The surge in demand for testosterone therapy has opened up a lucrative market for clinics and wellness providers, but it has also raised concerns that some Kenyan men are exposing themselves to potentially serious long-term side effects by taking the treatment for a condition they do not have.
More men are buying testosterone to deal with symptoms such as fatigue, weight gain, low libido and declining fitness, but urologists and endocrinologists say many of these men do not have low testosterone; instead, the symptoms are often linked to lifestyle factors.
Dr Onyango Oluoch is a consultant urological surgeon at a clinic in 5th Avenue Suites, Nairobi. He has watched the number of men coming to the clinic grow steadily.
‘Many have normal testosterone levels, while others have symptoms caused by stress, poor sleep, obesity, diabetes, depression, anxiety, medication side effects, alcohol use, relationship difficulties, or other health conditions,’ he says.
To be diagnosed with testosterone deficiency, a man must have both clear symptoms and consistently low testosterone levels confirmed through proper tests.
Deceptive marketing
These men are showing up at clinics in part because of how testosterone is old. On social media, wellness platforms, and at some clinics, it’s pitched as a shortcut to feeling younger, stronger, and mentally sharper. Dr Onyango says this is misleading.
‘Testosterone being marketed as an anti-ageing, energy-boosting, or performance-enhancing product can be misleading,’ he says.
‘Testosterone is a prescription hormone treatment intended for men with genuine deficiency, not a shortcut to improved fitness, youthfulness, or sexual performance.’
He says testosterone is not the only thing driving a man’s energy or sex life. The mind, emotions, relationship quality, blood flow, nerves, sleep, stress, and general health all play a role. Men who are struggling sexually or feeling drained should not assume the answer is a hormone injection.
Hormonal assessment cost
Before he prescribes treatment, Dr Onyango screens for diabetes, obesity, high blood pressure, high cholesterol, cardiovascular disease, sleep apnoea, depression, anxiety, thyroid problems, medication side effects, alcohol use, and stress. He says sexual health problems almost always have more than one cause.
A total testosterone test costs about Sh2,500. Luteinising hormone is Sh2,500. Prolactin is Sh2,500. Sex hormone-binding globulin runs around Sh5,000, and free testosterone, which is the portion of the hormone in the blood that is available for use by body tissues, costs roughly Sh6,000.
Altogether, a basic hormonal assessment can cost between Sh12,500 and Sh20,000 before adding a consultation fee or any additional investigations.
Injectable testosterone is generally less expensive than gels. Gels often provide steadier hormone levels but cost more over time.
Monitoring must continue long after treatment begins, covering fertility, heart health, prostate health, blood counts, and sleep.
The key question
For young men of reproductive age, Dr Onyango says that before starting testosterone therapy, there is one key question every patient must answer. ‘Do they desire to have children? This is because this therapy can profoundly impact treatment options,’ he says.
For men who want children, the approach changes significantly.
But beyond who qualifies and who does not, there is a harder conversation that specialists say is rarely discussed. What does this treatment actually do to the body when it is given to the wrong person, or even to the right one without proper care?
Dr Muigai Mararo, a consultant urological surgeon based in Nairobi’s Upper Hill, has seen those consequences up close.
‘When you talk about testosterone replacement therapy, this means you are replacing testosterone, and this should be for people who do not have testosterone,’ he explains.
The medical term for this condition is hypogonadism, where the body produces little or no testosterone and, as a result, very little sperm.
Those who need it
To qualify, a man needs two things confirmed. First, low testosterone showing in at least two separate lab tests. Second, real symptoms that are actually caused by testosterone deficiency. The blood test must be done at an accredited laboratory, between 8am and 10am, while fasting.
‘That is the time you usually have a spike in testosterone, so you get the correct figure,’ Dr Muigai says. ‘Eating may reduce your testosterone.’
The men who genuinely need testosterone replacement therapy (TRT) fall into two groups in his experience. The first is young men who lost their testicles to a condition called testicular torsion, while in school. When torsion happens, the testicle twists and loses its blood supply. It is a medical emergency that must be treated within six to eight hours or the testicle dies permanently.
He currently has three patients on lifelong TRT for this reason, the oldest being 29 years old.
‘Younger men who have lost their testicles may notice that their beards are not growing, that their voice is not deepening, or that their breasts are enlarging,’ Dr Muigai says.
The second group is older men whose testosterone has dropped naturally with age.
