The number of patients receiving testosterone therapy from Texas pharmacies has more than doubled over the last six years, with a growing share of those patients receiving versions of the hormone made by compounding pharmacies, according to a Houston Chronicle analysis of Texas Prescription Monitoring Program data.
About 86,000 patients filled a prescription for testosterone at Texas pharmacies in March 2019, with 35% of patients receiving customized, non-U.S Food and Drug Administration approved versions of the hormone drug from compounding pharmacies, the data shows.
About 187,000 patients filled a testosterone prescription in Texas in August 2025. Compounding pharmacies accounted for about 42% of those patients, according to the analysis, while industry groups say compounded drugs make up just 1% to 3% of pharmaceutical products overall.
The data underscores how Texas compounding pharmacies have profited from the explosive demand for the hormone by making more lightly regulated versions that are different from generic or brand-name drugs. Compounders make unique formulations that have not been tested in humans for safety and effectiveness, though the ingredients have to come from FDA-registered suppliers, and pharmacies are required to test higher risk products for contamination.
Compounders often make testosterone drugs in different concentrations or through different routes of administration, for example a lozenge that delivers the hormone while dissolving in the mouth. The pharmacies also add different ingredients that they say meaningfully change the drug.
The growing availability of compounded testosterone has been embraced by some physicians and viewed by others with skepticism over what they say is a lack of quality assurance and strong evidence of effectiveness.
About this series
This story is part of the series “A Dose of Disruption: How America’s desire for GLP-1s and testosterone fueled the growth of Empower Pharmacy and roiled the drug industry.”
“I hardly ever prescribe compounded testosterone because it is difficult for a clinician to keep track of the quality control of each compounding pharmacy,” said Dr. Michael Irwig, an endocrinologist at Beth Israel Deaconess Medical Center in Boston. “When I prescribe an FDA-approved product, I know exactly what the dose is and that there are some quality control standards at the facilities that produce the testosterone.”
Despite disagreement in the medical community, the drugs have opened access for a growing pool of patients who report life-changing benefits and sometimes know little about where the drugs come from.
“Within two weeks, I was sleeping better. I lost 15 pounds, and I was able to be more active,” said Deborah Tesar, a 61-year-old registered nurse who received compounded testosterone pellets at a wellness center in Houston. “They may have told me it was compounded. I think they probably did, but I don’t care.”
Deborah Tesar works on her yard in Houston on Sunday, May 10, 2026. Deborah Tesar, 61, is among roughly 40,000 women who are using compounded testosterone in Texas — a number that has been steadily increasing since 2019. Elizabeth Conley/Houston ChronicleThe history of testosterone
For men, testosterone is a hormone naturally produced by the testes. It’s essential for the production of sperm and red blood cells. It keeps the bones and muscles strong, enhances sex drive and promotes feelings of overall well being. For women, who produce testosterone at lower levels than men, the hormone is thought to play an important role in ovarian function, bone strength and libido.
Synthetic versions of testosterone were approved for medical use in the 1930s and took many forms over the ensuing decades — from injections to pellets to patches. Sports doping scandals that captured the public’s attention in the 1970s and 1980s ultimately prompted Congress to make testosterone and all other anabolic steroids controlled substances.
But in the 2000s, testosterone therapy found new life in the mainstream, driven by aggressive direct-to-consumer marketing, new treatment methods and shifting attitudes around men’s health.
“People have always wanted a fountain of youth,” said Dr. Landon Trost, a urologist in Utah who runs the Male Fertility and Peyronie’s Clinic. “Hormones, since really the 1970s or even earlier when they were first kind of discovered, were thought to be that fountain of youth.”
Men with low testosterone can experience low libido, fatigue, erectile dysfunction and a range of other symptoms. Studies indicate that testosterone levels are declining nationally, but experts attribute at least part of the demand to marketing that targets men who have normal testosterone levels. Today, testosterone is widely prescribed in ways that aren’t covered by insurance and that don’t always align with mainstream medical guidance.
