Men's Health Startups Fuel Testosterone Therapy Boom Amid Diagnosis Disputes

Nick Dooley never worried about his hormones as a young man. He saw himself as quite an outgoing, confident, chatty person. Around age 30, though, he started gaining weight and battling anxiety, slowly becoming a shell of his former self. By 38, he weighed 22 stone and faced a range of health issues. I spent most of my life sat in front of a TV, doing nothing, with zero motivation, and from how I was in my 20s, that wasn’t me. I knew something wasn’t right, he says.

In 2024, a private medical exam revealed fatty liver disease and low testosterone levels for Dooley. It wasn’t something I’d ever really heard of, he says. So I started down a Reddit rabbit hole. An NHS doctor deemed his blood testosterone at 11.2 nmol per litre within range, though guidance varies by trust and NHS England generally considers 8 to 30 nmol/L normal. The doctor offered antidepressants. I knew that wasn’t going to fix me, Dooley says. He turned instead to Manual, an online men’s health company that has rebranded as Voy. After two blood tests and a virtual consultation, Voy prescribed testosterone replacement therapy, or TRT.

TRT means Dooley’s body produces no testosterone naturally. He injects testosterone cypionate from a vial three mornings a week. It’s got me back to being myself, he says. I don’t suffer from anxiety any more. My depression’s completely gone. He lost 45 kg. Besides his job as a train driver, Dooley now promotes TRT as an influencer on social media. He also promotes Voy. Testosterone changed my life, he says.

Dooley is not alone in praising T. TikTok fitness influencers push T-maxxing, maximizing testosterone through sleep, diet, exercise or steroids. Celebrities like Robbie Williams and Joe Rogan discuss their TRT experiences. Voy ads cover the London Underground: Feeling irritable? It might be low testosterone.

Talk of low T among men has turned existential. In rightwing manosphere circles, it ranks as an insult like beta or simp. In October, US Health Secretary Robert F Kennedy Jr, 72, who injects testosterone in his anti-ageing regimen, claimed without evidence that American teenagers have 50% of the testosterone of a 65-year-old man. Some see testosterone at the heart of a masculinity crisis.

It’s been a real crescendo, says Channa Jayasena, an NHS endocrinologist and clinical professor of reproductive endocrinology at Imperial College London. NHS data show UK testosterone prescriptions jumped 135% from 2021 to 2024. US figures rose sharply too, especially among younger men. At a recent national endocrinologist conference, every group raised the issue. They’re clogging up our clinics. What do we do? Jayasena says.

Demand coincides with growth in direct-to-consumer firms like Voy, Hims and Numan. They target men via social media for erectile dysfunction, hair loss, obesity and low T. UK rules bar advertising prescription testosterone but allow test ads.

Endocrinologists worry testosterone deficiency is overdiagnosed, causing needless anxiety in healthy men. TRT supporters say it is underdiagnosed, with NHS approaches denying men vital care. The debate rages like two T-filled alphas.

Testosterone shapes masculinity. It literally turns boys into men, Jayasena says. Made mainly in the testes, it develops male anatomy in the womb. At puberty, boys’ levels spike up to 3,000%, driving facial hair, deeper voice, red blood cell production, bone density and muscle growth. It’s why men tend to be stronger and run faster, says Geoff Hackett, a consultant urologist and author of British Society for Sexual Medicine guidance on T. As an anabolic steroid, it is banned by World Anti-Doping Agency, though bodybuilders use extreme doses.

Women produce less testosterone via adrenal glands and ovaries. UK prescriptions for women rose 10-fold, spurred by Davina McCall, Kate Winslet and Halle Berry touting it for menopause symptoms, though benefits are under study. T also aids trans healthcare.

Male testosterone deficiency is hypogonadism, from testes problems or pituitary or hypothalamus disruptions. True diagnosis needs low levels plus symptoms like no morning erections, low libido, infertility, weight gain, osteoporosis or depression, Jayasena says.

George, a Manchester social care worker, long suspected hormone issues. In school PE, I look nothing like anybody else, he recalls. Overweight with extremely low sex drive, he struggled for diagnosis. In his early 20s, a social media TRT ad led to an at-home test borderline for NHS treatment. He took results to a doctor: I’m considering TRT. The doctor laughed. A second opinion revealed a teenage blood test had flagged potential hypogonadism, never disclosed. On TRT, I felt all these changes, George says. He lost weight, gained energy. My confidence has skyrocketed, in a healthy way. At work, my manager said, There’s something different about you.

Will started TRT in his late 20s after depression and erectile dysfunction. I’d just put it down to not being 18 any more. Surgery for an unrelated injury noted an atrophied testicle. His GP said levels were above treatment threshold and offered antidepressants. Doctors repeatedly refused further tests. A TRT clinic prescribed. It’s like I was wearing a pair of glasses with the wrong prescription; suddenly, all the blurriness lifted, he says.

Men’s testosterone peaks in their 20s and declines with age, once seen as normal. Now some, like RFK Jr, use it as a longevity drug.

