Testosterone therapy changed Shaun Noorian’s life in more ways than one.
In his telling, the Houston native had endured depression, low energy, low sex drive and an inability to gain muscle throughout his early 20s. And when the young oil field engineer sustained an on-the-job injury, he would seek care from a doctor who found the culprit:
A specialist prescribed him testosterone injections from a compounding pharmacy, a type of pharmacy that produces made-to-order versions of drugs that aren’t commercially available, for select patients who need them. After his first injection, Noorian said he gained 15 pounds of muscle “practically overnight.” He was flooded with energy and ambition.
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“I was like ‘Wow, what is this stuff?’” Noorian would later say on the “Dr. Gabrielle Lyon Show.”
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.”
That moment changed Noorian’s professional life, too. He opened his own compounding pharmacy — Empower Pharmacy — in 2009 to expand access to testosterone therapy and help others feel the same benefits.
Within 10 years, Noorian significantly grew the pharmacy’s size. Empower went from operating in a repurposed doctor’s office to two multimillion-dollar facilities totaling about 100,000 square feet. The company brought in more than $300 million in revenue in 2024, a massive leap from its $3.5 million in sales in 2014, according to internal sales records and financial statements attached to court filings.
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Empower’s rise has turned Houston into a battleground over the future of the niche compounding pharmacy industry, as some of these little-known but growing businesses take on Big Pharma for their right to produce more accessible — and riskier — versions of drugs that millions of Americans now consume.
EXPLORE THE DATA: Testosterone use in Texas is skyrocketing, and more than 40% comes from compound pharmacies
Some compounding pharmacies, like Empower, have turned into gold mines with the explosive demand for GLP-1 weight loss drugs and their ability to sell them at lower costs. Podcast personalities, online clinics and MAHA-aligned social media influencers have further propelled the industry’s reach by touting testosterone and longevity drugs that the pharmacies specialize in making.
Empower’s path to becoming one of the country’s largest compounding pharmacies has stretched the boundaries of this increasingly profitable corner of medicine. It has drawn the ire of Eli Lilly, one of the world’s largest drugmakers, who sued Empower in Houston federal court over its GLP-1 production. And it has brought additional scrutiny from regulators with little power to control the scale at which Empower operates.
Empower Pharmacy CEO Shaun Noorian addresses the crowd at a company celebration for a new FDA-registered outsourcing facility in Houston in 2016.
Elizabeth Conley/The Houston Chronicle
And Noorian isn’t done.
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“We only serve several million patients across this country,” Noorian said on a recent podcast. “There are hundreds of millions more that need this medicine. And billions more across the world that need it as well.”
Compounding pharmacies like Empower produce their own versions of brand-name GLP-1 drugs, like Zepbound and Wegovy, by changing the dosage strength and adding vitamins — changes they say are deemed necessary by a physician. An influx of prescriptions for these “personalized” versions has allowed them to dispense the drug nationally, under laws that exempt the pharmacies from costly requirements to test their drugs in humans.
‘A UNIQUE CASE’: Empower Pharmacy’s CEO helped a doctor pay rent. Is it a conflict of interest?
So while pharmacies like Empower produce drugs at a scale that experts say resembles those of traditional manufacturers, they don’t have to play by the same rules.
In its lawsuit, Eli Lilly says Empower is illegally mass producing its patented GLP-1s, but Empower has described the suit as an attempt to stifle competition.
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Noorian, now 43, talks publicly about compounding as a “revolution,” a way to not only serve individual patients but to openly challenge Big Pharma and create a “new pharmaceutical supply chain.”
Such is Noorian’s vision for a pharmacy that is already one of the largest in the country.
And it all started with testosterone therapy.
The age of ‘optimization’
Vials of testosterone compounds from Empower Pharmacy are kept in a locker at Gameday Men’s Health in Houston on Sept. 18, 2025.
Elizabeth Conley/Houston Chronicle
Testosterone therapy has become big business for telehealth companies, clinics and compounding pharmacies that sell it as a way for men to reclaim the energy and vigor of their youth.
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The appeal traces back decades.
