The men's health category has become loud, and loud has not made it better. Four claims keep circulating in advertising and influencer content that do not survive contact with the data. This is the brief version of why we do not write protocols around any of them.
Lie 1: Over-the-counter testosterone boosters work
The "T-booster" category is a $700 million market in the United States. It runs on three or four molecules: tribulus terrestris, fenugreek, D-aspartic acid, and zinc-magnesium aspartate. They are sold in chrome-and-black tubs with names that sound like jet fighters.
The data:
- Tribulus. Multiple randomized trials have shown no effect on serum testosterone in eugonadal men. The largest trial (n=39) found a placebo-equivalent response after 28 days. The compound was tested initially because of folkloric use, not because of mechanism.
- Fenugreek. A handful of small trials have shown modest changes in libido scores without consistent changes in total testosterone. The effect, where it exists, is more plausibly attributed to aromatase inhibition than to testosterone elevation.
- D-aspartic acid. Showed a small testosterone bump in one trial of resistance-untrained men. Failed to replicate in resistance-trained populations. The effect, if real, is a small percent in undertrained men and disappears with training adaptation.
- ZMA. Useful only if you are zinc deficient. Most men are not.
The honest summary: if your testosterone is low because of insulin resistance, sleep debt, or obesity, the booster will not move it. If your testosterone is low because of primary hypogonadism, the booster will not move it. The only condition under which a "T-booster" reliably moves anything is severe zinc deficiency, which is rare and is corrected with a $4 zinc supplement, not a $79 tub.
Lie 2: One supplement stack fits everyone
The "founder stack" model, popularized by every podcast in this space, sells the idea that a single set of pills is the right answer for adult men in general. The same five capsules, the same dose, regardless of physiology.
The data does not support this. A few obvious cases:
- Vitamin D. Roughly 40 percent of men are deficient. The other 60 percent do not need additional vitamin D, and a subset is at risk of hypercalcemia at sustained high doses.
- Magnesium. Useful for the man with cramping, poor sleep, and a magnesium-poor diet. Useless for the man with adequate intake.
- Creatine. Among the most consistently effective supplements in the literature for resistance-trained men. Not relevant if you do not train.
- Omega-3. Beneficial in the subset with elevated triglycerides or low EPA/DHA on a fatty acid profile. Marginal in men with high baseline fish intake.
- Berberine. Useful for the man with insulin resistance. Not useful for the man with normal glucose handling.
The right stack is the one that addresses the gaps the panel shows. Without the panel, the stack is a guess wearing a marketing budget.
Lie 3: BMI is a useful number for adult men
Body mass index is a 19th-century formula that divides weight by height squared. It was designed by a Belgian statistician to characterize populations, not to assess individuals. It is now being used to characterize individuals.
The problems for adult men in particular:
- BMI does not distinguish muscle from fat. A 6-foot man at 195 pounds and 14 percent body fat has the same BMI as a 6-foot man at 195 pounds and 27 percent body fat. Their cardiometabolic risks are radically different.
- BMI does not distinguish visceral fat from subcutaneous fat. A man with 25 percent body fat distributed peripherally has different risk than a man with 22 percent body fat distributed centrally.
- BMI categories were calibrated on average non-athletic adults a century ago. They are not calibrated on the modern male body composition distribution.
The better metrics:
- DEXA-derived body fat percentage for the gold standard.
- Visceral fat measurement (DEXA or BIA) for the cardiometabolic question.
- Waist-to-height ratio as the cheap, sensitive screen. Over 0.55 is elevated for most men.
- Skinfold or BIA as an adequate at-home measurement.
We do not use BMI to assess body composition at Vane. We use it occasionally as a coarse population statistic. The clinical decisions are made off the better measurements.
Lie 4: You can fix it without bloodwork
This is the most expensive lie in the category. The idea that you can dial in your testosterone, your cardiovascular risk, your metabolic state, and your inflammation without ever drawing labs is the central promotional claim of the supplement industry, and it is wrong.
The reasons it gets sold:
- Lab draws have historically been gated by primary care, which is slow.
- Insurance has historically not covered comprehensive panels.
- The supplement industry has no financial incentive to send patients to labs that would expose which products are doing nothing.
The reasons it does not work:
- Symptoms are unreliable. Low energy, low libido, and weight gain can be testosterone, can be sleep apnea, can be insulin resistance, can be subclinical hypothyroidism, can be depression, can be all five. The panel separates them.
- Without baseline labs, you do not know if the intervention worked. The placebo effect on subjective scores is well over 30 percent in this category.
- The most common testosterone problem in men under 50 is functional hypogonadism driven by metabolic disease. Treating it with TRT papers over the underlying problem. The panel surfaces this.
The labs are cheap. The Vane Baseline panel is $79. The information from the panel is the difference between writing a protocol and guessing at one.
Where Vane lands
We do not sell testosterone boosters. We do not sell a one-size-fits-all stack. We do not use BMI to assess our patients. We do not write protocols without bloodwork.
What we do is the slower, less viral version of the work: panel, read, protocol, follow-up, panel again. The men who want the entertaining version of men's medicine have many options. The men who want the version that moves the numbers have fewer.
The next post in this series covers why we publish outcomes data, which is the natural extension of the same idea.
The bottom line
The men's health category will improve when the customers demand evidence. The shortest path to demanding evidence is reading the data on what works and what does not. The four claims above are a starting point.
If a brand cannot show you its data, it is hoping you do not ask.
