The paracetamol controversy is a good example of how President Trump can take a complex problem and apply simple answers to it, writes Terry Maguire
Paracetamol Toxicity?
Donald Trump continues to claim that paracetamol taken in pregnancy causes autism, ADHD, and is linked to impaired intelligence. He made this claim in 2025 and it has already been a key element of his administration’s health policy during the first year of his second term in office. His claim is now supported by US health officials, who maintain that ‘many experts’ have expressed concern over paracetamol’s use in pregnancy.
In a speech in September 2025, President Trump said his administration was linking paracetamol to autism and, in turn, urged pregnant women to avoid the medicine. In 2025 a review led by Dr Andrew Baccarelli, Dean of the Harvard TH Chan School of Public Health, found that using paracetamol during pregnancy may increase children’s autism and ADHD risk, and urged caution over “especially heavy or prolonged use”.
In April 2025, Health Secretary Robert F Kennedy Jr had pledged that he would find the cause of a steep rise in reported autism cases – and that he would do this within six months, with particular attention paid to paracetamol and vaccines. This RFK Jr commitment was the reason for the Oval Office Presidential speech, referred to above.
The US Food and Drug Administration (FDA) then issued a letter to clinicians urging them to be cautious about the use of paracetamol in pregnancy, while also saying it was still the only drug approved for treating fevers during pregnancy. The FDA went on to say that “a causal relationship” between the drug and neurological conditions “has not been established”. Hardly a ringing endorsement of the President’s position.
The US advice is largely at odds with the rest of the world. At that time, the UK stressed that paracetamol remains the safest painkiller available to pregnant women. But the American claims led to confusion among women and concern among healthcare professionals and prompted new research that was published in The Lancet recently.
The Lancet article looked at 43 of the best-designed and robust studies into paracetamol use during pregnancy, involving hundreds of thousands of women. In particular, it compared pregnancies when women had taken the drug, to pregnancies when they hadn’t. In this way they could dismiss other factors, such as different genes and family environments, that might have an impact.
The research also looked at studies with a low risk of bias and those that followed children for more than five years to check for any link between paracetamol-taking and adverse outcomes.
The Lancet review found no association – there was no evidence that paracetamol increases the risk of autism, and this reinforced the guidance from major medical organisations in Ireland, the UK, US, and Europe on the drug’s safety.
In the chaos that is current US geopolitics, this story will go unnoticed, but it exemplifies what US President Trump does – ie, taking a complex and controversial problem and applying simple answers to it. Then, in the absence of any evidence, he claims to have solved the problem.
TRT – The New Way to Win Wars
In July, US Defence Secretary Pete Hegseth announced that all military personnel aged 30 and over will be annually screened for testosterone deficiency. Those with ‘low testosterone’ will be offered testosterone replacement therapy (TRT). ‘Warriors’ under 30 will be able to opt in for testing; however, the Pentagon is saying nothing on whether TRT will be available to women.
The evidence for an association between aggression and testosterone levels exists, but it is weak, according a 2019 meta-analysis. This weak association only exists in men and has a greater link to stressful situations that result in more aggressive outcome. Secretary Pete might not have considered the impact of his policy on domestic violence and bar-room brawls when his warriors are not fighting ‘bad people’, but trying to live civilian lives.
So, if you think that this is about soldiers ‘growing a pair’ and improving battlefield effectiveness, think again. Rather, it is a blatant marketing exercise on behalf of Big Pharma, who have been for years trying to normalise TRT as an essential life-long therapy for all men, and with some success. It is part of a broader push by the Trump administration to make it easier for medical professionals to prescribe testosterone. It’s all about business, Donald.
I first came across TRT marketing about 15 years ago at a professional meeting. I met a young, trendy lady GP, who told me that the big new thing in the Republic of Ireland was TRT – a sure-fire therapy for the flagging middle-aged male. She was being encouraged by her medical partners (males) to discuss with male patients the possibility that their tiredness, low mood, and general difficulties with life may not be symptoms of a mid-life crisis, but instead symptoms of the male menopause. “If testosterone levels are sub-normal, each man is a candidate for TRT,” she cynically confided.