The symptoms of low testosterone often start with fatigue before any sexual signs appear. Low libido, erectile dysfunction, muscle loss, and growing belly fat follow. Some men develop brain fog, have trouble concentrating, become irritable, or cannot sleep properly.
He describes a pattern he sees too often. Men with erectile problems walk into clinics, get a testosterone injection, feel briefly better, then crash when the injection wears off. By the time they reach him, they have had two or three injections and still feel unwell.
‘That was a wrong indication,’ he says. ‘Probably their erection problem was because of psychological issues.’
He warns that by giving testosterone to someone who did not need it, the body stops producing its own testosterone, starting a cycle that is very hard to break.
The risks go beyond that. TRT can cause blood clots in the legs that travel to the lungs. It can weaken bones and raise the chance of fractures. In men with undetected prostate cancer, it can make the disease spread faster.
Fertility concerns
The biggest concern for younger men getting the injections with proper diagnosis and follow-up is infertility. Injecting synthetic testosterone tells the body to shut down its own production, which also shuts down sperm production.
‘You go get an injection of testosterone, the next thing is you will come to me because you are not able to have children,’ Dr Muigai says.
When these men drastically stop TRT without proper care, withdrawal can set in. The weight comes back. The fatigue returns. Libido drops, and erections become difficult again. In extreme cases, the liver can also be damaged. ‘It is not an innocuous therapy,’ he warns. ‘It comes with serious, sometimes life-threatening complications.’
For men whose testosterone has dipped because of lifestyle, the answer is not an injection. Obesity, poor sleep, chronic stress, no exercise, and heavy drinking all reduce levels without wiping them out entirely. Excess belly fat is especially harmful because it converts testosterone into oestrogen.
‘Go exercise. Manage your sugar. Manage your stress. Quit alcohol and smoking. You do not need to start testosterone replacement therapy unless you absolutely have to,’ Dr Muigai says.
On cost, he says an injection costs about Sh1,200 every two weeks. Gels cost around Sh5,000. But money, he says, is not the real problem. ‘The biggest issue is not cost but misuse.’
Problem of misuse
The problem of misuse and misdiagnosis is one that Dr Vic Albert says he encounters just as often in his practice.
Dr Vic Albert offers advanced urology procedures and treatments. Most of the men who come to him asking about testosterone do not qualify once properly evaluated. The typical picture is a man in his 30s, 40s, or 50s.
Many of them have poor sleep, chronic stress, obesity, lack of exercise, are heavy alcohol users, depressed, or have diabetes, and not really a testosterone-related condition.
‘Some marketing creates the impression that testosterone is a shortcut to youth, confidence, muscle gain, or business success,’ he says.
The risk, he says, is that normal ageing or an unhealthy lifestyle gets turned into a medical problem that does not exist. ‘Good medicine starts by asking why a man feels unwell rather than immediately reaching for testosterone,’ he says.
Dr Vic notes that erectile dysfunction can sometimes be the body’s first signal of underlying heart disease, which makes a thorough check essential before anything else.
For men who want more energy or better gym results, he points to what he calls the four pillars of men’s health: sleep, exercise, nutrition, and weight management.
‘For many men, improving sleep alone can significantly improve energy levels and even increase natural testosterone production,’ he says. Resistance training, losing body fat, managing diabetes, cutting alcohol, and handling stress can all shift things considerably.
He acknowledges that lifestyle changes take longer than a hormone injection to show results, but argues the foundation they build is stronger.
‘If we can raise your natural testosterone and improve your health at the same time, that is usually better than immediately starting lifelong hormone therapy,’ he tells his patients.
On long-term effects, Dr Vic is honest about what remains unknown. ‘There are still unanswered questions because relatively few studies follow patients continuously for several decades,’ he says.
Specialists are still watching cardiovascular outcomes, prostate health, fertility effects, and how lifelong therapy changes ageing. What he does know is that starting TRT is rarely a short-term decision.
‘Many men will require ongoing treatment and monitoring for years,’ he says.
Before any man begins, he asks one cardinal question. ‘I always ask patients to think carefully about whether they are treating a true deficiency or chasing a lifestyle goal.’
His position on both sides of that question is clear. ‘Testosterone is not a fountain of youth. For the right patient, it can be life-changing. For the wrong patient, it can create problems that never existed in the first place. The key is proper diagnosis, proper monitoring, and treating the man, not just the laboratory number.’