That’s often where compounding pharmacies step in.
Testosterone clinics and telehealth companies that partner with compounding pharmacies market the treatment not only as a way to address a deficiency but also to “optimize” a patient’s physique and energy level. Physicians also may opt for compounded testosterone to avoid what they say are cumbersome insurance company requirements to verify a patient’s testosterone levels multiple times per year.
Compounded testosterone is also gaining traction among women, for whom there are no FDA-approved versions of the drugs.
Women seeing benefits from compounded testosterone
Tesar’s interest in weight loss drugs ultimately led her to testosterone therapy about three years ago. Her hairdresser had lost weight on a GLP-1 and recommended that Tesar visit a local wellness center for a prescription.
At the center, Tesar didn’t qualify for a GLP-1. She was, however, postmenopausal, and a blood test found that she was “hormone deficient,” Tesar said. A nurse practitioner prescribed a testosterone pellet, which was implanted under Tesar’s skin to slowly release testosterone and another hormone, progesterone, over a period of months. She was also prescribed an estrogen pill.
Within two weeks, she started seeing the benefits.
“I have actually started working out, being outside more,” she said. “I’m able to walk further. I’m not as short of breath. When I wake up, I feel rested.”
Deborah Tesar at her home in Houston on Sunday, May 10, 2026. Deborah Tesar, 61, is among roughly 40,000 women who are using compounded testosterone in Texas — a number that has been steadily increasing since 2019. Elizabeth Conley/Houston Chronicle
Men account for the vast majority of patients filling non-compounded testosterone prescriptions in Texas, but when it comes to compounded versions, women have led the way for most of the last six years, according to Texas prescription data.
In March 2019, the earliest month for which Texas maintains the data, about 19,000 women filled testosterone prescriptions at Texas compounding pharmacies, compared to 11,000 men, the data shows. As of August 2025, men and women accounted for an almost equal share of patients filling testosterone prescriptions at Texas compounding pharmacies, with about 40,000 male and female patients respectively filling prescriptions that month, the data shows.
Men experience a gradual decline in their testosterone levels as they age, but women can experience a precipitous drop-off once they hit menopause. Even so, there are no FDA-approved formulations for women, so doctors have been treating women by cutting down the doses of FDA-approved versions or offering modified doses made by compounding pharmacies.
Leading medical societies endorse off-label testosterone use for postmenopausal women to address persistently low sex drive, in doses that bring women close to premenopausal levels. But they also recommend against the use of compounded testosterone except in specific circumstances, citing unproven safety and efficacy data. The organizations said it’s “reasonable” to modify the FDA-approved versions for men.
But modifying the male doses can be imprecise and cumbersome for patients, said Dr. Susan Hardwick-Smith, a gynecologist who founded Complete Midlife Wellness Center in Houston and uses compounded hormones in her practice.
Take, for example, the brand-name Testim, a testosterone gel designed for men. She said women have to divide the gel into 10 smaller doses, while a compounding pharmacy will make a version that uses a pump to dispense the appropriate dose.
Some women are also uncomfortable visiting a traditional retail pharmacy for testosterone, she said, because of the public perception that it’s only used among men.
“It’s embarrassing,” said Hardwick-Smith. “You go stand in line and answer a bunch of questions. I’d just rather go to a compounding pharmacy and be treated nicely.”
Patients under 55 finding compounded testosterone
Increasing testosterone use among women explains a significant portion of the growth for compounded versions, but a growing share of patients under 55 years old are also receiving compounded testosterone, the data shows.
Patients in the 25 to 54 age group saw the sharpest increase in monthly compounded testosterone prescriptions in Texas, growing fivefold as the number of patients went from about 10,000 in March 2019 to nearly 50,000 in August 2025, the data shows. The group has outnumbered patients over 55 at both compounding and traditional pharmacies every month since late 2022.
