Testosterone is all the rage

0:01Noel King:We all have it. Men want more. Women also want more. You know what I'm talking about.

0:17Noel King:Testosterone. Big T. Today on Today Explained, the hormone of which ladies and germs cannot get enough. Everyone's on T. Should they be? Stay turned.

0:40Let's bring that bass back. Oh yeah.

0:52Give them a big T finish.

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1:47Step into a local croc store and step into your new look. Try it. Style it. Make it yours. Because the right pair doesn't just show up. It shows off. First day fits handled. Walk out ready for whatever's next. Visit your nearest croc store today. So the number one thing I think that doctors don't prescribe, which is a shame, is today explained.

2:16Noel King:Medical professionals, your doctors, your nurses, wrote 11 million prescriptions for testosterone in the U.S. in 2024. That was up from 7.3 million just five years earlier. That said, a lot of people are also getting tea, sometimes in troubling doses. I had to take mine down because I was like, it was like I was humping everything. Yeah, you'll just hump and hump and hump away. From nutritionists and med spas and wellness centers. I talked to Susan Dominus, a staff writer at The New York Times Magazine, for a show that first aired last year about a piece she wrote on women who take tea. In recent months, I've just been seeing the topic come up much more among influencers.

2:55Ladies, low libido, brain fog, depression, anxiety, low testosterone. Do you notice a difference with it? I do. Me too. My libido is bad.

3:04Noel King:Yeah, I know. And I have more energy. I found it again. I found my libido. Right? My friend started talking to me about their experiences with it. And I heard some kind of incredible stories about what happened to women when they went on unusually high doses of it. You know, the idea that a hormone could have such a hold, not just on how you felt physically, but how you felt emotionally and in relationship to other people. That was a really intriguing idea to me. What is this hormone? What does testosterone do exactly? And who has it? So both men and women have testosterone. Men have literally 10 times the amount of this hormone that women do, and it is something that declines gradually in men over time.

3:46But in women, who of course have much less of it to begin with, it actually diminishes over time even more dramatically, so that by the time they are around 60, they have about half of the amount of testosterone circulating through their body that they had in their, let's say, early 20s. And it's produced by both the ovaries and the adrenal glands in women, but it is only produced by the adrenal glands by that point in women's lives. As women have less testosterone over time, what starts to happen? What changes? Well, we're not exactly sure, to be honest. You know, it's one of these situations in which we know what happens when you replenish their testosterone, which is that, you know, if you restore women to the levels of testosterone that they had in their 30s when they are actually, let's say, in their 50s, there's a lot of research that suggests that it restores some of their libido and other things such as mood or energy.

4:44Noel King:And in your article, you very hilariously described what happens when women start taking testosterone. It was inspiring. Tell us what you learned. So there's, I mean, there's really two very different experiences, right? In the United States, when women take what is considered, I'm just going to use this, you know, colloquially, a standard dose of testosterone, one that's been approved by various illustrious medical societies, at least in short term use. You know, this is the amount that restores women in their 50s or 60s back to where they were in their late 30s to that level of testosterone.

5:19Those women report a minimal but meaningful, you know, restoration of their libido. I started to feel like I was attracted to my husband again in a different way that I haven't felt in quite some time. Think of this. Think of not going to bed hoping that your husband doesn't touch you. It's not that you have this crazy high sex drive. It's just that I can lay in bed normal. However, there's an entirely different cohort of women who are getting prescribed what are known as pellets or they're taking a lot more of the cream than their doctors would advise. And these women are getting into their systems several times the level of testosterone that they ever would have had in their bodies, even as very, you know, young women in their 20s.

6:07And those women are having unpredictable but fairly dramatic results. Some women report, you know, really intense, almost uncomfortable sex drives. I once got dosed with a man's amount of testosterone on accident. And I start looking at my boss and my coworkers and I'm like, oh my God, why do I want to do things with my coworkers? Like, this is making no sense. When that testosterone kicks in.

6:36Some women report irritability or even rage. Some women report side effects, like having chunks of hair fall out. hair growth on their faces or elsewhere on their bodies where they're not used to having hair grow. So you've got hair on your face and you want to know if it can be reversed. My biggest complaint with taking testosterone is the appearance of zits that I used to never get. And now I get them all the time. And also a lot of women on those high doses, I mean, it's kind of like a steroid, right? Like they report having tremendous boosts of energy.

7:09Noel King:You know, I've seen this on my own Instagram. Contact this company and they'll run a test for you. But insurance doesn't cover testosterone, right? Oh, it's not even FDA approved for women in any dose. So basically, a bunch of illustrious medical societies, you know, got together and issued a consensus statement in 2019. And they said, look, we know it's not approved by the FDA for women, but we're going to go out on a limb here and say that the safety data looks pretty good, at least in the short term, at least for postmenopausal women who are the women who have been studied the most for this.

