HONG KONG, June 14, 2025 /PRNewswire/ — Coinciding with Men’s Health Month, Yesoul promotes accessible home fitness tailored for today’s busy men—from young professionals to active retirees.

Prioritizing Men’s Health: Why It Matters More Than Ever

June is recognized globally as Men’s Health Month—a time dedicated to raising awareness about the physical and mental health challenges men face throughout their lives. From young professionals navigating demanding careers to fathers juggling family and work, and older men seeking longevity and vitality, men’s wellness is a multifaceted issue that deserves year-round attention.

Despite increasing public health campaigns, studies consistently show that men are less likely than women to seek medical advice, maintain regular fitness routines, or engage in preventive care. Factors such as time constraints, work-related stress, and cultural stigmas around masculinity contribute to rising rates of chronic illness, cardiovascular conditions, and mental health struggles.

That’s why accessible, tech-enhanced home fitness equipment—like the Yesoul R1 M PLUS Rowing Machine—is more essential than ever. Compact, versatile, and designed with real-life convenience in mind, the R1 M PLUS empowers men across all life stages to take control of their health, right from the comfort of their homes.

The Yesoul R1 M PLUS: A Modern Rowing Machine Built for Real Life

More than just a piece of exercise equipment, the R1 M PLUS is a wellness ally engineered for versatility, comfort, and intelligent fitness. With design elements tailored to support modern lifestyles, this machine helps eliminate common workout barriers, like time, space, and noise.

Foldable Design That Fits Any Space

One of the R1 M PLUS’s standout features is its space-saving foldability. Whether you’re in a city apartment, home office, or shared living area, its vertical-folding rail reduces the footprint by over 50%. Paired with smooth transport wheels, it’s easy to roll the machine away when not in use—making it ideal for men with limited space or irregular routines.

Full-Body, Low-Impact Workouts for All Fitness Levels

Rowing is widely considered one of the most efficient full-body workouts, engaging over 80% of major muscle groups—legs, core, back, and arms—while being gentle on the joints. It’s an ideal form of exercise for:

Busy professionals looking to build stamina and reduce stress

Dads fitting in workouts between family responsibilities

Middle-aged men maintaining muscle tone and metabolic health

Seniors who want a joint-friendly cardiovascular activity

Silent Magnetic Resistance with 100 Intensity Levels

The R1 M PLUS features a custom magnetic resistance system that delivers whisper-quiet operation with 100 adjustable levels, so users can tailor their workout intensity without disturbing others. Whether you prefer a relaxing endurance row or a sweat-inducing sprint session, this machine adapts to your goals without compromise.

Immersive 21.5″ Rotating Screen with Free Mirroring

The heart of the R1 M PLUS experience is its 21.5-inch 1080p full HD screen. Designed to rotate 360°, it enables not only rowing sessions but also access to stretching, HIIT, yoga, and strength training classes—all in one place.

A major highlight is the R1 M PLUS’s Free & Unlimited Screen Mirroring feature. Without requiring any subscription, users can simply connect their devices (note: Android phones require DisplayPort support) and stream content directly onto the 21.5-inch rotating screen—from YouTube workouts to popular fitness apps like, Kinomap, or Zwift. This gives users the freedom to enjoy their favorite platforms, videos, or routines on a larger screen, completely free of charge.

While some brands charge over $100 per year for app access, the Yesoul App remains affordable—offering a full library of workouts, real-time data tracking, and training features for less than the cost of a nice dinner out. And even without a subscription, users can still take full advantage of the screen mirroring feature to enhance their fitness experience at no cost.

This flexibility empowers men to stay motivated and consistent while tracking workout data like stroke rate, power, distance, resistance, and calories—all from the comfort of home.

Mental Fitness Matters, Too

Modern masculinity means taking care of both body and mind. Rowing provides a meditative rhythm that promotes stress relief and mental clarity. Combined with scenic virtual routes or relaxing music streamed through the screen, the R1 M PLUS becomes a tool for both physical and emotional balance.

Through the Yesoul app, users can enjoy mindfulness-based workouts, expert-led stretches, and calming cooldowns that promote relaxation and speed up recovery.

Ergonomically Designed for Comfort, Strength, and Safety

The R1 M PLUS features ergonomic handles, adjustable foot straps, and a sturdy yet minimalist frame. It’s engineered to accommodate a wide range of body types and rowing styles while minimizing strain and maximizing comfort.

Seamless Integration into Daily Life

Quick Assembly: Easy-to-follow instructions get you started in minutes

Minimalist Aesthetic: A sleek, neutral-toned design blends into modern interiors

Flexible Training Modes: Rotate the screen for cross-training, stretching, or floor workouts

Who Is It For?

This rowing machine isn’t just for one type of user. The R1 M PLUS was thoughtfully designed to support all men—across ages, goals, and lifestyles:

Young Professionals: Maximize limited time with full-body workouts that boost energy and reduce sedentary stress

Fathers: Stay strong, focused, and healthy with fast, effective at-home fitness

Middle-Aged Men: Maintain strength, manage weight, and protect cardiovascular health as priorities shift

Retirees: Improve balance, mobility, and longevity through safe, joint-friendly exercise

Whether you’re new to rowing or a seasoned athlete, the R1 M PLUS offers an inclusive path to consistent, long-term wellness.

Yesoul’s Broader Mission: Redefining Everyone

By spotlighting the R1 M PLUS during Men’s Health Month, Yesoul underscores its larger commitment to men’s well-being. The brand is actively shifting fitness culture away from intimidation and exclusivity toward accessibility, comfort, and relevance.

From smart bikes to treadmills to rowing machines, Yesoul is building an ecosystem that empowers men to prioritize self-care, redefine their health journeys, and access premium technology without premium pricing.

It’s More Than a Machine—It’s a Mindset Shift

In a world that often asks men to “tough it out,” Yesoul is encouraging them to slow down, check in, and row forward—one stroke at a time.

The R1 M PLUS makes fitness easier to begin, more enjoyable to maintain, and more adaptable to the realities of everyday life.

Make Wellness a Year-Round Priority

This June and beyond, take the next step toward better health with a tool that meets you where you are. The R1 M PLUS Rowing Machine isn’t just equipment—it’s a commitment to longevity, strength, and balance.

Explore more at www.yesoulfitness.com

Follow Yesoul for tips, tutorials, and community stories:

Instagram: @yesoulfitness.official

YouTube: @YESOUL FITNESS

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Hip Hop is a genre that demands armor. Stoicism, survival, and swagger at all costs. Emotions stayed tucked between metaphors or masked by bravado. Yet, over time, the beat changed. A new generation of artists began speaking plainly about anxiety, depression, trauma, healing, and wellness. Artists spit bars about what weighed heavy on their hearts. Others wrote open letters. All of them broke the silence.

Recent data underscores why spotlighting men’s mental health, especially among rappers, matters now more than ever. According to the CDC, men accounted for nearly 80 percent of all suicide deaths in 2022, with a rate four times higher than women. Alarmingly, the suicide rate for Black male adolescents and young adults rose sharply during the late 2010s and early ’20s, becoming the third leading cause of death in that group. Meanwhile, emergency department visits for mental health issues remain highest among Black adults, often due to lack of outpatient care access, calling attention to systemic barriers and the urgent need for culturally responsive support. These numbers reflect a deeper cultural truth that public figures, including rappers, are often navigating invisible wounds that deserve recognition and care.

Read More: 2 Chainz Raises Awareness For PTSD In The Black Community

This Men’s Mental Health Awareness Month, we’re centering the voices of rappers who spoke plainly about the weight they carried. They spoke up because silence was costing them more than truth ever could. In that honesty, they offered something real and a reminder that being human doesn’t make you weak, it makes you whole.

Ab-Soul Talks Mental Health & Suicide Attempt

When Ab‑Soul returned ahead of his 2022 album Herbert, he brought with him a level of transparency rarely shown in mainstream Hip Hop. A revered TDE artist and one of the genre’s most lyrically respected voices, Ab has long been known for unpacking complex philosophies, spiritual questions, and emotional weight through rhyme. This time, he shared the story of a suicide attempt that nearly took his life. During a period of severe depression and addiction, he jumped from a freeway overpass near his mother’s home. The fall shattered his leg and pelvis, knocked out his teeth, and nearly left him paralyzed. In recovery, he turned to therapy and chose to speak openly about the experience.

