With the credentials of a clinician and the pitch of a start-up founder, Cameron Sepah, Ph.D., a clinical psychologist, has become the new face of pharmaceutical masculinity. As founder of Maximus, a telehealth platform that promises to “maximize masculinity,” he’s built a for-profit business on the American male’s most common insecurities.
Sepah calls himself a “serial health tech entrepreneur” and insists his business model is no contradiction. “I don’t think doing good and doing well financially are mutually exclusive,” he says. By “good,” Sepah is referring to what disciples claim is a boost in energy, libido, and even mood from testosterone replacement therapy (TRT).
But TRT still makes some physicians uneasy, not because the treatment lacks evidence but rather because it’s often marketed like a gym membership. “It’s not as dichotomous as we once thought,” says Dr. Jesse Mills, a urologist and the director of the Men’s Clinic at UCLA and the author of A Field Guide to Men’s Health. “If you exceed the upper limit of normal, does that mean you’re going to die? Of course not,” he says, referring to patients whose testosterone levels land slightly above the standard clinical range after treatment.
Still, he adds, “The existential crisis in the world of men’s health is that figuring out who is and who is not a candidate for TRT is mostly driven by consumerism and partially driven by science. Easy access is less ‘medicine’ and more transactional.”
Mills is referring to the rise of walk-in and online low-T clinics, where testosterone is sold like hair gel. The hormone regulates energy, libido, body fat, and muscle growth, and it’s now available at chains with names that blur the line between irony and idiocy: Gameday, Maximus, and the like. Texas has become a stronghold (cheap rent), and Los Angeles remains fertile ground, thanks to its broken dreams and body dysmorphia.
Testosterone can be prescribed as gels, patches, pills, or injections. All forms suppress your body’s own testosterone production.
TRT has been around for decades. What has changed is how it is prescribed and marketed. Levels of testosterone in American men have dropped by roughly 50 percent over the last half century, and prescriptions have surged alongside that decline. (This so-called decline is largely due to the growth in awareness and testing.) One popular drug saw a fourfold jump in scripts between 2003 and 2013. From 2019 to 2024, overall numbers jumped another 150 percent, from 7 million to 11 million. What once required a full diagnostic workup now often amounts to a form and a 30-second blood draw.
The result is a new kind of patient. The average guy walking into a low-T clinic is not trying to solve a medical problem; he is trying to get jacked. Mills says the “bro science” logic that every man should be on testosterone is beginning to affect how the treatment is prescribed. Influencers like Joe Rogan, Dax Shepard, and even RFK Jr. have become unofficial spokesmen, touting their regimens, or at least their results, on massive platforms. The industry itself, appropriately, is now on steroids.
Doctors like Mills say the bigger issue with TRT going mainstream is the potential for clinics to skip basic safety protocols. “The No. 1 rule in screening is to identify and reverse reversible causes,” he says. That means addressing poor nutrition, sleep, or exercise first. Skipping this step doesn’t just overlook nuance. It can miss diabetes, depression, obesity, or serious cardiovascular problems. One screener that’s largely been abandoned: morning wood. “If a guy is still waking up with erections, his cardiovascular system and T levels are probably OK,” Mills says.
Mills advises starting with a proper blood test, ruling out fixable issues, and prescribing only if both symptoms and numbers warrant it. When that process is rushed, patients suffer. He treats men who felt great the first week, then crashed into mood swings and depression after dosages backfired or because walk-in clinics missed the actual underlying cause. There are long-term consequences too. Some regimens shut down sperm production entirely, and in certain cases, it doesn’t return.
Still, Mills acknowledges that getting it wrong today isn’t as dangerous as it once was. Roid rage, testicular shutdown, fatal liver conditions— those stories are mostly relics. Two widely cited studies from 2011 and 2013 that linked TRT to heart attacks and strokes have since been debunked.
And so Mills, like more and more urologists, finds himself cautiously optimistic. “These days, I’ll write a prescription for a guy who might be on the low end of normal, if there’s potential for better quality of life,” he says. “I’m meeting more patients where they are.”
He also sees the clinics, however messy, as serving a need. Awareness is up, demand is undeniable, and clinics are moving faster than institutions can adapt. “It’s no secret that a lot of these low-T centers have stolen our cookbook,” Mills says. “Anyone who can do a Google search has access to our recipes. I just want more clinics to take responsible stewardship of these people’s lives, not just of their credit card.”