The drugs have taken many forms — from injections to pellets to patches — since synthetic versions of the hormone were first approved for medical use in the 1930s. The therapy is designed to restore testosterone in men diagnosed with low levels of the hormone, which keeps the bones and muscles strong, enhances sex drive and promotes feelings of overall well-being. Men with low testosterone can experience low libido, fatigue, erectile dysfunction and a range of other symptoms.
Testosterone’s use in sports doping scandals in the 1970s and 1980s influenced public opinion around the drug. 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.
Testosterone prescription sales skyrocketed from about $100 million in 2000 to nearly $2.7 billion in 2013.
It was during this upswing that Noorian opened Empower Pharmacy, leasing space in a doctor’s office before moving to a 1,500-square-foot location in northwest Houston in 2011.
GLP-1 LAWSUIT: Eli Lilly targets Houston-based Empower Pharmacy over copycat diabetes, weight loss drugs
Today, testosterone therapy is marketed not only for low testosterone levels but as a way for men with normal testosterone levels to “optimize” their health by reaching their highest possible level of mental and physical well-being. It’s also a reliable money maker for clinics and pharmacies, as many men stay on the treatment for years, sometimes for life.
Celebrity podcasters like Joe Rogan and Dax Shepard have been open about their testosterone use. Social media influencers like Liver King, known for his extreme fitness and diet of raw animal organs, have admitted to using testosterone therapy and other steroids.
Even U.S. Health and Human Services Secretary Robert F. Kennedy Jr., the country’s top health official, has acknowledged that he uses testosterone to “stay swole,” as one telehealth company put it.
For social media users who search for hormone products, testosterone ads can become ubiquitous, with many offering cheap blood tests to check testosterone levels.
In one Instagram ad, telehealth company Joi and Blokes asks: “Not feeling like yourself? Check your hormone levels …” Another ad from the telehealth platform Maximus assures users: “It’s not you. It’s your low testosterone.”
In Noorian’s words, testosterone is part of a suite of wellness drugs that can help patients feel “superhuman.”
“We can make ourselves similar to high-performance athletes,” he said during an interview earlier this year on The CEO Magazine podcast. “We can be LeBron James. We can be Kobe Bryant. We can be Michael Jordan.”
An Empower spokesperson said Noorian’s “superhuman” reference was a “personal reflection” on the benefits of his treatment plan, “not a claim about testosterone therapy itself, and not a suggestion that it should be used for athletic or performance enhancement.”
While there are widely available forms of testosterone, Noorian’s experience opened his eyes to the benefits of “personalized” versions made by compounding pharmacies.
Seizing the opportunity
The son of an entrepreneur and a nurse, Noorian grew up riding and repairing go-karts at his father’s race track in Houston. He wanted to fix cars for a living, but the financial crisis that greeted him out of college in 2007 forced him to use his engineering degree elsewhere.
He got a job at the oil services company Schlumberger, working in hydraulic fracturing as a field engineer.
One day, Noorian damaged his spine as he lifted a piece of heavy metal. The injury sent him to physical therapy, where a doctor discovered Noorian had the testosterone level “of an 80-year-old man,” Noorian said on a podcast.
A urologist prescribed him testosterone made by a compounding pharmacy because, Noorian said, it would be more cost effective for someone who needed the therapy for life. He also said the pharmacy could alter the drug from the name-brand versions to meet his individual needs, which he did not specify during the interview.
For many large compounders that specialize in testosterone, it wasn’t their ability to offer a cheaper drug that caught their interest, according to interviews with multiple pharmacy owners and executives. It was their ability to make versions of testosterone that pharmaceutical companies didn’t — like testosterone made with different oils or in different concentrations — for patients who couldn’t access testosterone through traditional doctor’s offices and insurance companies.
Compounding pharmacies now largely serve telehealth companies and cash-based clinics that are more flexible in how they prescribe testosterone.
“It’s hard to say that we’re really focused on price,” said Matthew Montes De Oca, the chief clinical officer at Strive Pharmacy, a compounding pharmacy with locations throughout the U.S. that specializes in testosterone therapy, GLP-1s and other drugs. “It’s more so getting people access and getting them the highest quality.”