“I’ve been smoking cigarettes since I was about 16 years old. I still do. I’m addicted to cigarettes, I do hope to quit one day,” Ab-Soul shared in an interview. “[Vaping] was promoted as a better or safer alternative to cigarettes. In turn, it is not. It is causing severe anxiety and depression. I never understood depression until this. I get it now, I can’t even be in the same room as one of those things.”

“I recorded the majority of the album, pretty much finished the album, before I did what I did,” the rapper also stated. “As soon as I said everything I needed to say, I jumped. I took a leap of faith, if you will. And that was the only way I was gonna be able to put that vape down, bro… I got a lot of work to do, still. About 80 percent of my [leg] is completely reconstructed, all the way to my pelvis. Everything but my knee…. if my knee would’ve been affected, I might not be walking.”

Elsewhere, in a chat with NPR, Ab further said he wants mental wellness to be a staple, not a passing phase. “I’m hoping that it is not just becoming a trendy thing—like, the mental health, go get therapy. I’m hoping that, you know, people are doing this with intent. And I’m hoping that there aren’t people that are just going to therapy because they heard one of their favorite rappers do it. You have to find a therapist that you connect with, if you’re able to, with a goal to unpack trauma, to be their best.

Logic — “1‑800‑273‑8255” & Mental Health Transparency

Sir Robert Bryson Hall II, better known as Logic, opened the door on mental health in mainstream Hip Hop by sharing that he endured the most difficult years of his life struggling with anxiety, depression, and the pressure of public scrutiny. With his song “1‑800‑273‑8255,” he turned that private pain into a national intervention. The song peaked at No. 3 on the Billboard Hot 100, was nominated for Song of the Year, and it coincided with a certified 50 percent increase in calls to the National Suicide Prevention Lifeline after his 2017 MTV Video Music Awards performance. Logic’s message was clear that sharing lived experiences is power. His decision to appear on stage with suicide survivors and speak openly about therapy offered fans a rare moment of visible hope.

During an interview with the Recording Academy, Logic spoke candidly about his experiences. “I was so scared for so long to say that because society has lead me to believe that my anxiety is stupid and shouldn’t be talked about, or that suicide, ‘Who cares, who’s weak enough to kill themselves?,’ which is the most terrible, disgusting, ugly thing somebody can say,” Logic stated. “That’s why I decided to write about these topics.” He added, “I am bringing up and shedding light on the negativities that have shown themselves in my life to paint the picture of letting go and of setting myself free and surrounding myself in happiness.”

Jay‑Z — Therapy, Vulnerability & Redefining Strength

Jay‑Z has reframed emotional transparency as a form of power. In interviews tied to his 2017 album 4:44, he described therapy as a healing investment. It was then that he explained how it taught him to trace his reactions back to old wounds and handle conflict with empathy instead of aggression. He highlighted how clinic visits helped him unpack the lingering trauma of growing up in the Marcy Projects and whose influence spilled into his relationships. This includes a pattern of emotional shut-off rooted in survival instincts.

Further, Jay‑Z framed crying not as weakness, but as strength. “I grew so much from the experience,” he said of going to therapy while chatting with The New York Times. “But I think the most important thing I got is that everything is connected. Every emotion is connected and it comes from somewhere. And just being aware of it. Being aware of it in everyday life puts you at such a … you’re at such an advantage. You know, you realize that if someone’s racist toward you, it ain’t about you. It’s about their upbringing and what happened to them, and how that led them to this point. You know, most bullies bully. It just happen. Oh, you got bullied as a kid so you trying to bully me. I understand.”

“And once I understand that, instead of reacting to that with anger, I can provide a softer landing and maybe, ‘Aw, man, is you O.K.?'” Hov added. “I was just saying there was a lot of fights in our neighborhood that started with ‘What you looking at? Why you looking at me? You looking at me?’ And then you realize: ‘Oh, you think I see you. You’re in this space where you’re hurting, and you think I see you, so you don’t want me to look at you. And you don’t want me to see you.'”

“You don’t want me to see your pain. You don’t … So you put on this shell of this tough person that’s really willing to fight me and possibly kill me ’cause I looked at you. You know what I’m saying, like, so … Knowing that and understanding that changes life completely.”

Lil Wayne — Early Trauma & Ongoing Honesty

Louisiana icon Lil Wayne shared that around age 12, he attempted suicide by shooting himself in the chest. It was an event he described as occurring after he believed his mother would make him stop pursuing Rap with Birdman’s label. Law enforcement and medical staff rushed him to safety, and the episode became a fracture point in his life, not the end.

Over the years, he has referenced that moment in music and conversation, reaffirming the reality of early trauma and the fact that mental health struggles don’t follow any timeline. Later, through candid interviews, Wayne has repeatedly emphasized the importance of acknowledging pain and seeking support. “[I’m] hoping I can help anyone else out there who’s dealing with mental health problems by… being vulnerable,” Wayne told Uncomfortable Conversations. “To me, I look at it by being brave and stepping up.”

“I was willing to die for it,” Wayne added about attempting to take his own life if he couldn’t chase his Rap dreams. “Once my thoughts got radical and got to where you’ve got to stop yourself and stop and pause and say, ‘What did you just think again?’ Even if you’ve cried yourself to sleep with that thought on your mind and wake up the next day and be like, ‘I cannot believe I was thinking like that.'” While at the time the rapper admitted he doesn’t go to therapy, he said he relies on prayer.

Eminem — Raw Honesty About Addiction & Identity

Detroit’s very own hometown hero Eminem’s career has unfolded as a public study in mental health recovery. His song “Beautiful” (2009) delves into depression and isolation: “I’m just so f*cking depressed, I can’t handle the stress.” It became an unexpected Top 20 hit, reaching No. 17 on the Billboard Hot 100. Moreoever, Eminem has explained that his Slim Shady alter-ego amplified his struggles with addiction, fueling a period of heavy drug use that nearly ended his career.

“I think that’s one of the great things about Rap music is that you could put so much of your life in it,” Eminem told Sway in the Morning. “It’s therapeutic and that’s how it’s always been for me.” Elsewhere when speaking with Men’s Journal, he explained his addiction. “In 2007, I overdosed on pills, and I went into the hospital. I was close to 230 pounds. I’m not sure how I got so big, but I have ideas. The coating on the Vicodin and the Valium I’d been taking for years leaves a hole in your stomach, so to avoid a stomach ache, I was constantly eating and eating badly.”

That incident marked the beginning of a long road toward recovery and clarity. Since then, he’s celebrated over 15 years of sobriety, framing recovery as creative rebirth. It was a truth that emerged publicly through albums like Relapse and in conversations about therapy and healing. Eminem’s journey reflects the strength it takes to face inner chaos head-on. His openness about addiction, recovery, and mental health transformed personal pain into creative power, allowing him to rebuild both his life and identity on his own terms.

Tupac Shakur – Emotional Intimacy Behind The Persona

From prison letters to late-night interviews, Tupac Shakur consistently pulled back the curtain on emotional struggle, long before it was considered safe to do so in Hip Hop. He once admitted that after the 1994 Quad Studios shooting, he contemplated suicide and was only stopped by family intervention. That honesty, echoed throughout his 1995 album Me Against the World, marked one of Rap’s earliest and most unflinching explorations of depression, trauma, and existential crisis. Tupac’s genius lived in his ability to hold strength and suffering at once. He offered both without apology. His work made space for contradiction and truth, all spoken in the same breath.

“So Many Tears” lyrics:

Now I’m lost and I’m weary, so many tears

I’m suicidal, so don’t stand near me

My every move is a calculated step

To bring me closer to embrace an early death

Now there’s nothin’ left

There was no mercy on the streets

I couldn’t rest, I’m barely standin’

About to go to pieces, screamin’ peace

And though my soul was deleted, I couldn’t see it

I had my mind full of demons tryin’ to break free

They planted seeds and they hatched, sparkin’ the flame

Inside my brain like a match, such a dirty game

No memories, just a misery

Paintin’ a picture of my enemies killin’ me in my sleep

Will I survive ’til the morning to see the sun?

