Sex and testosterone in the age of T-maxxing

Over the past few years, there’s been a surge in interest in hormones. Some of it has undoubtedly launched necessary conversations. Taboo-busting dialogue about perimenopause, menopause, and the benefits of hormone replacement therapy. Empowering information about menstrual cycles and the correspondent waxing and waning of energy and libido. 

At the same time, some of the hormone focus has admittedly been for the worse. Conservatives’ constant fixation on trans people and the desire to bar their access to gender-affirming hormone therapy. The cottage industry of TikTok content pushing (mis)information about cortisol, dopamine, oxytocin… and any number of other hormones with names sounding like a pick-n-mix of sketchy, non-FDA-approved drugs. 

Thanks in no small part to reductive ideas of masculinity, the hormone which has recently come under the brightest spotlight is none other than testosterone. In the manosphere-adjacent corners of the internet, people are pushing the concept of testosterone-maxxing, also known as T-maxxing: the practice of artificially raising your testosterone levels. The purported benefits of T-maxxing include better concentration, more muscle mass, and a more “manly” appearance. 

There’s also the sexual element. Often, conversations about testosterone tap into ideas of male “success” in the dating sphere, equating stereotypical forms of masculinity with heightened attractiveness. This is reinforced by testosterone’s status as a sex hormone: responsible for libido as well as erectile functioning—drawing (largely) young, cis, straight men into T-maxxing with the promise of improving sexual "performance"—and shaping perceptions of masculinity and sexuality in the process. Beyond that, and perhaps surprisingly, cis women are pursuing testosterone boosts, too. 

So what do you need to know about testosterone and sex? To find out more we spoke to Dr Channa Jayasena, a consultant Endocrinologist and Andrologist, and Reader and Consultant in Reproductive Endocrinology at Imperial College, St. Mary’s, and Hammersmith Hospitals in London.

What's testosterone's role in sex?

Parsing a sea of online misinformation, you may well be wondering what’s fact and what’s fiction. When it comes to sex, testosterone is a key part of the puzzle. This is particularly true for cis men. 

“[Cisgender] men need testosterone to go through puberty and to have normal sexual function. If you have low testosterone, there are three common symptoms related to sexual function,” Dr Jayasena explains. “You can experience low libido, so reduced sexual thoughts. Several large studies have shown that you can also experience erectile dysfunction (ED), the inability to get or maintain erections when you want to. Also, depending on how young you are, it’s normal to wake up with an erection every day or most days, and this is often lost when testosterone goes down.”

However, intriguingly, conversations about testosterone aren’t only for cis men: it’s also of increased interest to cis women who are looking to boost their libidos. In particular, recent stories tell of cis women topically micro-dosing testosterone gel on their clitorises, and there’s been an increase in conversations around testosterone replacement therapy, particularly during perimenopause and related dips in libido. 

However, while the conversation around cis female libido and testosterone has only just begun, the reality is more complex than one might expect. “For [cis] women, the main sex hormone is estrogen from the ovaries, but women also make small amounts of testosterone, probably about five to 10 times less than [cis] men,” Jayasena explains. 

“We think that testosterone plays an important role in maintaining libido in [cis women]. The evidence, however, at the moment, comes from women in menopause [who are struggling with low sex drive],” he continues. “For [cis] women in menopause, hormone replacement therapy can be a really good way of improving libido. In other words, estrogen is the main libido-stimulating hormone in women, but we know that testosterone also plays a role.”

Jayasena is keen to exercise caution when it comes to experimentation with testosterone among pre-menopausal, cis women, and explains that the benefits are dubious, at best. “The role of testosterone for pre-menopausal women is much less clear. If you look on the internet, you could be forgiven for thinking that cis young women should be taking some testosterone to improve their libido,” he explains. “That evidence doesn't exist at all, and there are some risks associated with it, which are related to hair growth, acne, and voice deepening, which may be irreversible if you take too much.”

Testosterone-maxxing: medicalizing masculinity 

On TikTok, the conversation around testosterone has reached a critical mass among cis men. Testosterone is currently touted as the solution to any number of ills: poor concentration, sexual “under-performance,” low energy. 

And with influencers preaching the purported benefits of testosterone-maxxing, there are countless videos encouraging cis men to maximise their testosterone levels through methods like weight-lifting, increasing protein intake, and even (unnecessary, potentially dangerous) testosterone replacement therapy (TRT). 

To bolster this questionable advice, there’s also consistent, and often misplaced, messaging suggesting that young men might have low T. Emma Grundtvig Gram, a public health researcher at the University of Copenhagen, is the lead author of a study which analyzed conversations about low testosterone in social media content aimed at cis men. In her research, she found that this content tends to overstate the likelihood of young cis men having testosterone deficiency, and can prey on male insecurity and vulnerability. 

“Testosterone does tend to decline with age, so medically speaking, younger men are generally at low risk of having clinically low testosterone. What our research found, however, is that social media content often tells a very different story,” Grundtvig Gram explains. “In the material we analyzed, young men were frequently framed as being at risk of low testosterone, particularly in content connected to fitness, self-optimization, and ‘longevity’ culture. While a small number of young men may genuinely have low testosterone, this is unlikely to be widespread.”

Essentially, this online trend encourages many cis men to see a problem that—for many—isn’t there: blaming normal fluctuations of mood and the body on a hormone deficiency which doesn’t exist. Grundtvig Gram also notes that testosterone is linked to ideas of sexual performance and physical dominance, drawing on cis-heteronormative scripts to underscore what a “real” man should look like, and implicitly dismissing and pathologizing alternate ways of being. 

