What did @drjoshaxe actually say?
Axe stated that "men with low testosterone levels had an 88% increase in risk of death" compared to men with normal levels, and that this effect persisted after controlling for age, other illnesses, and BMI. He repeated the figure twice, framing it as near-certain: "they have an 88% increase in dying." This is a relative risk claim pulled from observational research, and he presented it as a near-certain causal relationship between low testosterone and mortality.
The core number is real. There is published epidemiological data showing associations in that ballpark. But the way he delivered it, stripped of context about what "low" means, which population was studied, and what a relative risk increase actually tells you in practice, leaves viewers with a distorted picture of the science.
Does the science back this up?
Partially, yes. The figure likely references a study by Khaw et al. (2007, Circulation) or more probably Laughlin et al. (2008, Journal of Clinical Endocrinology and Metabolism), which found men in the lowest testosterone quartile had significantly elevated all-cause mortality over a follow-up period. A 2019 meta-analysis by Araujo et al. published in the Journal of Clinical Endocrinology and Metabolism also found that low endogenous testosterone was associated with increased cardiovascular and all-cause mortality.
The 88% figure as a relative risk is plausible within specific cohort studies. But these are associations. None of these studies prove that low testosterone causes early death. Men with low testosterone often have more metabolic disease, chronic illness, and cardiovascular risk factors to begin with, which is exactly why researchers try to control for confounders. The studies Axe is presumably citing did attempt those controls, but residual confounding in observational data is always a legitimate concern.
What did they get wrong (or right)?
Credit where it's due: the association between low testosterone and elevated mortality risk is a real finding in the literature, not something Axe invented. The direction of the claim is defensible. Where he goes wrong is conflating association with causation and presenting a relative risk without a baseline. An 88% increase sounds catastrophic. But if your baseline risk of dying from a particular cause in a given time window is 2%, an 88% relative increase brings it to roughly 3.8%. Still meaningful, but a very different emotional impact.
He also never defines "low testosterone." Clinical hypogonadism is typically defined as total testosterone below 300 ng/dL with symptoms. Many studies define "low" differently across quartiles. Without that context, viewers hearing "low testosterone" may self-diagnose based on fatigue or libido complaints and assume they are facing a 90% higher mortality risk. That leap is not supported by the evidence, and it is a problem with how this content was framed.
- The relative risk figure is in the right ballpark for specific studies.
- Controlling for age, BMI, and comorbidities does strengthen the association, and Axe correctly noted this.
- He did not establish what threshold of testosterone counts as "low."
- He presented correlation as causation without qualification.
- Framing this as a personal death risk to every man watching is an overreach.
What should you actually know?
Low testosterone, meaning clinically confirmed hypogonadism with symptoms and lab values below accepted thresholds, is a legitimate medical condition worth treating. The research on its association with cardiovascular and all-cause mortality is real and worth taking seriously. But association studies cannot tell you whether treating low testosterone with TRT will reduce your mortality risk. That is a different and harder question.
The Testosterone Trials (Snyder et al., 2016, New England Journal of Medicine) showed TRT improved sexual function and bone density in older men with confirmed hypogonadism, but the evidence on cardiovascular outcomes and longevity from TRT remains genuinely mixed. Some data, including a 2023 study by Lincoff et al. in the New England Journal of Medicine (the TRAVERSE trial), suggest TRT does not significantly increase major cardiovascular events in men with hypogonadism and existing cardiovascular risk. But that is not the same as proving TRT extends life.
If you are concerned about your testosterone levels, get a morning blood draw for total and free testosterone, discuss symptoms with a licensed clinician, and do not let a social media video be the reason you pursue hormone therapy.