Only a small proportion of hypogonadal men receive testosterone replacement therapy (TRT), a new study suggests. Among these patients, less than half have recommended follow-up tests.

For the study, investigators identified men aged 18–85 years from Chicago’s NorthShore University Health System who obtained testing for serum total testosterone during 2009–2012. Among the more than 9,176 largely Caucasian men, 3,320 (36%) were found to have hypogonadism, with an average total testosterone level of 194.3 plus or minus 64.9 ng/dL. The researchers defined low testosterone as less than 300 ng/dL.

Only 17.7% of hypogonadal men received TRT, according to results published online ahead of print in Urology. Of these, less than half (40%) had follow-up liver function tests and/or complete blood counts within 6 months, and only 49% had a follow-up test to measure serum testosterone. Urologists tended to treat hypogonadal men more often, whereas endocrinologists more often prescribed TRT.

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The prevalence of hypogonadism far outweighs the treatment rate in this study and others, according to a research team led by Rena D. Malik, MD, of the University of Chicago Medicine and Biological Sciences. “Potential reasons for this may include physician discomfort with the prescription of TRT, controversy surrounding threshold values of serum testosterone levels for clinical hypogonadism, lack of large scale randomized studies attesting to the safety of TRT, or lack of familiarity with the literature regarding benefits of TRT.”

Among men aged 18–35 years, 4.8% received TRT, despite the potential risks of impaired spermatogenesis, testicular atrophy, and infertility.

“Although it is plausible that these men did not desire fertility, it is unclear if they understood the absolute risk of infertility associated with TRT,” the investigators stated. It remains important to counsel younger men about the risks of therapy.


  1. Malik, R, et al. Published online by Urology, April 7, 2015; doi: 10.1016/j.urology.2015.01.027.