As a family doctor, I agree with you somewhat.

We do indeed treat cisgender men who have low testosterone with testosterone, as endocrinologists do with transgender men. And the treatment goals for both groups are essentially the same widely accepted testosterone ranges that we would expect to find in a large group of healthy cisgender men.

However, there is a big problem of inappropriate testosterone use among young men. Many start taking testosterone taken illegally, elevating their blood levels far above the highest levels a healthy human body can produce, to the point where it is dangerous to their health. This actually causes a feedback loop where the body stops producing its own testosterone, causing levels to crash when they stop taking it. So they start “cycling” with medications used for female infertility, breast cancer, or menopause that have never been tested in men to try to mitigate that, all based on pseudoscientific nonsense theories that circulate widely on the internet. I’ve then gotten several of these patients in my office with crashing testosterone asking me to prescribe HRR, which of course will only extend the problem by continuing to suppress the body’s natural testosterone production.

There is also a big problem of people going to doctors with symptoms that could be caused by 100 different illnesses, who have convinced themselves that only testosterone could be the cause. They go to shady doctors who don’t care enough about the person to investigate the symptoms properly, and then just prescribe testosterone without doing any testing. Or they do some testing, find the testosterone is low, but don’t do any follow-up to figure out why it’s low. Which is frustrating because there are very clear guidelines based on extensive scientific data that are being ignored in exchange for easy money from patients.

While I agree that autonomy is important, I disagree that it should “always be the final word.” What if someone came up to you and said they have decided they need opioids for their pain, but they can’t afford them, so they want you to go rob a pharmacy and give them some? Would you do that in the name of bodily autonomy? Of course not: your bodily autonomy is yours. You can’t expect to go to someone else and ask them to do something they know is unethical, illegal, and/or potentially dangerous in the name of your bodily autonomy.

The guiding principle of medicine is “Do no harm.” Because of this, we as doctors have an ethical and legal obligation to protect patients from harm that we cause. You cannot expect to go to your doctor and ask them to do something they know is unethical, illegal, and/or potentially dangerous in the name of your bodily autonomy.

I’m happy to prescribe testosterone to my patients who need it. But I draw the line at people who want it without needing it, especially if they want dangerously large amounts, because I know the harm this med can cause if not taken correctly. So while that person might very well get testosterone elsewhere if I say no, I personally am not going to be a party to it.

Funny how complicated people make this very simple concept

I agree with informed consent and bodily autonomy, that seems like a great ethical foundation - but one downside might be in not preventing harm done when people duped by mannosphere social media influencers pushing pseudo-science claims about testosterone ask their doctor for testosterone therapy. The clinical value of hormone therapy for trans individuals is well grounded in empirical research, but testosterone therapy for healthy, young cis-men is not based on clinical benefits.

There clearly needs to be some counter-measure to misinformation about testosterone therapy, this is not like trans healthcare.