By Rolfe Winkler

From a strip mall in Delray Beach, Fla., a sales team hustles a fountain of youth—Botox for the skin, weight-loss drugs for the body and, a top seller, steroids for men chasing virility.

Medical practices typically don’t sell drugs to patients. But The Biostation is among hundreds of online and storefront clinics across the U.S. profiting from a booming business in testosterone replacement therapy known as TRT.

Testosterone, a steroid that strengthens muscle and enhances libido, has traditionally been reserved for men who can’t produce enough of the hormone, a medical condition called hypogonadism. The treatment is now often sought by healthy men, many in their 30s and 40s, to overcome obesity, erectile dysfunction or normal age-related hormone decline. 

Podcast king Joe Rogan, and action star Alan Ritchson, have said they have taken testosterone. So has former presidential candidate Robert F. Kennedy Jr. Last year, the 70-year-old posted a video of himself showing off an impressive physique. Elon Musk pushed a step further last week, retweeting a post that said “low T men” can’t think for themselves, and “high T alpha males” are the best decision makers for a democracy.

Motivational speaker Tony Robbins invested in a telehealth testosterone prescriber and promotes the steroid on Instagram. The Vitamin Shoppe, a national retail chain, announced Tuesday that its telehealth service will offer testosterone prescriptions.

Men generally pay anywhere from $1200 to $2600 a year for testosterone treatment, which is touted in online ads as a means to better performance in the gym and the bedroom.

“Guys have launched a thousand ships for women. Now we inject testosterone,” said David Pivovarov, a former patient at The Biostation who added 15 pounds of muscle to his 5-foot-8 frame and trimmed his body-fat percentage by a third with the treatment.

Walking shirtless along the beach, Pivovarov said, “I felt like I was 7 feet tall.” 

Prescriptions for testosterone cypionate, a generic form commonly sold by the clinics, have increased by eight times since 2010. When added to branded products, the total number of testosterone prescriptions is at a record high, according to prescription tracker Iqvia.

Some men swear by the treatment. Others suffer its side effects. Advertising for testosterone rarely mentions the risk of male breast enlargement, shrunken testicles, blood clots and infertility.

Ironically, testosterone’s artificially induced virility can cut a man’s sperm count to zero. Fertility doctors report a spike in the number of couples who can’t conceive because the man is taking the hormone, which reduces the amount of natural testosterone produced by the body.

“Certainly over the last five years, the number of people coming in on testosterone has skyrocketed,” said Barrett Cowan, a reproductive urologist at Posterity Health in Colorado. People tend to assume infertility is a female issue, he said. “Often it’s a male issue.”

Stopping the drug risks weeks of fatigue and depression while the body restarts production. 

Men who quit can also lose their improved physique. Some say they would rather use a sperm donor than stop taking testosterone, said Paul Shin, a reproductive urologist in Washington, D.C. The physical benefits of the drug, he said, are more important to them than “their need for a legacy.”

Testosterone clinics say doctors practicing traditional medicine are too conservative in prescribing the hormone and that men can benefit from raising testosterone levels from normal to what clinic doctors claim is “optimal.” 

Doses prescribed by the clinics are lower than the steroids taken by competitive bodybuilders whose muscles balloon to freakishly large proportions. The federal government classifies testosterone as a schedule 3 controlled substance, alongside codeine and ketamine, because of its potential for abuse.

The Biostation, founded in 2013, was a pioneer in testosterone treatment and has seen thousands of patients. The company trained salespeople to tell patients there weren’t side effects from testosterone treatment.

Patients “should ONLY have a positive impact with no negative side effects,” according to talking points from a sales manual reviewed. 

The Biostation didn’t answer questions about why the sales staff would discuss medical questions or say that testosterone treatment had no side effects.

This account of The Biostation’s practices is based on interviews with more than a dozen current and former company employees, contractors and partners, as well as a review of court records and internal documents.

Keith Foulis, The Biostation’s 45-year-old co-founder and “chief experience officer,” said the clinic tests patients before prescribing medications and monitors them closely during treatment. He takes testosterone himself and said it has helped him.

Foulis hands out customer leads and exhorts his team to pump sales, using phone calls and emails to get men in the door for blood tests and medical appointments. On a Wednesday in May, a whiteboard at the company’s headquarters spelled out a “Daily Revenue Goal” of $75,000 and listed “key performance indicators,” such as “convert leads to patients.”

With nine locations in Florida, many with bright interiors and blown-glass seashell ceiling fixtures, The Biostation rings up more than $10 million in annual sales. Hormone replacement therapy is the company’s bestseller—testosterone for men and, for women, estrogen, progesterone and testosterone.

The company said it prescribes testosterone only in cases where it is appropriate treatment, a standard that includes men who wouldn’t qualify under typical medical guidelines.

“Our number one rule is medicine over money,” Foulis said. “We’re not a boiler room.”

Most men who come to The Biostation for testosterone leave with a prescription, according to Dr. Martin Bloom, who left a cardiology practice to become the company’s senior doctor. The clinic’s co-founder and chief executive officer, Ross Bloom, a college dropout and former mortgage broker, is Dr. Bloom’s son. He declined requests for comment.

