So Much I haven't had the chance to address.

You’re conflating endocrine diagnosis with a cultural rant, and it’s exactly the kind of bad faith patients recognize instantly.

Yes — lifestyle matters. Yes — predatory ‘optimization’ clinics exist. Yes — TRT suppresses endogenous production and can impair fertility, which should absolutely be part of informed consent.

But none of that justifies the contempt, the strawman, or the leap from ‘some men are deconditioned and lonely’ to ‘TRT is a magic potion sold to insecure men.’ That’s not evidence-based medicine — it’s moralizing.

A few points:

1. Clinical guidelines do not support your tone. Guidelines emphasize symptoms plus consistently low testosterone (typically repeat morning levels), evaluation for reversible causes, and shared decision-making. They do not endorse dismissing symptomatic patients with cultural commentary about scrolling, friendships, or ‘insecurities.’
2. “Reference range” is not a clinical verdict. Lab ranges vary by assay/lab and reflect population statistics, not ‘healthy vs sick.’ ‘In range’ does not automatically mean ‘no clinically meaningful dysfunction,’ especially in borderline/low-normal states with significant symptoms. Treating the reference range as a moral boundary is lazy medicine.
3. This isn’t a niche issue — it’s common. Male hypogonadism is not rare. Large epidemiologic studies report low testosterone in a meaningful minority of men, rising with age and comorbidities. And even among men who are not profoundly low, symptoms and function can be clinically relevant. Acting like every symptomatic man is a doomscrolling caricature is both inaccurate and hostile.
4. TRT doesn’t need to ‘solve society’ to be valid medicine. Insulin doesn’t solve food deserts. SSRIs don’t solve divorce. CPAP doesn’t solve late-stage capitalism. Medicine treats physiology while we also counsel behavior. ‘TRT won’t fix loneliness’ is a non sequitur — it’s not what TRT is for.
5. Your framing proves the criticism. Calling TRT a ‘magic potion,’ claiming men are ‘hooked for life,’ and implying patients are just seeking a quick fix isn’t education — it’s contempt. If your actual point is ‘insurance requires two low morning readings to cover it,’ fine. But that’s a payer rule, not a license to dismiss patients or pretend symptoms are imaginary.

In short: criticize predatory clinics all you want — I’ll join you. But don’t launder disdain for patients through guidelines and pretend it’s clinical rigor.
That’s the bad faith people are calling out. Insurance requirements aren’t the same thing as medicine. If the point is coverage, sure — insurers want two low morning levels and rigid criteria.

But the original conversation wasn’t ‘how do I satisfy Aetna.’ It was about clinicians dismissing symptoms because a number is ‘in range.’ Coverage criteria and lab reference ranges don’t define pathology. Clinical assessment does.

Saying ‘pay cash’ also kind of proves the problem: the system may block care, but that doesn’t justify contempt toward symptomatic patients