Please Lord, forgive me for my sins, ’cause here I come

Kanye West — Bipolar Breakthroughs & New Diagnosis

Public scrutiny often drowned out the quiet signals Kanye West gave about his mental health. After a breakdown in 2016 led to hospitalization, he began speaking more openly about being diagnosed with bipolar disorder. On his 2018 album Ye, he scribbled, “I hate being bi-polar, it’s awesome,” across the cover. It became a reflection of how he coped with instability through contradiction and public self-awareness. He later described bipolar episodes as deeply disorienting, at times blurring reality and pushing him into paranoia.

Ye would detail his experiences while speaking with David Letterman. Specifically, he explained his time in a mental health facility. “You pretty much don’t trust everyone, and they have this moment where they handcuff you, they drug you, they put you on the bed, and they separate you from everyone you know,” said West. “That’s something that I’m so happy I experienced myself so I can start by changing that moment. When you are in that state, you have to have someone you trust. It is cruel and primitive to do that.”

Further, he described how mania affected his thinking and behavior, and emphasized how critical medication and support had been in managing his mental health. More recently, Kanye shared that he was re-diagnosed as autistic. His visibility, for better or worse, shifted the conversation around mental illness in Hip Hop.

“This is a sprained brain, like having a sprained ankle” West added. “And if someone has a sprained ankle, you’re not gonna push on him more. With us, once our brain gets to a point of spraining, people do everything to make it worse. They do everything possible. They got us to that point, and then they do everything to make it worse.”

“You know, if you guys want these crazy ideas, these crazy stages, this crazy music, and this crazy way of thinking, there’s a chance it might come from a crazy person.”

Method Man — Depression, Self-Love, & Reclaiming Joy

A quiet battle with depression followed Method Man through his rise with Wu-Tang and beyond. He began to recognize recurring anxiety and emotional pain that dated back to childhood, intensified by sudden fame and physical exhaustion. He credits insomnia, stress, and substance misuse for pushing him to face a deeper truth. In response, he embraced a regimen of late-night workouts, healthier eating, and self-reflection—actions that ultimately led him to sobriety and renewed purpose. Now, the rapper-actor often speaks about the importance of self-love and encourages people to check in on each other. Often, healing begins in connection, not isolation.

Read More: Method Man Opens Up About PTSD And His Mental Health

“It went from this childhood joy to this euphoric feeling of celebrity to feeling inadequate and not good enough,” Meth told Men’s Health. “What can I control? That’s what I did; I took control after that. I stopped valuing other people’s opinions, and instead of being my biggest critic, I became my biggest fan,” he explained. Other methods he experimented with were late gym sessions to aid in his fight with insomnia which lasted 18 months. All in all, he is in a better place, saying “Show that you love yourself. That’s all I’ve been doing. What people see now is just happiness.”

Kid Cudi — Healing Through Transparency & Reconstruction

Kid Cudi has spoken openly about facing severe depression, anxiety, and suicidal urges before entering rehab in 2016. In the early 2010s, he caught up with Complex to discuss his journey in seeking help. “I wouldn’t even go to a therapist or psychiatrist. But I gave it a shot,” he said. “It’s working for me but it’s not for everyone. I’ve got some f*cking problems.[Laughs.] It’s good for me to talk to someone who helps me see things. I had no other choice.”

During his time in treatment in 2016, Cudi suffered a stroke. It was an unexpected crisis that reshaped his recovery process. Cudi credits his ongoing balance to stepping away from constant public scrutiny, engaging in therapy, and grounding himself in fatherhood. In recent years, he has used his platform to advocate for mental wellness, from award show stages to youth-centered mental health initiatives.

Read More: Kid Cudi Says He Finally Loves His Life After 37 Years

In 2022, Cudi also sat down with Self Magazine to speak openly about his addictions. There, he shared that while he experiemented with drugs as a youth, things kicked into gear when fame reached his doorstep. “It wasn’t scary until later on in my life, as I was Kid Cudi,” he said. “I was suicidal. I was darker than I ever had been in my life. I’m thinking about, ‘How could I do this without my family finding out, without my friends finding out?’ Like I’m actually plotting my death.”

However, those extreme emotions prompted the rapper to take a chance. “That was what really scared me straight to the point where I said I needed to go get help…I want to live for my daughter, for my family, for my friends, for my fans. I want to live, I want this for myself. So, I made the choice for the first time in my life to go get help for what I didn’t understand.”

Welcome to Testosterone HQ—Men’s Health’s guide to the exciting, complicated, and revolutionary world of testosterone. For everything you need to know about T, click here.

WHAT’S CONSIDERED NORMAL when it comes to testosterone levels is relative. Normal varies from person to person, and doctors say your actual number may not be as important as you might think. How you feel is what matters most.

“It’s not all about numbers,” explains Paul Gittens, M.D. , a board-certified urologist and founder of the Rockwell Centers for Sexual Medicine and Wellness in New York City and Pennsylvania. “It’s about how your numbers reflect with your symptoms.”

Testosterone is a hormone produced by your testicles that plays an essential role in your sex drive, sperm production, muscle growth, bone growth, hair growth, voice deepening, and red blood cell production.

And, everyone functions at a different level, Gittens says. Your testosterone level even fluctuates throughout the day. So, what is “normal”? Does it matter? We asked the experts.

What testosterone level is considered normal?

A NORMAL, HEALTHY testosterone level can fall into a wide range. Healthy levels are typically between 264 nanograms per deciliter (ng/dL) and 1,000 ng/dL, according to some doctors. Anything below 264 ng/dL is low, and high testosterone is above 1,000 ng/dL.

Still, there’s variation within the normal range, says Gittens. “Some people feel miserable at 310 or 350. So, you have to take individuals and look at their symptoms.”

Generally, testosterone levels tend to decrease with age, starting in your 30s, says Brian Black, D.O., an American Osteopathic Association board-certified family medicine physician.

Testosterone levels also fluctuate throughout the day and are usually at their highest in the morning, Black says. That’s why doctors typically test your levels in the morning.

Two tests are done on different days to get a good reading. If your testosterone is on the low end, your doctor will determine the best treatment plan, Black adds. Testosterone therapy is a common treatment.

What affects testosterone levels?

MANY FACTORS INFLUENCE your testosterone levels. And even if your level is below 264 ng/dL, you might not experience the symptoms of low testosterone. “It’s not like if someone hits 300, automatically, you have low testosterone, or if you have 315, you don’t have low testosterone,” says Justin Dubin, M.D. , a urologist and men’s health specialist at Memorial Healthcare System. Other doctors say healthy T can still be healthy at 264 ng/dL.

Age is a big influencer. As you get older, you’ll likely see your total testosterone levels decline by about 1.6 percent a year .

Weight plays a role, too. There’s a link between obesity and low testosterone. Leptin, a hormone found in fat cells, is thought to inhibit testosterone production,

says. Excess fat cells can also increase estrogen levels, which lowers testosterone.

Other factors that might lower your testosterone include:

Medication, including chemotherapy

Testicle injury

Thyroid functioning problems

Chronic diseases or infections, like HIV, hypertension, or high cholesterol

Opioid drug use

Steroid use

Is it good to have a high testosterone level?

WHEN IT COMES to your testosterone numbers, higher isn’t always better. Testosterone levels aren’t a measure of masculinity, doctors say.

“Just because your testosterone is very, very high doesn’t mean you have a better libido or anything,” Dubin says. “Everyone’s body is different.”

Gittens says he sometimes sees patients who are focused on having their testosterone at a certain level—often because of something they’ve read online. “They’re just looking at those numbers, and it can be harmful to patients,” he adds.

If you’re on the higher end, it can actually be harmful, depending on the numbers, says John Lynam, D.O. , an endourologist who is board-certified by the American Osteopathic Association. High testosterone can trigger a number of symptoms, like low sperm counts, high blood pressure, mood swings, insomnia, and high blood pressure.