Not feeling on top form that evening and looking pretty washed out, I wondered was I a potential candidate. I saw a lot of myself in her description – the train-crash that is the male middle-age – but I could not agree with a clinical ‘male menopause’.
“You’re right, it’s bollocks,” she replied with forthright clarity. “And a shame on my profession,” she continued. “The male menopause is merely a symptom of the financial downturn since 2008 affecting Irish GPs’ bottom-line.”
Bollocks it is, according to the learned New England Journal of Medicine. A study into the safety and efficacy of TRT was stopped in 2009 on safety grounds. A small matter of a four-fold increase in cardiac events and the appearance of that appalling phenomenon of ‘man-boobs’, as well as a rise in the prevalence of prostate cancer and breathing problems during sleep.
The British Medical Journal confirmed that the male menopause is a myth, as only 0.1 per cent of men over 40 years have low testosterone, and this only rises to 5 per cent of men in their 70s. Yet the marketing men tell us we now live in a ‘You-Only-Think-You’re-Fine’ culture – so when you start gaining weight, have a noticeable reduction in energy, and start to lose interest in (or performance during) sex, then sensibly, something is wrong and seeking a medical solution seems only rational.
Yet according to the BMJ, the link to an age-related reduction in testosterone levels and specific clinical symptoms remains weak. Notwithstanding this, there is a section of the medical profession committed to making all age-related phenomenon into diseases. And 13 million Americans – the number that have been converted to monthly TRT – cannot be wrong…
…there is a section of the medical profession committed to making all age-related phenomenon into diseases
Small Testicles
I was reminded of my evening with the aforementioned GP while sitting outside a Belfast bar recently. A friend of old with her new partner happened along. They joined us, and (let’s call him) John, in his early 50s, was introduced. As we finished the second cocktail, John, getting more relaxed, asked me if I had ever considered TRT, telling me it had done wonders for him.
He stood up from his chair, placed his palms on his flat stomach and slid them up to his shapely pectorals. “See that?” he said, “that’s the benefit of TRT.”
After he turned 50, John said he awoke regularly without an erection and therefore had a sense something was seriously wrong. Having sold a successful business in England, he is now retired and lives in Spain. When he presented his “serious erectile problem” to his Spanish doctor, the physician suggested blood samples and – surprise, surprise – found his testosterone to be sub-normal. He needed TRT.
When asked what a ‘normal’ testosterone level is, he confirmed it ranged from 225 to 1,100. He was unsure if the units were milli, micro, nano, or pico grams (they are ng/dL). Anyway, he was 229ng/dL and as a result, he now spends over £150 a month on a testosterone gel which he applies (to his arm).
Side-effects? None, other than the fact that his testicles have reduced in size from “peach-stone size” to “pea size” – and not even the marrowfat variety, we are talking sweet garden pea here. This is to be expected, as the testes are the main glands for production of testosterone and since it’s on a negative feedback system, when you inject synthetic testosterone, testicular production stops, thus the change in size.
The TRT had no impact on John’s hair, which he claimed was as bushy as when he was 18. He claimed to have read extensively on the topic and, for this reason, he also takes an anti-oestrogen to stop him developing ‘man-boobs’. He has never felt or been better and, yes, each morning he awakes, he is impressed.
The Science Bit
Males with clinically low testosterone benefit from TRT, and this is a well-defined field of clinical practice. The marketing men are seeking to change the definition of ‘low’ to include a much wider cohort of the male population. This risks medicalisation of the ageing male. Also, given that the supply of TRT is already occurring in a gym near you without any clinical supervision, it is already a serious public health concern. TRT is widely used in Northern Ireland and used illegally.
This is clearly a complex clinical area. Accepting that TRT has an important clinical benefit, wider use of TRT is not a risk-free panacea for the ills of the ageing baby-boomers or the battlefield performance of American Marines. And let’s not forget, it is an important issue for those with shares in pharma companies that supply TRT.
