<i>Much Easier Just to Buy Underground From a Guy at The Gym</i> : The Politics of Accessing Testosterone Among Men Who use Prescribed Testosterone in Australia

Introduction: Testosterone replacement therapy (TRT) is widely used by men to manage testosterone deficiency and optimise hormone levels; however, its accessibility, efficacy, and social implications remain underexplored. This study explores the experiences of men using TRT in Australia, with a focus on access barriers, perceived health impacts, and self-regulation practices. Methods: Semi-structured interviews were conducted with nine men (aged 18 or older) currently using TRT, recruited through purposive sampling from peer networks. The interviews averaged 1 hour, were recorded via videoconferencing and transcribed. Five participants completed a follow up interview for deeper insight. Iterative categorisation was used to identify key theme-categories across the data. Results: Participants reported significant barriers to accessing TRT through regulated medical channels, including bureaucratic delays, financial costs, and stigma. Conversely, many reported the relative ease of obtaining testosterone from underground sources. Despite these challenges, TRT was seen as transformative, improving physical and mental health. Self-regulation of dosages and mixing prescribed and underground substances were common, reflecting active, self-managed care. Discussion: While TRT is framed as a medical intervention, its access is shaped by regulatory barriers, financial constraints, and informal routes. Men’s engagement with TRT underscores the need for adaptive, participatory harm reduction models beyond formal biomedical frameworks.