Testosterone Doesn’t Make the Man
How the "high-T" movement spread, and what clinicians can do about it
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After a busy clinic day, I received an unexpected call from a patient. I had seen Gino, a patient in his thirties with a neuromuscular disease, earlier that day for a routine visit. On his way home, he said the Uber driver was “intentionally blaring music and speaking to me like a child.” The story became darker from there. “He was questioning my manhood—seeing whether I would stand up to him.” During the call, Gino asked to come back to the office to have his testosterone checked.
I thought of Gino immediately after Pete Hegseth’s recent glamorization of testosterone and his desire to “have a high-T military.” Hegseth is riding a wave of interest in testosterone. Testosterone testing and prescriptions have nearly tripled in recent years. Industry revenue is likely in the low billions. Will screening for and treating low testosterone among troops create “better fighters”? The answer is decidedly no.
Why, despite the lack of evidence, do we continue to equate testosterone with strength, power, and masculinity? A left-leaning political analyst might explain the cultural mythology surrounding testosterone as part of a broader story about aggrieved men (many of them White) who fear losing their social status. If masculinity had a biological marker, perhaps these men could reclaim it. Gino hoped the same.
Stepping back, I realized that medicine rarely tackles a larger question: What does it mean to be a man? If much of the country believes there is a masculinity crisis, our medical culture has largely ignored it, leaving patients to be algorithmically fed incomplete (and often false) messages about “getting your testosterone back.” I routinely talk with my patients about the evidence for treating heart disease, diabetes, and insomnia.
When it comes to testosterone, however, the topic feels too broad and unwieldy to explain. I screen for low testosterone in men with symptoms, but beyond that, I leave patients to the cultural myths of TikTok and Instagram. Let’s confront those myths and truths about testosterone and end with a question every clinician can ask.
The top myths about testosterone
Over the past few decades, low testosterone has been rebranded from an “old man’s problem” into a marker of masculinity for younger men. Consider a few representative quotes from influencers: “Did you know that most people don’t have sufficient testosterone to be a normal healthy person?” Here’s another: “Show up the way you want to in the world. Have enough testosterone.” These quotes capture the culturally dominant “T-Rex” view of testosterone—that the hormone drives competition, reproduction, and domination.
Let’s start with three myths about testosterone:
Myth 1: Testosterone causes aggression – The evidence is remarkably weak on this point. In fact, testosterone rises in response to competition. For men, winning individual competitions increases testosterone, whereas for women, team competition tends to do the same.
Myth 2: Testosterone predicts a “masculine” personality – In an important study, researchers asked hundreds of university students to rate themselves on typically “masculine” (assertive, dominant) and “feminine” (gentle, devoted to others) personality dimensions. Researchers then measured salivary testosterone. Those with more “masculine” personalities had testosterone levels all over the map. Personality likely reflects the interplay of many hormones and inherited traits.
Myth 3: Testosterone improves physical performance – Before a 20-day simulated military operation, researchers gave a large testosterone injection to half the soldiers and a placebo to the other half. The soldiers receiving testosterone maintained more muscle. But their power, strength, and aerobic capacity were no different from those receiving placebo. A “high-T” military may even be harmful to troops. One study of Dutch soldiers deployed to Afghanistan found that pre-deployment testosterone levels predicted PTSD symptoms 1–2 years after their return. Another study found poorer cognitive performance as testosterone levels deviated further from the normal range.
If testosterone doesn’t reliably cause aggression, dominance, or even physical performance, what does it do?
What testosterone actually does
Robert Sapolsky, a neuroscientist at Stanford University, puts it best: testosterone is not simply a hormone of aggression but a hormone of status.
Consider a classic experiment. Researchers gave men $100 to split with a partner. If the partner rejected the offer, neither person received anything. Fair offers were usually accepted, while unfair ones could be rejected—even at a personal cost. In effect, the responder was saying, “I’ll give up my $25 to punish you for being an asshole.” Men given testosterone punished unfair partners more often. That fits the stereotype. But they also rewarded generous partners more often. Both behaviors help maintain social status.
Women behaved similarly. Testosterone led them to make fairer bargaining offers. Even more surprising, women who merely believed they had received testosterone behaved more unfairly. Given today’s largely unregulated testosterone marketplace, it’s worth asking whether some young men perform aggression simply because they believe that’s what testosterone is supposed to do.
