Study links ultra-processed foods to greater heart attack, stroke risk

 Ultra-processed foods (UPFs) are industrially modified products loaded with added fats, sugars, starches, salts and chemical additives like emulsifiers. From sodas to snacks and processed meats, these foods are stripped of natural nutrients. UPFs introduce many ingredients that our bodies have never encountered. In the United States today, UPFs make up nearly 60% of adults’ and 70% of children’s diets.

Prior studies have shown that people who consume large amounts of UPFs have higher risks of metabolic syndrome, a constellation of overweight and obesity, hypertension, dyslipidemia and insulin resistance, as well as increased levels of high sensitivity C-reactive protein, a sensitive marker of inflammation and accurate predictor of future cardiovascular disease (CVD), which is mainly comprised of heart attacks and strokes. However, data are sparse on whether people who consume higher amounts of UPFs have increased risks of CVD.

With consumption of UPFs on the rise and CVD remaining a leading cause of death in the U.S. and increasing around the world, understanding the link between the two is more urgent than ever – as insights could have profound implications for individual patient care as well as the health of the general public.

Researchers from Florida Atlantic University’s Charles E. Schmidt College of Medicine explored this possible link by examining data from the U.S. National Health and Nutrition Examination Survey (NHANES). The results of the study, published in The American Journal of Medicine, provide more troubling news for individuals who consume high amounts of UPFs.

“The findings from our study, based on a large, nationally representative sample of 4,787 U.S. adults, show that those with the highest intake of UPFs suffer a statistically significant and clinically important 47% higher risk of cardiovascular disease,” said Charles H. Hennekens, M.D., FACPM, FACC, senior author, First Sir Richard Doll Professor of Medicine and Preventive Medicine, and senior academic advisor, FAU Schmidt College of Medicine. “These results have major implications for future research as well as clinical care and public policy.”

The researchers analyzed data from the NHANES, which collects health, diet and lifestyle information from a large, random sample of U.S. adults. They analyzed the 4,787 participants aged 18 and older from 2021 to 2023 who had at least one day of detailed dietary records and information about heart attack or stroke. Participants reported everything they ate over two days, and researchers calculated what percentage of each person’s total calories came from UPFs, using a validated and widely used system that classifies foods. People were then grouped into four categories, ranging from low to high UPF food intake.

The study focused on CVD, defined as a self-reported history of heart attack or stroke. Researchers also accounted for factors such as age, sex, race and ethnicity, smoking and income. Average age of participants was 55 years, and 55.9% were women. After adjusting for these confounding factors, those in the highest quartile of UPFs intake had a statistically significant and clinically important 47% higher risk of CVD compared with those in the lowest quartile.

The researchers note increasing public awareness and policy change around UPFs may mirror that of tobacco in the last century. Just as it took decades for the dangers of cigarettes to become widely recognized, changing consumption habits around UPFs will likely take time, given the influence of multinational companies that dominate the market. At the same time, many people face real barriers to access healthier options, highlighting the need for a broader public health approach.

“Addressing UPFs isn’t just about individual choices – it’s about creating environments where the healthy option is the easy option,” said Hennekens. “Clinical guidance and public health education are necessary to make nutritious foods accessible and affordable for everyone.”

The researchers also address the rising rates of colorectal cancer in the U.S., particularly among younger adults as the risk factors are similar to those of CVD.  

“The increasing consumption of UPFs may be a contributing factor, along with other dietary and lifestyle influences that affect a range of common and serious gastrointestinal diseases,” said Allison H. Ferris, M.D., FACP, co-author and professor and chair of the Department of Medicine at the FAU Schmidt College of Medicine. “Awareness is the first step toward prevention.”

Although large scale randomized trials are needed, the researchers say that in the meantime, health care providers should advise patients to decrease consumption of UPFs in addition to adopting other therapeutic lifestyle changes and adjunctive drug therapies of proven benefit.

Choline intake in pregnancy linked to lower inflammation

 

 A new Cornell University study suggests that choline, a nutrient many pregnant people consume too little of, may play an underappreciated role in keeping inflammation in check during pregnancy.

Researchers analyzed data from more than 1,300 pregnant participants enrolled in the Alberta Pregnancy Outcomes and Nutrition (APrON) cohort, one of the most detailed long-running pregnancy nutrition studies in North America. They found that higher recent dietary choline intake was associated with lower levels of inflammation in the third trimester.