Traditional medical practitioners don’t appreciate the benefits of testosterone treatment, Dr. Bloom said. “Most doctors think I’m a charlatan, that it’s snake oil,” he said. “But it’s not.”

Joyless

Pivovarov was 38 and already muscular from weightlifting when he walked into The Biostation’s Miami office in 2022 and complained of fatigue. 

Blood tests showed his testosterone levels were above average, he said, yet the clinic prescribed vials of testosterone to inject himself. He said he felt great for the first month. The injections lifted his energy, improved his workouts and recharged his libido. 

Then side effects emerged: insomnia, anxiety, acne and higher blood pressure. He said he also lost all sensation during sex. 

Pivovarov had started lifting weights when a high-school crush said he was too scrawny for her. While taking testosterone, he said, he was attracting women but sex was joyless.

Even so, the shots gave Pivovarov such energy and muscularity that he kept taking the hormone for a year, trying other medications to ease the side effects.

His Biostation clinician, a nurse practitioner, suggested he switch from shots to an implanted testosterone pellet, which releases the hormone over a few months. The pellets cost hundreds of dollars. Pivovarov said he felt like he was dealing with a used-car salesman and declined.

“I thought it would let me be Sylvester Stallone in my 40s, but I had a whole gamut of issues,” he said. “I came to the conclusion that this is why most doctors don’t mess with it.” 

Last fall, he quit.

Pivovarov said he was never warned of the side effects, and his medical records from The Biostation don’t include the complaints he made about them.

Dr. Bloom said that he discusses side effects with patients and prescribes medications to manage them. Prescribing testosterone, he said, is an “art, not purely a science.” Foulis declined to discuss Pivovarov’s case, citing confidentiality rules. 

The Biostation generates leads on new patients from client referrals and Google searches by interested men. 

Clinic appointments start with a $499 blood test and a meeting with a clinician who writes prescriptions. The men are handed off to salespeople, so called patient advocates, who earn commissions. Testosterone is a reliable source of income because it is a continuing treatment.

Foulis said that the company no longer pays sales commissions, only bonuses, and it no longer employs patient advocates, which former employees described as salespeople. Five current employees list their title as “patient advocate” on LinkedIn and The Biostation’s website says patients are assigned one.

The Biostation sells drugs directly, unlike medical practices that typically write prescriptions for patients to use at pharmacies.  

Dr. Bloom, a part-owner of The Biostation, said he has no financial incentive to prescribe testosterone. “I’ve never been wealthy enough to practice medicine for fun only,” he said. “Like everyone else, I have to make a living. Pay my bills.”

He estimated he declines to prescribe the steroid to about 10% to 15% of men who seek it, including those who are under age 35, are in fragile health or who appear to be bodybuilders.

‘Are you sad’

The images of muscle-bound superhero actors and social-media influencers are nearly impossible to match without steroid treatments, according to physicians. The he-man look has raised expectations among American men about their appearance. 

The modern focus on male body image emerged in the 1980s, said Skip Pope, a professor of psychiatry at Harvard Medical School. He identified a condition called muscle dysmorphia that describes men who are pathologically preoccupied with increasing their muscle mass. 

Testosterone treatment gained mainstream attention a decade ago, when pharmaceutical company AbbVie, looking to boost sales of its testosterone gel AndroGel, bankrolled advertising for the website IsItLowT.com. The site offered a 10-question quiz and encouraged men to ask their doctors about testosterone for common age-related issues, including lower energy, diminished sex drive and shrinking muscles.

Testosterone clinics now widely use the quiz to evaluate symptoms: Are you sad and/or grumpy? Do you have a lack of energy? Are you falling asleep after dinner? 

John Morley, a retired professor of gerontology at St. Louis Medical Center, said he spent a few minutes drafting the questions while sitting on the toilet 20 years ago. Morley said profit-seeking physicians have used his quiz to prescribe the hormone inappropriately.

Pharmaceutical companies have largely abandoned the testosterone market, chased out by generic drugmakers, as well as class-action lawsuits that alleged heart attacks, strokes and other medical troubles were linked to the hormone treatments.

That has left an open lane for men’s health clinics.

After seeing an increase in the number of men complaining about infertility who had received testosterone from a men’s clinic, Justin Dubin, a urologist at Memorial Healthcare System in South Florida, posed as a patient himself to see if clinics would write him a prescription.He said he was 34 years old and wanted to have another child. His testosterone levels tested above normal, yet six of the seven national online clinics he contacted prescribed him testosterone when he asked. Dubin said he was shocked and disappointed.“It undermines the credibility of the medical system,” he said, when clinicians give inappropriate medical advice. “At the end of the day the patient suffers.

”This summer, seven months after stopping testosterone, Pivovarov said he still hadn’t regained normal sexual function. He found a doctor at another clinic to prescribe him a different anabolic steroid, which Pivovarov said alleviated the lingering side effects. At 40, Pivovarov said he now felt as energetic and muscular as ever. His new regimen costs about $200 a month, carries a long-term risk of heart complications and has one other catch. “I’m under the assumption I need to take this the rest of my life,” he said.