Testosterone therapy's popular in the online 'manosphere' — but doctor warns it's not for everyone

Derek Illman of London, Ont., is a fitness fanatic and a self-proclaimed "podcast junkie." 

Through conversations at the gym and while listening to podcasters, the 55-year-old learned about testosterone replacement therapy (TRT) and its potential in boosting energy and strength.

"I thought, 'If TRT can help me get some minor improvements in performance at the gym, will that translate to longevity?'" said Illman.

"It makes sense to me in my non-medical mind that improved performance at the gym should translate potentially into a healthier day-to-day feeling or ideally, better aging."

Illman said his gym friend told him it was easy to purchase TRT online, but Illman wanted to go through a trusted family doctor instead. After being assessed, he started on a low dose of TRT gel in December to improve low testosterone.

But while Illman was prescribed the therapy, a London urologist says some men are taking it without meeting the criteria, which can come with risks. 

"My concern is that many of these men don't have low testosterone, and if they're not properly assessed, they may just be prescribed the medication without really needing it," said Dr. Gerald Brock, former president of both the Canadian Urology Association and International Society for Sexual Medicine. 

Some symptoms of low testosterone include fatigue, decreased muscle mass and reduced sexual function, he said.

"I think often they go online, they look at the symptoms and they think that they have many of the symptoms that are outlined."

A study from the Amercian Urological Association found a quarter of men do not get their testosterone tested before starting TRT and about half who have begun the treatment don't get their levels tested afterwards.

There are valid medical reasons to be on TRT under the guidance of a doctor, said Brock. However, he added, about half of his patients interested in starting TRT have not been tested by a medical professional for low testosterone, and have instead picked it up through websites, friends or sellers at gyms. 

"That's a real problem because if you're taking any medication and it's not for the right reason, then you're not going to derive the benefits and you may be exposed to some of the harms," Brock said, adding a doctor will do blood tests and assess symptoms before prescribing TRT.

Risks of being on the therapy may include blood thickening, which can cause a stroke or heart attack, fertility issues and cardiovascular problems, Brock said — and these issues can be amplified when people take the wrong dosage or don't monitor possible side-effects with a doctor.

Low testosterone is not an increasing problem, said Brock, but there is more awareness of the issue and access to TRT, especially among younger men.