America's Testosterone Levels Are Probably Fine.

Studies show average testosterone in American men has fallen over recent decades, but experts say the average decline is modest and major clinical concern is limited.

Health officials, public figures, and some clinics have recently turned attention to testosterone and men's health. The Department of Health and Human Services has published new dietary guidance and is considering broader access to testosterone-replacement therapy. Research has documented a decline in average testosterone levels among U.S. men over decades, though experts describe the average drop as modest. At the same time, clinics and consumer products promising to raise testosterone have expanded. Key facts: - Multiple studies, including a long-term Boston study, report declines in average testosterone over recent decades. - Experts attribute the decline largely to rising obesity, chronic disease, sedentary lifestyles, and possibly higher testicular temperatures. - The medical “normal” range for testosterone varies by society and is not sharply defined, so the average decline affects people differently. - Use of testosterone-replacement therapy rose by about 30 percent from 2018 to 2022. - Some direct-to-consumer clinics have prescribed testosterone without complete diagnostic testing and have promoted very high treatment targets. - Excessive testosterone can raise hemoglobin and estradiol and may cause testicular shrinkage and infertility; medical groups emphasize diagnosing deficiency with blood tests plus symptoms. Summary: The current spotlight has increased demand for testosterone-related care and products and has prompted policy discussion at HHS about guidelines and access. Experts generally say the population-level decline is modest but view chronic disease as a more important underlying problem. Whether federal policy or clinical practice will change significantly is undetermined at this time.