Private Testosterone Prescribing Is Growing Too Fast, Says BMJ

A new editorial published in the British Medical Journal cautions that private testosterone prescribing has expanded so quickly that treatment is increasingly being offered to men with vague, non-specific symptoms and borderline blood test results — groups for whom the balance of benefit against risk is far less certain than in men with a clearly established clinical need.

The concern centres on testosterone replacement therapy (TRT), a treatment originally intended for men with hypogonadism — a condition where the body produces too little testosterone, confirmed by blood tests and associated symptoms such as fatigue, low libido, and reduced muscle mass. But the BMJ warns that the private sector’s growth in this area means prescribing may now be reaching well beyond that defined group.

Men with borderline test results sit in genuinely uncertain territory. Their symptoms may have other causes entirely, and the long-term effects of testosterone treatment in this population aren’t fully established.

According to the BMJ editorial, the risk-benefit calculation changes considerably when treatment moves away from men with a clear hormonal deficiency. Side effects of testosterone therapy can include raised red blood cell counts, effects on fertility, and cardiovascular changes — risks that are more justifiable when the clinical need is unambiguous.

The editorial does not call for a ban on private prescribing, but it does flag that the speed of market expansion may be outpacing the evidence base for who should receive treatment.

Anyone concerned about symptoms associated with low testosterone should speak to their GP in the first instance, rather than seeking a private prescription independently. NHS 111 can also provide guidance on next steps.