Testosterone replacement therapy has become one of the fastest-growing treatments in men’s health, but new research suggests many patients receiving prescriptions may not meet established medical guidelines. A study presented at the Endocrine Society’s annual meeting found only 12 per cent of men prescribed testosterone at one major U.S. medical centre received the recommended diagnostic testing before beginning treatment. Researchers say the findings raise concerns that the hormone is being prescribed too broadly, exposing some patients to unnecessary health risks while highlighting the need for more consistent screening before treatment begins.
Researchers at the University of Michigan reviewed the records of 200 men diagnosed with testosterone deficiency between 2020 and 2025. Current guidelines recommend confirming low testosterone with two separate morning blood tests, evaluating hormone levels and ruling out medical conditions that could either explain the symptoms or make treatment unsafe. The study found only 12 per cent of patients met all of those criteria before receiving a prescription. More than half of the men studied also had sleep apnea, while four per cent had prostate cancer, both conditions that can complicate testosterone therapy.
Our study findings highlight opportunities to improve patient care and reduce inappropriate testosterone prescribing
-Dr. Maria Papaleontiou, University of Michigan
What is testosterone
Testosterone is a hormone responsible for regulating muscle mass, bone density, metabolism, energy levels, sex drive and fertility. Men with clinically low testosterone may experience fatigue, reduced libido, erectile dysfunction, depression and difficulty concentrating. For patients who meet diagnostic criteria, testosterone replacement therapy can improve many of those symptoms through injections, gels, patches or implanted pellets. Physicians stress, however, that treatment is intended for men with confirmed testosterone deficiency rather than those seeking improved athletic performance or anti-aging benefits promoted across social media.
People casually using testosterone
The popularity of testosterone has increased dramatically over the past three decades. Business Insider reports that as many as 11 million Americans now use testosterone replacement therapy, driven partly by growing awareness of men’s health issues and online trends promoting so-called « T-maxxing. » Physicians say that increased interest has encouraged more men to seek medical advice for symptoms they may have previously ignored. At the same time, specialists warn that aggressive marketing and wellness influencers have created unrealistic expectations about what testosterone therapy can accomplish for otherwise healthy men.
Researchers say inappropriate use carries real risks. Taking testosterone unnecessarily can suppress the body’s natural hormone production, making long-term dependence more likely. Treatment may also reduce sperm production and fertility, increase red blood cell counts and potentially raise the risk of blood clots, heart attack or stroke in certain patients. Men with untreated sleep apnea may see their condition worsen, while testosterone can also stimulate the growth of existing prostate cancer. Those risks are why current guidelines require careful testing before treatment begins.
Not every physician believes the findings demonstrate widespread inappropriate prescribing. Dr. Justin Dubin, a men’s health specialist who was not involved in the study, said some patients fall into clinical « gray areas » where treatment may still be appropriate despite not meeting every element of existing guidelines. He argues testosterone can be both overprescribed and underprescribed depending on the patient, noting that some men with significant symptoms may still benefit from therapy even when laboratory results are less straightforward. The American Urological Association is currently reviewing its clinical guidance and is expected to release updated recommendations within the next several years.
The Michigan study also identified who is writing the most prescriptions. Primary care physicians accounted for 45 per cent of testosterone prescriptions reviewed, followed by urologists at 35.5 per cent and endocrinologists at 18 per cent. The most common form of treatment was topical gels or creams, representing nearly 70 per cent of prescriptions. Researchers say future quality improvement efforts should focus on helping physicians consistently follow established diagnostic protocols before initiating hormone replacement therapy, particularly as demand continues to increase.
Researchers have clarified that the findings should not discourage men experiencing symptoms from seeking medical care. Instead, they argue the study reinforces the importance of confirming a diagnosis before beginning lifelong hormone therapy. Testosterone replacement remains an effective treatment for men with genuine testosterone deficiency, but specialists say proper testing is essential to ensure the benefits outweigh the risks. As testosterone continues moving into the mainstream of men’s health, physicians expect growing demand will be accompanied by closer scrutiny of who receives treatment, how it is prescribed and whether existing guidelines need to evolve alongside emerging evidence.