“We all have these signaling proteins that can be inflammatory in our blood, but when they go beyond outside their normal range, we get worried,” said first author Elisabeth Larson, a doctoral student in nutritional sciences. “Inflammation can be caused by anything from viral infection to chronic disease, such as obesity or cardiovascular disease, and even things like psychological stress.” 

Most strikingly, Larson found that participants with the highest choline intakes had dramatically lower odds of having clinically elevated inflammation than those with the lowest intakes.

Choline is an essential nutrient involved in many biological processes, including cell membrane structure, neurotransmitter production, methylation, immune cell receptor agonism, and fetal brain development, and some of these biochemical processes play a role in the regulation of inflammation. It is found primarily in eggs, meat, fish, dairy and some legumes and cruciferous vegetables.

“It’s most abundant in animal-source foods,” Larson said. “If you’re vegetarian or vegan and not taking supplements, I would be concerned that you aren’t consuming enough choline.”

Despite its importance, choline remains something of a nutritional afterthought. It is not always emphasized in prenatal counseling, and many prenatal vitamins contain little or none of it. Surveys suggest that most pregnant people fall short of recommended intake levels.

The study found inflammation dropped most steeply as intake rose from very low levels into moderate and higher ranges, suggesting potential thresholds rather than a simple “more is better” effect.

“We had fewer data points at the lower or higher intake ends, so we need to do more research about a potential threshold relationship,” Larson cautioned. 

The current recommendation for choline during pregnancy is 450 mg, but there’s some evidence that that may not be enough, Larson said. 

The findings also raise questions about whether current dietary guidelines adequately reflect choline’s role during pregnancy, and whether clinicians should pay closer attention to it alongside better-known nutrients like folate and iron.

“There really isn’t enough work on these under-appreciated nutrients that might be predictive of health for mother and child,” Larson said. “It’s important because Mom’s health is very predictive of Baby’s future health.”

Among the best sources of chol;ine:

1. Whole Eggs

Eggs are one of the most convenient and versatile choline sources. A single large egg contains approximately 169 mg of choline, meaning just two eggs provide 61% of the daily value.

Nearly all the choline in eggs is concentrated in the yolk—about 680 mg per 100 grams of yolk compared to just 1 mg per 100 grams of egg white. This makes it essential to eat whole eggs rather than just egg whites to maximize choline intake. Research suggests that the choline in eggs may be better absorbed than synthetic forms found in supplements, as it’s bound to phospholipids that are readily absorbed by the digestive system.

2. Fish and Seafood

Various types of fish provide substantial amounts of choline. A 3-ounce (85-gram) serving of salmon contains approximately 187 mg, or 34% of daily needs. Tuna, cod, and other fish also offer good amounts.

Studies have linked low fish consumption with reduced blood choline levels. Research involving 222 pregnant women found that those consuming 75 grams or less of fish weekly had lower choline, DHA, and vitamin D intake compared to women eating 150 grams or more per week.

High consumption of ultraprocessed foods may be linked to cancer survivors’ risk of death

Bottom Line: Cancer survivors who consumed higher amounts of ultraprocessed foods as part of their diet had a significantly increased risk of both all-cause and cancer-specific death.

Journal in Which the Study was Published: Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research (AACR) 

Author: Marialaura Bonaccio, PhD, of the Research Unit of Epidemiology and Prevention at IRCCS Neuromed in Pozzilli, Italy

Background: Ultraprocessed foods can be considered unhealthy because they are often low in essential nutrients such as vitamins, minerals, and fiber, and the industrial processing methods used to produce them introduce additives, artificial flavorings, preservatives, emulsifiers, and high levels of added sugars and unhealthy fats that the body is not well adapted to handle, Bonaccio explained. With the consumption of ultraprocessed foods on the rise in many countries around the world, Bonaccio said it is important to better understand whether eating less ultraprocessed food could help cancer survivors live longer and healthier lives. 

“What people eat after a cancer diagnosis may influence survival, but most research in this population has focused only on nutrients, not how processed the food is,” Bonaccio said. “The substances involved in the industrial processing of foods can interfere with metabolic processes, disrupt gut microbiota, and promote inflammation. As a result, even when an ultraprocessed food has a similar calorie content and nutritional composition on paper compared to a minimally processed or ‘natural’ food, it could still have a more harmful effect on the body.” 

