrong, he started reading about the increasingly prominent theory that toxins in pesticides and plastics are throwing off men’s endocrine systems—and he started to wonder about his own testosterone levels.

The hormone is responsible for regulating the male sex drive and maintaing a host of other critical functions: generating red blood cells, distributing body fat, preserving bone density, increasing muscle mass, and making sperm. A lack of testosterone—low T, for short—can impair those functions, and a simple blood test is all that’s needed to diagnose it. Generally, according to the American Urological Association, low T refers to men with levels below 300 nanograms per deciliter of blood.

Devgon’s test found that his overall level was 421 ng/dL—higher than the AUA’s number, but well below normal levels for a guy in his 20s. Wanting a boost, he began taking the testosterone-enhancing drug enclomiphene in December 2021, and now Devgon says his total level has more than doubled. His mood has improved, and he’s also noticed other changes.

“I am hornier,” he says. “Before, I would never have morning wood, and now it’s pretty frequent.”

Devgon is still young, but more and more men are using performance-enhancing drugs, from human growth hormone for bulking up to injectable peptides for erectile dysfunction, to stave off the effects of aging and win at life—and, indeed, enclomiphene would get you kicked out of the Olympics or the Tour de France. 

Testosterone decreases as men get older. And while the FDA has cautioned against using the hormone for anti-aging, rather than treating a specific disease, boosting testosterone–either by stimulating the body’s natural production or directly supplementing with gels, creams, or injections–has become an increasingly fashionable way to fight back against the passage of time. One study found that the number of men on testosterone quadrupled between 2003 and 2013.

“As we age, we start to break down. It’s just what happens,” says Dr. Kara Fitzgerald, author of the new book Younger You: Reduce Your Bio Age and Live Longer, Better. “I don’t care how perfect you are. Your ability to perform at peak level is going to decline, period.”

Big names who have endorsed hormone therapy include Joe Rogan, who said in 2018 that he began testosterone replacement therapy when he was 40, claiming it “makes a big difference.” Sylvester Stallone is on the record as a supporter: “Everyone over 40 years old would be wise to investigate it, because it increases the quality of your life,” he told Time magazine. And last summer Dax Shepard revealed he had gained nearly 30 pounds and added muscle mass thanks to “heavy” testosterone injections, but that the mental effects were the most pronounced. “Forget the body,” he said. “Mentally, I love it, because it makes me far more on fire to be alive.”

Those are just the well-known men who have talked about hormone therapies, of course. Speculation surrounds middle-aged rich guys like Jeff Bezos, who is rumored to be an investor in a buzzed-about anti-aging startup and seems to be aging in reverse into Billionaire Mr. Clean, with viral fit pics to match. (For the record, people close to Bezos attribute his transformation strictly to diet and exercise.)

In any case, it’s not just the rich and famous: Doctor-approved doping is gaining ground among the everyday guy.

“You’d be surprised with how many people are on hormone therapies,” says Dr. Jessie Cheung, a dermatologist whose focus, in part, is on these treatments. “You look, feel, perform, think, recover, and age better.”

Testosterone is associated with physical changes like muscle growth and mental changes like confidence and aggression, though there is robust debate over the extent to which those effects should be understood as “masculine,” to what extent they’re shaped by existing social context, and whether these therapies show effects at a population level.

In any case, men are seeking these mental and physical changes, and Dr. Cameron Sepah, a professor of psychiatry at the school of medicine at the University of California, San Francisco, has noticed the uptick in popularity. He’s a clinician first, but has something of a vested interest as CEO of Maximus, which offers personalized treatment plans (a monthly membership is $149.99) to help men double their testosterone levels. Maximus men, Sepah claims, report having more energy, motivation, drive, and confidence.

“They don’t have the need for that afternoon nap anymore when they get sluggish toward the end of the day,” he says.

Chris Jones, who joined Maximus about a year ago, is 39 and works as an attorney in Los Angeles. When the pandemic hit, Jones became interested in assessing his overall health. While he says he never felt particularly tired or off-balance, he also had never taken a testosterone test, and was surprised to see that his total level was 260 ng/dL.

Since popping the enclomiphene, Jones says his level has jumped to 730. “I definitely feel more energy, more calm, more focus,” he says. “Just overall stronger and better.” The naps and extra cups of coffee he occasionally needed in the afternoons have tapered off. And his vertical—Jones works with a dunk trainer—has gone up eight inches.

While testosterone therapy provides benefits, some doctors will caution against turning to testosterone replacement right away if you’re feeling fatigued or less potent in the bedroom.

“There’s all these lifestyle factors that will cause low testosterone or sort of simulate low-testosterone symptoms,” says Dr. Kenneth Litwin, a physician who works with Fitzgerald at the Sandy Hook Clinic in Connecticut. “If you help the person to identify that and help them work on all those things, they may never need testosterone.”

That’s because testosterone levels can be affected by many factors. Getting eight hours of sleep or correcting a nutritional deficiency, like a low level of vitamin D, will restore your testosterone to its natural baseline. Strength training, looking for ways to decrease stress, and cutting out smoking are also key.

A good diet helps, too. Men produce both testosterone and estrogen, which aids our bone and heart health. Most male estrogen is made when aromatase, an enzyme found in the fat cells of the body, breaks down testosterone. Administering testosterone without taking into account your diet—especially if it’s poor—can lead to much of that testosterone being converted to estrogen instead.

Plus, if you’re interested in having children, there is a crucial caveat to consider. “I tell all my male patients that testosterone hormone therapy will shut down their own sperm production,” Cheung says.

But most doctors who prescribe testosterone note that sperm production will bounce right back if you stop. Dr. Joseph Raffaele, an internist by training, has treated hundreds of men in his 25-year-old practice with testosterone, many of them for decades, and says he’s never had a case where a man is producing any less sperm after coming off testosterone therapy than he was before.

“That will all recover, and I’ve had guys get their wives pregnant while on testosterone,” he says. “The idea is to put in the right dose.”

Still, it’s for this reason that Sepah’s company uses enclomiphene, which helps men generate more natural testosterone. His personal view is that direct testosterone replacement should be a last resort—but says that replacement is not unsafe when administered correctly.

The more common question Raffaele gets from his patients is how long they can stay on testosterone therapy. “That’s what we don’t have the answer to,” he says. There are doctors who warn about becoming dependent on consistent rounds of treatment and inconclusive but worrying side effects in men with heart trouble. Raffaele only sees benefits, however: “The things in the plus column for testosterone in most males, I think, are going to far outweigh the risks,” he says.

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