Women aged 45 to 54 filled the most compounded testosterone prescriptions of any group – over 14,000 in August 2025. Men aged 45 to 54 and 35 to 44 were close behind, with about 13,000 and 12,000 patients filling prescriptions that month, respectively.
The sharp increase among younger groups shows, in part, how marketing tactics are making an impact, said Irwig.
“There are a lot of shady clinics and online companies selling testosterone and other products to men with non-specific symptoms (fatigue, low libido) that are not related to testosterone deficiency,” Irwig said in an email, adding that the advertising on social media appears to be targeting younger age groups who are more likely to trust the messages.
Irwig and other physicians worry that prescription-happy clinics and telehealth platforms aren’t providing a strong enough evaluation before offering testosterone. Symptoms like low energy and low libido can be caused by a variety of factors, including obesity and depression, that need to be ruled out first, experts say.
Testosterone therapy has risks. It’s meant to be a long-term treatment with close physician oversight. If patients stop treatment, the symptoms they had before – such as low libido, erectile dysfunction and fatigue – can come back stronger. Depending on the dose, testosterone can increase the risk of blood clots and mood swings. It can also cause infertility, as testosterone drugs can lower the body’s natural production of testosterone and reduce sperm count.
But in the evolving world of testosterone therapy, there are few hard-and-fast rules.
What professional associations consider to be “normal” varies by age and weight. The American Urological Society and the Endocrine Society both have slightly different guidance for when to prescribe testosterone, and both associations say a patient’s symptoms also need to be considered. Further complicating treatment, testosterone levels tend to fluctuate over the course of the day, and an injection of testosterone could temporarily bring patients into a range beyond natural levels. Little is known of the long-term health risks of boosting testosterone levels that high.
Testosterone made by a compounding pharmacy adds a layer of uncertainty, said Trost, the Utah urologist.
Manufacturers of commercial drugs have strict, FDA-approved protocols that require them to make drugs with the same concentration of testosterone, under the same manufacturing conditions, every time.
Compounding pharmacies do not have the same level of regulation because they are mostly supposed to make drugs for individual patients. While the pharmacies are subject to FDA and state pharmacy board inspections and must abide by basic quality requirements, the specific formulations are not pre-approved by the FDA before drugs leave the pharmacy. That means the pharmacies do not have to test their products in humans to ensure they work as advertised.
That makes it hard for some physicians to trust the quality of compounded drugs.
“The FDA is the gold standard, but it’s extremely difficult to hit that standard,” said Trost. “You have to be a big pharmaceutical company with a lot of money, and because of that, there’s not much innovation that happens. On the flip side, compounders are a little bit shooting from the hip, whereas they have very few regulations, and they can get away with much more.”
Find the full series, “A Dose of Disruption,” here.
About the data in this story
The Houston Chronicle parsed, categorized and localized over six years of controlled substance prescriptions records maintained by the Texas Prescription Monitoring Program for this series.
The data covers prescriptions for controlled substances with accepted medical use — schedules II through V — filled in Texas from March 2019 to August 2025. It excludes schedule I substances, which have no accepted medical use, as well as non-controlled prescription drugs such as GLP-1 weight loss medications.
Tallies shown on the page represent the number of patients filling prescriptions in a month. Patients who filled multiple testosterone prescriptions in a given month are only counted once.
Reporters identified testosterone prescriptions by searching drug name information in the data. Roughly 63,000 or about 1% of prescription records with no listed drug name could not be categorized and were excluded from this analysis. An additional 230,000 records, less than 4% of the total, could not be assigned to a Texas county due to missing or incomplete geographic data.
A morning newsletter that keeps you connected to Houston in 5 minutes or less.
CreditsReporting by Julian Gill and Caroline Ghisolfi. Visuals by Lauren Ibanez, Elizabeth Conley and Jill Karnicki. Editing by Yaffa Fredrick and Robert Eckhart. Design and development by Caroline Ghisolfi. Production by Rebecca Hennes and Brady Stone.