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Life sciences · Journal article
Endocrine · August 8, 2026
Reinforces what was already believed, rather than introducing something new.
This retrospective audit of 294 men referred for low testosterone to two Australian tertiary centres over 5 years documents that functional causes (43%) outnumber pathological diagnoses individually, obesity and sleep apnoea are prevalent (65% and 28% respectively), and testosterone replacement therapy is prescribed in only 25% of cases—less often in functional than pathological forms (23% vs. 45%). The findings support clinical prioritisation of metabolic and reversible contributors before testosterone therapy and confirm that current prescribing broadly aligns with guideline recommendations.
Retrospective cohort study (two-centre audit). All consecutive new male patients assessed for low testosterone levels at Gold Coast University and Robina Hospitals over the study period; setting Australian tertiary endocrine referral centres. Intervention: Assessment for low testosterone (diagnostic workup, biochemical testing, imaging, management decisions). n = 294. Two centres: Gold Coast University Hospital and Robina Hospital, Australia.
Functional low testosterone 43% of cohort, exceeding all pathological diagnostic categories combined individually Obesity affected 65% of patients; obstructive sleep apnoea 28%, highest in functional low testosterone (48%; p < 0.001) TRT prescribed in 25% of men overall, less often in functional than pathological forms (23% vs. 45%; OR 0.37, 95% CI 0.22–0.62; p < 0.001)
Safety was not reported in the material analysed. Check the source before drawing any conclusion about harm.
Clinicians should recognise that the majority of men referred with low testosterone have functional (metabolic/reversible) rather than structural endocrine disease, and should prioritise investigation and management of obesity, sleep apnoea, and other modifiable factors before initiating testosterone replacement therapy. The low rate of pituitary imaging (25%) with actionable findings (4% of imaged men) supports a selective imaging approach aligned with current guideline recommendations.
Retrospective two-centre audit of 294 consecutive referrals confirms that functional low testosterone predominates over pathological causes and that current prescribing aligns with guideline restrictions, supporting existing clinical approaches but lacking a comparator arm or interventional design.
As stated by the source record.
Quoted from the source exactly as published.
Clinicians should recognise that the majority of men referred with low testosterone have functional (metabolic/reversible) rather than structural endocrine disease, and should prioritise investigation and management of obesity, sleep apnoea, and other modifiable factors before initiating testosterone replacement therapy. The low rate of pituitary imaging (25%) with actionable findings (4% of imaged men) supports a selective imaging approach aligned with current guideline recommendations.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Abstract Background The epidemiology and outpatient management of low testosterone in Australian tertiary care remain poorly characterised. Rising testosterone prescription rates and evolving guidelines underscore the need to delineate contemporary referral patterns, diagnostic adherence, and therapeutic practice. Methods A retrospective review was undertaken of all new male patients assessed for low testosterone levels at Gold Coast University and Robina Hospitals between 2020 and 2024. Demographic, biochemical, and management data were extracted from the integrated electronic medical record. Continuous variables were analysed using the Kruskal–Wallis test, categorical variables using χ² or Fisher’s exact test, and binary logistic regression identified predictors of testosterone replacement therapy (TRT) initiation and pituitary imaging. Results Among 294 consecutive referrals, functional low testosterone (43%) exceeded all pathological diagnostic categories combined individually. Obesity affected 65% of patients and obstructive sleep apnoea 28%, the latter highest in functional low testosterone (48%; p < 0.001). Two-thirds of referrals included two early-morning testosterone samples, pituitary imaging was performed in one-quarter of patients, with clinically actionable abnormalities identified in 4% of imaged men. TRT was prescribed in 25% of men, less often in functional than pathological forms (23% vs. 45%; OR 0.37, 95% CI 0.22–0.62; p < 0.001). Most patients were discharged after a median of three visits and six months’ follow-up. Functional low testosterone was associated with a high burden of cardiometabolic and psychological comorbidity. Across the entire cohort, 31% reported previous androgen exposure. Conclusions Most men referred with low testosterone did not have structural hypothalamic–pituitary–testicular axis disease, supporting a clinical approach prioritising identification of metabolic and reversible contributors before testosterone therapy. Diagnostic completeness and adherence to guideline-recommended imaging vary, but testosterone prescribing generally aligns with current Endocrine Society of Australia (ESA) and Pharmaceutical Benefits Scheme (PBS) restrictions. These findings support the establishment of a dedicated andrology service integrating metabolic, reproductive, and psychological care to optimise assessment and outcomes in men with androgen deficiency.
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