Millions of American Men Are Suffering From Low Testosterone. The FDA Is Finally Addressing the Crisis.
April 30 marked the first step in a shift toward reopening treatment access for American men with low testosterone but no diagnosis.
Millions of American men with documented testosterone deficiency don’t qualify for FDA-approved treatment, even though, according to testimony at the FDA’s December 10, 2025 expert panel, that treatment is often life-changing and even life-saving.
The reason traces back to a 2015 FDA regulatory change that restricted approved use of testosterone therapy — what the agency calls “on-label” use — to men with a specific structural or genetic diagnosis. Most symptomatic men don’t fit that category.
FDA labeling doesn’t just guide medical decisions. It shapes the entire system around them, influencing whether a doctor is willing to prescribe, whether insurance will cover the drug, and what rules pharmacies have to follow. That’s how faulty labeling creates an access and affordability problem that looks like a physician too spooked to prescribe, a drug too expensive to afford out-of-pocket, a pharmacy too restricted to fill.
On April 16, the FDA encouraged manufacturers of approved testosterone products to pursue a potential new on-label indication – initially focused on symptoms like low libido – for men with idiopathic hypogonadism: low testosterone without an identifiable structural or genetic cause.
On paper, this is a narrow regulatory move. In practice, it signals something much larger. Here’s what that announcement means for the men this labeling has failed to help for a decade.
Why Most Symptomatic Men Don’t Qualify
Since 2015, on-label testosterone therapy has been restricted to men with classical hypogonadism, meaning low testosterone with a specific cause such as a pituitary tumor, Klinefelter syndrome, or testicular damage from chemotherapy. Men whose testosterone is documented to be low but with an unidentified cause are classified as idiopathic or age-related. Both categories are off-label. Men with either are far more vulnerable to being denied coverage by their insurance company.
“For most health insurers, any excuse to exclude a drug from coverage will do. Their most favorite is lack of FDA approval,” says Katy Talento, former special assistant to President Trump and the CEO of AllBetter Health. “That means that men needing hormone replacement therapy have long been discriminated against compared to women, for whom HRT is becoming the near-universal standard of care. Fixing the FDA testosterone label is only fair, and will save men’s lives, health, and bottom line.”
The current framework excludes on-label prescribing of testosterone replacement therapy for the majority of men, leaving them at the mercy of insurers. Data presented at the December panel helps explain why. Most men with low testosterone don’t have a problem with the testes. Their condition is driven by something much more common – obesity, diabetes, or metabolic dysfunction that affects how the brain signals the body to produce hormones.
Slides presented by Dr. Martin Miner, co-director of the Men’s Health Center at Miriam Hospital and clinical professor at Brown University’s Warren Alpert Medical School, suggested roughly 85 percent of testosterone-deficient men fall into the category of secondary hypogonadism, meaning the problem originates in the brain’s hormonal signaling. Of those, only 11 percent have a medical condition that qualifies for on-label treatment. In other words, the FDA’s current labeling is built around a small minority of cases, excluding the vast majority by design.
Compounding the issue is the way “age-related hypogonadism” has been defined. Testosterone declines with age, but only modestly. The bigger drops are driven by metabolic disease. “Aging alone has minimal impact on testosterone levels,” says Dr. Mohit Khera, a professor of urology at the Baylor College of Medicine. “Comorbidities, not age itself, are the main drivers of significant decline in serum testosterone.”
Across medicine, treating a hormone deficiency doesn’t require knowing the underlying cause. Clinicians prescribe hydrocortisone without a requirement to confirm why the adrenals failed. They prescribe levothyroxine without a requirement to confirm why the thyroid stopped working. Deficiency and symptoms are enough. Testosterone is held to a different standard.
The human cost is not abstract. Dr. Helen Bernie of the Indiana University School of Medicine described what happens when men get treated: “They think more clearly, they move more easily, they reconnect with their families... This is restoration of health and dignity.”
FDA Commissioner Dr. Marty Makary framed the move as part of a wider course correction.
“Just as we’ve worked to tell women the truth about hormone replacement therapy, we are now turning our attention to men’s health,” Makary told The MAHA Report. “This step is part of a broader FDA effort to align our labeling with gold-standard science and expand access to meaningful treatments for the men who need them.”
A Starting Gun Not a Finish Line
Manufacturers had until April 30 to contact the FDA, but change will take time.
The panel’s closing summary stated there is “no scientific basis for excluding age-related hypogonadism” from treatment eligibility. That exclusion is still on the books, however. Experts also advocated for removing testosterone from Schedule III controlled substance status. It hasn’t moved. Prostate cancer warnings remain. Routine screening and clinical endpoints have yet to be addressed. But bad policy often doesn’t get dismantled all at once, with one announcement. Instead, it happens through a sequence of events.
The FDA rolled back cardiovascular risk warnings in February of 2025. April 16 marks the first step toward making testosterone therapy FDA-approved treatment for the millions of men who are currently shut out.
The direction is clear. The men’s health crisis is finally getting a regulatory response. And this is just the beginning.
Tiffany Ryder is a licensed emergency medicine clinician, researcher, and founder of Red Flag Media. She writes on health policy, the MAHA movement, and the future of American medicine. Read more of her work at signalandnoise.online
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There are so many natural interventions before looking to pharmaceuticals.
This is a great start. My husband has benefited tremendously from TRT, and not just for libido--his mood, energy, cognition and overall wellbeing and fitness have all improved. But to the FDA, I urge you: OK, now do this for women! Women make and need T too, and it declines precipitously with age, becoming most problematic during perimenopause and menopause. Low T in women causes low mood, fatigue, poor cognitive function and muscle loss. Yet there is NO FDA-approved testosterone product for women, and the only FDA-approved indication is low sexual desire (why is it only just about libido?!), so most doctors refuse to prescribe it (even though they Rx antidepressants for hot flashes and all other manner of drugs off-label for a variety of ailments). Many don't even know women make T (despite it being our most abundant hormone -- as much as 4X our estrogen levels throughout our reproductive years). I hope this move by the FDA to help men is the first step and that women will be next. And not with some proprietary, expensive "pink tax" dosing system. Just smaller dosing guidelines and more physician education.