What Testosterone Does Differently in Men vs Women and Why 11+ Million Americans Are Now Prescribed It
Testosterone prescriptions in the U.S. have jumped roughly 50% since 2019, climbing from 7.3 million to more than 11 million in 2024. The surge is real, but doctors are sharply divided on what’s behind it and whether millions of Americans now taking the hormone actually need it.
The debate reached a turning point in February 2025, when the FDA removed the cardiovascular black box warning that had shadowed testosterone replacement therapy for more than a decade. Yet new research continues to raise questions about long-term safety, online prescribing practices and a fast-growing women’s market that barely existed a few years ago. If you’re trying to understand what’s behind the broader hormone health conversation, the testosterone story is a useful place to start.
What Testosterone Does in Men and Women
Testosterone is often framed as a male hormone, but it plays a central role in both sexes. In men, it regulates muscle mass, bone density, libido, mood and cardiovascular and metabolic function, per a February 2025 systematic review in Cureus.
In women, testosterone levels are actually 10 to 20 times higher than estradiol throughout the lifespan, making it the predominant sex hormone in female physiology, per a November 2025 paper in Medical Research Archives. It supports sexual function, bone metabolism, mood, cognition and energy in women too.
A January 2026 review in the International Journal of Molecular Sciences confirmed that testosterone levels are declining across the population in a real, age-independent way, a trend researchers have linked to obesity, endocrine-disrupting chemicals and sedentary lifestyles.
Why Testosterone Prescriptions Are Climbing So Fast
The headline number captures only part of the shift. A 2024 study in PLoS One found a 27% increase in TRT patients between 2018 and 2022, with the sharpest jumps among men aged 35 to 44, up 58%, and men aged 45 to 54, up 35%. Injectable testosterone cypionate alone doubled between 2019 and 2025, per STAT News.
Women’s prescriptions are climbing even faster. A 2026 study in JACC: Advances found female testosterone prescriptions rose 2.6-fold between 2016 and 2025, including a 58.7% year-over-year jump from 2024 to 2025. Women aged 45 to 64 account for 62.2% of those prescriptions, reflecting growing interest in testosterone as part of perimenopause and menopause care.
The Three Possible Reasons For The TRT Surge
Doctors point to three competing explanations for the surge.
The first is genuine unmet need. An estimated 5.6% of men aged 30 to 79 have symptomatic testosterone deficiency, per the Boston Area Community Health Survey published in the Journal of Clinical Endocrinology and Metabolism, but a follow-up study in Archives of Internal Medicine found only 12% of those men were being treated. Supporters argue a decade of overcautious prescribing left real patients undertreated.
The second is commercial overdiagnosis. Up to a quarter of new TRT patients start without bloodwork, per STAT News. Some 325 new Low T clinics have opened since early 2024, fueled by private equity investment and influencer-driven demand.
The third is regulatory shift. The FDA removed the cardiovascular black box warning in February 2025 following the TRAVERSE trial, the largest randomized controlled trial on testosterone to date, which found no significant increase in cardiovascular events versus placebo. A December 2025 FDA panel recommended loosening restrictions further.
Is Testosterone Replacement Therapy Safe Long Term
For short-term use in properly screened patients, the TRAVERSE data is reassuring. For long-term users the picture is less clear. A 2025 study in the Journal of the Endocrine Society found a 55% increased risk of major cardiovascular events in long-term TRT users.
That gap between regulators easing restrictions and researchers flagging long-term risks is why endocrinologists urge careful clinical evaluation rather than online questionnaires.
What Women Need To Know About Testosterone Prescriptions
There is no FDA-approved testosterone product for women in the U.S., meaning most prescriptions are written off-label or compounded. The 2026 JACC: Advances study flagged the pace of growth as a cardiovascular safety concern given the absence of large-scale randomized trials in women. Researchers say the rapid growth underscores the need for more rigorous study in a population historically underrepresented in hormone research.
What To Ask Before Starting Testosterone Therapy
For anyone considering TRT, the most important question isn’t whether prescriptions are surging. It’s whether their own symptoms and lab values meet the clinical criteria for deficiency. Patients can ask a primary care doctor or endocrinologist for morning total testosterone measured on at least two separate occasions, along with a full discussion of symptoms, fertility goals and cardiovascular history.
The rise of telehealth has made access easier, but endocrinologists warn that brief online questionnaires without bloodwork fall short of established clinical guidelines. The people best served by the current boom are those who get a thorough evaluation first.
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