It’s rare for men to naturally have high testosterone, however. If they do, it’s usually due to testicular tumors or adrenal gland conditions. Men who take anabolic steroids or use testosterone therapy without a doctor’s supervision could have high levels, too, Black says.

What happens if my testosterone is too low?

HAVING LOW T doesn’t necessarily require treatment.

“There are guys who feel completely normal and may not want an intervention,” says Justin Dubin, M.D. , a urologist and men’s health specialist at Memorial Healthcare System. “There’s more to people than just numbers, so you treat someone based on their story and their labs.”

How you feel is more important, Gittens emphasizes. Low testosterone can cause a lot of unpleasant effects , including a low sex drive, muscle loss, a tanking mood, and low energy . If that sounds like you, your doctor will likely rule out potential causes of low T, such as obesity, opioid use, and issues relating to the pituitary gland or testicles. Your doctor will then determine proper course of action, which could be anything from lifestyle style changes to hormone therapy.

How to Know What Your Testosterone Levels Are

GENERALLY, DOCTORS SAY it’s not necessary to worry about your exact testosterone number—or even know what it is—unless you’re experiencing concerning symptoms, explains Black.

“My philosophy has always been more emphasis on treating the person and their symptoms over absolute numbers,” Lynam says. “If your testosterone levels are on the lower end, there are treatment options. If you are on the higher end, it can be harmful. Too much of a good thing can certainly not be a good thing.”

If you’re having symptoms of low testosterone—like low libido, fatigue, depression , erectile dysfunction , or difficulty concentrating—talk to your doctor about getting your testosterone levels checked. If your levels come back low and you have symptoms of low testosterone, you may be a candidate for testosterone therapy.

Doctors might also recommend lifestyle adjustments, such as exercising more, losing weight, getting more sleep, reducing stress, and eating a healthy diet, Gittens says.

“People are embarrassed many times to talk about these signs and symptoms because there’s a stigma associated with it,” Dubin says. “But we can’t help you unless you come to see us.”

Related Story Alan Ritchson’s Opens up About Testosterone Use

The Surprising Benefits of Donating Blood Amid an emergency blood shortage in New York, experts from NewYork-Presbyterian explain how donating blood not only helps someone in need, but also offers health benefits for the donors themselves. 7 Min Read

Every two seconds, someone in the U.S. requires a blood transfusion, according to the New York Blood Center. The benefits of donating blood include helping people injured in accidents, undergoing cancer treatment, and battling blood diseases, among other reasons. Unfortunately, the New York Blood Center announced that it was facing an emergency blood shortage, with inclement weather causing blood drive cancellations, organizations hosting fewer drives during holiday breaks, and respiratory viruses reducing donor eligibility. Low donor turnout has led to a 30% drop in donations in recent weeks. With the shortage causing dangerously low blood supply available for hospitals, blood donors are needed now more than ever. “Every time you donate blood, you can save up to three lives,” says Dr. Elizabeth Stone, assistant attending physician in transfusion medicine and cellular therapy at NewYork-Presbyterian/Columbia University Irving Medical Center. “There’s no substitute for blood, and there are a lot of different patient populations who need blood — sometimes emergently. If we don’t have a constant supply from healthy, altruistic donors, unfortunately, our patients may not get the lifesaving blood transfusions that they need.” For blood donors, rolling up your sleeve comes with some surprising health benefits. Here’s what you get when you give blood:

A Free Health Screening

“By going to donate blood, you are getting a mini-physical,” says Dr. Robert DeSimone, director of transfusion medicine at NewYork-Presbyterian/Weill Cornell Medical Center. Before you are allowed to donate, your vital signs will be checked to make sure you are fit enough for the procedure. This exam might turn up a condition that needs medical attention, such as high blood pressure or a heart arrhythmia like atrial fibrillation. In addition, you’ll be screened for infectious diseases you may be unaware of. “If we detect an issue with your vital signs or another health issue, we would direct you to go to a physician at that point to be checked,” Dr. DeSimone says. The health screening will also reveal if you have a rare blood type. This information can be useful if you ever face surgery or another medical situation in which a transfusion may be required. Plus, you’ll have the satisfaction of knowing your donation is particularly needed.

Dr. Robert A. DeSimone

A Healthier Heart and Vascular System

Regular blood donation is linked to lower blood pressure and a lower risk for heart attacks. “It definitely helps to reduce cardiovascular risk factors,” says Dr. DeSimone. What’s the connection? “If your hemoglobin is too high, blood donation helps to lower the viscosity of the blood, which has been associated with the formation of blood clots, heart attacks, and stroke,” Dr. DeSimone says. “Interestingly, these benefits are more significant in men compared to women. We think maybe it’s because women have menstrual cycles, so they do it naturally without donating blood.” People with a condition called hereditary hemochromatosis must have blood removed regularly to prevent the buildup of iron. Fortunately, this blood can benefit others. “People with hereditary hemochromatosis are essentially healthy and are otherwise normal, but they have a gene mutation where they make too much blood,” Dr. Stone says. “So, we can use their healthy blood to help patients who need it.” The New York Blood Center Hereditary Hemochromatosis Program allows people with hemochromatosis to donate blood rather than have it removed and thrown away. “Instead of having to go to their doctor’s office or a phlebotomy center to remove extra blood, they can go to any local blood drive,” Dr. Stone says.

Dr. Elizabeth Stone

A Happier, Longer Life

People usually donate because it feels good to help others, and altruism and volunteering have been linked to positive health outcomes, including a lower risk for depression and greater longevity. “Giving blood is a great way to help the most vulnerable people in your community around you,” says Dr. Stone. “People who do altruistic things like donating blood feel closer to their communities, and these positive feelings can lead to better health and longer lives.” “Creating moments of kindness during a time of need does wonders for your mental health and feeling of well-being,” Dr. DeSimone says.

Added Bonus: A Free Snack

“Every time you donate blood, it’s like burning calories without doing anything, as your body burns 500 calories to replace the blood that was removed,” says Dr. Stone. “And you get to have juice and snacks immediately afterwards, so it’s pretty great.”

What to Do Before Donating Blood If you plan to give blood, follow these steps: Drink plenty of water . Staying hydrated makes it easier to find your veins and helps prevent you from becoming light-headed after donating. Dr. Stone recommends planning a couple of days in advance. “Make sure you’re well hydrated and avoid drinking a lot of alcohol the day or two before donating.”

. Staying hydrated makes it easier to find your veins and helps prevent you from becoming light-headed after donating. Dr. Stone recommends planning a couple of days in advance. “Make sure you’re well hydrated and avoid drinking a lot of alcohol the day or two before donating.” Eat well beforehand . Don’t skip breakfast and be sure to eat snacks offered to you after you donate. “Make sure that you eat at least one balanced meal before donating. If you’ve eaten enough and had enough to fluids to drink the day you donate, you’ll be much less likely to have a donor reaction — like feeling dizzy — during or after donation,” Dr. Stone says.

. Don’t skip breakfast and be sure to eat snacks offered to you after you donate. “Make sure that you eat at least one balanced meal before donating. If you’ve eaten enough and had enough to fluids to drink the day you donate, you’ll be much less likely to have a donor reaction — like feeling dizzy — during or after donation,” Dr. Stone says. Exercise before donating blood, not afterward . It’s OK to go to the gym before you donate blood but not so wise afterward. “You might feel tired or dizzy, so take it easy for the rest of the day and minimize physical activity,” says Dr. Stone.

. It’s OK to go to the gym before you donate blood but not so wise afterward. “You might feel tired or dizzy, so take it easy for the rest of the day and minimize physical activity,” says Dr. Stone. Take iron tablets. The American Red Cross recommends that individuals who donate blood frequently take an iron supplement or a multivitamin with iron. “More and more, we’re recommending that teenage donors in particular take iron, because it’s been shown that teenage donors may become iron deficient after blood donation,” Dr. DeSimone says.

Prescriptions for testosterone have tripled in recent years, as some social media fitness influencers claim the hormone is a miracle cure for men. But who really benefits from testosterone therapy? And what are the risks?

