More men are using testosterone than ever — and many aren't being honest with their doctors about it. TRT prescriptions jumped 27% from 2018 to 2024, and illicit steroid use is likely far more common than reported. Experts say the key to better patient care is ditching the judgment and leading with curiosity — because the moment a patient feels lectured, the conversation is over.
Testosterone replacement therapy (TRT) prescriptions surged 27% between 2018 and 2024, with a striking 58% increase among men aged 35–44 — an age group not typically associated with low testosterone. Social media and online clinics marketing testosterone as a lifestyle product are fueling the trend, and experts estimate that up to one-third of TRT recipients may not even meet diagnostic criteria. Meanwhile, illicit use of image- and performance-enhancing drugs (IPEDs) is a growing concern, with an estimated 3–4 million Americans using them — likely a significant undercount.
The bigger clinical challenge? Most patients aren't telling their doctors. A 2020 survey found that physicians ranked last as a trusted source of IPED knowledge, behind coaches, bodybuilding media, and other users. More than half of those who did disclose felt discriminated against by their doctor. Experts say the fix starts with communication: ask why patients are using, understand their goals, and resist the urge to lecture.
Key Takeaways:
Why it matters: With TRT use booming and illicit steroid use vastly underreported, primary care clinicians are on the front lines of a growing issue. Building trust — not delivering lectures — may be the most effective clinical tool available.
