A discussion within a physicians-only online medical community in U.S., recently highlighted the ongoing debate surrounding testosterone replacement therapy (TRT), diagnostic thresholds, and the risks of self-prescribing controlled substances, even among medical professionals.
The discussion began when a 46-year-old male physician shared his health concerns with other members of group.
I need your input, I'm 46 male, I had my testosterone checked which came back at 330 mcg/dl, I do have some symptoms of low T mainly loss of drive and motivation, mood changes, brain fog, poor gym recovery, but no sexual issues, my PCP is not comfortable with prescribing TRT as it is still within normal range, despite me explaining to my PCP that when it comes to Testosterone, symptoms are a major determinant in treatment decision. can I self-prescribe TRT? Thank you in advance.
Notably, he stated that he had no sexual dysfunction, a symptom often considered central to testosterone deficiency.
Normal testosterone levels in men typically range from 300 to 1,000 ng/dL with age specific variations. With increased age, testosterone levels dip.
His laboratory testing showed a total testosterone level of 330 ng/dL, a value that falls within most standard laboratory reference ranges.
Multiple physicians responded quickly and strongly, emphasizing that testosterone is a Schedule III controlled substance in the United States and that self-prescribing it could carry serious legal consequences.
Several commenters warned that prescribing a controlled substance to oneself could lead to disciplinary action, loss of DEA (Drug Enforcement Administration) registration, loss of medical licensure, or even felony charges. Physicians compared the situation to self-prescribing opioids or benzodiazepines, stressing that medical credentials do not exempt clinicians from regulatory oversight. One particular response went like this:
Sure… you want the DEA alerted to you?… prescribe a controlled substance to yourself…🤦🏽♀️ And no, in the world of actual medicine, symptoms do not drive treatment decisions… actual low testosterone levels do. So, you have a couple of choices… try maybe improve your sleep hygiene, get some therapy, and maybe an SSRI…or find a gym rat dealing testosterone in the locker room…dont risk your DEA, medical license, and your career by prescribing yourself a controlled substance.
This is not like sending in something for gerd. Testosterone is schedule 2. If you wouldn't give yourself chronic narcotics don't give yourself testosterone. I know its misleading bc there are so many random clinics but this is in fact a big deal.
The conversation then shifted toward the diagnosis of hypogonadism, a condition defined by both biochemical evidence and clinical features.
Endocrinologists and urologists participating in the discussion emphasized that:
Symptoms alone are insufficient to diagnose testosterone deficiency
Many symptoms described, such as fatigue, low motivation, and brain fog are non-specific
Sexual dysfunction, particularly reduced libido, is often considered a more specific indicator, which the person has no issue with.
Testosterone levels should be measured at least twice, ideally fasting and before 8 a.m.
Assessment of free or bioavailable testosterone may be useful in select cases
One endocrinologist noted that testosterone assays have limitations, but emphasized that a level of 330 ng/dL is not equivocal and would not meet diagnostic criteria for hypogonadism under current guidelines.
Several physicians cited Endocrine Society guidelines, which recommend diagnosing hypogonadism only when:
There are unequivocally low testosterone levels
Measurements are obtained on two separate mornings
Clinical symptoms are consistent with androgen deficiency
Without biochemical confirmation, testosterone therapy is generally not recommended.
Several respondents recommended to get a full work up before deciding to get testosterone therapy and that his symptoms might be due to other causes, like
Depression or anxiety
Chronic stress or burnout
Medication effects
Poor sleep hygiene
Alcohol use or metabolic conditions
Pituitary disorders
sleep apnea
Having normal testosterone levels with symptoms you are describing doesn’t always mean it’s your testosterone causing these symptoms. There could be other reasons as well, diabetes, OSA, thyroid problems, lack of sleep, meds, alcohol and so on. By getting on TRT you are not treating the underlying problem just the symptoms. Also there are side effects of TRT. It will actually decrease fertility. If your main concern is infertility and have low testosterone then TRT is not the treatment. Talk to your Endocrinologist or Urologist for better treatment options.
Some contributors highlighted potential long-term risks associated with testosterone therapy when used without proper indication or monitoring, including:
Increased risk of erythrocytosis
Potential cardiovascular complications
Suppression of endogenous testosterone production
Fertility impairment
Possible increased risk of cerebrovascular events in susceptible individuals
One physician shared experiences with patients who developed serious neurological complications after being prescribed testosterone inappropriately.
Despite differing perspectives on testosterone thresholds and assay accuracy, the community showed near-universal agreement on one point: self-prescribing testosterone is inappropriate and unsafe, regardless of professional background.
Physicians repeatedly advised seeking evaluation from an experienced clinician, such as an endocrinologist or urologist who follows evidence-based protocols rather than pursuing unsupervised treatment.
References
1.Mayo Clinic. “Male Hypogonadism: Symptoms & Causes.” Mayo Clinic, updated date not specified. Accessed January 2026. https://www.mayoclinic.org/diseases-conditions/male-hypogonadism/symptoms-causes/syc-20354881.
2. Zhu, A., J. Andino, S. Daignault-Newton, Z. Chopra, A. Sarma, and J. M. Dupree. “What Is a Normal Testosterone Level for Young Men? Rethinking the 300 ng/dL Cutoff for Testosterone Deficiency in Men 20–44 Years Old.” The Journal of Urology 208, no. 6 (December 2022): 1295–1302. https://doi.org/10.1097/JU.0000000000002928.