Matthew, 60, a Manchester travel agent, started TRT for low energy affecting his sex life. I was getting a bit saggy and a bit sad. I didn’t want to give up on life. He buys from an underground pharmacy. I’m zipping around, I’m nightclubbing, I’m pubbing. I have a great time. He prefers injections for steady effects and has steroid experience from youth.

TRT keeps levels normal; steroids push beyond with other drugs for muscle. Arnold Schwarzenegger admitted his 1980s physique involved T and Dianabol. Steroid abuse risks heart attacks and damages sperm and natural production, sometimes leading to TRT need.

Online TRT and steroid communities overlap. Steroid users share side-effect and injection advice. The steroid community has been the most helpful, even when it comes to TRT, George says. That’s dangerous, because it can cause a rabbit-hole effect. TikTok soon showed steroid videos after T searches.

NHS diagnosis hurdles and private costs push some to self-medicate via underground labs. I shouldn’t have to pay a private clinic £200 a month, Will says. I’m not a gym juicer. I take enough to give me a normal level of testosterone and feel like a human being again.

The author tested via Voy after a broad questionnaire, paying £27.50 for an at-home kit. Results flagged low free testosterone. Total was 16.4 nmol/L, above NHS (8 nmol/L) and BSSM (12 nmol/L) cutoffs, as was free T. Voy urged a £79.95 enhanced test.

Jayasena reviewed results at Hammersmith Hospital: That is just wrong. That – 16! – is amazing. Your levels are fine. That’s absolutely shocking.

Menwell Ltd, Voy’s parent, founded in 2018 by Michalis Gkontas and George Pallis, expanded from hair loss and ED to TRT. It claims 1.5 million patients in UK, Germany, Brazil and $150 million raised.

Dr Jeff Foster, Voy men’s health director, grew interested watching NHS fail men. A lot of men would come and see me and ask questions about things like erectile dysfunction or testosterone. But referrals to endocrine or urology yielded no answers.

Foster worries about T-maxxing blurring into steroids. When you see an absolutely stacked 20-year-old on social media who says he’s using TRT, he’s not; he’s using steroids. Average Voy patient is 35 to 55. We spend a lot of time trying to weed out those who just need to lose a bit of weight.

Manual’s site claims one in four men over 30 have low T, from a 20-year-old US study where 24.3% were below 10.4 nmol/L but only 5.6% had symptoms, mostly over 70. Recent studies peg hypogonadism at 2% to 8%, rising with age.

On author’s results, Foster said total T at 16 was fine, free at 0.26 lowish but per some guidance OK. Second test needed. Enhanced test cost £79.95; Medichecks ordered for comparison.

Voy’s second results flagged both total and free T low, still above NHS, BSSM, Endocrine Society and others’ thresholds. Consultation pitched at £79.95, totaling over £180. Site repeated one-in-four claim.

Manual video testimonial from Ali, 34, was by a senior employee. ASA rules bar implying employees are consumers. Menwell, ASA-penalized thrice, said Ali is employee and paying patient; video personal.

Manual used 15 nmol/L threshold, despite small print saying over 12 usually needs no treatment. Previously flagged up to 17 nmol/L suboptimal. Foster dropped that: I’ve got rid of that because I don’t like the idea; either it’s low or it’s not.

There is an optimal range, Foster said, 15 to 30 nmol/L cutting all-cause mortality. No studies provided. Evidence for T in healthy men mixed; hypogonadal men face higher mortality.

Some endocrinologists say you’re just medicalising normal health, Foster noted. Dr Richard Quinton, Society for Endocrinology guideline co-author: They’ve invented a spurious pseudo-disease called low testosterone.

Private equity funds UK testosterone clinics seeking returns, Quinton says. Richie Gibbs of Origin clinic: I’ve spoken to at least 200 patients who have gone through the NHS, and some are on the brink of tears.

Pro-T side notes safety; prior prostate, heart risks downplayed in new studies. But Quinton: Excessive amounts significantly increase heart risks. T suppresses natural production, hits fertility (reversible), thickens blood, atrophies testes, causes acne, hair loss. High doses link to psychosis via limbic system, Jayasena says.

Some seek psychological boosts: more confidence, competitiveness. Matthew: First day or two after injection I’d be very argumentative, very aggressive. I think they call it roid rage.

T encourages status-seeking, reactivity to challenges. Low T results felt emasculating to author, sparking erection worries.

Men requested pseudonyms due to stigma. A Social Science & Medicine paper found social media medicalises masculinity. I felt quite ashamed, George said, to think I hadn’t got enough of the only chemical that defines me as a man.

Average T levels may fall over time, linked to sedentary life, chemicals, obesity (30% UK, 40% US). Fat converts T to estradiol. Weight loss raises T; jabs help obese men sans TRT.

Dooley ponders if fat caused low T or vice versa. Chicken and egg. He’ll take T lifelong at over £100 monthly. It’s like a second puberty. Libido of a 20-year-old.

Author skipped Voy consultation. Medichecks showed normal range. Social feeds now push T. Author added zinc, more meat. Foster: Ads promote awareness; screening weeds out ineligible, though they may resent £35 test cost.

Voy gets 2,000-3,000 into funnel monthly; under 20% convert initially, 70-80% post-second test and consultation.

Some names changed.