Managing testosterone deficiency in primary care: an international expert consensus.

Unanimous consensus was achieved across all ten resolutions covering diagnosis, treatment, monitoring, and referral recommendations for testosterone deficiency management in primary care.

• An international multidisciplinary panel including GPs, endocrinologists, urologists, andrologists, and clinical chemists convened in Amsterdam in November 2025.
• The consensus initiative was sponsored by the Androgen Society.
• Resolutions were subsequently refined in an iterative consensus process after the initial convening.
• The panel was described as an 'international panel of experts' covering multiple specialties relevant to testosterone deficiency management.

Both symptoms and/or signs of testosterone deficiency combined with low testosterone values are required before initiating testosterone therapy.

• The requirement is symptoms and/or signs of TD combined with low values of either total or free testosterone.
• This dual requirement (symptomatic plus biochemical) was identified as a key resolution for initiating testosterone therapy (TTh).
• Either total or free testosterone measurements can be used to establish low testosterone status.
• This resolution was among those achieving unanimous consensus.

Total testosterone concentrations less than 12 nmol/L (350 ng/dL) are considered low and are a threshold for clinical action.

• The specific threshold identified was less than 12 nmol/L, equivalent to 350 ng/dL.
• This threshold was established as part of the unanimous consensus resolutions.
• Free testosterone measurement was also identified as an alternative diagnostic parameter when total testosterone is borderline or symptoms persist.
• This cutoff was included among the key points of the consensus guidance.

Large randomized clinical trial data, including the TRAVERSE trial, reveals testosterone therapy is not associated with increased cardiovascular or prostate cancer risks.

• The TRAVERSE trial was specifically cited as a large randomised clinical trial confirming testosterone therapy safety.
• The consensus concluded that TTh is 'both safe and effective' based on this trial data.
• No increased cardiovascular risk was identified in the large randomized clinical trial data reviewed.
• No increased prostate cancer risk was associated with testosterone therapy according to the reviewed evidence.
• This safety profile was considered sufficient to support GP-level management of most cases.

Monitoring for symptom response and biochemical abnormalities is considered essential during testosterone therapy.

• Monitoring was identified as a key resolution among the ten unanimous consensus points.
• Both symptomatic response and biochemical parameters require monitoring during TTh.
• Specific monitoring parameters and intervals were addressed within the consensus resolutions.
• Monitoring was framed as an essential rather than optional component of TD management in primary care.

Testosterone deficiency frequently intersects with conditions already central to primary care, positioning GPs as ideally suited to diagnose and manage most affected men.

• Conditions listed as commonly co-occurring with TD include type-2 diabetes, obesity, fatigue, sexual dysfunction, anaemia, and impaired mood.
• Most TD cases initially present to GPs rather than specialists.
• The paper notes TD 'remains under-recognised in primary care' despite its prevalence.
• The expert panel concluded GPs are 'ideally positioned to diagnose and manage most affected men.'

Selected populations with complex presentations of testosterone deficiency warrant referral to specialists rather than GP management.

• Recommendations for referral to specialists for selected populations were included among the ten consensus resolutions.
• The specific criteria distinguishing complex cases from routine cases were addressed in the referral resolution.
• The guidance was designed to help GPs identify 'the subset of complex cases warranting specialist referral.'
• Referral guidance was presented alongside resolutions on diagnosis, treatment, and monitoring.

There has been scant clinical guidance or education available for GPs on the topic of testosterone deficiency management prior to this consensus.

• The paper identifies a gap in clinical guidance and education for GPs specifically on TD management.
• TD has traditionally been managed by specialists, leaving GPs without adequate preparation.
• Growing public demand for GP involvement motivated the development of these consensus recommendations.
• The consensus was described as addressing a previously unmet need for practical GP-level guidance.