Rapid Growth in Private Testosterone Prescribing Raises Safety Concerns

On October 14, 2026, The BMJ published an analysis by Stephen Atkin and Eric Kilpatrick warning about oversight gaps in private testosterone prescribing in the UK. The authors called for better reporting and clearer responsibility for ongoing care.

How It Worked

The analysis, reported by News-Medical, examined prescribing and oversight rather than testing a treatment. It brought together market estimates and NHS community dispensing figures with concerns about diagnosis and follow-up.

There was no enrolled participant group or trial duration to describe. Its figures about symptoms refer to men over 50 rather than a group whose response to testosterone the authors tracked.

That distinction matters when reading this as health news. The analysis addresses how treatment is offered and monitored. It does not provide a new estimate of how much testosterone improves strength, energy or sexual function.

The useful focus is therefore the care process: how a clinician confirms a need for treatment and remains responsible afterward. For related reading on the diagnostic question, see how low-testosterone evaluations are framed.

What It Found

Symptoms need context

The BMJ analysis says up to one-fifth of men over 50 may report symptoms associated with testosterone deficiency. It also reports that fewer than 1% receive treatment through the NHS.

Those numbers describe different things. Symptoms are not a confirmed diagnosis, and the gap does not by itself establish unmet treatment need. Atkin and Kilpatrick describe declining testosterone and libido as natural aspects of ageing.

The authors say diagnosis takes time and repeated testing. Their position is not a rejection of testosterone replacement: they describe it as valuable for carefully selected patients.

Clinical concerns

The clinical points need to be separated into warnings from the analysis and an outcome reported in related trial evidence:

• Treatment selection: Atkin and Kilpatrick warn that men with non-specific symptoms or borderline results may receive treatment when the balance of benefit and long-term risk is less clear.
• Ongoing monitoring: The authors identify potential heart and kidney problems as risks requiring follow-up. This is a warning about monitoring needs rather than a finding that every treated man will develop those problems.
• Cardiovascular evidence: A 2026 review in the Journal of Clinical Endocrinology & Metabolism reports that TRAVERSE found testosterone non-inferior to placebo for major adverse cardiovascular events in the studied population.

In plain language, testosterone met the trial's standard for being no worse than placebo on that cardiovascular outcome. That result belongs alongside the BMJ authors' warning rather than replacing it.

Growth signals

The analysis reports an estimated UK testosterone replacement market value of about $205 million in 2024. It gives a projection of $365 million by 2032.

It also reports a 52% increase in NHS community testosterone dispensing between 2020/21 and 2024/25. The market figures are an estimate and forecast. The dispensing figure describes a recorded change in NHS provision.

Atkin and Kilpatrick point to more private and online clinics, subscription offers and advertising as signs of expansion. The reported marketing channels include social media, influencers and outdoor advertising.

A service may be easy to buy without making the diagnostic question simple. That is the commercial tension identified in the analysis: speed and convenience are not evidence that a hormone prescription is medically justified.

Responsibility for care

According to the analysis, the private clinician who starts treatment remains responsible unless an NHS GP formally agrees to shared care. A private prescription does not automatically transfer follow-up duties to the NHS.

The authors say patients may still approach NHS GPs informally for tests or help with side effects. That makes the care arrangement part of the treatment decision rather than an administrative issue to settle later.

For men paying privately, the practical distinction is between access to a prescription and an agreed plan for continuing care. The BMJ authors' warning concerns both.

Where Evidence Stops

The analysis leaves several questions open. These gaps affect how strongly its warning can be interpreted and which conclusions would go beyond the evidence.

Missing national records

Private testosterone prescriptions are not recorded nationally, so the scale of private provision is unknown. Neither the market forecast nor the NHS dispensing increase measures growth in private prescribing. Clinic expansion and advertising are indicators rather than a national prescription count.

This matters for the headline claim. The analysis makes a case for closer oversight, but it cannot establish the number of privately treated men or the rate at which that number is changing.

Different diagnostic thresholds

Professional-society guidance uses differing diagnostic thresholds, according to the authors. They raise the possibility that NHS clinicians may inherit care for patients treated under a more permissive private threshold.

The analysis does not establish how consistently private providers use repeated testing. It does not provide a measured failure rate across clinics. Its concern is diagnostic consistency rather than proof that every private provider offers inappropriate care.

Unanswered risk questions

The TRAVERSE result applies to its participants and its defined cardiovascular outcome. It is not proof of safety for every patient group, every treatment setting or every possible long-term risk.

The forecast that monitoring may create extra NHS work is also the authors' assessment. The analysis does not give a national total for that workload or its cost. Those questions require data rather than assumptions.

Useful care questions

For a man considering treatment, the practical response is to clarify the care plan with a qualified clinician. The analysis supports asking the following questions before a prescription becomes a long-term commitment:

1. How will the diagnosis be confirmed? Ask how symptoms and test results will be assessed together. The purpose is to understand the clinical reasoning rather than treating a symptom list or borderline result as the decision itself.
2. What follow-up is planned? Clarify who will review treatment and arrange ongoing monitoring. Ask whom to contact about side effects rather than assuming that responsibility sits with another clinician.
3. Who holds responsibility? If NHS involvement is expected, ask whether a GP has formally agreed to shared care. Access to an NHS GP is not the same as an agreed transfer of treatment responsibility.
4. What happens if care changes? Discuss how follow-up would continue if the private provider or care arrangement changes. The authors identify transfers of care as something that better national reporting should track.

These are questions about the quality and continuity of care, not instructions to start or stop therapy. Personal decisions about symptoms and treatment belong with a qualified clinician.

The same distinction between access and clinical justification matters when weighing broad claims for testosterone therapy. A clear explanation of why treatment is indicated matters more than how simple the offer appears.

What Changes

The authors propose national reporting by private prescribers and dispensing pharmacies. It would record prescribing indications, patient numbers, monitoring and transfers of care. This is a proposed framework rather than a system the analysis says is already operating.

Such reporting would help answer questions that market estimates cannot: who is being treated and how that care is followed. The authors' aim is greater transparency while preserving access for people who need treatment.

What this changes: The analysis reinforces careful diagnosis and ongoing monitoring rather than changing current best practices, while strengthening the case for transparent reporting and clearly agreed responsibility for care.

How Everfitguys helps

Deciding whether a testosterone subscription includes a credible plan for diagnosis and follow-up is where Everfitguys brings an editorial focus on evidence. Conflicting hormone claims can leave men past 45 unclear about the purpose of treatment, so its research-led reporting explains the science in plain English to support informed understanding without offering medical advice.

Read the research

Sources

1. Rapid growth in private testosterone prescribing raises safety concerns
2. Key Findings on the Efficacy and Safety of Testosterone ...