How the Study was Conducted: In the Moli-sani Study, a prospective cohort study, Bonaccio and colleagues followed 24,325 individuals from March 2005 to December 2022 who were 35 or older at study initiation and lived in the Southern Italian region of Molise. Within this cohort, they identified 802 cancer survivors at baseline (476 women and 326 men) who had provided thorough information about their diet via the European Prospective Investigation into Cancer and Nutrition (EPIC) food frequency questionnaire. The NOVA classification system, which assigns foods into one of four groups based on the level and purpose of processing, was used to classify whether a food was ultraprocessed.  

The amount of ultraprocessed foods in each individual’s diet was then calculated in two ways: weight ratio (which divided the total weight of ultraprocessed foods consumed each day by the total weight of food and beverages consumed each day) and the energy ratio (which divided the total calories from ultraprocessed foods each day by the total calories consumed each day). Individuals were then divided into three groups based on the weight ratio of ultraprocessed foods consumed. The researchers also adjusted for multiple factors including demographic factors, smoking status, body mass index, leisure-time physical activity, medical history, cancer type, and overall diet quality based on the Mediterranean Diet Score. 

Results: During a median follow-up of 14.6 years, there was a total of 281 deaths among the 802 cancer survivors. Individuals in the highest third of ultraprocessed food consumed by weight ratio had a 48% higher rate of death from any cause and a 57% higher rate of death from cancer compared with those in the lowest third. A higher energy ratio of ultraprocessed foods showed similar results for cancer death, but not other causes.

“Some foods may weigh a lot but contribute few calories, or vice versa, which is why the results can differ depending on the measure used,” Bonaccio explained. “But the fact that the association between ultraprocessed foods and all-cause death persisted even after adjusting for overall diet quality suggests that the negative health effects are not explained solely by poor nutrient profiles, but that the level and nature of industrial food processing itself play an independent role in influencing long-term health outcomes.”

To examine the potential biological mechanisms that may be impacted by ultraprocessed foods, Bonaccio and colleagues analyzed inflammatory, metabolic, and cardiovascular biomarkers based on samples and data collected from participants. Among the biomarkers examined, adjusting for inflammatory scores and resting heart rate attenuated the association between ultraprocessed foods and all-cause death by 37.3%.

“These results suggest that increased inflammation and elevated resting heart rate may partially explain the link between higher consumption of ultraprocessed foods and increased mortality, and help to clarify how food processing itself could contribute to worse outcomes among cancer survivors,” Bonaccio said.

To better understand if the nutritional content of ultraprocessed foods made a difference, the researchers established and examined data for seven groups of ultraprocessed foods: artificially and sugar-sweetened beverages, artificial sweeteners, and spirits; dairy and cheese products; processed meat; salty snacks and savory foods; fatty spreads and sauces; starchy foods; and sugary foods and sweets.

Some groups were linked to higher mortality, while others showed no clear pattern. However, interpreting individual ultraprocessed foods is challenging, and they are best considered as a dietary pattern rather than isolated items, Bonaccio said.

Author’s Comments: “The main message for the public is that overall consumption of ultraprocessed foods matters far more than any individual item,” Bonaccio said. “Focusing on the diet as a whole and reducing ultraprocessed foods overall and shifting consumption toward fresh, minimally processed, home-cooked foods is the most meaningful and beneficial approach for health. A practical way to do this is by checking labels: Foods with more than five ingredients, or even only one food additive, are likely to be ultraprocessed.”

Study Limitations: Limitations of this study include the fact that, as an observational study, causality cannot be inferred, dietary intakes were self-reported making them susceptible to misreporting, dietary habits could have changed over the course of the follow-up period, and the study was subject to survival bias as diet was assessed an average of 8.4 years after cancer diagnosis. Additionally, the study had a small number of deaths, which limits its statistical power, and a lack of data regarding cancer stage at the time of diagnosis.

Funding & Disclosures: This study was funded by the Fondazione AIRC per la Ricerca sul Cancro ETS. Bonaccio reports no conflicts of interest.

