Talk of testosterone deficiency is hard to escape these days, with podcasters and politicians obsessing over how to avoid a “low T” lifestyle.
As the hormone’s cultural salience deepens, demand is growing. In a timely move, telehealth giant Hims just launched a testosterone replacement therapy service for cisgender men.
The direct-to-consumer juggernaut will offer two types of injectable treatments, as well as an oral pill option that can be sent to patients after they take an at-home capillary blood test. Peter Stahl, a urologist and a senior vice president of men’s health at Hims, wants to “cast as wide a net, and get as many people tested, as possible.”
Hims, which started out selling erectile dysfunction medications, has expanded into women’s health and grown from a startup to a publicly traded company serving 2.9 million customers since it launched in 2017. Offering testosterone replacement therapy, or TRT, is both a new phase for the health platform and a doubling down on men’s health care. “When we first started, we didn't have the capabilities to take care of a complex condition like testosterone deficiency,” Stahl says. “We've finally grown up.”
The company will compete with a wide array of online clinics offering testosterone therapy, many of which have cropped up in the past few years using turnkey telehealth services to launch quickly. Many of these services market the medication as a lifestyle enhancer or anti-aging solution.
Stahl sees testosterone deficiency as a medical condition that’s “really underdiagnosed” and “really misunderstood.” Testosterone became a controlled substance following the 1990 Anabolic Steroids Control Act, and for decades, taking it has carried an association with muscle-obsessed gym rats. “That created a lot of stigma,” he says. Older research also showed that testosterone therapy came with cardiovascular risks, though more recent findings suggest those concerns were overestimated.
Testosterone levels have become a MAGA fixation. This fall, Pentagon chief Pete Hegseth announced a mandatory testosterone deficiency screening for most male troops in the US armed services. Texas Republicans have been hurling the phrase “low T” as a masculinity-questioning insult in a hotly contested Senate midterm race between Ken Paxton and James Talarico.
A survey of 2,000 American men this summer commissioned by Hims indicates that they are increasingly willing to talk to one another about testosterone treatment, but the stigma persists around taking medication to address low levels.
Because testosterone is a controlled substance, it can’t be dispensed like many other treatments popular with digital clinics. Unlike GLP-1s and estrogen-based hormone replacement therapy, which are now often prescribed by clinicians after patients simply fill out a quick questionnaire, TRT requires "synchronous" care. That means any would-be users have to have a video chat with a clinician before getting a prescription, and for ongoing monitoring.
“It's important to remember that testosterone therapy can cause infertility, and you don't give it to someone trying to conceive,” says urologist Mohit Khera, the director of Baylor College of Medicine’s Laboratory for Andrology Research at McNair Medical Institute. Khera sees telehealth TRT services as promising ways to expand access to the medication, “as long as it’s monitored appropriately.”
While laboratory testing can show whether testosterone levels are below thresholds set by groups like the American Urological Association to indicate potential issues, diagnoses aren’t made based on bloodwork alone. Instead, clinicians assess labs along with patients’ symptoms and medical history. Common symptoms of hypogonadism (the technical term for the diagnosis) include sexual dysfunction and muscle loss. Stahl calls it a “powerful biomarker” for understanding someone’s health.
“Quite frankly, it’s underutilized,” he says, noting that men with low testosterone have a 35 percent increased risk in overall mortality.
The test doesn’t require a standard blood draw. Instead, Hims will send patients a Tasso blood collection device, a round single-use wearable that sticks to the upper arm and punctures the skin with microneedles to collect a small sample. (It may sound suspiciously like Theranos, but Tasso devices have a solid track record.) From there, the patient sends the collection off to a lab that will conduct an analysis of a broad selection of 21 different biomarkers to assess health, including triglycerides and thyroid hormones as well as testosterone.
Based on the results, a patient might be prescribed a compounded injectable testosterone, a commercially available injectable testosterone, an oral pill—or something else entirely, if their testosterone levels are not low. Stahl sees hormone testing as a way to persuade otherwise-reticent men to go see a doctor. “Getting screened for testosterone deficiency is much more exciting to a young man who's feeling good than getting tested for high cholesterol,” he says. “So we're trying to leverage that opportunity as much as we possibly can.”
Hims’ expansion comes at a Wild West moment for online testosterone sales. In 2022, urology researchers went undercover to test how digital clinics prescribed the medication, and found that six of seven platforms in the analysis offered testosterone replacement therapy despite reported normal levels of the hormone.
Although he wants to test people widely, Stahl has a more conservative philosophy about who should actually get a prescription for testosterone, especially in comparison to digital clinics that explicitly offer it as an anti-aging treatment or lifestyle enhancement: “If you're asymptomatic, it doesn't matter what your testosterone level is, you're not going to get treated on our platform.”