Managing testosterone deficiency in primary care: an international expert consensus

BACKGROUND: Testosterone deficiency (TD) has traditionally been managed by specialists, yet there is growing public demand for general practitioners (GPs) to become involved in the care of these men. Most TD cases initially present to GPs, and common medical conditions associated with TD are already managed by GPs, including obesity, diabetes, anaemia, and impaired mood. However, there has been scant clinical guidance or education for GPs on this topic. AIM: To provide consensus-based expert clinical guidance on the management of TD for GPs. DESIGN AND SETTING: International multidisciplinary consensus initiative sponsored by the Androgen Society. METHOD: An international panel of experts- including GPs, endocrinologists, urologists, andrologists, and clinical chemists- convened in Amsterdam in November 2025 to establish key points of guidance (resolutions) for GPs wishing to manage TD. Resolutions were subsequently refined in an iterative consensus process. RESULTS: Unanimous consensus was achieved for all ten resolutions, covering diagnosis, treatment, monitoring, and recommendations for referral to specialists for selected populations. Key points included the requirement of symptoms and/or signs of TD combined with low values of either total or free testosterone to initiate testosterone therapy (TTh); total testosterone concentrations less than 12 nmol/L (350 ng/dl) are considered low; and monitoring for symptom response and biochemical abnormalities is essential. Large randomized clinical trial data reveals TTh is not associated with increased cardiovascular or prostate cancer risks. CONCLUSION: These evidence-based, clinical recommendations serve as a practical guide for GPs wishing to incorporate the evaluation and management of men with TD into their practices.