---

Journal

Cancer Epidemiology Biomarkers & Prevention

DOI

10.1158/1055-9965.EPI-25-0808 

Mediterranean diet associated with lower risk of all stroke types

Highlights:

• Following a Mediterranean diet is associated with a lower risk of all types of stroke among women, according to a new study.
• The study does not prove that the diet causes the lower risk; it only shows an association.
• Women with the highest adherence to the Mediterranean diet were 18% less likely to experience any stroke, including a 16% lower risk of ischemic stroke and a 25% lower risk of hemorrhagic stroke.
• The Mediterranean diet emphasizes high intake of vegetables, legumes, fruits, fish, and olive oil, and low intake of dairy, red meat, and saturated fats.

Following a Mediterranean diet is associated with a lower risk of all types of stroke among women, according to a study published on February 4, 2026, in Neurology® Open Access, an official journal of the American Academy of Neurology. The study does not prove that the Mediterranean diet is the cause of the lower risk of stroke; it only shows an association.

The diet was associated with a lower risk of stroke overall, as well as ischemic stroke and hemorrhagic stroke. Ischemic stroke is caused when blood flow is blocked to part of the brain. It is the most common type of stroke. Hemorrhagic stroke is caused by bleeding in the brain.

The Mediterranean diet includes a high intake of vegetables, legumes, fruits, fish and healthy fats such as olive oil, and a low intake of dairy products, meats and saturated fatty acids.

“Our findings support the mounting evidence that a healthy diet is critical to stroke prevention,” said study author Sophia S. Wang, PhD, of City of Hope Comprehensive Cancer Center in Duarte, California. “We were especially interested to see that this finding applies to hemorrhagic stroke, as few large studies have looked at this type of stroke.”

The study involved 105,614 women with an average age of 53 at the start of the study who had no history of stroke. The participants filled out a questionnaire at the start of the study about their diet. Participants were given a score of zero to nine based on how closely they followed the Mediterranean diet. People received one point if they consumed above the overall average in the population in these categories: whole grain cereals, fruits, vegetables, legumes, olive oil and fish, plus drinking a moderate amount of alcohol. They also received one point if they consumed a below-average amount of red meat and dairy products. A total of 30% of participants had scores of six to nine—the highest group. And 13% had scores of zero to two, the lowest group.

The participants were followed for an average of 21 years. During that time, 4,083 strokes occurred, with 3,358 ischemic strokes and 725 hemorrhagic strokes. For ischemic strokes, there were 1,058 among the 31,638 people in the highest group compared to 395 cases among the 13,204 people in the lowest group. For hemorrhagic stroke, there were 211 strokes among those in the highest group, compared to 91 among the lowest group.

When researchers adjusted for other factors that could affect stroke risk, such as smoking, physical activity and high blood pressure, they found that those in the highest group were 18% less likely to have a stroke than those in the lowest group. They were 16% less likely to have an ischemic stroke and 25% less likely to have a hemorrhagic stroke.  

“Stroke is a leading cause of death and disability, so it’s exciting to think that improving our diets could lessen our risk for this devastating disease,” said Wang. “Further studies are needed to confirm these findings and to help us understand the mechanisms behind them so we could identify new ways to prevent stroke.”

A limitation of the study is that people reported their own diet information, so they may not have remembered correctly.  

Dietary patterns may play a role in adolescent mental health

 A study led by researchers at Swansea University suggests that dietary patterns may play a role in adolescent mental health and sets out a detailed research roadmap to better understand this relationship.

The review, published in the journal Nutrients, examined evidence from 19 studies exploring links between diet and mental health outcomes in adolescents. Across the studies, healthier overall dietary patterns were often associated with fewer depressive symptoms, while poorer diet quality was linked to greater psychological distress.

The researchers analysed six randomised controlled trials and 13 prospective cohort studies. They found that evidence supporting individual nutrient supplementation was mixed, with emerging but inconsistent findings that vitamin D supplementation may reduce depressive symptoms in adolescents. In contrast, whole-diet patterns and diet quality indices showed more consistent associations with favourable mental health outcomes.

The authors note that adolescence represents a critical period for brain development and mental health, offering opportunities for prevention and early intervention. Diet, they highlight, is a modifiable and scalable factor embedded in daily life. However, they caution that the current evidence base remains inconsistent and is influenced by demographic factors such as socioeconomic status and sex.

