Research suggests that only 12% of men receiving testosterone prescriptions underwent appropriate testing.
Only a small fraction of men prescribed testosterone therapy receive the diagnostic testing recommended by clinical guidelines, according to a study presented at ENDO 2026, the Endocrine Society’s annual meeting.
The retrospective chart review, presented by Sophia Sinha, MD, clinical assistant professor at the University of Michigan, analyzed 200 males diagnosed with hypogonadism who received an initial testosterone prescription between 2020 and 2025.
Data revealed that only 12% of patients met the criteria for guideline-concordant testing. This includes having two low morning testosterone levels—defined as total testosterone less than 300 ng/dL, free testosterone less than 70 pg/mL, or low bioavailable testosterone—measured between 5 am and 10 am. Criteria also included having luteinizing hormone or follicle-stimulating hormone measured and having no contraindications to the therapy.
“Our study findings highlight opportunities to improve patient care and reduce inappropriate testosterone prescribing. Long-term, these findings can lead to quality-improvement efforts and clinical decision support tools that promote consistent, guideline-concordant testosterone prescribing,” says Maria Papaleontiou, MD, associate professor at the University of Michigan, in a release.
Laboratory Assessment Trends
Regarding other laboratory assessments, 62% of patients had a prostate-specific antigen (PSA) test, and 77% had a complete blood count measured in the year before their initial prescription. Before being prescribed testosterone, 1.5% of the men had a PSA level greater than 4 ng/mL, and 55% had obstructive sleep apnea.
The study population had a mean age of 52.5 years. The most common coexisting medical conditions among the participants included obesity (63%), hypertension (52%), depression (40%), diabetes (28%), and arthritis (28%).
Prescriber Patterns
The researchers also tracked which specialties were issuing the prescriptions. Primary care physicians wrote 45% of the prescriptions, followed by urologists at 35.5%, and endocrinologists at 18%. Other specialists accounted for the remaining 1.5%. The most common prescription type was a topical formulation, used by 68.5% of the patients.
Sinha and Papaleontiou suggest that improving adherence to guidelines can help prevent avoidable risks for individuals who may not have a true clinical need for the therapy.
“Future studies should evaluate whether targeted interventions are needed,” says Papaleontiou in a release.
