CHICAGO, ILL. — A study presented Saturday at ENDO 2026 in Chicago, Ill., found that 12 percent of initial testosterone prescriptions met clinical guidelines. Sophia Sinha, a clinical assistant professor at the University of Michigan in Ann Arbor, Mich., presented the research.

The study utilized a retrospective chart review of a random sample of 200 males assigned at birth. Participants had at least one outpatient primary care visit at Michigan Medicine during the year preceding an initial testosterone prescription issued between 2020 and 2025. All participants in the study had a diagnosis of hypogonadism, and their mean age was 52.5 years.

The clinical guidelines for a testosterone prescription required two low morning testosterone levels, a measurement of LH and/or FSH, and no contraindications to therapy. Low morning testosterone was defined as a total testosterone measurement below 300 ng/dL, free testosterone below 70 pg/mL, or low bioavailable testosterone, with measurements taken between 5 a.m. and 10 a.m.

Various health conditions were present within the study population: 63 percent were affected by obesity, 52 percent by hypertension, 40 percent by depression, and 28 percent by diabetes and 28 percent by arthritis. Before receiving testosterone, 55 percent of the men had obstructive sleep apnea, and 4 percent had prostate cancer. A prostate-specific antigen level greater than 4 ng/mL was recorded in 1.5 percent of the men prior to their prescription.

A prostate-specific antigen test was performed for 62 percent of patients in the year before their initial testosterone prescription. A complete blood count was measured for 77 percent of patients in the year before their initial testosterone prescription.

Primary care physicians authored 45 percent of the prescriptions in the study, while urologists were responsible for 35.5 percent. Endocrinologists authored 18 percent of the prescriptions, and other specialists accounted for 1.5 percent. Topical formulations comprised 68.5 percent of the testosterone prescriptions.

Maria Papaleontiou, an associate professor at the University of Michigan and senior author of the study, said, "Our study findings highlight opportunities to improve patient care and reduce inappropriate testosterone prescribing." She added, "Long-term, these findings can lead to quality-improvement efforts and clinical decision support tools that promote consistent, guideline-concordant testosterone prescribing." "Future studies should evaluate whether targeted interventions are needed." Papaleontiou said.