Guests

Dr. Abraham Morgentaler, Blavatnik Faculty Fellow in Health and Longevity at Harvard Medical School’s Beth Israel Deaconess Medical Center. Urologist and pioneer in the treatment of testosterone deficiency in men. Founder of Men’s Health Boston.

Dr. Justin Dubin, urologist and men’s health specialist at Memorial Healthcare System. Co-host of the podcast “Man Up: A Doctor’s Guide to Men’s Health.”

Transcript

Part I

DEBORAH BECKER: This is On Point. I’m Deborah Becker in for Meghna Chakrabarti.

In a YouTube video made three months ago, 24-year-old Alex Eubank is opening a package he just got in the mail. He takes out a handful of plastic baggies holding tiny vials and syringes.

ALEX EUBANK: That’s definitely testosterone in there. Oh, man. Testosterone cypionate. (INAUDIBLE) slash 20 milligrams. I don’t know what any of this means.

BECKER: Eubank claims testosterone will help him build muscle faster. He’s a weightlifter and social media influencer.

Testosterone replacement therapy, also known as “TRT,” has exploded. The American Urological Association says testing and prescriptions for the hormone have nearly tripled over the past decade.

And social media is full of claims about its purported health benefits. Take this TikToker, who goes by “Kmart Fit.”

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KMART FIT: It was right around the three-month mark where I felt a massive difference. My energy level started to skyrocket. I no longer woke up exhausted in the morning and my mental clarity was definitely better.

BECKER: Or Australian James Manteit, a self-described “male online coach.”

JAMES MANTEIT: I’ve gained around seven kilos of lean tissue in the past 8 to 9 months. No fluff weight, I’m talking quality muscle. My strength has obviously shot up a ton, even in a calorie deficit. My mood is generally solid. I have a lot more focus when I’m doing just about anything.

BECKER: But who really benefits from testosterone therapy? And what are the risks?

Joining us to talk about this is Dr. Justin Dubin. He’s a urologist and men’s health specialist at Memorial Healthcare System in South Florida. He’s also co-host of the podcast, Man Up: A Doctor’s Guide to Men’s Health. Dr. Dubin, welcome to On Point.

JUSTIN DUBIN: Thank you so much for having me. Appreciate you having me come on today and talk about this important topic.

BECKER: So before we begin, though, we should say, are there any financial arrangements or potential conflicts that our listeners should know about before we chat?

DUBIN: I have no conflicts financially. No.

BECKER: Okay, great. So let’s talk about this increase in testosterone therapy that we’re hearing about on social media in particular, but also there have been studies and other research suggesting that there is a lot of testosterone testing and prescriptions being given and done out there.

What are you seeing in your practice?

DUBIN: You’re absolutely right. I think one thing that we know, there’s a lot of data. And you’ve already stated it, that initiation in testosterone levels have, or testosterone treatment has tripled over the last decade, for sure. And there was a study a while back showing that as many as 12.4% of all testosterone prescriptions were occurring in men under the age of 39. That study was done a while ago.

To be honest with you, I do feel like there has been a significant increase in the last five years, especially. And I have seen it in my office, I see a lot more younger men coming in with concerns of low testosterone, or men who have already been started on testosterone by other providers or other clinics, and coming to seek additional advice.

And this is something that we were interested enough in that we recently published an abstract. We’re working on the manuscript. Where we surveyed men under the age of 40 to see their interest in testosterone replacement therapy and whether they had used it before. And in our study, we found that about 13.5% of men under the age of 40 reported usage of testosterone supplementation of any kind.

And nearly 40% of our participants considered testosterone supplementation.

BECKER: But why? It seems like that’s very young. I was thinking this was for post 50 … talking to people in their thirties. Why are they taking testosterone?

DUBIN: A lot of it, there was concerns in our study. They were interested in energy, libido, muscle development. I do think that there has been this increase in uptick in. social media usage. And I think that in many ways, social media has promoted this idea of self-improvement. And there’s been, as you’ve already highlighted, a lot of health influencers have taken up the space in the last five or six years.

Really, it feels since COVID, where people were at home, starting to be able to focus either on their health or read more about their health. And this increase in social media had spiked. And we saw this enough that I was interested in my group. When I was at Northwestern, we did a project where we evaluated men’s health topics on TikTok and Instagram.

And what we did is we searched various topics in men’s health, including testosterone, infertility, vasectomy, things, something called Peyronie’s disease and erectile dysfunction. And we looked at these topics. We looked at the top posts and we categorized them.

We quantified whether they were accurate, who were they provided by, physicians, non-physicians, health care providers, non-health care providers. And the concerning thing was that these.

BECKER: Oh, I think we lost you. Dr. Dubin, are you with us? I think we seem to have lost Dr. Dubin’s line there.

I’m not sure if he is back with us or not, but he has been talking about the use of testosterone therapy and studies that he’s done showing that it is increasingly common. And it is common, particularly among younger men, who are seeking it out for bodybuilding and other fitness reasons, as well as for improved health.

And this has become unbelievably popular on social media, as Dr. Dubin mentioned. Popular podcast host Joe Rogan is among those who has repeatedly said that testosterone therapy has helped him. Rogan is in his fifties and here he is discussing testosterone therapy on his podcast, The Joe Rogan Experience back in 2022.

JOE ROGAN: I take testosterone replacement, so it’s not, I’m not demonizing it. I don’t think it’s bad. I think it’s wise. If you want your body to perform well, I think you should get regular blood work. You should do it from a very good doctor that understands hormone replacement therapy. You should be very smart about it.

You shouldn’t take too much of it, but if you want your body to perform well, it wards off diseases better. It keeps your immune system healthier. The more muscle you have, and the stronger your body is, the healthier your body is. To a point and to get to this bodybuilding range where you just look obscene.

BECKER: And that’s popular podcast host Joe Rogan talking about his use of testosterone. That’s what we’re talking about this hour On Point. And back with us is Dr. Justin Dubin. And Dr. Dubin, before we were cut off there, you were talking about social media and the influence of social media on taking testosterone and some of your research into that.

We just heard from Joe Rogan who talked about why he uses testosterone. What did your research suggest?

DUBIN: Thank you so much. Sorry about that disconnection there. So what we found on our study was that men’s health topics on TikTok and Instagram were incredibly popular. We’re talking about billions and billions of views.

But what was concerning was the majority of the men’s health topics were information that was not provided by a health care provider of any kind. And in fact, overall, the content was incredibly poor and incredibly inaccurate. What was encouraging though, when we compared physician to non-physician posts, the physician posts were overwhelmingly accurate, but obviously not even close to as popular as the non-physician posts.

Physician posts were not prevalent. Only about 10% of TikTok posts and 12.9% of Instagram posts, respectively. And only about 16.8% of the educational posts on TikTok were created by physicians. So when you have this distinct discrepancy in who is providing health information, whether it’s a person who is trying to gain financial means, it’s a company, or someone who’s just trying to socially be an influencer.

There is this concern of getting appropriate, correct information into the men’s health space.

BECKER: But there’s also, of course, resistance on the part of traditional medicine, right? To using testosterone for some of the health issues. So how do you balance that out? People do look to social media, because they’re not getting relief from traditional medicine and there you have it.

Social media is full of disinformation and folks who may not be medical professionals. So how do they ferret that out?

DUBIN: I do want to highlight that, because that is an incredibly important aspect here. So men’s health is health. However, the idea of men’s health is men have issues, erectile dysfunction, low testosterone, these are all signs and symptoms of other health issues potentially going on, or warning signs of other health issues coming down the pipeline.

The problem though, when we have men’s health, erectile dysfunction, low testosterone are the things that men associated with it. These are very stigmatized things, right? Having low energy, low libido, that is not what men want to picture themselves as. When they go to these social media posts, they see these ideas of what men are and what they want to be. And the reason why they’re not going to doctors in the standard setting is because of these stigmas. Men don’t feel comfortable going to a place, sitting in an office, and really identifying or pointing out almost to everyone else there that they have an issue.

