Testosterone Therapy in Men May Be Overprescribed, Study Finds Only 12% of Prescriptions Follow Clinical Guidelines
核心洞察
A University of Michigan study found only 12% of men prescribed testosterone received guideline-concordant diagnostic testing before their initial prescription.
The retrospective review of 200 patients at Michigan Medicine revealed that more than half had contraindications such as obstructive sleep apnea (搜索) or prostate cancer (搜索).
Primary care physicians wrote 45% of prescriptions, urologists 35.5%, and endocrinologists 18%, with topical formulations being the most common at 68.5%.
Only 12% of men who received an initial testosterone prescription underwent appropriate, guideline-concordant diagnostic testing, according to a study presented Saturday at ENDO 2026, the Endocrine Society's annual meeting in Chicago, Illinois. The findings raise significant concerns about the quality of care in one of the fastest-growing corners of men's health.
"Our study findings highlight opportunities to improve patient care and reduce inappropriate testosterone prescribing," said senior author Maria Papaleontiou, M.D., associate professor at the University of Michigan in Ann Arbor. "Long-term, these findings can lead to quality-improvement efforts and clinical decision support tools that promote consistent, guideline-concordant testosterone prescribing."
Study Design and Patient Population
The retrospective chart review, led by Sophia Sinha, M.D., clinical assistant professor at the University of Michigan, examined a random sample of 200 males assigned at birth with a mean age of 52.5 years. All patients had at least one outpatient primary care visit at Michigan Medicine in the preceding year, carried a diagnosis of hypogonadism (搜索), and received an initial testosterone prescription during the study period spanning 2020 to 2025.
The study population carried a substantial burden of coexisting medical conditions. Obesity (搜索) was present in 63% of patients, followed by hypertension (搜索) (52%), depression (搜索) (40%), diabetes (搜索) (28%), and arthritis (28%).
Guideline Concordance Falls Short
To meet guideline-concordant prescribing criteria, patients needed two low morning testosterone levels—defined as total testosterone below 300 ng/dL, free testosterone below 70 pg/mL, or low bioavailable testosterone—drawn between 5 a.m. and 10 a.m., along with measurement of luteinizing hormone (LH) and/or follicle-stimulating hormone (FSH), and no contraindications to testosterone therapy. Only 12% of men met all these requirements.
The study also revealed that 62% of patients had a prostate-specific antigen (PSA) test and 77% had a complete blood count measured in the year prior to their initial prescription. More than half of the men (55%) had obstructive sleep apnea (搜索), 4% had prostate cancer (搜索), and 1.5% had a PSA level exceeding 4 ng/mL before being prescribed testosterone—all conditions that warrant caution or represent contraindications.
Prescribing Patterns
Prescriptions were written across multiple specialties: primary care physicians accounted for 45%, urologists for 35.5%, endocrinologists for 18%, and other specialists for 1.5%. Topical formulations were the most commonly prescribed form of testosterone therapy, representing 68.5% of initial prescriptions.
Sinha and Papaleontiou emphasized that improving guideline-concordant testosterone prescribing can help prevent avoidable risks in people who may not have a true clinical need for the therapy. "Future studies should evaluate whether targeted interventions are needed," Papaleontiou said.
Clinical Implications
The findings underscore a gap between real-world prescribing practices and established clinical guidelines. Testosterone replacement therapy requires careful diagnostic workup, as levels fluctuate daily and symptoms such as fatigue, brain fog, and reduced libido can often be traced to other treatable causes including poor nutrition, sedentary lifestyle, or chronic sleep deprivation. The study suggests that many men may be receiving testosterone prescriptions without adequate baseline testing or despite the presence of contraindications, potentially exposing them to risks including worsening sleep apnea, elevated red blood cell counts, and other adverse effects.