Most Men on Testosterone Therapy Never Got Proper Diagnostic Testing
Only 12% of men prescribed testosterone received guideline-recommended testing, raising safety and efficacy concerns.
Summary
A retrospective chart review of 200 men prescribed testosterone therapy found that only 12% received guideline-concordant diagnostic testing before starting treatment. Researchers at the University of Michigan reviewed records of male patients diagnosed with hypogonadism, finding widespread gaps in pre-treatment evaluation. Nearly 40% had appropriate lab work but received testosterone despite documented contraindications like sleep apnea, prostate cancer, or elevated PSA. Testosterone prescriptions have quadrupled over the past 30 years in the U.S. without a corresponding rise in hypogonadism diagnoses. Risks of unsupervised testosterone use include high blood pressure, abnormal red blood cell production, and infertility. The findings, presented at ENDO 2026, highlight a systemic gap in clinical practice that could expose patients to preventable harm.
Detailed Summary
Testosterone therapy is one of the fastest-growing hormone prescriptions in the United States, yet a new study reveals that most men receiving it never underwent the diagnostic testing required by medical guidelines. Presented at ENDO 2026, the annual Endocrine Society meeting, the findings expose a significant disconnect between prescribing practices and evidence-based standards of care.
Researchers at the University of Michigan conducted a retrospective chart review of 200 randomly selected adult male patients diagnosed with hypogonadism. They assessed whether patients received the Endocrine Society's recommended workup before their first testosterone prescription. This includes two confirmed low morning testosterone readings, measurement of LH and FSH hormones, and a check for contraindications. Only 12% of patients met all these criteria. Nearly 40% had adequate lab results but were prescribed testosterone despite documented contraindications including obstructive sleep apnea, prostate cancer, or elevated PSA levels.
The most common reasons triggering evaluation were fatigue, erectile dysfunction, and decreased libido — symptoms that overlap with many other conditions. The median patient BMI was 32 and over half had documented sleep apnea, itself a contraindication to testosterone therapy. Over three-quarters of patients carried two or more comorbidities, including obesity and hypertension, making careful diagnostic evaluation especially critical.
These findings matter because testosterone prescriptions in the U.S. quadrupled over the last 30 years while actual hypogonadism diagnosis rates remained stable — a pattern suggesting widespread off-label or insufficiently justified use. Known risks of testosterone therapy include erythrocytosis, infertility, and cardiovascular effects.
The researchers emphasize that the study identifies clear opportunities for clinical decision support tools and quality-improvement initiatives to standardize testosterone prescribing. For health-conscious individuals, this underscores the importance of demanding thorough diagnostic evaluation before starting hormone therapy rather than relying solely on symptom-based prescribing.
Key Findings
- Only 12% of men prescribed testosterone received full guideline-recommended diagnostic testing before treatment.
- Nearly 40% had appropriate lab work but received testosterone despite documented contraindications like sleep apnea or prostate cancer.
- Testosterone prescriptions quadrupled in 30 years in the U.S. without a proportional rise in hypogonadism diagnoses.
- Over 55% of study patients had obstructive sleep apnea, a contraindication to testosterone therapy, yet were still prescribed it.
- Fatigue and erectile dysfunction were the most common triggers for testosterone evaluation, symptoms with many non-hormonal causes.
Methodology
This is a conference presentation summary from MedPage Today covering a retrospective chart review of 200 patients at a single academic institution presented at ENDO 2026. As a single-center study with a limited sample size, generalizability is constrained. The findings have not yet been published in a peer-reviewed journal, so full methodological details remain unverified.
Study Limitations
Single-center, retrospective design limits generalizability to broader prescribing practices across different healthcare settings. The study sample was 83% white and drawn from one academic medical center, which may not reflect community or direct-to-consumer testosterone prescribing patterns. Full peer-reviewed publication is pending, so complete methodology and statistical details are not yet available.
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