When Noorian first set his sights on the business, he became a licensed pharmacy technician and put his engineering mind to work.
“I wanted to learn how these drugs were made,” he said on a podcast.
He consulted with physicians to come up with unique variations of hormone drugs for patients, and, like other compounders, Empower began modifying the inactive ingredients and creating new forms of testosterone.
While the FDA-approved testosterone injections use cottonseed oil, Empower makes testosterone injections with grapeseed oil, which the pharmacy says allows patients to more comfortably inject it under the skin. The pharmacy also offers testosterone in lower concentrations than what’s commercially available and in different mixtures intended to modify how the hormone is released in the body.
EXPANSION: Empower Pharmacy opens $4.7M compounding facility
Noorian believes in the benefits of this “personalized” treatment, so much that he partnered with a prominent urologist in 2017 to open a testosterone clinic in Houston that would offer compounded hormone therapies. The partnership would allow physicians to collaborate with compounding pharmacies to produce “custom formulas” not available at traditional retail outlets, according to business plans obtained by the Chronicle.
The plans ultimately fell through over a property dispute, but the opportunity was there: The clinic aimed to enroll 5,000 patients in the Houston region by its third year, with $5 million in potential annual earnings.
Patients who are prescribed compounded testosterone aren’t always aware of the specific changes the pharmacies make to the drugs, though they still report benefits.
Patrick Hollingsworth, 57, of Houston, was looking for a way to maintain his energy after long hours monitoring equipment at oil refineries. His primary care doctor had suggested testosterone therapy years earlier.
Patrick Hollingsworth has been a client at Gameday Men’s Health and has noticed a significant change in his energy levels since starting testosterone therapy.
Elizabeth Conley/The Houston Chronicle
Through his own research, Hollingsworth early last year found Gameday Men’s Health, a national chain of cash-based testosterone clinics with 14 locations in the Houston area. He felt comfortable at the clinic, which prescribed him weekly injections of Empower’s testosterone.
At first, he said he didn’t know whether the drugs were any different from commercial versions, until he learned a few months later about the different carrier oil options. But the medicine worked: He found more energy to work out in the morning and keep up with his active 14-year-old.
“I haven’t felt like that since I was a young man,” Hollingsworth said. “And it feels great.”
The rejuvenating effects of testosterone would allow Noorian to expand the reach of his drugs — and make millions doing it.
Going big
Empower Pharmacy CEO Shaun Noorian gives a tour of the facility in Houston in 2016.
Elizabeth Conley/Houston Chronicle
From 2013 to 2016, Empower grew exponentially, its total assets climbing from about $66,000 to nearly $3 million, according to financial statements attached to public court filings.
Empower obtained licenses to ship drugs to all 50 states and embraced automation technology to churn out testosterone drugs from a 15,000-square-foot facility at 5980 W. Sam Houston Parkway North.
During the pandemic, Empower further expanded its footprint in Houston, opening a $55 million, 86,000-square-foot manufacturing plant at 7601 N. Sam Houston Parkway. In 2024, the company purchased another drug manufacturing plant in New Jersey, which it said would be capable of producing 50 million vials of compounded drugs per year.
Empower generated $311 million in revenue and dispensed nearly 3 million prescriptions in the first ten months of 2024, according to an internal sales dashboard obtained by the Chronicle. Empower said it does not comment on internal financial records.
Most compounding pharmacies don’t publish financial statements, but in sheer revenue, that puts Empower on par with a mid-size biopharmaceutical company, according to estimates from a McKinsey and Company report.
Empower now claims to be the largest and most advanced compounding pharmacy in the world.
The largest share of Empower’s revenue stemmed from GLP-1 sales, but a significant portion — about $26 million — came from Empower’s hormone drugs, according to the sales dashboard.
In a smattering of podcast and TV interviews, Noorian hasn’t given many specifics on how he built Empower to make drugs at “a scale and sophistication that very few in the compound space have even attempted,” other than his own drive to expand access.
