A retrospective chart review presented at ENDO 2026 evaluated whether initial prescriptions for testosterone therapy in men at a single academic center adhered to guideline-recommended diagnostic testing and safety checks. The investigation focused on a random sample of patients receiving their first testosterone prescription during 2020–2025 at Michigan Medicine. Investigators highlighted opportunities to align prescribing with professional guidance to reduce avoidable risks.
The analysis included 200 people assigned male at birth who had at least one outpatient primary care visit at Michigan Medicine within the prior year and who carried a diagnosis of hypogonadism and received an initial testosterone prescription during the study period. The cohort’s mean age was 52.5 years. The study design was a retrospective review of electronic charts; further methodological details beyond the random sampling, inclusion criteria, and dates were not reported in the source.
Investigators defined a composite standard for guideline-concordant evaluation prior to initiating testosterone. To meet that standard, a patient needed:
Only patients who met all components of this composite were considered to have received a guideline-concordant diagnostic evaluation before the initial prescription.
Using the study’s composite definition, just 12% of men who received an initial testosterone prescription had the complete set of recommended diagnostic tests and no documented contraindication prior to therapy. Routine pre-prescription testing was variable: 62% of patients had a prostate-specific antigen (PSA) measured in the year before the prescription and 77% had a complete blood count (CBC) during that interval.
Comorbid conditions were common in the cohort. The most frequently recorded coexisting medical conditions were obesity (63%), hypertension (52%), depression (40%), diabetes (28%), and arthritis (28%). These comorbidities are relevant when assessing the indication for therapy, potential contributors to low testosterone, and individualized risk–benefit assessment.
Initial testosterone prescriptions originated from several specialties. Primary care physicians wrote 45% of the prescriptions, urologists 35.5%, endocrinologists 18%, and other specialists 1.5%. The predominant formulation prescribed was topical testosterone, accounting for 68.5% of initial prescriptions.
The review identified several findings relevant to safety screening and contraindications. Prior to the initial testosterone prescription, 55% of patients had a diagnosis of obstructive sleep apnea. Four percent had a prior prostate cancer diagnosis and 1.5% had PSA values greater than 4 ng/mL recorded before starting therapy. The presence of these conditions or test results may influence suitability for testosterone therapy and the need for specialist involvement or additional evaluation.
Sophia Hemmrich Sinha, MD, and senior author Maria Papaleontiou, MD, interpreted the results as evidence that many men are started on testosterone therapy without a full, guideline-recommended diagnostic evaluation. They emphasized that improving guideline-concordant prescribing could prevent avoidable risks for people who may not have a true clinical need for testosterone.
The authors recommended quality-improvement initiatives and the development of clinical decision support tools to promote more consistent, guideline-aligned prescribing. They also called for future studies to determine whether targeted interventions are required to change practice and to evaluate the impact of such interventions on patient care and safety.
The source describes the study as a retrospective chart review of a random sample at a single institution and provides specific cohort characteristics and testing rates. The article does not report additional methodological details such as sampling frame size, statistical methods, interrater reliability for chart abstraction, or long-term clinical outcomes following prescription, so those details are not available from the source.
Clinicians should be aware that, in this sample, most patients who started testosterone did not receive the full set of diagnostic tests described by the investigators’ composite guideline standard. The findings underscore the potential role for system-level interventions—such as decision support, standardized order sets, or targeted education—to increase adherence to diagnostic and safety recommendations before initiating testosterone therapy. Future research is needed to test interventions and to link guideline-concordant evaluation with clinical outcomes.