“The problem is that this frames one particular version of masculinity as biologically superior, and others as lacking. It risks discouraging alternative ways of being masculine, or not masculine at all, and can set up unrealistic expectations about sex and bodies, especially for young people,” the researcher adds. “This reinforces the idea that desire, performance, and worth must follow straight, binary models of power and dominance.”

When we pursue these prescriptive, heteronormative sexual scripts, we may well be seeking pleasure. However, when we focus on such ideas of “performance,” or of equating hypermasculinity to heightened attractiveness, we’re actually boxing ourselves in. Rather than following genuine connection or focusing on what feels good in our bodies, we’re internalising ideas of what good sex “should” feel like and not centering how we and our partners genuinely feel pleasure and desire. 

It may seem obvious but it bears repeating: the best sex isn’t about who lasts the longest, is the strongest, or gets the hardest erection. It’s about creating a space for mutual vulnerability, exploration, and connection. 

The benefits of TRT for people with low testosterone 

While it’s worth calling out the rigid ideas of masculinity—often tied up with hormones—circulating online, there are also plenty of benefits to exploring testosterone replacement therapy (TRT) if you are a cis man who genuinely does have low testosterone levels. 

This is the case for Spencer*, a 30-year-old cis gay man based in N.Y.C. who began to investigate his testosterone levels after his boyfriend suggested he might have low T. After an initial doctor consultation, which confirmed his testosterone levels were low for his age, Spencer was prescribed TRT. 

As he explains, the benefits of TRT to Spencer’s overall wellbeing, both physical and mental, were profound. “The physical effects were as expected and as hoped. I gained muscle more readily and my metabolism increased,” he explains. “What wasn’t expected, that maybe was even more of a revelation, were the psychological effects. A wave of ease I’d never known came over me. I was confident that everything was going to be okay—or at least that I could do my best to ensure it would be.”

When it comes to intimacy, Spencer shares that he enjoyed a renewed confidence which allowed him to be more present during sex. “As for my sex life, I’m a gay man and that’s never been an area in which I’ve felt lacking. But the confidence spilled over here too,” he adds. “I knew I could fuck in the morning and the evening. And I knew I could jack off in between. But there was also an ease here too. I wasn’t anxious about when I’d next have sex. I knew I could have it when I wanted.”

However, Spencer is cautious about the long-term implications of TRT: namely, the ways it can suppress the body’s testosterone production, leaving individuals dependent on prescribed hormones. 

“At my age to do TRT for too long a time would mean committing for life. I didn’t want to do that. And so it is a cycle that resembles that of The Substance wherein I am this “better” more secure version of myself for a few months, and then for a few months I’m not. This loss is felt and it is profound,” he says.

Ultimately, Spencer sees the benefits in his own life, but is sceptical about the ways testosterone has been pushed to those who might not necessarily have low T levels to begin with. “[TRT] is an area where one should tread lightly. And [for it] to be peddled as a no-strings attached wellness fix is a danger. But I unequivocally would recommend [it], as long as you understand the deal. And I will do it again!”

The risks of unnecessary testosterone replacement therapy 

Traditionally, testosterone replacement therapy (TRT) was only considered to be a medical intervention for cis men who legitimately had low testosterone levels. Now, swathes of testosterone-maxxing videos on TikTok and Instagram have begun to position testosterone as a kind of consumer wellness product. 

In the U.K., while you can only access TRT on the NHS if you legitimately need it, some cis men are accessing testosterone more easily via private clinics or through online pharmacies. For Dr Jayasena, this raises concern, due to the side effects of unnecessary testosterone therapy. 

“When testosterone replacement therapy is well selected and given rightly, there’s no bad effect,” he explains. “However, if you’re given too much or given it unnecessarily then it can cause cardiovascular problems, greatly increasing the chance of heart attacks and death. It also raises your blood pressure, creating the risk of blood clots.”

It’s also worth noting the relationship between testosterone—a naturally occurring hormone—and anabolic steroids—the synthetic variation of testosterone, which is often used recreationally as an athletic performance-enhancing drug. Jayasena concurs that unnecessary TRT prescribed by unscrupulous private providers is “undoubtedly” being used as a way of micro-dosing the benefits of steroids. (For clarity, testosterone is classed as a controlled drug in the U.K. and U.S., meaning that it’s illegal to use recreationally and without a prescription).

All in all, while there’s nothing wrong with wanting to educate yourself on hormones, unnecessarily undergoing TRT, or bypassing medical screening and using testosterone you have purchased independently online, has the potential for serious health repercussions—ones that are often glossed over and not taken seriously enough on TikTok. Beyond misinformation, there’s also the fact that the internet’s fixation on testosterone-maxxing is just another way in which iron-clad gender roles are being pushed on social media and in the culture at large. Despite what so much online content seems to tell cis men, there is more than one way to be a man, and so many ways to express your gender. What’s most important is that it feels authentic to you. 

And for those of us convinced that testosterone is the panacea to all sexual ills, it’s worth treading cautiously. The physical is only one dimension of our sexual lives, and sexual empowerment can also mean attending to the emotional, psychological, and even spiritual aspects of intimacy. Being “good in bed” isn’t just about libido or about the kind of erections you get. Rather, erotic empathy, sexual curiosity, and shame-free experimentation all forge a path to truly free, open, attentive connections. 

*Name has been changed