Starting Testosterone in 2026? New Data Shows Only 1 in 5 Men Got the Testing Guidelines Call For

The October 27 report, run independently by two separate Epic Research teams who reached similar results, tracked whether men had lab work done before a first testosterone prescription. The headline numbers:

• 82.6% of men starting testosterone in the first half of 2026 had at least one testosterone test in the prior 12 months — up from 72.3% in 2017. So most men are getting some testing.
• Only 40.8% had two or more tests on separate days in the year before their prescription.
• Just 21.8% had two low total-testosterone results (below 300 ng/dL) within six months before starting — the study's stand-in for the American Urological Association's diagnostic standard. That's up from 16.9% in 2017, but still roughly 1 in 5.

The analysis also found that most testosterone prescriptions came from primary care (57.6%), followed by urology (17.4%) and endocrinology (11%). Endocrinologists were the most likely to have a documented low reading on file before prescribing (69.6%), with primary care at 63.5% and urology at 60%.

One caveat worth knowing: the data captures lab results inside major health systems. It can't confirm whether tests were drawn in the morning, whether symptoms were documented, and it likely misses men who got testosterone through cash-pay direct-to-consumer services — where testing practices vary widely.

The AUA defines low testosterone as a total testosterone level consistently below 300 ng/dL on at least two early-morning blood tests, considered alongside symptoms such as low libido, fatigue, or erectile dysfunction. That two-test, morning-draw requirement isn't bureaucratic box-checking — it reflects how the hormone actually behaves.

Testosterone follows a daily rhythm, typically peaking in the early morning and declining through the day. It also swings with sleep, illness, stress, and even short-term factors like a poor night's rest. A single afternoon reading can look "low" in a man whose levels are actually normal — and a single normal reading can miss a real deficiency. Repeating the test on a separate morning filters out that noise.

The practical stakes are real in both directions. A man started on testosterone based on one borderline lab may commit to a long-term therapy he never needed, taking on its side effects and costs. A man whose genuinely low levels are dismissed after one normal-looking result may keep living with treatable symptoms — or miss the underlying condition (thyroid disease, sleep apnea, depression, medication effects) that was actually driving them.

Part of why prescriptions are rebounding: the safety conversation around testosterone shifted meaningfully. In 2023, the large TRAVERSE trial found that in men with hypogonadism and elevated cardiac risk, testosterone therapy did not increase major adverse cardiac events compared with placebo. In February 2025, the FDA removed the boxed warning about cardiovascular risk from testosterone labels, while adding a class-wide warning about increased blood pressure.

Epic's data shows prescribing has responded: the share of men with a testosterone prescription fell from 0.83% in 2013 to 0.64% in 2021, then climbed to 0.93% in 2025 — past its early-2010s peak.

But "safer than once feared" is not "right for everyone." Testosterone therapy still has real side effects and screening requirements: it can raise red blood cell counts (which requires periodic hematocrit monitoring), increase blood pressure, cause acne and fluid retention, and suppress sperm production — a major consideration for men who want to have children. It's generally not appropriate for men with prostate or breast cancer, untreated severe sleep apnea, or elevated hematocrit. That's exactly why the diagnosis deserves two proper tests and a provider who reviews your full history before writing a prescription.

If you're considering testosterone therapy, a guideline-consistent workup is straightforward. Expect your provider to order a total testosterone blood draw in the early morning (roughly 7–10 a.m.), then repeat it on a separate day before any diagnosis is made. Alongside the hormone panel, a good evaluation covers your symptoms, medications, sleep, and baseline labs such as hematocrit and, for many men, PSA — plus a plan for follow-up monitoring once treatment starts.

It's also worth remembering that symptoms like fatigue and low libido have many causes, and erectile difficulties often respond to treatment even when testosterone is normal. For many men, ED medications such as sildenafil or daily or as-needed tadalafil are the evidence-backed first step, with hormone evaluation layered in when labs and symptoms point that way.

If a clinic — online or in person — offers to start you on testosterone without any blood work, or based on a single afternoon test, that's a signal to slow down. This new data suggests that shortcut is more common than it should be.

JoeyMed's licensed providers take the labs-first approach this research argues for: proper hormone testing, a review of your symptoms and health history, and a treatment plan built around what the numbers actually show — whether that's hormone support, ED treatment, or a broader wellness and preventive care plan. Everything is prescribed by a licensed clinician and delivered discreetly, with follow-up monitoring built in. If you've been putting off getting answers about low energy, low libido, or performance changes, start with an online visit at joeymed.com/sexual-health — and get tested before you get treated.