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., on June 14.
The retrospective chart review included a random sample of 200 males assigned at birth with a mean age of 52.5 years. All participants had at least one outpatient primary care visit at Michigan Medicine in the past year, were diagnosed with hypogonadism, and received an initial testosterone prescription during the study period from 2020 to 2025.
Obesity was present in 63% of the study population. Other common coexisting medical conditions included hypertension (52%), depression (40%), diabetes (28%), and arthritis (28%). The data show only 12% of men who received an initial testosterone prescription had two low morning testosterone levels (total testosterone less than 300 ng/dL), free testosterone less than 70 pg/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 test measured before receiving their initial prescription for testosterone therapy. Additionally, complete blood count was measured for 77% within the year prior to prescription. Overall, obstructive sleep apnea was present in 55%, prostate cancer in four percent, and PSA greater than four ng/mL in one and a half percent before being prescribed testosterone.
Prescriptions were written by primary care physicians for forty-five percent of patients; urologists wrote thirty-five point five percent; endocrinologists accounted for eighteen percent; other specialists wrote prescriptions for one point five percent. The most common formulation prescribed was topical (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.
