@jeremygoodmanmd's TRT clinic rant, fact-checked

What did @jeremygoodmanmd actually say?

Dr. Goodman listed three reasons he thinks a TRT clinic is "trash": patients never speak with an MD, clinics skip diagnosing the cause of low testosterone, and clinics push add-ons like aromatase inhibitors, HCG, and peptides unnecessarily. The tone is blunt and the target is clearly the mill-style testosterone clinics that have exploded in recent years. That context matters for evaluating what he got right and where he oversimplified.

The video is framed as consumer advocacy, not clinical guidance. He is not telling you what to do; he is telling you what a bad clinic looks like. That framing is fair, but it creates some problems when his generalizations bump up against legitimate clinical complexity.

Does the science back this up?

Mostly, yes, though the aromatase inhibitor point is more nuanced than he makes it sound. The core argument, that proper hypogonadism care requires physician oversight and a diagnostic workup, is firmly supported by every major clinical guideline in this space.

The American Urological Association and the Endocrine Society both recommend that hypogonadism diagnosis include morning serum testosterone on at least two separate occasions, along with LH and FSH levels to differentiate primary from secondary hypogonadism (Mulhall et al., 2018, Journal of Urology; Bhasin et al., 2018, Journal of Clinical Endocrinology and Metabolism). Skipping that differentiation, as Dr. Goodman correctly points out, is not just sloppy, it can mean missing a pituitary tumor, a reversible lifestyle factor, or a condition that responds better to clomiphene than to exogenous testosterone. That is not a minor omission.

On physician oversight, the evidence base is thinner because this is more a regulatory and ethical concern than a randomized-trial question. But patient safety literature consistently links care fragmentation to adverse outcomes, and having a supervising physician who has never interacted with the patient is a real problem in telehealth (Mehrotra et al., 2017, Health Affairs).

What did they get wrong (or right)?

He is right about the diagnostic workup. He is right about the ghost-physician problem. He is largely right that pushing peptides on every patient is not evidence-based care. But the aromatase inhibitor claim deserves pushback.

Saying a clinic is "trash" because it recommends an aromatase inhibitor is an overreach. Anastrozole is used in TRT for men who convert excess testosterone to estradiol and develop symptomatic hyperestrogenism. The Endocrine Society does not prohibit it; they recommend using it judiciously and only when estradiol elevation is symptomatic and confirmed by lab work (Bhasin et al., 2018). The problem is not that clinics offer aromatase inhibitors. The problem is that many clinics prescribe them reflexively to every patient regardless of labs. That distinction matters. His phrasing, "they say you must use" an AI, is describing protocol-driven overuse, which is a real problem. But a blanket indictment of AIs in TRT is not the same thing, and conflating the two could make a patient distrust a legitimate prescription they actually need.

HCG is similar. Some men on TRT use HCG to preserve testicular volume and fertility. That is a reasonable clinical choice for certain patients, not a scam add-on by default (Coviello et al., 2005, Journal of Clinical Endocrinology and Metabolism).

What should you actually know?

If you are on TRT or considering it, the diagnostic workup question is the most important thing to take from this video. Low testosterone is a symptom, not a diagnosis. Before starting exogenous testosterone, a competent provider should check LH and FSH at minimum. High LH with low testosterone points to primary hypogonadism, a testicular problem. Low or normal LH with low testosterone points to secondary hypogonadism, potentially a hypothalamic or pituitary problem, including prolactinoma, which needs imaging and a very different treatment approach.

On add-ons: the right question is not whether aromatase inhibitors or HCG are ever appropriate. They can be. The question is whether your provider is prescribing them based on your labs and your symptoms or based on a protocol they apply to everyone. Ask your provider why each medication is on your list. If they cannot give you a patient-specific answer, that is a red flag worth taking seriously.

• Request copies of your lab results before and during treatment. Any legitimate provider should expect this.
• Ask whether the diagnosing physician is available for questions. A supervisory signature on a script is not a patient-provider relationship.
• Differentiation between primary and secondary hypogonadism is not optional. It is the standard of care per both the AUA and Endocrine Society guidelines.