The review aimed to strengthen the real-world relevance of existing research by focusing beyond clinic-defined groups, with the goal of informing both clinical practice and public health policy.

The study also identifies significant gaps in the current literature. Most research to date has focused on depression, leaving outcomes such as anxiety, stress, externalising behaviours, self-esteem and aggression comparatively underexplored.

Why aren’t more older adults getting flu or COVID-19 shots?

Poll suggests need for more communication about vaccines’ power to reduce risk of severe illness in people over 50

Reports and Proceedings

Michigan Medicine - University of Michigan

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National Poll on Healthy Aging data from adults age 50 and over who replied to a poll in late December 2025 and early January 2026 saying that they had not received a flu vaccination in the last 6 months and/or had not received a COVID-19 vaccination in the last year, showing the main reason why they had not done so.

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Credit: Emily Smith - University of Michigan

This winter’s brutal flu season isn’t over, and COVID-19 cases have risen recently too. But a new poll taken in recent weeks shows that vaccination against both viruses lags among people 50 and over, and the national survey reveals key reasons why.

In all, the University of Michigan National Poll on Healthy Aging shows, 42% of people over 50 haven’t gotten either flu or COVID-19 vaccines in the past six months, though 29% have gotten both and 27% have gotten just the updated flu shot.

The poll also asked about COVID-19 vaccination since it became available in 2021: 49% of people over 50 said it’s been more than a year since their last dose, and 15% said they’ve never received it.

The leading reason people over 50 gave for not getting updated vaccines?

They didn’t think they needed them.

In all, 28% of people over 50 who didn’t get a flu vaccine in the past six months, and 29% of those who didn’t get a COVID-19 vaccine in the past year or ever, gave this as the main reason.

That’s despite clear evidence showing that staying up to date on both vaccines reduces the risk of serious illness and death in older adults, whose immune systems need regular “reminders” with updated vaccines tailored to recent mutations in the viruses.

Coming in second among reasons for not getting vaccinated recently were worries about the vaccines’ side effects (19% for flu and 27% for COVID-19), followed by a belief that the vaccines aren’t effective (18% and 19%, respectively).

Far fewer (10% for flu and 6% for COVID-19, respectively) said they just didn’t think of it. A few (4% and 3%) wanted to wait, and from 1% to 4% cited time, cost, insurance, availability or eligibility concerns.

The findings could help health care providers and public health agencies communicate better with middle-aged and older adults about the health benefits of annual vaccination and address any concerns, misinformation, or barriers.

The poll is based at the U-M Institute for Healthcare Policy and Innovation and supported by Michigan Medicine, U-M's academic medical center.

From late December 2025 to mid-January 2026, the poll team asked 2,964 U.S. adults age 50 and over if they’d gotten a flu vaccine dose in the last six months, and when their most recent COVID-19 vaccination was. Then, the team asked those who hadn’t sought vaccination recently their main reason why.

“The evidence is clear: these viruses can lead to serious illness, hospitalization, and death. That risk increases with age and underlying health conditions, and vaccination reduces that risk,” said Jeffrey Kullgren, M.D., M.P.H., M.S., the poll’s director, an Associate Professor of Internal Medicine at the U-M Medical School and a primary care physician at the VA Ann Arbor Healthcare System.

“These findings suggest that we must do a much better job helping people in their 50s and up understand that they will benefit from getting these updated vaccines each year, that the vaccine side effects are mild and short-lived, and that even if they later get infected and develop symptoms, vaccination means they won’t get as sick,” he added.

Emphasizing individual impacts is important, he noted. Experts and news stories often discuss vaccine effectiveness in percentages based on how well the vaccine reduces the risk of hospitalization or death in a population.

That’s different from what an individual might care most about: whether it will keep them from getting sick at all, or seriously ill, Kullgren said.

Even when a vaccine isn’t a perfect match for the virus strains that are circulating, a recent dose still nudges the immune system to be ready to fight off the virus in general, and can help reduce the severity and duration of symptoms, he notes.

No impact from changed recommendation for COVID-19 shot

Last spring, leaders at the U.S. Food and Drug Administration signaled a change in the agency’s recommendation about which adults should receive the COVID-19 vaccination. This was followed by an official change in the FDA approval and the recommendation from the Centers for Disease Control and Prevention in late summer.

