CHICAGO — Few men prescribed testosterone therapy received guideline-concordant diagnostic testing for androgen deficiency, and some received therapy despite contraindications, a retrospective chart review indicated.
In a random sample of 200 male patients cared for at a single institution, only 12% underwent testing according to the Endocrine Society’s recommendations. This included having two low morning testosterone levels followed by measuring LH and/or FSH, as well as having no contraindications to testosterone therapy. Low testosterone was defined as total testosterone below 300 ng/dL, free testosterone below 70 pg/mL, or low bioavailable testosterone between 5 a.m. and 10 a.m.
Nearly 40% of men who received testosterone had appropriate low morning testosterone level checks, LH, and/or FSH, but they had contraindications to treatment.
“This highlights quite a discrepancy in testosterone prescribing practice,” said Sophia Sinha, MD, of the University of Michigan (UMich) in Ann Arbor at ENDO 2026, the annual meeting of the Endocrine Society.
Co-author Maria Papaleontiou, MD, also of UMich, added that the study findings “highlight opportunities to improve patient care and reduce inappropriate testosterone prescribing. Long-term, these findings can lead to quality-improvement efforts and clinical decision support tools that promote consistent, guideline-concordant testosterone prescribing.”
Testosterone prescriptions quadrupled in the last 3 decades across the U.S. despite stable rates of male hypogonadism diagnoses, noted Sinha. Studies have shown that testosterone is being prescribed in many without clear proof of androgen deficiency.
A recent cross-sectional study reported increases in testosterone therapy use across all age ranges from 2018 to 2022, including in those 24 and under (120%), 25 to 34 (86%), 35 to 44 (45%), 45 to 54 (35%), 55 to 64 (17%), and 65 and older (12%).
“There are risks involved with testosterone use, including hypertension, erythrocytosis, infertility, and also concerns for abuse, so we wanted to understand testosterone prescribing practices at our institution, the University of Michigan,” Sinha noted.
The researchers performed a retrospective chart review of a random sample of adult male patients with a documented diagnosis of hypogonadism by ICD-9 or -10 codes. They assessed laboratory diagnostic evaluations prior to the first prescription and contraindications, which included an elevated prostate-specific antigen (PSA), a history of prostate cancer or breast cancer, erythrocytosis, and obstructive sleep apnea (OSA). Transgender individuals and patients with HIV were excluded.
The median patient age was 56, age of hypogonadism diagnosis was 53, and 83% were white. Two-thirds were sexually active and median BMI was 32.
Evaluation for hypogonadism was commonly triggered due to fatigue (63%), erectile dysfunction (62%), decreased libido (54%), and patient request (25%). Topical testosterone formulations were the most commonly prescribed (68.5%).
Over half (55%) of patients had documented OSA, 4% had prostate cancer, and 1.5% had a PSA greater than 4 ng/mL prior to the index testosterone prescription — all contraindications to testosterone therapy.
Most (76%) had two or more comorbidities, with the most common being obesity (63%), hypertension (52%), depression (40%), diabetes (28%), and arthritis (28%). Patients with two or more comorbidities were significantly less likely to receive an appropriate work-up for testosterone prescribing compared with those with fewer comorbidities (OR 0.25, 95% CI 0.08-0.80).
Testosterone was most commonly prescribed by primary care (45%), followed by urology (35.5%), and endocrinology (18%). Patients who received their prescription through endocrinology (OR 12.05, 95% CI 2.14-67.71) or urology (OR 5.62, 95% CI 1.12-28.19) were significantly more likely to have appropriate diagnostic evaluations than those prescribed testosterone by primary care.
Future studies should evaluate targeted interventions aimed at reducing inappropriate testosterone prescribing, Sinha suggested.
Source link : https://www.medpagetoday.com/meetingcoverage/endo/121749
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Publish date : 2026-06-14 20:20:00
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