7:40But it's not approved by the FDA, even at that level. And so insurance definitely does not cover any of this for women. I think there are a lot of people who stand to make a lot of money off of these high doses of testosterone because, you know, insurance doesn't get involved. They can charge women a lot of money. Sometimes they get, they certainly don't get addicted to it, but they have a hard time, you know, walking away from it. And it, you know, they, they, it can cost upwards of easily upwards of thousand dollars at a time to take these pretty high dose testosterone pellets. For example, it's not the only way women get high testosterone.

8:19I saw a job listing on one kind of aesthetic spa that was offering nurses$100 per shot of testosterone that they gave women in their spa. And, you know, then I heard stories from other women who said that they were basically directed before they even left the spa, like, go make sure you get your testosterone shot, you know. So the nurse is highly incentivized to provide it. Women are sort of being told, take our word for it. You're going to love it. Like, go book a hotel for you and your husband this weekend. You're going to be so busy, you know? So it's a very hard sell. They are sort of posing as medical practitioners.

8:54Some of them are. Some of them are OBGYNs or urologists who, you know, are trained. But the financial incentives are high. And sometimes women love it. And sometimes they discover midway through, let's say, a pellet, which can take three months to dissolve, that they're miserable. But there's nothing you can do about it once it's been inserted, you know, underneath the skin of your buttock.

9:16Noel King:Why hasn't the FDA approved this as a treatment for women? Well, the last time that a drug company got it together and actually did some trials of a testosterone patch, it was Procter & Gamble, that did show that women were having, you know, incrementally more satisfying sexual experiences. Their libidos were restored. But that was right after another study came out in 2002 that caused a big menopausal hormone therapy scare. And so basically, as I understand it, the people in the panel were concerned about cancer risks, you know, breast cancer specifically. And there was even a couple of excess cases in a fairly small sample size.

9:53And they just didn't have enough long term data is what they said to endorse it and give it FDA approval. Now, a lot of feminist followers of medical history have said, well, that was not required for testosterone to be approved for men. There was no long-term data for men required. All that the drug companies had to prove back then was that it restored men to the level of testosterone that would make them virile and youthful and strong again, to which other people would then say, right, but they don't get breast cancer and women do. So, you know, that's the concern with women.

10:28Noel King:Perhaps not surprisingly, some of the conversation around this has turned political. You wrote about the parallels between women, often conservative women, who are taking testosterone and gender affirming care for transgender people. Tell me a little bit about what you explored here. You know, I just thought it was interesting. One of the most influential testosterone influencers is this lovely person named Marcella Hill. To go from being dead inside, not wanting anyone to touch you, to wanting to have sex at all, having it in your brain at all, is a massive difference in how you show up to life.

11:05Who was a member of the Church of Latter-day Saints, and she was still in the church when she started taking really, really high doses of testosterone. Want to know what a middle-aged woman that feels good has in common with a bodybuilder? Testosterone. According to her, there are these aesthetic and wellness spas offering pellets and high doses of testosterone all over, you know, Utah, which is largely a Mormon community. You know, I pointed out to her, you know, you were taking so much testosterone that you were approaching the levels that people who are transitioning take. And she said, you know, I never really sat and thought about what I even think about that.

11:45It was she'd never really made the connection. And so it is just interesting because people who are taking testosterone in high doses, which is to say at levels that are two or three times higher than women ever naturally have, and that's to say many, many women across a political spectrum are also on, frankly, in a way you could say a transitioning spectrum or a gender affirming care spectrum. I think that they feel in a way that testosterone is helping them do gender affirming care in making them feel more sexual and therefore more wifely maybe. And maybe a lot of them talk about how it tones their arms and they feel like they look great, you know.

12:26But it actually is a hormone that has typically been associated with, you know, with masculinity. So it just to me kicks up all kinds of interesting questions.

12:36Noel King:There is a woman you wrote about who I will have a hard time forgetting. She's in her late 40s. She's a business owner. She's a mom. She gets on a high dose of tea and she feels amazing. Her sex drive improves, but then she loses her hair. So she scales back her dose. Her hair still has not come back. And you asked her, would you do it again? And she said, yes. What do you make of this? I think she feels that when she had that initial burst of energy, it is true that she lost her hair. Not all of her hair. She lost about 40 % of her hair. But that initial burst of energy gave her the inspiration.

13:18Even though she, I think, has four kids and was literally helping her husband run three jobs, she then took on getting a Ph.D. And she is so thrilled that she's on her way to becoming a doctor because she works very, very hard. And it's tough for her to get respect from the many men in her field. And she feels like having a Ph.D. will really help her cause. She's really proud of herself. And for her, I thought it would have been like the sex that made it because it really completely changed her sex life with her husband. They'd had very routine rote sex for years and years. It was not a big part of her life.

