Summary
A BMJ editorial argues that growth in commercial testosterone prescribing could shift treatment monitoring and side-effect management to the NHS. It calls for national reporting of private prescriptions and transfers of care.
A BMJ editorial published on 14 October 2026 argues that the expansion of private testosterone prescribing could increase the NHS workload for monitoring treatment and managing side effects. The commissioned editorial, by Stephen L Atkin and Eric S Kilpatrick, calls for national reporting of private prescribing, including treatment indications and transfers of care. It is an editorial, not a new clinical study, and was not externally peer reviewed.
The authors cite NHS Business Services Authority data showing that community dispensing of testosterone rose by 52% between 2020-21 and 2024-25. Private prescriptions are not recorded nationally, so their total volume is unknown. The editorial describes private and online clinics offering monthly subscriptions priced at £100-£375, which can include blood monitoring, telemedicine consultations and home delivery.
Why diagnosis is more than a testosterone test
Testosterone deficiency can be associated with symptoms including reduced libido, erectile dysfunction, fatigue and low mood. But the editorial stresses that these symptoms and a single low measurement are not enough to settle a diagnosis. Its account of diagnostic guidance describes testing total testosterone in two fasting samples: a level below 8 nmol/L confirms deficiency, while 8-12 nmol/L is classed as possible deficiency.
Clinicians also need to consider reversible causes. Obesity, some medicines, sleep apnoea and depression can contribute to low testosterone; the editorial notes that obesity-related “pseudo-hypogonadism” may respond better to weight loss than to testosterone treatment. Investigating these factors and repeating tests takes time, which the authors say may be difficult to accommodate in rapid-access subscription services marketed around non-specific symptoms.
Guidance thresholds also differ. The editorial gives examples from two professional societies: one recommends treatment for symptomatic men with testosterone below 12 nmol/L, or below 14 nmol/L in people with non-diabetic hyperglycaemia; another suggests treatment when three sexual symptoms accompany a level below 11 nmol/L. The authors say NHS clinicians may encounter patients who began private treatment under a more permissive threshold of 15 nmol/L or lower, making the diagnostic record and rationale important when continuation of treatment is requested.
Monitoring and responsibility after private treatment
The editorial points to the randomised, placebo-controlled TRAVERSE trial, which included 5,246 men aged 45-80 with confirmed hypogonadism and cardiovascular risk. Over a mean treatment duration of about 22 months and mean follow-up of 33 months, testosterone was non-inferior to placebo for major adverse cardiovascular events. The trial also found higher rates of atrial fibrillation, acute kidney injury and pulmonary embolism in the testosterone group; the reported absolute risk of atrial fibrillation was 3.5%, compared with 2.5% with placebo. These findings apply to the trial’s study population, rather than establishing risks for every person prescribed testosterone.
Ongoing monitoring is therefore part of the care pathway. The authors argue that NHS services may end up handling tests or side effects for people who started treatment privately. They note that, under the GMC and BMA guidance discussed in the editorial, responsibility remains with the private clinician who initiated treatment unless an NHS GP formally agrees to shared care.
The editorial recommends a reporting framework for private prescribers and dispensing pharmacies, covering indications, patient numbers, monitoring and transfers of care. Its aim is to make prescribing and responsibility clearer while retaining access to treatment for people who meet appropriate criteria.