Is the Testosterone Crisis Real? The Numbers Behind the Headlines | Signal Ep 1

Every week there's a new headline saying men are losing testosterone. A quarter of men now start testosterone replacement therapy without ever getting their blood tested. The supplement aisle is full of boosters that either do nothing or contain undisclosed steroids. And the lab test that gets everybody to the pharmacy? Half of low results normalize on their own.
In Episode 1 of the Signal launch series, Dr. Jordan Feigenbaum and Dr. Austin Baraki (both MDs and strength coaches) walk through the three-layer problem with how testosterone gets diagnosed and treated in 2026, then take apart the "testosterone is crashing" headline with the most current data available, including a 2025 meta-analysis of more than one million men.
Pre-order our book, Signal: barbellmedicine.com/signal
Timestamps
0:00 Mark's story: treating the number, not the patient
1:18 Welcome to the Barbell Medicine Podcast
1:41 Problem 1: A quarter of men start TRT with no lab work
3:36 Problem 2: Why testosterone boosters do not work (and what is in them)
13:40 Problem 3: Why one low testosterone lab is not a diagnosis
19:19 Setup: Is the testosterone crisis headline real?
20:04 The MMAS data and the 1%-per-year number
20:52 The 2025 meta-analysis of over 1 million men
22:02 Why the headline is inflated: three causes
22:27 Cause 1: The testing method changed (immunoassay to mass spec)
25:58 Cause 2: BMI cannot see visceral fat
29:37 The Nyante study: when you fix both problems, the decline vanishes
33:58 What this actually means for you
37:05 The broken testosterone system, summarized
38:24 Five takeaways from this episode
39:14 Next week: How testosterone actually works
39:39 About Signal and credits
What you'll learn in this episode:
Why 25% of new TRT prescriptions are written without any pre-treatment lab work (JAMA, 2015)
What actually happens when researchers test 50+ "testosterone booster" supplements (spoiler: 12% are contaminated with undisclosed steroids)
Why a single low testosterone reading is not a diagnosis, and the Massachusetts Male Aging Study data that proves it
The real size of the population-level testosterone decline (much smaller than 1% per year)
Why BMI cannot see the visceral fat that is driving most of the genuine decline
The Nyante study that shows the decline essentially vanishes when you use an accurate test and measure waist circumference
Five practical takeaways you can apply before your next lab draw
This is Episode 1 of a four-part series built around our upcoming book, Signal. Over the next four weeks we cover what testosterone actually is, how to tell when it is genuinely low, what is really driving population-level changes, and what the evidence says you can do about it.
Next Steps
Check out our new book, Signal (coming soon)
For evidence-based resistance training programs: barbellmedicine.com/training-programs
For individualized training consultation: barbellmedicine.com/coaching
Explore our full library of articles on health and performance: barbellmedicine.com/resources
To consult with Drs. Baraki or Feigenbaum email us at [email protected]
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Resources
Baillargeon, J., et al. (2015). Trends in Androgen Prescribing in the United States, 2001–2011. JAMA Intern Med, 175(8), 1413–1415. — 25% no preceding lab; post-prescription monitoring gap.
Rao, P.K., et al. (2017). Trends in Testosterone Replacement Therapy Use from 2003 to 2013 among Reproductive-Age Men in the United States. J Urol, 197(4), 1121–1126. — Prescription volume growth.
Selinger, S., & Thallapureddy, A. (2024). Cross-sectional analysis of national testosterone prescribing through prescription drug monitoring programs, 2018–2022. PLoS One, 19(8), e0309160. — Recent prescribing data, 3-4 million estimate.
Vesper, H.W., et al. (2015). Serum Total Testosterone Concentrations in the US Household Population from the NHANES 201...