But the poll suggests this change didn’t play a major role in older adults’ decision-making. Less than 1% of respondents who chose not to get vaccinated against COVID-19 in the last year said their main reason was they thought they weren’t eligible.

And in fact, the federal change only affects some of those who were polled: Those who are aged 50 to 64 without any chronic health condition that raises COVID-19 risk.

COVID-19 vaccination is still recommended for most older adults, including two doses a year for everyone over age 65 and anyone with a compromised immune system, and one dose a year for those under 65 who have underlying health conditions that put them at higher risk of severe COVID-19.

Many people ages 50 to 64 have at least one of those qualifying conditions, which include diabetes, asthma, obesity, high blood pressure, current or previous smoking, and physical inactivity.

The CDC didn’t change its recommendation that everyone over the age of 6 months should get an annual flu vaccination. And major medical societies and insurance companies announced that they would continue recommending or covering both vaccines for all children over 6 months and all adults, regardless of health status.

Differences in vaccination uptake

In addition to revealing reasons older adults didn’t get updated vaccines, the new poll data show some key differences in vaccination among different groups of people 50 and over.

The oldest adults (age 75 and over)– those with the highest risk of hospitalization and death from both viruses – had the highest rates of updated vaccination.

In all, 46% of those age 75 and up said they had gotten a COVID-19 vaccine in the last six months, compared with 37% of those age 65 to 74 and 20% of those age 50 to 64.

Flu vaccination was even higher in all age groups, with 76% of those in the oldest age bracket having gotten the latest flu shot, compared with 64% of those age 65 to 74 and 42% of those in their 50s and early 60s.

"This gap between flu and COVID-19 vaccination represents an opportunity to connect the dots for older patients: both of these viruses can put them at risk, both of them mutate rapidly, and both vaccines should be an annual tradition, even if they don’t get them at the same time,” said Kullgren.

He also points to the poll’s positive finding that adults 50 and over who report having at least one chronic health condition were much more likely to have gotten flu and COVID-19 shots recently than those without a chronic condition.

But even among those with chronic health conditions, 39% said they hadn’t had either vaccine in the last six months, though this rate was much lower than the 59% of those without chronic conditions who said so.

The poll also suggests a need for focus on those who have never gotten vaccinated against COVID-19, as they grow older and their risk of severe outcomes rises.

In all, 20% of those age 50 to 64 said they had never gotten a COVID-19 vaccine, along with 12% of those age 65 to 75 and 7% of those age 75 and up.

There’s also an income gap, with 19% of all those with household incomes under $60,000 saying they’ve never had a COVID-19 shot, compared with 12% of those with incomes over $60,000.

Not too late to vaccinate, including second doses of COVID-19 vaccine

Kullgren notes that it’s not too late in the current respiratory virus season for anyone to get a flu or COVID-19 vaccine if they haven’t already done so. It’s also almost time for second doses of the COVID-19 vaccine for those over 65 or with moderately to severely compromised immune systems who got this year’s version soon after it arrived in early September. They are recommended to get another dose starting six months after receiving the first.

So, if someone received their first dose in the first week of September, for instance, they can receive a second dose starting the first week in February. See the detailed adult vaccine schedule and the page about COVID-19 vaccines for immunocompromised people.

About the poll

The poll findings come from a nationally representative survey conducted by NORC at the University of Chicago for IHPI and administered online and via phone from December 29, 2025 to January 13, 2026 among 2,964 U.S. adults ages 50 to 98. The sample was weighted to reflect the national population. 

Read past National Poll on Healthy Aging reports and Michigan findings, and learn about the poll methodology. 

 

‘Masculinity crisis’: Influencers on social media promote low testosterone to young men, study finds

Young men are being encouraged to undergo testosterone testing and start hormone therapy through Instagram and TikTok content that promotes unproven health claims while downplaying medical risks, a new international study has found.  

 

The study was done at the University of Sydney’s Faculty of Medicine and Health, and led by Emma Grundtvig Gram, a visiting PhD student from the University of Copenhagen. It found that influencer marketing on social media is normalising unnecessary testosterone testing and treatment among healthy young men, despite these therapies being associated with potentially serious health risks including heart problems, infertility, kidney issues, blood clots, reduced libido and erectile dysfunction.  