13:54And that really changed on high dose testosterone. But I think she just felt like she could deal with the hair, you know, but nothing else would have gotten her enrolled in that Ph.D. And nothing else would have really changed her marriage quite as dramatically as it did.

14:17Noel King:Susan Dominus is a staff writer for The New York Times Magazine. Coming up, the young men who are taking testosterone and why.

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15:40Noel King:Support for Today Explained comes from NPR. Perhaps you're curious about the economic forces shaping your daily life. The Planet Money podcast from NPR makes sense of the economy in ways you'll not only understand but enjoy. Each story on Planet Money starts with a question. Recent episodes asked why Pokemon cards are growing faster than your retirement account. Don't invest in Pokemon rather than retirement regardless. I'm sure Planet Money would tell you that. how Russia's economy hasn't collapsed after four years of war and sanctions, and what a 750-pound robot means for the future of restaurant work.

16:13Noel King:The hosts go to unusual lengths to explain the economy. Yes, they do. They have published a book to track the global supply chain. I've seen it in bookstores. They have shot a satellite into space to understand the economics of the private space industry. They have gone inside of a live book auction to get ideas on how to market their book. Listeners of this show may know that I used to work at that show at Planet Money. It is a very good show about the economy, a thing that, honestly, we should all understand. And sometimes it feels a little bit exhausting. But Planet Money does not make it exhausting.

16:44Noel King:They make it interesting, genuinely. Follow NPR's Planet Money podcast and understand how money shapes the world. Hey, Chicago. Class it up with Crocs. You know back to school is coming in fast. So why wait to find your new fave footwear? Step into a local croc store and step into your new look. Try it. Style it. Make it yours. Because the right pair doesn't just show up. It shows off. First day fits, handled. Walk out ready for whatever's next. Visit your nearest croc store today. If you want your body to perform well, I think you should get today explained. My name is Rebecca Jackson. I cover the South for The Economist, and I write mostly about politics, a little bit about culture and economics.

17:34And I like to think of the states that I cover as like the former Confederacy from Texas down to Florida all the way up to Virginia.

17:41Noel King:All right. So in the first half of the show, we talked about how a lot of women are going on testosterone. And for many of them, it's working. For some of them, there are side effects. You wrote a piece about how men are doing the same thing. Where did the idea come from? You know, some of the best stories just come from conversations with friends. And this is an example of that. I have a friend who's a med student and he was doing a urology rotation. And he told me one day that there were all of these young guys coming in asking for testosterone. And I thought that was super interesting and decided to sort of look into it a bit more and found out that Pfizer had actually reported a shortage of testosterone this year because of rising demand.

18:22So I started talking to doctors and people in the pharmaceutical industry and found out that this is actually a huge trend.

18:28Noel King:How big a trend is it? Do we know how many men are doing this? So it's really hard to gauge how many people are doing it because some people are getting it doctors' offices. Others are getting it from a gym. Huh! Yeah. One of the things that sort of helped me quantify the rise was I went to visit a testosterone clinic. There are now all of these healthcare clinics popping up that are devoted to testosterone. I went to Game Day Men's Health Clinic in the Buckhead neighborhood of Atlanta. It takes only 10 minutes to measure your testosterone levels. Then we'll create a plan to optimize your health.

19:00Kind of anything you need as you get older as a guy and you look in the mirror and that light switch gets turned off, we help you turn it back on. And they opened in April of last year, and they were the company's 50th franchise. But in the 14 months since they opened, another 325 testosterone clinics, Game Day clinics, opened up across the country.

19:19Noel King:That is massive. And that's just one clinic. That's just game day. Yeah. So game day is one of the most popular, but there are tons of these types of clinics. Actually, when I went to game day, I walked out and across the street, there was another testosterone clinic competing with them. Huh. OK, so your friend who is a medical student told you the surprise was it was young men who were coming in. Yeah, so I think one important thing to remember here is that lots of health crazes do stem from real medical problems, and testosterone is no exception. So as men age, their testosterone levels tend to drop.

19:55That's natural and normal. But for some people, it can dip into an abnormal range, and that causes problems. It can make you, for example, have low sex drive, low energy, weight gain, have trouble putting on muscle mass. And like many medical problems, this is exacerbated by things like obesity and drug use, which has become more common in America. And so over time, this has become a bigger issue. And doctors have found that they can treat low testosterone and many of the symptoms that come along with it with these injections. But I think the troubling thing here and the trend that I'm most interested in is that the people who are taking to testosterone fastest now are not guys in their 70s.