To sum up, here are three truths about testosterone:
Truth 1: Testosterone amplifies the behaviors that earn status – If generosity earns status, testosterone can make us more generous. If cruelty earns status, it can make us crueler. As Sapolsky puts it, “If you took a whole bunch of Buddhist monks and shot them up with testosterone, they’d get all competitive with each other as to who could do the most random acts of kindness.”
Truth 2: Testosterone’s actions depend on social hierarchy – Give testosterone to those at the top of a hierarchy and they become more dominant. Give it to those at the bottom and they become more submissive. In this sense, testosterone makes us more of who we already are.
Truth 3: A “high-T” military comes with more risk than reward – Does testosterone increase risk-taking? No. Does it improve physical performance? No. What about teamwork among troops? One Lithuanian study found that higher testosterone was associated with worse team cohesion. For individuals with documented hypogonadism and symptoms, evidence-based treatment may help. But raising the average testosterone level or loosening treatment thresholds likely brings more risk than benefit – socially and medically.
The conversation we should be having
I saw Gino for a follow-up appointment and checked his testosterone. Sure enough, it was normal. Reflecting on the encounter with his driver, he said he “felt less like a man.” He had been in a wheelchair for the past few years after his muscle function worsened. We talked about whether muscles make a man. “I haven’t had muscles for years,” he said. He could still do “masculine things” like have sex, play video games competitively, and argue with his friends.
He said he didn’t actually want more aggression. As he reflected on the experience, he considered going back on an SSRI for his mood. “When I was on that anxiety medication, I felt less on edge,” he told me. The encounter with the driver hit hard for a deeper reason—a threat to his dignity and status. He agreed to see a counselor again to consider medication and talk through his anger. In a classic “doorknob” moment, as I left to see another patient, he asked whether a boost in testosterone could give him more energy.
At the time, I didn’t have a good answer and asked him to come back so we could discuss it further. Now, months later, I have my rehearsed pitch. Without a diagnosed deficiency, supplemental testosterone may give you a bit more muscle. But it won’t make you more aggressive, give you a more masculine personality, or improve your physical performance. Socially, it will make you more of who you already are and heighten your sensitivity to status. Fundamentally, testosterone does not make the man.
I now give that same pitch to every man who brings up the topic. If patients don’t hear the truth about testosterone from clinicians, social media will quickly fill that information gap, with the algorithm feeding on their attention to deliver increasingly provocative content. Like heart disease or diabetes, I now present patients with the evidence and then put the question back to them. Within the walls of the clinic, away from social media, influencers, and a political movement intent on defining manhood by a number, we can finally sit down and ask: “What kind of man do you want to become?”
Note: Some patient stories are composites of multiple individuals and identifying details have been changed to protect privacy.
Selected References:
1) Casto KV, Cohen DJ, Akinola M, Mehta PH. Testosterone, gender identity and gender-stereotyped personality attributes. Horm Behav. 2024;162:105540. doi:10.1016/j.yhbeh.2024.105540.
2) Dreher JC, Dunne S, Pazderska A, Frodl T, Nolan JJ, O’Doherty JP. Testosterone causes both prosocial and antisocial status-enhancing behaviors in human males. Proc Natl Acad Sci U S A. 2016;113(41):11633-11638. doi:10.1073/pnas.1608085113.
3) Eisenegger C, Naef M, Snozzi R, Heinrichs M, Fehr E. Prejudice and truth about the effect of testosterone on human bargaining behaviour. Nature. 2010;463(7279):356-359. doi:10.1038/nature08711.
4) Geniole SN, Bird BM, McVittie JS, et al. Is testosterone linked to human aggression? A meta-analytic examination of the relationship between baseline, dynamic, and manipulated testosterone on human aggression. Psychol Bull. 2020;146(3):261-289. doi:10.1037/bul0000234.
5)Sapolsky RM. Interview with Andrew Huberman. Huberman Lab. Episode 35, Science of Stress, Testosterone & Free Will. August 30, 2021.
6) Varanoske AN, Harris MN, Hebert C, et al. Testosterone undecanoate administration prevents declines in fat-free mass but not physical performance during simulated multi-stressor military operations. J Appl Physiol (1985). 2022;133(2):426-442. doi:10.1152/japplphysiol.00190.2022.