And this is where social media, direct to consumer, it provides you with the opportunity to have privacy and learn or improve your health. And I like to call this actually the IKEA problem or I used to call it the directions problem, but I think a lot of listeners aren’t familiar with not using google maps anymore. But the idea used to be, and you can, I don’t know how old you are. But it would be guys, we had this thing. We would never ask for directions. We would drive around for hours and hours, right?

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BECKER: (LAUGHS) Old enough to remember that.

DUBIN: And that was the old joke. We were going to figure it out on our own. If it took us three hours longer, we were going to figure it out. And now I translate that to the Ikea problem, right? Where as a guy, I’m going to go to Ikea. I’m going to buy a piece of furniture. I have the instructions in front of me. I’m not reading. I’m going to figure this thing out by myself. It’s going to come out maybe three hours later. It could have taken me 45 minutes.

The chair is going to be a little bit wonky when I sit and it’s going to bother me after about a week. Then I’m finally going to go back, read the instructions and fix it. And this is what guys are starting to do with their health. They are going online in the privacies of their home. They want to fix the problem themselves. They want to do it in the privacy of their homes. Because they don’t want to announce to the other people around them, their friends, their families, that they have this issue.

Part II

BECKER: Dr. Justin Dubin is with us. He’s a urologist and men’s health specialist at Memorial Health Care System in South Florida.

Also with us is Dr. Abraham Morgentaler. He’s a Blavatnik Faculty Fellow in Health and Longevity at Harvard Medical School’s Beth Israel Deaconess Medical Center. He’s also a urologist and helps treat testosterone deficiency in men.

Dr. Morgentaler, welcome to On Point.

ABRAHAM MORGENTALER: Hi, Deborah. Great to be with you.

BECKER: Before we start, as we asked Dr. Dubin, I’d like to ask you as well, any financial arrangements or potential conflicts that our listeners should know about before we chat?

MORGENTALER: Yes. I’ve received consulting and speaking fees from Marius Pharmaceuticals and Besins Healthcare.

BECKER: And they help make testosterone medications. Is that right?

MORGENTALER: Correct.

BECKER: Okay. But that, and that does not pose a conflict, at least in terms of what you’ll be telling us today during this conversation.

MORGENTALER: It does not. I don’t have stock or anything like that. It doesn’t matter to me whether those companies do well or poorly.

BECKER: Okay, great. On to the conversation. We were talking with Dr. Dubin about this unbelievable rise in the popularity of testosterone therapy. And he says a lot of folks are looking to social media to get advice about their health.

And some of that advice may not be great. Would you agree with that statement? And why do you think we’re seeing so many more people taking testosterone or engaging in testosterone therapy?

MORGENTALER: Deborah, I’ve been studying testosterone for, it’s amazing to say, 50 years, my entire adult life. And for most of that time, especially once I became a physician and started treating patients, I was busy advocating for physicians to pay more attention to what I call testosterone deficiency, which is the preferred term now.

And we were finally making some headway. And now we have the situation where testosterone is having a moment, if you will, where it’s being advertised everywhere, and often for the wrong reasons. And whereas I’ve been pushing in one direction, I listened to the ads that you played at the top of the show, and I just cringe and recoil in horror.

Because the problem is that we’re confusing and these ads confuse two separate issues. One is the true medical condition where men suffer from having too little testosterone. It can affect them sexually, can affect their mood, can affect their vitality, their quality of life, and it’s bad for them in terms of general health.

And then we have these ads that are saying, let’s add muscle. One of the ads that you played, I think from Australia, the guy mentions that he gained seven kilograms of muscle. That’s about 15 pounds.

And I just have to tell you that the men that I treat, and I’m sure Dr. Dubin treats too, where we’re trying to just normalize healthy, youthful levels of testosterone, will never cause 15 pounds of muscle mass. The only way you do that is by overusing, using incredibly high levels, not just of testosterone, but usually the guys who are doing that, looking for this muscle growth and muscle development, are stacking medicines. They’re using multiple agents at a time. And some of those anabolic steroids are more potent than testosterone.

We’ve confused the younger guys who have this idea in their head with bodybuilding and looking fantastic and muscular and ripped, with a condition that is really very important, associated with a host of important medical conditions like diabetes, obesity, osteoporosis. And they’re not the same. And we need to be able to make that distinction.

BECKER: I wonder though, aren’t there regulations about some of these promises? I just, can anyone go on social media and claim that you can gain 15 pounds of muscle mass if you take this? And what are the rules about how that should be done?

MORGENTALER: I’m not an expert on what people can post on their podcasts and stuff, but physicians are limited. Testosterone as a therapy is a controlled substance, just like narcotics. So doctors have to jump through a bunch of hoops in order to prescribe testosterone.

And on the whole, what we want is for the doctors to be doing a good job identifying men who have the symptoms consistent with the deficiency, doing the appropriate blood tests, treating to appropriate levels, but not excessive levels, and then monitoring carefully the men so that they don’t get into any of the health issues that are associated with that. If there’s a blogger out there who says, ‘Hey, I did this.” I don’t really know what governs his ability to say that. But we have, part of this moment I think does come because of these social media influencers.

And there’s been a state, I got interviewed by recently, just in the last few weeks by a number of national media outlets. And I said, what’s going on? Did I miss like some big study or something? And the thing that precipitated it all was that RFK, Jr. said on a podcast that he takes testosterone.

BECKER: We actually have a clip of him saying that, so let’s play that right now. This is Robert F. Kennedy Jr., newly confirmed Health and Human Services Secretary.

He was interviewed on the Lex Fridman podcast in 2023, where he talked about his diet and exercise routine and mentioned testosterone.

ROBERT F. KENNEDY JR.: I’m on an anti-aging protocol from my doctor that includes testosterone replacement, but I don’t take any steroids. I don’t take any anabolic steroids or anything like that. And the TRT I use is bio identical to what my body produced.

BECKER: Dr. Morgentaler, that is RFK Jr., newly confirmed Health and Human Services Secretary, talking about his use of testosterone, and you said you got a lot of national media calls recently when he had brought it up again. I’m wondering what advice do you give to folks when there is so much talk about the use of testosterone and how it might be beneficial, and how can they figure out if it, what, if it might be something that might help them?

MORGENTALER: I’m just shaking as you, shaking my head as you played that clip, because testosterone is a steroid.

A steroid is a, it’s just a chemical structure. Estrogen is a steroid. Cholesterol is a steroid. But testosterone is also a steroid. And it is anabolic, even though he says it’s not. Anabolic just means that we build up muscle and bone. That’s what anabolism is. And so technically testosterone is an anabolic steroid, but it’s not the usual ones that people talk about for bodybuilding or doping in athletes. So there’s just that.

But listen, so on the one hand, there is something really marvelous that’s happening, where there is now a conversation that’s happening, where regular folk are saying geez, I wonder if I have something that would be the part of the reason I’m just feeling so poorly, not getting up off the couch. I used to be active. I used to enjoy lovemaking with my partner. Maybe could that possibly be related to testosterone?

So for that reason, I’m delighted, because there’s been way too little awareness of that and there’s a lot of physicians, the mainstream medical community has been reluctant to embrace the incredible evidence we have now about the benefits and safety of testosterone.

So that part’s great. It’s the other ones where people say, oh, you can be amazing. Like it makes, it cheapens the whole testosterone story with some of these ads. And makes it sound like they’re being promised something that is impossible.

BECKER: Dr. Dubin, I want to just make sure that we clarify this as soon as we can.

Testosterone can be used for some of the things that we’ve heard both of you mention in passing, low energy, erectile dysfunction, cognitive or brain fog, if you will, folks just not feeling like they have enough energy. It’s also said to improve bone density, to help people who are dealing with or prevent obesity.

Are those sort of the big things that testosterone is expected to help?

DUBIN: Yeah. So testosterone is the male hormone. So it does play an impact on a lot of these things. And as Dr. Morgentaler, who has done more research than anyone on testosterone can agree with, we continue to see unknown benefits or newer benefits that we didn’t really highlight in the past.

We know that low testosterone is associated with cardiovascular risk. Now it was used to be the opposite way, where we used to think it caused heart attack or stroke. We know that’s no longer the case. We know that having low testosterone puts certain people at risk for other comorbidities.

