For years, Nick Dooley felt like a shadow of his former self. Once an outgoing and confident young man, Dooley spent his 30s sliding into a state of profound lethargy, battling anxiety and weight gain that eventually saw him reach 22 stone. By 38, he describes his existence as a cycle of zero motivation, spent largely in front of a television.
The turning point came in 2024 during a private medical exam that flagged fatty liver disease and low testosterone levels. While an NHS doctor informed him that his levels—11.2 nmol a litre—were “within range” and suggested antidepressants, Dooley felt the clinical answer missed the mark. He turned instead to the internet, falling down a Reddit rabbit hole that led him to Manual, an online men’s health company now rebranded as Voy.
After a virtual consultation and two blood tests, Dooley began testosterone replacement therapy (TRT). The results were transformative: he lost 45kg, his depression lifted and he regained a sense of vitality he hadn’t felt in a decade. Today, a train driver by trade, Dooley has become a TRT influencer, sharing his journey on social media to encourage other men to seek hormonal help.
Dooley’s experience is no longer an outlier. it is part of a surging global trend. In the UK, prescriptions for testosterone jumped 135% between 2021 and 2024. This spike is driven by a potent mix of direct-to-consumer marketing, a burgeoning “manosphere” culture on TikTok and X, and a growing perception that low testosterone is not just a medical condition, but a symptom of a broader masculinity crisis.
The Diagnostic Divide: Medical Necessity vs. Optimization
At the heart of the TRT boom is a fierce disagreement over what constitutes “low” testosterone. In clinical terms, true testosterone deficiency is known as hypogonadism—a condition where the body cannot produce enough hormone due to physical issues with the testes or signaling failures in the pituitary gland.
For endocrinologists, a diagnosis requires both low blood levels and specific symptoms, such as erectile dysfunction, loss of libido, infertility, or osteoporosis. However, the threshold for what is “low” varies wildly between the public health sector and the private “wellness” industry.
| Organization | Testosterone Threshold (nmol/L) | Clinical Approach |
|---|---|---|
| NHS England | Generally 8–30 nmol/L (Normal) | Treatment typically reserved for clear hypogonadism. |
| BSSM | 12 nmol/L (Cutoff) | Requires low levels plus key clinical symptoms. |
| Voy (Manual) | 15 nmol/L (Threshold) | Broader definition; focuses on “optimal” ranges. |
Dr. Channa Jayasena, an NHS endocrinologist and clinical professor at Imperial College London, warns that the industry is moving toward the “medicalisation of normal health.” While TRT is life-altering for men with genuine hypogonadism, Jayasena and other specialists worry that healthy men are being convinced they are sick.
This concern is echoed by Dr. Richard Quinton, a consultant endocrinologist and co-author of the Society for Endocrinology’s guidelines. He argues that some private clinics have essentially “invented a spurious pseudo-disease” to expand their market share, fueled by private equity investment seeking high returns from the growing men’s health sector.
The ‘Funnel’ of Direct-to-Consumer Health
The rise of companies like Voy, Hims, and Numan has shifted the patient journey from the doctor’s office to the smartphone. These platforms often use a “funnel” approach—a marketing term that views patients as customers to be converted. The process typically begins with a broad, social-media-driven questionnaire asking if a man feels tired or irritable, followed by an affordable at-home blood test.
The business model relies on a strategic loophole: while prescription drugs like testosterone cannot be legally advertised in the UK, the tests used to diagnose the deficiency can be. Once a man is in the system, the path to treatment is streamlined.
However, the accuracy of these “funnels” has come under scrutiny. In an investigation into Voy’s testing, results were flagged as “low” even when total testosterone levels were well above the thresholds set by the NHS and the British Society for Sexual Medicine (BSSM). In some instances, the company used the term “suboptimal” to describe levels that were clinically normal, urging patients toward more expensive “enhanced” tests and paid consultations.
Menwell Ltd, the parent company of Voy, has also faced regulatory pressure. The Advertising Standards Authority (ASA) has penalised the company three times for breaches of advertising standards, including the use of employee testimonials presented as independent consumer accounts.
The Risks of ‘T-Maxxing’ and the Steroid Blur
Beyond the clinics, a more aggressive culture of “T-maxxing” has taken hold on platforms like TikTok. Here, the line between medical TRT and performance-enhancing steroid use becomes dangerously blurred. Fitness influencers often promote the maximization of testosterone to achieve “superhuman” physiques, a practice that can lead men into the world of underground labs and unregulated pharmacies.
The risks of excessive testosterone use are significant and well-documented:
- Cardiovascular Stress: High doses can increase the risk of heart disease and heart events.
- Hormonal Shutdown: Exogenous testosterone suppresses the body’s natural production, which can lead to testicular atrophy and infertility.
- Psychological Impact: At extreme levels, testosterone abuse has been linked to “roid rage,” increased aggression, and in severe cases, psychosis.
- Physical Side Effects: Users may experience acne, hair loss, and blood thickening (polycythemia).
There is also the “chicken and egg” dilemma regarding obesity. Adipose fat can aromatize testosterone into estradiol (a form of estrogen), which in turn can lead to further weight gain. While TRT can help some men lose weight, many endocrinologists argue that weight loss through diet, exercise, or modern weight-loss medications can naturally raise testosterone levels without the need for lifelong hormone replacement.
The Psychology of the Modern Man
The debate over testosterone is as much about identity as it is about biology. In certain online circles, “low T” has evolved from a medical description into a social insult, equated with being “beta” or a “simp.” This has created a psychological environment where men feel an existential pressure to optimize their chemistry to maintain their status.
“I felt quite ashamed,” says George, a social care worker from Manchester who struggled for years to get a diagnosis. “To think I hadn’t got enough of the only chemical that defines me as a man.”
This anxiety is compounded by claims from figures like US health secretary Robert F. Kennedy Jr., who has suggested—without providing clinical evidence—that modern teenagers possess only half the testosterone of older generations. While some population studies suggest a general decline in testosterone levels due to sedentary lifestyles and endocrine disruptors, the “crisis” is often amplified by those selling the cure.
For men like Nick Dooley, the benefits are undeniable. For others, the push toward TRT may be a solution in search of a problem. The challenge for modern medicine is distinguishing between the man who is truly deficient and the man who is simply aging in a culture that no longer accepts the limitations of the human body.
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always seek the advice of a qualified health provider with any questions you may have regarding a medical condition or hormone therapy.
The medical community continues to monitor the long-term effects of widespread TRT use in non-hypogonadal men. A key checkpoint will be the upcoming release of new clinical literature on “optimal” hormone ranges, including a forthcoming book on the subject by Dr. Jeff Foster, which aims to redefine the boundaries of testosterone treatment.
Do you believe the definition of “healthy” testosterone is being widened for profit, or is the medical establishment ignoring a genuine health crisis? Share your thoughts in the comments below.
