Overview
- Researchers at the University of Michigan reported June 14, 2026 that a retrospective review of 200 men given an initial testosterone prescription between 2020 and 2025 found only about 12% received the full diagnostic workup recommended by the Endocrine Society.
- Guideline-concordant testing in the study meant two separate morning low testosterone measurements plus pituitary hormone tests (LH or FSH) to distinguish primary from secondary causes of low testosterone.
- Many patients had potential contraindications when therapy was started: 55% had recorded obstructive sleep apnea, 4% had prior prostate cancer, and 1.5% had a PSA above 4 ng/mL, raising risks for worsening sleep apnea, fertility loss, and hematologic or prostate concerns.
- Prescribing varied by specialty and formulation: primary care wrote 45% of initial prescriptions, urologists 35.5%, endocrinologists 18%, and topical gels or patches accounted for 68.5% of prescriptions.
- Authors and commentators say the pattern reflects demand-side drivers such as patient requests, social media and direct-to-consumer marketing and call for targeted interventions like clinical decision support, standardized order sets, and quality audits to reduce inappropriate starts and protect patients.