We know that if you have things like diabetes, obesity, cancer history, you’re at higher risk for having low testosterone. In fact, there’s been other data suggesting, especially in the orthopedic surgery space, the recovery process after surgery. There’s higher risks of complications or a slower recovery in patients who have lower testosterone levels.

A lot of the things that you have mentioned absolutely can improve with testosterone replacement, but it is when you highlighted before, muscle health, bone health, heart health. There are so many things that all play along, and it is a pretty rounded hormone in impacting your health.

BECKER: It seems very similar to what we’re hearing about in terms of estrogen therapy for women. Would you say that it is quite similar?

DUBIN: I do think, that’s why they have termed this, there’s this term of “MAN-opause.” And we’re talking about a menopause and we do know that estrogen is very important in women, obviously. And we’ve also started to understand the importance of estrogen in women, even after menopause, and the benefits that it can continue to have, even though there was controversy for a long time on that. And the same goes with testosterone, right?

Testosterone can decline as you get older. We know that the rates of testosterone decline, the Baltimore Longitudinal Aging Study showed that high, low testosterone levels increases with age about 20% in their sixties, 30% in their seventies, 50% of men in their eighties.

There’s been several papers showing that men under the age of 40, about 20% of guys have low T. And to be honest, I wouldn’t be surprised if some of these are older studies and, as a society, we’ve never been really more sedentary. We’ve never eaten worse. And these are things that can compromise our overall health. What we do to ourselves, how we live our lives, our lifestyles, our diets, our exercises, all impact our health. And that can impact what we like to say as urologists, what’s good for your heart is good for your parts and vice versa.

So these are all important things that, when people say, why are we having lower testosterone levels? Why are people complaining at testosterone? Why are we having these fertility issues? We have to look at the big picture and we have to say, Hey, listen, how good are we taking care of ourselves and how can we do better?

BECKER: Let’s talk about some of the risks of testosterone use first before we get into sort of some of the why there might be such a huge surge right now.

And Dr. Morgentaler, I’d like to ask you this. I know that we’ve mentioned, or Dr. Dubin said there’s no longer the belief that there’s a significant cardiovascular risk from taking testosterone, but I wonder what are some of the risks? Is infertility, prostate cancer, all the things that we had heard about before from taking testosterone, are those still somewhat of a risk for folks who might be using this for some of the health issues we mentioned?

MORGENTALER: So the big bugaboo for 80 years has been the fear that testosterone increases the risk of prostate cancer.

It’s an amazing story that really started in 1941 with a fellow named Charles Huggins, who later was awarded the Nobel Prize. And he discovered that in men who had metastatic prostate cancer, that if he removed the testicles, which is the source of the testosterone, that this blood test that they used back then called acid phosphatase would go down.

And he wrote that in every case where he gave testosterone, that blood test would go up. And because he wrote that, and he became the preeminent authority in prostate cancer. For 50 years, there was a global prohibition against the use of testosterone. Everybody was certain that it would cause cancer almost as soon as a man got a whiff of testosterone.

They get prostate cancer. I was a resident in my training in the 1980s, and this was like a certainty we never gave testosterone. And a lot of my work has been in the prostate cancer area. And I started with this, because I had worked with lizards as an undergraduate for three years, putting testosterone in their brain to see if we could regulate the male sexual behavior in the lizard.

And it worked, even in the males who didn’t have testicles anymore. And I wondered, and this was 10 years, I came out 10 years before Viagra showed up and there were men who were desperate around sexual issues. Doc, you got to have something you can give me. And I wondered whether men might be like lizards.

And it turned out that they were, I gave them some testosterone. And what was fascinating was that their sexual symptoms improved, which now is extremely well established. But I heard the men saying things that I had never expected, things like, “My wife likes me again. I wake up in the morning, I swing my legs over the side of the bed, and I feel optimistic about my day. I haven’t felt that way in 15 years.” A guy with four small kids says, “I come home at the end of the day and I’ve never, I used to be, I play with my kids, but man, I was just beaming. I’ve never had so much patience to play with them.”

So that was a real thing. And as I started treating men with testosterone, because of these rather remarkable benefits, but only if they had low testosterone to start with, that’s important. My patients didn’t get prostate cancer. And we published, I published with my colleagues, a number of papers on that. And that whole story has been challenged.

And then in 2023, I think comes really the definitive study. It’s called traverse, largest randomized control trial ever, with testosterone. And it showed number one, what Dr. Dubin was mentioning, that cardiovascular risk was no greater in men who got testosterone than in men who got placebo and also that the prostate cancer risk was identical in men who got testosterone and men who didn’t. Testosterone didn’t increase it. So prostate cancer, I think should be done. That’s not a risk anymore.

BECKER: But so then the risk, and we only have about a minute here, the big risk then is not prostate cancer, not cardiovascular disease, but perhaps blood clotting. Correct? Because your red blood cells increase, perhaps infertility. Are those some of the main — tell me what the main risks are for folks who are taking testosterone.

MORGENTALER: So here’s what they are. So if you take testosterone, it shuts down basically the male reproductive system. So you stop making sperm or very much sperm. Testicles can get smaller because much of the size of the testicles devoted to making those sperm young guys can get pimples or acne that they may not have seen in years.

Some men can get some fluid retention, especially older men, where they see like their ankles can swell a little bit. It’s not associated with heart failure. It’s just a thing that rarely men can get some swelling of one or both breasts. We call that gynecomastia. It’s reversible. It goes away if you stop it.

And then the one concern is, but you can get an increase in your red blood cell count, whether that’s really associated with blood clots or not is yet to be determined.

Part III

BECKER: Before the break, we heard from Dr. Dubin about some of the risks of testosterone therapy and we heard actually from you about some of the risks from testosterone therapy. And I’m wondering if there are others that you would add to. You mentioned red blood cell counts and fluid retention and acne. Are there other risks that folks should be aware of if they are considering testosterone therapy?

DUBIN: I think that Dr. Morgentaler really did a great job of highlighting the risks involved. The one thing that I always ask, a lot of patients and one thing that we hear a lot is like, why can’t we just keep going higher? And a lot of these risks don’t come at therapeutic levels, and I think that’s the important thing to highlight that Dr. Morgentaler said in the beginning, right?

We are trying to treat patients who are deficient and the analogy that I like to use when patients ask me this is believe it or not. I say heroin, and while I say probably heroin feels good, but does more heroin feel better? Yeah, probably. Is it good for you? Probably not. So I’m not saying obviously that testosterone is something that is bad, but more does not always equal better.

And when we really go to supertherapeutic levels of testosterone, that’s where we start to see people complaining of these things. And a lot of the people that we see on socials, like Dr. Morgentaler, said, are people who are probably not just on testosterone. They may be promoting a company or some product that is testosterone, but it’s very possible that they’re on other things.

Now, the one thing that I always, I also treat a lot of male infertility, is I really want to highlight this idea of infertility in men, because as we’ve already established, a lot more younger people are seeking out testosterone replacement therapy. The data shows that about 65% of men with normal sperm become sterile just within about four months of using testosterone therapy.

The good news, though, is if you are taking it, you can recover. But this recovery time really depends on how long you’re taking the medication. The longer you’re on it, typically the more dependent you become on the medication, and the longer it takes for your testicles to reboot.

The data shows in general about 90% of people have return of sperm to their ejaculate, which is not the same as having normal levels, at about 90% about 12 months after, about 100% at 24 months. But the thing here is that a lot of the data shows that you’re compared to your pretreatment semen parameters. You can get at best about 85%.

Now, a lot of these younger guys don’t know what their semen parameters are prior. They don’t know their fertility status, and they’re also not aware of this risk factor. So I can’t tell you how many guys I’ve seen who have been trying for fertility for two years with a partner, who came in after two years and I’m asking them what they’re taking and they say testosterone therapy, and they were never informed of that.

We do a semen analysis. It’s either very low or zero. And then we have to do a recovery protocol. Education in these situations is key, right? Would these people have gone on true testosterone replacement therapy if they knew that their goal later on in life was to have children, or there are alternatives? Things like Clomid and HCG and Clomiphene has become more popular, especially on the socials, but these are ways to increase your testosterone and preserve your fertility.

