The testosterone boom, and the question it skips
Testosterone therapy is one of the fastest-growing corners of telehealth. In its August 2026 earnings, the largest DTC health company called testosterone its fastest-growing specialty outside weight loss, heading toward a nine-figure run rate. When you see growth like that, it’s worth asking what’s driving it — and whether every man starting TRT actually needed to.
Here’s the uncomfortable part: TRT is often a lifelong commitment. Once you supply testosterone from outside, your body typically downregulates its own production. So the question worth answering before you start is the one the intake funnels tend to skip: why is your testosterone low in the first place — and is that cause reversible?
Low T is a symptom, not always a diagnosis
Testosterone doesn’t drop in a vacuum. For a lot of men — especially younger and middle-aged men with “low-ish” numbers and real symptoms — the low reading is downstream of something else. Fix that something else and testosterone often recovers on its own, no lifelong prescription required.
That’s not true for everyone. Some men have genuine primary hypogonadism where the testes aren’t producing, and for them TRT can be appropriate and life-changing. The point isn’t that TRT is bad. It’s that skipping the root-cause workup means some men medicate a symptom for life when they could have fixed the driver.
The reversible drivers worth checking first
Here are the common, correctable causes of low testosterone that a thorough workup looks for.
Visceral fat and insulin resistance. This is the big one. Abdominal fat is metabolically active and drives testosterone down, partly by converting testosterone to estrogen and partly through insulin resistance. Poorly managed blood sugar and type 2 diabetes are strongly linked to low T. The encouraging flip side: losing visceral fat and improving insulin sensitivity often raises testosterone measurably.
Poor sleep and sleep apnea. Most of your testosterone release happens during sleep, so short or fragmented sleep suppresses it directly. Obstructive sleep apnea is a particularly common and underdiagnosed culprit — and men with it often present differently than the stereotype. Treating the apnea can move the number without touching a hormone.
Chronic stress and cortisol. Cortisol and testosterone sit on a seesaw. Sustained stress and elevated cortisol suppress testosterone production. Chronic under-recovery — overtraining, relentless work stress, no downtime — shows up in the labs.
Thyroid dysfunction. An underactive thyroid can lower testosterone and produces overlapping symptoms — fatigue, low libido, brain fog — that get misattributed. This is why a full thyroid panel, not just TSH, belongs in the workup.
Medications. Opioids, corticosteroids like prednisone, some SSRIs and SNRIs, and anabolic steroid use can all lower testosterone. Sometimes “low T” is really a medication effect that a prescribing clinician can address.
Endocrine-disrupting chemicals. Compounds like phthalates — found in soft plastics, fragrances, vinyl, and food packaging — interfere with hormone signaling and have the most evidence for testosterone effects among common exposures. Not a magic fix, but a real and reducible load.
Inactivity and undertraining. Too little activity, and specifically too little resistance training, is itself associated with lower testosterone. Muscle-building exercise is one of the more reliable natural levers.
The workup I’d want before anyone commits to TRT
If you have symptoms and a low or borderline reading, a proper evaluation looks well beyond a single total testosterone number:
- Confirm it’s actually low — total and free testosterone, drawn in the morning, on more than one occasion. A single afternoon draw is not a diagnosis.
- Metabolic panel — fasting insulin, HbA1c, and a lipid panel to catch insulin resistance.
- Full thyroid panel — not TSH alone.
- SHBG, LH, FSH, estradiol, prolactin — to distinguish where in the system the problem sits and whether it’s primary or secondary.
- Sleep screening — including for apnea.
- A medication and lifestyle review — the reversible drivers above.
That picture tells you whether you’re a man whose testosterone will rebound once you fix sleep, weight, and stress — or a man for whom TRT is genuinely the right call. Both exist. The workup is how you know which one you are.
Where I fit, and where I don’t
Let me be clear about my role. I’m a Doctor of Acupuncture and Oriental Medicine — I don’t prescribe testosterone. If your workup points to TRT being the right choice, that’s a conversation with a prescribing clinician, and I’ll refer you.
What I do is the part the prescription funnels skip: the root-cause assessment and the non-pharmaceutical work. A full history and functional lab interpretation, the metabolic and sleep drivers, the resistance-training and nutrition plan that addresses insulin resistance and visceral fat, and the stress and recovery side. For many men that either restores testosterone without a prescription, or it’s the foundation that makes any therapy work better. The two aren’t in competition.
Frequently asked questions
What causes low testosterone besides age?
Visceral fat and insulin resistance, poor sleep and sleep apnea, chronic stress and high cortisol, thyroid dysfunction, certain medications, endocrine-disrupting chemicals, and inactivity — many of them reversible.
Can low testosterone be reversed without TRT?
Often, when the cause is reversible — losing visceral fat, treating sleep apnea, improving insulin sensitivity, and resistance training can raise levels. Some men do have genuine hypogonadism where TRT is appropriate.
Is TRT a lifelong commitment?
Usually, because supplying testosterone externally suppresses your own production. That’s exactly why it’s worth ruling out reversible causes first.
What tests should I get before starting TRT?
Morning total and free testosterone (repeated), fasting insulin and HbA1c, a full thyroid panel, SHBG/LH/FSH/estradiol/prolactin, and sleep screening — plus a medication and lifestyle review.
Does a DAOM prescribe testosterone?
No. A Doctor of Acupuncture and Oriental Medicine does not prescribe TRT. I do the root-cause assessment and non-pharmaceutical work, and refer to a prescriber when therapy is the right call.
Where to start
If your energy, libido, or drive is down and you’re being funneled toward TRT, it’s worth knowing what’s actually driving it first. Book a consultation in Tustin or virtually, and we’ll work out whether this is a reversible problem or one that genuinely needs a prescription — and be honest either way.
Author: Dr. Brandon Bright, DAOM, LAc — Tustin, Orange County. Educational content; not medical advice, diagnosis, or treatment. A DAOM/LAc does not prescribe testosterone or hormone therapy. Discuss TRT and any persistent symptoms with a qualified prescribing clinician. Cash-pay functional medicine; not in-network.
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