But Houston proved to be a fertile environment for growth, especially when it comes to testosterone therapy. Dr. Larry Lipshultz, one of the most prominent urologists in the field, practices here and prescribes drugs made by Empower and other compounding pharmacies.
RECALL: Houston’s Empower Pharmacy recalls 8,000 testosterone injections, citing quality concerns
One large national chain of testosterone clinics, SynergenX, started in Houston and has a large footprint in the area with 15 clinics. And the fast-growing GameDay Men’s Health, which also prescribes Empower’s testosterone, is aiming to expand its presence in the city to 26 clinics, said Farukh Bhagani, a Houston entrepreneur who owns five GameDay locations.
Gameday Men’s Health co-owner Faruk Bhagani talks about the business in Houston on Sept. 18, 2025.
Elizabeth Conley/Houston Chronicle
“Houston is a pretty dense TRT (testosterone replacement therapy) market,” said Bhagani. “There’s a lot of players here, and there’s a lot of urology capability here.”
Houston also has been a hot spot for non-traditional clinics, such as medical spas and IV hydration clinics, that typically offer compounded IV therapies, weight loss drugs and hormone therapy, said Sara Shikhman, a healthcare lawyer whose firm represents hundreds of wellness clinics nationwide.
Texas took steps to regulate some of these facilities this year, creating a new law that requires licensed healthcare professionals to administer IV therapy. But “historically, there hasn’t been a lot of regulation of those businesses, and Texas makes it very easy for those types of businesses to open,” said Shikhman.
Challenges to compounding
As the industry grows, Empower and other compounding pharmacies contend with skepticism from the medical community over the benefits and safety profile of their drugs.
The pharmacies do not have to test their drugs in humans before dispensing the prescription, although they are required to use raw ingredients that have been tested for impurities. Finished drugs that are deemed a high risk, such as injectables, are also required to undergo basic quality testing.
No peer-reviewed studies exist that assess whether testosterone made with grapeseed oil benefits patients more than the standard versions of the drug. In general, there is scant data around the effectiveness of compounded testosterone therapy, according to a study published in 2020 by the National Academic of Sciences, Engineering and Mathematics.
The 12-person committee that assembled the study, which included physicians, pharmacists and healthcare researchers, found that most information came from low-quality data, such as anecdotal claims and prescriber testimonies that didn’t prove the drugs were any more effective than commercial drugs. The lack of quality research and limited oversight around compounding poses a “public health concern,” the study concluded.
An Empower spokesperson said testosterone drugs in lower concentrations can benefit certain women who need the therapy, to reduce the risk of “overexposure.” The decision of whether to prescribe a compounded version ultimately rests with the clinician, the spokesperson said.
There’s also the issue of cost. Even though Empower markets itself based, in part, on its ability to expand “affordability,” compounding pharmacies are not meant to serve financial needs. They’re intended to make drugs for specific medical needs — a fact the company acknowledged in responses to the Chronicle.
“Compounded medications are not prescribed simply because of price,” a company spokesperson said.
Empower’s compounded testosterone may be a lower-cost option than commercially available generics, the spokesperson said, but pricing depends on factors like dose, formulation, quantity and whether a patient is using insurance or discount programs.
Generic injectable testosterone can cost as little as $30 without insurance, according to GoodRx, a website that tracks drug prices. Some fertility drugs commonly used in tandem with testosterone, however, can cost hundreds of dollars, and compounding pharmacies often sell those products for a fraction of the cost.
Despite questions from critics, Noorian continues to promote the benefits of compounded testosterone and other drugs that Empower offers — commonly touted by wellness influencers and doctors who focus on preventative care — for patients looking to have bigger muscles, clearer skin, better sex and longer lives.
“Once patients have been exposed to medication that is both affordable and may improve their outcomes because they’ve been personalized,” he said on the CEO Magazine podcast, “there’s very little going back.”
Empower Pharmacy CEO Shaun Noorian is reflected in the doors of the pharmacy while celebrating the company’s FDA-registered outsourcing facility on Sept. 29, 2016, in Houston.
Elizabeth Conley/Houston Chronicle
Find the full series, “A Dose of Disruption,” here.