BECKER: So they’re not, it’s not taking testosterone, it’s ways to make your body increase the amount of testosterone or increase your testosterone levels.

DUBIN: Correct. You are preserving your fertility by stimulating your testicles to create more testosterone and potentially even improve fertility in people who have low testosterone, who come see me, young men who want to preserve their fertility, who have testosterone deficiency, these are the things I offer them. I never offer them true testosterone replacement therapy because of the information that we have discussed.

Now, the one thing I do want to highlight is we were seeing enough of this where a few years ago at Northwestern, I did a secret shopper study where I pretended to be a patient at these direct-to-consumer companies. I went through seven different companies, all that were presenting, providing care to 50 states. And I pretended to be myself. I was a 34-year-old man at the time. And I had a script. I had the signs and symptoms of low testosterone. However, I did say that I wanted to preserve my fertility.

And at the time I went through the blood work, and we had not established yet, I think on this, in this podcast that testosterone levels per our guidelines, AUI, are 300 is considered low. My testosterone levels at the time were 675. Clearly not a good candidate when you combine my testosterone levels with my desire for fertility.

Now having said that, about six of the seven companies offered me testosterone replacement therapy and only half of the companies discussed fertility risks with me. So obviously, one thing that I really do want to highlight is this fertility concern, because we need to educate our patients. We need to educate people interested in testosterone replacement therapy, that they know these kinds of risks before taking these kinds of medications.

BECKER: Had you not been so aware of testosterone and testosterone therapy, could that have been dangerous if you had actually taken that level of testosterone?

DUBIN: It’s a good question. And I would love to hear Dr. Morgentaler’s opinion on that after I answer, but I think the answer is we still don’t know.

We don’t have many studies looking at putting people who are normal levels of testosterone on testosterone and what happens, right? But what is concerning when I asked in these clinical settings, what was your testosterone level goal for me? Because as a patient, I get that question all the time.

And several companies would say, we’re going to keep going higher until you feel where you want to feel. Some were saying 1,200, 1,500, and these are, as Dr. Morgentaler would agree, super therapeutic. We really don’t want to see you above a thousand is where our cutoff is. Obviously, I don’t know, and I would love to hear Dr. Morgentaler’s thoughts on this. But, we just don’t know at this point.

BECKER: Okay, let’s go to, yeah let’s hear from Dr. Morgentaler. What do you say about potential risks of someone who has a normal testosterone level and may in fact take testosterone, which according to Dr. Dubin’s secret shopper study, that may not be all that difficult.

MORGENTALER: Yeah, that was a good little study. It really points out some of the issues. Listen the first thing around that story is that the men who don’t have a low level of testosterone do not have a medical condition. And therefore, as a physician myself, there’s nothing for me to treat them for.

Like they’re not who we really want to be treating with this medication, testosterone. There are studies, but they’re more really about looking at what’s the effects of these very high levels in men. There are only a few, but they’ve looked at men who got five times the normal upper limit of normal of testosterone for usually, for short periods of time. And they gain a lot of muscle. That part is real.

And in those short studies, they really haven’t found much that’s troubling, but most of this stuff that goes on without ever being studied, right? So the bodybuilders and all that, there used to be anecdotal stories of them having like arrhythmias and heart attacks. And these young people, it’s hard to know from those anecdotal things, the part that concerns me the most around all this, as we focus on the young guys who are healthy without testosterone.

And the thing where this program could play a very important beneficial role is that there are plenty of men who are listening right now, or their partners who are concerned about them, or daughters of their fathers, who recognize that something has changed in their male partners, father, sibling, whatever. Like something’s different about them. These people who used to be active, engaged, full of personality, may have become withdrawn. They’re not doing the things that they used to enjoy. They’ve become grumpy old men before their time.

And what’s important to get out there is that most doctors have a testosterone test. It’s not part of the normal blood test routine that we get, like at your annual event, annual physical or whatever. And a lot of the medical community still is stuck in olden times with the fears about prostate cancer or more recently cardiovascular issues, or they think that testosterone is just related to muscle, which is how we’ve been described, how these promotional stuff goes on.

And they say, “I don’t want any part of that. It’s this is fringe medicine and it’s this anti-aging aspect” in the clip with RFK Jr., talked about, he said, “I’m on an anti-aging regimen” and doctors hate that.

One of the first things we learn in medical school is beware of anything that smacks of snake oil, where you’re going to get all these benefits. If it’s too good to be true, it’s too good to be true. It’s not real, right? And yet there is something, the guys who have low testosterone and go on treatment, will not infrequently say, I feel younger.

BECKER: And we should say there are women taking testosterone as part of hormone replacement therapy as well. It’s not just estrogen for women. Are there different risks there for women when they’re taking testosterone?

MORGENTALER: There are some, but before we get to risks, what you’re saying is very important. So women also have testosterone, and women can also become deficient in testosterone, especially in the perimenopause and in the postmenopausal years. And testosterone, the benefits are the same in women as they are in men. Has to do with sex drive and energy and fitness and strength and loss of fat. Probably has effects on appetite, not well studied, but anecdotally, that’s what we hear, people sleep better. So there’s plenty of benefits.

In women though, testosterone is the hormone that’s responsible for puberty, in males, adolescence. And it does that by making them more manlike, if you will. So women who are getting too much testosterone are prone, even though they’re well through puberty, can be susceptible if levels are too high, to getting dark hairs on their chin, right? Almost like a beard. The voice can deepen, the clitoris can enlarge. So there are things that women have to be more careful about than men do.

BECKER: And I wonder, Dr. Dubin, if you can tell us also what folks might wanna know about if they are considering testosterone, and it is becoming increasingly prevalent among men and women.

Is some of the other potential pitfalls here. Is there any risk of addiction or dependency? And we have just a few minutes left.

DUBIN: No worries. So it’s an important question and I think that the idea of addiction, I would say, it does not exist for testosterone replacement therapy, however, dependency does exist, right?

When you take what we say is exogenous testosterone or testosterone coming from an outside source, whether you’re injecting it, putting on a gel or a pellet or an oral version of it, you are signaling to your brain that you are making enough testosterone. And when your brain makes that read, it stops the signal to your testicles.

There’s two hormones. FSH, follicle stimulating hormone, is the hormone your testicles receive from your pituitary to make sperm, and LH is made by your brain, luteinizing hormone, the hormone that your testicles received to make testosterone. That signal pathway gets shut off. Why? Because your brain thinks you’re making enough testosterone.

So that’s where this cause of fertility and shrinkage of your testicle comes, because you’re not feeding your testicles anymore. Your testicles can atrophy and they’re not functioning to produce testosterone, and they’re not functioning to produce sperm. So the longer you’re on testosterone is the longer risk of becoming what we like to say is dependent on it.

Now we have a lot of different guys who can come off and I’ve seen guys come off who end up getting normal levels and live their lives normally. I have guys though, who have been on it for a year, and we sometimes call this a burnt-out testicle. They just cannot create testosterone anymore. And they require it for the long term, but you have to understand, the longer you’re on it, that’s more likely to happen.

BECKER: Okay. In our last minute here, I want each of you, to ask each of you what advice you would give to folks who are trying to decipher all of this information. Obviously, it sounds like a miraculous cure all for many things, that folks might like to feel better, might like to have more energy, yet there are things that people should be aware of.

One sentence to each of you, what advice do you give to people who may be looking at testosterone therapy. Dr Morgentaler, let’s start with you.

MORGENTALER: I would say to men or to their partners listening in, that if you feel like there’s something that’s wrong and it’s not, everybody’s tired, it’s not just the usual tired.

These men feel depleted and unable to do their normal things. If your sex drive has disappeared or greatly weekend. That’s not normal. And my advice is get a blood test for testosterone. Total testosterone less than 350 or calculated free testosterone less than 100 picograms per mil is an indication for treatment.

BECKER: Okay, Dr Dubin, you’ve got about 10 words now. What’s your advice?

DUBIN: Okay. Always ask who you’re getting your care from. Ask what their motivations are, ask how are you getting that care and what’s the benefit from you. Ask their backgrounds.