Only a small number of men who were prescribed testosterone therapy received appropriate, guideline-concordant diagnostic testing, according to a study being presented Saturday at ENDO 2026, the Endocrine Society’s annual meeting in Chicago, Ill, by Sophia Sinha, M.D., clinical assistant professor at the University of Michigan in Ann Arbor, Mich.
“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,” said senior author Maria Papaleontiou, M.D., associate professor at the University of Michigan in Ann Arbor, Mich.
The retrospective chart review included a random sample of 200 males assigned at birth (mean age, 52.5 years) with at least one outpatient primary care visit at Michigan Medicine in the past year, who had a diagnosis of hypogonadism, and received an initial testosterone prescription during the study period (2020 to 2025).
The most common coexisting medical conditions in the study population included obesity (63%), hypertension (52%), depression (40%), diabetes (28%) and arthritis (28%).
That data show only 12% of men who received an initial testosterone prescription had two low morning testosterone levels (total testosterone < 300ng/dL), free testosterone < 70pg/mL, or low bioavailable testosterone, between 5 a.m. and 10 a.m.), had their LH and/or FSH measured, and had no contraindications to testosterone therapy.
More than half of the patients (62%) had a prostate-specific antigen (PSA), and 77% had a complete blood count measured in the year before the initial testosterone prescription.
Overall, 55% of the men had obstructive sleep apnea, 4% prostate cancer and 1.5% PSA >4 ng/mL before being prescribed testosterone.
Prescriptions were written by primary care physicians (45%), urologists (35.5%), endocrinologists (18%) and other specialists (1.5%). The most common testosterone prescription was a topical formulation (68.5%).
Sinha and Papaleontiou said improving guideline-concordant testosterone prescribing can help prevent avoidable risks in people who may not have a true clinical need for it.
“Future studies should evaluate whether targeted interventions are needed,” Papaleontiou said.
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