Testosterone Prescribing Often Skips Recommended Testing

Originally surfaced June 17, 2026, drawing on Endocrine Society ENDO 2026 materials released June 13, 2026.

A study presented at ENDO 2026 found a large gap between testosterone-prescribing guidance and documented pre-prescription testing in one health-system chart review.

The Endocrine Society release describes a retrospective review of 200 adult men at Michigan Medicine who had a hypogonadism diagnosis and received an initial testosterone prescription between January 2020 and January 2025. The mean age at the first prescription was 52.5 years.

Only 12% of men in the review had the full guideline-concordant diagnostic pattern documented before testosterone was prescribed: two low morning testosterone measurements, LH and/or FSH measurement, and no contraindications to testosterone therapy. The ENDO abstract defined the low morning testosterone pattern as total testosterone below 300 ng/dL, free testosterone below 70 pg/mL, or low bioavailable testosterone, measured between 5 a.m. and 10 a.m.

That finding does not prove that every prescription was clinically wrong. It does show that the documented diagnostic workup often did not match the testing framework professional guidance describes.

What the guideline workup is trying to separate

Testosterone results are not interpreted like a simple yes-or-no screen. The Endocrine Society's 2018 clinical practice guideline says hypogonadism should be diagnosed in men with symptoms or signs of testosterone deficiency and unequivocally and consistently low testosterone concentrations. It also recommends confirming the diagnosis by repeating a morning fasting total testosterone measurement.

The LH and FSH step matters because those pituitary hormones help separate primary testicular hypogonadism from secondary pituitary or hypothalamic causes. That distinction can change the clinical question. A low testosterone value by itself does not explain why the value is low.

This is why a single total testosterone result is usually not the whole story. Timing, repeat measurement, symptoms, and related hormones all shape the interpretation.

The study population and prescribing pattern

The ENDO abstract reported that evaluation was commonly initiated because of fatigue, erectile dysfunction, decreased libido, or patient request. The study population also had a substantial burden of coexisting conditions, including obesity, hypertension, depression, diabetes, arthritis, and obstructive sleep apnea.

Prescriptions came from several specialties: 45% from primary care, 35.5% from urology, 18% from endocrinology, and 1.5% from other specialties. Topical testosterone was the most common prescription form.

Papaleontiou also noted in the Endocrine Society statement that testosterone prescriptions in the United States have quadrupled over the past three decades despite stable hypogonadism prevalence. She said nonconcordant prescribing may expose patients to avoidable risks without clinical benefit.

Those details matter because this is not a story about one specialty behaving badly. It is a documentation and workflow story across the places where testosterone conversations happen.

The LTS testing context

LabTestSuperstore has a total testosterone test, a free and total testosterone test, and a comprehensive testosterone test. Related hormone pages include LH and FSH. The ENDO 2026 finding is a reminder that these tests answer different parts of the hormone-workup question.

For safety-monitoring context, the study also reported that 62% of patients had a PSA test and 77% had a complete blood count measured in the year before the initial prescription. LabTestSuperstore has background pages for PSA testing and CBC testing, but this article is not a monitoring checklist or a treatment guide.

For broader background, see our low testosterone symptoms and erectile dysfunction pages.

What not to overread

This was a retrospective chart review from one institution, presented as ENDO conference data. It has not yet gone through the same review path as a full journal publication. The sample was 200 men, and the chart-review design depends on what was documented.

The useful conclusion is narrower than some headlines suggest: documented testosterone prescribing workups were often not guideline-concordant. That is different from saying every nonconcordant prescription was inappropriate or that testosterone therapy is never useful.

This article is editorial commentary and is not medical advice. It has not been reviewed by a physician and should not be used to make decisions about testosterone testing, testosterone therapy, fertility, prostate screening, sleep apnea, or hormone treatment.