 

Published in Social Science & Medicine, the study analysed 46 high-reach Instagram and TikTok posts promoting testosterone tests and treatments. The accounts behind these posts had a combined audience of 6.8 million followers and generated more than 650,000 likes. 

 

The researchers found the content was closely linked to the online manosphere, a cluster of online communities that promote narrow, hyper-masculine ideals and frame men’s health, identity and success through dominance, physical strength and sexual performance. Health and fitness misinformation is common within these spaces, and testosterone marketing has increasingly become part of this trend. 

 

“Influencer marketing is reframing everyday experiences like fatigue, stress, lower libido or ageing as signs of testosterone ‘deficiency’ that requires medical intervention,” said Dr Brooke Nickel, senior author on the study and senior research fellow at the University of Sydney’s School of Public Health

 

Manosphere influencers using fear to sell testosterone products

 

In one message analysed in the study, a “Sex coach” on TikTok with 102k followers warned: "Watch out for this SCARY sign of low testosterone levels … you should be waking up in the morning with a boner, if you're not waking up in the morning with a boner, there’s a large possibility that you have low testosterone levels. Get it checked!"

 

In another post, one influencer declared: “I was like 3 numbers away from being called a female,” equating a testosterone test score with masculinity and gender distinction. 

 

None of the posts included in the study cited scientific evidence to support their claims. 85 percent were published by individuals rather than health organisations, 67 percent included direct purchase links and 72 percent had financial interests, such as selling tests, supplements or clinic consultations. 

 

“What we’re seeing isn’t health education, it’s marketing and fearmongering dressed up as medical advice,” said Dr Nickel. “Young, healthy men are being told that common experiences like tiredness, stress or changes in libido are signs that something is medically wrong and that testosterone is the solution.”

 

Testosterone marketed as a solution to a ‘masculinity crisis’

 

The researchers identified four recurring narratives that shape how testosterone is marketed to men online: 

• low testosterone as a crisis that threatens male sexuality
• rebranding low testosterone as a young man’s issue linked to idealisation of unrealistically muscular bodies 
• an emphasis on self-optimisation and gym performance, and;
• the promotion of a narrow ideal of masculinity, portraying femininity as undesirable or shameful for men. 

 

The study shows how these narratives closely mirror those promoted within the manosphere, where hormone levels are presented as a measure of manhood and testosterone is positioned as a way for men to reclaim power, status and control.

 

Posts frequently used crisis language around sexual performance, energy and confidence, encouraged men to “be their own advocate” and seek testing, and positioned private clinics and direct-to-consumer products as faster and more effective than conventional healthcare. 

 

“These messages are turning testosterone into a lifestyle enhancement product that defines masculinity,” said Dr Nickel. “The problem isn’t that men care about their health, it’s that social media is medicalising normal experiences and selling young men a dangerous, often false diagnosis.”

 

Why this matters for men’s health

 

Historically known as an age-related condition that affects older men, the social media posts included in the study repeatedly rebranded low testosterone as a problem affecting younger men, particularly those engaged in fitness and body optimisation. 

 

Sexualised gym imagery, muscular physiques, and before and after transformation photos and stories reinforced the idea that testosterone is a gateway to strength, dominance and sexual success, while routine testing and ongoing hormone monitoring were advised.

 

The study highlights the medicalisation of masculinity, where normal variation in men’s bodies and experiences is reduced to a testosterone deficiency with a simple fix. The researchers say mass screening for low testosterone is not clinically recommended, as healthy men often have lower levels without symptoms, and there are significant health risks associated with testosterone therapy. 

 

Dr Ray Moynihan, co-author and senior research fellow at the School of Public Health, said the study reveals how online misinformation is shaping young men’s identity and health choices. 

 

“Like many men, I’m appalled by the manosphere and these misguided and misleading versions of masculinity, which only serve to undermine the capacity of men and boys to have meaningful and mature human relationships,” he said. 

 

“Promoting testing and treatment to men without clear medical indications raises concerns about overdiagnosis and overtreatment,” added Dr Nickel. “When testosterone is sold as a shortcut to confidence and success, it’s doing more harm than good.  

 

“Manosphere-driven health narratives can amplify fear, shame and distrust of mainstream healthcare. They shape how men understand their bodies, ageing and identity, and often lead to negative self-perception and mental health,” she said.