Many companies push testosterone-boosting supplements, but experts say theyre helpful only for certain conditions.
The popular ad features graying men whose female partners gaze longingly at them.
They proclaim: "Men: Feel younger and stronger," "Boost performance" and "Have sex again!"
The ads promote pills, creams and injections, and guide those yearning for their youth to clinics that can offer life-changing results.
Critics say the testosterone replacement therapy industry relies on aggressive marketing, touts some dubious claims and targets men who lack real medical needs.
Gahannas Low T Center has heard the good and the bad, and staff members must help new patients overcome objections and myths. Many customers are drawn in by ego and societys view of male virility.
"One of the main things that keeps guys from coming in is that they may think its like a hit to their man card," said Kortney Doss, a nurse at the Gahanna clinic.
The clinic and its sister location in Dublin each serves about 100 men daily, providing their weekly testosterone injections. The coronavirus pandemic has cut the visits in half, said Doss.
Its customers who continue coming, even during a health emergency, that clinics say are proof of the treatments effectiveness.
The same is true at Restorative Health in Dublin, which has as many as 900 regular patients many of them women, said Don Hale, the companys business consultant and spokesman.
Whether treating men or women, the marketing is driven by the male role in relationships, he said.
"A man will do anything to get and maintain an erection," he said. "I think it comes down to a mans ego."
A clinic typically performs a full physical, blood analysis and consultation at the first visit.
Even though testosterone is a natural hormone in both men and women, it can decline 1% per year after age 30 in men.
That "low normal" is not enough alone to prescribe testosterone, said Dr. Robert Murden, a geriatric specialist at Ohio State Universitys Wexner Medical Center.
Among his many patients, only six are doing TRT due to hypogonadism, an abnormally low hormone level, resulting in either low libido, erectile dysfunction, or loss of facial or body hair.
"Its specifically not recommended for people who are just tired. You shouldnt just try it. You dont give these things, with downsides, without clinical indications."
The risks include elevated red blood cell count, elevation in estrogen, acne or other skin reactions, testicular atrophy, and cardiovascular or liver complications.
Testosterone levels below 300 nanograms per deciliter put you in Low T territory, said Dr. Gregory Lowe, an OhioHealth urologist. That might cause fatigue, lack of sexual desire, worsening erections, issues with concentration and memory, or diminished recovery from workouts.
Some men come to him after seeing the ads.
"The main thing I hear from guys is to be able to put on muscle in the weight room and to be 18 again in the bedroom," he said.
But not all symptoms are caused by low testosterone. Lowe said they might instead be remedied by exercise, stress reduction, more sleep or improved diet.
"I always want my patients to be very critical of the therapy were providing, to tell me how it is helping," he said.
Lowe said he has no major complaints with private clinics where testosterone treatments include gels, patches or pellets injected in the buttocks to release the hormone slowly.
Dr. John Oliver DeLancey, an assistant professor of urology at Wexner Medical Center, said patients should first check with their primary care physicians before seeking treatment elsewhere.
"Testosterone replacement therapy gets sort of a bad rap for being overused and without appropriate testing and monitoring," he said.
"As long as you follow appropriate guidelines and put thoughtful care into why you are doing so and for the right reasons, it can be very safe and effective," DeLancey said.
Asked whether slowing down, and some of these changes, might not be just a normal part of aging, Hale, of Restorative Health, responded: "Is it normal to lose your teeth or hearing when you age, and do nothing about it?
"If so, I dont want to be normal."
Thirteen years ago, he and his wife, then both 57, began testosterone treatments and havent stopped.
"Weve been on a honeymoon ever since," Hale said.
The cost of treatment at the Dublin clinic is $3,950 per year for men and $2,950 for women. Some insurance plans reimburse up to half of that, whats considered routine blood work.
Dee Miller, a standout wide receiver for the Ohio State University football team (1994-98), said he was lethargic, overweight and often stressed out before beginning treatments in 2016.
"My wife even thought I was cheating on her" due to his lack of energy and romance, he recalled, laughing.
Since then, he said, "I feel mentally better. As for your libido, most honestly, yes."
An insurance agent, Miller is a paid endorser of Low T Center.
The treatments, he said, "are hitting all three facets: physical, emotional and socially."
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