Only 12% of Men Received Proper Testing Before Testosterone Prescription, Study Finds
A new study reveals a significant gap in adherence to clinical guidelines for testosterone therapy.
Key Findings
A study presented at ENDO 2026 found that only 12% of men who received an initial testosterone prescription had appropriate diagnostic testing per guidelines.
The retrospective chart review examined 200 males (average age 52.5 years) with hypogonadism who received their first testosterone prescription between 2020 and 2025 at Michigan Medicine.
Guidelines vs. Practice
Clinical guidelines recommend that before prescribing testosterone, clinicians should:
- Confirm low morning testosterone levels (total testosterone <300 ng/dL, free testosterone <70 pg/mL, or low bioavailable testosterone) measured between 5 a.m. and 10 a.m.
- Measure LH and/or FSH levels
- Rule out contraindications
Despite these recommendations, the study found significant gaps in pre-prescription evaluation.
Additional Testing Results
- 62% of patients had a prostate-specific antigen (PSA) test in the year before the prescription
- 77% had a complete blood count
Patient Characteristics and Comorbidities
The patients presented with multiple coexisting conditions:
- 63% had obesity
- 52% had hypertension
- 40% had depression
- 28% had diabetes
- 28% had arthritis
- 55% had obstructive sleep apnea
- 4% had prostate cancer
- 1.5% had PSA >4 ng/mL before the prescription
Prescribing Patterns
Prescriptions were written by primary care physicians (45%), urologists (35.5%), and endocrinologists (18%).
The most common formulation was topical (68.5%).
Expert Commentary
Sophia Sinha, M.D., clinical assistant professor at the University of Michigan, stated that the findings highlight opportunities to improve patient care and reduce inappropriate prescribing.
Senior author Maria Papaleontiou, M.D., associate professor at the University of Michigan, noted that the study can lead to quality-improvement efforts and clinical decision support tools.
Clinical Implications
Sinha and Papaleontiou emphasized that improving guideline-concordant prescribing may help prevent avoidable risks in patients without a true clinical need for testosterone therapy.
They concluded that future studies should evaluate whether targeted interventions are needed to address these gaps in care.